Do new reproductive technologies benefit or harm CHILDREN

This connection is explicitly recognized within the United Nations Declaration of the Rights of the Child United Nations, 1959, which calls for ‘special care and protection’ both for chi

Do new reproductive technologies benefit or

harm children?

Christine Overall

Department of Philosophy, Queen’s University, Kingston, Canada

In the recent ethical and social scientiWc literature on new reproductive technologies (NRTs) and practices there is not much discussion about their impact on children (e.g Birke, Himmelweit and Vines, 1990; Iglesias, 1990; Marrs, 1993; Robertson, 1994; Hartouni, 1997; Steinberg, 1997) As theWnal report of the Canadian Royal Commission on New Reproductive Technolo-gies (Royal Commission on New Reproductive TechnoloTechnolo-gies, 1993: p 42) puts it,

There is a dearth of information about, for instance, the direct outcomes of being conceived through assisted reproduction Physical outcomes are important to moni-tor, but there may also be emotional and psychological outcomes to being born through the use of assisted methods of conception For instance, we know very little about the eVect on a child’s sense of identity and belonging of being born through

assisted insemination using donor sperm or following in vitro fertilisation using

donated eggs.

Books and anthologies written from a feminist perspective mostly emphasize the eVects of NRTs on women (e.g Rowland, 1992; Spallone, 1989) None the less, there is a connection, in reproductive issues, between the status of women and the status of children This connection is explicitly recognized within the United Nations Declaration of the Rights of the Child (United Nations, 1959), which calls for ‘special care and protection’ both for children and for their mothers, ‘including adequate prenatal and postnatal care’ (Principle 4) Hence, it can plausibly be argued that if NRTs either beneWt or harm women, then their children may be comparably aVected For example, the criminalization of maternal substance abuse indirectly threatens the well-being of children, since the threat of criminal prosecution may deter pregnant women from seeking medical care (Blank and Merrick, 1995:

p 165)

In this chapter I evaluate, from a feminist perspective, a number of arguments about the direct beneWts and harms of reproductive technologies and practices with respect to children As a moral touchstone for their assessment, I use the United Nations Declaration of the Rights of the Child,

305

which sets forth, in a reasonably clear and uncontroversial fashion, some basic and essential moral entitlements for children everywhere, entitlements that are widely acknowledged, even if they are not always acted upon

I shall conWne my discussion to the western world, since that is the context

in which most of the arguments on both sides have been advanced For the purposes of this chapter I deWne a ‘child’ as a human oVspring, from the time

of birth up until the end of adolescence For reasons I shall not explore here, I

do not regard a human embryo or fetus as an infant or child; hence I reject the approach taken, for example, by Jerome Lejeune, who claims, in the title of one of his papers, that ‘Test Tube Babies are Babies’ (Lejeune, 1992) None the less, what is done to embryos and fetuses obviously can aVect the children they may become For this reason, the treatment of embryos and fetuses can

be highly relevant to – although it is not identical with – the issue of the treatment of children

Alleged benefits of NRTs and practices

It is important to notice that NRTs and practices are rarely defended in terms

of arguments about direct alleged beneWts for children The focus of argu-ment is almost always on potential parents, both women and men, and what they will receive However, there are a few recurrent claims about the beneWts

of NRTs to children that deserve attention Three main beneWts are repeat-edly cited: existence itself; loving, motivated, prosperous parents; and the avoidance of disabilities

Existence itself

One prominent argument is that technologies such as IVF (in vitro fertiliz-ation) are a beneWt to oVspring since without the technologies, some children wouldn’t exist – even if their existence includes physical or psychological health problems and/or disabilities Existence itself is a beneWt conferred by NRTs upon some lucky children Thus, John Robertson, a prominent de-fender of the use of NRTs, argues that however diYcult the problems may be arising from a life created through reproductive technology, that life is unlikely ever to be so bad as to be not worth living (Robertson, 1994: p 76)

He states, ‘Whatever psychological or social problems arise, they hardly rise

to the level of severe handicap or disability that would make the child’s very existence a net burden, and hence a wrongful life’ (Robertson, 1994: p 122) How should we assess this argument? Thomas H Murray points out that if

it is accepted without analysis, then virtually no ‘novel method of bringing children into the world’ could be morally condemned (Murray, 1996: p 37) The argument implies that criticizing a reproductive technology requires

showing that the children thus created would have been better oV never having been born Of course it seems true that being alive is usually good; I have little doubt that most children created through NRTs and practices are glad to be alive Still, this argument should not be allowed to trump all other evidence about possible harms generated by reproductive technologies

