Reproductive Technology: Ethical Issues

Reproductive technology encompasses a range of techniques used to overcome infertility, increase fertility, influence or choose the genetic characteristics of offspring, or alter the characteristics of a population. Each type of reproductive technology brings with it a range of ethical issues. With the accelerated pace of progress in modern medical technology, these issues have been brought squarely into the public arena, where they continue to provoke controversies involving the boundaries of government control, private choice, religious belief, and parental wishes.

Recoiling from Eugenics

Humans' ability to selectively breed desired characteristics into domestic animals and plants, combined with pride and concern for family and for national and ethnic heritage, has led historically to multiple suggestions and experiments aimed at "improving" the human race. These ideas gave rise to the eugenics movements in Great Britain and in the United States in the late nineteenth and early twentieth century, preceding and influencing the Nazi "racial hygiene" experiments of the 1930s and 1940s. The horror of these experiments caused an almost universal backlash against eugenic programs that continues to this day.

Nevertheless, from time to time suggestions are made to improve the human gene pool so as to produce people genetically suited for specific tasks, or to improve the general levels of intelligence or other traits that are considered desirable. Numerous ethicists have made strong arguments against such suggestions. The novelist Aldous Huxley decried them in his famous satire Brave New World. Paul Ramsey, a Methodist moralist and one of the founders of modern bioethics, argued in his book Fabricated Man that any change from natural procreation to mechanized reproductive technology would be harmful to individuals and to society in general.

A child is generally seen as a kind of gift of nature, conceived out of the love and passion of two people. However, as more technology is used in childbirth, there is a concern that the child may be seen increasingly as a commodity whose major purpose is to satisfy the emotional needs of the parents.

Another twenty or thirty years must pass before data will be available on the well-being of children born to couples as a result of reproductive technology, although anecdotal reports are positive. Data about children who have been brought into the world by technology for reasons other than infertility may have to wait another fifty to one hundred years before being analyzed because such children are few in number and difficult to find and study.

The Poles of the Debate

Because reproductive technology encompasses a wide variety of both goals and techniques, there is no single ethical position held by most thinkers considering its ethics. For many, the central, underlying question is when "personhood" begins, in the life of a fertilized ovum .

The most conservative stance, opposing all interventions in natural procreation and therefore opposing most reproductive methodologies, is adopted by the Roman Catholic Church and a number of other conservative groups, all of whom invoke some variation of Natural Law ethics. The conservative basis of this nonintervention stance is based on granting full respect to the conceptus from the moment of conception, defined as when a sperm penetrates an ovum.

Some methods used to overcome obstacles to childbirth are permitted by many of these groups. Many would not oppose concentrating a sperm sample from a husband whose sperm count was low, nor would they oppose bringing an ovum around a blocked fallopian tube so sperm could reach the ovum within the mother's reproductive tract. They also would not oppose administering medication to enhance ovulation. Each of these methods involves manipulating the sperm or ovum before conception.

Others who assign the beginning of personhood to later stages of development advocate a greater freedom to utilize reproductive technology depending on the ethical merits of specific situations and on the rights of other individuals who are involved. Within this group, a central question is where to draw the boundary between parental freedoms to choose methods of procreation and to influence the characteristics of their child on the one hand, and, on the other, societal interests in protecting the unborn.

Donor Gametes

One of the oldest and least controversial reproductive technologies is the use of donor sperm to overcome low sperm count on the part of the male or to avoid inheritance of some genetic condition that the male might pass on to his child. Donation is usually anonymous, but some characteristics of the donor are known.

Ethical issues arising in sperm donation include the extent to which parents have the right to choose desirable characteristics in the genetic father of the child, and the right of the child to eventually learn the identity of the father. Each of these issues has precedent in nonassisted reproduction, since prospective parents do choose their mates, and anonymous parenthood occurs in many adoptions. Payment for the sperm sample is generally low enough that the incentive to donate is not thought to be coercive for the donor, and so is not a significant ethical issue.

Donor ova (eggs) are now sometimes used in combination with in vitro fertilization technology. Women who are unable to ovulate, or whose ova might transmit a genetic condition they do not want to pass on, use this method. Ovum donation poses risks to the donor. Medication usually is given to cause the release of excess ova, and laparoscopy (in which a needle is inserted through the abdomen) is used to retrieve the ova. Reimbursement is higher and can easily become coercive. Large sums of money have been offered to young women at prestigious colleges, and glamorous potential donors have asked for as much as $100,000.

In Vitro Fertilization and Surrogacy

In vitro fertilization, even with anonymously donated ovum or sperm, is usually accepted as enabling a couple to experience gestation and create a family. However, the in vitro procedure typically creates more embryos than will be implanted. These excess embryos are usually frozen and may remain viable (able to develop normally) for several years. Is it ethical to create embryos that will never be developed? Are the embryos of a couple joint property, which can be divided upon divorce, or should they be considered children, with custody awarded to one parent or the other? What should be done with frozen embryos as they lose their viability?

