More About Gene Editing

I'm still thinking about that Time op-ed that objects to gene editing because, in so many words, if my parents had used it, my brother wouldn't have existed.  I went along with this assumption about existence in my last post on the subject, but only for the sake of argument.  It's actually quite debatable.

Suppose parents do want to avoid having a child with a gene for a serious disease, like the serious heart defect that was eliminated by researchers.  They can already do this, as long as both parents aren't carriers for the gene, by using PGD—pre-implantation genetic diagnosis. Using IVF, multiple embryos can be generated and five-day-old embryos can be biopsied.  An embryo without the gene could be implanted and the rest discarded.  If people used this method, it's certainly true that certain possible people wouldn't be born. Looking at an actual little brother (Harry, let's say) with a heart defect, it's true to say if my parents had used PGD, Harry wouldn't have existed. The embryo that led to Harry would have been discarded.  Larry, not Harry, would have been born.

It's much less clear that this is true, if gene editing is used.  Using gene editing, the embryo carrying the faulty gene is allowed to develop, but the gene is edited out of it on day one, at the zygote stage.  Would Harry have existed if one of 20,000 genes had been eliminated from the same embryo—the one that actually led to Harry?  I think it's true that if an embryo is radically edited, it will lead to a different child being born.  But minor editing?  Is our entire genome essential to us, so we can't exist if even one gene is edited out?

We're not used to thinking about this, since an individual's genes have always seemed unalterable. It seems to me that we could easily get used to the idea that the same person could have existed with somewhat different genes, and the idea wouldn't be incoherent.  If I had the serious heart defect the researchers focussed on, and my parents had been offered the option of gene editing, and had been able to afford it, I can imagine wishing they had created me without the heart defect.  That doesn't sound like a metaphysical impossibility.

If that's the right way of thinking about things, the Time magazine author really has things all wrong.  PGD, which is already available, is the technology that could potentially have made the author's little brother not exist.  But that horse is already out of the barn.   CRISPR-cas9 would have given his parents the option of having his little brother, but protecting him or her from the disease he was born with.

If that's the right way to look at it—the same people can be born, despite gene-editing—then gene editing starts to look not just permissible in certain cases, but possibly even obligatory.  Suppose you knew your child might be born with a serious heart-defect, and you also knew you could check in advance whether he or she had the relevant gene, and you could eliminate it.  Certainly if there was a drug that would fix the heart defect, and you could take it during pregnancy, it would be fair to say you should take it.  It's really not clear why gene editing is different.

OK--there are a bunch of other puzzles here, having to do with who winds up being born, if either PGD or gene editing is used, but I'll save that for another day.

Worrying about CRISPR

Scientists have developed a new technology, CRISPR-Cas9, for editing genes in day old human embryos. The technology (explained here with terrific graphics) was used to edit out a gene that leads to a severe heart detect, though the embryos were then discarded.

We won't be using this technology to create genetically modified people until there has been a lot more research. There's also going to have to be an ethical and legal debate. Is there something worrisome about editing an embryo's genes?  There might be, but we need to be careful to have the right worries.  It's very easy to have worries that just don't make sense.

Take this Time Magazine op-ed, by Joel Michael Reynolds.  The title says it all:  Gene Editing Might Mean My Brother Would've Never Existed. His brother Jason had muscle-eye-brain disease and had "muscular dystrophy, cerebral palsy, severe nearsightedness, hydrocephalus and intellectual disability." Jason was lovely and beloved, and so Reynolds questions a technology that would prevent Jason from ever existing.

It's no fun criticizing someone who reveals love and grief in the way Reynolds does, but this worry about a specific person not existing is the wrong worry to have.  There are many things we do to control who is born that are either neutral or mandatory, but would alter who exists.

• Picture the debate that went on before contraceptives were available. An opponent of legalizing contraceptives could look at his unplanned little brother and say that if his parents had had access to contraceptive technology, the boy wouldn't have existed. That fact surely has no weight at all, however much it may be painful to imagine a world without a specific person. 
• Imagine a woman being told by her dermatologist not to conceive a child while she's taking Accutane, because Accutane causes abnormalities. She ignores this advice and conceives a child with some abnormalities. Should she really feel good about her choice, because without it, her child wouldn't have been born? 

We are simply confused when we object to an action or practice because, if opted for, this lovely and beloved child wouldn't have been born.  At the time that we're choosing the action or practice, there are millions of possible children who could come into existence, and there's nothing that says that the one who actually will be born should be born.

Reynolds is concerned that Jason be born, but also that people like Jason be born.  He gives us this description of Jason's life, to convince us that that he wasn't worse off than other children.

He lived past his first year thanks to marvels of modern medicine. A shunt surgery to drain excess cerebrospinal fluid building up around his brain took six attempts, but the seventh succeeded. Aside from those surgeries’ complications and intermittent illnesses due to a less-than-robust immune system, Jason was healthy. Healthy and happy — very happy. His smile could light up a room. Yet, that didn’t stop people from thinking that his disability made him worse off. 

This reminds me of the old joke: "Aside from that, how was the play, Mrs Lincoln?" I don't see how a string of surgeries, complications, and illness, in someone who evidently died before the age of two, leaves very much to be good.  It's not ableist, but just realistic, to think Jason was worse off than other babies.

Reynolds chocks it up to ableism that many parents would like to avoid having a baby like Jason. But even he seems to admit there are health problems that ought to be avoided.

We, who are often still unable to distinguish between positive, world-creating forms of disability and negative, world-destroying forms — between Deafness, short stature or certain types of neurodiversity and chronic pain, Tay-Sachs or Alzheimer’s. It is with great responsibility that we as a society balance along the tightrope of biomedical progress. 

I don't know about putting muscle-eye-brain disease in the "positive, world-creating" list, as if babies could creatively construct their own distinctive way of life and identity, in the manner that some people with deafness and short stature say that they do.  The heart problem that was eliminated by the CRISPR research also doesn't seem to belong on the "positive, world-creating" list.

So what's the right worry to have? I do think gene editing could lead to far too much choosiness in prospective parents--too much constructing of the preferred child and too little receptiveness. It could be over-used. I don't think there's a good, coherent reason to think it should never be used.

"Motherhood Isn't Sacrifice, It's Selfishness"

This New York Times op-ed by Karen Rinaldi has generated a huge number of comments, a lot of them negative. Goes to show that the way you say something is all important. Here's one of the more provocative paragraphs:

Motherhood is not a sacrifice, but a privilege — one that many of us choose selfishly. At its most atavistic, procreating ensures that our genes survive into the next generation. You could call this selfishness as biological imperative. On a personal level, when we bring into the world a being that is of us, someone we will protect and love and for whom we will do everything we can to help thrive and flourish, it begets the question, How is this selfless? Selflessness implies that we have no skin in the game. In motherhood, we’re all in.

