Identity, Harm, and the Ethics of Reproductive Technology

Abstract

The controversial question of whether a future child can be harmed by the use of reproductive technology turns on the way that the future child's identity is understood. As a result, analysis of the ethical and legal obligations to the children of reproductive technology that are based upon the possibility of such harm depends upon the conception of identity that is used. This paper reviews the contributions of two recent books, David DeGrazia's Human Identity and Bioethics (2005) and Philip Peters' How Safe is Safe Enough? (2004) to this area of inquiry. It suggests that the use of a narrative rather than numerical conception of identity makes it possible to coherently claim that future children can be harmed by the use of reproductive technologies and that, as a result, potential parents can have obligations regarding the use of those technologies based upon that possibility of harm.

Keywords:

• future children
• harm
• identity
• reproductive technologies

I. INTRODUCTION

One controversial ethical and legal consideration relevant to the use of reproductive technologies is the possibility that the use of those technologies harms the children they are used to create. And at the heart of the question of whether or not those future children can be harmed by the use of such technology is the concept of identity. Many ethicists have argued that it is incoherent to claim that a child can be harmed by an intervention that she owes her very existence to, because the use of that technology changes the identity of the child brought into the world. Two recent books wade into this muddy water and provide some clarifying analysis. In Human Identity and Bioethics, David DeGrazia (2005) takes a close look at two different concepts of identity and examines their implications for several problems in bioethics, including those related to reproductive technologies. Philip Peters (2004), in How Safe is Safe Enough? Obligations to the Children of Reproductive Technology, addresses the possibility that reproductive technology can cause harm to future children and proposes a regulatory framework for the use of reproductive technologies that makes sense in light of that possibility. In this review, I aim to show where these two authors have made valuable contributions to the difficult ethical puzzles surrounding the possibility of the occurrence of harm in the context of reproduction and how, despite the significant differences in their approaches, they intersect in informative ways.

The foundation of David DeGrazia's Human Identity and Bioethics is his insightful and philosophically rigorous account of two distinct types of identity. Chapter 2 is devoted to numerical identity, or identity across space and time. DeGrazia argues that because we are, essentially, human animals, our numerical identity consists in the persistence of our human organisms. In Chapter 3, DeGrazia offers an account of narrative identity, which is composed of the stories that we tell about ourselves and the ways that others see us. I will discuss both of these accounts of identity in greater detail below. Chapters 4–7 address four different areas of bioethical inquiry in which identity plays a determinative or substantial role: the definition of death; advance directives of patients with dementia; the use of enhancement technologies; and the use of genetic interventions and reproductive technologies. In these chapters, DeGrazia uses the two types of identity to shed needed light on some difficult bioethical problems.

In How Safe is Safe Enough? Philip Peters first argues in favor of the idea that we can have obligations regarding future people based upon the foreseeable effects of our choices despite the fact that those people do not yet exist. He distinguishes three different ways that reproductive choices could affect such future people's well-being in Chapter 3. Chapters 4 and 5 identify and critically analyze the possible existence of two different obligations to the children who could be produced through the use of reproductive technologies. First, there may be a duty to produce future children using the safest method of reproduction available. Second, in cases in which a reproductive technology results in a life that is worse than nonexistence, there may be a duty not to use that technology. Peters' defense of these obligations is an important contribution to the ethical dialogue in this area, claiming that taking the interests of the future child into account is not only morally permissible but may, in some cases, be morally required. It is these two duties that will serve as the foundation for my later discussion.

