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Reproduction

Should Anyone get IVF?

25 Nov, 14 | by Iain Brassington

Cast your mind back to this summer, and Christina Richie’s paper about the provision of ARTs.  It attracted a fair bit of controversy because of the way it talked about gay people’s rights to access ARTs, and their “voluntary” infertility.  For my money, that was the weakest part of the paper, and it should have been left out of the argument; the majority of the paper, and the more ethically interesting part, had to do with the environmental impact of striving to have more and more kids, irrespective of their parentage.  But I can see why the part about gay people struck many people as worth commenting on.

Why mention all that now?  Well, there’s a nice paper by Emily McTernan currently on pre-pub in the Journal of Applied Philosophy asking whether any fertility treatment should be state-funded.  In it, she asks whether IVF should be state-funded at all.  In a nutshell, her claim is that many of the arguments about the good of parenthood are either weak in their own right, or else could apply equally well to any number of other goods that a person might pursue.  Those that are weak are obviously less likely to sustain a claim that iVF should be provided; those that apply equally well to other goods obviously suggest either that governments should fund the pursuit of those other goods as well, or that if pursuit of those other goods is not funded, then neither should IVF be.  Thus

it is unjustifiable for a state to provide fertility treatment more generously than it funds other valuable like projects, both in the quantity of funding and the lack of means testing.

What I really like about the paper is that McTernan sets out the main arguments for funding in a simple but never simplistic manner, and calmly knocks them down one by one.  I’m already inclined to be suspicious of, if not hostile to, public funding of IVF (there being things with a more pressing need for public money, and genetic relatedness being not all that important), but she puts the arguments more neatly than I ever could.  She’s very good at pointing out that a particular argumentative strategy might be tempting, but that we would probably fight shy of adopting it because it would commit us to moral conclusions we wouldn’t normally want to embrace.  So, for example, if you’re inclined to agree with the Daniels line that adverse departures from normal species functioning could count as disease, you might be tempted to say that infertility is a disease – and therefore ought to be treated, or at least ameliorated, by IVF.  But

lack of reproductive success cannot itself suffice to make for an adverse departure [from the norm]: we would not want to conclude that those preferring same-sex partners have a disease, given the reproductive failure resulting from their statistically unusual sexual preference, let alone that it should be treated.

 

Elsewhere, she attacks the idea of parenting as a unique good as a ground for providing IVF, and the idea that we ought to support and enable reproduction as a social good.  McTernan recognises that there is arguably a social injustice in that a woman’s most fertile years tend to coincide with the years most crucial for her career.  This means that a woman who wants kids is likely to defer pregnancy, thereby reducing her chance of getting pregnant.  IVF might correct for that.  However, McTernan contends, this isn’t compelling, not least because the argument transforms a social phenomenon – which she thinks constitutes an injustice – into a problem with the individual; providing IVF (which isn’t all that reliable anyway) might provide an interim solution to the social problem, but it does nothing to address it fundamentally.  So, she claims, the argument probably isn’t all that strong.

But she then makes a fascinating exception – and this is where her paper is in interesting contrast to Richie’s: it’s that we do have more of a reason to provide IVF to gay couples. more…

Film Review: “Obvious Child”

3 Sep, 14 | by Iain Brassington

We’ve not had a film review here before, have we?  OC-poster-screenshot-121013

As far as I can tell, the ratio of talked-about-ness to actual screenings of Obvious Child is unusually high; it doesn’t seem to have got all that much time in mainstream cinemas, which meant that I had to schlep along to Manchester’s Cornerhouse to see it.  (I have a theory about cinemas, which is that the artistic quality of the establishment is inversely proportional to the comfort of the seating.  The Cornerhouse is a nice example of this rule in action.)  Why it’s attracted so much attention is captured in the elevator pitch: it’s a romantic comedy about abortion.  It certainly got certain elements of the US commentariat all excited – RightWingWatch has a nice little compilation here – though admittedly, as far as I can tell, the objections haven’t been matched in the UK, where the emphasis has been much more along the lines of “It’s that film that got the American right all antsy”.

