Ethics of Risking Passing On Mental Illness to Children

The person who posed the question is asking a very good question and it is one that I am not going to answer. The reason I am not going to provide an answer is that it is not a black and white question where there is one clearly correct question. Like many ethical questions, a lot will depend on the situation and how one views the different aspects of. The ethical answer comes more from wrestling with these than from getting a simple answer that it is right or wrong. The very fact that the question is being asked and wrestled with is the first sign that he is engaging this question in an ethical fashion.

It is true that having a parent with bipolar disorder increases the probability that a child will develop bipolar. It is also true that having two parents with bipolar increases this risk. Family history also contributes to this probability. This is a reality. This is also true for many other things that are present (or absent) for the parents of a child. So this raises two ethical aspects to think about. The first is what positive characteristics are you (and her) also increasing the possibility of passing on to a potential child? What good can come from these traits being passed on? Does the good that you risk passing on to your potential child outweigh the bad? Stepping away from genetics and looking at environmental issues - moving frequently can affect a child's sense of stability and willingness to attach but it can also provide broad exposure to new ideas as well as enhance a sense of resiliency - the same thing being considered can be both positive and negative. At the same time, how do you view the "passing on" of bipolar? Is this entirely a negative thing? Let me expound on this in the next paragraph.

When we look at serious diseases and disorders, especially around the possibility of "inflicting" this on our children, we usually focus on all of the negative aspects of the disease or disorder. However, the reality is that there are both positives and negatives of having a disease or disorder. For example, while parental diabetes certainly brings with it the possibility of a daily regime of blood tests and injected medication, it also can bring with it stronger motivation to maintain a healthy lifestyle and early detection of other problems. Similarly, with there are negative and positive aspects of having bipolar disorder or having increased risk factors for the disorder. This dimension of the illness is something that we do not often talk about but it also needs to be considered to make an ethical decision.

So, from a biological standpoint, there are aspects to carefully consider when judging the ethical dimension of having children when you and a potential mate both have bipolar disorder, or any condition that has a genetic component that has demonstrated the ability to be inherited. These considerations will help decide whether you ethically feel that you could have biological children together. Considering these questions may also lead you to decide that you would not want to have biological children even if a potential mate did not have bipolar disorder. Regardless, as these considerations have only been about the genetic side of having children, there would remain adopting children as an option. Whether looking at biological or adopted children, the environmental factors should also be taking into account in order to answer the ethical question fully.

When looking at the environmental factors, you would need to carefully consider how controlled each potential parent's bipolar is. There are people who have bipolar who have long periods of stability where the disorder would not have any effect on their ability to parent. Regardless of the frequency and duration of periods of instability (whether these are depressed, manic or mixed episodes), what plans would be in place to care for the children, including if the parent needed to be hospitalized? If both parents were affected by an episode at the same time, are there resources available that would be able to safely care for the children - and by safely one would have to look at emotional as well as physical safety? Factoring into this might also be a consideration of how able the parent is to notice and take action during the early stage of an episode.

In the environmental dimension, as in the genetic dimension, there are positives and negatives. Here most people are apt to focus on the negative dimensions. However, there are positive dimensions of being raised by parents who are dealing with a mood disorder. If the parents are managing their illness well, then the modeling of their insight and ability to respond to what is going on inside of themselves is a gift for their children, whether the children have a mood disorder or not. Similarly, certain structures that are placed in their lives may help the lives of their children as well.

When you factor all of both the genetic and environmental factors, you will be able to determine whether you feel that it is ethical to consider having children. I know of people with bipolar disorder that if they became a couple the answer would be that it would be ethical to have biological children. I know of other couples where the ethical decision was to raise children, but that these children needed to be adopted and not their biological children. I have also dealt with couples where both had bipolar where the clear answer was that they should not be parents. Your situation and your wrestling with the factors will help you to determine what is right in your case.

IF you do all of the wrestling, or at least enough to be ready to talk with someone you are in relationship with, then you will be better equipped to have the discussion with them. How you raise the question is important. Equally important is that until you do talk together, you do not know what she is thinking. As each of the factors involve your own judgments and values about certain aspects, coming to a conclusion really involves to people talking. It is only through your dialog that you will come to a conclusion. Also, in as much as you will not want to hear this, if the bubble is going to burst over this (whether it is because you decide you want to have kids or do not want to have kids), it is better for this to burst in the context of a calm conversation and perhaps extended dialog than at a point where you cannot truly communicate. The question of having children is a relationship deal breaker for some people. It is also something that should be a joint decision and discussed at the right time in your relationship.

The fact that the question is being asked is a sign of hope. In working to an answer, you will find a place of health and wholeness, for you, for her and for any possible children. The path may be bumpy but you will learn by going down the path.