Personhood definitions and in vitro fertilization ethics

Personhood Debate vs. IVF

In 2010, developer of conception outside the human body technology, Robert G. Edwards, was awarded the Nobel Prize for Physiology or Medicine (Kolata). This open act of global recognition might be perceived as general acclaim for assisted reproductive technologies, which secure biologically inapt couples' reproduction by producing genetically related children for infertile parents, in conditions external to the human body. The present work is aimed at providing an insight into in vitro fertilization, dealing with the ethical aspects relevant to it with a special focus on personhood, and adopting an ethical stance regarding the extent to which this practice is permissible.

From a technical perspective, according to Discovery Life Journal, the process of in vitro fertilization involves five phases: ovulation hyper-stimulation, egg retrieval, insemination and fertilization, embryo culture and embryo transfer (Balasubramanian and Narayanan 15-16). During first stage, the woman ingests fertility medicines designed to enhance her monthly ovule production, and undergoes regular transvaginal ultrasounds and blood tests. Secondly, the ovules are extracted from the woman's ovaries in a surgical procedure executed under anesthesia.

Once the eggs are extracted, a few selected best are placed in an environmentally controlled chamber and mixed with sperm in a process named insemination. In this stage, the doctors might decide to perform intracytoplasmic sperm injection as an alternative to the natural fertilization process of the sperm into the ovule. The fourth phase of embryo culture occurs at approximately five days after fertilization, as the fertilized egg divides and becomes and embryo. At this point, the controversial option of pre-implantation genetic diagnosis is sometimes available, where specialists single out one cell from each embryo and investigate it for future genetic drawbacks. For the final stage, one or more embryos are transferred into the female womb in a surgical procedure conducted by the assigned physician, and the remaining embryos are either discarded or indefinitely stored.

Starting with 1978 and the birth of the first IVF-conceived child, the ethical focus transcended prior experimental onset with special emphasis on IVF itself, and shifted rather on dilemmas raised by the proceedings involved in the treatment. Specifically, the question of whether to preserve the resulting spare embryos for donation or further research ignited much controversy due to the increasing uncertainty revolving around the moral status of an embryo, and thus there was serious reserve in using, damaging or destroying human embryos. It is presently admitted that several of the procedures involved in the process, such as pre-embryo selection, cryopreservation, pre-implantation genetic screening, and even the transfer process itself, "pose significant risk of injury or destruction to the pre-embryos involved" (Will 44).

Between 1979 and 1985, Steinfels and Gorovitz argued that research would enhance IVF efficiency, Fletcher and Schulman even deemed it morally wrong to limit the potentially beneficial research, and Harris believed that it should not be allowed to waste any opportunity to "save or ameliorate lives" (Schermer and Keulartz 9). Although in this period the ethical concerns were still rather theoretical and hypothetical, a shift can be observed in the general focus, namely from concern with the well-being of the embryos, to concern with the psycho-social well-being of children already born under or growing up in these new and unusual circumstances.

Furthermore, by 1988, numerous ethical and regulatory committees had been appointed to issue acceptable public policies with regard to IVF. By and large, almost eighty-five committees in twenty-five countries elaborated statements, the majority of which seemed to converge on considering IVF ethically acceptable. Moreover, research based on human embryos was declared acceptable in principle by eleven committees, out of which six expressed that embryos should not be created exclusively for research purposes, whereas four would concede to that. However, the duration of embryo culture period for research purposes was limited to 14 days by nine out of the eleven committees (Schermer and Keulartz 10).

The period encompassed between years 1987 and 2000 is characterized by two main features in the IVF debate, namely the ideological critique of feminists and theologians, and the subdivision of the general IVF debate into multiple sub-debates focused on more specific problem-areas. While general guidelines were being engineered, applied and compared, several issues emerged in this third phase of the debate, which brought about a thorough reevaluation of the IVF ethical basis.

Most notably, the moral status attached to an embryo was still fervently argued, even though the emphasis had shifted from the problem of IVF-related embryo-loss and spare embryos, to the question of embryo experimentation. In this sense, the moral status of the embryo was one important matter but other issues surfaced, such as the nature of the experiments, the ethically acceptable period of embryo culture, the matter of using spare embryos as opposed to creating embryos strictly for research purposes, the proper motivations of such research and, lately, the use of embryonic stem cells for therapeutic goals. In addition, the embryo's personhood also became the central issue in the controversy about property rights over gametes and embryos. Thus, the dilemma expanded from the permissible utility of embryos to associating them either with children or property, to questioning the authority over extracorporeal embryos (Schermer and Keulartz 13).

