The Right to Have a Child: Are There Ethical Limitations?
Humans have always seemed to have an innate desire to reproduce. Not only do they have the physiological apparatus and natural drive for sexual intimacy, men and women have generally had a natural, God-given desire to bear and nurture children. Thus, given the dual facts that approximately one in ten North American couples are infertile today1 and that new reproductive technologies are widely available, we are faced with a new set of ethical questions. Most fundamentally these questions may be reduced to one question: Do we have a right to have a child at all costs?
The scenarios in which this question emerges today are legion: various forms of surrogacy for married couples, single women impregnated by donor sperm, lesbian couples having a child through donor sperm, various forms of in vitro fertilization, designer babies conceived in vitro to bypass (or inherit)2 a genetic disease or provide an organ for a terminally ill sibling, the possibility of reproductive cloning, and the list goes on. Of course not all the assisted reproductive technologies (ARTs) are of the same nature, and our moral response will vary from technology to technology. But underlying all forms and their ethical concerns is the fundamental question: Do we have a right to have a child at all costs? Our answer to this question will impact the more specific ethical issues surrounding each ART scenario.
One of the most basic (though clearly not the only) moral criterion for answering this question is how the technologies impact the offspring. ARTs are not merely the chosen action of consenting adults, for they result in the procreation of human life. Thus, both the physiological and psychological impacts upon the offspring must be considered, out of a framework that all human life has an inherent dignity and value that ought to be protected.
To apply this consideration to our fundamental questions regarding the right to have a child and the ethical limitations, consider the following scenario. Bill and Susan McNamara have huge reproductive problems.3 Bill has an extremely low sperm count, and Susan is allergic to the few sperm he has. Beyond that, Susan's uterus is misshapen, making implantation and growth of an embryo extremely difficult. Despite the immense barriers the McNamaras produced three beautiful children: twenty-month-old twins and their five-year-old brother. At first glance it appears to be a wonderful story of scientific success. But there is more to the story.
During the first days of embryonic development, the McNamara children were grown on pieces of cow uterus before being implanted in Susan's womb. The ethical issues with this procedure are not rooted in the utilization of non-human elements to aid the procreative process, nor in the so-called "yuk factor" (the visceral reaction to the very notion of embryos growing on animal tissue). After all, human therapy using heart valves from pigs involves the use of animal tissue to aid a human biological process, and yet there is not an outcry against this procedure.
So why the moral fuss over the McNamara's method of growing embryos? The heart of the issue is the potential risk to the children. Animal diseases, either known or unknown, can easily be transmitted to humans through xenotransplantation (the use of live animal cells, tissues and organs for transplantation). There is the potential, both in xenotransplantation and in the utilization of animals in the procreation process, of placing humans at major risk of contracting new types of infectious diseases. For example, while pigs show great promise as a source for human organ transplants, there is a concern over what are called porcine endogenous retroviruses (PERVs for short), which are part of the animals' genes and could lead to new diseases in humans. Underscoring this concern is our experience with the HIV virus (the virus that causes AIDS), since many researchers believe that this virus lived harmlessly in green monkeys but became deadly when it entered humans. These and other examples illustrate the clear need for very close regulation of newly emerging experimentation involving animals. The problem is that the use of animals in reproduction remains largely unregulated, as does the whole of the multi-billion-dollar ART industry.
The McNamara's procedure was a "co-culture" method that potentially runs the risk of grave danger to the offspring, without a system for discerning long-term risks. Co-culture, the use of animal cells and tissue to grow human embryos, has been in the works for some time at an experimental level. However, it was not until March 2002 that the FDA (Food and Drug Administration) began to realize this and sent warning letters to infertility clinics not to proceed without FDA approval. The FDA warned that this method was really a form of xenotransplantation and ran the risk of passing on infectious diseases to mother and offspring, diseases that might lie dormant for years before being detected. We simply lack knowledge of the potential long-term impacts. At this point, although the FDA regulation does not totally ban co-culture, it does recommend lifelong monitoring of people born through one of these procedures. Thus, the risks are very real.