For it would be a moral and conceptual mistake to assume that there are children who would have missed out on a beneWt – life – if not for NRTs It is not as if children exist in a limbo, waiting to be given the opportunity to live via NRTs Never having existed would not make some hypothetical child worse oV; there is no child to harm (ParWt, 1984: p 487) So, even if coming into existence is a type of beneWt, failing to come into existence is not a harm Having life is the precondition that makes all other beneWts – and harms – possible If a child suVers illness or disabilities because of the circumstances of his or her conception or prenatal existence, then we seem to have harmed him or her, in the process of beneWting him or her by causing his or her existence It is arguable that every person has an interest in possessing a healthy, non-disabled body If the damages incurred at conception are

suYciently great, there seems to be virtually no beneWt to the child at all

I conclude that, from a perspective before conception of a child, life is not a beneWt, since there is no one to beneWt; only from the perspective after conception has occurred is life arguably a beneWt – and then, only if the life is not heavily damaged through the process of conception itself Causing someone to exist is not a beneWt, since there is no one to beneWt; but once the person exists, she or he has life, which is usually a good thing

Loving, motivated, prosperous parents

A second alleged beneWt claimed for NRTs is based on the ostensible charac-teristics of the parents Prospective parents who use NRTs are often prosper-ous, seem really to want children, are in some instances supposedly assessed for stability, and are ready to have children More simply, the claim is that NRTs beneWt (potential) parents, who want children (Snowden and Mitchell, 1983: p 76; Macklin, 1994: p 56) and are pleased to have them; hence they indirectly beneWt the resulting child

This argument usually takes its most explicit form in the context of debates about so-called surrogate motherhood, or what I prefer to call contract pregnancy, where the claim is made that the children resulting from the contract receive all the beneWts of life within middle-class or wealthy families, who are equipped to provide the material, social and intellectual privileges seldom attained in working-class families Thus, the American Fertility Society (1990: p 312) claims,

Even if there are psychological risks, most infertile couples who go through with a

reproduction arrangement that involves a third party do so as a last resort In some cases, their willingness to make sacri Wces to have a child may testify to their worthi-ness as loving parents A child conceived through surrogate motherhood may be born into a much healthier climate than a child whose birth was unplanned.

However, this argument is not persuasive Its classist bias is immediately obvious: the assumption is that life in a middle- or upper-class family is inevitably a greater beneWt to a child than life in a working-class family This assumption worked to the disadvantage of Mary Beth Whitehead, a working-class woman, when she sought custody of her biological daughter, so-called

‘Baby M’, whom she contracted to create for William Stern, a well-oV professional

More signiWcantly, perhaps, the argument assumes that would-be parents who resort to NRTs and practices are especially motivated and beneWcent toward their subsequent children However, as I shall suggest later, there are also reasons to be concerned about the motives and goals of these people And, at the very least, there is no empirical evidence that I know of to suggest that they make better parents than those who do not use technology in reproduction

Avoidance of disabilities

The third main beneWt claimed for some NRTs and practices is that they can help to reduce or eliminate disabilities in children (Tauer, 1990: p 75) For example, Deborah Kaplan (1994: p 50) lists several possible beneWts to children of prenatal diagnosis (PND) and treatment First:

Prevention or amelioration of the disability using methods such as treatment through dietary changes or supplements for the mother or infant; prenatal treatment of the fetus through pharmaceutical or surgical interventions; other forms of treatment or therapy for the infant that occur after prenatal diagnosis.

Second:

Prevention of family disruption through prenatal preparation by family members This can entail obtaining information about the diagnosed condition and its conse-quences through reading or through talking to families who have children with similar disabilities or to adults who live with the disability themselves It may also include such means as Wnding out about available public or private resources or forms

of assistance, purchasing equipment, or making home modi Wcations.

So, the suggestion is that the technologies of prenatal diagnosis beneWt children directly through the prevention and amelioration of disabilities, and indirectly, by assisting parents These claims seem justiWed

However, it would be a mistake to accept the related claim, made by some, that NRTs produce better, or even perfect, babies (Spallone, 1989: pp 113,

117; Snowden and Mitchell, 1983: p 77); that, for example, babies generated

by IVF or donor insemination (DI) using sperm from gifted fathers are smarter or prettier (Scutt, 1990: p 285) There is no clear evidence to support these claims And there are reasons to be cautious about them, since, as I shall later show, they betray a eugenicist agenda

Possible harms of NRTs and practices

I turn now to those arguments that claim that NRTs and practices harm children These claims arise from asking, what kind of future do NRTs give to children, speciWcally to those born as a result of them, but also to other children who may be aVected by the attitudes that NRTs foster?

