Ethical Dilemmas in Reproduction
Authors: Gillian Tindall
Journal: Journal of the Royal Society of Medicine (2002)

The subject of this collection of papers is not only topical but radical: what at first sight seem to be intricate technical dilemmas in fact go to the root of our perceptions about life, choice and human value. All the contributors deserve praise for venturing into these waters and trying to dredge up some principle, coherent deduction or statement of natural justice—but some drown in the shallows of legalistic argument and special pleading. The best essays are by those who manage to remain aware of just how deep, when it comes to reproduction, the waters of human nature are.

Embryos frozen as future ‘insurance’ for either the sick or the well, cloning, egg and sperm donation, multiple pregnancies due to assisted reproduction, ‘creating a child to save another’: the themes are a rollcall of the issues that have surfaced in recent years, with greater or less accuracy, into general press coverage. To a man and woman the contributors' hearts seem to me in the right place; for instance W J Dondorp concludes, with careful argument, that the benefits of freezing the ovarian tissue of healthy women for later use are rather low as yet and the risk of shortening fertility thereby is real. But an over-cautious fairness leads this author, and one or two others, to wander down such philosophical dead-ends as the possible use of frozen tissue by trans-sexuals, or the moral least-worst decisions involved in giving fertility treatment to the HIV-positive.

Typical is the contribution of J Tizzard, ‘Gamete donation: secrets and anonymity’. She reviews the shift of opinion and practice over the years from anonymity towards controlled disclosure (thought to be a Good Thing) but fails to address the evasion of truth at the heart of this whole topic—namely, that both sperm and egg donation have in the past been encouraged as if they were simply generous acts, and the momentous implications of abandoning one's own genetic material in this way have been obfuscated. The essay contains no comment on the coerciveness of those current assisted reproduction programmes in which treatment is bargained in return for spare eggs: the fact that egg-donation itself is illegal in some highly developed countries does not apparently sound any warning note.

Nor does it seem to occur to Tizzard that many men who have donated sperm readily in the past have only done so because they are young and heedless, and that any suggestion that their contribution might come under scrutiny many years later would cause the supply, so to speak, to dry up. Contrary to a widely held belief, mature and careful reflection is not helpful in every circumstance. It comes as some relief to be told that many parents ‘seem not to heed’ supposedly mature and careful advice to tell their children about their irregular conception. I suspect that these parents have understood viscerally something about the private spaces in the human psyche which are inaccessible to current correct thinking.

The only paper that shows a full awareness of these private spaces is the one on the rights and wrongs of preimplantation genetic diagnoses (familiar to a lay public as the ongoing fuss about ‘designer babies’). Paradoxically, the authors, Drs Pennings and Liebers, both of Belgium, are rather less judiciously even-handed than the other contributors and do not hesitate to show what they actually think—which is that ‘conceiving a child to save another is a morally defensible decision... The use or instrumentalization of that child does not demonstrate disrespect for his or her autonomy and intrinsic value’. So much for the recent rejection of such a case in Britain by the Human Fertilisation and Embryology Authority (who, by the way, do not appear to be consistent in their views, since an identical case a few months earlier produced a different ruling).

What some of the overwrought public comment on the Whitaker case did not take into account, which this paper does, is that ever since bone-marrow transplants first became feasible parents have been having additional children in the hope of thus saving an existing one. Also, in a much broader sense, having another child to benefit an existing one or to replace a dead one or to fulfil any one of a whole range of parental needs is as old as humanity. It does not mean the new child is not loved for himself or herself. You cannot, as the authors say, codify decisions to procreate—indeed, ‘the whole idea of wanting to morally evaluate the parents' motives is questionable and almost doomed to fail’. For such fundamental insights I recommend this book wholeheartedly.