The ability to fertilize an ovum in a glass dish makes it possible to combine gametes from any man and woman and implant the fertilized ovum into any other woman. Should this be done for other than a husband and wife? For instance, should a reproductive specialist be allowed to refuse to help an unmarried or same-sex couple have a child? Antidiscrimination laws cover some of these issues, but the application of this law to reproductive technology services is still developing.

In vitro fertilization also raises the possibility of employing a woman to be a surrogate mother, acting as the carrier of a child who is expected to be raised by another woman. Women have contracted to render this service in exchange for having all their medical costs covered and in exchange for a stipend to be paid when the baby is delivered. The ethical and legal problems posed by such arrangements have drawn much attention, and many states regulate the boundaries of such agreements.

The birth mother (surrogate) usually signs a contract to allow the adoption of the baby upon birth. However, hormonal changes during pregnancy, especially the increased levels of oxytocin, can produce a variety of behavioral changes, often termed "maternal instinct," in the pregnant woman. The woman may have been quite willing to surrender the child upon birth, but she may have become unwilling to do so after birth.

In general, the birth mother has the principal right to decide about fulfilling her contract to give over the baby, but the state has stepped in, making contrary decisions when the welfare of the child is at stake. Surrogacy has other potential problems, such as what happens when there are prenatally diagnosed abnormalities and termination decisions must be made or when there are differing standards of prenatal care between the surrogate and the contracting party, and when there is a desire for control of the contracting individual or couple over the surrogate.

Genetic Selection and Medical Motives

Ova and sperm can be genotyped so that particular genes or combinations of genes can be selected. While this is usually very expensive and not yet foolproof, success has been reported in influencing the sex of a child.

Cells from early embryos can be removed for even more precise genotypic determination and selection. Such selection has the potential of being more and more precise. Technology may even become capable of altering traits, as the genome becomes better understood. What kind of genetic selection should be allowable in embryos? Should one avoid mental retardation in potential children? Should one select for possibilities of greater intelligence? Is it ethical to choose to have a child only of a particular sex?

Genetic analysis also allows parents to have children whose genes can help others. But should a child be brought into the world simply for the sake of another, or should it be brought in only for its own sake? In a widely reported case in 2000, a couple selected for implantation an embryo that was found to be a perfect bone marrow match for their child, whose own marrow was failing due to Fanconi anemia.

Testing showed that the embryo did not have the recessive disease and that his marrow would not be rejected by his sister, who needed a transplant. The parents attested to their desire for another child, they refused to give birth prematurely for the sick child's sake and they refused to put the infant in any risk by extracting marrow for transplant. They used only the stem cells from the placenta to begin the repopulation of the older daughter's marrow. The process worked! This case highlights the difficult issues involved, and probably represents the best process and outcome possible in such a case. The future may bring more problematic cases as the technology advances to allow treatment of more conditions through tissue or stem cell transplantation.

Stem Cells

The existence of stem cells—cells with the potential to develop into a wide variety of other cell types—presents other ethical issues. Placental stem cells may not be able to become every type of cell in the body. In contrast, stem cells derived from developing embryos can. People who believe abortion is ethically acceptable usually have little problem with stem cell collection, because they do not accept the embryo as a person at this stage of gestation.

Most people who believe that personhood begins at conception object to harvesting stem cells from embryos, even from the many thousands of embryos frozen in reproductive clinics that gradually lose their viability as years pass. In 2001 President George W. Bush declared that federal funds could be used for research only on stem cell lines that were already in existence, and that the creation of new lines could not be funded by taxpayer money. Stem cell research is allowed if funded by private sources. Many scientists feel federal money should be allowed to fund stem cell research, citing the enormous potential benefits it can bring.

see also Cloning Organisms; Eugenics; Genetic Testing: Legal Issues; Prenatal Diagnosis; Privacy; Reproductive Technology.

Robert C. Baumiller

and Charles J. Grossman

Bibliography

Andrews, Lori B. The Clone Age: Adventures in the New World of Reproductive Technology. New York: Henry Holt, 2000.

Ramsey, Paul. Fabricated Man. New Haven, CT: Yale University Press, 1970.

Sacred Congregation for the Doctrine of the Faith 1987. "Introduction on Respect for Human Life in Its Origin and on the Dignity of Procreation." Origins 16, no. 40 (March 19, 1987): 698-711.

Internet Resource

Ratzinger, Joseph, and Alberto Bovone. "Respect for Human Life: Congregation for the Doctrine of the Faith." Rome. The Feast of the Chair of St. Peter, the Apostle. February 1987. <http://www.ewtn.com/library/curia/cdfhuman.htm>.