The Ethics Of In Vitro Fertilization

NPR's Robert Siegel talks to Jeff Kahn, director of the Center for Bioethics at the University of Minnesota Medical School, about the ethics of in vitro fertilization.

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ROBERT SIEGEL, host:

In 1978, the phrase in-vitro fertilization was something the experts said.�The rest of the world spoke of test-tube babies. Newspaper columnists and editorial writers invoked Aldous Huxley's image of baby hatcheries in his dystopian novel "Brave New World."

Jeffrey Kahn directs the Center for Bioethics at the University of Minnesota Medical School. And, Jeffrey Kahn, have four million births through IVF trumped all the moral and ethical questions that were posed by the procedure?

Dr. JEFFREY KAHN (Director, Center for Bioethics): I think at the outset there was such concern about the new and uncertain technology that this proposed that people were quite afraid. But four million births later, those early issues went away, but new ones certainly came in the aftermath.

SIEGEL: As for the old issues, though, I mean, there were concerns of the potential eugenic consequences of IVF, that it wouldn't just help people who couldn't conceive, but it would help people who couldn't conceive with the kind of mate they would like to conceive. That, I guess, is part of life today.

Dr. KAHN: Absolutely. And I think that technology has evolved in ways that have brought some of those concerns to light so we can now test embryos outside of the body and make decisions about which ones to implant based upon the results of those tests. And that's what people were fearful of in 1978. The technology just didn't exist until well into the 1990s.

SIEGEL: You spoke, though, of concerns that were anticipated back in 1978 that have developed. What would place in that category?

Dr. KAHN: Well, I think things around new combinations of parents, effectively. So now we have the ability to combine sperm from one man, egg from one woman, that resulting embryo can be implanted into a third woman. And then the child born from that pregnancy can be raised by a separate couple.

So we have, in that case, five different people involved in the creation and eventual rearing of a single child. And that, I think, wasn't thought about in prospect quite in the way that it turned out to be a reality.

SIEGEL: There is another area of concern, which is the notion that embryos that are not implanted are frozen and whatever we do with them, are we doing that with human life? Is disposing of them disposing of human life?�That problem persists.

Dr. KAHN: Absolutely. And I think it's something that was foreseen in some respect. But the numbers at which we create and now store the excess embryos has really gotten to the point where we need a societal conversation and maybe a policy decision about what to do with those leftover embryos. The estimates are something like a million frozen embryos left in the United States alone. And we don't really have good plans for what ought to be done with them.

SIEGEL: What about the ethical and moral issues for doctors? That is, should they facilitate multiple births for a woman who has no apparent means of support of sextuplets or octuplets? Or is it the doctor's job to honor the patient's wishes and let the chips fall where they may?

Dr. KAHN: Well, it may be even a more fundamental conflict than that, in that we think about the right to have children as a basic fundamental liberty that we recognize. And so, when an individual says I'd like to have children, we don't usually ask why or how many or what techniques do you propose to use.

And so we have the technology that allows us to create these high multiple birth pregnancies bumping up against what we think of as a quite fundamental liberty. And we really haven't wrestled that to the ground either. And that's an issue that started in 1978, and then certainly persists today.

SIEGEL: There's another level of discussion of medicine, which is what do we think are the normal needs of making people well that should be covered by insurance plans - public and private. Have we settled that one when it comes to fertility treatments and IVF? Do we understand what it is that every woman or every couple is entitled to?

Dr. KAHN: No, absolutely not. In fact, in the United States there's quite a variety of coverage when it comes to reproductive medicine techniques. So some policies will cover a few cycles of in-vitro fertilization for any one individual. Many, many policies don't cover it at all, viewing it not as treatment of an illness or a disease but something that is rather more optional than that.

So it is far from being a settled issue when it comes to who pays and if they pay for it, how much.

SIEGEL: Jeffrey Kahn, thank you very much for talking with us today.

Dr. KAHN: My pleasure.

SIEGEL: So Jeffery Kahn, who is director of the Center for Bioethics at the University of Minnesota Medical School.

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