NOT DELIVERING THE GOODS

 

            A spokesman for the fertility industry found “a lot to like” the President’s Bioethics Council’s Reproduction and Responsibility (2004).  It’s little wonder. The Council calls for very little change in the status quo regarding this enterprise, while the very profitable beat goes on.  And speeds up. 

 

            The report is little more than bioethics as consumer protection.  Chiefly, the Council observes that the $4 billion/year (and growing, given insurance subsidies)  fertility industry operates with almost no governmental oversight.  The Council suggests almost no new limitations. Instead, it recommends the gathering of more information so that, ultimately, consumers get what they are paying for: goods of merchantable quality. 

            More (and more longitudinal) studies-- “voluntary, of course--” are recommended to assess the health impacts of ART on adults and, especially, on children, to follow up on earlier studies that show, e.g., that 9% of IVF offspring have major birth defects and 25% are born prematurely and 30% have low birthweight.  Yet, to the extent that concern about reprotech arises from its effects on children later born thereof, a dilemma is presented: if American law does not recognize the personhood of the pre-term child, can government act on behalf of someone who does not exist?

 

            Almost no attention is given to the perceptual and social impacts of ART. In the Council’s view, if it pleases individuals and doesn’t cause major health problems, ART is worthy, because it supplies important the important “good” of “biologically related children.”  While the Council assumes that the desire to have biological children fundamentally trumps all other considerations, it fails to consider the possibility that this desire is contextually conditional; if reproduction were an existential imperative, childless people could never be happy.  Moreover, the “basic drive” view does not explain why many of the infertile have very actively suppressed the drive to bear children at a more physically appropriate age. 

 

            Using the Council’s standards, such ventures as television, inner-directed real estate development, Internet porn and the car culture would be support-worthy because they fulfill individual wishes with relatively few, immediately observable health effects.  In a recent newspaper profile of Celine Dion, the singer breezily notes that she has a “little iceberg” frozen in an IVF clinic that she will have implanted in three years, when she finishes her current Vegas gig.  Presumably, the Council would applaud the exercise of freedom that animates this story.  

 

            The Council gives almost no regard to the impacts of reprotech on the way people perceive themselves, and others, and interact. One panel member asks-- ostensibly rhetorically-- if Americans feel diminished by the cloning of embryos in South Korea.  Clearly, many do not.  However, many never hear and/or are similarly unmoved by reports of starvation in the Sudan, Cambodians stepping on land mines or public bombings in Russia, Israel, Colombia or even Lower Manhattan.  Plainly, many struggle enough to put one foot in front of the other, especially in a world that has already imposed so many challenges to finding human meaning.

 

            Yet, many others are bothered by activities, such as human destruction and commodification, that do not immediately and measurably affect their health.  Although no H-bombs or ICBMs fell on people between 1960-1990, the existence of nuclear arsenals undeniably darkened human moods.  To use another example, if the U.S. undertook a Ceaucescu-style architectural renewal program by tearing down all of its pre-War buildings and replacing them with drab concrete, glass and steel, that would profoundly affect the human spirit, albeit in an unmeasurable way.  Does everyone who thinks about the larger world storm the barricades?  Or are their reactions more subtle: do they drink heavily, take Paxil, feel less guilty about mistreating others, while unknowingly embracing nihilism?  Codes regarding professionals’-- or gang members’-- wearing of uniforms and proscriptions of profanity or hate speech reflect a long list of limitations on conduct that does not cause physical harm but is believed to affect human relations. Using individual, medical health as the unit and scope of analysis is a dangerously narrow research model.

 

            The Council opposes efforts to end, or even regulate, practices such as gamete sales and mass-scale cold storage of embryos.  But the Council’s failure to use consistent standards in its analysis becomes apparent when it expresses concern that “someday,” ART may turn life into “manufacture” and may distort familial relationships.  IVF fits squarely within the made by hand, mass-scale, profit-driven, quality control definition and model of manufacture.  Sperm and egg sales and surrogacy do, too, and these also grossly distort family relations. The Council’s willingness to rationalize via creative language becomes darkly comical when the Council observes that sperm and egg sellers are not paid for their “product” but, rather, for their “time” and “effort.”  Aside from ignoring what’s plainly going on in the masturbatorium, does that mean a guy who goes to a sperm bank and, despite “effort,” fails to generate “product” would still be paid? 

 

            Beyond that, the Council reasons that these measures, and IVF, have been used for long enough that they are fait accompli, with established constituencies, and that, therefore, efforts to curb these practices would be uncomfortably “controversial.”  But isn’t nearly every issue reported in the news controversial? And isn’t the function of government to address that which is controversial? Or does it reflect a fundamental misunderstanding of American government to so suggest?  i.e., is the government supposed to either avoid or at least, pretend to address, that which is disturbing or dysfunctional, while actually declining to meaningfully do so? 

 

            Moreover, the notion that practices are immune from regulation because they have been occurring for a while defies acceptance. Virtually all conduct that is proscribed by law had been occurring for an extended period before it was banned.  The validity of legislation is not diminished by the continuation of such activity-- though presumably to a lesser degree-- after it has been proscribed.  Using the Council’s rationale, should there have been no opposition to the Vietnam War beyond the mid-sixties because it had been going on for a while before that?  Should the Iraq War continue indefinitely because, hey, we’ve got the materiel there?

 

            Neither of the foregoing reasons for a permissive approach to reprotech, namely controversy or established practice, explains how the governments of Italy and Canada and the European Parliament have recently enacted broad reprotech limits.  The Council suggests that American legal system differs from some others in that “liberty” interests are emphasized and the concept of “dignity” is not to be found.  But, in this context, how could the Council justify any of even the modest limits suggested by the Council below?  Each would constrain liberty in the name of dignity.   

 

            The Council congratulates itself for reaching consensus on some  issues.   They urge a ban on the following activities: implanting human embryos into animal wombs; the production of a human-animal hybrid by fertilization of human eggs with animal sperm or vice versa; the transfer of a human embryo to a woman’s uterus for any purpose except to attempt to perform a live birth; attempts to conceive a child by fusing blastomeres from two or more embryos, or from gametes from the aborted or embryonic stem cells; experiments of embryos older than 14 days and the buying and selling of embryos.   This list is hardly ambitious.

 

            The Council never asks why so many have come to rely on the infertility treatment.   There is no consideration of infertility’s socially and self-induced basis: most of those seeking treatment have postponed childbearing until their prime reproductive years have passed, and a large percentage have scarring from STDs or abortion. The Council’s unwillingness to consider the etiology of infertility may stem from its insular, academic and professional demographic: in the academic and professional world, postponed childbearing has become a cultural norm.  More unbiased research and, especially, publicity, is needed infertility’s cause.  If multiple partner sexual histories and contraceptive-driven postponement of commitment have reproductive consequences, shouldn’t the public be made aware of this, as has wisely been done regarding other public health issues, such as tobacco use? In a culture glutted with sexual messages, is sexual responsibility too indelicate to discuss?  

 

            Finally, regarding responsibility, the crisply alliterative title does not reflect the text.  The book does not explain what responsibility is owed to whom or why. Overall, this is a very disappointing work.  Although it is touted as a starting point, the Council’s laissez-faire orientation and its low regard for unborn life seem to ensure that any subsequent analysis would be similarly tepid and, by then, even more untimely.