Part II of How Safe is Safe Enough? is devoted to the development and defense of a plausible and conceptually coherent regulatory framework for the control of reproductive technologies. In Chapter 8, Peters defends the presumption in favor of protecting potential parents' procreative liberty and shows how different kinds of regulation affect that liberty. Regulations such as informed consent laws, consumer protection laws, and agency pre-approval do not interfere with parental liberty and so can improve the safety of the use of reproductive technologies without limiting parental reproductive autonomy. Regulations that involve the prohibition of the use of some reproductive technologies under some circumstances must be based on the balancing of parental procreative liberty against the well-being of the future child. Peters suggests that regulations of the former type should be attempted in order to protect the future child before regulations of the latter type are implemented and provides a useful set of considerations for weighing the harm to the future child against the burdens such restrictions would pose on parents. Chapters 9–13 defend the regulatory framework, demonstrating that any regulation developed using it would be found to be constitutional. Part III applies the framework to four different types of reproductive technologies: intracytoplasmic sperm injection; multiple embryo transfer; cloning, and germ-line genetic engineering.

The regulatory framework Peters proposes and defends is an important contribution to the bioethical dialogue surrounding reproductive technologies, advancing the discussion of an underdeveloped topic. It takes seriously the possibility of harm to future children while at the same time carefully respecting the procreative liberty and interests of potential parents. However, for the purposes of this review I will be focusing not on Peters' regulatory framework but on the duties that he argues we may have to the children of reproductive technologies.

II THEORIES OF IDENTITY

A Numerical Identity

Identity in the numerical sense refers to an individual's persistence conditions and so deals with conditions under which each individual exists through time. In order to correctly understand these conditions, DeGrazia argues, it is necessary to understand what we are, essentially. DeGrazia rejects personhood essentialism (the idea that we are, essentially, persons) in favor of biological essentialism (the idea that we are, essentially, biological organisms), holding that even the most plausible version of the personhood view, Lynne Rudder Bakers' constitution view, encounters difficulties more serious than those that trouble the biological view. I respectfully disagree with DeGrazia's conclusion. I find the weaknesses of the personhood view reasonably palatable while it seems that the problems he identifies with the biological view are more difficult to swallow.

On Baker's constitution view, we are persons constituted by human organisms. Each individual is made up by his or her human organism, but is not the same as that organism in the same way that billions of gallons of water make up Lake Michigan, but are not the same as it. According to the constitution view, it is the continuity of an individual's capacity for a particular kind of first-person perspective that serves as her existence criterion. This first-person perspective is, “a perspective from which one thinks of oneself as an individual facing a world, a subject distinct from everything else” (Baker, 2000, p. 60). It is not enough for one to simply have a first-person perspective, she must also be aware that she has that perspective and have continued capacity for that kind of perspective.

DeGrazia identifies two problem cases that he believes challenge the adequacy of the constitution view. First, the constitution view is vulnerable to the “newborn problem”—that on this view each of us was never born. That is, because we did not have the capacity for the proper kind of first-person perspective at the time of our births, we did not exist at that time. We therefore cannot coherently say that we were born according to the constitution view, which, DeGrazia argues, is an unacceptable result. ¹ Intuitively, it makes sense to say that we were born. My intuition, however, is that this is not a serious problem. I find it just as likely that by saying “I was born on February 16th” I mean that “the organism that constitutes me was born on February 16th” rather than “I am identical to the entity born on February 16th.” ²

The other type of cases that DeGrazia holds to be problematic for the constitution view are science fiction scenarios that involve body-switching, the transfer of persons into newly created bodies, and the fission of persons. In order to make sense of such scenarios, we must have some understanding of the kind of thing a first-person perspective is that it can be moved among bodies or split in two. DeGrazia suggests a few different criticisms of the constitution view, all of which focus on the ambiguity surrounding what type of thing a first person-perspective is. (pp. 41–45) His objections seem to be based on the idea that the first-person perspective must be some kind of a subject of a mental life or a “container” for experiences, both of which, he argues, imply that the first-person perspective must consist of some sort of substance. ³ And, as DeGrazia and Baker both reject substance dualism, this is problematic. I disagree, however, that the constitution view implies substance dualism. The first-person perspective can exist but be entirely without substance other than the substance that constitutes it in the same way that Lake Michigan exists even though its only substance is the water that constitutes it. Admittedly, it is not clear what, exactly, this perspective is and how it could move among bodies if it is not a substance. However, it should not count against a theory that it cannot account for the technical details of procedures that are current impossibilities and quite possibly will never become reality.

