Abstract
The focus of this paper is on the ethics of the act of wilfully “abandoning” human embryos. I offer a critique of this unique behaviour, which draws on empirical data about who wilfully abandons their surplus embryos and why. I argue that wilful embryo abandonment is in all cases avoidable. Given this, I make three observations which speak to the moral unacceptability of embryo abandonment. The first has to do with the abandoner’s unfair treatment of the clinic storing their abandoned embryos, and the second the abandoner’s apparent lack of sympathy for the plight of other people like them, who require assistance (e.g. donated embryos) in pursuing their family-building goals. The third observation has to do with the abandoner’s failure to meet their responsibility for directing the handling of their embryos, and what their reaction to that responsibility (through abandonment) says about their moral character in certain respects. There is good reason to conclude that wilful embryo abandonment is morally unacceptable. One implication of this normative conclusion is that clinics have reasonable grounds for justifying the design of their policies and practices so as to make wilful embryo abandonment impossible.
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Notes
Following Cattapan and Baylis (2015), I find the label “abandoned” embryo to be less than ideal, due to its value-laden undertones, among other things. However, I use the term “abandoned” throughout this paper since (1) I take it to be a more accurate description than the alternatives (e.g. ‘orphaned’ embryos), and (2) this is the language that is being used in the relevant literature and policy guidelines.
I follow Provoost et al. (2011b and 2012) in emphasizing the distinction between “intermediate” and “final” embryo disposition decisions. A patient makes the intermediate decision to store their surplus embryos cryogenically (for their intended future reproductive use), whereas the final disposition decision is irreversible, since the embryo is either destroyed (expressly, or after its research use) or transferred to a woman’s uterus.
Our understanding of embryo abandonment is culturally variable. For example, some IVF patients in certain regions of Equator believe that cryopreservation itself is a form of abandonment. See Roberts (2011).
Although the exact number of abandoned embryos currently in storage is unknown, it is estimated to be tens of thousands or more worldwide (e.g. ECASRM 2013). In 2013, there was an estimated 20,000 abandoned human embryos being stored in U.S. clinics alone (Kirkey 2013). See also Asemota et al. (2013).
Here I am only concerned with wilful abandonment (and not non-wilful abandonment), i.e. where the abandonment is avoidable, in the control of the abandoning patient(s).
While there is a sense in which clinics could abandon the embryos entrusted to them to store, by (e.g.) permanently evicting the clinic space and the cryopreservation tanks it houses in the middle of the night, in this paper I am concerned only with instances of embryo abandonment where the patient is the abandoner.
As per Canada’s Assisted Human Reproduction Act (2010), and Assisted Human Reproduction (Section 8 Consent) Regulations (SOR/2007-137), for example.
Provoost et al. (2011a, p. 1981) found this in a different study as well: non-repliers to disposition requests did not need more information than other patients; in fact, only one of the 40 respondents who did not reply to a disposition request form said that she did not have enough information about the options in order to come to a (final) disposition decision.
Provoost et al. (2011a, p. 1982) also discuss the possibility that some patients (erroneously) view the impacts of freezing on embryos as being the same as the freezing effects on food. Even if it is true that some patients (including some abandoners) believe that frozen embryos have an expiry date, they should also be presumed to be aware that they are nevertheless required to make a final disposition decision regarding their stored embryos.
Child abandonment is illegal under the Canadian Criminal Code (§218), for example, for reasons having to do with undue and avoidable harm caused to the child. Children are the possessors of certain rights and interests, and a level of moral agency that makes their deliberate abandonment unacceptable.
There may be ways to track down patients if resources beyond those typically available to clinics were to be made available (e.g. hiring private detectives, say). Yet, in order for this sort of strategy to go through, those independent bodies would need consent from the patients to allow the clinic to disclose their personal information on file, something that abandoning patients will not be around to consent to.
One potential difference between embryo abandonment and child abandonment is that child abandonment can be ‘done for the sake of the child’, whereas embryo abandonment cannot be done for the sake of the embryo, since the embryo has yet to develop interests (‘a sake’) of its own at that point.
