Non-judgmental Ethics Sunday: What Should I Have Done After an I.V.F. Mix-Up?

posted by Joshua on December 13, 2015 in Ethicist, Nonjudgment
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Continuing my series of alternative responses to the New York Times column, The Ethicists, looking at the consequences of one’s actions instead of imposing values on others, here is my take on today’s post, “What Should I Have Done After an I.V.F. Mix-Up?

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I continue to struggle with decisions I made many years ago following an in vitro mix-up. The technology was then relatively new. I became pregnant with another couple’s child because of the negligence of the medical staff during the transfer of embryos from the petri dish to my womb. The mistake was discovered when the nurse called me by the wrong name as I was wheeled out of the operating room. I asked my husband to make sure our embryos were not at that moment being transferred into another woman. Thankfully, that had not happened.

We met with the rightful parents of the embryos that were transferred to me. (To those who don’t think an embryo can have parents, rest assured that once you have moved heaven and earth to create them, they feel very much alive to you and worthy of all parental considerations.) We talked about a lavage technique whereby the embryos might be flushed from my womb, and possibly captured and returned to the rightful parents. The hospital staff indicated that the risk of ectopic pregnancy to me was too great to consider such a procedure. We then turned to the idea of a ‘‘morning after’’ pill, which the medical staff assured me would not cause me harm and could potentially end the pregnancy. I did think it more than reasonable that I should try to stop any embryo from implanting itself in my womb, and I was enormously relieved when the other woman told me she did not want me carrying her baby.

So I took the morning-after pill. When a menstrual period occurred in a few days, I thought all was well, but it was a far from normal period. It soon became apparent that the pill hadn’t worked and that I was pregnant. I can scarcely describe the torment. I knew I was ‘‘entitled’’ to an abortion. But I also could not imagine presenting myself to a doctor to end the life of a baby that was indeed very much wanted by its real parents.

I had wanted a second child so badly. We had a young boy from a previous in vitro attempt, and we wanted a sibling for our son. I knew that carrying a pregnancy to term for someone else would set our own goals back for a year or more. Family and friends began to weigh in. I was shocked at how opinionated other people were. I went immediately for counseling, but felt incredibly alone with the magnitude of my decision.

Without my divulging what occurred, can you weigh in on the ethical considerations of my plight and my responsibilities to the other parents? And how the morning-after pill affects that responsibility? I did refuse the hospital permission to inform the other couple of my circumstances until I could decide my course of action. Obviously, this dilemma has stayed with me as one of the defining events of my life. I have never thought and agonized with such intensity in my life, all while failing to make any progress toward a decision I could believe with confidence was ‘‘right.’’ Name Withheld

My response: The ordeal sounds difficult. I can’t imagine the physical and emotional ordeal you went through. I don’t think anyone else can.

I nonetheless think the answer to your question is simple: you have the right to do what you want with your body. I’m not sure what more to say. Others might not like your choice, but we all have to deal with other people choosing things we don’t like.

If you continued the pregnancy and gave birth to a baby, you might have legal disagreements with the biological parents, which you’d probably resolve through talking to them, not newspaper columnists, or in the courts if you couldn’t agree, or you might all agree. Being unable to reach agreement with them would mean you’d have different values, which would mean you’d have different ethical perspectives, all more meaningful to each of you than a newspaper columnist’s.

You know your life better than I do, but I think the bigger issue for you is how to resolve the emotional challenges if you feel guilt or some other emotion you don’t like. If so, I suggest that developing your emotional skills to handle the emotions you feel may help more than exploring abstract philosophical questions with the New York Times.

The New York Times response:

There’s excellent reason for your uncertainties. Our intuitions about the moral significance of childbearing are more secure when the gestational mother is the genetic mother, because, for most of human history, that has been the only possibility. We have long practice in thinking about adoption — in which the social and the biological parents are distinct — because adoption, too, is age-old. But when the genetic mother is not the gestational mother? There, we have no long-established traditions.

When you say that the genetic parents were the ‘‘rightful parents,’’ you’re saying you think they had the rights over the embryo that parents normally have. Yet this was not a normal situation. So let’s establish a few ground rules. Those rights can’t include requiring you to undergo the risks of a medical intervention (like the lavage technique, which the hospital thought was medically dangerous for you) or to have an abortion.

Beyond the moral status of abortion, about which people in this country are deeply divided, there is the issue of bodily autonomy. It would even apply to a patient who received a kidney meant for someone else, owing to a transplant-list mistake. What was done can’t be undone. You can’t require an unwitting patient to submit to the removal of what was given to her in error.

Given that you consider the genetic parents to be the ‘‘rightful parents,’’ that the genetic mother told you she didn’t want you carrying her child and that you think terminating an early pregnancy is morally permissible, you had good reason to do so. But as we’ve seen, this conclusion comes with a waiver: You were perfectly within your rights not to do so. Often we have the right not to do something we have very good moral reasons to do.

Which brings us to a fiercely contested question. Whose baby would this be? You don’t indicate that your predicament led to a conflict other than your internal one. In similar situations when the question was litigated, though, courts around the world have been divided. If you’d had a surrogacy agreement, the law of contracts would have helped decide. (You would surely have given up the child had you agreed to do so before the embryo was implanted.) If embryos were simple possessions, morally speaking, property law might have done the work. But they aren’t.

Our moral intuitions certainly pull us in different directions. Imagine the anguish of parents who had conceived a child, had hoped to raise it, had perhaps dared to imagine a future of clarinet lessons and soccer games. Now they must picture her being raised by strangers — forever a phantom member of their family, an ache of absence. Yet a womb is not an Airbnb rental. So imagine the gestational mother who has nurtured and sustained the child within her uterus; now her colostrum flows as the infant latches onto her breast to nurse. At which point, exactly, do you want to usher an officer into her room to take that infant away?

Your reference to your ‘‘own family goals’’ suggests that you think you would have been obligated to hand the child over to the genetic parents. I disagree. Perhaps you thought the embryo belonged to them. But as I’ve said, it isn’t helpful, morally, to think of embryos as property. You would have been entitled to hand the child over (assuming he or she was wanted), and this might have been a generous act. But if you carried the child for nine months, I can’t see that you would have had an automatic obligation to do so.

Medical negligence, sadly, put you in circumstances where distress lay at every turn. No surprise that your own hasn’t fully subsided. New technologies can call on us to develop new moral traditions — traditions that offer a set of expectations and norms. They may not spare us from agony, but they can, at least, lessen our agonizing.

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