A Criticism of Moral Conservatism's View of in Vitro Fertilization and Embryo Transfer

A CRITICISM OF MORAL CONSERVATISM'S VIEW OF IN VITRO FERTILIZATION AND EMBRYO TRANSFER RICHARD M. ZANER* In a recent article, Hans O. Tiefel argues for "a more cautious or conservative position" on in vitro fertilization/embryo transfer (IVF/ET) for human beings [I]. His argument is not merely against recommendations for federal support for such programs but is to provide a "decisive" moral objection to this technology itself—whether used therapeutically or for purely research purposes [2]. His major point concerns the supposed "unknown risks" to the offspring. A subsidiary but also key point is that the requirements of informed consent cannot be fulfilled with regard to the offspring. A good deal of research into animal and human reproductivity has been conducted, with much evidence collected over die past decade from clinical applications of IVF/ET [2-6]. Nonetheless, Tiefel contends, "nobody knows for sure" about possible damages that may result to the infant-product of this technology. Because of this, we are obliged to make moral judgments in the absence of certain knowledge, and this means that an "ethics of risk" is needed. This ethics is guided by two main principles. (1) Every child is owed "a fair chance at physical and mental health," which requires that no parent should "take chances" with the health of any child-to-be. (2) Without clear and certain knowledge , and in the absence of informed consent from such an infant, no risk taking can be tolerated. His conclusion is that only total "abstinence" from IVF/ET is justified ediically. Tiefel's main argument is derived from Leon Kass's earlier argument. Kass urged that in these prospective experiments on the unconceived and the unborn, "it is not enough to know of any grave defects; one needs to know that there will be no such defects—or at least no more than there are without the procedure." He concluded, "The general presumption of ignorance is caution. When the subject-at-risk cannot * Stahlman Professor of Medical Ethics, School of Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee 37232.© 1984 by The University of Chicago. AH rights reserved. 0031-5982/84/2702-0386$01.00 200 I Richard M. Zaner · In Vitro Fertilization give consent, the presumption should be abstention" [7]. Tiefel cites and agrees widi Kass's principle: "One cannot ethically choose for the would-be-child die unknown hazards that he must face and simultaneously choose to give him life in which to face them" [7]. Parents otherwise unable to bear children have nonedieless earnestly desired to utilize IVF/ET. Like Kass before him, Tiefel regards these desires as unobjectionable in themselves. However, one cannot justify the use of this technology simply by appealing to diese desires. To accede to them, Tiefel believes, is to endorse a most unfortunate "ediical relativism." This would devastate medicine: "If one lets go of objective and universal values to defer to dubious patient choice, one also relinquishes the heart of medicine, whose life is the objective value of healing and doing no harm" [I]. Thus, IVF/ET cannot be ethicallyjustified by reference either to the future child or to the parents' desires. The claims of such moral conservatism require careful scrutiny, for they are expressive not only of a prominent view among some ethicists working within medicine but also of a widely held view in our society today. The (Question ofRisk to Offspring Even though the likelihood of possible but unknown risks is the major concern, it is quite difficult to telljust which risks concern Tiefel. At one point he asserts that one must have a "wide conception" of risk: "Mental or physical, emotional or social, possible or actual, detracting from the health or worth of any or all parties" [I]. This "wide conception," however, is not helpful, and not only because it is so sweepingly general and vague. The idea would also commit Tiefel to being opposed to many if not most "natural" pregnancies. After all, it is hardly unreasonable to point out that parents could not possibly know, in advance of initiating a pregnancy, what emotional, social, mental, or other actual or possible "risks" might occur and which would compromise the health or...