Sunday, 7 September 2014

Reproductive Public Health Ethics at the MANCEPT Workshops in Political Theory, 2014.

In a few hours, I'm off to Manchester, UK, for participation in a so-called panel ( ≈ special symposium) at the MANCEPT Workshops in Political Theory 2014. The panel is on the topic of Reproductive Public Health Ethics and has been conceived of and convened by myself. The topic itself is described thus, at the Mancept website:

Human reproduction and resulting population patterns is a classic concern of public policy, yet philosophical and ethical applications to this area remain imprecise, scattered and unsystematic. The point of this workshop is to stimulate a more integrated addressing of this area for social and political philosophical analysis from a public health standpoint. Reproductive bioethics hosts established interest in the regulation of reproductive technology, yet mostly ignoring overarching societal concerns to the benefit of a discourse focusing on individual reproductive liberty. This individualism has stimulated the emergence of public health ethics, where queries regarding health policy are put at a population level, but reproduction- and population issues have not been in focus, partly due to a common conflation in public health between reproductive and sexual health. In parallel, biopolitics subjects cultural layers of policy to critical scrutiny regarding “identities” and concepts central to laws across the world – e.g. parenthood and family – in light of, e.g., technological developments. Also here, public health ethical perspectives are scant, while dimensions of justice otherwise often ignored are addressed, making possible, e.g., explorations of hidden presumtions behind reproductive policies. More basic research on population ethics, while having somewhat informed reproductive bioethics, remains largely unexplored as to more conrete political and policy implications in either of the mentioned dimensions, e.g. in the face of environmental challenges and expected consequences in the form of resource scarcity and global migration. There are also theoretical conundrums which need attention, e.g. how justice-oriented discourses of biopolitics can be squared with the intricate problems of population ethics, or how the combination of these and a globalised public health ethical approach relates to the individualist assumptions of reproductive bioethics. The workshop assembles a selected group of presenters from the Netherlands, Romania, Sweden and the UK.
The same website also lists an, alas, not so up to date speaker list, as I've had a few cancellations and a few new people entering the program since it was initially presented to the Mancept organisation. The actual program looks like this:

  • Session 1: Sept 8, 2 PM - 5:30 PM

Christian Munthe, University of Gothenburg: Reproductive Population Health and the Goals of Public Health: Exploring a Territory of Moral Unease

Angus Dawson, University of Birmingham: Public Health Reproduction: Defending the Very Idea

  • Session 2: Sept 9, 9:30 AM - 1 PM

Daniela Cutas, Umeå University & University of Gothenburg: The Nuclear Family and Reproductive Policy: Ethical Challenges

Marian Verkerk, University of Groningen & Ulrik Kihlbom, Uppsala University: Preconception Genetic Testing and Reproductive Counselling as Challenge to the Family as Social Institution

Anca Gheaus, Sheffield University: Biological Parenthood: Gestational not Genetic – Implications for Reproductive and Family Law

  • Session 3: Sept 9, 2 PM - 5:30 PM

Stephen Wilkinson, Lancaster University: The Public Health Ethics of Selecting Future Children

Anna Smajdor, University of East Anglia: Postponed Motherhood and the State

Rebecca Brown, University of Aberdeen: Incentives for Reproductive Public Health

  • Session 4: Sept 10, 9:30 AM - 1 PM

Kalle Grill, Umeå University: Population Policy in the Face of Environmental Challenge: What Place for Reproductive Liberty?

General discussion on future developments and prospects of the topic in forthcoming endeavours

If you happen to be at the Mancept Workshops event, please don't hesitate to drop in on our panel, or approach about interest in the general topic!

Thursday, 28 August 2014

I and Other Philosophers/Bioethicists Criticise Richard Dawkins' Tweets and Statements on Abortion and Down Syndrome

So, I don't think anyone missed Richard Dawkins' recent ill-considered and inconsiderate tweet – in response to a personal, cautious reflection by a follower – that abortion of foetuses with Down Syndrome is morally obligatory, as well as the storm of outraged reactions to that and Dawkins' own retrospective apology and defence of his statements. Some reports are here, here, here and here. And Dawkins' own statement of apology and defence is here.

Now, in an article by Elizabeth Picciuto in The Daily Beast, a number of philosophers/bioethicists, among these myself, comment on Dawkins' statement from an intellectual point of view, as well as his attempt at formulating an intellectual and "logical" (a favourite adjective of Dr. Dawkins in his comments on the criticism) defence of it. Spoiler: it's not worth the paper it's written on and, in particular, it's peppered with logically invalid inferences.

On a personal note, I would like to add one thing to what's said in the article: Richard Dawkins' actions in this matter are especially peculiar in light of his former standing as Oxford professor of the public understanding of science. What he has done here is to promote widespread misunderstanding of bioethics, moral philosophy, as well as regarding the health science aspects of Down Syndrome and the rationale of liberal abortion legislation and prenatal diagnosis.

