The ethics of selection: reproductive technologies, disabilities, and the quest for healthy children
Date
2024
DOI
Version
OA Version
Citation
Abstract
In the face of recent and upcoming advances in reproductive technology, it is vital to determine what kinds of choices parents should make in the reproductive context with respect to using these technologies, and how medical professionals should advise their patients in the reproductive context with respect to these choices. This dissertation explores these issues by focusing on the ethical choices facing prospective parents and medical professionals with respect to screening and selection for or against disability traits. I argue that prospective parents should select against most if not all disability traits in their future children, because doing so is usually the best or ideal option for prospective parents to strive for as long as their situation allows for it. Regarding medical professionals, I argue that the most plausible account of how they should treat their patients in the reproductive context is not a monolithic, one-size-fits-all approach. Instead, I show that in reproductive contexts, genetic counselors should be directive about some things but not others. Specifically, genetic counselors should actively encourage their patients to pursue testing and screening for disability traits, but should refrain from being directive in any way about selection against some trait or condition. To lay the groundwork for these arguments, I also demonstrate that the increasingly popular view that disability traits are mere differences rather than bad traits to have is implausible, at least for many if not all disability traits. Chapter I offers a defense of the widely-held intuition that all things considered, it is better to be abled than to have some disability trait. I show that the three main strategies commonly employed to critique the intuition that it is overall bad to have some disability trait are not nearly as successful at dealing with the intuition that overall it is better to be abled with respect to some disability trait. I then show that since many of the key purported benefits of disability traits can be substituted for by similar or equivalent goods that are available to abled individuals, and the purported benefits of disability traits that cannot be adequately substituted for are likely outweighed by various costs of having those disability traits (costs abled individuals are not subject to), critics of this intuition lack a plausible response to it. I conclude that this casts doubt on the overall plausibility of the view that disability traits are mere differences. Chapter II contends that with respect to most if not all disability traits, prospective parents should select against most if not all disability traits in their future children, because doing so is usually the best or ideal option for prospective parents to strive for as long as their situation allows for it, and is praiseworthy on that basis. To establish this, I draw upon both wellbeing-based and non-wellbeing-based considerations. I also address the most ix prominent potential objections to the desirability and moral permissibility of selection against disability traits in one’s future children. Finally, the third chapter of my dissertation engages with practical implications of my arguments for medical best practices. I argue that medical professionals should adopt a directive attitude with respect to testing by actively recommending genetic testing to their patients, but a non-directive attitude regarding questions of selection. That is, medical professionals should not push their patients to take a certain course of action based on their genetic test results. This position stakes out a middle ground position between disability rights activists who oppose the use these technologies both to test and select, and those who want to promote directiveness with respect to testing and selection.
Description
2024