A Child by IVF vs Adoption:: Ethical Defining of "Want" vs "Need"
The issue is simply or perhaps not so simply the addition of a member to the family where there is an infertility problem of the couple. Should the couple "want their own kid", a child of their own genetic background, to carry on the family's genes by attempting an expensive and with some risk the invitro fertilization (IVF) and implantation of the embryo into the mother? Or would it be less expensive and more ethical in a societal sense to adopt a child who needs parents and a home? What is the ethical difference between need and want?
Physician-ethicist Erich Loewy wrote a response about "need" and "want" to a bioethics listserv dealing with this issue about the "wants" of infertile couples. He has given me permission to reproduce his comments here.
"Want their own kids" or want their own anything is the disease we in
Capitalist societies have, the "I need" is equated with I want. I
need food, water, shelter, the opportunity to get educated (no
comment please---I know it is too late!!) and to have health care. I
want is substantially different. I want to see the Great Chinese Wall
but if I don't, so what. I (actually) wanted to become a conductor
but lack perfect pitch which a first rate conductor needs. So, I
changed my want to something else. If I am terribly thirsty I need
water (same for hunger--and I do not mean appetite) and if I do not
get it I will die.
Having your own child may be a want but it surely is not a need. We
have (and I will not cite statistics once again) myriads of children
that need a home. Yes---they need it because there is more to a
child's surviving than what I have called "first order needs" (see
above). The problem is that many children who are homeless in today's
splendid Capitalist society happen to be Afro-American and (horor of
horrors!, I should have a Black, Jewish or Hispanic child!!!). So
instead of the needy glut we spend perhaps billions to artifically
satisfy somebodies want and let the need of others slide. Further,
this society is as full of racism (although the fraud of PC covers it
with a veneer of probity) as Austria, Germany and, yes, the US had of
anti-Semitism after the first war and, alas has today but again
hidden by a veneer of PC.
If a person is sterile (and I remember several classmates who would
have liked to be!!) that is unfortunate. If I lack perfect
pitch--that is unfortunate. Engelhardt woud claim that if I am ill,
that is unfortunate or unlucky. It however puts no obligation on
anyone to help me. But you see that is an entirely different one. My
"wanting" medical care is not a want---it is a need and it is
therefore that a decent society would provide single tiered
(everybody gets the same and no one can buy more of those things that
are "wants"---private rooms, TV in the room, nicer curtains, etc.
which do not affect outcome, However, the same physicians, staffing
with nurses, diagnostic or therapeutic means, waiting time, etc which
do affect outcome.
Being unable to have my own child is no more a "need" than is my
having perfect pitch is. It seems perverse to me that a society and a
world which already have more than it can take care of (or is willing
to take of!!!) goes out and with great effort and the use of many
resources tries to make more of what we already have but neglect severely.
Erich
Dr Erich H. Loewy
Professor of Medicine and Founding Chair of Bioethics (emeritus)
Associate in Philosophy
University of California, Davis
E-mail: ehloewy@ucdavis.edu
How do you look at this "want" vs "need" decision of infertile couples? ..Maurice.
posted by Maurice Bernstein, M.D. @ 7:01:00 PM
12 comments
12 Comments:
It is an interesting thought. The money and useage of healthcare, and taxation on the mother's body as opposed to a child that alreay exists.
In a way I think it is wrong to do that (use extensive reproductive tech) but certainly creting a regulation agaist that is hard (and also unethical) I find it interesting that the EU does not allow surogogacy and many from the EU come to the US to get women to make babies for them. The EU also has a regulation that only 1 egg/sperm combo is put in a mom at a time (as opposed to 8 or more...see Octomom)
Dr. Bernstein,
I have no problem with couples seeking IVF or other infertility services as long as they bear the cost burden and it is not passed on to everyone else. Just like any other elective care such as cosmetic surgery (breast implants, face lifts, etc.), if they are able to bear the financial burden and willing to take the risks involved. The fact is, the vast majority of health insurance programs do not cover infertility services.
Not all infertility treatment requires expensive procedures such as IVF. Simple, relatively inexpensive drugs such as Clomid are effective in a significant percentage of infertility cases.
