ART Frontiers and Parenthood

Just as I was taking a step back to think more broadly about some of the issues I discuss here, the New York Times began a series on the promise and perils of modern reproductive technology.  There have been two articles so far, both on the front page, one yesterday and now another today.   They’re gripping and sobering, too.  Definitely worth a read. 

Today’s story opens with a harrowing account of the experiences of Thomas and Amanda Stansel.  They used intrauterine insemination (IUI) as well as drugs to stimulate super-ovulation.  This is less hi-tech, less expensive, and presumably more common that IVF.     I’ll just leave it to you to read the story, which recounts what followed from their choice.  

Assisted reproductive technology (ART) unquestionably offers new opportunities to countless people who are unable to reproduce without some sort of assistance.   At the same time it brings with it countless difficult decisions and wrenching stories, legal challenges and regrettably, some bad outcomes.   (I realize we probably won’t all agree on which outcomes are bad outcomes, but I think we probably all ought to recognize that there must be some.)

A Child-Centered Perspective and Natural Parenthood

I want to move off the last topic, even though it has spurred much discussion which I suspect is not exhausted, and try to broaden my thinking.  

I think many of the comments on the last discussion were from what I will call a “child-centric” perspective.  (For some reason this reminds me–no one actually addressed my question about what rights, if any, a donor (as opposed to a child) ought to have.   What do I make of that silence?)  

The idea of a child-centric perspective is to judge various rules/practices by how well they serve children.  That’s not an easy thing to do by any means, partly because children vary enormously and partly because we probably don’t agree on what is good for children.  Choosing the path that makes children happy isn’t always best for them.  But I’ll skim over these difficulties for now. 

Anyway, the comments on the last thread considered donor insemination from the perspective of donor-created children.   Some of the commenters suggested that various people should not have access to donor sperm (or should only have access to it under certain conditions) because having access to it will allow them to create children who will not be raised in a what they consider acceptable circumstances.    

Shouldn’t we do the same sort of analysis non-donor created children–children who are concieved without the use of any ART? 

Coming Soon?–Three “Genetic Parents” and the Baby You Choose?

The wonders of modern science seem to consistently produce new questions for us to ponder.  I will turn from my current topic to consider this story. 

You can read the story to get a better idea of the science (I am no expert) but the basic idea is this:   Two female monkeys donate eggs.   The mitochondrial DNA (mDNA) from one is combined with the nuclear DNA of the other.  The resulting egg is then fertilized.   The resulting offspring have DNA from three sources–the two female monkeys and the one male monkey. 

The reason for doing this is that it is possible to have mDNA that could cause various serious diseases while you have perfectly fine nuclear DNA.   In such a case, a woman (for the idea would be to use the technique with humans, of course) could provide an egg which could then be combined with health mDNA from a donor and end up with a child that carries her nuclear DNA.  

Regulating Adoption/ART, II: For Example

This really picks right up on yesterday’s post, so you’ll want to read that first I should think.   I want to offer an example on the theory that this will help me (and perhaps readers, too) evaluate the point I’m trying to make. 

Imagine X, a very wealthy and eccentric single man who wants a child.    (Yes, I’ve been thinking about Michael Jackson and his children yet again.  I know it’s all quite sensationalized, but this item  about the third child, Blanket(?), caught my attention.)   It seems to me he might have two options.  

Plan A:  X tries to adopt a child.   As far as I know, no matter what state the person chose, this would involve some sort of home study that included evaluating  X’s fitness as a parent.   If X were sufficiently eccentric, this could be a problem.  

If You Regulate Adoption, Can You Regulate ART?

I’ve been thinking a little more about yesterday’s post and some comments on the blog and on Facebook (though not all on this post).   In particular, I’ve been thinking about a different way to approach questions about regulation of access to ART in particular and parenthood more generally.  

Let me start from a different point.   Generally we seem to be comfortable with the idea of regulating adoption.   I don’t mean to suggest that we all agree on what exact regulations should be in place.  Indeed, the eligibility of single people and unmarried couples (including lesbian and gay couples) to adopt is very much in contention just now.     What I mean is, there seems to be broad agreement that there should be some regulation of who can adopt.   There’s not a large contingent out there arguing that we should do away with all home-studies and let any person who steps forward become an adoptive parent. 

Rationing Health Care/Rationing Parenthood

There’s a discussion current in the UK just now about access to IVF under the UK’s National Health System.  This little commentary is a reflection of that larger discussion, and I’ll use it as my taking-off point. 

