Making families: Whose interests count?
This is a guest post by Daniela Cutas (Lund University). She discusses her new book, co-edited with Anna Smajdor and Kristien Hens, entitled The Ethics of Human Reproduction and the Family: Individual and Collective Interests. It is now available, with open access, from Bloomsbury.
What are the effects of maternal norms on mothers’ decisions to donate their womb to their daughters? What does milk kinship tell us about the nature of motherhood? What should happen when women’s procreative interests come into conflict with those of the state (and can the state be said to have procreative interests)? All these questions, and many more, are discussed in a newly published collective volume that addresses the interplay between individual and collective interests in family-making.
The contributors analyse reproductive interventions facilitated by medical advances, especially those that transcend the limits of consent or bodily integrity. These include, for example, the collection at the parents’ request of reproductive tissue from children facing conditions or medical interventions that are a threat to their reproductive potential. Another example is that of uterus transplantation from mother to daughter. And yet another example is the collection of reproductive material from comatose or deceased people in order to use it to create children. How are such interventions justified?
They tend to be justified by appealing to the interests of the person on whom the intervention is performed. The removal of reproductive material from children has a therapeutic purpose, of allowing the child to become a parent later in life. It is in the interest of women to be able to carry a pregnancy and become mothers. A man who has lost his life before becoming a father is assumed to have an interest in his wife having his child, or his parents having grandchildren, even after his death.
These explanations sometimes obscure the expectations and interests of those who request or carry out the interventions. Parents could also request fertility preservation interventions on their children in order to preserve their own potential to become grandparents. Researchers who create extraordinary opportunities could also stand to gain prestige from such achievements. The wife or parents of a man who can no longer choose to become a father might also be acting in their own interests.
It is inevitable that the interests of family members, patients and doctors, research participants and researchers do not always coincide. The problem arises when the interests of some of the participants in a decision or intervention threaten, compromise or completely replace those of the very individuals who are the subjects of the decision or intervention. Moreover, certain conceptual entities such as the family are sometimes treated as having their own moral status and interests that may conflict with those of family members. When they do, the family’s interests are sometimes given priority over those of its members. The volume examines such situations.
Intrafamilial adoption in Romania: children as an investment in one’s own future
Two researchers based in Bucharest, Diana Elena Neaga and Valentin Quintus Nicolescu, studied intrafamilial adoption in a rural community in Romania.
In the cases that they explored, adults facing infertility and lacking either the means or the willingness to seek fertility treatments expressed a strong preference to adopt children who were related to them, such as a niece or a nephew, rather than “strangers”. Biological relatedness was seen as a guarantee that the child’s development would be predictable, as their heritage was familiar.
The study found a contrast between adults’ and children’s perspectives on the adoptions and their outcomes. While adults typically assumed that children were better off growing up in a more affluent home, the children longed for their childhood homes, their first parents, and their siblings. Adoption in these cases also brings about responsibilities that the adults agreed will be created in this way. As people cannot count on reliable state support when they can no longer care for themselves, the family, and especially one’s children, are expected to provide that care. Adopting a child from the extended family is supposed to ensure that this need is taken care of, and reliably so, since the child is related to her adoptive parents.
The study depicts a world constrained by social taboos on issues such as infertility, pressure from family members, and insufficient social and state support for children, parents and the elderly. In such conditions, children are a form of insurance, an investment in the parents’ own future: according to the researchers, children were viewed in this way in all the cases encountered in the study.
The study is a reminder that, under conditions of scarcity and social constraint, parent-child relationships can take forms that are far removed from familiar ideals of parenthood and from the recognition of children as individuals with interests of their own.
Was the first successful uterus transplantation trial ethical?
Mats Johansson and I discuss the arguments put forth in favour of allowing the world-famous Swedish clinical trial of uterus transplantation to proceed. We pick apart some of the relevant interests affected by the trial and the degree to which these were given adequate consideration.
Medical research tends to be justified in terms of the important medical needs that it can help meet. Research on uterus transplants differs substantially from many other scientific pursuits: it involved the removal of an organ from a healthy woman to place it in the body of another healthy woman. The women who gave away their wombs will never get them back. They may not have parted from their wombs had they not hoped that it would enable their daughters to become mothers. The people whose job it was to make clear to the donors and recipients the risks that they were incurring were the very same in whose interest it was to secure the necessary donors and participants for their research. Likewise, the researchers will have made clear to all parties that the intervention was a part of a research project rather than treatment.
Had it been treatment, what would it have been a treatment of? One could answer here that uterus transplants treat the inability of certain women to become pregnant and give birth. But this is done at the expense of another woman’s ability to become pregnant and give birth: the donor herself. Many people lack this ability, and they would not have been accepted as research participants in the trial. For example, women who didn’t have a male partner would not have been accepted however well they satisfied the other inclusion criteria. And it is unlikely that women who do not intend to raise the children that would be born to them subsequent to a uterus transplant would become eligible for such a treatment in the foreseeable future.
So by itself the inability to become pregnant and give birth cannot be the reason. The suffering that this inability brings about for some people and not others might be why. However, as far as is known from the documentation available on the research trial, no other ways to relieve this suffering were explored before the trial was chosen as the appropriate one. (And the suffering itself was not among the criteria for inclusion as a research participant.)
The interests of the researchers themselves, on the brink of achieving something never achieved before, might have played a part in the decision to undertake the trial. The alignment with state interests in new citizens may have also contributed to allowing it to proceed. The members of the ethics review board having approved the trial could also themselves find the potential of new life to be a worthy goal in itself.
As resources are finite, other interests may have had to be put to the side when this specific trial was funded. Animals’ interest in not suffering was also seen as a part of an acceptable cost of making the transition to research on human participants possible. Therefore, questions about the ethical basis of the trial remain important even though the trial was considered a success and has paved the way for similar work in other countries.
What does it mean to be related?
Kristien Hens challenges two common assumptions in both the ethics literature and in our societies. The first of these is that it makes sense to distinguish between ‘genetic’ and ‘social’ in the determination of who our kin or family is. The second is that kinship is constrained by species boundaries: another human might turn out to be my kin, but someone who is not human could not. Hens shows how both beliefs are based on understandings of biology as carving strictly separate categories that it simply does not.
Remember the news about the bird living in the tree just outside your home sharing more of its microbiome with you than with a bird of the same species, but lives in the woods? This makes the birds in the trees outside our homes, in one sense, more biologically related to us than to those other birds. If we care about biological bonds, then this also means that we need to be more flexible in our understanding of species boundaries: those boundaries are themselves flexible.
Hens also draws on non-Western cosmologies, in which the separation between humans and the rest of the animal world is much less sharp than it tends to be in the Western world. We are all already aware that the things that tie us together are sometimes biological, sometimes social, sometimes both. Hens encourages us to embrace this complexity, and to let it guide us towards a richer appreciation of the interconnectedness of all living beings.
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Family-building decisions may be facilitated by medical professionals and researchers or shaped by the state. New technologies bring about new opportunities to build families. The ways in which these choices are made, and in which new technologies are deployed, raise important questions about whose interests are being served in which circumstances. “The Ethics of Human Reproduction and the Family: Individual and Collective Interests” addresses some of these questions.
