Tuesday, 12 August 2014

Could Reproductive Liberty be Ethically Curtailed for Environmental Policy Reasons? or Why I Would Have Rejected Cristina Richie's Article on IVF

It's been a bit of a gale (as opposed to a bona fide storm) lately, following an article in the Journal of Medical Ethics by Cristina Richie, entitled "What would an environmentally sustainable reproductive technology industry look like?". It's not the question of a full hurricane, as in the infamous "after birth abortion" paper from 2012, but this rather raving rant is on the more aggressive end of the scale of reactions to Richie's piece. I dislike the language and the attitude expressed at the end of this article for simple reasons of decency and respect, but I also rather dislike Richie's article for more intellectual reasons. In fact, having read it, I have come to the conclusion that, had I been the JME reviewer for it, I would have recommended rejection.

Based on the undisputed fact that human reproduction carries with it a carbon footprint (assuming fixed per capita consumption levels related to population-size and -growth), Richie's paper argues about assisted reproductive technologies (ART), such as IVF, that...

The use of ART to produce more human-consumers in a time of climate change needs to be addressed.  Policymakers should ask carbon-emitting countries to change their habits to align with conservation. And though all areas of life – from transportation, to food, to planned technological obsolescence – must be analysed for ecological impact, the offerings of the medical industry, especially reproductive technologies, must be considered as well.

More specifically, she argues that access to ART should be restricted to "those who are not biologically infertile", meaning thereby to exclude, e.g., homosexual couples, single individuals and other "rainbow" family constellations. In particular, she claims, such restriction should befall publicly funded medical services of this kind. To season the stew somewhat, Richie is openly declared as belonging to "catholic theorlogical ethics", attached to an openly Catholic academic institution, the theology department of Boston College, a church well-known for its officially set hostile stance towards both ART in general and, in particular, technological facilitation of human reproduction in other social forms than within that of a married heterosexual couple.

Iain Brassington at the JME's blog has opposed the idea that Richie therefore should have declared a conflict of interest. He does however concur with several critics, some described here, that the attempted distinction between "biological" and other types of infertility is swampy territory. In fact, all infertility is always partly social, as it depends on a person or a group of persons being unsatisfied by existing alternatives to using ART, such as keep on trying the old "natural" way, attempt to adopt, or remain childless. A particularly tricky thing is that many times, individuals belonging to the group that Richie would presumably call "biologically" infertile, their infertility may very well be due to the fact that they prefer to keep to their couple relationship. Already here, had I been a reviewer of the paper, I would have unconditionally demanded revision. This is sloppy conceptual work of a sort a philosophy teacher slams A-level students for and it is given the job of providing substance to one of the article's main theses. I'm frankly surprised that reviewers and editors of a leading bioethics journal could let that one pass.

At the same time, Brassington insists in another comment that the general idea, which is the other thesis of the article, of subjecting human reproductive liberty and policies to the challenge of their impact on pressing environmental problems is not necessarily ill-conceived. Again, I agree, as I should do, having argued some 18 years back (an open access preprint is here) that global justice and health concerns may be reasons for people to avoid having children and rather adopt or otherwise assist existing children in need. As I argued in that context, however, Brassington observes that there seems to be no reason to restrict the environmental argument to the use of ART, but rather that if the argument bites, it points towards more general conclusions about the value of avoiding human procreation, e.g. via adoption or policies like the infamous Chinese 1-child restriction or other types of limitations.

Another comment that expands this particular line of criticism has emerged from Dominic Wilkinson, also on the JME blog, where he argues that Richie's argument is flawed to the core, due to its claim that ARTs are in some way extra environmentally problematic. Now, Richie herself does openly confess that this may very well not be so, but that she nevertheless chooses to restrict her paper to a thesis pertaining to ART. In other words, the main thesis of the article is entirely dependent on an ad hoc and arbitrary restriction of its thematic scope. Richie presents no argument justifying this restriction, but her article nevertheless is left to pursue a main claim pertaining to ART and only ART. This, given the level of ethical controversy around ARTs, is unjustified bias. Had Richie presented an argument in favour of the limitation of the scope it hadn't been so, but since she in fact claim herself that there's nothing special with ARTs, the article is clearly skewed in an unwarranted way. Therefore, had I been reviewer, I would have faulted the article on that ground, demanding a more general discussion of reproductive liberty in the face of environmental policy – alternatively, independent arguments for singling out ARTs as a specific target. This is a major flaw that the review or editorial process should have caught.

Together these two problems with the article point to a third one, namely that it aims to prove two intellectually independent main claims. This is asking for trouble, as everyone knows, but it is obvious why Richie wants to take the risk: without the combination, she wouldn't have been able to aim her shot specifically at the application of ART for the facilitation of reproduction within "alternative" families. Thus, Richie has an apparent (possibly religiously motivated) agenda to place a questioning of ART and specific applications of ART in a well-regarded scientific journal. Even if that doesn't amount to a conflict of interest, it undercuts the claim to intellectual honesty one would require of a researcher worthy of publication in the JME. Again, I'm surprised that this wasn't picked up in the JME review or editorial process.

Having said that, the general ethical issues arising out of the link between human reproduction and environmental concerns (of all kinds), are sure worthy of more reflection. In fact, this is something that I will be addressing with qualified colleagues at a panel convened by myself on Reproductive Public Health Ethics at the MANCEPT Workshops in Political Theory in just a few weeks.


2 comments:

  1. nice and informative post.

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  2. Some commentators seem to think that Christina Richie has a conflict of interest – relative to her analysis about the availability of assisted reproductive treatments – by reason of her inferred religious beliefs (she is a member of Catholic Theological Ethics in the World Church) and by reason of her institutional membership (she is a graduate student at Boston College).

    Claims along these lines are virtual nonsense, as far as I’m concerned. Once upon a time, I was myself a graduate student at Boston College, and it would have been virtually impossible to conclude the nature of my views from any reading of that university’s mission statement or looking to its Jesuit sponsorship.

    Let’s look at the issue more closely. Suppose a Catholic university professor, a theologian moreover, a priest on top of that, and an employee of a Catholic university said the kinds of things that Richie has said. Would anyone think it would be fair to lodge complaints about a conflict of interest in this man in offering views to his peers through professional communications? I think it would be entirely specious to do so. Why then would it make sense even to raise this kind of complaint agains someone even further down the academic food chain?

    As far as I’m concerned, the real worry here is Richie’s proposal, which – frankly – seems to link Topic A (protecting the environment) to Topic B (limit access to fertilty medicine) almost as a random way to get to a greer world. That connection has, however, a pernicious effect for gay and lesbian people. I have recently recommended that bioethics stop treating the interest of gay and lesbian people in fertility treatments as requiring any sort of justification over and above what is required of anyone else (see J Medical Ethics, at: http://jme.bmj.com/content/early/2014/01/31/medethics-2013-101699.abstract).

    Ms. Richie seems to think that her proposal to exclude gay men and lesbians from assisted reproductive treatments because they are infertile is not prejudicial because the proposal also excludes others in the same boat. I disagree and strongly and will be saying so in a professional communication shortly.

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