Dr. Loewy is certainly entitled to his opinion, but I can't help but feel that his efforts would be better served addressing the source of the problem he describes rather than suggesting that couples be deprived of infertility services as a possible treatment of the symptom.
Hexanchus, I know Dr. Loewy's philosophy for years and it has always been directed to ethicists and those who can change the social system to meet the needs of the great numbers of those in this world who have real needs (food, clothing, shelter, health...)which are not currently being met. I look at his selecting the couple going for IVF rather than adoption as just one example of the wrong way of correcting the social problem. The "source of the problem" is multifactoral and when those who could have the alternative to parenthood by adoption and who don't represent one such factor.
It would be better for him to defend his position here than me. I hope he takes me up on the request. ..Maurice.
I totally agree re the difference between wanting and needing. Having worked in the field of adoption reform for more than 30 years as a peer support group leader, researcher and writer focusing on issues of mothers' rights and family preservation... I can tell you that there is no more vocal group demanding their alleged "right" to parent a child than infertiles. You do not hear amputees or those on kidney dialysis screaming nearly as loudly about their loss and how much they "deserve" to have a replacement as you do among infertiles.
Where I disagree (I think) is in the differentiation between those who want a biologically connected child and those willing to adopt. The fact of the matter is that the vast majority of those dealing with this issue start out wanting a child that is genetically connected to at least one of the couple. Their journey from there depends on the size of their pocketbook, and some other factors like their ages.
For the vast majority, however, adoption is a last resort, yet they loudly proclaim a "right" to that as well...a "right" to another's child!
Infertility is a medical problem and needs to be addressed in terms of education and prevention - since a great deal of it is preventable. Like all other medical issues, there is not a social "remedy" and no one "owes" anyone a child any more than the blind "deserve" or are "owed" eyes.
Please read a recent blog post of mine:
http://familypreservation.blogspot.com/
2009/09/there-is-no-right-to-adopt.html
(copy and paste the ENTIRE url)
Mirah Riben, author
The Stork Market: America's Multi-BIllion Dollar Unregulated Adoption Industry
PS It is interesting to note as well that our culture dictates who is and who is not "deserving" to be a mother based on age, marital and financial status.
If you are "too young" or "too poor" your wanting of a child - your OWN child - is judged as SELFISH!
Yet, older more affluent - even single women - are altruistic for wanting another's child.
Why should only infertile couples adopt? Does this Dr have any of his own biological children? Why didn't he adopt if he feels so strongly about it? Ignorant ( and fertile) people always assume that adopting is an easy option. I live in Australia and adoption is virtually impossible. It can take years and years before a child is adopted out to a couple. Also there are barely any Australian babies available for adoption so prospective parents must look to overseas adoption ( which also takes years). Now there is another ethical dilemma. Many believe that babies should not be taken away from their country and culture. What if a same sex couple want a child? Here they are also excluded from adopting. Why is it unethical for a well off western couple to do IVF, yet it is OK for a couple from a poor 3rd world country to have many children that they cannot take care of?
NP
My husband and I started trying to conceive as soon as we were financially stable. I was 30 and should have had no problems. Well, many years, and over $100,000 later, we had two failed adoptions and several failed IVF under our belt (birth mothers changed their minds after birth, and after we'd put significant emotional energy and financial resources into it - IVF led only to miscarriages, and I've now had six). I can tell you almost universally what couples want who are seeking parenthood (and singles too) is simply a child to love. Adoption however can be fraught with heartache and difficulty (for adoptive parents AND kids) and most of these situations are "open" now with birth families in and out of the children's life. We have several adopted kids in our extended family and they are loved and cherished probably more than any others in our family b/c it was so difficult to bring them into the family. But not every story is happy, and in fact my nephew has severe learning disabilities and behavioral issues due to drug exposure in utero. Still, having heard many horror stories, we tried to adopt. It's just not that easy, though. In the end we conceived twins using donor eggs AND donor sperm. Genetics are not important to us - we only wanted a child to love and didn't care how he/she came to us.
On another track, how many children have you adopted, sir? I fail to see how one's medical problem (infertility) obligates an individual to be the nursemaid to others' offspring, who are often the result of careless sex. If a medical procedure can fix a medical problem, why should we not avail ourselves of that? I think you should put more energy into promoting safe sex practices so that others are not producing children for whom they can not or will not care.
