Ethics: Mother and sister, mother and grandmother

Margaret Somerville,
Citizen SpecialPublished: Friday, April 27, 2007
Page a15 / arguments

Now that human eggs can be frozen, the effects of gamete donation on the resulting children are the subject of an overdue debate

Last week it was announced that a Montreal woman, Melanie Boivin, hadundergone ovarian stimulation and had her ova (eggs) frozen for possiblefuture use by her daughter, Flavie, who has Turner's syndrome and who willbe infertile as a result. While Melanie's action was done entirely out oflove for her child, if Flavie uses those ova she would give birth to herhalf-brother or half-sister, and the child would be the son or daughter andgrandchild of Melanie.

The media reported this case on two fronts: The scientific focus was therecent "breakthrough" of being able to freeze human ova.

The ethical issues this raises was the other focus. Leaving aside for themoment the most fundamental question of whether any gamete donation isethical, here's a sampling of some ethics questions I've been asked in thepast few days.

If a young man is infertile and his wife fertile and they belong to acultural group in which genetic relationship is very important, is itacceptable for the man's father to donate sperm to inseminate his son'swife? This would result in the same genetic relationship on the male side as would result on the female side in the Boivin case.

I would argue that both are ethically unacceptable, but if the male donationis seen as acceptable, consistency seems to require, at least at firstglance, that the female donation be treated in the same way.

Is one problem here that it's a parent donating to a child? What about theother way around -- a daughter donating ova to her mother who hasexperienced premature menopause? If we accept that gamete donation can beethical in some circumstances, would it be ethical for a brother to donate sperm to a brother, or a sister donate ova to a sister? Or is any donationbetween close relatives unethical?

An obvious case of such ethical unacceptability would be a brother donatingsperm for his sister's use. This would not be incest, because that requiressexual intercourse, but the vast majority of people would see it asethically wrong, quite apart from the genetic risk involved for theresulting child. But how should we view these other "related donor" casesand do they all raise the same ethical issues?

For instance, is a man donating sperm for his son's use ethically differentfrom a woman donating ova for her daughter's use? The wider question thatraises is: Are there ethically relevant differences between male and femaledonation of gametes? And the even wider one: Is gamete donation itselfethically acceptable?

Let's start with the last question, whether gamete donation, in general, isethically acceptable.

"Anticipated consent" is an emerging doctrine in ethics. It requires us toask whether we can reasonably anticipate that the persons most affected bywhat we plan to do would, were they able to decide, be reasonably likely togive their consent. The answer we are now getting from many people conceivedthrough gamete donation is that they would not have consented.

They believe that an ethical wrong was done to them -- especially if thedonation was anonymous -- and that society was complicit in that wrong byproviding its resources to make their conception through gamete donationpossible. Some people respond that many children conceived naturally don'tknow who their father is or are reared in a family where their mother'shusband is not their genetic father, so why is sperm donation an ethicalproblem?

The reason is society's intentional involvement in their conception in thatway. This complicity requires society to ethically justify the outcome forthe child. Because ova donation can never occur naturally and alwaysrequires technological intervention, unlike "private" sperm donation,society will necessarily be complicit in it, and therefore must ensure suchethical justification is present.

That being said, might there be differences between sperm donation and ovadonation that are ethically relevant? Children conceived through spermdonation have life handed on to them through the natural process ofconception and birth. That is not true of ova donation, because the gestational mother is not the biological mother, a situation that couldnever occur naturally.

Usually, the nearer we are to the natural in using the new science, thefewer ethical difficulties we are likely to encounter. This distinction issometimes summed up as the difference between repairing nature when it failsand doing what is impossible in nature.

In a broad sense, all children are conceived by "sperm donation," whichmight explain why we have not analysed the ethics of such donation asclosely as perhaps we should have. Sometimes, further scientificdevelopments cause us to revisit practices that we have regarded asethically settled and identify further ethical questions that need to beaddressed.

I believe ova donation is doing that in relation to sperm donation, at leastregarding the conditions under which it should be allowed. For instance,there is a growing international consensus that anonymous gamete donation isunethical and should be prohibited. To the contrary, the Canadian AssistedHuman Reproduction Act makes it a crime, with heavy penalties, to disclosethe identity of gamete donors without their informed consent.

