Following the devaluation of babies in the developed world in the 1970s and 80s, babies became scarce and, consequently, desirable once again. Now, any means used to make babies is seen as good, as long as pregnancy occurs at a convenient time.
Some cannot conceive naturally. The prevailing view is that those who cannot do so should have free access to such reproductive technologies as in vitro fertilization (IVF) or the purchase of gametes, i.e., sperm and eggs. Yet, many do not know what occurs in IVF labs and others do not care, as long as offspring result. The zeitgeist favoring “reprotech” obscures the serious social problems that reproductive technologies both reflects and facilitates.
For example, the growing demand for IVF is, in large measure, a response to Western cultural changes. As birth control and abortion became widely available, sex was more reliably separated from procreation and childbearing has been widely postponed. Deferring parenthood into the mid-thirties and beyond worked for some, but has created many fertility clinic users. Further, aside from delaying child-bearing, contraception enabled serial sexual partners and over ten million new cases of sexually transmitted infections (STIs) each year, which scar reproductive organs and also impair fertility. IVF is often used to bypass these obstacles.
IVF and the Effectuation of the Brave New World
Such academic commentators as Leon Kass, Francis Fukuyama and Bill McKibben have observed that human genetic engineering, nanotech and robotics will demoralize individuals and damage human community. They write, for example, of futuristic highly-skilled classical pianists or athletes who know that their parents purchased strong musical or athletic genes for them, and of the existential crises caused regarding the source of, and credit for, their respective accomplishments. They observe that democracy will become untenable if some use these technologies to create a master race. They view these threats to community as prospective, though imminent, as cloning and gene manipulation research continues in earnest.
These warnings are, at once, an exaggeration and an understatement. They are an exaggeration because, although genomic research has enabled scientists to identify the effects of many DNA sequences, we are still a while (vagueness deliberate) away from having a clearer sense of which genes influence many other traits. They are also an exaggeration because many have observed that, to date, gene manipulation efforts reveal that genes cannot often be simply cut and pasted, one for another, especially without causing serious unanticipated effects.
The authors understate the dangers posed by IVF because, in the interim at least, this reprotech enables efforts to clear these technological hurdles. It uses the same lab equipment and provides cumulating knowledge, techniques and an oversupply of embryos needed to advance genetic engineering and cloning. IVF is to genetic engineering and cloning what nuclear power plants are to nuclear weapons proliferation.
Reprotech’s effects on the aforementioned commentators’ concerns are understated in another, more important way. The same ethic of reproductive control that animates IVF also allows egg and sperm shopping, genetic screening and embryo selection—or its companions, sex-selection or eugenic abortion. One may maintain that the embryo is not a person but one cannot dispute that the embryo at seven days tells us much about the person at 27 years. With its multi-embryo production, IVF already enables parents to select between embryos for numerous lifelong traits, including sex and disability. Despite their backgrounds, sperm and egg shoppers display distinct preferences for gametes from tall, conventionally attractive gamete sellers with much formal education. These choices are clearly intended and they are not futuristic practices, which may never become available; they occur every day.
Thus, even if genetic manipulation or cloning never become possible, the eugenic age is already well underway and is accepted by our consumer-sovereign society. If prospective parents don’t like their unborn’s genes, they can, and often do, end the life. For example, over 90 percent of fetuses diagnosed with Downs Syndrome are aborted. Not in some futuristic hell, but today, we are ending disability through a medically mediated rendering of Jonathan Swift’s “A Modest Proposal,” by purging the disabled.
In a society that increasingly and appropriately declines to execute even serial killers, it seems inconsistent to effectively impose prenatal capital punishment/genocide on the disabled. Consider further the effects of genetic screening on the self-perception of the able-bodied. How does it feel to know you were born because you met the standards of your parents and a quality control inspector? In place of unconditional love, reprotech allows the introduction of discrimination with regard to human dignity based on biological, psychological or educational development, or based on health-related criteria.
Some commentators have suggested that eugenic abortion or embryo selection could be legislatively limited to genes with “life-or-death” diseases. That proposal does not inspire confidence.
First, who can say that a disabled or a relatively brief life—even one with much suffering—is not worth living? As John Paul II stated in Evangelium Vitae (1995), “The courage and serenity with which so many of our brothers and sisters suffering from serious disabilities lead their lives when they are shown acceptance and love bears eloquent witness to what gives authentic value to life, and makes it, even in difficult conditions, something precious for them and for others.”
Most parents will de-select embryos or abort fetuses whose genes suggest they will someday have MS, ALS, breast cancer or Huntington’s. These conditions seldom kill, or even afflict, the young. Besides, as many have observed, the lines between disease and trait or cure and enhancement are quite blurry. What will be the legislative status of embryos that have genes for schizophrenia? Deafness? Depression? Below average intelligence or height? Even limiting either genetic manipulation or embryo selection for seemingly esthetic purposes seems impossible, given society’s and the law’s strong support for reproductive choice. And with reproductive choice as the guiding principle, how will we prohibit parthenogenesis, artificial wombs or chimeras?
