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Abstract
Some commentators argue that conception signals the onset of human personhood and that moral responsibilities toward zygotic or embryonic persons begin at this point, not the least of which is to protect them from exposure to death. Critics of the conception threshold of personhood ask how it can be morally consistent to object to the embryo loss that occurs in fertility medicine and research but not object to the significant embryo loss that occurs through conception in vivo. Using that apparent inconsistency as a starting point, they argue that if that embryo loss is tolerable as a way of conceiving children, it should be tolerable in fertility medicine and human embryonic research. Double-effect reasoning shows, by contrast, that conception in vivo is justified even if it involves the death of persons because the motives for wanting children are not inherently objectionable, because the embryo loss that occurs in unassisted conception is not the means by which successful conception occurs, and because the effect of having children is proportionate to the loss involved. A similar outcome holds true for in vitro fertilisation in fertility medicine but not for in vitro fertilisation for research involving human embryos.
- Reproductive Medicine
- Research Ethics
- Embryos and Fetuses
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Some researchers estimate that more than half the zygotes and embryos conceived in vivo following intercourse fail to develop, fail to implant, spontaneously abort, or are otherwise lost in the course of early development, so that the number of human beings actually born represents only a subset of all conceptions.1 Some commentators maintain that conception is the threshold of human personhood in a metaphysical sense. For example, John Finnis has said: ‘every living being which results from human conception and has the epigenetic primordia (which hyaditiform moles and, even more obviously, human sperm and ova lack) of a human body normal enough to be the bodily basis of some intellectual act is truly a human being, a human person’2 On this kind of interpretation, the early loss of zygotes and embryos should be understood as the death of persons. Critics of this interpretation ask how it is possible to object—as some commentators do—to assisted reproductive treatments (ARTs) and embryo research on the grounds that these practices put human embryos at risk of death but not also object to conception in vivo of children. In 2006, Dan W. Brock said that the view that embryos are persons involves certain inconsistencies, including the outcome in ‘normal sexual reproduction’ that three embryos die for every embryo that manages to develop till birth (a ratio for which he cites no evidence).3 Acknowledging that ‘the wilful creation and sacrifice of embryos is an inescapable and inevitable part of the process of procreation,’ John Harris said in 2007 ‘that no one who regards it as acceptable to try and have children (or indeed to have unprotected sex) has (therefore) any principled objection to the creation and destruction of embryos in a good cause’.4 Along the same lines, Robert Sparrow said in 2009: ‘A willingness to conceive naturally therefore requires that the couple be prepared to sacrifice those embryos that may be spontaneously aborted in the course of the attempt to become pregnant for the sake of the life of the child that is eventually born’.5
On its face, this line of criticism raises questions of consistency in regard to the welfare of human zygotes and embryos considered as persons. Should a moral red flag not be raised against conception in vivo that leads to the death of more than half the zygotic and embryonic persons that ensue? Or, should we openly embrace the ethics standard that seems to be involved in tolerating that loss of life: some embryonic persons may be exposed to circumstances that will end in their death so long as the purpose is at least as important as that in having children.
Although I do not accept the view that conception signals the onset of personhood in a moral or metaphysical sense, having children through conception in vivo is defensible against the charge that it amounts to wrongful tolerance of the exposure of human embryos to death. Double-effect reasoning can be used to defend conception in vivo despite the embryo loss involved.i While there are different versions of double-effect reasoning, I will model my analysis on the version outlined by Aquinas as I analyse intentions, means and the proportional effects of conception in vivo as a way of having children. As I say, I do not accept conception as the threshold of personhood, but I offer this analysis in order to defend it against the charge that it throws clinically unassisted in vivo conception of human beings into moral doubt. I will try to show that one cannot point, therefore, to the embryo loss of associated with conception in vivo as itself a moral precedent alone justifying clinical and research practices that involve the death of embryos, which is not to say those practices do not have other justifications.ii
In defence of conception in vivo
Aquinas noted that ‘Nothing hinders one act from having two effects, only one of which is intended, while the other is beside the intention’.6 That distinction opens the door to a defence of conception in vivo, by separating out its dual effects, and I will review not only those effects but also intentions, means and proportionality of effects to offer a defence of conception in vivo. In the discussion that follows, I will treat all conceived human organisms as persons in a metaphysical sense.
