0:04

On today's show, as we wrap up this season,

0:06

we're doing something a little different. We're

0:09

going into the future to learn

0:11

about a technology that's in the works

0:14

but not yet available, a

0:16

technology that even in its development

0:18

stage, has people asking all

0:20

kinds of questions. Imagine

0:23

it became possible so that you could go to a

0:25

hotel where Brad Pitt had been, you could take

0:27

the dead skin, and you could use that genetic

0:29

material to produce children. Would

0:31

that be something that was problematic. We're

0:34

talking about a type of reproductive

0:36

technology called in vitro gametogenesis

0:39

or IVG, that has the potential

0:42

to open up a whole world of options

0:44

for how humans procreate. IVG

0:47

is essentially a process where cells,

0:50

including human skin cells, could be

0:52

used to make babies. Glen

0:54

Cohen knows all about IVG. He's

0:57

a professor of bioethics and law at

1:00

Harvard Law School. You could

1:02

both produce sperm an

1:04

egg yourself and have a child

1:06

that is your direct genetic descendant,

1:09

but completely taking your genetic material

1:11

rather than someone else. Now, I think for most people

1:13

this strikes them as extremely strange

1:16

as a desire. Why would you possibly

1:18

ever want this? But just as there are people

1:20

who want a single pair. In terms of rearing a child,

1:23

there might be people who want to not have anybody else's

1:25

genetic material involved. This

1:28

may sound like science fiction, but

1:30

scientists and biotech startups

1:33

are already working or making

1:35

it a reality.

1:44

I'm Laurena Rora Hutchinson. I'm the

1:46

director of the Ideas Lab at the Johns

1:48

Hopkins Berman Institute of Bioethics.

1:51

On today's episode, there are a

1:54

lot of ways IVG could be used.

1:57

People who for any reason aren't

1:59

able to juice eggs or sperm could

2:01

still have biological children, like

2:04

people who've gone through menopause and people

2:06

whose fertility has been impacted by

2:08

cancer treatment. And

2:10

people in same sex relationships

2:13

could both be the genetic parent

2:15

of the same child.

2:18

But given that we could be shaping the future

2:20

of humanity with this new technology,

2:22

there are a lot of ethical questions

2:24

to unravel. Are there good

2:27

or bad reasons to do IVG? How

2:30

much should regulators play a role? And

2:33

how long do we have before all this

2:36

becomes a reality. Some

2:38

researchers predict that it may take

2:40

decades, while commercial startups

2:43

promise proof of concept trials

2:45

within one to two years.

2:49

From pushkin Industries and the Johns Hopkins

2:51

Berman Institute of Bioethics. This

2:54

is playing God. We'll

3:03

hear more from Glen Cohen later on in

3:06

this episode, but first I

3:08

wanted to understand more about this technology,

3:11

like how it actually works and where the research

3:14

stands today. So I

3:16

called up Amanda Clark. She's

3:18

a professor of molecular, cell and Developmental

3:21

biology at the University of California,

3:24

Los Angeles, and she's an

3:26

internationally renowned researcher and expert

3:28

on in vitro gamito genesis. She's

3:31

been working on developing it for decades.

3:35

I am a basic scientist,

3:37

and I'm interested in questions

3:40

that are related to fertility and

3:43

infertility and reproductive

3:45

health. And what I

3:47

saw as I looked at the scientific landscape

3:50

for what's available to couples who

3:52

are struggling with infertility, is

3:55

that there seems to be

3:57

a limit to what can currently

3:59

be achieved with assisted reproductive

4:02

technologies and medical technologies.

4:05

So for those individuals who,

4:08

for example, they're ovary or

4:10

testis was destroyed as part of

4:12

occupational health injury

4:15

or due to chemotherapy

4:17

or radiation therapy following a

4:19

cancer diagnosis, and now they're cancer survivors.

4:22

All of these types of injuries destroy

4:25

the cells in the overy in testice

4:27

that enable a person to have a biologically

4:30

related child. And so as

4:33

a stem cell scientist, I became really

4:35

interested in what could we do

4:37

as in a scientific community to be able

4:39

to help those individuals and couples who

4:41

want to have a family that don't have

4:44

the cell types necessary for it anymore.

