Parental Obligations and Bioethics: The Duties of a Creator
Bernard G. Prusak
Book Review by: Nuha Taysir Swaidan[*]
Parental Obligations and Bioethics: The Duties of a Creator investigates the obligations and duties that parents -who are considered as creators- bear by bringing a child into being. It develops different accounts to explain how parental obligations are acquired, then, it discusses the content of these obligations. These duties are extended to those that are respecting the child’s right to an open future. Moreover, it discusses the ethics of adoption, child support, surrogacy, gamete donation and prenatal genetic enhancement in regards to parental obligations. Finally, the book is closed with social and public responsibilities for children which are argued to be much more than those that are recognized.
Bernard G. Prusak is the author of Parental Obligations and Bioethics: The Duties of a Creator book that was published in 2013 by Routledge in Annals of Bioethics series. Prusak is a professor of philosophy and director of the McGowan Center for Ethics and Social Responsibility at King's College in Wilkes-Barre, PA, USA. He is specialized in ethics (theoretical and practical), philosophical anthropology, political and social philosophy. He has many publications in scholarly journals on the topics of parental obligations and children's rights, war, religious liberty, conscience, and the moral limits of markets. Additional to this book that will be reviewed, he published another book in 2016 which has the title of Catholic Moral Philosophy in Practice and Theory: An Introduction (1).
The following review provides a summary for the indicated book, a view for book reception and a critical evaluation of the book.
The book is divided into six main chapters, where the first five are mainly discussing the parental obligations for born children from different aspects, while the last chapter briefly outlines the public responsibility towards children. Prusak prefaces by two main positions of what sets obligations of creators towards their offspring which are the causal account and voluntarist account. In the causal account which Prusak supports, “one acquires parental obligations by having voluntarily acted in such a way that had the reasonably foreseeable consequence of bringing a child into being in the normal course of events”. While in the voluntarist account which is an opposing position, “one acquires parental obligations only by voluntarily assuming such obligations, whether explicitly or by so-called tacit acceptance”.
In chapter 1, Prusak discusses the “non-identity problem,” which states the impossibility of harming a child by bringing this child into being, where the only alternative option would be not to exist at all, with the exception of the condition where the child’s life would be extremely horrible which would make child’s life not worth to be lived. In response to this problem, Prusak stated that, even if one cannot have direct obligations for a non-existent child, not to procreate is still an obligation for those who rationally believe that they would be incapable to fulfill their obligations toward the child when created. For clarification, Prusak views the case of a couple who decides to conceive a child with the intent to give up the child for adoption. He claims that, a justifiable response of relinquish child for adoption can be in cases of those who realized after procreation that they are incapable to attain their parental duties; nonetheless, transferring these obligations to the adoptive parent does not completely protect from the harms and risks that may accrue to children who have perturbed relationship with their biological parents. Though transferring parental obligations to adoptive parents could be the best solution in cases of children who may be exposed to harms by their parents who are not committed to carry out their responsibilities, bringing a child into being with the intention to concede such obligations to adoptive parents holds the risk that those adoptive parents cannot be assured for their capability to fulfill their parental duties. In addition, such transferring denies the inherent value of the given biological relationship.
Prusak starts his defense for the causal account in chapter 2. In contrast to the view of Elizabeth Brake who argued that the term of “procreative costs” is exclusively means that parents are only obligated to bear the essential needs for survival such as nutrition and healthcare, Prusak argues that in addition to the basic needs, parents are also incur the responsibility of protecting the child from such risks, and helping the child to tolerate such burdens, that life itself will unavoidably bring to the child without his/her consent. Therefore, parental obligations go beyond those that prevent harms by providing essential needs to those that “provide, in person, support, warmth, and affection during the child’s minority and beyond.”
