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Feature Articles: Reproductive EndocrinologyA.R.T. And ConsequencesGuy I. Benrubi, M.D., Guest Editor |
Technology is the means by which humans apply scientific understanding to every day needs. Humans are fairly fragile animals; if they were to rely solely on their bodies for food, shelter, and avoidance of predators we would quickly expire as a species. The reason why humans were able to thrive and become the dominant species on the planet is their ability to develop and use technology. The ability to conceive of, develop, and use tools in conjunction with the apposable thumb, ensured man's survival. Technology is the method through which man achieves freedom. Whether that is freedom from darkness by having fire, freedom from the elements by developing means of shelter, on through the ages to freedom from floods by erecting dams, or even to freedom from time and geographical constraints through aviation. Whether via simple tools or complex machines the ultimate goal of technology is to allow humans to make their existence fall more under their control, and less under the whims of chance. From time immemorial and in practically every studied society, the major concern of humans seems to be fertility and procreation, followed closely by the ability to choose gender and order of offspring. From a teleological molecular perspective that makes sense. The current "molecular" view of "progress" is the concept of the DNA of a species making sure that it gets reproduced. The religious rites of early societies revolved around fertility rituals. Even in more advanced ancient societies such as Greece and Rome, fertility rites were a dominant part of religious observance. These observations are cross-cultural and found through modern times. Twenty-two years after the first in vitro fertilization child was delivered, we are now approaching an era, though still down the road, when fertility can be universally assured, and not only offspring gender, but also traits can be preordered. What will be the consequences of these technological advances? These advances will occur. The history of technology is such that if it can be done, it will be done. Government regulations, or culture specific ethical concerns, do not stop technological innovation. In assisted reproduction, legislation is not uniform across nations capable of carrying out the technology. In fact some European nations have no regulations at all. Additionally there is nothing to stop nations which need foreign exchange from creating sites for "reproductive tourism". If "sex tourism" to Bangkok is a big industry why wouldn't "fertility frolics" in Minsk or Kiev be future growth industries? So the future will happen. The consequences will be the ability of humans to determine outcome in one more area of their lives. The "benefit" will be disproportionately enjoyed by the rich versus the poor, until further technological innovation makes widespread use of the advances possible. There will be multiple redefinitions of entrenched concepts not least of which is "motherhood". Until 1967, death was defined as the absence of a heart beat. With the advent of heart transplants, we had to redefine death. Until in vitro fertilization and surrogacy, "mother" was defined as the human in whose uterus the infant spent the first months of existence. Now "motherhood" has to be specified as genetic, gestational, or rearing. There is one other consequence of the new world of ART. In many cultures the wish for male offspring is all consuming. This has led to all kinds of reprehensible acts from female infanticide, to mistreatment and lack of education of daughters, to outright sexual exploitation and slavery. Recently the CIA estimated that approximately 50,000 women and female children are brought into the U.S. annually, to function essentially as slaves. Many of these children were sold in their country of origin by their parents who preferred to have an electrical appliance in their homes rather than the burden of a female child. It is conceivable that with widespread development of gender preselection, many of these abuses will be stopped. Female infanticide, daughter sales, and child neglect may significantly decrease. Eventually the "marriage market place" may even put a premium on female children. This issue of the journal shows what assisted reproductive technology has accomplished, and gives a sense of where this branch of medicine is heading. Guy Benrubi, M.D., Professor and Associate Chair Jacksonville Medicine / May, 2000 What's New
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