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In Vitro Fertilization
"The unexamined life is not worth living." With these words, Socrates stated the creed of reflective men and women and set the task for ethics: to seek, with the help of reason, a consistent and defensible approach to life and its moral dilemmas (Walters 22). Ethical inquiry is important to us when we are unsure of the direction in which we are heading. "New philosophy calls all in doubt," wrote John Donne in the wake of the Copernican Revolution and of Charles I's violent death, suggesting that new thoughts had challenged old practices (Donne). Today, new practices in the biomedical sciences are challenging old thoughts: "New medicine calls all in doubt" (Walters 22).
Few moral convictions are more deeply ingrained than that of the sanctity of life. If plausible once, however, the view that life is a "sacred process" (initiated, sustained, and finally halted by God) is now more difficult to maintain (Baier 1-4). Recent advances in the biomedical sciences allow us to intervene in, and sometimes take control of, the processes of life and death. Not only can death, quite often, be kept waiting by the bed or machine, doctors and scientists can now also intervene in, indeed, initiate the process of life: cloning and recombination of DNA are two examples; in vitro fertilization (IVF) is another (Walters 23).
It is not surprising, then, that in the wake of these revolutionary developments, bioethics is flourishing. Despite the obvious enthusiasm of philosophers to take a stand on many complex moral issues in the biomedical sciences, however, a curious skepticism pervades the enterprise (Walters 23). Take the comments by a dean of an Australian Medical School on the teaching of medical ethics:
Like any other lifelong clinical teacher I have firm views about such topics as euthanasia, continuing severe pain, acceptable and unacceptable risks of various treatments, the appropriate use of life support systems and numerous other matters of this sort which I discuss with my colleagues, assistants, and students but would not wish to teach dogmatically since much depends on the religious and ethical views which they may have and which also must command my respect ("Medical Ethics").
The paragraph suggests that although ethics is not a matter of dogmatism, it is a matter of personal preference or choice, something one cannot-or should not-argue about. Then there is another attitude, implied in a newspaper article by B.A. Santamaria, that ethical inquiry is useless unless those investigating bioethical issues have been "Ð’â€¦endowed with authority by Almighty God [or] the Prime MinisterÐ’â€¦" (Santamaria). Since the study of ethics is all about what is right and what is wrong, it is not possible to come to a correct conclusion unless one is directly appointed by God to make this conclusion. God is the only One who can correctly decree what is ethical and unethical; we as imperfect humans should not even attempt to do this job.
IVF raises many of these difficult moral issues. If the above conceptions about the nature of ethics were correct, however, discussion of these issues would either be futile (because morality is a matter of personal choice or opinion) or superfluous (because morality is what a divine or secular authority says it is) (Walters 23). In this paper, I want to suggest that it is not only possible, but also necessary to inquire into the ethics of such practices as IVF because the fact that we can do something does not mean that we ought to do it.
To begin with, I will provide the basic medical facts involving IVF to give a solid understanding of what goes into the whole process and what facts involving this process cause the questioning of the ethical and moral issues. Infertility affects about 4.9 million couples in the United States, or one in every twelve. Approximately one-third of infertility cases can be traced to causes in the female (Encarta). However, a small proportion of infertile women can produce healthy eggs but, although they have a normal uterus, they have damaged or diseased fallopian tubes which prevent the egg from passing from the ovary to the uterus (Warnock 29). Aside from conventional methods of fertility treatment, there are also several newer techniques, collectively known as assisted reproductive technology (ART). The best known of these is in vitro fertilization (IVF) (Encarta).
The concept of IVF is simple. A ripe human egg is extracted from the ovary, shortly before it would have been released naturally. The egg is then mixed with the semen of the husband or partner so that fertilization can occur. The fertilized egg, once it has started to divide, is then transferred back to the mother's uterus. It is common practice to transfer more than one embryo to a potential mother whenever possible because of the normal hazards that come along with pregnancy, such as the egg not attaching to the wall of the uterus (Warnock 29-30).
As many ripe eggs as are accessible are harvested. Each egg is then mixed with semen to achieve fertilization. Assuming there is no abnormality in the semen, the success rate of fertilization is usually at least 75%. When the time comes to transfer the embryos to the woman, it may be that only one embryo is suitable for transfer, or there may be several. The reason for transferring more then one embryo is that this should give the woman a better chance of achieving a pregnancy (Warnock 30).
Nearly 0.2% of American and 1% of British babies are being born after IVF. There are now more than 300,000 IVF babies worldwide. Patients stand in line for treatment, regardless of the stress, discomfort, and risks, and despite the fact that the success rate for the treatment is seldom better than 1 in 5 or 20% (Gosden 26-27). This surprisingly high number of IVF babies, and the many more IVF attempts that do not produce babies, which are currently being produced around the world present a need for the discussion of the ethical, or unethical-ness of in vitro fertilization.
To call an infant born as the result of IVF a "created" individual is to imply that there is some difference between a child conceived and brought to term in this way and one conceived in the womb and carried through completely to term by the mother. To many religious people, the work of creation belongs, in the first place, to God, as it is outlined in the creation stories of the book of Genesis. God is the one who creates life and order out of chaos. Mankind is the highest product of creation, made from materials, which are part of creation. To man, who is made in the image of God, there is given dominion over the created world and the authority to exercise a stewardship which involves caring for what has been created. This has been developed within the Christian tradition so that man may be considered a partner with God in the continuing work of creation (Walters 88).
