Medicine Studies

, Volume 4, Issue 1–4, pp 1–13 | Cite as

Paternal-Fetal Harm and Men’s Moral Duty to Use Contraception: Applying the Principles of Nonmaleficence and Beneficence to Men’s Reproductive Responsibility

Article

Abstract

Discussions of reproductive responsibility generally draw heavily upon the principles of nonmaleficence and beneficence. However, these principles are typically only applied to women due to the incorrect belief that only women can cause fetal harm. The cultural perception that women are likely to cause fetal and child harm is reflected in numerous social norms, policies, and laws. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not (or cannot) cause such harm. My goal in this paper is to begin to fill the void in the academic literature about men’s reproductive responsibility by highlighting the health-related, economic, and social harms men can cause to potential fetuses and children and then examining what it would mean to hold them responsible for preventing these harms. Applying the principles of nonmaleficence and beneficence to men, I conclude that men have a moral duty to use contraception if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior.

Keywords

Contraception Nonmaleficence Paternal-fetal harm Men Responsibility 

Women’s moral duty to prevent harm to their fetuses and children (e.g., not to smoke while pregnant, pressure to be a stay-at-home mom, etc.) receives lots of attention both in the bioethics literature and in the popular press. In contrast, men’s moral duty to prevent harm to their fetuses and children is often neglected. My goal in this paper is to begin to fill the void in conversations about men’s contraceptive responsibility.

I begin in the first section by elucidating the concept of reproductive responsibility and show that much of it depends upon the principles of nonmaleficence and beneficence. Then, in the second section, I then show how these principles are typically only applied to women due to the incorrect belief that women alone—rarely or never men—can cause fetal harm. There is a cultural perception that women are very likely to cause fetal and child harm, reflected in limitations on women’s participation in clinical trials and certain jobs, public service announcements telling women not to drink alcohol while pregnant, and extensive media coverage of “crack babies” and other babies thought to be “damaged” by women’s behavior. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not (or cannot) cause such harm. Finally, in the third section, I examine what it would mean to hold men responsible for preventing harm to potential fetuses. Much of the harm prevention discussions center on commissions and omissions during pregnancy that lead to harm, and obviously, men do not experience pregnancy. In order to encompass the harms men can cause, I employ a broad temporal view rather than limiting the discussion to harms that can occur prior to conception or during pregnancy. Applying the principles of nonmaleficence and beneficence to men, I argue that men have a moral duty to contracept if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior.

Two caveats before moving on: First, I am limiting my normative discussion to moral responsibility. I am not endorsing state enforcement to ensure certain types of behavior, nor am I condoning punishment for those who deviate from “acceptable” behavior. I am merely outlining what individuals should do if they want to act in a way that is responsible toward (and respectful of) their potential fetuses and children. Second, there are numerous harms parents can inflict upon their children. Obviously, I cannot address them all here. I consequently confine my discussion to health-related,1 economic, and social harms, broadly construed.

Reproductive Responsibility and the Principles of Nonmaleficence

The principle of nonmaleficence—“do no harm”—can be traced back to Hippocrates and continues to play an important part in medicine today. In particular, the principle of nonmaleficence occupies a central role in discussions of reproductive responsibility, and as Boukje Van Der Zee and Inez de Beaufort assert, the centrality of this principle to reproductive responsibility is well accepted. Assuming women are carrying a pregnancy to term, there is a consensus that “potential persons should be protected from being harmed in their capacity of being future persons.”2 John Arras and Jeffrey Blustein also highlight the significance of preventing harm in their explanation of responsible reproduction: “If one can reasonably be expected to predict that, should a person decide to reproduce, the resulting child’s existence would fall below a certain threshold of acceptable well-being, the person can be blamed for reproducing irresponsibly.”3

These understandings of responsible reproduction rely upon a link between causal responsibility and moral responsibility. The potential parents are viewed as the causal agents of harm and thus should be held morally responsible for the harm. Clearly, causal responsibility does not always leads to moral responsibility; a simple counterexample is killing in self-defense. However, harms caused by irresponsible reproduction are a type of causal responsibility that can be classified as the result of what Ronald Dworkin calls “option luck,” which is “a matter of how deliberate and calculated gambles turned out” and not “brute luck,” which is “a matter of how risks fall out that are not in that sense deliberate gambles.”4 Option luck refers to the results of decisions in which an agent has deliberately considered the risks and benefits involved. (Implicit here is that the agent has knowledge about the risks and benefits of the decision, a point I will return to when I discuss whether men know their actions can harm potential children.) According to Dworkin, individuals should be held responsible for their option luck decisions because they are the epitome of informed, individual decision-making. Indeed, they result directly from the agents’ deliberate choice rather than something outside them or beyond their control (aka brute luck).

If potential parents know an action could potentially harm their potential children and they opt for that action anyway, they should be held responsible for any negative consequences of their actions because the type of luck in this situation was option, not brute. To use the language of Arras and Blustein, it is irresponsible and perhaps even unjust for people to have children who they believe will fall below the threshold of acceptable well-being. While preventing harm to potential children seems like something most people would intuitively support, it does raise some ethical questions and concerns.

