Ask a Bioethicist: Reproductive Technology

Tuesday, March 05, 2013

We begin a series about medical ethics with Duke University bioethicist Nita Farahany, who sits on the Presidential Commission for the Study of Bioethical Issues. Each week, she'll discuss some of the thorniest bioethical conundrums of our day.

Today's topic: Reproductive technology. We want your suggestions of bioethical questions we should discuss. Should parents be able to choose the sex of their baby? Should there be age limitations on people who undergo in vitro fertilization? That kind of thing. Ask your question below and we'll tackle as many as we can. 

This complete interview originally aired live on March 5, 2013 as part of a month-long series. An edited version was re-aired on August 2, 2013 as part of a special hour of Ask a Bioethicist in a best-of episode of The Brian Lehrer Show.

Comments [28]

dan from Long Island

Ethical opinions are just that; but they should be informed by facts. Several statements on this segment were incorrect: NY State does NOT have an insurance mandate to cover infertility treatments of ANY kind (specifically it is only for diagnosis). The surrounding states: NJ (IVF mandate if employer has >50 employees), CT (IVF mandate if woman <40) and MA(virtually unrestricted coverage for IVF) are far more progressive. The OPPOSITE was stated by Brian and affirmed by the guest during the program. Lapsed journalism by the former and poor scholarship by the latter.

Mar. 09 2013 09:46 AM
Noach (Independent, Anti-Corporate Traditionalist) from Brooklyn

@tag from NJ, 01:15 p.m.:

G-d bless you for that post, and G-d bless the nation of Italy for demonstrating the sanity, enlightenment, decency and courage in enacting the policy you cite.

As for the questions you ask, I suspect you may know the answers. They are much the same as the answers to no less disturbing questions that surround another area in which our health and educational policies and institutions are complicit. This concerns nothing less than what is one of the greatest, most outstanding menances to public health (as well as basic decency): The whitewashing and effective promotion of a gruesome, grossly unhygienic, anatomy- and physiology- defying practice that and spreads deadly infection more than any other. Simply-put, because to oppose this crime against society at large and our youth in particular, to declare the empirical, life-saving truth, would be nothing short of, "hateful", "intolerant", "bigoted", and of course, "homophobic" [sic]. (Never mind that, as pointed-out by homosexual dissidents such as Bill Weintraub and Rob McGee, the greatest victims of this crime, /by far/ are homosexuals themselves...)

Yes, Virginia, there is trumping of _science_, public _health_ and _sound policy_ by _agenda_ and _ideology_ on the _left_ too. Such failings and crimes exist there as certainly as they do on the right. Same for rank hypocrisy. (And I could elaborate at some length and cite plenty of other examples.) Such failings are _universal_ to the _human_ condition.

Mar. 05 2013 05:28 PM
tag from New Jersey

In 2004 Pres. Ciampi of Italy signed a law banning artificial insemination using donated sperm, embryo freezing, egg donation, surrogate motherhood, pre-implantation genetic diagnosis. Assisted reproduction is limited to stable heterosexual couples and women past childbearing age are forebidden to have fertility treatment. Why aren't the rights of the fetus protected in the USA. Why don't we have more standards. We do not have a civilized way of protecting the family and the child. We should do as Italy is doing and protesting these wild procedures. Please address these issues on the show.

Mar. 05 2013 01:15 PM
Ed from Larchmont

The real ethical thing to do would be to make abortion illegal and to give these children, whose parents can't raise them, to couples who are dying to have children.

Mar. 05 2013 01:12 PM
Kim from NJ

Is it really fair to ask women undergoing cancer treatment to consider whether they know they will be able to parent the child well into adulthood? While this seems a reasonable concern, we do not ask this question before others who are considered healthy try to conceive.

Mar. 05 2013 11:46 AM
Genetic Counselor from New Jersey

Why are there so many hurdles placed in front of infertile couples who want to have a healthy child, yet society is full of people who conceive naturally and may never have passed a test to assess their ability to parent?

