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Book Review: Choosing Tomorrow's Children - The Ethics of Selective Reproduction

7 June 2010
Appeared in BioNews 561

Choosing Tomorrow's Children: The Ethics of Selective Reproduction

By Professor Stephen Wilkinson

Published by Oxford University Press

ISBN-10: 0199273960, ISBN-13: 978-0199273966

Buy this book from Amazon UK

'Choosing Tomorrow's Children: The Ethics of Selective Reproduction' by Professor Stephen Wilkinson

To what extent is it permissible for people to choose for or against certain desired characteristics in their future children? There's a range of ways in which we might do this - for example, we might attempt to insert or delete a particular gene into or from a gamete prior to conception, or we might choose embryo C from the petri-dish over embryos A, B and D after a course of IVF. We could decide to reproduce using eggs or sperm carefully chosen from a catalogue in which precise details about donors are given, in the hope that the donor's talent for mathematics or playing the oboe has a genetic component that can be passed down. Or we could simply decide not to have any children at all if we believe that they would inherit some characteristic that we think undesirable. Each of these strategies would have, in a way, a comparable outcome, inasmuch as each would make a difference to the precise genetic make-up of the next generation. However, each strategy is quite different, too, and therefore poses different moral questions. For example, choosing one embryo over another might well result in the destruction of that other embryo, whereas a decision about whether to have sex - with this partner in particular or with anyone at all - will not result in any embryonic death. A person may therefoe find the former scenario more problematic than the latter.

In Choosing Tomorrow's Children, Stephen Wilkinson looks at the ethics of selection, concentrating mainly on 'same number' decisions that we may make. A 'same number' decision is one in which we have chosen to bring a child to birth, but have not decided which. (A 'different number' decision, by contrast, would be one in which we have to choose whether to reproduce at all.) Put another way, he is concerned with choosing between different possible future people (p5). Within this range, though, there's a number of different situations that may give us cause to want to choose: we might be making decisions about choosing an embryo to act as a 'saviour sibling', choosing an embryo to avoid a certain disability, choosing in favour of a (prima facie) disability - as in the case of Candace McCullough and Sharon Duchesneau, who sought specifically to have a deaf child - or choosing one gender over another. Wilkinson spends time considering all these variations on the 'choosing children' theme, and is guided by a presumption of permissibility - a presumption that everything is permitted unless and until it is forbidden, and that the onus is on the person doing the forbidding to make the case for impermissibility.

As far as Wilkinson is concerned, many (if not most) of the arguments that one might mount to establish the impermissibility of choosing children fail. This principle applies even in relation to controversial decisions such as McCullough and Duchesneau's. For in their case, the strongest argument that they would have to face would in all likelihood have to do with the welfare of the child created thereby: that deafness is welfare-reducing, and that it is wrong deliberately to created a child with lower welfare than it might otherwise have enjoyed. Yet, says Wilkinson, even this claim is weak. Partly this has to do with a scepticism about whether choosing for a disability is necessarily the same as choosing for a lower quality of life; partly it has to do with a claim that, even if disabled, people overwhelmingly have a life worth living, and that since this is the only life they could possibly have lived, there is no sense in which they could be said to suffer from a wrongful life; partly it is because the impersonal 'Same Number Quality Claim' - the idea that we ought to select for a higher quality of life whenever possible - does not reliably tell us that all examples of selecting for disability are wrong, and so, even at its strongest, will not tell us that this particular instance of choosing disability is de facto wrong.

What about choosing against disability, though? Objections to this tend to be couched in terms of worries about eugenics, or in terms of the 'expressivist objection' - which is that selection against disabled embryos is socially dangerous, perpetuating an undesirable attitude to the disabled and their lives. Wilkinson devotes a chapter to these related concerns, which he dismisses pretty unequivocally. Assuming that eugenics is simply a programme of improving the gene-pool, the question prompted asks whether the idea of improving the gene-pool is flawed or immoral; Wilkinson argues that, as long as we look at this question in a reasonably sophisticated way, it is neither. Moreover, the objection that removing disability-related traits indicates undesirable attitudes to those who carry them is also given short shrift: '[t]here is nothing wrong with assigning a negative value to the functional impairment aspects of disability and this negative valuation of impairment does not entail and need not be accompanied by any negative valuation of the person with the impairment' (p 166).

