Kimberly Leighton. Bioethics. Editor: Bruce Jennings, 4th Edition, Volume 1, Macmillan Reference USA, 2014.
Adoption as a practice of family making prompts a consideration of assumptions about what is normal and good, what it means to be related, and how we should create—and not create—children. Ethical inquiry into whether and to what extent adoption is morally permissible must take into account the interests and needs of children; the social and material conditions under which adoption becomes a possible, or even necessary, practice in domestic and international contexts; and societal attitudes, both negative and positive, toward adoption. Although it is a commonly held view that adoption is an option of last resort when sexual reproduction—or for those who can afford it, assisted reproductive technology—has failed to deliver a biological child “of one’s own,” a consideration of the ethical questions related to adoption leads to a more complicated picture.
Adoption and Women’s Reproductive Autonomy
In US history, two culturally accepted narratives have long informed how people imagine a woman’s decision to give up her child for adoption: (1) adoption is the consequence of a woman’s free choice based on the best interests of her child, and (2) adoption is the ethical means of saving a child from a desperate situation. Many women do, in fact, make well-informed and uncoerced decisions about placing a child for adoption, and many children prior to their adoptions are in situations of desperate need. In an ethical consideration of adoption, however, it is essential to highlight the conditions that lead many women to have to surrender their children (or that lead to the removal of their children). The contexts in which children are in need of being adopted include poverty, illness, violence, and war, as well as the legacy of racism. Historically, women who experienced so-called out-of-wedlock pregnancies were regarded as “fallen,” depraved, or even mentally deficient, and therefore unfit to be mothers. Being unmarried and pregnant in the first quarter of the twentieth century could qualify a woman for commitment to a mental institution with a diagnosis of sexual deviancy. Although such women were more often poor and black than wealthy and white, sex—and therefore pregnancy—outside of marriage for women was seen as evidence of mental illness across race and class differences (McWhorter 2009).
The ethics of adoption has a longstanding association with the ethics of abortion. The central themes in discussions of the ethics of abortion in the United States are the moral status of the fetus and the right of women to make reproductive health decisions. Prior to the landmark US Supreme Court decision in Roe v. Wade in 1973, giving up a child for adoption in the United States was the central legal option for women who did not want or were unable to enter into an ongoing parental relationship with a child. Adoption scholars have tied Roe v. Wade to the dramatic decrease in the number of infants surrendered for adoption, as well as increasing social acceptance of households headed by unmarried women and single mothers by choice.
The issue underlying adoption and abortion is birth control. The history of adoption as a mechanism for managing human sexual and reproductive behavior—most directly that of women—echoes many of the moral and political issues that arise in discussions of abortion (Solinger 1992, 2001). Discussions of abortion and adoption reflect the many ways in which women have or have not been autonomous in their sexual and reproductive lives. When lacking safe and reliable methods of contraception, women are exposed both to the risk of unplanned pregnancy and to judgments of sexual activity evidenced by pregnancy. Until very recently in the history of the United States and the West in general, to be pregnant and unmarried was sufficient to subject women to the societal judgment that they are morally bad and thus unfit to be mothers. The decision to have an abortion, like the decision to surrender a child for adoption, is not necessarily a matter of free choice, and historically women have undergone various degrees of coercion (Solinger 1992). Lack of support for single parenting, shame about evidence of sexual activity, sexual abuse and lack of safety, and religious and cultural double standards about sex have contributed to the conditions under which women have undergone the experience of pregnancy.
Prior to Roe v. Wade, terminating a pregnancy by abortion was an option most women had access to only at the hands of nonmedical practitioners. Even women who could afford physician fees, and the cost of travel to see those physicians, were often left damaged by illegal abortions. Women weighing the decision to have an abortion thus often had to consider not only religious or moral apprehensions but also the high risk of permanent physical harm from unregulated abortifacient treatments. The lack of access to safe and legal abortion was—and for many women continues to be—one of the key conditions for the development and institutionalization of adoption as a means of resolving a pregnancy where raising the child is an unwanted or unmanageable outcome. Where women have safe, legal, and morally non-punitive access to abortion and birth control, the number of children surrendered for adoption is substantively lower than where such access is impossible.
