Monday, September 10, 2007

Ethics Behind Artificial Birth Still Murky

Stephanie M. Caballero
By Karen Lindell

Assisted reproductive technology, in all its forms, raises ethical and moral questions. Issues such as how to handle stored embryos that aren't used, whether to remove embryos when more than one develops, sorting out surrogacy legalities and figuring out who's in charge of keeping clinics in line.

Little regulation exists in the U.S. fertility industry. Clinics are required to report their pregnancy rates to the Centers for Disease Control and Prevention each year, and the Food and Drug Administration requires screening of those who donate sperm, eggs and embryos, but oversight ends there.

"Reproductive medicine has the feeling of being a wild, wild West without many sheriffs," said Art Caplan, chairman of the department of medical ethics and director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. Caplan is concerned that the U.S. does not have a system for following up on the health of children conceived using new technologies.

"We don't keep a registry to see whether the kids are sicker (or) smaller or have learning disabilities," he said. "The tendency is to say, You had a baby, so everything is fine.' We don't do a good job monitoring, like we do with drugs."

Caplan said the lack of regulation also leads to discrimination and screening inconsistencies. With egg freezing, for example, he said, "Do you offer it only to married people? What about gay people, single moms getting older someone who doesn't have a job? How hard do you screen?

"It's also a justice issue," Caplan said. The average cost of an ART cycle is $12,400, but because fertility technology generally isn't covered by insurance, only the wealthy can afford the costly process.

Reproductive technology, Caplan said, "is a huge business. It's hard to get independent information. Many programs say, If you have the money, we'll do what you want.' A conflict of interest among people providing the technology doesn't lead them to push alternatives. They may not talk to you about adoption, for example, or childlessness."

That raises another question: With so many children in need of parents around the world, why go to such lengths to conceive a child? Why not adopt?

Caplan doesn't agree with the "who cares if it's genetic offspring or not" argument. "Some people want a genetic or biological relationship to their child," he said. "I can respect that."

And you could ask the same moral question of any couple who want to have children: "Why make babies if there are already a lot of babies around?" he said. "It's not a problem unique to the infertile."

Nancy Hemenway of Arlington, Va., is executive director of the International Council on Infertility Information Dissemination (INCIID, pronounced "inside"), a nonprofit organization that provides support and information related to infertility, pregnancy loss, adoption and child-free living.

"People going through infertility hate to hear, Why don't you just adopt?'" Hemenway said.

"I am both an advocate for adoption as well as infertility treatment depending on the individuals and their set of circumstances. The issues surrounding adoption are hugely complex. Adoption is not a fix for infertility."

Hemenway is the mother of two daughters: a 12-year-old born with the aid of fertility treatment and a 7-year-old adopted from Romania.

"I have two miracles," she said. "One grew under my heart, and one grew in it."

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