In Vitro Fertilization Poses Risks to the Unborn Child
Setting priorities: the desire of adults or the good of the children
A study has recently been published by American researchers of the National Center on Birth Defects and Developmental Disabilities which reopens the ethical debate on topics concerning in vitro fertilization.
The discussion has been limited to the topic of the moral legitimacy of extracorporeal fertilization and the elimination of supernumerary or diseased embryos. The study (Human Reproduction, November 2008), in fact reports that babies born through in vitro fertlization (IVF) have a higher risk of malformations than other babies.
The problem was raised in L'Express by Claire Brisset, the ombudsperson for children of the French Republic, in its 16 January 2003 issue: "Regarding ICSI [intracytoplasmic sperm injection] it is absolutely neccessary to proceed with a retrospective evaluation of this technique of whose effects we know nothing.
"Do we have the right to risk conceiving children who risk being hypo-fertile without having pondered what this means? The technique is effective. People are happy. This situation will be short-lived. I hope for a moratorium until we have acquired sufficient information".
And Didier Sicard, President of the French National Bioethics Committee, echoed her words: "Today the desire of adults is held as sacred. Certain fertilization techniques pose risks to the children who will be born". Hence the principle of caution is also to be hoped for in the context of procreation.
Scientific literature had in fact begun to reveal data on child health; and the data began to interest the scientific community and to give rise to a certain anxiety, to the extent that Kendall Powell published an article in Nature Magazine, 17 April 2003, significantly entitled "Seeds of doubt".
In it she concluded: "Given the existing preoccupations and potential for further unpleasant surprises, some researchers are requesting funds for projects to investigate the biology of fertilization and implantation, for studies on the effects of manipulation of oocytes and embryos and for broader and better epidemiological studies" (cf. ibid.).
Since then there has been one study after another. Some show that on average the neurological development of babies will have suffered no side effects, and a recent review published by the Lancet (July 2007) says that "children born through IVF at full term and healthy will experience a development similar to that of others".
But the Lancet reports also that in the case of IVF "the major risk depends on multiple births. The risk of miscarriage is 20-30 percent greater than that among the general population. The risk of diseases caused by an altered number of chromosomes is greater, just as the risk of premature births is double in comparison with the normal population. And the risk of fetal growth delay is also increased. The risk of major malformations is 1.3 times that of the general population", and there is "also a greater risk of cerebral paralysis".
Other reviews also present data similar to Lancet's, such as Nancy Green's in Pediatrics in 2004, or Jane Halliday's in Best Practice and Research Clinical Obstetrics and Gynaecology in 2008.
In fact, the percentages of children with malformations in the general population (four percent of those born), or cerebral paralysis (two percent) are relatively low and their increase by 1.3 times — just as that of malformations — is far from sensational. Yet it cannot be disregarded, as the above-mentioned reviews emphasize.
It is precisely this fact that brings into the debate the principle of caution, which calls for the need to study prospects, for an improvement of procedures and for an attentive analysis of the course undertaken up to this point. This is also suggested, for example, by Parens and Knowles in the non-medical bioethical review Hastings Center Report as well as in the report by the American President's Council on Bioethics, Reproduction and Responsibility.
What we have reported introduces a central figure into the ethical and reproductive debate, who has perhaps been given little consideration so far: the child, with the great or small risks to which he is subjected and which his parents accept for him.
In considering the risks that IVF poses for children, Parens and Knowles explain that "future parents must balance their desire to create a child with their desire to protect him from foreseeable risks", a topic on which the Los Angeles Times focused last 11 August in an article entitled "Babies, the easy way?".
This opens the door to a serious reflection on the rights of the unborn child and on the protection that he needs from the possible difficulties resulting from IVF, including also the absence ex lege of a parent in the case of heterological insemination, or the possibility of sterility inherited as a consequence of the parents' sterility, even to the point of the parents' decision to conceive not a 'healthy' child but rather one with some anomaly that such parents suppose desirable. (See the case of the deaf mother who desired to conceive a deaf child by the use of sperm from a donor who was also deaf; Journal of Medical Ethics, October 2002).
A reflection on the ethics of accepting risks on behalf of the child in order to gratify one's own personal desire then becomes imperative. This reflection is already being made since an impelling demand for deeper knowledge and prudence in meddling with the heart of human life is now spreading in the world, as has been shown by a poll taken by the British institution Human Fertilisation and Embryology Authority. It reported in November 2005 that while 85 percent of people view IVF as an important scientific advancement, only 50 percent consider its advantages to compensate for its risks.
This reflection restores the child to the centre of the ethical discussion, no longer as a "right" (no person is the right of another), but rather as a personal subject who needs protection and to be treated with caution, even as concerns the act of his conception.
And perhaps it is precisely in a deepening interest in the child that a point of departure for a calm debate over the ethics of human fertilization can be found.
Weekly Edition in English
21 January 2009, page 12
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