Some claims about harms to children of NRTs are not plausible For example, I am unpersuaded of the necessity, insisted upon by some Roman Catholic critics of NRTs, of ‘naturalness’ in reproduction, and of marriage as the ideal or the only moral site for the raising of children (Iglesias, 1990:

p 159) For if naturalness is the criterion of moral acceptability, then many medical interventions are morally unjustiWed If marriage is the criterion, it is hard to account for the growing number, and evident success, of common-law relationships in which children are being born and raised

Among the problems of NRTs for children that I think are serious areWve that deserve special examination: the emphasis on a genetic link with one’s

oVspring and the possibility of eugenicist tendencies in the application of reproductive technologies; the sexism of sex preselection and the hetero-sexism and racism of selective access to NRTs; the possible dangers to children’s health of some reproductive techniques; the selling of children through contract pregnancy arrangements; and the violation of the right of children who are created through sperm or egg ‘donation’ or contract motherhood to know the identity of their progenitors

Genetic links and eugenicist tendencies

The motive behind many new reproductive technologies and related prac-tices (e.g contract pregnancy and IVF for male subfertility problems) is the goal of obtaining, particularly for the potential father, a genetic link with one’s oVspring But this emphasis on a genetic link is thought by some commentators to reinforce a cultural notion of the child as possession, as a form of property When producing (better) babies is treated as a business opportunity, infants are seen as commodities, as consumer goods marketed

to the infertile (Rowland, 1992: pp 3–4, 243)

Such a view of children is arguably incompatible with Principle 2 of the United Nations Declaration of the Rights of the Child (United Nations,

1959), which mandates ‘opportunities and facilities’ to enable children ‘to develop physically, mentally, morally, spiritually, and socially in a healthy and normal manner and in conditions of freedom and dignity’, and also with the recognition in Principle 6 that children need ‘love and understanding’ for

‘the full and harmonious development’ of their personalities

The result of the longing for children, especially children of a certain kind,

a longing which, to some extent, NRTs exacerbate, could be the generation of performance pressures on children to live up to parental expectations Such pressures seem inconsistent with the spirit of Principle 7 of the United Nations Declaration of the Rights of the Child, which states that the ‘best interests of the child shall be the guiding principle of those responsible for his education and guidance.’

A related concern, frequently expressed in the literature by feminist theor-ists, involves worries about eugenicist tendencies generated by the use of techniques of prenatal diagnosis (e.g Birke et al., 1990: p 184; Bopp, 1990:

pp 205–7) The concern is both for general eVects on children (Blank and Merrick, 1995: p 101), with the fear that the quest to improve the characteris-tics of infants may cause psychological hardship and exacerbate the com-modiWcation of children, and also, more speciWcally, for the negative impact

of the existence and use of prenatal diagnosis on children with disabilities, who may be made to feel that they are mistakes who should never have existed (Kaplan, 1994; Murray, 1996: p 132), and who may be made less welcome within this culture

In response to the latter claim, however, the Canadian Royal Commission

on New Reproductive Technologies argues that it ‘does not seem likely’ that

‘funding for PND will aVect the funds available for social support for people with disabilities’ (Royal Commission on New Reproductive Technologies, 1993: p 800) Their reason is that PND has little aVect on the incidence of disabilities (Royal Commission, 1993: p 799), and people who seek PND may already have a child with disabilities whom they love: ‘[E]vidence suggests that in countries where PND is practised, there is greater rather than less interest in the welfare of people with disabilities as a result of increased medical and social awareness of their needs and rights’ (Royal Commission, 1993: p 802)

My own view is that it is not inevitable or necessary that the use of PND for fetal impairment will lead to the devaluing of children with disabilities Indeed, the informal evidence suggests that even while the use of PND is growing, attempts to integrate people with disabilities within ‘mainstream’ culture, while at the same time providing for and supporting their di Veren-ces, are also growing Although I am concerned about the potential com-modiWcation of children caused by the use of NRTs, I agree with Ruth Chadwick, who argues, ‘If we say that it is better, all things considered, to produce a child who is not handicapped rather than one who is, this does not

commit us to saying that handicapped children are less worthy of respect It is just that, other things being equal, it is preferable for the individual, the family, and the society’ (Chadwick, 1992: p 112) The use of NRTs and practices to reduce or ameliorate disabilities seems acceptable, provided it can be separated from the expectation or use of NRTs to ‘perfect’ oVspring or

to set inappropriate standards for the health, achievements and acceptability

of children (Murray, 1996: pp 133–7)

