Ethical Issues in In Vitro Fertilization

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National Reference Center for Bioethics Literature
The Joseph and Rose Kennedy Institute of Ethics
Box 571212, Georgetown University
Washington, DC 20057-1212
888-BIO-ETHX; 202-687-3885; fax: 202-687-6770
e-mail: [email protected]
Ethical Issues in
In Vitro Fertilization
Mary Carrington Coutts
It has been ten years since the birth of Louise Brown, the world’s first “test tube” baby, generated
in England with the assistance of Drs. Patrick Steptoe and Robert Edwards. It is estimated that by
the end of 1988, more than 12,000 babies will have been born worldwide using the medical
technique called in vitro fertilization (IVF). The original fear that babies fertilized in vitro would be
abnormal has not been substantiated by the early statistics and concerns now center on the complex
philosophical, religious, legal and social issues surrounding the use of assisted reproduction.
With trends in the United States toward more women working, later marriages and delayed child
bearing, more couples desiring children are discovering that they cannot conceive naturally. In 1982
the National Center for Health Statistics estimated that 8.5% of married couples of childbearing age
in the United States (2.4 million) were infertile (U.S. ... INFERTILIT Y..., p.9). As IVF becomes
more successful, more accessible, and perhaps less expensive, more couples will consider the option
of initiating pregnancy through the use of this new technology.
In the simplest case, a woman is given a course of hormone treatments to cause her ovaries to
produce multiple eggs. The eggs are surgically removed just prior to ovulation, either under general
anesthesia through the abdomen (laparoscopy) or under local anesthesia through the wall of the
vagina (transvaginal retrieval). They are then placed in a culture dish with the father’s sperm.
During the next few days, the dish is periodically examined to see if fertilization has occurred.
In approximately 48 hours, when the embryos reach the eight-cell stage, those that appear healthy
and that are growing normally are transferred into the uterus, where, it is hoped, some will implant
and develop full term. A woman may have to undergo several treatment cycles before she becomes
pregnant. (Gamete Intrafallopian Transfer (GIFT) is a variation of IVF, in which the sperm and eggs
are not combined outside the body in a culture dish; in the Scope Note, we will concern ourselves
only with IVF procedures where fertilization takes place outside the body.)
Current success rates vary; some clinics report pregnancy rates as high as 25% per treatment cycle
(American Fertility Society, p. 4), though half of the 169 IVF clinics in the United States have never
had a pregnancy. A criticism leveled at some IVF providers is that the clinics are misleading infertile
10 couples by not adequately informing patients of their chances of actually bringing a baby home from
the hospital (Blackwell, p.10); others defend IVF providers by stating that the success rate in
natural conception is not dramatically different from that achieved by the IVF clinics. Some of this
confusion can be attributed to the fact that many clinics report their success rates in terms of
pregnancies established, while patients are concerned with live, healthy babies.

In more complex permutations of in vitro fertiliza-
1987, the total expenditure on IVF was estimated
tion, third parties (known or unknown to the
at $66 million for the United States alone (U.S. ...,
couple) become involved in the reproductive
INFERTILITY..., p.9) The current price for one
process. It is now technically possible to use
treatment cycle varies, but the average cost is
donated sperm, donated eggs, and donated em-
$5,000. It may be necessary for a woman to
bryos. Surrogate motherhood employs a “bor-
undergo several treatment cycles before conceiving
rowed” uterus; one woman carries a fetus for
a child, and to bear the siguificant expense of the
another infertile woman and then gives the child
treatment as well as forego any income that she
up after birth (See Scope Note 6 in this series). In
might be earning were she not receiving treatment.
the future it may even be possible to use an artifi-
Currently, there are only five states where a health
cial uterus and to bring an infant to term com-
insurance company is required to pay for infertility
pletely outside of the womb. While some argue
treatment (Arkansas, Hawaii, Maryland, Massa-
that even “simple” IVF is objectionable, these
chusetts and Texas). Though the trend is toward
variations on the simplest form of in vitro fertiliza-
more insurers paying, most companies will not
tion raise additional ethical questions.
reimburse subscribers for IVF services because
they are still considered an “experimental” proce-
At a basic level, some believe that society should
dure. Thus, at the moment, IVF is largely limited
not allow any of the reproductive technologies
to those who are affluent enough to be able to pay
(artificial insemination, surrogate motherhood, sex
for the service themselves.
preselection, in vitro fertilization, etc.) because
they separate the conjugal act from the procreative
At a more specific level, there are ethical quanda-
act. This is seen as both unnatural and a threat to
ries surrounding the retrieval of the eggs, and their
the unity of the family and the dignity of the
subsequent treatment. The doctors involved in the
human person (Congregation..., p.5).