The question currently raised in the UK is whether the NHS should cover IVF.   IVF, like a lot of assisted reproductive technology, is fairly expensive.   Health care resources are limited.   Given these circumstances, perhaps it is reasonable to discuss whether IVF should be covered as necessary medical care, or perhaps doled out on some discretionary basis. 

In the view of the commentator, the problem is that some (many?) people need to resort to IVF because they chose to wait to have kids.  In other words, need for IVF is the logical consequence of free choice.   The implication is that a woman who wants to use IVF because she chose to wait is less deserving (and hence, should be further back in the line) than a woman whose need for IVF is unrelated to her choices in life.   

Georgia Update–Embryo Adoption Legislation Enacted

For some time now I’ve been following legislation in Georgia.   You can read through the older posts by following that link.   This all seemed to begin with the octuplets born in California.   (I’ve written quite a bit about that circus.  You could use the tag “octuplets” or start here and poke around a bit.)   The uproar around the octuplets (who you may recall were conceived via ART) lead to calls for regulation of ART.   At the time I wrote that this rush to regulation worried me and might go off in all sorts of unexpected (and to my mind undesirable) directions.

The Georgia legislation is actually a pretty good example of how the legislative process, once set in motion by public concern over one particular topic, can develop a life of its own.  Or perhaps more accurately, can serve as a vehicle for other interests.

I won’t retrace the whole history here–it’s there in the past posts on Georgia’s legislation.   But this is the end of the story, at least for this year.   The Georgia legislature has enacted a bill--HB388--that ostensibly provides for the adoption of embryos.  (It’s called the Option for Adoption Act.)    If you do not want to read the actual bill, you can read news coverage here.

A Second Surrogacy Agency Gone Bad?

Last week it was SurroGenesis.   Now there’s a story in the LA Times about a second surrogacy agency (B Coming) that may have defrauded its clients and its surrogates.

I have no particular view on the truth of what’s asserted here.   But it seems to me that there are likely to be increasing calls for the regulation of surrogacy.   This might be especially likely in California, given the octuplets and now two surrogacy agencies in the center of controversies.

I don’t think there’s anything wrong with regulation per se.   Requiring proper escrow accounts and such like would be enormously helpful.   But various interests may use the sudden interest in regulation to advance efforts in restricting access to ART.   Witness what’s been going on in Georgia.   I guess what that ultimately means is that it’s worth keeping an eye on this.

Global Surrogacy Update

Here’s a recent article from the BBC. It’s been quite a while since I’ve discussed the globalization of surrogacy in any detail.   It sounds as though some sort of regulatory legislation may be proceeding in India, which is one of the main foreign destinations for intended parents.

Three things particularly strike me in the article.   First, the reference to someone as a professional surrogate mother.   There’s really no reason why only the brokers in the middle should be considered professional, but it does seem a bit at odds with the ideal of altruistic surrogacy.

Second, the reference to restrictions the intended parents place upon the surrogate–here the foods she eats and the methods of transportation she utilizes.   Actually, perhaps as much as anything what’s striking here is the phrase used in the story–”dictate terms.”    It’s all about control.   For that period of time during which she is pregnant, the surrogate may be subject to the terms dictated by the intended parents.   It’s really not that surprising, given how carefully pregnancy is managed these days.

Finally, the description of the relationship between surrogate and IP towards the end of the article as “mutually beneficial.”   The following quote is  “[s]he is getting the money she wants and we are getting a baby.”   I guess that makes it seem pretty stark to me.  And again, I am left to ponder the difference between the transaction described here and the actual purchase of a child.

Perhaps I just need to get over that hurdle and say that under certain circumstances, baby-selling could be okay.  But surely if I were to go down that path, I’d insist on rigorous regulation of the practice, which seems at odds with the current largely unregulated state of surrogacy.

Once more, news from Georgia

I’ve been following some legislation in Georgia recently.  It’s gone through a number of revisions.   You can read about them in the earlier posts. Interestingly, you can trace the origins of this legislation back to the furor over the octuplets.  The unease about the octuplets seems to have provided a vehicle for groups more generally concerned about ART.

The new version of the bill, one passed by the Georgia state senate, is described here.    Provision limiting sale of sperm and eggs are gone, as are restrictions on the number of embryos that can be implanted transferred and who can utilized ART.   The bill now provides that embryos can only be created for the treatment of human infertility.  The question of what qualifies as “infertility”–an important question when you consider people who wish to parent singly as well as same-sex couples, is left rather fuzzy.

Apparently there is also a separate bill, passed out of the Georgia House of Representatives, that promotes embryo adoption.  This is the first I’ve heard of this second bill, but you can find some discussion of embryo adoption here.