First, what types of parental actions can be classified as responsible and irresponsible reproduction? Parental actions that violate the principle of nonmaleficence are generally viewed as more unethical than parental actions that violate the principle of beneficence. Indeed, an action that will “lower a child’s potential” (e.g., drinking alcohol during pregnancy) is more ethically troubling than “parents who do not optimize their child’s potential for a good life” (e.g., genetic enhancement).5 Yet, there are some who assert that upholding the principle of nonmaleficence is a necessary, but not sufficient component to responsible reproduction and parenting. For instance, Julian Savulescu (2001) argues that we are morally obligated to produce the “best” children possible, especially when using medical technologies such as in vitro fertilization and preimplantation genetic diagnosis. Likewise, Lisa Cassidy’s discussion who should decide to become a parent aligns with the idea that the principle of beneficence should be the baseline for responsible reproduction and parenting. Cassidy concludes that only people who will make excellent parents should have children because “parenting is just too important to do in a way that is just good enough.”6

Second, what types of harms place lives below the threshold of acceptable well-being? There is clearly much disagreement about what counts as an acceptable quality of life, so it seems unlikely, if not impossible, that a universal standard could be established. But beyond determining a clear-cut consensus on where this threshold lies is the deeper issue of the eugenic nature of responsible reproduction. Inherent in many definitions of responsible reproduction is that certain types of lives are unacceptable and that potential parents have a moral obligation to act in a way to prevent these unacceptable lives. Given the historical abuses in the name of eugenics (e.g., forced sterilizations, a “master” race), it is not surprising that the goal of creating a “perfect,” or even just a “normal,” baby makes people nervous. Yet, those in favor of the “new” or “liberal” eugenics movement distinguish themselves from previous eugenics movements by claiming that their beliefs are “pluralistic, based on good science, concerned with the welfare of individuals, and … respect the rights of individuals.7” Critics, however, remain concerned that these new eugenics proponents are better able to mask their problematic views in cutting-edge science rather than acknowledging that disability is often a social problem, not a medical one (Asch 1999).

Contrasting Social Views About Women’s and Men’s Potential to Cause Harm

It is important to begin this section by explicitly stating that both women and men can cause fetal harm either before conception or during the pregnancy. The negative effects of maternal smoking and drinking on fetal health are well known, at least in part because of warning labels on cigarettes and alcohol. Yet, paternal smoking and drinking can also result in fetal health problems, specifically an increased chance of birth defects and low birth weight. Furthermore, paternal use of other drugs (such as cocaine, hashish, opium, and heroin) can also lead to fetal health problems because of abnormal sperm.8

Even though both women and men can cause fetal harm, social views on their ability to do so vary dramatically. Women are generally, if not almost always, identified as the cause of harm. The typical response to immediately blame women overlooks both the societal factors at play as well as the ways men cause harm to their fetuses and children. As Cynthia Daniels argues, “Debates over fetal risk are not so much about the prevention of fetal harm as they are about the social production of truth about the nature of men’s and women’s relation to reproduction.”9 The focus on women in discussions of fetal harm reinforces the belief that women’s bodies are permeable: That they easily spread harms to others, especially an innocent fetus.10 Furthermore, the long history of the medical realm treating women’s bodies as weak, inferior, and inherently diseased contributes to the worry that women’s bodies will “infect” fetuses and in contrast, men’s bodies as seen as stable, bound, and healthy; therefore, they are not a risk to fetuses. Because men’s bodies are thought to be stronger than women’s, men are thought to be invulnerable to harm from toxics, or if they are harmed, they are assumed to become infertile and thus incapable of harming others.11

These problematic understandings of women’s and men’s bodies essentially fail to acknowledge any significant role for men in reproduction, further perpetuating the assumption that reproduction really only involves only one person: the woman. Clearly, human reproduction requires two people, yet “the man’s involvement seems insignificant, amounting to nothing more than the ejaculation of a small quantity of seminal fluid. And even this has been codified in conventional wisdom as primarily a sexual act, rather than a reproductive one.”12 There is even legal precedent that men’s role in reproduction is just ejaculation. A 1998 case determining which member of a divorced couple should have custody of their biological embryos used this reason when to rule in favor of the wife for this reason.13 Men’s role in reproduction is reduced to a onetime event, whereas women’s role in reproduction consists not only of pregnancy, but also anytime she is not pregnant (during childbearing age). The potential for women to become pregnant—the idea that women are constantly in a state of pre-pregnancy—was the main reason why the FDA issued new guidelines in 1977 that recommended prohibiting women of childbearing age from the early phases of clinical trials, except for life-threatening diseases.14 That the harm to potential fetuses of potentially pregnant women was accepted as a legitimate reason for women’s exclusion from biomedical research for 16 years shows how deep the fear runs that women will (perhaps unintentionally) harm their fetuses.

