Artificial means of reproduction and our understanding of the family.

The new reproductive technologies force us to rethink the concepts `mother,' `father,' `family.' As we draw analogies to traditional patterns, we must distinguish between ethical and conceptual questions. Ruth Macklin is professor of bioethics, Albert Einstein College of Medicine, Bronx, N.Y. It is an obvious truth that scientific and technologic innovations produce changes in our traditional way of perceiving the world around us. We have only to think of the telescope, the microscope, and space travel to recall that heretofore unimagined perceptions of the macrocosm and the microcosm have become commonplace. Yet it is not only perceptions, but also conceptions of the familiar that become altered by advances in science and technology. As a beginning student of philosophy, I first encountered problems in epistemology generated by scientific knowledge: If physical objects are really composed of molecules in motion, how is it that we perceive them as solid? Why is it that objects placed on a table don't slip through the empty spaces between the molecules? If the mind is nothing but electrical processes occurring in the brain, how can we explain Einstein's ability to create the special theory of relativity or Bach's ability to compose the Brandenburg Concertos? Now questions are being raised about how a variety of modes of artificial means of reproduction might alter our conception of the family. George Annas has observed: Dependable birth control made sex without reproduction possible .... Now medicine is closing the circle ... by offering methods of reproduction without sex; including artificial insemination by donor (AID), in vitro fertilization (IVF), and surrogate embryo transfer (SET). As with birth control, artificial reproduction is defended as life-affirming and loving by its proponents, and denounced as unnatural by its detractors.[1] Opponents of artificial reproduction have expressed concerns about its effects on the family. This concern has centered largely but not entirely on surrogacy arrangements. Among the objections to surrogacy made by the Roman Catholic Church is the charge that "the practice of surrogate motherhood is a threat to the stability of the family."[2] But before the consequences for the family of surrogacy arrangements or other new reproductive practices can be assessed, we need to inquire into our understanding of the family. Is there a single, incontrovertible conception of the family? And who are the "we" presupposed in the phrase, "our understanding"? To begin, I offer three brief anecdotes. The first is a remark made by a long-married, middle-aged man at a wedding. The wedding couple were both about forty. The bride had been married and divorced once, the groom twice. During a light-hearted discussion about marriage and divorce, the middle-aged man remarked: "I could never divorce my wife. She's family!" The second is a remark made by a four-year-old boy. I had just moved to the neighborhood and was getting to know the children. The four-year-old, named Mikey, was being tormented by a five-year-old named Timmy. I asked Mikey, "Is Timmy your brother?" Mikey replied: "Not any more. Not the way he acts!" The third story appears in a case study presented as part of a bioethics project on everyday dilemmas in nursing home life. A resident, Mrs. Finch, is a constant complainer who seeks more choices and independence than the nursing home allows. A social worker at the home talked to Mrs. Finch about her adaptation, suggesting that she think of the residents and staff group as a large family where "we all make allowances for each other" and "we all pull our weight." Mrs. Finch responded that she is in the nursing home because she needs health care. She already has a family and does not want another one. In my commentary on the case of Mrs. Finch, I gave an analysis that suggests some of the complexities in understanding the concept of the family. …