Given the difficulty that the constitution view (and any other view based upon personhood essentialism) has with explaining the relationship between an individual and that individual's human organism, a presumption exists in favor of the biological view, DeGrazia argues. On this account, we are, essentially, animals that are members of the species homo sapiens. We are not essentially persons (although we may achieve personhood during our existence), but are instead living biological organisms that exist as long as those organisms are alive. Despite his support for this view, DeGrazia admirably acknowledges and discusses in detail some of its problems.

The biological view has difficulty dealing with (currently) hypothetical scenarios in which a brain is transplanted from one body to another (pp. 51–54). According to the biological view, an individual is a human organism, and so would stay with the body (as opposed to the brain) in such cases. However, if Jodi Foster's brain were transplanted into Morgan Freeman's body, we would be more likely to say that Jodi Foster is now in Morgan Freeman's body than we would be to say that Jodi Foster's brain is now residing in Morgan Freeman. That is, intuition suggests that we would go with our brains rather than our bodies in a transplant scenario. DeGrazia toys with the idea that if the brain stem were transplanted along with the cerebrum, the biological view might be able to accommodate this intuition, but, I believe rightly, does not even endorse this position himself. ⁴ He considers several other possible responses but quickly rejects those as well, concluding that brain transplant cases are a “thorn” in the biological view's side. I agree.

A second set of problem cases for the biological view involve bodies that contain two consciousnesses, including cases of multiple personality disorder and conjoined twins. In cases in which two consciousnesses inhabit a single body, intuition suggests that there are two distinct beings of our kind, not just one. On the biological view, however, there is a single human organism and therefore only one being of our kind. DeGrazia proposes a plausible interpretation of instances of multiple personalities, arguing that in such cases there exists not two beings, but just one very sick being. This argument, however, does not resolve conjoined twins cases as neatly. DeGrazia's proposal that what we really have in such a case is a single being with two different consciousnesses is intuitively unsatisfying. Consider a set of conjoined twins in a condition that is incompatible with continued life so that the redundant parts must be removed in order to allow a being to survive. If the set of twins has two heads but a conjoined body, intuition suggests that removing one of the heads is more than simply eliminating a locus of consciousness but is instead equivalent to terminating the life of one of the twins. In contrast, if other parts of the body must be removed to allow a being to survive, the act of doing so does not seem like it is killing one of the twins. The biological view cannot account for the difference in these intuitions. ⁵

Despite these problem cases, DeGrazia claims that “the biological view can respond fairly well to the major challenges that confront it,” and that it is this view that best describes the essence of our being. On the whole, however, I am not convinced. DeGrazia's responses to serious problems with the biological view (the brain transplant and conjoined twins cases) are not persuasive. In contrast, the constitution view's problem cases (the fetus problem and the question of what the first-person view consists of) seem manageable. The challenges to the biological view are more significant and more intractable than those facing the constitution view. As a result, there is good reason to reject DeGrazia's conclusion that we are essentially human organisms in favor of the idea that our numerical identity is based upon our continuing capacity to have a first-person perspective. Nonetheless, DeGrazia's careful elucidation of the many strengths and weaknesses of both of these accounts of identity is a valuable contribution to the literature on this topic.

B Narrative Identity

The most significant contribution of Human Identity and Bioethics is DeGrazia's development of the concept of narrative identity: the idea that “you are the person who is realistically described in your self-narrative or inner story” (p. 83). This kind of identity does not deal with persistence conditions, but instead is predicated on the story that an individual tells about herself, which is made up of the things that she believes to be true about her, how she interprets those facts, and the relationships she has with other individuals. On DeGrazia's account, the individual's own version of her story is the most important determinant of narrative identity. The perceptions of others contribute to an individual's identity in that they give information back to the individual that helps form her own narrative identity, providing a sort of “reality check” for her story. In addition, the story must be realistic in light of the facts about her life.

