'Test tube' conception: ethical questions linger in US?
With 19 ''test-tube'' babies born throughout the world, and more expected at any time, experts do not view the first such birth in the United States recently as an especially spectacular event.
Discussing this at a conference here, several of them said its real significance, scientifically and ethically, is as an indicator of how slow the US has been to adopt what they called this new ''technology'' of human reproduction. They attribute that slowness to political and ethical factors.
John Biggers, a physiologist at Harvard University, and LeRoy Walters, director of the Center of Bioethics at Georgetown University, said the technique for test-tube fertilization of human eggs, followed by implantation of the resulting embryo in a human mother, is rapidly becoming a routine clinical procedure. It has reached a point where any remaining medical uncertainties are overshadowed by the ethical questions involved, the two experts said.
At a press conference and in a symposium during the annual meeting of the American Association for the Advancement of Science, Drs. Biggers and Walters said they believe test-tube fertilization now is a relatively safe technique both for the embryo and for the mother. Dr. Biggers explained that the rate of successful fertilization seems to be roughly what it is for natural fertilization -- about 30 percent. He said this is a preliminary conclusion based on limited experience with the new technique, animal experiments, and theoretical considerations.
Dr. Walters added that the number of embryos that develop to term (living birth) is not quite as high for the implanted embryos as it is for naturally conceived embryos. This is where further work needs to be done, he said. However , he considers the technique clinically sound.
As to concerns that the technique might produce an unusually high rate of malformed children, the two experts said that so far there is no sign of this. Of the 19 test-tube babies now born, only one had a (surgically correctable) defect. This, he said, is not out of line with the percentage of defective births occurring among naturally conceived babies.
Dr. Biggers also pointed out that the figure of 19 test-tube babies should not be taken too literally. It is a minimum number that changes from week to week as more such babies are born. But there may be births of which he has not yet learned. Indeed, there probably has been a 20th such birth in India that has not yet been confirmed in medical literature.
All told, Dr. Biggers said, the technique is being adopted rapidly by an increasing number of countries. The 19 births represent 12 for Australia, 6 for Britain, and 1 for the US. The latter occurred Dec. 28, 1981 at Eastern Virginia Medical School. Dr. Biggers said the occurrence of test-tube baby births will likely accelerate. He noted there have been 103 such fertilizations and 91 embryo implants so far in Australia. These have resulted in 15 pregnancies.
Against this background, Drs. Walters and Biggers said that from their point of view, the US has been backward in this field. They see no ethical reason now not to pursue it at both the clinical and research levels.
Dr. Walters pointed out that 21/2 years ago, the Ethics Advisory Board of what was then the US Department of Health Education and Welfare (HEW) found no ethical objection to the technique as a means of overcoming infertility in married couples. It also found no ethical objection to federal support of research in this area -- under tightly controlled guidelines. However, neither HEW nor its successor, the Department of Health and Human Services (HHS), has acted on this report. HHS supports test-tube fertilization research with animals but not with humans.
Dr. Walters says HHS should respond to the HEW report, even if it is only to explain why HHS won't endorse or support such work with humans. This is needed to clear the air, he said. Other countries are rapidly moving ahead in this important field with government support and guidance, while in the US, research is left solely to the initiative and discretion of uncoordinated private efforts.
The issue is politically sensitive. ''Right-to-life'' advocates distrust the technique. Not only is it perceived as ''unnatural,'' but defective embryos are destroyed either at the test-tube stage or after implantation. Yet lack of HHS action will not halt the spread of the technique. It only makes it harder to do the necessary research in the US and to come to grips with what Dr. Walters sees as an important ethical issue -- making the technique available to all who need it.
He estimates there are some 600,000 couples in the US who might want to use it. Will this medical service be restricted to those who can pay the several thousand dollars it now costs?
Ruth Hubbard, also a Harvard biologist, put the ethical question in another perspective. She noted that couples seeking such help are utterly at the mercy of the experts who developed the technique. These experts set the conditions, judge the technique's safety, and set the fee. The technique is so new that no one else can give independent advice, she pointed out.
She views this situation as dangerous for the patient and the country. She warned that a new medical technique with far-reaching implications is being introduced by scientists and physicians, the majority of whom ''are part of the social and economic elite.''