Privilege? I have no idea why she says this. It's not as if we have to apply to become parents.  Everyone gets to become parents, if they're capable.  But "not a sacrifice" makes more sense to me and "selfish" makes some sense, but it's the wrong word. I think what she was really after, as a contrast with "selfless," is "self-interested." When we have a child "we bring into the world a being that is of us." Yes. Because my child is part of my extended identity, so to speak, when my child is better off, I'm better off. When my child is worse off, I'm worse off.  It's because we've enlarged ourself, thereby including our child as part of our extended identity, that caring for my child is self-interested.  But that doesn't mean it's "selfish." Selfish people don't enlarge themselves.

Since the self-interestedness of parenthood is really built in, and not just a feature of bad parents, she's off track when she writes that motherhood is a privilege (again, why a privilege?!) "that many of us choose selfishly."  But she gets back on track at the end of the op-ed.

If we start referring to motherhood as the beautiful, messy privilege that it is, and to tending to our children as the most loving yet selfish thing we do, perhaps we can change the biased language my mother used. Only when we stop talking about motherhood as sacrifice can we start talking about mothers the way that we deserve.

Again, there's the privilege talk, which I find bewildering.  But now the selfishness (no, self-interestedness!) is portrayed as built in.  It's not the bad mother who's selfish (no, self-interested), it's motherhood itself.  Much better!

The Metaphysics of Pregnancy

I wish I'd read this Aeon article on the metaphysics of pregnancy on time to include the topic it raises in my book, The Philosophical Parent.  Suki Finn asks a great question, which is explored in a forthcoming article in Mind by Elselijn Klingma: is a mother a container for her fetus or is the fetus part of her?  They've definitely succeeded at two things: making the metaphysics of pregnancy seem fascinating and making the part view seem like at least a contender.

Let's first list the possibilities, along with some sub-options.

I. On the container model, the mother contains the fetus, which is "a distinct entity in its own right" (Finn, Aeon). I would add that if the mother is a fetal container, there are many kinds of containers.  Something inside a container can be non-dependent on the container—like a watch in a drawer.  But something in a container can be completely dependent—a brain in a vat needs its container. Containment plus connection is a possibility, and surely that's the possibility most relevant to pregnancy. (I used to have an ipod charger that both contained the ipod and connected it to a charger. It wasn't quite as cute as the one on the right.)

II. On the parthood model, the fetus is a part of the mother, like a tail is part of a cat (Finn, Aeon). Finn is not saying the fetus is really tail-like.  That example is just supposed to clarify what we mean by a part. If a fetus is a part of its mother, there are many sorts of body parts.  A kidney, a freckle, a tumor, some fat, some blood, a hand, a nose, the lower half of my body—they're all parts.  If you settle on the parthood model, your next question will be "what kind?"  Important clarification made by the authors: the parthood model doesn't rule it out that the fetus is a human being, or even a person.  The fetus might be a part of a human that's also a human being, like the mother. (More on that below.)

III. The parthood and container models are stated in such a way that they're mutually exclusive.  That's because on the container model, the fetus is not a part, but rather "a distinct entity in its own right."  Why not, though, contemplate an inclusive option? Could a fetus be both inside a container and a part of the mother?  I don't see why not.  Take a Russian doll.  The innermost doll is contained by the outer dolls.  At the same time, the innermost doll is part of the Russian doll. If it's missing, the Russian doll is incomplete.

The container model seems to be the received wisdom among philosophers, Finn and Klingma both say. In fact, I would say there's something a bit alien or even yucky about the notion of the fetus as a part of the mother. If fetuses grew on trees, we'd surely think of them as parts of trees (like apples are parts of trees).  It's a little weird to think of a fetus as being even remotely like a pre-plucked piece of fruit. Why?  Maybe that doesn't comport with what we see as the separateness and dignity of the baby-to-be. That dignity may not have to do with lofty notions like personhood and humanity. It might have to do with not-so-lofty notions of animalhood.  At the level of sheer gut feelings, I also find it odd to think of a fetal kitten as a pre-plucked piece of fruit.

These are real pears!!!
http://bit.ly/2we7aFo

But that's just a matter of initial gut feelings.  There are also some serious worries about the possibility of a human being having a part that's a human being, or a cat having a part that's a cat.  Finn discusses a puzzle about a person who's sitting in a chair, about to have a haircut.  Is the person minus the hair that's about to be a cut a part of the person who still has her hair?  If so, there would be two persons sitting in the chair, which is absurd. We can rule that out by postulating a "maximality principle":  a whole of a certain kind can't have a part of the same kind.  But that will stop a fetus, assuming it's a human being (at least at some point in gestation) from being a part of its mother.

I agree with Klingma (in the Mind article) that it seems odd to postulate the maximality principle in order to solve the haircut problem, and then apply it to the very different circumstance of pregnancy.  It's also true that we can easily think of things of kind K that clearly do have parts of kind K.  See picture on right.

All in all, I think Finn and Klingma make a convincing case that parthood is a contender.  I still think, though, that the container model (option II) is a contender.  There are a lot of features that make a fetus appear to be an entity distinct from the mother, and contained by her uterus, which is contained in her body.  I don't see why its connection to her, through the umbilical cord, and its total dependence on her throughout most of gestation, must make it a part of her. Think ipod in dock or brain in vat.

I'm pulled in both directions, which I think counts as success for Finn and Klingma. They have at least succeeded in making their case that there are two models worthy of consideration here, and not just one.

Having Fewer Children Because of Climate Change

You care about climate change, so should you have fewer children?  Here's an article in the Guardian that argues for this, and the accompanying graphic.

The pitch here is to the individual. Like you might decide to recycle or wash in cold water or eat less meat, in response to climate change, the idea is that you should decide to have a smaller family, in response to climate change.  

I find this way too simplistic, for many reasons.

Many of the circles on the graphic have no downside. It's all good, if people recycle. However, it would be problematic if a lot of people had fewer children.  If you had one child instead of two, and so did a lot of people for the foreseeable future, that one child would be facing a very troubled future. She would be more burdened with responsibility for older members of society than we are at the present, and as she aged, she would suffer from there not being enough people to meet her needs. If the population decrease were dramatic, it could easily be true that her future would be far more marred by the population decrease than by climate change. It's notable that in countries (like Japan) where there is concern about climate change, but also a shrinking population, the shrinking population is seen as a curse, not a blessing.

Now you might say that these worries are misdirected. Very few people are actually going to have fewer children for environmental reasons. But if that's true, there has to be another worry. The children of the people who procreate less are more likely to care about environmental issues--people do tend to pass on their beliefs and values.  But then, you have to worry that governments are going to be less likely to take needed action on climate change when the voting population shifts to being created by the least environmentally concerned people.  For environmentalists to have fewer children might leave us with a world of Trumpians marching toward total eco-disaster.  Well, maybe!  (I'd like to see someone make a dystopian movie with this premise.)