4:47

So could we regenerate these

4:49

cell types from stem cells?

4:51

And that's the basis of in vitrogemetogenesis.

4:55

Could you give me the broad strokes of what's

4:57

going on with IVG and

4:59

how it works, So if you're just explaining this

5:01

to someone who had no idea what it was, So

5:04

let's begin with the G in

5:06

IVG. So IVG

5:09

stands for in vitro gametagenesis.

5:12

So most people understand what in vitro

5:14

is because in vitro fertilization

5:17

is used currently as a medical

5:20

technology to help an individual

5:22

or a couple to have a baby. The

5:25

G gametogenesis means game

5:27

meats eggs and sperm. So if

5:29

we add it together, in vitro gamita

5:32

genesis means making eggs

5:34

and sperm in the lab for

5:36

the purposes of reproduction.

5:39

For those people that their testes and their

5:42

ovaries aren't working properly, they may

5:44

not make a functional egg cell

5:46

or a sperm cell. And so

5:48

if your egg cell or sperm cell's not functional

5:51

or you don't make them in

5:53

your body, that means you can't

5:55

have a biologically related child. And

5:58

so with IVG eggs or

6:00

sperm cells made, So in

6:02

future, agamtagenesis means instead

6:04

of these egg and sperm cells being

6:07

made inside of the body, they

6:09

are made in the lab by researchers,

6:13

starting with a different

6:15

cell type in the body, for example a skin

6:18

cell. So scientists now

6:20

know how to take a biopsy of the

6:22

skin or perhaps a biopsy of

6:24

the blood, and to grow those cells

6:26

in the lab and to use

6:29

molecular biology to convert

6:31

those cells to a stem cell.

6:34

And this stem cell has

6:36

the potential to become an

6:38

egg and sperm cell in the

6:40

lab that could then be used for

6:42

fertilization through in vitro fertilization.

6:45

So, just to be clear on this, it means someone

6:48

would be able to create an

6:51

egg or sperm which was genetically

6:53

matched to them because they'd be using their own

6:56

skin cells. Yes, that's right. So

6:58

in future, agametera genesis provides

7:01

the opportunity for having

7:03

a genetically related child

7:05

because the skin cell, for example,

7:08

comes from the person who's the intended

7:11

parent. Wow. So

7:13

where exactly is this technology currently?

7:15

In future, gemtagenesis is

7:18

being used for research because scientists

7:21

still can't make an egg or

7:23

sperm cell in the lab from human cells.

7:26

So what scientists are able to do is

7:29

to make very immature egg

7:31

or sperm cells in the lab from human

7:33

cells. And so this is actually very

7:36

helpful because we don't understand much about

7:38

how egg and sperm cells are made inside the

7:40

body because they're inside

7:42

an organ and they're relatively

7:44

rare cell type, and so in future,

7:47

cometagenesis is providing really

7:49

important molecular

7:51

and genetic information about how gameat

7:54

forms and that can help us to understand the

7:56

disease of infertility. But

7:59

it's not yet at the point of making

8:01

a GA meat that can be used for reproductive

8:03

purposes. We are looking at

8:05

decades away from being able

8:07

to make an egg or sperm cell

8:10

in the lab that could be used for

8:12

reproductive purposes, and that's where

8:14

the field would like to go. When

8:17

we do get to that point, what

8:19

applications do you think would be the best

8:21

to try first for clinical

8:24

research? Well, one

8:26

of the options is to study in vitrogametogenesis

8:29

in a species that is closely related

8:32

to humans, for example,

8:34

using non human primates as

8:37

an alternate model to make

8:39

game meats in the lab, and

8:41

to use those lab made

8:43

gameats the egg or the sperm cell in

8:46

order to cure

8:49

a disease model of infertility. And

8:52

once those scientific models have

8:54

shown that the game meat can successfully

8:57

lead to a healthy pregnancy

9:00

and a healthy baby, and that the

9:02

resulting animal itself is fertile,

9:05

only then will this technology

9:07

move into clinical trials inhuman

9:13

And so, if it

9:15

is shown to be safe and

9:18

effective, as you've just explained,

9:20

and it becomes approved

9:23

as a reproductive technology, who

9:26

do you think would be interested in using

9:28

it? And why? I certainly

9:30

get emails on a regular basis

9:32

from couples that have been

9:35

going through in viture fertilization

9:38

for five years or

9:40

more and successive rounds,

9:42

and none of them have been successful,

9:45

and so this is the sort of group

9:48

who would be very interested in signing

9:51

up for in future commutagenesis.

