Bioethics. Группа авторов

this example. Most of us hold a person‐affecting, not an impersonal, principle. If we reject Hare’s view, there are cases where this makes a great practical difference. But if we accept Hare’s view, it makes no difference. The person‐affecting principle, when combined with Hare’s view, leads to the same conclusions as the impersonal principle.

      Some of these conclusions are, as I said, striking. I shall now begin to argue towards them. We can avoid these conclusions only if we both accept what I shall call “the restriction of our principles to acts which affect people” and claim that our acts cannot affect possible people. Hare denies the latter; I shall be denying the former. The person‐affecting restriction seems to me, at least in any natural form, unacceptable.

      We can start with one of the two questions that I postponed. Can it be in our interests to have been conceived? Can we benefit from receiving life?

      If we can, the childless couple are again at fault, even on person‐affecting grounds – for if they have children they will be benefitting people, as principle (2) tells them to do.

      We might say: “But we can only benefit if we are made better off than we would otherwise have been. This couple’s children wouldn’t otherwise have been – so they cannot benefit from receiving life.” I have doubts about this reasoning. For one thing, it implies that we cannot benefit people if we save their lives, for here too they wouldn’t otherwise have been. True, there are problems in comparing life with non‐existence. But if we assume that a person’s life has been well worth living, should we not agree that to have saved this person’s life many years ago would be to have done this person a great benefit? And if it can be in a person’s interests to have had his life prolonged, even, say, just after it started, why can it not be in his interests to have had it started?

Here is a second problem. If we cannot benefit a person by conceiving him, then we cannot harm him either. But suppose we know that any child whom we could conceive will have an abnormality so severe that it will live for only a few years, will never develop, and will suffer fairly frequent pain. It would seem to be clearly wrong to go ahead, knowingly, and conceive such a child.⁴ And the main reason why it would be wrong is that the child will suffer. But if we cannot harm a child by giving it a life of this kind, then this reason why the act is wrong cannot be stated in “person‐affecting” terms. We shall have to say, “It is wrong because it increases suffering.” We should then be back with half of the impersonal principle; and it will be hard, in consistency, to avoid the other half. (We might perhaps claim that only suffering matters morally – that happiness is morally trivial. But this position, though superficially attractive, collapses when we think it through.)

      We have been asking whether the act of conceiving a child can affect this child, for better or worse. If we answer “Yes,” the person‐affecting restriction makes no difference; principle (2) leads to the same conclusions as principle (1). We may therefore wish to answer “No” – but to this we have found objections.

      The problem here can, I think, be solved. We can state the person‐affecting principle in a different form:

      1 It is wrong to do what, of the alternatives, affects people for the worse.

      We interpret (3) so that if people fail to receive possible benefits, they count as affected for the worse. If we adopt principle (3), we can afford to allow that conceiving someone is a case of affecting him. Since failing to receive benefits counts as being affected for the worse, principle (3) still tells us – like principle (2) – to do what benefits people most. But there is one exception. To the one benefit of receiving life (3) – unlike (2) – gives no weight. For when we fail to give this benefit, there isn’t an actual person who fails to receive it – who is thus affected for the worse. (I am now assuming, you remember, that we cannot affect possible people.)

      Most of us, I claimed, think there is nothing wrong in not having children, even if they would have been very happy. But we think that having children who are bound to suffer is wrong. Principle (3) supports this asymmetrical pair of judgments. It supports our view that the Childless Couple did no wrong; but it also supports our view about “wrongful conception” – for the child here is an actual person affected for the worse.

In the move from (2) to (3), a natural principle is revised in a somewhat artificial way. But this revision does not seem to drain the principle of its plausibility. All the revision does is this. When we are choosing what to do, we are told to aim, not to achieve the outcome where people are better off, but to avoid the outcome where they are worse off. This procedure, adding up the “minuses,” seems to be just as general and as plausible as the other, adding up the “pluses.” So we are not, in moving to (3), “tailoring” our principles in an ad‐hoc way. And the justification for the move is that only principle (3) (combined with the assumption that conceiving is affecting) gives support to the asymmetrical judgments that we find plausible.⁵

      So far, so good. But I shall now argue that the person‐affecting principle needs to be more drastically revised. This may drain it of its plausibility.

      Consider the following case, which involves two women. The first is one month pregnant, and is told by her doctor that, unless she takes a simple treatment, the child she is carrying will develop a certain disability. We suppose again that life with this disability would probably be worth living, but less so than a normal life. It would obviously be wrong for the mother not to take the treatment, for this will disable her child. And the person‐affecting principle tells us that this would be wrong. (Note that we need not assume that a one‐month‐old foetus is a person, for there will be a person whom the woman has affected for the worse.)

      We next suppose that there is a second woman, who is about to stop taking contraceptive pills so that she can have another child. She is told that she has a temporary condition such that any child she conceives now will have just the same disability; but that if she waits three months she will then conceive a normal child. It seems clear that it would be wrong for this second woman, by not waiting, to deliberately have a disabled rather than a normal child. And it seems (at least to me) clear that this would be just as wrong as it would be for the first woman to deliberately disable her child.

But if the second woman does deliberately have a disabled child, has she harmed him – affected him for the worse? We must first ask: “Could he truly claim, when he grows up, ‘If my mother had waited, I would have been born three months later, as a normal child’?” The answer is, “No.” If his mother had waited, he would not have been born at all; she would have had a different child. When I claim this, I need not assume that the time of one’s conception, or the particular cells from which one grew, are essential to one’s identity. Perhaps we can suppose that I might have been conceived a year later, if we are supposing that my parents had no child when they in fact had me, but a year later had a child who was exactly or very much like me. But in our case the child the woman would have if she waits would be as unlike the child she would have now as any two of her actual children would be likely to be. Given this, we cannot claim that they would have been the same child. (To argue this in another way. Suppose that I am in fact my mother’s first child and eldest son. And suppose that things had gone like this: she had no child when I was in fact born, then had a girl, then a boy. Can I claim that I, her first child, would have been that girl? Why not claim that I, her eldest son, would have been that boy? Both claims are equally good, and so, since they cannot both be true, equally bad. So, if she had waited before having children, I would not have been born at all.)⁶

      The second woman’s disabled child is, then, not worse off than he would otherwise have been, for he wouldn’t otherwise have been. Might we still claim that in deliberately conceiving a disabled child, the woman harms this child? We might perhaps claim this if the child’s life would be not worth living – would be worse than nothing; but we have assumed that it would be worth living. And in this