Let's dig a little deeper.  It's interesting what's on the graphic and what isn't.  You can certainly suggest to people that they buy hybrid cars and wash their clothes in cold water, but certain things are beyond the pale.  There's no circle for ending your life at age 40. But that circle would be huge (about half as big as the one-less-child circle).  There's no circle for refusing medical care after the age of 70, even though that tends to involve a lot of energy and resources.  That would also be a big circle. Some sacrifices can't be expected--they're of a different order altogether.  Sacrificing a second child is that sort of sacrifice for many of us. Why?  My new book explores this in the first several chapters.  Even without a long further story, you can see the graphic is odd. It's not clear skipping child number two should be on the graphic, side by side with changing lightbulbs and washing in cold water.

Bottom line: I don't think any individual should think "I must have fewer children, because of climate change," especially if they live in a society where procreation is already at the replacement rate. Climate change is a problem but population shrinkage is also a problem, so it's not at all clear that one is the best solution to the other.

But if you do live in a society with a growing population, it's another story.  In that case, there may be ways for change to take place without individualistic moralizing.  Such a society shouldn't valorize huge families and shouldn't stigmatize people who have no children or very small families. In ballooning societies, it's all to the good, environmentally, if people don't think of having a family as their primary vocation.  I'm just not convinced that it's either convincing or reasonable to say, even to those people, "you should wash in cold water, recycle, and skip your longed for second child."

Choosing life, choosing death

Julian Savulescu and Peter Singer take a position that seems right to me on the question of Charlie Gard--see their opinion on the matter here. They think the parents ought to be allowed to take the baby to New York for further treatment. But their reasoning puzzles me. Here's how Savulescu and Singer support their stance on Charlie Gard: in cases of "reasonable disagreement, we believe that we should accede to the wishes of the parents and err on the side of a chance of life. The alternative is certain death." I'm puzzled because "acceding to the wishes of the parents" can't always go along with "erring on the side of a chance of life," since some parents prefer death.

There's a moving example of this in a (New York Times) Stone column written by Gary Comstock. In this case there was probably reasonable disagreement, but the parents' wish was to let their baby die. What then? Should the wishes prevail, or should we "err on the side of a chance of life"? I wonder how serious Savulescu and Singer are about the second part. Should we "err on the side of a chance of life" even against the preferences of parents?

How decisive is it that parents prefer life, or don't prefer life, in these kinds of tragic cases which involve reasonable disagreement? If Charlie Gard's parents turned around and decided they wanted to withdraw life support, I wonder what Savulescu and Singer would say. Now "acceding to the wishes of the parents" would mean supporting them, but "erring on the side of a chance of life" would mean wresting away control. I think parents get to make these decisions (when there is reasonable disagreement), and not just when they choose life.

The Charlie Gard Case

http://nyti.ms/2su9HcY

The basic facts of the case are covered here.

Dominic Wilkinson has written an interesting commentary at the Practical Ethics blog--he sides with the decision of the UK court, which has been upheld at higher levels. He argues that there is too much suffering involved in continued treatment, considering the tiny chance of further treatment being beneficial. Julian Savulescu thinks, by contrast, that the parents ought to be able to bring the child to the US for experimental treatment, which has been offered by a US physician and has already been crowd-funded online. He's written several commentaries on the case, here and here.

Wilkinson links to a very interesting paper he (and others) have written on the difference between the legal approaches to these kinds of problems in the US and UK. They write that courts in the UK apply a best interests of the child standard, whereas in the US, courts give more weight to parental preferences and patient autonomy. However, he says the emerging consensus among medical professionals and ethicists in the US is that the best interests of the child standard is the right one.

After years of shifting standards on medical treatments, there is now a strong consensus in the medical and ethical literature in the United States that it is the best interests of the patient not the desires of the family or the personal predilections of the physician which ought to prevail. That standard does not rest on autonomy or an attempt to determine what the patient would have wanted, but solely on a concern for the patient's welfare. Such protection is particularly important with regard to infants and children because with it they are now seen not merely as the pawns of parents, but as patients in their own right. The implication is that although parents may continue to be involved in decision making for their children, they do not have an absolute right to refuse— or to require—medical treatment for their child. It is the child's best interests, and those alone, that are to be the focus and goal of medical treatment decisions made on behalf of children. 

Children are not "pawns of parents,"  the authors say. In his most recent blog Wilkinson says it another way:  children are not "property of their parents."  It seems to me that if we leave it at that--not pawns, not property--and say nothing more about what children are to their parents, then it's very hard to make sense of a part of the approach Wilkinson supports. Why is it that, though parents don't have an "absolute right to refuse," they "may continue to be involved in decision making for their children"?

There is some kind of special entitlement of parents to their kids that is not respected if we seriously, literally, across the board, adopt the best interests of the child standard. If we really did so, in all domains, many parents wouldn't even be allowed to have custody of their biological children, considering the availability of better equipped adoptive parents. But no--they're your children, so you get to keep them and you have quite a lot of decision making power when it comes to the way they are raised and treated.  I believe this is the consensus, both in the US and the UK.

But there are limits.  When parents start to make decisions that are too extremely at odds with professional medical judgment, they lose their prerogatives. So it's not that the best interests standard is the only one, and is allowed to prevail in every situation. It starts to trump everything else when the stakes start to be greater. Parents are not allowed to make terrible medical decisions on behalf of their children.

If that's right, the question in the Charlie Gard case is not simply whether it would be better for Charlie to be taken off of child support, but whether it would be glaringly, obviously better.  Are the parents making a huge mistake by trying to take him to the US, a mistake of the type that should remove them from making the ultimate decision?

Elysha Waldman, a palliative care pediatrician, sides with the parents in this New York Times op-ed. She says parents get to decide, but not no matter what.  US courts do sometimes step in and insist on what's in the best interests of a child, she points out. Unfortunately, she sides with the parents for the wrong sort of reason.  She doesn't say that taking Charlie to the US makes some medical sense.  She writes:

In the end, it doesn’t matter that Charlie Gard has become a household name. He is, ultimately, the child of Connie Yates and Chris Gard and they know better than hospitals or the courts about what is best for their terminally ill son.

No, parents don't magically possess a better understanding of what's best for their children than anyone else.

For me to think think the parents should decide, I'd have to think what they want does make some medical sense.  From all I have read, it sounds like they want to make a bad decision (Wilkinson is convincing about this), but I'm not sure if it's bad enough that they should lose the usual prerogatives that come with being parents.

Scattered Seeds

One of the key ideas in my new book The Philosophical Parent is that we see children as self-like because they "come from us"—in one of several senses.  I can't state this as any kind of a universal truth, but it tends to be true, and I think it's with good reason that we see children this way.  We're not delusional.  However, I do have to acknowledge some factors that either intensify the perception of children as self-like or decrease that perception.  I talk about sexism, poverty, high infant mortality rates, and so on.

