Ellen Painter Dollar
A recent New York Times Magazine cover story considered so-called “three-parent” embryos, an IVF technique involving mitochondrial DNA (mtDNA). Our mitochondria convert oxygen into energy and power our cells; mtDNA exists separately from our other DNA, and is passed straight from mother to child without recombining with the father’s DNA. In the “three-parent” IVF technique, mtDNA from one woman’s egg is removed and replaced with mtDNA from another woman’s egg, and the egg is then fertilized. A child born as a result would still inherit half of his/her regular DNA from the father and half from the mother. But his/her cells would also contain donor mtDNA.
A related technique, in which cytoplasm (which likely contains some mitochondria and mtDNA) from one woman’s egg was transferred into another woman’s egg, has been used successfully for some women whose previous IVF cycles were unsuccessful. It remains unknown how the technique helped, whether the children born as a result actually have any of the donor’s mtDNA in their cells, and whether the children might have any long-term adverse effects.* Some experts speculate that replacing the mtDNA of older women’s eggs with mtDNA from younger women’s eggs could potentially help “rejuvenate” the older women’s eggs, though this remains unproven.
The technique could also potentially help women with a history of mitochondrial disease (which can result in a huge spectrum of health issues, from minor to major) have healthy children. The New York Times article focused on an FDA meeting prompted by two U.S. groups who want to conduct clinical trials of the technique for this purpose. As I read the article, my heart sank as I realized it, like so much of the conversation around reproductive ethics, was rife with weak moral arguments and wrong assumptions bound to send readers down fruitless and irrelevant paths of ethical inquiry.
That the article was intended to engage ethical questions and not merely the FDA meeting or the technique’s scientific foundations was clear from this tagline:
A new treatment could sidestep certain hereditary diseases by altering the genetic makeup of the egg. Is there anything wrong with that?
The article did a fine job of describing the science and what happened at the FDA meeting. But the writer’s and her interviewees’ engagement with ethical concerns was confused and superficial. I understand that neither the writer nor those she interviewed are professional ethicists. I understand that ethical questions were not the article’s sole focus (although that tagline makes clear that ethics were far from tangential). I also can’t really blame the writer or her subjects for the poor quality of ethical consideration. They were merely echoing some of the most common arguments that regular folk—patients and clinicians and government administrators and pastors and counselors—make about the ethics of reproductive technologies. The problem with these arguments is that they lead too easily to uninformed conclusions, while ignoring other ethical questions that are far more relevant.
Here are the major observations and arguments that stood in for more germane ethical inquiry in the New York Times piece:
The “God gave us medicine” argument: A woman who successfully used cytoplasm transfer to have a baby girl after seven failed IVF cycles said, “Being a person who’s been involved in science my whole life, the way I looked at it is: God gives us doctors to help us, and they help us with things like infertility.” Believing that God is the source of all creation doesn’t mean that God’s creatures are incapable of doing wrong. In fact, that we are capable of doing wrong in spite of being made in God’s image is Biblical theology 101. God presumably “gave us” criminals, wife beaters, and porn stars; this doesn’t mean we must approve of everything they do. God made me; I’m certain God doesn’t approve of everything I do. Doctors, not to mention our medical system as a whole, are not infallible. As flawed as our medical system is, we have licensing and disciplinary requirements, government regulations, and FDA hearings precisely because the provision of new types of medical care—new drugs, new procedures, new technologies—are not automatically assumed to be good just because we consider medical care in general to be a good thing.
The “this isn’t about designing babies” argument: This is what the writer says about fears that such technologies are a form of eugenics whereby we weed out traits considered undesirable and pave the way to “designer babies”:
As the scientists who were pressing for mitochondrial replacement kept pointing out, these fears [about designer babies] were somewhat unfounded. [The three-parent technique] cannot allow people to design babies to their specifications.
