Utilitarianism and the right to a child

Do we have a right to a child? Here are some utilitarian reflections.

The right to conceive is one of the few remaining absolutes (in the UK, if not in China). You have a test in some other key areas of our shared existence, but not to be or become a parent. You can be any age, race, income group, any moral or religious disposition, just as long as you are fertile. Then you can keep your baby if you want, just as long as you don’t fall foul of the social services. No wonder that the 18% of women who have difficulty conceiving (infertility is defined in law as “we’ve been trying hard for two years and … nothing”) feel deeply that life’s not fair.

However when we examine infertility treatment we discover it’s even less fair. To begin with, a morality clause was amended into the Embryology Act (1990) by the family values lobby.

“A woman should not be provided with infertility services unless account has been taken of the welfare of any child who may be born as a result of the treatment, or of any other child who might be affected by the birth”.

Hospitals have an ethics committee to decide on difficult cases: in one year King’s College Hospital in London treated 1,500 women, had concerns over 77 of them as being in some way “unsuitable” and refused just six. So the right, it seems, is only denied in a very small number of cases. Here are the full nice guidelines.

Is this another example of how utilitarian ethics has infected social legislation? Professionals are asked to judge on likely consequences (as with the Abortion Act, although in this case with little rigour). But one of the first things we notice about utilitarian ethics is the difficulty we have in judging consequences. Unintended and unforeseen consequences often apply and no-one has the omniscience to identify exactly how the future will unfold. So women’s past life, lifestyle or livelihood is being scrutinised in order to judge whether she is likely to be a suitable mother.

In addition, the right to infertility treatment is something that exists only for the rich. A cycle of in-vitro treatment costs between £5,000 and £10,000. So the treatment is rationed by the NHS. Some hospitals insist a woman must be under the age of 38, others stipulate 35, yet others, an age range of 32-35. Different hospitals have different policies on how many cycles of treatment are allowed. Research in 1998 revealed a huge disparity in regions of the country, from 21.3 cycles per 100,000 people in Scotland to just 0.3 per 100,000 people in the south-west of England. In 2010 it was admitted that within Soctland there were huge discrepancies – they discovered that couples in Lanarkshire can access treatment in six months whereas in the Lothians area, patients can wait for three years. You do get three cycles of treatment in Scotland, whereas in most of the UK you have the chance of just one. But only 40 per cent of the 402 primary health care trusts offer free IVF treatment, so your chances of getting that one cycle are less than 50:50.

It is estimated that to give three cycles of treatment to all eligible women under 35 would cost £85m, which is £85m fewer hip replacements, or screening programmes, or vaccinations. Should free treatment be given at all to something which isn’t a clinical need? Again on utilitarian grounds, that is very hard to answer – how do you weigh the misery of infertility against the misery of not getting your dodgy hip replaced? One is a physical pain, the other an anguish of the spirit (can we have higher and lower pains to go with Mill’s higher and lower pleasures?). So you see, facts do have something to do with morality, and this is before we even have a chance to discuss the ethics of different types of treatment.

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