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Tuesday, January 16, 2007

Blech to William Saletan

It's not that there aren't nuggets of truth in the Slate article, "The Embryo Factory" by William Saletan. It's just that it's written in such a glib manner that any chance he has to convince me of his argument is lost as he screws up his analogies and slides around on the slippery slope that is ethics and fertility treatments.

Profiting off of fertility treatments doesn't feel ethically sound. Knowing that someone is netting $43,000 due to my medical condition is sort of shitty. I wish medicine was a not-for-profit endeavour.


Please show me the fertility doctor who isn't a businessperson. Show me the fertility clinic that charges solely the cost of the procedure along with minor additional funds to put towards future research, rent, or office costs. Show me the sperm bank or egg donor that provides their services solely at cost. Even if you can find a friend or altruistic donor who is willing to give this ultimate gift, there are still people in line waiting to make money--the people who handle the transaction or harvest the eggs or draw up the legal documents or perform the procedure. People see a place to turn a profit and they are making money off of the needs of others. On that end, how can one judge Jennalee Ryan unless they are judging the entire industry? And I'm fine judging the entire industry, but people should be careful when pointing fingers that they're not involved in other for-profit endeavours off the backs of others. Diamonds anyone?

Do I find her endeavour completely sound? No--but one of the non-monetary elements that bothers me is also what appeals to me. How is that for the screening paradox? On one hand, she has gotten around the inherent judgement and screening in adoption by calling this "embryo donation." Since it is a donation, the person accepting the embryo isn't chosen. Like every other easy breeder out there, they are becoming a parent because they want to become a parent. As opposed to adoption where a person may want to become a parent, but they need to be screened and have an agency agree that they are ready to be parents. This is, of course, in the best interest of the child. One wouldn't want to place a child in an abusive situation. But since easy breeders don't have to jump through these hoops and prove their worthiness (anyone who has dealt with CPS knows that it is very difficult to remove a child from their home even when abuse has been proven so the whole "we all do have to prove our worthiness" argument doesn't really hold up), why should people who need to use a donor's embryo due to a medical condition or age? That's the paradox--I don't want the screening, but I do want the screening.

There have been cries of racism and eugenics. Saletan sounds horrified that a blond-haired blue-eyed customer would like to have a blond-haired, blue-eyed baby. In a world where it can take an additional ten minutes to get through the food store as everyone needs to ask you invasive questions about your children, I completely understand the desire to circumvent that situation by using donors that resemble you physically. I completely understand the desire to have a donor who is at the same education level as the prospective parent. I understand the desire to find your almost-doppelganger. The You who can conceive. The You who can provide you with the materials to reproduce.

I understand Saletan's fear that reproductive technology is a racing train out-of-control. Technological advances are moving faster than ethics, with the philosophers chasing after the train shouting their theses into thin air. It doesn't truly matter what ethicists think because science keeps proceeding and proceeding. They can keep commenting, but it would be more helpful to gauge the reaction of the community and report it rather than imposing ethical debates on situations that are outside their realm of understanding.

Diane Ehrensaft, a psychologist who often counsels families who are the products of A.R.T., asks two excellent questions (amongst many) in her book Mommies, Daddies, Donors, and Surrogates that ring out during this debate over Ryan's donation center. Do we (in this case, the collective we: Jennalee Ryan, reproductive endocrinologists, scientists, researchers, those who utilize A.R..T. to build their family) really know what we're doing--not just in regards to this donation center, but in regards to all the advances in reproductive technology? And what are we actually anxious about when it comes to these advances? I'm posing these questions to you because I have my own answers, but they're obviously not the only ones out there. And I'd like to add a third question: is science taking into account ethics when charging ahead--and whose ethics should be taken into account?

Maybe if Saletan had ever sat in the office at a fertility clinic and felt that desperation that comes from listing how long you've been trying and knowing the statistics of success, he would be able to form a better argument against Ryan's endeavour. It's not that one needs to have a personal stake in order to comment intelligently on an ethical dilemma. But Ehrensaft points out the obvious, "'Icky' feelings [about A.R.T.] reverberate loudly and clearly from people all around, in fact even more so because these folks have no investment in getting over their anxiety as they're not the ones who are hoping for a baby." Maybe the desire to have a child and the stark fact that I need assistance to do so enables me to quickly see the good in A.R.T. Or, on the other hand, perhaps if Saletan had personal experience with infertility or if he was a gay male seeking his best chance to become a parent, he would discuss the matter respectfully rather than trying to be sensational by creating mismatched analogies to wholesale vs. retail as well as finishing his article with the cold and crass statement: "Tested, personalized, affordable, disposable. You've come a long way, baby." Smoke this, Saletan.


