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[Expositions 8.2 (2014) 155–159]  Expositions (online) ISSN: 1747–5376 
 

Prusak, Bernard G. Parental Obligations and Bioethics: The Duties of a Creator. New York: 

Routledge, 2013). 162pp. $125.00 (cloth). ISBN: 978–0–415–70333–8.  

 

 

Many bioethical issues directly implicate the relationship between parent and child. These issues 

range from terminating a pregnancy that will, depending on how one views the matter, prevent a 

child from coming into existence or ending an already extant child’s life to the prospect of 

altering a child’s genetic constitution such that they come to have certain desirable traits or not 

have certain undesirable traits. Of course, parental obligations do not end upon birth, but 

continue throughout the child’s growth and development, and perhaps throughout their lifetime. 

Bernard Prusak’s careful and detailed analysis of the “duties of a creator” begins with the 

foundational question of what grounds parental obligations to one’s offspring (Chs. 1 and 2). He 

then addresses some specific bioethical issues, such as abortion (Ch. 3), gamete donation and 

surrogacy (Ch. 4), and genetic enhancement (Ch. 5). The book concludes with a brief discussion 

of societal obligations towards children and the intrinsic value of familial relationships (Ch. 6). 

Prusak’s project is fundamentally philosophical in nature and will thereby enjoy wide-ranging 

applicability to a host of ethical issues concerning the parent-child relationship. Furthermore, in 

debating the particular bioethical issues Prusak discusses, scholars often presume certain parental 

obligations without the benefit of a cohesive theoretical framework that grounds various putative 

obligations. This volume thus offers a valuable contribution to bioethical debate on these and 

other issues that will invalidate certain argumentative strategies while affirming others. 

Prusak starts off by critically engaging two distinct accounts of what grounds any obligation 

of a progenitor towards their offspring. The causal account, which Prusak affirms, “holds that 

one acquires parental obligations by having voluntarily acted in such a way that had the 

reasonably foreseeable consequence of bringing a child into being in the normal course of 

events” (3). The contrasting voluntarist account “holds that one acquires parental obligations 

only by voluntarily assuming such obligations, whether explicitly or by so-called tacit 

acceptance” (4). In this context, Prusak must first take on the “non-identity problem,” which 

states that it is not possible for parents to harm a child through procreation if the only other 

option would be for that particular child not to exist at all, unless the condition of the child’s life 

would be so tremendously bad that their life would not be worth living (Ch. 1). Prusak counters 

that, although it is true that one cannot directly have obligations towards a non-existent child, 

there could still be an obligation not to procreate if one does not reasonably believe that they will 

be capable of, or is not committed to, carrying out their obligations to the child once created (9). 

To illustrate this point, Prusak considers a case in which prospective parents decide to procreate 

with the intention of giving the child up for adoption. He argues that giving one’s child up for 

adoption can be a justifiable response when one has procreated and then realized that they would 



Review of Parental Obligations and Bioethics  156 
 

not be capable of fulfilling their parental obligations; nevertheless, this does not render the 

transfer of one’s parental responsibility to an adoptive couple good simpliciter, as harms may 

accrue to children whose foundational relationship of unconditional love with their birth parents 

has been disrupted. While the transfer of parental responsibility in cases of adoption may be the 

best response a situation in which conceived or born children may be harmed by their parents not 

being capable of fulfilling their obligations, conceiving a child with the intent to transfer such 

responsibility runs the risk that the adoptive couple may not in fact fulfill their parental 

obligations, as well as negating the inherent value of the given biological relationship (19–21).  

Having grounded the existence of parental obligations solely by virtue of having caused a 

child to come into existence, Prusak is now in a position to directly rebut the voluntarist account 

(Ch. 2). Against Elizabeth Brake’s view that parents are only minimally obligated to satisfy basic 

survival needs, such as providing nutrition and healthcare, as “procreative costs,” Prusak argues 

that parents bear some degree of responsibility for the burdens and risks that life itself will 

inevitably bring to which the child was not able to consent: having consented on the child’s 

behalf that they will experience such burdens and risks, “procreators have, at the least, 

responsibilities to avert the risks, where possible, and to help the child bear the inevitable 

burdens” (33). Fulfilling such responsibilities requires procreators to go beyond the mere 

prevention of harm by satisfying basic necessities, “but to provide, in person, support, warmth, 

and affection during the child’s minority and beyond” (37).  

