Cheryl Erwin, Assistant Professor, University of Iowa Carver College of Medicine. Secondary appointments, University of Iowa College of Law and College of Public Health. I would like to thank Johanna Reimer and Mark Stromer for their assistance in making this Symposium and the focus of this issue of the Journal possible. I would also like to thank Professor Sheldon Kurtz who made this topic a focus of a recent course on Biotechnology Law at the University of Iowa College of Law.
The twentieth century witnessed an explosion of scientific knowledge and technological achievement. The discovery of insulin in 1922 led to treatments for diabetes. The unique properties of penicillin, discovered in 1928, were called a medical miracle and a "magic bullet" when the drug was used on infected wounds. Only years later did we realize that an antibiotic resistance arms race had been set up between humans and bacterium. Other scientific and medical discoveries followed: kidney dialysis, tetracycline, oral contraceptives, and pharmaceutical products that help millions of Americans every day. The last century also witnessed the development of in-vitro fertilization techniques that produced Louise Brown, the first "test tube baby," born on July 25, 1978 in Oldham General Hospital, England. The technique was the first of many under the rubric of assisted reproductive technologies (ART) and has been used by countless couples around the world to conceive and bear children they may not have otherwise had.
Along with the scientific miracles of the twentieth century, we learned that scientific progress can have its downside. The atomic bomb did not make the world a safer place, although it did make the world a much more anxious one.1 The promise of eugenics was a sort of medical utopia brought about through selective sterilizations in which humans would be free from Page 622 debilitating conditions.2 The introduction of oral contraceptives launched a deep social debate, and newer drugs are no less controversial.3 Indeed, the progress brought about by new technologies has seldom brought pure good to humans unalloyed with new burdens and unanticipated challenges.
The message of technological progress together with new constraints and problems has been a part of utopian writings for at least 500 years. While we welcome the new possibilities opened to human procreation through assisted reproductive technologies, we would be wise to remember the lessons learned from past human experience and imagination. Professors Goodwin and Baruch each remind us that ART can be useful in alleviating human suffering yet the techniques involved can also, because of their innate ability to alter the course of a life, cause unanticipated hardship, result in lifelong burdens, or simply fail to deliver the promise of new life at all.
This Commentary on the Goodwin4 and Baruch5 presentations will begin with the assumption that the techniques of ART are medically appropriate and medically helpful to many individuals who could not conceive and carry a pregnancy to term without the assistance of this biotechnology. It will challenge assumptions that the technology is always appropriate or without its own set of risks. Part II will examine the contribution of utopian novels as social commentary on what new technology is and what it could be. Part III will examine the regulation of these technologies and explore some of the safety concerns of in-vitro fertilization (IVF) and pre-implantation genetic diagnosis (PGD). In Part IV, I will combine the hopes and dreams of couples wanting to conceive with the practical reality of ART; a reality that not only underachieves its goals, but has the potential to devastate those who suffer its worst consequences. Finally, in Part V, I will examine the intersection of longing, nature, and the human condition as revealed in the utopian literature.
Utopian literature grew out of the humanism movement in the renaissance period and reflects the optimism of faith in the power of human reason to improve the living conditions of humanity,6 though the literature may properly extend back to Plato¥s Republic7 and may include such recent artistic works as John Lennon¥s Imagine.8 The passionate arguments for a better society reflect an acknowledgment that the current social order fails to satisfy human needs for self fulfillment and living in community with others. There are many themes that run through utopian writings, and I will not attempt to discuss all of them here. The two themes that I will draw on are: first, excessive reliance on technology may limit the power of the human spirit to imagine better conditions for human flourishing; and second, the desire to use technology in order to liberate humans from unhappiness and instability may ironically set the basis for other limitations. To show how this literature reveals enduring human longings and limitations, I will draw from two writings that are particularly applicable to our current quest to improve our reproductive options, Sir Thomas More¥s Utopia9 and Aldous Huxley¥s Brave New World.10 I will focus on the ways utopian thinking can mirror hopes for progress through reproductive technologies. Our hopes can become utopian when we fail to reflect on the limitations of these technologies or to imagine other possible ways to work out our need to bear children and raise them while also pursuing full lives as women and couples.
The term "utopia" was coined by Sir Thomas More (1478-1535) who wrote the novel Utopia as a way of illuminating the hopes and limitations of the human imagination.11 The word "utopia" is comprised of the syllable Page 624 "eu" meaning good, and "topos" meaning place.12 However, the homonymous prefix "ou," which means "no," also applies to the word, leaving one with the unmistakable notion that More meant utopia to mean both "good place" and "no place."13
In several places More writes in glowing terms about conditions the inhabitants take for comfort and happiness but which the reader easily recognizes as suppressing the human spirit. "Throughout the island they wear the same sort of clothes without any other distinction, except what is necessary to distinguish the two sexes, and the married and the unmarried. The fashion never alters, and it is neither disagreeable nor uneasy."14 The effort to create a better society through uniformity and strict adherence to rules leaves the inhabitants comfortable, but one senses they are missing diversity of opinion and expression in even the most intimate details of life. The caution in More¥s novel is that even in a good place we can lose the ability to reflect on our condition and understand our limitations. The danger is more pronounced if the fashion is comfortable and seems to comport with our needs.
The utopian vision of Aldous Huxley¥s Brave New World adds a technological slant, in which society is improved through the wisdom of the Director of Hatcheries and Conditioning in charge of the Fertilizing Room.15 The goals of producing gammas, deltas, and epsilons are primarily focused on social stability, as we learn at the beginning of the novel.16 Like More¥s Utopia, Huxley¥s focus on social stability and a lack of change over time allows for social control of otherwise chaotic human urges, but this also leads to an unfortunate intolerance for diversity. Thus technology can liberate humans to control their society and eliminate the burden of pregnancy. At the same time, however, it has the potential to become the master over humanity when real choice is diminished and diversity is reduced in persons who maintain a sense of happiness through the use of Page 625 "soma," a type of drug that induces a sense of comfort and well being.17 In this state of controlled "social stability" humans lose their sense of innovation, creativity, and tolerance for other possible ways of being in the world. Most importantly, the technology that was once meant to liberate humans now enslaves them and seals their fate.
The utopian literature contains themes that inform the current discussion of assisted reproductive technologies. In particular the presentations by Goodwin18 and Baruch19 illustrate the limitations of these technologies and question the promise of a better future, a magic bullet solution to infertility. The search for stability in the form of control over reproduction and genetic endowment has the apparent advantage of avoiding uncertainty, but it is bought at the price of health risks and the possibility of not having a child with one¥s own egg or sperm. Rather than giving us more control over reproductive choice, the failure to acknowledge the downside of these technologies may lead women to delay pregnancy, only to discover they have a diminished choice when a pregnancy does not occur or cannot be carried to term. With new information about the health and safety risks to women and children born using ART,20 it is time to renew our sense of creativity and explore other possible ways of allowing women both to work and nurture a family.
Utopian literature warns that technology and control over...