Chapter 13 : Reproduction: Assistance and Control Issues
|Section 4. Readings|
Author: Cynthia B. COHEN
Title: "Give Me Children or I shall Die!" New Reproductive Technologies and Harm to
Printed in: Hastings Center Report,Vol. 26, no. 2 (1996)
It is wrong to have children knowing that they will or will likely have defects, suffering, or deficits. There is no obligation to do whatever is available to have a child.
Summary by Stephen Tiffany ( SCCC 2002)
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"Be fruitful and multiply," is the command that God is said to have given to people. Rachel, in Genesis, was unable to conceive and is said to have cried out to Joseph, "Give me children or I shall die!" According to Cynthia Cohen, this is the basis for a great deal of the new reproductive technologies that provide otherwise barren women and couples with the ability to bear children.
What are the ethical limits that are brought into focus when children are conceived other than through sexual intercourse? What are the implications for these children? Is life at all costs more valuable than no life at all? Is there a relevant argument that indicates the preexistence of some kind of intelligence floating in some unidentifiable space just waiting to be born? And, what are the standards of harm that are to be applied to possible children, those that have not yet been conceived, to potential children, those that are developing fetuses, and to children who have been born and who are alive? Cohen approaches each of these concerns in her article.
The Harm to Children Argument
Studies indicate that a substantial number of children conceived and born through the new technologies may suffer from serious deficits. There are very few studies of physical defects as a result of technological conceptions, and those that do exist seem to contradict one another. There are, as yet, no long-term studies of possible psychological damage that results from IVF and other non-conventional forms of conception and birth. The lack of studies does not indicate that there are not serious deficits attributable to conception with the new technologies. Critics of these methods of conception and birth are concerned that children so conceived will view themselves as commodities rather than individuals with human rights and responsibilities. They feel that there is not enough data to prove that these technologies are truly valuable and they insist that the burden of proof must be on the shoulders of those who are in favor of these alternatives to sexual intercourse.
The Interest in Existing Argument
This is the argument that claims: "since it is, in almost all cases, better to be alive than not, and these children would not be alive but for the employment of these techniques, using them to bring these children into the world is justified."(Text. p. 687) This argument makes a distinction between "devastating harm—harm that brings such suffering into a person’s life that this life is worse than no life at all" and "serious harm—harm that does not render life worse than death, but that includes such detriments as major physical impairments, severe mental disability, and/or considerable pain and suffering." (Ibid.) Those who espouse this position believe that the benefit of existence must always and rightfully outweigh the alternative. This argument cannot be used in the situation where a surrogate mother is fighting with the rearing parents, as there is a different way to resolve the issue so as to cause less harm to the child … "it was not a necessary condition of the child’s very existence that the conflict among these various parents occur." (Ibid.)
The Harm of Not Existing
There is really no harm of not existing unless one presupposes that "children with an interest in existing are waiting in a spectral world of nonexistence …"(Text. p. 688) If this were the case, then the failure to use all possible technologies to allow these specters to exist would be an error of grave consequence. Prior to conception, there is no spectral existence and children have no interest in being born. The argument regarding the interests of the fetus, once conceived, is in a separate realm from that of those who are arguing the harm of not existing. In the fairly recent tort cases that sue for "wrongful life," the courts seem to conclude that life, regardless of how it is conceived and lived, is better than no life at all. In arriving at these decisions, the courts are making a specious comparison between the world of existence and that of non-existence, a world that cannot be known. While it is true that most people consider life more precious and less frightening than non-life, this is only the case after a person comes into existence. This is the comparison that can be made between life and death that ends life. It is not a valid comparison if applied to nonexistence before life … as there is no way for the living to assess whether or not there is a state of nonexistence preceding life. Proponents of this argument are left with two problems, the conceptualization and comprehension of nonexistence, and the justification of the claim that it is better to exist. (Ibid.) In the case of the Harm to Children Argument, the decision to use the new technologies is made before the fact. "At this time, unlike the wrongful life cases, no child exists who could be harmed." (Text. p. 689) What is at the heart of all these arguments, and what cannot be left out, is precisely the issue of "whether these children ought to have been conceived and born." (Ibid.) It is interesting to note that very few lives meet the standard for devastating harm that qualifies them as less preferable than non-existence. Therefore, the Interest in Existing Argument would seem to encourage many births that would seem to be ethically less than acceptable.
