A little while back I wrote about counselling and screening in the context of surrogacy. At the time some of the closing lines from the film “Casablanca” came to mind. Those are the one’s where Rick (Humphrey Bogart) is trying to persuade Ilsa (Ingrid Bergman) to leave Casablanca with her husband, Victor Lazlo. Rick says
If that plane leaves the ground and you’re not with him, you’ll regret it. Maybe not today. Maybe not tomorrow, but soon and for the rest of your life.
The argument works. Ilsa leaves with Lazlo.
There’s another quote I could have used and it’s the one I’ve put in the header here–it’s from a song, perhaps most famously sung by Edith Piaf. It means “I regret nothing.” And I’m sure there are many others I could invoke, because I’m inclined to think that regret, and avoidance of regret, is one of the universals of human existence. We’ve all done things we regret. Equally important I strongly suspect we’ve all harbor regrets over things we failed to do when we had the chance. Indeed, I think the Piaf quote reflects an impossible stance–I regret nothing? I am inclined to think I would look askance at anyone who would make that claim.
I’ve been thinking about regret particularly because it plays a role in debates/discussions about counselling with regard to ART. Thus, one of the things one might consider before deciding to participate in ART (as a gamete provider or as a purchaser or whatever) is whether one might come to regret one’s decision to participate. Or perhaps not to participate. I don’t see any reason why regret is generally more likely to attach to action than inaction. After all, regret is really about ruing the choices one makes and inaction is typically a choice just as action is.
To my mind, there’s no denying that anyone travelling this road (ART) ought to think about how they will feel about their choices ten years from now (or twenty or thirty or whatever.) That said, perhaps I should note that I’d say the same thing about any major life choice. And I’m not sure any particular conclusion follows from this beyond the minimal “people should really think about this” point.
And truly, I worry a good deal about the way in which potential regret is deployed as a tactic of persuasion/coercion. Think about Rick and Ilsa. He got her to leave by presenting her with the prospect that she’d come to regret a decision to stay. Now she might also come to regret the decision to go, but Rick doesn’t point that out to her because he’s not really interesting in promoting careful consideration on her part. He’s seeking a specific end–to get her to leave with Lazlo.
I worry generally that people with a particular end in mind will deploy regret strategically in order to better the chances a person will make the right choice, just as Rick does. I think you see this happening in the debates over abortion. “Counselling” (and I put it in quotes deliberately) that focusses only on the potential of regret at electing to have an abortion is designed to prevent women from choosing abortion while appearing to leave the matter to individual choice.
I see suggestions of the same dynamic with the calls for counselling of egg providers. (There’s a side point here–the whole regret thing seems to play much more when the decision maker is a woman (abortion/egg provider) than a man (sperm provider). Perhaps that’s another topic.) If the people insisting on counselling are in fact seeking a particular result (ending the use of third-party gametes) then any counselling they design/provide is likely to over-emphasize the regret on one side of the equation. (I don’t mean to suggest that all those who support counselling seek this result, but some do.)
I also wonder about how we measure the efficacy of this kind of counselling. Surely not by women who make one particular choice or the other–that presupposes that there is a “right” choice here.
It seems to me that the possibility of regret and even the reality of regret is just something we have to live with. It’s a part of being human. When we face hard choices we may regret the road we take just as we regret the road not taken. Sometimes there just aren’t any “no regrets” paths available to us and we probably regret that, too.
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I really think that counseling on the regret factor is not evenly balanced on both sides when it comes to the gamete donor.
The reason is that donating may have implications for life. But the implications of non-donating boils down to the loss in financial compensation, cash which would be used up soon enough anyway.
Regarding abortion I often wonder; very few people actually regret having their children once they have them. Some do of course and are afraid to admit it- even to themselves. But I also think the odds of regret really are much more likely when choosing to abort.
(Although the options remains for some people solve the regret by getting pregnant again shortly after).
Of course, we can not counsel a person to choose based on odds. Statistics are a poor substitute for self awareness.
I see the point you’re making about the regret factors in providing gametes. But even if the observation is true (and I suppose I ought to think about it a bit more) I’m not sure it changes the point I wanted to make. (Though perhaps I didn’t make it well.)
Regret is a risk with many choices in life–it’s an essential feature of any difficult choice, I think. The fact that you might have regrets doesn’t tell you what to do necessarily. It is, as I think you suggest, something one needs to be self-aware about.
The prospect of regret can also be used quite manipulatively, and this troubles me. I actually think that is the point in Casablanca. Rick’s goal is to get Ilsa to go, not to get her to make a careful decision. And this is what worries me in various forms of counselling, most clearlyl that some would mandate around abortion. If the counsellor has a goal pushing a person to make a particular choice rather than simply making sure a person is thinking it all through, then the invocation of regret may be manipulative.
That concern is present for me even if there’s more reason to think a person might come to regret one decision rather than the other. (One could also argue that regret is so likely to result that one shouldn’t be allowed to make a particular choice, but that’s not what I meant to talk about here–that’s a different point.)
Finally, and really tangentially, I disagree about your statement on abortion. I think there are more than a few peope who are sorry to have chlidren, though I don’t know how we count them because of your point about not admitting it. I don’t think we know nearly enough to say anything about which course of action carries greater regret in general and of course, individuals vary. It wouldn’t surprise me to find that both choices bring with them some regret–the “what might have been” questions. But in the end, I agree. We cannot counsel based on odds. These are profoundly personal choices and I think in the end we have to have some confidence in people’s (women’s) abiliity to run their own lives.
Kisarita
You have written many well crafted responses. This one is freaking brilliant. I may not like the slightly anti-choice tilt to the second half of your comment but there is no room for argument by anyone hoping to sound intelligent.
Your first point about counseling women who conceive their children through IVF fertility treatments anonymously – is so accurate. I’d be interested in anything anyone could come up to counter what you said I don’t think they can. Its not opinion you stated, its fact.
I had some new thoughts on this that I think are pretty neutral but helpful items to discuss with someone considering conceiving their offspring this way. Without talking about regret it would be helpful if as part of their consent process that person was asked about limitations to their agreement to consent. Whether their agreement to conceive and remain uninvolved in their child’s life is contingent upon the child being raised by the person they conceived with. That the child should at no time be abandoned to the care of the intended parent or any adoptive parents – that they might only donate if the chain of custody would fall to them in the event something happend that the other parent could not or chose not to raise the child. I can think of a million other limitations a person might wish to put on their agreement to conceive offspring, they might only want to participate if they thought they were helping a lesbian couple say or a single woman. I’m thinking about something I read recently where a baby was given up because he had down’s syndrom and this was disturbing for lots of reasons not the least of which was I wonder if the father knew would he or his family want raise his child so the child would have some connection to family. Also maybe someone in his family has down syndrom and would be able to help advise, something. Also would you want to be named on the child’s birth certificate in order to properly identify all the offspring you create as being your children because recording that child as the offspring of a man and sending the CDC two pages of medical history that is totally irrellevant to the child does not do the child any good and creates false statistics. Would you want to continue donating if you knew you’d had 10 babies with downs syndrom?