Saturday, February 6, 2016

Attention Same-Sex Couples: Margaret Somerville Feels Your Pain, but Don’t Expect an Apology Anytime Soon

By her own words, law professor Margaret Somerville feels the hurt gay and lesbian people experience when they encounter her view that the law should exclude same-sex couples from marriage.  Really, she does, or at least that’s what she says in her new book, Bird on an Ethics Wire. But don’t expect any apologies soon.

Somerville has long defended the view that the law should exclude same-sex couples from marriage, and this book doesn’t back down from that view. Far from it:  Somerville presents herself as speaking on behalf of Nature itself, on behalf of all children whose well-being is overlooked in the rush to  have children any old which way.

Somerville interprets marriage as having symbolic dimensions important in the “sexual ecology” of the “transmission of life.” Same-sex couples can’t – without other’s gametes – transmit life that way, and even if they could, they run into another problem: two men or two women cannot themselves offer a mother and father to children as they raise them.

Somerville goes so far as to maintain that children have the right not to be born to under these circumstances. Better that children should not exist at all than to be born to same-sex couples, maybe especially married same-sex couples.

Somerville offers a fig leaf of legal cover to same-sex relationships by endorsing the consolation prize of civil unions. But those unions are distinct from marriage and should not, as a matter of ethics or law, entitle couples to children. Children belong – so far as possible – in the moral and psychological confines of marriage.  Somerville calls on the law to exclude same-sex couples from marriage and thus to exclude those couples from the right to found a family as a privilege of the marital state. 

Somerville says that she recognizes that her “opposition to same-sex marriage has hurt some people who support it.”  “I genuinely regret the hurt it inflicts.” Rather than revise her views in order to avoid that hurt, she simply stands on her views and advocates “for children’s human rights” with “moral regret.” 

But all is not lost, as she sees it. The door is open for same-sex couples to adopt.  What’s the difference? Gay and lesbian couples don’t bring those children into existence, but they can help take care of children when no one else will, when all else fails. Second-class children are entitled to second-class parents, evidently. 

So, there you have it: Margaret Somerville can live with the hurt her views inflict on same-sex couples looking to have children and/or marry. I suspect, for their part, that same-sex couples can also live with the hurt they inflict on her when they marry and/or have children, as more and more of them do in more and more places around the world and do so under color of law. So sorry, Margaret. We feel your pain. Really.

Thursday, February 4, 2016

A Right Not to Be Born?

In her new book, Bird on an Ethics Wire, Margaret Somerville continues to make the case against certain kinds of assisted reproduction.  

In the course of making that bioconservative case, she urges recognition of a human right to be born from natural biological origins.

When it comes to law and regulation of assisted reproductive treatments, she says “we should work from the presumption that, ethically, children have an absolute right to be conceived from an untampered-with ovum from one identified, living, adult woman and an untampered-with sperm from one identified, living adult man.”

This presumption really represents a variety of conclusions, but let me here just sketch out what the position would exclude:

      1.    Anonymous donation of ova and sperm
      2.       Use for conception of gametes from deceased women or men
      3.       Mitochrondrial transfer to ova, intended to protect against certain heritable diseases
      4.       Any genetic modification to gametes used for conception
      5.       Intentional twinning
      6.       Cloning, should that prospect for human beings emerge
      7.       Use of synthetic sperm derived from a man to confer genetic fertility on him
      8.       Use of synthetic ova derived from a woman to confer genetic fertility on her
      9.    Use of synthetic gametes to enable transgender women to conceive children as their mothers and to enable transgender men to conceive children as their fathers. 
     10.     Use of synthetic gametes to create the prospect of shared genetic parentage in same-sex couples
     11.   No gametes from fetuses

Central to this position is the idea that children have the right not to be born, but what can this mean? Non-existing beings cannot have any rights. The only thing that Somerville might mean, then, is that parents should not bring their children into existence under certain conditions, because those conditions are very bad for the children.  But whether being conceived in the ways above leaves to very bad conditions is a matter of evaluation.  Somerville characteristically stays away from scientific studies, and typically deploys an anecdote as evidence. By contrast, I think it’s almost impossible to show that children must suffer some harm so great that they should never be conceived through the interventions mentioned above. She is also among the last true believers that ‘nature’ ought to be the arbiter of human decisions, no matter the evidence that Nature is profoundly indifferent to the well-being of human beings.  We confront nature on many fronts, in order to make lives better for ourselves. Why should only those lucky enough to be favored by the ‘natural lottery’ be entitled to have children without the kinds of help above?

Saturday, December 12, 2015

Helping Transgender People Have Children: An Ethics Report That Could Have Been Stronger

The Ethics Committee of the American Society for Reproductive Medicine has offered advice that fertility clinicians make their services  available to transgender people. To support this recommendation, the Ethics Committee reviews some of the standard worries about transgender people as parents. One of those standard worries is that transgender people are 'disordered," which view was in fact the prevailing view in medicine until very recently.

The Ethics Committee is free to defend cross-sex identities against the label of ‘pathology.’ The Committee notes that neither the American Psychiatric Association nor the American Psychological Association any longer consider cross-sex identification in itself as evidence of a disorder. (The shift from 'gender identity disorder' to 'gender dysphoria' is significant: what matters is not the cross-sex identification but the distress that involves; treat the distress, not the cross-sex identity.) Not only that, but the Committee points to research that shows that “transgender persons can be highly educated, stably employed, sustain long-term partnered relationships” and that “they do not exhibit mental disorders more often than any other group.”

