The Ethics of In Vitro Fertilization

I've begun my bookstore and library talks on A Perilous Conception with remarks to the effect that in vitro fertilization used to be a hot topic, the subject of considerable debate between scientists and liberal ethicists on one side, and religious leaders and conservative ethicists on the other side. I've shown my audiences the cover of the June 13, 1969 issue of Life Magazine, which asked, "When new methods of human reproduction become available - Can traditional family life survive? Will marital infidelity increase? Will children and parents still love each other? Would you be willing to have a 'test-tube" baby?"

Now, more than thirty-three years after the birth of Louise Joy Brown, it's become clear that fertilization in a plastic dish, rather than in a fallopian tube, carries no excess risk for offspring, parents, or society. Today, in vitro fertilization is an accepted standard medical procedure.

But not everyone's convinced. Monday morning's newspapers carried Newt Gingrich's call "for a commission to study the ethical issues relating to in vitro fertilization clinics, where...large numbers of embryos are created."

So, back we go to Square One. Forty years ago, the ethics of in vitro fertilization were extensively discussed and argued, and the issues were resolved to the satisfaction of the great majority of the American public. But Gingrich's proposal has nothing to do with the question of whether IVF babies are at higher risk for physical or mental abnormalities, or whether the mothers might be damaged by the procedure, or whether there might be adverse societal fallout. The presidential candidate is trying to court voters who believe human-ness begins not at fetal viability, nor with a beating heart, nor with organ differentiation, nor at embryonic implantation, but at fertilization. To this bloc, he holds out the hope of exerting official control over the handling of the eight-cell embryos created during the IVF process.

So, hello again, Roe v Wade. Easy to see the coming end-run, another attempt to legislate the will of a minority of the population past a ruling by the United States Supreme Court.

But Gingrich's self-serving gesture to the far right has the ring of a cracked bell. I wonder what would be the political stances and religious convictions of the members of his commission. This candidate has complained loud and long about the intrusion of government into our everyday lives, but he seems to think it'd be just fine for the government to dictate his-size-fits-all reproductive choices. He might do well to consider the beliefs and feelings of the ten percent of American couples who find themselves infertile. Do the math, Newt. They also vote.

Lovely Voices From The Past

On my recent tour of indie mystery bookstores, several readers asked whether I missed practicing medicine. My answer was to the effect that my head has always known that trying to help people with medical problems is more important than putting words up on a computer screen, but my heart and gut just don't get it. I'm now into my eighteenth year of full-time writing, and have never looked back with regret.

Still, during the tour, I had a couple of poignant reminders that my time in medicine did have rewards beyond providing background material for murder mysteries.

 For the past twenty-seven years, I've scrupulously avoided releasing the name of my patient who delivered the Pacific Northwest's first in vitro fertilization baby - but there she was at the Seattle Mystery Bookshop Debut Signing, dispensing hugs to all of us who'd participated in her success, and saying "I was Number One!" to anybody who didn't already know. Well, okay. Her prerogative.

Another customer at SMB was a patient who'd suffered several mid-trimester pregnancy losses, but was finally able to carry a baby to term after a surgical procedure to strengthen her cervix. More hugs, more happy exclamations.

Then, at the Poisoned Pen Bookstore in Scottsdale, who should come by but a couple who had just retired to Arizona. Thirty-four years ago, the husband's brother, a medical colleague, had asked me to keep a lookout for a newborn that his brother and sister-in-law might adopt. I told him I thought the odds were mighty low, so of course, the very next week, I got word that a single teenager on the Family Practice Service had given birth, and wanted to put her baby up for adoption. I called the prospective adopters, and they contacted a lawyer, who had some concerns regarding the birth mother's mental capacities. He worried that the baby might be similarly affected. "What you're seeing is depression," I told him. "If you were 16 years old, single, and had just had a baby you were giving up for adoption, you'd be a little depressed yourself." He agreed, and the adoption went ahead. The baby now has a family of her own, and holds a job that requires pretty high-level brainwork.

My patients' outcomes were not always good. But some of the victories were spectacular, and even after all these years, they make me feel that those days, nights, and weekends on call just might've been worthwhile. But when someone at one of the bookstores asked whether I might ever go back to medical work, the head went with the heart and the gut. My headshake was prompt and firm.

Porky, The King, and Me - A Perilous Conception

When I was a young boy, I had a crippling stutter. My mother used to tell me, well, all right, the King of England stutters too. My reaction was along the lines of "fat lot of good that does me, when I have to go out tomorrow and listen to people finish my sentences, or worse, tell me, 'Spit it out. Just spit it out!'" And then, there were the omnipresent flocks of mocking birds: "What's the m-m-matter, L-L-L-Larry? C-c-can't you t-t-talk? You s-s-s-sound like P-P-P-Porky P-P-P-Pig."

So the movie, "The King's Speech," was a revelation for me, an intense two hours of slam-dunk empathy. King George VI's childhood stuttering history and mine were carbon copies, and when that poor guy grew up, he had to get behind a microphone and talk to millions of people by radio, sometimes while staring at hundreds of anxious faces in a live audience. Talk about blood running cold. My fingers were like ice.

But I got to apply a lesson from the King and Mr. Logue, his speech therapist. Last Thursday, I gave a talk to a group about my ragtime mysteries, and afterward, someone asked what my next book was going to be. "It's about an overly-ambitious obstetrician in 1977, racing to become the first physician to develop a baby by in vitro fertilization," I said. "But there are complications that lead to blackmail and murder."

Then someone asked me the title. My whole body tensed. "A P-p...A P-p-p-" I said, and froze.

The woman's face twisted into concern. How the hell could I have been so stupid, putting a word beginning with a hard P into my title? Now I was going to have to try to spit that out for months of promotional appearances.

Then I thought of the King, giving his critical speech at the conclusion of the movie, and Mr. Logue, like an orchestra conductor, coaching him along. "Slip in an 'ah' and ride it through," Logue whispered, as the King approached a stumbling block. My throat relaxed. "Ahp-erilous Conception," I said.

The woman's eyes widened. "A Perilous Conception" - that sounds intriguing."

Logue's face beamed pleasure. The King smiled.

Bad News, Good News

      The bad news is that it's past 10 o'clock on a Wednesday night, and I just realized I haven't written my weekly blog.
      The good news is that it happened because I got so wrapped up in my book-in-progress, I forgot about everything else.  
      For the better part of a year, now, Colin Sanford, a brilliant doctor, determined to produce the world's first in-vitro-fertilization baby, and Police Detective Bernie Baumgartner (Bernie the Bulldog), determined to sort out why people in Sanford's operation have ended up dead or missing, have been going back and forth on my computer in a cerebral life-and-death chess game. But this morning, all of a sudden, one of them spoke just the right words, and there they were, in Sanford's office, slugging away at each other like a couple of kids in a street fight. And when the fight was over, it all came to me. I saw who really were the good guys, and who were the bad, and how it was going to sort out. My working title for the book has been "Unfinished Business." Today, I saw why. I spent the rest of the day joyously scribbling notes that would take me to The End.
      And just now realized I hadn't written my blog. Well, there it is.