Is there a moral obligation to select healthy children?

Abstract

Reproductive decision-making in the post-genetic age is a minefield of complex ethical problems. One such problem centres on whether there is an obligation on reproducers to choose the best possible child. This paper focusses on a simplified scenario: there are two embryos to choose from, one of which will develop a condition that diminishes quality of life but would still have 'a life worth living', the other of which is normal. Is there an obligation to choose the healthier child? If so, what is the nature and scope of this obligation? The answer to these questions relies on a satisfactory answer to the non-identity problem (NIP). This paper explores several solutions to the NIP and argues for a solution grounded in the concept of harm. Various accounts of harm are discussed and synthesised to provide a new 'comparative bad state view' of harm. This account is used to justify the obligation to choose the healthier child. How far should this obligation go? This paper rejects the conservative position of 'procreative autonomy' - which holds that such obligations have no place in reproductive decisions - and the radical position of 'procreative beneficence' - which holds that there is an even stronger obligation to make the best possible child. The obligation to choose the healthier child may be over-ridden by countervailing reasons; the moral calculus in any individual case will be largely dependent on the expected quality of life of the child.

Prenatal genetics: An instrument of eugenics or protecting lives?

“…Moreover, for bioethics it was as unclear then as it is now. [2] This notwithstanding, some brave minds went even further. They made a step from prenatal genetic analysis to genetic modification of future children.…”

Mapping ethical, legal, and social implications (ELSI) of preimplantation genetic testing (PGT)

“…The debate gradually shifted to focus more on the limits to genetic selection rather than the ethics of using PGT in the first place [47,48]. Arguments were raised, often in response to Savulescu, defending or opposing claims about parental and social moral obligation to select against diseases and disabilities or in favor of "good traits" [49][50][51]. Furthermore, at least 35 articles raised debates about genetic enhancement derived from hypothetical, non-proven uses of PGT to select non-medical traits [52][53][54].…”

Human Germline Genome Editing

“…38 One concern that arises in discussions of trait selection, prenatal testing, and the potential for gene therapy or gene editing is the possibility that allowing parents the choice to control aspects of their child's genetic inheritance (procreative autonomy) could create expectations of this sort of control or even obligations to ''create the best children'' in what has been called procreative beneficence. 39,40 These are among the specific concerns about eugenics expressed by the bioethics community and the public, but perhaps the most deeply felt uneasiness is conceptual: the sense that in identifying some individuals and their traits as ''unfit,'' we experience a collective loss of our humanity. Often articulated as a concern is that we might be ''overstepping'' and ''playing God'' by making such changes in a way that modifies the germline and thereby affects future generations.…”