It is worth noting, however, that even if -- even if -- one considers cross-sex identification as a disorder in some sense, it does not follow that the disorder would by itself disqualify transgender people as parents. By itself, cross-sex identification is a very narrow ‘disorder" in the sense that it involves one's interpretation of one's sex. Transgender people need not otherwise have any cognitive or emotional deficits.

Certainly, it does not follow from the mere fact of a cross-sex gender identification that anyone would be unable to understand the nature or consequences of parenting, any more than certain other psychiatric/psychological disorders disqualify people as parents. Unless there were some other disease/disorder present, someone with the ‘disorder’ of a cross-sex identity could still very well-qualify as a responsible and able parent. Even under the older designation of cross-sex identities as disorders, some of the people  would have been “highly educated, stably employed,” and in “long-term relationships.”

What I'm saying here is that clinicians might well have obligations to help transgender people even if they consider cross-sex identities as disordered. Not all psychological disorders disqualify people from having children or from securing help in having children. In short, the defense of helping transgender people have children is much stronger than the Ethics Committee of the American Society of Reproductive Medicine lets on.

(The report:  Ethics Committee of the American Society for Reproductive Medicine. Access to fertility services by transgender persons: an ethics committee report. Fertility and Sterility 2015 (104): 1111-1115.)

Thursday, September 10, 2015

Commercial Surrogacy: Selective Reduction

The National Post has posted a story about a Canadian woman who agreed to serve as a gestational surrogate but found herself pregnant with triplets. The couple contracting with her didn't like the prospect of children for several reasons. A selective reduction in fetuses followed, with the further unintended loss of another fetus. In this article, the woman expresses some of the conflict she experienced.

Saturday, March 28, 2015

What if you could see what your child would look liks as an adult?

Researchers have been working to produce images of adults, relying on their DNA alone.

This effort is of interest to criminal investigations. Say someone who has committed a murder leaves only a DNA sample behind, in the form of blood or hair. If criminal investigators have no other evidence to go on, it will be difficult to identify suspects, if that DNA is not already in their data banks.  They will not have any idea, for example, of what the suspect would look like.

But DNA phenotyping works to project an image of what someone with that DNA would look like.  The results so far are not perfect, but I imagine that they will be refined over time, as more and more associations between DNA and its influence on appearance become better known.

That's one use of DNA phenotyping, but it might also be used to project images of what an embryo or fetus might look like.  DNA can be cultivated from embryos and fetuses, and the same projective techniques might be used.

Would it be okay -- as a matter of ethics -- to select an embryo when trying to have a child on the basis of its projected appearance as an adult? Would it be okay to select against a fetus for the same reason, namely its projected appearance?

These are interesting questions, and I've said more about them at the Hastings Center Bioethics forum:

Thursday, December 18, 2014

Uterus Transplants for Transgender Women?

Earlier this year, Swedish clinicians reported a live birth to a woman who had a uterus transplant.

That success opens the door to gestation for other women who cannot gestate a child.

But are women who were born without a uterus or who have lost a uterus to disease the only candidates for uterus transplantation?

What about uterus transplantation for transgender women?  Transgender women are not born with a uterus, but some might want a uterus in order to gestate a child, in the same way that many non-transgender women do.

What about uterus transplantation for men? for men who would like to gestate a child? If they used their own sperm, they would be the gestational mother of the child and also be the genetic father of the child.

I have just published an article that explores some of the questions that would come up in trying to offer transgender women and men the option of uterus transplant. For one, only a focused line of research would make that possible, if it is possible. Who should pay for such research? the government? And should anybody be doing this kind of research at all?

Some critics don't like the idea of using government money to develop uterus transplantation for men -- and maybe not even for transgender women,but I don't think their argument succeeds. Changing technologies are opening new prospects for becoming parents. I'm not saying that the state must fund uterus transplantation as a top priority for transgender women or men, but I do not think there's any good reason to think the government should never fund that research.

Here's the formal summary of my article, which came out yesterday.

Timothy F. Murphy, Assisted Gestation and Transgender Women, Bioethics 2014 (Dec 17).
DOI: 10.1111/bioe.12132

Developments in uterus transplant put assisted gestation within meaningful range of clinical success for women with uterine infertility who want to gestate children. Should this kind of transplantation prove routine and effective for those women, would there be any morally significant reason why men or transgender women should not be eligible for the same opportunity for gestation? Getting to the point of safe and effective uterus transplantation for those parties would require a focused line of research, over and above the study of uterus transplantation for non-transgender women. Some commentators object to the idea that the state has any duty to sponsor research of this kind. They would limit all publicly-funded fertility research to sex-typical ways of having children, which they construe as the basis of reproductive rights. This objection has no force against privately-funded research, of course, and in any case not all social expenditures are responses to ‘rights’ properly speaking. Another possible objection raised against gestation by transgender women is that it could alter the social meaning of sexed bodies. This line of argument fails, however, to substantiate a meaningful objection to gestation by transgender women because social meanings of sexed bodies do not remain constant and because the change in this case would not elicit social effects significant enough to justify closing off gestation to transgender women as a class.

You can find the article are here: . Or you can contact me.