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Current and Future Issues in Assisted Reproduction
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Current and Future Issues in Assisted Reproduction

The last quarter of the twentieth century has given rise to reproductive technologies and arrangements that in the earlier part of the century could only be dreamed of by the authors of science fiction. We stand in the middle of this reproductive revolution, trying to cope with the developments that have already occurred but with an uneasy sense that the future may be even more complicated ethically than the past and the present. In this brief essay, I will survey recent ethical and public-policy discussions of two reproductive techniques (assisted insemination and in vitro fertilization) and one reproductive arrangement (surrogate motherhood). After distinguishing three phases in the normative debate, I will briefly comment on some of the characteristics of, and continuing ambiguities in, the ethical debate of the past 25 years. At the conclusion of the essay, I will attempt to anticipate three future issues in ethics and reproduction.

The Recent History of Ethics and Reproduction (1970-Present)

At least 12 major developments in ethical and public-policy debates about assisted reproduction have occurred in the past 25 years. They are:

  1. 1. Articles and essays on reproductive technologies by Leon Kass and Paul Ramsey, who express the conservative viewpoint, and Robert Edwards and Joseph Fletcher, who provide the liberal perspective (the early and middle 1970s);

  2. 2. The birth of Louise Brown, the first “test-tube” baby (1978);

  3. 3. The report of the HEW Ethics Advisory Board on in vitro fertilization (1978–1979);

  4. 4. The international debate about IVF, initiated by Australia and the United Kingdom (1982–1987);

  5. 5. Three sets of American Fertility Society guidelines on ethical aspects of the new reproductive technologies (1986, 1990, 1994);

  6. 6. The dispute between “surrogate mother” Mary Beth Whitehead and the Sterns about Baby M (1986–1988); [End Page 383]

  7. 7. The Vatican Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation (1987);

  8. 8. The Office of Technology Assessment reports on infertility and artificial insemination (1988);

  9. 9. The critique of assisted reproduction by some feminists (mid-1980s to the present);

  10. 10. A new federal law, the Fertility Clinic Success Rate and Certification Act of 1992 (Public Law 102-493, 24 October 1992);

  11. 11. The splitting of human embryos by researchers at George Washington University (October 1993); and

  12. 12. The report on new reproductive technologies by a Canadian Royal Commission (November 1993).

Major Phases in the Ethical and Public-Policy Debate

In retrospect, the discussion of reproductive ethics involves three distinct but overlapping phases. The first phase (1970–1978) is characterized by the writings of individual scholars, who commented on already-available techniques or who anticipated as-yet-undeveloped techniques like in vitro fertilization. Point 1 highlights the work of several of these scholars. The second phase (1979–1988) might well be called the heyday of guideline writing. The United States and specifically the HEW Ethics Advisory Board pioneered in this effort; soon thereafter, Australia, the United Kingdom, and numerous other European and North American countries followed suit. Points 3, 4, 5, and 8 illustrate this phase. Since at least 1986, a third phase can be identified, one that might best be called an agonizing reappraisal. The philosophical and theological critique of new reproductive technologies emerged almost simultaneously from some religious bodies and from some feminists. A new federal statute that threatened to impose heavy regulation on infertility clinics soon followed (Points 7, 9, and 10). The agonizing reappraisal reached its culmination in the report of the Canadian Royal Commission, Proceed with Care—the most thoroughgoing critique of the new reproductive technologies by a government-appointed study group (Point 12).

Perspectives on the Ethical Discussion of Assisted Reproduction

My first observation in reviewing the history of the debate about assisted reproduction is that feminist authors have contributed to the discussion in important ways. More specifically, the male-dominated commentaries of the early to mid-1970s tended to be technique- or arrangement-centered—e.g, shall we clone a human being?—whereas feminist authors have adopted a more person-centered approach, focusing especially on the physical and psychological suffering that many women experience in the quest for children. [End...