Having said this, Wilkinson does think that there is a very limited class of situations in which the 'expressivist objection' - the idea that selecting against certain characteristics sends an unacceptable message to those with those characteristics - might be sound. These are situations in which would-be parents who believe themselves not to be exceptionally bad parents choose not to reproduce at all, because they think that a world without their would-be child is objectively better, and their belief about the world is false or unjustified. I'm not so sure that Wilkinson is completely correct about this. Merely having a false belief can't carry that much moral weight, since lots of people have all kinds of false beliefs. And being unjustified is problematic, too: a person's beliefs may be unjustified in principle, as when they derive from wilful ignorance; or they can be unjustified simply in the sense that they are naive and unargued. Yet such beliefs also need not carry much moral weight, and can be held in good faith. And if there is a message that's sent out by such beliefs, and if that message is unjustified, it's not obvious that this is a moral problem, or that the problem is wholly attributable to the person allegedly sending out the message. After all, as Wilkinson himself concedes, 'one possibility is that people who select out do not mean to send out a negative message about people with disabilities' (p 171); one might add that they need not think they are sending out any message at all. There's a plausibly Humean response to the expressivist objection that says that the message detected by some people cannot be found by looking at the action, but only by looking within their own breast.

It's also worth noting, in passing, that Wilkinson seems to make use of the expressivist objection himself: when he's considering arguments around sex-selection, he articulates a worry that 'family-balancing' arguments are 'pejorative and [imply] that families not containing boys and girls in roughly equal numbers are somehow defective. And while many parents… do desire 'balance', it is difficult to see how one could justify any suggestion that families with all girls or all boys are objectively inferior' (p 218). True: but one might not have to justify it if the pejorative aspect of 'family balancing' is inferred rather than implied. The rebuttal of the expressivist objection to selection against disability can be applied equally well to a similar objection to selection against one sex or the other.

Overwhelmingly, Wilkinson's approach to selection is liberal, and he reaches similarly liberal conclusions about other potentially controversial uses of embryo selection. Although he does spend some time rehearsing the arguments for this or that method of selection, this is only really necessary as scene-setting; he does not have to do any more, granted the guiding assumption that everything is permissible unless a reason can be given why it is not. He is able to say that there are very few - if any - examples of selection that are a priori impermissible, simply because the arguments for impermissibility are weak.

Having said this, some of Wilkinson's claims are counterintuitive, such as the suggestion that 'selection for the purposes of whole organ donation is defensible'; but even this claim comes with a qualification: 'provided that there are adequate safeguards in place for all living organ donors' (p 129). Such safeguards would include, at a minimum, either consent from the donor, or the approval of a guardian and a court decision that donation would be in the donor's best interests. This seems to me to narrow the scope of the claim so far as to make it just about formalistic; Wilkinson, though, is willing to entertain the possibility that it could be held to be in the donor's best interests to donate based on an appeal to emotional, social or psychological considerations (p 121). I'm not convinced by that - not least because it seems to me that the (broadly) Millian framework within which Wilkinson is working has a hard time dealing with emotional harms and benefits even at the best of times. But that objection is for another day; Wilkinson's argument is valid, even if there are possible worries about his choice of premise.

Naturally, there are a few quibbles with some of the claims made in this book, but none is major. It is an admirably clear and compelling defence of the ability to choose tomorrow's children.

Buy Choosing Tomorrow's Children: The Ethics of Selective Reproduction from Amazon UK.

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A seminar entitled 'Selective Reproduction, Bioethics, and the Idea of Eugenics' held at the Wellcome Collection Conference Centre on 6 June attempted to untangle what is meant by the contemporary 'idea of eugenics' in relation to bioethics and, specifically, selective reproduction. Stephen Wilkinson, professor of Bioethics at Keele University and author of 'Choosing Tomorrow's Children: The ethics of selective reproduction', asked the question: 'Is the fact that an action or policy is a case...
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