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Choosing Assisted Reproduction

Social Emotional and Ethical Considerations

By Susan Lewis Cooper and Ellen Sarasohn Glazer

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