Since May, I have been organising the conference '21st Century Motherhood' (TCM), which will take place at University College London (UCL) on 18 September. During this time, it has been interesting to see the responses of the prospective speakers to the phenomenon. Everyone approached has expressed views on how interesting and important it is to hold this conference. The consensus is that the conference is needed and Maria Bousada's case probably heightens the need and urgency to have a public debate on the conundrum. A number of persons approached expressed the opinion that though this was a very important topic, there was a paucity of data and expertise. Some were reluctant to participate because, even though they were experts in the ethics, sociology, anthropology or psychology of human reproduction and technology, they felt the lack of hard data made it difficult to make meaningful statements on the subject.
What are the problems then? If a review is done of the world's press, despite headlines indicating ethical and moral outrage, the content of the articles contains little or no discussion of the ethical issues. The key criticisms centre on the individual selfishness of the 'mother(s)' and their lack of responsibility. Comments have been made on the dangers of pregnancy and giving birth at an advanced age, but other than a few mutterings concerning the welfare of the children there have been few other issues mentioned.
All those years ago, when working with Ian Craft and Paul Serhal (now UCL's IVF medical director) at the Wellington Hospital, I recall my reticence about the ovum donation (OD) project, which the Wellington team pioneered in the UK. As head of the laboratory, my job was to provide 'engine room' support to the project. As such, I really saw OD as just a 'small beer' option for young ladies who had undergone premature menopause. My reticence was linked to the way that the egg donors were recruited (at the time controversial, but now commonplace and routine), but perhaps it was also linked to a subconscious foreboding. Who would have thought that OD would spawn a field which would produce about 2,000 cycles per annum in the UK alone! Moreover, who would have predicted that it would be used to treat 70 year old ladies?
Now, almost 25 years after the first UK OD babies were born, and a journey stretching from specialising on male infertility to a diploma in counselling (trying to help couples cope with childlessness and letting go of treatment), when reflecting in the cold light of day, in fact TCM is not really a surprise. Rather, it is the ultimate expression of a primal desire. Over the years, it has become clear to me that infertile couples very rarely let go. This seems to happen only when egg or sperm and money run out. In the old world, this produced a halt. In the new world, technology has yet again moved the goal posts. The danger is that TCM is on the threshold of moving into the realm of OD. It might be that 10 years from now there will be 2,000 per annum of this modern phenomenon.
The conference will help throw more light on the matter, hopefully serving to highlight what the real issues are, helping to generate new insight which will help the clinics and the regulators deal with likely increasing demand. For me, the ethical issue which looms largest is the likelihood that TCM is driven by desire and that object of desire is children. TCM costs a lot of money and the desire seems to place the child(ren) in the worrying position of commodity. Kant's ideas of being a 'means to an end'; i.e. making a child the 'means to an end', is a bad idea. When I heard about Bousada's death, my first thought was of the twins and my second thought was that this is what happens when you make children a 'means to an end' (commodity). Forget all the other arguments, the objectivisation of people is perhaps the biggest danger here.