Intentions
The intent to conceive children in vivo does not in itself require any intention to expose any embryos to the risk of death. One can wish for children without—as a condition of expressing that hope—also hoping that some embryos face disorders and death. The former does not entail the latter logically or morally. In fact, for most of human history, the scope of zygote and embryo loss would have been unknowable to people trying to have children. Earlier human beings would not have even been able to link the two effects into a single motive. The intention to have children is not, therefore, morally disqualified in itself.
Means
In applying double-effect reasoning one must ask whether the exposure of some embryos to the risks of death is the means by which the end of having children is achieved, but it is not. Some conception, implantation and gestation occur without loss of zygotes, embryos or fetuses. In this sense, embryo loss is extraneous to the conception of children that results in children since it does not have to happen and is therefore not inherently the ‘bad’ means by which a ‘good’ outcome is achieved. Certainly, any particular couple cannot know in advance whether that their acts of intercourse will end in the death of embryos.
A skeptic could go back to reproductive basics here and note that embryo loss in human beings is an inescapable and a species-typical feature in having children: there is no successful conception and implantation in human beings as a class where there is not also embryo loss. In this general sense, a couple could estimate as a matter of probability that some of their own embryos will be lost. Despite this concession, it remains true that the death of some embryos is not inherently a condition of success for conception in vivo that results in children, so that we cannot treat efforts to achieve conception in vivo as involving a necessary evil used as the means to a good end. In other words, some conception does not succeed because other conceptions fail, and that remains true whether we are talking about individual couples or the species as a whole.
Could it nevertheless be argued that alternatives exist to conception in vivo as a way of having children, such that the outcome of embryo death is avoidable by relying on other means? Becoming a parent through adoption would involve no new exposure of human embryos to death, and it might be that some ARTs would involve exposure of fewer embryos to death overall than a couple's repeated attempts at conception by intercourse. By themselves, these options would not be, however, adequate to the task of providing children since not enough children are available for adoption by those who want them and ARTs are constrained by economics, law and their failure rates. Moreover, people turning to ARTs for help cannot know in advance that they would necessarily expose fewer embryos to the risks of death that way than through their own unassisted attempts at conception. Depending on circumstances, the embryo loss that occurs in fertility medicine might be equal to or even greater than the embryo loss involved conception in vivo. No embryo will be protected against a lethal genetic endowment, for example, simply because it is conceived in vitro rather than in vivo. Adoption would therefore fail as an option in giving children to all who want them, and ARTs would not necessarily diminish the total number of zygotic and embryonic persons exposed to risks of death.
Proportionality
Double-effect reasoning requires that any undesirable effects that might occur in the course of an action be proportionate to their desirable effects. Aquinas discusses this proportionality in a killing carried out in self-defence: ‘and yet, though proceeding from a good intention, an act may be rendered unlawful, if it be out of proportion to the end. Wherefore if a man, in self-defence, uses more than necessary violence, it will be unlawful: whereas if he repel force with moderation his defence will be lawful, because according to the jurists, ‘it is lawful to repel force by force, provided one does not exceed the limits of a blameless defence’’.6 On this logic, someone's right to self-defence would not ordinarily extend to using lethal force against, say, a child wielding a small knife. However, if an adult male wielding a gun were to attack, the victim's right to self-defence would extend to lethal force if it were necessary to save his or her own life.
On this kind of account, the ethics of human embryo loss through conception in vivo will turn on the relative importance of conception in vivo. It is hard to see how wanting to have children could be said to be in any way trivial; on the contrary, if anything can be counted as proportionate to the loss of human life, it would seem to be the new generation of new human life. At least as a prima facie rationale, it seems reasonable to conclude that having children is sufficiently important in itself to offset the fact that some zygotes and embryos are lost in the course of conception and which are, moreover, lost for reasons entirely beyond anyone's control.