With a theoretical foundation and defense of robust parental obligations being entailed by 

consensual procreative activity, Prusak turns his attention to the vexed issue of abortion (Ch. 3). 

Prusak’s rebuts an argument—also from Brake—in support of the conclusion that, if a woman 

does not acquire parental obligations by virtue of having voluntarily engaged in potentially 

procreative activity, then neither does a man acquire such obligations by having voluntarily 

engaged in such activity. In other words, if abortion is morally and legally permissible for 

pregnant women who have procreated via consensual sexual activity, then men who have 

procreated through such activity should be free to disavow their putative responsibilities to their 

offspring as well. If this thesis holds, then it would undercut the causal account of parental 

obligations. Prusak’s strategy is not to deny Brake’s conditional, but to show that the antecedent 

is false by pointing out the fallacy of Judith Jarvis Thomson’s “famous violinist analogy” to 

abortion upon which Brake relies. Prusak contends that there is a categorical difference between 

unplugging oneself, and thereby allowing the violinist to die, and performing an abortive 

procedure that involves dismembering the fetus in order to kill and extract it from the uterus 

(49). There are, though, ways of aborting a conceived embryo or fetus—such as the drug RU–

486—that are more similar to the violinist case in that the embryo or fetus is merely extracted 

from the uterus without being directly killed. Nevertheless, as Prusak notes, while extractive 

abortions appear to be more like a case of merely “letting die,” some such cases can be morally 



157  Eberl 
 

tantamount to “killing” (53). In the violinist case, what ultimately kills the violinist is his 

underlying kidney disease; in the case of extractive abortion, what will kill the embryo or fetus is 

the lack of nutrition and a supportive environment, which are basic necessities of life that even 

Brake admits fall under the category of “procreative costs.” So, unless there is some other reason 

to justify men disavowing their procreative responsibilities while denying that pregnant women 

may do so—and such justification does not appear to be forthcoming—the causal account stands. 

Chapter 4 responds to a challenge to the causal account based on the practices of gamete 

donation and surrogacy, neither of which arguably entails parental obligations despite the 

essential causal role played by donors or surrogates. Prusak counters that, in such cases, 

“intended or sponsoring parents, gamete providers, surrogates, and clinicians, technicians, and 

the like all incur procreative costs by doing what they do” (66). This assertion is premised upon 

life being a mixed benefit that inherently includes risks and unavoidable burdens. Hence, the 

laudable motive of helping would-be parents, who cannot have their own genetically-related 

progeny, through gamete donation or surrogacy does not disavow the donor or surrogate from 

their own procreative responsibilities that follow from having causally participated in bringing a 

child into existence. It seems that it would be preferable, instead of bringing a new life into 

being, that infertile couples should look towards adoption of an already conceived or born child 

whose parents cannot fulfill—or have abandoned—their procreative responsibilities. Prusak 

notes, however, the ardent desire of some infertile couples to have “a genetic tie with the child 

they are to raise” (74). Prusak prudently avoids engaging in any normative evaluation of this 

desire, which evidently drives the assisted-reproduction industry even when there are a 

significant number of children lacking a supportive and loving familial environment. 

Nevertheless, there is lost opportunity here to investigate the source of this desire and engage in 

at least a preliminary assessment of whether the satisfaction of this desire, however valid, is 

proportionate to any related costs. Prusak does assess the case of children born through donation 

or surrogacy and notes that, while there are documented burdens associated with the lack of 

social ties to their biological progenitors, the lives of such children are not so disproportionately 

burdensome to conclude that the practices of gamete donation or surrogacy are inherently bad; 

however, he still finds the practice problematic for other reasons (76–7). What is lacking in 

Prusak’s analysis is whether the burdens borne by children awaiting adoption disproportionately 

outweigh the benefits of prospective parents to have genetically-related offspring. Of course, this 

would implicate natural procreation as well as that assisted by in vitro fertilization, gamete 

donation, and surrogacy; although the burdens Prusak cites for the latter two practices, combined 

with those experienced by children awaiting adoption, may together render those practices 

disproportionately burdensome compared to the benefits experienced by prospective parents 

desiring genetically-related offspring. 