In examining the question of IVF we are not looking at a question of creation out of nothing, but rather what may be seen, from the religious viewpoint, as an aspect of the trust given to mankind to care for creation. It may then be more appropriate to think of the "facilitated" rather then the "created" individual when we consider human intervention in the process of human fertilization (Walters 88).
In considering this question and its ramification we will look at the viewpoints of some writers, both within and outside the Judeo-Christian ethical tradition, and try to determine whether or not basic notions of humanity are threatened by the artificiality which some have claimed is involved in the process.
One argument against IVF is presented by the Roman Catholic Church using natural law as the basis for their argument. The theory of natural law is widely taken to mean that God has visibly set forth God's laws in nature and humans should obey them (Dyson 52). The primary feature of IVF that comes under scrutiny from natural law is undoubtedly concerned with IVF as "external" fertilization. This is to say, the primary accusation coming from natural law focuses on the fact that in IVF, fertilization occurs in vitro in a glass dish, rather than in vivo, namely in the woman's body. A second feature of IVF that is challenged by natural law is the use of masturbation by the husband or donor to provide the sperm without which the external fertilization cannot go ahead (Dyson 53). A rebuttal against this is presented by Fletcher, in which he has proposed a
personal instead of a biological interpretation [of the natural law theory], so that the "nature" to be respected becomes not the reproductive process but "what is worthy of a human being"-freedom, planning, control of physical nature to serve human nature! Ð’â€¦Man's vocation is actually to frustrate nature as do medicine and technology, if rational needs and purposes require it (Fletcher 323).
Another argument that many use to defend IVF, and also abortion, is that the embryo is not actually a human being but instead just a mass of cells with the potential to become a child, therefore not worthy of respect or careful treatment as that which would be awarded to a baby. Walters, however, argues that the embryo
is actually living: it metabolizes, respires, responds to changes in the environment, grows, and divides (Kass 32-60). It is actually human; it pertains to the species homo sapiens. It is inappropriate, therefore, to refer to it as "potential human life." We could, however, say it is potentially a mature human being (Walters 51).
Walters continues this argument using the reasoning of Paul Ramsey.
The human individual comes into existence first as a minute informational speckÐ’â€¦ (with the single exception of identical [multiple births]) no one else in the entire history of the human race has ever had or will ever have exactly the same genotype. Thus, it can be said that the individual is whoever he is going to become from the moment of impregnation. Thereafter, his subsequent development may be ascribed as a process of becoming the one he already is.
However, some would counter-argue that, since twinning and recombination are possible in the early days after fertilization, irreversible individuality had not been achieved at this stage. These possibilities show the uncertainty of human individuation at conception. If the uncertainty remains as long as twinning is possible, it would seem that individuality could be certainly established only at blastocyst (an embryo four to six days after fertilization). Before this period, the embryo may be considered as "only potentially a human being." This would imply that it is worthy of respect but not the same degree of respect as accorded to a "mature" human being (Walters 53).
There are many more arguments concerning the ethicalness of in vitro fertilization, but the discussions stated above are the main points stated by the opposing sides. I do not believe one single conclusion can ever be drawn from these arguments. One can form him or her own personal opinion, but there will never be a single right or wrong answer.
Based on the arguments I have read and learned about while writing this paper, I have drawn my own conclusions regarding the ethicalness of in vitro fertilization. I believe an embryo is a human being from the moment of conception and therefore its life should be treated with as much respect as a born baby should. I believe this life is precious and a creation of God. A baby is also, or should be, the representation of two people coming together in love to create a life. It should not be done outside of the body. An argument presented in Walter's book that defends this position states:
Those who reject human interference at the beginning of life would most certainly do so on the basis that what nature has decreed cannot take place ought not to take place. For an infertile couple, this implies that they must remain infertile: if they cannot produce a child by the normal means of conception then they must remain childlessÐ’â€¦(89)"
This is not necessarily the case and is a very narrow-minded conclusion to draw, as I will explain in the next paragraph.
I sympathize with the couples who wish to have a child that shares their genetics, but I believe God made the couple infertile for a specific reason. He made them infertile so they could have the opportunity to give an orphaned or abandoned child a home. There are thousands, maybe even millions, of children without families all over the world. These children deserve love and a home just as much as the couple deserves to have a child. As William Walters put it so clearly, "instead of insisting on the right of a couple to have a child, as some have done, let us be mindful rather of the right of a child to have parents" (Walters 78). Just because a couple cannot produce their own genetic child does not mean that they must remain childless.
While many people may not agree with other conclusions I have drawn regarding the personhood of the embryo or the immorality of a couple having a child outside of intimacy, there is no disputing the fact that infertile couples have an alternative to having a child created through science. They could make something good out of a seemingly bad thing by giving a child without a family a home, love, and a life. There is an alternative to infertility without relying on scientists, test tubes, and small chances. They can create their own miracle by giving life to an already-born deserving child.
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