At long last, in vitro fertilization pioneer Robert Edwards has been awarded a Nobel Prize. Back in 1978, his research with his colleague Patrick Steptoe led to the birth of the world’s first test tube baby, Louise Joy Brown. The public (and makers of public policy) initially reacted to Edwards’ research with moral horror. However, once he and Steptoe had succeeded in producing a healthy baby girl, revulsion swiftly turned into wide approval and ethical acceptance.
In 2001, when Roberts was given the prestigious Lasker Award for medical research, biochemist Joseph Goldstein quipped, "We know that IVF was a great leap because Edwards and Steptoe were immediately attacked by an unlikely trinity—the press, the pope, and prominent Nobel laureates." Edwards’ scientific career traces out the ethical arc that characterizes reaction to much technological progress during the last century—initial fear and loathing followed by a warm embrace. Yuck followed quickly by yippee.
In 1969, a Harris poll found that a majority of Americans believed that producing test-tube babies was "against God's will." In 1970s, the federal government imposed a moratorium on federal funding of in vitro fertilization research and legislation that would have outlawed IVF was considered by Congress. Yet just one month after the birth of Louise Brown, the Gallup poll reported that 60 percent of Americans approved of in vitro fertilization and more than half would consider using it if they were infertile.
Advances in biomedicine—especially those that touch most closely on birth and death—have been the most ethically fraught. A lot of moral struggles have centered on control over reproduction. Let’s set aside the long fight over abortion and look chiefly at a couple of the other moral struggles over fertility control, contraception and artificial insemination, as examples of this process of progressive moral endorsement.
Contraception was essentially outlawed in the United States by the passage of An Act for the Suppression of Trade in, and Circulation of, Obscene Literature and Articles of Immoral Use in 1873. Championed by moral crusader Anthony Comstock, this act outlawed, among many other things, the sale of “any article or medicine for the prevention of conception.” Violators could be “imprisoned at hard labor in the Penitentiary for not less than six months nor more than five years each offense, or fined not less than $100 nor more than $2,000, with costs of court.” Anthony Comstock was immediately made a special agent of the Post Office, and he spent the next 42 years vigorously enforcing the new law.
By the beginning of the 20th century, agitation for birth control information was increasing—as well as official pushback. In 1915, The New York Times reported on the trial of William Sanger, husband of birth control pioneer Margaret Sanger, for handing over a copy of his wife’s pamphlet, Family Limitation, to a Comstock agent. According to the Times, Margaret Sanger had earlier fled to Holland after being “indicted by the Federal authorities for sending through the mail Woman Rebel, a monthly paper which she edited and published.”
During Sanger’s one day trial, the three justices each examined the pamphlet and then immediately convicted and fined Sanger $150. When Sanger refused to pay, the justices ordered him hauled off to jail for 30 days. The Times quotes Chief Justice McInerney’s reproof of Sanger: “Such persons as you who circulate such pamphlets are a menace to society. There are too many now who believe it is a crime to have children. If some of the women who are going around and advocating equal suffrage would advocate women having children they would do greater service.” The Times disapprovingly reported that the courtroom was crowded with a bunch of unruly socialists and anarchists.
A year later the Times reported that the New York Medical Society was divided on birth control. In New York state, the penal code made it a criminal offense for a physician to give any advice to a patient concerning birth control. “At present any physician who gives information on this subject is liable to go to jail,’ noted the vice president of the society, Dr. J. Bentley Squier. “At the same, however, it must be remembered that if the Penal Code on the subject were altered, it would be possible for unprincipled persons to do a great deal of damage.” On the other hand, Dr. Abraham Jacobi favored changing the law “to allow every licensed physician to give advice to married people on the question of birth control.”
