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The experimental IVF procedure recently given a green light by the United Kingdom’s House of Commons and under investigation in the United States, to allow for a mitochondrial DNA surrogate to avoid transmission of mitochondrial disease, has been described as some parents’ “first glimmer of hope that they might be able to have a baby that will live without pain and suffering.” More dramatically, some have hailed the technology as potentially “life-saving”. This is incorrect and misleading: This technology is not life-saving, and it will not prevent cases of mitochondrial disease.
Mitochondrial replacement IVF (mtIVF) is not a treatment for an individual with a mitochondrial disease; it is a method for creating a new person with healthy mitochondria. The only circumstance in which this technology will be used is if a woman knows that she has a mitochondrial mutation, and so chooses not to risk creating a sick child, but instead creates a different, healthy child.
That means that there would not be a single person who would otherwise have been sick, and who will, as a result of the technology, be healthy. Nor would there be anyone alive who otherwise would have died. There will simply be different people born.
So the procedure isn’t necessary to prevent harm or to save a life. Parents can guarantee not passing along the harmful condition by either not having a child, or by using another woman’s egg in order to get pregnant through traditional IVF.
Travis N. Rieder
Travis N. Rieder, PhD, is a Hecht-Levi Fellow at the Johns Hopkins Berman Institute of Bioethics focusing on ethical issues related to human procreation. He teaches the course “The Ethics of Making Babies” at Johns Hopkins University..
If mtIVF isn’t necessary, then we should ask: why is there demand for this procedure? My worry is that demand for this technology is driven by a problematic genetic fetishism, and that we should try not to enable this attitude. Not procreating does not equal not starting a family; one could adopt one of the millions of orphans in the world who need a family. However, adoption is often seen as a last resort option.
Why? Well, the answer often given is that prospective parents want a genetic relationship with their offspring, and adoption doesn’t provide this. But of course, in the case where a mother’s egg cannot be used, IVF offers at most a partial genetic relationship – one with the father – and so the mother misses out on what she may perceive as a good. And now we can understand the draw of mtIVF: a resulting offspring will be a genetic child to both parents, and so no one misses out on the sought-after relationship.
What this explanation makes clear is that development of this technology only makes sense against a backdrop of certain values and desires. Parents so strongly desire a genetic relationship with their child that they are willing to go to great lengths in order to obtain it. And this, I think, is worrisome because the genetic relationship isn’t obviously good, and so prizing it so highly, at the cost of failing to promote other genuine goods, is a kind of moral distortion. Families are good, and familial relationships are among the greatest goods in life; but creating a genetic child isn’t necessary for these goods. Inviting a non-genetic child into one’s family isn’t less good, or less desirable, and there is a massive need for it.
A common objection to adoption is its enormous cost, compared with having a family the “natural way.” So, what many parents want is also what they can afford: genetic children. But the invention of IVF and then gamete donation changed all of that, as creating a biological child through the use of these technologies can be even more expensive than adopting. While these technologies are easy to praise for their ability to ‘give desperate parents a family,’ putting the point that way is uncomfortable: anyone who can afford these technologies can also afford to adopt a needy orphan, which also ‘gives desperate parents a family’.
With the advent of reproductive technology then, we, and our culture, made very obvious our value rankings: we prioritize genetic relationships to such a degree that we created and utilize a technology to allow one or both parents to have this relationship, even when doing so requires great intervention on the body and to the exclusion of inviting a needy child into our homes.
What could justify that preference? Would I love a genetic child more? Is a genetic child somehow more valuable than an adopted one? Even asking these questions is offensive to an adopted parent (and most of us, I would hope). Making a genetic child and adopting are different, but equally valuable ways of forming a family. And once we see this, the effort and resources that we put into creating genetic children begins to look worrisome; our valuation of the genetic relationship starts to look less like a mere preference and more fetishistic—that is, more like an extravagant, irrational devotion. And this kind of fetishism is not benign, as the intense focus within reproductive technology on making new, genetic children perpetuates and normalizes a system in which we ignore the suffering of existing children and view non-genetic families as abnormal and maybe even less valuable.
And now we are considering taking the next step. The development and support of mtIVF allows us to create genetic relationships in yet another place where we previously couldn’t (at least, not without risking harm to the offspring). Tellingly, we are considering pursuing this technology even in the face of uncertainty and risk. Following through, I worry, is both a reflection and an endorsement of our inappropriate valuation of the genetic relationship. It sends the message, yet again, that genetic families are the ideal, and that we will move heaven and earth to make it possible for each person to have one.
But they aren’t the ideal; they are just one, valuable way of forming a family. So perhaps it would be better to stop devoting so much attention and so many resources to satisfying the desire for a genetic relationship, and instead to look for other opportunities to help prospective parents form a family.
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