After Prusak’s theoretical defense and foundation of strong parental obligations that will be demanded by being involved in a voluntarily procreative activity, in chapter 3, Prusak continues his defense for the causal account by turning his discussion towards the controversial issue of abortion. Again, Prusak refutes Brake’s argument that advocates the idea that, if pregnant woman has the right to abort a fetus who has been procreated by consensual sexual activity, so a man who has been involved in such activity should have the right also to deny his presumed obligations to his offspring. If such an argument holds, the causal account of parental responsibilities would be undermined. In response to this argument, Prusak falsifies the idea of Judith Jarvis Thomson to defend abortion which Brake relies on, which is called the “famous violinist analogy.” He affirms a definite difference between the violinist case where unplugging oneself will lead to violinist death, and abortion where different procedures can be applied to kill the fetus and extract it from the uterus. Although there are several extractive abortion procedures that can lead to fetus death without direct killing, Prusak claimed that though extractive abortion seems to be similar to the case of letting die (violinist case), some of these abortion cases can be considered morally equivalent to killing. He elaborates this argument by stating that the ultimate cause underlying behind the violinist death is his kidney disease; whereas in extractive abortion, the definite cause that kills the fetus is the withdrawal of life support requirements which are necessary for fetus’s life, and such essential requirements are even acknowledged by Brake thought of “procreative costs.” Thus, the causal account position of parental obligations stands.
Further in chapter 4, Prusak disputes another challenge to the causal account which is the use of assisted reproductive technologies to procreate and bring a child into being. Gamete donation and surrogacy are the main practices that are discussed in this chapter, where gamete donors and surrogates appear to be arguably free from parental obligations in spite of their crucial causal role in bringing a child into being. Prusak counters that “intended or sponsoring parents, gamete providers, surrogates, and clinicians, technicians, and the like all incur procreative costs by doing what they do.” In his argument, he claims that helping would-be parents to procreate does not abolish the procreative obligations incurred by gamete donor or surrogate as they voluntarily participated in bringing a child into being. Through Prusak assessment of burdens that may result from the lack of social ties between children who are born by either gamete donation or surrogacy and their biological parents, the presented burdens cannot lead to the conclusion that such practices are inherently bad; nonetheless, gamete donation and surrogacy remain problematic issues for other reasons from Prusak’s perspective.
Then in chapter 5, Prusak raises another concern regarding the probability of genetically engineering one’s child. He states that doing such enhancement to one’s child may result in making the parent-child relationship too conditional on the basis of parents’ satisfaction for the outcomes of such enhancements. In addition, he confirms that parental authority is based and confined by children’s interests; however, an important question remains. Whether parental rights are limited to protect child’s presumed “right to an open future” by assuring that child will have the greatest range of reasonable lifestyle choices to pursue when entering adulthood which is so-called “liberal argument,” or free to shape and develop a particular character using specific moral and cultural values that may affect and limit the range of lifestyle choices; however, a happy life is fulfilled. Finally, he does not impose any conclusive position regarding the prenatal genetic enhancement as he states “ I do not claim that it is always wrong for this or that reason, or that it cannot be morally permissible, praiseworthy, or perhaps even morally obligatory;” however, he has two concerns to worry about when applying such enhancements as some enhancement may violate child’s right to an open future or impair parent-children relationships.
In the last chapter, Prusak explores social responsibilities towards children within the society. Although transfer of parental obligations to adoptive parents can be justifiable in cases where parents who procreated children fail to carry out such obligations, it is not the ideal solution; instead, the society incur such obligations that may assist and support procreators to perform and fulfill their parental duties. However, such social intervention to support procreators is restricted by the intrinsically valuable familial bond that is characterized by its inability to be displaced by any other type of communal obligations for raising children.
This reviewed book, to the best of my knowledge and according to Google database, was reviewed three times and cited ten times. One of these reviews was written by David Archard who is a Professor at School of History, Anthropology, Philosophy and Politics in Queen's University Belfast, and his review was published in 2014 by Notre Dame Philosophical Reviews journal (2). While the second review was done by Jake Earl who is a Postdoctoral Fellow at Department of Bioethics in National Institutes of Health Clinical Center, and his review was published in 2014 by Kennedy Institute of Ethics Journal (3). Whereas, the third review was written by Jason T. Eberl who is a Professor of Health Care Ethics at Albert Gnaegi Center for Health Care Ethics in Saint Louis University, and his review was published in 2014 by Expositions journal (4).
Both Archard and Earl agreed in their reviews that Prusak’s writing style in the reviewed book is easy to read as it is direct, forthright, engaging, honest and explains even the most technical sections of presented arguments. In addition, both agreed that Prusak’s book represents and discusses many significant issues in reproductive ethics (2,3). However, some analytical issues have been raised in the reviews of this book. Archard, in his review found that Prusak’s argument that answers the question of “whether the given and unique relationship each of us has with our creator must, save at great moral cost, always be developed into the relationship of a child with her guardian” is not fully convincing (2). In addition, Earl in his review noted that, Prusak recognizes the notion of harm in reproductive ethics as hugely controversial issue, and due to his adoption to Shiffrin’s noncomparative analysis of harm in this book, most of his conclusions are unfortunately hypothetical (3). Lastly, Eberl’ review appears to give a summary for the reviewed book, without arising important critical points (4).
