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What would an environmentally sustainable reproductive technology industry look like?
  1. Cristina Richie
  1. Correspondence to Cristina Richie, Theology Department, Boston College, Stokes 310N Chestnut Hill, MA 02467, USA; RichieC{at}bc.edu

Abstract

Through the use of assisted reproductive technologies (ARTs), multiple children are born adding to worldwide carbon emissions. Evaluating the ethics of offering reproductive services against its overall harm to the environment makes unregulated ARTs unjustified, yet the ART business can move towards sustainability as a part of the larger green bioethics movement. By integrating ecological ethos into the ART industry, climate change can be mitigated and the conversation about consumption can become a broader public discourse. Although the impact of naturally made children on the environment is undeniable, I will focus on the ART industry as an anthropogenic source of carbon emissions which lead to climate change. The ART industry is an often overlooked source of environmental degradation and decidedly different from natural reproduction as fertility centres provide a service for a fee and therefore can be subject to economic, policy and bioethical scrutiny. In this article, I will provide a brief background on the current state of human-driven climate change before suggesting two conservationist strategies that can be employed in the ART business. First, endorsing a carbon capping programme that limits the carbon emissions of ART businesses will be proposed. Second, I will recommend that policymakers eliminate funded ARTs for those who are not biologically infertile. I will conclude the article by urging policymakers and all those concerned with climate change to consider the effects of the reproductive technologies industry in light of climate change and move towards sustainability.

  • Environmental Ethics
  • Reproductive Medicine
  • Public Policy
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Introduction

While ecologists and policymakers address vehicular pollution, sustainable energy and laws to preserve natural habitats of endangered animals, the environmental impact of the medical industry is largely ignored. And, while all of medicine and healthcare should be evaluated in terms of ecological sustainability, the assisted reproductive technologies (ARTs) industry deserves special ethical attention, as they not only absorb the ‘typical’ medical resources like buildings, medical instruments and intellectual capital, they are unique in that they alone create carbon legacies in addition to having a carbon footprint.i

Though certainly the same can be said of people who reproduce naturally, the ART business is also decidedly different, as fertility centres provide a service for a fee, and therefore can be subject to economic, policy and bioethical scrutiny. Therefore, for the purposes of this article, I will focus on the ART industry as an anthropogenic source of carbon emissions which lead to climate change, while holding in the background the undeniable impact of naturally made children on the environment, and the need to reduce carbon emissions in all areas of life.

Through the use of ARTs multiple children are born, adding to worldwide carbon emissions. This is a burden on the already over-taxed ecosystem to support new beings who might not have existed without medical intervention. It is therefore the obligation of environmental policymakers, the ethical and medical communities, and even society to carefully weigh the interests of our shared planet with a business that intentionally creates more humans when we must reduce our carbon impact. Evaluating the ethics of offering reproductive services against its overall harm to the environment makes unregulated ARTs unjustified, yet the ART business can move towards sustainability as a part of the larger environmental movement. In the medical industry, this can be accomplished through the established discipline of environmental bioethics and the nascent field of green bioethics.

Since the 1980s, the field of environmental bioethics has made the connection among pollution, carbon emissions and human health.14 The impact of climate change on world citizens has continued to receive interest in the medical industry, urging consumption reduction to better the lives of those who currently suffer under conditions of food scarcity, respiratory disease and drought as a result of CO2 emissions.5 Environmental bioethics focuses on healthcare of people alive today as it relates to ecological challenges and has already influenced the medical industry though organic food in hospital cafeterias, using renewable sources to generate energy in medical compounds and ‘cradle to grave’ manufacturing processes that reduce carbon dioxide.6 It takes a comprehensive, but superficial view of the carbon emissions of the medical industry. Environmental bioethics is largely reactive to climate change and rarely examines the offerings of the medical industry. As a compliment, the developing field of green bioethics is proactive, closely scrutinising medical developments, techniques and procedures.

Green bioethics analyses current and future medical practices such as genetic engineering, organ transplantation, preventive medicine, contraception and pharmaceuticals. Green bioethics offers four specific principles to guide the development and distribution of medical technologyii and determines the sustainability of medical developments, techniques and procedures based primarily, but not solely, on their environmental impact.7 When green bioethics is integrated into the ART industry, climate change can be mitigated and the conversation about consumption become a public discourse.

Of course natural reproduction and resource consumption should be addressed too. Reproduction-related CO2 is primarily due to choices of those who have children naturally: a huge majority of all births. Therefore, resource consumption that leads to carbon emissions cannot be separated from any procreation or any lifestyle choice. However, for the purposes of this article, I have chosen to limit my analysis of reproduction to ARTs as this is an article on ecology, policy and ARTs, not ecology in the larger realm of sexual ethics and procreation.

