Lovemaking & babymaking

Callahan, Sidney

LOVENAKING & BABYMAKING ETHICS & THE NEW REPRODUCTIVE TECHNOLOGY SIDNEY CALLAHAN How should we ethically evaluate the new reproductive technologies developed to treat the increasing problem...

...Mammalian "in vivo" reproduction and primate parent-child bonding provide adaptive means for protection, defense, and complex socialization of offspring...
...Therefore, the response to alternative reproductive technologies has been to proceed full steam ahead with due process...
...certain values have been preserved by these existing norms...
...Do we wish to sanction male detachment from their biological offspring...
...Physicians or other health care personnel can hardly, in conscience, cooperate with, and make possible, irresponsible or ethically inappropriate reproductive acts affecting innocent new lives...
...To counter the tendency or temptation toward sexual irresponsibility or parental neglect, western culture has insisted that men and women be held accountable for their contribution to the creation of new life...
...It seems almost miraculous that medical technology can often overcome a couple's infertility and restore normal function, with techniques such as artificial insemination by husband (AIH) or in vitro fertilization (IVF) or tubal ovum transfer methods...
...It is ethically appropriate to use alternative reproductive technologies if, and only if, such technologies are making it possible for a normal, socially adequate, heterosexual married couple to have a child as they would, or could, if their infertility were not an obstacle...
...Yet encouraging persons to give, or worse, to sell their genetic or gestational capacity attacks a basic foundation of morality that is, taking responsibility for the consequences of one's actions...
...Fantasies about a child's past and future do make a difference, as all students of child development or family dynamics will attest...
...When a child or relatives are not lied to, the identity of the donor(s) becomes an issue for all concerned...
...Technology must be ethically assessed and rationally controlled...
...Can children comprehend the fact that mothers make babies and sell them for money...
...But as medical professionals and the society as a whole confront these innovative interventions, the ethical, psychological, and cultural dimensions of technological procedures cannot be discounted...
...The right to marry, for example (itself not absolute), does not obligate society to provide spouses...
...How should we ethically assess the innovative array of techniques developed to overcome infertility egg and sperm donations, surrogate mothers, in vitro fertilization, or embryo transplants...
...The parental enterprise is rightly seen as basically an altruistic one children should not be viewed as a form of personal property, or as a means to satisfy adult desires or needs...
...In the past some persons have wanted children to secure an inheritance, prove sexual prowess, procure a scapegoat, gain revenge, increase marital power, secure social prestige, or have someone of their own to love...
...The advantages and safeguards of having such parents are manifold, basic, and not accidental in biological and cultural evolution...
...Biological ties become psychologically potent, because human beings operate as imagining, fantasizing persons in their emotional interactions with one another and with their children...
...Alternative reproductive techniques made available to single men or women, or to homosexual couples, will endanger the child's status as having been engendered as a gift of a prior, ongoing, transcendent marital relationship...
...The great primordial reality of interdependency *8d mutual bonding represented by mother and child is attacked...
...As ethical understanding has broadened to include the dignity, worth, and rights of women and children, so our understanding of morally responsible parenthood has been refined and developed...
...It seems wrong and alienating to isolate a person's reproductive capacity from his or her personal life and identity...
...Do we want to encourage women to be able psychologically to distance themselves from the child in their womb enough to give it up...
...But my focus here is upon the most recent challenge...
...I have argued for limits to alternative reproductive techniques which remedy infertility...
...But more telling, psychologi238: Commonweal cally, is that pregnancy is not simply a neutral organic experience, but a time of bonding to a child...
...The above article is a shortened version of a chapter aPpearing in Medical Ethics: A Guide for Health Professionals, tasted by David C. Thamasina and John Monagle, Aspen Publicart«w, 1987...
...They are irreversibly connected and made kin through the biological child they have procreated...
...Moreover, society has already decided that when adequate childrearing, and the well-being of children are at stake, social and professional intervention is justified...
...A donor is enjoined to hand over to physicians or others, often unknown others, his or her personal genetic heritage and reproductive capacity...
...Without considering here the ethical problem concerning the justice of allocating medical resources to increase individual fertility in an overpopulated world, I think the correct statement of the ethical question is whether, or how far, present norms should be altered...
...Yet, because we are rational, we can also see that a fully permissive attitude toward reproductive technology presents its own severe problems...
...the family provides one of the most important elements in a human life...
...potential regulators are enjoined to show that concrete harmful consequences will result from a particular practice...
...The most ^serious ethical problems in using thirdparty donors in alternative reproduction concern the well-being of the potential child who is being made party to a social experiment without his or her consent...