9:55

Of course, we had the really

9:58

important breakthrough study that

10:00

was published using a mouse

10:03

model, which is a model that scientists

10:05

use in the lab where

10:08

the sex of a gameat can be switched so

10:10

that an egg cell can be made

10:13

from cells that are

10:15

taken from a man.

10:18

And so this opens up the possibility

10:21

of same sex reproduction for

10:24

those that are socially infertile. And

10:27

I think that this is a really important aspect

10:29

of the technology as well.

10:31

And what would it take

10:34

to make sure that it would be

10:36

a safe process? Yeah, in vitrogametogenesis

10:39

would need to be proven safe. That game

10:41

meat would need to be proven to

10:43

have the equivalent quality

10:46

competency of a gameat

10:49

an eggorosperm that would have been made

10:51

inside of the body. And

10:53

so what this means is testing

10:56

the quality of the gameat,

10:58

the competency of the gamat and

11:01

developing scientific tools that don't

11:03

exist yet. And so a

11:05

lot of that technology now needs to be developed

11:08

too. Do you think that could be potential

11:10

safety risks two children born via

11:13

IVG. Well,

11:15

human reproduction itself is actually

11:17

not very successful and that is

11:19

why the use of in future

11:22

fertilization is increasing

11:24

year over year of a year around

11:27

the world. And one

11:29

thing we have learned about

11:32

studying embryos in

11:34

the IVF lab is there's

11:36

a lot of genetic abnormalities during

11:38

early embryo development in humans,

11:41

much more so than in any other species.

11:44

And actually we understand very little about

11:46

why there is so much genetic instability

11:48

in the early human embryo. And of course,

11:50

genetic instability in the early human

11:53

embryo leads to early pregnancy

11:55

loss. And so when

11:58

we turn now to in vitrogamy genesis,

12:01

the expectation is that the game

12:03

meat made a research

12:06

in the lab and used in

12:09

fertilization studies is also going

12:11

to have these same issues that

12:13

a game meat made in the body has. And so the

12:15

question is how do we measure the

12:17

quality of an embryo made from

12:20

an in vitrogametogenesis gameat

12:22

eggosperm versus an eggosperm

12:25

cell that's made inside the body. And

12:27

so that's the beginning of understanding

12:30

how these ga meats would be safe. But

12:33

in the end not even natural conception

12:36

has always successful, and so

12:39

we know that there are children that

12:41

are born who do suffer

12:43

from genetic abnormalities, and so

12:45

it's safeguarding against all of those potential

12:48

eventualities with a game meat made

12:50

inside the lab, and are

12:52

there concerns in the academic research community

12:55

about this technology being used in a

12:57

way that's risky or problematic. So

13:01

I think it's really important that

13:03

the academic community talks

13:06

about the promise but also the

13:08

realistic challenges of in

13:10

viuturogemeta genesis. What

13:13

makes me very nervous is that

13:15

it's potentially possible to get ahead

13:18

of the science and talk about in viuture

13:20

gemeta genesis as being a

13:22

technology that's right around the corner

13:24

for use in reproduction. But

13:27

what we're talking about is a

13:29

reproductive technology that

13:32

has the potential to be transformative.

