In vitro fertilization (IVF) has been on a long road to becoming an accepted method of conceiving children in the face of infertility in the United States. The technique, developed by researchers Robert “Bob” Edwards and Patrick Steptoe, involves the laparoscopic collection of matured oocytes (eggs) from a woman’s ovary through a small incision in the abdomen, fertilization outside of the body in the lab with a collected sperm specimen, and then the transfer of the resulting embryo back into the woman’s body. Almost two decades before 1978, the year that Louise Brown was born in England as the first successful IVF birth,[1] religious and secular arguments for or against IVF’s implementation could be traced back to reproductive rights legislation from the 1960s.

The 1965 Griswold v. Connecticut U.S. Supreme Court ruling asserted marriage as a fundamental area of privacy protected by the Ninth Amendment, inherently extending that privacy to the realm of procreation.[2] Seven years later, Eisenstadt v. Baird guaranteed “the right of the individual, married or single, to be free of unwarranted government intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child.”[3] In other words, single people, particularly women, supposedly now had the right to decide for themselves their own procreative path. IVF was a new technology that could allow them to do just that through a minimally invasive medical intervention in their bodies.

Since its implementation across the world, IVF has gained a controversial moral reputation

Yet, since its implementation across the world, IVF has gained a controversial moral reputation. In the mid-2000s, the Catholic Church across the world began waging a crusade against the technology, framing it as a “sophisticated form of abortion”[4] in that the disposal of unused embryos which is standard in the procedure constitutes killing a human being and as an interference in the divinely-sanctioned procreative process through marital intercourse. In response, Dr. Thomas Hilgers and the Pope Paul VI Institute in Omaha, Nebraska began promoting their church-approved ‘Natural Procreative Technology’ (also known as NaProTECHNOLOGY) throughout the Catholic world—spanning from Canada to Eastern Europe—as an effective method of conception for married couples that involves the hormonal or surgical treatment of infertility that promotes the in vivo—in the body, through marital intercourse—fertilization and growth of an embryo, despite a lack of evidence backing the procedure’s efficacy from the medical profession.[5]

In addition to the pushback from religious institutions, secular critics have been debating the moral permissibility of IVF since Edwards’ and Steptoe’s publication of their initial development of the IVF method in 1970 in Nature.[6] Like the Catholic church, many were concerned with the moral status of the early embryos, though less so about the interference in marital conception. The three most prominent stances are those of full-protectionists, modified-protectionists, or non-protectionists; either the early embryo created through IVF is a human with potential future sentience whom it is wrong to ‘kill’, that the early embryo does not have moral status but that the more developed zygote or fetus does, or that a human does not have moral status before birth.[7]

On the other side of the spectrum, Princeton’s own Peter Singer refutes the full-protectionist stance by stating it necessitates an extension to individual egg and sperm sex cells, which it would be ridiculous to try to prevent the disposal of.[8] Alternatively, in the eyes of Columbia political scientist Robert Blank, both the full and modified-protectionist stances are irrelevant to the moral impermissibility of IVF. To him, the moral status of the embryo doesn’t matter—IVF is an expensive use of taxpayer money on a procedure that hovers at around a ten percent success rate on the first round.[9] Both of the primary ethical review boards concerned with evaluating IVF in England and the United States—the Medical Research Council Advisory Group and the USA Ethics Advisory Board—rejected the embryo’s moral status issue as impertinent.[10] The MRC Advisory Group discussed the issue and deemed it ethically acceptable to continue research in spite of moral status concerns because the technology’s development was pertinent to “practical problems of clinical medicine.”[11] The USA Ethics Advisory Board came to the same conclusion in 1979, as long as embryo transfer was only attempted to “lawfully married couples,”[12] in spite of the Eisenstadt ruling in 1972 purportedly giving both married and single individuals the right to make their own decisions about how and whether to have children.

