NINETEEN EIGHTY-FOUR has ended, and Huxley's vision of the future in "Brave New World" now seems more likely than Orwell's. Huxley envisioned both state hatcheries that would replace human reproduction, and the chemical manipulation of human embryos while they developed to maturity in the laboratory. The hatcheries also predestined and conditioned the embryos. "Parenthood" became obsolete; "motherhood" was abolished, and made-to-government-specification children were the norm.
In 1985, we could be close to a future in which prefabricated human embryos are frozen and sold in supermarkets and through mail-order catalogs. One could order twins or triplets, and (eventually) a daughter could give birth to her genetic sister, who could in turn give birth to her genetic mother.
We can also picture a world in which human embryos are fabricated not for reproduction, but purely for experimental purposes. The embryos could be used for such things as testing the toxicity of new drugs, chemicals, and cosmetics, in much the way rabbits' eyes are now used. Are these developments we should look forward to and encourage? Fairy tales we can afford to ignore? Or real dangers we should attempt to avoid by reasonable legislation and regulation?
The birth of Baby Louise in England in 1978 ushered in the current wave of enthusiasm for in vitro fertilization (IVF) and embryo transfer (ET) and the related requirement for embryo research. The plight of infertile couples is devastatingly painful. The IVF process, which permits infertility caused by diseased fallopian tubes to be "bypassed" by surgically removing eggs from the woman, fertilizing them with her husband's sperm in a petri dish (in vitro) usually within hours after removal and then transferring the resulting embryos to her womb hours later for gestation (ET), has permited hundreds of infertile couples to have children.
Pictures of these children have graced the covers of leading popular magazines around the world, and their existence is the major argument in favor of artificial reproduction. But IVF has also raised serious issues about the status of the human embryo produced in the laboratory, and what should and should not be done with it if it is not transferred to the woman's womb. How should we view them? Should we purposely make them to exploit them? Should we be concerned with what the embryo is, what it looks like or what it feels? Or should we be concerned with what it will be, look like or feel?
One of the major areas of research involves freezing human embryos collected in IVF. The primary purpose is to use them for subsequent cycles if a pregnancy is not obtained, eliminating the need for additional surgery to recover more eggs. But what if a pregnancy is aceved, or if the couple dies before another attempt can be made? What should be done with the embryos?
The death of a wealthy American couple who left two frozen embryos in an Australian clinic has already caused an international debate. Should they be considered "orphans" and placed for "adoption"? Or like unclaimed baggage and given to the storage facility for whatever use is seen fit? Or simply disposed of since the reason they were created no longer exists?
Techniques for creating children without sex close a circle opened by effective contraception, which made sex without reproduction dependable. Society seems as supportive of these new techniques as it was of contraception, but more anxious about the implications which are likely to be at least as profound as those that have resulted from effective contraception.
For example, that the embryo can be transferred to a woman genetically unrelated to the woman from whom the egg was obtained means that now children can be born with five distinct parents: a genetic father; a rearing father; a mother who provides the egg; the woman in whose womb the embryo gestates, and the mother who ultimately rears the child. Separating the genetic and rearing roles of fathers has long been recognized as a possibility, summed up by Red Foxx's aphorism, "Momma's baby, Papa's maybe." But how should we react to the completely novel possibility of the separation of a child's genetic and gestational mother? As between the woman who contributed the genetic material in the egg and the woman who gestated the embryo and actually gave birth to the child, which one should properly rear the child?
Experimentation on the human embryo unfortunately has the same divisive potential as abortion since how one comes out on its propriety may depend excusively on one's view of the status of the embryo itself. Therefore compromises are difficult, and the use of inherently arbitrary definitions is to be expected.
We no longer ascribe to the medieval "homunculus" view that the sperm by itself contains a fully formed miniature human being that grows to baby size after it is successfully introduced into an egg. This view, well described by Laurence Sterne in "Tristram Shandy" (1759), holds that the homunculus "consists as we do, of skin, hair, fat flesh, veins, arteries, ligaments, nerves, cartilages, bones, marrow, brains, glands, genitals, humors, and articulations -- a being of as much activity -- and, in all senses of the word, as much and as truly our fellow-creature as my Lord Chancellor of England."