...Similarly, the burden of proof should be upon those who wish to experiment with the lives of others...
...When a person gives this capacity away, or sells it, he or she breaks an implicit compact...
...To argue the case against third-party donors, even for acceptable couples, we need to focus upon what values, goods, and safeguards have been inherent in the cultural norm two heterosexual parents who are the genetic, gestational, and social parents of their child...
...Cultural norms, based upon biological predispositions, have been selected for the unity of genetic, gestational, and rearing marital ""S within an extended-family kinship system...
...Socially informed ethical judgments on behalf of the society are unavoidable...
...Everything that can be done to satisfy individual reproductive desires should not be done...
...The question of outright rejection of imperfect or non-optimal babies contracted for by alternative reproductive technology is also a difficulty...
...When one is begotten not made, then one shares equally with one's parents in the ongoing transmission of the gift of life from generation to generation...
...The burden of proof in this argument falls to those who would limit alternative reproductive technology...
...On we one hand, a conservative approach adopts as a moral SIDNEY CALLAHAN is associate professor of psychology at Mercy College, Dobbs Ferry, New York, and the author of several books, '"eluding The Illusion of Eve and Parenting...
...Their genetic link with the child, shared with their own family, produces a sense of family likeness and personal identification, leading to empathy and affective attunement...
...When a woman donates her egg and gestational capacity there is a particular danger of exploitation, feminists have warned...
...The claim that an individual's right to reproduce would be violated if fertility treatments are not available to any individual who requests them, seems vvrongheaded...
...One parent will be related biologically to the child...
...This genetic generative capacity is not like a kidney, or any other organ, but is a form of basic identity received from one's own parents...
...In such a serious matter, it is prudent to look first to the values and goods safeguarded in the present operating norms of reproduction and childrearing, before contemplating radical alterations...
...The much discussed case of the Whitehead-Stern court struggle is an example of the divisive chaos, struggle, and suffering possible in surrogate arrangements...
...An ethic based solely on the natural biological integrity of marital acts will not serve because the mastery of nature through technological problem solving is also completely natural to our rational species...
...Medical professionals should be ethically guided by a form of "substituted communal judgment" informed by our cultural values and norms...
...It is also wonderful that medical reproductive technology can remedy the handicap of an infertile couple...
...The western cultural ideal, slowly winnowed of patriarchy as it has recog nized the equality of women and children, has ensured far more than law, order, and social continuity...
...In conclusion, society is facing another challenge to its traditional understanding of the ethics of reproduction and the norms of the family...
...As trustees, medical professionals have a moral duty not to take risks on behalf of unconsenting others...
...The power to intervene makes medical professionals and medical institutions into morally responsible trustees of a potential child's future...
...As the heterosexual couple freely choose each other, they make a loving com...
...However, a remedial standard based upon operating cultural norms maintains the unity of genetic, gestational, and rearing parents, and requires that parents be alive and well, in an appropriate time in their lifecycle, and possess average or adequate psychological and social resources for childrearing...
...The most frequently cited causes of divorce in second marriages are the difficulties presented by another person's children...
...As Gandhi said, "means are ends in the making...
...The need to know about potential half-siblings and other kinship relationships may become urgent at a point in later development...
...Employing third-party donors or surrogate mothers is not ever, in my opinion, an ethically acceptable use of reproductive technologies...
...One of the foundations of a responsible ethic of sexuality has been to see sexual acts as personal acts involving the whote person...
...Heretofore we have not ethically or legally faced the practice of deliberately conceiving a child in order to give it to others for adoption, with, or without, payment...
...The only ethical stance toward new reproductive technologies would be absolutely to cease and desist...
...sexual intercourse and procreation must remain united in each marital act so that "lovernaking and babymaking" are never separated...
...Such asymmetry has always been problematic, from Cinderella to today's stepparents and reconstituted families...
...These intersecting social developments have produced the pressing need to develop a new ethic of parenthood and responsible reproduction...
...When technological intervention without donors, such as AIH or IVF or tubal ovum transfer, is used to correct infertility, the time, money, stress, and cooperative effort required by ihese procedures focuses the couple upon their marital relationship and their equal and mutual contribution to childrearing...
...Collaborative reproduction using third-parties will come at too high a price...
...From the child's point of view the asymmetry of relationships with one's rearing parents is also a factor...
...mitment to share the vicissitudes of life...
...If we legitimate the isolation of genetic, gestational, and social parentage and govern reproduction by contract and purchase, our culture will become even more fragmented, rootless, and alienated...
...From another perspective, the woman could also be seen as deliberately producing and selling her baby...
