"Procreative Beneficence"- A Place in Reproductive Technologies?

Posted: June 05, 2008
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jennifer_kimball.jpgCulture of Life Executive Director Jennifer Kimball offers a summary of her recent presentation given at a UN Panel on Biomedical Issues titled “The Coming Age of Procreative Beneficence: To Have the Best Child Possible?”   

         The human desire for children and family is both noble and authentic; it is natural.  Along with a couple’s transmission of life is also the desire to care for and protect that life – for beneficence. When problems occur, however, it follows that a couple might seek recourse in science and medicine, both to help actuate the desire for offspring and to protect and care for the new life they conceive.  Yet, employing techniques which replace the natural and organic transmission of life in order to actuate the desire for children requires the collaboration of multiple individuals and acts far removed from procreation.  Acts that consequentially bring into play a plethora of diverse and overreaching interests.  The present use of the term “Procreative Beneficence”(1) as applied to artificial reproduction, as I will set forth here, is a form of linguistic gymnastics that attempts to justify the instrumentalization of human life at its earliest and most vulnerable stages –acts which are not “beneficent” but rather maleficent and quite opposing to procreation.


         Having a desire for children, and indeed willing the conception of a new life actively by use of therapeutic means are both “natural” to the human person.  In as much as they are natural they are also authentic and noble.  The use of the term “natural” must be clarified and does not imply that such a desire is of nature itself. Rather, it is of the nature of man as a rational creature specifically to desire the gift of new life, to care for it and bring it into relation with others.  “Procreative Beneficence”  is a term coined by Professor Julian Savulescu, Uehiro Chair in Applied Ethics at the University of Oxford. This term attempts to bring together two distinct realities of human action: procreation and beneficence.  Implicit in procreation is the participation of a man and woman in an event of creation.(2)   A result of their free union is a willingness to receive and bear responsibility for that gift. Because their act of openness to the gift of new life is free, giving, and mutual, it is also responsible.  This is the proper setting and condition for an act of procreation which belongs to man and woman in their sexual encounter. Those performing the sexual act bear an active responsibility to be open to receiving and caring for the life that could result from such a union.  Procreation is not a pragmatic act of force; it is a participatory act of openness to the possibility of the generation of a couple’s progeny.


        Generation requires the physical contribution of egg and sperm, of necessary gametes in order to supply the means of new life. This activity is not the bringing about of a new creation from nothingness; rather it furthers and perpetuates the human species by means of mutual and personal donation.  We do not say that a couple “creates” a child in the sexual act, we say they “procreate,” namely they participate in the coming into being of new life.  In essence, the couple partakes in the great event of a new human life in such a way that their decision is at the same time a consent to an initiative that precedes them.(3)  Procreation is in itself something beneficent when its participation is within the marital sexual act.  It is above all a mutual donation, an event that is charitable, responsible and accepting of the mystery of new human life.  In the same respect, a sexual act within marriage that remains open to the possibility of new life, even when no life results, remains a procreative act by its very nature.   To imply that something is “beneficent” with regard to reproductive technologies that replace the natural and organic transmission of life with technological means is clearly a mis-joining of terms. The methodology of artificial reproduction, and particularly to produce the perfect child, is ultimately for someone or something other than the child itself. 

    
        Generative acts which are implemented by force, manufactured, altered and produced for the sake of human desire such as with the practice of In-vitro Fertilization or other methods of artificial reproduction do not embody the virtue of beneficence. Instead they invite the harm of maleficence, a dis-charity. They replace the idea of human life as a good in and of itself with that of a utility. Its value is defined by those who desire to “have” it.  Though the desire to bring new life into the couple’s care is authentic, it nonetheless causes a child to be manufactured for his/her sake, which may by intention be to care for a child, but cannot be for the sake of the child if it does not yet exist. Thus the use of the term “Procreative Beneficence” is an inappropriate application when speaking of reproductive technologies that go contrary to the participatory and organic transmission of life.  The “good to be done” is not ordered to the new life that results but rather forces into being a new life for the sake of another. 


         When we speak of “beneficence” in contemporary society, we often speak of ethics or principles. The term beneficence has its roots “…from Latin beneficentia, from beneficus, kind, generous, obliging, from bene, well (from bonus, good) + facere, to do.”(4)  The most current use of the term implies an obligation to do the good.  When applying “beneficence” to the Principalist theory it becomes the imperative to do the most good for the most possible.  Most commonly, we see the term within the Principalist school of Bioethics offered by Beauchamp and Childress (5) where it resides within the framework of four governing principals for biomedical ethics: 1. Beneficence 2. Non-malefecence 3.Respect for Autonomy and 4. Justice.  Employed here, the term “beneficence” implies the imperative to do the good that is possible. (6)  These principals together are proposed as obvious to all and acceptable to any morality within a given society.  They are the minimum or base principals applicable to any moral ascription which, more specific to beneficence and justice, are without foundation for determining the good to be achieved or the harm to be avoided.  The “good,” according to this philosophy, becomes obscured in the conflict between the good of the autonomous individual and the “greater good” of the society. The key problem with this application is that it denies the personalist norm, which is to do the good for the person itself – for its own sake first and foremost. The highest value by which all goods are ordered is human life. To respect the person is first of all to respect their existence, without which health, freedom, society and all other human goods are unable to exist.  This reality directs us to place respect for human life as the most fundamental value and responsibility.