IVF procedure must strike a delicate balance
between retrieving and fertilizing enough eggs to
Others would argue that the world is already
establish a pregnancy, but not implanting so many
overpopulated, and that those unfortunate couples
preembryos that they are faced with a high occur-
not able to conceive naturally should adopt a child
rence of multiple pregnancies; these usually result
rather than struggle to conceive their own biologi-
in low birth weight babies, which have a statisti-
cal child. A related question is whether it is right to
cally higher risk of neonatal problems and death.
expend the significant economic resources re-
When doctors do have too many fertilized em-
quired to create just one child through IVF when
bryos to transfer back to the mother, they must
our health care resources are already overbur-
decide what to do with the “spare embryos.” There
are several possible alternatives: 1) discard them;
2) donate them to a recipient who is either unable
As with many other new or exotic medical proce-
to produce eggs, or whose genetic background
dures, there are questions about the fair allocation
makes it inadvisable for her to use her own egg, 3)
of resources and the selection of patients for the
freeze the embryos for later transfer, should no
IVF program. Most IVF programs and the profes-
pregnancy occur in the current cycle; or 4) donate
sional societies dealing with the reproductive
the embryos to a research project. All of these
technologies approve the use of IVF services for
options have stimulated the debate on the signifi-
married couples, and some accept unmarried
cance of the human embryo.
heterosexual couples who have established lasting
and stable relationships. The availability of IVF to
For some people involved in IVF, the decision to
lesbian couples and single women is much more
discard a spare embryo is a pragmatic one; the
restricted (Walters (1987), p.6). Other women may
embryos discarded are usually those that are not
be rejected from IVF programs because they are
developing properly in the culture dish, and thus
too old, because they already have children, or
may not be healthy enough to implant themselves
because they are unable to pay for the procedure.
if they were transferred to the womb. The early
disposal of these embryos is merely carrying out
In vitro fertilization is an expensive process. In
what nature would probably do herself. For others,

the moral significance of the embryo is much too
understanding of early human reproduction (and
important to permit its disposal.
perhaps to improve our success rates with the
reproductive technologies) or to study genetic or
The opportunity to donate one’s spare embryo to
chromosomal problems. Donating the embryo to
another couple is frequently attractive to couples
research provides the hope of contributing to new
involved with in vitro fertilization. These couples
knowledge about the reproductive process, and
have undoubtedly undergone a great deal of diffi-
thus perhaps helping couples in the future to
culty and emotional stress before they ever reached
overcome infertility.
the stage of having extra embryos themselves, and
the chance to help similarly unfortunate couples is
In all of the above options, the moral status of the
often welcomed. Critics of such embryo donation
embryo causes concern. Some have argued that the
programs point to the difficulties experienced by
human embryo is the moral equivalent of a human
adopted children and their parents. The uncertain-
adult or child, and as such, is due the utmost
ties of the genetic backgrounds of the donors and
respect. It should never be handled or manipulated
potential custody controversies are enough to deter
outside the body, and should never be subjected to
some who might consider accepting a donated
research. Some think that the embryo should only
be manipulated if the procedure will directly
benefit the embryo itself.
Freezing of “spare” embryos is attractive to pa-
tients and IVF clinicians for a number of reasons.
Others who are willing to allow IVF in some
It offers an opportunity to save embryos for subse-
circumstances would require that all embryos that
quent transfer into the mother, should the first
are fertilized and growing properly should be
implantation attempt fail. This saves the mother
transferred into the mother; freezing and embryo
the financial expense and the physical and emo-
donation are not morally acceptable because of
tional strain of a second laparoscopy procedure,
their experimental status, and, for these people,
and gives the IVF team a better chance of achiev-
disposing of spare embryos is also unacceptable.