Although the FDA changed its policy in 1993 to include women in clinical trials in order to study sex/gender differences in treatments, clinical researchers continue to view women’s bodies as dangerous to potential fetuses. A study by Cain and colleagues found that only 8.5 % of all trials had no restrictions for women’s participation; the rest mandated contraceptive use or sterility.15 Yet, “contraception was unnecessary in one-third of the protocols studied (24-h–2-day drug use) because timing to menstrual cycles would prevent potential exposure during pregnancy.”16 These trials mandating women use contraception exemplifies the lack of trust toward women to make good contraceptive and reproductive decisions, thereby justifying paternalistic intervention.17 The protectionist mentality is so strong that 41.7 % of the trials Cain examined received FDA approval to mandate contraceptive use for women without providing any reasons.18 Furthermore, almost all the trials demanded a negative pregnancy test, and 99.3 % of trials requiring contraceptive use mandated signature certification or documentation that women are using an “acceptable” form of contraception—often a hormonal form—in order to participate. This “proof” was required even if the woman was celibate, lesbian, had a sterile partner, or was in a situation not conducive to reproduction (e.g., being in an intensive care unit).19

None of these sorts of restrictions are placed on men in clinical trials because men are rarely thought to transmit harm to fetuses. What is particularly egregious is that “even when studies were restricted to men because of known teratogenicity of the drug studied, the reproductive control required was for female partners of subjects … No mention of abstention, vasectomy, or sterility as a requirement to prevent fetal exposure by male subjects was included.”20 The targeting of women’s bodies (the female partners of subjects) in this situation rather than men’s bodies (the actual research participants) shows that while researchers recognize that men can harm fetuses, they refuse to hold men responsible for such harm. Instead, the responsibility for preventing harm is transferred to women, as is the implication of causal responsibility. Placing the onus on women to prevent fetal harm makes women seem causally responsible and hence blameworthy for any harm that does occur since it insinuates that they are the only ones with the power to stop such harm.

The cultural belief that only women cause fetal harm is not limited to clinical trials, but is also seen in public life. For example, warnings on alcohol bottles caution only against pregnant women drinking. There is no similar warning for men seeking to become fathers, though “paternal alcohol use has been found to cause low birth weight and an increased risk of birth defects.”21 Nor are there any warnings about all the other harms that occur due to alcohol consumption, harms that often cause more overall damage and affect more people, such as drunk driving and crime. Although illegal in the United States thanks to the 1991 unanimous Supreme Court decision International Union versus Johnson Controls Inc., the UK still permits employers to exclude women from certain occupations if there is potential harm to potential fetuses. Here again, women, rather than others, namely their mostly male employers, are held responsible for fetal harm: “the removal of the women, rather than the chemical is thus the solution to avoiding the risk.”22 No workplace chemical has been outlawed because of its effects on women’s reproduction, yet there is a double standard: The pesticide dibromodichloropropane was banned because of its harmful effects on male reproduction.23

As these examples show, the message that women can (and do) cause harm to fetuses is ubiquitous. More insidiously, these examples reveal that men are not usually viewed as causally responsible for fetal harms. Women, in contrast, are viewed as in need of constant protection because “maternally mediated fetal risks are assumed to be certain and known”; that is, women are “scientifically-proven” causal agents of fetal harms.24 Men are typically not seen as causally responsible for fetal harm because of various dominant cultural narratives, including they are not thought to be able to prevent such harm, there is denial that men’s bodies can cause harm, and men are usually not associated with reproduction. By upholding and perpetuating gendered beliefs, the media contributes to why men are not viewed as causally responsible for fetal harm. Cynthia Daniels analyzed newspaper coverage of fetal harm over a ten-year period and, not surprisingly, found a huge discrepancy in the number of articles about women (over 200) versus men (only 17).25

What is interesting to note is that there is scientific evidence that many of the actions believed to be most risky are not as dangerous to fetuses as the way they are publically presented. For example, a study linked the prevalence of fetal alcohol syndrome (FAS) to poor nutrition, a result of low socioeconomic class: Women who consumed at least three drinks a day but ate balanced diets experienced a rate of FAS of only 4.5 %, while women who drank the same amount and were malnourished had an FAS rate of 71 %.26 While this study uncovers that FAS is mainly just a risk for poor women, women of all classes are targeted by the medical establishment and the public to abstain from alcohol while pregnant for the sake of their fetuses. It is not surprising that this study has not gotten much media attention, as it goes against the dominant norm that women should make extreme sacrifices to prevent their permeable bodies from causing fetal harm, even if the possibility for such harm is close to zero.

In presenting these examples, I do not mean to suggest that women’s actions cannot lead to fetal harm. Rather, my point is that the risks of certain actions have been overstated or that there is no evidence to confirm such harm. It is ethically troubling that women are typically targeted and blamed women for fetal harm, even when there is not adequate evidence. Yet, men are rarely reproached for their behavior even when there is scientifically confirmed, unexaggerated information that it can lead to fetal harm. Studies documenting paternal-fetal harms began in the 1980s, and in some cases earlier, yet this information is still not widely disseminated.27 As Koren et al. (1989) explain, this lack of dissemination is partially due to editors of science journals rejecting papers that violate scientific “believability”; in this case, the claim that men can cause fetal harm is not believable.