DeGrazia argues that one of the most important aspects of narrative identity is each individual's ability to change her narrative. The ability to change our life trajectories and to shape our characters is central to being human. DeGrazia claims that “we find that narrative identity is, for many of us, clearly insufficient. We don't just want to have a self-narrative and know who we are. We want our inner story to go a certain way” (p. 89). In other words, one vital part of having a successful human life is the ability to control and recreate our narrative identity and to impact the way that our life story develops.

A central feature of narrative identity is its inherent flexibility. The story that an individual tells about herself is constantly changing. Throughout her life, some features of the narrative may be left behind and others may be picked up. This fluidity is particularly vital in light of the possibility of, and value placed in, projects of self-creation (or recreation). Even the most fundamental aspects of an individual's narrative may be the target of her self-creation project. Narrative identities must have substantial flexibility in order to accommodate this kind of change. The importance of this feature of narrative identity will become apparent in the next section.

DeGrazia argues that narrative identity, as opposed to numerical identity, deals with what really matters to us about survival (pp. 79–80). We care much more about the continuation of our perspectives, projects, and relationships than we do about the persistence of our human organisms alone. As a result, numerical identity is valuable to most of us primarily instrumentally in that it provides a platform on which to build our narrative identity.

I would like to suggest that, if it is narrative identity that is important to us, narrative identity should be used in ethical deliberation rather than numerical identity. For the purposes of ethical analysis, it would be more appropriate to use whichever type of identity more closely correlates to what is meaningful to us, and DeGrazia claims that it is our narrative identity that captures what matters in survival. Our ethical intuitions are likely to be based on the type of identity we find more meaningful—narrative identity. If ethical deliberation is based instead on numerical identity, puzzles arise in those rare cases in which narrative and numerical identity are not identical. In such instances, ethical conclusions that are based upon narrative identity would be more likely to coincide with our intuitions whereas those that are based upon numerical identity are likely to conflict. Assuming that there is at least some connection between our intuitions and adequate moral analysis, there is good reason to believe that it is narrative identity rather than numerical identity that should have ethical primacy. The value of such a shift in perspective will become apparent in the next section.

By developing this concept of narrative identity, DeGrazia defines and characterizes a valuable and under-utilized tool for understanding who we are and what matters about our identity. The distinction between numerical and narrative identity is a fundamental one that brings a novel perspective to persistent problems of bioethics. There are many fascinating implications and applications of DeGrazia's work in Human Identity and Bioethics, but here I will focus on its contributions to the ethics of the use of reproductive technologies.

III OBLIGATIONS TO THE CHILDREN OF REPRODUCTIVE TECHNOLOGY

Placing moral primacy on narrative identity could provide insight into some of the issues Philip Peters grapples with in his discussion of obligations to the children created through reproductive technologies. I believe that these issues may be resolved more cleanly and intuitively by relying upon narrative rather than numerical identity in ethical analysis in this area.

As noted above, Peters' proposed regulatory framework includes two key variables. One, the importance of procreative liberty, is fairly uncontroversial. There exists a reasonably wide consensus (at least in most of the Western world) that this kind of liberty must be considered and, in most cases, respected. The other variable, the need to protect future children from harm, is, at least philosophically, quite contentious. Peters recognizes this in his discussion of the two obligations that, he holds, the possibility of such harm could generate.

