Creating Humans: Ethical Questions, Parts 6 & 7

~Lectures 6 and 7 of the course discuss the ethical and legal issues surrounding abortion and surrogacy, respectively.  I've already covered most of the thorny issues surrounding the ethics and legality of abortion, and it's a depressing topic to revisit, so I'll be brief.  The lecture reiterates that the "debate" between moralistic crusaders consists of two utterly irreconcilable positions, while the actual laws in most countries are an elaborate series of legal compromises.  The lecture did, however, note that the rate of abortion in nations with few restrictions vs those nations with tight or full restrictions are actually not that different.  To the moralist, this fact is irrelevant: the principle of the position often outweighs the actual effects of enacting such a principle on either side of the debate.

I see the ossified abortion debate as a form of smoke and mirrors, masking more challenging, less clear-cut moral issues.  Instead, marching in pro-life & pro-choice rallies and so forth is an easy way for protesters to feel better about themselves on what they see as a clear moral issue.  After all, if the abortion question was "solved" to the satisfaction of one side or the other, those same marchers might have to put just as much effort into other moral issues such as poverty, corruption, and social justice -- things that most people just don't want to think about or deal with.

The importance of these other issues is masked or otherwise ignored by the imperative that because abortion is the murder! of helpless children! or a violation! of a woman's rights! over her body!, the issue renders all other moral issues utterly irrelevant by comparison.  In other words, many people seem to feel that because abortion is so important, all other issues must remain on the back-burner until abortion is legally "solved" (not going to happen...).  I find this to be a dangerous and manipulative way of looking at the many ethical challenges humans face today

Moving on, surrogacy is a fascinating area of medical ethics and laws, and contains many possible and actual problems that society and the law are forced to confront.  The origin of surrogacy -- having a woman bear a child for another couple -- stretches back thousands of years.  For example, the book of Genesis in the bible tells the story of Sarah, wife of Abraham, who was unable to conceive a child.  To "solve" this problem, she gave her maid, Hagar, to Abraham, so the maid could have his child, which would be raised by Sarah.  Obviously, Hagar and Abraham used a controversial (to say the least) standard method of surrogate insemination, but surrogacy in the modern sense usually refers to the use of in-vitro fertilization, allowing a woman to bear a child for another couple, while not herself being genetically related to the child.

Even with technology removing the sexual aspects of surrogacy, the practice is still controversial.  Some feel that surrogacy is a commercialization of reproduction, which, being such an intensely personal and private act, should not involve a third party.  We saw this same argument earlier in the course, during the discussions of genetic donors.  But surrogacy is a far more obvious, in-your-face commercialization: a couple pays a woman (almost always a less-well-off woman) to bear a child for them.

The question here is: does surrogacy result in children becoming a commodity?  Is it ever acceptable to pay money for a child?  Of course, a proponent of surrogacy would argue that the payment is not for the child, but for the services of the mother, much in the same way that an adoption fee is not tantamount to buying a child (such as buying a slave might have been).  Our modern legal system clearly distinguishes between parental rights and ownership rights; parents have near-total control over their children, but do not own them and cannot sell them.  What do you think?  Is it acceptable to exchange childbearing services (in a crude sense, to rent a womb) for money?

This involvement of money for services can create the perception that surrogacy is exploitative, because in almost every case it involves a couple paying a less-economically-advantaged (i.e. poor) single mother to bear their child.  Some would say that this is market economics at work, but is it really alright to allow it for reproductive purposes?  What do you think?

Another argument against surrogacy is that even though the child is not genetically the offspring of the surrogate mother, parenthood is so strongly ingrained into us that many find it disturbing that a mother would ever give up a child she bore in exchange for cash.  This becomes an even more difficult issue when you consider the question of whether or not a surrogate mother has any legal rights or legal relationship to the child she bears.  Consider the example of a surrogate mother who agrees (and signs a legally binding contract) to bear a child for a couple, but upon having the child, finds herself so attached that she no longer wants to give it up.

