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12/14/2016

Pushing the IVF ethical envelop

When we discuss IVF in the Medical Ethics class that I teach we talk about the concern that IVF opens up the possibility of doing things that are at best morally questionable. There are also concerns that IVF fundamentally alters how children are created and should not be done under any circumstances, but many of my students are not ready to go that far. They are more likely to see IVF as something that can be done in a morally acceptable way as long as it is used correctly. They would argue that such things as creating excess embryos which are discarded, sex selection, PGD (pre-implantation genetic diagnosis) with the discarding of genetically abnormal embryos, creation of savior siblings, and human germline modification may be wrong uses of IVF, even if IVF itself is not wrong. Thus, if you can do IVF without doing any of those things it is morally permissible.

Some, such as Leon Kass, who suggest that there are things about IVF which are intrinsically wrong have a concern that it changes the way we think about the process of having children in way that is harmful. They would say that it makes a child into the product of a human project, and that this is very different from seeing a child as a gift who should be accepted unconditionally. To many of my students this is too nebulous to seem like a serious moral concern. However, I think that this fundamental characteristic of IVF is what leads to it being used in ways that invoke other concerns. A recent news article in the Telegraph seems to illustrate this. The British press is a great source of material for bioethical discussion. This article discusses two gay men who have five children who have been produced by IVF and gestational surrogacy. The couple currently have one girl and four boys. They have ten cryo-preserved embryos left from when the youngest two boys were conceived. They are planning to try to use sex selection to produce female triplets. In explaining this in the press one of the men I quoted as saying there was “too much testosterone” in their household and that “I need to have another princess in my life – or two or three.”

If the use of IVF means that children are a product that we can create as a project that we choose to do, then it is natural for us to choose to do projects that meet our needs and fulfill our desires. Thus, we would choose to make children to fulfill our needs and desires. Like this couple, we would chose the characteristics of the children we create by choosing a Brazilian model as an egg donor and want to choose the sex of our children. We may want to choose other genetic characteristics when that becomes feasible. We will tend to focus on our own self-centered desires and forget the concerns about the harm to the surrogate mother or the embryos that are not chosen and get destroyed, or the risks to the surrogate mother and babies by having triplets. We may forget about the well-being of the children we create who intentionally do not have a mother who is involved in raising them. While the children created by IVF are likely to be loved, is it different to be loved because you are the fulfillment of your parent’s desires and meet your parent’s needs or because you are a gift who is loved unconditionally? Of course naturally conceived children can be conceived for self-centered reasons, but does the use of IVF magnify that?

God created us to be born as the result of the unifying act of love that is at the center of the life long covenant of marriage. There is something about a child being given to us as the consequence of our expression of love that has a meaning that is important to how we see our children. By turning reproduction into a human manufacturing process we can lose something important that God was trying to tell us about who children are by how he chose for them to come into being.

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