How Under-Regulated ART Hurts the Best Intentioned

I’ve been thinking about the surrogacy gone awry I wrote about last time.   I think (as do some of those who commented) that the fault must like with the surrogacy agency that appears to have allowed people to go forward with a surrogacy arrangement without full counselling, etc.    Of course, I don’t know this for sure, but it looks like it to me.

It isn’t the first time I’ve written about a case where all sorts of trouble was created by an incompetent or unscrupulous agency or individual working in the ART field.   And I have no doubt that some shoddy or dishonest actions are motivated primarily by greed–after all, the surrogacy agency doesn’t get paid until the deal is made.  

Sorry Circumstances and Surrogacy

I have been thinking about this story from yesterday’s NYT.  (I think it was yesterday as it marked “Sunday Review” but the date on it is November 3.   In any event, I only saw the on-line version.)   I found it both sad and disturbing and I assume my reaction was not unlike that of many other people.

The essay, by Susan Straight, portrays the life of C, a neighbor of Straight’s.   C is something like a professional surrogate.   She’s been pregnant for other couples three times.   She has been paid a total of $115,000.   While that is doubtless a lot of money, the day to day circumstances of her last pregnancy weren’t pretty and nothing in this story would make you want to rush out and be a surrogate.  Indeed, I think it is hard to finish the essay without a feeling that something is wrong with this picture.

And what is it that is wrong? 

Is There A Chinese Sperm Shortage?

As I’ve written in the past, there have been persistent reports of sperm shortages in the UK and Canada.  The stories–particularly the ones from the UK–are vexing as people draw causal links that seem to me to be unwarranted.  (In particular, people related the UK sperm shortage to a change in UK law regarding anonymity despite the fact there appear to be more donors since the law took effect.)

Anyway here’s a very brief story about another reported sperm shortage–one new to me.   This time it is in China. 

Exhibit 2 In The Case for Regulating Non-ART Conception

I link to this story with some reluctance.    Still, perhaps it is worth comparing Ed Houben to Desmond Hatchett.   Hatchett was the subject of a post a few days back.   He has 30 children with 11 different mothers.

Houben leaves him in the dust.  He has fathered 82 children in the last ten years and, if the story is correct, there are ten more women who are pregnant.   It’s unclear to me how many different mothers there are but I’m quite sure it is a lot.

Now there’s a difference between these two men.   The women Houben impregnates are trying to get pregnant–that’s the whole point. 

The Case For Regulating Non-ART Conception

I sorry to say I am caving to an irresistible impulse I probably really ought to resist.   But at least I can keep this short.

I’ve written in the past about the case for regulating ART.   It’s often raised when some startling story hits the news–Nadya Suleman (aka Octomom) or a man with hundreds of offspring.   It’s not that these cases are typical ones.   Quite the contrary–they are unusual and eye-catching.   But they become the jumping off point for the regulatory discussion.

So it seems only fair to flag this story and consider (analogously) the case for regulating non-ART conception.   Desmond Hatchett has 30 children born to 11 different women.  

The Supreme Court’s Opinion and the Fine Art of Drawing Lines

I’ve been thinking about the opinion the US Supreme Court issued yesterday–the one about whether posthumously conceived children qualify for social security benefits.   I did a fairly quick review of the opinion yesterday, but there’s surely more to say.   There are layers of questions about what lines are drawn, who draws them, and whether they are permissible.

The children here argued that the line had been drawn in an impermissible way.

“Under the government’s interpretation . . . , posthumously conceived children are treated as an inferior subset of natural children who are ineligible for government benefits simply because of their date of birth and method of conception.”

Brief for Respondent 42–43.  In other words, she asserted that drawing a line between children conceived before the death of the husband/sperm provider and those conceived after his death was impermissible.

Of course, line drawing is often what law is all about.  

Genetic Testing and Tracking Sperm Donors–Where Does This Path Lead?

