Ethical Minefield

I visited an in vitro fertilization (IVF) clinic today as part of our OB/GYN rotation. I am aware of the debate around assisted fertility – Should people who are infertile for whatever reason be able to use technology to achieve pregnancy? Should the government allocate any resource for assisted fertility? Isn’t infertility natural selection in play – that people who are infertile are not meant to pass their genes to the next generation? Are we interfering with evolution by providing the means for those people to achieve pregnancy? – but with the IVF clinic visit, I came to realize a whole broadened range of ethical issues beyond the rationale behind the use of IVF.

Okay, this is an IVF clinic, the people working here and the patients probably all have looked past the ethical issues of using IVF. But IVF comes with a slew of new ethical issues. Each IVF cycle produces a number of embryos; the guideline allows only one to be implanted, so the rest of them are frozen for five years. After that, the couple needs to make a decision on what to do with them – keep them frozen for another five years or let them thaw (and die). What if a couple splits during that time? Does each parent have custody of half of the embryos? What if the father gives custody of all of the embryos to the mother? Will he still be liable for child support if the mother then decides to have a child using one of the embryos? Just when the law and guidelines are interpreted to provide a solution to a scenario, more what-ifs can come up, each one pushes the ethical and legal boundaries and contributes to the minefield that can potentially blow up in the faces of doctors and patients.

One of the doctors told us that, after working in the IVF for a while, he came to realize that everyone needs to come to terms with each ethical dilemma that may arise with every decision. On the issue of when life starts, he has come to the conclusion that life does not always start at conception. Like with natural conceptions where chromosomal abnormalities are the most common cause of first-trimester miscarriage, a good percentage of the eggs fertilized via IVF technology contain chromosomal abnormalities and thus not viable for implantation. Not all eggs and sperms are created equal and, due to de novo mutations, not all embryos are created equal. To someone who believes absolutely that life begins at conception, the number of embryos destroyed for that reason alone would make the place seem on par with abortion clinics, not to mention the thawing of all the frozen embryos. Clearly, one would have to become a moral relativist to be able to work in this field.