Jacobs Benjamin Meir
J Med Ethics. 2015 Aug;41(8):696-700. doi: 10.1136/medethics-2014-102400. Epub 2014 Nov 4.
Reproductive decision-making in the post-genetic age is a minefield of complex ethical problems. One such problem centres on whether there is an obligation on reproducers to choose the best possible child. This paper focusses on a simplified scenario: there are two embryos to choose from, one of which will develop a condition that diminishes quality of life but would still have 'a life worth living', the other of which is normal. Is there an obligation to choose the healthier child? If so, what is the nature and scope of this obligation? The answer to these questions relies on a satisfactory answer to the non-identity problem (NIP). This paper explores several solutions to the NIP and argues for a solution grounded in the concept of harm. Various accounts of harm are discussed and synthesised to provide a new 'comparative bad state view' of harm. This account is used to justify the obligation to choose the healthier child. How far should this obligation go? This paper rejects the conservative position of 'procreative autonomy' - which holds that such obligations have no place in reproductive decisions - and the radical position of 'procreative beneficence' - which holds that there is an even stronger obligation to make the best possible child. The obligation to choose the healthier child may be over-ridden by countervailing reasons; the moral calculus in any individual case will be largely dependent on the expected quality of life of the child.
后基因时代的生殖决策是一个充满复杂伦理问题的雷区。其中一个问题聚焦于生殖者是否有义务选择可能是最优的孩子。本文聚焦于一个简化的情景：有两个胚胎可供选择，其中一个会患上某种降低生活质量但仍“值得活下去”的疾病，另一个则是正常的。是否有义务选择更健康的孩子？如果有，这种义务的性质和范围是什么？这些问题的答案依赖于对非同一性问题（NIP）的一个令人满意的回答。本文探讨了对非同一性问题的几种解决方案，并论证了一种基于伤害概念的解决方案。讨论并综合了各种关于伤害的解释，以提供一种新的关于伤害的“比较坏状态观点”。这种观点被用来为选择更健康孩子的义务提供正当理由。这种义务应该延伸到什么程度？本文反对“生殖自主性”的保守立场——即认为这种义务在生殖决策中没有立足之地——以及“生殖善行”的激进立场——即认为有更强的义务去生出可能是最优的孩子。选择更健康孩子的义务可能会被相互抵消的理由所推翻；任何个别情况下的道德考量在很大程度上都将取决于孩子预期的生活质量。
