The ethics of fertility treatments are struggling to keep up with rapid-fire advances in biotechnology. The case of Nadya Suleman, the “Octomom” who gave birth to octuplets in January 2009 through reproductive technology, is just an extreme example of the ethical dilemmas that parents, medical professionals and religious leaders are facing.

In addition to the ethical questions raised by the “Octomom” case, other significant issues related to the in vitro fertilization procedures she used are also emerging, among them ethical questions raised by pre-implantation genetic diagnosis (PGD) and embryo adoption.

Reproductive technology sits at the nexis of numerous and often conflicting prerogatives, both moral and legal. Would-be parents believe they have a right to avail themselves of procedures that can help them conceive and bear a child. But what happens when those parents divorce and, for example, each stakes a claim to frozen embryos? Or what of the biological parent — does he or she have a greater claim to custody of a child? And what of the rights of surrogate mothers, or sperm donors?

“Assisted reproductive technologies raise the hopes of those who yearn for biologically related children, but they may also pose unreasonable health risks and an enormous financial burden,” said Kate Ott, associate director of the Religious Institute and author of a guide on religious ethics and reproductive technology. “Faith leaders must arrive at an ethical response that respects every individual’s desire to have children, while calling for accountability and equity in how these technologies are used.”

This edition of ReligionLink provides context and experts for reporting on this developing story.

What’s new

• The American Society for Reproductive Medicine, the nation’s chief professional organization for physicians who treat infertility, expelled Dr. Michael Kamrava, the Beverly Hills fertility specialist responsible for the eight babies born in January 2009 to Nadya Suleman. As this USA Today story reports, the society confirmed in October 2009 that its disciplinary committee took the action against Kamrava for repeatedly violating its standards by implanting more embryos than guidelines recommend.
• In December 2009 the state medical board of California filed a complaint against Kamrava accusing him of “gross negligence.”
• A Los Angeles doctor, Jeff Steinberg, provoked an uproar in March 2009 when he offered to help prospective parents choose embryos based on eye and hair color. He later retracted the offer and said he would limit the selection to screening for genetic diseases.
• Read a Jan. 25, 2010, New York Times story, “A Legal Puzzle: Can a Baby Have Three Biological Parents?,” about advances in fertility technology and the potential and current ethical and legal problems they pose.
• In November 2009, the Catholic bishops of the United States approved a document called “Life-Giving Love in an Age of Technology,” which explains the Catholic Church’s opposition to a range of infertility treatments and addresses certain developments in biotechnology in light of church teaching. Among other things, the document notes that while the church regards frozen embryos as human life that should be protected, it cannot sanction “embryo adoption” for other ethical reasons.
• The document from the U.S. bishops was prompted by a December 2008 Vatican statement, “Dignitas Personae,” or “The Dignity of a Person,” explaining church teaching on a range of bioethical issues.
• The Religious Institute, a multifaith organization based in Westport, Conn., in September 2009 published “A Time to be Born: A Faith-Based Guide to Assisted Reproductive Technologies.” The guide is descibed as “the first multifaith resource to address the scientific and ethical complexities of reproductive technologies from a religious perspective.”
• In February 2009, the Religious Institute published an “Open Letter to Religious Leaders on Assisted Reproductive Technologies,” calling on the nation’s religious leaders to “engage the ethical considerations of assisted reproductive technologies and to become stronger counselors and advocates for the safety, effectiveness and accessibility of these technologies.”

Background

At the time the woman at the center of the “Octomom” uproar, Nadya Suleman, gave birth to only the second set of octuplets born in the United States, she was the unmarried and unemployed 33-year-old mother of six other babies also conceived by IVF. The births inspired controversy on both medical and moral grounds and highlighted the question of whether and how IVF should be regulated.

At present, the practice is essentially unregulated in the United States, although many other countries, including a number of European democracies, regulate it closely. Despite the ASRM action, for example, Dr. Kamrava retains his medical license and his right and ability to perform IVF treatments. (That could change depending on the outcome of the state medical board inquiry.)

Multiple births are known to be more dangerous than single births — and births of many children far more dangerous — for both mother and children, and to produce elevated levels of often-serious birth defects. In the early days of in vitro fertilization, when it was not known whether embryos would survive, implanting multiples was not uncommon. As the technology advanced and survival improved, however, expert opinion shifted toward implanting much smaller numbers of embryos.

Experts overwhelmingly regard Kamrava’s action as unsafe and irresponsible, despite the argument that Suleman, as the owner of her embryos, has the right to determine their use and she wanted them implanted at once. That right, most ethics experts agree, is not unlimited and does not outweigh issues of safety and medical judgment. Nor does it supersede the responsibility of parents to support and care for their children.

Other IVF-related issues are also emerging.

For example, the use of pre-implantation genetic diagnosis (PGD) is growing. PGD allows doctors to examine the genetic endowment of embryos and select for implantation only those that meet certain criteria. It was originally developed to save couples who are known to be carriers of deleterious genes for severe genetic diseases from giving birth to children doomed to suffer and die in infancy or childhood. Some religious traditions permit PGD as a means of preventing avoidable suffering, and others forbid it because it can result in discarding some embryos.

More recently, PGD has been used to select among embryos to prevent much less serious conditions or to choose a baby’s gender. Some suggest that it could be used to produce babies with desired traits completely unrelated to disease, such as particular talents or appearances. Whether producing such “designer” babies using PGD is in fact feasible is not known, but the possibility has ignited discussion because the practice of selectively aborting pregnancies on the basis of the fetus’ sex is already widespread in some countries.

Embryo adoptions, donations and transfers are also posing growing challenges. IVF clinics in the United States have created approximately half a million embryos, large numbers of which have been frozen for storage and potential future use. Many of these probably will never be used by the couples who own them. Some groups favor donating these unused embryos to other infertile couples, who then would have them implanted and carry the resulting pregnancies to term. The practice, variously known as embryo transfer, donation or adoption, is gaining popularity, especially among some Christians. It may now be spreading to other groups as well. This area is relatively new, and the positions of various faith communities on the practice are still emerging.

Resources

• ReligionLink’s Guide to beginning-of-life issues provides a wide range of experts and resources for covering issues involving IVF.
• See a Jan. 10, 2010, USA Today article about a couple who turned to pre-implantation genetic diagnosis 10 years ago to select an embryo most likely to be a good candidate for a bone marrow transplant for their young daughter, who had a life-threatening illness.
• The New York Times in 2009 ran a series called “21st-Century Babies: A Painful Dilemma.” The first story, on Oct. 10, 2009, was ” The Gift of Life, and Its Price.” The second story, “Grievous Choice on Risky Path to Parenthood,” was published Oct. 11, 2009. The final story ran Dec. 12, 2009, and was called “Building a Baby, With Few Ground Rules,” about problems surrounding surrogacy.
• Read a Jan. 7, 2010, London Times story in which a North Carolina doctor says he expects the demand for “designer babies” to grow dramatically.
• Read a June 2, 2009, Religion News Service story, “What to do with excess embryos?” about a doctor who hopes to create an “embryo bank.”
• Read three articles about the Octomom case in the May-June 2009 issue of The Hastings Center Report: “Judging Octomom,” “The Octuplet Case:_Why More Regulation Is Not Likely” and “More Than a Village: Meeting the Health Care Needs of Multiples.”
• Read “Embryo adoption becoming the rage,” which ran April 19, 2009, in The Washington Times.
• Read “A Baby, Please. Blond, Freckles — Hold the Colic” a Feb. 12, 2009, column in The Wall Street Journal about pre-implantation genetic diagnosis and the possibility of making “designer babies.”

Organizations

• The American Society for Reproductive Medicine, an organization of physicians, has issued reports and statements by its ethics committee on various beginning-of-life issues. Dr. Robert Rebar is executive director. Contact 205-978-5000.
• The Embryo Adoption Awareness Center of Loveland, Colo., provides information and resources. Kimberly Tyson is program manager. Contact 970-663-6799, info@embryoadoption.org.
• The National Embryo Donation Center of Farragut, Tenn., is a nonprofit organization “whose mission is to protect the lives and dignity of human embryos by promoting, facilitating and educating about embryo donation and adoption.” Its medical personnel facilitate transfer and gestation of donated embryos. Dr. Jeffrey Keenan is medical director. Contact 866-777-2013.
• The Religious Institute describes itself as “a multifaith organization dedicated to advocating for sexual health, education and justice in faith communities and society.” Contact communications director Tim Palmer, 914-438-4127, palmer@religiousinstitute.org.

