sábado, 29 de septiembre de 2018

Bioethics Observatory Child selection bioethics assessment. Savulescu's principle of Procreative Beneficence

Bioethics Observatory Child selection bioethics assessment. Savulescu's principle of Procreative Beneficence


Bioethical debate on the principle of Procreative Beneficence

What future awaits our children? Can natural selection be overcome by IVF embryo selection techniques? Child selection bioethics assessment

Posted On 21 Sep 2018


Natural or artificial selection? See the below video about recent findings of the sophisticated selection in the natural fecundation process 
The principle of Procreative Beneficence (PB) developed by Julian Savulescu [1,2] continues to monopolise much of contemporary bioethical debate about the beginning of life. Redefined in 2009 with the collaboration of his colleague at Oxford University, Guy Kahane [3], PB is currently set forth as follows: If couples (or single reproducers) have decided to have a child, and selection is possible, then they have a significant moral reason to select the child, of the possible children they could have, whose life is expected, in light of the relevant available information, to go best or at least not worse than any of the others [3: 274].
The core of PB is the “moral imperative” that supposedly obligates parents to bring into the world the best specimen possible, something that can only be done through in vitro fertilisation. This allows us — following preimplantation genetic diagnosis (PGD and PGS) — to have relevant information to determine which embryo should be transferred, i.e. which offers greater guarantees of enjoying a healthy life.
In a recent article published in the Journal of Medical Ethics [4], T.S. Petersen shows that the objections raised to this principle have so far been unsuccessful. Hence, he presumes to propose a practical situation that effectively reveals the aporias of PB. Below, we will briefly outline Petersen’s article, to then present our ethical assessment of the principle proposed by Savulescu.
For Petersen, the first failed argument came from the hand of J.A. Robertson, who countered the “moral imperative” of fertilizing in vitro with his “principle of Procreative Autonomy” (PA) [5]. According to this, any procreative option is morally plausible provided that it is chosen autonomously by the parents. Savulescu, however, reproaches the PA that allows the reproducers to select the child with least guarantees of enjoying a happy life [1: 279-280].
The second failed argument alludes to the unfounded probabilism that underlies PB. Thus, Parker believes that the active pursuit of the best progeny through in vitro fertilisation does not guarantee that we get the best version of the child that could arise through natural selection. However, Savulescu thinks that this possibility is no impediment for parents to procure the best start in life for their children that they can foresee, even if in doing so they are mistaken [2: 287].
Petersen, in particular, points to the moral partiality of PB. To begin with, he recognises that it is an intuitively attractive principle since potential parents tend to want the best life possible for their future child. Hence he accepts the partiality towards the child with the greatest expectations of enjoying the best life because of their lower predisposition to disease. However, he raises an objection: this partiality cannot disregard the indications of practical reason and common sense. Specifically, Petersen asks two questions about the supposed “significant moral reason that helps parents to select the child whose life can be expected to go best”. The first is, what exactly does “to have a significant moral reason” mean? And the second, why is partiality bias towards one’s own children a “significant moral reason”?
With respect to the first question, Savulescu understands that all those reasons that have greater relative strength compared with competing moral reasons are “morally significant”. With respect to the second, he recognises that the weight of these reasons is only evident when they refer to the individual well-being of the child selected in relation to children that are discarded, but not in relation to what is defined as “persons already existing”, which for him are persons already born. Savulescu and Kahane admit, in fact, that “BP will require most reproducers to select the most advantaged child unless doing so is predicted to lead to a very significant loss of well-being to existing people” [3: 281].
The supposed practice that, in Petersen’s opinion, invalidates PB, can be summarised thus: Let’s suppose that a couple has to decide between two future children, A and B, who have equal chances for a good life. However, child A has a blood type that makes him a universal recipient. Petersen believes that the partiality implicit in PB provides a “significant moral reason” to choose child A. But practical reason and common-sense morality call for the optimisation of the world, which would suggest the selection of child B. Consequently, there is an insurmountable conflict between practical reason and PB. And for Petersen, science and moral philosophy should always incline towards rationality, avoiding bias arising from a lack of information and/or distraction by irrelevant circumstances [1:774].
Our ethical assessment
We appreciate that Petersen’s criticism reveals some of the antinomies of PB. Nevertheless, it “forgets” some important aspects of the issue. This oversight is not unrelated to the current state of the bioethical debate, whose shift from the instance of foundation to the instance of application has occurred so fast that it seems that the latter has already been overcome.
Note, for example, that Petersen accepts without question the ethicality of the “selection” of children by their parents, who he repeatedly refers to as “reproducers”. In fact, he centres on the ethical dilemma of PB on two points:
  1. on whether or not there is a duty of partiality in favour of the child with the best chance of enjoying a happy life; and