ing a pregnancy. Yet the freezing of human em-
Still others argue that the very early human em-
bryos has its detractors. The effects of freezing are
bryo is not morally equivalent to a human being,
not known. A few children have been conceived
and that it is therefore acceptable to freeze the
using frozen embryos, and they appear to be
embryo or to perform limited research and to study
normal, but to date, there are so few children that
the embryo until it reaches a later stage of develop-
the safety of freezing is unknown. As the tech-
ment, perhaps 14 days after fertilization. It is
niques are still in the developmental stage, it is
argued that the value of the knowledge to be
argued that the human embryo is being subjected
gleaned from this research, carried out in a respect-
to a high risk procedure with unknown outcome
ful and closely monitored manner, outweighs our
and without being able to consent to its own
concerns about the moral status of the human
treatment. It is argued that life is too precious to
endanger in such a way. Some embryos do fail to
develop after being thawed, but supporters of
Legal concerns about IVF include the ownership
freezing believe that those embryos are probably
and status of the embryo in the event of divorce or
the weakest, and would be unlikely to implant
death. Some IVF clinics are now requiring poten-
themselves even in the natural reproductive pro-
tial parents to make specific decisions regarding
such matters before they undergo IVF treatment.
For example, parents need to decide if they would
The option to donate an embryo to research has
like their “orphan embryo” to be thawed and
some of the appeal to IVF couples of embryo
implanted in another person (perhaps a relative),
donation to a third party. Donating an embryo to
donated to research, or simply disposed of. There
research provides the hope of learning more about
is one court case where a couple sued the hospital
the reproductive process, and thus perhaps pre-
where their IVF procedure took place after a
venting future couples from remaining childless.
doctor allegedly disposed of an embryo he judged
The aim of such research is usually to improve our
to be unsuitable for implantation (Del Zio v.

Presbyterian Hospital (1978), U.S. District Court,
from ACOG, 409 12th Street S.W., Washington,
Southern District, New York). Additional issues
D.C. 20024, 202-638-5577.)
relate to the paternity of a child created with
ACOG approves the use of IVF and embryo
donated sperm, or a donated egg or embryo, and
placement provided that husband and wife
whether there is, in fact, a constitutional right to
participate and no embryos are frozen. Concerns
are raised over the optimum number of eggs to
be retrieved and fertilized (and the subsequent
IVF technology has so many potential applications
status of surplus embryos, should early IVF
that the “slippery slope” argument has frequently
procedures result in a pregnancy). The statement
been used as a justification to challenge its use.
supports insurance coverage for IVF procedures
Most people would agree that using IVF to pro-
and allows single women to be considered for
duce a generation of identical super warriors
IVF. Provisional approval is given to freezing of
would be an inappropriate and undesirable applica-
embryos, embryo donation, early gender selec-
tion of this medical technology. Yet, if we allow
tion (to avoid sex-linked disorders) and “embry-
IVF in its “basic” form, what other more complex
onic biopsies” as a type of prenatal diagnosis.
permutations of the technology should be legal?
The use of human embryos for laboratory re-
Should we allow couples to implant only male
search is advocated, provided that the research is
preembryos and to discard female preembryos? If
guided by ethical standards and is subject to peer
early embryos may be manipulated in a laboratory,
and subject to experimentation, what kinds of
manipulation are permissible and which are not?
American Fertility Society. Ethics Committee.
Ethical Considerations of the New Reproduc-
Ethics committees and government agencies and
tive Technologies. Fertility and Sterility 46(3),
commissions continue to play important roles in
Suppl. 1: 1s-94s. September 1986.
developing public policy and regulations regarding
The Committee finds “basic” IVF ethically
IVF and research on human embryos. Agencies
acceptable. Also conditionally accepted were the
and commissions in Great Britain, Australia,
use of donor sperm, donor eggs and donated
Canada and the United States have all studied the
preembryos. Uterine lavage, freezing of sperm,
issues and made different recommendations (see
eggs and embryos and surrogacy were also
section below). The Ethics Advisory Board of the
discussed, but there were enough concerns about
U.S. Department of Health, Education and Wel-
the practices that it recommends that they be
fare recommended in 1979 that “basic” IVF was
pursued only as clinical experiments. A 14-day
morally acceptable, but to date, the United States
limit is recommended for human embryo re-
government has been very slow to adopt guidelines
or to generate laws or regulations. Eight years after
the first Ethics Advisory Board was disbanded, a
Australia. New South Wales. Law Reform Com-
proposal has been made to establish a new Ethics
Advisory Board that would provide advice to the
Secretary of the Department of Health and Human
ney, Australia: The Commission, July 1988. 175 p.
