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Artificial insemination by donor and the view of man
Europenn .fownaI of Obstetrics & GynecorogY nnd Reproductive Biology, 28 (1988) 347-352
347
Elsevier
EJO 00603
Artificial insemination by donor and the view of man On the issue of artificial insemination by donor (AID) widely divergent views are set against each other. This is also true for a number of other types of medical assistance in the field of procreation. What one person calls ‘helping’, another thinks of as being ‘immoral manipulation’ against which the individual harmed most in the process, i.e. the child, has no chance whatsoever of defending itself. Whoever endorses the latter view should feel the obligation - based on a well-developed sense of justice - to defend the interests of the harmed child. But anyone who is convinced that artificial insemination is or can be ethically justified will want to defend his actions, in the interest of the people requiring help, if he is accused of ‘immoral practices’. Such a confrontation ought to result in a qualitative exchange of thoughts, which brings the implicit views on man to the surface. For it is at this subsurface level that the views start to diverge. Only if the effort is made to reach the core can the discussion be fruitful. Curiously enough, that discussion has never really been initiated. A taboo of these times is clinging to it. Only a minority, predominantly made up of opponents on principle, explicate the anthropological basis for their views. People who hold a different opinion will rarely take up the gauntlet in the name of every man’s freedom of conscience. I think that their refusal to react is not justified: it is a social issue involving the well-being of a third party. I shall try to express the presuppositions of my ethical view on AID assistance. I hope that those who hold another view will accept the following as a challenge to submit their own underlying views on man for discussion. I shall not (yet) proceed to write down concrete rules in order to prevent the critics from being tempted to get their teeth into issues such as ‘Is insemination allowed in the case of a lesbian couple?’ However important that and other questions may be for everyday assistance, they are of secondary importance from an ethical point of view: the answer to those questions can be derived from an outlook on the way people live well together. For that reason I shall confine myself to the question whether - and if so, in what framework of meaning - AID can enrich the (shared) life of human beings. A view of mankind should be judged on its own and not - at least not in the first place on the basis of concrete rules derived from it. Human dignity and fertility When two people have sexual intercourse, each of them lets the partner know something about him/herself and about what he or she means to the other. Sexuality is communication. Body language can be the messenger of very different 0028-2243/88/$03.50
0 1988 Elsevier Science Publishers
B.V. (Biomedical
Division)
348
information, from crude egoism to the most tender expression of love. Different emotional contents may take the form of one and the same gesture. Sexual behaviour as such is a subject that a moralist can say little about. A value-judgement requires deeper insight. First of all, the following two questions must be answered: (a) Does the message that is put across by means of the sexual behaviour enrich both partners? (b) Does the body language that is used fit the purpose? So sexuality is thought of as being language, as a symbol: a tangible gesture that is at the same time the carrier of an intangible meaning. Sexual intercourse is ethically good, is worthy of man, if it embodies partner involvement, so intensely that this involvement can be adequately symbolized by means of the act. The meaning of fertility can be couched in similar terms. (a) What are the man and woman expressing in begetting new life? Here again, there are various messages possible: a child may be the living image of partner love, on the other hand it may just as well be the harrowing symbol of a rape. (b) Is it justified to let a child be the carrier of this message? By leaving the possibility of impregnation open, the dimension ‘future’ is introduced. In that case the symbolic meaning of the coitus goes beyond the present involvement with the partner. The couple declare themselves prepared and competent to venture the transition to parenthood. The man and woman consider their love relationship sufficiently mature to extend their availability as a couple for working on the future of the child. Being good parents means that the parents should make a living and loving example out of their mutual relationship, and, by doing so, awaken the child’s capacity to love. So a child thus biologically produced is pre-eminently suited to serve as a symbol of loyal love. Love and loyalty are the ethical pillars of justified parenthood. Expressing feelings and sensations in