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.

The Right To Information Regarding One's Genetic Origins
The history of gamete donation in the United States began in the late 1800s. Dr. William Pancoast, who performed the first insemination of donor sperm, claims to have done it secretly, not ever telling his patient that she had been inseminated with a donor's sperm, and not telling her husband until after the fact. Thus began a tradition of secrecy that most donor couples have practiced for almost a century -- telling no one (neither the child, the child's physician, nor the extended family, etc.) the circumstances of the conception. Anonymity -- the condition whereby both donor and recipient couple consent to the process but are unknown (and unidentifiable) to each other -- has occurred along with secrecy in donor insemination.

A third concept -- privacy -- is often confused with secrecy. Privacy refers to the fact that each of us has the right to establish boundaries between ourselves -- or our families -- and others. When we identify these boundaries we are not being secretive, but rather, we are saying that it is our basic human right to maintain some separateness from those around us. Hence, we are being neither dishonest nor deceptive nor withholding if we do not tell everybody, everything.

The Right to Procreate with Unknown Gametes
Although sperm donation has been occurring for over one hundred years, improved technology, resulting in the ability to separate gestational and genetic motherhood, has paved the way for ovum donation as well. Although few people in the medical and mental health fields have openly questioned the moral acceptability of gamete donation, it does raise an important ethical question: Is it morally acceptable to bring a child into the world with an unknown genetic parent?

This issue may be more timely now because our understanding has deepened in recent years about the relative weight of nature versus nurture in determining who a person will ultimately become. Although scientists are not quite ready to map the human genome, more and more information about biological destiny is unfolding on an almost daily basis. Because we now understand that genetics plays a very large role -- larger than previously thought -- in providing a blueprint for adulthood, the ethics of bringing a child into the world with unknown genetic origins is more questionable today than it was in the past. The concern is whether it may be psychologically or medically harmful to a person to have no information -- or little information -- about his/her genetic make-up. On the other hand, to deny a would-be parent the right to chose to procreate with donor gametes threatens both the patient's autonomy and his/her reproductive freedom.

The Right to Know the Truth About One's Genetic Origins
Knowing the truth about one's genetic origins and conception is different from having identifying information about one's genetic parents. As long as the practice of anonymous sperm donation continues in this country and the laws surrounding it do not change, donor offspring will not have access to their donors. Although many sperm banks are currently providing extensive information to parents regarding their donor's medical and psychological history, most couples using DI in this country are still choosing not to tell their children the truth about their origins. In recent years a large body of mental health professionals, including family therapists, have begun to question the ethics of secrecy regarding gamete donation. These clinicians believe that denying people essential information about their identity, especially when it includes their medical history, is morally unacceptable. Furthermore, they cite the literature that comes from family therapy -- and from adoption -- documenting the negative impact of family secrets on parents and children and on family systems (see Chapter 10, "Telling the Truth: Why, When and How to Do So").

Separating the various components of parenthood means that individuals and couples can create children who may be deceived about their genetic make-up and possibly (in the case of surrogates or gestational carriers) about who gestated and gave birth to them. As with the previous ethical dilemma -- the right to procreate with unknown gametes, questions arise about whether a patient's autonomy -- in this case, the right to choose not to tell one's offspring the truth -- should take precedence over the possible harm done to that offspring if he or she goes through life being duped about his/her identity and conveying a false medical history.

Liberation vs. Exploitation of Women for Reproductive Purposes
Although there are many who believe that the new reproductive technologies are nothing short of miraculous and open up choices to women and to couples that would never have been possible, there are others who believe that they are a curse on families and upon women. Assisted reproductive technology is not without medical side effects or risks (see Chapter 2, "In Vitro Fertilization and the ARTs"), and people who are desperate for children may not be in the best position to objectively evaluate these risks to themselves or to third parties. The separation of the various components of motherhood means that some women who are not the intended parents (ovum donors and/or surrogates or gestational carriers) are being subjected to these risks. Many argue that an infertile couple/woman has the right to chose a procedure that involves potential physical harm, but that it is morally unacceptable to subject a young, fertile woman to these same risks when she is not the intended parent. Furthermore financial incentives may be inducements to third parties to ignore these potential harms. Here we see examples of when concerns about autonomy and beneficence may collide.

A common worry among caregivers and couples opting for known ovum donation, surrogacy, or gestational care (via a friend or relative), is that the physical ordeal may produce short or long term side effects that are harmful. Careful counseling -- both medical and psychological -- of willing third parties, enables these collaborators to thoroughly consider the risks before deciding to proceed. And many argue that third parties, like infertility patients, are also entitled to autonomy when it comes to decisions regarding their bodies. Others argue, however, that there is always inherent coercion (financial or personal) for donors, surrogates, and carriers that cannot be dismissed and that amounts to exploitation.

Go back to part one 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.