It is an open question when procreation is justified. Antinatalists argue that bringing a new individual into the world is morally wrong, whereas pronatalists say that creating new life is morally good. In between these positions lie attempts to provide conditions for when taking an anti or pronatal stance is appropriate. This paper is concerned with developing one of these attempts, which can be called qualified pronatalism. Qualified pronatalism typically claims that while procreation can be morally permissible, there are constraints on when it is justified. These constraints often concern whether an individual is motivated to procreate for the right reasons. For instance, if someone is not sufficiently concerned with the child's future welfare, the qualified pronatalist will say that procreation is not justified. Moreover, David Wasserman says that this concern forms a role-based duty. That is, prospective parents have special duties to be concerned for the child's future welfare by virtue of the role they occupy. In this paper, I argue that a proper examination of a prospective parent's role-based duties entails that more is needed to justify procreation. Bringing a new person into the world leaves fewer resources for people who already need them, and the current size of the human population is unsustainable from a planetary point of view. Therefore, even if there is nothing wrong with procreation per se, the external condition of overpopulation, and its ensuing public health issues, plausibly gives rise to a role-based duty that prospective parents must account for when deciding whether to procreate.
Evidence suggests that one reason doctors provide certain interventions in assisted reproductive technologies (ART) is because of patient demand. This is particularly the case when it comes to unproven interventions such as 'add-ons' to in vitro fertilisation (IVF) cycles, or providing IVF cycles that are highly unlikely to succeed. Doctors tend to accede to demands for such interventions because patients are willing to do and pay 'whatever it takes' to have a baby. However, there is uncertainty as to what moral weight should be placed on patient-led demands in ART, including whether it is acceptable for such demands to be invoked as a justification for intervention. We address this issue in this paper. We start by elucidating what we mean by 'patient-led demand' and synthesise some of the evidence for this phenomenon. We then argue that a doctor's professional role morality (PRM) yields special responsibilities, particularly in commercialised healthcare settings such as ART, because of the nature of professions as social institutions that are distinct from markets. We argue on this basis that, while there may be reasons (consistent with PRM) for doctors to accede to patient demand, this is not always the case. There is often a gap in justification between acceding to patient-led demands and providing contested interventions, particularly in commercial settings. As a result, acceding to demand in such settings needs a strong justification to be consistent with PRM.
Fertilization in Vitro , Reproductive Techniques, Assisted , Humans , Morals
