How to Ethically Analyze Reproductive Technologies | Glenn Cohen | Big Think

So, reproductive technology is sort of a family of technologies. We have in vitro fertilization where essentially an egg is being fertilized outside of the body. So that involves harvesting eggs from women and then implanting sperm into that and putting it in. There are some variations on that.

Another very common form of reproductive technology is surrogacy. In surrogacy, an embryo is being carried by a woman who is not the genetic mother of the child, so another woman is carrying the egg and sperm combined into a fetus. And then we have a series of other brand new technologies like mitochondrial replacement therapy where you're taking the egg from one woman, you're removing the mitochondria from that egg and putting in the mitochondria from another egg to deal with mitochondrial disease.

Here, there's an idea that there's actually three genetic parents: the genetic father who provides the sperm, there's the mitochondrial donor, and there's the woman who donates the rest of the egg. So in reality, there's three genetic parents, even though the mitochondrial donor is only giving a very small part of genetic material in the DNA.

So those are three reproductive technologies. Two are very common. One is brand-new. And, of course, the oldest one that we have is artificial insemination. In fact, this goes back to the 1800s, I believe, in the United States at least. This is essentially when a man ejaculates his sperm and it's used to inseminate a woman, typically through an injection, although the old things they say about turkey basters are actually true. You can do at-home insemination with a turkey baster.

So those are four technologies: artificial insemination, in vitro fertilization, surrogacy, and mitochondrial replacement therapy. As a society, there's a series of, I would say, traditional and then more novel challenges posed by these technologies.

So the traditional ones involve, first of all, how do you get the sperm and egg? Is it ethical to purchase sperm and egg, and in particular egg, where women have to take hormones? With egg retrieval, there's some medical risks. Is it ethical or unethical to ask a woman to donate her egg or to sell her egg? How much can you pay a woman for that purpose?

With sperm, there's also, in particular, a question of sperm donor anonymity. In the United States, we allow sperm donors to be anonymous if they want to be. Most sperm donors in the United States are anonymous. Many other countries in the world require individuals to put their names and identifying information into a registry available to the child that's born. The donor can see the child at age 18, so the child can try to track down that person and try to make contact.

Many donor-conceived children say they have a right to know their genetic origins, a right to encounter this person. In the U.S., as a matter of law, we don't recognize that right. In terms of surrogacy, we really have two kinds of surrogacy. We have gestational surrogacy, where a woman carries a fetus from the sperm and egg of other people.

In traditional surrogacy, the surrogate is inseminated by a man's sperm but it's her egg. In traditional surrogacy, she's both the carrier of the baby as well as the genetic mother. In gestational surrogacy, she only carries the baby. There are cases that we have reported in literature, like the famous Baby M case, where women who carry babies for other people become attached to them.

They want to have the children as their own, and there is a break-up of the agreement that was made ahead of time when the baby is delivered. How should we adjudicate the rights of a surrogate? Do we think of the surrogate, just to use a provocative phrase, just as an oven, just a cupboard? Or do we think about that as a person who is a real mother to the child and not to have rights?

There's also a lot of transnational surrogacy where people go abroad to use surrogates, in particular to India, in part because the cost is so much lower and you have women serving as surrogates from poor villages, making for them a lot of money, much less than surrogates make in ...