For those defending what they consider to be the right to life of the fetus, the shift away from adoption as a resolution to pregnancy represents a moral crisis. Pro-life literature commonly invokes the slogan “adoption not abortion,” reflecting a stance that has influenced what information health care providers are required by law to offer to women seeking an abortion. Since Congress enacted the Adolescent Family Life Act (AFLA) in 1981, a law that tied federal funding to the promotion of adoption for pregnant teens, adoption has become a component of discussions of the politics and public policy of abortion. Moreover, the Infant Adoption Awareness Act (IAAA) of 2000 specifically designated funding for the development of curricula and other tools that would train counselors and health care providers in how to offer pregnant women information on options other than abortion. Previous federal guidelines for family planning funding under Title X already required “adoption information and referrals [be given] to pregnant women on an equal basis with other courses of action included in nondirective counseling.” Critics of the adoption not abortion position contend that the view misleads women into thinking the two actions are morally comparable. A significant difference for some is that, as progenitors, birth parents are causally responsible for a child’s coming into existence, a fact that holds them in a relation of moral obligation to a child, even after adoption (Porter 2012).
Intercountry Adoption
Intercountry adoption (ICA), the adoption of a child by adults outside that child’s nation of origin, is a practice regulated primarily by the laws and policies of the home or “providing” countries, with some regulation of immigration by the “receiving” countries. Ethical concerns regarding ICA have focused on two issues: whether and to what extent ICA can be accomplished without encouraging corruption or exploitation of providing countries by receiving countries, and whether and to what extent ICA is in children’s best interests. Some argue for the abolition of ICA, contending that removing a child from her home nation violates the child’s fundamental interests as it denies her access to what is referred to as heritage rights—a fundamental need to be raised by one’s group or community of origin (Bainham 2003). Opponents of ICA make a human rights-based argument, relying on documents such as the United Nation’s (UN) Convention on the Rights of the Child (CRC). Others maintain, also referencing the UN CRC, that ICA is ethical on the grounds that it gives some children a chance to escape from adverse conditions, such as war, poverty, and lack of available education, in their home country—or, in the case of orphans, of having no parents at all. Advocates of ICA argue that heritage rights amount to an essentialist, and thus excessively limiting, understanding of origins. Critics of ICA who are heavily invested in notions of blood or genetic kinship as the only form of “real” family face the charge that they are merely echoing the dominant view in many countries in which adopting children, in its presumed announcement of infertility, is culturally frowned upon. Expecting in-country adoption to satisfy the needs of parentless children in orphanages is thus unrealistic in countries where adoption itself is considered shameful or stigmatizing. Rather than adopting, the infertile who can afford to, in countries such as India, often opt for donor-assisted conception as donor “matching” and pregnancy can hide the fact of infertility in a way adoption cannot (Bharadwaj 2003).
Those who argue for reforming ICA point to the risk that extreme global inequities might subject impoverished families and pregnant women to exploitation by corrupt lawyers and agencies. Such agencies may contribute to the commodification of children on what is feared to be an international “baby market.” Some critics argue that ICA is inherently unethical as it represents a form of child trafficking (Smolin 2004). In response to such concerns, many nations in Central and South America, for example, have outlawed adoption intermediaries, allowing only an overarching state authority to carry out adoptions. Critics of this move have countered that outlawing intermediaries in ICA in effect abolishes ICA, as most countries with large populations of children in need of parental care lack the infrastructure needed to secure a child’s status as adoptable or to determine prospective adoptive parents’ eligibility. India has sought to mitigate the alleged harms of ICA to children who are, in fact, in need of parents by instituting policies requiring that at least 50 percent of all children eligible for adoption be adopted by Indian citizens. Such policies seem in concert with the international regulatory document on ICA known as the Hague Intercountry Adoption Convention (1993), which, though not prohibiting international adoption, clearly supports provisions that prioritize in-country adoption over ICA, even if this results in children spending more time in facilities such as orphanages.
