Population Ethics: I. Elements of Population Ethics: A. Definition of Population Ethics

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I. ELEMENTS OF POPULATION ETHICS: A. DEFINITION OF POPULATION ETHICS

Population studies deal with fertility, mortality, and migration. Fertility refers to human reproduction, mortality to death, and migration to the movement of people from one region to another. The articles on population ethics and population policies in this Encyclopedia take up only those aspects of fertility and migration with close links to healthcare and the life sciences, that is, to bioethics.

Population ethics has two main foundations: moral principles and factual information. Moral principles come from religious traditions, philosophy, declarations of human rights, and other sources. Factual information derives from careful analysis of what is happening or has happened in a given place or situation. Judgments about the ethics of population policies require the application of moral principles to cases based on solid, factual information. Vague principles or a poor understanding of how population programs really operate lead to questionable judgments about population ethics.

The articles on normative approaches and on religious traditions show similarities and differences in the moral principles applied to population policies. One major normative framework, accepted in principle by most countries, includes the universal statements on human rights developed by the United Nations. By endorsing and defining rights such as life, liberty, and welfare, the United Nations has established ethical standards applicable to all social programs, including those dealing with population. The major religious traditions of the world also have their own perspectives on fertility control and migration. Many of these are fully compatible with U.N. statements on human rights, but some are not. The main conflicts over population ethics arise when governments, most of which have officially accepted U.N. standards on human rights, violate those rights in their own population programs.

The articles on population policies apply moral principles to strategies used in fertility control, health standards required in that field, ethical issues in programs involving migration and refugees, and the work of donor agencies dealing with fertility control and migration and refugees. Strategies of fertility control can range from the application of force to information campaigns aimed at voluntary changes in attitudes and behavior. They include compulsion, which has been used to force China's one-child-per-couple policy; strong persuasion, such as the application of heavy government and community pressure on potential users of fertility control; financial incentives and disincentives given to users, field workers, and communities; and educational or information campaigns aimed at promoting greater acceptance of fertility control. The ethical issues are most serious with the use of compulsion and least serious, though still significant, with information campaigns.

Debates over whether rapid population growth poses problems for human societies also show the need for clear moral principles and solid factual understanding. Advocates enter those debates with different principles and factual information.

The moral principles guiding discussions about population problems include preventing environmental pollution (Ehrlich and Ehrlich); keeping population size within the carrying capacity of the world (Hardin); and promoting economic growth (World Bank). Each principle leads to a different focus on factual information. Those concerned with pollution analyze data about global warming, acid rain, and depletion of the ozone layer. Those proposing to keep population size within the carrying capacity of the world look, for example, at figures on population density. Students of economic growth consider the many links between birth-rate and economic development, including relationships among fertility, education, and healthcare. Because each concern leads to a different meaning of a population problem and a different selection of information, it is difficult to compare one problem definition with another.

Two research practices have held back the development of an adequate factual base for population ethics. One practice begins with conclusions and then selects only those facts consistent with them. Analysts claiming that rapid population growth has had negative consequences for economic development often cite facts supporting that conclusion and leave out contrary evidence (World Bank). Those claiming benefits from rapid population growth do the same (Simon).

The second practice involves assigning more or less weight to population conditions than objective research would support. Some advocates of fertility control claim that rapid population growth has caused starvation and political instability in the developing countries. Such simple interpretations overlook the many other influences leading to those conditions, such as the lack of food in poor countries, corruption among political leaders, and ethnic conflicts.

The strategies countries use to control fertility have provoked the sharpest debates about population ethics. China and India have used outright coercion to promote sterilization or abortion. In China, women found to be pregnant with unauthorized children have been forced to undergo abortions (Aird). Between 1975 and 1977, police in some parts of India rounded up eligible men and required them to be sterilized (Gwatkin). Indonesia's use of strong community pressures to increase use of contraceptives has also been controversial. To gain new users the Indonesian government has relied on such methods as repeated visits to eligible women from village heads, family-planning workers, and members of Acceptors Clubs; pressure to accept intrauterine devices during "safaris" attended by prominent public officials; and promoting a positive image of small families. Those defending coercion and heavy social pressures argue that countries such as China, India, and Indonesia require vigorous methods of fertility control to curb swelling populations. Voluntary methods, they say, will work too slowly to prevent damage to the economy and create impossible demands for a nation's schools and other public services. Critics respond that applying force and heavy pressure violates human rights and disregards international agreements on fertility control, such as the 1974 World Population Plan of Action (United Nations).

