Designing Babies: How Technology Is Changing the Ways We Create Children

Abstract

Advances in assisted reproductive technology have granted individuals the power to choose aspects of their offspring in ways that were once considered science fiction. In the book Designing Babies: How TechnologyIs Changing the Ways We Create Children, Robert Klitzman, MD, presents these technological advances along with the choices, stressors, and ethical concerns that clinicians and patients face. Dr Klitzman is a Professor of Psychiatry who has published widely on reproductive technology and ethics, and this book is the culmination of his interviews with infertility treatment providers and their patients. The print and digital versions were used for this review. The book spans 360 pages and 19 chapters which are divided into 5 sections. Part 1 is a brief overview that emphasizes the psychological and social stresses of infertility. Part 2 is a comprehensive, fascinating review of reproductive technologies and the plethora of choices and potential issues to consider. The section includes quotes and viewpoints from a variety of perspectives including a psychotherapist and single-mother-by-choice, an infertility doctor, and several women who worked in reproductive clinics and underwent infertility treatment themselves. The perspectives provide a window into the dilemmas posed to clinicians and patients by the availability of reproductive technology and the social and emotional process for patients of using this technology with varying success. How old is too old to carry a pregnancy or to become a parent? How does one decide whether or not to use donor eggs and, if so, which to buy? When do people use donor sperm and how do patients choose a sperm donor? Should people select embryos to avoid disease? These questions and many more are raised along with an extensive discussion of preimplantation genetic diagnosis, cost limitations, disclosure dilemmas, leftover embryos, adoption, and the limitations of our current reproductive technology for different patient populations. The book’s shortcomings are made evident in Part 2 and continue throughout Parts 3 and 4, “Choosing adults” and “Facing and addressing stresses,” respectively. Weaving together viewpoints from dozens of individuals requires sometimes cumbersome reintroductions whenever someone comments on a new topic. While the perspectives provide valuable insights into these complex decisions, the writing occasionally lacks focus, and some paragraphs combine topics that might have been better addressed separately. Several topics are addressed in less detail than one might expect. For example, the author delves into the rights of children born through reproductive technology, yet these individuals’ perspectives are absent. The book includes clinicians’ views of gay and lesbian patients seeking reproductive assistance, but no gay or lesbian patients are quoted. When the author discusses discrimination by clinicians, the voices of those affected by discriminatory attitudes and policies are left out. Finally, the book could have taken deeper dives into eugenics, the psychosocial impact of being a “designer baby,” the medical and social implications of the multiple genetic half siblings that can result from sperm donation, and assisted reproductive technologies other than in vitro fertilization. Part 5, the final section of the book, brings together the themes laid out in earlier sections and is more focused and flows better than the previous sections. Dr Klitzman presents, in detail, the broader social and regulatory landscape that shapes the treatment dilemmas that reproductive clinicians and patients face. He incorporates patient and provider insights from earlier sections into a cogent argument regarding changes that should be made to the current regulatory system. The book concludes with musings on where the field of assisted reproductive technology will be headed in the future. In summary, while the book has flaws and is not related directly to anesthesia or analgesia, the book is an informative read for individuals seeking to learn and understand this fascinating, timely topic within medicine. Dr Klitzman blends historical facts, modern-day anecdotes, patient and provider quotes, and technical explanations in an entertaining way that should appeal to both health care professionals and the general public. Olivia Nelson, MDDepartment of Anesthesiology and Critical Care MedicineChildren’s Hospital of PhiladelphiaPhiladelphia, PennsylvaniaAllan F. Simpao, MD, MBIDepartments of Anesthesiology and Critical Care Medicine and Biomedical and Health InformaticsChildren’s Hospital of PhiladelphiaPhiladelphia, PennsylvaniaDepartment of Anesthesiology and Critical CareUniversity of Pennsylvania Perelman School of MedicinePhiladelphia, Pennsylvania[email protected]