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Friday, September 28, 2012

New Book: "Ethics, Sexual Orientation, and Choices about Children"


My new book -- Ethics, Sexual Orientation, and Choices about Children -- is now available from The MIT Press. 
 

In this book, I trace the history of a debate:  Would it be ethical for parents to  select the sexual orientation of their children? This question surfaced in the ethics literature in the late 1970s and has taken many twists and turns since then.  I report the views of the main players in this debate, and I evaluate them for what they mean for parental rights and the well-being of children.

This kind of choice is hypothetical at this point; there is no known way to ensure the sexual orientation of a child one way or the other. But scientific research has opened tantalizing prospects for extending the reach of parental choice over the traits of their children. Some would want to choose the sexual orientation of their children if they could. And that's where the debate begins:  What would it mean for gay and lesbian people if most parents took steps to have only straight children? Should people be able to choose gay and lesbian children, knowing that they might face disadvantages straight children would not? Various commentators have staked out starkly opposed positions.

One of the signal debates in bioethics today concerns the reach of parents into the lives of their children. My analysis considers sexual orientation as an in-depth case study, but it also offers a way to think about the motives for wanting to choose the traits of children in general, a way to evaluate the methods involved, and a way to assess the social effects of making those kinds of choices.
 
For further information, see http://mitpress.mit.edu/catalog/item/default.asp?ttype=2&tid=13046

Monday, September 24, 2012

Homosexuality Ceases Procreation?



CNN aired an interview between Piers Morgan and Mahmoud Ahmadinejad, the President of Iran on September 24, 2012.  Mr. Morgan asked the President about freedom for gay people.  Ahmadinejad decided to inject children into his discussion. 

Mr. Morgan asked the President, “Shouldn't freedom and individuality and all those things extend to people who just happen to be gay? They were born gay.  They weren't made gay. Wouldn't it be great for the President of Iran to say, 'You know what? Everyone is entitled to be whatever sexuality they are born with.' That would be a great symbol of freedom.”

Mr. Ahmadinejad replied by asking “Do you really believe someone is born homosexual?” When Mr. Morgan said that he did, absolutely, the Iranian president said “Let me ask you this: do you believe anyone has given birth through homosexuality? Homosexuality ceases procreation.”  He went to ask “Who has said that if you are doing something ugly. they are denying your freedom? Who has said that?”

Not to be put off, Mr. Morgan noted that the president has two sons and a daughter: “What would you do if one of them was gay?”

The president’s reply was this:  “The proper education must be given. The education system must be revamped. The political system must be revamped. And these must also be reformed and revamped along the way. But if you -- if a group -- recognizes an ugly behavior or deed as legitimate, you must not expect other countries or groups to give it the same recognition?”

I mention this discussion here because of the way in which children play a role. In Mr. Ahmadinejad’s mind, the sterility of two men and two women functions as a strong reason to object to the “ugly behavior” of homosexuality.  In 2007, students at Columbia University laughed at the president when he told them that “In Iran, we don't have homosexuals, like in your country.”

While it may be true that there is not in Iran the public pair-bonding of two men or two women that is almost commonplace in the United States, there are men and women who have and express their homosexuality.  Many of them will be in opposite-sex relationships and have children.  Homosexual men and women do have children, even if many of them in opposite-sex relationships. And the American Society for Reproductive Medicine now counsels its membership to offer reproductive treatments to all parties, independent of their sexual orientation.  

Homosexual acts are sterile in themselves, as are many sexual acts between men and women who are infertile and as are sexual acts that, for one reason or another, are situationally infertile. Homosexuality is not, therefore, alone in ‘ceasing procreation.’ For that reason, the infertility of same-sex couples is no reason to throw up obstacles to social freedom.  

Thursday, September 20, 2012

The Ethics of Uterus Transplants



Clinicians at Gothenberg University in Sweden reported  this week that they have carried out uterus transplants with two women, actually four since their mothers were the uterus donors. This is a very long way to go in order to have a child.

