IVF and Non-Identity, Continued

Iain Brassington, over at the Journal of Medical Ethics blog, has posted a nice response to my post, IVF Babies at Enhanced Risk. But Why, and So What? In that post I raised the question (based on Derek Parfit's non-identity problem) whether an IVF baby born with a disability has any right to complain, since that baby would not exist if it weren't for the IVF which resulted in the disability. This argument seems logical to me, but it also troubles me, because it often seems capable of proving too much. I gave the example of the slave, to whom (in the right circumstances) one might plausibly argue, "You have no right to complain of being a slave, since without the institution of slavery you would never have been born." Another similarly-structured argument might be addressed to animals being bred in awful conditions by agri-business: "You have no right to complain, little piggy, because if it weren't for this horrific factory farm, you wouldn't exist at all." (Of courses, both the slave and the animal would have grounds for complaint if their lives were so wretched as not to be worth living--but that's a high (or a low) bar.

Iain suggests a couple of ways to think about the problem. One involves the idea that the non-identity argument is weakened if it's at least possible that the very same person could have been born without the complained-of injury. The very same person might have been born not a slave. But I think that's fiddling with the hypo. If we're talking about the person who owes his existence to the institution of slavery because, for example, his mother met his father only because they were sold to the same plantation, I don't see what leverage is gained by arguing that it's at least metaphysically possible that the same person could have been born outside the peculiar institution.

More promising, to me, is Iain's suggestion that an IVF baby might have been harmed, but not wronged, by being born, just as the slave of a benevolent master would still be wronged by the institution of slavery, even if she has not been harmed by it. This leaves us with the question, when we debate about the existence of a complaint "from a particular person's point of view," are we talking about complaints of wrongdoing, of harm, or (as in tort) only of harmful wrongdoing?

Finally Iain tries to distinguish the case of the disabled IVF baby from the case of a baby harmed in utero (as when mom drinks, or ingests Thalidomide). The second sort of baby, Iain argues, would clearly have a complaint about the harmful behavior, because the very same baby might have been born unharmed.

But as I said briefly in my comment to Iain's post, I'm not so sure that personal identity is genetic at root. I don't think it's too much to argue that the disabled baby is a different person from the genetically-identical baby that would have been born but for mom's behavior. So the non-identity problem is not solved by reference to continuity of genetic makeup, or even by reference to bodily continuity with the same blastocyst.

     

IVF Babies at Enhanced Risk. But Why, and So What?

This Australian study in PLOS One shows significant risk of health problems in babies born from assisted conception as opposed to spontaneous conceptions. Compared to spontaneously-conceived singletons, singletons from assisted conception were almost twice as likely to be stillborn, more than twice as likely to be pre-term, almost three times as likely to have very low birth weight, and twice as likely to die within the first four weeks after birth. Outcomes varied by type of assisted conception. Very low and low birth weight, very preterm and preterm birth, and neonatal death were "markedly" more common in births from IVF and, to a lesser degree, in births from ICSI. Use of frozen embryos elminated the risks of ICSI, but not of IVF. But frozen embryos also had increased risk of macrosomia.

The study mentions, but doesn't linger on, data showing that kids spontaneously born of parents with untreated infertility problems also have adverse outcomes compared to kids of non-infertile parents. Compared to spontaneously conceived children of women with no infertility problems, spontaneously conceived children of women with infertility problems were nine times more likely to have very low birth weight, seven times more likely to be very pre-term, and almost seven times more likely to die within the first 28 days of birth. Some experts say that this may mean that the problems experienced by children of assisted reproduction may be more due to parental infertility than to infertility treatment.

Let us leave aside the possibility that many or most IVF-related risks are really just infertility-related risks. The sort of data discussed in this study always brings to my mind some variations on the "non-identity" problem invented by Derek Parfit. Suppose a child of IVF is born with low birthweight, and experiences lifelong significant complications which were foreseeable by the parents when they decided to used IVF. Has that child any complaint against the parents? One possible answer is, "No, because the condition of the possibility of that particular child's ever existing at all was his or her parents' use of the IVF which caused both his or her existence and his or her low birthweight. Only a child whose life was so wretched as to literally not be worth living could complain about his or her parents' use of IVF." The argument in this form seems sound but it also troubles me, because (for example) one can easily imagine the circumstances in which one might accurately say to a slave, "You have no right to complain about being born a slave, because without the institution of slavery, you would never have been born at all."

If IVF is risky, and a child of IVF is born with a disability, and the child would not have been born without IVF, what sort of complaint can one mount, from the child's point of view, about the disability?