Selektion zum Wohl des zukünftigen Kindes?

ZusammenfassungDer Beitrag setzt sich kritisch mit dem Prinzip des prokreativen Wohltuns (principle of procreative beneficence, PB) von Julian Savulescu und seinen Implikationen für den Umgang mit der Präimplantationsdiagnostik (PID) auseinander. PB fordert angehende Eltern dazu auf, aus mehreren möglichen zukünftigen Kindern dasjenige auszuwählen, dessen Leben voraussichtlich am besten verlaufen wird. Paare mit Kinderwunsch sind danach zumindest unter bestimmten Umständen (z. B. wenn im Rahmen einer unabhängig indizierten IVF mehr Embryonen entstehen, als übertragen werden können) moralisch verpflichtet, eine PID in Anspruch zu nehmen, um die Weitergabe genetisch bedingter Krankheiten zu verhindern. Die Auswahl von Embryonen im Rahmen einer PID kann jedoch nur dann mit dem Wohlergehen des zukünftigen Kindes begründet werden, wenn man die entsprechende Wohltunspflicht mit Savulescu und Kahane als „unpersönliche“ moralische Pflicht versteht. PB wirft daher die Frage nach der Relevanz unpersönlicher Erwägungen für Entscheidungen über Fortpflanzung und Familiengründung auf. Gegen Savulescu und Kahane argumentiere ich dafür, reproduktive Verantwortung als einen integralen Aspekt elterlicher Verantwortung und damit als personenbezogene Verantwortung zu deuten, und verteidige diese Konzeption reproduktiver Verantwortung gegen Einwände, die sich aus einem von Savulescu und Kahane konstruierten hypothetischen Szenario – dem Röteln-Beispiel – ergeben.

Genome editing and ‘disenhancement’: Considerations on issues of non-identity and genetic pluralism

In the decade prior to CRISPR-Cas9, Michael Parker criticised Julian Savulescu’s Procreative Beneficence (PB) Principle by arguing against the confidence to know what’s best in terms of genetic traits for our offspring. One important outcome of this criticism was a greater moral acceptance of deaf people genetically selecting deaf children. Although this outcome may have been morally controversial in an impersonal harm context, in such genetic selection (PGD) cases, a deaf child is not harmed in person-affecting terms because no other life is available to that child. We highlight that the person-affecting versus impersonal harm distinction is still held by many as making a significant moral difference to their overall argument (i.e. Savulescu, Parker, Boardman, De Miguel Beriain) and so for the purposes of this paper, we will assume it makes ‘some difference’ (even if only at the level of the message it sends out). Insofar as one considers the presence person-affecting harm to be morally important (and to whatever extent), the impersonal harm context in which the Parker–Savulescu debate arose thereby blunts an arguably even more radical outcome—that of genetically engineering, or gene editing, deafness into pre-existing embryos of future children. Now, the potential of CRISPR-Cas9 has revitalised such debates by reframing impersonal and person-affecting benefits/harms in the context of such disputes on the harm or not of a (chosen) disability. Replacing the genetic selection context with a genome editing context, we argue that Parker’s argument should also deem it morally acceptable for people who are deaf to genetically edit embryos to become children who are also deaf. Felicity Boardman’s recent comments suggest a similar radical potential as Parker’s, with the radicalness also blunted by an impersonal context (a context that Boardman, at least, sees as significant). We conclude that the genome editing reframing will push such arguments beyond what were originally intended, and this will create a more radical message that may help further define the relationship between new genomic technologies and disability.

Procreative Autonomy Versus Beneficence in Assisted Reproductive Technologies

Since its beginning, healthcare has focused its attention on helping patients become healthier and live longer. One of the areas in which medical technology has made impressive strides is assisted reproductive technologies. Some bioethical issues are common to most or all of these newer reproductive technologies. The uncertainty of long-term risks posed by reproductive technologies generate potential challenges to the values of beneficence and non-maleficence and strain the already divisive dichotomy between procreative autonomy and procreative beneficence. Procreative autonomy and procreative beneficence are both important values that physicians and prospective parents ought to evaluate when considering the use of assisted reproductive technologies. However, the moral prescriptives associated with each value may diverge and conflict with one another; when this occurs, minute arguments may shift the balance between them. For physicians, prioritizing the value of procreative autonomy or procreative beneficence mainly influences the way in which they choose to present information–that is, whether they are directive or non-directive when consulted about family-planning options. Assisted reproductive technologies have dramatically increased the range of choices available to prospective parents, and this breadth of choice may lead to potential ethical conflicts between the competing values of procreative autonomy and procreative beneficence. In the following article, we will address this friction, focusing our attention on normative considerations related to medical risk management and the telos of the prospective child.

Whose Ethics? Making Reproductive Ethics More Inclusive and Just

As the field of assisted-reproductive technology progresses, bioethicists continue to debate whether and how the availability of this technology creates new moral duties for parents-to-be. It is rare for these debates to seriously engage with questions related to race and class. Camisha Russell asks us to move race from the margins to the center of our discussions of reproductive ethics. She argues that this shift can work as a kind of corrective that will lead to better theory. In this paper, I build on Russell’s work by considering two proposals related to prenatal genetic diagnosis [PGD] that received a lot of attention and debate—Julian Savulescu and Guy Kahane’s argument in favor of a “principle of procreative beneficence” and Janet Malak and Judith Daar’s argument in favor of a legal duty, in certain cases, to use PGD. My analysis of each of these arguments shows how a lack of diverse viewpoints leads to bad theory. I end the paper by showing how including a diversity of perspectives shifts our focus from rights to justice.

Nascere per sbaglio / To be born by mistake

Il danno da procreazione costituisce una fattispecie giuridica che da qualche decennio impegna molti tribunali di Paesi occidentali. Il testo affronta la questione dal punto di vista filosofico, analizzando il concetto stesso di danno da procreazione, nel suo duplice versante di nascita sbagliata e di vita sbagliata, e le argomentazioni che sostengono il dovere morale di non far nascere esseri umani con un problema di salute. In particolare vengono prese in esame la tesi di Harris e di Savulescu, secondo cui tale doverosità deriva dall’obbligo di non introdurre sofferenza inutile nel mondo (Harris) e dal Principio di Beneficialità Procreativa (Savulescu). L’analisi è condotta secondo due livelli: il primo rimanendo nella logica stessa della beneficialità e della non maleficienza, cercando anche di vedere se le premesse poste dai due autori portino effettivamente alla conclusione dell’esistenza di tale obbligo morale; la seconda discutendo alcune delle premesse teoriche di tali tesi. ---------- For a few decades, many courts of western countries are facing the claims for wrongful birth and wrongful life. The paper addresses the issue from a philosophical perspective, analysing the same concept of a “damage from procreation”, in its double face of wrongful birth and wrongful life, and the arguments that support the moral duty of not giving birth to human beings with a health problem. Specifically, it examines the thesis of Harris and Savulescu, according to which such dutifulness derives from the obligation not to introduce unnecessary suffering in the world (Harris) and the Principle of Procreative Beneficence (Savulescu). The analysis is conducted on two levels: the first, remaining in the logic of beneficence and non-maleficence, trying to see if the premises laid down by the two authors lead to the conclusion of the existence of this moral obligation; in the second, discussing some of the theoretical premises of these theses.