One factor I didn't write about much is the attitude of sperm donors, egg donors, and surrogate children to offspring who did come from them, but with the understanding that someone else would be the parent.  That understanding is no doubt one of the factors that can decrease the perception of children as self-like.  Another factor that didn't cross my mind is the sheer number of offspring a person has. This issue comes up particularly in conjunction with sperm donation.  I didn't realize it until I recently heard Jacqueline Mroz on the radio talking about her new book Scattered Seeds, but sperm donors can have incredible numbers of children.  She talks about men making donations three times a week for years, and each donation being split into 10 or 20 portions.  The result is that some sperm donors have as many as 200 offspring!

Is there anything troubling about a sperm donor having 200 children?  In early chapters of the book Mroz focusses on Wendy Kramer, mother of a donor-conceived child, founder of the Donor Sibling Registry, and a critic of the sperm bank industry.  Kids very often want to know about their biological father or even meet him. They see their origin as central to who they are.  Most sperm donors are open to being found and having a relationship of some sort with their offspring, but the worry is that the man's willingness is likely to be reduced, when he has not 2 or 10 or even 20 children, but 200.  You just couldn't experience meeting your offspring as anything terribly profound if you went through it 200 times.  Thus, some donor conceived offspring are doomed to feeling like a mass-produced product, in relation to their biological fathers.  Kramer favors federal regulation, record-keeping, and limits on the number of children a donor can produce.

Whenever Kramer is the focus, Mroz seems rather worried about the sperm bank industry and seems sympathetic to restrictions.  But in the last chapters of the book, the angst goes away.  She focuses on the offspring of Todd, an Apple Executive with 200 offspring.  He treasures all his offspring, inviting them for lavish get-togethers, giving them gifts and traveling with them, but restricting himself to a rich uncle sort of role, not crossing the line into playing an inappropriate father role. It's all good, from the kids' perspective too.  They don't see the father-child relationship or the sibling relationship being diluted or cheapened; they don't feel like mass-produced commodities. They feel like a clan, as opposed to a family.  Though they are actually half-siblings with the other 199 offspring of Todd, they regard each other like most of us regard cousins. As long as we're willing to expand our conception of family and kin, no harm done.

I'm not sure why she ends this way, as if this case were more representative, rather than ending with some of the more painful stories in the book--stories about donor fathers who want more of a relationship than their offspring desire, stories about kids who write Father's Day cards that they put in a box year after year, stories about marriages that fall apart, because donor fathers get more involved with their offspring than their wives can tolerate. If there were a limit of 10 children per donor, just as many parents would get to experience parenthood and just as many children would get to enjoy existing.  Wouldn't some of the problems with donor conception be alleviated?  Why not support more regulation?

Overall, this is a really interesting book, but I wish it had better "back material." It has no bibliography, so it's not easy to look up the books and articles Mroz references. It also has no index, so you can't look up, for example, all the references to Wendy Kramer or to other people who are discussed in multiple chapters.  It has endnotes, but instead of citing sources in the usual way, so people can consult them, Mroz always uses urls, some of them many lines long. (Where urls are appropriate, why not use a url shortener?)  Also, there are also a few errors here and there--doesn't she mean to say that George Washington was infertile, not impotent?  In one place the word should be "motility", not "modality".  But now I'm being picky!

Accutane Ethics

My son has been taking Accutane for the last several months.  Boy it works well (for acne).  It also raises some first class ethical questions.  There's an extremely strict regimen for taking Accutane, because apparently if a woman takes it and conceives a child, the child will likely be born with significant but not super-serious abnormalities. For example, the child's external ears may be malformed.  As a result of this (and for other reasons), patients taking the drug have to see a doctor every 30 days. Women have to promise to use two forms of birth control while using the drug. Every time you break the seal on a pill, you see a warning about avoiding pregnancy.  The assumption behind all this is that it would be wrong or bad to conceive a child with malformed ears, when you could easily wait just 6 months (the usual course) and conceive a child with normal ears.  Of course it would be wrong or bad!

But maybe ... (Note: I truly love the Louis C.K. "Of course...but maybe" routine.  Do watch if you haven't seen it.  Start at 34:00.)   Enter: David Boonin's new book The Non-Identity Problem and the Ethics of Future People, reviewed here by Molly Gardner. At least in the review, the focus is on a slightly different sort of case.  Boonin contemplates Wilma, who can either conceive now and have Pebbles, who will be blind but will have a life worth living, or take a pill for two months and have Rocks, who won't be blind.  Boonin embraces the argument that concludes it wouldn't be wrong to conceive Pebbles. Here's how it goes--

According to Garnder, Boonin's book looks at all sorts of ways of rebutting this argument and finds them all wanting.  So we should just accept the conclusion. It really wouldn't be wrong to conceive Pebbles.

There's an Accutane version of the argument, and I would rather see that be the focus for two reasons. First of all, Wilma and Pebbles are just cartoon characters--literally.  These issues have a different feel when they come up in real life.  Thousands of women are right now considering whether to heed their doctors' warnings about conceiving while taking Accutane.  It's easy to give Wilma the green light to conceive Pebbles, but surely not so easy to give a real woman the green light to conceive on Accutane.  I'm not sure we're thinking seriously about these things until we're thinking about real people's decisions.

The Accutane version is more real world-ish, and also has some parameters that may make a difference to our intuitions.  In the Accutane scenario, a drug causes the undesirable features--the malformed ears. In the Wilma scenario, a drug causes the desirable features--sight, rather than blindness.  Unconsciously, what might make someone accept (C) in the Wilma argument is the intuition that nobody has to go out of their way, taking special drugs, to have a "better" child.  It might not really be that the conclusion gains whatever plausibility it has from the argument's explicit premises.

So let's look at an Accutane scenario. Mary is thinking about ignoring all the warnings and conceiving in July while taking Accutane. If she does so, she'll have a baby we'll call "July"--a baby with malformed external ears. If she waits until she's finished taking the drug, she'll have a different baby we'll call "December," one with normal ears.  Is it wrong to conceive July?  The argument parallel to the Wilma argument would go like this:

Now that we're talking about real decisions in the real world, not cartoon characters, the conclusion looks quite a bit more amazing, even thought the abnormality in question is far more minor.  Or so it seems to me.  I would be absolutely amazed if the wisdom of our best ethics gave permission to Accutane users to ignore all the warnings and conceive while using the drug.  That would be incredible.

So what's going on here?  July is not worse off for being born--P1 seems right.  So she's not harmed by being conceived--P2 seems right.  Let's ignore P3, since even if it were false, that's not the heart of the matter, surely.  If July is not harmed by being born, then she's not wronged--that's what P4 says.  OK, that seems plausible.  That leaves P5.  If an act wrongs no individual could it still be wrong?