Services on ethical issues in health care and bio-
In a proposal for establishing less stringent
medical research, including IVF, but at this time,
embryo research guidelines than those of neigh-
it is impossible to predict the impact of such a
boring Victoria, the New South Wales Law
Reform Commission recommends a 14-day
limit on research on human embryos. This
Committee Statements
longer time period is supported by the Commis-
sion as a way to bolster experiments that might
American College of Obstetricians and Gynecolo-
improve the success rates of IVF. The Commis-
gists. Committee on Ethics.
sion takes the stance that embyros need not be
given the full rights of a human being. The
Commission also recommends banning cloning
and cross- species fertilization and states that an
TEE STATEMENT. July 1986. 4 p. (Available

embryo should not be used, dealt with or dis-
is morally illicit. Also rejected are using live
posed of without the consent of the couple for
embryos for commercial or experimental pur-
whom the ovum was fertilized.
poses, freezing embryos, artificial insemination
for unmarried women, and surrogate mother-
Australia. Victoria. Committee to Consider the
Social, Ethical and Legal Issues Arising from In
Vitro Fertilization (Chairman: Louis Waller).
Great Britain. Department of Health and Social
Security. Committee of Inquiry into Human Ferti-
lisation and Embryology. (Chair: Dame Mary
and 88 p., respectively.
The Waller Commission accepts “basic” IVF for
Majesty’s Stationery Office, 1984. 103 p. (Also
married couples and permits the freezing of
available in the United States as: Warnock, Mary.
embryos. A five-year limit is placed on the
storage of embryos and embryo disposal is
permitted. Some embryo research is condoned,
AND EMBRYOLOGY. New York: Basil Black-
within a 14-day time frame, but no embryos are
well, 1985. 110 p.)
to be created solely for research purposes.
The Warnock Committee was established to
study issues of reproduction and embryology
Canada. Ontario Law Reform Commission. RE-
and to make recommendations for future British
legislation. Suggestions include creating a Li-
censing Authority to regulate and monitor re-
Ontario, Canada: The Commission, 1985. 2vols.
search and infertility services. Other topics in-
Artificial conception technologies, including
clude basic IVF; sperm, egg and embro dona-
IVF and in vivo fertilization followed by lavage,
tion; informed consent of participants; disposal
should continue to be made available in Ontario.
of embryos; and freezing sperm, eggs and em-
Single women should receive treatment. Also
bryos. A 14-day limit is suggested for study of
covered in the report were informed consent,
human embryos.
selection for treatment, commercial aspects of
the technologies, gamete banks, legal mother
U.S. Department of Health, Education and Wel-
and father, and confidentiality of medical re-
fare. Ethics Advisory Board. REPORT AND
cords. Specifically relating to IVF were recom-
mendations regarding the transfer of eggs,
fertilized ovum research (within a 14-day limit),
freezing of spare embryos and the status of
APPENDIX. Washington: Department of Health,
orphan embryos.
Education and Welfare, Ethics Advisory Board,
1979. 114 p. and 766 p., respectively.
Congregation for the Doctrine of the Faith. IN-
The Ethics Advisory Board concluded that the
conduct of research pertaining to IVF was ethi-
cally acceptable and that a model statute should
be drafted to define the rights of IVF donors,
offspring, parents and professionals. This report
can City: The Congregation, February 22, 1987.
was never accepted by any Secretary of the
(Reprinted in the New York Times, March 11,
Department of Health, Education and Welfare,
1987: A14-A17.)
and therefore no funding has ever been granted
The Vatican rejects the use of IVF because
nor any legislation drafted. This Ethics Advisory
“...The gift of life must be actualized in marriage
Board was disbanded in 1980; a proposal to
through the specific and exclusive acts of hus-
establish a new Ethics Advisory Board appeared
band and wife....” Thus the interference of the
in the Federal Register on September 12, 1988
physician or a donor in the procreative process
(pp. 35232-35233).

Walters, LeRoy. Ethical Issues in Human In
Law professor Annas reviews scientific and
Vitro Fertilization and Embryo Transfer. In:
societal developments in artificial reproduction
Milunsky, Aubrey; Annas, George J., eds. GE-
in the U.S., U.K. and Australia. The author
stresses the need for legislation and regulation of
Plenum Press, 1985: pp. 215-225.
the services, the need to define parenthood and
Walters surveys major ethical issues in human
the need to create guidelines for clinical practice.
