Book Review: The Ethics of Pregnancy, Abortion and Childbirth - Exploring Moral Choices in Childbearing

Academics have written at length on the ethics of reproductive technologies, abortion and speculative possibilities such as reproductive cloning. But pregnancy itself up until recently has been a somewhat neglected topic. Among the philosophers who are addressing this gap is Helen Watt, whose book 'The Ethics of Pregnancy, Abortion and Childbirth: Exploring Moral Choices in Childbearing' takes a detailed look at the meaning of pregnancy itself in various contexts.

The scope of the book is broad, but one of the most interesting aspects it deals with are reproductive technologies and surrogacy. Much of Watt's interest and concern with pregnancy relates specifically to the ways in which modern medicine and reproductive technology have changed the ways in which humans reproduce.

A thread that runs throughout the book is the intrinsic value of the natural processes involved in human reproduction. If in the past, there were certain biological necessities that aligned themselves with our assumptions about parenthood, it is evident that these are no longer as powerful as they once were. Watt discusses surrogacy, gamete donation, PGD (preimplantation genetic diagnosis), embryo freezing and IVF as techniques that have fractured the biological integrity of reproduction.

Here, Watt parts company from mainstream bioethics. The dominant discourse of reproductive autonomy in academic bioethics has largely treated this widening array of options in reproductive technology as a beneficial, expansion of choice. Reproductive autonomy is about deciding when, whether and how to become a parent. Watt, however, specifically objects to the idea that parenthood is chosen. A parent is simply what you are given certain biological circumstances. Thus the separation of gestational from genetic parenthood, in surrogacy, for instance, is treated as a problematic severing of roles that should be inalienable.

Increasing the degree of choice involved in reproduction opens the possibility that becoming a parent may start to resemble a consumer activity, Watt argues. She considers that sexual conception is a better way of starting a pregnancy than IVF, because the act has its own meaning and value. She differentiates 'openness to conception' that is, having unprotected sex, with using ARTs (Assisted Reproductive Technologies).

ARTs, she argues – correctly, I think – cannot be associated with openness in this way, since they are an active attempt to bring about the conception. Rather than being passively open to the workings of biology, prospective parents and their doctors attempt to harness biology and make it work to fit their wishes. The naturally conceived child, on Watt's view, is 'received' by its parents, rather than produced. ARTs, on the other hand, exist only to produce offspring, and by implication, this is problematic. Thus, ARTS serve to commodify and instrumentalise reproduction, and perhaps offspring themselves.

Watt illustrates her concern about the role of technology in facilitating this instrumentalising tendency with a quote from a woman who used donor eggs for conception, became pregnant with twins and chose to abort one of them. Because it was in some sense an artificial pregnancy, the woman said, she regarded it as having a different moral status from a 'natural' pregnancy. She had chosen to create the embryos and thus felt a stronger sense of the right to control their destiny than she would have done otherwise. Watt describes this comment as 'remarkable', and indeed it is a fascinating insight into the way in which a person's ascription of moral value to an entity may be shaped by their sense of authorship or ownership of it.

Watt is highly critical of selective reduction generally, claiming that 'increasingly reduction to a singleton pregnancy from either twins or triplets is being carried out on women who wish for social (for example, economic) reasons to ensure that only one baby will survive.' However, aside from the specific example discussed above, she does not provide any data to support this. It would be surprising if this is correct, given the invasiveness of selective reduction and the associated risks of losing the pregnancy altogether.

Elsewhere, Watt states: 'ARTs encourage the couple to think of themselves as "commissioners" of the child-product, assembled... separated causally from its coming-to-be, but invited to take, explicitly or by default, owner-type attitudes towards it.' Watt's conviction of the value of natural reproduction may lead the reader to wonder if she is drawing unjustifiable inferences about the link between morality and nature. In places, Watt's book comes perilously close to this. However, she rejects the idea that embryo adoption, for example, is objectionable simply because it is 'unnatural', pointing out that IVF is unnatural as well.

Nevertheless, Watt does object both to embryo adoption and to IVF. Although she claims that this is not simply on the grounds of their unnaturalness, her arguments rely heavily on the naturalness of parent roles. Almost without exception, new technologies are portrayed as threats to this value.

In all, this is both a fascinating and frustrating book. Watt relies heavily on rhetorical questions and appeals to intuition to support her arguments. The structure of the book is peculiar: the connection between chapters and their sub-sections is not always clear. Yet Watt is asking vitally important questions that tend to be side-lined in mainstream bioethics. As it stands, this short book is perhaps best not seen as offering answers to the key questions it raises, but as enlarging the sphere of debate to accommodate those areas in which many bioethicists are reluctant to engage.

Buy The Ethics of Pregnancy, Abortion and Childbirth: Exploring Moral Choices in Childbearing from Amazon UK.