Yes.  Mary wrongs no individual yet she causes more suffering than necessary.  The suffering of July about her ears--surely inevitable--just didn't need to be. It would have been no worse to create December, and creating December would have eliminated that suffering.  Usually what matters is harming individuals, wronging individuals and moral categories of that sort, but it doesn't seem surprising that in the special area of procreative ethics, other principles kick in.  "Cause no more suffering than necessary" is that sort of non-individual-specific principle.  Not that this is the only principle relevant to procreative decisions--the one and only master principle--but it seems relevant if you're a woman wanting to both clear up your acne and have a child.  Refusing to wait six months to conceive is wrong because you'll thereby cause more suffering than necessary.

I bet somewhere in Boonin's book this response is discussed and disparaged--I will have to read the book and find out.  Truth be told, I'm sure I'd shift to some other explanation if I could be convinced that this one was wanting, because what I'm absolutely sure about is that Mary shouldn't conceive while taking Accutane.  That's what's so extremely evident, not the reasons why.

Bedtime Stories

Harry Brighouse and Adam Swift ask an interesting question about conferring advantage on children in their new book Family Values.  We do all sorts of things that confer advantage, from reading kids bedtime stories to sending them to private schools.  All these things get in the way of fair equality of opportunity, they say, giving children a leg up just because they happen to be born into better off, more educated families. But where should we draw the line?  Which of our advantage-conferring practices, as parents, can be justified?  Actually, they focus on a narrower question:  which of these things can be justified "by appeal to the value of the family and must be permitted if people are to realize that value in their lives"? (p. 246) 

Their answer is that advantage-conferring practices can be justified by appeal to the value of the family only if they are needed for intimate family life. Reading bedtime stories is fine, even if it does confer advantages over others, and so is attending church together.  Here's a passage that conveys the general idea--

Without substantial opportunity to share himself intimately with his child, in ways that reflect his own judgments about what is valuable, the parent is deprived of the ability to forge and maintain an intimate relationship, and the child is deprived of that relationship.  The loss is to the core of what is valuable about the relationship.  The loss is to the core of what is valuable about the relationship.  Imagine that parents are barred from engaging in these or relevantly similar activities, or, less drastically, that such activities are made very difficult: the opportunities for realizing the familiar relationship good that justify the family would be severely limited. (p. 125)

Their paradigm case of a practice not justified along these lines is sending kids to private school.  That confers an advantage that interferes with equal opportunity and isn't necessary so that parent and child can enjoy an intimate, mutually satisfying family life. 

This way of drawing the line is going to validate some of what affluent parents do, but also condemn a lot of what they do.  So let's see, what gets validated?  (Most of these examples aren't theirs.)

• Bedtime stories, they say. I'm not so sure.  Possibly I could have as much quality, intimate time with my kids if we watched a little TV before bed.  But let's let that pass.  Bedtime stories are in.
• Going to museums.  This confers an educational advantage, but maybe it passes muster, if my child and I love being together at museums in a way we don't love being together at, say, a bowling alley.
• Traveling to national parks. There's definitely an educational advantage conferred, but it might be OK, since vacation time does generate family intimacy, and I just can't enjoy Disneyland in the way I can enjoy a national park.

A lot will not get validated.

• Buying high school students laptop computers so they can easily manage schoolwork, access online assignments, etc.  The computers confer an advantage and aren't necessary for family intimacy. Yes kids appreciate the gift, but only briefly so, and laptops actually tend to make kids retreat from the family.
• Flying around on college trips so kids can decide where to apply "early decision".  All of that confers an advantage, reducing fair equality of opportunity, and doesn't do much for family intimacy.  (Stress, arguing, etc.....)
• Music lessons.  All advantage, not a lot of intimacy, considering the stress over the years about practicing, performing, etc.

I have felt bad over the years about conferring advantages, but haven't had the view that the authors put forward: that it's wrong for parents to confer advantages on children, except when required for intimate family life; and that the state would be entitled to prohibit parents from conferring advantages like those in the second group. There is a milder judgment one could make: that collectively we should make up for or avoid the inequalities.  Schools should give kids access to computers.  Colleges should get rid of "early decision."  There should be cheap music lessons in public schools.  I'm for all of those kinds of solutions, but should I go farther and admit to wrongdoing, to the extent that I've offered my kids advantages that aren't needed for intimate family life?

Though not a libertarian, I am drawn to what many libertarians say about the family.  My personal liberty to spend my own money includes liberty to spend on my kids, because "children themselves form part of one's substance."  They "form part of a wider identity you have" (Robert Nozick, The Examined Life, p. 28).  If I may buy myself a laptop and thereby have advantages over other workers (Brighouse and Swift don't say otherwise), I'm very tempted to think I can also buy my kids a laptop.  The worry that all kids ought to start life on an equal footing falsely presents kids as totally distinct from their parents.   But that's a huge thing to try to argue, especially in a quick blog post.

I have a more modest objection to what Brighouse and Swift are saying about when it's OK to confer advantages.  Suppose I have all sorts of money to spend on laptops, books, education, and whatnot, for myself.  I may secure those advantages for myself; presumably I'm entitled to them, on their view.  What kind of family life would I have if I bought myself a laptop and then told my kids they couldn't have one, because they needed to remain on a level playing field with other children?  Imagine this happening again, and again.  "X is fine for me, but not for you!"  Conferring advantages (without an intimacy payoff) may actually be necessary for a family life that's internally harmonious and egalitarian.  An alternative would be that I don't get to have a laptop either, but that would put an awfully heavy burden on parents. Do they really have to make themselves less competitive at work, once they have kids?

Surely there are some ways of conferring advantage on children that are illegitimate (I can think of several that amount to outright cheating). I'm just not entirely convinced that as many things are illegitimate as the authors claim.

The Accidental Mixed Race Baby

It's all over the news:  a lesbian couple used a sperm bank to create their baby girl and now they're suing, because the bank used sperm vial 330 (from a black man) when they had selected sperm vial 380 (from a white man).  They love their daughter, but they're claiming they've somehow been damaged by the mix up. 

One thing's for sure, this legal wrangle should have been conducted privately, because even if the couple is right to hold the sperm bank accountable for their error (should sperm banks really be less accountable than Best Buy for flubbing up orders?), their daughter may be harmed when one day she finds out about her parents' dissatisfaction with her race.  The parents and the sperm bank should have reached a discreet settlement.  Aside from that, is there any problem here?

There are those who condemn this couple for having any racial preference at all.  But why? Race enters into people's attractions, like hair color or body type or other superficial features do.  Your attractions at the romantic level probably have some bearing on which children you find attractive.  (Hey, don't pretend you find all children equally cute and lovable! You don't.)   Picking white donor 380 sounds more racist, but is it really more racist than marrying white guy John Doe, knowing and welcoming the fact that the two of you will have white children?  People condemning the couple for caring about the race of their sperm donor ought to have to publicize a list of people they've dated and 'fess up to how racially selective they've been!  It is not entirely different.