The fertility industry -- a $5-billion (U.S.) per year business in theUnited States -- is strongly opposed to prohibiting either anonymous gametedonation or payment of gamete donors, because such prohibitions can decreaseaccess to gametes. Yet, strikingly, altruism is used as a major marketingtool to recruit donors. I suggest that emphasis helps to suppress moral intuitions donors may experience about the ethics of what they are doing inrelation to their resulting child. What is clear is that without payment,whether in cash or kind, many people -- in particular, women -- are not willing to donate.

Other, more general, questions I was asked in relation to freezing ovaincluded whether women would now store ova as teenagers in order to attaintheir career goals before having babies in their 50s. The companion commentwas invariably, "If men in their 70s can father a child (and usually CharlieChaplin and Pierre Elliott Trudeau were mentioned as examples), what's wrongwith a woman being a new mother at that age? Isn't preventing women fromfreezing their ova to use at any time during their lives, discrimination onthe basis of sex and age?"

I would argue, again, that there is a difference ethically between thatwhich happens naturally (old-age fatherhood) and that which is impossiblenaturally and requires a technological intervention to do an end run aroundnature (old-age motherhood).

Sometimes scientific advances solve some ethical problems rather than -- or, as well as -- creating new ones, and that is true of freezing ova. Just aswe've been able to freeze sperm for young men whose fertility is threatened by cancer treatment, we can now freeze ova for young women in the same circumstances. That will avoid the ethically troublesome situation of havingto create an embryo in order to preserve a young woman's opportunity to haveher own genetic child and heartbreaking situations such as that of theBritish woman who stored embryos created with her partner's sperm beforecancer treatment that left her infertile. Her partner later withdrew hisconsent for her use of the embryos and the European Court of Human Rights,the final court of appeal, consistent with all the other courts which heard the case, has just ordered them destroyed.

Ova freezing is just one more example that raises the broad question: Howshould we deal ethically with scientific advances in reproductivetechnologies? I propose that all these technologies must be ethicallyevaluated primarily through the lens of the children who will result from their use.

That lens requires that, at the very least, we first do no harm to thosechildren; that we respect their fundamental human rights to come into beingfrom natural biological origins; and that we act in their "best interests,"in particular, in preserving their natural genetic relationships.

Except for concern about physical risks to children from using reproductivetechnologies, the focus up to now has been almost entirely on the rights ofadults, who want to have a child, to use these technologies -- that is, onlythe adult lens has been used. That has caused a failure to consider, in thedepth and breath required, both what ethics requires with respect to thechildren conceived through the use of reproductive technologies and thefundamental human rights of those children with respect to their coming into being.

Washington Post: "Embryo Bank" Stires Ethics Fears

'Embryo Bank' Stirs Ethics Fears'

Firm Lets Clients Pick Among Fertilized Eggs

By Rob Stein
Washington Post Staff Writer
Saturday, January 6, 2007; Page A01

A Texas company has started producing batches of ready-made embryos that single women and infertile couples can order after reviewing detailed information about the race, education, appearance, personality and other characteristics of the egg and sperm donors.

The Abraham Center of Life LLC of San Antonio, the first commercial dealer making embryos in advance for unspecified recipients, was created to help make it easier and more affordable for clients to have babies that match their preferences, according to its founder.

"We're just trying to help people have babies," said Jennalee Ryan, who arranged for an egg donor to start medical treatments to produce a second batch of embryos this week. "For me, that's what this is all about: helping make babies."

But the embryo brokerage, which calls itself "the world's first human embryo bank," raises alarm among some fertility experts and bioethicists, who say the service marks another disturbing step toward commercialization of human reproduction and "designer babies."

"We're increasingly treating children like commodities," said Mark A. Rothstein, a bioethicist at the University of Louisville in Kentucky. "It's like you're ordering a computer from Dell: You give them the specs, and they put it in the mail. I don't think we should consider mail-order computers and other products the same way we consider children."

Prospective parents have long been able to select egg or sperm donors based on ethnicity, education and other traits. Couples can also "adopt" embryos left over at fertility clinics, or have embryos created for them if they need both eggs and sperm. But the new service marks the first time anyone has started turning out embryos as off-the-shelf products.

Before contracting for the embryos, clients can evaluate the egg and sperm donors, and can even see pictures of them as babies, children and sometimes adults. A fertility specialist will then transfer the embryos into a client's womb or into a surrogate, which Ryan can also arrange.
"We're unique," Ryan said. "We're the only one in the world doing this right now."

Some fertility doctors and ethicists are undisturbed by the Abraham Center because the service does not differ markedly from what already happens routinely at fertility clinics.

