Boy or girl, we choose! (PART 2)

Chance, choice and control: Lay debate on prenatal social sex selection.



Choice, the good parent and autonomy

Where the participants’ discussion did differ from much of the secular–liberal bioethical literature is that their conclusion about the absence of noteworthy harm or benefit did not lead them to conclude that prenatal sex selection is morally neutral. Rather, participants saw it as an expression of parental preference instead of response to the child's need, and therefore it was considered to be the kind of choice that parents should not make. Many connected their notions of choice to a substantive concept of what a good (or good enough) parent is. We have elsewhere detailed how, in describing a child as “a gift not a commodity”, these discussants work their way through a complex and interrelated set of beliefs: about valuing a person (and child) for itself, about showing respect for the child's future autonomy, and about good parenting consisting in adults not imposing their expectations on a child unless it is to protect the child from harm or to preserve its access to an “open future”.

These ideas parallel the set of ethical and political ideas from which western culture draws its meaning of choice. In their book From Chance to Choice: Genetics and Justice give several important moral grounds for favouring reproductive freedom. Among these are the claims that reproductive freedom contributes to individual happiness or well-being, and that reproductive control encourages the equality of men and women. But their most powerful argument is that reproductive freedom is a particular expression of the political value of personal liberty, which in turn draws its strength from the ethical value of autonomy. Etymologically, autonomy is about self-governance of states or persons: in the ethical realm, it describes a person's ability to self-determine. Autonomy has central importance in our ethical and political thinking because the ability to act autonomously is foundational to the most widely held understanding of agency, and ultimately of personhood, in moral philosophy and western culture as a whole. And in contemporary western societies, personal liberty tends to be equated with having free choice. This means there is a line of reasoning that goes: increasing the array of reproductive choices results in increased reproductive freedom, which is good because it thereby maximises personal liberty, and hence individual autonomy, both of which are also good.

Reproductive technologies such as PND and PGD are presented as ways of increasing choice, and therefore of increasing individual freedom. In the liberal consensus that personal liberty should only be curtailed to prevent harms to others, the lack of unequivocal, significant harms as a result of prenatal sex selection would mean there are no substantial arguments to set against the high positive value of increasing reproductive choice in implementing prenatal sex selection by PGD.

This form of reasoning is not without its critics, who tend to argue that the liberal approach is “biased in favour of individual autonomy and towards individual rights generally”. Such a bias, if it exists, might make the secular–liberal approach less appropriate, or less useful, for looking at reproductive or family issues that by definition have something to do with a third-party (embryo, foetus or future child). As Buchanan et al. note,”[P]arental self-determination is not unlimited…The fundamental interests of the child place moral limits on this parental self-determination, as is reflected in typical child abuse and neglect laws” . Nevertheless, the involvement of the future child is downplayed in secular–liberal analyses, because they concentrate on parental acts and their consequences for parental freedom. In part, this focus follows from the widespread philosophical premise that convincing arguments must be person-affecting: not-yet-existing entities have no, or much reduced, moral relevance.

In marked contrast, many of the participants considered the consequences of prenatal sex selection for the not-yet-existing child's autonomy to be highly relevant to their ethical judgements. One interpretation of the concerns about reproductive choice expressed by these participants is that they place a high value on the personal liberty of the child. In principle, then, they upheld autonomy as a basic moral value, even though they were unlikely to use the term. But they appeared unconvinced by the equation of personal liberty (and by extension autonomy) with freedom of reproductive choice.

To understand this, we first need to note that the participants did not use “autonomy” or “freedom” as abstract ethical concepts, but as concepts embodied in specific acts and orientations within the framework of a situation—in this case, being a parent. Viewing autonomy like this entails regarding parental autonomy as different in some respects from individual (or non-parental) autonomy, because the circumstances of being a parent call for a unique constellation of acts and orientations that reflect the features (responsibilities, vulnerabilities, virtues) of parenthood. In the absence of these acts and orientations, a person might be engaged in the business of parenting—but many of the participants would not consider him or her to be acting as a good, or even adequate, parent. As we have noted, one of the defining features of good parenting in the discussions was self-limitation of control over the child, even in circumstances when it is in fact possible to make life-changing choices on the child's behalf. In this sense, then, the self-determination of a parent is constituted by their voluntary relinquishment of choice, other than choices to do with protecting their child from harm or keeping future options open for it. This is in direct contrast to the view that “parents are generally regarded as having permission, and some would say an obligation, to [make the choices that] produce the ‘best’ children they can”.

