For any number of reasons, it may be impossible for some couples to conceive in “the natural way.” However, these prospective parents may still be able to form families through the use of reproductive technologies like sperm/ova donation, surrogacy, and in-vitro fertilization (IVF). The use of these technologies expands the number of choices available to prospective parents beyond those available without assisted reproduction: they can choose their sperm and ova donor based on the presence (or absence) of certain desirable (or undesirable) characteristics, and can even go so far as to choose particular embryos for implantation. Some would argue that allowing these choices leads to a new kind of eugenics; one that is not driven by state ideology, but is rather the incidental result of a number of factors including, but not limited to, the availability of these technologies, the parents’ desire to have a healthy child who will have a good life, and a changing idea of what is exactly “being healthy” or having a “good life” involves.
Infertility, IVF, and reproductive choice
Most couples assume that, when the time comes, they will be able to conceive without difficulty. For approximately 7% of Canadian couples this will not be the case: they are infertile. And individuals who are infertile are not the only ones who face a barrier to conception: same-sex couples or single parents are also unable to bear children the natural way, and therefore require technological assistance in order to exercise their reproductive rights.
The most well-known and widely used reproductive technology is IVF, a procedure in which ova are fertilized outside the body. After successful fertilization one or more of the resulting embryos are transferred into the uterus. Because the embryo spends some time outside the body preimplantation genetic diagnosis (PGD) is possible: one cell can be removed from the developing embryo and tested for a number of genetic conditions, which range from the primarily cosmetic (polydactylism) to the severe (Tay-Sachs). Because of the possibility of PGD, use of IVF expanded beyond strictly infertile couples to those with hereditary diseases: these couples could therefore screen potential embryos and implant only those that did not carry the defective gene(s). However, the high cost and relatively low success rate of IVF has caused PGD to become popular among infertile couples who do not want to risk passing on a hereditary condition: prospective parents want to choose the healthiest of the available embryos in an attempt to secure a successful pregnancy, and also to ensure that the resulting child is “worth the investment.” These couples may therefore screen their embryos for congenital abnormalities like Down syndrome (or other intellectual disabilities), muscular dystrophy, deafness, or blindness.
PGD is not the only way for parents to exercise choice about the kinds of children that they want to have: this can also be accomplished, with varying degrees of success, by choosing a particular sperm or ova donor. For example, one lesbian couple wanted their children be deaf like them. This motivated them to seek out a sperm donor with a family history of deafness. So, while some parents with disabilities may want to use reproductive technologies to have children who are like them, more commonly the technologies are used to select against disability, or for those traits perceived by the parents to be desirable. Many gamete “banks” will provide prospective parents access to information about sperm and ova donors: their physical traits, academic achievement, interests, and family medical history. However, choosing a smarter sperm donor in hopes of having a smarter child may be wishful thinking on the part of prospective parents, as there is (currently) no clear genetic basis for intelligence or athletic ability.
Regardless, when it comes to recruiting donors there is evidence to suggest that sperm banks, and ova banks in particular, put a premium on “high quality” gametes: advertisements for ova donors in American college newspapers sometimes specify minimum SAT score, appearance, or ethnicity requirements; and, according to one study, an increase of one hundred SAT points translates to an increase in compensation to the donor of approximately $2,000. However, it is not clear if this is a conscious effort on behalf of the ova banks to procure "smart gametes," or whether they are simply responding to demand from prospective parents.
The rise and increased use of reproductive technologies has led to something that looks suspiciously like eugenics. One of the major reasons for this is that reproductive technologies focus on genetic health and quality of life of future generations, concerns quite similar to those originally motivating eugenics—although a notable difference is that the process is no longer explicitly driven by ideology or subject to state control. Authors have chosen to call this trend “family eugenics,” “private eugenics,” or “new-genics.” It has arisen, almost incidentally, out of the convergence of several factors, including: increased genetic knowledge, the availability of reproductive technologies, a culture of preventative medicine, a disposition on the part of parents to want a healthy child who will have a good life, and a changing understanding of what it means to be healthy, and of what it means for a life to be good.
“As long as it’s healthy” is, of course, the constant refrain from parents who desire to have children. Parents rightly feel responsible for the physical well being of their children, and many might feel as though they are doing something wrong by bringing an unhealthy child into the world when there is something that they could have done to prevent that from occurring. This is, of course, the reason that mothers refrain from drinking and smoking while they are pregnant, as well as why they take supplements like folic acid: it’s for the good of the child. But it’s not just about health: there is also a strong desire on the part of potential parents to have children who will, themselves, have good lives: something that might be hindered, in the opinion of prospective parents, by the presence of certain conditions. Since the technology exists to allow parents to bring one child into the world over the other, it might seem irresponsible to have a child that would not have the best possible life.
This relates intimately to the issue of preventative medicine: in such a culture there is less emphasis on the treatment of disease and more emphasis on preventing individuals from becoming ill in the first place. This is, in part, a solution to the problem of health care rationing, because individuals who take care to avoid health problems create less demand on the health care system. This is why we encourage individuals to exercise regularly and eat healthy: if they do not get sick, then they will not require treatment. With respect to reproductive technologies, therefore, the logic is simple: if sick children are not born, then we do not need to treat them and can use those scarce medical resources in other ways, perhaps to help individuals who could not have avoided becoming sick or injured. This also offers prospective parents an economic reason to choose one embryo over another, as it can be expensive to raise children with physical or intellectual disabilities.
The sum of morally defensible parts?
The individual ingredients that contribute to “new-genics” seem, on their own, to be morally defensible. It seems clear that prospective parents ought to be able to choose which sperm or ova donor to use, and it seems just as obvious that these donors ought to be screened for genetic conditions or other illnesses in order to ensure the health of the child. What it means to be healthy, however, is evolving, and is doing so in an upward manner: in the direction of “healthy” standing in for “no discernible physical or mental impairments, and no predicted such impairments” or, as the WHO puts it, “a state of complete physical, mental, and social well being” and not merely the absence of disease or infirmity. It is, therefore, not enough for parents to have a physically healthy child: they also want their child to have the best possible chance at social success, which could explain why they are concerned with the SAT scores of sperm and ova donors. However, as we well know, the simple possession of traits like intelligence or good looks does not necessarily translate to success in life; likewise, a child can have social success, and live a rewarding life, with a disability.
Further, while the idea that we ought to take a preventative stance with respect to illness is an extremely morally plausible one, there is something suspicious about the way that “disability” is quietly being conflated with “illness.” While there is often an undeniable physical component, proponents of the social model of disability would maintain that disability differs from illness because it is, at least in part, socially constructed, and individuals can be more or less disabled depending on the structure of society. Illness, in contrast, is more of a biological fact that is independent of social factors. Accordingly, proponents of such a model would argue that there is no justification for extending the attitude of preventative medicine to individuals with physical impairments because their problems are social rather than medical. In addition, social factors are likely responsible for why the lives of people with disabilities are perceived as “not good,” and their lives could, therefore, be seen as better if society were structured in a different way.
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Spriggs, M. (2002). Lesbian couple create a child who is deaf like them. Journal of Medical Ethics, 28(5), 283.