Wednesday, July 14, 2010

When faith and facts collide: the spanking of Margaret Somerville

Regular readers will know that I have little time for the works of Margaret Somerville, the bioethics queen currently holding court at McGill University and uttering her edicts, decrees and injunctions through the popular press.

I have long suspected that Margo is a religious zealot in academic drag--opposing gay marriage, euthanasia and abortion, inveighing against stem cell research and adoption, but avoiding specifically religious vocabulary. (There is method in this madness, and I'm not alone in seeing it.)

Most recently, she published an op-ed piece in the Globe and Mail arguing that people who do not know their genetic origins suffer harm as a result, equivalent to the suffering of aboriginal children in residential schools. This prompted a letter from bioethicist Arthur Schafer and none other than Amir Attaran, a professor at the University of Ottawa. Attaran is better known perhaps for his opposition to our conduct of the Afghanistan war, but he works in the field of public health.

What follows is very lengthy--caveat lector--but it is worth reproducing as a prime example of how a seasoned academic, like Attaran, confronts mysticism and prejudice with facts and reason. It takes place in the course of a series of email exchanges which are here reproduced unabridged. I now yield the floor.

1. From: Amir Attaran
Sent: Tuesday, July 13, 2010 7:01 AM
To: Margaret Somerville
Subject: Your essay in the Globe and Mail

Dear Margaret,

I obviously profoundly disagree with you about gamete donation. To be totally frank, as scholars should be, I found your piece in the Globe over the weekend poorly done in its use of hand-picked anecdotes, to the exclusion of methodologically rigorous, scholarly evidence. Had it been written by a student of mine, it would have received a low mark for falling prey to a hoary statistical fallacy about comparisons of groups: i.e. that if donor-conceived people are psychologically equal to naturally-conceived people, then of course one will find a few donor-conceived people offering up dark and unhappy anecdotes about their origins, because as everyone knows there are naturally-born people (e.g. Woody Allen) who are clinically anxious, depressed, or otherwise neurotic about their origins.

In other words, even if donor-conceived people are not a jot worse off than naturally-conceived people, a teleologically-driven researcher will easily turn up anecdotes of unhappiness among them.

My view is that to research this question credibly, one has to leave the anecdotes aside, and if there is such a thing as donor-driven psychopathology, it should be observable in psychosocial cohort studies. Don’t you agree?

I attach at the end of this email seven such cohort studies and one review.* This is NOT an exhaustive list of studies, but it is the preponderance, and it is representative of the vast majority of studies in concluding that people born of donated gametes are psychologically no better or worse off than the population at large (and I am well aware that one or two studies somewhat disagree). These cohort studies in some cases have lengthy follow-up, into the adolescent years.

That said, I do not want to close my mind to contrary evidence, and so if I am wrong, can I please ask for a little reciprocity: i.e. can you please send me a collection of psychosocial studies which you think support the thesis in your article? Specifically, can you please send me a few studies -- not one isolated study, but a few -- which show that as a population, donor-conceived people are more likely to be of impaired mental health compared to naturally-conceived people?

If you undertake to send me those studies, I give you my solemn promise I will read them carefully, and after weighing the evidence, I will change my mind if that is warranted.

I look forward to receiving the studies from you.

Warm regards,
Professor Amir Attaran, D. Phil. LL.B.
Canada Research Chair in Law, Population Health and Global Development Policy
Faculties of Law and Medicine; University of Ottawa

2. From: Margaret Somerville
Sent: July-13-10 11:50 AM
To: Amir Attaran
Subject: RE: Your essay in the Globe and Mail

Dear Professor Attaran,

I find the tone of your email arrogant and offensive and, consequently, would prefer not to engage in an exchange with you.
Margo Somerville

Margaret Somerville AM, FRSC, DCL
McGill Centre for Medicine, Ethics and Law

3. Dear Margaret,

I mean zero offence and apologize unreservedly if you are offended. I am, however, trained as a scientist (DPhil, Oxford; MS, Caltech, BA, Berkeley) and the scientific culture is notoriously blunt when it comes to debate.

But surely, whether you were offended has no bearing on whether the harm that you allege exists in donor conception—harm that you compared to residential schools trauma—actually is real. That is a question to be decided purely by the evidence—and the tone of my email, or one’s religious leanings, or one’s inherent preferences, are simply irrelevant.

As professors both, let us have the maturity to treat this as a purely professional transaction: Can you please send me citations to psychosocial studies which you think support the thesis in your article? Specifically, can you please send me a few studies -- not one isolated study, but a few -- which show that as a population, donor-conceived people are more likely to be of impaired mental health compared to naturally-conceived people?