symbols is essential to man, who is in essence a social being. In this way you can be explicit to others about something that concerns you; the others, in their turn, can find the appropriate response to it. The more intense the feelings and sensations are, the greater the need will be to make them external. The way in which this is effected is not arbitrary, but a familiar one to the outside world: by using the language of symbols. The ‘communication’ element is always present, if not consciously then at least pre-consciously. Communication has a dual purpose here: not only ‘to inform’, but also ‘to let someone take part in’. The bliss of love also wants to communicate itself. For the outside world the emphasis is on informing: ‘We wish to admit and bear witness to our happiness’. For the child it is the ‘letting take part’ that prevails: ‘We want your happiness, it will only add to the intensity of our own happiness’. Communication for the second purpose is achieved directly in the parent-child relationship; communication for the first purpose requires an intermediary for its realization: our child, the symbol of our love. Infertility
When a man is not able to beget a child, the physical disability renders the couple as such infertile. (This is equally true if the woman cannot conceive a child, but in the present context the primary attention is to indications for AID.) This is not just a physical matter: the couple is not capable of embodying its loyal
349
love-relationship in the way they had imagined: a handicap of a symbolical order; cut off from the medium handed them, so to speak, by nature to externalize and communicate their happiness. The couple feels isolated, locked up within itself. This is a crisis that, in addition, poses a threat to the relationship itself: the biological infertility causes a breach in the ego-image of the man; as a partner, too, he no longer meets the expectations, either his own about himself, or those of this wife about him. This results in a painful process of mourning: to have to part with the child - flesh of their flesh - which they had already made room for. All that they had built up together is trembling in its foundations. If man and wife together succeed in getting over this crisis and in building themselves a new identity in which they experience their - biologically infertile relationship as being meaningful, satisfactory and complete, they will once again feel the need to disseminate their fulfilment of each other outside the boundaries of their own selves. They have let go of the symbol that is best designed to do so, but that in their case is not available, and are now able to look out for another way. Four possibilities can be thought of, none of which, however, is ‘naturally’ suitable: deciding to live their shared life without children, taking a foster-child into their midst, adopting a child, and artificial insemination by donor. Involuntary childlessness can be turned into a positive option after this non-ability has been classified as belonging to a series of established factors that set bounds to the opportunities for development. What used to be emptiness has now become a space for creative use in other forms of fertile love. It is striking that, one way or another, a fairly large percentage of involuntarily childless couples go in the direction of social engagement. Taking a foster-child into their midst is one way of doing so: letting a biologically alien child take part in the love-relationship without completely burdening it with the full symbolical meaning. Can a biologically alien child or a biologically part-alien AID child be ‘raised’ to become a genuine ‘child of our relationship’? Genuine parenthood Earlier on in this article the assumption was made that the child biologically produced by a couple is pre-eminently suited - destined by nature, so to speak to serve as symbol of loyal partner love. Is the ‘blood-tie’ an essential feature of this symbol function? The characteristic of a symbol is that it carries a double meaning: it is what it is, and at the same time it refers to something else, usually something intangible. Thus, offering a red rose may be an expression of feelings of friendship. The tangible token cannot in itself justify this connection. A red rose does not ‘naturally’ refer to friendship. Yet this connection is not arbitrary: it has come into being because our civilization thought this tangible reality the appropriate medium for representing the intangible meaning-content, though without forcibly establishing the connection. Other patterns of behaviour are equally suitable for expressing feelings of friendship; the red roses that the flower-man hands to the buyer have no symbolic meaning whatsoever. So the connection between the symbol and the symbolized is not intrinsic, but function-related. The reference function is an ‘additional charge’ which is added by an individual person who lends the meaning to a tangible object found fit for the purpose by the culture.