A The Duty to Use the Safest Available Method

Peters argues that there may be a duty to use the safest reproductive method possible that will result in the creation of a child. This duty applies in cases in which a parent intends to bring a child into existence but must decide how and when, rather than to cases in which a parent is choosing whether to have a child or not. ⁶ In such cases, Peters rightly argues, although it is intuitively satisfying to hold that the duty to use the safest reproductive method possible is based upon the prevention of harm to future children, Derek Parfit's (1984, p. 359) non-identity problem suggests that this intuition is misguided. According to the non-identity problem, any change in the timing or method of a child's conception alters the identity of the child who comes into existence, because the change would cause a different sperm and egg to be united. If the future child's identity is affected by a parent's reproductive choice, Parfit argues, it is incoherent to claim that that choice harms the child who was brought into existence because that child would not have existed had the other reproductive path been taken. It would not have been possible for that child to have been conceived under any circumstances but the ones that he actually was conceived under—his only other possibility was not to be conceived at all. As a result, the child is not harmed by his parent's choice as long as his life is worth living. Choosing among reproductive technologies would involve this kind of identity-altering change. Therefore, a child brought into existence using a risky reproductive technology cannot have been harmed by the parent's choice to use that technology (as long as his life is worth living) because he otherwise would not have existed at all. If we accept Parfit's argument, then, it is not possible to harm a future child by choosing a riskier reproductive method and so the duty to use the safest reproductive method cannot be based upon the harm that failing to fulfill this duty would cause. This argument therefore calls into question the existence of a duty to use the safest reproductive method.

Peters addresses this problem. He concedes that it is not possible to harm individual future children and that such harm therefore cannot justify the regulation of reproductive technologies. He instead proposes that such regulation be based upon the welfare of the class of future children as a whole, claiming that “public health regulation … can and should take into account the unnecessary harm that risky reproductive choices can inflict on future children as a class whenever safer methods of reproduction are available to the would-be parents” ⁷ (p. 32). As Peters rightly points out, this is a sensible approach to take in the context of creating public health regulations because such regulations are concerned with the well-being of an entire population. As a result, it provides a reasonable foundation for such regulation. However, this solution does not provide grounding for the sort of individual claims of damages that would be needed for a future child to bring suit against those using or performing the technology. Further, in terms of supporting an ethical duty that takes seriously the intuition that by not using the safest reproductive method a parent puts an individual child at risk of harm, this account falls short. Because this solution does not accommodate this intuition, it seems to be an incomplete solution to the non-identity problem as a whole.

This is where David DeGrazia's notion of narrative identity may be useful. Peters' analysis of the possibility of harm to future children and Parfit's account of the non-identity problem are clearly based upon a numerical understanding of identity. If a change in the egg and sperm used to create a child completely alters the identity of that child, Peters and Parfit must have something like DeGrazia's biological view of identity in mind. However, I argued above that our narrative identity is more relevant to ethical considerations. Using narrative identity rather than numerical identity in the ethical analysis of this case could produce different results.

Could narrative identity bridge numerical identities? Could it create the requisite continuity of identity among possible future children and so solve the non-identity problem, at least in some cases? I believe that there is good reason to believe that it could.

An objector might point out that narrative identity is not applicable in the context of conception because narrative identity cannot exist before the first-person perspective is developed. However, this objection is based upon an emaciated concept of narrative. As DeGrazia points out, an individual's narrative is not simply the story that she tells about herself. It also consists of the facts about her life and her relationship to other individuals, some of which precede numerical existence. As a result, significant portion of an individual's narrative is determined before she is even conceived, let alone able to create her own narrative.

This view does directly contradict DeGrazia's claim that numerical identity is necessary for narrative identity (p. 80n2). This is certainly true in most ordinary instances. However, it may be the case that the creation of a human being is not an ordinary instance. The understanding of narrative identity that I am relying upon in order to make preconception identity possible may be a bit more robust than the one DeGrazia describes, but I don't believe that it is different enough to be problematic. As a result, it seems that DeGrazia's claim about the necessity of numerical identity for narrative identity, although true in the vast majority of cases, may have been slightly exaggerated.

At its inception, a child's narrative is limited. It consists of the identities of the future child's parents, their plans to conceive a child, the decisions they make in enacting that plan, the hopes and dreams that they have for their child's future, and the role that they envision that child playing in their lives. When the child is conceived, the facts surrounding that event become part of the child's narrative. And as the child is born, grows, and develops into an entity who can write her own narrative, these all are added to her narrative identity.

