When parenthood becomes a moral dilemma

Mrs A is a 44-year-old housewife and a mother of three daughters. She was diagnosed with depression following the birth of her middle daughter, who had autism. At a recent consultation, Mrs A informed me that her husband wants another baby, specifically, a boy, so he can become a protector and guardian for his autistic sister when the parents die. He suggested undergoing in vitro fertilisation (IVF) to ensure that the mother would become pregnant with a boy.

Mr A expressed unease and moral confusion about the suggestion, while she understands her husband’s desire to secure the well-being of a vulnerable child. Yet she was concerned about the ethics of bringing a new child into this world with a specific, predetermined mission.

Parents of children with disabilities often worry about the long-term future. What will happen when they are no longer around to provide care and advocacy? In many cultures, the family remains the primary support system, and the idea of a sibling assuming that role may seem natural or even expected.

Parenthood ideally begins with unconditional love and acceptance of a new life for its own sake, not as a means to an end. When the intention behind conception is using a potential child as a “future caregiver", it risks turning that person into a tool for solving a family problem, rather than an individual with their own right to autonomy and self-determination.

There are also practical and emotional uncertainties. What if the new child is not interested in caregiving or develops challenges of his own? Burdening a child with the lifelong expectation to care for a sibling can be psychologically damaging. It may also strain the future sibling relationship that is built on moral obligation.

Mrs A’s hesitation is also coloured by her age and emotional state. At 44, pregnancy carries medical risks, and she is already struggling with depression. The emotional and physical toll of pregnancy, during which she has to stop her medication for at least the first three months, combined with the demands of raising a newborn and caring for a child with autism, could worsen her mental health. Her needs and well-being deserve as much consideration as her husband’s fears.

Perhaps the most ethical approach lies not in creating another life for a specific purpose, but in strengthening the support systems that already exist. Families like Mrs A’s should not have to rely solely on future siblings for care. Society — through inclusive education, adult support programmes and community networks — has a collective moral duty to ensure that individuals with autism can live dignified, independent and supported lives.

Mrs A’s story is not unique, and it forces us to confront a painful but necessary truth: love can sometimes blur ethical boundaries. Her husband’s wish comes from love; her resistance comes from conscience. Between them lies a moral terrain where intentions are noble but consequences complex.

In my opinion, perhaps the question is not whether to have another child, but how to ensure that people with autism are cared for with compassion, dignity and shared responsibility, without placing the weight of that future on the shoulders of an unborn child.