350
In relation to the blood-tie issue this means that it is true that a biological child is a very suitable medium for symbolizing loyal partner love, but that it is not irreplaceable. In principle, the same feelings can be represented by an adopted or AID child, for our culture accepts adoption and AID parenthood as genuine. Whether a biologically (part-) alien child can be really transformed into a child of love depends on the particular couple. Many find it difficult to accept and do not consider it as an option, at least not for them, because, in the way they feel, parenthood is always connected with blood-relationship. There are others, though, who can accept it, also in point of feeling. They have abandoned ‘the myth of the blood’ and believe in the fullness of parenthood without there being a biological basis, a choice that has far-reaching results, for blood-relationship is firmly anchored in our civilization. It is one of the ruling principles of the procreation ‘discours’ (Foucault) the interplay of discussing, thinking and acting in relation to procreation and descent - and is one of the factors determining the answers that our society gives to questions such as ‘Who am I?’ and ‘Where do I come from?‘. For a couple who break away from this structure and want to transform a biologically (part-) alien child into ‘the incarnation of our love treaty’, it will be largely their own responsibility and task to redesign the biological parenthood model in a way that fits them. It requires extra efforts and creativity, the source of which must be their strong love treaty. Adoption and AID are even more demanding than biological parenthood where the quality of the partner relationship is concerned. And what about the well-being of the child? The interests of the child can, in this early phase, be translated into the question of whether the parents can and will take the responsibility for its harmonious development. If such a child is brought to life as a means of embodying loyal love, it is fair to assume that the relationship provides a fertile soil for a new human being to grow up on. The development psychology teaches us that the foundations of the growing identity are based on the interaction within the father-mother-child triangle. It is not the manner of begetting, but the way in which man and wife fulfil their parts as parents towards their child that is decisive here. The manner of begetting becomes important, only after the child has been informed of its true descent. In the case of adoption, informing the child is always necessary. In the case of an AID child there is no urgent reason why it should be informed about its biological descent, unless the insemination by donor was on a genetic indication. Opinions differ widely as to what extent informing may be sensible. So far, little is known about the personal and social effects of informing the child. However, it does not seem necessary to insist on absolute secrecy where the child is concerned. The experiences in adoption cases (‘donors’ both ways!) allow the assumption that a qualitatively sound parent-child relationship can absorb the possible upsetting effect of being told the biological truth, the more so as it may prove how much conscious planning and loving expectation were involved when the parents were looking forward to their child.
351
Asymmetrical
parenthood
The rapidly decreased availability of children for adoption makes the question of whether adoption or insemination by donor is to be preferred less relevant. Nevertheless, contrasting the two may help to produce better insight into the characteristics of either type of assistance. Adoption does not involve a biological asymmetry in blood-relationship between mother/child and father/child which is a feature of insemination by donor. This asymmetry is sometimes given great emphasis because it is feared that this unequal contribution will of necessity lead to a psycho-socially asymmetrical parenthood. Is it possible, then, after what has been said above, that AID contributes to genuine human well-being? Is adoption, for the same reason, the better choice of the two, in the interest of the child and of the partner relationship? The acknowledgement that adoptive parenthood can be just as authentic as parenthood in the case of biological children puts the so-called blood-ties, i.e. the importance of the physical relationship between mother and AID child, in a different perspective, and, consequently, just as much affects the meaning of the physical asymmetry in the parenthood situation. Biological parenthood, too, is not exempt from a similar imbalance: that the mother carries her child for nine whole months, the father cannot match: he cannot actually carry it, he can only ‘bear it in mind’. So the biological asymmetry does not necessarily result in a different psychic involvement with the child. But there is more. With adoption there is initially even such a thing as psychic unbalance. The husband is infertile, a bodily handicap; the wife is infertile, too, not for biological reasons, but by force of the choice that they have made as a couple based on the biological infertility of the male partner. He is unable to; she refuses to make use of her fertility opportunities. Nevertheless, there are no indications - as far as I know - that this imbalance has any negative influence on the way in which the man and woman relate to their adopted child as father and mother. So the fear of psycho-socially asymmetrical parenthood can be no argument for refusing AID assistance on ethical grounds and for preferring adoption. Besides, these fifteen years of