Applying the Principle of Nonmaleficence to Men and Responsible Reproduction

Equipped with the knowledge that men’s actions, like women’s, can cause fetal harm, I now apply the principles of nonmaleficence and beneficence to men and responsible reproduction. According to a simple justice argument (that like cases should be treated alike), if we hold women responsible for behavior that can cause fetal harm, then we should do the same for men. Since men’s role during gestation is limited, it is more difficult to make a case that fetuses deserve positive rights from their fathers28 while in utero, except in the case where men actively want to be fathers. I consequently will limit my discussion of the rights fathers owe their fetuses to negative rights. It is easier to claim that children deserve positive rights from their fathers and indeed some has been written on this topic, especially regarding the economic and social rights children should receive from their fathers.29 Since many fetuses become children, it would be shortsighted to neglect the rights of the children. The harm men can cause to their potential children is not limited to the act of conception. In refusing economic and social support—both positive rights—men are also causing harm to their potential children that could be avoided by contracepting. In the next two subsections, I explore the moral duties of men who do not want to father a child and those of men who are actively trying to father a child. I restrict my discussion to heterosexually active men for the sake of simplicity.

Men Who Do Not Want to Father a Child

Since much of paternal-fetal harm occurs prior to conception (i.e., due to damaged sperm), if men are to act according to the principle of nonmaleficence, then they either need to cease behaviors that can cause harm or they need to prevent conception. For men who are not interested in fathering a child, the simple answer is to use contraception as it prevents harms to future fetuses by preventing the creation of future fetuses, thereby achieving two goals (preventing paternal-fetal harm and avoiding fatherhood) with just one action.

At first glance, the claim that men should contracept to prevent harm to future fetuses and children might seem too demanding and perhaps even unfair, but I hope to show that the benefits of contracepting outweigh the disadvantages, inconveniences, and risks. Men have two types of contraception available to them: vasectomy, which is a permanent method, and male condoms, which are a reversible barrier method. The costs, side effects, extent of medical involvement, and degree of bodily invasion are minimal for vasectomy, especially compared to female contraceptives, and even more nominal for condoms. Vasectomy is approximately a third of the price of tubal ligation and is much cheaper than female hormonal methods over a lifetime of use. Furthermore, the side effects of vasectomy are less in number and severity than for tubal ligation and female hormonal methods.30 Male condoms are one of the cheapest types of contraception, require no medical involvement or bodily invasion, and have only one health-related side effect: allergy.31 One significant disadvantage of male condoms is that their failure rate in actual use is 16 %, much higher than most hormonal female methods.32 For men who are not ready for vasectomy, which has an extremely low failure rate, the only reversible option available to them is the male condom; the lack of long-acting, reversible male methods simultaneously diminishes and enhances men’s reproductive autonomy.33

Even though the burdens men experience in contracepting are fewer and less serious than those women experience,34 this fact alone is not a compelling enough reason for why men should contracept to prevent harm to potential fetuses and children. However, in comparing the burdens men experience in contracepting with the possible harm to potential beings if men do not contracept, claiming that men should contracept does not seem unreasonable. Not contracepting can cause health, social, and economic harms for resulting fetuses and children that are significantly greater than the burdens of contracepting. For instance, the birth defects and low birth weight that are caused by paternal smoking seem to be greater problems than spending $100 a year on condoms and dealing with the possibility that condoms may decrease sexual spontaneity and sensitivity. I do not want to completely minimize the demands of contraceptive responsibility, as its associated burdens can take a toll on men. My point is that these burdens are minimal in comparison with the harms men can cause to potential children and fetuses if they do not contracept. In short, the burdens and limitations men face in contracepting are justifiable because they are limited—in number, severity, and duration—and they prevent causing significant harm to others.

Furthermore, using contraception is not just about preventing harm to others35; it is also about preventing harm to oneself. Using male condoms protects men (and women) against STIs. Contracepting also prevents unintended pregnancy. While unintended pregnancy does not directly cause health-related harms in men since they do not experience the bodily changes of pregnancy,36 men can have indirect health harms due to pregnancy, like stress and insufficient sleep. Additionally, unintended pregnancy can entail economic and social harms for men. As I will discuss later in the paper, raising a child is quite expensive. Channeling their money to this end can adversely affect men’s quality of life and even deplete their financial resources. If the biological parents are not living together, determining the father’s financial contribution can be a legal, economic, and social nightmare. The role of father can also negatively affect men’s relationships with others and in particular the mother of the child and his own family. For instance, he may be pressured to stay with or live with the mother or there may be family tension if his parents want to be involved with their grandchild’s life, but he does not want such an active role as father. In sum, using contraception is a way for men to prevent harm to themselves.

Recognizing that men contracept not only to avoid harming potential fetuses but also for themselves minimizes the degree of sacrifice men are thought to be making for the sake of potential fetuses and children. Though many men contracept in order to prevent harm to potential beings, the desire (or even moral duty) to protect themselves also typically factors into why men contracept. Having two reasons rather than one to contracept means more support for one’s decision. Yet, if one of the reasons men contracept is to protect themselves, then we cannot affirm that men are acting in a self-sacrificing way. In other words, men who contracept in part to protect themselves against STIs and/or unintended pregnancy are not being self-sacrificing. The reason this is worth noting is that when we are motivated by self-interest, even if it is only partially, then it is more difficult to assert that we are making undue sacrifices for others. We cannot parse out the burdens we accept only to prevent harm to others from the burdens we take on to prevent self-harm. Hence, determining whether burdens are unfair according to the principle of nonmaleficence is more challenging since there are two intertwined reasons for making such burdens: preventing harm to others and preventing harm to ourselves. That men contracept for themselves as well as others means that the degree of burden they take on for others is not so great. This point, coupled with my previous claim that the burdens men take on in contracepting are justified in comparison with the possible burdens to potential beings, leads me to conclude that men contracepting is not an unjust situation given the harms they prevent to both themselves and others.

