The Ethical Debate Over 'Designer Babies' Wages On
In vitro fertilization (IVF) has provided a solution for fertility, but various scientific advancements in the field have opened up new options for families and controversial issues for bioethicists. The multi-step process of IVF aims to assist in the conception of a child outside the body for individuals who cannot conceive naturally. Through a series of procedures, mature eggs are retrieved from the ovaries and fertilized in a lab by sperm. The fertilized egg is then transferred to the uterus.
While the basic process of IVF is generally standardized across the board, some clinics allow couples to choose the sex of the embryo to be implanted, a controversial process known as "family balancing." Family balancing allows couples the option of having children of both sexes to "balance" their family. While some see this option as an exciting new opportunity, the practice has many critics.
"Doing so is ethically problematic in a couple of ways," said Lisa Parker, Ph.D., director of the University of Pittsburgh's Center for Bioethics and Health Law. "First, trying to guarantee traits in another person is inappropriately controlling—it interferes with the person's agency or ability to develop as her own person in her own ways.
"Second, biological inputs into a child—genes and gestational environment—only set the stage for how the child will develop in a range of environments (including the economic and social environment, peers' influences, education)," Parker continued. "Therefore, parental desires to control that outcome of that development are likely to be frustrated to some degree."
"When you start going down the road of IVF and family balancing, to some, it becomes an ethical dilemma," cautioned Kendall Brown, a registered nurse in Pittsburgh. "It's a slippery slope to what some articles call 'designer babies,' especially when choosing the sex is for nonmedical reasons." Some couples, she pointed out, might opt to choose the sex of their child to avoid certain genetic disorders that only affect one sex, such as Turner syndrome.
A 2015 story from the New York Post titled "We spent $100K to guarantee a baby girl" highlights this slippery ethical slope. In this case, the couple had simply always dreamed of having a daughter and were determined to make it happen. Celebrity couple Chrissy Teigen and John Legend made headlines after announcing they had selected the sex of both of their children while undergoing IVF.
The American College of Obstetricians and Gynecologists (ACOG) declined requests for an interview, but a media representative from the organization echoed Brown's suggestion of a "slippery slope," stating, "[ACOG] already opposes all forms of sex selection not related to the diagnosis of sex-linked genetic conditions."
"In the near future," the ACOG statement reads, "other potentially controversial genetic manipulations may be available. Complex genetic systems such as cognition and aging soon may be determinable and may be constituents of potentially desirable characteristics, such as intelligence or longevity."
The real cost of designer babies
The cost of IVF will depend on a number of factors, including your insurance and geographical location, but, on average, it costs about $20,000 for treatment and medication. And that's just for one round. For couples undergoing multiple rounds of IVF, those costs can quickly become astronomical. Additional processes, like gender selection, are extra. If ACOG's concerns hold true and other forms of genetic manipulation do become available, it likely won't be cheap.
"In the United States," Parker said, "healthcare has not been treated as an infrastructure necessary to enable all to have fair equality of opportunity by treating health conditions that present barriers to their pursuing their life plans. Therefore, it is not surprising that a healthcare service like IVF is offered only on the basis of the ability to pay or as part of more comprehensive health insurance plans."
Parker also identified how the pandemic has illuminated our disproportionate allocation of healthcare services to the wealthy. In countries where universal healthcare is the norm, the barriers to starting and supporting a family are greatly reduced by providing support for family planning and medical care for children growing up in lower-income environments. In America, however, these things are limited by one's ability to either pay out of pocket or afford a high premium health plan. Without adequate healthcare coverage, many who wish to start a family can encounter a litany of issues.
'Even designer babies will grow up and may, in effect, thwart the design their parents had for them.'
"Some of the causes of infertility may be related to a lack of access to healthcare to treat conditions that lead to infertility—for example, diabetes and hypertension can affect the formation of sperm, while untreated STIs or lack of access to the vaccine for HPV can lead to problems with fertility in women," Parker continued. "Health and healthcare disparities affecting people of color reflect concerns about the justice of conditions leading to health problems, delayed treatment or lack of treatment."
According to data from the Kaiser Family Foundation, non-white Americans are more likely to not have health insurance, meaning they also have less access to high-cost procedures such as IVF and the choices that accompany it.
Another criticism of family balancing is that it reinforces the gender binary and the stereotypes that accompany it. For example, "A person or couple that 'implants an embryo to ensure having a girl'…is likely to have rather particular ideas about what it means to be or raise a girl," Parker stated.
Whether it's wanting a girl so you can dress her up in flowers or wanting a boy so you can toss a ball outside, these preconceived notions contribute to the larger cultural understanding of what gender is—a concept that is being challenged daily as younger generations come of age.
Of course, as children age, they get to make their own decisions about gender. As Parker said, "Even designer babies will grow up and may, in effect, thwart the design their parents had for them."