ARTs and population growth are not the issue

Since the first successful human birth resulting from in vitro fertilisation (IVF) in 1978, ethicists have debated a wide spectrum of moral questions raised by reproductive technologies including ‘concerns about economic exploitation, profiteering, health effects on women's bodies, interference with traditional family norms, and children's welfare.’12 The environmental impact of ART babies has hitherto only been addressed as it relates to population growth, not resource consumption that leads to carbon emissions.

In 1986, the Ethics Committee of the American Fertility Society (ECAFS) considered the issue of assisted reproduction in world with a rapidly multiplying human population and declared their clients not culpable stating, ‘the infertile couple should not be held responsible for the population problems of the world.’13 Writing within a decade of the first IVF baby, the world population was in a drastically different state then than it is now. In the mid-1980s, world population was at 5 billion people, but in the last two decades we have passed the 7 billon mark.

While the ECAFS did acknowledge a global population problem, ARTs are not a major culprit of local population growth, and are typically provided in countries with low birth rates. Since 1978, ‘only’ five million children have been born through IVF worldwide.14 More striking for the purposes of this article is the carbon emissions that each medically assisted birth leads to.

ARTs and consumption are the issue

While population growth and ARTs are not the primary environmental issue that should concern ecologists and bioethicists, the numbers of ART babies are increasing at an exponential rate. If we were to look at these numbers in terms of carbon emissions instead of raw population growth data, the statistics look grim.

As of 2010, the largest number of ART births came from the USA,15 the country the EPA listed as the number one carbon emitter in the world.16 In the USA, each single child will use the equivalent in resources of seven children in China.17 This is environmentally significant, more so than just the number of ART births and makes ‘green parenting’ in some countries nearly an oxymoron. For instance, in America there is nothing that a potential parent could do, short of moving to another country, to offset the carbon of a biological child.18

Furthermore, we are now at the point where babies who came from medical intervention are leaving a carbon legacy through reproducing themselves.19 The multiplying effect of procreation is a major source of CO₂ emissions; therefore, the ecological implications of reproductive technologies must be considered in light of the effects of climate change.

Due to the extreme impact of children born via the fertility business, I suggest that the industry implement certain strategic measures to become more environmentally sustainable. While a moratorium on all fertility clinics would be the most ecologically sound decision in this purview, it is unlikely that established fertility procedures or treatments would be effectively ‘banned’ until global CO₂ emissions stabilise. Therefore, persuading the reproductive business to follow after the other viable models of conservation is preferable. Those in the medical industry who are concerned about carbon emissions can encourage carbon capping for the ART industry and a restriction on insurance and government provided ARTs to those who are fertile.

Carbon caps for the fertility business

‘In step with the dramatic rise in CO₂ emissions and other pollutants in recent years, a variety of new financial markets have emerged, offering businesses key incentives- aside from taxes and other punitive measures- to slow down overall emissions growth and, ideally, global warming itself.’20 These incentives include meeting targeted carbon emissions caps.

If the ART business were to address sustainability through carbon capping, they would not have to reinvent the wheel. There are already several environmentally sustainable models in place that could be implemented. In the first scenario, the reproductive technologies industry could voluntarily join a programme like the Chicago Climate Exchange ‘a carbon-trading scheme in which companies make a voluntary but legally binding commitment to meet emissions targets.’18 Each fertility clinic could join as a stand-alone entity. This would be most applicable in deregulated countries like the USA.

In a second scenario, entire sectors work to reduce their total emissions. This is particularly effective in countries that have government sponsored medical care. Here, the ART business would be included among other technological offerings of the medical industry. The National Health Service (NHS) Carbon Reduction Strategy for England is one example of sector-specific carbon limitations. After calculating that the NHS is responsible for 25% of England's public sector emissions (over 18 million tons of carbon dioxide a year), strategies for carbon reduction were proposed and implemented. Decreasing the amount of meat served in hospitals and water waste were top suggestions.21 The USA should take note. In 2007, the US healthcare sector expended an estimated 546 million metric tons of carbon dioxide,22 over 30 times higher than the UK.

In addition to voluntary measures in local business and corporate sectors, another option would involve an initiative like the Kyoto Protocol and make an entire country accountable for carbon emissions, thus forcing each and every sector to examine their consumptive practices. Yet even if fertility clinics were otherwise ‘green’ and used recycled energy, renewable materials and functioned off the grid, they still could not offset the carbon output of their products under current production models.ⁱⁱⁱ

One downside of these carbon capping approaches is that typical carbon programmes calculate only the environmental effects of manufacturing the product they sell and do not consider the impact of the merchandise on the environment. For instance, carbon limitations on automobile companies are localised to each specific business; the manufacturer is not responsible for the way in which the natural resources are excavated, the carbon costs of transporting the materials or, most importantly, the emissions of their cars once driven off the lot.^iv Instead of assessing only a fraction of the carbon output of each company—that which is local to the manufacturing plant—I believe that calculating the net effects of the business must be taken into account as well.

Accounting for the externalities of consumption would take a more comprehensive approach to carbon limitations. Just as the automobile industry could be held responsible for the emissions of each car, so too could the fertility business be responsible for the carbon of each child. Calculating the carbon emission of each live birth by taking the lifetime consumption of the average citizen and adding it into the fertility industry carbon budget would necessarily lead to a dramatic decrease in baby production. In the USA, for instance, data from 2008 indicated that each person produces 19.18 metric tons of CO₂ per capital per year. With an average lifespan of 80 years, the figure is 1534 metric tons or 3 068 800 metric pounds. If these total figures could be integrated into a carbon-capping programme, great strides could be made to reduce carbon emissions. And while the idea of carbon limitations may be initially resisted, regulating carbon emissions of businesses would reduce the effects of climate change.

At the same time, corporations only account for 60% of carbon emissions, so some ecologists have been critical of targeting business carbon emissions without attending to the consumers who use their services. Proposals for a more comprehensive environmental solution for reducing carbon emissions under a capping plan include carbon caps for a household family, carbon limits for each new individual and fees for having more than two biological children.23

In addition to carbon caps on the fertility industry itself, healthcare policymakers can also lobby for legislation that promotes conservation through rewriting provisions for ARTs through healthcare, both private and governmental, to only provide ARTs to the biologically infertile.

Healthcare policy and ARTs

Although the ART business has been hitherto unregulated by any environmental standards,^v as the world grapples on a daily basis with what it means to be responsible citizens, we are faced with choices about what goods society will promote and what it will attenuate. Drugs and techniques that promote fertility instigate climate change due to the connection between humans and carbon emissions. To be sure, all medical treatments have the possibility for perpetuating carbon emissions. It is legitimate to ask, therefore, how ARTs are different from other medical interventions that extend opportunities for consumerism in a time of climate change. My answer is fivefold.

First, life-extending medicine typically fits within the goals of medicine defined as ‘the prevention of diseases and injury and the promotion and maintenance of health; the relief of pain and suffering caused by maladies; the care and cure of those with a malady, and the care of those who cannot be cured; the avoidance of premature death and the pursuit of a peaceful death.’24 ARTs do not treat, cure or prevent infertility as a disease.

Second, there is widespread consensus that we should continue to provide life-extending medicine and therapies to patients. Bioethicists do not spill ink attempting to convince the healthcare industry that standard forms of medicine are unethical. In contrast, ARTs continue to be subject to feminist, policy, environmental, social, sociological, religious and financial debate. They are ethically contested.

Third, ARTs leave a carbon legacy and not just a carbon footprint. Whereas life-extending medicine does provide the opportunity for extra years of CO₂ emissions, only the carbon footprint of the individual is affected and not the carbon legacy. In contrast, carbon emissions from lineage-extending fertility treatments continue after the parent dies and are often perpetuated in additional descendants. There is an exponential carbon legacy impact in ARTs.

Fourth, while a prereproductive person who has received life-extending medical treatments may or may not go on to have children, this is merely an environmental side effect of the medicine; it is not the direct intention. People who use ARTs are deliberately seeking a carbon legacy. While we can claim ignorance on the reproductive decisions of those using life-extending medicine, the expressed purpose of ARTs is to create carbon-emitting humans.

Finally, even when comparing the carbon legacy of parents who use ARTs with parents who conceive naturally, ARTs have far greater environmental externalities. ARTs use scarce communal resources such as intellectual research, government funding for development and medical buildings. Natural procreation qua procreation does not. That is, a woman wishing to become pregnant through ARTs has to go to a clinic, visit a doctor and use the carbon-intensive resources of the medical industry. In contrast, a natural pregnancy takes no extra physical resources to achieve conception. And, considering many fertile people who could become pregnant without any extra resources use ARTs, this is an environmental waste that contributes to the bloated carbon footprint of the medical industry.

Given the gravity of ARTs, then, there are several categories in which policy limitations on the fertility business could be implemented. Eliminating reproductive technologies that are not used to circumvent infertility such as cosmetic appearance of children, preimplantation genetic diagnosis that selects for the presence of disabilities and sex selection not related to disease25^–27 are some examples. Furthermore, no reproductive policy to my knowledge specifies that a woman or couple seeking fertility treatment from health insurance or the government has to be childless. The Primary Care Trust in the UK does recommend that women with children from a previous relationship not be eligible for treatment, but does not enforce this.28

In some cases, these are mothers who already have biological children and receive complimentary fertility treatments.^vi In other cases, it is a father and mother who have voluntarily chosen to terminate their fertility through sterilisation and then later seek ARTs to provide more children to their family. Since these people were fertile, had biological children and then made a choice to become functionally infertile, they should not be eligible for government or insurance funded fertility treatments.^vii These wasteful policies demand attention in the future. However, here I will focus on fertility treatments for fertile women without children.

Fifteen states in America—Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia—include fertility services for their healthcare policyholders.29 Similarly, in the UK, Belgium, Sweden, Australia and Israel, citizens are given fertility treatments under socialised healthcare schemes. Among the fertile receiving free fertility treatment are single women who choose not to have partners and fertile women who choose to have a same-sex partner. I am not suggesting that in order to achieve pregnancy one should be forced into an unwanted sexual relationship either by taking a partner or an opposite-sex partner. However, the capacity for using one's fertility does not always correspond to one's sexual orientation or partner status. This does not negate the fact of biological fertility or infertility, and therefore circumstances, such as partnership, should not be confused with a biological infertility.

Though these women are unlikely to have children in their current situation, their ‘infertility’ is due to circumstances and not biological conditions like blocked tubes, amenorrhoea or other factors leading to female infertility. We cannot therefore consider these people biologically infertile. I do, however, recognise that these women may have difficulty achieving pregnancy in their current state and therefore are, in a way, ‘infertile.’ However, these women are not medically infertile in the plain sense, that is, in a way that could necessitate medical treatment to address a somatic cause of infertility.^viii

With the correlation among consumption, reproduction and carbon emission of humans, free fertility services for the biologically fertile must be attended to. Putting limitations on access to paid-for treatment for only those who are biologically infertile would reduce the carbon output of the ART business, as fewer clients would seek its no-fee services. Those who could become pregnant without medical assistance might choose to pay for ARTs out of pocket, but they should not be given free treatments. And, although the fertile might choose to have biological children through natural means, and this would impact the environment, it would have to be addressed through individual or national carbon caps and is beyond the reach of the ART industry.