One might argue that the changes that occur during the time surrounding conception are so great that a single narrative could not be flexible enough to sustain such changes. However, because these elements of narrative identity have yet to be determined at the point of conception, these are not actually changes to the child's narrative identity, but instead are additions to it. These additions, even though they will become fundamental parts of the child's narrative, do not disrupt her identity. Even as adults, we continue to add elements to our narrative identities, some of which are enormously significant. Such additions, however, do not alter our identities despite the fact that they will dramatically affect our narratives. As emphasized in the previous section, because of the possibility and importance of self-creation (or recreation), narrative identity has to be flexible and fluid in order to be able to accommodate significant changes in one's life story. Admittedly, the use of narrative identity in this way might require more flexibility than DeGrazia had in mind, but it does not seem implausible.

When reproductive choices are conceptualized using narrative identity in the way just described, there exists a continuity of identity among the children of different numerical identities that could result from different reproductive choices. As a result, the non-identity problem is no longer a problem when narrative identity is given primacy in the ethical analysis. Parental choices about the use of reproductive technologies are therefore choices that influence the future child's narrative. Peters' proposed obligation to use the least risky reproductive technology is therefore an obligation to prevent unnecessary harms that might become part of the future child's story. It would therefore not be necessary to ground this obligation in claims about public health, as Peters advocates, creating regulations based upon the well-being of the entire class of children. Instead, it would be possible to coherently propose regulation in order to prevent harm to individual future children.

B Technologies Too Dangerous to Use

In Chapter 5, Peters identifies a second kind of limitation that could be placed upon the use of reproductive technologies: the obligation to avoid using technologies that are too dangerous for the future child. As was true of the obligation to use the least risky reproductive technology, this duty has intuitive traction based upon the goal of protecting a future child from harm. Again, then, the possibility of causing harm to a future child is central to the understanding of obligations regarding the use of reproductive technologies.

There may be some cases in which parents can fulfill the obligation to not use technologies that fall in this category and still have a child. The obligation not to use these extremely risky technologies is overdetermined in such cases, because the parent would also have the obligation to use the least risky technology, and so would violate that obligation by making such a choice. The interesting cases for this second obligation, then, are those in which a parent must choose between using an extremely risky reproductive technology and not having a child at all. These cases raise another identity-related problem, although one that is slightly different than the problem discussed in the previous section.

In cases in which a choice must be made between using an excessively risky reproductive technology and not bringing a child into existence at all, the intuition that the risky option causes harm to the future child is undermined by the argument that a child who is conceived using an excessively risky technology has no grounds for claiming that she was harmed by the use of this technology, because the child's only other option was nonexistence. If the technology had not been used, that child (or any child) would not have been brought into being. As a result, the child is only harmed if her life is so miserable that she would have been better off never existing.

As Peters points out, the comparison between the quality of one's life and nonexistence is a difficult one to make. He provides a nice overview of this problem, discussing objections to the possibility of making such a comparison based on the ambiguity of what sort of value can be placed upon nonexistence, objections based on the inherent value of all human life, and objections based on the impossibility of calculating the relative value of these two options. In response, Peters suggests that the measure that should be used as a yardstick against which to compare a future child's well-being is not the value of non-existence, but the value of a life of at least minimally decent quality.

In characterizing this idea of a minimally decent life, Peters argues that to describe a life as minimally decent is not the same as describing a life that is worth not ending. ⁸ The fact that someone does not want to end his own life does not entail that his life was worth bringing into existence. In other words, the threshold at which a life is worth bringing into existence is higher than the threshold at which a life is worth continuing to live. This is absolutely correct and so can set the standard for bringing a child into the world higher than the standard of a life that is worth living. As a result, it makes sense to argue that an obligation exists to not use any reproductive technology that is likely to threaten the future well-being of the fetus to the point that its life might not be of minimally decent quality. However, we are left with the problem of how to characterize a minimally decent life. This, again, is a place in which placing ethical primacy on narrative identity may be useful. There are at least two ways in which narrative identity can inform the difficult question of what constitutes a minimally decent existence.

