This is a reproduction from New England Journal of Medicine, which is something one should read if you are one of the guys/girls who visit my blogpost and read my dreams.
In fact my book of dreams III is out now at Amazon.
I sometime feel what I dream are not dreams but real life situation acted on my relaxed and ACTIVE BRAIN WITH DIVINE INTERVENTION!
Made-to-Order Embryos for Sale — A Brave New World?
Embryo donation (also known as embryo adoption)
is the compassionate gifting of residual cryopreserved embryos by
consenting parents to infertile recipients. At present, only a limited
number of such transactions occur. In 2010, the last year for which U.S.
data were available, fewer than 1000 embryo donations were recorded.
These acts of giving, unencumbered by federal law, are being guided by a
limited number of state laws. Moreover, the practice is sanctioned by
professional societies, such as the American Society for Reproductive
Medicine, subject to the provision that “the selling of embryos per se
is ethically unacceptable.”
As such, the not-for-profit donation of existing embryos by consenting
parents comports with a triad of commonly held ethical attributes.
First, donated embryos are not sold for profit. Second, donated embryos
are (by original intent) generated for self-use. Third, donated embryos
are the product of an unambiguous parental unit and as such are
transferable. All told, embryo donation constitutes an established if
limited component of present-day assisted reproduction.
Embryo Banks
The
proliferation of commercial gamete sources (e.g., sperm and oocyte
banks) has opened the door to a made-to-order embryo industry in which
embryos are generated with a commercial transaction in mind. This
prospect of a for-profit embryo bank is no longer theoretical. Indeed,
as recently as November 2012, the Los Angeles Times reported on
one such clinic that “sharply cuts costs by creating a single batch of
embryos from one oocyte donor and one sperm donor, then divvying it up
among several patients.”
The report went on to state that “the clinic, not the customer,
controls the embryos, typically making babies for three or four patients
while paying just once for the donors and the laboratory work.”
At
present, the legal fabric relevant to the sale of embryos is limited.
Since there is no federal law on the subject — the National Organ
Transplant Act does not apply to gametes or embryos
— the practice appears to be legal in all but two states (a third is
more ambiguous). In Louisiana and Florida, the sale of embryos for
reproductive purposes as “valuable consideration” (i.e., beyond
reimbursement for costs) has been explicitly rendered illegal.
New York, in turn, prohibits the creation of embryos from donor gametes
for reproduction except on “the request of a specific patient who
intends to use such embryos for her own treatment,”
which might be read to prohibit made-to-order embryo banks, though the
language is more ambiguous. In this Sounding Board article we examine
the legal and ethical issues raised by made-to-order embryos for sale,
evaluate arguments for and against the practice, and recommend that
state legislatures and professional organizations collaborate to devise
legislative solutions to the thorniest challenges herein identified.
For-Profit Embryo Sale versus Nonprofit Donation
The
most obvious distinction between embryo donation and the sale of
made-to-order embryos is the fact that the latter constitutes a
for-profit transaction in which embryos are being treated as a
profit-generating commodity. In light of the above, the ethics of
selling made-to-order embryos could well be called into question.
Indeed, it could be advanced that the sale of embryos is more troubling
than the sale of gametes.
First, it might be postulated that the
sale of embryos will crowd out embryo donation and in so doing exclude
recipients of limited means. However, at present, there is no evidence
that this will occur. Moreover, given the limited availability of donor
embryos, further diminution of this pool appears to be inconsequential.
Second,
it could be argued that individuals will be coerced or exploited or
unduly induced into selling gametes in order to form embryos. However,
these concerns seem largely the same regardless of whether gametes are
used to create embryos at the behest of prospective parents or by a
commercial entity.
Third, it could be posited that the sale of
embryos denigrates the value of reproduction by turning it into a
commercial enterprise. To differentiate the sale of embryos from the
sale of gametes, one would need to show that it is more corrupting of
our views of reproduction than is the sale of gametes. It is unclear,
however whether this argument is an empirical claim about attitude
modification (that prohibition is justified to avoid the undesirable
consequence of changes of attitudes) or a principled argument (that
prohibition is justified even if undesirable consequences do not follow,
because the practice is intrinsically wrong) and how either might be
proven.