IVF and/or embryo transfer both in the clinical
and laboratory settings. Six major ethical posi-
Eccles, Matthew R. The Uses of In Vitro Fertil-
tions taken by various government or religious
ization: Is There a Right to Bear or Beget a
committees are identified. The positions range
Child By Any Available Medical Means?
from advocating only natural reproduction to
Pepperdine Law Review 12(4): 1033-1057, 1985.
allowing clinical IVF with any kind of embryo
The author examines the legal question of
whether there is a constitutional right to conceive
and bear a child by means of the available
Walters, LeRoy. Ethics and the New Reproduc-
reproductive technologies. Eccles weighs the
tive Technologies: An International Review of
right to have access to IVF against the societal
Committee Statements. Hastings Center Report
concerns about possible abuses and inappropri-
17(3), Special Supplement: 3-9, June 1987.
ate uses.
This overview article summarizes the important
points covered by 15 major government commit-
King, Patricia A. Reproductive Technologies. In:
tees from eight countries on the topics of in vitro
BIOLAW, edited by James F. Childress, et al.
fertilization, surrogate motherhood and human
Volume 1, 1986. Resource Manual. Frederick,
embryo research. A detailed table includes an
Md.: University Publications of America, 1986:
indication of how each committee voted on
several issues relating to IVF’s general accept-
An overview of the reproductive technologies in
ability, on eligibility and counseling require-
general and specifically IVF, this article pro-
ments, on freezing or disposal of embryos, and
vides a discussion of the legal cases and laws
on third party involvement in IVF.
relating to IVF as well as an extensive bibliogra-
phy. Law professor King highlights the legal
Legal Aspects
climate for the reproductive technologies in
Great Britain, Canada, Australia and the U.S.
Andrews, Lori B. Legal and Ethical Aspects of
Quigley, Martin M. and Andrews, Lou B. Human
New Reproductive Technologies. Clinical Ob-
In Vitro Fertilization and the Law. Fertility and
stetrics and Gynecology 29(1): 190-204, March
Sterility 42(3): 348-355, September 1984.
A guide to the laws regulating IVF, intended for
Attorney Andrews discusses the legal atmo-
physicians undertaking the procedure. The
sphere in which we make our evaluation of IVF.
article identifies the legislation that relates to in
She briefly outlines the arguments made by the
vitro fertilization and the artificial insemination,
major committee statements and identifies the
paternity, adoption, fetal research, abortion,
U.S. laws that regulate the technologies in 1986.
human experimentation regulations that are also
She also addresses the moral issues of potential
relevant to IVF.
harm to participants, i.e., parents, children and
society as a whole, and concludes that develop-
Robertson, John A. Embryos, Families and
ments in the reproductive technologies need to
Procreative Liberty: The Legal Structure of the
be carefully monitored.
New Reproduction. Southern California Law
59(5): 942-1041, July 1986.
Annas, George J. Making Babies Without Sex:
This article studies the legal rights of persons
The Law and the Profits. American Journal of
hoping to have a child by employing one or
Public Health 74(12): 1415-1417, December
more of the reproductive technologies. Robert-
son evaluates the rights of the embryo, the

offspring, participants in collaborative reproduc-
en its scope and audience.
tion and their families. Concerns are also raised
about the commercial aspects of the reproduc-
Caplan, Arthur L. The Ethics of In Vitro Fertil-
tive technologies and necessary regulation.
ization. Primary Care 13(2): 241-253, June 1986.
In an overview of the ethical issues surrounding
Robertson, John A. Ethical and Legal Issues in
IVF, ethicist Caplan urges more subdued enthu-
Cryopreservation of Human Embryos. Fertility
siasm for the procedure and recommends careful
and Sterility 47(3): 371-381, March 1987.
oversight and regulation. In particular, the author
Although still experimental, the freeze-thawing
examines the concept of infertility as a disease,
of embryos is likely to prove effective and
resource allocation and IVF, and the moral status
economical, and will likely be incorporated into
of the embryo.
the routine IVF procedure. Legal, ethical and
policy issues that arise for society, physicians
Gerber, Rona. In Vitro Fertilization, AID and
and patients are examined.
Embryo Experimentation: Some Moral Con-
. Journal of Applied Philosophy 3(1):
Singer, Peter. Making Laws on Making Babies.
103-109, March 1986.
Hastings Center Report 15(4): 5-6, August 1985.