Relational autonomy

Buchanan et al., and many other secular–liberal bioethicists, assume that the move from people being at the mercy of reproductive chance to being able to exercise controlled reproductive choice fosters parental freedom and therefore the parents’ autonomy (whatever it does for the child's autonomy). Our interpretation of the participants’ reasoning suggests instead that they work from the premise that the “good parent” is defined by foregoing a degree of choice, in a way that in another context would be considered to reduce his or her autonomy.

The secular–liberal description outlined above is not the only approach to conceptualising autonomy offered by contemporary bioethics. The regnant model of autonomy in ethical and political discourse is of individual self-determination, the capacity to live one's life freely in accordance with one's own reasons and choices, independent of interference from others. Critics of this description have considered it to be too focused on an idealised picture of a rational, self-interested, independent, free-floating individual. Partly as a result of dissatisfaction with this model of autonomy, and drawing on work in the empirical human sciences that takes into account the social and intersubjective nature of people's lives, feminist ethicists have developed an alternative model of relational autonomy. Relational autonomy stresses the non-individualistic nature of the moral agent. It depicts the autonomous human as being inescapably constituted through relational networks. Autonomy is relational not simply because in real life people live in groups and therefore necessarily relate to each other, but primarily because the self is considered to be constituted in relationship with others. Relationship then becomes a precondition of autonomy. In this model, autonomy is not an intrinsic property held or expressed by an individual, but a feature of the moral agent that comes into existence and is maintained through the agent's interdependencies with, and responsibilities towards, others.

We are not claiming that our participants consciously drew on a theory of relational autonomy in their discussions of prenatal sex selection. As far as we could tell, none of them had a knowledge of contemporary ethical theory that would have given them access to the relevant vocabulary. Nevertheless, a relational picture of autonomy seems better able to capture their framing of the issues than does a conventionally individualistic one. Our participants were saying that good parents must give up some ways of exerting control over their children, even when such control is in principle possible. A conventional evaluation would see this as a loss of the ability to make choices that are self-determining (such as, “I choose to be the parent of a girl, not of a boy”), and hence a loss of autonomy. But we think the participants were claiming something more than that having children places constraints on a person's freedom, or even that cultural expectations of how parents should behave places constraints on their choices. They were saying that certain kinds of choice that would be legitimate in another context are not merely inappropriate if exercised by a parent: they are incompatible with the nature of the good parent–child relationship, as they understood it. The identity of the good parent is constituted by this voluntary self-limitation. Parental autonomy can only operate within the limits set by this framework. Otherwise the choices, however freely made or in line with the individual's life goals, do not foster the autonomy of a good parent, but of an individual failing to be an adequate one.

Concluding comments

Almost all the participants in this study showed a degree of scepticism about the benefits of choice. Given the ubiquity with which the new genetic and reproductive technologies are described as offering a wider range of choice to the healthcare consumer, this response is intriguing, and indicates that at least some of the general public take a critical approach to the commercial and political rhetoric of choice. A dominant feature of participants’ critique here was about discerning levels of reproductive control that are appropriate to the peculiar nature of the identity of a parent, and the relationship between parent and child. By following our participants’ reasoning, we have been able to make connections between their statements about choice, good parenting and individual autonomy. We find this particularly interesting because while most bioethical analyses of prenatal social sex selection also rely on concepts of the right to parental self-determination, they routinely come to the opposite conclusion to the majority of our participants.

Our interpretation of how the discussion groups used concepts of self-determination fits more comfortably within a model of relational autonomy than in the secular–liberal framework more common in western bioethics. In saying this we are not suggesting that the lay public uses an organised theory of relational autonomy in its ethical deliberations. Nonetheless, these observations reinforce arguments in favour of taking seriously the opinions of the general public in debates about new genetic and reproductive technologies. It has been argued that the public contribution to these debates is uninformed and incoherent, and therefore should not form the basis for policy. As our discussion shows, in the right setting, lay people can not only give their opinions but can also provide reasons for their opinions that have a grounding in sophisticated and morally relevant concepts of personhood, relationship, responsibility and freedom.