While the contract may be binding and enforced by the law, many people would find it very difficult to literally pull a child out of its mother's arms and hand it off to another person.  Whose moral rights are stronger, the genetic donors', or the surrogate mothers'?  What do you think should happen in this scenario?  Does the law trump all emotional considerations, or should there be exemptions?

Surrogacy laws by state in 2007.  It's not easy to read, but note that the white states have no regulations covering surrogacy.  See this page for details by state.

The lecture brought up the fascinating (and again, disturbing) example of the Beasley-Wheeler dispute.  In this case, a British legal secretary named Helen Beasley agreed to be a surrogate mother for the Wheelers, a couple living in California, in exchange for $19,000.  Embryonic implantation went normally until the seventh week of Beasley's pregnancy, when she discovered that the embryo had divided into twins.  The Wheelers requested that she abort one of the fetuses (!), as the contract they'd made with Beasley stipulated that she bear one child for them; the Wheelers didn't want two.  Beasley sued them in court in 2001 to terminate the Wheeler's parental rights and collect the unpaid fee; she found another family to pick up the contract and adopt the twins.

While I haven't been able to find the outcome of this case (perhaps it hasn't been resolved, as the wheels of justice can grind more slowly than those of Amtrak), it shows how complex surrogacy can be.  I imagine that most people, upon reading the above paragraph, would be horrified at the behavior of the Wheelers and consider them bad people for not agreeing to take both children.  Whether or not you agree with this assessment, it shows the weakness of the law in this area.  In many states and nations, there are few or no laws explicitly regulating surrogacy to prevent these sorts of practices.  Do you think there should be?  Or would that be an unacceptable government interference in the market for surrogates?

Finally, we must consider the legal rights of children born to surrogate mothers.  Does a child have the right to know that they were carried by a surrogate?  Most of us would agree that an adopted child has the right to know that he or she was adopted, and to know the identity of his or her biological parents.  Is surrogacy different? How so?

Modern IVF-assisted surrogacy, like many of the other reproductive technologies in this course, are still in their infancy and the law has, in many cases, not caught up with the available technologies.  For example, the above chart shows that the legislatures of many U.S. states haven't taken up the issue of surrogacy or are unwilling to do so.  The Beasley-Wheeler dispute (which was between a British woman and an American couple) also shows us yet again that laws regulating reproductive practices can only have a real effect if they are international conventions; otherwise, bans on practices such as abortion, surrogacy, genetic enhancement, and so forth can be easily flouted by those with the means to travel to places where such practices are allowed.

I hope this lecture analysis has made you think about the legal and ethical dimensions of some highly controversial subjects.  My next lecture analysis will be on the fascinating issue of pre-natal screening, so look forward to it!

On Books

An insight:

• All books are self-help books.

Another Reason Why I Like Rain

~After some light rain yesterday, upon exiting the grocery store I was greeted with the sight of a beautiful rainbow stretching across the sky to the north:

Another picture:

Creating Humans: Ethical Questions, Part 5

~Our next lecture in the course is about gender selection.  The first major idea is that despite technological advances in reproductive technology, gender selection has been going on for a very, very long time, usually in favor of male children.  Many societies, both past and present, either overtly or subtly favor having male children, or at least more males than females.  There are many reasons for this: the need for a male heir to carry on the family line, a greater perceived usefulness of a man in a labor-intensive and/or violent society, an unwillingness to pay a dowry for a daughter, and (perhaps most importantly) the tradition of sons caring for their parents in their old age.

For most of human history, the practice of gender "selection" was simple and brutal: infanticide (often by exposure).  But within the last few decades, the widespread availability of ultrasound technology has enabled gender identification in relatively early stages of pregnancy, widely influencing the decision of whether or not to abort.  Although many regard abortion as morally equivalent to murder, there are many who don't, and even for those that are squeamish, it's presumably less agonizing to abort an unborn child than it is to kill a newborn infant.