During most of the 20th century, the public, the press, and policy makers turned to religious leaders for guidance on the ethics of various biomedical issues. The Roman Catholic Church has had a long tradition of reflecting on the moral consequences of reproductive technologies. A November 3, 1930, article in the Times headlined “Sees Birth Control As Road to Atheism,” reports a lecture by Rev. Ignatius W. Cox, Professor of Ethics at Fordham University. Rev. Cox denounces various Protestant denominations for caving into acceptance of modern contraception as being moral. He specifically noted that the Lambeth Conference, the worldwide gathering of Anglican bishops, had 10 years before declared that birth control “errs against purity,” but now had “allied themselves, partially at least, with modern pagans on marriage.”
“The modern doctrines on sex and morals are the logical conclusion of an atheistic philosophy of life, and their practice logically leads to atheism,” argued Cox. “Why? Because modern doctrines on sex and morals are the declaration of physical and moral independence of God. They serve notice that man does not come from God, that man, and man alone, is man’s chief concern.”
Artificial insemination was becoming a more common procedure to overcome infertility in the 1950s. The Times reported in 1956, that “Pope Pius XII again condemned artificial insemination today as a means of helping childless couples to have offspring.” In 1958, 20 years before the birth of the world’s first test tube baby, the Times reported that Geoffrey Fisher, the Archbishop of Canterbury, “condemned artificial insemination by donors today as ‘an offense against the social and legal implications of marriage.’” The archbishop urged that artificial insemination “be made a criminal offense altogether” or “if that cannot be, then the law should require that every case of artificial insemination by donor be registered and the register should be available for inspection under safeguards.” The archbishop was not alone in Britain. Also in 1958, the Methodist Conference of Great Britain, according to the Times, “condemned artificial insemination because it invaded the essence of Christian marriage and deceived both the child and society.” Despite these denunciations, The New York Times reported that by 1976 as many as 500,000 children had been born by means of artificial insemination.
In 1960, one of most consequential technological introductions in the 20th century occurred—the Food and Drug Administration approved the new birth control pill. “Approval was based on the question of safety,” said FDA associate commissioner John L. Harvey to the Times. “We had no choice as to the morality that might be involved.” The Catholic Church ended up maintaining its opposition to artificial methods of contraception. The pill had a wider approval among Protestant denominations, but that acceptance went only so far. For example, Bishop Fred Pierce, president of the World Methodist Council, argued in 1966 that “morally and religiously, birth control methods should be prescribed only for married couples after consultation with their religious advisors, if they are associated with a religious body.” Bishop Pierce added, “Making it easy to secure an over-the-counter product will create an evil brood of moral deterioration as well as economic and social problems.”
In a 1965 New York Times magazine article, Cornell government professor Andrew Hacker wrote to reassure the public that stories about college health clinics giving out prescriptions for birth control pills to unmarried female students were “overrated, and certainly over-reported.” In fact, he could find no college clinics that were prescribing the pills to unmarried students. Hacker reported that he had surveyed his 200 freshmen students about whether the university clinic should be willing to prescribe the pills to undergraduate girls who request them. “It is hardly necessary to say that a good majority of the boys thought this was a splendid idea,” reported Hacker. “But what surprised me was that most of the girls also agreed with this proposal.” He was particularly startled to find that the steady churchgoers were almost as strongly in favor of dispensing the pill as were his non-religious students.
What Hacker’s little survey discovered was that the sexual revolution had already taken off despite the handwringing of religious and political authorities. Hacker, however, was prescient when he concluded, “Just as we have adjusted our lives to the television set and the automobile, so—in 20 years’ time—we shall take the pill for granted, and wonder how we ever lived without it.” Yes, indeed. In April of this year, the Harris poll reported that 86 percent of Americans believe that having the birth control pill available is good for society.
In a 1972 New York Times magazine article, William Gaylin, a practitioner the nascent field of bioethics, was already wringing his hands over the possibility of using in vitro fertilization not only to produce babies for the infertile but also applying it to selecting the sex of embryos or diagnosing disease in embryos before implanting them in a womb. Gaylin also warned that some women might one day implant in herself donor eggs fertilized with her husband’s sperm or conversely pay another woman for the use of her uterus to carry her embryos to term. In addition, Gaylin feared that humanity’s growing reprogenetic powers would result in cloned people.