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Sunday, February 19, 2012

Conception of Children: 60 Years from Now


What will the world look like 70 years from now?  Stanford professor Hank Greely has this to say about the conception of children:

“Human reproduction will be much more selective.  Most children, except for the poorest inhabitants of the poorest nations, will be conceived through in vitro fertilization so that pre-implantation genetic diagnosis can be used to select the genetic traits of the next generation.  The key development here will be making human eggs from induced pluripotent stem cells, freeing IVF from the unpleasant, expensive, and risky process of egg retrieval.”

Since most people seem to believe that a better future involves having more and more control over the traits of children, I have no doubt that people will turn to assisted reproductive treatments in order to pave the way to better human lives.  Will most people turn to those options?  Maybe, but I suspect a good chunk of people will not, especially if the more than one billion Catholics in the world hew to their church’s teachings against those options. Countercultural types may also want to opt out of a planned reproductive economy too, especially since in vivo conception is a lot cheaper than all other alternatives.  In any case, the costs of IVF are going to function as a barrier for more people than just the poorest inhabitants of the poorest nations, and some people will want to opt out of that approach to conception for reasons of their own.  

What’s most interesting in this prediction – which Greeley acknowledges as fallible – is that he foresees a way in which women will not have to bear the burdens of egg donation in order to make in vitro fertilization work.  In the future, he expects ova will be manufactured at will from induced pluripotent stem cells.  Some of those stem cells will originally require ova from women, of course, but another options may come along too.  Some researchers have derived mammalian sperm and ova from somatic cells:  no original gametes are required.  Any man or any women might someday be the source of gametes.  That would certainly lift the burden of egg donation from women.  But it also upends the idea that only men can be fathers and that only women can be mothers.  That’s a more revolutionary future than one in which IVF is used routinely.

See other Greely predictions at:  http://www.councilforresponsiblegenetics.org/GeneWatch/GeneWatchPage.aspx?pageId=403

Saturday, February 18, 2012

Dim sum and curries? Yes, please. Female fetus abortion? No, thanks.


The Canadian Medical Association Journal released a signed editorial (Jan. 16, 2012) entitled “‘Its’ a girl” – could be a death sentence.”  The editor opens the discussion of a proposal to limit access to fetal information by noting that  “When Asians migrated to Western countries they brought welcome recipes for curries and dim sum.”  So, far so good.  The editor goes on to say, however, that “Sadly, a few of them also imported their preference for having sons and aborting daughters.”  The editor says next that “Female feticide happens in India and China by the millions, but it also happens in North America in numbers large enough to distort the male to female ratio in some ethnic groups.”

He then engages this question:  “Should female feticide in Canada be ignored because it is a small problem localized to minority ethnic groups?  No.  Small numbers cannot be ignored when the issue is about discrimination against women in its most extreme form.  This evil devalues women.  How can it be curbed? The solution is to postpone the disclosure of medically irrelevant information.”  (At:  http://www.cmaj.ca/content/early/2012/01/16/cmaj.120021.full.pdf+html

The analysis goes further to say that abortion decisions made to avoid female children represent discrimination against women “in its most extreme form,” no matter the numbers involved.  A policy – the editorial says – of disclosing the sex of a fetus only after 30 weeks policy would require the understanding and willingness of women of all ethnicities to make a temporary compromise.  Postponing the transmission of such information is a small price to pay to save thousands of girls in Canada.”

The Canadian Assisted Human Reproduction Act (2004) is of a piece with this editorial, insofar as it prohibits clinicians “to perform any procedure or provide, prescribe or administer anything that would ensure or increase the probability that an embryo will be of a particular sex, or that would identify the sex of an in vitro embryo, except to prevent, diagnose or treat a sex-linked disorder or disease” (http://laws-lois.justice.gc.ca/eng/acts/A-13.4/page-2.html?term=probability+increase#s-5). 

The analysis makes the usual provision of providing information about fetal sex in order to avoid sex-linked disorders, but it otherwise wants to close the door on parental choice.  Why?  It argues that doing so helps avoid discrimination against women.  But it’s not clear to me from these kinds of analysis why parents should not be entitled to have the kind of children they want.  At the very least, one has to assume that female children born into families who do not want them – families who would have taken steps to avoid them if they were available – do not fare as well as other children.

I don’t disagree that people can have dubious motives for wanting to have only boys or only girls or only children in a particular order by sex.  I would have been happier to see an argument against abortion decisions based on fetal sex that addressed the issue head on:  why should parents – whoever they are – not be entitled to have children of the sex they want?  Why should the natural lottery alone decide what sex people have in their families?

A Man Gives Birth? Time to Sound the Ethics Alarms?


In the United Kingdom, some “medical ethics experts” have called for an investigation into the birth of a child to a trans-man. 
 
“Josephine Quintavalle, of Comment on Reproductive Ethics, said there needs to be a proper inquiry in to the issues surrounding these births. ‘We have to sit up and consider these things,’ she said. ‘I don't think it is in the interests of the child to distort nature this way. We are prepared to do anything possible to fulfill the rights of the adult.’ ‘But I think it is at the expense and rights and welfare of the child.’  Trevor Stammers, director of medical ethics at St Mary's University College, London, said: ‘You are hardly going to end up with a baby that's going to have a happy, productive and optimal childhood.’  (Source:  http://www.telegraph.co.uk/health/healthnews/9077506/Sex-change-British-man-gives-birth-to-son.html)

Many of these objections are familiar as objections to homosexual men and women having children, but no one should be surprised that trans-men and trans-women are interested in having children.  Most people say that they want to have children, and there’s nothing about a transgender identity itself that nullifies that interest. 

Many trans-men and trans-women have children, of course, but many of them had those children before transitioning.  What is different now is that people are taking steps to have children after transitioning.  To address this issue, the World Professional Association for Transgender Health has recommended that all people seeking body modifications, especially permanent ones, be advised about options for preserving their fertility afterward.  The Endocrine Society in the United States offers the same advice to clinicians involved in transgender body modifications, including hormonal interventions offered to adolescents. 

So, as far as an inquiry into these matters is concerned, let’s start here:  there is nothing about a trans-identity that makes someone unable to appreciate the nature and consequences of being a parent.  What about feared effects on the child?  Perhaps the child will grow up in a state of gender confusion.  There is precious little study of this area, but what little research there is does not suggest that children are disordered themselves because their parents make unconventional choices in gender expression.