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  • Print publication year: 2016
  • Online publication date: February 2016

Part III - Controversies in health care ethics: treatment choices at the beginning and at the end of life


Health care options at the “edges” of life, near the dramatic events of birth and death, can reveal deep value differences among us and provoke intense moral conflict. Contemporary health care offers unprecedented choices about whether, when, and how birth and death will occur. Part III of this volume is devoted to examination of these choices.

The beginning of life

For a variety of reasons, reproductive decisions are among the most significant and controversial of human choices. Reproduction is, after all, a life-altering event for most of us. It creates a new human life, and it enables the joys and imposes the responsibilities of parenthood on those who choose it. Reproduction is almost always the result of sexual intimacy, one of the most valued and intense of human experiences. It raises the question, therefore, whether couples should be able to share this experience without reproduction as a consequence. Reproduction requires two people, but the major burdens of pregnancy, labor, and delivery fall on women, and that raises questions about the rights of women to make reproductive decisions. Finally, reproduction sustains, but may also threaten human societies. Western European nations with shrinking populations, for example, offer special benefits for their citizens who choose to have children. China, in contrast, for many years imposed penalties on couples who had more than one child, in an effort to control overpopulation.

Human reproductive values and desires vary across a wide spectrum. Consider the following three attitudes toward reproduction, for example:

  1. For many people, reproduction and parenthood are highly valued and sought-after experiences. If these people have difficulty reproducing, they may seek medical assistance. Should technological assistance in fulfilling reproductive goals be available to all who desire it? Chapter 12, “Assisted reproductive technologies,” addresses this question, examining the scope and limits of reproductive freedom and the role of health care professionals and public policy in providing and controlling access to assisted reproductive technologies.

  2. For many other people, reproduction is a highly undesirable event that they strive to avoid. Should abortion be available to all who desire it to prevent reproduction? Chapter 13, “Abortion,” explores this controversial question through a review of two representative positions on the morality of abortion, one pro-life and one pro-choice.

  3. For still others, reproduction may be a matter of relative indifference.[…]