All uses of assisted human reproduction technologies should be primarily child-centred, not adult-centred, as is the case today.
Apple's and Facebook's announcement last month that they would offer $20,000 health insurance coverage to women employees to cover the cost of freezing and storing their eggs, to enable them to postpone child-bearing and keep working, elicited a rush of commentary and debate. But only now are the full ethical ramifications of this proposal becoming fully clear.
Egg or ovarian tissue freezing can be used for medical or social reasons. Medical use — for example, freezing tissue from a young woman who might become infertile because of cancer treatment so she can later have her own children — does not raise the same ethical issues as social use, the issue I address here.
Many younger women journalists who called me opened our conversation saying they were at an age when they were thinking of having a baby and they felt very disturbed by this story, but were not sure why. A common comment was "It [egg freezing] just doesn't seem right." Their reaction is probably an example of the "ethical yuck factor" — we intuit that something is ethically wrong, but need time to explore the matter to identify the nature of that wrong.
We've had some of that time now. So, is egg freezing good for women? Is it good for the resulting child? Is it good for society? And is it good for corporations, such as Apple and Facebook?
The last question is the easiest and simplest to answer: If it wasn't good for the corporations, including their profits, they wouldn't offer to pay for it. What about women? A major goal of so-called "progressive values" adherents is maximizing individual autonomy and choice, in particular, "reproductive choice." Egg freezing augments the range of that choice: Have your babies when you retire at 60; have both a full career and a family, but sequentially and in that order.
However, as Seema Mohapatra points out in an article in the Harvard Law and Policy Review, offering egg freezing could mean women who choose not to postpone childbearing might be seen as not sufficiently committed to their career, thus harming their progress. Do such coercive possibilities mean a decision to postpone is not autonomous and free? Is that also true if a woman's parents offer to pay for freezing and storage, because they want to ensure they will have grandchildren? Is there informed consent to the risks of freezing the eggs? Until recently this was considered an experimental procedure. Is there false certainty and false hope that children will be possible when "the time is right"?
Will the time come where a woman who does not choose to postpone starting a family is seen as insufficiently committed to her profession?
What about the resulting child?
Although I've addressed the woman's perspective first, ethically all uses of assisted human reproduction technologies should be primarily child-centred, not adult-centred, as is almost always true at present.
It's too early to know whether egg freezing will harm resulting children, but there is emerging evidence that suggests that children conceived through in vitro fertilization may have more health problems than those naturally conceived. Is having an old mother harmful? Is there a reification and commodification of the future child, making him a thing or object put aside and stored on a "payment plan" to be claimed at a later date? What about the implied message that career is more important than the child or a family? And what about society? What will be the impact on important values on which we found our society of the technologization, depersonalization, dehumanization, commodification and commercialization of our most intimate relationship, that created by the passing on of life to our children? What will be the effect on the family and its members' relationships? How will issues of justice, raised because only rich people will have access to egg freezing, be handled? Does it matter that this is a further expansion of the "fertility industry" (the assisted human reproductive technologies market), which in 2013 was already a $16-billion a year enterprise worldwide? Does egg freezing differ in any ethically relevant respects from sperm freezing?
These are very real questions that we don't have answers to yet, but that need to be considered. We need to revalue the natural and to recognize that just because we can use technology to do an end run around nature does not mean that we are necessarily wise in doing so.
Margaret Somerville. "The ethics of egg freezing." National Post, (Canada) November 17, 2014.
Reprinted with permission of Margaret Somerville.
Margaret Somerville is Professor of Bioethics in the School of Medicine at the University of Notre Dame Australia. Until recently, she was Samuel Gale Professor of Law, Professor in the Faculty of Medicine, and Founding Director of the Centre for Medicine, Ethics and Law at McGill University, Montreal. She is the author of Bird on an Ethics Wire, The Ethical Imagination: CBC Massey Lectures, Death Talk: The Case Against Euthanasia and Physician-Assisted Suicide, The Ethical Canary: Science, Society, and the Human Spirit, and Do We Care?.Copyright © 2014 Margaret Somerville
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