Other grounds for objections to ICA are the effects it might have on providing countries’ broader institutions, policies, and social norms. ICA could be seen, for example, as relieving nations from developing critically needed social services for unmarried mothers or from providing benefits to extended kin willing to adopt related children. If a major ethical concern is the noncoercion of birth parents, it must also be recognized that some state policies, such as the People’s Republic of China’s one-child rule, encourage relinquishment or abandonment of children. Another ethical issue arises from situations in which the receiving country could seem to be endorsing the providing nation’s assumptions about who is an appropriate adoptive parent. The regulations of providing nations commonly exclude some groups—for example, gay and lesbian people, unmarried women, and people with disabilities—from eligibility as adoptive parents.
Transracial Adoption
As with intercountry adoptions, transrectal adoption (TRA) has raised two main ethical issues: To what extent are adoptions morally permissible when the adoptive parents are recognized as being members of a “race” different from that of their adopted child? And, even if such adoption is regarded as morally permissible, to what extent might TRA be a part of unjust institutional practices? With TRA, the ethics of adoption come in contact with historic practices of racism, classism, and gender oppression. TRA compels us to ask under what systemic conditions children might become available for adoption, and how adoption might function as a means of regulating the population in terms of racist norms. In the United States, the public debate about TRA can be traced, to some extent, to concerns raised first in the 1970s and then again in the 1990s over foster care, a system in which children are placed in temporary homes until they either are returned to their birth families, are adopted, or reach the age of eighteen and exit the system. Unlike infants placed for adoption, very few children in foster care were surrendered at the will of a birth parent; commonly, they have been removed from their families by the state based on apparent evidence of neglect or abandonment and sometimes of abuse.
The majority of children in foster care in the United States, and the majority who remain in foster care because they are never adopted, are African American (Roberts 2005). Many regard this situation as a crisis, but there is strong disagreement as to the nature of the crisis and ways to resolve it. “Too little attention has been paid to why so many Black children are available for adoption in the first place” (Roberts 2005, 234).
In the 1970s those working in the area of child and family services regarded adoption as the solution to the rising number of children in foster care. For many holding this view, a key impediment to moving children into adoptive families was the policy of “matching.” A persistent practice in the history of adoption, matching placed children with adoptive parents on the basis of how much the child and parents together would resemble a “normal” family (i.e., one in which the children were biologically related to their parents) (Carp 1998). Advocates of matching have historically defended it as being in the best interest of adopted children because it allowed adoption to be less obvious, and consequently would make children feel less different and promote greater family unity. As the number of African American children in foster care grew exponentially in the 1970s, the efficacy of maintaining matching in adoption was challenged.
At the time, those in favor of racial matching in adoption argued, in keeping with a 1972 statement by the National Association of Black Social Workers (NABSW), that ending it would have a deleterious effect on adopted black children. Proponents of matching pointed to two important considerations: First, although white families may be able to love and parent a black child, they cannot effectively give black children the skills they need to challenge the racism they are likely to face throughout their lives. Second, white parents may not be able to engender in black children a strong and positive identity as a black person—a quality essential for life in a socially segregated society that privileges whiteness in nearly every regard.
Sandra Patton (2000) argues that the NABSW’s 1972 position on matching was misunderstood and misrepresented as equating TRA with racial genocide, a view associated with black nationalist politics. In 1994 the NABSW issued another statement emphasizing the importance of preserving African American families through better social and economic support of families in need. State-authorized removal of African American children from their families should be a last resort after at-home provision of care—which is more often made available to white families—has been exhausted.
The debate over TRA was in some sense resolved by the Multiethnic Placement Act, passed in 1994 and amended 1996, which prohibited any consideration of race in the context of adoption. But it was the passing of the Adoption and Safe Families Act in 1997 that, in response to what many saw as earlier policies’ risky emphasis on reunifying families, prioritized as “paramount” the health and safety of children over any consideration of maintaining biological family ties (Patton 2000). Since the 1990s discussions of the ethics of TRA have shifted away from an either-or identity politics to recognize the needs of minority children to dwell in communities where they not marked as different, but are, at least part of the norm in terms of race or ethnicity. Concerns about the inherent harm of TRA have been replaced by an increasing focus on the need of parents in TRA families to live racially integrated lives.
