The Bottom Line

Mark Oshinskie
Reproduced with Permission

In Pandora's Baby: How the First Test Tube Babies Sparked the Reproductive Revolution (2004), Robin Marantz Henig anecdotally summarizes the race to create the first test tube baby and related litigation. Thoughout this work of selective scope and partisan sensibility, she advocates for IVF, asserting that it's a technological story with a happy ending.

Her fundamental view is that IVF must be OK because Western Civilization hasn't unraveled since IVF began. Initially, this is an impossibly lax standard for judging the net effect of an event or the net value of an activity. Despite World Wars, nuclear arsenals, jets flying into buildings, an endless string of scandals, and much more, Western Civilization stumbles along. Moreover, the notion that something is good because it's gone on for a while bespeaks its own absurdity; there are plenty of bad things that have lasted a very long time. The more useful test of an activity's value is whether or not we're collectively better off as a result of it.

Some of the effects of such events as the foregoing are measurable. Some are not, but unquestionably shape both collective and individual consciousness. Less cataclysmic technological developments also have undeniable, though similarly unquantifiable impacts. For example, although -- or, rather, because -- many individuals use them, television, cars and birth control pills have profoundly changed the social landscape fostering, along with any benefits, immeasurable boredom, isolation and disposability. When one sees, for example, the many pages of photo ads in the back of the Village Voice, one might be tempted to conclude that sexuality separated from reproduction has become kind of cheesy.

As do the majority of Americans, Henig sees the individual as the only unit of analysis and the near term as the only period that matters. Yet, one cannot sensibly evaluate something based merely on its superficial, immediate effects on the individuals who use it. Process and context matter. For example, by downloading term papers from the Net, college plagiarists can bypass thought and obtain, and exhibit, immediate, apparent knowledge regarding a topic. In the same way, performance-enhancing substances have enabled higher, though corrupted, levels of achievement in both academia and athletics. Similarly, it is simplistic to assert that reprotech's ends -- pleasing those who use it -- justifies the means-- industrializing life. Would we build affordable housing in Yosemite Valley?

Consequence also matters. The effects, on others, of reprotech's commodification of life seem far beyond the author's ken. From abortion to IVF to sex selection to mail order sperm and eggs, to genetic screening, life creation and destruction have become consumer-sovereign industries. Instead of being seen as divine or natural wonders, children have increasingly become possessions, on display, whose lives are medically mediated and scheduled and managed to suit parents' desires, even from conception and delivery. Although it is difficult to operationalize the impact of reproductive capitalism and the ascendancy of parental satisfaction, these developments will lessen human solidarity far more profoundly than TV, cars and consumerism have. Henig concedes that the equipment and techniques used for IVF are the same that are being used for human cloning and design efforts. Thus, for both social and technological reasons, it is short-sighted to conclude that the IVF story has had a distinct, happy ending. Rather, the IVF story merges seamlessly with the larger story of reproductive capitalism.

In arguing for IVF, Henig cites polls as proof of the value and morality of this activity; if the majority supports a given activity, it is deemed worth doing, and moral. By itself, the limitations of, and moral dangers inherent in, such a stance should be obvious. The liabilities of poll-driven morality should be even more apparent when the public not only fails to consider the broader consequences of various activities but lacks comprehensive information about them. Unquestionably, most people have enough trouble fulfilling their own daily responsibilities than having to learn about or react to what is happening out of their sight, whether it's in another country or neighborhood or behind closed lab doors.

Ignoring that even today some well-educated, non-Christian observers who know what IVF entails oppose it, Henig labels IVF opponents as religious "extremists" who use "flowery" language. As a starting point, one wonders if she would acknowledge her own secular fundamentalism and judgmentalism, or her analytical limitations. For example, in order to justify the use of ARTs, Henig asserts that the human desire to have children is instinctual. This seems far more like cliche than empirically established fact. Firstly, if instincts are universally spread through a species, how does one explain the substantial numbers of people who eschew biological parenthood altogether? Further, even in those who do eventually wish to create genetic replicas, this desire is highly situational, with a large social component. Were it not, why do so many spend so many fertile years actively suppressing births? She also submits that, because some high risk couples may attempt to conceive a child in the privacy of their homes, society has no basis to bar, and should subsidize, cost-intensive medical office procedures like IVF for anyone who wants to try it at any age.

