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Ethics Matters

We'll Pay You Not to Have Kids

June 28, 1999
Web posted at: 1:10 p.m. EDT (1710 GMT)

by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota

A California-based private group called C.R.A.C.K. (Children Requiring A Caring Kommunity) has reportedly been succeeding in its goal of preventing drug-addicted women from having unwanted children. The program offers cash payments of $200 to men or women who undergo long-term birth control (like Norplant, or an IUD) or permanent sterilization (such as tubal ligation or vasectomy). And now C.R.A.C.K. has begun exporting its program to other states. This approach pits the goals of protecting children from harm against reproductive liberty, and we need to ask how far we should go in favor of each.

for Bioethics

What's your opinion?
Selling the right to procreate?

No one should have children they don't want. It's bad for both the children and their parents. And contraception offers a way to avoid it. But offering cash in return for long-term contraception makes birth control someone else's idea.

Some people lack the financial means to obtain birth control, but public health programs offer it to them for free. Paying drug-addicted women to give up the ability to have children takes advantage of the fact that drug addiction often leads people to do anything for money to support their habit. Offering cash in return for sterilization can lead to questionable, and potentially irreversible, decisions. Since the right to procreate is basic in our society, how appropriate is it to allow women to "sell" that right under the duress of addiction?

Deciding who counts as a good parent

C.R.A.C.K.'s underlying principle seems to be that these women and men should not be having children. Its activities put those who run the program in the position of determining what counts as acceptable parenting. We certainly all have our views about what makes good parents, and we are generally free to apply them in our own lives. But paid sterilization begins to impose one perspective onto a particularly vulnerable group. Efforts to help people succeed in conceiving or not conceiving children are good so long as it is the individuals' desires that are served, not those of whoever runs a program like C.R.A.C.K.

Efforts to influence reproductive choices are not new. Some have even suggested licensing parents as a way of controlling who is allowed to have children. But who gets to set the standards for licensing, and how would society enforce them? Could we tolerate forced contraception and the "reproduction police" needed to carry out such a policy? It is easy to see why such an approach would and should fail.

Good options, good choices

We can all agree that we ought to do what we can to protect the interests of children, but we can go too far. Does preventing the birth of a child protect his or her interests? Should we focus on discouraging drug-addicted women from having babies, or on the drug abuse that is the root cause of questionable decision-making? Programs that combine drug abuse rehabilitation with free contraception might give women the means they need to make better choices for themselves and their children.

We long ago determined that no one should be forced to give up their right to procreation, and while offers of payment are not the same as threats of force, both succeed by undermining free decisions. Programs such as C.R.A.C.K. force us to ask just how free we want these decisions to be.

A California-based group called C.R.A.C.K. (Children Requiring A Caring Kommunity) offers cash payments of $200 to drug-addicted men or women who undergo long-term birth control or permanent sterilization. How far should we go in protecting children from harm when the cost is reproductive liberty? Who should decide who can be a parent, and how can such decisions be enforced? Should programs such as C.R.A.C.K. be allowed?

Post your opinion here.

Visit the
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.

"Ethics Matters" is a biweekly feature from the
Center for Bioethics and CNN Interactive.

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