Review of Parental Obligations and Bioethics  158 
 

Prusak raises significant concerns with respect to the prospect of genetically enhancing one’s 

child, concluding that “choice of a child’s genetic characteristics could render a parent’s love all 

too conditional: namely, on the child’s satisfying parental expectations” (5). Following John 

Locke, and having argued throughout the previous chapters for various forms of parental 

obligations incurred through consensual procreative activity, Prusak contends that whatever 

rights parents have with respect to how they raise their offspring, free from interference by the 

state, are grounded in their responsibilities (86). In other words, parental rights do not exist for 

the sake of the parents, but are valid insofar as respecting such rights is generally in the best 

interest of children. A significant question remains, however, whether the aim of parental rights 

is limited to protecting a child’s putative “right to an open future,” by ensuring that the child will 

enter adulthood capable of pursuing the greatest range of reasonable lifestyle choices – the so-

called “liberal” view championed by theorists such as Amy Gutmann building on John Rawls’s 

concept of intergenerational justice—or whether parents have the freedom/responsibility to shape 

a child to develop a specific character imbued with certain cultural and moral values that may 

have the effect of limiting his range of lifestyle choices, but nevertheless result in a happy and 

fulfilling life (87–9). 

Framed appropriately, then, the issue of genetically enhancing one’s children is premised 

upon whether certain enhancements may be one way of fulfilling parental obligations. The 

primary concern, Prusak notes, is that some “hyperparents” may utilize enhancement technology 

to mold their children according to their own ambitions. Prusak is careful to distinguish the 

different motivations prospective parents may have in electing to utilize enhancement technology 

for their children and to issue a blanket disapproval of genetic enhancement itself (97–9). 

Nevertheless, a more detailed analysis is warranted insofar as specific forms of enhancement 

must each be evaluated from the perspective of which are likely to serve as a vehicle for esoteric 

hyperparental desires, aimed at specific lifestyle options to which the child has not consented, 

and which would result in an increase of fundamentally basic human goods—such as increased 

cognitive function, immune responsiveness, and overall emotional and physical health—that 

would allow children to avail themselves of the widest possible range of objectively fulfilling 

lifestyle options. The next question would center on whether any approved use of genetic 

enhancements would fall under the scope of “permissible” or “obligatory” parental choice. If the 

former, there would be the risk that social pressure may create an implicit mandate to enhance 

one’s children so that they would not be disadvantaged compared to their enhanced peers. If the 

latter, the shadow of the historical eugenics movement would darken whatever progress has been 

made over the past half-century in securing rights to reproductive autonomy, as well as ignoring 

intercultural awareness of how various qualities may be valued differently in distinct human 

societies. Despite the last concern, there remains a valid argument for a set of basic, objective 

human goods that may, or ought to, be not only protected and any obstacles to their fulfillment 



159  Eberl 
 

removed, but also enhanced beyond the current natural given. Prusak’s analysis appears to be 

open to such a conclusion in principle, but he rightly cautions that the pursuit of even legitimate 

enhancements must not disrupt the fundamental good of the unconditionally loving relationship 

between parent and child. 

Prusak’s analysis centers upon the obligations that individual parents have towards the 

children they procreate. In the final chapter (Ch. 6), he discusses what obligations society may 

have to support parents in their creation and raising of their children. It is clear from the 

preceding chapters that the primary obligation to fulfill the needs of children is had by the 

parents who procreated them; however, in circumstances in which procreators are unable to 

fulfill their parental responsibilities, they may justifiably transfer such responsibilities to 

adoptive parents. This is not an ideal situation, though, and so it is incumbent upon society to 

assist procreators to fulfill their parental responsibilities. Natural familial bonds, grounding a 

child’s initial relationships of unconditional love, are intrinsically good, as well as instrumentally 

valuable for the sake of a child’s ability to form healthy relationships in the future. Hence, social 

intervention to assist parents in fulfilling their obligations is limited by the inherently valuable 

familial bond, which cannot be supplanted by any form of communal responsibility for raising 

children—as envisioned for children born into the “guardian” class in Plato’s hypothetical 

Republic (103). The result is that children, born into different families of different 

socioeconomic status, will not have equal opportunities as a result of their upbringing; but the 

cost of equalizing the next generation’s future opportunities—that is, by eliminating the familial 

bonds in which children first experience unconditional love—would deny children a fundamental 

good that grounds many other goods comprising a happy and fulfilling life. 

 

JASON T. EBERL 

Marian University College of Osteopathic Medicine 

Indiana University Center for Bioethics 

 