In this article, I will provide a brief background on current human-driven climate change before suggesting two strategies that can be employed in the ART business to reduce CO2. First, endorsing a carbon capping programme that limits the carbon emissions of the ART business will be proposed. Second, I will recommend that policymakers eliminate funded ARTs for those who are not biologically infertile. This would allow the fertility business to continue to operate, but with a limit on its production in terms of output. I will conclude the article by urging policymakers, bioethicists and ecologists to consider the effects of the reproductive industry in light of climate change and move towards sustainability.

Climate change

Anthropogenic carbon emissions that lead to climate change have prompted a flurry of discussion in recent decades demonstrating widespread concern for sustainability. In 2010, the Environmental Protection Agency (EPA) released its report ‘Climate Change Indicators in the United States,’ which detailed 24 causes of global warming. The verdict was ‘clear evidence that the composition of the atmosphere is being altered as a result of human activities and that the climate is changing.’8

Global CO2 emissions—an indicator of human resource consumption—increased an astonishing 4.4% between 2008 and 2010 alone.9 The Woodrow Wilson Center for International Scholars identified the disproportionate impact of wealthy consumers on the environment. They comment, ‘the world's richest half billion people, seven percent of the global population, are responsible for fifty percent of the world's carbon dioxide emissions. Meanwhile, the poorest fifty percent are responsible for just seven percent of emissions.’10 For highly consumptive countries, each person translates to greater carbon emissions that lead to climate change. Despite the detrimental effects of climate change on the environment and human health, there has been little effective progress in the public sector addressing policy changes aimed at ameliorating the situation.

Population growth, resource consumption and country of locale all factor into carbon emissions making policy recommendations complex. For instance, the USA and China were the top two countries leading in CO2 emissions in 2008. And while the birth rate was about the same in each country, China only emitted an average of 4.91 metric tons per capita, while the USA produced nearly four times that amount at 19.18 tons per capita.11 Environmental policy must examine both corporate and individual CO2 across all areas of life.

Assisted reproductive technologies

The use of ARTs to produce more human consumers in a time of climate change needs to be addressed. Policymakers can and should ask carbon-emitting countries to change their habits to align with conservation. And though all areas of life—from transportation, to food, to planned technological obsolescence—must be analysed for ecological impact, the offerings of the medical industry, especially reproductive technologies, must be considered as well.

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.

Suggestions for a more sustainable art business

The fertility industry is just one small piece of the jigsaw puzzle of rampant consumption that leads to climate change. Yet, the industry can become more sustainable through environmental regulations. Some businesses have had success in limiting carbon emissions through carbon capping. When policy reflects values of environmental concern, society can stand united against climate change instead of indifferent in the face of perhaps the most pressing problem of the 21st century.

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 disease2527 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.

Conclusions

Global climate change due to carbon emissions is moving at an unsustainable pace. While the EPA warns that human resource consumption must be attenuated, an entire business continues unchecked with the sole purpose of creating more consuming humans. Environmental ethics asks that we ‘reduce, reuse, recycle,’ but the ART business is premised on ‘increase, consume, dispose.’ Medical ethicists, healthcare workers and all concerned with the issue of climate change must collaborate on supporting policies that reduce CO2.

The unregulated ART business can no longer be endorsed and the medical industry ought not operate in an environmental vacuum. Retrenchment in all areas of life is the key to slowing down or halting carbon emissions that lead to climate change. For each child made through medical intervention a carbon legacy results. ARTs should be allocated with due concern for the environment and sober consideration for the implications of climate change. Carbon caps on the fertility business and eliminating funded ARTs for those who are not biologically infertile are the beginning of an environmentally sustainable ART business.

References

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • i A carbon footprint is the aggregate of resource use and carbon emissions over a person's life. A carbon legacy occurs when a person chooses to procreate. All people have carbon footprints; only people with biological children have carbon legacies.

  • ii Current human medical needs should take priority over current human wants for enhancement; simple medical treatments should normally be chosen before complex ones; a general allocation of medical resources should occur before special interest access to elective treatments; financial profit should not drive medical technology, but rather compassion and justice.7

  • iii Here I pick up on the refrain of ‘manufacturing children’ not to dehumanise children born through medical intervention, but rather to emphasise that the ART business is based in commerce. Though ARTs do add to human families with new human life, sentiment cannot cloud judgment with regard to scientific facts about the environment.

  • iv Individual cars must follow emissions standards in the USA and this is one way the products of the businesses are regulated, but there are no caps on the number of cars sold or how much they can emit corporately.

  • v This portion of the article will not assume regulation of the fertility business for people who pay for fertility services out of pocket because they already have a monetary disincentive from pursuing reproductive technologies.

  • vi For example, US woman Nadya Suleman, a single mother of six children used the fertility business to bear eight more children.

  • vii This is another issue with health insurance coding. Certain plans, for instance my Massachusetts Blue Cross Blue Shield Elect Preferred PPO plan, do not cover reversal of voluntary sterilisation, but do provide unlimited ARTs.

  • viii These women could be dubbed the ‘socially infertile’ to account both for their social circumstance and the gap between ability to secure a desired or actual pregnancy.

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