I do not have children by choice but feel that someone who is willing to undergo fertility treatment is deeply committed to having and raising a child. If they have the means to afford the technology available today it is their right and choice. There is nothing unethical about not wanting to take on an issue they feel they are not able to take on. In many cases the children available for adoption had a birth mother who cared so little about them, but selfishly preferred her drugs, alcohol or abusive partner instead of committing her life to the care and safety of the baby. Perhaps it would be more ethical to prevent those who should not have children in the first place.
EEN
EEN, I am curious, how would you suggest to prevent those who you find "who should not have children in the first place" from bearing children? Would you also include those women who live in 3rd world countries and environment whose resources are so poor that any children born would be handicapped or die because of the life there?
Would the prevention include mandatory tubal ligation or contraceptives or abortion. None of these would be acceptable in some religions or by certain groups in society. You made a worthy challenge to a situation but what would be the logistics? ..Maurice.
If you were told that the doctor in the emergency room could amputate your broken leg cheaply, or operate on it and save it (expensively), what would you do? Do you really NEED your leg? Many people have very productive, satisfying lives with just one leg. How can you justify the use of resources for something you don't really need?
I think many couples experiencing infertility feel that having children is at least as important to their sense of happiness and well-being as having two healthy legs is. Until you've know the pain infertility can cause, please refrain from platitudes like "why not *just* adopt?"
L.R.
I am a single mother to an infant daughter I conceived (after five years of infertility treatments) using donor eggs and donor sperm. During this journey I heard many people ask "Why not just adopt?" The word "just" is quite curious in this context, because, as anyone who has tried to adopt can tell you, it is *not* easy and it is *not* cheap! The short answer to the question, in my case, is that it was much cheaper to pursue fertility treatments (at an overseas fertility clinic that was less expensive than in the U.S.), than it would have been to adopt (foreign, and even domestic, adoptions can cost upwards of $30,000...I could do an IVF cycle for one-third of that price). Many people I know who've tried to adopt have had difficulties and disruptions (such as a birth monther changing her mind), or unforseen problems with the adoptive child (such as severe attachment disorder, or learning disabilities from alcohol or drug abuse in the birth mother). I preferred not to take that risk, but to try to have a healthy pregnancy where I could control the uterine environment.
So, two reasons, neither of which is "unethical"-- I couldn't afford to adopt, AND I wanted to insure, to the best of my ability, that I would have a healthy child.
Finally, why is it that people who apparently think so highly of adoption, aren't willing to adopt themselves? I have no idea if this doctor has done so, but unless he's willing to do it himself, he has no business pushing this very personal decision upon others. If one is truly concerned about over-population and the well-being of unwanted children in the world, then one should adopt whether or not one is fertile. Nothing is forcing fertile couples to have their "own" biological child; to do so is just as much a "want" (rather than a "need") as in the example of the infertile couple. In my opinion (and experience) every person who chooses to become a parent does so for "selfish" reasons, to some extent--ie, one wants to experience the joy, delight, and love that comes from sharing life with a child. One also is responding to a deep internal "need"; a strong desire which compels them to seek parenthood even at great cost and personal sacrific. Some women feel a strong desire to experience pregnancy and the process of giving birth...another reason many many choose to pursue fertility treatments rather than adopt. Whether defined as "need" or "want", the point is, the desire is there. To quibble over the definition is irrelevant; some women and couples (whether fertile or infertile) will choose to have that experience rather than pursue the adoption alternative. It is both judgmental and naive to expect them to behave any differently (and they certainly won't be apt to change their minds just because someone with an "ethics" degree scolds them for their choice!).
B.A.
It is a somewhat sad, yet true fact that it seems to be more costly and time consuming to pursue adoption vice fertility treatements. I am unexpectedly facing fertility difficulties in my marriage due to scar tissue that my husband developed following surgery to remove benign cysts. I had always thought of adoption as a possibility in our lives (in addition to biological children). Facing infertility, we researched adoption sooner than anticipated, and were suprised at how time consuming and costly it actually is. And it does seem that it is those who are blessed with fertility that are the ones to question us about seeking adoption as an alternative.
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