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: