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In 1978 Louise Brown was born: she was the first baby conceived through the technique of in vitro fertilization with subsequent implant of the embryo (IVF & ET). Over the years, this practice has spread and diversified, also allowing the procreation and birth of children whose genetic patrimony is not that of their social parents (the so-called heterologous IVF & ET).
Even though the effectiveness of this technique is still far from the standards which may be regarded as satisfactory (the most optimistic estimates say that, after various IVF & ET cycles, only 20% of cases lead to the birth of test-tube conceived babies), within civilized society and the medical community, a certain consensus has been reached at least with respect to homologous IVF & ET (that is the technique whereby social parents coincide with biological parents) even though there also are dissenting opinions, especially in connection with the fact that, when this technique provides for the preimplantation selection of embryos, it involves the intentional destruction and death of many human embryos. In actual fact, the problems related to the respect and safeguard of unborn babies (which deserve to be dealt with separately) are difficult to solve unless we first clarify what type of cultural and anthropological transformations have been introduced with the IVF & ET technique.
Extracorporeal generation, which today tends to go under the inaccurate definition of “assisted procreation”, gives rise to numerous moral problems, which in actual fact surpass the reductive medical perspective through which this technique continues to be viewed. This is not simply the umpteenth attempt to medicalise one of the phases of our life, nor is it simply the identification of a new therapy against the various forms of sterility or infertility, since it actually perverts the nature of the procreation act, which has a cultural and symbolic value that deserves due consideration, irrespective of any other controversy.
First of all, we need to clear our mind of the equivocal definition of IVF & ET as a therapy. IVF & ET does not involve a recovery of health or the restoration of physiological functions, but replaces part of the reproductive process. Even by resorting to a broader concept of therapy, and to an analogy with dialysis, which is a therapeutic act even though it replaces a function, IVF & ET still cannot be viewed as a therapy, owing to the specific nature of the reproductive process. Whereas with dialysis we are assisting a sick person, we are curing a body, with procreation we are generating another person. It may be said that IVF & ET has a therapeutic function with respect to the affliction of the potential parents.
But the treatment of an existential or psychological discomfort should be administered on the same level, that is through moral or psychological support: can we view a child, that is a human being, as a “therapy”? If, for the sake of intellectual clarity, we clear our mind of equivocal definitions, we end up facing an obvious fact: extracorporeal procreation introduces a reproductive method that radically transforms the human act of procreation. First of all, it is quite clear that the “players” involved in the generation process have changed. Indeed, the couple’s most intimate and personal act is converted into a process governed by the logic (and deontology) of medicine and biology, which means we have some sort of procreative proxy. By shifting procreation from the couple’s interpersonal relation to a medical procedure, we are socialising a personal, “private” act and subjecting it to the timing and work allocation schedules typical of all complex biomedical practices. Besides, children in the seminal state, generated through IVF & ET, may be cryopreserved, which means that the time of generation and that of delivery may be distanced at will. In addition, should one resort to the so-called surrogate motherhood, the generated being would spend a certain gestation period in the womb of a woman who is not the biological mother and who will subsequently become (in certain cases, not always) the social mother. In short, this technique makes it possible to shatter the unified process of procreation into different phases, by involving different agents, and therefore different responsibilities. Procreation control also changes. So far, generation was conditioned by the exertion of self-control, in other words, by regulating personal acts.
The couple could abstain from sexual intercourse, resort to contraceptives, follow the rhythms of female fertility and make its choices about procreation through free control over personal acts: now the control process is shifted to the genetic material first (the male and female gametes), and then to the generated being (preimplantation embryo selection) and to the timings of gestation and delivery (which may take place even years after the fertilisation phase). Again from a descriptive point of view, it is quite clear that with extracorporeal procreation we are also introducing some sort of biological involution, since we are going back to a form of asexual reproduction.
Are we really in a position to claim that these changes, which have been made possible by our improved technological skills, are of no importance from a moral point of view? In other words, can we really state that the desire to have children is sufficient to legitimate the irruption of zootechnical practices in the complex and composite human experience of procreation?
We certainly cannot simply answer these questions by referring to the legitimate requirements of potential parents who suffer from their sterility, or by appealing to the so-called progress of medicine.
In fact, on one side we should question whether this practice is not fostering a progressive impoverishment of man from an axiological point of view: in other words, whether it is not leading to a neutralisation of the intrinsic value of human existence and of its own distinctive ways of being; on the other side we should take into account that this practice is saddling civilized society with additional and unusual responsibilities, since it places the initial stages of life itself under its direct guardianship.
IVF & ET is transforming certain aspects of human experience and is passing on to us for consideration, but also for review in the light of our moral awareness, questions which should not be undervalued. (to be continued) (Traduzione Interpres sas-Giussano)

Adriano Pessina