Assisted Reproductive Technology

Interview with the Council on Biblical Manhood and Womanhood

Back in November I had the privilege of sitting down with Scott Corbin from the Council on Biblical Manhood and Womanhood (CBMW) for an interview. The interview is now available as part of the CBMW podcast series.

Over the course of about 20 minutes, we covered topics ranging from why I chose to study and teach ethics, the nature of marriage, the place of friendship, and the work of the church.If you endure to the end, you can even here a quick synopsis of the paper I presented at the annual meeting of the Evangelical Theological Society (aka, my nerd convention) about third-party gamete donation in assisted reproductive technology. Is the use of donor sperm and/or eggs adultery? Listen to find out what I concluded.

You can listen to the interview at the CBMW website or download it here.

Family Balancing: A New Trend in the Fertility Industry

One of the jobs I held in college was working for a fertilizer and weed control company. It was a family-owned small business with probably 8–10 employees. We met at the owner’s house around 7:00 a.m. to get our trucks and supplies and hit the road to make people’s yards look beautiful. The owner had six daughters who ranged in age from about 2 to 17 at the time. I once asked him what it was like to be the only man in a house with 7 women. His response was classic: “I get to hire all the sons I want and then fire them when I get tired of them.” Even though his response was in jest, it made me work a little harder on the job.

My former boss and other families like his would have been prime candidates for a procedure highlighted in today’s Wall Street Journal—family balancing. Sumathi Reddy reports:

About one out of five couples who come to HRC Fertility, a network of fertility clinics in Southern California, doesn’t need help getting pregnant. Instead, they come for what is called family balancing, or nonmedical sex selection. ‘They usually have one, two or three children of one gender’ and want their next child to be of the other sex, said Daniel Potter, medical director of HRC Fertility, which includes nine clinics.

The testing required to make such selection is called preimplantation genetic diagnosis (PGD). PGD is most often used during the in vitro fertilization (IVF) process to test for genetic diseases, but some clinics are now offering the testing in order for families to select the gender of their babies. Essentially, a woman can have IVF and request that the only embryos injected into her uterus be of a certain gender.

Interestingly, this practice of family balancing through PGD is only legal in a few countries, two of which are the U.S. and Mexico. There is also a difference of opinion among professional organizations on the ethical implications of the practice. The American Society for Reproductive Medicine states that fertility practices are under “no ethical obligation to provide or refuse to provide nonmedically indicated methods of sex selection.” However, the American Congress of Obstetricians and Gynecologists opposes the practice.

As with many aspects of the fertility industry, little thought has been given to the ethical ramifications of such practices. Let us consider two related to sex selection.

First, preferential sex selection for “family balancing” opens the door to eugenics.

The WSJ article notes, “Arthur Caplan, director of the division of medical ethics at New York University School of Medicine, said family balancing can become a smoke screen for families who want boys. ‘When you are treating the fertile in order to produce something that they prefer as opposed to a disease, I do think you’re really opening the door to a potential slope toward eugenics,’ Dr. Caplan said.”

My family would fall into the category of unbalanced. We have three girls and one boy. We know of other families with even greater imbalance. However, the gift of life is so precious that gender should not matter. I would not trade any one of my girls for another boy even if it meant we had achieved more balance.

Much like the result of the one-child policy in China, sex selection through PGD could end up producing an imbalance in genders for a generation or more. While the article describes the practice of balancing both genders in a family, at least one of the fertility clinics mentioned places no restrictions on sex selection even for the first child. If couples prefer one gender over another, they could select never to have any children of a particular gender.

The practice of eugenics has a long and ugly history (as I noted in a post a few years ago). The net result of American eugenics programs was those deemed undesirable by society were eliminated. What if girls are deemed undesirable because they are weaker? What if boys are deemed undesirable because they are troublesome? The use of preferential sex selection allows families to operate their own small-scale eugenics program.

Second, preferential sex selection for “family balancing” results in the destruction of unwanted children.