With this technology has come a significant and subtly dangerous side-effect: a gender imbalance in some societies.  The two nations most affected are India and China; the latter was especially affected by the One Child policy instituted in 1979 to control China's rapidly-rising population.  When you combine a society in which families need a son for a variety of cultural and economic reasons, with a policy harshly penalizing families that have more than one child, you end up with a lot of boys, and fewer girls.  Adding to the problem of gender imbalance is the transfer of unwanted girls to foreign parents via adoption; 99% of such foreign adoptions are of girls.

Although the One Child policy has been largely phased out, the gender gap was created over decades and has yet to play out.  But is a gender imbalance in a given population really a problem?   Consider this:  In 2009, for every 100 girls born in China, 119.5 boys were born (the usual ratio is 105:100).  By 2020, the nation is expected to have 24 million men of marriageable age unable to find a wife.  The effects are already being seen: a rise in the trafficking of women from other countries, increased migration (and overpopulation) from rural to urban areas, economic strains as elderly single men have no family to support them, and possible correlations to increases in crime.  While some have argued that the gender gap helps empower women (as they are in a better bargaining position for selecting a mate), others have argued the opposite (i.e. the aforementioned trafficking of women).

I think it's reasonable to assume that a healthy society has a fairly equal ratio of males to females.  Significant gender gaps correlate to societal problems, while extreme gender gaps (often the subject of speculative fiction), are disastrous.

The problem is widely recognized, and there have been steps to correct the ratio.  For example, China has outlawed sex-selective abortions (although the problem persists), and the nation is attempting to reform its pension system (leaving the elderly less dependent on sons to care for them in their dotage).  Assuming gender-imbalanced nations can weather their gap-related issues, I think (hope?) the problem will eventually solve itself as cultures mature towards equality of the sexes, where girls are as valued just as much as boys.

Now, consider this question: given the effects of a gender imbalance, is sex selection ever ethically acceptable?  I think many people, especially readers from Western nations, would quickly come to the conclusion that it is not, and that it should be illegal (or at least severely frowned upon), even for pre-pregnancy procedures such as In-Vitro Fertilization.  However, remember that it's very, very easy to judge others when we ourselves are not faced with the same problems.

Imagine a poor farming family in rural India with several daughters and no sons.  To have the girls marry well, dowries must be paid, and the family has no savings or pension for their impending old age, and equally-poor relatives.  If the means are available, can we really blame the parents for ensuring their next-born child is a boy?   The course presented another difficult scenario: a married woman in a misogynist culture (I'm looking at you, Saudi Arabia), who has given birth to several daughters, angering her potentially-violent husband who wants a male heir.  Can we really blame her for using assistive technology to ensure her next child is a son?  Is sex selection always wrong, or are there cases when it might be acceptable?

Summary:

• Gender selection is an old issue that has been a problem for a long time, and some cultures are still adjusting to its effects.  Although the morality of the issue may seem clear-cut to many, as with so many ethical issues, it's important to take personal and cultural realities into account before we condemn.

• A better approach to the problem is to focus on the underlying societal pressures which cause parents to practice sex selection, rather than condemning the practice outright.  For example, pension reforms to support the elderly in developing nations, giving parents there less reason to prefer having a boy.

Creating Humans: Ethical Questions, Part 4

~The next lecture in the course is about cloning.  The public perception of cloning has been irrevocably shaped by (bad) science-fiction films such as The 6th Day and Attack of the Clones.  As a result, many people (and lawmakers) have distorted views on what cloning is and isn't.  As an added complication, cloning technology is still in its infancy, and the ability to create human clones is not yet available (despite over-hyped "breakthroughs" every few years that turn out to be hoaxes or fakes).