What is missing from these secular and religious mainstream debates about a technology which primarily involves intervention in a woman’s body is gender. Contemporary legal feminist philosophy is concerned with the assertion of women as free and equal citizens under the law while maintaining the unique inequities women face compared to men. Many of these inequities stem from female physiology and reproductive capacity.[13] To most contemporary feminists, women cannot be free and equal if they do not control their own bodies.  Therefore, in feminist circles, the moral status of the embryo is rarely discussed. Instead, the main concern is the gendered power dynamics surrounding a woman’s decision to undergo the procedure and a woman’s control over her own reproductive destiny. Feminist proponents of IVF emphasize the technology being a tool that gives women further control over their reproductive capacity: women have the ultimate power over whether a child will be born, whether if it will be genetically theirs, and whether the relevant risks are worth this child’s birth.[14] Yet, precisely this same power may also compel men to control women and their bodies. Feminist critics of IVF worry that the relevant women are not informed and aware of the associated risks of IVF—largely consisting of the physical pain of laparoscopy and the time and money eaten up by undergoing at least two two-week IVF cycles—as they are of the benefits.[15]

What is missing from these secular and religious mainstream debates about a technology which primarily involves intervention in a woman’s body is gender.

The USA Ethics Advisory Board actually concerned itself with this now feminist issue, making the focal point of their moral inquiry into IVF the proper consent procedures followed by physicians using the IVF technique.[16] This had come as a response to reports in JAMA that Edwards and Steptoe’s trials of IVF on female research subjects involved a murky consent process, where women were told their “only hope was to help [Edwards and Steptoe],” framing their participation in the study as a last hope solution to their fertility problems rather than the voluntary participation in a research inquiry.[17] Yet, despite this concern over the proper treatment of a woman and her body, the USA Ethics Advisory Board ended up concluding that IVF was only permissible for married couples—a man had to be involved. Clearly, the concern over the coercion of women was there, but so was the importance of her being bound to and protected by men: her husband, the researchers, and the government Ethics Board.

Almost 40 years later, as government control over women’s reproductive rights tightens in America under the current administration and the ethics of IVF continue to be debated, feminists still ask: where are the women? Why are the women’s voices drowned out by men’s in an issue that largely doesn’t concern them? Following January’s anti-abortion executive order, the Huffington Post published a series of noteworthy photos of roomfuls of men signing legislation about women’s health, pointing out the irony.[18] One could almost imagine a photo of the 1979 USA Ethics Advisory Board being among them.

 

References:

[1] Blank, Rationing Medicine, 63.

[2] Robert H. Blank, Rationing Medicine (New York: Columbia University Press, 1988), 61.

[3] “Eisenstadt v. Baird,” Oyez, Accessed October 22, 2017, https://www.oyez.org/cases/1971/70-17.

[4] Magdalena Radkowska-Walkowicz, “Between Advanced Medical Technology and Prayer:
Infertility Treatment in Post-Socialist Poland,” Sociologický Časopis / Czech Sociological Review 50, no. 06 (2014): 942.

[5] Ibid, 944.

[6] R. G. Edwards, P. C. Steptoe and J. M. Purdy, “Fertilization and cleavage in vitro of pre-ovulatory human oocytes” Nature 227 (1970), 1307-1309.

[7] Rosemarie Tong, Feminist Approaches to Bioethics (Boulder: Westview Press, 1997), 173-181.

[8] Peter Singer, “Technology and Procreation: How Far Should We Go?” Technology Review 88, no. 2 (February-March 1985), 27.

[9] Blank, Rationing Medicine, 189-252.

[10] Jennifer Gunning and Veronica English, Human In Vitro Fertilization: A Case Study in the Regulation of Medical Innovation (Brookfield, VT: Dartmouth Publishing Company, 1993), 15-31.

[11] Ibid., 16.

[12] Ibid., 19-20.

[13] Leslie Francis and Patricia Smith, “Feminist Philosophy of Law”, The Stanford Encyclopedia of Philosophy (Winter 2017), Edward N. Zalta (ed.), https://plato.stanford.edu/archives/win2017/entries/feminism-law/.

[14] Tong, Feminist Approaches to Bioethics, 184.

[15] Ibid., 181-186.

[16] Gunning and English, Human In Vitro Fertilization: A Case Study in the Regulation of Medical Innovation, 19-20.

[17] Paul Ramsey, “Shall We Reproduce: The Medical Ethics of in vitro Fertilization” JAMA 220, no 10, 1346-1350.

[18] Amanda Terkel and Sam Stein, “Great Moments In Roomfuls Of Men Legislating Women’s Bodies,” Huffington Post, January 23, 2017, sec. Politics, https://www.huffingtonpost.com/entry/men-legislating-womens-bodies_us_58866d4fe4b096b4a233edad.