Researchers have been investigating this kind of transplant with monkeys and baboons for some time now, but there have been efforts at human transplantation too.  In 2011, Turkish clinicians carried out a uterus transplant, and it has been successful enough that the woman experiences menstruation (No author, 2011).  To date, however, she has not had a child.

In February of this year, a study group offered “The Montreal Criteria for the Ethical Feasibility of Uterus Transplantation in Women” (Lamarck et al. 2012). According to this group’s standards, clinicians must ensure that the woman is medically able to sustain the transplant and that she have uterine factor infertility, namely that she lacks a uterus altogether or that she has a demonstrated inability to gestate.  She must also be competent to make a make a free choice to agree to the risks of the transplant, and this choice must not be the result of some psychological disorder. The woman must also appear to be a suitable candidate for motherhood, namely not show any signs of maternal unfitness. 

One of the most interesting proposed criteria for uterus transplantation is this:  the woman must have either (a) a personal or legal reason to avoid surrogacy and adoption as a way of having children or (b) or her goal must be the experience of gestation.  By itself, this standard is broad enough to permit any woman who wants a transplant – and meets the other criteria – to have one.  In other words, any reason important to the woman is reason enough.

In April of this year, the Gothenburg group signaled their readiness to undertake uterus transplantation (Brännström et al.), and their first efforts involved a woman who lost her uterus to cancer and a woman who was born without a uterus, and their mothers as living donors.

The Gothenberg group did not disclose whether the women receiving the organs had a capacity to have children in other ways.  If they did, clinicians might have been able to retrieve ova from them and use IVF in order to help them have children. This option might not always work, of course, since it has its own failure rates and requires a surrogate mother. 

If the women lack their own ova, however, even if gestate their children – if the transplants succeed and pregnancy occurs –they will be doing so with children that are not their own genetically. Most people seem to want to have children that are genetically related to them, unless they can’t. Some people are generous enough to adopt children who have no genetic relationship at all to them, but others would rather have no children than adopt. In the Gothenberg cases, gestation seems to be as important as anything else.

Ironically, these transplants come at a time when some feminists have been trying to liberate women from gestation altogether. For example, Anna Smajdor has argued for strong research commitments to the development of artificial wombs (Smajdor, 2007). She calls for ‘priority’ for this research, without saying priority over what, but she argues that pregnancy is “barbaric” and the sooner women are beyond its reach the better. 

As I say, uterus transplants are long way to go toward having a child and, especially if the goal is primarily to experience gestation. In the Swedish cases, four women assumed a lot of risk: two in donating their uteruses and two in having uteruses transplanted into their bodies.  That’s a lot of pre-operative psychological evaluation, a lot of pre-operative medical evaluation, surgery, and post-operative recovery. I’m all in favor of autonomous choice with regard to choices about having children, but a healthy dose of feminist skepticism toward gestation is in order here. And that’s all the more true when other options for having children exist.

References

Brännström M, Diaz-Garcia C, Hanafy A, Olausson M, Tzakis A. 2012. Uterus transplantation: animal research and human possibilities. Fertility and Sterility (97) [Jun]: 1269-1276. Epub: Apr 28 2012.

Lefkowitz A, Edwards M, Balayla J.  2012. The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation. Transplant International (4):439-47. Epub: Feb 23.

No Author.  2012. First uterus transplants from mother to daughter are reported. New York Times, Sept. 18. At: http://www.nytimes.com/2012/09/19/world/europe/sweden-first-uterus-transplants-from-mother-to-daughter-are-reported.html

No Author. 2011. Nurse hopes to have world’s first baby from a transplant womb donated by her own mother. Daily Mail. Oct. 18. At:  http://www.dailymail.co.uk/health/article-2050401/Married-nurse-hopes-worlds-baby-womb-transplant-donated-MOTHER.html

Smajor, A. 2007. The moral imperative for ectogenesis. Cambridge Quarterly of Healthcare Ethics (16): 336-345.