National sources

• Dr. Jeffrey Botkin is professor of pediatrics and adjunct professor of medicine at the University of Utah School of Medicine in Salt Lake City. His writings include “Line drawing: developing professional standards for prenatal diagnosis” in Prenatal Testing and Disability Rights. Contact 801-581-7170, jeffrey.botkin@hsc.utah.edu.
• Sarah Vaughan Brakman is director of the Ethics Program and professor of philosophy at Villanova University in Villanova, Pa., and co-editor of The Ethics of Embryo Adoption and the Catholic Tradition: Moral Arguments, Economic Reality and Social Analysis (2008). Contact 610-519-4004, sarah.vaughan.brakman@villanova.edu.
• Rabbi Michael J. Broyde is a law professor at Emory University in Atlanta and academic director of Emory’s Law and Religion Program. His primary areas of interest are law and religion, Jewish law and ethics, and comparative religious law. His writings include “Cloning People: A Jewish Law Analysis of the Issues” in the Connecticut Law Review and “Pre-implantation Genetic Diagnosis, Stem Cells and Jewish Law” in Tradition: A Journal of Orthodox Jewish Thought. Contact 404-727-7546, mbroyde@law.emory.edu.
• Naomi Cahn is the John Theodore Fey Research Professor of Law at George Washington University Law School in Washington, D.C., and the author of Test Tube Families: Why the Fertility Market Needs Legal Regulation (2009). Contact 202-994-6025, ncahn@law.gwu.edu.
• Arthur Caplan is Emanuel and Robert Hart Professor of Bioethics and director of the Center for Bioethics at the University of Pennsylvania in Philadephia. He is one of the nation’s best-known bioethicists and does research on reproductive technologies and genetics. Contact 215-898-7136, caplan@mail.med.upenn.edu.
• David Goldstein is professor of molecular genetics and microbiology and director of the Duke Institute for Genome Sciences & Policy at Duke University in North Carolina. Goldstein has predicted there will be a growing demand for “designer babies.” Contact via assistant Angelique Cherry, 919-684-0896, angelique.cherry@duke.edu.
• Kate Ott is associate director of the Religious Institute and author of the institute’s guide on religious ethics and reproductive technology, cited above. Contact 203-222-0055, kott@religiousinstitute.org. The Rev. Debra W. Haffner is co-founder and executive director of the Religious Institute. Haffner leads the Unitarian Church in Westport, Conn., where the Religious Institute is based. Contact 203-222-0055, debra@uuwestport.org.
• Josephine Johnston is a research scholar and director of research operations at the Hastings Center in Garrison, N.Y. Her writings include “Judging Octomon” in the Hastings Review and “Reproductive Health: Control and Use of Gametes and Embryos” and “Reproductive Health: Storage and Disposal of Gametes and Embryos” for the Royal College of Physicians and Surgeons (London, UK) Bioethics Education Project. Contact 845-424-4040 ext. 208, johnstonj@thehastingscenter.org.
• Maxwell Mehlman is professor of bioethics and Arthur E. Petersilge Professor of Law at Case Western Reserve University in Cleveland. He is co-author of Genetics: Ethics, Law and Policy and author of Wondergenes: Genetic Enhancement and the Future of Society. Contact 216-368-3983, mjm10@case.edu.
• Dr. Eric M. Meslin directs the Center for Bioethics and serves as associate dean for bioethics and professor of medicine, as well as of medical and molecular genetics, at the Indiana University School of Medicine in Indianapolis. He is also professor of philosophy in the School of Liberal Arts and co-director of the Indiana University-Purdue University Indianapolis Signature Center Consortium on Health Policy, Law and Bioethics. Contact 317-278-4034, emeslin@iupui.edu.
• Thomas H. Murray is president of the Hastings Center. He is the author of The Worth of a Child and co-editor of the Encyclopedia of Ethical, Legal and Policy Issues in Biotechnology and Genetic Ties and the Family: The Impact of Paternity Testing on Parents and Children. Contact 845-424-4040 ext. 201, murrayt@thehastingscenter.org.
• John A. Robertson holds the Vinson & Elkins Chair at the University of Texas School of Law at Austin. His books include The New Reproductive Technologies, and his articles include “Ethical Uses in New Uses of Pre-implantation Genetic Diagnosis” in the journal Human Reproduction. He is chairman of the Ethics Committee of the American Society for Reproductive Medicine. Contact 512-232-1307, jrobertson@mail.law.utexas.edu.
• Darlene Fozard Weaver is associate professor of theology and director of the Theology Institute at Villanova University in Villanova, Pa. Weaver co-edited The Ethics of Embryo Adoption and the Catholic Tradition: Moral Arguments, Economic Reality and Social Analysis (2008). Contact 610-519-4218, darlene.weaver@villanova.edu.

