Birth and origin, balancing desires and rights In vitro fertilization has turned the intimate and personal act of a couple into a high-profile medical trial. Discussing the moral dilemmas posed by in vitro fertilization means acknowledging first and foremost what this reproductive authority involves.

Acknowledging that the players in reproduction are becoming physicians and biologists means understanding that we are facing an expansion of responsibilities, and hence new forms of duties and rights. It is anything but clear that there is an actual right to procreation, i.e., that sterile couples have a de facto right to have a child at any cost. In fact, every right implies a duty. Now, on what basis can we establish that those who are not capable of producing a child have the right to have someone take steps to guarantee them the birth of a child? It’s a complex issue. First of all because it is not obvious that a child constitutes an asset to which the couple has a “strong” right, i.e., strong enough to imply a direct duty on the part of third parties.
Of course, a couple may legitimately desire to have a child, but who has the moral duty to get it for them, if the couple is not able to produce one? Can civil society (and the political community itself) deem the couple’s desire sufficient to establish the duty of medicine to implement various strategies (with costs that are not merely social) to bring into existence another person, another citizen? The technical possibility in and of itself provides not a response but rather the very condition for which the problem is posed. Let us assume for the sake of argument that it is believed that there exists this right to maternity and paternity, and that medicine has some sort of duty to satisfy this desire: what then are the values that must be respected? And what new situations do we need to evaluate? As is well known, the most significant ethical dilemma involves the existential condition of the person created, what in biological terms is called a “human embryo.” On the one hand, in fact, in vitro fertilization, insofar as it is aimed at generating another person, should be implemented in a context that prevents the person generated from being subjected to manipulation, discrimination, and the danger of dying.
Second, human society acquires a de facto responsibility to see that this generated person (this “child”) is wanted in a context that does not undermine his integral development, both physical and psychic, but that, based on the principle of the equality and dignity of every person, the newly generated person is placed in conditions of growing in a balanced anthropological and social context. If the biological and social parents are the same (the so-called homologous in vitro fertilization), this situation seems overall to be somewhat assured. But if the relationship between social and biological parents is broken (the so-called heterologous in vitro fertilization), this situation seems to be compromised, with the complicity of medicine and the social and legal structures that may permit it. People speak somewhat cavalierly of anonymous “donors” of sperm and eggs.
But in reality these “donors” have a specific name: they are the biological mother and father, since to donate - or sell - male and female gametes means to bring into the world “children” with one’s own genetic heritage that will quite likely also have brothers and sisters, unknown. Can the category of desire be sufficient to face this situation? Sanctioning in the name of desire the absence of any moral, social, and legal responsibility of the anonymous “donors” vis-à-vis the children generated with their genetic heritage means introducing into the social fabric a destabilizing factor that no one wants to bear responsibility for. The reasons advanced against the practice of homologous and heterologous in vitro fertilization constantly seem to run up against a partial representation of reality that appeals almost exclusively to the psychological suffering of the potential sterile or infertile parents but that does not take into account the moral, social and psychological fallout of such a practice. In the name of the power of desire (which psychoanalysis has often denounced for its narcissistic aspects), a very unique condition is advanced: the first phase of human existence - the embryonal state - is no longer subject to maternal care and responsibility but becomes the object of social responsibility.
Once the womb is replaced by the test tube, the problem arises of what to do with the embryos generated, with those that present pathologies, the frozen ones, those that must be chosen to be implanted into the mother’s womb. Recent debates over experimentation on human embryos, over research using embryonal staminal cells, over human cloning for therapeutic or reproductive purposes, run up against the old question of the so-called pre-embryo. The new moral dilemmas, introduced by the possibilities of technology, arise because for the first time humanity is dealing with having to answer for the existence of new children who find themselves in a place that is not their own: a test tube, in a laboratory, and no longer in the womb.
And on this topic we all need to keep asking ourselves: modifying the condition of “child” and turning it into a technologically controlled “product” means also changing a category that involves us all, because even if we’re not all mothers and fathers, we are all children. What does it mean to be the “children” of in vitro fertilization, and what duties do we have towards them in the initial phases of their existence, when they are placed under the direct de facto responsibility of those who generated them? Another problem arises here, to which the category of desire can not give any meaningful response.
(To be continued) (traduzione Interpres sas-Giussano)