The question of how to practice TRA in an ethical way remains unsettled. Critics of color-blind approaches to adoption contend that, far from being postracial, such policies inadvertently invest in whiteness as the universal. On the other hand, inadvertently positioning children of color—US- or foreign-born—to represent their race or ethnic heritage is equally problematic. As Hawley Fogg-Davis notes, “a fine line divides racial awareness and racial discrimination” (2005, 248). The philosopher Sally Haslanger, a white mother of two adopted black children, writes, “I have, in an important sense, been resocialized by my kids, and although I do not share their ‘blood,’ I have ‘inherited’ some aspects of their race” (2005, 285).
Gay and Lesbian Adoption
The norms most often guiding adoption policy replicate dominant views about what is in children’s best interests, specifically in terms of what family structure can best protect and promote those interests. Views critical of permitting gay and lesbian couples to adopt children allege that the families such couples can offer, even when the couples are married, cannot meet children’s essential needs. Although ongoing debates about gay and lesbian adoption seem to hinge on concerns about the sexuality of potential adoptive parents, these worries suggest broader investments in gender norms and the importance of the family in upholding them.
The question of whether gay and lesbian people should be parents at all is, in some important ways, moot. According to a 2007 study, more than one in three lesbians has given birth, and one in six gay men has fathered or adopted a child (Gates et al. 2007). The 2000 US Census indicated that 65,000 children lived with same-sex parents; by 2012 the number had risen to 110,000 (Alper 2012). In terms of adoption, an estimated 65,500 adopted children are living with a lesbian or gay parent. Gay and lesbian parents are raising 4 percent of all adopted children in the United States, and as of 2007, 14,100 foster children, or 3 percent, are living with lesbian or gay parents (Gates et al. 2007).
Opposition to gay adoption in the United States is found largely among organizations such as Focus on the Family, the Center for American Values, and Concerned Women for America. Such groups view states’ legalization of gay marriage as a profound threat to the health and safety of marriage and the family, and thus of children. Using a loosely Christian-based argument connecting marriage with reproductive sex and the family with heterosexual marriage, these groups argue that when the government permits gays to adopt, it violates children’s rights in two ways: first, it denies children the right to be raised with the kind of love that only a married mother and father can provide, and second, by providing children with state-sanctioned less-than-optimal families, it abandons children’s best interests in the name of asserting gay rights. According to the Thomas More Law Center in Ann Arbor, Michigan, there is an “inherent distinction” at stake in the debate about gay marriage: “there are those pairs capable of engaging in the act which can produce human offspring, and those pairs which cannot” (Thomas More Law Center 2013). Such a distinction makes allies of gay and straight families formed through adoption, as both can be thought to belong to the “cannot” category.
Gay adoption advocates draw on the abundance of research that provides data contradicting fears perpetuated about gay and lesbian people as potential parents. Studies of children raised in lesbian and gay families, for example, show that such children in no statistically significant way suffer harms different from other children. National professional organizations such as the American Psychological Association (APA) echo this view: “Overall, results of research suggest that the development, adjustment, and well-being of children with lesbian and gay parents do not differ markedly from that of children with heterosexual parents” (APA 2004). In fact, a twenty-five year study of children born to lesbian parents affirmed that if there were any marked differences, these children “were rated significantly lower in social problems, rule breaking, and aggressive problems” (APA 2004). In 2011 the American Academy of Pediatrics released a statement announcing that, consistent with its mission of promoting children’s health and well-being, it supports adoption by people who are willing and able to provide a home, regardless of sexual orientation; it reaffirmed this support in a 2013 statement on gay marriage.
The ultimate threat posed by gay adoption, for bioethicists like Margaret Somerville, is that it permanently “unlinks” the social and biological elements of the family. A gay family, state-sanctioned through marriage, “radically changes the primary basis of parenthood from natural or biological parenthood to legal (and social) parenthood” (2007). For Somerville, this cleavage of the natural and the social is itself a source of harm to children, a view that supports arguments not only against gay adoption, but against all modes of family making outside of the marriage of a woman and a man who have children created through unassisted heterosexual coitus. The permitting of gay marriage and adoption, she contends, will have a ripple effect as it spreads the purportedly harmful view that families need not be biologically related to be real and good for children.
