March 5, 2024

Parents can have a duty to use IVF, say bioethicists

Yet another controversial utilitarian proposal has popped up in the March issue of the American Journal of Bioethics. Two bioethicists contend that some parents are morally obligated to use pre-implantation genetic diagnosis to create a healthy baby.

When two Italian-Australian utilitarian bioethicists declared in the Journal of Medical Ethics that infanticide (or after-birth abortion) was morally permissible, they lit the fuse on a world-wide storm of condemnation. But a proposal which may be even more controversial has popped up in the April issue of the American Journal of Bioethics. Two bioethicists contend that some parents are morally obligated to use pre-implantation genetic diagnosis to create a healthy baby.

Janet Malek, of East Carolina University, and Judith F. Daar, of Whittier Law School, in California, argue that eventually the law should and will impose “a duty on IVF-reproducing parents to maximize the well-being of their future offspring by all reasonable means.” Why? The authors cite three reasons: increasing the child’s well-being, expanding his or her self-determination, and reducing inequalities. 

If this reasoning evokes the notorious “after-birth abortion” article, this may be because the authors rely upon ground broken by Julian Savulescu, Guy Kahane and John Harris, three utilitarians working in Britain who influenced the authors of the previous article. The British bioethicists are pushing “procreative beneficence” — the notion that parents should endow their baby with the best possible qualities. Malek and Daar argue that this is morally good not only because it has good consequences (ie, stronger, healthier, more intelligent kids) but it also promotes fairness and autonomy. 

The immediate concern is what to do for parents who are carriers of a severely disabling disorder like autosomal recessive polycystic kidney disease. It seems clear enough to Malek and Daar that these parents are morally obliged to sift through embryos to find one which does not have the disease:

“prospective parents who make an independent decision to reproduce using IVF and who know or reasonably should know they are at substantial risk for transmitting a serious genetic anomaly to their offspring may be subject to legal liability for failing to utilize PGD to avoid birthing a child who suffers grave harm from the heritable condition.”

Eventually, of course, this means that the government will mandate health insurance so that everyone using IVF can avoid having defective babies. From a public policy point of view, this makes economic sense, as taxpayers will not have to support sick children. In the words of Malek and Daar, “Shifting benefit outlays for significant post-birth health care to a far less costly preconception procedure strikes us as a worthy public policy trade-off.”

Malek and Daar’s article was critiqued by a number of other bioethicists in the same issue of AJOB. Some thought that their proposal would lead to “reproductive police”, as in Margaret Atwood’s dystopian novel, The Handmaid’s Tale. But others felt that they did not go far enough. All parents at risk of conceiving a sick child have a duty to use IVF and PGD, argue bioethicist Rosalind Ladd, of Wheaton College, and Edwin Forman, of Mt Sinai Medical School. 

Michael Cook