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The Limitation of a Mother’s Autonomy in Reproduction: Is the Ban on Egg Donation a Case of Indirect Paternalism?

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New Perspectives on Paternalism and Health Care

Part of the book series: Library of Ethics and Applied Philosophy ((LOET,volume 35))

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Abstract

In order to prevent a person from harm it could be reasonable to act against the person’s will in his or her own interest. This paternalistic action can be justified by the aim of benefiting the person. Here, the person who is interfered with is the same as the person who is better off. But regarding this in a medical context there are other cases in which paternalistic actions are not opposing the autonomy of the person that should be protected from harm. Rather than protecting the mother from a risky medical service the focus on benefit is placed on the prospective children. Thus, a third party is involved. For example, egg donation in Germany is forbidden to protect children from mental harm. But is this a good reason to limit the mother’s autonomy? Is the anticipated welfare of an unborn adequate as a reason for this limitation? Is it in general plausible to speak about harm of an unborn, which is not harmed if it will not be born? Indeed it is not clear at all, therefore it is required to find a proper meaning and find out who would be harmed or in what way someone’s right or interest is violated in case of egg donation. The purpose of this chapter is to clarify if and how it could be justified, based on Mill’s harm principle, to restrain reproductive autonomy.

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Notes

  1. 1.

    “The liberal society is one in which to the maximum degree people are at liberty to exercise their personal autonomy.” (Charlesworth 1993, 16).

  2. 2.

    Paternalism is the interference of the state or a person with another person, for the purpose of benefiting (protecting from harm) the person. In the case of indirect paternalism the interference is motivated by benefiting another one as the acting person.

  3. 3.

    Many arguments against egg donation apply as well on surrogacy because in both cases they deal with split motherhood, i.e. the distinction of genetic and biological motherhood. See fn. 32.

  4. 4.

    Kant (1996, 89).

  5. 5.

    Höffe (1996, 199).

  6. 6.

    Kant (1996, 97).

  7. 7.

    Schöne-Seifert (2007, 40), Knoepffler (2008, 145); see Beauchamp (2007).

  8. 8.

    Even if Beauchamp and Childress emphasize respect for autonomy as prima facie duty and has therefore another moral ground, their notion of autonomy obviously follows Mill. (Beauchamp/Childress 2001, 63 f).

  9. 9.

    O’Neill (2005, 30). For example: “Mill in whose philosophy naturalism and the ideal of rational autonomy are the two deepest convictions, is particularly committed to the assumption that they are indeed reconcilable.” (Skorupski 1989, 43).

  10. 10.

    Mill (1996a), On Liberty, 261. “Autonomy – the freedom to make one’s own decisions in one’s own private domain – is in its own right a categorical human end, one of the essentials of a worthwhile life.” (Skorupski 1989, 21).

  11. 11.

    Mill (1996a), On Liberty, 219.

  12. 12.

    Mill (1996a), On Liberty, 224.

  13. 13.

    Mill (1996a), On Liberty, 272.

  14. 14.

    Gräfrath (1992, 30); for discussion see Riley (2004, 167–176).

  15. 15.

    Mill (1996b), Principles of Political Economy, 208.

  16. 16.

    Mill (1996a), On Liberty, 261.

  17. 17.

    Gräfrath (1992, 75).

  18. 18.

    Mill (1996a), On Liberty, 262.

  19. 19.

    Mill (1996a), On Liberty, 223.

  20. 20.

    Indirect does not mean the harming consequence is not obvious but that it is, and not directly linked to the action. In such cases the consequence of an action leads to some harm not the initial action itself.

  21. 21.

    It is contested whether the offense principle is a genuine part or rather a self-contained extension of the harm principle. For further discussion see Riley (2004, 176–187).

  22. 22.

    Mill (1996a), On Liberty, 262.

  23. 23.

    Feinberg (1989, 48).

  24. 24.

    Of course there are a lot of external and internal influences (e.g. social, economical, religious…) on our daily decision-making process, but as I mentioned before I presuppose a sufficient capacity of self-determination.

  25. 25.