True enough. No technology currently available allows parents or clinicians to select a host of genetic traits, to create a child who will have a particular hair color and be of a particular height and have a host of desirable traits, such as high intelligence and athletic prowess.However, technologies do exist that allow parents and clinicians to select embryos with one particular genetic trait, such as the preferred gender, a particular eye or hair color, or without a trait considered undesirable, such as a genetic mutation leading to specific health problems. The children born as a result are far from being “designer babies.” However, many argue that even being able to select for or against a single trait is akin to eugenics, particularly when traits are considered desirable or undesirable because of cultural biases (e.g., a patriarchal culture where baby boys are prized over girls; a mother who wants a daughter because she fantasizes about having a partner for doing things associated with femininity in our culture, such as putting on frilly dresses and getting pedicures; or the rampant cultural assumptions around the difficulty and worth of life when one’s has a significant disability). That a true “designer baby” isn’t possible with today’s technology (and is unlikely to become possible because of the complexity involved) doesn’t absolve us from asking whether genetic selection of any kind allows us a potentially dangerous level of control and judgment concerning what sort of children are desirable and acceptable.
The “who are we to tell people they shouldn’t want a baby of their own” argument: The writer quotes Marni Falk, a mitochondrial specialist at Children’s Hospital of Philadelphia, who said, “There’s an enormous drive to reproduce—that’s just within us. I think it’s unfair to put that on people with mitochondrial disease, that they shouldn’t have that drive or desire.” I agree that it’s unfair that people facing complex reproductive decisions have to justify a desire that is accepted without question in other situations. As I wrote in No Easy Choice:
[With both adoption and assisted reproduction], prospective parents confront questions and assumptions—about why they want children and how they will behave as parents—that those who conceive naturally do not. No one responds to a couple’s pregnancy announcement by asking, “Why is biological parenthood so important to you?” No one did a home study of me and Daniel before we brought Leah home from the hospital.
However, questioning how far it is ethically appropriate for parents to go in having the biological child they desire is not akin to telling people that “they shouldn’t have that drive or desire.” We can accept that the drive to have biologically related children is both innate and incredibly powerful for many people, and still encourage them to ask relevant ethical questions about reproductive technologies. The appropriate response is to provide support for people who grieve not having the biological child they so deeply desire—including acknowledging that their grief is real and justified—not to argue that their desire trumps moral discernment.
The “IVF is no longer a subject of moral concern because it has created so many happy families and healthy babies” argument: This argument, related to the last one in that it privileges people’s feelings over moral concerns, was particularly popular in media coverage of Dr. Robert Edwards’ Nobel Prize for Medicine in 2010. Edwards developed IVF technology, and mainstream media coverage of his Nobel-winning work frequently claimed that ethical concerns about IVF and related technology are moot, because people who have babies via IVF are happy. For example, from the New York Times:
Advances in human reproductive technology arouse people’s deepest concerns and often go through a cycle, first of outrage and charges of playing God, then of acceptance. In vitro fertilization proved no exception. “We know that I.V.F. was a great leap because Edwards and Steptoe were immediately attacked by an unlikely trinity — the press, the pope, and prominent Nobel laureates,” said the biochemist Joseph Goldstein in presenting the Lasker Award to Dr. Edwards in 2001…Though in vitro fertilization is now widely accepted, the birth of the first test tube baby was greeted with intense concern that the moral order was being subverted by unnatural intervention in the mysterious process of creating a human being..The objections gradually died away — except on the part of the Roman Catholic Church — as it became clear that the babies born by in vitro fertilization were healthy and that their parents were overjoyed to be able to start a family. Long-term follow-ups have confirmed the essential safety of the technique.
Author Kim Tingley makes essentially the same argument in the three-parent IVF article:
Americans were uneasy with IVF and its “test-tubes” until they saw that it created unblemished babies; 40 years and millions of births later, we now accept it as routine.
Not only are these assertions factually inaccurate (plenty of people and institutions outside of Roman Catholicism continue to explore the moral implications of IVF and related procedures), but the argument that happy parents and healthy babies make ethical concerns irrelevant is bizarre. That our consumption-oriented American lifestyle makes for lots of people living happy, healthy lives in centrally heated and cooled homes, our refrigerators full of vitamin-rich produce shipped from around the world, our closets full of inexpensive clothes to protect us in any kind of weather doesn’t, in fact, absolve us of the moral questions raised by fossil fuels, climate change, overseas workers in unsafe garment factories, and the many other quandaries that our comfortable lifestyles raise. It’s not that parents’ happiness and babies’ health don’t matter; of course they do, and ought to be part of our ethical considerations. But happiness doesn’t make moral inquiry irrelevant.