Mar. 05 2013 11:20 AM

Can you please discuss some of the ethical issues implicated in the medical management of pregnant women with non-obstetric disorders. For example, how should obstetricians communicate to a pregnant woman the risks of continuing medications to manage non-obstetric illness given the paucity of research that includes pregnant women? Are pregnant women carrying a fetus to term obligated to act only for the benefit of the fetus, irregardless of the harms to the pregnant woman? If so, are they then obligated to cease any and all medications managing non-obstetric illness where there is a risk to the fetus or the risk to the fetus is unknown? If not obligated to act only for the benefit of the fetus, are pregnant women ever obligated to cease taking such medication?

Mar. 05 2013 11:14 AM


Mar. 05 2013 11:05 AM
Janet from Forest Hills

I want to bear and raise a daughter with my own genes - in vitro parthenogenesis. How soon might this be possible, both legally and medically?

Mar. 05 2013 11:02 AM
Noach (Independent, Anti-Corporate Traditionalist) from Brooklyn

Who decided that anyone other than a married, heterosexual couple have the right to deliberately create new children?

Perhaps the most fundamental human right is to be born to and raised by a _male_ father and a _female_ mother who are committed to each other and able to provide a stable, safe, wholesome, nurturing environment for their child(ren).

The arguments made in favor allowing _adoption_ by people other than married, heterosexual couples do not apply to the use of reproductive technology or surrogate motherhood.

In the case of the former, the children /already exist/. In the case of the latter, the children are being deliberately _created_; brought into a sub-optimal, unfair situation. Sanctioning that is nothing short of unconscionable.

Mar. 05 2013 11:00 AM
Hannah from Brooklyn

I am currious about screening potential families before receiving fertility treatments. Should anyone just be handed a baby?

Mar. 05 2013 10:56 AM
Phoebe from Bushwick

I would like to hear her opinions on older women getting fertility treatments. How old is too old for the well being of the child? a woman who has a baby at 50 will be 70 when her child is 20. How should this factor into the decision?

Mar. 05 2013 10:54 AM
Ed from Larchmont

The Nazis would have tried to do it.

Mar. 05 2013 10:54 AM
John A

It may be somewhat worthy of ridicule that we as a society resort to assisted contraception for part of our lives, and more frequently need then assisted conception later. Profits both coming and going for the Med industry. Do these profits cloud the morality of it?

Mar. 05 2013 10:54 AM
Maggie from NYC

I am troubled by the fact that male reproductive issues end up having to be covered (if you choose to go the IVF/IUI route) through the woman's insurance - especially since men tend to still have higher paying jobs, better insurance, etc.... That seems wrong to me, though I went that route not having had much choice.

Mar. 05 2013 10:48 AM
Ed from Larchmont

NAPRO technology is a lot less expensive and it's more effective and within moral restrictions.

One key idea is that a couple doesn't have a right to a child, a child is a gift.

Mar. 05 2013 10:48 AM

Perhaps not on point for today... but

Why is intervening in the maintenance of an elderly life called "Playing God", while intervening in the conception or premature delivery of an infant is not??


Mar. 05 2013 10:44 AM
Lisa from NYC

what is the doctor's view on fetal reduction? this is troublesome to me.

Mar. 05 2013 10:44 AM
Daniel from Washington Heights

If we have the ability to select genes for our children so that they'll live healthier lives, how can it be ethical NOT to do this? Not doing this is basically the same as having a pill that cures cancer and not giving it to your child. Don't we want our children to be the healthiest that they can be?

Mar. 05 2013 10:44 AM
IVF Oopsie from NY

Relative to IVF, have there been any epidemiological studies that research whether there are positive correlations between IVF and autism? Clearly, if there is a positive correlation, the age of IVF parents could be an influence. But if there is a positive correlation, what if a supposedly benign chemical in the medium/Petri dish where the sperm and egg are fused or other seemingly benign facets of IVF protocols (e.g. LN2/liquid nitrogen or other methods of freezing harvested/created embryos) influences a known or unknown cascade that results in autism?

