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Edited by H Haker, D Beyleveld. Ashgate Publishing Co, 2000, £45.00 (hb), pp 335. ISBN 0 7546 1021 7
This is a challenging book that I recommend for anyone who wishes to engage with contemporary philosophical discussions relating to assisted reproduction, pre-implantation genetic diagnosis (PGD) and embryo research. It consists of six principal papers, each accompanied by responses from two discussants. There is also, in an appendix, a summary of the discussion that followed each of these six sessions in the final symposium of the EU-funded European Network for Biomedical Ethics held in Sheffield in 1999. In addition, there is a seventh paper in which the network, funded from 1996–1999, is evaluated, and there are introductory and closing remarks to the volume by Dietmar Mieth, Professor of Social Ethics at Tübingen.
In his introductory contribution, Professor Mieth asks us to consider the words that are used to describe the practices of IVF and PGD and the problems they generate. He follows Illich in problematising the word “life”, tracing its use over the past two centuries in the context of our mechanistic biology and our society’s possessive individualism. He argues that the terms of the “official” moral debates in this area—the terminology of bioethics as well as the terms of reference of the learned bodies and committees—have pre-empted these deliberations so that they can only lead to the fully liberal, permissive position.
In the first major paper, Sheila McLean discusses the “right” to procreation. What does this amount to? When may obligations to a future child restrict or potentially infringe upon parental freedom to make specific decisions? And when can individual wishes be challenged in the interests of society—the wider community?
In the responses to this paper, Anders Nordgren sets out a coherent position in which there can be limited, local, contractarian rights to fertility treatments and a limited autonomy on the use of prenatal diagnosis and decisions about selective terminations of pregnancy. Onora O’Neill applies the concept of the “good enough” parent to the realm of assisted reproduction, and asks how the new ways of becoming parents may lead to new ways of being parents. She asks us to examine the ethical issues in this area from the perspective of children born as a consequence of the new technologies. She emphasises the differences between that perspective and that of the perspectives of children who have been adopted or fostered. An increase in choice for adults may lead children to feel rejected by their genetic or gestational parents. Chosen relationships are often understood as very different from given relationships, and more easily become conditional. How may this alter parent-child relationships? Notions of autonomy, it is argued, should not be the only or central concern in regulating this area. Finally, Walter Lesch discusses the question of when parents or children can be considered “good enough” in the genetic sense. He maintains that it is legitimate for the standard of “good enough” to vary, depending upon the biological and social origin of the child.
A similar format applies in the five other sections. Derek Beyleveld presents a technical argument about the status of the embryo and the fetus, starting from the ethical system of Alan Gewirth. I found this unconvincing, as did the two discussants for several reasons, but I am happy to concede that this topic is outside my area of expertise.
The third paper is presented by Jean-Pierre Wils. Autonomy, it is argued, only makes sense in the context of a relationship in which the other is recognised as a(nother) moral agent. Accordingly, the difficulty in achieving this in relation to an embryo or fetus makes it difficult to treat the embryo with full respect, and technological modes of visualising the embryo or fetus can make this even more difficult. Our habits of perception pre-empt our ability to choose how to understand what we see. Wils argues for a graded recognition of (active) personhood or (passive) moral rights. In the discussions, Engels emphasises the danger of determinism and Dierickx discusses the depersonalisation that often accompanies prenatal screening programmes at the population level and the altered notion of responsibility (for the genetic health of one’s children) now that nature need not simply take its course.
The fourth paper, by Regine Kollek, locates the new reproductive technologies within modernity—and therefore within the paradoxical conjunction of both increased freedom and heightened accountability for one’s “free” choices. The notion of risk management is crucial to this paradox, and Kollek discusses the impact this has on women’s lives. The ways in which the new reproductive technologies can reinforce the emphasis on genetic identity—one’s “true” family consisting of one’s molecular relations—is also discussed. And Kollek echoes Mieth’s criticism of bioethics as a mechanism that controls and silences opposition to the new reprotechnologies. The discussants to this paper both challenge Kollek and extend the scope of her argument.
The fifth paper, by Marcus Düwell, is methodological; it considers how to justify an ethical position in this area. He outlines several of the areas of contention already discussed and proposes a framework within which to consider them. He suggests—and I disagree—that bioethical principles can define what is justified, allowed or forbidden while other considerations (of apparently lesser importance, beyond the scope of ethics) can guide other aspects of behaviour. The discussants criticise this view too, objecting to the narrow scope of applicability of this ethics and the framing of ethical responsibility as (merely) the recognition of justified interests.
The final paper, by Beyleveld and Pattinson, examines the legal frameworks within which various European countries tackle IVF, PGD, cloning, and related technologies. The substantial differences are accounted for in several ways, including messy political compromise, and the nation-specific meshwork of legislation and non-legislative regulation, professional codes of practice etc—as discussed further in a commentary. The other discussant examines the specifically medical aspects of fertility treatment.
This is a wide ranging volume that examines reprotechnology and reprogenetics from several, conflicting perspectives. The resulting compilation is especially valuable for bringing strands of Continental philosophy, with a heavy representation—especially from Tübingen, into dialogue with a more Anglo-Saxon bioethics. This breadth of perspective is uncommon, impressive, and very helpful. I hope that further contributions of this sort emerge from future collaborative projects in Europe.