...The "commodification of the child," drafting a child definitively into the service of parental will, is an infringement upon the child's dignity...
...Cannot any persons who declare themselves a family be a family...
...The marital gestation of their mutually conceived new life during pregnancy also unites the couple and prepares them for the parental enterprise...
...At the other extreme, a different form of "act analysis" focuses on the individual's desire for a child and the private arrangements made for reproduction...
...But as a cultural invention, why must a "family" be based upon biological kinship...
...Ethical standards which protect and strengthen positive outcomes for children, childrearing 24 April 1987: 235 conditions, and cultural norms of responsible parenthood, should be used to judge the appropriateness of a particular request for treatment of infertility...
...the child is heir to more than money or property when it is situated in a rooted kinship community...
...What will these practices do to the other children a surrogate may have, or for that matter to other children in the culture...
...Without societal consensus on the ethical use of medical technology to plan, limit, or interrupt pregnancies, we are ill-prepared to evaluate the newest alternative reproductive technologies which generate conception and pregnancies...
...But the adequacy of "after the fact" crisis management does not justify planning (^forehand to voluntarily replicate similar childrearing situations...
...Love, sexuality and procreation are united in openness to children, who thej} have a claim to equal parental care from both father an4 mother...
...Two heterosexual parents supported by kin and clan engage in even more arduous parenting, nurturing the young over an extended period...
...And as child abuse and the deaths of children regularly attest, it is far better to err on the side of safety than take risks...
...As long as due process and informed consent by competent adults are guarded by proper contracts, any adult should be able to engage in any alternative reproductive procedure technology can provide, 24 April 1987: 233 and persons can sell or procure...
...A donor, whether male or female, who takes part in collaborative reproduction cannot assume personal responsibility for his or her momentous personal action engendering a new life...
...In the past, innovative uses of technology have resulted in ecological and ethical disasters Abuses have been either fully intended, as with the Nazis, or inadvertent and accidental, as in the use of thalidomide...
...Such a separation whether in artificial insemination by donor (AID), embryo transplants, or surrogate mothers poses too many ethical and social risks to the dignity and well-being of the future child, the donor, individual spouses, the family as a whole, and our cultural ethos...
...In addition, the extended family of both parents js important as a support to the couple, especially in cases <jf death or disaster...
...Neither of these approaches to reproductive technologies is adequate...
...Our national debate over these troubling issues is just beginning...
...Those individuals who do not marry and found families, or those elites who achieve membership in larger communities, are still strongly connected to others through their families...
...If we succeed in isolating sexual and reproductive acts from longterm personal responsibility, this moral abdication will exacerbate existing cultural problems...
...Of course, since there are as yet no existing consequences, it is impossible to prove harm before the fact...
...When there is » third-party donor(s) or sperm, eggs, embryo, the child is e& off from either half or all of its genetic biological lineage...
...Third-party donors and surrogates cannot be counted on to disappear from family consciousness, even if legal contracts could control other ramifications or forbid actual interventions...
...Should not medical professionals be similarly responsible in carrying out the interventions which will, in essence, give a couple a baby to rear...
...One definition of the family is those people who share genes...
...Unfortunately we are still saddled with residual ideologies which view children as a form of personal possession...
...The child who was wanted for all the wrong reasons may be pressured to live up to parental demands or dreams of the perfect child...
...We find ourselves ethically perplexed because, as a society, we have not yet achieved cultural consensus on the ethics of reproduction and responsible parenthood...
...Even if there is no physiological harm to the child, the psychological relationship of the child to its parents is endangered with or without the practice of deception and secrecy about its origins...
...With third-party genetic or gestational donors, however, the exclusive marital unity and equal biological bond is divided...
...Even when there have been relevant cases, as in the example of children conceived by artificial insemination by donor (AID), no long-term in-depth studies have been made...
...Why has the norm of the nuclear family worked for so long and held first place in the cultural competition...
...Each human being exists within a social envelope and must do so to flourish...
...The good of the potential child, and the cultural conditions which further childrearing and family support systems, should take precedence over other considerations...
...With the advent of long-living rational animals, such as the human species, the basic primate models are broadened and deepened into a family unit, now including the great cultural leap forward to include fathers and additional kinship bonds...
...In the case of reproductive technology, ethical positions best emerge from the question: What will further the good of the potential child, the family, and the general social conditions of childrearing, while strengthening our moral norms of individual responsibility in reproduction...
...Culturally this is understood as the fusion of two genetic heritages so that the child is situated within two lineages...
...What would responsible parents-to-be deem ethically appropriate reproductive behavior in a particular case...