Another unfair accusation is that the lesbian couple wanted a "bespoke" baby, as all sperm bank clients supposedly do.  Clients at sperm bank do have the option of choosing a donor who's extra smart, athletic, good-looking etc., and so this looks very designer-baby-ish.  But you have to put your feet in the shoes of the clients for a moment.  Fertile male-female couples narrow down the type of child they'll have enormously, by choosing each other.  So they can seem completely open to the unbidden, in a Michael Sandel-approved fashion.  A lesbian couple, by contrast, has vastly less control.  Should we really expect them to be, unlike the rest of us, open to having a child with absolutely any father in the universe?  It's true that sperm bank clients often gain control by choosing a smart, handsome whatever-race father, but I suspect this is  in some respects fortuitous. What they want is really just control over the way they reproduce, and the only form of control on offer is optimizing the sperm donor.

So, allegations of racism and wanting a "bespoke" baby: dismissed.  I don't think the couple's choices are objectionable. However, there is something unfortunate here. Ordinary reproduction with a partner has a tendency to make us exclaim, when a child is born, "He's perfect!" or "She's perfect!"  You have to wonder if this baby has been received with that much joy and appreciation, given the lawsuit.  Are babies more vulnerable to parental rejection and dissatisfaction when the gametes are bought at a sperm (or egg) bank?   The lawsuit (regardless of its merits) makes you think "maybe". 

Taboo Questions

I've been working forever on one chapter of my manuscript/book on parenthood--the chapter on gender.  I think I know part of the reason why it's been so hard and time consuming to get this done.  In other chapters I've felt free to philosophically explore, even if the issues are controversial, but there are a lot more constraints here.  Certain views, and even certain questions, are politically incorrect, taboo, probably genuinely hurtful to some audiences.  And so I can't get into "figuring it out" mode and stay there. I keep feeling hemmed in by what I'm supposed to think, as a feminist, or what I'm supposed to say, as a respecter of LGBT people. And so I read some more, think some more, read some more.  Well, maybe the end result will be a better chapter!

As evidence of how political correctness can distort inquiry, take this New Yorker article about clashes between so-called radical feminists and transgender activists.  It does sound to me like the radical feminist side has some daft views about transgender people and cares too much about safeguarding born-women's spaces, but they do ask some good questions.  It really is puzzling how it could be that a biologically female woman and a trans woman are both women in exactly the same sense.  What is it that makes them both women?  I believe that's a hard question worth thinking about.  The radical feminists asking the question may approach these things with inappropriate animus, but at least they're asking the questions. I get the impression from the article that one is no longer allowed to in some academic settings.

There is some philosophical literature on the hard question but I honestly find most of what I've read not in a purely philosophical mode.  Politics is in the driver's seat a great deal, not the usual philosophical methods--analysis, thought experiments, testing claims with counterexamples, etc.  So people say things that would not withstand philosophical scrutiny, if the topic were something politically neutral like causation, or intentionality, or reference, or whatnot.

What does gender, or transgender, have to do with parenting?  The question I'm trying to tackle is whether parents should care about or cultivate gender differences at all.  But as a preliminary, I tackle the metaphysics of gender.  Are girls/women and boys/men two naturally distinct groups?  Interesting, difficult question. I'd really like to approach it as a philosophy question, not as a matter of politics.

Vaccine Refusers

Most vaccine refusers seem to fall into four groups:

1. Conscientious Refusers--people who reject all vaccination, like conscientious objectors in wartime reject all fighting.  They usually have religious reasons. 
2. Critical Refusers--people critical of mainstream science and medicine.  They will go on thinking vaccines cause autism (for example) no matter how many studies show otherwise.
3. Doing/allowing Refusers--they see a problem with doing something that stands a chance of causing serious side effects, but see no problem with allowing a child to be infected with a vaccine-preventable disease.  Unlike those in group 1, they would accept a vaccine with no associated risks.
4. You-first Refusers--people who think enough other people are vaccinating their children so that they don't have to.  In the early days of a vaccine, when herd immunity doesn't exist yet, they will vaccinate their children.  In the late days, when they think herd immunity protects their children sufficiently, they opt out.

It's the You-first refusers that are interesting, to my mind.  Thinking about them, you have to open the "social ethics" toolbox, maybe taking out the prisoner's dilemma, the tragedy of the commons, Kant's categorical imperative, the voter's paradox, the social contract, questions about the morality of freeriding, etc.

But who thinks like a You-first refuser?  Aren't real world vaccine refusers all in groups 1 and 2?  In fact, a popular author outright welcomes his readers to be You-first refusers.  Here's a delicious/horrifying passage from The Vaccine Book, by Robert Sears, MD.

 

I do "fault parents who think vaccines are too risky and decide to put their own kids first."  I don't think parents "do, and should, have the right to decline vaccination"--if he means a moral right.  I'm not even sure parents should have a legal right.  But how exactly to make the case?  The passage is interesting and challenging because it's not immediately obvious how best to respond.  Or rather--you can come up with a roughly right response pretty fast, but it's not obvious what is the exactly right response.

Back to work....

The Elves and the Cobbler

Here's a scenario from Garrett Cullity's article "Moral Free Riding"--

The Enterprising Elves
On the first day in my newly carpeted house, I leave my shoes outside. In the morning I am delighted to find they have been extraordinarily well repaired.  I am less delighted when I receive the bill. (p. 10) 

This is supposed to be the same type of situation as Robert Nozick's radio thought experiment, which is meant to show there's not always an obligation to pay for benefits nonvoluntarily received. 

I say "Right" about this scenario--I don't have to pay the elves--but it seems to me that outright requesting benefits is more than what's needed for there to be an obligation to pay.  Consider this continuation of the story of the elves:

The Enterprising Elves and the Cancelled Cobbler
After putting on my shoes and tossing out the bill, I stroll to my cobbler's shop and cancel my monthly shoe repair appointment.

That seems to change things.  If I were indifferent to the elves' services and had no monthly plan with the cobbler, I could indeed toss out the bill and never look back.  But in fact I welcome their services.  Now at this point in the story, it's hard to say I have to pay for the elves' work.  Should I pay the elves even though they invaded my cobbler's turf?  Should I pay my cobbler, even though he didn't repair my shoes?  But consider this:

The Elves Come Back
A month has passed and as usual I leave my shoes outside my door.  The elves once again repair my shoes.  I no longer have a standing appointment with my cobbler.  Once again I toss out the bill.

To my my mind, now the unrequested repairs do have to be paid for. True, I didn't request the repairs, but I welcomed them and my behavior shows I'm counting on the elves to show up.  If I'd really wanted to avoid the obligation to pay the elves, I would have had to keep my shoes inside. If I couldn't do that--remember the carpets--then I needed to show I was not counting on the elves by maintaining my appointments with the cobbler and paying his bills.  But it just can't be that I may continue to receive the repairs, having arranged my life accordingly, but I don't have to pay for them.

