How to think about ethics: An introduction

During the course of the next six weeks, we’ll encounter a number of choices that people often have to confront when thinking about assisted reproduction and genomic medicine in general. We thought it would be helpful therefore to introduce a few concepts to help us structure our thinking around the issues we’ll be discussing as we go through the course.

There are many ways of thinking about ethics, and no course can do justice to all the different ways of conceiving of ethical principles. This course will take as its starting point the distinction between rights, on the one side, and harms, on the other. Whilst not exhaustive by any means, this distinction is useful, because we often encounter conflicts of rights or the balancing of harms.

One example of the conflict of rights is what we will discuss in Week 3 when we look at the ethics of donor-conception and anonymity. Here, the right that the parent has to privacy is in conflict with the donor-conceived child’s right to know their biological heritage.

An example of the balancing of harms might be the use of a surrogate within the context of international contract pregnancy, a topic we will cover in Week 4. Here there are those who argue that we need to weigh the harm that the surrogate might suffer in the course of the contract pregnancy, with the harm she might suffer whilst not working or working in a more dangerous job.

Thinking of ethics in terms of rights and harms is also useful when these come into conflict with each other, that is when one person’s rights might cause harm to someone else.

Below you will find a glossary of some of the key terms used throughout this course. The glossary is not exhaustive and you might find that you have a different interpretations of some of the terms included below. These concepts are not rigid structures, and can mean slightly different things in different contexts.

• Autonomy
  Within ethics, autonomy expresses the condition of being free from external control or influence. Being autonomous means acting on motives, reasons, or values that are one’s own. In the clinical context, autonomy is crucial because without it, a person is not independently able to consent to treatment. Doctors often try to find ways to support and increase a patient’s autonomy, as this enables them to make informed choices.

• Reproductive freedom
  Reproductive freedom means the freedom to make one’s own decisions about one’s body and one’s fertility options. The concept is closely related to autonomy, and is indeed sometimes referred to as ‘reproductive autonomy’. When a person is said to exercise their reproductive freedom, what is meant is usually that their rights to family planning, good-quality reproductive healthcare; and their ability to make informed reproductive choices is guaranteed. In this course, we will encounter reproductive freedom in almost every week, perhaps most saliently in Week 2 when we will ask the question whether egg freezing increases or decreases a woman’s reproductive freedom.

• Rights-based thinking
  Rights-based thinking is an approach to ethics that takes as its starting point that every individual has certain rights. These are not earned but follow from being a sentient human being. Rights have a long history, but it was in the 20th century that rights were given prominent status, especially after the United Nations passed the Universal Declaration of Human Rights in 1948. What makes a right a right can sometimes be a thorny question, as we will see in Week 3 when we discuss whether there is a right to know one’s genetic origin.

• Harms
  When we speak about harms in the context of ethics, we usually imply that whether something is ethically right or wrong depends on the consequences of an act. In fact, this approach is sometimes called consequentialism, by which we mean the focus on potential harmful consequences as a guide to the correct ethical decisions. The founder of this school of ethics is none other than the English philosopher Jeremy Bentham (1747–1832), whose life-like statue sits sits at the end of the South Cloisters at UCL. There are many types of consequentialism, and if you want to read more about this, have a look at the relevant article in the Stanford Encyclopedia of Philosophy.

This course is intended for anyone with an interest in modern fertility medicine. This is not a philosophy course, but rather intended to give you an insight into the stories and perspectives of stakeholders from a range of backgrounds. We hope the course will give you some useful thinking tools, as well, so that we can all think more clearly about these urgent issues.