    O’Neill (2005, 50).

  26. 26.

    Assuming there is a strong parental desire of having a genetically related child, the world will not be crowded by supermen and wonderwomen. But even if it would be, this fact itself is not an objection.

  27. 27.

    Mill (1996a), On Liberty, 292.

  28. 28.

    To simplify the discussion I used the term patient according to a typical doctor-patient relationship where the patient suffers (from involuntary childlessness) and therefore seeks help by a doctor. In what way this meets a consumer oriented model of a doctor-patient relationship needs to be discussed on another stage.

  29. 29.

    For sure, there are external influences in social and economic dependencies as well as social constraints controlling individual’s life. Especially arguments of commercialisation and exploitation strengthen the importance of that matter. Actually women in economic distress might not be aware of medical risks that arise in the procedure of harvesting eggs and thus women in low income countries bear the main part of the burden of donation. (Berg 2008, 245; Graumann 2008, 182 f.) Albeit such cases that form a constraint on someone’s autonomy could justify paternalistic interventions, there is a need for a separate consideration about the actual condition of autonomy but this cases cannot be discussed with the argument of autonomy as a moral claim.

  30. 30.

    Government draft bill ESchG, BT-Drs. 11/5460, 7; Beitz (2009, 224).

  31. 31.

    By passing the German Embryo Protection Act in 1990.

  32. 32.

    Split motherhood (gespaltene Mutterschaft) is originally a term of the German juristic debate about the Embryo Protection Act. Unfortunately there is no clear translation because this argument exists in this way only within the German discussion.

  33. 33.

    Keller/Günther/Kaiser, ESchG (1992), § 1 Abs. 1 Nr. 1, margin number 1; Günther/Taupitz/Kaiser, ESchG (2008), § 1 Abs. 1 Nr. 1, margin number 1.

  34. 34.

    This is the way the German legislature argued.

  35. 35.

    Cf. Hare (1993).

  36. 36.

    If someone does not accept the strong relation between maximizing happiness and avoiding harm, it could be said alternatively, avoiding harm means to bring no children into existence anymore.

  37. 37.

    Parfit (1986, 355 f).

  38. 38.

    From this point of view arises no moral obligation towards the parents of bearing a healthier and happier child. Parfit refers to the problem as that of “non-identity” (Parfit 1986, 351–356), and Kavka dubs it as “Paradox of Future Individuals”. (Kavka 1982, 95).

  39. 39.

    Steigleder (1998, 106). David Heyd emphasizes moreover that these two options are incommensurable. It is not possible to set non-existence as (selectable) alternative to existence. (Heyd 1992, 32).

  40. 40.

    I will not concern any diseases which will lead to death directly after birth, e.g. spina bifida combined with anencephaly.

  41. 41.

    Steigleder, 109. “One who has never known the pleasures of mental operation, ambulation, and social interaction surely does not suffer from the loss as much as one who has. While one who has known these capacities may prefer death to a life without them, we have no assurance that the disabled person, with no point of comparison, would agree. Life and life alone, whatever its limitations, might be of sufficient worth to him.” (Robertson 1975, 254).

  42. 42.

    Within the German juristic discussion this concept is expressed by the term Kindeswohl (literally: the children’s welfare).

  43. 43.

    Keller (1989, 710).

  44. 44.

    If a patient is not able to interact or his actual will is not directed in advance the substituted judgment standard means to figure out his will according to affiliates. Even if this is not possible anymore, one attempt to define the best interest standard in general.

  45. 45.

    President’s Commission (1983, 134–136).

  46. 46.

    President’s Commission (1983, 6–8), British Medical Association Ethics Department (2013, 133 f).

  47. 47.

    See Downie/Randall (1997).

  48. 48.

    See Eekelaar (1994). Accordingly, the criticism of the best interest standard refers basically to the individual interpretation and indeterminacy, which is subjected to cultural and time-bound interpretations. (Dörries 2003, 124).

  49. 49.

    Häyry (1991, 6).

  50. 50.

    Feinberg (1989, 21 f).

  51. 51.

