A Concerning Nobel Prize

Earlier this week, British biologist Robert G. Edwards won the Nobel Prize in medicine for developing in vitro fertilization (IVF) technology. Edwards and his late research partner, Patrick Steptoe, pioneered the process by which the first so-called "test tube" baby was born in 1978. Since that time, it is estimated that four million babies worldwide have been born via IVF technology.

Much of the news coverage of Edwards's prize, tends to dismiss moral and ethical concerns as passé. In an NPR interview with bioethicist Jeffrey Kahn, host Robert Siegel began by asking, "[H]ave four million births through IVF trumped all the moral and ethical questions that were posed by the procedure?" It's an odd question, like asking whether Americans' continued reliance on fossil fuels trumps the moral questions raised by global warming. To his credit, Kahn responded by naming ethical concerns that remain, such as how scientists should handle millions of leftover frozen embryos.

Other news stories, however, fail to address ongoing ethical questions at all, portraying Edwards as a brave pioneer who fought back against uptight alarmists. A New York Times article, for example, states that the following:

Advances in human reproductive technology arouse people's deepest concerns and often go through a cycle, first of outrage and charges of playing God, then of acceptance. In vitro fertilization proved no exception. 'We know that I.V.F. was a great leap because Edwards and Steptoe were immediately attacked by an unlikely trinity—the press, the pope, and prominent Nobel laureates,' said the biochemist Joseph Goldstein in presenting the Lasker Award to Dr. Edwards in 2001.

The same article goes on to say that, "The objections [to IVF] gradually died away—except on the part of the Roman Catholic Church—as it became clear that the babies born by in vitro fertilization were healthy and that their parents were overjoyed to be able to start a family."

However, Roman Catholics are not the only ones concerned about the ethics of reproductive technology, and parental joy does not negate complex moral issues. If anything, the questions raised by IVF have grown rather than diminished, as the technology has become more sophisticated and ubiquitous. Edwards himself famously crystallized one major concern in a 1999 newspaper interview, in which he said, "Soon it will be a sin of parents to have a child that carries the heavy burden of genetic disease. We are entering a world where we have to consider the quality of our children."

Edwards was referring to a procedure called preimplantation genetic diagnosis (PGD), which is IVF with the added step of screening embryos for particular genetic mutations, usually those causing genetic disorders such as cystic fibrosis or Tay-Sachs, although it can also be used for sex selection, adult-onset diseases such as breast cancer, and even certain physical traits. In naming the "quality" of children as a reasonable concern, Edwards, intentionally or not, was advocating for a reproductive process that treats babies as products, manufactured to parental and cultural expectations, and subjected to quality control. When genetic disorders are transformed from an unexpected turn of fate into a parental "sin"—when disabled children are entirely their parents' fault—there is great potential for children with disabilities to lose the increased access, inclusion, and support they have gained in recent decades.

The potential eugenic use of IVF and PGD is only one area of concern.

Other moral issues raised by IVF and related technologies include:

• the manipulation and disposal of human embryos;
• whether parenthood is a right, vocation, or choice;
• the effect of reproductive technology on orphans and adoption;
• how the use of PGD for sex selection reinforces oppressive gender roles;
• the increase in "reproductive tourism," whereby citizens of wealthy nations travel to places like India for less expensive fertility treatment, including hiring poor women to serve as surrogates; and
• how our increasingly perfectionist parenting culture, in which parents are expected to do everything and more to ensure their children's ultimate success, might influence the use of reproductive technology, and vice versa.

Most aspiring parents who use IVF, with or without PGD, do not want "designer" babies. My husband and I used IVF with PGD to try to conceive a baby who would not inherit my disabling genetic bone disorder. We didn't care about our child's "quality," but we did hope to have a child who would be spared the pain and disability of frequent broken bones. Our PGD cycle failed and we now have three naturally conceived children, one of whom inherited the disorder, all of whom are gifts. We know from experience that the longing of parents for healthy babies is not merely understandable; it is utterly human.

But the ethical concerns raised by IVF are far from passé. Reproductive technology has progressed faster than our capacity to consider the ethical questions it raises. Even as we celebrate Robert Edwards's scientific accomplishments, let's give the moral implications of IVF the attention they deserve.