{"id":2705,"date":"2014-01-11T12:57:56","date_gmt":"2014-01-11T11:57:56","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=2705"},"modified":"2014-01-11T12:57:56","modified_gmt":"2014-01-11T11:57:56","slug":"identity-and-ivf","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2014\/01\/11\/identity-and-ivf\/","title":{"rendered":"Identity and IVF"},"content":{"rendered":"

It’s good to see that Stephen Latham is blogging again after a short hiatus; and he’s come back with a really thought-provoking post<\/span><\/a><\/span><\/span> on IVF and problems of identity.<\/p>\n

The background is this: apparently, there is evidence that children conceived by IVF are at an elevated risk of health problems compared to kids conceived naturally:<\/p>\n

Compared to spontaneously-conceived singletons, singletons from assisted conception were almost twice as likely to be stillborn, more than twice as likely to be pre-term, almost three times as likely to have very low birth weight, and twice as likely to die within the first four weeks after birth. Outcomes varied by type of assisted conception. Very low and low birth weight, very preterm and preterm birth, and neonatal death were “markedly” more common in births from IVF and, to a lesser degree, in births from ICSI. Use of frozen embryos elminated the risks of ICSI, but not of IVF. But frozen embryos also had increased risk of macrosomia.<\/p><\/blockquote>\n

This<\/span><\/a><\/span><\/span> is the paper that Stephen mentions; but it’s not the only one<\/span><\/a><\/span><\/span> to report potential risks associated with IVF. \u00a0A rather kneejerk response to this is to go “Eeeep! \u00a0This means that IVF is dangerous, and we’re harming kids by conceiving them by this method”. \u00a0(I suspect that there’s an element of that in posts like this<\/span><\/a><\/span><\/span> – though admittedly if that element is there, it’s being deployed merely as a part of a wider attack on IVF, motivated for different reasons.) \u00a0But, of course, kneejerk reactions are rarely all that morally insightful, and the conventional response to concerns about IVF is rather more sanguine.<\/p>\n

Borrowing heavily from Parfit, the standard response is this: each of us is reliant on a particular egg and a particular sperm having fused in a particular way. \u00a0Had that been different, we would not have come into being. \u00a0A month later, and it’d’ve been a different egg; and it could easily have been a different sperm cell. \u00a0Any resultant child would be related to us only in the same way as a sibling – except that it wouldn’t be our sibling, because we wouldn’t be there. \u00a0This indicates that,\u00a0if IVF represents a child’s only chance of coming into existence – and it probably is – it is hard to say that the child has been harmed or wronged thereby. \u00a0There may be a qualification to add, along the lines that should the child’s life be so bad that non-existence would be preferable, existence may be a harm; but that kind of outcome is probably hyperbolic in practice. \u00a0An elevated risk of any congenital characteristic is therefore unlikely to count as a harm.<\/p>\n

So, as Stephen points out, we can ask a question:<\/p>\n

Has that child any complaint against the parents? One possible answer is, “No, because the condition of the possibility of that particular child’s ever existing at all was his or her parents’ use of the IVF which caused both his or her existence and his or her low birthweight. Only a child whose life was so wretched as to literally not be worth living could complain about his or her parents’ use of IVF.” […]<\/p>\n

If IVF is risky, and a child of IVF is born with a disability, and the child would not have been born without IVF, what sort of complaint can one mount, from the child’s point of view, about the disability?<\/p><\/blockquote>\n

And the answer we’d expect is “Not much”.<\/p>\n

However, there is one clarification that needs to be made, which is that all this applies only to disabilities or characteristics that are genetic in origin, and so necessary to the child in front of us. \u00a0Not all disabilities are. \u00a0There will be some IVF children born with a disability whose disability could have been avoided without avoiding them<\/em>: for example, we might imagine that the pregnant mother-to-be accidentally ingests some chemical that causes disability – something like Thalidomide is a good example. \u00a0Kids who had birth defects as a result of that could have been born without them, and, though they’d have different biographies, it’d be the same person whose biography it was.<\/p>\n

Why is this a clarification that needs to be made? \u00a0Well, there’s something I chopped from the quotation above. \u00a0This is it:<\/p>\n

The argument in this form seems sound but it also troubles me, because (for example) one can easily imagine the circumstances in which one might accurately say to a slave, “You have no right to complain about being born a slave, because without the institution of slavery, you would never have been born at all.”<\/p><\/blockquote>\n

There seems to be something to that. \u00a0A child born on a plantation to slaves would almost certainly not have been born without the events that brought his ancestors together; and so in a certain sense it is true that there is a group of people who owe their existence to slavery. \u00a0We could say the same for anyone who was conceived in morally repugnant circumstances. \u00a0These are all aspects of the more general idea that each of us owes our existence to the historical quirks that brought all our ancestors together.<\/p>\n

