by Josephine Johnston and Michael K. Gusmano
At first blush, one might conclude that requests for twins must represent free and informed choices. But there are reasons to be skeptical, including that the preferences of many patients seem to be very strongly shaped, if not sometimes completely constrained, by concerns about costs—costs that mainly result from the routine exclusion of in vitro fertilization from health insurance coverage.
Susan B. Apel
“To Sleep until Death”: a letter from Blair Henry, Mervyn Dean, Victor Cellarius, Larry Librach, and Doreen Oneschuk about “Rethinking Guidelines for the Use of Palliative Sedation” (May-June 2010), with a reply from Jeffery T. Berger. “Rights vs. Liberty”: a letter from Maxwell J. Smith about “Multiple Embryo Transfers: Time for Policy” (May-June 2010), with a reply from David Orentlicher.
By John A. Robertson
In vitro fertilization and assisted reproductive technologies, or ARTs, have always posed a regulatory conundrum. They’ve been hugely successful (52,000 births from 152,000 IVF cycles in 2005) and are firmly established as the treatment of choice for many kinds of infertility. But over the years there has been a steady drip of ethical lapses. The IVF industry argues that there is more regulation in place than meets the eye, citing the many federal and state laws that impinge on IVF practice in some way. Critics of the industry argue that it’s like the wild west—anything goes if patients can pay. Yet these critics are remarkably silent on what specific form more regulation should take. The Bush-appointed President’s Council on Bioethics was concerned enough to spend two years examining the field but found no reason to urge major regulatory intervention.
By Josephine Johnston
Just over a week after her eight babies were delivered by caesarean section in a California hospital, Nadya Suleman explained to an NBC reporter that her extraordinary pregnancy was the result of in vitro fertilization. Having conceived her first six children using IVF, Suleman said she visited her fertility doctor in 2008 and insisted that he transfer all of her six remaining frozen embryos at once. All six embryos implanted, and two divided to create twins. Like many familiar with the ins and outs of fertility treatment, I initially assumed that the octuplets resulted from Suleman’s body “overreacting” to fertility medications. The idea that IVF—the most controllable form of assisted reproductive technology—had been used in such clear contravention of current professional guidelines and practice was almost unthinkable.
By Dena S. Davis
Parents have dreams for their children, sometimes quite specific and narrow. Musical families may assume that their children will choose an instrument early and devote so many hours to practice that other activities and even friendships are severely constrained. Society tolerates such dreams quite well. But should we also encourage access to genetic and reproductive techniques that allow for the creation of “babies by design,” or what I will term directed procreation? And does it matter if these techniques require a large or small investment of parental time, money, and energy? The argument for permitting directed procreation is grounded in the respect Western culture gives to reproductive liberty. However, this respect, almost reverence, for autonomy in reproduction also grounds reasons for limiting directed procreation.
By Françoise Baylis and Gillian Crozier
Hastings Center Report
By Kathy L. Hudson
The team of scientists at Advanced Cell Technology led by Robert Lanza has announced that it has developed a method to create stem cells from a single cell extracted from a human embryo without destroying the embryo. Heralded by some as the perfect solution to the political stalemate over funding stem cell research, Lanza’s work—at the moment—raises as many questions as it answers.