ART in America
Whether or not there is a veritable "epidemic," more responsible medical practice and better regulations would result in fewer multiple pregnancies and lower health risks for mothers and children. Doctors tend to leave the choice of how many embryos to implant to the patients, who are desperate to conceive and typically given little time and information to make the decision. LaMantia's pregnancy probably would have gone smoothly if her doctors had transferred two embryos instead of three. (She later gave birth to twins.) Mundy convincingly argues that the number of embryos transferred should be limited by law to two, as is already the case in much of Europe.
Another culprit here is the lack of federal funding for embryo research, thanks to antiabortion activism. We're more familiar with the impact of the funding ban on stem-cell research, the most promising area of medicine that holds the potential to cure diseases such as Parkinson's and maybe even to regrow limbs. But the same funding ban has seriously hampered reproductive medicine too, with the result that all experimentation happens inside wombs. Meanwhile, infertility groups support embryo research but oppose government regulation of the fertility industry, on the grounds of reproductive freedom. The two campaigns have contributed to more multiple pregnancies, miscarriages, selective reduction and infant mortality. In effect, these disparate ideologies have colluded to undermine the interests of their respective constituencies--"preborn children" and infertility patients.
Mundy emphasizes that while bioethicists and the media fret about "designer babies," the more pressing issue is closer to the opposite. ART is creating children with disadvantages--those from multiple births but also, as Kohl touches on, IVF singletons. This affects not only the children and parents but also society at large, in terms of staggering healthcare costs and special educational needs.
Yet these dangers seem unlikely to captivate the popular imagination the way designer babies have: low birth weight, miscarriages and overwhelmed parents are mundane, compared with choosing Tyler's eye color or trying to engineer Chloe's IQ. The prospect of manufacturing a dream baby plays on desires and fears, harking back to our uncertainty about the ethics of usurping God or nature. Our doubts derive not only from the hazards of the process or the inequities that would ensue; the awesome possibilities are themselves threatening. In the same vein, one wonders if the right-wing resistance to stem-cell science is about more than the embryo. Perhaps, especially to people of conservative temperament, there's something hubristic, even blasphemous, about the radical curative potential. Even those of us who support stem-cell research can probably relate to the uneasiness about revolutionary advances and miracles of human provenance.
Such uneasiness regarding these and other innovations is a reaction to what bioethicists call a "yuck factor." These cringes are worth our attention, especially in the realm of personal decisions. But a big part of the yuck factor is novelty. In 1985 Leon Kass, the conservative bioethicist and future chair of the President's Council on Bioethics (2002-05), thundered that IVF would inevitably lead to "self-degradation and dehumanization." Now he endorses the treatment for married couples. Kass famously relies on the "wisdom of repugnance" in assessing biotechnology, but apparently repugnance has a half-life.
The yuck factor is alive today, but its power is eroding as we become ever more blasé about novelty and as our connections with nature become ever more mediated. That's why, in the end, ART isn't really very shocking. On the contrary, it fits right into our world. Although some ART parents hesitate to tell their children about their origins, the kids in Mundy's book don't seem particularly nonplussed. "I'm a miracle!" exults one little girl. A teenage boy says, charmingly, "I'm very thankful for all the technology and all the money put into, um, me."
After all, to kids who grow up in a culture thoroughly dominated by technology and commercialism, what could seem more natural? Indeed, given the extreme measures some take to produce children, the debt and the hormone injections and the devastating failures, what seems amazing is that other people accomplish the same feat with a method that's free and easy and that they'd presumably be more than happy to do anyway. Now that is a miracle.