Gerber addresses the issue of the rights of hu-
A summary of the Infertility (Medical Proce-
man embryos created as a by-product of IVF and
dures) Act passed in Victoria, Australia in 1984.
concludes that their potential to become human
Based on the Waller Commission recommenda-
beings does not justify our granting them rights
tions, the legislation deals with the legality of
equivalent to those of human beings. She also
IVF, experimentation on embryos and surro-
discounts objections to IVF based on the unnatu-
ralness of the procedure.
Smith, George P. Australia’s Frozen ‘Orphan’
Grobstein, Clifford; Flower, Michael; and
Embryos: A Medical, Legal and Ethical Di-
Mendeloff, John. Frozen Embryos: Policy
lemma. Journal of Family Law 24(1): 27-41,
Issues. New England Journal of Medicine
312(24): 1584-1588, 13 June 1985.
The case of the American couple, Mario and
Issues associated with the freezing of embryos
Elsa Rios (who undertook a course of IVF
are examined, and approaches for resolving
treatment in Australia and were subsequently
them are suggested. Among the issues consid-
killed in a plane crash, leaving two unimplanted
ered are the risk of inducing abnormalities in the
“orphan” embryos), is examined. Smith outlines
embryo, the social and ethical implications of
the legal setting in which a decision had to be
freezing, and public policy options ranging from
made regarding the disposition of embryos left
active promotion to stringent government regula-
without parents or guardians, and without a will
tion at the federal and/or state levels.
to direct the IVF clinic.
Grobstein, Clifford. The Moral Uses of ‘Spare’
Philosophical Aspects
Embryos. Hastings Center Report 12(3): 5-6,
June 1982.
Brown, Jeremy.
Biologist Grobstein contends that freezing spare
Research on Human Em-
human embryos is not morally different from
bryos— A Justification. Journal of Medical
undertaking IVF itself. At least scientifically, a
Ethics 12(4): 201-205, December 1986.
person, or a multicellular individual does not
The author provides some common arguments
exist until it reaches the eight-cell stage of
against embryo experimentation and concludes
division. Thus it is morally licit to freeze an
that they are unconvincing arguments. Brown
embryo at the two-cell or four-cell stages be-
states that the intentional creation of embryos for
cause they do not bear the moral status of a
research is only wrong if one can also conclude
that current laws on abortion are also wrong. The
author also critiques the Warnock Report and
encourages the embryo research debate to broad-
Ozar, David T. The Case Against Thawing

Unused Frozen Embryos. Hastings Center
Gaare. Frederick, Md.: University Publications of
Report 15(4): 7-12, August 1985.
America, November 1986, pp. S31-S36.
Studying the case of the American millionaires,
Bonnicksen views IVF not only as a medical
the Rioses, who died leaving behind two frozen
issue, but as a significant political issue for
embryos, Ozar examines the rights of embryos
women as well. She raises the critics’ concerns
and fetuses, moral obligations owed them, and
surrounding the physical and emotional costs of
the value of life. It is concluded that, whether or
IVF, fears of gender selection abuse, and the
not one believes that embryos have moral rights,
high-tech nature of IVF and its impact on the
frozen embryos ought to be preserved until they
natural childbirth movement and on women’s
can be implanted or until they are no longer able
liability to produce healthy babies.
to survive.
Scarlett, B.F.; Singer, Peter; and Kuhse, Helga.
The Moral Status of Embryos. Journal of Medi-
cal Ethics 10(2): 79-81, June 1984.
CIAL WOMBS. New York: Harper & Row,
Scarlett challenges the argument that it is legiti-
1985. 374 p.
mate to destroy excess embryos produced by
Feminist Corea writes of IVF from the view-
IVF. There is a difference in potential between
point that many developments in the new repro-
an embryo and the gametes (eggs or sperm) that
ductive technologies stem from the male-domi-
can create an embryo. Even though it is moral to
nated medical establishment’s interest in con-
destroy sperm and eggs while they are separate,
trolling reproduction, and thus, the female body.
the embryo should be protected from destruction
Part III on IVF provides a history of the progress
as soon as it has been created.
in the technology, emphasizing the role that
women played and their frequent lack of consent
Singer, Peter and Dawson, Karen. IVF Technol-
to various procedures.
ogy and the Argument from Potential. Philoso-
phy and Public Affairs
17(2): 87-104, Spring
Golombok, Susan and Rust, John. The Warnock
Report and Single Women: What About the
The anti-abortion argument, that the human
Children? Journal of Medical Ethics 12(4):
embryo deserves protection because it has the
182-186, December 1986.
