September 1981 III/1
EVALUATING IN VITRO FERTILIZATION: A METHODOLOGY
When preparing a scientific protocol, the most important part of the endeavor is asking the right questions. If the wrong questions are posed, then the project will fail, even though the scientist might find the right answers to the wrong questions. When preparing an ethical evaluation, the situation is similar. One must be careful to pose the proper, the comprehensive, the right questions, or else one certainly will reach a conclusion which is erroneous or only partially valid. This methodological truth is illustrated clearly in the ethical evaluation of in vitro fertilization (IVF). If IVF is successful, a married couple who have been infertile are able to have a child of their own. Insofar as the parents of the child are concerned then, the result of IVF is good. But this limited view of the situation does not allow the conclusion that IVF is an ethical good. Simply because one result is good does not imply that the matter in question is good under every aspect. For an action to be judged ethically good it should be good from every point of view. In addition to the parent's benefit, then, other questions concerning the effects upon the child and society, as well as the nature of the generative act, must be considered before an accurate ethical evaluation of IVF can be offered. What are the right questions then that should be posed in order to evaluate IVF properly? The following interrelated questions seem to be essential for such an evaluation.
1. When does life begin?
Significance: If human life begins at fertilization then IVF is experimentation upon a human being and should follow the norms of that type of research. Moreover, discarded zygotes or embryos lost in unsuccessful implantations, at present a foreseen possibility of IVF, would be human. Steptoe reported that out of 150 attempts to implant human embryos only four actually were successful and only one was carried to term. (1) Knowingly and willingly wasting human beings is unethical. On the other hand, if there is evidence that human life does not begin until after implantation, then IVF would not be unethical from the point of view of the zygote because only animal life would be present. The following query sums up this aspect of the issue: Is the zygote human life with potential or potential human life?
2. How should children be brought into the world?
Significance: Pleasure, a disposition for love, and procreation of children are natural components of the act of sexual intercourse. Today, human beings have the power to separate artificially these elements of the act. Thus it is comparatively simple to assure through intervention in the natural generative processes, either that the procreation of children will not occur even though persons join in sexual intercourse, or that it will occur, obviating sexual intercourse. Though we have the power to do these things, do we have the right to do such things? Because a couple is infertile, do they have the right, with the aid of scientists, to circumvent the natural process of generation? Or are the creative powers which people share with God limited in such a way that they should stop short of interfering with natural processes such as the generation of new human beings, even though it is clear that a substitute method for the natural process can be found? Clearly, we have the right to modify our person/body entity so that natural actions are more aptly performed. But do we have the right to change our body/person entity so that natural actions are eliminated, the same results being achieved through artificial means?
3. What results (consequences) will there be to parents, children, society due to in vitro fertilization?
Significance: Bonding (effective love) arises from intimate physical and emotional contact between parents and children. Would the result of less physical and emotional contact in the generation of in vitro children weaken family bonding? Will in vitro children be looked upon as possessions rather than persons with their own rights and destinies? Will they be as secure as natural children? In an ethical evaluation, in order to understand the nature and consequences of a particular action, it is sometimes helpful to ask, "What if everyone does it all the time?" What effect would there be upon society and the family if the fertilization and even gestation of all children were achieved in a wholly artificial manner? The family has had a dramatic effect upon the evolution of the human species. (2) Would the development of the family and thus the progress of society be weakened by IVF? Have the potential effects of such far-reaching changes in the process of human generation upon children, parents and society been evaluated?
4. To which projects should research efforts of medicine and science be directed?
Significance: The resources of society are limited and should be directed toward projects which will be beneficial for as many people as possible and which will alleviate serious health problems. Is infertility a serious health problem? Is IVF the best method for treating it? Have the efforts invested in IVF to date justified the results? Would a sufficient number of people benefit from IVF to justify the time and energy that would be necessary to develop it from the comparatively unsuccessful process that it is today to the point where it is more dependable as a means of generation?
In vitro fertilization is but one of the many forthcoming medical procedures capable of drastically modifying human activities and relationships. Genetic surgery and gene splicing are on the horizon and they too will have great influence upon the human genotype and phenotype and thus upon the family and society. In order to balance responsibility with scientific research, we must ask not only, "Is it possible?"; we must also ask, "Is it ethically sound?" In answering these question, we consider not merely one or two good results, but we consider also the effects of such procedures upon the human function in question, upon the relationship of man to God, and upon the family and society. Lastly, we must consider whether such a procedure is a beneficial and wise use of our limited resources. Only when a procedure is good from all these points of view can it be declared ethically acceptable.
Kevin O'Rourke, OP
1. "Reimplantation of a human embryo with a subsequent tubal pregnancy." The Lancet. Apr. 24, 1976: p.880-882.
2. Johanson, Edy. Lucy, The Beginning of Mankind.. Simon and Schuster, 1981.
3. J. Biggers. "In Vitro Fertilization and Embryo Transfer in Human Beings. NEJM. Feb. 5, 1981: p.336-342.
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