A relational model for selective reproduction
The relational approach to the welfare of the child proposed in Chapter 4 encompasses both individual and collective interests. The individual interests of a child and the collective interests the child shares with his/her family may not, however, always coincide. A relational decision-making model must therefore acknowledge and accommodate individual and collective interests within a family. This chapter proposes a relational model for selective reproduction that requires the interests of the child to be born to be considered in connection with the interests of other family members. I draw from relational approaches proposed in the context of general medical decision-making to devise a collaborative decision-making process that attempts to reconcile family interests where possible. As discussed in Chapter 4, a relational approach to the welfare of the child
may at times require some of the individual interests of the child to be born to be compromised in favour of other family interests. Compromising the interests of a child does not sit easily with the traditional concept of ‘best interests’ that is frequently employed in relation to decision-making involving children.1 A relational approach more accurately reﬂects, however, the way in which ‘everyday’ decisions are generally made within families. A relational decision-making model should, nevertheless, ensure that the basic needs of the child to be born are not sacriﬁced. It is therefore important to determine the point at which acceptable compromise becomes unacceptable sacriﬁce to prevent the child to be born from being exploited, abused or neglected. There is increasing support for relational medical decision-making models in Western medicine, although not speciﬁcally in the context of assisted reproduction. Rather than detracting from the welfare of the child to be born, I argue that a relational model promotes a broader conception of the welfare of the child by acknowledging the relational nature of the interests of the child within the context of his/her family and the importance of intimacy to human ﬂourishing. I begin this chapter by examining, in section 5.2, the nature of general decision-
making within families. In particular, I analyse the scope of parental duties and discretion and the impact of familial character on family decision-making.
In section 5.3, I propose a test for determining when necessary compromise becomes unacceptable sacriﬁce in order to protect the child to be born from exploitation, abuse and neglect. In section 5.4, I examine the role of families in general medical decision-making and explore some relational models developed in this context. In particular, I investigate a ‘process model’ of informed consent, whereby the values and preferences of the patient take shape through a shared process of decision-making with his/her family. The idea of a relational medical decision-making model is not novel. It has gained some momentum in recent times by ethicists who are sceptical of the bias in Western bioethics towards the individual patient.2 To date, however, a relational decision-making model has not been adopted in the context of assisted reproduction. In section 5.5, I draw from the relational approaches discussed in section 5.4 to develop a relational decision-making model for selective reproduction based on a modiﬁed collaborative decision-making process.