Monday, May 15, 2006

I'm always . . . shocked? baffled? incredulous? at the arguments offered by reproductive endocrinologists when they are questioned about the ethics of this or that aspect of their work. I'm often led to wonder how our educational system can allow someone that deficient in basic logic not only to graduate from high school but to have an advanced medical degree.

This article on sex selection in the US really contains some doozies.

My favorite, of course, is the most wide-ranging, the one which blesses all:

"In the United States we really guard and cherish reproductive choice and we are very reticent to allow the government to impinge on that."

(This is from the reproductive endocrinologist featured in the article, a Dr. Steinberg.)

Note how "choice" itself is a value--a virtue?--irrespective of the actual choice made. Because we value choice, he's saying, the government is not allowed to discriminate between good and bad choices. What's interesting, of course, is the implication that neither is he. He is a service provider; he is under no obligation to exercise judgment over his clients' choices; indeed, he too must honor their choices, whatever they may be.

Now, even if one grants the inadvisability of government intrusion in certain life choices (I do not, but I'll play along), one does not thereby require that individuals lend their aid to those making choices. It is perfectly legal for a man to drink himself into a coma every night of the week, and twice on Sundays, but no bartender, liquor store owner, or airline attendant is legally required to provide him with a single drop of alcohol. It is perfectly legal for a woman to take an entire bottle of Tylenol in the hopes of killing herself, but it is not legally required that her husband help her with the child-proof lid. It is perfectly legal to fire someone for having red hair. It is perfectly legal to . . .

Well, I could go on. But the point is that legal permission does not on any account equal moral obligation. One cannot point to the law and say, "See, it's allowed, so I must help!" If there is a realm of judgment into which we are reluctant to allow the government, that realm does not suddenly become a judgment-free realm.

But there are others!

The article, of course, brought up some of the ethical problems with Steinberg's work. One was the potential demographic effect: if parents were allowed to choose the sex of their child, demographic imbalance might result. (I am confident, by the way, that whichever way the demographic imbalance swung, it would be bad news for women. Too many men, too few women? The women would become the slaves of the men. Too many women, too few men? The women would become the slaves of the men.)

One ethicist's response to this problem was. . . well, it bordered on hilarity: the particular procedure that Steinberg uses (pre-implantation genetic diagnosis) is too expensive to make much difference in global demographics.

So, poor people in India and China resort to infanticide (they peek at the genitals and kill newborns who have the wrong ones), but rich people can afford to do it differently, so we don't have to worry about them. The moral weight of their act is excused because it is presumed to have little statistical impact. Even if this were the case, we all know better than to do morality-by-statistic, don't we? But in fact, the recent research on this very topic demonstrated that the wealthiest provinces in India have the greatest gender imbalance. Precisely because the wealthy can afford to fly to the United States and do what is illegal in their country.

The article also referenced concerns about waste embryos. (We can talk some other time about how the journalist cast this as a concern only of "conservative Christians.") When a procedure produces five to ten "waste" embryos for every two implanted, oughtn't we be concerned about the reasons people are using it? Can't we prioritize? Doesn't "family balancing" seem a little inadequate to the moral weight of discarding ten embryos in order to implant two?

No, no! Dr. Steinberg responds: "His clients mostly opt to keep fertilised eggs in his eggbank rather than discard them."

Oh, well that changes everything! They're not throwing the embryos away--they're just storing them for all eternity. That's totally different.


In fact, Dr. Steinberg has a ready response to any ethicist that suggests negatives to his work:

"People have been warning of that slippery slope since the first in-vitro baby was born more than 25 years ago, but we haven't gone down it yet."

Do you remember some of the things people were worried about 25 years ago? I do.

That post-menopausal women would use IVF to bear children.

That excessive numbers of waste embryos would be created. (Current estimates on the number of stored embryos ranges from 100,000 to 400,000. No estimates exist on the number of embryos simply discarded.)

That such embryos would be treated as research material.

That people would use the technology to select for the sex of their baby.

I wonder what would count as evidence that we're on that slope.

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