I can see why certain sectors of the commentariat have got upset about it; the film is remarkable in just how down-to-earth its handling of the plot is.  The plot is dead simple: a woman (Donna, played by Jenny Slate) loses her boyfriend and her job within the space of about three frames, gets drunk, has a one-night-stand, gets pregnant, decides to have an abortion, lets the father of the child know all this in the course of a stand-up routine, has that abortion, then decides to watch Gone with the Wind.  It’s that straightforward.

For Donna, it’s less a matter of obvious children than obvious decisions.  She doesn’t want to be pregnant, and sets about not being.  There’s no indication that she’ll regret the decision; there’re no lingering shots of Donna agonising over whether it’s the right thing to do; the father (Max, played by Jake Lacy) says he wants to be a grandfather in passing, but doesn’t try to talk her out of it, or even insist that he should have a say.  Donna is a little nervous about the procedure – but then, it makes sense to be a little nervous about having a mole removed or any other minor surgery.  There’s no moral freight, though.  Donna is not irresponsible – I mean, she might have done something a bit irresponsible in not taking more care with the contraception, but that’s a shared thing with Max; and making a decision about what to do in the wake of having done something a bit daft is responsible.

In other words, Obvious Child is just about a person making a decision. more…

Oh, dear, Richard…

20 Aug, 14 | by Iain Brassington

Look, I know that Twitter really isn’t the place for nuanced debate.  But, by that token, everyone else should realise that as well – especially intellectual superstars. So how, then, to explain Richard Dawkins’ spectacular foot-in-mouth moment earlier today? It started off reasonably enough, with him tweeting about Catholicism’s stance on abortion and providing a link to this piece by Jerry Coyne in the New Republic; lots of people are going to agree with both Coyne and Dawkins, and lots to disagree, but we should expect that.  The tweet got a couple of replies.  I can’t be bothered transcribing them, but here’s a screenshot; you should be able to click to enbiggen it. Screen shot 2014-08-20 at 19.50.23

So far so good.  Dawkins’ reply is about as good a version of the sentience argument that you could cram into 140 characters; and InYourFaceNewYorker’s point articulates a problem faced by any number of women who are carrying a child with a disability of some kind.  (Well, by any number of parents, I suppose, except that it’s women who hold the moral trump here simply by dint of being the one carrying it.  Fathers could agonise about the best thing to do, too; it’s just that they don’t get to make the final decision.  Oh, you know what I mean.)  Where you stand on abortion doesn’t preclude recognising that it’s a genuine moral dilemma for many people, and a that there are respectable arguments and proponents of those arguments on both sides – by which I mean that people on either side should be able to recognise that their opponents are at the very least worth the effort of an argument. InYourFaceNewYorker goes on to articulate some of the aspects of the debate that make it so emotive and so intellectually rich:

Screen shot 2014-08-20 at 19.58.49

That doesn’t reflect Dawkins’ response to the dilemma, though.  Brace yourselves. more…

On Conflicts of Interest

28 Jul, 14 | by Iain Brassington

It’s only a few days since Richie’s paper on providing IVF in the context of global warming was published, but already there’s been a couple of lines of objection to it that have been fairly widespread; I thought it might be worth nodding to one, and perhaps offering an attempt of a defence against the other.

The first objection is that there’s no justification for the claim about same-sex couples in Richie’s paper – that she shouldn’t have treated homosexuality as a lifestyle choice and as “non-biological” infertility.  I think that there’s significant merit to this objection to the paper; and though neither Dominic nor I mentioned the objection explicitly, I think that it’s there between the lines of each of our commentaries.  (It’s certainly an aspect of the paper that’s picked up by the Telegraph‘s coverage of the paper, and it’s been mentioned a couple of times on Twitter and Facebook by people I know and follow.  (I note that the Telegraph also gave a highly bastardised version of my post here.  Ho hum.))  I think that Richie’s argument would have been at least as strong if she’d talked about providing IVF to anyone whatsoever – the qualifications about different “sorts” of infertility and lifestyle, I suspect, weakened the paper, inasmuch as that a paper with unnecessary and argumentatively weak aspects is more vulnerable to objections generally than one in which those aspects have been left out.  So, yeah: I think that that might count as having been – at best – a strategic error on Richie’s part.