    These are among others the costs for health care services as well as the opportunity costs.

  52. 52.

    It can hardly be estimated how many cases there are in fact. Affected are women whose ovarian activity is not given, but who could meet their desire to have children by egg donation. In addition to some acquired diseases that can make this happen, there is as well a possibility of surgically removed ovaries (e.g. as a result of cancer or accident). Another case for using donated eggs is in prevention of transmission of genetic characteristics. Overall, this should be a quite manageable number. Most likely the number of children who cannot be begotten due to reproductive age is significantly greater.

  53. 53.

    See Golombok et al. (2005), Murray/MacCallum/Golombok (2006).

  54. 54.

    Murray/MacCallum/Golombok (2006, 610), Revermann/Hüsing (2010, 164). Neither physical nor psychosocial development indicates any abnormalities. Ibid. 166.

  55. 55.

    See Devlin (1962).

  56. 56.

    Funcke/Thorn (2010, 19). There again, the formal structure of a nuclear family has not lost any binding character for family arrangement since other kinds of family life emerged. Ibid. 23.

  57. 57.

    S.H. and others v. Austria, ECHR Judgment (Grand Chamber), Application no. 57813/00, 3 November 2011, § 70.

  58. 58.

    Engelhardt (1996, 7).

  59. 59.

    Hart (1977, 86).

  60. 60.

    Again, this is the way the German legislature argued. See fn. 32.

  61. 61.

    Feinberg (1987, 99).

  62. 62.

    See Strong (1998, 284–286), and for further discussion Strong (2005).

  63. 63.

    Feinberg (2007).

  64. 64.

    However, Strong does not establish a right against nature nor undermine the natural lottery as a point of social justice.

  65. 65.

    At this point liberty is not any more meant as a negative freedom but becomes a requirement of enabling a positive freedom.

  66. 66.

    E.g. the value of naturalness of childmaking.

  67. 67.

    Mill (1996a), On Liberty, 223.

  68. 68.

    Lee (1986, 15–17).

  69. 69.

    Häyry (1991, 106).

  70. 70.

    Charlesworth (1993, 166 f).

References

  • Beauchamp, Tom L. 2007. History and theory in “applied ethics”. Kennedy Institute of Ethics Journal 17(1): 55–64.

    Article  Google Scholar 

  • Beauchamp, Tom L., and James F. Childress. 2001. Principles of biomedical ethics, 5th ed. Oxford: Oxford University Press.

    Google Scholar 

  • Beitz, Ulrike. 2009. Zur Reformbedürftigkeit des Embryonenschutzgesetzes: Eine medizinisch-ethisch-rechtliche Analyse anhand moderner Fortpflanzungstechniken. Frankfurt am Main: Peter Lang.

    Google Scholar 

  • Berg, Giselinde. 2008. Die Eizellspende – eine Chance für wen? In Umwege zum eigenen Kind: Ethische und rechtliche Herausforderungen an die Reproduktionsmedizin 30 Jahre nach Louise Brown, ed. Gisela Bockenheimer-Lucius, Petra Thorn, and Christiane Wendehorst, 239–253. Göttingen: Universitätsverlag.

    Google Scholar 

  • British Medical Association Ethics Department. 2013. Everyday medical ethics and law. New York: Wiley.

    Google Scholar 

  • Charlesworth, Max. 1993. Bioethics in a liberal society. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Devlin, Patrick. 1962. Law, democracy, and morality. University of Pennsylvania Law Review 110(5): 635–639.

    Article  Google Scholar 

  • Dörries, Andrea. 2003. Der Best-Interest Standard in der Pädiatrie – theoretische Konzeption und klinische Anwendung. In Das Kind als Patient: Ethische Konflikte zwischen Kindeswohl und Kindeswille, ed. Wiesemann Claudia, Andrea Dörries, Wolfslast Gabriele, and Simon Alfred, 116–130. Frankfurt am Main: Campus.

    Google Scholar 

  • Downie, Robin S., and Fiona Randall. 1997. Parenting and the best interests of minors. Journal of Medicine and Philosophy 22(3): 219–231.

