Recently, one of my friends shadowed a doctor in a fertility clinic and encountered the following ethical dilemma: one day, a middle-aged woman who was suffering from difficulties getting pregnant and who had already almost exhausted all the different methods of treatment came into the fertility clinic and told the doctor that she wanted to try the IVF method. She specified that she wanted the doctor to fertilize several of her eggs using her husband’s sperm, choose the healthiest among them after a few days, implant it into her womb, and then throw away the rest of the fertilized eggs. The rationale behind this proposal was that the one-time IVF was the last treatment she wanted to get; if it was not going to work, she was prepared to give up. The doctor refused her proposal and told her that he would only provide IVF for her if she agrees to freeze or donate the rest of the eggs.
In my opinion, though, doctors should allow patients to create multiple fertilized eggs and only implant one while throwing the rest away, as long as the patient is sure that a one-time IVF trial is the last effort she is going to make to become pregnant. For those who believe that life begins at fertilization, there is a common misconception about the frozen, unused embryos. There is always some sort of hope that they would be implanted later, that we are not really killing them if we preserve their lives in a freezer. However, it is very clear that the eggs will remain in the freezer indefinitely, for many years, or possibly forever, since the patient already specified that she does not want to try again if the one-time IVF she is opting for does not work. Furthermore, the shortage of storage space for these extra embryos is a significant problem. According to the American Journal of Bioethics, there were 400,000 total unused embryos stored in freezers in the US in 2003. As IVF’s become more ubiquitous, it becomes less and less sensible to increase spending on logistics simply to place false hope in embryos that are unlikely to ever be implanted.
The other option that the doctor suggested – donating the extra embryos – is not a perfectly sensible solution either. Couples who have trouble having children want their IVF-fertilized embryos to come from their own eggs and sperms. They would not opt for using an already-fertilized, donated egg if it is possible for their baby to be biologically related to them. As for couples who are physically incapable of having children, including heterosexual infertile couples as well as homosexual couples, it is a lot less costly to adopt a child, rather than spending stupendous amounts on an implantation, not to mention finding a suitable surrogate mother. In addition to the practical nature of the adoption choice, the moral obligation to save the lives of existing children should be seen as greater than the obligation to save the embryos, which, in diverse views, may or may not even be considered as alive. According to UNICEF, there are 210 million orphans in the world. Couples who want to have children but are incapable of it would and should opt for adoption instead of using donated embryos to go through a much more tedious and less morally compelling process.
For these reasons, I think a doctor should allow a patient to discard unused embryos in the IVF process, provided she is certain that the single-embryo implantation will be her last attempt to have a child.
3 comments:
I find it very interesting that the choice the middle-aged woman had to make was between freezing the embryos or donating them for use in someone else’s fertility treatment. Could there possibly have been a miscommunication between the doctor and the patient? I ask this because, as far as I know, couples usually have the option to donate the embryos to stem cell research. I certainly agree with what you said in your statement, that parents should be allowed to pursue IVF while choosing to destroy left over embryos, as long as the choices they are given are the same as those you describe. However, if a choice is to be made between donating the embryos to research and having them discarded – then I say donation should be elected every time. Thus, if this is the condition the doctor meant to provide his patient with, it becomes an immensely more defensible stance, in my opinion.
Stem cells are the subject of an extremely promising area of medical research. As undifferentiated cells, they can be programmed to grow into many cell types of the body, replacing dead or damaged tissue. According to the NIH website, stem cells could provide the cure for many currently serious or even incurable conditions. The applications range from repairing damaged heart muscle to repairing the body’s ability to produce certain hormones, such as insulin, curing diabetes. Even neurological conditions like Alzheimer’s and paralysis resulting from spinal cord injury could potentially be reversed by application of stem cells. For these reasons it is important to maintain the research, and one of the issues it faces is where to get stem cells from.