Even if people agree that contraception is a reasonable way for men to preventing harms, they may still oppose holding men responsible for harms, especially fetal harms, because they do not think men know their behaviors can cause them. As Daniels’s media analysis shows, there is a lot of information about the ways in which women can harm fetuses, while information about men causing fetal harm is scarce. Most accounts of causal responsibility affirm that people should only be morally responsible for the consequences of their actions that they can foresee; those consequences that reasonable people have reason to expect may occur.37 Yet, while some types of ignorance may absolve individuals from moral responsibility, other types do not. As many philosophers writing on epistemologies of ignorance argue, ignorance is often “actively produced for purposes of domination and exploitation.”38 Especially in a world filled with oppression, ignorance is typically not neutral or accidental. Marilyn Frye argues that ignorance “is not a simple lack, absence or emptiness, and it is not a passive state…[it] is a complex result of many acts and many negligences.”39

Men’s ignorance surrounding paternal-fetal harm is also not a simple lack or an accident, but rather is a series of actions and omissions that reinforce men’s domination. Although there are patriarchal social forces at play that shape men’s beliefs and behavior, men are also morally culpable for their complicity with oppressive power structures. That many men are blinded by their privileged positioning is not a good reason to excuse them of moral responsibility. Men who resist dominant gender ideologies may come to suspect that women are not the only ones who can cause fetal harm; men can too. Even if men do not challenge gender ideologies, if they critically reflect on well-known scientific findings, such as that secondhand smoke is dangerous to others, they may conclude that their actions can also be harmful to potential and actual fetuses.

Some may oppose holding men morally responsible for fetal harm because they believe it is unreasonable to expect men to know about the possibility of paternal-fetal harm given the dearth of media coverage about it. However, this objection carries less weight as information about paternal-fetal harm becomes more commonplace. I found eight mainstream newspaper articles on this topic (using Lexus-Nexus) published during the two-month period of February through April of 2008, whereas Daniels found only seventeen articles during a ten-year period from mid-1980s to mid-1990s.40 Additionally, of the articles I found, the main topic of most of these articles was paternal-fetal harm. Interestingly, the majority of these articles were not published in the United States, but in other English-speaking countries (the UK, Australia, and Canada). While I do not endorse my research as following the rigors of social science, that I was so easily able to find so many (relatively speaking) articles on paternal-fetal harm does indeed seem to indicate a significant change from even just 10 years ago. Perhaps, I was able to find so many articles because my search was international and other countries are more likely to publish stories on paternal-fetal harm. Even if this is the case (and it may well be as four of the articles were published by British newspapers), given the internet and our globalized world, information is more quickly and easily disseminated, which means important stories such as these will hopefully spread to the United States.

Although some may not be convinced that men should be held morally responsible for fetal harm because men may be ignorant that their actions can cause such harm, there are other types of harms men can cause to future beings (fetuses and children) that they can, without question, foresee. I now turn to economic and social harms rather than health-related bodily harms. Additionally, instead of focusing on harms to fetuses, I take a more long-term view and examine harms to potential children that result from men’s failures to contracept. For example, there are social harms to children by fathers who are not interested or not involved in their lives as well as economic harms that befall children of fathers who do not financially contribute to their well-being.41 I do not want to imply that children who do not know their fathers or do not have relationships with their fathers are always or necessarily socially harmed.42 Yet, some social science research has found that having an absent or uninvolved father increases the probability for a variety of social problems, such as behavioral problems, academic failure, unhappiness, mental health problems, and increased health risks.43 While some men who were not interested in having children (or at least not at that time or with that particular woman) become great fathers, men who do not want children are probably more likely to be “bad,” or simply not “good,” fathers than men who do want children. It is true that we cannot always foresee how we will respond to a future situation. However, our interest in a certain realm typically affects our success in that realm, as our interest motivates and commits us. Following this reasoning, men who are interested in being fathers have the advantages of motivation and commitment to parenting that will help them succeed as parents, whereas men who are not interested in being fathers do not, at least initially, share these advantages, which may make it more difficult for them to be “good” parents. In fact, their lack of interest in being fathers may lead them to have little to no involvement in their children’s lives.