...In adoption, both parents are also equal in their relationship to the child they are jointly rescuing...
...In fact, the donor contracts to abdicate present and future personal responsibility...
...Emergency solutions make poor operating norms...
...Since weare embodied creatures, the psychological bonds of caring and empathy are built upon the firm foundation of biological lies and bodily self-identity...
...Then, if a couple is judged to be within the normal range of average expectable parents, remedial techniques maintaining the unity of genetic, gestational, and rearing parentage techniques such as AIH or IVF or tubal ovum transfer would be ethically acceptable...
...Procuring donors of sperm, eggs, embryos, or wombs is an essential component of collaborative reproduction...
...This permissive stance is justified as an exercise of individual liberty, reproductive privacy, and reproductive right...
...It seems a sign of cultural progress that children are highly valued and infertility is acknowledged as a misfortune...
...In families under stress in which biological kinship is absent, one finds more incest, child abuse, and scapegoating...
...In this "act analysis" no technological intervention in the sexual act is approved for any reason...
...There is a grain of truth in the warning that "control of nature" can be a euphemism for the control of some people by other, more powerful people...
...Feminists rightly protest that allowing women to be surrogates will turn some women into babymachines bought and regulated by those rich enough to pay...
...Already epidemics of divorce, illegitimate conceptions, and parental irresponsibility and failures are straining the family bonds necessary for successful childrearing...
...The search by adopted children for their biological parents and possible siblings reveals the psychological need of humans, to be situated and to know one's origins...
...Being wanted and being well-reared are not identical...
...24 April 1987: 239...
...Adult persons are held morally responsible for their words and deeds...
...there still exist extremely complex fantasies and psychological currents to be settled in the family triangles of mother, father, and child...
...Why should a child, in its creation, be treated as a property, or product, or a means to satisfy the wishes of powerful adults...
...based kinship and small cooperating social units of invested relationships...
...While there is certainly no real question of adultery in such a bypassing situation, nevertheless, the intruding third-party donor, as in adultery, will inevitably be a psychological reality in the couple's life...
...The psychological bonding between them can transcend the stress endured and the less than ideal technological interventions in their sexual lives...
...These may both be supportive, or one may be more important than the other, but having two sets of kin provides important social resources...
...True, the bypassed parent may have given consent, but consent, even if truly informed and uncoerced, can hardly equalize the imbalance...
...She is co-editor, with Daniel Callahan, of Abortion: Understanding Differences (Plenum r*«, 1984...
...Even if the Freudian psychoanalytic account of Oedipal family relationships is not correct in all its details...
...Infertility is clearly an unfortunate dysfunction or handicap for a married couple, which medicine may sometimes remedy...
...Older arguments employed against artificial contraception are reiterated and applied to condemn any procedure separating functions which naturally occur together, i.e., all reproduction by in vitro fertilization, artificial insemination, or third-party surrogacy are deemed immoral...
...Their |ove, commitment, and sexual bond have been made manifest in a new life...
...At the same time we have seen rapid advances in regulating fertility, we have also experienced a cultural evolution of attitudes toward women, children, sexuality, and the family...
...Helping the severely retarded, the mentally ill, the genetically diseased, the destitute, the aged, or a widow with a dead spouse's sperm, to have the child they otherwise could not, would not be ethically acceptable by this standard...
...In alternative reproduction the question of "Whose baby am I?" becomes inevitable...
...The physiological risks and drastic intervention J8a woman's reproductive system needed for surrogacy or embryo transplants are considerable...
...Parental responsibility has been seen as the essential form of the natural responsibility of human beings as members of humanity, a moral claim not superseded by other contracts or commitments...
...Empathy, identification, a sense of kinship, and assurance of parental authority arise from family likeness and biological tics...
...Psychologically and socially the family gives emotional connections social purpose, and meaning to life...
...With equal investment in their child, both parents are equally responsible for childrcaring and support...
...Fertility and reproduction have been given an overriding priority in the couple's life...
...Bonded in love and Icgai contract they mutually exchange exclusive rights, giving each other emotional and economic priority...
...In the average situation, two parents with equal genetic investment in the child are unified by their mutual relationships to their child...
...The child's genetic link to each spouse and his or her kin, strengthens the marital bond...
...A child who has donor(s) intruded into its parentage will be cut off from its genetic heritage and part of its kinship relations in new ways...
...We have forbidden (he selling of babies, and the purchase of brides, sexual intercourse, and bodily organs...
...The family is one remaining institution whe» status is given by birth, not earned or achieved...
...How can ethical guidelines for employing alternative reproductive methods strengthen rather than threaten our basic cultural values...
