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Monday, Jan. 19, 2009
In vitro fertilization stands test of 30 years
By PETER SINGER
MELBOURNE, Australia — Louise Brown, the first person to be conceived outside a human body, turned 30 last year. The birth of a "test-tube baby," as the headlines described in vitro fertilization, was highly controversial at the time.
Leon Kass, who subsequently served as chair of President George W. Bush's Council on Bioethics, argued that the risk of producing an abnormal infant was too great for an attempt at IVF ever to be justified. Some religious leaders also condemned the use of modern scientific technology to replace sexual intercourse, even when it could not lead to conception.
Since then, some 3 million people have been conceived by IVF, enabling otherwise infertile couples to have the child they longed for.
The risk of having an abnormal child through IVF has turned out to be no greater than when parents of a similar age conceive though sexual intercourse. However, because many IVF practitioners transfer two or three embryos at a time to improve the odds of a pregnancy occurring, twins and higher multiple births are more common, and carry some additional risk.
The Roman Catholic Church has not moved away from its opposition to IVF. In a recently released instruction, Dignitas Personae, the church's Congregation for the Doctrine of the Faith objects to IVF on several grounds, including the fact that many embryos are created in the process, and few survive. This outcome is not, however, very different from natural conception, for the majority of embryos conceived by sexual intercourse also fail to implant in the uterine wall, with the woman often not even knowing that she was ever "pregnant."
In addition, the Vatican objects to the fact that conception is the result of a "technical action" rather "a specific act of the conjugal union." But while any couple would prefer to conceive a child without the intervention of doctors, that option is not available for infertile couples. In those circumstances, it is harsh to say to a couple that they cannot have their own genetic child at all.
It also appears contrary to the broad thrust of the church's teaching about marriage and the family as the appropriate context for rearing children. Dignitas Personae says that new human life should be "generated through an act which expresses the reciprocal love between a man and a woman." But if by that the church is referring to sexual intercourse, then it surely has an unduly narrow view of what kinds of acts can express reciprocal love between a man and a woman.
Taking the several inconvenient and sometimes unpleasant steps required to have a child together by means of IVF can be, and often is, the result of a much more deliberate and reciprocally loving act than sexual intercourse.
A better objection to IVF is that in a world with millions of orphaned or unwanted children, adoption is a more ethical way of having a child. If that is the argument, however, why should we single out couples who use IVF? Why not, for example, criticize Jim Bob and Michelle Duggar, the Arkansas couple who recently had their 18th child? Yet Michelle Duggar was named "Young Mother of the Year" in Arkansas in 2004, when she had already given birth to 14 children. I haven't noticed the Vatican telling them that they should be adopting instead of conceiving so many children.
Religious opposition notwithstanding, the use of IVF by infertile couples of normal reproductive age has been widely accepted around the world, and rightly so. But in countries where the church's influence remains strong, IVF opponents are fighting back. In Poland, for example, proposed new legislation would drastically restrict its availability.
Elsewhere, the ethical debate is not about IVF itself, but the limits of its use. Last November, Rajo Devi, a 70-year-old Indian woman, became the world's oldest mother, thanks to IVF. She and her 72 year-old husband have, she says, longed for a child through 55 years of marriage. Her husband's sperm appears to have been used, but news reports are unclear about the source of the egg.
Some will find it grotesque to become a mother at an age when most women are grandmothers, but the more significant question is what kind of care such children will have if their parents die or become incapable of rearing them. Like many people in rural India, Devi lives in an extended family with other relatives, so she is confident that there would be others to bring up her child if necessary.
But, as this example suggests, the impact of parental age on a child's welfare will vary from one culture to another. Becoming a mother at 70 is more acceptable for someone living in a joint family than it would be for Western couples living in their own home without close relatives or friends nearby.
Peter Singer is professor of bioethics at Princeton University and laureate professor at the Center for Applied Philosophy and Public Ethics at the University of Melbourne. © 2009 Project Syndicate (www.project-syndicate.org)