Consider the consent argument for antinatalism (the view that human reproduction is morally wrong) that we shouldn’t impose great risks on people without their consent, but by having a child one imposes great risks on them (life may turn out really badly), and one cannot get consent.
One obvious response is that we are willing to accept proxy consent in medical decision making when the patient is incapable of consent. And of course in the case of a child, normally the first people we turn to for proxy consent are the parents. So it seems reasonable to think that proxy consent from the parents should take care of any worries about the child’s not having consented to come into the world.
What kind of a response can an antinatalist give?
One response is that the whole idea of proxy consent in medical cases is itself bogus. We just should not do medical procedures on children or other non-competent persons that are of a sort that would require consent—say, procedures that are highly invasive or significantly change the course of future life in ways that are not unambiguously for the better. If it is a choice between amputating a child’s leg or letting the child die, we should just let the child die, because a choice whether to live without a leg is the kind of choice that a person should make, and if they cannot make that choice themselves, no one should make it for them.
This seems implausible. It seems pretty clear that we shouldn’t let a child with a gangrenous leg die when the parents consent to amputation. But perhaps the antinatalist can try to distinguish the cases of procreation and amputation. In the amputation case, the child already exists and will suffer a painful death if we do not amputate. Perhaps that overrides the autonomy concerns to a sufficient degree that proxy consent becomes sufficient to justify the amputation. I think that doesn’t work. We can suppose that the child is unconscious, and that in the absence of amputation death will be painless. And it still seems permissible to amputate with parental permission.
A response that I’ve seen is that the fact that standard medical proxy consent cases differ from the procreative case because one cannot even give proxy consent on behalf of someone who doesn’t exist. But this response seems to me to be rather problematic. For if one thinks one cannot give proxy consent on behalf of someone who doesn’t exist, it seems that by the same token one cannot violate the autonomy of someone who doesn’t exist.
But actually both ideas seem false. We can violate the autonomy of someone who doesn’t exist. For instance, we can manufacture a robot that is going to be dormant for 25 years, and will then activate, choose a random 20-year-old and forcibly perform cosmetic surgery on them, radically changing their appearance. By manufacturing the robot we are violating the autonomy of someone who doesn’t exist. And similarly it seems quite possible for prospective parents to provide proxy consent for emergency medical procedures prior to the existence of their children. For instance, supposing (in violation of antinatalist norms) they have several children and expect to have several more, and are afraid that they will forget to sign emergency medical consent forms for their future children, so they sign a blanket consent form for single-leg amputation in case of otherwise untreatable gangrene for all of their present and future children.
Another possible response is that while it’s acceptable for parents to give proxy consent for medical procedures for their incompetent children, the life they create in procreating will one day be the life of a competent person who never agreed. However, this just doesn’t create a disanalogy, because in a number of cases of proxy consent for medical procedures, the child’s entire future life is affected, including the future life once the child reaches competency—this is true in typical cases of amputation.
Furthermore, the idea that one cannot give proxy consent for things that can have significant negative effects on the future life of a competent person, but one can in the case of things that only affect the parts of life when the person is incompetent, leads to the following really weird consequence. A couple is ordinarily not permitted to have a child, but if they find out that they have a genetic condition which will result in the painless death at age four of any child they have (after an ordinary life, without any suffering beyond the ordinary), and if there is no afterlife, then they are permitted to have the child, because their proxy consent does not affect the future life of a competent person. That finding out about this condition would make procreation permissible, while it would be impermissible absent the condition, seems absurd.
