Wednesday, February 18, 2009

Ethics of reproduction

In a vein related to the story of the single mom of 14, whose fertility doctor transferred more than the generally accepted two embryos even though she'd already given birth to six children before her octuplets were born, this recent story came out of Canada about a 60-year-old woman who went to India in order to conceive her twins.

Obviously, apart from the sensationalistic quality of the media stories, and the debates about whether this is or is not acceptable, will come the discussions about regulating the fertility industry (overseas treatments notwithstanding) so that doctors are held responsible for "over-fertilizing" certain patients.

And, of course, this discussion will beg the question of who is acceptable and who is not? Who decides? Should there be uniform laws, or clinic-by-clinic policies? Should psychiatric evaluations be required of all candidates? Just single ones? Non-heterosexual ones? Candidates over the age of 40? 50? Should one counselor, or one doctor, be the arbiter?

In my view, the octuplets story focus has been skewed by the fact that she is a single woman. Regardless, implanting six embryos in an IVF procedure for a 33-year-old woman who has successfully delivered six children already, should certainly have raised red flags by the fertility doctor -- even if she was married. That she could pay for the expensive treatment does not mean that she could also pay for the caretaking of that many children, with the potential health issues of multiple births. And even though she requested it, any fertility doctor knows that a woman (or couple) willing to have that many children at once is not thinking clearly about long-term ramifications.

In the donor industry in general, I know that there have been concerns raised in other countries that if parents are required to use an open-identity donor, as they now are in the U.K., for example, it would restrict the number of donors available and curtail the ability of people requiring insemination to build a family.

While there are different recruitment practices that can keep donors coming through the door, my strong view is that yes, it might be harder to create children if there is a restriction placed on what donated gametes can be used, but if there is a strong reason that compels that restriction, then it should be employed. In the case of the U.K., and several other countries, government did decide that it is IN THE BEST INTEREST OF THE CHILD to have the ability to know something of their biological "other half" should they desire it, based on research with adopted and donor-conceived adults.

In the U.S., I do not see open-identity as becoming a requirement, since we are a country too vast and too wedded in choice to require it.

Nor, octuplet publicity aside, do I see being a single parent as becoming a deterrent. Even if we were to move toward greater regulation of the industry, the case is quite strong that single parents can and do raise great children (the isolated statistics in troubled non-Choice families notwithstanding).

Now it is a matter of more people in policy-making power of certain states, adoption agencies and clinics to recognize as well that non-heterosexual parents also do a great job of raising kids.

On the other hand, there is to my mind NO compelling reason for anyone to potentially have six or more children at once. The desire of someone to "increase the odds" of a successful (costly) IVF procedure by implanting more than two at once is uncalled for and should, indeed, become a regulation based on common sense.

What is your opinion? Are regulations uncalled for? Or warranted?

Here is one of the earliest reactions to the octuplets story, taking root in Georgia.