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In considering the value to parents of being biologically related to their children, Ezio Di Nucci probes into a mysterious and difficult-to-weigh sort of value, given that it tends to correlate with other important values such as the parent-child relationship. Di Nucci is concerned with exploring the fertility technology of IVF-with-ROPA (reception of oocytes from partner). This technology enables women in same-sex relationships to become parents of a child to whom they are both biologically related in different ways. One partner gestates a baby using eggs donated by the other partner; as a result, one partner is gestationally related to the resultant child, while the other partner is genetically related.
There are various reasons why lesbian aspiring parents—and aspiring parents in general—might wish to be biologically related to their children. Di Nucci considers the question of whether parents ought to value biological relatedness to their children. He concludes that, while the wish to be biologically related to one's children is not objectionable (so, the state ought not to interfere with it), there is no further value to being biologically related to one's children beyond satisfying this wish.
I will discuss two issues in relation to this fascinating topic. First, I will place pressure on the view that the wish to be biologically related to one's children is not objectionable. Second, I observe that talk of the value of being biologically related to one's children is ambiguous: there is more than one value at stake, and this has implications for our decisions about what values to support in fertility treatment.
A legitimate wish for biological relatedness
Di Nucci claims that wanting to have ‘a biological connection (either genetic or gestational) to one's children’ is non-objectionable in the sense of being ‘legitimate’. He goes on to explain: ‘The language of positive and negative rights may help illustrate this point: wanting to have a biological connection to one's children is legitimate, so the state ought not to interfere with it; but, having no deeper meaning than liberty, the state may not be obliged to support this wish by, say, paying for it.’ Di Nucci makes this claim without arguing for it; his argument is, rather, focused on showing that the sort of biological relatedness in question does not have value in addition to its satisfying what he claims is a legitimate wish.
But is this wish really legitimate, in the sense that ‘the state ought not to interfere with it’? Is it any more legitimate than, say, a wish to associate only with people to whom one is racially connected (however we might interpret ‘racially connected’)? Culturally, we tend to view the wish to be biologically related to one's children as more benign than the wish to be racially related to one's associates. But cultures can be wrong about things like this, as we can see by considering that in the past, and in some cultures presently, the wish to associate only with members of one's race is also viewed as benign. Further, the wish to be biologically related to one's children—like the wish to associate only within one's racial group—can have harmful effects. The wish to associate only with members of one's own race can (and does) result in people being denied important opportunities on account of their race. And the wish to be biologically related to one's children means that the vast majority of aspiring parents create new babies, despite there being millions of existing children without families in need of adoption or foster care; as a result, aspiring parents' preference for biological relatedness to their children leads to existing parentless children being denied the opportunity of a family.
This observation is not yet enough to support a claim that the state would be justified in interfering with would-be parents' wish to be biologically related to their children, but it puts pressure on Di Nucci's undefended claim that this wish is legitimate.
What do we value when we value biological relatedness?
In the course of arguing that creating children to whom one is biologically related has no value beyond satisfying the legitimate wish to be biologically related to one's children, Di Nucci attacks an argument by David Velleman, who holds that biological ties are valuable—so valuable, in fact, that children are disadvantaged by being raised by people to whom they are not biologically related. Velleman argues that being biologically related to one's family is important for one's sense of identity. Di Nucci counters that, while one's family history and upbringing may certainly be important to one's identity, Velleman's claim that biological family ties in particular make a difference to one's identity is implausible.
I share Di Nucci's view that Velleman's case for the importance to one's self-conception of biological family relatedness is unconvincing. Indeed, Velleman's argument that children are disadvantaged by not knowing their biological relatives is a vivid example of unhelpful armchair philosophy. He makes his case without any attempt to discover how people raised without their biological families actually conceive themselves in relation to their biological and adoptive relatives, beyond observing that adoptees often have a compelling desire to meet their biological families. As Di Nucci shows, this observation does not actually support the claim that biological relatedness is itself valuable.
Setting concerns about Velleman's argument aside, however, it is worth remarking that both Velleman and Di Nucci run together two different ways in which biological relatedness might potentially be valuable. The first is the value that aspiring parents place on creating children to whom they are biologically related. The second has to do with the value we place on already existing people to whom we are biologically related. Both Velleman and Di Nucci take observations about the value of biological ties with existing family members to tell us something useful about the value to aspiring parents of creating children to whom they are biologically related. In particular, they both accept that if it turns out that our biological ties to existing family members are valuable, then this lends support to the view that there is something valuable (beyond its satisfying the legitimate wish discussed by Di Nucci) about creating children to whom one is biologically related.
However, from the fact that one values a certain quality in an existing family member, it does not follow that there is value in creating a new person with that quality. Imagine an aspiring parent who values their mother's self-sacrificing nature and their father's stubbornness. Suppose also that the aspiring parent has good reasons to value these qualities in their parents—perhaps being raised by people with these qualities contributed in an important way to the aspiring parent's self-conception. Would any of this support a decision by the aspiring parent to conceive—with the help, perhaps, of an advanced form genetic engineering that has been proven to be medically safe—a self-sacrificing, stubborn child? I think it would not; further, I think that while many of us would view valuing qualities like self-sacrifice and stubbornness in one's parents as pretty benign, we would be disturbed by an attempt deliberately to create a self-sacrificing, stubborn child merely because of the value one places in these qualities. There are various reasons why we might find this idea disturbing, exploring which is beyond our scope here. Our lesson from considering this case can be that valuing a certain quality in one's existing family members does not entail that there is value in creating a child with this quality.
Having dealt effectively with Velleman's argument, Di Nucci does not need the support offered by my observations here for the claim that there is no—to use Di Nucci's expression—‘intrinsic value’ in being biologically related to one's children. Even so, distinguishing between the value of biological relatedness to existing family members and the value prospective parents place on creating children to whom they are biologically related is important as we face future decisions about what values are most important to prioritise in fertility treatment.
Di Nucci's paper is one of two in this issue on topics in reproductive ethics. The other is by Benjamin Pojer, who considers the question of whether it is ethical to create a child as a carer for a disabled parent. We also have three extended essays this issue. In the first, Euzebiusz Jamrozik and his co-authors argue that people who opt out of vaccination are morally responsible for any harms suffered by others as a result. Next, Brent Michael Kious argues that it is possible for individuals to be mistaken about what is good for them, and considers the consequences of this for paternalism in medicine. And third, Julian Savulescu and his co-authors consider under what circumstances use of a placebo control in surgical trials is permissible. Another essay on clinical research comes from Rosalind McDougall and her co-authors, who describe an interesting and concerning phenomenon that they call ‘therapeutic appropriation’, in which research participants or clinicians view research interventions as beneficial to the research participant, despite also recognising that this is not the direct aim of the research project.
We have four papers focused on new empirical research. Domnita Badarau and her colleagues report the results of a survey in Romania exploring the attitudes of physicians and parents about the involvement of children in their cancer care. Paraskevas Vezyridis and Stephen Timmons analyse opt-out forms used by patients to withdraw from a programme to share their medical data, and make recommendations about the format that such forms should take. Adélaide Doussau and Christine Grady consider the appropriateness of the ‘stepped wedge’ design of clinical trials to Ebola vaccine research. Finally, Jennifer Kesselheim and her colleagues report the results of a survey of recently trained paediatricians' ethics knowledge.