Sunday, September 11, 2005

Ethics and reproductive medicine

Recently was scanning through Virginia Postrel's blog and she cited this Elle article on in vitro fertilization with donor eggs.

As a single guy in my 40s, the article is interesting in a hypothetical sort of way. However, if I were to join the ranks of married people, it is likely me and my wife would be prime candidates for requiring the help of medical technology to have children. Thus, it set me off to wondering about what the scenarios are and what guidelines would govern the decision.

So dear readers, I know this is usually a family friendly blog so reader discretion is now advised as I describe some scenarios.

After reading the scenario ask yourself: would I do that? Why or why not?

Scenario one: husband and wife do what they are supposed to do and 9 months later a little one arrives into the world the usual way!

Scenario two: husband is infertile, wife is fertile, use donor sperm with artificial insemination.

Scenario three: husband is fertile, wife is fertile but conception is difficult thus couple uses in vitro fertilization and then implantation into wife.

Scenario four: husband is fertile, wife is infertile, use husband sperm with donor egg with in vitro fertilization and then implantation into wife.

Scenario five: husband is infertile, wife is infertile use donor sperm and donor egg with in vitro fertilization and then implantation into wife.

Scenario six and beyond: all of the above scenarios within the context of a surrogate mother because wife is unable to sustain a pregnancy.

If one is a secularist (non-religious world view) what would be the principles one would use to guide the decision? Or would all scenarios be acceptable?

If one is religious, what would be the principles one would use to guide the decision? Or would all scenarios be acceptable?

As I see it, there are three areas to consider.

Issue one
One's view of the status of an embryo strongly influences the decision.

(1) In vitro fertilization (IVF) usually involves the generation of more embryos than will actually be implanted so some remain in storage to be used if the first attempts at implantation are unsuccessful. If successful, the unused embryos remain in storage where they are ultimately discarded or donated to research or given up for adoption.
(2) Implantation attempts usually involve more than one embryo to insure at least one successfully implants. A friend of mine who works as a neo-natal unit nurse told me that there are a lot of twins from IVF. In these cases, the couples accept the risks of carrying twins but if more than two implant they are faced with a tough choice: do they selectively abort some of the implanted embryos to reduce the risk to the mother and increase the chance of the embryo(s) going to full-term?

Issue two
Another issue is cost. If one accepts the possible destruction of embryos or opts to proceed in a manner that attempts to avoid destruction of embryos, is there a point when the cost of these procedures become ethically problematic?

This WebMD article put the cost at $12,400 per cycle.

In all fairness, the cost of adoption is not trivial either. This article says the costs can go as high as $30,000. Another web page puts the high end at $40,000 but says $10,000 to $15,000 is fairly common.

Issue three
Intricacies due to the involvement of other people besides the couple. What role if any should a donor (sperm or egg) or surrogate play? When and how should the child be told of the role of those individuals?

Again, in all fairness, those issues arise in the context of adoption as well.

As someone sympathetic to the pro-life position, issue one is a very important bright line test.

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