Henig frequently assails the "slippery slope" arguments that IVF opponents have been making since at least the 1960s. Instead, in an unconvincing attempt to reassure, she submits that a saloon door -- which swings both ways -- or a train -- to which brakes may be applied -- are better metaphors for how society manages technologies, including reprotech. There are two basic problems with this contention. Firstly, many eagerly make slippery slope arguments in other situations when they foresee secondary consequences they would rather avert: from parental notice requirements for abortion, to construction in an environmentally sensitive or historically significant area, to gun ownership, to moments of silent reflection in public schools, to bombing nuclear reactors in Iraq.

Beyond that, she provides no examples of limits, either voluntary or compulsory, that either have been, or might be, imposed on reprotech given the limitlessly relativistic and permissive standards of contemporary academic bioethics. If IVF is valid because it fulfills parental wishes, isn't sex selection similarly valid? What is wrong with the booming, hidden eugenic program in which, inter alia, over 95% of those who receive a prenatal Down's diagnosis abort or deselect? What problem could anyone have with cloning or artificial wombs when they become market-ready? For that matter, why not design embryos to please parents? When has the door ever swung back? Using the parent-pleasing guiding principle applied to the IVF debate, who but Henig's intrusive "zealots," will ever apply the brakes on the reprotech train? Far from revealing the limitations of the slippery slope metaphor, reprotech provides a particularly clear example of this phenomenon.

The author repeatedly invokes pop culture distortions of embryology. For example, we hear once again that the young embryo is just a (purportedly morally worthless) collection of cells. This assertion is especially dubious when one considers the lengths that some go to in order to ensure that only their own, presumably special, cell collections are placed within their wombs. The cell collection view also fails to explain why big lawsuits are filed when it becomes obvious that one couple received the cell collections of another couple, why many life-long characteristics of the individual can be ascertained by scanning these cell collections or why efforts to engineer humans will succeed if these cell collections can be altered even slightly. Moreover, she trots out the old saw that the possibility of (monozygotic) twinning in embryos less than two weeks old reveals that early embryos are just collections of cells. However, this view ignores that twinning can occur only in those rare instances when some cells physically break away from the embryo. If embryonic cells were truly independent from each other, there is no reason why each cell would not typically develop on its own. Instead, embryologists have determined that immediately after fertilization creates a new being, the cells in that unique being begin, on their own, to differentiate functionally and to work, complementarily, to grow the individual.

The author's only criticisms of IVF are grounded in consumer protection. She notes that birth defects in IVF offspring tend to be double that in the general population. These data seem not to take into account that more than half of the IVF births are multiples (IVF literally entails buying in bulk) and that multiples tend to have even more complications than that. She scarcely mentions that reproductive cancers may arise from using drugs to hyperstimulate ovulation. She barely acknowledges the disposal of hundreds of thousands of extra embryos from IVF. In comparing IVF embryo disposal to the fate of the natural zygote, she fails to discuss the common natural phenomenon of incomplete fertilization or to recognize the difference between deliberately killing disposed IVF embryos, on the one hand, and unknowingly and unwillfully letting them die inside a woman, on the other. She seems untroubled by the burgeoning private eugenic movement facilitated by IVF's preimplantation genetic diagnosis and completely ignores the common practice of selective reduction of the extra embryos through the injection of potassium chloride into the hearts of the "excessive."

The author falsely suggests that infertility is an idiopathic "mistake of nature." The demand for IVF arises largely out of the underpublicized sexually transmitted disease epidemic of the past thirty years. And she fails to observe the class/race bias that underlies IVF: many who use these technologies have waited a very long time to bear children as they have lived upper middle class lives and over 98% of American IVF are users are Caucasians. The very high costs of ARTs and the complicated births and childhoods that often follow are heavily subsidized by others' health insurance premiums. Mandatory infertility coverage has caused health care costs to increase 4% (or $400/family/year) in a country where 48 million lack even basic health insurance.

A balanced presentation requires at least as much. But balance is too much to expect when there is much more money to be made performing IVF, or promoting it.