    Article  Google Scholar 

  • Eekelaar, John. 1994. The interests of the child and the child’s wishes: The role of dynamic self-determinism. International Journal of Law, Policy and the Family 8(1): 42–61.

    Article  Google Scholar 

  • Engelhardt, Hugo T. 1996. The foundations of bioethics, 2nd ed. New York: Oxford University Press.

    Google Scholar 

  • Feinberg, Joel. 1987. Harm to others, The moral limits of the criminal law, vol. 1. New York: Oxford University Press.

    Google Scholar 

  • Feinberg, Joel. 1989. Harm to self, The moral limits of the criminal law, vol. 3. New York: Oxford University Press.

    Google Scholar 

  • Feinberg, Joel. 2007. The child’s right to an open future. In Philosophy of education: An anthology, ed. Randall R. Curren, 112–123. Malden: Blackwell.

    Google Scholar 

  • Funcke, Dorett, and Petra Thorn. 2010. Statt einer Einleitung: Familie und Verwandtschaft zwischen Normativität und Flexibilität. In Die gleichgeschlechtliche Familie mit Kindern: Interdisziplinäre Beiträge zu einer neuen Lebensform, ed. Dorett Funcke and Petra Thorn, 11–33. Bielefeld: Transcript.

    Chapter  Google Scholar 

  • Golombok, Susan, et al. 2005. Families Created by Gamete Donation: Follow-Up at Age 2. Human Reproduction 20(1): 286–293.

    Article  Google Scholar 

  • Gräfrath, Bernd. 1992. John Stuart Mill: “Über die Freiheit”: Ein einführender Kommentar. Paderborn: Schöningh.

    Google Scholar 

  • Graumann, Sigrid. 2008. Eizellspende und Eizellhandel – Risiken und Belastungen für die betroffenen Frauen. In Umwege zum eigenen Kind: Ethische und rechtliche Herausforderungen an die Reproduktionsmedizin 30 Jahre nach Louise Brown, ed. Gisela Bockenheimer-Lucius, Petra Thorn, and Christiane Wendehorst, 175–183. Göttingen: Universitätsverlag.

    Google Scholar 

  • Günther, Hans-Ludwig, Jochen Taupitz, and Peter Kaiser. 2008. Embryonenschutzgesetz: Juristischer Kommentar mit medizinisch-naturwissenschaftlichen Einführungen. Stuttgart: Kohlhammer.

    Google Scholar 

  • Hare, Richard M. 1993. The abnormal child: Moral dilemmas of doctors and patients. In Essays on bioethics, ed. Richard M. Hare, 185–191. Oxford: Clarendon.

    Google Scholar 

  • Hart, Herbert L.A. 1977. Immorality and treason. In The philosophy of law, ed. Ronald M. Dworkin, 83–88. Oxford: Oxford University Press.

    Google Scholar 

  • Häyry, Heta. 1991. The limits of medical paternalism. London: Routledge.

    Book  Google Scholar 

  • Heyd, David. 1992. Genethics: Moral issues in the creation of people. Berkeley: University of California Press.

    Google Scholar 

  • Höffe, Otfried. 1996. Immanuel Kant, 4 Aufl. München: Beck.

    Google Scholar 

  • Kant, Immanuel. 1996. Groundwork of the metaphysics of the morals. In Practical philosophy, ed. Mary J. Gregor, 37–108. Cambridge: Cambridge University Press.

    Google Scholar 

  • Kavka, Gregory S. 1982. The paradox of future individuals. Philosophy and Public Affairs 11(2): 93–112.

    Google Scholar 

  • Keller, Rolf. 1989. Das Kindeswohl: Strafschutzwürdiges Rechtsgut bei künstlicher Befruchtung im heterologen System? In Festschrift für Herbert Tröndle zum 70. Geburtstag am 24. August 1989, ed. Hans-Heinrich Jescheck and Theo Vogler, 705–721. Berlin: de Gruyter.

    Google Scholar 

  • Keller, Rolf, Hans-Ludwig Günther, and Peter Kaiser. 1992. Embryonenschutzgesetz: Kommentar zum Embryonenschutzgesetz. Stuttgart: Kohlhammer.