A few months ago I blogged about a sad story of a family struggling with their young son’s cystic fibrosis.   The boy, Jaxon Kretchmar, was conceived with third-party sperm.   The story has now surfaced in the New York Times.    Though most of the details were in the earlier post, it’s still a chance to revisit a critical topic.

The facts are fairly simple.  Sharine and Brian Kretchmar  used third-party sperm in conceiving their second child.  They researched carefully and chose a provider from New England Cryogenic Center.   The Center represented that the sperm it sold had been tested for a variety of genetic defects, but in fact the sperm the Kretchmar’s chose had been donated years before to a different sperm bank and exactly what testing was done (and how it was done) is at issue.  

Number of Drug Addicted Newborns On the Rise

Given yesterday’s post it seems only right to put up a quick post to note this story.  Bottom line is that the number of drug addicted  newborns tripled between 2000 and 2009.   (Actually, it says that the infants aren’t actually addicted, but rather dependent and I’m going to try to use that language from here on out.)

Now on some level this supports the underlying hypothesis for the Alabama prosecutors–we have a problem.  But there are a couple of ways in which today’s story is strikingly different. 

Criminalizing Pregnancy and the Problem Of Bad Mothers

There’s a long story  called “The Criminalization of Bad Mothers” by Ada Calhoun that was in yesterday’s New York Times.    It’s about prosecution practices in Alabama where a law designed to protect kids from exposure to meth labs is routinely used to prosecute women who use drugs while pregnant.  Perhaps it is only tangentially related to my topics here, but I think it’s worth a look and a few thoughts.   (If you’re wondering, I’ll do this first and then get over to comments that are waiting.)

The crime in Alabama is chemical endangerment of a child and its a Class A felony, which means it carries a heavy penalty–mandatory ten years to life.  

Is Regulation The Answer? Who Would Be The Regulator?

The last post (about the US as major sperm exporter) raises important questions about the regulation of ART generally and third-party gametes in particular.   As the post notes part of the reason the US dominates the world market is tied to the fact that in some regards the US is essentially unregulated while in other regards (STD testing) it is quite regulated.   If regulation were uniform, the US would lose a lot of its competitive advantage.

This raises the question of regulation of ART.  I’ve written before–with some frequency–about the inconsistent nature of ART regulation.   Part of the problem is identifying the level at which regulation should occur.  Should it be state by state?   Nation by nation?  In either case you get variation and inconsistency.

I want to tie this back to a post I put up a couple of weeks ago about ART regulation in Canada.    The main national regulator is being disbanded, although there is some debate about the significance of this move.    Just after I put up today’s post I came across this article.   The headline pretty well sums it up–in the view of the authors of a study done at the University of Calgary, regulation province by province will be more effective than national regulation.

As someone familiar with the haphazard pattern of regulation you find state to state in the US this seems a curious conclusion.    If the provinces enact different regulatory regimes, then people can evade the regulations simply by travelling next door.  This is, of course, what happens as people travel between the US and Canada as well but creating more difference may not make things better.

But perhaps regulation should be more local rather than national.   As the article notes (and as I think this blog demonstrates) many of the issues involved in drafting regulations are ethical or moral.    If we’re going to legislate morality, perhaps it should vary state to state (or county to county or province to province).  The study’s authors think these issues should be left to legislators, but that doesn’t tell us what level of legislators.

Though the article (and I guess the study) does not address it, I find myself thinking about international regulation as well.  I think that for some people the idea of uniform regulation globally seems like a good idea.  There is something appealling about it, I must say.   But I find it impossible to imagine that this is possible in this field.

For instance, as I mentioned in the last discussion, countries differ in who is allowed to use ART.     These differences are rooted in differing cultural as well as religious ideals of the family and how it ought to be constructed as well as different views of the importance of individual autonomy.    Where would a uniform international standard come from?

I’ve really no conclusion to offer, I’m afraid.  I do see that it is a mess out there and people get caught in between inconsistent legal regimes and people get hurt.  I just don’t see any terribly clear solutions.