At its next meeting, in early April, the President's Council on Bioethics is expected to issue a long-awaited report on in vitro fertilization. The flowery deliberations of the council, which has been meeting under the leadership of the biologist and conservative ethicist Leon Kass for two years now, have been closely watched not just by infertility patients and their doctors but also by worried pro-choice activists. The pro-choicers' publicly voiced concern is predictable: They fear that the Kass commission (which has already released reports on stem-cell research and cloning) intends to use the IVF report as part of a back-door anti-abortion mission, further eroding abortion rights by granting the embryo enhanced moral standing. But privately, what has pro-choicers unnerved is their own failure to face up to the issues posed by the profitable and ever-growing field of high-tech baby-making.
It's easy to understand why Planned Parenthood, NARAL, and other reproductive-rights groups warily eye the work of Kass and his council of academics and others. When the bioethics group issued an overview of IVF technology last spring, there seemed to be a distinct ideological slant to their meditations on an industry that has produced more than a million children since Louise Brown was born in 1978. The first set of draft recommendations repeatedly referred to an embryo not as an embryo but as "nascent human life," "nascent life in vitro," or even a "child-to-be." Kass and Co. also took pains to lay out the ways in which IVF technology sometimes pits the interests of a potential parent against those of a potential child—by, for example, giving parents the ability to choose certain lab-made embryos for implantation, while passing over others. If you are a pro-choicer, you immediately think "dangerous precedent."
The early version, which surveyed the unsettling commercial aspects of a notably unregulated technology, also ventured policy options that would severely erode reproductive privacy. The draft proposed that every embryo created in the United States be tracked and records kept of its fate; that a federal registry be created of IVF children; that arrangements like paid surrogacy perhaps be prohibited.
But a curious convergence of ambivalence has been under way since then, as both the council and its critics have begun to take stock of the limitations of ideologically tidy positions. A new draft released by Kass' group several weeks ago was considerably watered down. The report lost much of the child-to-be-type language, abandoned drastic proposals for embryo inventories and a surrogacy ban, and preserved milder regulatory measures, such as closer monitoring of clinic outcomes. It's clear from their discussions that the council is torn on many issues. And the fissures extend upward. Arthur Caplan, a bioethicist at the University of Pennsylvania, points out that any call for greater regulation of the fertility field must be delivered to a president with a record of letting industries flourish unfettered. If you want to plead the cause of embryos, IVF is going to be a hard place to do it, because within the conservative fold, "there is a very strong internal tension between listening to the quasi-religious conservative voice and the libertarian market voice." When all is said and done, Caplan predicts, "there is no way they are going to regulate that industry."
But conservatives aren't the only ones with internal tensions. Assisted reproduction has exposed dilemmas within the same pro-choice groups that are monitoring Kass. Some of these came to light last summer, when a Newsweek article on the "fetal rights" movement pointed out that the latest reproductive technologies—providing, as they do, the ability to see embryos sooner and cultivating, as they do, an atmosphere in which pregnant women happily scrapbook those early ultrasounds—have created a real image problem for the pro-choice movement. As Kirsten Moore, the president of the Reproductive Health Technologies Project, put it, the piece "kind of prompted us to realize, oh my God, our movement's messages suck."
This realization led to a series of quiet conversations in the reproductive-rights community. As more and more women find themselves in fertility clinics, veteran pro-choice groups like Planned Parenthood are reconsidering the old paradigms. What does it mean for their approach, their pitch, and their priorities that a woman desperately hoping for a positive pregnancy test has a whole new attitude toward the embryo? "Women in their 20s and 30s are probably more worried that their eggs are going to age than whether they're going to be able to obtain an abortion," Moore acknowledges. Consultants were called in, who urged abortion rights groups to "reframe the debate" and "take back" words like "baby" and "mother."
"Unless Planned Parenthood can grapple with the bioethical issues of reproductive life in the 21st century, it's going to be left behind," said Paul Root Wolpe, another Penn bioethicist, during one of those conversations held at a Planned Parenthood retreat last summer. There, top brass, clinic staffers, and academics debated precisely the same issues as the Kass commission. They, too, talked about surrogacy, asking aloud how a women's organization should feel about women bearing the children of other, typically more affluent women; whether gay men paying surrogates and egg donors is a heartening example of collectivism or, as one attendee scathingly put it, "reproductive capitalism" in which "men with checkbooks" buy babies. They wondered how to think about sex selection, which enables would-be parents to destroy a female embryo in favor of a male one, or vice versa. Supporting abortion rights is one thing when it involves a desperate woman or girl. What about when it involves a fertility doctor implanting five embryos to raise his own clinic success rates, knowing he can then use selective reduction, which is essentially abortion by toxic injection, to winnow them down?
Must you, if you are Planned Parenthood, feel OK with every reproductive scenario that IVF makes possible? According to some, yes. Bob Blomberg, a veteran PP staffer, said that in his opinion sex selection is, like abortion, a private matter. Others were less certain. "With most reproductive technologies, I think that most of us are genuinely unsure," said a clinician from Poughkeepsie. Others begged the central staff to come up with positions and provide them with, say, a bulleted tip sheet.
"Every state is already proposing and passing legislation, and so far, when the legislators turn to us … and ask what is our position on surrogacy, and any number of other issues, our response is: nothing," said Patti Caldwell, the CEO of Planned Parenthood of Southern Arizona. "We have no comment. We have no position. It is deeply difficult for each of us in the field. There's 120 of us who speak to our press on a regular basis. … The time is now. Our legislatures are meeting now. We need to decide fairly quickly if there are things we can take a position on, and if there are things we can't, that we are clear on why we can't."
Arthur Caplan, one of the invited academics, ventured that children produced from egg and sperm donors have the right to know the identity of the donors. Nobody disagreed. There they were, the brain trust of Planned Parenthood, accepting that rights of unborn children sometimes trump the rights of the adults who begat them. At one point, one attendee told another that she sounded like Leon Kass. People laughed. The thing is, it was true.
Oddly enough, the real standoff may loom between two parties that would seem to be natural allies, the abortion-rights groups and the infertility-patients groups. Both of these movements are dedicated to helping women control their reproductive lives; both have closely monitored the Kass deliberations; both deeply oppose greater federal involvement in reproduction. "We don't want the government touching, monitoring, getting involved with our eggs, our sperm, our embryos," says Pamela Madsen, the head of the American Infertility Association. "It's ours, not theirs. Get their bloody mitts off of them."
That echoes the sentiments of the pro-choice camp, yet the two groups have a hard time striking common cause. "Their mandate," Madsen says of the women's organizations, "is not to support or protect reproductive rights when it comes to creation—only when it comes to abortion and birth control." Yet she's at pains to differentiate her mission from that of the abortion-rights camp. "We're about creating life, not ending it," she says. "We're the put them in people, not the take them out people." Which is not exactly true. In the case of frozen embryos, IVF patients are more like the "put some of them in, keep the others on standby" people. As for selective reduction—well, it's hard to deny that abortion can be part of IVF treatment. In fact, fertility clinics have long feared being targeted by pro-life protesters.
At the same time, the abortion groups are somewhat leery of Madsen, largely because of the unwelcome truth she represents: that eggs do age. That if you wait too long to have a baby, you may end up with no baby. "We need to know that we have a limited amount of time," Madsen urges. The tension IVF exposes is between old-line pro-choice groups that have dedicated themselves to the idea that women can indefinitely control their childbearing and newer infertility groups made up of women who, sadly, know better. Biology, sometimes, really is destiny, and women's groups are going to have to figure out how to accommodate that fact.