Now that we can retrieve sperm from dead men and egg-bearing ovarian tissue from dead women, parenthood after death is possible for virtually anyone. No agency or group monitors this practice, so the number of children born this way can only be guessed at (although sperm retrieved posthumously has been used at least once). No law in the United States formally bars posthumous retrieval and use of gametes, leaving the option open to survivors and clinicians. And medical organizations are largely silent on the technique. In 1997 the American Society for Reproductive Medicine said that a request of this kind need not be honored, but that advisory does not mean, of course, that it can never be honored.
What standards of access and equity should apply in harvesting gametes? Whose requests for retrieval should be honored, if any? Are there risks to children that would outweigh the benefits of this kind of conception, and how would one know without evidence one way or the other? Are children produced this way entitled to the usual inheritance and social welfare benefits?
Or does none of this matter, really? Some bioethicists have chastised their peers for chasing these questions. When the topic came up in an online bioethics discussion group, one participant called attention to it obscene, in light of global problems concerning health care, hunger, and homelessness. In a couple of commentaries in the British Medical Journal, the bioethicist Leigh Turner has argued that if we mapped bioethicists' activities onto morbidity and mortality from a global perspective, we would see surprising disparities between what the intellectual vanguard of bioethics is doing and what the real-world needs of most people are.
In one way, the critics have it right. Disasters like the January 2005 tsunami across the Indian ocean can make the question of gamete harvesting look trivial. The media love drive-by ethics commentary, and some bioethicists have never missed a bandwagon. But, that said, there are pressing questions here with important legal and policy implications; how could bioethics not pay attention to them? And taking Turner's global perspective would ignore too much. The 1970s saw lots of ethical debate about parents withholding hydration and nutrition from newborns with severe disabilities. Measured against the needs of the world's children, that debate might be trivial, but without that inquiry, we would still be mired where we were three decades ago.
Moreover, there is a way to bring these issues all together. Responding to natural disasters like the tsunami requires political advocacy more than philosophical or ethical analysis, but political advocacy can be improved by thinking about the ethics of biomedical innovations like cloning, in vitro fertilization and embryo transfer, gamete donation, surrogate motherhood, and the posthumous collection of gametes. These innovations all raise questions about human identity and relationships: What identities are possible for children born with their help, when connections to deceased parents are simply biological? Are we forging new opportunities for human intimacy and well-being or fracturing the dynamics essential to family life?
These questions don't stop at the doors of the fertility clinics. Thinking about them and about how they can be altered by biomedical innovations can lead us on to other problems of global justice, which in turn can be thought about as issues of global health care relationships. What kind of relationships do we understand ourselves to be in with others, what responsibilities do we have toward others remote and unknown to us, and what moral ideas ought to guide us in building new relationships? What are our obligations to people in close relationships, and how do they compare with those we have to strangers?
Let's not assume that the only heavy lifting to be done in bioethics is political rhetoric about world hunger and disease. The analysis, understanding, and protection of relationships ought to be the touchstone for the field, and it can provide a common framework with which we can confront the challenges not only of technological innovation, but also of age-old scourges and mass calamities.