Ethics of the Donation and Reproductive Use of Frozen Embryos
I received today in the snailmail Volume 1 Number 1 issue of the "Embryo Connection", a publication of the National Embryo Donation Center which received a 2 year federal grant from the United States Dept. of Health and Human Services "to provide an evidence-based asssessment of embryo donation and adoption." The results of their beginning data base can be found at their website:
http://embryoconnection.org
To my recollection, I don't think we have previously discussed on this blog the ethical issues involved in the utilization of the frozen excess embryos of IVF through the donation by one couple to be nurtured thru pregnancy to birth by another couple and the resultant child parented by that second couple. (IVF,In Vitro Fertilization is, as you may know, the fertilization of the eggs by the sperm of a couple and allowing for an embryonic forms to develop some of them may be implanted into the uterus of a woman for development and birth or the excess embryos stored in a frozen state for later use or to be discarded.)
Some of the ethical and legal issues I see are:
Are the frozen embryo use analogous to organ donations by a living or deceased donor to the benefit of the recipient?
Beyond the donor couple giving permission to use the embryo, should there be monitary compensation for that use?
Should the donor couple have any say in the final outcome of the child after birth, such as the recipient couple deciding later to give the child up for adoption?
How much medical and genetic information should the receiving couple obtain about the donor couple before decision for embryo use?
Should both couples share experience with the born child?
When the child is born to the second couple, who is the legal mother? Is legal adoption of the child necessary?
Does the recipient couple have the responsibiltiy to inform the child, at some age, that the child was originally a frozen embryo created by IVF by another couple?
Is preserving excess embryos for later implantation and birth really the right thing to do in a world with increasing population and poverty, hunger and poor health care for some thoughout the world including the United States?
Any more that I missed? And what do you think the answers should be regarding the ones I thought of above? ..Maurice.
posted by Maurice Bernstein, M.D. @ 9:30:00 PM
7 comments
7 Comments:
I found your blog through google alerts.
My husband and I are soon-to-be adoptive parents through Embryo Adoption with the Pioneers of so called "Embryo Adoption"
So perhaps I am not the most neutral person to join your discussion but would like to none the less.
Because the Embryo is its own unique being, I liken it more like adoption and less like an organ donation. On the other hand, third party reproduction using a donor gamete and some of our own would be more analogous to an organ donation because at that point, the gamete has no existential autonomy.
Embryo Donation and Adoption was created to provide a life-honoring way to deal with "extra" embryos. As there is no cost to the donor parents to place their embryos through a program like Nightlight, and as it is unlikely that they "created" extra embryos in the first place for the sole purpose of donating them, I think financial compensation is unnecessary. No other alternative use for the embryos provides compensation so there is not even the need to "compete" with incentives offered by alternative solutions. Once the match takes place, the adoptive couple assumes transport and storage costs so there are no additional fees assessed to the donor couple.
Any amount of "say" that genetic parents have post-birth is determined contractually before the FET ever takes place. This varies from couple to couple. I know of one placing family who is specifying that the recipient couple store the cord blood, and another who dictated that an infant baptism be administered shortly after the child's birth. So long as both parties enter in to the arrangement willingly and such arrangements do not harm the well being of the child, I don't think there is a moral absolute on which arrangements should be determined.
I want to answer the rest of your questions but I have to run now--I'll be back! Thanks for a great discussion. I look forward to reading prior entries.
The issues you raise on embryo donation and adoption are certainly on point. Not everyone will come to the same conclusion. For those who accept the fact that life begins at conception (the issue being when is it deserving of protection) embryos are preborn human beings at the earliest point of development. So in this light, they are not the same as organ donation. There is s difference between living tissue and life.
Our Snowflakes program was the first to develop a plan to treat the transfer of embryos from a donor family to a receiving family in a manner analogous to an adoption. The law does not require a legal adoption, but does require a clear written document evidencing the intent of the parties, including the intent of the donor family forever relinquish their rights to the embryos. There has been 166 babies born in the Snowflake program and, of course, many more through the National Embryo Donation Center and clinic donor programs.
The key to treating the process like an adoption is to learn from adoption and be better prepared to discuss their "story" with the resulting children -- who I believe should be told of their beginnings. Many of the Snowflake adoptions are "open adoptions" where the families commuicate regularly, but do not co-parent.
The issue of favoring embryos over children in orphanages or living in poverty with their families in poor countries is not a question or either/or. We need to offer the embryos a chance at life AND reach out to orphaned children and provide humanitarian aid to the poor. Not everyone is called to the same mission -- but there is certainly enough to be done to keep us all busy.
Thank you for highlighting this subject -- more people need to know what their choices are.
Ron Stoddart, Exec. Director, Nightlight Christian Adoptions (Snowflakes Program)
Oops--it looks like you edited my post and it resulted in a tag being left open-my apologies for all the underlining.