Here’s the other claim that I’ve seen a few times about the paper: that it’s weakened by a conflict of interest because of the author’s affiliation.  This isn’t directly a claim about the quality of the argument in the same way that the previous objection is.  Rather, it’s a claim that there’s something unreliable about the very fact of the argument’s having been put.  (I’m not articulating the distinction very well, but I think you can see what I mean.)  In essence, the worry is this: Richie works for a Jesuit Institution; this isn’t clear from her affiliation in the paper; there’s something iffy about this; this iffiness is some form of conflict of interest and her argument is likely to be biased.

I’m not sure what to make of this. more…

Gaia Doesn’t Care where your Baby Comes From

25 Jul, 14 | by Iain Brassington

Guest Post by Dominic Wilkinson, Associate Editor, Journal of Medical Ethics

In a provocative paper published today in the Journal of Medical Ethics, US theologian Cristina Richie argues that the carbon cost and environmental impact of population growth in the West should lead to restrictions on artificial reproduction.  She points to the substantial carbon emissions that result from birth in developed countries like North America.  Seven percent of the world’s population contribute fifty percent of the world’s CO2 emissions, and children born by in vitro fertilization are likely to be in this seven percent.  Richie argues in favour of a carbon cap on artificial reproduction and argues that IVF should not be funded for women who are “biologically fertile”.

Richie is correct to point to the enormous carbon cost of additional human population. One of the most significant ways that individuals in Western countries can reduce global carbon emissions is by having fewer children. However, her focus on artificial reproduction and on the “biologically fertile” is not justified.

Richie ignores questions about the moral implications of climate change and climate cost for natural reproduction.  She sets to one side “the larger realm of sexual ethics and procreation”.  Yet there are two reasons for thinking that this is a mistake.  First, as Richie notes, “Reproduction-related CO2 is primarily due to choices of those who have children naturally: a huge majority of all births.”  Only 2% of all children born in the UK are conceived by IVF.[1]  Therefore interventions to reduce the number of children naturally conceived will potentially have a fifty fold higher impact on carbon emissions.  Secondly, it is profoundly unjust to apply restrictions to reproduction only on those who are unable to conceive by natural means.  It could be justified to limit the reproductive choices of women because of concern for the environment.  However, if this were justified, it would be equally justified to try to limit the reproduction of the naturally fertile and the naturally infertile.  It is ad hoc and unfair to confine our attention to those who must reproduce artificially.

Second, Richie proposes that public funding for IVF be confined to those who are “biologically infertile”, excluding same sex couples and single women.  However, she provides no reason at all for restricting the availability of IVF for these women.  Put simply, the carbon cost of artificial reproduction is exactly the same for a woman who is infertile because of endometriosis or polycystic ovary syndrome or because she does not have a male partner.  The only possible reason for making a distinction between biologically infertile and biologically fertile women is because Richie believes that lesbian and single women are less deserving of public funding because of their lifestyle choices.  However, that argument, as problematic and contentious as it is, is completely independent of the question of environmental impact.  The carbon cost of children born to gay couples is likely to be exactly the same as the carbon cost of children born to women with endometriosis.

The carbon cost of additional births might well be sufficiently important for the state to justify limiting reproductive freedom.  However, if the state is going to interfere in couples’ decisions about whether to have children or the number of children that they have, it should do so fairly and equally.  Carbon caps should be applied equally to those who conceive naturally and those who require artificial reproductive treatment.  They should not be used as a way to discriminate against those who are single or gay, or have some other ‘undesirable’ characteristic.