Provoost et al. (2011a) found that 10.3 % of the non-repliers surveyed had experienced miscarriage after their last treatment cycle. This is somewhat lower than the average miscarriage rate reported in assisted reproduction clinics in (e.g.) Canada, at 19 % (CARTR 2014). While there is no evidence to indicate whether embryo abandoners have a similar rate of miscarriage, or that this was the reason why non-repliers did not reply, the rate of embryo abandonment is far lower than the rate of miscarriage (and childlessness), which suggests that, for the majority of people at least, experiencing miscarriage does not prevent them from keeping the clinic in the loop, or making a final disposition decision at some point later on.
According to Provoost et al. (2011a), “The most important reason [why patients did not respond]…was that the patients could not reach a decision[,] either because they could not decide what to do (59.0 %) or they were unable to reach a joint decision (12.8 %)” (p. 1981).
I think that other sorts of cases speak to this as well. For instance, this seems to be one of the reasons why the least favoured final embryo disposition decision (in most jurisdictions) continues to be donation for the reproductive use of others. It also seems to be (part of) the root explanation of practices such as ritual burying of ‘deceased’ embryos and early-term foetuses that have miscarried or been aborted.
In cases of embryo abandonment as a result of intentional death, the issue is complicated by the ethics of suicide, and the extent to which the abandonment was avoidable, given the particular circumstances of the patient. As a practical issue, however, it may be prudent to treat all deceased patients as if they are non-wilful abandoners. Determining that the patient(s) are deceased is far more realistic than determining the exact nature of the consequences surrounding their death.
As noted earlier, ceasing to engage with clinics (to the point of embryo abandonment) in jurisdictions that have a set time limit for storage is in some sense to make a final disposition decision, by omission/default. Yet, even in such cases, the moral harms of wilful embryo abandonment identified in this paper hold, albeit the harm to clinics in this case may be less significant.
If the abandoning patients are not the gamete providers, then, in the cases of abandonment in places where consent of the gamete providers is legally required, the clinic would need to shift dispositional control back to the gamete providers. Of course, if the gamete providers were not able to be contacted, then this would result in abandonment as well.
I do not have space here to provide a full account of the moral wrongness of having a disrespectful attitude towards others. My thinking on this point is inspired by the work of Christine Swanton’s pluralistic virtue ethic (2003, especially Chap. 5). For Swanton, respect is a central mode of moral acknowledgement, which manifests as appropriate coming close to/keeping one’s distance from others. For Swanton, “mockery, dismissiveness, and insults are all forms of contemptuous psychological attack” (p. 106). Other inappropriate ways to keep one’s distance/come close to others, according to Swanton, include “ignoring the presence of another, being cold and indifferent” (p. 107).
Perhaps, the water hoarder lives in an isolated rural area, and thus it would be difficult for him to manage the transfer of the surplus water to others. Or, perhaps the hoarder is deeply hydrophobic, and thus experiences significant anxiety and distress when handling (or thinking about handling) water. Even so, we might expect that he ask for help or else notify those in a position to help that he is having such difficulties.
A recent example of this is the widespread public disapproval when it came to light that a network of hospitals in the UK was burning foetal remains from terminated pregnancies, unbeknownst to the women whose ‘biological waste’ it was. See http://www.telegraph.co.uk/health/healthnews/10717566/Aborted-babies-incinerated-to-heat-UK-hospitals.html Accessed November 20th, 2014.
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Acknowledgments
I am grateful to Françoise Baylis, Samantha Copeland, Matthew Herder, Jonathan Ives, Tamara Kayali, Tim Krahn, D. Robert McDougall, Robyn MacQuarrie, Heidi Mertes, and Jacqui Shaw for their engaging and helpful comments on earlier drafts of this manuscript.
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Tonkens, R. The moral unacceptability of abandoning human embryos. Monash Bioeth. Rev. 34, 52–69 (2016). https://doi.org/10.1007/s40592-016-0060-4
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DOI: https://doi.org/10.1007/s40592-016-0060-4