Restricting Access to ART: One View on Ethics

There’s been a lot of discussion on my blog about donor insemination, and particularly the use of anonymous donors.   I’m ready to take this is a broader direction.  I’ll start with this short post. 

 This morning I came across this document, which provides ethical guidance to ART (that’s assisted reproductive technology)   professionals.    (DI is is one facet of ART.)   It was developed by the ASRM(American Society for Reproductive Medicine).  While it doesn’t address the issue of anonymous donors, it is focused on the use of ART by people who will frequently be using anonymous donors.    

It’s not particularly new (2006) but it is interesting to me the way the discussion is organized.  As the title makes clear, this paper is addressed to the use of ART by lesbian, gay or unmarried people.   The question posed is whether it is permissible to discriminate in the provision of ART–that is, to provide it to (heterosexual) married couples, but not to unmarried couples or single people.  

Framing the question like this requires the justification of restriction rather than the justification of access.   That’s consistent with an underlying assumption that we should all be treated equally unless there is a reason not to do so.    I think often the approach taken is the opposite, with each constituency having to justify why it should have access to what is already available to married couples.  

In considering the ethics of restricting access to ART, the authors here examine three interests–those of the people seeking to use the technology, those of any children that might be created because of use of the technology and the interests of the providing professional.   Their ultimate conclusion is that there is no ethical justification for generalized discrimination in access to ART. 

I’m undoubtedly a little less concerned with the interests of the providing professional than is the ASRM.   And I recognize that there is probably an inherent bias in favor of more treatment for more people (and more money for the providers.)   But apart from that I think they have identified the interests we ought to be concerned about.  

I also appreciate the systemic nature of the analysis here.   My own goal is to try to be transparent and systematic in working through these issues.    And I notice they have others, some more recent.  I’ll be looking at those in the next few days just to see what else they have to say. 

To be clear, this is a different and independent question from that regarding donors.    If one contended that the use of anonymous donors was impermissible generally, then presumably one would not discriminate between various people who might wish to use them.   At the same time, the questions raised here arise whether you use known or unknown donors, at least in any regime where the donor is not a legal parent.  

Also, as is discussed at some length in previous postsand comments, if the donor is to be recognized as a legal parent, it will generally alter the practice of ART dramatically.   I suppose even then, though, the question of differential access to ART arises.

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14 responses to “Restricting Access to ART: One View on Ethics

  1. It’s all very well that a committee recognizes that all groups of people are fit parents whether married, cohabiting, single, gay, hetero or lesbian (notably transgender was missed out – so is it OK to discriminate against them?) But academic committees have long bveen espousing that if not coitally conceived a child feels no need for its missing genetic parent – and we know that is absolute hogwash – so I give little credence to this glib study!

    • Do you really mean “not coitally concieved”? Some children are conceived using sperm from a man and a woman who will raise them, but are not conceived coitally–some ART procedure like ICSI is used. I think you might mean children conceived using donor sperm?

      I know some do take the view that a child must only be concieved by intercourse. I do not.

  2. Well said, there should be no prejudice against those giving or those receiving in this matter.

  3. Yes, I meant that people claim that a child who was not-coitally conceived magically does not need his/her absent genetic parent. However, frequently those same people talk a lot about how children need fathers and beat up on deadbeat dads.

    Sperm donors = Dead beat dads

  4. Sandy May, You are pointing out an important contradiction in our present views on the importance of fathers.

    By allowing single women to buy sperm we are sending the message that fathers don’t matter. By rounding up dead beat dads we are sending the opposite message.

    We are talking about two different groups of women. Upper middle class women who can buy sperm and hire a nanny, and less fortunate women living on the other side of the tracks.

    At the moment we are sitting on the fence, but we won’t be sitting there for long. Procreation, free of responsibility, is an economic absurdity in an agening society which is pushing its debts on to the next generation. It is also a moral absurdity because it assumes that the childs need for a father depends on the mode and circumstances of its conception.

  5. It is unethical for a health care provider to assist in ART if they have particular evidence that person will not be a competent parent, but that can not be based on discrimination against entire groups eg lesbians, singles, etc.

  6. In the end of the day I think the question is this:

    Do we want to discriminate against lesbians and single women, or would we rather prefer to discriminate against the donor children? In my opinion the child comes first because it is a person in its own right, and not just a commodity brought into the world to satisfy the urge for procreation of its mother.

  7. -you can not discriminate against someone who does not yet exist

    -no one has yet succeeded in proving the dire consequences of being raised by single women or lesbians.

    -The identity issues facing donor offspring are the same even if the sperm is purchased by a heterosexual couple, and for all we know, possibly even more so.

  8. Derek, you wrote “no prejudce against those giving or receiving in this matter” so I hope you extend the ‘no prejudice’ to honest birth certificates. Sadly, there’s the hazards of incest and useless/dishonest medical records otherwise.

  9. PS it’s because the DI c0mmunity (and adoptees) don’t have a fair deal – so they are prejudiced against. Or must they live in some mystery shadow to suit others?

  10. kisarita, I am not talking about discrimination against someone who does not yet exist, but about discrimination against children of single mothers created through ART. They loose half their rights to know and be supported by their family. The UN convention of the rights of the child (Which President Obama is soon going to sign) is a declaration of universal rights and does not make exceptions based on the mode of conception of the child.

  11. kisarita, you say that -no one has yet succeeded in proving the dire consequences of being raised by single women or lesbians. I hope not, because I was myself raised by a single women, namely my fathers mother, because my mother died shortly after my birth. This has however nothing to do with the rights of the child. 5% of all single women who use ART, die before the child is 18. This is a dire consequence of ART. I did not suffer the same fate of becoming an orphan because I had two parents and thereby an extended family.

    • Then again, 95% of the signle women who use ART survive. That’s a pretty high percentage. Is the suggestion that those 95% should not be allowed to use ART because of the other 5%?

      Could we also say that 5 % of all women (single or not) who use ART die before the child is 18? Perhaps not because maybe single mothers who use ART are (on average) older than non-single mothers who use ART? I wonder if this is so. (I don’t believe single mothers (generally) are older than non-single mothers, but I don’t know the break-down with ART.)

      Anyway, isn’t the answer that anyone going the single parent route better have a back-up plan? And isn’t it really true that anyone who is a parent ought to be thinking about what happens if they (singular or plural) die? No one should simply be relying on statistics that say the odds are good they’ll live.

      I would not make the right to become a parent dependant on an individual’s statistical odds of survival for 18 years. (It’s actually sort of interesting to think about what would happen if you did that on a case-by-case basis. Probably a lot fewer military parents?)

  12. Julie, it is not a matter of numbers. It is a question about rights. How do you explain to the orphans created through ART that they lost the rights that other children have? The UN convention of the rights of the child makes no exception for children created through ART, and the UN has confirmed that the convention also applies to children created though ART. Some European countries have accordingly changed their laws about ART (anonymous sperm donation) because of this convention.

    When asking why single women should be disadvantaged in access to ART, you can with equal justification ask why the child created through ART should be disadvantaged compared to other children.

    Some children created through ART get full rights, others get half rights. From the point of view of the child it is a lottery, not law.

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