The very idea of wanting to bring children into existence has come under certain challenges that could alter this conclusion. Antinatalist commentators argue that children should not be brought into existence at all. For example, David Benatar argues that the goal of having children is wrongful in itself, given the uncompensable pain and suffering that attach to human life.7 In a way, this is an argument based on consequences rather than intentions, but on this antinatalist view no parent can hope for a child except that the child will necessarily face uncompensable pain and suffering. On this view, the very desire for children cannot be disentangled from objectionable outcomes. The antinatalist perspective turns ordinary expectations about having children on their head since it requires seeing embryo loss as preferable to success in having children. Seen from the antinatalist perspective, the human beings who come into existence as zygotes and embryos but who undergo an early demise are protected against the pain and suffering of existence because their demise occurs prior to any capacity for sentience. As antinatalists see things, that's a life to be envied if one has to live at all. For those who find more value in life than antinatalists are able to muster, it almost goes without saying that children are a matchless good around which valuable identities, relationships and social institutions are forged. The poet Robert Frost once asked whether ‘all the soul-and-body scars / Were not too much to pay for birth’.8 For those willing to accept those scars as the price of life's benefits, there is nothing inherently objectionable in wanting to have children, as a way of sharing with others the value that life confers on its subjects.
Judged on the terms of double-effect reasoning (intentions, methods and proportional effects), conception in vivo proves morally defensible no matter that some zygotic and embryonic persons lose their lives in the process. If wanting children is not objectionable in itself but even a matchless good for human life, it is hard to make the case that the method of conception most available to people and the method most successful in conceiving children should be closed off as morally objectionable, and certainly not in the absence of generally available alternatives.
Implications for ARTs and embryo research
What I have shown so far is that conception in vivo is defensible by the logic of double-effect reasoning. This principled reason for tolerating embryo loss means that critics of the conception threshold of person cannot point to conception in vivo as an ethical affront to that standard. Neither does it mean that the embryo loss tolerated in conception in vivo by itself legitimises the exposure of embryos to risks of death in other circumstances although, as I have said, other justifications may ground those practices. In what way, if any, does double-effect reasoning apply to clinical uses of in vitro fertilisation (IVF) to produce children and to produce embryos for research?
In fertility medicine, the motive for IVF can be the same as for conception in vivo: to have a child. There seems nothing objectionable about this in itself. Is the means of conception in vitro the cause of the unwanted outcome, namely the death of some embryonic persons? It seems hard to make this case either, since—for conception in vitro as in vivo—the loss of some embryos is not the means by which other embryos thrive. Moreover, for any particular couple there is not necessarily in IVF more loss of life than occurs in vivo; the outcomes are situational. What about proportionality of effects, namely the moral comparability of the two outcomes? Here again, the unwanted loss of some embryonic life seems counterbalanced by the desirable generation of new lives. One might argue that to preserve proportionality, there should be no more loss of life in conception in vitro than occurs in vivo, but given the scale of embryo loss that occurs in vivo, there is considerable room for tolerable embryo loss in vitro.iii
When it comes to the matter of human embryos for research, what does double-effect reasoning allow? Without specific reference to double-effect reasoning, Katrien Devolder has argued that if the loss of embryos that occurs in IVF and embryo transfer for the purposes of achieving a pregnancy is morally tolerable, the creation of embryos for research should be tolerable as well.9 This conclusion does not follow, as Dan W. Brock pointed out in a 2009 comment on Devolder's view by noting that embryo loss in fertility medicine uses of IVF is not intended, as against the intentional destruction of embryos that occurs in research. Brock says he does not support double-effect reasoning, but he says correctly that it would vindicate the conception of embryos in vivo (and the loss that entails) without also (by itself) justifying the production of embryos for research.10 This criticism therefore also applies to his own 2006 judgment that tolerance of embryo loss in conception in vivo involves inconsistency for those who maintain that embryos are persons.3 On an analysis using double-effect reasoning, in any case, there is a prima face case for defending the embryo loss that occurs in IVF for purposes of having a child as a matter of double-effect reasoning, which outcomes does not hold true for conception in vitro for research.