Extrapolation to vaccination ethics ... well, long story.  We'll save that for another day.

Nozick's Group Radio Thought Experiment

Here's a fun thought experiment from Anarchy, State, and Utopia (Robert Nozick), with a few variants at the end:

Do I have to take my turn and produce a radio show?  Surely not.  We can't be lassoed into obligations that easily--just because some group of people decides to jointly bring about a public benefit.

My thought is: OK, I agree with Nozick about that scenario--you don't have to produce the radio show on your appointed day.  But what's going on here, and how is this different from other cases in which you are a nefarious freerider for refusing to contribute to a joint enterprise you benefit from but didn't request or initiate?

Circumcision Ethics

The simple case against circumcision says the procedure harms children (since the costs exceed the benefits), and parents shouldn't harm their children.  To make this case, you've got to stress the pain of the procedure plus the lost sensitivity. And then compare the benefits: lower risk of various problems, advantages of conformity (if most other boys are circumcised), etc.  This is a tricky calculation, so it's understandable that some opponents of circumcision would want to go another route.

The open future of an uncircumcised boy

For example, in a recent issue of the Journal of Medical Ethics, Robert Darby says circumcision violates a boy's right to an open future.  In other words, boys shouldn't be preempted from making this choice for themselves when they're older.  But why must they make this particular choice for themselves?  In Joel Feinberg's seminal article on this right, he doesn't just hold up an open future as a self-evident good (because the more possible futures the better), but says an open future is good because "self-fulfillment" requires making your own choices.  I find that term rather opaque, but "self-fulfillment" is basically "self-actualization," or "becoming who you are," in Nietzsche's phrase.  If your parents choose your career for you at age 10, you may wind up a lawyer when the real you is a doctor.  Using that reasoning in the present context, the opponent of circumcision has to say newborn circumcision can stop a boy from coming into his real self--if it so happens it would have been truer to the boy's self to have his foreskin.  

A compelling argument? I can certainly see that newborn surgeries sometimes conflict with later self-fulfillment--for example, in the case of female "circumcision" and surgery for inter-sex states.  But is it really self-defining to have or lack a foreskin?  For the vast majority of men, I would think not.

Perhaps the best case against circumcision simply has to do with sovereignty and self-determination, where the body is concerned.  My body is my birthright, not to be irreversibly tampered with except in cases of true medical necessity.  It may not be terribly harmful to circumcise and may not get in the way of self-actualization, but it's an intrusion upon the boy's private territory, without a good enough reason.  When all is said and done, this is the thought I find most compelling.

Enjoying gender

Today my class on procreation and parenthood discusses whether parents should foster gender differences in their children--reinforcing girlness in girls and boyness in boys.  There are lots of reasons to say No, but also some reasons to say Yes.  Here's food for thought from Alice Dreger:

While on the road a few years back, I met a stridently-feminist soon-to-be mom who pulled me aside to worry aloud about how she was going to raise her child. How was she going to keep this child free from gender expectations? Here’s what I told her: Gender isn’t just about oppression. It’s also about pleasure. We get pleasure from our genders. You will get pleasure from your child’s gender, and will sometimes delight in it the same way you will delight in your child growing and learning how to count. Your child will get pleasure from his or her gender. When we have sex, it is often in gendered ways—we enjoy sex as a woman with a man, or as a woman with a woman. How much more evidence do you need that gender can be joyfully delicious? Why oppress yourself and your child with your expectation that gender is always about oppression?

"You will get pleasure from your child's gender"... yup, it's true.  There are a lot of other good points in the article, though some will say she strawmans the social constructivists.

Creation Ethics

I love the Frankenstein allusions in Parental Obligations and Bioethics: The Duties of a Creator, by Bernard Prusak.  I also recently read that novel, precisely to think about parental ethics.  The basic idea of Prusak's book is that creators have special obligations to their creatures, like Dr. Frankenstein did to his monster.  Frankenstein was wrong to abandon the poor creature at birth (he runs out of the room when he wakes up, unlike in the touching picture above).  It would be wrong if a couple deliberately produced children for others to adopt, we think (don't we?).  But why? What are the grounds for parental obligation?

Prusak proposes a "causal theory" of parental obligation, in contrast with a voluntary commitment theory, on which you are obligated to raise a child only by the fact that you voluntarily took on that project. 

men and women acquire parental obligations to a child by voluntarily acting in such a way that the coming-into-being of this child was a reasonably foreseeable consequence in the normal course of events (p. 24)

The causal condition is supposed to be a sufficient condition for having parental obligations, not a necessary condition.  Frankenstein meets the condition, so has parental obligations to the monster. And procreators meet the condition when they bear children.  At least, usually.  Suppose a man winds up fathering a child because of a broken condom or a flawed vasectomy.  Was the sheer act of having sex an act with the coming-into-being of a child as a reasonably foreseeable consequence?  I'm not sure, but I think that's the idea.

Anyhow, here's what I have misgivings about.  The causal theory makes A have parental obligations to B in a highly diverse range of cases.   The causal theory by its very nature doesn't separate the case of making your own child (in the usual way) from other cases of creation.  Frankenstein is the parent of the monster, on  this account, no less than I am the parent of my children.  The problem, I think, is that we seem to have a special class of creator obligations to those that we create in the way parents create their children. That way of creating makes a child practically like a second self (as Aristotle puts it); and the parent, to the child, is a sort of second self too.  The causal theory says nothing distinctive about the parent-child case, but should.

The adoption puzzle is a great puzzle.  Why shouldn't a couple deliberately produce babies for others to raise?   On Prusak's causal account, the producers have obligations to parent the children they produce.  But how to make this more compelling?  He says parents, by creating a child, saddle the child with the mixed blessing of existence.  The child is owed an explanation and defense that can only come from the parent, as the responsible party.

If life is not an unequivocal good, then procreation is not a morally innocent undertaking, and it makes sense to think that a procreator has much to answer for in bringing a child unbidden into being. (p. 42)

Frankenstein ought to take care of the monster, not entrust him to someone else (p. 36):

In other words, it was Frankenstein's fault that the monster existed, so only Frankenstein could help him become reconciled to his existence.  And parents general ought to be available to help children become reconciled to existence.

I'll buy this as the reason why Frankenstein must take care of the monster (which he doesn't--he runs out the room the moment the poor monster wakes up!).  But our lives aren't fraught with "burden's and travails" in the same way.  I've been around for 16 years to help my kids cope with the fact that they exist, and haven't been called upon to do so.  I hypothesize that these kinds of discussions rarely take place, and so it can't be that parents have a prima facie obligation to raise their own children in order to have them.

