When ART Shines

At last I am back from my travels and, for a while now, no travels before me.   This means that I can get back to postings and comments here, too.   I’m  happy to be here and will try to play catch-up efficiently.

Though the focus of this blog is not exclusively ART (that’s assisted reproduction technology, or something like that) it certainly does come up a lot.  And typically I focus on current stories of one sort or another.   And the media being what it is, many of the stories are rather sensational, focussed on instances where things wrong, often terribly wrong.

I wonder if this has distorted the discussion.    So today I want to take a step back for a moment and then focus on an instance where things went right. 

It seems to me that fundamentally ART is a tool.   It is something we can use.  It is therefore neither inherently good nor inherently evil (Catholic teaching notwithstanding), any more than a hammer could be good or evil.  It’s all about how it is used.

To be clear, I think it is possible to say that it is so easy to misuse and so hard to use properly that it still should be banned or sharply constricted.   But that is not my take on it.   Instead, I think we need to focus on ways to minimize /curtail the misuse of ART.  (I don’t really think eliminating misuse is an attainable goal though I’d love to be wrong about that.)   This in turn requires being clear about what constitutes misuse vs. good or productive use.    I think this last is the subject of a lot of the conversation here.

As you may know I’ve been travelling a bit.  I’ve spent some time with an amazing group of attorneys who spend a lot of time thinking hard about ART in all its complexity.  I never fail to learn from them.   But I was also struck–this time in particular–by the ways in which they use their authority to try and ensure that ART is used in the best ways possible.

It’s hardly original to note that lawyers are, in many settings, people with power, especially in the US where we set great store in claims of legal right.   As with ART itself, law is a tool.  It’s versatile and can be used for many different purposes, some good and some not so good.

I’ve often focused on lawyers who have misused the law even as they have misused ART.   It’s just as important–perhaps even more important–to recognize that lawyers can be critical players insisting on the best uses of ART.    Because lawyers can be deeply involved, particularly in things like surrogacy, they are well-positioned to insist that everyone is treated with dignity and respect.  They can articulate the interests of children who may be conceived via ART.   They can insist that their clients behave in ways that make ART all that it can be.

And it isn’t just theoretical.  I just spend the weekend with lawyers who do just this, lawyers who are every bit as concerned with the potential and real abuses of ART but who also see the good it can bring.   I think it is imporatnt to take a moment to acknowledge the existence of such lawyers and to appreciate the critical roles they can play.

And if there is any doubt that ART can be a good thing, check out this story from Time’s Healthland blog about a woman, Jessica Brown, who served as surrogate for her sister and brother-in-law (Melissa Brown and Steve Mohler.)  Melissa had to under treatment for breast cancer and before beginning chemotherapy had preserved some eggs, fertilized to become embryos.   When she could not carry the pregnancy that might result from the transfer of the embryos,  Jessica volunteered.

Jessica doesn’t fit the classic profile of a surrogate–she doesn’t have children of her own, for example–but the sisters were clearly very close and it’s not hard to understand why she would offer to do this.

And it’s pretty hard for me to see anything that anyone could object to.  Here’s a child who will always know her origin story and who will always have contact with the important people in that story of creation.    This is, to my mind, ART being well and thoughtfully used.


12 responses to “When ART Shines

  1. Julie – I think it is great that lawyers are talking and willing to look at all sides. My concern though is of course when profit stops the honest dialogue.

    I do believe that has happened in the adoption industry as lawyers also solicit for mothers and prospective clients, the sums of money are huge, you are working on behalf of both sides – where one side has what the other wants, and you are the one who makes it happen.

    Perhaps there will be less profit for a lawyer in the ART industry so less chance of that happening? Do you understand my concern regarding regulations created by those who profit from the work iteself? Can the ART industry avoid that pitfall?

    • I totally get your concern about regulating by the regulated. I’m afraid that sometimes, though, only the insiders really understand things well enough to know what regulations are needed and what will be effective. (I get this feeling with regard to banking these days.) That’s not a reason to trust people–I do not mean to suggest that. It is just a factor to consider. .

      With regard to adoption/ART, it seems to me that there are both unprincipled and principled participants. Lawyers, like all the other sorts of players, can fall on both sides of the line. Some of the people I’ve met are (in my view) deeply concerned with the well-being of children, but it is perfectly obvious that not all people involved are. Some are deeply concerned with their own personal profits.

      Another thing to consider (which I think is at least tangentially raised in your comment and which you’ve raised other places) is that many of the players in the whole ART/adoption operation are very vulnerable. Children, birth parents, people who desparately want to be parents. That sort of vulnerability increases the possiblity of exploitation, I think.

      So what to do? Have broad groups of stakeholders involved in crafting regulations? Create some outside agency to do that, or to enforce them? (This might be a good idea, but it is expensive and I wonder if we’ll see it anytime soon.) Have serious penalties for those who transgress?

      I think public discussion is good and I think it is valuable when the media calls attention to abuses–it makes it more likely that people will be alert, maybe makes it easier to identify the bad actors. All I meant to do here was to say that there are also good actors, and they won’t be as likely to make the papers.

      And I find all this terribly unsatisfying, I must say. But what can we do to really solve the problem? You can look at countries that some might say have taken a stronger stand (say, Canada) and what you might find is an underground economy. I just don’t know.