First, narrative identity more naturally accommodates judgments about the quality of life than does numerical identity. Numerical identity is one-dimensional, simply being concerned with continued existence or the persistence of an entity through time. The only evaluative mechanism inherent to this kind of identity is the length of one's existence. In contrast, narrative identity is concerned with the kinds of things that make life worthwhile. It takes into account many different dimensions of existence, so that a life can be evaluated by the richness of its narrative. Using narrative identity, it would be possible to describe a life that is better than non-existence as a narrative that is worth experiencing or a story that is worth telling. The qualitative nature of narrative identity is therefore a significant advantage in this context.

Second, in his account of narrative identity, DeGrazia emphasizes the importance of self-creation. He argues that for many people this ability is what gives life meaning and makes it valuable. A narrative without this ability seems in some ways less valuable to the person experiencing it. If self-creation is such an important factor in what matters, it seems that the ability to self-create, at least to some degree, would be necessary (and possibly sufficient) for having a life that is at least of minimally decent quality. This standard may therefore be able to create a threshold for a minimally decent human life and sets the bar higher than the standard of preferring continued existence to death. It therefore makes it possible to meaningfully argue that some technologies may be too dangerous to use because they are not likely to result in the creation of a child who has a minimally decent quality of life and that we therefore have an obligation not to use such technologies.

The conferral of moral primacy on narrative identity therefore provides significant support for the claims that Peters wants to make regarding our obligations to the children of reproductive technology. It makes it possible to ground the obligation to use the safest reproductive technology possible when conceiving a child on the harm that the failure to fulfill this obligation could cause individual future children. The use of narrative identity also gives content to the idea that in the rare cases in which a technology is extremely dangerous to use, an obligation exists not to use that technology not to conceive a child, even if that child would have a life worth living.

Both DeGrazia's Human Identity and Bioethics and Peters' How Safe is Safe Enough? are essential reading for anyone interested in the ethics of the use of reproductive technologies. Both make significant contributions to the scholarship in this area. They approach the relevant issues from very different perspectives, but even so the synergy that exists between the two books makes it possible to draw conclusions even greater than those that each arrives at individually.

Notes

1. DeGrazia criticizes Baker's attempt to argue that the inclusion of those with the capacity for a first-person perspective can be sufficient to create continuity of identity. I agree with his criticism that Baker conflates capacity with potential but believe the argument is unnecessary.

2. This view has the related consequence, DeGrazia argues, that it compromises the moral status of human newborns. This, however, is only true if moral status is dependent upon personhood, which could be, but is certainly not necessarily, the case. (While Baker does hold this to be true, DeGrazia rejects this view and instead bases moral status on sentience, which it seems that newborns do have. As a result, this consequence is not problematic.)

3. Another expression of this same objection seems to be made a bit later in the chapter when DeGrazia (2005, p. 50) talks about the possibility of “following our minds” among bodies. He objects that this sort of intuition seems to reify our minds, which leads to substance dualism.

4. In fact, this suggestion could lead to the unlikely conclusion that we are, essentially, brain stems, as we would go wherever this (admittedly important) lump of tissue goes.

5. DeGrazia also addresses the corpse problem (the difficulty of describing the relationship between a human animal and its corpse) and some other practical problems, but he deals with those quickly and reasonably effectively.

6. That is, this duty is relevant to what Derek Parfit calls “same number problems” and not to “different number problems.”

7. As Peters acknowledges, this solution to the non-identity problem was proposed by Dan Brock (1995, p. 269) in “The Non-Identity Problem and Genetic Harms—The Case of Wrongful Handicaps.”

8. Here he follows Cynthia Cohen (1997, pp. 34–35).