    Google Scholar 

  • Knoepffler, Nikolaus. 2008. Patientenautonomie – Anspruch und Wirklichkeit am Beispiel der Sterbehilfedebatte. In Medizin zwischen Humanität und Wettbewerb. Probleme, Trends und Perspektiven. Beiträge des Symposiums vom 27. bis 30. September 2007 in Cadenabbia, ed. Volker Schumpelick and Bernhard Vogel, 145–156. Freiburg: Herder.

    Google Scholar 

  • Lee, Simon. 1986. Law and morals: Warnock, gillick and beyond. Oxford: Oxford University Press.

    Google Scholar 

  • Mill, John S. 1996a. On liberty. In Essays on politics and society 1. Collected Works of John Stuart Mill, vol. 18, ed. Robson John M. Reprinted, 213–310. London: Routledge.

    Google Scholar 

  • Mill, John S. 1996b. Principles of political economy: With some of their applications to social philosophy; Books I – II. Collected Works of John Stuart Mill, vol. 2, ed. Robson John M. Reprinted, London: Routledge.

    Google Scholar 

  • Murray, Clare, Fiona MacCallum, and Susan Golombok. 2006. Egg donation parents and their children: Follow-up at age 12 years. Fertility and Sterility 85: 610–618.

    Article  Google Scholar 

  • O’Neill, Onora. 2005. Autonomy and trust in bioethics, 3rd ed. Cambridge: Cambridge University Press.

    Google Scholar 

  • Parfit, Derek. 1986. Reasons and persons. Reprinted. Oxford: Clarendon Press.

    Google Scholar 

  • President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. 1983. Deciding to forego life-sustaining treatment: Ethical, medical, and legal issues in treatment decisions. Washington: U.S. Government Printing Office.

    Google Scholar 

  • Riley, Jonathan. 2004. Mill on liberty. Reprinted. London: Routledge.

    Google Scholar 

  • Revermann, Christoph, and Bärbel Hüsing. 2010. Fortpflanzungsmedizin – Rahmenbedingungen, wissenschaftlich-technische Entwicklungen und Folgen: Endbericht zum TA-Projekt. TAB-Arbeitsbericht Nr. 139.

    Google Scholar 

  • Robertson, John A. 1975. Involuntary euthanasia of defective newborns: A legal analysis. Stanford Law Review 27(2): 213–269.

    Article  Google Scholar 

  • Schöne-Seifert, Bettina. 2007. Grundlagen der Medizinethik, Kröner Taschenbuch, vol. 503. Stuttgart: Kröner.

    Google Scholar 

  • Skorupski, John. 1989. John stuart mill. London: Routledge.

    Google Scholar 

  • Steigleder, Klaus. 1998. Müssen wir, dürfen wir schwere (nicht-therapierbare) genetisch bedingte Krankheiten vermeiden? In Ethik in der Humangenetik: Die neueren Entwicklungen der genetischen Frühdiagnostik aus ethischer Perspektive, ed. Marcus Düwell and Dieter Mieth, 91–119. Tübingen: Francke.

    Google Scholar 

  • Strong, Carson. 1998. Cloning and infertility. Cambridge Quarterly of Healthcare Ethics 7(3): 279–293.

    Article  Google Scholar 

  • Strong, Carson. 2005. Harming by conceiving: A review of misconceptions and a new analysis. Journal of Medicine and Philosophy 30: 491–516.

    Article  Google Scholar 

Download references

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  1. Department of Philosophy, Bielefeld University, Bielefeld, Germany

    Clemens Heyder

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    Thomas Schramme

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Heyder, C. (2015). The Limitation of a Mother’s Autonomy in Reproduction: Is the Ban on Egg Donation a Case of Indirect Paternalism?. In: Schramme, T. (eds) New Perspectives on Paternalism and Health Care. Library of Ethics and Applied Philosophy, vol 35. Springer, Cham. https://doi.org/10.1007/978-3-319-17960-5_18

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