The Human Cost of In Vitro Fertilization Technique

The individual who is a servant of technique, Jacques Ellul writes, must be completely unconscious of himself. Without this quality, his reflexes and his inclinations are not properly adapted to technique (The Technological Society [New York, 1964]). These undramatic sentences refer to technique, Ellul's term for the single most efficient, most rational and economical way of handling any task. The servants of technique, accordingly, are those who are completely plugged into this or that technology. Such a person, says Ellul, has to pay what seems to me a horrendous price: it costs him his awareness of who and what he essentially is. Realizing how abstract this way of speaking is, Ellul cites an actual example, a test pilot whose wife cried tears of joy every time he came home from work. This restored the lost or suppressed consciousness of his putting his life at high risk every day and led him to give up his profession for the sake of his family.

I want to explore Ellul's thesis as it applies to a technique that did not reach fruition until about a quarter-century after La Technique appeared in 1954. The first so-called test-tube baby was born in 1978, and the servants of technique I will discuss are the physicians and technical assistants skilled at in vitro fertilization of human ova and the implanting of embryos in the womb to start pregnancies.

What is the process by which a servant of technique becomes completely unconscious of himself? What are the long-term consequences for someone who loses that portion of consciousness early in his career? In tackling these questions we need to keep in mind that a gynecologist with an IVF clienteleI will call him Dr Gtypically captains a team of trained personnel: licensed and registered hospital or clinic staff and lab technicians. The team is pledged to further a seemingly unimpeachable aim: helping couples overcome impediments to their fertility. Thus, when we speak of Dr G's becoming unconscious of himself, we are saying that his technical training has taught him to view IVF practices not as himself a human being who started life as an embryo, but strictly through the eyes of an IVF team member with his sights set on helping those would-be parents.

To make this clearer we turn to IVF procedures. Efficiency calls for the team to start a number of embryos, say four or five, so that if the first implant fails spares are immediately available. When the first implant triggers a pregnancy, the spares are no longer needed. It is easy to see why the notion of surplus or leftover embryos and of their disposal upsets a lot of people. Gena Corea, e.g., in The Mother Machine (New York, 1985) mentions protests against the potential wastage of embryos in IVF procedures. Traditional mores affirm a policy of Hands off! where the earliest stages of human life are concerned. Thus, it can seem grossly inappropriate for Dr G and his aides to start new lives, like their own, and then terminate some or most of them. When a servitor of technique such as Dr G apprehends those embryos as surplus and ripe for disposal, he apprehends them with the mind of a technical team rather than the mind of a personal self. To the team mind, it is not Dr G and his lab helpers but IVF technique that produced those embryos and, likewise, pronounces them surplus and orders them flushed down the sink or otherwise trashed. Technique directs the skilled and steady hands of Dr G and his aides. Viewed with a team mentality, technique appears in some undefined sense to be the sole responsible party among all the parties involved in the complex of IVF practices.

Obscurity is precisely what Dr G and his associates desire in the matter of responsibility. They are understandably in no position to implant unneeded and unwanted embryos or to nurture them themselves. Designating technique as responsible for the spare embryos lets individual team members off the hook. Like most of us, Dr G will have retained some elements of a traditional sensibility from his upbringing. Without a team mentality to shield him he would experience severe inner discord at the thought that he helped launch lives like his own without looking after them as he had been looked after at the embryonic stage.

Let us be more specific about the tensions Dr G would suffer if he viewed IVF practices through his personal mentality instead of a team's collective and exculpatory one. What does full-fledged membership on the team cost Dr G in terms of modifications of his consciousness of self? We begin with stress in the home. An in vitro team member, who as such has experienced a second upbringing, a technical one, typically lives with family members who have not. This makes for stress when his children or guests wonder what Dr G specializes in at the clinic. He might explain, I work with infertile couples anxious to have children. In a lot of cases we have to start an embryo in laboratory glassware, a test-tube baby as some people call it, and hope it will take hold inside the mother. Details about research on leftover embryos and methods of disposal are better left unmentioned to forestall gasps and quizzical glances. He knows the two upbringings can clash and, in the interests of domestic peace, openness about his line of work may suffer. At home he has to guard against giving away too much, but when he is actually serving the IVF technique, he can forget his being a family man. He can operate purely as a team functionary. Dr G is trained to bury the thought that he can see the embryo in himself and himself in the embryo. An apprehension of even a hint of equality between himself and an ill-fated leftover embryo would send him into a funk every time he unlocked the clinic door, and his service to IVF technique would sink that much closer to zero.

The ongoing moral tug-of-war over abortion poses another threat to Dr G's peace of mind. As Maureen McTeer says:

To ensure that a woman has a better chance of developing a pregnancy using IVF, several embryos are routinely transferred to her womb.... In some situations, where more embryos implant and begin to develop than the woman's womb can safely handle, one or more will be aborted.... This process is euphemistically referred to as selective reduction. The Tangled Womb (Toronto, 1992)

Again, it is technique that implants multiple embryos and calls for abortions when too many take root and threaten to crowd the womb. In thinking this way, Dr G assumes the non-human attitudes of the team mentality that prevails wherever IVF procedures are followed. Each local team is made up of individuals coached never to react personally to what their specialization requires them to do. The team seeks to spare its members any internal distress that might impair their efficiency.