potential to become a human being, is chal-
Psychologists Golombok and Rust examine the
lenged as an argument against human embryo
development of children’s psycho-sexual iden-
tity and the impact this would have on a lesbian
or single woman who wished to use IVF or
Public Policy Aspects
artificial insemination to conceive a child. They
conclude that the Warnock Committee’s ratio-
nale for rejecting such women from IVF pro-
Abramowitz, Susan. A Stalemate on Test-Tube
grams is based on irrational fear, rather than on
Baby Research. Hastings Center Report 14(1):
rational thought. The authors do not foresee any
5-9, February 1984.
special problems for children brought up by
Although the now-defunct HEW Ethics Advi-
single or lesbian mothers.
sory Board concluded in 1979 that research on
IVF with embryo transfer was ethically accept-
Gorovitz, Samuel. Engineering Human Repro-
able, federal approval and funding was not
duction: A Challenge to Public Policy. Journal
forthcoming. Arguments over the moral status of
of Medicine and Philosophy 10(3): 267-274,
the embryo, the danger of abnormal fetuses, and
August 1985.
the possibility of undesirable applications of
New prospects for assisted reproduction require
research are the major reasons for delay.
the development of public policy concerning the
limits to reproductive autonomy and to research
Bonnicksen, Andrea. Feminist Dimensions of In
on human embryos. U.S. efforts to clarify policy
Vitro Fertilization. In: BIOLAW, Volume II,
on such matters have been limited; Gorovitz
1986. Edited by James F. Childress and Ruth

recommends Congressional action to stimulate
ment Printing Office, May 1988. 402 p.
debate and policy formation.
A compilation of facts, figures and perspectives
on infertility and infertility services in the United
Grobstein, Clifford. SCIENCE AND THE UN-
States. Includes information on the demography,
BORN. New York: Basic Books, 1988. 207 p.
prevention, diagnosis and treatment of infertility,
Although this book is broader in scope than just
as well as details on expense and insurance
the reproductive technologies, Grobstein exam-
coverage of infertility services. Appendices
ines the status of the embryo, and comments on
include pertinent fetal research laws, interna-
IVF’s implications for the fetus. The author
tional developments, and religious perspectives.
combines scientific, ethical and public policy
theory to discuss the controversy of the status
Religious Aspects
and treatment of the unborn.
Cahill, Lisa Sowle and McCormick, Richard A.
Singer, Peter and Wells, Deane. MAKING BA-
The Vatican Document on Bioethics. America
156(12): 246-248, 28 March 1987.
OF CONCEPTION. New York: Charles Scribner
While questioning the morality of the reproduc-
& Sons, 1985. 245 p.
tive technologies that employ third parties,
After describing the techniques and applications
Cahill challenges the Vatican’s refusal to permit
of some of the new reproductive technologies,
married couples to use IVF to overcome infertil-
the authors raise concerns regarding the rights of
ity. McCormick sees flaws in the Vatican docu-
the embryo, the risks involved in IVF, and issues
ment, centering around the condemnation of
of resource allocation and access to the new
reproduction without intercourse and on the
technologies. One appendix includes a survey of
“dominance of technology over the origin and
IVF patients and their attitudes to ethical issues.
destiny of the human person.” He suggests that
the Instruction be seen as a source of dialog
Uniacke, Suzanne. In Vitro Fertilization and the
within the Catholic Church.
Right to Reproduce. Bioethics 1(3): 241-254,
July 1987.
Johnstone, Brian V. In Vitro Fertilization and
The assumption that people have a right to have
Ethical Dualism. Linacre Quarterly 53(1):
children is considered in relation to the question
66-79, February 1986.
of whether society has an obligation to allocate
The author analyzes moral objections to IVF on
resources to make clinical IVF available, at least
the grounds that the procedure separates the
to married couples where the woman is infertile
“love union” (sexual intercourse) from procre-
and the couple provides the sperm and the egg.
ation. Using the framework of ethical dualism,
Johnstone challenges those who argue that the
United States. Congress. House. Committee on
“ends justify the means” and rejects IVF for its
Science and Technology. Subcommittee on Inves-
separation of the rational from the spiritual
tigations and Oversight. HUMAN EMBRYO
aspects of humanity.
TRANSFER. Washington: U.S. Government
Printing Office, 1985. (Hearings held August 8, 9,
May, William E. ‘Begotten, Not Made’: Further
1984.) 371 p.
