|the perfect baby
We all think a pregnant woman should protect her probable future child, A. Annie should get good prenatal care, stop smoking, absolutely not engage in binge drinking, go on bed rest if needed to avoid premature delivery, etc. She ought to try to bring A into the world without any abnormalities she can prevent.
Now suppose Betty isn't pregnant yet, and she's taking a drug that could cause fetal abnormalities. Her doctor says to delay conception until she's off the drug. Once again, there's a very strong impulse to say she should avoid those abnormalities. This seems just like the first case, but on closer inspection there's a big difference. This is not a matter of protecting a probably future child, but of having one child or another. Her doctor is really telling her not to have A (with abnormalities) but to have B (without).
It seems, despite the difference here, that essentially the same duty is involved. We ought to do our "personal best" where creating offspring is concerned. Julian Savulescu defends a principle of this sort*, The Principle of Procreative Beneficence (PB):
If you think of Annie as choosing between two versions of the same child (A and A*), then she is covered by PB, and so (more obviously) is Betty. Furthermore, Cathy is covered as well--
Cathy and her husband are trying to conceive using IVF, and have 5 embryos sitting in a laboratory. Using pre-implantation diagnosis (PGD) it's possible to tell if any of these embryos are abnormal. PB says Cathy ought to avail herself of this technology, and select the child (the embryo) with the best potential to have a good life. Intuitively, PB applies to Annie and Betty, but about Cathy we're not so sure.
I would like to understand why we're not so sure about Cathy, but let's start with Betty. I think it would be possible, and not flat out irrational, for someone to be not so sure about Betty. Or rather, they could be not so sure about Betty if they've squarely faced the fact that Betty is choosing between two different children. That's a "buried" truth that doesn't immediately meet the eye.
OK, but it's clearly true. Betty is choosing between two different children, A and B. Derek Parfit argues that the difference between A and B "makes no difference"--and in fact Betty's case is just like Annie's. But this is not inevitable. Suppose I think the creating a child is beneficial to the child--it saves them from the very bad state of non-existence. On this view, if A is created, A is lucky to be born, and B unlucky. If B is created, B is lucky to be born, and A unlucky.
If I seriously do think this way, then Betty's situation is very different from Annie's. Annie has to decide whether it's better for A to come into the world with or without the abnormality. The obvious answer is "without." Betty must think about a completely different question: whether the abnormality in question makes B more worth saving from non-existence than A.
This would be a not completely different situation-- a lifeguard sees two swimmers drowning. They're the same age, and otherwise not remarkably different. One has an abnormality and the other doesn't. Of course it's better to lack it than have it, but that's not the issue. The lifeguard has to decide whether the abnormality makes the abnormal swimmer less worth saving from non-existence than the normal swimmer.
I think the lifeguard could, would, and should think the abnormality makes no difference to how much a person is worth saving from non-existence. Likewise, if I seriously see creating people as benefiting them, I can coherently think Betty has no duty to avoid A and have B.
Maybe, though, we should "modus tollens" the last paragraph. Obviously (we might think) Betty does have a duty to avoid A and have B. So creating people doesn't benefit them, and is nothing even remotely like saving people from drowning. Maybe so. My point is that there's at least more to think about in the case of Betty, and there's no immediate and quick route from an Annie judgment to a Betty judgment.
OK, so what about Cathy? The above has been a warm up exercise. Now that you see there's no immediate step from Annie to Betty, I'm hoping you'll agree there's no immediate route from Betty to Cathy either.
Now, I'd very much like to comment on Cathy without sounding even remotely like Michael Sandel, in his book The Case Against Perfection. Let's not talk about the evils of mastery, or the wonders of beholding instead of molding; I promise not to say life is a gift, and we should be open to the unbidden.
Let's talk instead about reproduction--the basic "what?" of it. Reproduction is an essentially "agent-centered" act. The couple thinks "let's have our own child." The first-person pluralness of this is crucial. The reproductive state of mind is completely different from a third-person managerial state of mind. Your goal is not to fill the earth with the best possible creatures--the ones with the highest possible quality of life, but to have children who are your own (for better or for worse!).
Now, delaying conception until Betty's off the drug doesn't compromise "our own"-ness in the slightest bit. Betty and her partner can have children that are "our own" in January or in March.
With Cathy, it's just a bit different. True, she's still using her own and her husband's gametes. But opting for PGD shifts her into the more managerial state of mind. Suddenly, what would have been good enough in an ordinary couple (whatever sperm-egg combination has transpired, in the darkness of the womb) isn't necessarily good enough. The ordinary couple is permitted to act on the self-affirming thought that their offspring is overwhelmingly like to be fine, but Cathy is supposed to scrutinize, compare, and optimize. She's being turned into a "who exists?" manager, when she and her husband only wanted to create "our own."
Now, I think Savulescu does recognize "our ownness" as a consideration, though not in the Cathy type of case. In a footnote, he clarifies that PB is only meant to apply in cases where a couple are using their own biological material.
He's thus pre-empted a case like this-- Cathy and her husband do opt for PGD, and they're about to implant a terrific embryo, when the clinic tells them they have some leftovers from the world's most fantastic couple. They're gorgeous, brilliant, disease free for generations, etc. If Cathy has little baby C, the child will have longer, higher quality life.
Perhaps Cathy and her partner do have some reason to have C instead of B, but their urge for "our ownness" has to be considered legitimate and overriding. So "our ownness" is a factor in competition with PB--the only question being whether it really ought to count for Cathy. May she have the self-affirming thought (like any ordinary couple would) -- "Our embryos are all (probably) fine"? Or must exercise managerial control, use PGD, and opt for the best of the lot?
You can't say the "soft" considerations about "our ownness" don't count at all, if you think Cathy may obviously decline the splendid couple's leftovers.
* Savulescu, "Procreative Beneficence: Why We Should Select the Best Children." Bioethics, 2001. Savulescu and Kahane, "The Moral Obligation to Create Children with the Best Chance of the Best Life." Bioethics, 2009. The quote and the later footnote are from the second article.