Sunday, March 16, 2014

Even more ways of making babies

Here's this weekend's column in the Kingston Whig-Standard.

You might have thought that the reproduction revolution had arrived and ended with the birth of Louise Brown, the world’s first known IVF-generated baby.
She was born on July 25,1978. Louise Brown got married in 2008 and has since given birth to two children of her own, not conceived by means of IVF. In those days religious campaigns against IVF were running in overdrive. It was said that IVF babies would be discriminated against, IVF was somehow unnatural, IVF babies would be horrified and suffer dramatic psychological harm once they found out how they came about and the list goes on. None of these predictions turned eventually out to be true. Today opposition to IVF is pretty muted, and often it is predicated on concerns about the cost involving in making such babies.
After that we had a short upheaval caused by our successful attempts at cloning higher mammals. Humans are higher mammals, so if we can produce sheep, and even primates, there is no in-principle reason why we shouldn’t be able to do the same with humans. This would have been a neat tool to weed out all sorts of genetic diseases, but the international outcry was such that human reproductive cloning suffered a stillbirth. The moral panic was pretty much manufactured by religious organizations such as the Vatican. A thoroughly misinformed public feared cloned Hitler-type armies as opposed to a surplus of Claudia Schiffers and Albert Einsteins, stuff like that. These were implausible scenarios anyway.
To be fair, there were also some concerns that could not be brushed aside that easily. It took a lot of miscarriages and seriously disabled sheep to produce Dolly the first cloned sheep at the time. Not unreasonably some opponents of reproductive human cloning wondered aloud whether this would be a price worth paying. Still, one more time religious opponents trotted out the well-worn tropes deployed during the culture wars on IVF. Cloned people would be discriminated against, cloning is unnatural and cloned people would suffer psychological damage on discovering that they’re clones. Critics also showed a remarkable lack of understanding of what gives us moral and legal standing. Some suggested the cloned humans would eventually be abused as involuntary organ sources. That is about as implausible as suggesting that IVF babies could be used for that purpose. For better or worse, birth establishes today a right to life and bodily security in modern democracies.
Fast-forward to 2014. Reproductive health research has thrown up yet more potential means of human reproduction. The news headlines were all over it: We are actually able to produce three-parent babies. Well, kind of. The clinical objective here isn’t to enable three-people relationships to produce a joint child. The objective is to reduce the occurrence of genetic disease. The New Scientist explained a decade ago as good as anyone what’s involved: ‘The procedure would involve fertilising a woman's egg by in-vitro fertilisation outside the body and transplanting the fertilised nucleus to an egg from another woman which has had its nucleus removed. Any child born following implantation of such an embryo would have cells containing a nucleus with genes from both parents, and mitochondria from a woman other than their mother.’ That was then, today this technology is ready to be used.
At this stage, I’m sure, you won’t not be terribly surprised to learn what ‘ethical’ objections have been deployed against this procedure: It goes without saying that it is 'unnatural,’ that it goes ‘against God,’ and, of course that old chestnut about myriad psychological problems the off-spring would suffer from.
My colleague Francoise Baylis at Dalhousie University raises a number of more serious ethical objections. Among other concerns she warns that there are risks to the egg donors. The procedure involves hormone injections. These injections ‘can result in cramping, abdominal pain, nausea, vomiting, bloating, mood changes and irritability. More serious potential physical harms include rapid weight gain and respiratory difficulty, damage to the other organs such as the bladder, bowel and uterus, decreased fertility, infertility and life-threatening haemorrhage, thromboembolism and ovarian, breast or colon cancer.’ Now, it’s one thing if you accept such risks for yourself because you want your own genetically linked child, but it’s quite another if this happens in order to support someone else’s desire to have their own genetically linked child. This argument still begs the question, however, why should we assume that women considering getting involved in such a manner somehow have no, or such seriously impaired, agency preventing them from making their own informed, voluntary choices that we should prohibit such technologies. Baylis also wonders whether this kind of research should be a priority, given competing global health needs. I think she is correct on that count. This kind of work is probably best characterized with the hashtag #richpeopleproblems.
Would future children conceived by such means be harmed or in some other way wronged? The long and short of it is that that isn’t the case, and here is the reason why: The only prospective parents who would avail themselves of such technologies are people who could not conceive their own genetically-linked child otherwise or who would face a high risk that their future child would suffer from a devastating genetic illness. A child born as a result of the described mitochondrial replacement technology would have to ask herself whether her existence is preferable to not existing at all, or existing with an illness that would render her life truly miserable and likely brief. The answer to this question seems like a no-brainer to me. Interestingly, British Columbia’s Family Law Act is ahead of the curve on this. It permits three-parents to be listed on children’s birth certificates already.
The human reproduction revolution continues.
Udo Schuklenk teaches bioethics at Queen’s University, he tweets @schuklenk.

1 comment:

  1. Last time I tried to count, there were more than 50 ways to reproduce mammals -- it's a kinky new world in veterinary medicine. 3 parents, 4 parents, 5 parents -- all possible. Three mothers, no father -- difficult, but doable.