  2. Julie – back in the 90’s (?) they tried to get a model adoption law passed nationwide – obviously it failed but with ART / Surrogacy still in it’s infancy so to speak, now would be the time to create even a minimum standards each state would be required to meet or exceed (kind of like labor standards and companies are required to meet those standards). To me that would be the starting place to go from.

    I do agree there are good (want to do it right for all) and bad (profit only) lawyers and that all three parties as you laid out are at risk for exploitation.

    I do think they could come up with best interests/protections for all in minimum standards by having all a stakeholder from each area (bioethicists, lawyers, doctors, DC, parents, etc.) each coming to the table with minimums and get it done – with perhaps a retired judge or someone of that caliber as the mediator and final arbritraitor for a law to get passed at the federal level. I am assuming it would have to be approved by all states or majority?

    Is the above something that is possible?

    • I really don’t mean to be a wet blanket, but it seems to be so hard for even an individual state to pass ART legislation that organizing national legislation might be nigh on impossible. My guess is that there are groups that would oppose any piece of regulation from all possible sides. Surely people will want to insert conscience clauses (allowing discrimination in provision of services based on religious beliefs of the provider) and that would be controversial. Some will want to insert instructions about when life begins or what happens to extra embryos.

      Maybe that’s all too pessimistic. Maybe you could carve out a small piece at a time–record-keeping for those conceived with third-party gametes. But it really is hard for me to see this happnening. Not because it isn’t important, mind you. There are plenty of important things that don’t happen on a national level.

      Which leaves people with the state to state problems. And they are quite serious. Look at the VA/UT case on the unwed father (which I’ll post about again later today.)

      • Maybe the Federal Marriage Amendment can be altered to not only preserve marriage as a man and a woman, but prohibit intentional conception using unmarried gametes. Maybe it could even prohibit ART and establish married sexual intercourse as the only ethical way to create people.

        It certainly doesn’t make sense for this to be a state issue, since we are talking about creating American citizens here. In general, the phrase “state’s rights” should be a red flag that those with power are violating the rights of vulnerable people.

        • I take it this is a reference to the proposed amendment to the US Constitution that would restrict access to marriage for same sex couples? Since it isn’t actually very far along in the process it might well be possible to alter it, and of course, if you think about changing the Constitution the fact that the proposed changes might violate the Constitution as it is currently understood becomes irrelevant, since you are after all changing the constituion. FWIW, at present I think an law establishing married sexual intercourse as the only ethical way to create people would violate the Constitution, though I’m not sure because in general the laws define legal rather than ethical conduct.

          In general, virtually all of family law has historically been understood as a matter of state’s rights, perhaps because family law more than many things reflects community customs. So, for example, some communities require particular formalities for marriage while others require different formalities or even no formalities. Increased mobility makes variation difficult, but a lot of that gets dealt with via a doctrine called comity. Generall if you are properly married in state A all other states will also recognize you as married. The whole controversy around recognition of same-sex marriage is an exception to this, of course.

          Perhaps the more general point I should make, though, is that I don’t think your view is one that is shared by enough people to be enacted on a federal level or even on a state level. Setting marrige to one side, no state has laws that do any of the things you propose.

          And do gametes really have a marital status?

  3. Wanted to leave this link as there are some bioethicists comments as well re surrogacy.

    • Thanks. I’ve been meaning to comment on the Romney story and that’s a good article to include as one to spin off. What strikes me reading this is that with surrogacy (as with adoption, as with other ART, as with most anything in life) it can be done well and it can be done badly. I worry, too, about the exploitation of surrogates, particularly poor women, especially when you think of globalized surrogacy. But those concerns aren’t always applicable–surrogacy can be done well, with respect for the surrogate and with reasonable compensation. It’s easy for opponents of surrogacy to conjure up bad cases–whether from India or Los Angeles. But to me it doesn’t follow that surrogacy is always bad.

      Anyway, thanks for posting this. It really is on my (very long) to-do list.

  4. “And it’s pretty hard for me to see anything that anyone could object to.”

    It wasted money and energy. It created a person intentionally, which reduces people to material products and makes parents into owners. It was totally unnecessary and makes other infertile people jealous. I don’t see anything to like about it whatsoever. It’s terrible.

    • okay–I stand corrected. I overstated my case. You object and therefore it is clearly the case that some people could object. I should have said “few people could object.”

      But I wonder if it is possible that you, too, have overstated your case. Can you really not see anything to like about a sisters who stand together in times of need, even if you don’t like the things they do? Not anything to like in the fact that there is a new person in the world who is loved and cared for (and not, in any way that I can see, treated as property)? Or that people who suffered through hardship are now happier?

      Isn’t this a case of what you might call “married gametes?”

  5. No, I don’t think it is good that someone can be coerced into carrying someone else’s baby because they are siblings, it’s not something anyone should ever have to do for anyone, people should be content to be childless, or adopt, or be a foster parent. It’s utterly terrible to think that people make babies on demand like that. It makes me think all babies are just someone’s planned ego project and I have no sympathy or support for anyone with a baby anymore, I’m just like, whoop-dee-doo, good for you, get your disgusting slave project out of my face. Then I have to remember that maybe, just maybe, they had their baby naturally, not on purpose, and I should be supportive of them and happy for them.

    But yeah, you do seem to understand what married gametes means, obviously it means gametes of people married to each other. Did you know gametes are named after gamos, the Greek word for marriage?

    • You do know that naturally pregnancies can be conceived on purpose? Over 50% of married couples who had children naturally are not living by your absurd standards either.

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