Why Have Children?: The Ethical Debate

8 Illness, Impairment, and the ProcreationDecision

8 Illness, Impairment, and the Procreation Decision In chapter 7, I argued that there is no obligation to achieve procreative beneficence in Savulescu’s sense of the term, largely because of its costs to women. But that is not to say there is no responsibility at all to consider the future child’s health. It ought to be obvious and not in need of argument that the aim in procreating should not be merely to produce a child whose life is minimally tolerable. One should aim much higher, and I think the vast majority of women and men do. In this chapter, I consider the moral implications of illness and impairment with respect to the procreation decision. The question whether adults with impairments should be “allowed” to become parents has a long and mostly unsavory history. The issue was raised in eugenics debates during the nineteenth and twentieth centuries about the supposed need to improve the human species by discouraging and preventing procreation by individuals with certain mental or physical characteristics. And the question of whether and when abortion may be morally justified on the grounds of fetal impairment is a familiar one to both philosophers and the public. In jurisdictions that place legal restrictions on abortion services, access is often permitted on the basis of the fetus’s characteristics. I examine the first question, whether illness or impairment in the potential parents morally precludes their procreating, later in this chapter. The second question, whether and when fetal impairment or illness can morally justify abortion, is not the main part of my focus here. Instead, I am interested in a problem that appears more extreme: Are there cases where fetal impairment or illness makes abortion not merely permissible, but the morally obligatory choice? In other words, are there cases where the obligation not to procreate is so strong that failure to abort because of the fetus’s condition would be a moral wrong? And because the choice 150 Chapter 8 of abortion is at best the decision of last resort to prevent procreation, it is also necessary to ask whether there are potential conditions of the fetus (and the child it would otherwise become) that merit the prevention of conception altogether. These questions about the conception of impaired or ill fetuses and the failure to abort them are where I shall begin. A responsibility to use contraception does not appear morally equivalent to a responsibility to have an abortion. For several reasons, a responsibility to have an abortion seems more demanding. For example, having an abortion may often require a higher degree of intervention into the woman’s body than contraception. But not always. The comparative degree of intrusion depends in part on the kind of contraception used: hormonal methods might have a very powerful effect on the woman’s body, whereas the use by her male partner of condoms likely will not. The degree of intrusion also depends on the kind of abortion and the stage of pregnancy at which it takes place: a very early abortion will involve less upheaval to the woman’s body than a very late one. At the same time, the responsibility to abort appears to be a more demanding duty than the responsibility to use contraception because, whatever one’s metaphysical views of the fetus’s status, it is indubitably a living thing whose existence ends when an abortion is performed, whereas the practice of contraception simply prevents a being from coming into existence . In addition, for some women, having an abortion can be like the end of a relationship, a relationship that the woman may have chosen to initiate and value very highly: the relationship to her fetus and to the child that it may become. “If the child is wanted, parents often view their fetus as their already existing child, a distinct person” (Vehmas 2002, 49). For these reasons—that abortion can require major intervention into the woman’s body; that it can be like the end of a relationship; and that it ends the life of the fetus—a moral requirement to abort will usually require a stronger argument in support of it than will a moral requirement to use contraception. The Non-Identity Problem To begin, consider some thought experiments—cases proposed by Derek Parfit and James Lenman. In the classic Parfitian case (Parfit 1984, Illness, Impairment, and the Procreation Decision 151 367–71), we are asked...