Moreover, men who are not interested in being parents are probably less inclined to financially support their children. We generally prefer to spend our money on things and people we like, although this is often not possible because of financial obligations and basic needs (e.g., car payments, taxes, food). Indeed, we are usually happy to spend our money on people we care about, while we are reluctant to give money to others we do not know, do not like (or even just feel neutral about), or do not think deserve our generosity. If people prefer not to be parents—they do not like the role of parent and/or they do not like their child(ren)—they may resist giving money to their child(ren). And given the number of women who take their male partners to court to get child support, it seems that many men do indeed resist financially supporting their children (11,406 women were awarded child support in 2005 and ten times as many women as men sought governmental assistance in securing child support).44 Even men who are willing to financially support their children may be in no position to do so, as raising children is quite an expensive undertaking. According to the U.S. Department of Agriculture, the average cost of raising a child for 18 years (not including college) ranges from $143,790 to $289,380, depending on income.45 While not all parents are economically prepared for the cost of raising a child, people who are interested in and actively planning on becoming parents have probably reflected on their economic situation and possibly started financially preparing for a child. In contrast, for people who are not interested in being parents, the cost of raising a child is likely not something that crosses their minds and consequently they have not financially prepared for a child. Fathers’ lack of financial support can harm their children by placing them at risk for poverty or in poverty, with all of its associated harms. Beyond economic struggles, men’s lack of financial support can harm children due to the increased probability of a strained relationship between biological parents over money.

Because the dominant social norms for fathers include the roles of breadwinner and disciplinarian, men who do not fill these roles are often view themselves as and are viewed by others as unmanly.46 Furthermore, such men are thought to be harming their children not only because they do not contribute socially and/or economically, but also for a more subtle and sexist reason: Men who do not uphold their fatherly duties challenge both the norms of masculinity and the heteronormative, patriarchal norms of what it means to be a family. Challenging these dominant norms is often thought to be dangerous to children—it will teach children that it is acceptable, and even desirable, to resist gender norms. These same concerns are raised against other types of “nontraditional” families, such as single parent families, gay or lesbian families, and even against heterosexual families in which the woman works outside the home. While I am in favor of challenging gender norms within the family (as well as in general) and believe that doing so is beneficial to children, the dominant narrative is that families should consist of a heterosexual couples who follow standard gender roles and that families that deviant from this arrangement are hurtful to their children. This cultural understanding persists even though there is strong empirical evidence to the contrary.47

Although I do not think men’s lack of social and economic support is harmful to children because it challenges gender norms, the other possible consequences of uninvolved fathers I mention above (e.g., poverty, behavioral problems) are damaging to children. Additionally, there is a cultural narrative that men who are not socially or economically involved in their children’s lives harm the children through this omission. Negative terms like “absent father” and “deadbeat dad” are used by individuals, politicians, and the media to refer to men who do not adequately fulfill their fatherly duties. These terms reflect the social belief that fathers ought to be involved in their children’s lives. The U.S. government, moreover, upholds the importance of father involvement through laws and policies, such as child support. In 2005, the U.S. government proclaimed the need for more than just financial involvement from fathers by allocating $150 million each year to promote healthy marriage and fatherhood through the Healthy Marriage Initiative of the Deficit Reduction Act. The goal of this legislation is “to encourage healthy marriages and promote involved, committed, and responsible fatherhood.”48 Given the prevalence of the expectation of involved fatherhood (at least financially), it seems unlikely that men could genuinely not be aware of the cultural perception that absent fathers harm their children.

If men foresee that they would not be involved fathers, thus potentially harming their potential children, then they have a duty to contracept according to the principle of nonmaleficence. Some may object that it is misleading to compare bodily harms to social and economic harms because the former occurs from a onetime event before birth—the insemination of abnormal sperm—while the latter takes place continuously over a child’s lifetime. First off, it is worth pointing out that many of the bodily harms that occur during conception affect children throughout their lives (e.g., various birth defects) and not just during the fetal stage. Just as bodily harm can begin at conception, so too can social and economic harms. For example, pregnant women who do not receive emotional or financial support from their partners have a greater chance of facing situations that can adversely affect the fetus, such as stress and lack of prenatal care.49 Hence, bodily and social/economic harms are similar in that they can endure throughout a child’s life. However, proponents of this objection are right to point out that the majority of paternal-fetal bodily harm results from a single occurrence while social and economic harms are due to a series of individual actions. Yet, this difference does not diminish my argument. If anything, the recurrence of social and economic harms strengthens my claim, as, assuming a similar degree of harm, recurring harms seem more pernicious than onetime harms. In sum, since men know that harms often befall children who have absent fathers, men who think they will not be socially and economically involved in their children’s lives have a duty to contracept.

It is important to note that I am not making any suggestions about what men’s roles should be in their children’s lives after birth, or even after conception for that matter. My argument is merely that men have a duty to prevent harm to potential children by using contraception if their actions could cause harm. Beyond this, I do not make any normative claims about how the public and the government should respond to such men. I do not, for example, seek to answer the questions of whether such men should be held responsible for fetal harms if they use contraception that failed, or whether the government should mandate child support from unwilling fathers. Careful responses to such questions merit their own papers.50 Instead, my focus is on men’s responsibility to prevent harm to their potential children. Men whose behavior, including their future behavior, could be harmful to their potential fetuses and children have a moral duty to prevent such harm by contracepting.