The “healthy babies” part of this argument is problematic for another reason. One of the parents whom Tingley interviewed for her article, Sharon Saarinen, said this about her daughter, who was conceived via IVF with cytoplasm transfer, “As my daughter grew and she’s fine and so intelligent, it just backed my belief that it was the right thing to do.” (Emphasis is mine.) Tingley makes a point of describing another IVF-conceived teenager in terms of her accomplishments—senior class treasurer, varsity sports, etc.
The message here? If a procedure produces intelligent, attractive, successful children, it must be a good thing. The problem goes back to those fears concerning eugenics and how reproductive technology can potentially reinforce troubling cultural norms and values. It’s a short journey from “a technology that produces healthy, intelligent children is fine” to “a technology that produces healthy, intelligent children is preferable, because those sorts of children are preferable.” The assumption that having an intelligent, successful child is the “right thing to do” implies that having a child with cognitive problems, physical impairments, and/or a limited ability to succeed by traditional measures might be the wrong thing to do. What happens when a child conceived via three-parent IVF turns out to be a C student with ADHD, asthma, autism, OI, dwarfism, or deafness? Does that child’s existence render the technique morally problematic? If so, what does that tell us about how and why we value the children we bear?
And finally, while straightforward IVF itself is indeed widely perceived as morally acceptable, the many technologies and situations that IVF makes possible, from surrogacy to the three-parent embryos that are the subject of this article, are still subject to intense ethical debates.
The “we already do all sorts of things to control what sort of children we have” argument: Tingley concludes her essay with her own take on the moral questions raised by three-parent IVF:
What often gets lost in the loaded language of the debate over three-parent babies is the fact that ordinary human reproduction is, by definition, genetic modification. The risks involved are unpredictable and potentially tragic; the subject of the experiment is a future person who cannot consent. We constantly try to control this process, to “design” our children, starting with our choice of sexual partner. During pregnancy, we try to ‘enhance’ them by taking folic acid, not smoking, avoiding stress; once they’re born, we continue the process with vaccines and nutritious food, education, clean air and drinking water. Some of these pre-and postnatal environmental factors, we now know change their biology in heritable ways. Is mitochondrial replacement, because it takes place in a petri dish, any more unnatural or morally repugnant than this?
The human reproductive process does indeed provide ways for parents to make both conscious and unconscious choices affecting what sort of child we end up with. This argument is not adequate to set aside serious ethical considerations around assisted reproductive technology, however, for several reasons:
That “nature” does it doesn’t mean that we can set aside morality and do it too. Nature doesn’t operate via moral rules and laws, but people do. And thank God for that. In the wake of last week’s Supreme Court decision allowing the family that owns Hobby Lobby stores to opt out of providing certain types of contraceptives under their employee health plan, based on their religiously-motivated belief that those contraceptives are abortifacients, I saw frequent reference to this argument: Given that a large percentage of fertilized human eggs never make it past the blastocyst stage—that, in essence, “nature” disposes of fertilized eggs as a matter of course—why does it matter if our medications (or abortion providers, for that matter) do the same? Despite my opposition to the Supreme Court’s decision and support for abortion rights, I find this argument ridiculous. The human death rate is 100 percent. “Nature” kills every single one of us, one way or another. That doesn’t make the morality of murder irrelevant.
The key word is “try.” Yes, we try, consciously and not, to ensure our children’s health, well-being, and success by choosing a partner whose traits we value, eating well during pregnancy, and more. But marrying a strapping Ivy League math professor with impressive cheekbones is no guarantee that our child won’t inherit his grandmother’s weak chin and fail math. The most pristine pregnancy diet can’t guarantee that our child won’t be autistic or get leukemia. Genetic screening and manipulation, in contrast, allow for a precision unknown with natural reproduction—a precision whose long-term implications, for individual children and our culture, are largely unknown. The difference between natural reproduction and genetic manipulation is the difference between wooing one’s beloved with a favorite meal, a flattering outfit, and a bottle of wine, and asking the neighborhood wizard to brew up a little love potion. It’s the difference between art and science.