The majority of parents allowed to choose between having a fully capable—or perhaps, ultracapable—child, on the one hand, or casting a diffuse vote for an already attenuated democracy on the other, will serve themselves, not the larger group. As genomic knowledge and embryo selection increase, the pressure to have “perfect” kids will only intensify. As the number of people with imperfections decreases, society’s acceptance of, and support groups and services for, the imperfect will shrink. Stanford Law Professor Hank Greely has predicted that, given these competitive pressures, within 50 years, most Americans will be the product of IVF. While allowing for some incorrect predictions in individual cases, genetic screening will cause the social stratification and personal alienation that the commentators fear, even without the genetic manipulation they foresee.
All we have to do to advance this dystopia is more of what is already done: embrace reprotech, screen gametes/embryos and use/implant those with the traits the parents want. Even if we could agree on and proscribe what constituted abuses of these practices, regulation of these micro-scale technologies, which involve high stakes to their demanding consumers and the clinics that compete for their business, and which occur behind closed doors in hundreds of office parks, is impracticable.
Distributive Concerns
On a population-wide basis, American medicine is better at generating revenue than it is at advancing health. Americans spend twice as much per capita on medical care as does any other nation and America ranks twenty seventh in life expectancy, just slightly ahead of Cuba.
Medical insurance funds hundreds of billions of medically unnecessary treatments. We routinely test for conditions that are only remotely possible. One in six adults takes psychoactive drugs, largely because ordinary sadness is now considered a disease. Sports surgeries are performed to enable 40-somethings to continue to run marathons and ski, instead of taking up walking.
IVF fits squarely within this model of providing elective treatments for the affluent, while the poor do without basic goods and services, and medical care, in the United States and, especially, abroad. The typical IVF cycle costs $12,000 and multiple cycles are common. Insurance coverage for IVF is legislatively mandated in 15 of the most populous states. By itself, IVF adds over 5 percent to medical insurance premiums. The insurance cost of IVF grows sharply when the inflated costs of post-natal care for IVF offspring are considered. A recent study concluded that twins cost six times ($105,000) and triplets twenty times ($400,000) more than do single babies. Multiple births have increased six-fold because IVF often involves the implantation of multiple embryos. In a lengthy article in the New York Times Magazine entitled “The Two Minus One Pregnancy” (2012), we learn that multiples are often reduced in number, in utero, by injections of potassium chloride into the hearts of the “excess,” seemingly weaker, fetuses. While the fertility industry gains an increasing share of insurance dollars, public health/environmental protection measures that would benefit all people are seriously underfunded in relation to the threats presented.
In addition to misallocating resources, IVF facilitates human exploitation. Like many commercial processes, it allows child-bearing to be outsourced to low income surrogates in the US and abroad. Instead of mothers producing their own eggs, eggs are harvested from well-pedigreed college students, who risk their health and deplete a significant part of their egg supply, which may endanger their own fertility and accelerate menopause and which enables what the progressive commentator Andrew Kimbrell called “technological adultery.”
Reprotech’s Impact on Self-Perception
Apart from creating a genetically privileged class, reprotech already affects the perception of other beings and basic kinship or solidarity. Despite vast demographic, ideological and personality differences, until about thirty years ago, humans shared a common, mysterious origin in the union of a woman and a man. This is no longer universally the case. In its place, reprotech, immensely profitable in a slow growth economy, applies a corporate model, not only in its technical practices, but in its advertising and competition for market share.
Increasingly, as life is manufactured and sold, it becomes less awesome and more like other possessions.
While reprotech is the ultimate reductionist activity—sperm plus egg plus gestation equals human—it cannot be reduced into its component parts; like all things, we must take its benefit and harm as a unitary whole. As children have become products of subjective desires and labs, life has been radically altered in ways unreported by the TV news. Relativism and utilitarianism have taken firm hold. God has been removed from most discourse. Churches of all denominations are nearly empty. Marriage is postponed and eschewed and is increasingly separated from childbearing and raising; more adults live alone and more children live with one parent than ever. A hook-up culture has supplanted the mutual affection and acceptance of courtship.
The perception and treatment of children have also changed: instead of being born in the fullness of time, many are prenatally frozen or their births are scheduled, they are formula-fed, placed in day care, over-managed and overscheduled. Social scientists report numerous indicia of sharply diminishing social cohesion since the 1970s. Have contraception, abortion and reprotech singlehandedly caused each of these changes? No, but they fit squarely within a cultural context that makes everything, even human life, bend to individual sovereignty, engineering principles and ultimately, commerce. As Waclav Havel wrote, “The tragedy of modern man is not that he knows less and less about the meaning of his life but that it bothers him less and less.”
Fundamentally, reprotech places the interests of the individual above those of the community. Using it is like building one’s home on the beach at Normandy or in Yosemite Valley. It pleases the consumer and their family and friends. But it costs the culture something more precious and universal, namely the notion of the sacred and the continuation of a society where genetic advantage cannot be purchased. Reprotech has generated many offspring. But with its effects on human perception and community, reprotech users should not expect the emerging world to resemble the one their parents grew up in, or be much of a place to raise children.