experience with insemination by donor have not yielded conclusive evidence that when the decision is taken after thorough consideration, inequality with respect to physical blood-relationship is apt to pose a threat to the harmonious expansion of the father-mother-child triangle. What holds for most cases is, however, no guarantee that each single couple will have a harmonious parent-child relationship. Countless men and women will continue considering equilibrium in the physical relationship with their child as a prerequisite for feeling and living as parents in their togetherness. To them, AID is no alternative to involuntary childlessness. If in spite of all this they still opt for artificial insemination, professional guidance must help to bring this problem to the surface. It is not to be ruled out that it will constitute a psychic contra-indication. An ethical stumbling-block Sperm is the carrier of a genetic identity, of genetic individual characteristics: an individual, concentrated in its most elementary component. In the sexual act of love
352
man and woman meet; in the impregnation (the elementary components of) man and woman melt into new life. Quite a few moralists consider the direct relationship between procreation and the sexual act of love so essential that they reject any disconnection - as there is in the case of AID - as being ethically unacceptable. It should be noted, however, that they apply this criterion less strictly when adoption is concerned. The above analysis has resulted in a view of man that on the one hand insists on the connection between partner love and procreation, but on the other hand leaves room for adoption as well as for insemination by donor. However, AID cannot be fitted into this view on man without there arising a problem. That problem is donorship. AID is based on the presupposition that a donor will lay no claim whatsoever with respect to his semen, for it would be unacceptable if, along with the genetic cells, a ‘third partner’ were to make his appearance in the world of the parents-to-be. The donor disappears in clouds of anonymity: the gift no longer bears any reference to the person of the giver: the sperm is a neutral element for the realization of the wish of an infertile couple to have a child. Can a man, although his name is never known and secrecy is guaranteed, renounce all interest in and responsibility for those who are his own offspring? Insemination by donor is based on an agreement between the parties concerned which delegates the responsibility for the results of the donorship entirely to the receiving couple. This delegation of responsibility safeguards the well-being of the child and opens new development perspectives for the couple, without causing any harm to either party. The necessary de- and re-personalization of the donor semen is, however, a difficulty. It is based on a dualism that makes the physical - semen cells as carriers of characteristics of the individual - into an object which can be used by a subject in any way he likes and can even be handed over to another subject. Such a presupposition I cannot make to fit into my view on man! However, this theoretical objection is not confirmed by practical experience with AID. Practical experiences, too, are allowed their own rights in the ethical reflection. But this philosophical anomaly cannot be discarded as ‘insignificant’. It is intended as a constant warning that for the sake of inherent risks, AID assistance should always be surrounded with the greatest possible care in the interests of the child, the prospective parents and the donor. Dr. Marc Christiaens Department of Medical Ethics, Faculty of Medicine and Dentistry, Catholic University of Nijmegen, The Netherlands
347
Elsevier
EJO 00603
Artificial insemination by donor and the view of man On the issue of artificial insemination by donor (AID) widely divergent views are set against each other. This is also true for a number of other types of medical assistance in the field of procreation. What one person calls ‘helping’, another thinks of as being ‘immoral manipulation’ against which the individual harmed most in the process, i.e. the child, has no chance whatsoever of defending itself. Whoever endorses the latter view should feel the obligation - based on a well-developed sense of justice - to defend the interests of the harmed child. But anyone who is convinced that artificial insemination is or can be ethically justified will want to defend his actions, in the interest of the people requiring help, if he is accused of ‘immoral practices’. Such a confrontation ought to result in a qualitative exchange of thoughts, which brings the implicit views on man to the surface. For it is at this subsurface level that the views start to diverge. Only if the effort is made to reach the core can the discussion be fruitful. Curiously enough, that discussion has never really been initiated. A taboo of these times is clinging to it. Only a minority, predominantly made up of opponents on principle, explicate the anthropological basis for their views. People who hold a different opinion will rarely take up the gauntlet in the name of every man’s freedom of conscience. I think that their refusal to react is not justified: it is a social issue involving the well-being of a third party. I shall try to express the presuppositions of my ethical view on AID assistance. I hope that those who hold another view will accept the following as a challenge to submit their own underlying views on man for discussion. I shall not (yet) proceed to write down concrete rules in order to prevent the critics from being tempted to get their teeth into issues such as ‘Is insemination allowed in the case of a lesbian couple?’ However important that and other questions may be for everyday assistance, they are of secondary importance from an ethical point of view: the answer to those questions can be derived from an outlook on the way people live well together. For that reason I shall confine myself to the question whether - and if so, in what framework of meaning - AID can enrich the (shared) life of human beings. A view of mankind should be judged on its own and not - at least not in the first place on the basis of concrete rules derived from it. Human dignity and fertility When two people have sexual intercourse, each of them lets the partner know something about him/herself and about what he or she means to the other. Sexuality is communication. Body language can be the messenger of very different 0028-2243/88/$03.50
0 1988 Elsevier Science Publishers
B.V. (Biomedical
Division)
348
information, from crude egoism to the most tender expression of love. Different emotional contents may take the form of one and the same gesture. Sexual behaviour as such is a subject that a moralist can say little about. A value-judgement requires deeper insight. First of all, the following two questions must be answered: (a) Does the message that is put across by means of the sexual behaviour enrich both partners? (b) Does the body language that is used fit the purpose? So sexuality is thought of as being language, as a symbol: a tangible gesture that is at the same time the carrier of an intangible meaning. Sexual intercourse is ethically good, is worthy of man, if it embodies partner involvement, so intensely that this involvement can be adequately symbolized by means of the act. The meaning of fertility can be couched in similar terms. (a) What are the man and woman expressing in begetting new life? Here again, there are various messages possible: a child may be the living image of partner love, on the other hand it may just as well be the harrowing symbol of a rape. (b) Is it justified to let a child be the carrier of this message? By leaving the possibility of impregnation open, the dimension ‘future’ is introduced. In that case the symbolic meaning of the coitus goes beyond the present involvement with the partner. The couple declare themselves prepared and competent to venture the transition to parenthood. The man and woman consider their love relationship sufficiently mature to extend their availability as a couple for working on the future of the child. Being good parents means that the parents should make a living and loving example out of their mutual relationship, and, by doing so, awaken the child’s capacity to love. So a child thus biologically produced is pre-eminently suited to serve as a symbol of loyal love. Love and loyalty are the ethical pillars of justified parenthood. Expressing feelings and sensations in symbols is essential to man, who is in essence a social being. In this way you can be explicit to others about something that concerns you; the others, in their turn, can find the appropriate response to it. The more intense the feelings and sensations are, the greater the need will be to make them external. The way in which this is effected is not arbitrary, but a familiar one to the outside world: by using the language of symbols. The ‘communication’ element is always present, if not consciously then at least pre-consciously. Communication has a dual purpose here: not only ‘to inform’, but also ‘to let someone take part in’. The bliss of love also wants to communicate itself. For the outside world the emphasis is on informing: ‘We wish to admit and bear witness to our happiness’. For the child it is the ‘letting take part’ that prevails: ‘We want your happiness, it will only add to the intensity of our own happiness’. Communication for the second purpose is achieved directly in the parent-child relationship; communication for the first purpose requires an intermediary for its realization: our child, the symbol of our love. Infertility
When a man is not able to beget a child, the physical disability renders the couple as such infertile. (This is equally true if the woman cannot conceive a child, but in the present context the primary attention is to indications for AID.) This is not just a physical matter: the couple is not capable of embodying its loyal
349
love-relationship in the way they had imagined: a handicap of a symbolical order; cut off from the medium handed them, so to speak, by nature to externalize and communicate their happiness. The couple feels isolated, locked up within itself. This is a crisis that, in addition, poses a threat to the relationship itself: the biological infertility causes a breach in the ego-image of the man; as a partner, too, he no longer meets the expectations, either his own about himself, or those of this wife about him. This results in a painful process of mourning: to have to part with the child - flesh of their flesh - which they had already made room for. All that they had built up together is trembling in its foundations. If man and wife together succeed in getting over this crisis and in building themselves a new identity in which they experience their - biologically infertile relationship as being meaningful, satisfactory and complete, they will once again feel the need to disseminate their fulfilment of each other outside the boundaries of their own selves. They have let go of the symbol that is best designed to do so, but that in their case is not available, and are now able to look out for another way. Four possibilities can be thought