Regional sources

IN THE NORTHEAST

• Kenneth A. Richman is associate professor of philosophy and health care ethics at the Massachusetts College of Pharmacy and Health Sciences in Boston. He is author of Ethics and the Metaphysics of Medicine: Reflections on Health and Beneficence. Contact 617-732-2927, kenneth.richman@mcphs.edu.
• Thomas A. Shannon holds the Paul McKeever Chair in Moral Theology at St. John’s University in Queens, N.Y., and is professor emeritus of religion and social ethics at Worcester Polytechnic Institute in Worcester, Mass. His books include Made in Whose Image?: Genetic Engineering and Christian Ethics. Contact through Elizabeth Reilly, 718-990-5789, reillye@stjohns.edu.

IN THE EAST

• Adrienne Asch is director of the Center for Ethics and Edward and Robin Milstein Professor of Bioethics at Yeshiva University in New York City. Her writings include “Assisted Reproduction,” in From Birth to Death and Bench to Clinic (2008). Contact 212-960-0834, asch@yu.edu.
• Ronald Cole-Turner is H. Parker Sharp Professor of Theology and Ethics at Pittsburgh Theological Seminary, author of The New Genesis: Theology and the Genetic Revolution and editor of Design and Destiny: Jewish and Christian Perspectives on Human Germline Modification (2007). Contact 412-924-1426, coleturn@pts.edu.

IN THE SOUTHEAST

• Jennifer Collins is a law professor at Wake Forest University in Winston-Salem, N.C. She is co-author of an article on issues raised by Octomom, “Eight Is Enough,” in Northwestern Colloquy. Contact 336-758-3852, collinjm@wfu.edu.
• Kenneth Goodman is director of the Bioethics Program at the University of Miami and professor in the department of medicine. He has appointments in the department of philosophy, School of Nursing and Health Studies, department of epidemiology and public health. Contact 305-243-5723, kgoodman@miami.edu.

IN THE SOUTH

• Dr. Ellen Wright Clayton is Rosalind E. Franklin Professor of Genetics and Health Policy and professor of law and pediatrics at Vanderbilt University in Nashville, Tenn. Contact 615-322-1186, ellen.clayton@vanderbilt.edu.
• Glenn Graber is a philosophy professor at the University of Tennessee in Knoxville. His writings include “The Moral Status of Gametes and Embryos: Storage and Surrogacy” in Health Care Ethics: Critical Issues for the 21st Century (2nd Edition). Contact 865-974-7213, ggraber@utk.edu.

IN THE MIDWEST

• Rebecca Rae Anderson is associate professor in the College of Public Health at the University of Nebraska Medical Center in Omaha. She is an attorney and a board-certified genetic counselor and the author of Religious Traditions and Prenatal Genetic Counseling. Contact 402-559-1997, randerso@unmc.edu.
• Mary Briody Mahowald is professor emerita of obstetrics and gynecology and a faculty member at the MacLean Center for Clinical Medical Ethics at the University of Chicago. Her books include Women and Children in Health Care: An Unequal Majority and Bioethics and Women: Across the Life Span. Contact 737-702-9300, mm46@uchicago.edu.

IN THE SOUTHWEST

• Mark Cherry is professor of philosophy at St. Edward’s University in Austin, Texas, and co-editor of At the Roots of Christian Bioethics: Critical Essays on the Thought of H. Tristram Engelhardt Jr. (2009). Contact 512-448-8536. markc@stedwards.edu.
• Marilyn Coors is associate professor of bioethics and genetics in the department of psychiatry at the University of Colorado at Denver. Contact 303-724-3993, Marilyn.Coors@ucdenver.edu.

IN THE WEST/NORTHWEST

• Lawrence Hinman is philosophy professor and co-director of the Center for Ethics in Science and Technology at the University of San Diego. Contact 619-260-4787, hinman@SanDiego.edu.
• David Magnus is director of the Stanford Center for Biomedical Ethics and professor of pediatrics, medicine and philosophy, and co-chair of the Ethics Committee for the Stanford Health Center in Palo Alto, Calif. He also directs the Scholarly Concentration in Biomedical Ethics and Medical Humanities in the School of Medicine. Contact 650-723-7735, dmagnus@stanford.edu.