If there's one rule you should remember when listening to someone's opinion, it's this: anyone who says things are black and white is wrong. It might be hard to work out how they're wrong at first, but you can be sure they are. That's where the solid moral ground runs out.

Says Saletan, in his recent article on the embryo bank set up by Jennalee Ryan, "That's the central question Ryan's venture poses. She didn't invent commerce, quality control, or trait selection in human reproduction. Those trends are rampant in the egg and sperm markets. All she did was extend them across the line of conception. Does that line matter? If it does, you'd better figure out how to square that with your views on abortion and stem-cell research. But if it doesn't, you'd better figure out where to draw the next line. Because the logic of what Ryan is offering—more control, more customization, higher quality, fewer hassles, lower cost, and lower risk—won't end here."

And that's the problem, isn't it. There's no logical boundary to this moral problem. At what point does the state have the right to interfere on behalf of the child? When the genetic and social parents are being selected(1)? Once the embryo is conceived(2)? At some point during gestation? After the baby's born? Or perhaps when a social worker has documented several years of systematic abuse? And to what extent is the state obligated, or indeed allowed, to interfere on behalf of the adults? To protect donors from exploitation? How about the potential for exploitation of infertile couples by birth parents or surrogates?

It's not good enough to demand one rule for infertile couples and another for everyone else. That's exactly the inequality Ryan is striking back against. It's these inequalities, and not some evil industry or amoral desperation, that drives businesses like hers forwards. And it's only through increased access to improved reproductive technology that these conundrums will ever come close to being resolved.

So let's start insuring IVF properly - either through state or private cover. Let's fund those research programs. Let's treat infertility like the medical condition it is. I look towards a future where infertile couples have an honest shot at parenthood, as if they're just as important as everyone else(3). A future where no-one has to get hurt.

Sure, we'll still need some tidying up around the edges; some case-by-case musings over unusual scenarios(4). Society can handle that - it happens in every facet of life. After all, nothing's ever black and white.

(1) I include, here, the selection of genetic and social parents in instances of natural, as well as artificial, conception.

(2) I don't buy into the argument that full human rights should be conferred at conception. I haven't met a prolifer yet who truly thinks an embryo is just as important as an adult human being. The simplest demonstration of this fact is the scenario in which the baby has to die in order for the mother to live. I have not spoken to anyone who wouldn't terminate, however regretfully, the life of that unborn child. And now we're back to drawing lines in the grey.

(3) I should add that in some parts of the world the entire social welfare system leaves a lot to be desired. Take it as read that everyone in society should be treated as if they have value.

(4) There are, of course, other valid ways to build a family than having the female partner of a heterosexual couple gestate their genetically-related child, and I don't mean to imply otherwise. Let's not even get into the whole issue of same-sex couples, for example. But there are an awful lot of heterosexual couples who only turn to alternative methods of family creation after reaching the limit with ART (we may yet fall into that category). In the ideal I'm striving for, those involved in alternative methods of family creation (donors, adoptive and birth parents, etc) will be there because they want to be, not because they had no other choice(6). See also comment #1.

(6) Except parents whose children are forceably removed from their care on reasonable grounds. There's choice and there's abusing your freedom until it gets taken away. Go on, find me another unexplained grey area to write a footnote about.


Bea said...

Just to add - and I will stop soon, I promise - but I'm not naive enough to think this frolicking state of choice and control is just around the corner. There are too many practical hurdles, for a start.

It's just every time something like this comes up, we have to have an anti-ART frenzy, when really the logical answer is to *improve* funding and access to reduce the number of times dilemnas come up.


serenity said...

Bea - well put. I can't agree with you more.

There's a market for Ryan's services because there's a latent need out there. And we can stand here and draw lines all we'd like, but until fertility treatments are treated like a medical condition, not an elective option, then services like hers - which of course, charge top dollar - are going to thrive.

It saddens me that, at least in the US, the people who spend the most money have a better chance of bringing home a baby.

And it further depresses me that people who take part in Ryan's services are branded as "desperate" or some other negative connotation. We are still so far from real societal understanding of infertility and ART.

Anyway - I could spend hours reiterating your post. Suffice it to say that I agree wholeheartedly.

The Town Criers said...

There are so many grey areas here. It saddens me that someone is profiting off of another person's medical condition so blatantly. But why shouldn't she do it when everyone else does too (who doesn't turn a profit in the medical community?)? I can't hold her to a different standard.

I agree completely--until insurance funds it (and therefore puts it as "legitimate" in the eyes of the general public), you're going to have a focus on the business of reproduction. Rather than the very real people who are hurt by infertility.

Carol said...

very well put.

The part of this whole controversy that bothers me the most is the assumption in a lot of the news stories that couples would choose this route because they want a genetically perfect baby. Don't people get that what couples really want is their own genes in their baby - and they would choose this option as only a last resort? Well I guess I can answer my own question - they don't get it. Have you ever come across anybody who is doing IVF just so they can get a baby that is more attractive, smarter, etc. than they would be able to produce with their own eggs/sperm? gimme a break.

And I also agree w/ Serenity and Mel - if IF were better covered by insurance, than this talk of the 'business' of making babies probably would go away (in the media anyway)

Lut said...

I stumbled across that news item too. After our IVF cycle with 0 embryos (joy, oh, joy) the donor route suddenly came a lot closer. So it is something I've given some thought in the past months.

I find the link you make with insurance very interesting. I live in a country where ART is covered fairly generously by national health care (bless my taxes).

At the same time, legislation is very strict on donorship. No payment of donors is allowed beyond the most minimal refunding of expenses. On principle, I don't have a problem with that, but there are repercussions. Sperm banks exist, but there is no market, and very little in the way of selection of donors. Egg donors are rare, waiting lists are very long, selection of donors is inexistent. Embryo donor programs exist within some clinics, but I've never heard of an embryo bank.

Since there is no market, there is no competition to deliver diversified services.
I'm very interested in identity-release donor programs, but that doesn't exist ahere. All donorship is anonymous (with very limited exceptions).

I could consider going abroad, but that means paying everything ourselves, and that could very well be outside of our reach.

So what is the best policy? No commercialisation whatsoever or some freedom to trade within bounds? Donorship policy is definitely a grey area.

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