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In this second edition of Genetic Dilemmas: Reproductive Technology, Parental Choices, and Children's Futures, Dena Davis explores the scope and limits of parental reproductive autonomy. Reproductive autonomy is by many perceived as being one of the leading values in reproductive genetic technology. It is usually defined as the right to control one's own procreation unless good and sufficient reasons exist for denying a person that control. The rationale behind this principle is that in a liberal democratic society, the presumption is that people should be free to make their own choices according to their own values. Although most will accept this (negative) right to control one's own procreation, it is less clear whether this also implies a positive right to assistance to realize those reproductive rights and a correlating duty of the physician.
Davis argues that parental decision making should be curbed when parental choices may infringe on the child's future autonomy. She conceptualizes the child's autonomy as, what Feinberg coined, “the child's right to an open future,” meaning a right to have one's future options kept open until one is capable of making one's own decisions. This implies that parents should not deliberately constrain the ability of their (future) children to make a wide variety of life choices when they are adults.
With this framework, she explores and reviews the recent developments in reproductive and genetic technologies, ranging from genetic testing of minors, embryo selection, and sex selection to reproductive cloning. She consistently argues that a potential infringement of a child's right to an open future forms an appropriate threshold for allowing certain practices. According to Davis, sex selection for nonmedical reasons should, for example, be discouraged because if future parents have such a strong preference for a certain gender that they go through techniques such as sperm sorting and artificial insemination, they are likely to raise the child against the backdrop of strong gender-role expectations. This kind of gender stereotyping would threaten to violate the child's right to an open future.
Another contentious issue extensively addressed by Davis regards the question to what extent parents may choose to have a deaf child, for example by means of IVF and preimplantation genetic diagnosis. This leads to an interesting review on the “disability debate,” including the question what disability actually is.
For a European reader, the debate on whether reproductive genetics should be regulated remains an intriguing one, because the European and US approaches toward (non)regulation are very different. In the last decades, many European countries accepted laws governing issues such as embryo research, sex selection, and genetic testing. Some laws were updated last years, such as the UK Human Fertilisation and Embryology Bill—which is included in this second edition.
This lucid and well-written book is accessible to a wide audience of readership—despite the fact that Davis does not avoid the philosophical conundrums inherent to the ethics of reproductive genetics. Particularly in the first part of the book, Davis frequently makes use of case examples. I would recommend this book to all people interested in the ethical complexities of parental and reproductive decision making, ranging from families and policymakers to genetic counselors and clinicians.