Utilizing a cow uterus to have children is not the only thing the McNamaras did. They also unsuccessfully attempted intracytoplasmic sperm injection (ICSI), in which a single sperm is injected directly into an egg. This procedure, first developed by researchers in Brussels, is now utilized in 40% of all ART cycles. Many scientists have been skeptical of the technology because it bypasses the natural selection process that often ensures that unhealthy sperm and eggs are not united, a union that could result in the passing on of genetic defects from parents to future generations. In March 2002, a study in The New England Journal of Medicine reported that the risk of birth defects doubles with the two most common reproductive technologies--IVF (in vitro fertilization) and ICSI. When children are conceived naturally, 4% have major birth defects, but 9% of children conceived from IVF or ICSI techniques were reported during their first year of life to have major birth defects. Further studies have evidenced a potential link between ART and birth defects such as childhood cancer, genetic disorders, heart problems, and cognitive dysfunctions. At this point the exact nature of the link is unknown, and the exact point at which it becomes unethical to assume such risks is not totally clear. But to move forward with new methods of conception and procreation without considering the risks to the resulting children is highly problematic.
The concern of potential risks to offspring is not primarily about the economic or psychological impact upon the parents in raising a child with disabilities. After all, parents may prepare for and manage quite well with such challenges. Rather, the issue is about the impact on the children, which brings us back to our fundamental question: Do we have a right to have a child at all costs? In answering this question, we should note up front that rights always have limitations and that good, God-given drives are meant to function within the parameters of God's design of and givens for human life. Unfortunately, in a rights-oriented culture such as our own, the limitations are too often set aside.
There are, to be sure, various ethical limits to reproduction that emerge from the perspective of a Christian world-view. For example, the separation of procreation from the one-flesh relationship of husband and wife and the intrusion of multiple parties into the procreative process are contrary to the designs of creation and serve to confuse and exacerbate personal identities and family patterns. But along with these concerns is the ever-present concern of an ART's impact upon the well-being of the offspring. This concern for the well-being of the offspring includes both the concern to protect embryonic life from destruction and the concern for the kind of life that embryo will have when he or she grows up. To begin by placing personal or parental rights over the dignity, value and well-being of the offspring is to begin the entire reproductive process on a questionable footing.
The McNamara's controversial method stemmed from a good, God-given desire. But we live in a fallen world in which our natural desires too often become self-centered, thus failing to comprehend the impact of our actions upon others. As Susan McNamara put it, "We were so desperate to have a baby, we would have done anything." And as husband Bill put it, "Is there a possibility of long-term effects? Yeah, there is. And that worries us. But even if we'd found the kids would be at higher risk, we would have still done it."4 Unfortunately these are the conclusions and attitudes that stem from answering the foundational question in the wrong way.
Do we have a right to have a child at all costs? It should be obvious that our rights must be limited for the sake of others, especially when our own actions would endanger the lives of others. Are there ethical limits to our good, God-given desire to reproduce? There are limits to all our good desires, precisely because these desires are given by God to be coordinated with one another according to His specific design for human beings. When we add to this the fact that our God-given desires are mingled with sinful desires, selfish impulses, and fallen drives, the need for limits becomes even more apparent. Only a people and culture that can learn to live within the boundaries of those limits deserves to be called good.
Admittedly, the degree of risk in procreation does not yield unambiguous ethical direction. There is risk in all procreation, and yet with that small risk we still have both a legitimacy and responsibility to carry out this God-given creation order. But, as we face situations and technologies of increased potential risk to our offspring, we will never have the moral wisdom to choose the good unless we have first correctly answered the fundamental questions. No, we do not have a right to have a child at all costs. For, yes, there are ethical limitations to our good, God-given desire to reproduce.
1 Studies give varying statistics on infertility, ranging from about 8% of American couples to 16%.
2 Kilner, John F., "The Ends Don't Justify the Genes," Washington Times, Sunday May 12, 2002, page B5.
3 The story of the McNamaras and description of the various technologies utilized is from Rebecca Skloot, "Sally Has 2 Mommies and 1 Daddy," Popular Science, http://www.popsci.com/popsci/medicine/article/0,12543,439442,00.html (Accessed March 4, 2003).
4 Ibid., pp. 1,5.