Mr. Stoddart said a lot of what I wanted to say.
I think a key mental distinction is acknowledging that Embryo Adoption/Donation is not primarily a "fertility treatment." Because there is another person involved, with full rights to life and personhood, one cannot act in a vacuum.
A lot of the rest of the questions you ask can be answered by answering the question "What is best for the child that will result from this?"
Because Nightlight and other organizations like it are committed to the welfare of all children in need (they facilitate traditional adoptions too), they require hefty screening and education of prospective parents, as well I think they should. I think any future ED/EA Programs that develop should follow this framework.
Studies have shown that in a large majority of cases, children who know their whole history, rather than just a part of it, generally are better off. Obviously there are cases for exception, but in occasion of normal, stable, healthy adults, I cannot believe that closing a chapter of a child's story for him or her is ideal.
I think that conviction by design answers a lot of your questions. Where possible, the child can only benefit by having knowledge of or access to information about medical history.
It absolutely should be disclosed to the child that he or she is adopted, with the revelation of the special nature of Snowflake (Embryo) Adoption.
So long as the relationships are clearly defined and not confusing to the child, I think that it cannot be a bad thing that more adults than less love and be invested in a child. On the other hand, clear boundaries of who the parents (in this case, the adoptive parents) are is also necessary for the child to develop clear understandings of authority and relationship. I do not advocate "co-parenting" and I think you'd find few open adoption proponents who do. But there is a large cavity between co-parenting and completely anonymous adoption and where everyone falls in between those two extremes I think will vary based on the temperaments of the adults and child involved.
To answer your question about poverty, hunger and excess population, it's important to realize that Embryo Adoption does not advocate that Embryos are more worth saving than children already born. Each family is equipped and impassioned differently. The problem is not an excess of Embryos. That would imply that the elimination of all such embryos would immediately produce solutions to the above-mentioned world afflictions. The problem is an an epidemic of apathy and self-indulgence on the part of adults in a self-serving, post-modern culture.
One way I think to treat this is to stop framing the discussion of adoption (of any kind) within the framework of infertility. If stable, healthy adults world wide asked the question "Can I help?" rather than placing it on the shoulders of the infertile, eg "Why don't you just adopt?" I think the world would look very different. One could follow your logic and argue that most people should avoid biological procreation but instead adopt children already in need. But I digress...
While poverty, hunger, and poor health care are tragedies, it would be depraved to compound such tragedies with a sort of clinical infanticide that would result from the removal of a life-honoring alternative for excess embryos. If one acknowledges that these embryos are life (and science and biology say they are), or at least potential-life, then it follows that any alternative except offering them the chance to grow to adulthood would increase tragedy, not decrease it.
"Any more that I missed?"
How about issues for the 3rd parent. How about the n-th parent?
Currently some DNA is taken by the embryo from the carrying mother if the egg is donated from another source thus technically making 3 parents. The amount is small in this case. In the future however with gene splicing and other biotech engineering there could be multiple parents so the questions you ask are only the tip of the iceberg.
----
(seperate point)
I think for health history reasons children should be allowed access to the donor's health history provided the donor allowed an avenue for the adoptive parents to take.
The more health information a "buyer" of such services can obtain ahead of the game will make things easier down the line. Fortunately there are those who have donated eggs in the past and have made attempts to tell the parents when they discovered that they have gotten early breast cancer or other health issues. In these cases the doner should/could go to the organization that provided the service and inform the family of the donated egg. This way anonymity can still be preserved (if so required) while still passing on valuable health information.
TS
I've posted a notice about this discussion here: http://college-ethics.blogspot.com/2008/04/abas-code-governing-assisted.html
My college Ethics students are looking at this topic from different perspectives, and you've presented it better than than I ever could. Thanks.
Ahhhh.... very interesting questions. Rather than attempt to answer any of them, I'm going to add one (if you will indulge me).
My husband and I endured infertility treatment for years. We finally acheived our goal of a family via donor egg IVF (now 3 year old twins). We were also fortunate enough to have 10 embryos left over to freeze.
My husband died suddenly last year. I know that I have legal custody of the embryos, but do I have the moral or ethical right to use these embryos to bear his child after his death? If it makes any difference we were in the middle of an FET cycle when he died. I cancelled that cycle for obvious reasons.
Any thoughts?
Thanks,
angrycanrn, I would say that it would be ethical, if it is your desire, to have an addition to your family utilizing FET as you have done previously. The ethics probably depends on whether your husband would have wanted you to have more children. Though, I can assume that managing a family has changed since your husbands death, the fact that you both initiated the last FET attempt to enlarge your family, shows that your husband was not against another try. You are the one now who can decide whether you can cope with a larger family. This, I see is the main decision and which ever decision you make would be ethical. ..Maurice.
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