Anonymous said...

There seems to be a lot of it in the media lately, between FS's under investigation in the UK and embryo banks. All sensationalised in the worst possible way.

It's all very well to want to discuss eugenics when it comes to ART, but to warble hysterically as if people are going to stop having babies through sex because IVF is, you know, so much more fun just kind of makes me tune out. Which is shame because there is a discussion to be had.

If I could make sure the people involved in these discussion were all starting out with the premise that infertility is, in fact, a legitimate medical condition worthy of treatment and not some form of mental illness or lifestyle choice, maybe we could get somewhere.


Anonymous said...

Obviously, mental illnesses are legitimate medical conditions also, That was an ill-thought-out reference to a specific comment I heard recently.

It was suggested that since infertility causes depression in many couples, the legitimate treatment should not be ART but... therapy. AD's if necessary.

I hope this person is also prepared to start a "don't use chemo - just make patients ok with death!" campaign for cancer patients.

I apologise for implying mental illnesses aren't real. Some of my best friends etc.


Anonymous said...

I find that I have this weird "ick" reaction to selling embryos (which is, honestly, what is going on) that I don't have when I think about selling eggs or sperm. I don't know why that is. I have to think about how I feel about this one and why I have an irrational "ick" response.

Anonymous said...

As far as Saletan's piece goes-give me a break! People have been selecting mates for characteristics they would like to propogate probably since we evolved all those years ago. The fact that Ms. Ryan made a statement like: "Who wants an ugly, stupid kid? I mean, come on, if you chose yourself" shows what kind of person she is. But, can you imagine if Ms. Ryan was doing her business for several years and it was determined she was selling embryos made from eggs and sperm from whoever she could pay the least for this service? And while the embryos are created from individuals who are attractive and intelligent, that can go only so far in determining what that blast will turn out to be as a baby, child or adult.
Saletan's financial figures assume perfect fertilization and all the best of every other step in ART. I think it this piece has stretched the reality of ART to some fantasyland of perfect retrieval, fertilization, transfer, implantation, pregnancy, blahdy-blah-blah. Which doesn't exist and frankly I don't think that her figures take into account what Ms. Ryan may have to pay an embryologist if/when this business really takes off.
I am actually more alarmed by the article in the side bar tagged "Can my embryos get freezer burn?" next to a picture of what must be a fetbryo around 2 months of gestational age. Then the "explainer" goes on to tell us how embryos are stored in liquid nitrogen. Why the F*&^ can't they show an 8 cell blast since that is what is actually getting frozen (under the best of circumstances). It enrages me the way that ART is misrepresented and sensationalized in the popular press.

Anonymous said...

i declare only people who have gone through IF are allowed right the rules/books/articles about it - then this sort of madness from non ivloved parties can stop being what is right and start beign just another point of view.

persoanlly it hinkt hey should odo a tv show like 'crash test mummy' for people who dont get IF and the strains it put people under - they should be hypnotised and set loose... then we'd see how tunes change after the 30th night in a row wondering if drug a is better than drug b or if that dodgy curry is to blame for your low temps post DTD...

I knbow more non medical people in the IF field who know more about the drugs and prodecures than anything - they research and research - no one goes into art blindly - we all knwo the odds,t he risk sna dhte miracles - we all want a slice of the joy that IS possible...

now all we need is society to back off and let us breatht oo would be nice.

lunarmagic said...

I think it's fairly obvious that the author of that article has NO idea what people go through. Selling embryos is a little weird... but when you think about it... it IS what (some) people want. Like you said... you want the screening but you don't want the screening. you want what's best for the child... but having to go through screening and waiting processes and being observed and graded when all you want is what other people seem to get without trying... well, it can feel like quite an insult.

So really to me... Ryan's business doesn't bother me too much. They already "sell" sperm and eggs. I don't see the big difference.

Oh, and about the mentality that seems to be all over the place in the media that IVF is an "easy way out". Like the article said - "Why risk it in your infertile, 40-year-old body when Ryan can find a healthy 25-year-old to carry it for you?" Excuse me?? Do they honestly think that any IFer WANTS to give up that biological link and use donor eggs and sperm? That they WANT to hand over gestation to someone they don't even know? The legal aspects alone of surrogacy are still such a muddle. Offhand snide remarks like that really piss me off.