Shandy's view finds its modern counterpart in President Reagan, who asserted in the first presidential debate with Walter Mondale that "until and unless someone can establish that the unborn child is not a living human being, then that child is already protected by the Constitution." Although we cannot properly term the collection of cells that is the early human embryo a "child," as British professor of law and ethics Ian Kennedy notes, we "intuitively do not equate a fertilized human egg with a hamster or a piece of mouse tissue."
We also recognize that the human embryo is equal to more than the sum of its constituent parts. Not only does it have the complete genetic complement of a unique human being, it is also a powerful symbol of human regeneration and the future of the human race. We can thus value it and afford it legal protection from exploitation even though we do not similarly value or protect either the human egg or sperm.
But we do permit the loss of human embryos naturally, and even permit direct intervention to destroy human fetuses. Thus what we seem to be dealing with in discussing human embryo protection are the obligations that we incur by actively intervening in the natural process of human reproduction, and creating human embryos in the laboratory that are separate from the human female and must be dealt with on their own.
Only about 40 percent of all eggs fertilized within a woman through sexual intercourse successfully implant to initiate a pregnancy. No one in any culture has ever seriously contended that women should be required to make any effort at all to recover or rescue these unimplanted human embryos. Of course it is nature, and not our own actions, that have deemed that these embryos will not be permitted to mature. No human intervention is likely to affect the fate of such embryos in any event. When nature discards these embryos as a matter of course, we do not treat them as life forms that have died. We ignore these embryos and do not mourn them.
Consistent with the Shandy view of the embryo as a miniature child, the Reagan administration has refused to permit any federal funding of research on human embryos in the United States, and no formal research is done here. Limited embryo research is under way in England and Australia.
The primary rationale given by almost all proponents of human embryo research is that it is necessary to improve the success rates of IVF, now put at about 17 percent. The British Medical Research Council has also suggested that embryo research might be useful in understanding the nature of defective sperm function, preventing genetic defects and understanding developmental abnormalities. This agenda seems overstated, but we can properly assume that some reasonable scientific problems would be more easily dealt with by using human rather than animal embryos. This is a necessary, but not sufficient, condition for legal and ethical human experimentation.
Major public debate on the government's role in human experimentation began with the passage of the National Research Act of 1974. This act set up a national commission to study the regulation of human research, especially that relating to human fetuses. Strict regulations for such research were drawn up, and a de facto moratorium on research with human embryos commenced because these regulations required prior approval of a national Ethics Advisory Board (EAB) in addition to normal institutional and peer review.
The EAB proposed limiting the use of human embryos to very early stages of development, specifically requiring that "no embryos will be sustained in vitro (in the laboratory) beyond the state normally associated with the completion of implantation (14 days after fertilization)." This type of line-drawing is analogous to that used by the U.S. Supreme Court in its 1973 abortion decision where "viability" was set as the relevant time after which fetal interests could legally be protected, and paramount to most maternal interests. There are no maternal bodily privacy issues in embryo research, however, because the embryo is outside the woman's body. Thus we need not balance the embryo's "rights" versus those of its "mother."
The EAB's report was published in the Federal Register in June 1979. More than 13,000 public comments were received. The overwhelming majority were negative and concerned not IVF per se, but the destruction or disposal of human embryos. Health, Education and Welfare Secretary Joseph Califano also received letters from 20 senators and 73 representatives, most arguing that the potential abuses of the embryo outweighed the potential benefits. Given this response, it is not surprising that no action on the report was taken by Califano, his successor, the late Patricia Roberts Harris, or by either of Reagan's secretaries of Health and Human Services.