On the other hand, as I previously mentioned that this book was cited ten times. One of these citations was by Prusak himself who cited this reviewed book in his second published book that has the title of Catholic Moral Philosophy in Practice & Theory: An Introduction. This book was published in 2016 which introduces the living tradition of Catholic moral philosophy (5). Additionally, this reviewed book was cited in chapter 5 “Parents, Special Obligations and Reproductive Genetics” which was written by Wojciech Lewandowski (Assistant Professor at the Department of Applied Ethics in Faculty of Philosophy of the John Paul II Catholic University in Lublin) in a book that has the title of The Ethics of Reproductive Genetics: Between Utility, Principles, and Virtues which was published in 2018. He cited the reviewed book when he was addressing the idea of “Continuity of Parental Reasons” (6).
Moreover, the reviewed work was cited in three journal articles; however, unfortunately, I was not able to get full access to all of them. One of these articles was written by Heiko Puls (from Universität Hamburg), published in 2016 by Kantian Review journal and entitled as Kant’s Justification of Parental Duties (7). Another article was written by Stephen Puryear (Associate Professor at the Department of Philosophy and Religious Studies in North Carolina State University), published in 2017 by European Journal of Philosophy under the title of Schopenhauer on the Rights of Animals (8). The last article was written by David Wasserman (Research Scholar, Institute for Philosophy and Public Policy, University of Maryland), published in 2017 by Kennedy Institute of Ethics Journal and has the title of Better Parenting through Biomedical Modification: A Case for Pluralism, Deference, and Charity (9).
Finally, the reviewed work was also cited in one thesis and three different doctoral dissertations. It was cited throughout the thesis that was done in 2017 which has the title of “A Theological Retrieval of Communal Parenting as a Moral Response to Baby Stealing and Childlessness in Nigeria” (10). While the titles of the doctoral dissertations that were citing the reviewed book were as the following: “Procreative Justice: The Ethics of Creating and Raising Children” which was done in 2016 (11), “What We Owe to Those We Make: A Causalist Account of Procreators' Parental Obligations” which was completed in 2017 (12), and “What We Owe to Our Children Relationships and Obligations in Public Care” which was submitted in 2018 (13).
In general, the book was mainly written on a basis of philosophical and moral perspectives when discussing different issues related to parental obligations such as adoption, abortion, gamete donation and surrogacy (both which are used as an assisted reproductive technologies). Therefore, when these issues were addressed, the author did not have a definitive conclusion to either allow or reject the use of the above-mentioned techniques. In addition, people from different backgrounds such as medical sciences who are not used to read such type of books, may face some difficulties in reading the material as well as getting the points from different arguments. However, Prusak’s writing style in this reviewed book was characterized by the different stating ways of one particular idea and in many cases, the ideas were presented in a way of examples, in order to make the addressed ideas simpler and easier to understand.
Abortion is one of the issues that challenge the causal account of parental obligations. In Prusak’s defense of causal account, he argued that Brake’s claim (which is mentioned in para.4 in summary section) is false by pointing the sophism of Thomson’s defense of abortion that considers the extractive abortion is similar to the case of letting die. In his defense, Prusak considers most of these abortion cases are morally equivalent to killing. However, his main focus regarding abortion is not about the morality of abortion, instead he focuses on the “alleged link between the moral permissibility of abortion and the grounds of parental obligation.” His conclusion can be summarized as pregnant woman incurs strict duties to her fetus, thus performing extractive abortion “would constitute culpable killing rather than merely letting die”. From a religious point of view which is lacked mainly in most arguments raised by Prusak in the reviewed book, and particularly from an Islamic perspective, the majority of Muslim scholars agreed about the permissibility of abortion before 120 days of gestation -prior to ensoulment- only for some acceptable reasons such as those that are related to the health of either the mother or the fetus where therapeutic abortion can be performed. While after 120 days of gestation, abortion is prohibited for any reason by a consensus of all Muslim scholars as it is considered as killing of a real being, except for the reason of saving mother’s life which is in danger. These rulings are mainly based on the Islamic legal rule of “necessity knows no law” and legal premise of “the greater evil should be warded off by the lesser evil.” Similar to Prusak’s conclusion, contemporary Muslim scholars reject the reasons that may initiate a pregnant woman to undergo abortive procedures such as the willing of one of the parents or both to relinquish their obligations towards their future child (14).