13:35

But there's a lot of scientific

13:37

hurdles that need to be overcome

13:40

in order for this technology to

13:43

become a reality, and it's really important

13:45

that as scientists we communicate that effectively

13:48

so that we're not giving false hope

13:51

to people who think this technology is

13:53

going to be right around the corner and

13:55

could help them within the next five

13:57

to ten years, when the technology

14:00

is just not there yet, and the most

14:02

important thing will be ensuring

14:05

the safety of the technology, and

14:07

that in the end comes down to the

14:09

quality of the erg or sperm cell

14:11

made in the lab and ensuring that

14:14

that quality is equivalent to the

14:17

quality of an erg or sperm cell that would have

14:19

been made in the body. Thank

14:21

you, Amando. It's been amazing to

14:23

hear about this new technology and all the important

14:25

work that you're doing. So happy

14:28

for the opportunity to talk about the science. After

14:32

the break, we'll go back to Glen Cohen. The

14:34

ethicis we heard from earlier. We'll

14:36

find out how he thinks as a society

14:39

we should approach IBG. Let's

14:51

go back to Glen Cohen. Glenn is a

14:53

professor and deputy dean at

14:55

Harvard Law School. There, he's

14:58

also the director of the Peak

15:00

Flom Center for Health Law, Policy,

15:02

Biotechnology, and Bioethics.

15:06

Glenn thinks reproductive technologies

15:08

like IVG have the potential

15:10

to really change our society and

15:12

spark new ethical challenges. So,

15:16

Glenn, could you tell us about some of the ethical

15:18

issues surrounding IVG. So

15:20

when talking about IVG, I think it's really important

15:23

to distinguish different use cases, because different

15:25

use cases raise different ethical questions.

15:28

Start with the easiest use case, I think, ethically

15:30

speaking, which is the use of IVG

15:33

to help individuals who cannot produce scam

15:35

meat, So, for example, people who cannot produce

15:37

eggs during their regular,

15:39

normal, healthy fertility period.

15:42

For that group, some of the issues are,

15:45

what do we have to do to perfect this technology?

15:47

Does it involve a lot of embryo destruction

15:49

along the way and is that a problem?

15:52

How do we know when this is safe and effective

15:54

and ready for human use? And when do we move

15:56

to first in human How will

15:58

we know what the inter generational effects

16:01

might be and how do we track that? And can

16:03

we actually demand to have data

16:05

from successive generations people

16:08

who never consented, for example, to

16:10

this because they were born this way. And then

16:12

I think we have some kind of interesting questions about

16:14

policing inappropriate use,

16:17

So whether, for example, we're worried that people

16:19

might derive eggs from adult cells

16:22

from someone who didn't consent, so taking

16:24

leftover skin cells for example.

16:26

And then maybe finally is just a broader

16:29

question about whether this is a worthwhile

16:31

goal for humanity, especially when we

16:33

have so many people with other kinds of medical

16:35

needs. Is this really where we should

16:38

be spending our time, spending our money,

16:40

and spending our research effort. Yeah,

16:42

a lot of different ethical issues there. So

16:45

you've begun with talking about keeping

16:47

it within a person's period

16:50

of life where they would, in

16:52

theory be able to produce eggs.

16:55

Could you talk about some of the ethical issues

16:57

around using IVG

17:00

for a person who's gone through menopause,

17:02

for example. So I often like

17:04

to distinguish what I call mimicking uses

17:07

versus extending uses of new reproductive

17:09

technologies. Mimicking is attempting

17:12

to give people who by virtue of

17:14

medical issues would ordinarily

17:16

be able to do the kind of reproduction

17:18

that everybody else does, enabling

17:21

them to do that. So a way of thinking about this is there's

17:23

a person with a disability and we're trying

17:25

to correct for that disability. Extension

17:28

uses are attempts to extend and give

17:30

people fertility options that would not be

17:32

available to other people similarly

17:35

situated. And the post meant apausal

17:37

example is a good example of an extension use.

17:40

Women have as a species a

17:42

set reproductive period where they

17:44

are producing eggs that comes to an

17:46

end, and the question is should we extend

17:48

beyond that end. So,

17:51

in terms of the ethical issues that are raised here,

17:54

one set of issues has to do with whether enabling

17:57

reproduction later in life is a worthwhile

17:59

goal. There are some individuals who are

18:01

worried that when you produce children whose

18:03

parents are quite old, that's an unfortunate

18:06

circumstance for the child. And that's a relevant

18:08

thing to think about. So that's one issue.

18:11

Another is that there are some individuals who just think

18:14

the human species is a particular kind

18:16

of thing and living a uniquely

18:18

good human life is to be

18:20

a particular kind of entity. And that's an entity

18:22

that has a period for everything, right, a time

18:25

for all things in life, and it's just

18:27

wrong to go beyond that. Yeah.

