Androlog Mail:
> A woman, patient of a local physician, has requested insemination with a
> mixed "wash" preparation from her husband and brother-in-law. I am
> suggesting that the two samples be prepared and inseminated separately
> either in the same or alternate cycles...
This letter brings up an important point that is of general interest to
us all. When I read this, I thought it was one of my jokes I had just
received from a friend of mine. To me, the ethical questions of IVF and
ICSI really center around expense and convenience. With such a mixed
preparation, will the child be able to determine which of the two men is
his uncle and father? I am not a clinician, but suggest that the woman
consent to being inseminated with her husband's semen first. If that
fails, to try again with her brother-in-law, assuming everyone is in
agreement.
It is interesting to me that the institution's ethicist "wondered if
there [are] any ethical issues which should be considered about this
request". The fact that the very person who is employed to help
determine these issues puts the question to a general audience is an
indication of how broadly the field of assisted fertilization has failed
to develop a disciplined ethical groundwork for the incredible pace with
which we are developing techniques. This has been difficult because
ethical limitations on procedures will almost certainly result in
decreased revenues for the clinics offering them, where almost no limits
exist now. This has put our field in the difficult position in which
the individuals most suited to help develop the ethics surrounding the
issues are the least incented to do so.
But if a concerted effort is not made, and made quickly, to develop
this ethical format for the practice, it will backfire in two ways.
Eventually, the FDA will begin to question whether the government needs
to issue its own standards, taking away our control of the practice, and
the procedures that are currently being performed that would be limited
by such an ethical format will manifest their disasters. The recent
press on the birth of the octuplets is only one example. How many such
ethical violations will the press identify in 20 more years? We must
develop the ethics of our own technology. We cannot mimic Oppenheimer
and his colleagues who said of atomic weaponry "We only develop the
bomb, its up to the government to decide whether to use it or not."
History has judged them, fairly, in my mind for failing in participating
in the ethical discussions of their work. They were the only ones who
could integrate the science with the human question, since they were,
after all, human beings themselves.
We must develop a stringent ethical groundwork for our work. We
must do this, now.
W. Steven Ward, PhD
Director of Urologic Research
Division of Urology, MEB-588
Robert Wood Johnson Medical School
1 RWJ Pl.
New Brunswick, N.J. 08903
Tel: 732-235-8073
Fax: 732-235-6042
E-mail: sward@umdnj.edu
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