Snapshots of beaming parents cuddling perfect offspring can take the sting out of criticisms of IVF practices. Sweet talk about curing infertility also helps to dim or soften the fact that the parents are as implicated as Dr G in the dark side of IVF, since practices such as trashing and aborting surplus embryos have been widely publicized. Nevertheless, a man and woman who turn to IVF technique once or, perhaps, twice in their lives are in a different situation from those who apply it every day. People in Dr G's profession shun deeper self-interrogation for the same reason they shun bungee jumping and skydiving jamborees: they have families and practices to look after, and they owe their patients a steady hand. Why introduce a new and risky complication into their lives? It would be extraordinary, I believe, for someone with Dr G's job to undertake a voyage of self-discovery that could cost him his profession. Whether a servant of IVF technique can be .completely unconscious of himself, as Ellul expressed it, is a question I do not answer, but all signs point to a severely limited consciousness of self, and for the very reason Ellul identified, viz., Dr G wants to be attuned to his demanding line of work. When a servant of technique is under a full head of steam, the suggestion that his consciousness of himself could be at stake must seem quite unreal.

If Dr G were to allow his personal mentality its full say, his reflection might be something like this: Here I am, a caring physician yet at the same time a routine destroyer of human embryos. My daily practice shows me thinking two ways at once about what it's worth to be one of those and to be turning into another life like my own, my wife's, or my child's. I regard a successfully implanted and healthy one as beyond price but leftover ones as trashable. Nobody treated my embryo as one too many.

Isn't it grotesquely out of line for me to treat as garbage what's turning into one more like me? What does IVF specialism tell me about what I think my own existence is worth, or about what I secretly think it's worth?

The hazards to Dr G's career of this line of thought hardly need to be spelled out.

Accordingly, when Dr G resolves to let the team mentality of IVF practitioners silence his personal inner voice, he gives the team mentality the final say on matters such as trashing or doing research on leftover embryos and aborting surplus implants. In other words, Dr G will let the team decide what, if anything, in his treatment of human embryos is unethical or horrible. This is part of what it costs Dr G to be an active and efficient member of an IVF team.

The self which the servant has ceased to be conscious of is the critic within, the side of Dr G's personal mentality that is sensitive to clashes between his original upbringing and his later, technical one. When Dr G suppresses that side of his mentality in order to follow a course the team dictates, he becomes unconscious of that side. As Ellul observes, Dr G's reflexes and inclinations would falter if that side were allowed to react every time he destroyed a human embryo. The critic within, that part of himself that sees himself in the embryo and vice versa, would recoil not only at the trashing of live embryos but also at the technique that calls for creation of spares in the first place. For Dr G to have a smooth career in IVF services, it is plain that his inner critic must not be overruled merely time after time but silenced once and for all; only then can Dr G be completely unconscious of that side of himself. The critical side of Dr G's mentality is also the personal, caring side, the side that watches out for his happiness, tries to spare him lasting regrets, and wouldn't mind if he earned bare subsistence digging clams.

What becomes of Dr G when he turns his back habitually on his caringly critical side? Is expelling from consciousness that side of his interior life, or silencing it for the length of his career, what Ellul, means by being completely unconscious of himself? I follow Elul's lead in not even hinting at any sort of mental pathology that would call for therapy. We use no clinical language in saying Dr G forsakes that critical but caring side of himself or exiles it. But ruling out pathology does not mean we rule out confusion, specifically confusion about the importance of the reactive and occasionally critical side of himself.

No one knows how serious it is to gag that loving critical side of oneself. Coming to know that aspect of the self is closely bound up with knowing oneself and thus with the conviction that oneself is worth knowing. Dr G risks a lot if he assumes that the questioning voice within him is anything less than an essential pan, even the very nucleus of himself. The servant of IVF technique is not unconscious of himself in an unqualified sensethat would be hard to imaginebut is indeed completely unconscious of any side of himself that is forbidden to enter his consciousness or is locked in some mental dungeon.

If the reactive, critical, and caring side is of the essence of self, the danger Dr G faces is dehumanization of a specific kind. It has nothing to do with maddog behaviour. Rather, it relates to the kind of duality that characterizes human interiority and nothing else on earth. I form part of a twosome with myself as the only kind of creature that uses reflexive verbs: I may blame or excuse myself, praise or curse myself, indulge or deny myself. The question then is: What happens if one side of Dr G's twosome refuses to notice the other side's critical reactions to his medical specialism and regularly censors them out of consciousness? Does that make a twosome that never came together to form a proper human self? Does it mean that one side of that self is developed while the other is arrested at a larval stage? The point is that, if no one has answers to questions like these, it would be extremely obtuse of Dr G to assume that his career as a votary of IVF technique can have only good consequences for himself, no distressing ones. A systematic forgetting of the dark side of IVF technique has unknown consequences for the forgetter.