18:29

So it's really interesting hearing your distinction

18:31

of extension versus mimicking. And

18:34

I'm just really curious when people are in the same

18:36

sex relationship and they want to reproduce

18:39

genetically, would you also put them

18:41

in the extension category. Yeah,

18:43

so I think this is a really interesting question,

18:46

especially if we're talking, for example, about two

18:48

women. Right, you may have two women who

18:50

are actually completely healthy in terms of their

18:52

reproductive life. Right, if we were to provide

18:54

sperm, each of them would be able to reproduce.

18:57

And yet they're making an ask to say that's

19:00

it's not what we want. We want to both be genetic

19:02

parents, And they're saying It's

19:05

not that I want to kind of have parody

19:07

with somebody who's healthy when I'm unhealthy.

19:10

Instead, they're saying, I want to have parity with everybody

19:13

else who's heterosexual, infertile, who's

19:15

able to basically use sperm and egg from

19:17

both parts of their couple. I do

19:19

think that this is an extension use. Now calling

19:21

it an extension use does not itself

19:24

determine whether it's right or wrong, good or bad,

19:26

But I think it does acknowledge that the ask

19:29

here is a little bit different, and

19:31

that the political theory and the questions we're

19:33

going to ask about whether this is the kind of ask that's

19:35

appropriate or one society should support,

19:38

are a little bit different than the case of somebody who's

19:40

facing medical infertility. Some

19:42

of my colleagues, they prefer the term disfertility

19:46

for this situation. Single individuals,

19:48

same sex individuals. So it's not that

19:50

they are, in terms

19:52

of their healthcare or their medical state, infertile.

19:55

It's that there's a social reason why they can't

19:57

reproduce, and they are making an ask of society

20:00

to help them overcome this social reason. Yeah,

20:03

so interesting the different ways that things become

20:05

framed, even in the development of the science

20:08

has big impacts on how

20:10

it's then perceived by wider society.

20:12

And that's exactly right. And it's worth emphasizing

20:15

that one of the leading IVG

20:18

commercial players, there's not that many on the scene,

20:20

but have been public about it in the

20:22

press about them and the New Yorker story that

20:24

was done about them, there's a lot of emphasis

20:26

that the leading kind of scientists

20:29

and the leading kind of business person in it are

20:31

gay men, right, and this idea of kind of personalizing

20:34

it. So a big part of their story and their pitch

20:36

is that as gay men, we wanted

20:39

to have children with our partners that

20:41

are also genetically both of ours. All

20:43

of this puts pressure on the question about whether

20:46

genetic parentage is the end all and be

20:48

all right, because you might say, there's

20:50

a way in which all of this discussion

20:52

of IVG might strike adoptive

20:55

parents, for example, as quite untoward.

20:57

Is to say, it's so important that I know adopt

21:00

that actually that I want to invent this entire

21:03

new technology and do this. So there's

21:05

a way in which how you frame this

21:07

is also how you frame questions about

21:09

the value of genetic connection versus

21:11

other kinds of connections, and I think it's

21:13

worthwhile for us to have that conversation.

21:16

That conversation requires us to take

21:18

a hard look at ourselves and say, why

21:20

is genetic parentage so important for us?

21:23

Why is it so important that both of us be genetic

21:25

parents? And it's true, fertile heterosexual

21:27

individuals are able to do this, no problem.

21:30

But you know, is this the kind of thing that we think it's

21:32

a really strong moral imperative

21:35

to have technology to solve, or

21:37

instead should our goal be to try

21:39

to de emphasize genetic parentage.

21:41

And there's a certain irony here because

21:44

chosen family and I'm gay, so I can say

21:46

this chosen family is a big adage

21:48

within the gay community. And yet

21:50

it seems to be there's a way in which this is a chosen family,

21:53

but also a way in which this is a very genetically

21:56

related family that in some ways reproduces

21:59

very typical, very heterosexual conceptions

22:01

of what family is. I think that

22:04

some of the questions that are raising here, we

22:06

really have to think about this as we are moving

22:08

into this new unknown territory

22:11

and the directions we're going in, the implications

22:13

that can have so would

22:16

IVG resolve any of the ethical

22:18

concerns around existing alternatives

22:21

to biological procreation, so

22:24

for example, using an egg donor surrogacy

22:26

or adoption. So one thing

22:28

that's nice about IVG that helps

22:30

kind of resolve some of the ethical considerations

22:33

about other technologies is for egg retrieval.