However, what’s important to note is that there’s two different things going on in a phrase like “You have no right to complain about being born a slave”: we can bracket the last two words. \u00a0Though it may be unlikely that a given person would have been born had it not been for slavery, it is still possible, from a metaphysical point of view: slavery is not a genetic condition, and so not a necessary condition for a person being who they are. \u00a0That is: it may be true that a person has no right to complain about being born; but it doesn’t follow from that that they have no right to complain about being born\u00a0a slave<\/em>, because they could have not been.<\/p>\n

To that extent – and although the analogy isn’t absolutely great – being born a slave is a bit more like being born with Thalidomide-related birth defects than it is like being born with some undesirable genetic characteristic, inasmuch as that we could imagine \u00a0a world in which neither the condition of slavery nor the somatic defect was present, without the person affected also being absent.<\/p>\n

Actually, come to think about it, even the somatic\/ genetic distinction isn’t all that important here. \u00a0Let’s return to the reduced birthweight aspect, and imagine (for the sake of the argument) that all IVF children have reduced birthweight and the concomitant health problems. \u00a0Now, it might be tempting to think that that\u00a0is<\/em> analogous to slavery, inasmuch as that we could imagine an IVF child born with a normal, healthy, birthweight – and a corresponding right to complain. \u00a0All the same, if it were to turn out that a reduced birthweight was an inescapable part of IVF, the right to complain would, I think, be that much weaker, since the undesirable outcome would be an indissociable part of having come to exist at all.<\/p>\n

What, finally, of this world, where – as far as we know – a reduced birthweight is not indissociable from having been created by IVF? \u00a0Doesn’t that maintain the slavery analogy? \u00a0I’m not sure.<\/p>\n

The objection to slavery, I think, is that it is a wrong committed against another, not that it’s a harm (or, at least, not primarily that it’s a harm: it might be that as well, of course). \u00a0To see why, imagine a slave-owner who thinks his slaves are morally equivalent to his farm animals – but who recognises that, as such, he has an economic reason to keep them healthy. \u00a0These slaves might be, in some material sense, better off than at least some badly-off people, in roughly the same way that cattle on a farm might be better off than wild cattle: they get medicine when necessary, shelter, regular nourishing food, and all the rest of it. \u00a0But, of course, that wouldn’t strike us as proper compensation. \u00a0One might live in a gilded cage, but one still lives in a cage; a slaveowner who treats his slaves well is a slaveowner for all that. \u00a0Being a slave would be a wrong even if it somehow made you better off than you otherwise would have been.<\/p>\n

The point is this: one would remain deeply wronged by being a slave even if not harmed. \u00a0A person whose birthweight was lower than it might have been owing to some as-yet not understood aspect of IVF would be in a different position, though. \u00a0Plausibly, they’d be able to say that they were harmed. \u00a0The question is, would they have been wronged?<\/p>\n

On the face of it, possibly. \u00a0They have plausibly less of some good that they could otherwise have had. \u00a0The good would not have been removed deliberately, but we might think that using IVF is reckless given the risk to which one would necessarily expose any child; and to be at the receiving end of reckless action does seem like a wrong. \u00a0This may remain so even if one is not actually harmed – one might justifiably complain about having been exposed to a risk unnecessarily, irrespective of the outcome. \u00a0On the other hand, it’s tempting to think that wrongs can be graded; maybe being recklessly exposed to the risk of a lower birth-weight isn’t all that significant a wrong. \u00a0I don’t know how you’d begin to assess that.<\/p>\n

I guess the analogy here, then, might be with someone who feels wronged because his mother didn’t stop smoking or drinking, or start taking folic acid, during pregnancy. \u00a0The question that that raises is one of how seriously we’d take the complaint. \u00a0I’m inclined to suspect that the answer’s “Not very”; but maybe there’d be something worth saying about it.<\/p>\n","protected":false},"excerpt":{"rendered":"

It’s good to see that Stephen Latham is blogging again after a short hiatus; and he’s come back with a really thought-provoking post on IVF and problems of identity. The background is this: apparently, there is evidence that children conceived by IVF are at an elevated risk of health problems compared to kids conceived naturally: […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1240,511,591,475,2022,472],"tags":[317],"class_list":["post-2705","post","type-post","status-publish","format-standard","hentry","category-blogosphere","category-in-the-news","category-life-and-death","category-politics","category-reproduction","category-thinking-aloud","tag-research"],"yoast_head":"\nIdentity and IVF - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2014\/01\/11\/identity-and-ivf\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Identity and IVF - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"It’s good to see that Stephen Latham is blogging again after a short hiatus; and he’s come back with a really thought-provoking post on IVF and problems of identity. 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