Shopping for Your Kids, Bioethically Speaking

You’re looking for the perfect gift, so you do what my 12-year-old calls ‘some research.’ In the early 21st century, this means you google what you’re looking for, compare prices, read online reviews. You order and pay for it, then wait. Seems harmless enough.

But what if the ‘it’ is a baby? What if you’re desperate to have a child, but you can’t carry one yourself? Or maybe either you or your partner, or neither of you, is able to provide healthy gametes (eggs or sperm).

If (and this is a big if) you have the $100,000 or so needed, you could follow, more or less, the instructions in the first paragraph: go to a Web site that deals in eggs and sperm, contact the brokers therein, pay for the ‘best’ eggs and sperm you can afford from the best sources (‘best’ as determined by things like the jobs and grades of those whose sperm and eggs you are ‘using’), find a fertility clinic, pay the clinic to mix the eggs and sperm and put the resulting fertilized eggs into a surrogate mom (found, for example, at the Center for Surrogate Parenting) whom you are also (usually, but not always) paying. Then wait.

More and more people, some of them with partners, some not, are doing this. Amy and Scott Kehoe did this recently. At first, things seemed to go well: they received their twins (many in vitro pregnancies result in multiple births). But then, the surrogate mom found out Amy Kehoe had a history of mental illness. The surrogate mom argued through the courts that since she didn’t know about the mental illness previously, she and her husband should get the babies back. The surrogate mom now has the twins to raise along with her other children.

An entire course could be taught on the issues this case raises. Just for the tip of the iceberg:

What makes for a family? So much for the whole ‘who begat whom’ thing. Who are the parents here? Even from a biological perspective, this is less than clear. The sperm and the egg came from two people who never met each other or the twins their sperm and egg became. The surrogate mom carried the children; she did at least meet the Kehoes, who ordered/arranged for the children and provided all the finances involved.

Who is fit to be a parent? Remember the old Steve Martin movie Parenthood? One character wonders why you don’t need a license to have kids, since you need one for relatively mundane things like driving. Potential parents who want to have kids the old-fashioned way don’t need to first be screened for psychological problems. Should cases like this be any different? Who defines what mentally ill is, or decides when you’re cured of such illness?

What about the money? There are sperm and egg brokers and contributors, and the for-profit IVF clinics. These are organizations and people with a significant conflict of interest, and little or no outside oversight, giving advice to often-desperate people. Some relevant professional organizations provide guidelines, but virtually no government regulation exists here. How are we sure whose sperm or egg we are actually getting? Minor little things like that bug me.

What are the assumptions regarding biology? For example, there’s the assumption that good sperm and egg come from good people, as defined by how those people look or how much money they are making as adults. But this is weak at best. The genes, of course, hold the capacity, but telling the story of one’s life depends vitally on the environments those genes experience. And this experience includes time right after fertilization, when the new embryo is in a dish, as well as the environment inside and outside the mom later carrying the embryo. If all this is sounding totally Brave New World, consider that there’s an entire closet industry of poor, third-world surrogate moms carrying babies for first-world parent wannabes. The ethical and bio-environmental issues ripple out quickly.

For all these questions, the challenge of who decides how to answer looms large. Right now the system mostly stumbles along until something goes wrong and then trips into the lap of the legal system. Courts though, of course, decide cases based on laws, which often have no direct connection to reality. For example, in the Kehoes’ case, they say the surrogate parents ‘legally stole’ the twins because the courts’ decisions focused on specific state laws about surrogate moms and ignored some of the more substantial issues raised above.

So, should the government intervene? It seems reasonable that the federal government carefully regulate the sperm, egg, and IVF industries. But do we go further and attempt to define what makes a parent? (The same way by many normally keep-government-out-of-our-lives conservatives support legislating what makes a marriage?)

All this modern technology (the internet, creating life in a tube, etc.) still comes back to basic, but profoundly complex questions of what it means to be human, and how to do it best.