22:35

There's many people who say egg retrieval imposes

22:38

risks on women, and in particular,

22:40

if you think about egg freezing, where we're talking about

22:42

young women who are kind of proactively

22:45

trying to retrieve eggs and freeze them

22:47

for a potential future use, there's a

22:49

way in which they are imposing hardship on themselves,

22:52

costs upon themselves, and also the

22:54

potential low risk levels but

22:56

potential for things like ovarian hyperstimulation

22:58

syndrome for a potential future

23:00

use. And if you could tell people, if you ever find yourself

23:02

in that situation, we'll have a solution

23:05

then and there you don't have to proactively do that,

23:07

that might be quite attractive. So that's one thing

23:09

that might be ethically good about this or solve

23:12

another ethical problem. The other is

23:14

the question of markets for eggs more generally

23:17

and sperm to a lesser extent. But there are some people

23:19

who find it objectionable that

23:22

we have widespread markets in the United

23:24

States where people buy and sell eggs.

23:26

If you think those kinds of markets are problematic,

23:29

there's a way in which IVG solves the problem

23:31

because you now are able to do it

23:34

to yourself. So it ends a

23:36

certain market that at least some people find

23:38

problematic. Those are two kind of advantageous

23:41

parts about IVG. One disadvantage

23:44

is, at least in the case of gay men or single

23:47

men or women who have a medical

23:49

issue that stops them from carrying to term, it

23:51

might increase the use of surrogacy.

23:54

And for people who think markets and surrogacy or

23:56

surrogacy as a whole is problematic,

23:59

it may be that by stimulating

24:01

surrogacy use in the United States or

24:03

across the world is a problem.

24:06

So how will we know when it's ready to do a trial

24:09

with human participants? So

24:11

this is a very very complicated

24:13

process. You know, we have an agency FDA,

24:15

which is very good at looking at drugs, for example,

24:18

to say we're ready to do a clinical trial

24:20

in human beings. It does not have

24:23

particular experience with reproductive technologies.

24:25

And in the US at least that's partially

24:27

a political reality that it doesn't.

24:30

But I think that essentially what you're going to do is

24:32

you're going to get increasingly close

24:34

to human kinds of processes in animals

24:36

and animals whose biology and reproduction is

24:38

closer and closer to humans. You're going to get more

24:41

and more evidence, and then at some point

24:43

we're going to have to just make a decision, and it's probably

24:45

going to be a regulator who's going to make the decision that

24:48

we are close enough and we have enough

24:50

evidence that with people who are fully

24:52

informed of the risk, who are well

24:54

selected for a clinical trial to minimize

24:56

the risk, that it's time to begin a clinical trial

24:59

in human beings. And some of

25:01

the groups that are furthest along in getting

25:03

IVG technology ready for human reproduction

25:06

are for profit companies. Where

25:09

are they coming from? These

25:13

our companies that I think have a lot in common

25:15

with some of the tech companies we've seen in Silicon

25:18

Valley. And this is not uncommon when people are

25:20

pushing an envelope that there is kind of

25:22

a philosophy in Silicon Valley that there's a great

25:24

idea, there's an unmet need

25:26

and we should solve it with technology,

25:29

and there's a way in which that's exactly what's

25:31

being done here. But in the biospace as

25:33

opposed to the technological space, it

25:36

seems like IVG could end up being pretty

25:38

expensive. So how

25:40

do f this think about the problem

25:42

of unequal access to these new

25:44

reproductive technologies. You

25:47

know the writer William Gibson, I think he said

25:49

this on NPR once. It was quoted as saying, the

25:52

future is already here, it's just

25:54

not very evenly distributed. And

25:56

I think that's like an interesting perspective on

25:58

this or ethicists like

26:01

me. It is a concern when we

26:03

have something that's good, that we think is

26:05

going to make people's lives go better, that

26:07

it only be available to a small subset

26:10

of the population. So I

26:12

do think that this is something to keep one's eye

26:14

on. But that said, if we look

26:16

at in vitro fertilization as kind of a predecessor

26:19

of technology, it's still extremely

26:21

expensive. It's still not available to

26:23

most people, and although I think it's somewhere

26:25

between fifteen or nineteen US states

26:27

have some requirement that insures cover

26:30

IVF, it's a relatively weak

26:32

form of coverage. So in some ways,

26:34

I would say, if you ask me the cynical hat on.

