IFV and Bio-ethics

In today's Slate, Liza Mundy discusses a new NBC drama that centers around a clinic that offers in vitro fertilization, and contrasts it to IFV in the real-world:

"NBC's decision to set an overdetermined, soap-operatic, pretty seamy, never-quite-funny drama in a fertility clinic is itself a barometer of the national mood on the subject. Just as the network gay shows signaled the arrival of the cultural moment when everybody either knew a gay person, knew someone who was related to a gay person, or was gay, so now we seem to have arrived at a point where every adult has either undergone fertility treatment or has a friend who has."

If the mere existence of the show reflects a prevalence of the procedure in our society, how does what happens on the show compare to what happens in real life?:

"The scenarios were often far-fetched, and there was lots of fudging with science and with normal lab procedure. Still, what rang true was the sight of clinic staffers deciding, on their own, whether to accede to the desires of, for example, a soldier who wants to conceive a child using eggs frozen by his soldier-wife before she shipped out to, and died in, Iraq. What rang true were decisions quietly made based on bottom-line profit-making; fear of lawsuits; the desire for publicity; scientific principles; committed medical professionalism; fundamental decency; what's known in science as the "yuck" factor; and real delight in giving somebody a baby."

Further down:

"And yet, I kept asking myself, are these scenarios really so far-fetched? The series was created by two gay men who themselves have families with the help of surrogates, which makes it odd that among the most unappealing characters is a gay man who spies on his surrogate to make sure she doesn't eat pork rinds or drink alcohol. But it's true: People who hire surrogates can overstress about fast-food habits. I once watched a roomful of real and potential gay fathers debate how fat is too fat in a surrogate. And many real-life scenarios are every bit as melodramatic as those the creators have come up with here. I once spent the day with a clinic psychologist who had received a request from a bereaved mother who wanted to use her dead son's frozen sperm, and a surrogate, to create an IVF grandchild. The psychologist had herself lost a parent young, and had a horror of "creating orphans," as she put it. So her clinic said no to cryo-grandma, even though a competing clinic had already agreed to take her on. One counselor mentioned that a patient on her egg-donor waiting list had been waiting a while because she specifically wanted a donor who was blonde and good-looking, better-looking, in fact, than she was. Other doctors regularly struggle with whether to help patients who are really sick: women with autoimmune diseases, for example, or who are dangerously diabetic, whose bodies may be endangered by pregnancy. Another doctor I interviewed was approached by an infertile man who, wanting a baby as close to "his," genetically, as possible, asked to use his own father as sperm donor. Since there is no rule book here, the doctor called her father, a minister, to ask him what God would think of this. Her father told her he thought that God would think it was OK. Technically, it was something close to incest. The family, according to the doctor, is incredibly happy."

I guess I'm hopelessly naive about this sort of thing, but I didn't know that some of these things were going on. Clearly people looking for a surrogate will judge that person, rightly or wrongly, on completely superficial factors that have little to do with the potential genetic health of the child. But a clinic that will create a grandchild from a dead son's frozen sperm? A man who uses his own father as a sperm donor? How is this isn't regulated?:

"In the United States, we do not have much in the way of public discussions of reproductive technology, in part because we do not seriously regulate it. For better and worse, in England and much of Europe there are laws and/or bureaucrats determining which procedures can be offered and to whom. The decisions that get handed down invariably lead to public disputes, which lead to ongoing, anguished attempts to hammer out a collective moral consensus. Here—where the U.S. Centers for Disease Control and Prevention does little more than track patient loads and outcome rates for clinics that choose to be monitored—moral "consensus" often means doctors sitting around a table, or e-mailing bioethicists, or deciding on their own. Rarely do these discussions bubble over into the public."

To me, this is astonishing. Has our technology raced so far ahead of our moral ability to understand the consequences of it's use that we can't even effectively regulate it? How is it that no one talks about this issue, that no one wonders if these sorts of things should even be possible?

My concerns over this relate back to the similar concerns I've expressed before on genetic experimentation on animals, and the creation of human-animal hybrids. Except that it appears that we are more willing to regulate such experiments much more carefully then we're willing to regulate IFV. Such laxness on our part makes it seem as if we're unwilling to accept animals that might or might not be partly human, and yet are willing to accept children brought into the world parent-less.

Clearly it's difficult to balance the interests and desires of those who wish to have children with the lives of those children themselves. In general my moral standard is pretty flexible; as long as you don't hurt anyone else, you can do pretty much anything you want. But this sort of thing runs afoul of even my liberal sensibilities. Yes I respect the right of parents to have children when and how they see fit, but we impose by law upon those parents one obligation and burden after another as to the absolute minimum standard by which they can bring their children up in the world. Yet we can't bring ourselves to regulate how those children come into the world? I know this isn't an easy issue to address, because there are many real-life situations that we allow now that parallel scenarios brought about by IFV that we might have trouble with. But we have to start somewhere.

It's long past time for a national debate on this subject, on both sides of the fence, liberal and conservative. I'm open to ideas about where to go from there.