"The Disposition Decision" -- What to Do With the
Embryos?
Posted: Friday, August
28, 2009 at 12:32 pm ET
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For
most Americans, the moral status of the human embryo is a question that
seems quite remote.
Even
as hundreds of thousands of "excess" human embryos are now stored in
American fertility clinics and laboratories, to most Americans these
frozen embryos are out of sight and out of mind. Thus, one of the most
important moral challenges of our day remains largely off the screen of
our national discourse. The issue cannot remain out of sight or out of
mind for long.
Indeed, for hundreds of thousands of couples (and
in many cases, just individuals) this crucial moral
question grows more difficult to ignore by the day. For those whose
progeny are now frozen in fertility clinics, the "disposition decision"
will eventually have to be made. The decision about the eventual
disposition of these human embryos will reveal what these couples truly
believe about human dignity and the sanctity of human life. On the
larger landscape, the pattern of these decisions and the policies
adopted by medical practitioners will reveal the soul of our culture as
well.
Writing in
The New Atlantis, Jacqueline Pfeffer Merrill contributes an
essay on this issue that is both informative and haunting. She begins
with an anecdote that establishes the moral sense of urgency we face on
this issue:
Noah Markham was born in January 2007 to
worldwide media notice. Like his Biblical namesake, this Noah had been
saved from a flood. He had been one in a barrel of frozen embryos
transported in a flat-bottomed boat from a flooded east New Orleans
hospital in the days after Hurricane Katrina by the Louisiana State
Police and Illinois Conservation Police. Interviewed at the time of
Noah’s birth, his mother, Rebekah Markham, said that she and her husband
Glen were uncertain about whether they would use their remaining three
frozen embryos to add to their family of Noah and his big brother Witt.
Interviewed again on the occasion of Noah’s first birthday, she said,
“How can I not? I’m happy with two, but how can you not when you know
what the possibility is? We almost lost Noah. I don’t want to lose the
others voluntarily.”
Of course, most of these stored human embryos are
not in direct danger of a hurricane. Nevertheless, they are all in
danger of both neglect and destruction -- a moral context of quicksand
that is the inevitable consequence of producing far greater numbers of
embryos than are ever intended to be transferred to a mother's womb.
Of course, the moral issues related to advanced
reproductive technologies are manifold and complicated. Advances in IVF
technology now project the potential that frozen embryos could be
successfully transferred into a womb years or even decades after
fertilization. For the first time in human history, this allows for a
form of generational confusion human beings have never encountered
before. Quite literally, an embryo from a genetic ancestor generation
could potentially be transferred into a womb and gestate, thus being
born after the generation of what would be considered his or her
grandchildren. Are we ready for this? A technology that has allowed so
many couples to give birth to desperately-wanted children has also
brought a host of moral complications.
Clearly, the majority of women whose fertilized
eggs are now stored in reproductive health clinics are not even ready to
make a decision about the disposition of the embryos that will not be
transferred into their wombs. Jacqueline Pfeffer Merrill cites two
studies indicating that over 70% of such women lack a plan for what to
do with these embryos and seem intent to postpone that decision as long
as possible.
In the most important part of her essay, Merrill
cites a study published in the scientific journal
Fertility and Sterility in which patients were asked to
rank their estimation of the moral status of the embryo from "minimum
moral status" to "maximum moral status." Only 10% of these patients
indicated their belief that the human embryo should be considered as
having "minimum moral status." But this means that one out of ten
patients responded that they consider the human embryo to be of
virtually no moral significance whatsoever. Some see these embryos as
something akin to excess body parts. Some actually spoke of these
embryos as being stored in the event they needed a "replacement" for
other children. As Merrill explains, "Presumably the disposition
decision is easiest for these few patients who think of embryos as
lacking moral worth, free of the weight of morally fraught deliberations
at the conclusion of their IVF treatment."
The other nine out of ten patients estimated the
moral status of their embryos on a continuum ranging from some moral
status to "maximum moral status." As these patients reflected, the
decision about what to do with their embryos was understood to be
freighted with moral consequence. As Merrill reports, these patients
recognized their own “strange feelings about discarding human life."
Nevertheless, "strange feelings" are no substitute for responsible moral
decision-making.
As Jacqueline Pfeffer Merrill makes clear, the
structure of the IVF process allows for hundreds of thousands of frozen
human embryos to be created in laboratories without any clear plan for
their future. She is undoubtedly correct in suggesting that most
patients see these embryos as the promise of fertility at the time of
their treatment. But what about these embryos and their future once the
childbearing years are over? Some patients indicated a willingness to
allow other infertile couples to "adopt" their embryos. Nevertheless,
these represent only a fraction of the patients involved in the study.
Furthermore, many of these individuals and couples are apparently more
theoretically committed to this option then in fact. In the end, very
few patients choose to allow the adoption of their embryos -- often seen
as akin to "virtual children."
Another small percentage indicated a willingness
to allow the embryos to be used in medical research. As Merrill
explains, this is often a hypothetical possibility anyway, since most of
these embryos are unsuitable for medical research. Of course the greater
problem with this option is that it views human embryos as mere material
for medical research. The embryos are destroyed in the name of medical
science.
A significant number of patients are deciding to
"thaw" their embryos and allow their demise. Hauntingly, Merrill writes
of some patients and couples who understand clearly enough that these
embryos are of some moral significance, and some patients express a
desire for some ceremony to accompany the demise of their embryonic
progeny.
For the vast majority of patients, the current
decision is to make no decision at all. This condition will not last,
for the reproductive technology industry faces logistical, moral,
financial, and technological limitations to the indefinite storage of
what may even now be more than a million human embryos that are never to
be transferred into wombs.
The "disposition decision" related to these frozen
human embryos represents one of the most significant, if neglected,
moral crises of our age. This crisis is entirely the result of our own
technologies and we as a society bear responsibility for this moral
crisis. As it now stands, we face the specter of untold thousands of
frozen human embryos who will meet their demise largely out of sight and
out of mind.
Perhaps the most chilling question is this: How
long will it be before someone asks about the moral status of all
human beings -- embryonic or otherwise --- and proposes that this moral
status be estimated on a continuum from "minimal moral status" to
"maximum moral status?" We cannot fool ourselves into thinking that this
essential question of human dignity will be restricted to frozen embryos
in the laboratory.
_____________________________
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