26:37

My guess is if IVG ever becomes available,

26:40

it'll take a while to have any requirement of insurance

26:42

coverage, and I doubt that the insurance coverage

26:44

requirement will be more robust than the one we have

26:47

for IVF at the moment, which is not

26:49

all that robust. So with IVF

26:51

and all reproductive technologies, it's become a game

26:53

of the haves and have not And

26:56

what is the best case scenario

26:58

in your mind regarding the laws and regulations

27:01

surrounding IVG. For

27:04

me, the best possible story of

27:06

regulation, We'll start with a particular

27:08

use case, and I would say start with one of the less

27:10

objectionable, easier to get behind use

27:12

cases, So, for example, the use

27:14

of IVG to allow individuals

27:16

who are still within their typical reproductive

27:19

years to reproduce because they

27:21

are not able to produce eggs or sperms. Supply

27:23

them the thing that they are missing, And

27:26

basically we would start there. We'd

27:28

have significant public engagement, maybe we'd

27:30

have citizen juries, deliberative democracy

27:32

experiments, we'd have widespread discussion

27:34

as a country, we'd have debates in

27:36

Congress or in parliament, and we

27:38

would settle on what I would hope would be a

27:41

heavily regulated system where we have a

27:43

government agency supervising

27:45

learning, licensing, getting

27:48

data, and then evaluating after

27:50

a set period of time whether to expand

27:52

to one of the other use cases, and again providing

27:55

an opportunity to engage on those questions.

27:58

And so that's the best case. Could you tell

28:00

us the worst case? Well,

28:02

I think there are two worst cases. One worst

28:05

case is straight out prohibition.

28:07

That we have people who could benefit from this technology,

28:09

and we decide without any real deep

28:12

reflection it's just too weird, it's

28:14

too icky, We're just going to prohibit it. And for me, that's

28:16

a bad case scenario because if there's value

28:18

to this for some people, I'd like to at least us

28:20

have an adult conversation about it. The

28:22

other worst case scenario, I think would be a totally

28:25

unregulated system where anybody

28:27

could do this tomorrow, just at

28:30

you find it too a physician or a lab that's

28:32

willing to do and the technology is available and nobody's

28:34

monitoring it, nobody is concerned, nobody's

28:36

considering the ethical objections. So I guess

28:39

it's with developments like these,

28:41

the science needs to happen but also the

28:43

infrastructure around the regulations

28:46

also needs to happen too. I

28:48

think that's right. And also I'll just say

28:51

the human face of what we're talking about, right,

28:53

Yeah. One of the reasons why we're seeing enforce in

28:55

the United States a raft of personhood

28:57

bills and restrictions on abortion.

29:00

Any of the same arguments might apply to embryo

29:02

destruction, but we don't see huge

29:04

attempts to politically restrict in vitro fertilization

29:07

in the United States. And if you ask why, one

29:09

of the answers is even very conservative

29:11

legislatures they know or they themselves

29:14

have used in viuture fertilization. There's somebody

29:16

who they picture when they picture the technology, and

29:18

they picture the happy family that is the result.

29:21

The more those kinds of stories can be, the stories

29:23

of things like in vitro commutagenesis, the

29:25

more likely it is that you will find a political

29:28

majority in favor of permitting it. The less

29:30

you are able to tell that kind of story, the harder

29:32

it will be. It was so fascinating

29:35

for me to talk with Amanda and Glenn

29:37

and hear about where we are at with this new

29:39

technology. I can

29:41

see how something like IVG would

29:43

bring so much to so many people who

29:46

long for having a genetically related

29:48

baby. But I can also see

29:50

the importance of thinking really intentionally

29:53

about this how if IVG

29:55

becomes widely available, we'll

29:57

need to be careful about how it's used for

30:00

what purpose. Even though it

30:02

remains to be seen how this technology develops

30:05

and how we can use it responsibly, I

30:07

think it's important that we all start

30:09

having these conversations now. Throughout

30:12

the series, we've been talking about

30:14

the decisions we make about technology,

30:17

and specifically what the ethical

30:19

implications are of how new

30:22

medical technologies are used. I'm

30:24

thinking about the strong in Goldberg's losing

30:27

their son, Sally Settel's search

30:29

for a kidney, Andrew Cameron

30:31

fighting for his patients, and

30:34

so many other moving stories of patients,

30:36

families, scientists, and caregivers.

