May 12, 1989
Ophiiotii
Page 3
I’
Urge and urge and urge.
Always the procreant of
the world.
Walt Whitman, "Song
of Myself"
The last week before finals
was appropriately dubbed ‘
by some as "Bioethics
Week." In a series of public
lectures and classes, two
visiting scholars gave spe
cial attention to problems in
biomedical ethics. St. An
drews has a remarkable stu
dent interest in this subject.
About 15% of the current
enrollment have studied bi
omedical ethics during this
semester. Few other col
leges, if any, have such a
vigorous student interest in
this field.
Why this interest? My
hunch is that St. Androids
have a way of identifying
issues that they have a stake
in. They sense issues that
will not go away, and that
will continue to demand
our best knowledge and our
most critical thought if v.'e
are to create ana £!> stain the
humane society we aspire
toward. Take the "new biol
ogy," for example. This
promises a greater shift in
our - alf-understarding
than that effected by the
Copei .'-ican Revolution, the
Industrial Revolution, Dar
win, Marx, Freud, or the
advent f the Nuclear Age.
For the firs'; ;me in human
history the powers of mod
ern science and technology
have been turned directly
upon ourselves, not upon
the natural world "out
there." Our fundamental
understanding of our
selves, our origin and our
destiny, our embodiment
and our sexuality, our rela
tional life and the gifts of
parenting—all these are
"up for grabs." A host of
ethical, legal, and policy is
sues are involved in the new
biology. And as usual, the
technological imperative
functioning in the t casearch
center and in the private en
trepreneurial sector has
thrust upon us radically
new possibilittes; and now
we are required to respond
to these, to try (in effect) to
get our ethical analyses and
our legal responses current
with the evolving technol
ogy. Wecannotasksuchan-
As I See It.
Dr. W.D. White
terior questions as: "Do we
want this technology? For
whose benefit? At what
cost? At whose cost?" Nor
can we ask, "Who should
decide?
Conc’der the new human
reproductive technologies.
Some fifty years ago physi
cians treating infertile mar
ried women decided to
bring over from the cattle
industry the practice of arti
ficial insemination. Tens of
thousands, we do not know
how many, of these proce
dures have been done. They
have been followed by a
b'ain of ethical and legal is
sues and conflicts that con
tinue despite much legisla
tive effort to solve them.
Physicians justified this
practice as a therapeutic
intervention, done for hu
mane reasons to relieve in
fertile couples of suffering
childlessness. Nothing in
the training or experience of
physicians equipped them
CO make such a policy deci
sion—nor to predict the
train of ill consequences
that would accompany this
valief of some infertile
couples.
It is a strange public pol
icy: that allows male medi
cal stude"ts and young
male phys.cians to be sperm
"donors ' (at $35.00 per
throw), j^uarantees them
anonymity, and through
medical practice (and now
by law in most jurisdic
tions), I'rees them of all
moral and economic re
sponsibility for any off
spring that might be
b;'ought into the world by
their "donation." They
make thc.r deposit, collect
their fee, and walk away
forever.
But lock what happens to
other young men, who in a
moment of love or pas
sion—or even perhaps of
"recreational sex"—leave a
deposit which makes a
baby. Are they protected by
law? Is their behavior "con
fidential," so that their ano
nymity is protected? Can
they walk away freely? No,
they are held liable by law
and public morality for the
well-being of any child bom
under such circumstances.
As indeed they should be.
But it is a strange and inco
herent public policy: to pro
tect and free from all re
sponsibility the rational,
economically-motivated,
impersonal, disembodied
"semen donor" in the Medi
cal School; while holding re
sponsible the young man
who embodies his love or
passion in a conjugal act
that brings about procrea
tion. Did the physicians
who took it upon them
selves to bring over from the
cattle industry the practice
of artificial insemination
think about such issues?
But of course artificial in
semination is not a technol
ogy as such. You don't have
to go to a physician for that.
A turkey baster will do the
trick, as some women know
full well. More crucial to
this discussion is the "re
production" that does re
quire technology—and so
phisticated, at that. 1 have in
mind in vitro fertilization,
where an egg (now usually
eggs through superovula
tion) is surgically removed
from a woman, mixed in a
petri dish with human
sperm, and then after fertili
zation, at just the right mo
ment, placed back in the
woman's uterus for implan
tation, pregnancy and birth.
