|Bioethics and Medical
Philosophy Educating Humanity?
Maja E. Pellikaan-Engel
ABSTRACT: Over two millennia of Western philosophy has not yet contributed much to the education of humanity. Philosophy has almost always been the exclusive domain of a small group of men. This elite character makes the assumption that philosophy could contribute to the education of human beings towards humanity a humanity of human rights improbable. If we want to educate human beings towards humanity, we will first have to teach them a sense of responsibility. The power of persuasion needed in order to teach such a sense of responsibility requires that we demonstrate our involvement in and co-responsibility for their concrete problems by presenting clear analyses of these problems and by setting a good example wherever possible. One of the most universal and concrete problems of life is the issue of procreation. As regards this issue, however, philosophers have failed miserably: they themselves have often exhibited irresponsible procreation and have, in fact, only recently begun to consider the issue a subject for philosophy. I will try to analyze when a decision to procreate or abort may be called responsible and whether and to what extent the applications of modern techniques such as in vitro fertilization are in line with our views of human rights.
Two and a half thousand years of Western philosophy have not yet contributed much to the education of humanity. Philosophy has always been the almost exclusive domain of a small group of men, conversing in esoteric language on the most abstract of subjects, without being much concerned about the needs of the ordinary people around them. This elitism undermines the assumption that philosophy could contribute to the education of humanity as a whole, and it makes the assumption that it could contribute to the education of human beings towards humanity a humanity of human rights entirely improbable.
If we want to educate human beings towards humanity we will first have to teach them a sense of responsibility: the awareness that each is responsible for his or her own actions and the consequences which can be expected to ensue, together with the awareness that a persons rights and freedoms may not encroach upon the corresponding rights and freedoms of another. The power of persuasion needed in order to teach such a sense of responsibility requires that we demonstrate our involvement in and co-responsibility for their concrete problems, by presenting clear analyses of these problems and by setting a good example wherever possible.
One of the most universal and concrete problems with which every sexually mature person, male or female, is continually and inevitably confronted over several decades is the decision whether or not to cooperate in the creation of a new human being. This is not some irrelevant private choice. It is always an interactive decision, involving not only the existence, needs and rights of a new human being, but also profoundly and protractedly influencing the existence and duties of those directly responsible and eventually of the whole community.
One might therefore have expected philosophers to have analyzed and dealt with these complex problems and to have set good examples in their own behaviour. As regards this issue, however, they have failed miserably: only recently have they even begun to consider procreation (1) as a subject for philosophy at all. Worse, they themselves have often given examples of irresponsible procreation.
To give you one example (2): Socrates, famous for his appeal to reasonableness and justice, acted irresponsibly when, very old and poor, he had children with Xanthippe, without being willing to provide any material care for them. Xanthippe, notorious for the ways in which she expressed her protest, had to bear the full burden of their common responsibility with regard to their children. If only this caricature of a marriage between Socrates and Xanthippe were an isolated fact! If we look, however, to the extent to which philosophers have so far considered the problems of their own responsibilities with regard to the procreation of humankind, we are justified in concluding that Socrates and Xantippess marital problems seem to have increased in scale rather than having been solved.
Men have always determined and continue to determine the patriarchal thought structures of religious dogmas, political ideologies, economic power structures and technological developments, in which they make decisions about the lives of women and children without being aware of their own responsibilities. It is high time that a philosophy of responsibility bends its theoretical reflections towards the care for actual life, and strives for the realization of human rights for existing and future generations of all human beings, children, women and men.
The basic dilemma
Let us turn to the fundamental question: the dilemma of whether or not a person should or should not cooperate in the creation of a new human being. I propose that the decision be tested against our concept of human rights, as laid down in the Universal Declaration of Human Rights (UDHR), the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW) and the Convention on the Rights of the Child (CRC). Even if these declarations are more explicit in their definitions of rights than of duties, the rights do imply duties. After all, the complement of the pursuit of human rights is the obligation to avoid any action that would result in a violation of the human rights of others. The limit to one human beings rights is where those of others begin.
All human beings are endowed with reason and conscience (art.1 UDHR). It therefore seems a just requirement of morality (art.29 UDHR) to hold every adult individual endowed with reason and conscience responsible for his or her actions and the consequences which can be expected to ensue from those actions. If a person makes an essential contribution to the production of a child, that person is also responsible for that child. It is also primarily the parents responsibility to raise their children (art.7, 9,18 CRC). This responsibility must be taken into consideration if a morally justified decision about procreation is to be taken.
The first condition for such a morally justified decision is, therefore, connected to the individuals own opinion of his or her ability and willingness to be responsible for the child. That responsibility implies a reasonable guarantee, that is, as certain a guarantee as is possible under the circumstances, of the human rights of the future child and his or her protection against any infringement of those rights. However, as one person alone cannot produce a child, those concerned should each make a separate positive assessment of their own willingness and ability to be responsible for the child they should also make a positive assessment of the others willingness and ability, and of their ability to cooperate to this end, if they are to make a morally justified decision to make a child.
