Bioethicists: IVF a Moral Duty

When two Italian-Australian utilitarian bioethicists declared in the Journal of Medical Ethics that infanticide (or after-birth abortion) was morally permissible, they lit the fuse on a world-wide storm of condemnation. But a proposal which may be even more controversial has popped up in the April issue of theAmerican Journal of Bioethics. Two bioethicists contend that some parents are morallyobligated to use pre-implantation genetic diagnosis to create a healthy baby.

Janet Malek, of East Carolina University, and Judith F. Daar, of Whittier Law School, in California, argue that eventually the law should and will impose “a duty on IVF-reproducing parents to maximize the well-being of their future offspring by all reasonable means.” Why? The authors cite three reasons: increasing the child’s well-being, expanding his or her self-determination, and reducing inequalities.

If this reasoning evokes the notorious “after-birth abortion” article, this may be because the authors rely upon ground broken by Julian Savulescu, Guy Kahane and John Harris, three utilitarians working in Britain who influenced the authors of the previous article. The British bioethicists are pushing “procreative beneficence” — the notion that parents should endow their baby with the best possible qualities. Malek and Daar argue that this is morally good not only because it has good consequences (ie, stronger, healthier, more intelligent kids) but it also promotes fairness and autonomy.

The immediate concern is what to do for parents who are carriers of a severely disabling disorder like autosomal recessive polycystic kidney disease. It seems clear enough to Malek and Daar that these parents are morally obliged to sift through embryos to find one which does not have the disease:

“prospective parents who make an independent decision to reproduce using IVF and who know or reasonably should know they are at substantial risk for transmitting a serious genetic anomaly to their offspring may be subject to legal liability for failing to utilize PGD to avoid birthing a child who suffers grave harm from the heritable condition.”

Eventually, of course, this means that the government will mandate health insurance so that everyone using IVF can avoid having defective babies. From a public policy point of view, this makes economic sense, as taxpayers will not have to support sick children. In the words of Malek and Daar, “Shifting benefit outlays for significant post-birth health care to a far less costly preconception procedure strikes us as a worthy public policy trade-off.”

Malek and Daar’s article was critiqued by a number of other bioethicists in the same issue of AJOB. Some thought that their proposal would lead to “reproductive police”, as in Margaret Atwood’s dystopian novel, The Handmaid’s Tale. But others felt that they did not go far enough. All parents at risk of conceiving a sick child have a duty to use IVF and PGD, argue bioethicist Rosalind Ladd, of Wheaton College, and Edwin Forman, of Mt Sinai Medical School.

Michael Cook

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Michael Cook likes bad puns, bushwalking and black coffee. He did a BA at Harvard University in the US where it was good for networking, but moved to Sydney where it wasn’t. He also did a PhD on an obscure corner of Australian literature. He has worked as a book editor and magazine editor and has published articles in magazines and newspapers in the US, the UK and Australia.

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  • Pargontwin

    Considering that IVF is not a morally permissible procedure in the first place, the point is moot…until and unless those “reproductive police” start sticking their noses into the business of people who conceive naturally.  I can easily foresee this resulting in the requirement of a license to procreate, which would involve genetic testing; those who carry genetic anomalies would be forbidden to have children.  Shades of China’s forced aobrtion policy!

  • Terrygeorge

    pargontwin – that is scary but ‘conceivable’.  sad that the authors both come from institutions with roots in judeochristian tradition.  how far we have strayed!

  • Mrgrt

    Not only is IVF not morally permissible but I have heard that it is likely to be responsible for health problems for those babies.  Why hasn’t there been research done to show how those IVF children have faired?  What per cent have neurological illness? Rumors of all sorts are out there. Without thorough research it’s anyone’s guess what can be the cause of many of them.  Perhaps these scientists attempting to make little gods have had a lot of ginny pigs to play with. The only god, God who made heaven and earth (as well as the eggs and sperm so badly used), has been good to us Catholics. He has forbidden us to tamper with reproduction such as has been done.  We should pray our neighbors who do not know the love of God for all His creation. 

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