of, none of which, however, is ‘naturally’ suitable: deciding to live their shared life without children, taking a foster-child into their midst, adopting a child, and artificial insemination by donor. Involuntary childlessness can be turned into a positive option after this non-ability has been classified as belonging to a series of established factors that set bounds to the opportunities for development. What used to be emptiness has now become a space for creative use in other forms of fertile love. It is striking that, one way or another, a fairly large percentage of involuntarily childless couples go in the direction of social engagement. Taking a foster-child into their midst is one way of doing so: letting a biologically alien child take part in the love-relationship without completely burdening it with the full symbolical meaning. Can a biologically alien child or a biologically part-alien AID child be ‘raised’ to become a genuine ‘child of our relationship’? Genuine parenthood Earlier on in this article the assumption was made that the child biologically produced by a couple is pre-eminently suited - destined by nature, so to speak to serve as symbol of loyal partner love. Is the ‘blood-tie’ an essential feature of this symbol function? The characteristic of a symbol is that it carries a double meaning: it is what it is, and at the same time it refers to something else, usually something intangible. Thus, offering a red rose may be an expression of feelings of friendship. The tangible token cannot in itself justify this connection. A red rose does not ‘naturally’ refer to friendship. Yet this connection is not arbitrary: it has come into being because our civilization thought this tangible reality the appropriate medium for representing the intangible meaning-content, though without forcibly establishing the connection. Other patterns of behaviour are equally suitable for expressing feelings of friendship; the red roses that the flower-man hands to the buyer have no symbolic meaning whatsoever. So the connection between the symbol and the symbolized is not intrinsic, but function-related. The reference function is an ‘additional charge’ which is added by an individual person who lends the meaning to a tangible object found fit for the purpose by the culture.
350
In relation to the blood-tie issue this means that it is true that a biological child is a very suitable medium for symbolizing loyal partner love, but that it is not irreplaceable. In principle, the same feelings can be represented by an adopted or AID child, for our culture accepts adoption and AID parenthood as genuine. Whether a biologically (part-) alien child can be really transformed into a child of love depends on the particular couple. Many find it difficult to accept and do not consider it as an option, at least not for them, because, in the way they feel, parenthood is always connected with blood-relationship. There are others, though, who can accept it, also in point of feeling. They have abandoned ‘the myth of the blood’ and believe in the fullness of parenthood without there being a biological basis, a choice that has far-reaching results, for blood-relationship is firmly anchored in our civilization. It is one of the ruling principles of the procreation ‘discours’ (Foucault) the interplay of discussing, thinking and acting in relation to procreation and descent - and is one of the factors determining the answers that our society gives to questions such as ‘Who am I?’ and ‘Where do I come from?‘. For a couple who break away from this structure and want to transform a biologically (part-) alien child into ‘the incarnation of our love treaty’, it will be largely their own responsibility and task to redesign the biological parenthood model in a way that fits them. It requires extra efforts and creativity, the source of which must be their strong love treaty. Adoption and AID are even more demanding than biological parenthood where the quality of the partner relationship is concerned. And what about the well-being of the child? The interests of the child can, in this early phase, be translated into the question of whether the parents can and will take the responsibility for its harmonious development. If such a child is brought to life as a means of embodying loyal love, it is fair to assume that the relationship provides a fertile soil for a new human being to grow up on. The development psychology teaches us that the foundations of the growing identity are based on the interaction within the father-mother-child triangle. It is not the manner of begetting, but the way in which man and wife fulfil their parts as parents towards their child that is decisive here. The manner of begetting becomes important, only after the child has been informed of its true descent. In the case of adoption, informing the child is always necessary. In the case of an AID child there is no urgent reason why it should be informed about its biological descent, unless the insemination by donor was on a genetic indication. Opinions differ widely as to what extent informing may be sensible. So far, little is known about the personal and social effects of informing the child. However, it does not seem necessary to insist on absolute secrecy where the child is concerned. The experiences in adoption cases (‘donors’ both ways!) allow the assumption that a qualitatively sound parent-child relationship can absorb the possible upsetting effect of being told the biological truth, the more so as it may prove how much conscious planning and loving expectation were involved when the parents were looking forward to their child.