The principle of equal rights in a marriage between the partners (art.16 UDHR and art. 16 CEDAW) need not result in an impasse concerning the decision. Simply because women exert greater efforts in the process of pregnancy and bearing children, the principle of equal rights under equal circumstances leads to the specification that every woman has the right to decide whether she wants to become pregnant and to bear children. Logically, this means that she has a right of veto over her pregnancy, but, in the case that she positively decides that she wants to become pregnant, the fulfillment of her wish depends on the cooperation of her partner, who has to make his own morally justified decision.
The declarations of human and childrens rights seem to lead to relatively simple moral standpoints. A combination of article 3 of the UDHR: Everyone has the right to life, liberty and security of person , and the principle of legal protection of the child before birth from the preamble of the CRC, apparently leads to the simple conclusion that abortion is not compatible with human and childrens rights under any circumstances. However, things are not so simple.
A quite common case in practice is that of a woman who has become pregnant against her will and who has very negative expectations about the needs and the realization of the rights of the future child, and / or she may fear that the realization of these rights will harm the needs and rights of existing persons: her own, for instance, or those of other children. She may then, having weighed all needs, rights and responsibilities, come the the morally justified conclusion that she will have an abortion, preferring to commit the lesser evil (killing the embryo or foetus, that may be assumed to be incapable of suffering pain during the first 25 weeks, although the termination of her pregnancy does imply a certain violation of her own integrity), than the greater evil of violations of rights which would imply a disproportionate amount of suffering.
In my view, then, abortion can without doubt be morally justified under certain circumstances. It is, however, often the circumstances which are at fault. Women should never be forced to have sexual intercourse and they should have information about and access to contraceptives. Everything possible must be done to prevent unwanted pregnancies and thus also to guarantee the rights of women, so that they are not tragically forced to choose the lesser of two evils, but can decide freely and responsibly whether they want to get pregnant.
In vitro fertilization
In recent decades a whole new problem area has arisen, and it is one which demands special attention. Although developments in genetic engineering have led to unprecedented achievements, we now find ourselves confronted with unprecedented moral problems. You and I grew up in an age in which we were all convinced that every child could be the product of only one biological father and one biological mother and we knew that tragical circumstances could lead to situations in which the guardians or legal parents of a child might not be his or her biological parents.
Today we are increasingly being forced to apply a technological, function-focused, analytical thought structure to the production of children. Within this structure the child might be the product of:
This procreative manipulation leaves us with a large number of possible combinations of functions, not all of which are morally unproblematic, to say the least.
A relatively simple case of in vitro fertilization, in which the functions of A, C and E are combined in one female person and those of B and F in one male person, seems to entail few fundamental moral problems. Ds function is restricted to medical help (I have to skip over the many technological problems that can affect this procedure in practice, and which make one wonder whether there really are no fundamental problems at all).
There are already more complications in a simple case of artificial insemination by sperm donation, where the functions of A, C and E are combined in one female person, but B and F are two different persons, F being either a man or a woman, or even absent. It has to be asked whether, and if so to what extent, it is possible in practice for a sperm donor to bear the responsibility for the consequences of his contribution, and the extent to which the rights of the child not to be separated from his or her (real or biological) father and the right to maintain personal relations and direct contact with him on a regular basis (art. 9 CRC) can and will be observed.
In the case of anonymous sperm donation the donor does not take any responsibility at all and the rights of the child just mentioned cannot be realized, in principle. But, the sperm donor may say, I trust that D will take over my responsibility and will make sure that my sperm is received by a woman who can and will combine the functions of A,C and E in her person and who can find a suitable F to support her in raising the child. Sufficient arguments seem to have been given for the superfluousness of any further responsibility on Bs part, and his disappearance into anonymity seems to be justified. But he has shifted his personal obligations onto the set of persons I have called D, without any guarantee that D is able and willing to bear that responsibility.
On the contrary, however. The potential parents specific task is to make a careful consideration of his own, and his or her potential partners willingness and capacity to fulfil their obligations towards the potential child. The specific task of persons employed in the medical sector is to meet demands for medical help if they can, without discrimination. In practice this means that in my country, The Netherlands, any woman can have artificial insemination, whether she wants to be an unmarried woman or to live with another person, male or female.
In my view, what those involved must realize is that when the child born this way grows up, goes in search of its identity and asks about its fathers identity, it can never receive a sincere and satisfactory answer. The sperm donor who disappears into anonymity, the woman who is inseminated with his sperm and the medico-technical persons whom I called D, all deprive the child of the possibility of knowing its descent or its biological origins and therefore since the last is a relevant entity in relation to identity also deprive it of its right to identity (art. 8 CRC).
But things can get a lot more complicated. The various functions A,B,C,D, E and F need not be combined in specific persons at all. A case that no longer belongs to the realm of fiction is one in which D implants the genetic material of A and B into the surrogate mother C, who has been contracted by the childless couple E and F to bear their future adoptive child. This can be arranged at several clinics in the USA, the procedure costing some tens of thousands of dollars. Now it is quite possible that all parties concerned act in good faith, intending to fulfil the wish of the childless couple E and F to have children. Putting the medical technology into practice could seem morally admissible, the more so because the regulation and practice of traditional adoption are far from perfect. The aspect, however, that strikes us the most is the fact that in this set-up the child is reduced to a commodity from its conception until after its birth, and that is contrary to article 35 of the CRC. Furthermore we have seen that in this procedure the rights of the child with regard to its identity as well as its right not to be separated from its own that is, its biological parents are violated.
