The following excerpt is from Chapter One "Emotional and Ethical Consideration of Assisted Reproductive Technology." This book is published by Perspectives Press: The Infertility and Adoption Publisher.

For the first time in history, as an outgrowth of in vitro fertilization technology and research, the three components of parenthood -- the genetic, the gestational, and the nurturant -- can be separated, so that the loss of one does not necessarily result in the loss of the others. For a man or woman who may not be able to conceive a child genetically connected to him or her, ovum donation or sperm donation offers the opportunity for gestation and parenting of a child genetically connected to half of the couple. For a woman unable to carry a pregnancy to term, gestational care may be the alternative of choice. For couples who cannot provide egg or sperm, but who wish to experience pregnancy, embryo adoption may be an alternative route to parenthood.

Reproductive choices are not made easily. As couples near the end of their biological options, most contemplate -- if only for a split second -- what it would be like not to be parents at all. If they decide that raising children is their primary goal, they begin to think about alternative routes to parenthood. The array of adoption and third party parenting options available challenges couples to examine the relative importance to them of gestational vs. genetic connections. Prospective parents must think carefully about what it would mean to them to be a parent without experiencing pregnancy, or a parent with no genetic connection to their child. Others contemplate what it would be like not to be parents at all...

The Separate Components of Parenthood: Ethical Considerations
"Just because we can do something, should we do it?" This is a question that has plagued scientists in the last half of the twentieth century. The field of reproductive medicine in particular has faced this question -- perhaps more than any other field. The array of parenting options afforded by reproductive technology is staggering. The development of in vitro fertilization has made it possible for one child to have as many as five different "parents" -- an ovum donor, a sperm donor, a gestational carrier, and two adoptive (rearing) parents. Furthermore, cryopreservation of sperm and of embryos has enabled people to preserve their potential fertility almost indefinitely. Cryopreservation of embryos has even enabled posthumous motherhood to be possible. The new parenting paths -- and configurations -- raise a profoundly difficult and often disturbing ethical question: Is it in the best interest of children to be created and parented through third, fourth, or even fifth parties?

The Right to Reproduce vs. the Rights/Best Interests of Children
Until recently, a couple's right to procreate has rarely been questioned. However, because of the new reproductive technologies, the question has arisen about whether the right to procreate includes the right to procreate using available technology and/or donor gametes or a host uterus. Many experts in the field, including John Robertson, a U. S. attorney/ethicist specializing in the field of reproductive technology, argue for procreative liberty, asserting that since the United States Constitution affords people the right to procreate coitally, it also gives individuals the right to procreate non-coitally. Robertson believes that having children satisfies basic biologic, social, and psychological drives for many people and that "noncoital reproduction should thus be constitutionally protected to the same extent as is coital reproduction, with the state having the burden of showing severe harm if the practice is unrestricted."

Those who believe in procreative liberty would agree, however, that although the law gives people the right to reproduce, it does not give people the right to parent the children they reproduce if they are deemed unfit. Unfortunately there are many instances in which the State, acting in the best interest of a child, removes that child from it's home because the child is determined to be at risk. Furthermore, not everyone is eligible to become a parent through adoption. Several states have outlawed private adoptions and require parents to "pass" a homestudy conducted by a licensed social worker before they can legally adopt a child. Thus the purpose of the law is to protect children from harm -- both physical and psychological -- and the duty of the State is to advocate for the welfare of children. The question here is whether or not someone should be advocating for the rights of children who are not yet born or conceived, and whether we can know -- even prior to conception -- whether a child will be psychologically harmed as a result of the circumstances of its conception or birth.

There is a great deal of controversy about whether caregivers -- from physicians to mental health clinicians -- have an obligation to act as gatekeepers for unborn children. Procreative libertarians argue that the role of providers is to offer the technology if it is medically appropriate, rather than to make judgments about who deserves to become a parent or about how children should be created. This group of caregivers believes steadfastly in patient autonomy, in each person's right to chose whether and how to procreate. Others feel strongly that when individuals/couples ask for assistance in procreating, caregivers then have an obligation to protect the interests of children (even if they are not yet born or conceived). They argue that not to do so would be abdicating their responsibility and could even be a violation of beneficence (assuring good and avoiding harm) if the caregiver sincerely believes that harm may be done.

Another ethical question arises from the ability to separate genetic from gestational from rearing parenthood: Is it is moral to create children from donor gametes when there are already children in the world who have been born and who need homes? Elizabeth Bartholet, an attorney, adoptive mother, and author of Family Bonds : Adoption and the Politics of Parenting (Houghton Mifflin, 1993) is critical of the new reproductive technologies. She believes that ART clinics intentionally attempt to convince couples that reproduction in one form of another is inherently better than adoption and that families created from genetic ties (or partial genetic ties) are stronger and more desirable than those created by adoption. Bartholet argues that what she sees as objective counseling would surely steer more infertile couples away from technological means of reproduction to adoption. In fact many infertile couples do struggle with this issue. Longing for a gestational and/ or genetic (or partial genetic) connection to their offspring, yet aware that too many children in the world need good homes, many prospective parents wonder if this longing to reproduce should take precedence over the right of existing children to have loving homes.

As we will see in Chapter 7 ("Surrogacy"), the ability to separate genetic from gestational motherhood means that offspring can be born (and have been born) to women old enough to be grandmothers and great-grandmothers and who are likely to die before their children reach adulthood. The use of anonymous sperm or egg donation means that children may have several half siblings that they do not know. Furthermore, the separation of genetic and gestational motherhood may mean that a couple who have donated frozen embryos has several biogenetic children who are being raised by different families, and who know nothing about each other's existence. These are but some of the ethical and psycho-social dilemmas brought about by the new reproductive technologies -- dilemmas that couples face as they consider their parenting and treatment options.

Read part two here.

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About the Author: Susan Lewis Cooper, Ph.D. is a psychologist in private practice with over twenty years' experience specializing in infertility, adoption, and third party reproductive options. In addition, she is a psychologist at the Reproductive Science Center-Boston and at Focus Counseling and Consultation, Inc., in Cambridge, where she is co-director. Susan's writing partner and friend, Ellen Sarasohn Glazer, is a clinical social worker with twenty years experience focusing on infertility, pregnancy loss, adoption and related issues. She is also program counselor at the Fertility Center of New England Memorial Hospital in Stoneham. The two Boston-based women met during years of working with RESOLVE (both have served on its national board of directors) and struggling with their own infertility quests. Both women are members of the American Society of Reproductive Medicine's Mental Health Professional Group. Together they have written two previous books (both now out of print) and Ellen wrote the still-in-print The Long Awaited Stork. One of their co-authored books, Beyond Infertility: The New Paths to Parenthood, was revised, rewritten, expanded and updated for a winter, 1998 release through Perspectives Press under the new title Choosing Assisted Reproduction: Social, Emotional and Ethical Considerations.