Furthermore, the argument that the sale of embryos denigrates
reproduction may be incompatible with views held by supporters of
reproductive rights and of human embryonic stem-cell therapies. In
particular, it may be difficult to claim that respect for personhood
requires that the sale of embryos be prohibited at a time when
parentally sanctioned embryonic destruction (with or without the
generation of a human embryonic stem-cell line) is being practiced. Even
if one believes that embryos deserve special respect not granted to
gametes, it is far from clear why the sale of embryos to facilitate
family building is any more contrary to that respect than the
destruction thereof.
Finally, it would be wrong to equate the
sale of embryos with the patently illegal sale of children. The latter
involves potential harm to an already existing child. The former
involves choosing whether particular children will be produced or not,
and the practice is more similar to the sale of gametes than the sale of
children. Other issues — such as concern about accidental incest, in
which children traceable to the same embryo batch later meet and become
romantically involved — apply equally to embryo donation and to gamete
sale more generally. In this context, the same potential solutions
(e.g., registries, limitations on the number of children attributable to
the same genetic parents) could be given consideration.
Existing versus Newly Created Embryos
Another
important distinction between embryo donation and embryo sale is the
reliance on existing surplus embryos as distinct from newly created
counterparts. To some observers, the latter may prove unacceptable
because it dehumanizes reproduction, either by turning it into
manufacturing or by distorting the parent–child relationship by
providing parents with overweening control over genetic traits with the
oppressive psychological parenting pressures that go with such control.
However, it is not immediately apparent whether the generation of new
embryos (possibly with limited preselected traits) is all that different
from ordering the constituent gametes replete with particular desired
attributes. Indeed, there may be fewer eugenic overtones or concerns
about oppressive parental expectations, in that parents are buying one
embryo from a batch of already made embryos, as compared with the more
bespoke practice of ordering specific desired gametes.
Furthermore,
it is not clear how the sale of made-to-order embryos differs from the
sale of oocytes for the manufacture of embryos by somatic-cell nuclear
transfer for stem-cell derivation, as is presently sanctioned by New
York State.
Indeed, one might think that this practice — creating embryos for the
purpose of destroying them to derive stem cells — is more ethically
challenging than the notion of creating embryos for the purpose of
alleviating infertility.
Legal Parentage of Made-to-Order Embryos
Finally,
there is the question of the parentage of made-to-order embryos.
Existing state (statutory and case) law establishes (if imperfectly)
legal parentage in the context of gamete donation. Similar guidance has
been provided (again imperfectly) for the disposition of cryopreserved
embryos whose parentage is being contested in the course of a legal
divorce. In contrast, however, state statutes relevant to embryo
donation are few and far between. Oklahoma requires physicians to file
with the court explicit consents from both the donor and recipient
parties to ensure the orderly transfer of parental rights and
obligations.
Georgia, in turn, requires that the transfer of legal parentage be
accomplished through a written contract and that the recipients petition
the court for an order of adoption to formalize the transaction.
It is unclear whether either of these schemes can be adapted to the
transfer of the legal parentage of made-to-order embryos. Indeed, in
this circumstance, the sole potential guardian is the very clinic
responsible for the generation and the sale of the embryos in question.
However,
uncertainties inevitably abound. What, for example, would happen to
made-to-order embryos if the relevant clinic goes bankrupt? What would
happen to such embryos if a gamete provider objects to the sale after
fertilization or demands that the embryos be returned or destroyed?
These unanswered legal questions give us the most pause about
mainstreaming made-to-order embryos. Coordinated efforts by legislators
and professionals will be required if this legal void is to be
addressed.
It is readily apparent why the prospect of
made-to-order embryos for sale may give rise to apprehension. However,
viewed through a legal and ethical lens, the concerns raised by this
potentiality appear to be similar to those associated with widely
accepted and more common reproductive technologies, such as the sale of
gametes. What is new and unique here is the lack of clear legal guidance
as to the parentage of the embryos in question. Joint efforts by state
legislatures and professional organizations will be required to forge
appropriate legislation if made-to-order embryos for sale are to become a
practicable reality.
