Bioethics Discussion Blog: A Child by IVF vs Adoption:: Ethical Defining of "Want" vs "Need"

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Thursday, September 24, 2009

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.

19 Comments:

At Friday, September 25, 2009 4:12:00 AM, Blogger SuSuseriffic said...

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)

 
At Friday, September 25, 2009 8:20:00 AM, Blogger Hexanchus said...

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.

 
At Friday, September 25, 2009 9:16:00 AM, Blogger AdoptAuthor said...

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

 
At Friday, September 25, 2009 9:21:00 AM, Blogger AdoptAuthor said...

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.

 
At Friday, September 25, 2009 3:38:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Monday, October 12, 2009 5:23:00 PM, Anonymous Anonymous said...

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

 
At Monday, October 12, 2009 6:19:00 PM, Anonymous Anonymous said...

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.

 
At Monday, October 12, 2009 7:12:00 PM, Anonymous Anonymous said...

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

 
At Monday, October 12, 2009 9:21:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Monday, October 12, 2009 10:02:00 PM, Anonymous Anonymous said...

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.

 
At Tuesday, October 13, 2009 11:54:00 AM, Anonymous Anonymous said...

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.

 
At Saturday, October 31, 2009 3:15:00 PM, Anonymous Anonymous said...

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.

 
At Sunday, March 07, 2010 6:18:00 PM, Anonymous Anonymous said...

There is no obligation for anyone to adopt, period. A person is morally and legally entitled to create their own child. It makes NO DIFFERENCE whether or not they create their child through IVF, or in the bedroom. People need to get a life, and quit trying to control how other people create their families. I have nothing against those who choose to adopt, but don't you dare disrespect my right to have a biological child. Don't insult my choices, and I won't insult yours.

 
At Saturday, March 13, 2010 5:13:00 PM, Anonymous Anonymous said...

I am stupefied by this author's all-or-nothing self righteousness that his: 1. A doctor; 2. An "ethicist"; 3. A professor.

I'm sorry, sir, but I find your entire basis of judgment to be less than ethical.

 
At Saturday, March 13, 2010 6:15:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous from today 3-13-10, what do you mean by: "all-or-nothing self righteousness"? As moderator and to encourage open discussion, I will not present my view but I would like to ask whether those who completely reject adoption and advocate only natural or assisted pregnancy could also be characterized as "self righteous"--- characterizing their conclusion as the only right one for creating a family? ..Maurice.

 
At Thursday, March 18, 2010 9:36:00 PM, Anonymous Anonymous said...

People who reject adoption have their own personal reasons for doing so. It doesn't mean they think an adopted child is "inferior". And regardless of how it makes others feel, they have the right to get pregnant. Period. No ifs, ands or buts. Its their body, their eggs, their sperm. They can have a bio child if they want to. Its unfortunate that many people waste mental energy being angry at those who seek fertility help. If you are concerned about homeless children, then go adopt some yourself.

 
At Sunday, March 21, 2010 7:25:00 PM, Anonymous Anonymous said...

Its interesting that posters are all referring to "my" right or the individual's right to making his/her choice, whatever that choice may be. Perhaps the thrust of the original post is more about each of us looking beyond our need/want to what is sustainable within our communities -- whether that community is our family or the global community?

 
At Wednesday, July 28, 2010 11:55:00 PM, Anonymous Anonymous said...

I am particularly interested in this specific article because it highlights 'needs and wants'.

Thing is, there are different scenarios to IVF. I want to discuss a very specific one:

If a want-to-be mother is single with no husband, I consider it SELFISH to ask a friend to be the father. Why?

I don't care how much money this woman has. I don't care if she a team of 500 family members helping the child in any way. What irks me is the selfishness of wanting your own genetic stamp on a child and the selfishness of wanting to experience the birth process.

Why?

If you have a need to be a Mother, a need to love another human being so selfLESSly, WHY OH WHY is there the selfish need to carry it in your stomach or have your DNA in this child?

Do you realize how many unwanted children that need to be adopted?

First off, I intellectually understand that even the best of circumstances where a child would have their monetary needs met to live a charmed life, you first are denying the child of a mother and father who are IN LOVE and have built a family unit!

Secondly, albeit the child would know his father and understand his or her 'roots', what kind of father is this IVF sperm donor?

It seems highly confusing and unfair to a child to know that his genetic father is not financially responsible for he or she, nor interested in his mother as a wife and love of his life.

O.K. I hear someone saying, "Oh but a child of a single mother wanting IVF would receive so much love and the child would know his/her father!" Well, again, it is a SELFISH NEED just to see YOUR eyes, nose, etc. in a child. A study has proven psychologically speaking; IVF babies and adopted babies do not differ in behavioral/emotional health. If you want proof, I'll site the case study.

With that said, to me, it is all very SELFISH to ask a friend if you are single to father a child and cum in a cup a few times no matter how much the child is 'WANTED'.

If you WANT to LOVE a child so damn badly, and NEED your maternal needs satiated so very badly, adopt a child that NEEDS AND WANTS your love!

How beautiful is it to ask a friend to sire your child in a Doctor's office so your great friend has the responsibility of standing up as an Uncle figure while the reality is, the guy’s the FATHER?

Is that being a GOOD DAD?

No financial responsibility.
Pfff

How selfish it is of a woman to ask that of a friend! The donor could be single, married, divorced or gay for all that matters. The question is, does the woman who WANTS this baby thinking how a wife, a girlfriend would feel if a child is in the world that is not hers?

Sure, there are plenty of divorced men with kids. Thing is with IVF, you have the CHOICE just like a married couple would to conceive a child.

How about loving a child that NEEDS a life instead of being selfish for a genetic stamp and carrying case in your stomach to validate your own SELFISH needs to satiate your own ego?

ADOPT and stop using people like partial dog-owners and lab rats.

UGH

If you WANT to be a Mother and NEED to fulfill a maternal instinct, I doubt it really matters if you see yourself in your child or if it pops out of your birth canal.

WHAT IS IMPORTANT IS LOVING THE CHILD

If the child grows up emotionally as healthy as an adoptive child, then I conclude the WANT to have a 15-30K procedure or getting it for -0- from a friend is not only truly selfish but also, outrageous!!!!!

Are these women trying to love a human being or save a few bucks by asking their friend for some high-price masturbation?

My three and a half cents.

I stand by my words, hands down.

JB

 
At Wednesday, September 05, 2012 6:16:00 AM, Anonymous Anonymous said...

great points indeed mate, the whole racism thing is rife within todays society and im only 17 and can see that i'm coming into a world ruined by stupid societal stereotypes, one thing i would say is you need to work on your grammar haha, half of your sentences are mushed together and are hard to read.... could just be me though

 

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