Had some interesting issues to toss around in my genetics class this week dealing with some of the more creative ways that people are going about making babies nowadays. First up on the chopping block was the question of whether or not it’s ethical for the widow of a soldier who has fallen in combat to use a sperm bank to have the baby that she always wanted to have with her husband, but never got a chance to. Sperm banks are, apparently, completely unregulated. “Successful” births don’t necessarily mean that the baby survived. Further complication: is the child eligible for benefits if the widow chooses to have a child with her, well, for lack of a better description, dead husband? We’ll assume for the moment that the necessary deposit was made for postmortem family planning ahead of time. A similar case did actually go before the Massachusetts Superior Court in 1995, and the SSA’s original refusal to provide benefits to the wife was reversed by the courts.
Against all of my instinctive objections to bringing new life into the world and then relying on federal aid to support that child, I’m going to have to say that I side with the rights of the widow on this one. It’s a responsible decision to wait until the family unit is stable to have kids, and without that “security measure”, I’m concerned that young couples might (read: do) choose to conceive right before deployment (or while home on leave), when the time really isn’t right for it. Best to wait until after the hoped for safe return of the spouse, and plan the pregnancy afterwards. I do think that it’s reasonable to demand significantly higher insurance premiums from the would-be parents who take advantage of this technology, though. Compared with the costs of raising a child, the increase in premiums would be small… but it would help pay into the system if their children did come up with birth defects. Microarray analysis on the children could be performed at the parent’s will, to see if they might qualify for a reduction in premiums after the child is born. There would have to be a rider on this stating that the insurance companies would not be allowed to raise the rates if this test turned up with issues tied to the process, though.
Some other bioethical issues tied to sperm banks and various means of tweaking the process of conception brought up were whether or not sperm would be used for monetary gain. Interesting issue….
Let’s say I’m Murphy Brown, and I want to have a child who has a solid genetic background, but I haven’t been able to find a donor who I feel is capable of providing that. Is it necessarily wrong for me to pay extra for gametes from a Nobel Laureate? I don’t think so. Smart kids rock, and raising them is fun.
And the final issue that we covered was ICSI (intracytoplasmic sperm injection), which is used in situations where the father would like to pass on his gametes, but take a pass on giving the baby AIDS. (It’s also a way for couples who are fighting low sperm counts to cheat the system, because it bypasses the gauntlet course the boys typically have to run through.) I’ll leave out all the fun details about disruption of the meiotic spindle and nondisjunction (in English: risk of Down’s Syndrome and other bad things that happen when chromosomes don’t act the way they should) and simply say that the risk of birth defects with this technology is surprisingly just about the same as the risk of birth defects in a normal conception– with one exception. Microdeletion on the Y chromosome (a problem for about 10% of infertile males) can cause male children to turn up infertile later in life.
I realize that infertility is devastating to people who really want to have a child, but it’s something that occurs naturally as well. Given the choice of having a baby with AIDS or a baby that can’t have babies when he grows up, I’m thinking that the choice is remarkably simple. It’s also possible that the child could wind up having no problems whatsoever. Another solution (and one that genetic counselors actually recommend) is to go for the sperm that carry the X instead of the Y. Two wrongs don’t make a right, but two X’s are better than one X and a potentially faulty Y.
In any case, we can predict, but we can’t guarantee. Life is annoying like that. I really don’t have a problem with this technology being used, and I think that the lessons we learn from studying it far outweigh the risks that parents take in using it. I would, of course, prefer that they choose to adopt– but if they insist on doing it the “old fashioned way”, I’m willing to support them. <Insert standard disclaimer about increased cost of health insurance and mandatory microarray analysis at birth in order to secure a reduction in the premium here.>
I guess a final note that I would add is that parents who choose to use fertility treatments shouldn’t foreclose on this option. There are plenty of ways to be important in the life of a child that don’t involve actually having children of your own. I wish that our species as a whole would start looking at this as a possible solution to some of the more pressing problems in our global community instead of assuming that the “right” to be a parent is something that everyone should want to exercise.
I wouldn’t change my mind about my decision to have my daughter if I went back in time and had it to do over again, but I’m certain that there are people on this planet who had children thinking that this was the road to happiness, and found that it wasn’t. This, to me, is a profound tragedy, and it’s one that our society as a whole doesn’t deal with all that well.