Although federally-funded research has been prohibited in the United States for all practical purposes, this ban has had only a marginal effect on the proliferation of IVF clinics around the country. Because IVF was introduced in the United States without a formal "research" stage, deriving its basic methodology from those developed in England and Australia, it is difficult to classify the work being done as human experimentation, innovative therapy or therapy. Nonetheless, the extracorporeal embryo has had to be dealt with directly, and almost all IVF programs have elected to deal with it by simply transferring all embryos created in the process to the otherwise infertile woman.
In Australia and England where research is openly conducted to improve IVF success rates, the public debate on the propriety of research on human embryos continues. In England, a commission under the leadership of Dame Mary Warnock approved embryo research in licensed facilities, but only until day 14, because day 15 marks the beginning of the "formation of the primitive streak" (which will become the spinal cord) and thus "the beginning of indivdiual development of the embryo." Similarly in Australia, the Waller Commission approved the use of "spare" embryos in research until day 14 because this is the end of the "stage of implantation; after this stage the primitive streak is formed and differentiation of the embryo is clearly evident."
There is thus international agreement that the human embryo is worthy of legal protection and cannot be treated like a hamster or other experimental animal. Legal protection does not require that we grant the human embryo personhood or citizenship, any more than we need grant a stand of redwood trees, a river or a dolphin personhood to protect them legally. Nor need we grant the embryo any rights of its own to afford it legal recognition. We need merely agree that it is an appropriate subject of our concern and protection.
There is also international agreement that no research should be permitted after 14 days following fertilization in the laboratory, but the reasons for this cutoff vary. Unfortunately, until the basis of a 14- day limit is more clearly articulated and publicly accepted, it cannot long serve as a legitimate regulatory boundary.
We can acknowledge a slippery slope without sliding down it. But if research on embryos will likely cheapen our view of human life and lead to the commercialization and sale of prefabricated human embryos, then achievement of all of the research goals thus far articulated will not be worth the price paid. We have already decided that kidneys should not be bought and sold. Forbidding the sale of manufactured human embryos is even more compelling.
Embryos, like babies from surrogate mothers, will be bought and sold in the belief that they will produce a healthy child, and possibly children of a certain physical type, IQ or stature. When the child is not born as warrantied or guaranteed, what remedies will the buyer have against the seller -- return defective goods for a refund, partial refund, or exchange? Because the sale of human embryos will quickly become confused with the sale of human children, regardless of how we come out on embryo research, the sale of human embryos should be legally prohibited.
Society is rightly concerned that science cannot restrain itself as we witness one media event after another in the area of heart transplantation research. Society has properly entered the era of regulation and prudently fears the potential dehumanizing impact of research on human embryos, and their production solely as a means to our own commercial and research ends. Unless and until socially satisfactory and enforceable boundaries to human embryo research are constructed in a principled manner, with meaningful public input, the de facto moratorium on human embryo research in the United States should continue.
On the related issue of defining motherhood, it seems most reasonable legally to assign rearing rights to the gestational as opposed to the genetic mother. This woman will have contributed more biologically to the child in terms of the pregnancy, will have risked more in terms of her own health, will have physically (and probably psychologically) bonded to the child and will definitely be with the child at the time it is born. Thus, not only will she be identifiable, she will also have made the greatest contribution to the child and, therefore, for both her own and the child's protection, she should be considered the child's legal mother. These guidelines will permit the donation of eggs and even embryos from one woman or couple to another (sometimes termed "prenatal adoption"), but does not necessitate permitting commerce in human embryos.
A model state law designed to clarify the identity of the gestational mother as the legal mother and outlaw the sale of human embryos should be drafted and enacted now. The moratorium on discussion of human embryo research should end, and the public examination of the issues it raises, begun by the EAB, should be renewed. The EAB itself should be reestablished with a substantial non-scientist majority to oversee all human embryo research.
Almost 30 years after he wrote "Brave New World," Huxley wrote in "Brave New World Revisted": "That we are being propelled in the direction of 'Brave New World' is obvious. But no less obvious is the fact that we can, if we so desire, refuse to cooperate with blind forces that are propelling us." Its time to take off the blindfold and confront the extracorporeal human embryo.