30:39

I'm also thinking about all the people

30:42

whose stories we haven't heard because they

30:44

weren't able to access the care they needed.

30:47

Sometimes these medical dilemmas

30:49

involve difficult decisions, often

30:52

with no perfect answer. Whatever

30:55

we choose, we must live or

30:57

die with the consequences. We

31:05

hope you've enjoyed playing God and

31:07

we have something extra lined up for you. Next

31:10

week. It's a prequel episode

31:12

about a troubling chapter in medical history

31:15

that helped give birth to the field of

31:17

bioethics. In the nineteen

31:19

sixties in Seattle, a committee

31:22

of everyday people sort of like a

31:24

jury of peers, was tasked

31:26

with deciding which critically

31:28

ill patients in their community deserved

31:31

to live and who should

31:33

be left to die. So watch

31:35

out for that in your podcast feed next week.

31:39

Thanks to our guests in this episode, Amanda

31:42

Clark and Glen Cohen. Playing

31:45

God is a co production of Pushkin

31:48

Industries and the Johns Hopkins Berman

31:50

Institute of Bioethics. Emily

31:53

Vaughn is our lead producer. Production

31:56

support from Sophie Crane and Lucy

31:58

Sullivan. Our editors

32:01

are Karen Shakergie and Kate Parkinson

32:03

Morgan. Mixing by

32:05

Samir Sengupta, the music

32:08

by Echo Mountain, Engineering

32:10

support from Sarah Bruguerre and

32:12

Amanda Kaiwang. Show art

32:15

by Sean Karney, fact

32:17

checking by David jar and Arthur

32:19

Gompertz. Our

32:22

executive producer is Justine

32:24

Lang at the Johns Hopkins

32:27

Berman Institute of Bioethics. Our executive

32:29

producers are Jeffrey Kahan and Anna

32:32

Mastriani, working with Amelia

32:34

Hood and with support from

32:36

Susan Snead, Aaron Henkin,

32:38

Abigail Brickler, Kim bikermer

32:41

Anna Oakes, and Jamie Smith. Special

32:44

thanks to Ari Cohen. Funding

32:46

provided by the green Wall Foundation. Special

32:50

thanks to voice coach Vicky Merrick.

32:54

This is our last episode, so we'd like

32:57

to thank some of the many people at Pushkin

32:59

who've supported this show throughout the season,

33:02

including Jacob

33:04

Weisberg, Heather Fane,

33:07

John Snarz, Letal Malad

33:10

Greta Cohne, Carl

33:12

Mcliori, Jasmine

33:15

Perez, Eric Sandler,

33:18

Jordan mcmill, Isabella

33:21

Navarez, Nicole op

33:23

Den Bosch, Maya Kanig,

33:27

Jake Flanagan, Owen

33:29

Miller, David

33:32

Glover, Nina Lawrence,

33:34

Mia LaBelle, and Ian Petzer.

33:38

To learn more about bioethics and the

33:41

issues presented in this series, please

33:43

visit Bioethics dot jhu

33:46

dot Edu Forward slash

33:48

Playing God. I'm

33:53

Lauren Aroora Hutchinson. Thanks

33:55

for listening to Playing God. As

33:59

you've heard through the series. I'm the

34:01

director of the Ideas Lab at the Johns

34:03

Hopkins Berman Institute of Bioethics

34:06

at the Ideas Lab. We are exploring new

34:08

innovative ways of telling stories about

34:11

the intersection of ethics, science,

34:13

medicine, and public health. As well

34:15

as podcasts, we do screenwriting, films,

34:18

and immersive experiences. To get

34:20

involved, visit Bioethics dot Jhu

34:23

dot edu, Forward Slash Ideas

34:25

Lab