Sounds simple, bul it is
not. There are dangers,
physical and psychological,
to the woman involved (as
well as her husband). And
the costs are very high. The
disappointments of infertile
couples are even higher,
since the "success rate" is
quite low—and almost im
possible to discover before
the event. This technology
is now virtually standard
medical practice (for the
affluent, that is)—including
the freezing of sperm, of
ova, of embryos. It is a
highly entrepreneurial
medical practice. Some 90%
of physicians involved in
this "service" make it acces
sible to only to infertile mar
ried couples; about 10% will
accommodate such re
quests by single persons or
same-sex couples.
Again, the technological
imperative in medicine (If it
can be done, it must be
done), joined with entrepre
neurial interests to develop
a technology without seri
ous thought about the ethi
cal, legal, and public policy
issues in its wake. No seri
ous public decision went
into asking: "Do we want
this technology? For whose
benefit? Whose cost? Who
should decide?" Now we
are having to figure out how
this technology will be
used.
Perhaps even more prob
lematical is the issue of ge
netic engineering and con
trol of human offspring. We
can already identify hun
dreds of diseases that are
genetically based. And we
are developing the technol
ogy to eliminate many of
these diseases. Who should
decide which "diseases" to
eliminate? What criteria
would be used? Is there
anything in the training of
physicians that equips them
to make such ethical and
public policy decisions? We
can already identify the sex
of children in utero. And we
are developing ever-more
reliable ways to determi le
before conception the sex of
our offspring. Do we want
to live in a society whero
children can t>e selected—or
aborted—solely on the basis
of their sex?
Male pregnancy is techno
logically just around the
comer. There is every rea
son to believe that if we
wish to do it, we will de
velop the technological ca
pacity for males to gestate
children. Do we want such
technology? For whose
benefit? At what cost? Who
should decide?
Human cloning is by no
means a far-fetched science
fiction scenario. Do we
want to clone human
beings? For whose benefit?
At what cost?
Ultimately the issue boils
down to what kind of soci
ety we want to live in. As
contraceptives made pos
sible sex without babies, so
the new technologies make
possbile babies withoat sex.
Making babies for fun and
profit offers entrepre
neurial attractions! But oo
we want a society' v/nich
commodifies human pro
creation—which indeed
quite properly speaks of the
new processes as human
"reproduction," a term
taken from manufacturing
and business? Do we want a
society that has forgotten
the importance of embodi
ment?
Do we want a brave new
world where a child can
have five different and
identifiable "parents"—
and where, as recently hap
pened in South Africa, a
mother can bear as a surro
gate her daughter's child,
becoming thus her
grandchild's mother? Do
we want ot forget the highly
symbolic importance of our
navel and our genitals: our
navels , which are a sign of
our connection with the
past through our mothers;
and our genitals, which are
signs of the promise and the
hope of a connection with
the future through our chil
dren? Do we want to live in
a world where the mystery
of loving and caring , pro
creating and rearing chil
dren, are disjoined? Do we
want parenting to be split
tietween the "genetic do
nor" parent, the gestating
parent, and the rearing and
nursing parents? Do we
want baby brokers to ar
range contracts for such
services?
All this might sound very
harsh toward the suffering
of infertile persons in our
society. In the past 50 years
infertility has grown from
about 1 married couple of
childbearing age out of 10,
to almost 1 out of 6. A com
plex of cultural, social, eco
nomic, environmental, and
medical causes lie behind
this startling increase. Some
40% of this in.'ertility can be
traced to the female; some
40% lies in the male; and the
rest seems to be "rela
tional." The highest cause
of infertility in males is alco
hol and dmg abuse. The re
productive technologies do
not address the causes of
infertility; they merely seek
to bypass it.
Would it not be a better
public policy to address the
causes of infertility, and try
to alleviate these? Could we
not also address the social
and cultural biases that
make infertile women feel
less than human, and infer
tile males feel terribly de-
masculanized? Could we
not find a way to challenge
the absolutizing of human
infertility as a disvalue?
These approaches strike me
as viable alternatives to our
obsession with technology.
We must learn that medicine
Ccinnot be asked to be a cure for
death; end that technology
cannot finally save us.