Adoption vs. Assisted Reproductive Technology
Couples facing difficulties conceiving sometimes turn to assisted reproductive technology (ART). Given what many deem the success of ART despite its costliness, the idea has been proposed that government should require insurance companies to cover infertility treatment for all who need it. This suggestion has been met with concern, however, that greater use of ART could have harmful consequences for children in need of adoption. Critics of expanded access to ART through government-mandated insurance view it as a biased and even harmful form of incentivization (Bartholet 1999). To the extent that such mandates lend greater support to genetic family making, they pose the risk of discouraging infertile people from adopting children awaiting the opportunity (Freund-lich 1998). Thus, because indirect government support for ART may have harmful effects on children waiting to be adopted, such mandates are not ethically permissible according to critics (De Wispelaere and Weinstock 2014).
The various objections to indirect government support of ART raise ethical questions not only about the regulation of ART but also about the ethics of policies on adoption (Hollinger 1985). Should mechanisms such as tax breaks or mandated insurance coverage be put in place that effectively subsidize one method of family making but not another? Does this represent an endorsement by the state of a preferred mode of family making? Would such mechanisms put infertile couples who would rather adopt at a disadvantage? One might also ask whether indirect financial incentives have the effect of coercing the infertile into seeking medical treatment. Individuals’ infertility might be a medical condition, but it poses a relevant harm to their lives only if they want to have genetically related children. As Elizabeth Bartholet contends, “society drives the infertile away from adoption and toward efforts to reproduce with a wide array of conditioning mechanisms and regulatory structures” (Bartholet 1993, 30). Another, possibly more contestable view is that a government’s duty to promote the health of all its citizens requires promoting their interests, if not equally, then at least in a way that benefits the most vulnerable. A policy that promotes in vitro fertilization (IVF) over adoption, then, if it leads to more uses of IVF and less adoption, would unethically discount the interests of children waiting to be adopted.
Some scholars question the assumptions underlying objections to government support of ART. These objections seem to give more weight to the needs and interests of adoptees than those of infertile adults who want children. Glenn Cohen and Daniel Chen (2010), criticizing what they call the “substitution theory,” argue that there is no direct evidence that encouraging IVF will in fact lead to fewer adoptions. The core of the objection to mandating coverage for ART is that such a turn fails to prioritize the needs of the most vulnerable—children without parental caretakers. Cohen and Chen note that, though surely laudable, the prioritizing of children’s interests requires additional justification, specifically for the premise that the burden of adopting should fall on the infertile. If there is a duty to put the interests of children without parents above the interests of adults who want to have genetically related children, then should it not be the case that no one may reproduce until all of the parentless children find homes?
Ultimately, ethical considerations underscore the importance of addressing the needs of children without parents. Joan Heifetz Hollinger cites the potential “risk of indifference” to children “who are already born but in desperate need of parents to raise them” (1985). To commit to addressing those children’s needs touches on society’s understanding of the family in terms of genetic relatedness. The core of the moral problem is that the infertile are not alone in their preference for children who would be genetically related to them; yet it is they who are positioned as needing to resist this generally accepted preference. To put the burden on the infertile raises the question of why the fertile, just because they are capable of reproducing, are not expected to adopt.
Embryo Adoption
Another area where government support of ARTs has raised ethical questions, especially in terms of possible effects on adoption, concerns so-called frozen “spare” embryos. There are an estimated 600,000 embryos that are being cryopreserved, a result mostly of in vitro fertilization, a fertility treatment that commonly involves producing a larger number of embryos than will be utilized to create children (Nightlight 2013). Close to 90 percent of these “supernumerary” embryos that remain in cryopreservation do so at the request of parents who wish to maintain the option of future reproductive use (Hoffman et al. 2003). Despite this fact, many worry that parents will either allow the embryos to die or opt to donate them for research. Beginning in 2002 the US Congress approved a program that would provide education to the public about the importance of what has come to be called embryo adoption. Run by the Office of Population Affairs (OPA), under the guidance of the Department of Health and Human Services (HHS), the Public Awareness Campaign on Embryo Adoption has provided nearly $24 million to organizations (as of fiscal year 2013), many of which have a religious mission aimed at encouraging parents to give up for adoption those embryos they will not be using in conceptions. According to the OPA website, the purpose of the campaign is “to educate Americans about the existence of frozen embryos (resulting from in-vitro fertilization), which may be available for donation/adoption for family building” (HHS 2013).