 

[1] http://www.hfea.gov.uk/ivf-figures-2006.html#1284

ARTs in a Warming World

25 Jul, 14 | by Iain Brassington

There are some people who disagree, but we can take some things as read: there is such a thing as global climate change, it is at least substantially anthropogenic, and there are moral reasons to try to minimise it.

With that in mind, how should we think about reproductive technologies?  These are techniques whose intent is to create humans, and – presumably – those humans will have an environmental impact.  This is a question that Christina Richie confronts in her paper in the JME:

The use of ART to produce more human-consumers in a time of climate change needs to be addressed.  Policymakers should ask carbon-emitting countries to change their habits to align with conservation.  And though all areas of life – from transportation, to food, to planned technological obsolescence – must be analysed for ecological impact, the offerings of the medical industry, especially reproductive technologies, must be considered as well.

One of her suggestions is of carbon-capping for the fertility industry; she’s more reluctant to suggest a moratorium on the use of ARTs.  But she does suggest thinking quite seriously about who should get access to fertility treatment.  After all, she points out, fertility treatment is unlike other medical treatments in a number of ways.  Not the least of these is that someone whose life is saved by medicine will go on to have a carbon footprint bigger than it might have been – but that’s not the intention.  The whole point of fertility treatment is to create new humans, though – and therefore the treatment has not just a footprint, but a long-lasting carbon legacy.

I wonder, actually, whether the argument could be radicalised. more…

Are FIGO’s Regulations Risking the Lives of Pregnant Women?

10 Jul, 14 | by Iain Brassington

Guest post by Douwe Verkuyl

The International Federation of Gynecology and Obstetrics (FIGO) Committee for the Ethical Aspects of Human Reproduction and Women’s Health believes that there is never an indication for a tubal occlusion (TO) to be performed at the time of caesarean section or following a vaginal delivery in cases where this sterilisation has not been discussed with the woman in an earlier phase of her pregnancy.  This applies even if there is a uterus rupture.

But what if a mother of 5 children, living in rural Africa near a Catholic clinic, unexpectedly needs referral to a government hospital because of arrested labour, and faces a journey of at least 4 hours over a dirt road?  Does the Committee’s recommendation against belated TO counselling still apply if referring establishments have deliberately ignored its advice to counsel pregnant women early in pregnancy about the option of a concurrent sterilisation in the event that a caesarean section is needed?  Catholic institutions – which are often the only health facility for miles around – not only ignore this advice, but also fail to assist a woman with “sinful” modern contraception after she has returned with a scarred uterus.  In many Western, developed countries, Catholic contraception doctrines are mostly inconvenient, guilt-provoking and expensive.  In rural Africa, Latin America and the Philippines, they often kill.

Imagine a 37-year-old woman in labour in a well-equipped and staffed Doctors Without Borders (DWB) emergency hospital which happened to be located near her home.  She has previously given birth, with some difficulty, six times at home, and now there is a full civil war.  The doctors detect foetal distress.  They think there might be a 10%-30% chance her child will be damaged or die before it is born.  On the other hand, with the uncertain political situation – consider that on 17 June a DWB hospital was bombed in Sudan – and poor infrastructure, it might be the case that her chance of dying from a uterine scar during a subsequent labour is around 30%, and the probability that she has continuous access to reliable reversible contraception for the next 13 years is zero.  If she would choose to have a TO with a caesarean section that would solve the quandary.  Is it really unethical to ask her, or unethical not to give her that choice?

Read the full paper in the latest edition of the JME here.

Their Poor Little Heads might Explode

1 Jun, 14 | by Iain Brassington

There’s a nice little piece by Martin Robbins in this week’s Guardian in which he talks about the fact that women seem to be less supportive of abortion than men.  That does seem counterintuitive, given that… well, given the obvious physiological facts and the relative burden of risks related to pregnancy.  So there’s an interesting little anthropological puzzle here; and he suggests a number of factors that might explain the phenomenon. For example, there’s some research that finds that women are more likely than men to agree that life begins at conception – though, as he points out, while that might help explain the different views of termination, we’d still need to know why more women think that to begin with. Another potential explanation is that men like the idea of not having to do the right thing by their pregnant partners by paying child-support or, if you’re reading this in the 1950s, marrying them: abortion gives a way out of that.  But – and Robbins doesn’t mention this – that again presupposes keeping the baby as the default position to which people are looking for an alternative.  We could also talk about social pressure, and the way that women are still expected to be mothers, and how that feeds into attitudes.  In fact, we could talk about a lot of things:

So which is it? Internalised sexism, men’s liberation, fundamentally different ideas about the point at which life begins, or something else entirely? I doubt only one factor is at work, but it seems that we lack a definitive answer. And that’s a shame, because in the ongoing battle of ideas it seems like a very important question to ask.

I suspect some will deride his “we need to do more research” conclusion, but it seems eminently sensible to say that, faced with a quirk of attitudes, a full explanation would be at least aesthetically satisfying, even if not especially urgent.  He also provides lots of useful links.

Over at the CMF blog, Philippa Taylor’s suggestion – which also has lots of useful links – is a little different. more…

Oh, and while we’re talking about media hype…

1 Apr, 14 | by Iain Brassington

… there’s this, from last week’s Independent:

Thousands of unborn foetuses incinerated to heat UK hospitals

The bodies of more than 15,000 unborn foetuses have been incinerated in the UK, an investigation has found, with some treated as “clinical waste” and others burned to heat hospitals.

The practice was carried out by 27 NHS trusts, with at least 15,500 bodies burned over the last two years alone.

Ten of those trusts admitted to burning more than 1,000 sets of remains along with other hospital rubbish, while two said they were incinerated in “waste-to-energy” furnaces that generate energy used to power and heat hospitals.

Gasp!  One kind of human tissue is disposed of in the same way as other kinds of human tissue!

From the tone of the reporting, one would only be mildly surprised to find people employed to encourage abortions in order that hospitals can save money on fuel.

Except that that’s nonsense.  If clinical waste is incinerated in waste-to-heat plants, it doesn’t follow that it’s being incinerated to provide heating; rather, it’s that the heat from the incinerator is captured and put to use, rather than being wasted.  For sure, the physics is the same; but the emphasis makes a heck of a difference.  (And, as PZ points out, for abortus* to be an effective fuel would require them to be “the most energy-dense substance in the world”.)  So what we actually have is a situation in which an abortus is incinerated.

And the problem with that is…?

Um…

Well, I’m sure there must be one, because health minister Dan Poulter is reported as describing the practice as “totally unacceptable”, and Poulter is an honourable man.

Actually, there is a few things that might strike us as questionable – though as we’ll see, the fact that something prompts a question doesn’t really tell us much, since some questions can be answered easily.   more…

Multiplex Parenting: in vitro Gametogenesis and the Generations to Come

24 Mar, 14 | by BMJ

Guest Post by César Palacios-González, John Harris and Giuseppe Testa; for the full paper, click here.

Recent biotechnology breakthroughs suggest that functional human gametes could soon be created in vitro.  While the ethical debate on the uses of in vitro generated gametes (IVG) was originally constrained by the fact that they could be derived only from embryonic stem cell lines, the advent of induced Pluripotent Stem Cells (hiPSC) creates the possibility that somatic cells may be used to generate gametes.  This means that in the future it might be possible to generate human sperm and oocytes from male cells, and oocytes from female cells.  (So far it has not been possible to derive sperm from female cells.)

Among the different applications that have been explored in the academic literature, like the creation of embryos for genetic research and what has been called “in vitro eugenics”, we think that the most dramatic application of IVG will be in the field of human reproduction.  In a recent article in the Journal of Medical Ethics, Robert Sparrow rightly notices that IVG could allow post-puberty males who are unable to produce viable sperm, women who have undergone premature menopause, and those who have lost their gonads due to injury or had them removed in the course of cancer treatment to have genetically related kin.  To this list we add (and explore in our paper) a fourth use that has been overlooked until now: that IVG would allow the reparation of some of the harms done to people by means of biological involuntary sterilization. more…

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