In order for PGD-based sex selection to work, IVF must be employed. The IVF process results in multiple fertilized eggs that develop into embryos. Those embryos are then genetically tested for gender and only those of the selected gender would be injected into the uterus. The remaining embryos could be frozen or discarded. If the purpose of sex selection is to provide “balance” to an already “unbalanced” family, then the embryos that do not match the preferred gender would most likely be discarded. In effect, this is the elimination of human life.

Even when they are not discarded, frozen embryo storage has become an ethical dilemma. Most estimates put the number of frozen embryos in the U.S. at over 600,000, although it is uncertain anyone knows the real number. Storage of frozen embryos costs roughly $500–1,000 per year. Many embryos are stored indefinitely or discarded when the responsible party no longer desires to keep them in storage or fails to pay the storage fees.

Since life begins at conception, these unwanted or frozen embryos are children who deserve a chance to live. However, the number of frozen and discarded embryos increases each year, resulting in the destruction of children who are “unwanted.” This is a tragedy that must be addressed. While some have promoted embryo adoption, the better option is probably to reevaluate the whole fertility industry that results in this tragedy.

The saddest line from the article came from the medical director of a fertility clinic in New York. The WSJ reports, “Joel Batzofin, medical director of New York Fertility Services in Manhattan, said about 20% of its patients come for sex selection. Nearly a third of them come from abroad. ‘If people want to avail themselves of the technology, why not?’ Dr. Batzofin said. ‘They’re not hurting anyone. They’re paying for it. [The American Society for Reproductive Medicine] thinks that it’s OK.’”

Technology without a moral compass is dangerous. In the case of “family balancing,” it appears we have crossed the moral line.

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Sumathi Reddy, “Fertility Clinics Let You Select Your Baby’s Sex,” The Wall Street Journal, 18 August 2015.

The Dark Side of Surrogacy

The Associated Press released a story yesterday highlighting the dark side of surrogacy. A Thai woman who served as a surrogate for an Australian couple is still caring for the 7-month-old boy to whom she gave birth after the biological parents did not take custody of him because he was born with Down syndrome and a congenital heart condition.

For the uninitiated in the world of assisted reproductive technologies, surrogacy is the practice of using a third-party gestational carrier in order to have a baby. In simpler terms, a couple signs a contract with a woman to carry and give birth to their baby for a fee. At birth, the baby is handed over to the parents who initiated the contract. The details can vary on who the biological parents are and what (if any) role the surrogate could have in the life of the child. But the essence of the practice is that a woman gives birth to a child who is not hers biologically.

The surrogate mother, Pattaramon Chanbua, was promised approximately $9,300 to be a surrogate. During her seventh month of pregnancy, doctors and the surrogacy agency informed her that one of the twins she was carrying had Down syndrome. They suggested she have an abortion. Pattaramon refused to have an abortion and is now caring from the boy after the biological parents took his twin sister back to Australia.

What makes this situation more complicated is the fact that paying a surrogate is illegal in Australia, and it is also illegal to pay a surrogate living in another country in some states of Australia. By contrast, Thailand has few regulations regarding surrogacy and is a popular destination for those seeking an international surrogacy contract.

What should we think about this situation and surrogacy in general?

First, we need to recognize the callous nature of actions taken by the biological parents. They have apparently abandoned their child in another country due to medical hardships that he faces. They do not recognize the value of all life. Genesis 1:26–27 clearly states that we have been created in the image of God. Even though sin has brought disease and pain into the world, we are still image bearers, even those who face serious medical hardships.

Second, we need to recognize that technology is not ethically neutral. Just because someone can employ a surrogate to give birth to a child does not mean that it should happen. Surrogacy is often described as an industry because it represents a service to be bought and sold. There are moral implications that come with participating in this industry. For the Christian, the moral problems with surrogacy raise major red flags about the value of human life, using other humans as a means to an end, and potentially allowing another person to make life-and-death choices for your child with little or no input.

