“The Disposition Decision” — What to Do With the Embryos?

For most Americans, the moral status of the human embryo is a question that seems quite remote. Even as hundreds of thousands of “excess” human embryos are now stored in American fertility clinics and laboratories, to most Americans these frozen embryos are out of sight and out of mind. Thus, one of the most important moral challenges of our day remains largely off the screen of our national discourse. The issue cannot remain out of sight or out of mind for long.

Indeed, for hundreds of thousands of couples (and in many cases, just individuals) this crucial moral question grows more difficult to ignore by the day. For those whose progeny are now frozen in fertility clinics, the “disposition decision” will eventually have to be made. The decision about the eventual disposition of these human embryos will reveal what these couples truly believe about human dignity and the sanctity of human life. On the larger landscape, the pattern of these decisions and the policies adopted by medical practitioners will reveal the soul of our culture as well.

Writing in The New Atlantis, Jacqueline Pfeffer Merrill contributes an essay on this issue that is both informative and haunting. She begins with an anecdote that establishes the moral sense of urgency we face on this issue:

Noah Markham was born in January 2007 to worldwide media notice. Like his Biblical namesake, this Noah had been saved from a flood. He had been one in a barrel of frozen embryos transported in a flat-bottomed boat from a flooded east New Orleans hospital in the days after Hurricane Katrina by the Louisiana State Police and Illinois Conservation Police. Interviewed at the time of Noah’s birth, his mother, Rebekah Markham, said that she and her husband Glen were uncertain about whether they would use their remaining three frozen embryos to add to their family of Noah and his big brother Witt. Interviewed again on the occasion of Noah’s first birthday, she said, “How can I not? I’m happy with two, but how can you not when you know what the possibility is? We almost lost Noah. I don’t want to lose the others voluntarily.”

Of course, most of these stored human embryos are not in direct danger of a hurricane. Nevertheless, they are all in danger of both neglect and destruction — a moral context of quicksand that is the inevitable consequence of producing far greater numbers of embryos than are ever intended to be transferred to a mother’s womb.

Of course, the moral issues related to advanced reproductive technologies are manifold and complicated. Advances in IVF technology now project the potential that frozen embryos could be successfully transferred into a womb years or even decades after fertilization. For the first time in human history, this allows for a form of generational confusion human beings have never encountered before. Quite literally, an embryo from a genetic ancestor generation could potentially be transferred into a womb and gestate, thus being born after the generation of what would be considered his or her grandchildren. Are we ready for this? A technology that has allowed so many couples to give birth to desperately-wanted children has also brought a host of moral complications.

Clearly, the majority of women whose fertilized eggs are now stored in reproductive health clinics are not even ready to make a decision about the disposition of the embryos that will not be transferred into their wombs. Jacqueline Pfeffer Merrill cites two studies indicating that over 70% of such women lack a plan for what to do with these embryos and seem intent to postpone that decision as long as possible.

In the most important part of her essay, Merrill cites a study published in the scientific journal Fertility and Sterility in which patients were asked to rank their estimation of the moral status of the embryo from “minimum moral status” to “maximum moral status.” Only 10% of these patients indicated their belief that the human embryo should be considered as having “minimum moral status.” But this means that one out of ten patients responded that they consider the human embryo to be of virtually no moral significance whatsoever. Some see these embryos as something akin to excess body parts. Some actually spoke of these embryos as being stored in the event they needed a “replacement” for other children. As Merrill explains, “Presumably the disposition decision is easiest for these few patients who think of embryos as lacking moral worth, free of the weight of morally fraught deliberations at the conclusion of their IVF treatment.”

The other nine out of ten patients estimated the moral status of their embryos on a continuum ranging from some moral status to “maximum moral status.” As these patients reflected, the decision about what to do with their embryos was understood to be freighted with moral consequence. As Merrill reports, these patients recognized their own “strange feelings about discarding human life.”  Nevertheless, “strange feelings” are no substitute for responsible moral decision-making.

As Jacqueline Pfeffer Merrill makes clear, the structure of the IVF process allows for hundreds of thousands of frozen human embryos to be created in laboratories without any clear plan for their future. She is undoubtedly correct in suggesting that most patients see these embryos as the promise of fertility at the time of their treatment. But what about these embryos and their future once the childbearing years are over? Some patients indicated a willingness to allow other infertile couples to “adopt” their embryos. Nevertheless, these represent only a fraction of the patients involved in the study. Furthermore, many of these individuals and couples are apparently more theoretically committed to this option then in fact. In the end, very few patients choose to allow the adoption of their embryos — often seen as akin to “virtual children.”

Another small percentage indicated a willingness to allow the embryos to be used in medical research. As Merrill explains, this is often a hypothetical possibility anyway, since most of these embryos are unsuitable for medical research. Of course the greater problem with this option is that it views human embryos as mere material for medical research. The embryos are destroyed in the name of medical science.

A significant number of patients are deciding to “thaw” their embryos and allow their demise. Hauntingly, Merrill writes of some patients and couples who understand clearly enough that these embryos are of some moral significance, and some patients express a desire for some ceremony to accompany the demise of their embryonic progeny.

For the vast majority of patients, the current decision is to make no decision at all. This condition will not last, for the reproductive technology industry faces logistical, moral, financial, and technological limitations to the indefinite storage of what may even now be more than a million human embryos that are never to be transferred into wombs.

The “disposition decision” related to these frozen human embryos represents one of the most significant, if neglected, moral crises of our age. This crisis is entirely the result of our own technologies and we as a society bear responsibility for this moral crisis. As it now stands, we face the specter of untold thousands of frozen human embryos who will meet their demise largely out of sight and out of mind.

Perhaps the most chilling question is this: How long will it be before someone asks about the moral status of all human beings — embryonic or otherwise — and proposes that this moral status be estimated on a continuum from “minimal moral status” to “maximum moral status?” We cannot fool ourselves into thinking that this essential question of human dignity will be restricted to frozen embryos in the laboratory.

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