So, what is the problem with the deliberately relinquishing couple?  I think it has to do with what makes ordinary parenthood distinct from Frankenstein-style creation.  Biological parents can legally transfer their rights and obligations to adoptive parents, but can't, at will, completely sever the tie between parent and child that makes one seem like a second self to the other.   So the parents are likely to be troubled-- they will either suffer or delude themselves.  And the child is likely to be troubled, in a long-term irresolvable way, by the transfer.  And it will be especially hard for such a child, compared to a regular adopted child, because he'll know this was intended by the parent, not accidental.

That may not be 100% satisfying as a complete explanation why having whole children for others is bad, but it seems part of the complete explanation.  And better--more generally applicable--than the idea that biological parents need to be around to help their children understand why they were born.

There are tons of juicy issues in this book, and it has a great bibliography--I am currently working my way through some of the titles, starting with a book about child abandonment by historian John Boswell.  My most serious complaint--why the ludicrous $130 price-tag?  If it weren't for that, I'd be saying "go read it!"

Intergenerational Amnesia

Suppose a 10 year old child had a life-threatening illness that could only be cured at the cost of amnesia. She would lose all memory of her first 10 years, but go on living. It would be bad to forget her early years, but surely worth it to stay alive.  I think we should say roughly the same thing about the practice of saving babies' lives by placing "baby boxes" hear hospitals. When a desperate mother abandons her baby, the baby loses all chance of knowing her origins, but gets to go on living (infanticide is prevented), and will hopefully be adopted by a loving family.  There's a loss, but it's worth it.  Given that characterization, it makes sense to try to change attitudes, so that mothers don't feel compelled to furtively abandon their babies, but instead either keep them or relinquish them in open adoptions.  That would be better for the children, it seems to me.

Charlotte Witt takes a different position on baby boxes here.  She contests Article 8 of the UN Convention on the Rights of the Child, which has been invoked against baby boxes: "States Parties undertake to respect the right of the child to preserve his or her identity, including nationality, name and family relations." To my ear, "undertakes to respect" is rather mild.  You could "undertake to respect" the right in question, and still have a system of baby boxes, justifying it by saying in that particular case, saving lives takes priority.  But  Article 8 does postulate a right to know about one's origins (in so many words), and Witt objects.  The alleged ground of the right, she says, is that knowing your family of origin is "central to the healthy formation of identity." So (this is her gloss) one needs to know one's family of origin to form a health sense of identity.  But that's not so, she argues. To the extent that we gain a sense of identity by knowing what we got from our parents and grandparents, they could equally well be custodial, not genetic, parents and grandparents.

I don't know about the idea that there's a psychological need to know one's origins. Do mental health experts really think we're impaired by not knowing anything about our biological parents? But most people do deeply care about their origins.  This is not a matter of just caring about our genes. You couldn't get a genome map of yourself, and thereby dispense with the need to know who your parents and grandparents are.  In caring about our origins we care about our ... origins.  Where we came from, who our progenitors were. This is like wanting to know who created a painting, or who was the author of a novel.  Knowing origins can tell you more about the person, painting, or novel, but is also of independent interest. We want to know where things came from. Period. This seems like a fundamental and not irrational desire.

The person who starts life in a baby box will, like most of us, have a desire to know her own origins. Now "knowing my origins" is a sufficiently elastic concept that we could know a lot by knowing about our custodial parents, grandparents, teachers, nannies, or whoever was closely involved in our lives.  But most of us also want to know our origins in the strictly biological sense.  We'd be missing an important piece of the puzzle about ourselves if we didn't know who our biological parents (and grandparents) were.  It's unfortunate, then, to start life in a baby box--not worse than not living at all, but worse than starting life in a position to know about one's biological origins. Or so it seems to me.

Is this position "bionormative" in some pernicious sense? That seems to be Witt's view.  She seems to think attaching value to knowledge of origins gives some sort of special status to families formed in the standard, biology-based fashion.  But I think biology is normative in some ways.  We all really think so, as evidenced by our intuitions about the following two puzzles.

Puzzle #1 When a child is born, the biological parents are entitled to custody even if they have vastly worse potential to give her a good life than candidates for adoption. Imagine a refugee camp in Chad, where babies are born in abysmal conditions.  Child mortality rates are high.  People can easily live in the camps for decades.  International Rescue Committee workers visit the camp regularly and could take babies home with them, to raise in western health and affluence.  If it's "bionormative" to say refugees are entitled to keep their children, then bionormativity is not to be dispensed with. Biology does in fact enter into determining which adult is entitled to custody of which child.

Puzzle #2  Now imagine a biological parent in that refugee camp who does decide to give up her child for adoption to one of the visiting workers.  There are several candidates, and from a detached, objective standpoint, it's pretty clear who would be better able to provide the child with a good home.  Does the biological parent get to decide between them?  The answer, surely, is yes. And that's "bionormative"--again, the biological facts enter into who is entitled to decide between the candidates.  

Norms are sometimes rooted in biology, so it's not an automatic demerit for a position to be "bionormative".  Bionormative as this judgment may be, it does seem unfortunate to start off in life with "intergenerational amnesia"--permanently unable to know anything about our biological origins.

"Life begins at conception"

 
Mary Elizabeth Williams declares herself a pro-choice liberal, but wants to concede that "life begins at conception". To her, this is undeniable common sense. But in fact, there is actually a very solid reason to doubt that any human's lifespan starts as early as conception.  At conception, what exists is a single-celled zygote.  That zygote contains the makings of not just the embryo (fetus, etc.), but of all the structures that will support the embryo (fetus, etc.)--the placenta, amniotic fluid, etc.  Imagine (only somewhat analogously) a very full box you take off the shelf at Ikea (with great effort!). The box contains the makings of a bed, but also instructions, tools, packaging, styrofoam, etc.  You take it home and put together the bed, discarding everything else.  Would you say the bed started its lifespan as the full box? No, of course not.  There is no bed until a bed has started to take form and become separate from everything else that was in the box.  And at the point, it really makes no sense to say "the bed was once the full box."

Likewise, once an embryo has become differentiated, a few weeks into gestation, it would make no sense to say it started its lifespan back when there was just a zygote. The zygote is analogous (somewhat--this is not a perfect analogy) to the full bed-box. It's a forerunner of the embryo and all the support structures.  I think the very common idea that life could start at conception stems from ignorance about what a zygote is.  It's not an embyronic human being yet.  It's a kit for making a human being, including components for housing, protecting, feeding, etc.  You might be able to convince yourself that you were once an embryo (I think this is an intelligible position), but it really makes no sense to think you were once a zygote--a people-kit. No you weren't!  You came from a people-kit, but you weren't one.  It's much like in the bed/box example: the Ikea bed came from the  box, but beds don't start their careers being boxes.  No equal sign would make sense up there, between the box and the bed, and no equal sign would make sense between a zygote and an embryo (or fetus or baby).