So what exactly is meant by "cloning"?  The science of cloning can be said to have begun with the successful cloning of Dolly, a sheep, who was created by taking a cell from an adult sheep and fusing it with an unfertilized egg of an ewe in 1996.  Her creation was hailed as both a major scientific breakthrough and a serious ethical concern, because it was assumed by many that it wouldn't be too long until humans were being cloned.  As I mentioned above, the distorted public view of cloning led many to fear that we'd be copying ourselves and having our own doppelgängers running amok.  This is an example of the "slippery slope" logical fallacy: that the cloning of animals (even a single animal cloned purely as an experiment) will somehow automatically lead to the cloning of humans.

So human cloning is seen as "bad" by most.  Why?  Part of it is an argument against hubris: that by cloning people, we are somehow "playing god" and meddling with Things Man Was Not Meant To Meddle With.  People also seem repelled by the individual hubris of people so vain that they might want to create copies of themselves simply to "live on" in them, more so than with the genetic mixing in "normal" children.  Finally, and most importantly in my view, are the as-yet-unknown risks to a cloned child.  277 cell fusions were required to produce Dolly, but only 29 viable cloned embryos were created, and only one survived to birth.  Even with genetic and technological advances over the past 14 years, the ethical consequences of creating so many miscarriages are simply too ugly for most respectable (and publicly-funded) research laboratories to seriously consider, and serious future health risks to the child are quite possible.  I imagine most people don't like the idea of creating a clone child simply as an experiment, to see what (if any) health problems it develops as a basis for future, healthy clones.

Fortunately, widespread cloning isn't likely to happen even if the technology is safe and available.  People are hardly lining up to be cloned, and cloning is a frequent target of biomedical ethics laws and international conventions.  Part of this is because cloning is such an easy target: unlike the divisive issue of abortion, since "everybody" sees cloning as bad, it's easy for a politician to score ethical points by denouncing cloning and vowing to ban it.  It also helps that doing so is effectively banning something that doesn't actually exist yet, which makes it all the easier to ban.  I wonder how many politicians actually know what cloning is and what we are (and aren't actually) capable of.

So at present, the ethical issues of cloning humans are something of a moot point.  But of course, those sci-fi movies continue to rear their ugly heads.  Sure, we upstanding, moral citizens might oppose cloning, but what about totalitarian nations eager to create clone-armies of their best soldiers?  Crazed dictators and kings with god-complexes who want to rule eternally though a clone lineage?  A nightmarish corpocracy where companies create, own, use, and sell clones as merchandise?  The potential misuses of cloning technology are endless, but are also presently more than a bit fanciful.

If human cloning does actually occur in the near future, it is likely to be the result of an unethical (and condemned) experiment by volunteers who are in it for fame and money.  The first cloned child is likely to be something of an oddity, and may become moderately famous.  But society is fickle, and there are no prizes for second place in science, so I doubt there will be a sudden wave of clones.  However, a far more sinister scenario, taking place a bit later, is for wealthy, morally-bankrupt people (perhaps the aforementioned dictators) to clone themselves using surrogate mothers, not to perpetuate their lineage but to ensure a perfect match for organ donations.  Clones created for such a dark purpose are likely to spend their miserable lives locked away, pampered but isolated, only to be used and disposed of as needed.  Outlandish?  I wouldn't put it past someone like Kim Jong Il or unscrupulous billionaires.

Still, I don't see this as becoming a major problem in society at large, at least not for a long time.  And even if the unfortunate scenarios I've outlined do take place, they are likely to be rare and hidden away by their perpetrators, like all despicable crimes.  I think most people can accept that a clone is not the same as the person they are cloned from; they are an independent human with their own mind and differences created by their life experiences.  A healthy democracy would not treat clones as slaves, property, or second-class citizens, but as normal people, no different from the way we treat identical twins or people with genetically-inherited handicaps.

To summarize: the possibility of cloning raises serious ethical and medical challenges, but cloning isn't likely to be problematic in the near future.

Oregon Trail: The Movie

~Hitch your oxen, load up on ammunition, and prepare for some serious dysentery: it's Oregon Trail: The Movie!  [note: this is fake]

^ "Nobody wants to be the carpenter!"