The ethics of the federal government subsidizing organizations promoting embryo adoption is uncertain. In addition to possibly encouraging the use of ARTs over adoption of already existing children, the campaign indirectly contributes to ongoing debates over the moral status of embryos. As noted by many who see frozen embryos as presenting a moral crisis, “adoption of this sort implicitly recognizes embryos as human beings” (Iozzio 2002). Thus, the government’s promotion of embryo adoption could make morally problematic policies that permit, for example, abortion or the use of embryos in research.
The campaign actually developed out of Senate hearings on stem cell science where the issue of the number of frozen embryos in existence raised concern. Senators worried that these “spare” embryos would be donated by parents to research, thus being destroyed in the process, and advocated for the government taking an active role in encouraging adoption as the solution. Some critics of the campaign have noted how the language of embryo adoption lends support to arguments against abortion based on the purported “personhood” of embryos and fetuses, a view the campaign directly preceded (Sweet 2012).
Organizations that have received a bulk of the funding include the National Embryo Donation Center and Nightlight Christian Services. While the former defines its mission as “protecting the lives and dignity of human embryos,” the latter is known for creating “Snowflakes” in 1997, the first embryo adoption program. The Snowflakes program has two aims: to assist couples in donating embryos and to help those facing infertility “give birth to their adopted child” (Nightlight 2013). In such a view, embryos not only have the dignity of being human but also should be considered as children waiting for adoption. According to the Evangelical Christian Gabriel Fluhrer, being against abortion requires, in addition to picketing, “doing the hard work of adopting the orphans around the world, whether embryos or orphans living in China” (Kapralos 2012). Bioethicists such as Sarah-Vaughan Brakman, who are in support of what they call heterologous human embryo transfer (HET), make the connection between embryo adoption and adoption clear: “the adoption paradigm provides the proper lens through which to analyze the moral issues raised by HET” (2007, 192). This view can be defended in part because like adoptees, children born through HET will not be genetically related to their parents (Widdows and MacCallum 2002). Whether this similarity is sufficient to require, for example, those seeking to “adopt” embryos be rigorously vetted in the way prospective adoptive parents are remains an issue of debate.
“Genealogical Bewilderment” and the Right to Know
Adoption, as a topic for ethics, can contribute to current discussions of the management of genetic information, especially—though not only—in relation to ARTs. In particular, adoption can reveal connections between how personal identity and the family are understood as grounded in “genetics” and how genetic information is believed to be important to know. The position that adoptees have a right to know who their biological parents were has played a central role in both the history of adoption and the history of adoptees. The adoption rights movement is largely based on the belief that adoptees’ right to know counters the legacy of secrecy and shame commonly associated with so-called illegitimacy. An ongoing and active project in the adoption rights movement is fighting to open sealed adoption files for adoptees who seek information on their birth parents. The goal of this project is broader than allowing adoptees to read documents or discover birth parents’ names, though to be sure these are important goals for many adoptees. The open records movement represents a challenge to much of the history of adoption, in which attitudes toward women’s sexuality and identity in relationship to pregnancy contributed to stigmatization, secrecy, and deception (Fessler 2007).
During the early years of formal adoption in the United States, information was shared with adoptive parents as a means of “preparing” and reassuring them. The move away from relative full disclosure toward restricting the exchange of information in adoption was coincident with a shift in the overall understanding of adoption as a mode of family making. Originally, the aim of adoption in many countries where it was formally regulated was the finding of homes for parentless children; in the pre- and post-World War II (1939–1945) era, when the rate of infertility and the desire for adopted children rose dramatically, the aim was expanded to bring parentless children and childless adults together as a “normal” family. Adoption as a mechanism for making unrelated people intelligible as a normal family—that is, as if they were related by blood—thus required not merely the creation of legal structures, but a view of children as capable of being, in a sense, reborn in and through their new families (Modell and Dambacher 1997).