Tuesday, 12 August 2014

Could Reproductive Liberty be Ethically Curtailed for Environmental Policy Reasons? or Why I Would Have Rejected Cristina Richie's Article on IVF

It's been a bit of a gale (as opposed to a bona fide storm) lately, following an article in the Journal of Medical Ethics by Cristina Richie, entitled "What would an environmentally sustainable reproductive technology industry look like?". It's not the question of a full hurricane, as in the infamous "after birth abortion" paper from 2012, but this rather raving rant is on the more aggressive end of the scale of reactions to Richie's piece. I dislike the language and the attitude expressed at the end of this article for simple reasons of decency and respect, but I also rather dislike Richie's article for more intellectual reasons. In fact, having read it, I have come to the conclusion that, had I been the JME reviewer for it, I would have recommended rejection.

Based on the undisputed fact that human reproduction carries with it a carbon footprint (assuming fixed per capita consumption levels related to population-size and -growth), Richie's paper argues about assisted reproductive technologies (ART), such as IVF, that...

The use of ART to produce more human-consumers in a time of climate change needs to be addressed.  Policymakers should ask carbon-emitting countries to change their habits to align with conservation. And though all areas of life – from transportation, to food, to planned technological obsolescence – must be analysed for ecological impact, the offerings of the medical industry, especially reproductive technologies, must be considered as well.

More specifically, she argues that access to ART should be restricted to "those who are not biologically infertile", meaning thereby to exclude, e.g., homosexual couples, single individuals and other "rainbow" family constellations. In particular, she claims, such restriction should befall publicly funded medical services of this kind. To season the stew somewhat, Richie is openly declared as belonging to "catholic theorlogical ethics", attached to an openly Catholic academic institution, the theology department of Boston College, a church well-known for its officially set hostile stance towards both ART in general and, in particular, technological facilitation of human reproduction in other social forms than within that of a married heterosexual couple.

Iain Brassington at the JME's blog has opposed the idea that Richie therefore should have declared a conflict of interest. He does however concur with several critics, some described here, that the attempted distinction between "biological" and other types of infertility is swampy territory. In fact, all infertility is always partly social, as it depends on a person or a group of persons being unsatisfied by existing alternatives to using ART, such as keep on trying the old "natural" way, attempt to adopt, or remain childless. A particularly tricky thing is that many times, individuals belonging to the group that Richie would presumably call "biologically" infertile, their infertility may very well be due to the fact that they prefer to keep to their couple relationship. Already here, had I been a reviewer of the paper, I would have unconditionally demanded revision. This is sloppy conceptual work of a sort a philosophy teacher slams A-level students for and it is given the job of providing substance to one of the article's main theses. I'm frankly surprised that reviewers and editors of a leading bioethics journal could let that one pass.

At the same time, Brassington insists in another comment that the general idea, which is the other thesis of the article, of subjecting human reproductive liberty and policies to the challenge of their impact on pressing environmental problems is not necessarily ill-conceived. Again, I agree, as I should do, having argued some 18 years back (an open access preprint is here) that global justice and health concerns may be reasons for people to avoid having children and rather adopt or otherwise assist existing children in need. As I argued in that context, however, Brassington observes that there seems to be no reason to restrict the environmental argument to the use of ART, but rather that if the argument bites, it points towards more general conclusions about the value of avoiding human procreation, e.g. via adoption or policies like the infamous Chinese 1-child restriction or other types of limitations.

Another comment that expands this particular line of criticism has emerged from Dominic Wilkinson, also on the JME blog, where he argues that Richie's argument is flawed to the core, due to its claim that ARTs are in some way extra environmentally problematic. Now, Richie herself does openly confess that this may very well not be so, but that she nevertheless chooses to restrict her paper to a thesis pertaining to ART. In other words, the main thesis of the article is entirely dependent on an ad hoc and arbitrary restriction of its thematic scope. Richie presents no argument justifying this restriction, but her article nevertheless is left to pursue a main claim pertaining to ART and only ART. This, given the level of ethical controversy around ARTs, is unjustified bias. Had Richie presented an argument in favour of the limitation of the scope it hadn't been so, but since she in fact claim herself that there's nothing special with ARTs, the article is clearly skewed in an unwarranted way. Therefore, had I been reviewer, I would have faulted the article on that ground, demanding a more general discussion of reproductive liberty in the face of environmental policy – alternatively, independent arguments for singling out ARTs as a specific target. This is a major flaw that the review or editorial process should have caught.

Together these two problems with the article point to a third one, namely that it aims to prove two intellectually independent main claims. This is asking for trouble, as everyone knows, but it is obvious why Richie wants to take the risk: without the combination, she wouldn't have been able to aim her shot specifically at the application of ART for the facilitation of reproduction within "alternative" families. Thus, Richie has an apparent (possibly religiously motivated) agenda to place a questioning of ART and specific applications of ART in a well-regarded scientific journal. Even if that doesn't amount to a conflict of interest, it undercuts the claim to intellectual honesty one would require of a researcher worthy of publication in the JME. Again, I'm surprised that this wasn't picked up in the JME review or editorial process.

Having said that, the general ethical issues arising out of the link between human reproduction and environmental concerns (of all kinds), are sure worthy of more reflection. In fact, this is something that I will be addressing with qualified colleagues at a panel convened by myself on Reproductive Public Health Ethics at the MANCEPT Workshops in Political Theory in just a few weeks.