Another challenge Prusak discusses in his defense of the causal account of parental obligations is the use of assisted reproductive technologies namely gamete donation and surrogacy. During his defense, instead of rejecting these practices altogether, Prusak supports those legislators and legal scholars who are seeking to reform and organize gamete donation and surrogacy rather than abolishing such practices. Nonetheless, he still finds those practices problematic issues due to reasons other than those related to parental obligations such as abuse cases of commercial surrogates. On the other hand, though there were debates and huge discussions regarding the use of gamete donation and surrogacy practices as assisted reproductive technologies within the Islamic tradition, these discussions have ended by forbidding these two practices, primarily in order to protect the lineage of the child by relating him/her to the biological parents, as “Islam limits legitimate fatherhood and motherhood strictly to marriage, and the mixing of the husband’s sperm with the wife’s egg” (15).
In the end, it seems that Islamic legislations and rulings regarding reproductive issues preserve child’s lineage and appreciate the inherent value of the given biological relationship. In addition, these legislations seem to frame the reproductive ethics and parental obligations which Prusak was trying to outweigh through the causal account that he supports.
In conclusion, Prusak’s book of Parental Obligations and Bioethics: The Duties of a Creator has introduced obligations that procreator bear towards their children and discussed different reproductive issues that may challenge these obligations. As the volume of the book is 103 pages, reading such book is a manageable task. It can be recommended mainly to those who are interested in reproductive ethics.
(1) Prusak, B. G. (2013). Parental Obligations and Bioethics: The Duties of a Creator Routledge.
(2) Archard, D. (2014). [Review of the book Parental Obligations and Bioethics: The Duties of a Creator, by Prusak, B]. Notre Dame Philosophical Reviews.
(3) Earl, J. (2014). [Review of the book Parental Obligations and Bioethics: The Duties of a Creator, by Prusak, B]. Kennedy Institute of Ethics Journal.
(4) Eberl, J. (2014). [Review of the book Parental Obligations and Bioethics: The Duties of a Creator, by Prusak, B]. Expositions.
(5) Prusak, B. G. (2016). Catholic Moral Philosophy in Practice & Theory: An Introduction. Paulist Press. Paulist Press.
(6) Lewandowski, W. (2018). Chapter 5 Parents, Special Obligations and Reproductive Genetics. The Ethics of Reproductive Genetics: Between Utility, Principles, and Virtues, 67-80.
(7) Puls, H. (2016). Kant’s Justification of Parental Duties. Kantian Review, 21(1), 53-75.
(8) Puryear, S. (2017). Schopenhauer on the Rights of Animals. European Journal of Philosophy, 25(2), 250-269.
(9) Wasserman, D. (2017). Better Parenting through Biomedical Modification: A Case for Pluralism, Deference, and Charity. Kennedy Institute of Ethics Journal, 27(2), 217-247.
(10) Omeike, H. U. (2017). A Theological Retrieval of Communal Parenting as a Moral Response to Baby Stealing and Childlessness in Nigeria.
(11) Magnusson, E. (2016). Procreative justice: the ethics of creating and raising children (Doctoral dissertation, University of Oxford).
(12) Earl, J. C. (2017). What We Owe to Those We Make: A Causalist Account of Procreators' Parental Obligations (Doctoral dissertation, Georgetown University).
(13) Gundersen, E. C. (2018). What We Owe to Our Children. Relationships and Obligations in Public Care.
(14) Brockopp, J. (2003). Islamic ethics of life: abortion, war, and euthanasia. Univ of South Carolina Press.
(15) Sachedina, A. (2009). Islamic biomedical ethics: principles and application. Oxford University Press.
[*] Nuha Taysir Swaidan, received her Bachelor’s degree in Biomedical Sciences from Qatar University in 2016. She worked as a Research Associate for a year and half at the Interim Translational Research Institute (iTRI) in Hamad Medical Corporation in Doha, Qatar. In 2019, Nuha completed her Master’s in Genomics and Precision Medicine from Hamad Bin Khalifa University in Doha, Qatar.