Public Health Ethical Aspects of Human Reproduction

1. Public Health Ethical Aspects of Human Reproduction Christian Munthe christian.munthe@gu.se

2. PH Ethics vs. HC Ethics HC Ethics OBJECT ISSUE 1 ISSUE 2 PH Ethics OBJECT ISSUE 1 ISSUE 2 Right? / Wrong? Right? / Wrong? HC staff patient population What policy / regulation of object? What policy / regulation of object? society society health institutions

3. Goals and restrictions of PHE are not about individual health states and means for attaining these used by individual agents Not as evident as in HCE that individual rights have foundational priority Respect for autonomy (of the person) less obvious as a default restriction PHE in a sense “prior to” HCE Population health (basic societal concern) Health equality (outcomes and/or opportunities) Cost-effectiveness Moderation to guard against counter-productivity (e.g. preservation of trust in PH institutions) Moderation to guard against inter-sectorial dysfunction (criminal law, economy, stability, peace…) Consequences

4. The size, composition and functionality of the population have a major impact on population health and other central societal concerns Longstanding societal interest in controlling sexuality, reproduction and child rearing + the family as a basic societal building block Infanticide, geronticide, eugenics, family & sexual policy/morality, pre-state customs re. power allocation and structures of reproductive collective units (the family), e.g. the patriarchal model Modern times: maternal and infant mortality, STD, contraceptives, abortion, prenatal testing, IVF + social security and uniform education systems supporting desired reproductive patterns. Misconceptions: sterilization policies, Ceausescu abortion policy Concern for individual reproductive rights and autonomy follow PH increases, rather than causes them? China 1 child policy – a necessary complement? Evironmental problems may impose new limits… Reproduction and Public Health

5. State responsibilities re. sexual health (HIV/AIDS in Africa) Dickens & Cook (2007) Effects of IVF on population health: reason for regulation Clemmit (2009) Family planning education for the sake of promoting individual autonomy Hale & Hale (2010) PROBLEMS: “sex is overrated” + healthy children of infected mothers as a PH resource Individual autonomy promotion not an obvious concern in PHE PHE concerns on IVF seem to go against the default reproductive liberty view developed in HCE General: unsystematic PHE framing & uncritical consideration of potential conflicts between PHE, HCE and other ethics concerns PHE literature on reproduction

6. Restricting reproductive liberty due to PH reasons 1 All individual liberty restrictions may not be possible to justify with the harm-to-others clause Accommodation of climate refugees may create a need for reduced nativity Reducing nativity to enable maintained material standard in environmental crisis PH reasons to control and regulate the IVF and genetic testing industry (avoiding the “picking up the pieces” effect) Crippling the private HC sector (IVF, PND, PGD, et cetera) with taxation to fund reduction of health inequalities Containment of PH emergencies structurally restricting individual reproductive choice Restricting reproductive liberty due to PH reasons 2 Promoting nativity to boost growth in developing countries Restricting nativity DITTO (possibly in environmental problem context) Eugenics / reproductive control DITTO (but is it a good way? Cf. sterilization….) Controlling reproductive behaviour as a means to social stability (does it work?) What is reproductive population health and how important is it? Right into the Parfit – Arrhenius mess? Can reproductive liberty be somehow given a role in the goals of reproductive PH? Equality of reproductive opportunities once a basic PH level is secured? Implications for sexual freedom… Examples & questions