Sexism, heterosexism, racism and NRTs

Another possible danger of NRTs and practices is connected to invidious forms of discrimination For example, in the practices of sex selection and preselection, children are being sought or avoided on the basis of their sex Some commentators have worried that the resulting children will be expected

to conform to certain gender stereotypes; to be ‘real girls’ or ‘real boys’ Gena Corea suggests that the social validation of the role of ‘surrogate mother’ also raises a general problem of sexism: ‘Is it in the best interests of female children to be born into a world where there is a class of breeder women? How damaging might that be to the self-esteem of girl children?’ (Corea, 1990a: p 159)

Based on its own surveys, the Royal Commission claims that in Canada

‘most prospective parents expressed a weak preference for an equal number

of sons and daughters’ (Royal Commission, 1993: p 890) While the Com-mission takes thisWnding as evidence of the absence of sexism in oVspring choice, I believe we should be uneasy A truly gender-indiVerent parent would probably not care about the balance of girls to boys Certainly, a preference for equal numbers of boys and girls could lead to disappointment

if, for example, only girls are born

Moreover, within the practice of assisted reproduction, the pronounced tendency to favour heterosexual relationships, and in some jurisdictions, to explicitly deny DI or IVF to lesbians (Rowland, 1992: p 251), socially sanc-tions a blatant form of discrimination which, in addition to its injustice to lesbians, may also harm children who are growing up with lesbian or gay parents

In addition, the motive to preserve racial lines, avoid miscegenation, and protect the interests of white people over those of people of colour is another form of discriminatory behaviour revealed within some reproductive practi-ces For example, the solicitation of ‘donor’ ova often invokes racial criteria – only ‘Caucasian’ potential ‘donors’ need apply Moreover, the principles and precedents governing the legal resolution of disputes about contract preg-nancy show that racial bias is an active ingredient in determining who is considered to be the ‘real’ parent of a contractually produced child In the dispute between Mark and Crispina Calvert, a white man and Filipina

woman, and Anna Johnson, a black woman who gestated their embryo and then claimed to bond with the child she bore, the debate was framed to call into question the reality of any feeling a black woman might have for an unrelated putatively white child (Hartouni, 1997: pp 94–6) Once again, the enactment of prejudice and stereotype – this time on the basis of race – is unlikely to have positive outcomes for children, especially those who are being raised within so-called ‘mixed-race’ families

I suggest that discriminatory practices within the applications of reproduc-tive technologies are incompatible with the spirit of Principle 10 of the United Nations Declaration of the Rights of the Child (United Nations, 1959), which mandates the protection of children from all forms of discrimi-nation

Possible dangers to children’s health

Principle 4 of the United Nations Declaration of the Rights of Children (United Nations, 1959) says that children are entitled to ‘grow and develop in health’, and that children have a right to adequate medical services But some commentators suggest that children’s health is potentially jeopardized through certain reproductive technologies and practices For example, in donor insemination, the existence of uneven standards and ‘unsafe practices’ with respect to sexually transmitted diseases and genetic diseases may com-promise the health of the resulting children (Royal Commission, 1993:

p 471) Questions have also been raised about the potential for transmission

to children of genetic diseases as a result of the use of intracytoplasmic sperm injection (ICSI) to treat male infertility (Tripp et al., 1997) In addition, it is argued that the experimental use of hormones in conjunction with NRTs may have long-term, unforeseen eVects on the oVspring (Rowland, 1992:

pp 50–2), much as the long-term eVects of the hormone diethylstilboestrol (DES) were unforeseen

Another signiWcant potential danger of NRTs to children arises from being conceived as part of large multiples The use of IVF, with the return of several embryos to the woman’s uterus, increases the likelihood of multiple preg-nancy (Templeton and Morris, 1998) But multiple pregpreg-nancy is not an optimal gestational condition (See Chapter 16.) There is a greater risk of ectopic pregnancy, spontaneous abortion, pre-term delivery, low birth weight, Caesarean section, and stillbirth in IVF and GIFT (gamete intra-fallopian transfer) pregnancies (Baird, 1992; Rowland, 1992: pp 46, 64–5) Low birth weight can result in breathing problems, and low birth weight infants are more likely than normal weight infants to have cerebral palsy, poor eyesight, short attention span, poor learning skills, hyperactivity, read-ing diYculties and poor co-ordination and motor skills in childhood (Royal Commission, 1993: p 528)