The "Wrongful Life" Standard of Substantial Harm
Substantial harm, according to Robertson, "puts one in a condition that renders life so ‘horrible’ and so ‘full of unavoidable suffering’ that it is worse than no life at all."(Ibid.) For Robertson and his cohorts, death is the equivalent of never existing. Cohen states: "This is a mistake. Nonexistence before coming into being and nonexistence after having lived are two distinct concepts." (Ibid.) Death at the end of life concerns us, according to many of the earlier philosophers, because death deprives us of our most valuable commodity, our life. Preconception nonexistence does not deprive of us of anything. This being the case, we are indifferent to preconception nonexistence. In addition, death happens to each person and it reminds us, inexorably, of our vulnerability. Death, as a result of its conditions, is considered bad. Preconception nonexistence has none of the properties of death and it is neither good nor bad. Though possible children may be determined to never have the opportunities afforded them through life, they have not lost anything if they are never born. It is difficult enough to determine the interests of the fetus. How then are we to cope with the interests of those who have not even been conceived? Do they actually have any interests and rights at all? Wrongful Life proponents argue that any life is better than no life and that only those lives that meet the standard for devastating harm are or can be considered wrong. Those who disagree believe that a seriously flawed life may be worse than no life at all because the state of nonexistence is neither good nor bad. This would seem to mitigate the wrongful life standard and to insist on a reevaluation that would not encourage the use of new technologies if they were proven to increase the numbers of individuals born with serious deficits.
The Inadequate Opportunity for Health Standard of Substantial Harm
How do we determine the lines between serious, less serious and devastating harm? In different cultures, in different times and in different situations, what appears to be harmful for one individual may in fact be negligible for another. The reverse of this is equally true. Even those who are trying to propose useful standards of substantial harm seem to have a difficult time arriving at satisfactory conclusions. Aside from cultural differences, there is no denying that some children are born with conditions that may be reversed and remediated if they are in a situation where the parents have the opportunity to do so. There are serious disagreements among the proponents of these arguments as to what constitutes a morally acceptable situation for conception and birth of children with deficits. Cohen states: "Under current circumstances in our culture in which children born with disabling disorders have inadequate support, it would be morally questionable, at least, knowingly to conceive a child suffering from some of the deficits [considered moderate]."(Text. p. 692)
Obligations to Actual and Possible Children
There are differences in our obligations to children who are alive and to those whom we have not yet conceived. This reverts to our conceptualization of nonexistence and our obligations to possible people who have no place in our world. We have no obligation to them nor do we have any inherent obligation to conceive them, as their existence would materially harm our culture and our society. There are some people who believe that it is our moral obligation to conceive and to bear only those children who will never become a burden on the greater society. No one, however, believes that, once born, a child who needs societal help for her/his continued existence should receive less than the maximal amount that society can provide. What we do know, according to Cohen, is that we have no obligation to conceive and bear children whose existence is less than optimal. We may suggest that the individuals themselves might be better served if they were never born. This is not the same thing as suggesting that society would be better served if the individual children were never born. It may be regrettable that these children, who do exist and who have the rights incumbent on all people, have these disorders, but their actual existence, once it is a fact, is not regrettable. We do not devalue children but we do try to avoid bringing those with seriously devastating disorders into existence. Unfortunately, once these children are born and they do exist, we may be guilty of not providing adequate services to help them be successful in their lives. This may be attributed to the fact that children with disabilities remind us, constantly, of our own vulnerability … something we all wish to avoid.
Taking Harms Seriously
The Bible does not insist that we should and must do everything we can in order to maintain the species. It is unfortunate that the Interest in Existing Argument leads to a belief that the use of the new technologies provides its own justification simply because it produces more children. This view of producing children because all existence is better than nonexistence never concerns itself with the welfare of the children who result from the intervention of technology … or with the general welfare of many children who are born into less than optimal circumstances. Cohen states: "…if it were known ahead of time that children conceived with the assistance of the new reproductive technologies would not have an adequate opportunity for health, it would be wrong to use them."(Text. p. 693) Prospective parents who wish to use these technologies must be educated as to the possible negative outcomes of the undertaking. We need a great deal more investigation of the possible serious effects of conception with the aid of reproductive technologies. Without more in-depth and serious studies of these effects, society faces "an agonizingly difficult decision when [it] considers[s] whether to use the new reproductive technologies." (Ibid.)
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