Men Who are Actively Trying to Father a Child

Men who are autonomously and intentionally trying to father51 a child have a responsibility to prevent harm to and promote the welfare of their future child in order to act according to the principles of nonmaleficence and beneficence. Men who do not think they can abide by these principles have a moral duty to contracept. In other words, if men know that their actions have the potential to harm their fetuses and/or their future children, they ought to contracept even if they want to become fathers. I do not want my argument here to be misconstrued as stating that only certain people are worthy of and thus should be allowed to reproduce. I reject reproductive paternalism: permitting the government, the medical establishment, or anyone else to make reproductive decisions for others or punish people for “bad” reproductive choices and outcomes. Yet, disagreeing with reproductive paternalism does not rule out the moral claim that people should not become parents if they know that their behavior has the potential to harm their fetuses and future children. For example, should a man who is a smoker have a duty to contracept to prevent the possibility of low birth weight and birth defects in his future children? Should a man who works an hourly job for minimum wage who is constantly in jeopardy of losing his job due to downsizing have a duty to contracept to protect his potential children from economic uncertainty and possible poverty? Should a man who travels for work and is only home on weekends have a duty to contracept because his potential children might feel socially abandoned?

In response to these questions, let me first state that I recognize that various factors, including ones beyond people’s control like poverty and arguably drug addiction, affect people’s ability to adhere to the principles of nonmaleficence and beneficence. Because of the social circumstances that many disadvantaged people face, they may not be able to uphold the principles of nonmaleficence and beneficence in the same way or to the same degree that privileged people can. For instance, people who are poor are more likely to struggle to provide clothes, shelter, food, material goods, and so on for their children than people who are wealthy. It is important to acknowledge that being a good parent involves more than a focus on harm. Even though the men in the examples above have the potential to cause harm to their fetuses and children, they could otherwise be excellent fathers. Sara Ruddick (1989) posits three facets of good mothering: preservation (meeting children’s basic needs), nurturance (meeting children’s emotional and psychological needs), and inclusion (preparing them to be part of their social world). If men are able to mostly or fully meet these three criteria, then they are probably good fathers (assuming we think that the qualities used to define a good mother are the same as those to define a good father).

But even if we conclude that the men in the three examples above would otherwise be good fathers according to Ruddick’s definition, should they still have a duty to contracept because of their increased probability to harm their fetuses and future children? I am hesitant to make a universal claim that in situation X all men should contracept because such an assertion fails acknowledge people’s different social positioning. Indeed, my worry with having a blanket interpretation of what it means to adhere to the principles of nonmaleficence and beneficence is that this interpretation will reflect the values of the dominant group. Groups who do not meet the white, middleclass, able-bodied, heterosexual norm would likely be prohibited or discouraged from reproducing (through laws, denial of rights, stigma, normalization, etc.).

Instead of enumerating all the situations in which people should contracept even if they want to have children, a better way to prevent harm to fetuses and children is to educate the public about potential risks. Equipped with this knowledge, people can make autonomous and informed decisions about reproduction that respects their cultural beliefs. This suggestion does not absolve people of reproductive responsibility. People who want to have children still have a moral duty to follow the principles of nonmaleficence and beneficence. However, they are the ones who determine what it means to uphold these principles, and whether they are capable of doing so given their individual circumstances. If people do not think they can adequately maintain these principles, then they have a moral duty to contracept even if they want to have children. Some may be concerned that allowing people to make subjective decisions about what counts as following these principles will increase the probability of “bad” choices. While there is no doubt that letting people autonomously make decisions can result in “bad” choices, I think permitting people the autonomy to make reproductive decisions on their own is a better alternative than a top-down method that coerces or mandates the forms of acceptable reproductive behavior. My suggestion does not prohibit the government, medical establishment, or organizations from educating people about how their behavior can harm their fetuses and children and aiding people in making responsible reproductive decisions. In fact, I encourage such involvement, as it would be a real boon to individuals and society overall while avoiding reproductive paternalism.

In addition to the concern that people will make “bad” reproductive choices, there is also a worry that my position leads people to hold individuals responsible for every small action they take that has the potential to cause fetal harm. Although my position does not inherently entail such extreme measures, it is true that my position allows people the freedom to endorse such measures (e.g., the social norm that women should monitor every little thing they do to ensure that they are doing what is best for their fetuses and children). While some may suggest that this is a problem with my position because I support people making their own reproductive decisions, including what counts as harm and how to act to prevent it, I contend that this is a problem with our dominant cultural values. That is, allowing people reproductive autonomy is not the cause of extreme decisions; the social ideologies that lead to such decisions are. Although reducing people’s reproductive autonomy would probably generate a particular desired outcome (i.e., the reproductive decisions that the government and/or other organizations endorse) and might lead to a shift in dominant ideologies, this approach is coercive and unjust.

In sum, men have a moral duty to contracept if they believe their actions have the potential to harm their future fetuses and children. What degree of possibility for harm is enough for people to contracept? For example, is a ten percent chance of birth defects significant enough for people to have a moral duty to contracept? Again, I believe this decision is best left up to individuals. However, as stated above, I think other agents—the government, medical establishment, and organizations—should educate people about these risks so that people can make informed decisions that reflect their personal values.