Moreover, being born as part of a multiple may not result in optimal conditions for growing up, depending on the amount of practical help and Wnancial assistance the parents receive (Raymond, 1992: p 67; Royal Com-mission, 1993: p 529): ‘In one example, Hon Campbell in North London was virtually housebound for a year with her triplets In 1989, one Perth woman had to relinquish three of her quads for adoption because of the strain associated with their unwanted arrival’ (Raymond, 1992: p 67) It is import-ant to point out that all of these risks are, of course, undertaken without the consent of the children themselves, let alone their knowledge and under-standing

Contract pregnancy and the sale of children

One practice in which children are arguably harmed and their rights certainly violated is in contract pregnancy arrangements, in which children are bought and sold The evidence for the claim that a purchase occurs lies in the fact that contracts stipulate that the full sum will not be paid if the child is stillborn; the complete fee is paid only on delivery of a living baby

In earlier work (Overall, 1987, 1993) I have argued that the buying and selling of infants, no matter what the context, is a form of slavery, and hence morally inexcusable It is in clear contravention of Principle 6 of the United Nations Declaration of the Rights of the Child, which states, ‘a child of tender years shall not, save in exceptional circumstances, be separated from his mother.’ It seems unlikely that the United Nations would be willing to regard

a contract for selling the child as constituting a genuinely ‘exceptional circumstance’, for Principle 9 of the Declaration states clearly that the child

‘shall not be subject of traYc, in any form’

Defenders of so-called ‘surrogacy’ arrangements have argued that the practice is not baby-selling because:

the resulting child is never in a state of insecurity From the moment of birth, he or she

is under the care of the biological father and his wife, who cannot sell the child Moreover, no matter how much money is paid through the surrogacy arrangement, the child, upon birth, cannot be treated like a commodity – a car or a television set Laws against child abuse and neglect come into play (Andrews, 1990: p 176.)

True, the practice of contract pregnancy does not mean that the child is necessarily treated badly; ‘Many material objects, after all, are treated with respect and kept for a long time; but they are objects nevertheless’ (Capron and Radin, 1990: p 63) But it does mean that in these arrangements, the child is treated as no more than a means to an end (Royal Commission, 1993:

p 677), the end being the purchasing father’s acquisition of a child Contrary

to ordinary adoption practices, the ruling criteria in contract pregnancy are the interests of the adults involved, not the interests of the children (Annas,

1990: p 45) The contracting parents are usually not screened; ability to pay is the only criterion for eligibility to buy a child (Royal Commission, 1993:

p 677)

Moreover, even if a child once incorporated into a family is never again thought of as something acquired in an expensive transaction, the fact remains that during the

process of transaction the child was a thing People had a transferable ownership

interest in it and bargained over it in a market in which other ‘products’ were also for sale and in which other potential buyers may also have been bidding.

(Capron and Radin, 1990: p 63, their emphasis.) The fact that the child is ‘‘‘bought at a price’’ could make the child feel like

a commodity that can be bought and sold, and create pressure for him or her

to live up to his or her ‘‘purchase price’’’ (Royal Commission, 1993: p 677)

In addition, it is incorrect to say that the child produced through these arrangements is never in a state of insecurity The child loses his or her connection with the gestational mother, and also misses out on the beneWts of being breast-fed If the contract arrangement runs into problems, the child is placed in an extreme state of insecurity, and may either become the target of custody battles between a purchasing father and a gestational mother no longer able to give up her child, or become unwanted by anyone, in situations where, for example, the child has a disability (Raymond, 1992: p 191), as in the Stiver-MalahoV case

Experience shows that diYculties can arise even when the child produced, while healthy, is just not what was ordered:

When ‘surrogate mother’ Patty Nowakowski delivered twins – a girl and a boy – in

1988, one child was as intended and the other not The Michigan man who hired Nowakowski to be inseminated with his sperm wanted a girl So he took the girl child and left the boy behind The boy was put into a foster home until Nowakowski, pained at his fate, claimed him as her own (Corea, 1990b: pp 171–2.)

Hence, contract pregnancy arrangements signiWcantly contribute to insecur-ity for the children who are generated, and are harmful to them as a consequence

A number of commentators have also expressed concern about the poss-ible eVects on the biological siblings of contract children of seeing their baby sibling sold – in some cases, against the wishes of their mother, who changes her mind (Rowland, 1992: pp 189–91) Proponents of contract pregnancy have claimed that the so-called surrogate mother can anticipate the eVects on her existing children of selling the baby, and can mitigate those eVects through what she says to the children (Andrews 1990: p 177) But there are reasons to doubt this:

One woman reported that her daughter, now seventeen, who was eleven at the time of the surrogate birth, ‘is still having problems with what I did, and as a result she is still