Bitesize: Is there a duty to have the best children possible?
The question of the moral, procreative duties of parents is an issue hotly debated in bioethics. Whilst traditional accounts have defended the importance of minimising incidence of disease or developmental conditions in foetuses, I argue that these fail to justify their means sufficiently. Further, it appears that the duty of care ordinarily attached to the duty to create the best child possible can better and more intuitively be described as a duty of acceptance of parents and enabling flourishing of a child, despite biological limitations.
Note, for a concise analysis, I will focus only on ‘medical’ (over ‘non-medical’) biomedical technologies, which also aim solely at reducing incidence of disease – such as pre-natal screening. Whilst much debate surrounds the use of new technologies to enhance the biologies of future children, it is sufficient to explore the limitations of more restrictive forms of intervention here.
First, then, Savulescu (2001) argues that there is a moral duty to have the best child possible, found at least in promoting the interests of that child. Approaching the debate from a Neoliberal bioethicist perspective, Savulescu’s aim is to maximise the future child’s biological capacity for autonomy – that is, increasing intelligence, strength, emotional stability, immune system resilience, etc. All these factors contribute to a child having “the best life, or at least as good a life as…others” (2001:413). Given the moral duty for parents to promote the interests of their future child, then, Savulescu defends the principle of ‘Procreative Beneficence’: to use existing biomedical technologies to avoid lessening the quality of life of their future children.
This argument seems largely convincing; there are a wide array of medical conditions which clearly disadvantage children, which – if avoided – would surely improve their quality of life. Indeed, as Savulescu notes, conditions such as asthma “reduces quality of life”, both in the long-term steroid medication use (and their side-effects), as well as the risk of great harm, and even death, in asthma attacks (2001:417). Since it appears uncontroversial that parents have a special duty of care towards their offspring – i.e. in providing them food, healthcare, education, etc. – it therefore seems no great leap to extend these duties of care pre-birth.
On the other hand, Shakespeare (1998) presents a bleaker picture of a world of procreative beneficence. For Shakespeare, parents – in attempting to create the ‘best possible’ child – may suffer from “the ‘supermarket syndrome’” (1998:666). This is where parents adopt the unrealistic expectations that medical technology can rid their baby of all impairment or illness, and that they indeed have this moral duty to keep retrying in order to honour this duty. However, as is apparent, this appears further from the duty of care Savulescu described, and closer to – as Shakespeare describes – ‘weak eugenics’. Indeed, for pre-natal screenings in Europe, this certainly appears the case; as Lou et. al (2020) report, the termination rate of foetuses after being identified with Down Syndrome from screening was on average >89%. In Denmark, it reaches >95%; as a result, each year from 2004-2020, only 35 babies are born with Down Syndrome, out of nearly 60,000.
Savulescu somewhat pre-empts this concern; different from the eugenics Shakespeare presents, Savulescu argues that at least the justification behind procreative beneficence is simply concerned with the interests of the child, rather than a population. As he explains, the ‘public interest’ intention behind eugenics “is different from Procreative Beneficence… [which] is an essentially private enterprise” (2001:424). Whilst dealing with this matter on the surface, Savulescu fails to see how – regardless of the intention – the material outcomes of either project may end up the same. This is a particular worry for Sinason (1992), who highlights that the assumption underlying Savulescu’s analysis – and why these cases of pre-natal termination are so disturbing – is that they confuse ‘differences’ with ‘imperfections’. For Sinason, whilst those with developmental conditions or chronic diseases may have certain restrictions on their lives, this does not come close to outweighing the great value, beauty, and joy that those future children can find in life. In these ways, she argues that the duty of care of parents is not to create the perfect child, but rather, to ensure the potential for quality of life does not fall below a reasonable baseline. Indeed, this critique is compelling – the burden remains on Savulescu to demonstrate why the active abandonment of a potential child, such as with Down Syndrome, can be justified to reach some ‘best possible’ state.
Whilst Sinason remains convincing in her critique of Savulescu’s apparent ‘perfectionism’, Persson (2009) argues for the right to choose of parents. For Persson, parents – in addition to a procreative duty – have procreative liberty. Thus, parents may choose (subject to their duties) to birth children which match Sinason’s account of minimum standard – likewise, they may choose the ‘best possible’ child. Whilst this seems to have some initial appeal, however, Persson’s critique appears to lack moral depth. Despite it being the case that there is no ordinary obligation to procreate (thus, justifying parents’ right to terminate a foetus), it lacks guidance on how exactly parents ought to use this liberty.
Whilst this may be precisely Persson’s point, McDougall (2005) provides a more compelling account. Taking a virtue-ethicist approach, McDougall argues that what ought to guide parents is a virtue of ‘acceptance’ over ‘perfecting’; “the flourishing of the child is facilitated by the parent’s embracing of the child”, regardless of their biological limitations (2005:602). This case is indeed more compelling; whilst procreative liberty indeed exists, it the existence of some guiding principle is required to answer our issue of whether parents ought to have the best child possible. Given the duty of care previously discussed, it would seem uncompelling to argue that – assuming that parents have some duty to their child before they are born – parents do not have a duty to facilitate their flourishing by exercising this virtue.
In conclusion, whilst Savulescu’s principle provided an intuitive account of the moral duties of parents, it was unable to convincingly justify its consequences for society, and the unrealised future children. Sinason’s critique convincingly established that the duty of care of parents only rises to the level of a minimum standard of life, rather than perfection. Likewise, McDougall demonstrated that the duty of care is more intuitively formulated as a duty of acceptance, such that the best child possible - the one that flourishes the most - is the child that is most accepted by their parents.
