Deciding What Is Best for the Child: The Ethics of Different-Child Choices in Reproductive Selection

Recent advances in assisted reproductive technologies as well as in preconception, preimplantation, and prenatal screening and testing give prospective parents more information and more reproductive options than previous generations had. But, for families with a history of a serious, heritable medical condition, having more options does not necessarily make it easier for prospective parents to know how to do what is best for their children. Testing is available for a number of conditions for which there is no treatment, leaving prospective parents in a position to make a so-called "different-child choice." If they want to have biological children of their own, they can choose to create only a child that will not inherit the condition or to leave it up to chance whether the condition will be passed on to the next generation. In this dissertation, I consider the moral difficulties that prospective parents in this situation face. I analyze several prominent approaches to selection in different-child choices, including the expressive effects approach made by disability rights advocates, the parental beneficence approach, the parental acceptance approach, and the non-identity problem approach. These existing approaches reach starkly divergent conclusions about the permissibility of reproductive selection in different-child choices. I argue that each of these existing approaches fails to capture the full moral complexity of the decisions these prospective parents face. I then offer my own account of the ethics of reproductive selection in different-child choices, arguing that prospective parents should focus on what is best for the child in their deliberations by acting as a proxy decision maker tasked with evaluating the balance of benefits and burdens for a child born into each possible initial situation. Only by carefully evaluating the expected effects of having a particular condition in a particular family's context can the prospective parents make a good decision in a different-child choice situation. The ethics of different-child choices in reproductive selection are deeply context-dependent, and prospective parents should not expect any easy answers in many of these cases