The motive for conception in vitro is to conduct human embryonic research that contributes to biomedical knowledge. This goal is not only unobjectionable, it has much to recommend it. However, the unwanted effect here (the death of human persons) is the means by which the wanted effect (biomedical progress) is achieved. For example, the derivation of embryonic stem cells requires the disaggregation of human embryos, which destroys them as embryos, even if cell lines developed from them live on indefinitely.
To the extent that embryo destruction is the very means by which human embryonic research goes forward, to that extent it is not morally defensible as a matter of double-effect reasoning. For reasons like this, the Catholic Church argued that the only permissible research on embryos is research that respects the life and integrity of the embryo, that does not involve disproportionate risks, and that is ‘directed towards its healing, the improvement of its condition of health, or its individual survival.’11 If it were possible for researchers to extract some embryonic cells from a human embryo without thereby destroying the embryo, the terms of this analysis would change, and it might be possible to defend some such research. That biomedical research involves the death of embryos construed as persons means, of course, that further questions about the proportionality of the wanted and unwanted effects are moot. Even if one were to claim that the downstream effects of that research would be extraordinary—a benefit to uncountable people—the fact that the intervention necessarily required the death of a human person would disallow it.iv This conclusion depends, of course, on interpreting human zygotes and embryos as persons; approaches that do not confer personhood that way could proceed with embryonic research on other justifications.
Conclusions
Some commentators think it is inconsistent for those who see conception as the threshold of personhood to object to fertility medicine and embryo research because of the embryo loss involved but not also object to conception in vivo as its own cause of foreseeable embryo loss. Double-effect reasoning shows, however, that conception in vivo as the consequence of intercourse can withstand moral scrutiny, at least at present, despite the embryo loss involved. Conception in vivo does not require any intent to expose embryos to the risk of death, the embryo loss that occurs is not the means by which successful conception occurs, and the effect of having children is as important as any to be found in human life. So long as no other readily available means of conception comes along that would reduce the total amount of embryo loss that occurs in unassisted conception, people who hold that conception is the threshold of personhood may continue to turn to conceive children in vivo without moral inconsistency. As far as double-effect reasoning allows, conception in vivo is principled and not morally unmoored, as some critics maintain.
As a matter of double-effect reasoning, however, a prima facie case can be made in defence of conception in vitro for fertility medicine, since no objectionable motives are involved, the objectionable effect is not the means by which the desirable effect is achieved, and there is an important benefit from IVF that counterbalances any undesirable outcome. The same cannot be said of conception in vitro for the purposes of any research that destroys embryos, since the means by which the desirable outcome of improved knowledge is achieved is the destruction of the embryos. Research that intended therapeutic benefits to the embryo would, however, survive moral scrutiny, so long as any embryo death that might occur was not the means by which the research went forward. In this case, critics of the conception threshold of personhood who argue that the toleration of embryo loss of conception in vivo also requires toleration of embryo loss in research have it wrong.
Acknowledgments
I thank the Journal's three anonymous reviewers for their assiduous reading of this analysis.
Footnotes
↵i In this analysis, I do not take up the question of what embryos construed as persons are owed by way of duty of rescue.12 ,13
↵ii Neither does significant embryo loss following conception amount to a reductio ad absurdum of conception threshold of personhood. It may seem odd that so many ‘persons’ face death so early on in their lives, but death is the fate of persons necessarily. Nothing about personhood protects anyone from death.14
↵iii Considerations other than the death of a person could be brought forward to object to IVF intended to produce children. The Catholic Church has held, for example, that children have the right to be conceived only in vivo as the result of acts of intercourse between married, opposite-sex people. If this were true, then one should presumably not use IVF for the purpose of having children, but that argument depends on specific religious beliefs and not on the principle of double effect.11
↵iv The Catholic Church expressed their view of the wrongfulness of the matter this way: ‘In fact, this research advances through the suppression of human lives that are equal in dignity to the lives of other human individuals and to the lives of the researchers themselves.’ Congregation for the Doctrine of the Faith. Instruction Dignitas Personae on certain bioethical questions. Sept. 8, 2008, III.32b. http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_ 20081208_dignitas-personae_en.html(accessed July 16, 2012).
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Competing interests None
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Provenance and peer review Not commissioned; externally peer-reviewed.
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