Third, we need to understand that surrogacy amounts to the commodification of people. Buying and selling the womb of a woman for the sake of having a child reduces both the surrogate and the child to a commodity. The surrogate’s womb has been purchased to provide a service. The child is the “product” of that service. Money is at the center of the surrogacy agreement. Certainly there are times when surrogates may provide their services free of charge, but it is still a commodity to be negotiated for. Little thought is usually given to the price the surrogate pays to give up a child immediately after giving birth. The child may not be her biological offspring, but she has devoted the last nine months of her life to caring for the child in her womb.

We need to think twice before promoting this reproductive technology. The costs are high for all involved, and the children are the ones who potentially suffer the most.

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Rod McGuirk, “Australia May Intervene in Surrogate Baby Case,” Associated Press, August 4, 2014.

Good Reading: The Rights of Children: Biology Matters

There is an interesting article on the Public Discourse regarding anonymous gamete donation and the rights of children to know their biological parents. Here are some of the highlights:

Now that many children conceived with the help of donor sperm or eggs have reached adulthood, many of these donor-conceived adults have claimed a right to know their biological parents. This phenomenon has led a number of European countries to outlaw gamete donation. Even in places where anonymous donation remains legal, such as the United States, there is a growing trend toward the use of non-anonymous donors. This shift away from the use of anonymous gamete donors parallels the shift toward greater openness in adoption, and it marks an increasing recognition that knowledge of one’s biological origins and contact with one’s biological parents when possible are important for human well-being.

This recognition points to a more fundamental critique of donor conception. Indeed, the basic premise of arguments against anonymous gamete donation—the recognition that children have a fundamental interest in knowing their biological parents—implies that conceiving children with donor gametes is always morally problematic, even when the donor is not anonymous, because it always involves conceiving children with the intention of depriving them of a parental relationship with (at least) one of their progenitors. Thus, it is different from the usual case of adoption, in which a child already exists; putting a child up for adoption is an attempt to give that child the best possible care in non-ideal circumstances.

After further explaining her premise, the author provides the following scenario to illustrate her point:

Amanda and Arnold are in desperate need of money. Amanda learns of a local fertility clinic that is offering generous compensation for participation in a study on the effectiveness of fertility treatments. Amanda and Arnold decide to participate in the study, foreseeing that Amanda will most likely become pregnant as a result. If conception does occur, they plan to give the child up for adoption as soon as he or she is born, because their financial situation would make it impossible for them to care for the child adequately.

This case seems to be the exact moral equivalent of what egg and sperm donors do. Just like Amanda and Arnold, donors knowingly perform actions that will most likely lead to their becoming biological parents, while having no intention of raising their offspring themselves. If we think that Amanda and Arnold’s actions are wrong, we should also think that the actions of gamete donors are wrong, and for precisely the same reason: a child has a prima facie right to be raised by his biological parents, based on the absolute right to be loved by his biological parents.

The entire article is worth your time and can be found at here at the Public Discourse.

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Melissa Moschella, “The Rights of Children: Biology Matters,” The Public Discourse, February 20, 2014.

Anonymous Parenthood: The Brave New World of Childbearing

This semester I have been watching a series of lectures from Michael Sandel, professor of government at Harvard, on the issue of justice. In one of those lectures, he referenced advertisements that ran in the Harvard Crimson seeking egg and sperm donors for infertile couples. In the course of the lecture Dr. Sandel raised the moral question of whether it is right to pay anonymous donors for their eggs and sperm for the purpose of creating life. Sandel’s concern is that egg and sperm donors are merely being used as a means to an end rather than being treated as ends in themselves. While Sandel’s concern is certainly valid, I believe an underlying theological issue rests beneath the surface.

In the world of reproductive donation, most donors remain anonymous by working through fertility clinics. The donors receive payment for their reproductive materials and go on with their lives with no knowledge of any subsequent offspring. The theological question this raises is that of parenthood. Does the anonymous donation of eggs and sperm undermine the biblical concept of parenthood?

Read the rest of my article here.

*I have the privilege of being a contributor to the Council on Biblical Manhood and Womanhood’s Public Square Channel. I will be writing articles for them periodically and linking back to their page from here. Find out more about CBMW at www.cbmw.org.