351
Asymmetrical
parenthood
The rapidly decreased availability of children for adoption makes the question of whether adoption or insemination by donor is to be preferred less relevant. Nevertheless, contrasting the two may help to produce better insight into the characteristics of either type of assistance. Adoption does not involve a biological asymmetry in blood-relationship between mother/child and father/child which is a feature of insemination by donor. This asymmetry is sometimes given great emphasis because it is feared that this unequal contribution will of necessity lead to a psycho-socially asymmetrical parenthood. Is it possible, then, after what has been said above, that AID contributes to genuine human well-being? Is adoption, for the same reason, the better choice of the two, in the interest of the child and of the partner relationship? The acknowledgement that adoptive parenthood can be just as authentic as parenthood in the case of biological children puts the so-called blood-ties, i.e. the importance of the physical relationship between mother and AID child, in a different perspective, and, consequently, just as much affects the meaning of the physical asymmetry in the parenthood situation. Biological parenthood, too, is not exempt from a similar imbalance: that the mother carries her child for nine whole months, the father cannot match: he cannot actually carry it, he can only ‘bear it in mind’. So the biological asymmetry does not necessarily result in a different psychic involvement with the child. But there is more. With adoption there is initially even such a thing as psychic unbalance. The husband is infertile, a bodily handicap; the wife is infertile, too, not for biological reasons, but by force of the choice that they have made as a couple based on the biological infertility of the male partner. He is unable to; she refuses to make use of her fertility opportunities. Nevertheless, there are no indications - as far as I know - that this imbalance has any negative influence on the way in which the man and woman relate to their adopted child as father and mother. So the fear of psycho-socially asymmetrical parenthood can be no argument for refusing AID assistance on ethical grounds and for preferring adoption. Besides, these fifteen years of experience with insemination by donor have not yielded conclusive evidence that when the decision is taken after thorough consideration, inequality with respect to physical blood-relationship is apt to pose a threat to the harmonious expansion of the father-mother-child triangle. What holds for most cases is, however, no guarantee that each single couple will have a harmonious parent-child relationship. Countless men and women will continue considering equilibrium in the physical relationship with their child as a prerequisite for feeling and living as parents in their togetherness. To them, AID is no alternative to involuntary childlessness. If in spite of all this they still opt for artificial insemination, professional guidance must help to bring this problem to the surface. It is not to be ruled out that it will constitute a psychic contra-indication. An ethical stumbling-block Sperm is the carrier of a genetic identity, of genetic individual characteristics: an individual, concentrated in its most elementary component. In the sexual act of love
352
man and woman meet; in the impregnation (the elementary components of) man and woman melt into new life. Quite a few moralists consider the direct relationship between procreation and the sexual act of love so essential that they reject any disconnection - as there is in the case of AID - as being ethically unacceptable. It should be noted, however, that they apply this criterion less strictly when adoption is concerned. The above analysis has resulted in a view of man that on the one hand insists on the connection between partner love and procreation, but on the other hand leaves room for adoption as well as for insemination by donor. However, AID cannot be fitted into this view on man without there arising a problem. That problem is donorship. AID is based on the presupposition that a donor will lay no claim whatsoever with respect to his semen, for it would be unacceptable if, along with the genetic cells, a ‘third partner’ were to make his appearance in the world of the parents-to-be. The donor disappears in clouds of anonymity: the gift no longer bears any reference to the person of the giver: the sperm is a neutral element for the realization of the wish of an infertile couple to have a child. Can a man, although his name is never known and secrecy is guaranteed, renounce all interest in and responsibility for those who are his own offspring? Insemination by donor is based on an agreement between the parties concerned which delegates the responsibility for the results of the donorship entirely to the receiving couple. This delegation of responsibility safeguards the well-being of the child and opens new development perspectives for the couple, without causing any harm to either party. The necessary de- and re-personalization of the donor semen is, however, a difficulty. It is based on a dualism that makes the physical - semen cells as carriers of characteristics of the individual - into an object which can be used by a subject in any way he likes and can even be handed over to another subject. Such a presupposition I cannot make to fit into my view on man! However, this theoretical objection is not confirmed by practical experience with AID. Practical experiences, too, are allowed their own rights in the ethical reflection. But this philosophical anomaly cannot be discarded as ‘insignificant’. It is intended as a constant warning that for the sake of inherent risks, AID assistance should always be surrounded with the greatest possible care in the interests of the child, the prospective parents and the donor. Dr. Marc Christiaens Department of Medical Ethics, Faculty of Medicine and Dentistry, Catholic University of Nijmegen, The Netherlands