During periods when this theme of rebirth was less central to the justification of adoption, more information about children was released to would-be adoptive parents. As adoption became identified with the state’s ability to make adoptive families as “good” as blood-related families, adoptees became reborn in the sense of being issued new birth certificates with the adoptive parents’ names listed as mother and father and the sealing of original birth certificates. This public procedure through law thus finalized the shift in the metaphysics of adoption: a child’s body could become unmarked by the stigma of illegitimacy, and thus could be released from the future his biological parents as his parents would have determined for him. It was not that nurture won out over nature, but that nature could be remade through the right match.
Ethical issues surrounding adoption and the disclosure of information have resurfaced in debates over donor-assisted conception. In this form of conception, couples make use of donated sperm, ova, or embryos to conceive a child. The child so conceived typically has no access to identifying information about the donor where policies permit anonymous gamete donation. Specifically appropriating the language of rights used in the context of adoption and sealed records, some ethicists argue that people who were “donor-conceived” have a right to know the identity of the donor or donors involved, just as adoptees have a right to know who their biological parents were, because they too suffer from their ignorance about their own identity (Velleman 2005). The ethics literature on the topic of donor-assisted conception consistendy refers to the debate about open records in adoption and, more specifically, the harm adoptees have suffered in their lack of knowledge about themselves, or “genealogical bewilderment.”
In a 1952 article, the psychiatrist Eric Wellisch used the term genealogical bewilderment to describe what he saw as a disorder suffered by children, particularly children who were adopted, when they were “without genealogy.” According to Wellisch, “lack of knowledge of their real parents and ancestors can be a cause of maladjustment in [adopted] children” (1952, 41). The symptoms of such maladjustment were thought to include feelings of alienation from “foster parents,” tendencies to running away, and suicidal ideation. According to Wellisch, adoptees have a weakened ability to develop a coherent body image, a requirement for a complete sense of self-identity.
The justification for sealing adoption records and maintaining the confidentiality of birth mothers was the worry that, if children discovered that they were adopted, they would suffer from a kind of psychological uncertainty. Significantly, however, the purported diagnosis of genealogical bewilderment as understood by its originators applied equally to adoptees who knew and who did not know they were adopted. From Wellisch’s point of view, the cause of the harm was not knowing one’s genealogy rather than knowing one was adopted. H. J. Sants (1964) developed more fully the concept of genealogical bewilderment, contending that adoptees could never achieve a sense of true belonging with parents not of their own kind.
Both Wellisch and Sants considered the desire to know—or even curiosity about—birth parents a symptom of the bewilderment itself. Thus, according to the “logic” of genealogical bewilderment, adoptees who do not know they are adopted are like ticking time bombs, able to experience the effects of their bewilderment at any time. Should they show a desire to know, this interest in their genealogy could turn into a social problem, even “delinquency.” According to Sants, adoptees’ “concern over their lack” of knowledge will likely “at some time” become a “searching for clues. Once they have begun, their preoccupation with the task can reach disturbing proportions” (1964, 133).
The term genealogical bewilderment was reclaimed by several early critics of the historic secrecy of adoption who wished to bring attention to the experience of adoptees and to the need for policy change that would allow for opening adoption records so that adoptees could have access to their original birth certificates. The term has also been used by adoptees themselves in court cases involving a fight either for access to their individual adoption records or original birth certificates or for the overturning of policy preventing such access. In their attempts to gain access to information that many adoptees feel they have a right to know, adoptees have had to prove to courts that their suffering was deeply damaging.
Jean Paton, founder of Orphan Voyage, the first adoptee organization in the United States in 1953, was among the early activists speaking out on behalf of adoptees. These activists incorporated the concept of bewilderment into their understandings of what the adoptee’s search for information involved. According to the adoption scholar Ellen Herman, Paton conceptualized the adoptee as in some sense defined by her desire to search. Paton believed “that the desire to know the natural parents can be the deepest and most compelling factor in an adopted child’s life” (quoted in “Search and Reunion,” Adoption History Project).