        Within medical ethics, however, Principalism has been widely adopted and employed in the practice of medicine and research today.  The philosophy of Principalism has its roots in the social adaptation of Bentham and Mill’s Utilitarianism, Kant’s Categorical Imperative and in the idea of Prima Facie Principals.  Thus the acts of a member of society are weighed in accordance with the utilitarian concept of the “greatest good for the greatest number” with the intent of minimizing pain and maximizing pleasure.  In this way an individual may weigh another based on his or her usefulness. This can lead to the rational attempt to justify sacrificing an individual’s good for the sake of the common good or because the individual’s good has been determined by the many to be of lesser value. 


           When speaking of procreation or the generation of new human life the personalist norm directs us with regard to what is due to new life from the very moment it comes into being as a unique human individual. The concern is with what is just, namely, the good that is due to each and every member of the human species. The hierarchy of human needs begins with what is most basic, life and all that is necessary for its sustenance, such as nutrition, hydration, relation and ultimately love for its own sake.  The ability to act with regard to the true good of the child conceived according to the personalist norm, becomes relative when applied to the principalist theory. It often tends toward achieving the good to be gained for the acting agents, such as the parents, doctors, clinic, and ultimately the industry of the embryo marketplace. 


           The process involved in artificial reproduction involves several participants in addition to those who procreate; the male and female genetic parents, the technician or technicians, lab assistants, etc. A woman undergoes the invasive procedure of hormone induced hyperovulation and extraction of ovum.  A man commonly makes his contribution in a private room into a tiny cup.  One or both commit to spending an unknown yet considerable amount of money for the procedure of IVF in anticipation of the child to be produced.  The technician becomes a third party profiting from what ought to be a sacred and private affair. What this scenario provides is an active market place of pre-conceived dues and expectations.  It is not to “select” the best for the child; it is to provide “options.” The silent participants are the embryos whose just dues of life, family and relation, are at the mercy of human expectation and not in the hands of responsible and beneficent individuals.  The good to be done for the child generated is again, relative to the desire of those who will to have it.  Expectation, it has been said, is merely “premeditated resentment,” which is directly opposed to acceptance.


           For an authentic employment of the term “Procreative Beneficence,” the good to be achieved must be for the child generated – for the very life or lives at stake.  In the same respect, for an authentic employment of technologies offered by advancements in medical sciences, the good sought for the sake of the offspring must in major form be to ensure its wellbeing – for its overall health and necessary therapy.  It is here at the pinnacle of human achievement for the noble virtue of beneficence that we have established the institutions of science, medicine and technology in order to bring to fruition acts of healing, health and wellness for mankind.


           Dr. Savulescu asserts that the prospect of the ability to select the better child, or the smarter child, or the prettier child, or even the male or female child by means of IVF or other available artificial reproductive technologies, is an act of beneficence towards the very child selected. (7)   This selection does not achieve the best for the child for its own sake, but seeks to achieve the best child possible for the object of obtaining what others consider to be conditions or predispositions for the ability to achieve the highest quality of life.  What he proposes is a reverse order of the subjective and the objective.  By means of “selection” several lives are generated and discarded for the sole purpose of choosing the one most likely to be superior to all.  To say that it is charitable to permit life only to the child most likely to achieve a higher degree of pleasurable living is also to say that it is proper to eliminate those who are imperfect.  With this theory, if one does not have a great ability for experiencing pleasure, one does not have the ability to experience life. This concept is purely eugenic as Dr. Savulescu himself admits this.


            Furthermore Professor Savulescu, in proposing his theory of “Procreative Beneficence,” argues that “couples should employ genetic testing for non-disease traits in selecting which child to bring into existence and that we should allow selection for non-disease genes in some cases even if this maintains or increases social inequality.” (8)  His theory of beneficence as it relates to human reproduction is to surpass therapy for the sake of enhancement and ultimately to bypass natural procreation for the seemingly superior option provided by technological means. 


            In effect, with the theory of selecting the best child possible for living the best life, it would be advisable for couples to have recourse to artificial means of reproduction and replace the conjugal act of procreation, not for therapy or to overcome infertility, but in order to offer the most possible good to their offspring. Whatever is good is determined according to the desire of the parents, such as enhanced intelligence, height, eye color, etc.  The therapy sought is the generation of the ideal child to appease another’s suffering or supply the “good” of those who so desire it, i.e. the parents.  The child itself becomes the therapy for the sake of others, no different than a drug for sale on the shelf of your local pharmacy.  In very explicit words, the manufacturing of humans has become the tool for procuring an object of disordered human desires. We cannot determine what is best for that which does not yet exist nor can we select to sustain only the life of “the best” at the expense of the lives of others. In conclusion, what is termed ‘Procreative Beneficence’ by the principalist school would more accurately be described as the “Commodification of Humanity.”

 

(1)  J. SAVULESCU: “Procreative Beneficence: Why We Should Select the Best Children”, Bioethics, 2001, Volume 15, pages 413-426.
(2)  See P. J. CATALDO: The Conjugal Act: Clarification of the Procreative Meaning, Ethics & Medics, 1991, Vol. 16 No. 12, pages 3-4.
(3)  Cf. G. ANGELINI: Il figlio.  Una benedizione, un compito, Glossa, Milano 1992 (3rd printing 2003), pages 91-201.
(4)  Dictionary.com http://dictionary.reference.com/wordoftheday/archive/2005/10/05.html last visited May, 2008.
(5)  T. BEAUCHAMP, J. CHILDRESS: Principles of BioMedical Ethics, Oxford University Press, 2001. 
(6)  Ibid. pg. 165
(7)  J. SAVULESCU: “Procreative Beneficence: Why We Should Select the Best Children”, Bioethics, 2001, Volume 15, page 424.
(8)  Ibid, page 415.

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