Technological reproduction fails to leave as much room for fate, or providence, or whatever you want to call it. Natural procreation is a crap shoot, a gamble with the highest possible stakes. Our inability to control it with scientific precision leads to heartbreak of many kinds—miscarriage and stillbirth, sick and disabled and dying babies. It also leads to a breathtaking sort of discovery, an exceeding of our highest expectations, as we get to know the children who are in so many ways a mystery when they are born. Our lack of control leaves room for possibilities that we aren’t wise enough to know we should leave room for. As I wrote in an essay pondering my feelings about passing my painful, disabling bone disorder on to my oldest daughter:
I can never be grateful that my daughter inherited my brittle bones, even as I understand how the pressures of living with our disorder have shaped her in beautiful ways. But I am grateful for who she is. And I am also grateful that parents don’t get absolute control over our children’s inheritance, that we don’t get to pick and choose what they get from us, With my anxieties so focused on what sort of bones my child would have, with my vision so limited, I could never have predicted, much less devised, the wounded and gracious person my daughter has become.
Or, as Anglican bioethicist Oliver O’Donovan, in his essay “In a Glass Darkly,” wrote:
The element of chance is one of the factors which most distinguish the act of begetting from the act of technique. In allowing something to randomness, we confess that, though we might, from a purely technical point of view, direct events, it is beyond our competence to direct them well. We commit ourselves to divine providence because we have reached the point at which we know we must stop making, and simply be. . . . Randomness is the inscrutable face which providence turns to us when we cannot trace its ways or guess its purpose. To accept the fact is to accept that we cannot plan for the best as God plans for the best, and that we cannot read his plans before the day he declares them. . . . We do not, in natural begetting, bring sperm and ovum together, and as it were, forcibly introduce them to each other.
I discussed this article on Facebook with a professional ethicist (we have a mutual friend) who was far less bothered than I was by the poor quality of ethical discussion. She said that ethics weren’t the article’s focus and didn’t expect a writer to try being an ethicist. She also said that she believes that people making decisions about whether to use these sorts of technologies ought to consult a professional ethicist before doing so—a suggestion that echoes one of mine in No Easy Choice. I would like to see fertility clinics acknowledge the deep and complex ethical concerns their practices raise, and at minimum suggest, at most require patients to consult someone well-informed on those concerns (perhaps pastoral counselors, genetic counselors, and/or mental health professionals specially trained in ethical deliberation?) as part of the clinical process.
It would indeed be helpful for everyone considering IVF, PGD, three-parent embryos, surrogacy, gamete donation, or even routine prenatal screening to have access to someone trained to focus on the most relevant and useful ethical concerns. But as things stand now (and possibly forever, given our cultural reticence to be proactive in considering ethics of emerging reproductive technologies), the vast majority of people considering reproductive technologies will limit their ethical questioning to the superficial, not quite relevant, sometimes illogical concerns included in the New York Times piece and described above. They, and the friends, family, clinicians, and other professionals they consult, will read the Times article and others like it in the Sunday paper or online, nodding over their oatmeal at how obvious it is that God gave us medicine, and no one has a right to tell anyone they shouldn’t want a baby, and that we already make choices about our prospective and actual children’s futures anyway. And they will go on to make or endorse decisions that can potentially change not only our children and families, but our entire culture, without really understanding the implications.
I’m not necessarily opposed to three-parent embryos. Particularly when it comes to halting the march of mitochondrial disease in a family, I am deeply sympathetic, given my own debilitating genetic disorder. But I am opposed to sanctioning this technology, and others like it, without first considering the actual moral conundrums they raise, not the well-meaning but ultimately immaterial ones so often discussed in articles like this one.
*I edited this sentence, because originally I mistakenly wrote that mitochondrial transfer—the technique that the FDA is considering for human clinical trials—had been used successfully for women whose previous IVF cycles were unsuccessful. In fact, these successful cases involved cytoplasm transfer, not mitochondrial transfer. The techniques are related but not the same. My thanks to George Estreich for pointing this out. George’s response to the New York Times article, focusing on what the author’s rhetoric reveals about her bias, is published on the Center for Genetics and Society site and is well worth a read.
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