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There is a great deal of controversy about whether caregivers--from physicians to mental health clinicians-- have an obligation to act as gatekeepers for unborn children. Procreative libertarians argue that the role of providers is to offer the technology if it is medically appropriate, rather than to make judgements about who deserves to become a parent or about how children should be created. This group of caregivers believes steadfastly in patient autonomy,in each person's right to chose whether and how to procreate. Others feel strongly that when individuals/couples ask for assistance in procreating, caregivers then have an obligation to protect the interests of children (even if they are not yet born or conceived). They argue that not to do so would be abdicating their responsibility and could even be a violation of beneficence (assuring good and avoiding harm) if the caregiver sincerely believes that harm may be done.
Another ethical question arises from the ability to separate genetic from gestational from rearing parenthood: Is it is moral to create children from donor gametes when there are already children in the world who have been born and who need homes? Elizabeth Bartholet, an attorney, adoptive mother, and author of Family Bonds : Adoption and the Politics of Parenting (Houghton Mifflin, 1993) is critical of the new reproductive technologies. She believes that ART clinics intentionally attempt to convince couples that reproduction in one form of another is inherently better than adoption and that families created from genetic ties (or partial genetic ties) are stronger and more desirable than those created by adoption. Bartholet argues that what she sees as objective counseling would surely steer more infertile couples away from technological means of reproduction to adoption. In fact many infertile couples do struggle with this issue. Longing for a gestational and/ or genetic (or partial genetic) connection to their offspring, yet aware that too many children in the world need good homes, many prospective parents wonder if this longing to reproduce should take precedence over the right of existing children to have loving homes.
As we will see in Chapter 7 ("Surrogacy"), the ability to separate genetic from gestational motherhood means that offspring can be born (and have been born) to women old enough to be grandmothers and greatgrandmothers and who are likely to die before their children reach adulthood. The use of anonymous sperm or egg donation means that children may have several half siblings that they do not know. Furthermore, the separation of genetic and gestational motherhood may mean that a couple who have donated frozen embryos has several biogenetic children who are being raised by different families, and who know nothing about each other's existence. These are but some of the ethical and psycho-social dilemmas brought about by the new reproductive technologies--dilemmas that couples face as they consider their parenting and treatment options.
© Ellen Sarasohn Glazer, LICSW
Susan Lewis Cooper
