Sunday, July 12, 2009

Q&A with Gregory S Loeben, Ph.D. - Bioethics Professor at Midwestern University - Glendale, AZ

We asked our bioethics professor some questions pertaining to the Trebing case and the issue of discarded embryos in IVF/PGD. This is what we received.

1) What is an embryo to you, is it a human being? or a collection of cells? Explain.

I assume by embryo you mean the developing entity from conception onward. I point this out because the developmental continuum is long and the entity changes in important ways along that continuum. There are many ways to describe the entity and the appropriateness of those descriptions may change as the entity changes. The term embryo creates a certain picture in most people’s minds, an image that can then influence their beliefs about how it should be treated. This picture is usually not an accurate representation of the early stages in the developmental process so one might be careful about what language they use to refer to the developing entity.

Even in its early stages, the entity is clearly human because it has a human genetic code. But that doesn't tell us very much about it's overall ethical standing. All of my cells are human and yet they are not ethically valuable in the way that I am. Is it a human "being"? That depends on what you mean by adding the notion that it is a "being". I would argue that in the earliest stages the entity is human but is not yet a singular being. The argument for this includes the fact that the entity can actually be split (either on its own or manually) and will develop into more than one entity and can even reform back into one entity, as well as deeper philosophical ideas about what constitutes a "being". However, after a short period of time as it develops the entity clearly becomes a human being. There is no bright line where this happens. Biology works in processes more than sharp delineations. But on my view, relatively early on it becomes a human being. This does not mean that it is equal in ethical standing to all other human beings. We get some value in virtue of the fact that we are human beings, but that is not where all of our ethical value comes from. In the early stages of development, the embryo is human but there are a number of reasons why it's ethical value is considerably less than it will be as it progresses along the developmental continuum. This is important. There are many forms of life that we value less than people. Why? What is it about them that makes them appropriate to kill or eat or use? Is it simply that they are not human? That seems superficial to me. These other life forms can be complex, unique, and some are capable of emotion and awareness, and yet many people think it perfectly acceptable to kill them. Why? My point is that merely saying “life begins at conception” tells me very little. I can agree with that, but still think that the life in question is less valuable than other lives. And simply saying it is a human (because it clearly has human genetics) doesn’t tell me much about why I should value it more than other types of life. The explanations for why humans matter are more complex and don’t all apply (though some do) in the very early stages of our formation.

One other aspect I would mention is that ethical value can exist intrinsically (in the thing itself regardless of others valuing it) or extrinsically (as a result of someone valuing it). Early embryos can have value in themselves (which I would argue starts weak and becomes stronger) but they can also have value because someone (or some group) values them. For example, if this were my embryo and my partner and I valued it greatly in its early stages, that would affect the value of the entity in the world, not just for us, but generally. There is a sense in which the value of things that may not have great intrinsic value can be increased extrinsically by others valuing it. And this value needs to be considered as well, though exactly how to factor it in is difficult to state simply.

2) What are your thoughts on IVF/PGD and the embryos that are discarded during the process?

Such a complex issue. There are so many children in the world without families. In one sense, I find it sad that we can’t move our conceptions of parenting and family in ways that would allow people who want children to find greater satisfaction in adoption of children who already exist. Having said that, I also understand that many people desire to have a child that they have biologically created.

I am comfortable with IVF and PGD. In the very early multicellular stages, I do not think that these entities have substantial intrinsic worth, so I do not find their creation and destruction to be ethically wrong in itself. They can be applied inappropriately in particular instances, but that is a different concern.

There are two things about IVF and PGD that I find interesting. The first is that it is one area where a number of proponents of the view that “life begins at conception and the entity is a human worthy of full consideration” do not seem as uncomfortable with embryos created and discarded as part of assisted reproduction as they do with certain forms of birth control (for example, the morning after pill). Many people are consistent in their beliefs here, but it seems to be one area where inconsistency often appears.

Second, this is an area where you often hear objections based on the claim that it is “unnatural” which is an argument that I think suffers from overuse and a lack of clarity. The boundaries of what is “natural” are notoriously difficult to pin down conceptually. Often, the argument amounts to something like “I don’t like this thing and it’s being done in a way I don’t like.” Saying it is unnatural requires a more careful explanation of what makes something unnatural. On top of that, simply identifying it as unnatural isn’t enough. There are lots of unnatural things that people accept as morally good or required. Saying it is unnatural also requires that you say why this particular unnatural thing is bad when those other unnatural things are good.

3) If you were in the situation of the Trebing family and had the option of IVF/PGD to have a baby that will be able to save your ailing child, would you go through with it?

Yes. I find it disingenuous to argue that the Trebings are having a child for the wrong reason. People have children for all sorts of reasons, and sometimes for no reason at all. The Trebings are creating a child that they will love and who they hope will be able to help their other child. The burdens on that new child will not be unacceptable. The risks to it are not significantly greater than those on most other children brought into the world. In fact, they are far less than most other children in the world. And it is simply absurd to argue that they are only doing it to save their first child. People decide to have kids for a variety of reasons, but in the vast majority of cases the existence of the child and their love for it goes beyond those reasons.

4) Anything else you want to say, thoughts

What do people mean to be arguing when they make the statement that "everything happens for a reason"? In the video of people’s opinions, a young woman offers as a partial justification against the Trebing’s having a second child to save their first that everything happens for a reason. She appears to be implying that the death of the first child (if it occurs) can be seen as part of a larger plan. I fail to see why this is relevant and I find the widespread use of this belief as an argument to be particularly frustrating.

If everything happens for a reason, then anything that happens would happen for a reason, including having the second child to save the first. The belief offers no way to say which one the Trebing’s should do. It is simply a way after something happens to say that we should accept it as part of good system (if it was part of a bad system, why would we be relieved to say that it happened for a reason?). So, either one means this literally, in which case they seem to be saying that they believe all actions and choices and consequences are part of an ethically good larger plan that we don’t know and so we should accept them (if it doesn’t imply that we should accept them, why say it?). Or they are saying something like “I really don’t know what to think about this situation, so I’m just going to believe that this terrible thing (like the death of the Trebing’s child) is happening for a reason so I can feel better about it.” What a convenient belief to hold. With that belief we don’t need to determine good and bad, we can just believe that it’s all good at some level. This drives me a bit crazy. Things happen and reasons exist. That doesn’t mean everything happens for a (good) reason. And saying everything happens for a reason doesn't tell us anything about good and bad.

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