Our Duties towards the unborn

Jul 20, 2018

In Feb 2018, there was news that a Pune based woman became a grandmother to twins born via surrogacy methods, using her dead son's cryo-preserved semen.

Her life had come to an unexpected standstill when her son had succumbed to cancer in Germany in 2016.

Today, her joy knows no bounds!

As a woman, I cannot but feel happy for this woman and be grateful to the technology that allows us to do this- on the other hand, an IVF specialist, I worry about the moral obligations of posthumous reproduction.

As reproductive technology develops, it opens up several moral and ethical issues in its wake. For e.g.

What were the person’s wishes when they stored the sperm? Were these wishes re-ascertained nearer to their demise?

1. Is there a likelihood that they may have changed their views?

2. As this man was facing death, where his decision making skills compromised?

3. Who can take ownership of the stored sperm after death? Society expects a stable

partner/wife to not be in close relation to the man. Hence is it morally right for a man to leave his sperm to say his mother or sister?

4. In short can, biological gametes having the capacity to procreate be handed down, like

property? Curiously, I am reminded of Isaac Asimov’s quote, “The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom.”

I agree, that the decision whether or not to have a child is a private matter and a fundamental right of an individual adult. Yet, a single man, who after his death, wants to use his sperm with donor eggs, impregnate a donor's eggs and have a surrogate to carry the child, is actually not working towards parenthood, as neither he nor the donor nor the surrogate will become parents to the child that is born.

An unmarried person about to die leaves no fit parent for any child that is conceived after their death. Even before the child is born, it is an orphan.

Hence the other obvious part of this narrative is that welfare of the child should be paramount when it comes to IVF and surrogacy, or both.

What do you tell this child as he/she grows up? Your father died before you were born and the mother who gave the egg is unknown and the mother who carried you and delivered, actually didn't want you / can't keep you?

It can be crushing for the child to be told all this!

Also, if the grandparents are going to raise this child, then their age it decreases their physical ability to parent a child. Older parents/guardians will have age-related changes, hypertension, diabetes etc., will they make healthy parents? Does a child not deserve the love and protection of parents until fully grown and independent? Lastly, coming to the doctors who helped with the IVF and surrogacy- Are physicians obliged to do whatever the patient requests?

There has to be equilibrium between the autonomy of the treatment provider and the autonomy of the patient. It is morally binding upon the doctors to look out for the welfare of any resultant offspring that they help bring to this world.

Indeed in countries such as the UK, the HFEA demands that the treating physician completes a mandatory ‘welfare of child’ form. Practice directive 8A of the HFEA states that “No treatment services regulated by the HFEA (including intrauterine insemination - IUI) may be provided unless account has been taken of the welfare of any child who may be born as a result (including the need of that child for supportive parenting) and of any other child who may be affected by the birth.”

Unfortunately when such guidance and directives / regulations are sorely lacking in India, it becomes the duty of the treating doctor to stand by his Hippocratic oath. To do no harm- even to the unborn child.

So while it may never be possible to have a consensus on multitudes of issues that arise but at the same time it is not right to delegate these moral decisions to either philosophers and thinkers or government regulations.

Do No Harm needs to be the foundation for any complex decision making.

Dr. Rajalaxmi Walavalkar, Consultant, IVF and Reproductive surgery, Cocoon Fertility

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