The current controversy over stem cells results from the fact that the most ubiquitous samples that can be obtained are those of the inner cell mass of an early embryo. The debate over when life begins has overflowed into this arena, and discouraged use of embryonic cells. Other forms of stem cells, placental and adult, are less pliable, as they have limits on the types of cells that they can become. Research is currently attempting to induce adult cells back into pluripotent forms (the potency of embryonic stem cells) and there has been mild success in doing so. However, studies suggest that induced pluripotent stem cells live are significantly more likely to undergo apoptosis, cellular suicide, than their naturally variable counterparts. Additionally iPS lines are thought to be more prone to be cancerous and much harder to grow in culture than embryonic stem cells. Therefore, as of yet there is no definite alternative to using embryonic cells, and there are plenty of labs that are ready to accept donated embryos. In fact, several states, including New York, New Jersey and California, have enacted policy which both encourages and funds embryonic stem cell research.
Returning to the original issue, unused embryos from IVF operations are a perfect source of the stem cells which could hold the key to unlocking many of the terrible diseases of our time. So provided a couple has no ideological objections (since they were going to destroy the embryos, I am assuming they don’t) they should always opt to give the leftovers to science. This is why I believe an IVF doctor who requires his patients to choose either freezing or donating (to science) is in the right. Freezing (with the intention that someone will use them someday) should satisfy the people who believe that the embryo is alive, while donating them brings us one step closer to letting quadriplegics walk again, to stopping Alzheimer’s in its tracks, to curing diabetes, and to many other potential breakthroughs.
http://www.ncsl.org/issues-research/health/embryonic-and-fetal-research-laws.aspx
http://stemcells.nih.gov/info/basics/basics6.asp
http://www.scientificamerican.com/article.cfm?id=cell-induced-pluripotent
I applaud the utilitarian leanings of this blog-post, but I think the bpan failed to address the major issue at stake here. Certainly, freezing and storing fertilized eggs costs money that could be put to other, debatably better, uses. But, I have a very hard time believing that the doctor bpan describes as refusing in-vitro fertilization wanted the embryos just to store them for later implantation into women in pregnancy-seeking couples but infertile couples. The real reason, or at least the more controversial and more likely reason, is that the doctor probably wanted to use the embryos for stem cell research.
Before I proceed, I want to apologize if I am reading too much into this; obviously I am not a primary source, or even a secondary source, so my judgment is merely conjecture, but I feel that, regardless of the intent of the individual doctor mentioned, the issue of embryonic stem cell research is very intimately related with IVF. Considering how commonplace IVF is (according to Wikipedia, 236 IVF cycles per 100,000 people), it is inevitable that a large number of embryos will be “created” and then either thrown away or saved and frozen (as cited in bpan’s post). Or, these embryos are donated to stem cell research. No one denies the importance of stem cells and their potential to cure so many different diseases. And no one denies how contentious the debate has been over the ethics of embryonic stem cell research.
I should be more clear with my terms. I am writing about embryonic stem cells – those stem cells that come specifically from discarded embryos “created” in IVF. Rather recently, scientists have created induced pluripotent stem cells from adult cells which have some similar uses as embryonic stem cells, such as cloning (see below for citation).
Due to the ease with which adult cells can be harvested (and since collecting such cells does not harm the donor), there is virtually no ethical debate over the use of induced pluripotent stem cells. However, because collecting embryonic stem cells kills the embryo, there is a huge debate over the morality of embryonic stem cell research. Those who engage in this debate – and particularly those who oppose embryonic stem cell research – are making a mountain out of a molehill; after all, many of those embryos would be discarded anyway (as is mentioned in bpan’s post). In the end, I believe – and have cited evidence to support the assertion – that embryonic stem cell research is ethical so long as it only uses cells from embryos marked for discard anyway. I believe that because of the incredible potential such research has for curing diseases, people should not be so hasty to criticize research (and funding for research) that could very well enable them and their progeny to live longer and happier lives.
http://en.wikipedia.org/wiki/In_vitro_fertilisation
http://en.wikipedia.org/wiki/Stem_cell_research#Adult
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