  2. on whether this partiality should be limited by practical reason and common sense.
However, he does not go into previous bioethical issues that have a more fundamental nature, and that we list below:
  • First, that the selection proposed by Savulescu is only possible after preimplantation diagnosis of embryos fertilised in vitro. And this, in itself, presents obvious bioethical controversies, especially when proposed as the only form of procreation, disassociating parenthood from the loving encounter between a man and a woman.
  • Second, that the selection itself implies the “exclusion” of unselected embryos.
  • Third, that if the excluded embryos belong to the human family (an aspect over which Petersen tiptoes), then they have inalienable rights. And if something defines the rights of man, it is that they do not depend on the judgement of conscience of others [7:100 and 8:343]. A right that can be revoked by those for whom it is a source of obligations, does not deserve the name of right [8: 111].
But above all, Petersen becomes entangled in the net woven by the creators of PB, namely: Consequentialism. This is so because he accepts that it is feasible to anticipate the future that awaits our children based purely on the information provided by PGD and PGS. We, on the other hand, find no relation of necessity between the health of the early embryo and the expectations of enjoying a happy life when it has completed its development.
From consequentialism, indeed, specific indications cannot be derived for the moral action, except with the aid of additional assumptions, which are either not sufficiently accredited, or ruin the consequentialist principle itself. These assumptions are:
a) that the agent knows all the possible global states of the world that may occur at all times subsequent to their action; and
b) that the agent can judge the function of each of his actions for each of those global developments [8:192].
In order for the first of these conditions to be fulfilled, we should be able to anticipate all the possible global developments of the cosmic process, as the quality of each individual human life is not independent of the sequence of its states. And this knowledge is difficult, says Spaemann ironically, “when our gaze does not even cover all the possible global developments of a single chess move” [8:192]. And if we cannot know all the possible developments in the world, we can hardly judge how our actions influence them. But even saving this truism, to be in a position to judge the function of each of our actions, we would need to know the way in which others will react to them because their consequences really depend on this. How can it affect a teenager to know that, if he has been born, it is only because his health was better than that of his siblings? How will he assimilate the fact that, had he been sick, he would have been discarded?
In Consequentialism, therefore, we are forced to imagine that optimization in the short term, in a limited context, will also have positive repercussions in the long term. But it gives no reasons why it must necessarily happen like this. In this way, it annuls itself, because it promises more than it can deliver. The pretence of subjecting all the possible global processes of world events to a comparison of their value, reaching in that respect an unequivocal hierarchy and steering one’s own behaviour in accordance with its function of utility for an optimum course of events falls squarely within the realm of mere fantasy” [8: 215].
PB, in short, faces an insurmountable contradiction: on one hand, it claims that the basis for determining the morality of the selection resides in the idea of the best world possible, whether it be for the child selected or, as the case may be, for the already born, and on the other, it is forced to fall back on mere fantasy, when it claims that we will be able to subject all the possible global processes of world events to a comparison of their value, ordering them hierarchically and acting accordingly. The criterion of adaptation to the optimisation strategy thus becomes inconsequential for the moral assessment of our actions. PB, therefore, is invalidated.
In any event, selecting a child is not the same as choosing a piece of furniture for a room. People are “someone”, not “something”. And we are thus in all the stages of our development. And from the “recognition” of the embryo as “person” derives our duties towards it; its recognition, in effect, enjoins us to treat it ethically. This recognition, at its basic level, translates into acceptance and respect; and at its higher personal level, it crystallises into benevolent love. Human dignity has an absolute legal effectiveness that prohibits any type of weighting. All people have, without any discrimination, the inalienable right to exist, regardless of whether their state of health is more or less ideal. Every human life has an absolute value, and, consequently, it is unacceptable to think that one life could be worth more than another.
Enrique Burguete
Institute of Life Sciences
Bioethics Observatory
Catholic University of Valencia

Bibliographical references
  1. Savulescu J. Procreative Beneficence: why we should select the best children Bioethics 2001;15:413-26.Savulescu J. In defense of procreative beneficence. Journal of Medical Ethics 2007;33:284-8.
  2. Savulescu J, Kahane G. The moral obligation to create children with the best chance of the best life. Bioethics 2009;23:274-90.
  3. Petersen, TS. Journal Medical Ethics 2015;41: 771-774.
  4. Robertson, JA. Children of Choice: Freedom and the New Reproductive Technologies. Princeton University Press, 1994.
  5. Parker M, The Best Possible Child. Med. Ethics2 007;33:279-83.
  6. Spaemann, R. Ética: cuestiones fundamentales (7ª ed.). (J. M. Yanguas, Trad.) Eunsa, 2005.
  7. Spaemann, R. Límites. Acerca de la dimensión ética del actuar (J. Mardomingo, & J. Fernández, Trads.). Ediciones Internacionales Universitarias, 2003
female’s eggs are able to select sperm with the best genes to ensure the healthiest offspring possible

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