Creating Humans: Ethical Questions, Part 3

~The next topic in this course is The Science of Reproduction.  The first (and most obvious point) made by the lecture is that, in a global sense, infertility is not really a problem.  The population of the Earth continues to rise at an astounding pace; despite an overall decline in the actual rate of growth, it's still growth.  While fertility rates have declined in some areas, for our species, infertility is not likely to wipe us out any time soon.  We're hardly in a Children of Men situation yet.

However, declining birthrates are a problem in some societies.  For example, the population of Japan is falling and, barring a major change in society, will continue to do so.  This has led to some unusual attempts at solutions; for example, Japan's largest business association urged its members to allow workers to go home earlier in order to "have more babies".  In Russia, loosened immigration restrictions in the post-Soviet era, combined with societal and economic problems, has led to a mass exodus of young Russians and a corresponding decrease in population (the nation is expected to lose 30 million people over the next few decades).  In response, Russia has severely restricted abortions, although population experts expect this to have little impact on the decline of Russia's population.  Or consider Israel, with the largest number of fertility clinics per-capita in the world and extensive socialized medical benefits for reproductive assistance...and an intense need to increase its Jewish population.  This results in a great deal of social pressure to use these technologies, especially among Orthodox communities in which female infertility is grounds for divorce.


The upshot of all this is that in the developed world, populations are likely to level out and, in some areas, fall. In the developing world, populations will continue to rise, although not as fast as in the past century due to improvements in hygiene and education, as well as from infections such as HIV.  So if the global population is still rising fast, should people with fertility problems have the right to use assistive technology?  I imagine the response of many people would be, "Can't they adopt?"  Yet what right does society, and by extension the law, have to restrict this fundamental human drive?  After all, from a biological perspective, the entire purpose of life is to reproduce itself (not to enjoy itself, although luckily for humans evolution has cleverly combined enjoyment with reproduction).

But the increasing availability of assistive technology raises another, more subtle problem.  In nations with falling birthrates and declining populations, or in societies/cultures/ethnicities within those nations with similar problems, do these technologies pressure otherwise-infertile women to use them?  In other words, if a woman is unable to naturally become pregnant, will she feel a social obligation to "go the extra mile" and partake of these technologies?  Does reproduction become a social responsibility?  I don't think we're likely to end up in some Orwellian nightmare where people are forced to reproduce; this is a question of societal pressures and overall direction.

Consider this article, which describes the intense guilt felt by childless women in Japan. While this is in some ways a product of Japanese culture, I can see the same thing happening in other countries as well.  For example, according to the U.S. Census Bureau, white Americans will no longer be the majority in the U.S. within a few decades, and I'm sure we will see less tolerant people (i.e. racists) bemoaning this fact and pressuring white couples to have more children.  Consider the creepy Quiverfull movement, where Christian fundamentalist couples seek to have as many children as possible.  Although often couched in terms of faith, there is a not-so-subtle subtext of "race suicide" they're trying to prevent.

Disturbing.

I think that it's important that as reproductive technologies become increasingly available, steps are taken to ensure that people do not feel pressured to use them.  Perhaps some pressure is inevitable, if only because there may be choices where before, no choice existed for an infertile couple.  Still, I'd hate to see the kind of social pressure that exists in Japan spread to other countries with declining birthrates.  I think it's fine that health insurance programs now cover many reproductive procedures, but it would be interesting to see a study of whether or not women (and men) feel pressured to make use of them.  

Reproduction is an intensely personal and private act, and these technologies force it partially into the public sphere.  So what do you think about all this?  Do you see societal pressure to use this technology as a problem, or a future problem?  Why or why not?  Do you think that we as a society need to do anything about it?  I don't really see America banning advertisements for these services; instead, it's up to you and other people, as individuals, to keep in mind that the fertility problems of other people are none of your business.