Mar. 05 2013 10:43 AM

Should a child conceived with donated eggs or sperm be told that they are not the "full" biological child of their birth mother?

Mar. 05 2013 10:42 AM
John A

The existence of contraception allows shift of first motherhood by perhaps five years on average, and many will use or abuse the privilege to attempt first motherhood well into their thirties. With that there will be an increased risk of birth defects. Isn't it the duty of medical care to clearly advertise these risks?

Mar. 05 2013 10:40 AM
John A.

"the human being is not a product of conception ... life begins at the moment it is conceived"
Ed, watch yourself. You may be losing clarity in your message.

Mar. 05 2013 10:23 AM
stealing hope from NY

Stealing Hope, One Clinical Trial Enrollee at a time?? ... The disingenuousness that emanates from the Memorial Sloan Kettering Cancer Center is intermittently palpable. The Institute's raison d'etre is non pareil and most people who work there are selfless. However, there are those, some powerful non-clinicians, who drop their guard and act in a manner in variance with the stated mission, putting their own potential profit ahead of patient safety. This occurs when at times very large 'milestone' royalty payments from a sponsoring biotech or big pharma company contingent upon completion of a clinical trial phase are in play. Non-clinicians may attempt to leverage clinicians into fulfilling enrollment in variance with the clinician's intuition/evidence of a drug candidate's efficacy. Non clinicians may instruct colleagues to embargo dissemination of known information to patients relative to the availability of clinical trial candidates created by competitors of an in-house candidate. This egregious selfishness is exhibited by people who clearly know better and stands to hurt innocent, desperate, cancer stricken people. When brought to the fore, Sloan attempts to sweep this under the rug, not because this behavior is clearly reprehensible, but because Sloan could lose its license to oversee clinical trials. Think this doesn't go on? “Sloan is pursuing a systemic approach to reducing expenses and increasing revenues […] One example of this is discouraging terminally ill patients from seeking initial treatment or second opinions from the cancer center […] the admission of such patients is counterproductive […] to Sloan Kettering.” [paraphrasing salient features, MSKCC, CFO/Chief Financial Officer] ... when challenged relative to COI (conflicts of interest) concerns, rest assured the above referenced powerful non-clinicians conjure and synchronize their cover stories.

Mar. 05 2013 10:20 AM
Pepper from Brooklyn

As a non-catholic I interpret the gift of God to be the living creature as well as the impact it has on your life. The act of raising a child in whatever condition it enters the world is a noble acceptance of the unbidden. I agree that this is a most healthy experience that teaches us humility.

In the last century our knowledge of how to affect childbirth beyond when and where it takes place has greatly increased. The ethics of reproduction is an important conversation about what we know and when or if we should use it, and when to say enough.

Most of us use a hospital with its tools and staff to cooperatively monitor and manage birth. This topic is as much about fertilization as it is about our increasing ability to affect fetal development. Do we consider some birth defects life threatening? If we operate on adults to save them from life threatening illness and injury, would we operate on a fetus to affect its life outside of the womb? If we find that acceptable, will we accept that this kind of operation could require genetic manipulation?

Mar. 05 2013 10:17 AM

"a gift of God..." that happens every month to every woman when she menstrates, so everytime those eggs are not fertilized either the parents sinned or god screwed up. Ed, should we stone every woman every month or could you ask god to be less falable?

Mar. 05 2013 10:16 AM
Ed from Larchmont

Ethics is really practice, what people do and see as acceptable and unacceptable. That is distinguished from morality, which is what is just or unjust according to the nature of things.

Mar. 05 2013 08:08 AM
Ed from Larchmont

The Catholic view should be represented, which is that the human being is not a product of conception or something created by and for the parents, but a gift of God placed in the care of the parents. The result of their mutual, sacrificial love. And that its life begins at the moment it is conceived.

For example, in vitro fertilization is a grave evil because conceived embryos are discarded, among other reasons. I image most ideas brought up here will be far outside the realm of the morally acceptable.

Mar. 05 2013 05:58 AM

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