Reflections on the Laboratory Generation of
In testimony before a Congressional subcommit-
Human Life. International Review of Natural
tee, a number of doctors, lawyers, theologians,
Family Planning 10(1): 1-22, Spring 1986.
philosophers and patients provide their perspec-
Theologian May argues that any act of generat-
tives of the ethical dilemmas surrounding IVF
ing human life that is non-marital is irresponsi-
and other reproductive technologies, specifically
ble and violates the respect due to human life in
focusing on legal and public policy concerns.
its generation.
United States. Congress. Office of Technology
McCormick, Richard A. Therapy or Tampering?
The Ethics of Reproductive Technology. Amer-
SOCIAL CHOICES. Washington: U.S. Govern-
ica 53(17): 396-403, 7 December 1985.

Responding to official Catholic doctrine, theolo-
Schenker, Joseph G. Jewish and Moslem Aspects
gian McCormick argues that not everything that
on In Vitro Fertilization and Embryo Transfer.
is artificial is unnatural. The author sees IVF
Annals of the New York Academy of Sciences 442:
“not as a substitute for sexual intimacy, but as a
601-607, 28 May 1985.
prolongation of it”, and not necessarily a separa-
An overview of Jewish and Moslem views of
tion of the conjugal and procreative acts.
IVF, artificial insemination, surrogate mother-
hood and embryo and oocyte donation. The
McDowell, Janet Dickey. Ethical Considerations
author outlines the religious laws governing both
of In Vitro Fertilization. Christian Century
faiths and the grounds for either rejecting or
100(30): 936-938, 19 October 1983.
supporting reproductive technologies.
The author challenges the Roman Catholic
church on its stand against IVF in all forms, but
Tiefel, Hans O. Human In Vitro Fertilization: A
raises concerns that IVF encourages an “obses-
Conservative View. Journal of the American
sive concern with having one’s own child.”
Medical Association 247(23): 3235-3242, 18 June
McDowell also discusses embryo transfer and
embryo and egg banking as outgrowths of
Tiefel contends that the unknown risks and
standard IVF that pose definite problems for
uncertainties associated with IVF, and the in-
Christians. Embryo transfer makes surrogate
fant’s inability to grant informed consent to its
motherhood possible, a practice that McDowell
own creation make the procedure immoral.
rejects because the kinds of relationships neces-
Every child is owed a fair chance at physical and
sary to make surrogacy work are not consistent
mental health, which requires that parents should
with Christian values. McDowell condemns
not take chances with the health of their child-
embryo banking because it purposefully creates
to-be. Also included is the relationship between
a life not desires by either genetic parent; a
abortion and IVF, freezing of embryos, non-
couple’s desire to experience pregnancy and
therapeutic research on embryos and public
birth does not outweigh the likely trauma to the
policy regarding the use of federal funds for IVF
O’Donovan, Oliver. BEGOTI’EN OR MADE?
Additional Readings
Oxford: Clarendon Press, 1979. 88 p.
Theologian Donovan discusses IVF in the con-
American Fertility Society. Ethics Committee.
text of Christianity and advancing medical
Ethical Considerations of the New Reproduc-
technologies. The author analyzes the use of
tive Technologies in the Light of the Instruction
donor gametes and IVF to assist infertility and
on Respect for Human Life in Its Origin and on
the changing concept of the human person in
the Dignity of Procreation Issued by the Con-
relation to the debate over human embryo re-
gregation for the Doctrine of the Faith. Fertility
and Sterility 49(2), Supplement 1, February 1988.
7 p.
Rosner, Fred. In Vitro Fertilization and Surro-
gate Motherhood: The Jewish View
. Journal of
Blackwell, Richard E. Are We Exploiting the
Religion and Health 22(2): 139-160, Summer
Infertile Couple? Fertility and Sterility 48(5):
735-739, November 1987.
Rosner discusses IVF in the context of the two
Jewish principles that life is of infinite value and
Brahams, Diana. Warnock Report on Human
that human beings are holy and must be treated
Fertilisation and Embryology. LAN C ET
with dignity and respect in life and death. While
2(8396): 238-238, 28 July 1984.
Jewish laws do not prohibit IVF, they do require
careful attention be paid to potential benefits and
Brandes, Joseph M., et al. Reduction in the
risks of “tampering with the very essence of
Number of Embryos in a Multiple Pregnancy
Quintuplet to Triplet. Fertility and Sterility

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