Ethical dilemmas in embryo harvesting, freezing, and genetic manipulation

¶ … Astrue v. Capato, the Supreme Court ruled that children conceived posthumously -- that is, through in vitro fertilization after the biological parent is deceased -- are not entitled to the same rights and privileges as children born while that parent is alive. The case refers specifically to the Social Security Act, which provides for the common welfare by establishing a system whereby children may be listed as dependents on their parents. Children who are born to parents during the course of the parent's lifetime, even if conceived via in vitro fertilization, are entitled to the parent's Social Security Benefits as well as to inheritance. However, in Astrue v. Capato, the court ruled that children conceived via in vitro fertilization after the biological parent has died are not classified as "dependents" or as heirs under the law. The decision has serious ramifications for health care workers who deal with cases that are similar to this one.

Although not expressly about the ethics of in vitro fertilization itself, Astrue v. Capato does raise important questions for health care workers. To discuss some of the ramifications and ethical issues in Astrue v. Capato, I interviewed a hospital administrator with over fifteen years of experience. The administrator has worked with the parents and children of in vitro fertilization, but had never before encountered a case involving a posthumously conceived child as in Astrue v. Capato. The administrator admitted to following the case closely when it was pending, and indicated that she was not surprised at the decision but would have preferred to see more decisive action on the part of her colleagues in terms of ensuring the rights of children born in situations like these. When asked about her worldview, the administrator paused and said, "I believe in equality, freedom, and justice. My worldview is constantly changing. I am open minded." When asked to articulate her nursing philosophy and philosophy regarding technologies like in vitro fertilization, the administrator said that in vitro is the mother's right, and did not see why the children born via in vitro fertilization should be treated differently. The administrator admits that she often finds herself pulled in two different directions, as the needs of healthcare workers and the patients they represent sometimes clash with the needs of insurance companies. The administrator suggested the Astrue v. Caputo case raises more ethical questions related to the health care system and how it dehumanizes patients, than it does to in vitro fertilization itself.

The hospital administrator also pointed out that Astrue v. Capato raises questions about issues related to the use of medical technologies, especially those used to create life. Creating life posthumously is a tricky area, noted the administrator, who said that she feared that occasionally people might decide to have multiple children in this manner without being prepared financially or psychologically to care for those children. The death of a loved one is a traumatic experience. As Capato herself stated during the heat of the trial, it was precisely the pain and suffering she felt that warrants greater sensitivity and attention. Parents whose children are conceived in a manner similar to that of the Capato twins should not necessarily be discriminated against, and nor should the children. The children do have a biological parent, and simply because that parent happens to be dead should not negate that child's access to essential services. The administrator said that it seemed strange that the siblings would receive preferential treatment, but also indicated something to the effect that the mother could potentially have five more children with the husband's sperm and that might end up creating further problems for her family as well as for the taxpayer. From a utilitarian standpoint, states the administrator, the Supreme Court's decision makes perfect sense. However, from a deontological point-of-view, the court's decision lacks merit.