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Spiritual Life
In baby business, what are the rules?
The idea that babies can be a product like pharmeuticals or blue jeans is a notion that scrapes against spiritual sensibilities. But Harvard Business School professor Debora Spar, who is leaving this summer to become president of Barnard College, didn't get her new job for bland scholarship.
Assisted reproduction is a business, she says; in 2004, revenue from fertility treatments in the United States totaled almost $3 billion, according to Spar's book, "The Baby Business." In that 2006 volume and in speeches, including one last month at Harvard Medical School, she argues that confronting the commerce in this enterprise is necessary to correct current problems for both the parents and the children involved.
Spar is not religious, but she and the National Catholic
"I found looking at the Bible to be a really interesting source document," she said in an interview last week, "because it suggested to me just how deep-seated and ancient these concerns are."
The Roman Catholic Church opposes assisted reproduction, including in vitro fertilization.
While disagreeing with the church's stand, Spar admires its consistency; its position is that life starts at conception and that "conception should only be part of a loving, intimate relationship between two married heterosexual people."
By contrast, some evangelical Christians support IVF because it promotes family. Spar finds their support at odds with their antiabortion position, since both abortion and IVF destroy embryos.
Many Jews, she said, endorse IVF as a way of enlarging the Jewish population, while Muslims split over the issue. She herself does not condemn reproductive technologies.
"Kids are wonderful," she said. "I think when people have a medical condition that prevents them from procreating naturally, fertility treatments are yet another medical marvel."
The bioethics center's website warns against genetic engineering and "designer babies," but Spar doesn't worry about parents trying to customize a child with bulging muscles or IQ. Her research convinced her that most people want to design their babies only to the extent that they can screen out genetic illnesses. "People are doing it to have a child who's not going to die," she said.
But she calls for tighter government regulation, starting with a requirement that fertility clinics and other providers disclose the health risks of any procedure and the relevant success rates.
She would also study those risks more and rein in procedures where appropriate. For example, Spar said studies have shown that half of all twins and 90 percent of triplets are born prematurely; twins are six times more likely to have cerebral palsy than single pregnancies, triplets 20 times more likely.
Europe is beginning to ban the transfer of more than two embryos into a woman and recommending the transfer of only one, she said.
She would also would allow children produced by technology to be told their genetic parents' identity, after her research found that many want that information. Finally, she would treat infertility as a medical condition, meaning that health insurers would cover certain treatments while defining those that would not be paid for.
Spar has an ally at the Catholic bioethics center. The Rev. Tadeusz Pacholczyk, the center's director of education, would like to see IVF outlawed, but knows that a generation after the first test-tube babies, no ban will be forthcoming. As a result, he supports Spar's proposed restrictions and regulations.
As for framing the discussion in terms of a business or market, Pacholczyk agrees with Spar there as well. The evil of the enterprise lies in "moving reproduction out of the bedroom and into the laboratory," he said.
"'Humans are too valuable to be treated as commodities . . . but the reality is our society hasn't thought this through and [has allowed] the desire for children to steamroll" ethical considerations, he said.
Spar said that of the half-dozen books she has written, only "The Baby Business" made her cry, after she encountered stories of woman cycling through numerous IVF treatments, only to have a stillborn child, or of children dying from rare genetic diseases after their parents' futile efforts to conceive a sibling who might donate life-saving marrow to the sick firstborn.
"I had to keep the tissues by my desk as I was writing," she said.
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