...Faced with new reproductive technologies, we should not let the technological imperative (what can be done should be done), fueled in this casety individual desires, decide the question of whether a course of action is right or good...
...A couple absolutely driven to have a child, in the obsessive way some couples become when faced with infertility, may not be prepared to rear the actual child once it is born...
...It should be clear that adoption, which is a rescue of a child already in existence, is very different ethically from planning ahead of time to involve third-party donors in procuring a child...
...The family st be seen as an intergenerational institution existing through time and space in ecological relationship with the society...
...One obvious sign of the society's unresolved conflicts over the morality of reproduction can be found in our bitter debates over abortion, contraception, and contraceptive education in the schools...
...The result of their joint effort, as in natural parenting, will be a baby they are equally invested in and equally related to...
...The nuclear family is founded on biology, but it is as a cultural invention with psychological and social effectiveness in generating responsibility, socialization, and deep altruistic bonds that the family has remained universal...
...Much is made of the cases in which persons cope with single parenthood, or successfully adopt, or adjust to other less than ideal situations...
...If deception is practiced about the child's origins, then both the child and the extended family have been wronged by the HeSince family secrets are rarely kept completely, the delayed revelations produce disillusionment and distrust among those 236: Commonweal deceived...
...Right now there is a lacuna in law and regulatory procedures, while innovative medical practices proceed without ethical consensus...
...standard the biological integrity of the marital sexual act, which must not be tampered with for any reason...
...Nor would it be acceptable to alter "average expectable conditions" by efforts to produce multiple births, or routinely to select for sex...
...Contracts and regulations can hardly stem the psychological and social harm alternative reproductive technologies "ake possible...
...While no child is conceived by its own consent, a child not artificially produced is at least born in the same way as its parents and all other persons normally have been...
...Even if there is no jealousy or envy, the reproductive inadequacy of one partner has been reified, and superseded by an outsider's potency, genetic heritage, and superior reproductive capacity...
...While the internalized psychological image, idea, and intention to belong to a family does partially constitute a family, there is no denying the bond created by genetic kinship...
...234: Commonweal One troubling tactic used by those urging the permissive cceptance of all new reproductive technologies is that arguments are based upon analogies from adoption or other childfearing arrangements that arise from divorce, death, desertion, Of parental inadequacy...
...Adoption procedures, custodial decisions, and the child abuse laws are examples of the right and duty of professionals to make judgments on the fitness of parents...
...Strictly limiting and monitoring these reproductive techniques will serve the good of the potential child, the family, and the need of the culture for morally responsible reproductive behavior...
...If a great deal of money is offered for surrogacy, needy women will be tempted to sell their bodies and suffer emotional consequences and the experience of prostitution leads one to expect that many of these women will be handing over their money to males...
...Individual identity is rooted in biological...
...In fact, the unwill ingness of infertile couples to adopt and the struggle to have their own baby are testimony to the existence of what appears to be a strong innate urge to reproduce one's self...
...No "act analysis" of one procreative period of time in marriage can do justice to the fact that the reproductive couplg exists as a unit within a family extended in time and kinship Grandparents, grandchildren, aunts, cousins, and other relatives are important in family life for both pragmatic and psychological reasons...
...We should move beyond a narrow focus upon either biology or individual desires for children...
...The adopted child, while perhaps harboring resentment against its birth parents, must look at its adopters differently from parents who have had him or her made to order...
...The motives for conception influence the future relationships of child to parent...
...LOVENAKING & BABYMAKING ETHICS & THE NEW REPRODUCTIVE TECHNOLOGY SIDNEY CALLAHAN How should we ethically evaluate the new reproductive technologies developed to treat the increasing problem of human infertility...
...Even in natural reproduction, we now consider it ethically suspect to attempt to 24 April 1987: 237 have a child because an adult wants to satisfy some personal need or desire...
...Having two parents, one of each sex, with whom one can safely identify, love, and leave behind, is a great advantage...
...In serious matters with lifelong, irreversible consequences, we rightly hold persons to high standards of moral and legal responsibility...
...indeed, it is the glory qf homo sapiens...
...Two inadequate assessments of the new alternative reproductive technologies are mirror images of each other in the narrowness of their focus and the limits of their analysis...
...Only gradually have we welcomed children as gifts, new lives given in trusteeship, who are equal to adult persons in human dignity, despite their dependency and powerlessness to determine their own fate...
...Procedures using donors and/or surrogates, separate and variously recombine the source of sperm, eggs, embryos, gestational womb, and rearing parents...
...the other parent will not...

Vol. 114 • April 1987 • No. 8


 
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