"I know some people say: 'This is shocking. Embryos made to order,' " said John A. Robertson of the University of Texas at Austin, who advises fertility specialists on ethical issues. "But if you step back a little bit, you realize that people are already choosing sperm and egg donors in separate transactions. Combining them doesn't pose any new major ethical problems."

But others condemned the process as the unsettling culmination of recent objectionable developments, including the payment of egg and sperm donors and the growing tendency to try to select traits such as sex, intelligence and appearance.

"People have long warned we were moving toward a 'Brave New World,' " said Robert P. George of Princeton University, who serves on the President's Council on Bioethics. "This is just more evidence that we haven't been able to restrain this move towards treating human life like a commodity. This buying and selling of eggs and sperm and now embryos based on IQ points and PhDs and other traits really moves us in the direction of eugenics."

"We find this very troubling," agreed Steven Ory, president of the American Society for Reproductive Medicine. "This is essentially making embryos a commodity and using technology to breed them, if you will, for certain traits."

Ryan dismissed the complaints.

"People can say, 'Oh, this is the new Hitler.' That's not the case," she said. "I don't take orders. I say 'This is what I have' and send them the background. If they don't think it's right for them, they don't have to take them."

So far the embryos Ryan has created have been from white donors, but she said that was because most of the couples that have contacted her are white. Among the more than 150 couples on her waiting list are African Americans, and she plans to try to create embryos for them, as well as possibly other races and mixes of races.

Ryan is, however, using only egg donors who are in their 20s and have at least some college education and only sperm donors who have advanced education, such as a PhD or law degree.

All must undergo a standard round of health tests required for all egg and sperm donors, as well as screening to make sure they have no criminal record or family history of mental illness, Ryan said. They answer detailed questionnaires that ask about their childhood temperaments, favorite books, adult hobbies and family histories.

"If I do discriminate, it's that I only want healthy, intelligent people," Ryan said. "People will say, 'You're trying to create the perfect human race.' But we've always done gene selection just by who women choose as their husbands and men choose as their wives. This is no different."

Ryan said the main advantage is not the attributes of the donors but the cost: She charges $2,500 per embryo and estimates the total price tag should be less than $10,000 for each attempt at pregnancy, which is much less than the cost of standard adoption or in vitro fertilization.

Some experts questioned the creation of embryos for unspecified recipients when about 400,000 excess embryos are in storage at fertility clinics. But Ryan said her embryos are better because she uses young, fertile donors, whereas excess embryos frozen in storage tend to come from older women with fertility problems.

The cost, convenience, prospects of success and ability to vet the donors all are attractive to Ryan's clients -- potentially not only infertile couples and single women but also gay men and lesbian couples.

"You get to get an idea of what your baby will look like, and it just seems like it's a lot easier and more affordable," said Joan, 42, of Birmingham, Ala., who asked that her last name not be used.

She contacted Ryan after she was unable to get pregnant using three egg donors and becoming disenchanted by the prolonged process of trying to adopt a child or a leftover embryo. She and her husband want a sibling for their 3-year-old son. "I am not going to give up until I have another baby. This seems very, very attractive," she said.

Some experts, however, warn that the legal status of these embryos remains unsettled.

"Having an interstate business involving human embryos seems to be a bad practice from pretty much every perspective," said Susan L. Crockin, a lawyer in Newton, Mass., who specializes in reproductive technology.

So far, Ryan said, she has produced one batch of 22 embryos using an egg donor in her 20s from Arizona and a sperm donor from Fairfax Cryobank, a sperm bank operated by the Genetics & IVF Institute in Fairfax. He is a 6-foot-tall lawyer with blond hair and blue eyes. She is a student with brown hair and hazel eyes.

A single woman in her 40s from California and a married woman from Canada in her 30s each had two of the embryos implanted and are five months pregnant, Ryan said. In case they want more children or the pregnancies fail, the two clients split the rest of that batch and had the embryos frozen.

A Houston doctor whom Ryan planned to hire to create the second batch dropped out after learning what Ryan was doing, she said. Another doctor in New York subsequently signed on to use the same sperm donor and a blond-haired, blue-eyed egg donor from Utah who works for an airline. The egg donor started taking hormones this week to trigger ovulation.

Another single woman from California in her 40s has signed a contract for two of these embryos, with a 30-day option for more, Ryan said. Any remainders can be shipped frozen to clients on the waiting list, she said.

"When the first 'test tube' baby came out, some people said it was evil," Ryan said. "I think the same thing is happening with this. Because it's new, it's getting all this criticism."