Overall, it would be interesting to observe that the main arguments for and against the personhood of an embryo were noted rather early in the debate and seem to have been re-enunciated ever since. Yet despite that it is still largely undetermined whether a human embryo used in the process of in vitro fertilization has the same status as an adult person or not, the tendency now is to try and settle for some middle ground by granting the embryo some, but no full, moral status. Hence, this potentiality argument has helped to perceive the embryo as entitled to a certain amount of protection, and to a certain degree of respect.

Personhood, as an ethical theory applicable to IVF, aims to provide a framework in which human life enjoys "extended protection from the earliest moments of biological development, without any exception" (Will 64). Various concepts of personhood have been adopted at different times and places. For instance, Aristotle claimed that ensoulment or personhood occurs 40 days after conception for the male fetus and 80 days after conception for the female fetus or Muslims believe that personhood occurs 14 days after conception (Shaikh 35). What is more, Thomas Shannon contends that three weeks after the formation of the zygote, as totipotency gives way to specialized cellular development, a pre-embryo can be considered a person. From this perspective, prior to reaching third week, the pre-embryo is not an individual and cannot be deemed a person. Focusing on the argument from a totipotency standpoint results in the conclusion that human personhood and, consequently, human individuality, emerges in a matter of weeks after the ovum is fertilized (Shaikh 36).Two largely endorsed views of nowadays are that a human becomes a person either at the very moment of birth, or at the moment of conception. Within this confusing context, deciding the exact moment when an embryo is endowed with person rights based on its biological development might be erroneous.

The conservative outlook on IVF is represented by the Christian Ethics embodied in Catholic Church teachings, which claim that a human being is a valid person at the moment that the ovule is fertilized. In this theoretical onset, all prenatal life in post-fertilization is of full and equal moral status to that of all other persons, and no distinction is made between discarding an embryo and aborting a fetus, both being morally unacceptable. Consequently, adopting this view excludes selective pregnancy reduction and research conducted on embryos, and might require that all embryos be implanted during IVF instead of the usually selected few.

A divergent ethical standpoint, summarized by the arguments of Mary Anne Warren or Michael Tooley, holds that moral status is conferred by cognitive traits such as consciousness or reasoning, which newborns, fetuses and embryos altogether lack. In this light, fetuses and embryos are perceived as equally devoid of any significant moral quality (Botkin 17). However, most ethicists seem to settle for middle views, similar in advocating that all prenatal human life should be linked with a special moral status, but one that is not equal to that of a mature person. Specifically, these views generally propose that the relative moral status is determined by the embryo or fetus's developmental stage. Therefore, since the development process is largely perceived as a continuum, the moral status of the embryo or fetus allegedly increases with time.

It would be relevant to note that the two main ethical theories employed in supporting the IVF progressive policies may be Utilitarianism and Ethics of Care.

A Utilitarian approach is based on the assumption that the final goal of a constructive action justifies any means employed, and the right action is proved right only if it results in the most happiness and common welfare for the whole community. Beauchamp and Childress suggested in 2001 that the principle of utility "asserts that we ought always produce the maximal balance of positive value over disvalue (or the least possible disvalue, if only undesirable results can be achieved)" (341). Additionally, the utilitarian position presents the advantage of objectively quantifying the interests of everyone affected by the decision, for the sole purpose of promoting common welfare. Thus, harvesting, fertilizing, genetically screening, implanting and researching human embryos at the risk of damaging or destroying them - is entirely justified from this perspective, and any progressive endeavor is encouraged.

Nevertheless, this approach might involuntarily discourage many IVF clients as it appears to be too rigid and provides them with little autonomy in making decisions regarding their own embryos. Interestingly, a utilitarian might not even support IVF treatment, due to the risks involved in the whole process - namely a large financial loss if the process should fail -, an therefore it is uncertain whether or not this infertility treatment would meet the Utilitarian requirements of avoiding pain and creating the most amount of happiness; there might be a lot of future un-happiness more so than future happiness. Moreover, the IVF treatment is designed to unfold over a long period of time and might not be completed due to an unforeseen complication. In an extensive interpretation, Utilitarianism from an IVF onset may be seriously faulty, because the future is uncertain to the extent that it is virtually impossible to infer whether or not the baby grows up to become helpful for others and create happiness later in life.