Policies on migration and refugees also raise questions of ethics. Under what conditions, if any, do residents of one country have the right to enter another? Are the moral claims of potential migrants stronger when they are facing starvation, persecution, or violence? Do countries have the right to bar or expel immigrants they see as harmful to their national interest, as the United States did with Haitian immigrants in the early 1990s? What obligations, if any, does a government have to undocumented aliens within its borders? Can it deny them healthcare services regularly available to its own citizens? What kinds of aid should donor agencies, such as the World Food Program or the International Committee for the Red Cross, provide to migrants, refugees, and displaced persons? And how should that aid be distributed?

Issues of medical risks and proper standards of healthcare arise in fertility control as well as migration and refugee programs. Family-planning programs sometimes put more emphasis on achieving numerical targets for clients than on safeguarding the freedom and health of users. Field workers may promote medically unsafe methods of fertility control, fail to disclose the risks of a given method, or be unavailable to deal with the side effects that do occur. Or they may insert the subdermal contraceptive Norplant and then refuse to remove it at the client's request (Ubinig). Fertility-control programs also differ in the health support they provide to users, such as local clinics to deal with minor problems or hospitals to handle serious complications.

Questions about standards for healthcare also arise in programs for refugees. Program managers often have to decide whether refugees should be sent back to countries from which they fled, where they may be tortured, imprisoned, or killed. If they are kept in camps, what should be done to prevent the high rates of illness sometimes seen in those settings? Possible preventive measures include providing adequate food, safe water, suitable shelter, sanitation, immunization of vulnerable groups, and a primary healthcare system.

International donor agencies, such as the World Bank, the United Nations Population Fund, and the U.S. Agency for International Development, also face moral choices in their assistance to fertility-control programs. Among those choices are whether donors should support programs known or thought to involve coercion, such as that in China; whether those organizations funding a variety of projects, such as the World Bank, should put pressure on countries to initiate fertility-control programs as a precondition for other aid; and how far and in what ways they should ensure that recipients of their funds provide honest explanations of methods to clients and adequate health support for complications or side effects.

In migration and refugee programs, ethical principles affect decisions about who receives assistance and who does not. Are those decisions based mainly on the health and welfare needs of those to be served or on other criteria, such as racial or ethnic politics? This question is particularly salient in countries where the government controls donor access to areas in which its political opponents want to be evacuated. Donors must likewise make moral choices in designing programs for migrants or refugees. In interventions for disaster relief, they must often choose between strategies providing rapid action by outsiders, such as building homes, or slower methods of educating residents in how to become more self-sufficient (Parker). Instead of constructing new homes after an earthquake, donors might show community members how to build their own homes using earthquake-resistant methods of construction. The result could be greater self-sufficiency and better protection against future disasters.

Population ethics thus involves the application of moral principles to what are often complex empirical situations. Its greatest challenges are to select principles that are broadly applicable to population issues, rather than those that advance some specific interest, and to explore their implications with an adequate factual understanding of the circumstances involved.

donald p. warwick (1995)

revised by ronald m. green

BIBLIOGRAPHY

Aird, John Shields. 1990. Slaughter of the Innocents: Coercive Birth Control in China. Washington, D.C.: AEI Press.

Ehrlich, Paul R., and Ehrlich, Anne H. 1990. The Population Explosion. New York: Simon and Schuster.

Gwatkin, Davidson R. 1979. "Political Will and Family Planning: The Implications of India's Emergency Experience." Population and Development Review 5(1): 29–59.

Hardin, Garrett James. 1993. Living within Limits: Ecology, Economics, and Population Taboos. New York: Oxford University Press.

Parker, Ronald S. 1994. The Achievement of Educational Objectives: A Study of the A2Z Relief and Development Agency's Projects and Procedures under Emergency Conditions. Doctoral dissertation, Harvard Graduate School of Education, Harvard University.

Simon, Julian Lincoln. 1990. Population Matters: People, Resources, Environment, and Immigration. New Brunswick, NJ: Transaction Publishers.

Ubinig. 1991. "'The Price of Norplant Is TK. 2000! You Cannot Remove It.' Clients Are Refused Removal in Norplant Trial in Bangladesh." Issues in Reproductive and Genetic Engineering: Journal of International Feminist Analysis 4(1): 45–46.

United Nations. 1975. Report of the United Nations World Population Conference, 1974. E/CONF.60/19. New York: United Nations.

World Bank. 1984. World Development Report 1984. New York: Oxford University Press.

Encyclopedia of Bioethics