Anonymous said...

But I may have missed the important questions. I'm just angry with the media lately.

1. There are pros as well as cons with for-profit medicine.

2. We never really know what we're doing til it's done. It is worth pausing to check for blatant errors, though.

3. The concern is that the consequences will not be worth it. The means will not turn out to justify the ends - at least not on balance, taking everyone's interests into account. Again, valid concern, just a little too much hysteria going on and not enough rational looking at the big picture.

For example - the clinic wants blue-eyed blond-haired donors because business is business. But why is it that the the demand for donors doesn't accurately reflect the broader racial mix of society? I'm pretty sure the answers to this question lie *outside* the ART industry.


Anonymous said...

I'm going to make this my last comment, I promise. There is much more to say about this. But I disagree with you about the role ethicists should take in this. Journalists are for reporting, ethicists need to take a more proactive role. Society on it's own has a poor general track record. Salem. Auschwitz.


mary said...

Having just finished a donor egg cycle this article hit close to home. Understanding and coming to terms with the fact that I had to give up the biological connection if I wanted children was one of the hardest things I've done. I can't imagine anyone choosing that if they didn't have to. Also I wanted a blond haired blue eyed donor because I am blond haired and blue eyed. Even though I was giving up the biological aspect I still wanted my children to look like me in some way (another thing that people who have biological children take for granted.) It is so hard to know you will never see your mother's eyes or your father's chin in your child.

Anyway, my real point is even though they are screeening and creating these "perfect" embryos, you never know really what you are getting. We used a well screened egg donor, got pg and miscarried soon after. We now just discovered that the donor has a rare genetic disorder that is fatal to all male babies and all females will be carriers. It was reccomended that we discard all of our frozen embryos. We thought we knew what we were getting into using a donr, but really there are no guarantees no matter how much you pay.

Anonymous said...

I agree...only people who have endured the heart break, desperation, disappointment, physical and emotional pain can comment at all on ART.

Anonymous said...

I commented on Bea's post today/yesterday on this.

Personally, profiting off someone's infertility makes me go "ick" too. But as long as there's a need, there will be a market for it. That's the basis of all economy. And clearly there's a need for Ryan's services.

It just makes me depressed to see how much societal ignorance there is regarding infertility and ART.

So yes. Blech to William Saletan. He doesn't get it. And he's pandering to the other people who don't get it either. The ones who think that couples who use Ryan's services are doing it strictly to have a blue eyed, blonde haired baby boy.


Paper_whore said...

I don't see how paying for an embryo is any different than the thousands of dollars adoptive parents pay for their child. No, with adoption the money is not labeled as paying for the child, but the adoptive parents are still forking over entirely too much money to the bureaucrats who make adoption possible in this country. So that part of selling embryos does not make me feel icky at all.

Sarah said...

I read a blurb about Ryan's services in the newspaper two weeks ago and thought it sounded like a fabulous idea. I think she is brilliant. An over 40 single woman I know is just now trying to decide if she will use donor eggs. She is already trying to get pg with donor sperm. In addition to mourning the loss of a biological connection to herself, she is also struggling with the cost aspect -- what if she spends all the money on an egg donor and doesn't get many viable embryos? Ryan's service seemed tailor made for her -- she wouldn't pay if there were no embryos, and she'd presumably get results much faster than if she chose to persue adoption of someone else's embryos or more traditional adoption. Win-win in my book.

I really don't think it sounds all that different from what is already done with egg and sperm donors. In fact, it seems as if it improves upon that process by taking some of the risk out of the process.

Anonymous said...

I've been writing about my experiences donating my 3 spare embryos. It cost me $18,000 to make all 6 but I'm not accepting any $ for my gift.

If donation is OK why not reimburse sperm donors, egg donors and the clinic for the cost of making embryos? But even tho I'm donating I disagree w/embryo donation in general. Here's why

Anonymous said...

I've been writing about my experiences donating my 3 spare embryos. It cost me $18,000 to make all 6 but I'm not accepting any $ for my gift.

If donation is OK why not reimburse sperm donors, egg donors and the clinic for the cost of making embryos? But even tho I'm donating I disagree w/embryo donation in general. Here's why