A world in which the state coordinates the conception of almost every child comes straight from the pages of dystopian science fiction. And yet that was the implication of a recent suggestion that the NHS ought to freeze the sperm of all 18-year-old males to counter the effects of the increasing age at which men become fathers.
Writing in the Journal of Medical Ethics, Dr Kevin Smith of Abertay University points out that children of older fathers have an increased risk of certain medical conditions such as autism, bipolar disorder, obesity and schizophrenia. This means, he argues, we should enable older men to use their younger sperm to father children by creating a universal sperm bank.
Smith claims this idea is “ethically unproblematic”. But there are, I think, a number of concerns he simply fails to consider. Given Smith is a self-avowed utilitarian he should, at least, consider if the harms supposedly eliminated by his proposal will not simply be replaced by another set of ethically relevant burdens. Unfortunately a number of important concerns are absent from his discussion.
For example, the proposal implies that artificial insemination would become “the norm for procreation”. This would mean those women who want to reproduce with an older male would, at minimum, have to undergo a relatively risk-free but somewhat unpleasant medical procedure – artificial insemination – in order to become pregnant. Others would have to endure the greater risks, and discomfort, of in vitro fertilisation (IVF).
Given that no human-designed and operated system is ever entirely free from error, there will always be the possibility of a mistake. Sperm might be labelled wrongly, it might be kept in sub-optimal conditions, or it might be accidentally destroyed. If it becomes the norm for young men to bank their sperm, they may also become more inclined towards vasectomy as a form of contraception. This might mean an increase in sexually transmitted infections. Taken together, these effects could leave some men unable to procreate.
This system would also mean the state would essentially control a genetic database that covered virtually the entire population, something that would create a number of other ethical issues. As we have seen in recent court battles involving wives wishing to access their husband’s frozen sperm, preserving fertility in this way raises the questions of who has the right to access that genetic material, and under what conditions.
It also raises questions about the state’s responsibly for the well-being of any offspring. Should the state allow men to access their banked sperm regardless of their age, or should there be a cut-off point? If the latter, would that not undercut the very purpose of such banks, as some of these older men may well successfully reproduce the old-fashioned way?
Socially stigmatising later-life reproduction, as Smith’s article seems to advocate, seems ethically disconcerting at best. But it also seems at odds with the cited aims of his proposals to enable older parenthood. How is one meant to distinguish between a child conceived artificially using the sperm of a young man and one conceived through the sexual activities of an older man and his partner?
The other issue created by widespread state responsibility for artificial conception is that of our procreative freedom. At present, most of us have a large degree of reproductive autonomy. With two fertile individuals of the opposite sex, human procreation can proceed without interference. Currently, the state essentially licenses adoptive parents, and some have argued that the kind of conditions they have to meet should be demanded of parents more generally. But most people would consider the state taking action to prevent individuals reproducing to be a moral travesty.
But the routine use of a universal state sperm bank would inevitably raise questions that could lead to just that. Should banked sperm be provided to a man who already has a number of children? What if he has multiple children with different women? Should there be an interval – and how long – between providing a man’s sperm to conceive with one woman and then again with another? How long must a man and woman know each other before the state administered sperm bank will provide them with artificial insemination services? Must a man be in a relationship with his procreative partner? If so, what sort of relationship must that be? How should sperm banks deal with open or polyamorous relationships? Indeed, how should it deal with adulterous relationships? If a man wants to conceive with two women, must the state sperm bank ensure they know about each other and consent to the reproductive choices being made?
These questions cannot easily be accommodated by the supposedly non-judgmental stance inhabited by contemporary medical professionals. Contrary to what Smith claims, universal sperm banking would face fundamental challenges at both a practical and ethical level. A responsible bioethicist who purports to offer an ethical solution to what is, in fact, a relatively ill-defined biomedical concern, cannot simply ignore them. Unfortunately, that seems to be precisely what Smith has done.