Conclusion

Reproduction is generally associated with women, and thus, it is not surprising that when most people think about fetal harms, they assume only women can cause them. However, as I have pointed out and something that is becoming more common knowledge is that fetal harm can also be the result of the future father’s actions prior to conception and during pregnancy. Yet, paternal-fetal harm is rarely discussed in the bioethics literature. One of my goals in this paper was to begin a more gender-specific discussion about what it means for men to responsibly reproduce. I have done this by drawing on the principles of nonmaleficence and beneficence, which are commonly evoked in broader discussions of reproductive responsibility. I argued that men have a moral duty to use contraception if their behavior—past, current, or future—could lead to health-related, economic, and social harms for the potential fetuses and children who result from their unprotected sexual behavior. Hopefully, this paper will spark more conversations about paternal-fetal harm within the field of bioethics (and beyond) and will lead to further (and much needed) work on developing a rich conception of men’s reproductive responsibility.

Footnotes

  1. 1.

    More specifically, I limit the type of health-related harms I discuss to those caused by parental behavior (e.g., parental smoking leading to low birth weight).

  2. 2.

    Van Der Boukje and de Beaufort (2011, 452).

  3. 3.

    Arras and Blustein (1995, S27).

  4. 4.

    Ronald Dworkin (1981, 293).

  5. 5.

    Arras and Blustein (1995).

  6. 6.

    Cassidy (2006, 47).

  7. 7.

    Sparrow (2011, 32).

  8. 8.

    Daniels (1997, 597).

  9. 9.

    Daniels (1997, 579).

  10. 10.

    For both historical and current examples, see Kukla (2005).

  11. 11.

    Daniels (1997, 583).

  12. 12.

    Sheldon (1999, 130).

  13. 13.

    Kass v. Kass (1998).

  14. 14.

    Sarto (2004).

  15. 15.

    Cain et al. (2000, 862).

  16. 16.

    Ibid. 863.

  17. 17.

    For more on the lack of trust for women to use contraception, see Campo-Engelstein (2012).

  18. 18.

    Ibid. 862.

  19. 19.

    Ibid. 864.

  20. 20.

    Cain et al. (2000, 864); emphasis added.

  21. 21.

    Daniels (1997, 597).

  22. 22.

    Sheldon (1999, 144).

  23. 23.

    Ibid.

  24. 24.

    Daniels (1997, 602).

  25. 25.

    Ibid. 601.

  26. 26.

    Daniels (1997, 587).

  27. 27.

    Daniels (1997, 579).

  28. 28.

    While I think it is problematic to refer to pregnant women as mothers and their male partners as fathers, I use such language due to the lack of better terms that are not awkward.

  29. 29.

    Onora O’Neill and William Ruddick’s (1979) edited collection is an early example.

  30. 30.

    Knight and Callahan (1989, 286–287).

  31. 31.

    Medicinenet.com (2008).

  32. 32.

    Hatcher et al. (2004, 245).

  33. 33.

    Campo-Engelstein (2011).

  34. 34.

    Campo-Engelstein (2011).

  35. 35.

    Although I have limited my discussion to harms experienced by potential fetuses and children, unintended pregnancy can also lead to harms for women, a topic which is outside the scope of this paper.

  36. 36.

    Kraft (2012).

  37. 37.

    See, for example, Gerald Dworkin (1987).

  38. 38.

    Sullivan and Tuana (2007). See their edited collection for some excellent articles on race and epistemologies of ignorance.

  39. 39.

    Frye (1983, 18).

  40. 40.

    The eight articles on paternal-fetal harm are by Goldberg (2008), Jha (2008), Laurance (2008), Macrae (2008), No author (2008a) (Chromosomal abnormalities), No author (2008b) (Fathers who smoke ‘hit future generations’), Smith (2008), Taylor (2008).

  41. 41.

    Following empirical evidence, my assumption here is that, in situations where the biological parents are not living together, children will generally live with their mothers.

  42. 42.

    My concern in making this argument is that it will be misconstrued and used to buttress claims that children need to be raised in heterosexual, two parent households in order to avoid harm. I do not agree with that claim. I think the reasons fathers (and mothers) can harm their children are complex and are beyond the scope of this paper. What I want to make clear is that just because absent or uninvolved fathers can harm their children, this does not mean that present and involved fathers do not cause harm or provide an overall better environment for their children. Furthermore, as I discuss later in the paper, there is strong evidence that children raised in nontraditional families are just as well adjusted (and in some instances more so) than children raised in traditional families.

  43. 43.

    Amato (1994), Boyce et al. (2006), Scharte et al. (2012).

  44. 44.

    U.S. Census Bureau (2005).

  45. 45.

    Lino (2007, ii).

  46. 46.

    Coughlin and Wade (2012).

  47. 47.

    See, for example, Wainright et al. (2004), Golombok and Badger (2010) and Brewaeys and van Hall (1997).

  48. 48.

    U.S. Department of Health and Human Services (2008).

  49. 49.

    Glazier et al. (2004).

  50. 50.

    For interesting responses to these questions, see Elizabeth Brake (2005) and Sally Sheldon (2003).

  51. 51.

    It is interesting to note the difference between the verb “to father” and “to mother.” The former, and its synonym “to sire” both have to do with impregnating a woman—they are limited to the one time event of fertilization. In contrast, the latter refers to a life-long process of caregiving and nurturing.

Notes

Acknowledgment

I'd like to thanks Lisa Schwartzman for reading earlier drafts of this paper. I'd also like to thank my anonymous reviewers for their helpful comments.

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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Alden March Bioethics Institute, Department of OBGYNAlbany Medical CollegeAlbanyUSA

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