The work of Betty Jean Lifton, a psychologist and adoptee, drew heavily on the meaning and value of the search for adoptees. For Lifton the search represented an act of defiance and self-assertion, a claiming of one’s true self: “the very idea of search and reunion is empowering.… Empowerment and reconnection are the core experiences of recovery. Healing begins when adoptees take control of their lives by making the decision to search … as one sets out on this forbidden journey toward self” (1994, 128). The scope and value of the search for Lifton thus has a doubleness to it: at once, the desire to know reflects a deep, perhaps unhealable wound, and—yet—the search itself is a mode of claiming one’s identity.
Perhaps this tension at the heart of the adoptee’s desire to know is what appeals to activists in what some have referred to as the donor-conception movement (Cahn and Kramer 2011). Many arguments against anonymous gamete donation turn on the claim that knowing the identity of the donor is paramount to the well-being of someone who was donor-conceived; such criticisms of anonymous gamete donation (AGD) specifically align the experiences of the donor-conceived with those of adoptees including their right to know, their suffering from genealogical bewilderment, their history of secrecy and shame. These arguments have coincided with changes in policy on AGD. Where once anonymity was required, it is now in some places prohibited in the context of donor-assisted conception: Sweden first instituted this policy in 1984, with the United Kingdom, most of Australia, and many countries in the European Union following.
Some critics have questioned the aptness of the analogy between the harm of secrecy suffered by people who were donor-conceived and people who were adopted. Kimberly Leighton has argued that the analogy itself could be harmful to adoptees as it “geneticizes” their identities, removing the specificity that comes with being adopted (2011). The literature on the ethics of AGD, however, seems increasingly weighted toward defending the analogy, and using it to support claims for the right to know of the donor-conceived. In some contexts, people who were donor-conceived have been presented as “genetic orphans” or “gamete adoptees.” A much-publicized Canadian legal case on AGD, Pratten v. British Columbia, rested on the very question of whether or not the harm of not knowing one’s donor for a donor-conceived person was sufficiently analogous to the harm of not knowing one’s birth parents for an adoptee. Writing for the Supreme Court of British Columbia, Justice Elaine Adair found that denying a donor-conceived person’s right to information about her origins, in that such a right is recognized for adoptees, is a form of discrimination (2011). Adoption, as the justice noted, provides an example of the suffering that results from “alienation by whatever means of a child from a biological parent.” The decision was overturned on appeal, but the widespread coverage of the case brought much attention to ethical issues surrounding donor-assisted conception and adoption, and encouraged the overall acceptance of the analogy.
Conclusion: Pre-adoption Genetic Testing
Adoption continues to raise questions about what constitutes family and what is the value of genetic relatedness. If adoption is in the best interest of children who need parents, issues remain undecided regarding which adults should adopt which children and how information about adoptees should be circulated. Advances in and increased reliance on genetic medicine only complicate issues about the ethics of adoption and disclosure. Pre-adoption genetic testing (PAGT), for example, is a practice growing in acceptance where prospective adoptive parents test children for genetic disorders prior to the child’s actual adoption. Whether children available for adoption should be able to be tested beyond the ethical limits observed for children with parents continues to be debated. Advocates of increased PAGT argue that, to the extent that it will help “match” the right parents to the right children, genetic testing should be permitted, if not encouraged (Jansen and Ross 2001). Critics of this view counter that such arguments risk investing in kind of genetic determinism that, as this history of adoption illustrates, is not necessarily in the best interests of children available for adoption, for adoptees, or for adoptive families. Concerns over the implications of PACT will likely continue as explanations of psychological, intellectual, and emotional characteristics—in addition to health concerns—are increasingly framed as genetic in nature. Prospective adoptive parents may find themselves in a serious ethical dilemma when considering adoption, especially if adoption is a “second-best” option to having children to whom they are genetically related. They will need to decide to what extent testing the genetics of a child prior to adoption is in the best interests of that child and to what extent it serves the self-interests of the prospective parents. The promotion of such testing may even contribute to regulatory norms about identity, reproduction, and the family.