But the woman who offers to be a surrogate mother should also ask herself whether she is doing the right thing by herself and the child. This is not only with regard to the fact that if she does it for financial reasons, her actions are in conflict with the rights of the child, who should never be an object of trade. Even if she does not do it on a commercial basis, she commits herself to giving up or being separated from the child that has formed an organic unity with her own body, and that has been, or has become by ovum donation, her child. With this commitment she not only violates the right of the child not to be separated from the mother, but she also throws away her own right not to be separated from her child. When discussing the abortion issue, I touched on the problem that terminating a pregnancy always represents a tragic infringement of her own integrity, as any woman who has actually had an abortion will testify. For this reason the problem is better avoided, or if this is impossible, at least to abort as soon as possible after conception. If a mother has to relinquish her child after bringing the pregnancy to full term, we may suspect that this violation of her fundamental right not to be separated from her child implies a long-lasting trauma.Yet it must be feared that there are enough poor women in the world who are willing or can be forced to give up their bodies to rich profiteers in this latest form of exploitative prostitution. The term surrogate motherhood is in fact a misleading euphemism for prostitution of the womb.
Let us review this whole procedure once more. Persons who cannot themselves conceive and produce children place an order for a child to be produced, have the order carried out by third parties by means of reproductive technology, cause the disappearance of the biological parents (that is, the ovum donor A and the sperm donor B, who are together the genetic parents + the surrogate mother or womb prostitute C), and when it is born adopt the child to take care of it as if it was their own. In this way they are simultaneously responsible for the production of a new person as well as the separation from and total disappearance of that persons real, biological parents. In fact they reduce the child to a commodity, they make an orphan of the child and deprive it from its identity. These are all gross violations of the rights of the child and violate the repeated principle:in all cases the interests of the children shall be paramount (art. 16 CEDAW, art. 21 CRC). One could wonder if the very persons responsible for these violations should be entitled to adopt these children as their own. The term adoptive parents is, in this case, a misleading euphemism for parents who commission the production of an orphan. If one persons desire can only be fulfilled by sacrificing the rights of another, it is clear that the protection of rights has priority over the fulfillment of desires.
These cases of sperm donation, womb prostitution and orphan production clearly show that the medicotechnical, functionally segregated, analytical structure of thought has gone too far in reducing human procreation to the simple sum of A,B,C and D, whose result is then handed over to E and possibly F. But the product, the child, could justifiably reproach us afterwards, that we had behaved irresponsibly and in contravention of human rights.
Allow me to cite one actual instance. In September 1997 a Los Angeles judge declared a two-year-old girl an orphan, though all the adults who contributed to her existence are probably still alive. The girl is the result of the efforts and contributions of a medico-technical team, a sperm donor, an ovum donor and a surrogate mother, but the couple who had ordered the child divorced before the child was born. The judge declared that the man of the couple, since he had never become the legal father, had no obligations towards the child, but also that the woman in this couple could be no legal mother. So the girl was declared an orphan, because the responsibility of all those who contributed towards her was so fragmented that it could be denied by and for all.
How can we possibly expect that such a child, so uprooted from its biological heritage, brought into the world so irresponsibly, in a way so clearly at odds with basic human rights, will grow up and become a balanced human being with a sense of responsibility for others? We might expect, rather, that such children suffer serious identity problems in later life, and should not be surprised if they develop such a hatred towards humanity that they form a time bomb under our society.
Medical science, itself split up into innumerable specialized fields, no longer sees the human being as an entirety, but has a caricatural, reductionist view of humankind. Todays specialized medical field of human procreative technology can produce tomorrows psychiatric patients. These developments in science should be reconsidered. This need is all the greater now that the newest scientific developments include cloning. All too often we have had to concede that the possible applications of new technologies were implemented before we had found an answer to the fundamental question of whether what is possible is also permitted, and of where the boundaries of the morally acceptable actually lie.
The declarations of human rights are widely accepted as standards for human behaviour; the implementation of human rights is an issue often included in political agreements. Instead of just holding them up as examples to people in far-away countries, we should also conduct ourselves according to their principles. If philosophers really want to educate human beings, then they should develop a philosophy of responsibility. They should direct their intellectual powers towards the production of clear analyses of the concrete problems with which people struggle every day. In word and deed they should give an inspiring example of responsibility towards humanity and commitment to the fight against violations of human rights.
NOTES(1) I prefer the term procreation in stead of reproduction; see my article: Menschenrechte und Menschen-Produktion in 1789 / 1989 Die Revolution hat nicht stattgefunden ed. by Astrid Deuber-Mankowsky, Ulrike Ramming, E. Walesca Tielsch, Tübingen 1989 (2) See my article: Socrates Blind Spots in Against Patriarchal Thinking ed. by Maja Pellikaan-Engel, Amsterdam 1992