I have sent my evidence comprising seven original, peer-reviewed studies showing that donor-conceived children get on fine, equally well as their peers. Despite my best efforts to search, I am aware of no persuasive studies showing harm of the kind that you say exists.

But, that said, I always want to keep an open mind in case I am wrong, and so can I please ask for YOUR evidence?

Warm regards,

4. Dear Amir,

Over the years I have come into contact with many donor conceived people. To be quite frank it never occurred to me what the harm done to them was until I got to know them. I would not have characterized it as psychological harm (although that, too, may well be present), but as existential harm, which is what I was speaking about in my essay. A feeling of having been deliberately cut loose from their human roots and moorings and a longing to know through whom life travelled to them. They can feel this most keenly, it seems, when they themselves are considering having children, because they believe they would be inflicting the same loss they have suffered on their children. They feel a loss of identity and, as one of them said to me, “Each morning when I look in the mirror I feel that half of me is missing”. If you read Ishiguro’s book, “Never Let Me Go” you will find an extensive description of the kind of harm I am speaking about. And for first person donor conceived adults’ stories see

As well the research psychologist David Vellaman has described how important a feeling of genetic identification with our close relatives is in forming our own identity. We identify traits in them that we also share and those traits we like, we decide to copy and those we dislike we vow “never to be like our mother”. It may well be that I’ve met more of these people than many other people, as the first cohort of donor conceived people to reach adulthood were in Australia, because Australia had the earliest, large IVF program in the world in the early 1980’s. In fact, the IVF researchers sought me out and I spent a sabbatical working with the program and did some of the legal and ethical work for them.

I believe the kind of harm I am describing deserves attention, even if it’s more ephemeral than “mental illness” measured through classic scientific research methodologies. Moreover, it deserves attention even if it is not common, although we have no idea how common it is. One problem with research in this area is that probably the vast majority of donor conceived children don’t know that is what they are so they can be followed. That also means that we then have the issue of the harm and ethics (or more accurately lack thereof) of deception. As well, those who do know their status can be traumatized by discussing it or they want to safeguard their privacy – all of which are “flow on” harms of donor conception. The current estimates are that between 30,000 and 60,000 donor conceived children are born in the US each year. We have no idea how many know their real status regarding their biological parentage.

For some evidence of the kind of harm you are interested in, there is a new report just released “My daddy’s name is donor” written by Elizabeth Marquardt et al. And I’ve just acted as an external examiner on a PhD thesis “A critical examination of Sperm Donation Practice” by Joanna Rose submitted to the Queensland University of Technology, which has 27 pages of references. That should be publicly available in the near future, if you want to follow up on the references.

I do not want to enter a debate with you about the validity of the science in the references you sent to me, but I’m sure you are aware that at least some studies of this kind can be challenged and have been.

I’m swamped with work and am not going to continue any debate, so please don’t be offended if I do not reply to any further emails.

Kind regards,

5. Margaret,

Thank you for your reply. If you have the Marquardt paper and Rose thesis to hand, would you please share the same?

I appreciate the honesty of your answer, though I find it surprising on one point. You say that donor-born children suffer “existential harm,” rather than “psychological harm.” Further, the picture you paint of this existential harm is not that it is permanent or debilitating, but “ephemeral.” You also say that it “deserves attention even if it is not common,” but you also qualify that by saying nobody knows how common it is, because it is impossible to measure.

Taking all those qualifiers at face value, aren’t you actually speaking of the flimsiest of threats, or in other words, a threat which practically (and I choose my words carefully here) is an article of faith?

I probably cannot change your mind on this, but I invite you to rethink the comparison you made in the Globe and Mail, where you likened this ephemeral, existential harm which may exist with egg or sperm donor offspring, to the more tangible, traumatic, lifelong psychological harm, often manifested by serious clinical psychoses, wrought upon Canada’s residential schools offspring? In arguing against creating donor offspring, you wrote in the Globe:

“Are we repeating in a new context and in new ways the terrible errors and grave injustices that occurred with Australia’s “stolen generation” of aboriginal children, the United Kingdom’s “home children” sent to Canada and other British Commonwealth countries, and the “scoop” of native children from reserves into Canadian residential schools?”

Now, that you have done me the courtesy of clarifying your position on the donor children, it appears you’ve retreated several furlongs from what you wrote in the Globe, and probably you wouldn’t make that comparison any longer. I am grateful for your flexibility on this matter, and I hope you stand by your softer position in the future.

But I have to say this, because all scholars, myself included, need to be reminded sometimes: As public intellectuals, Margaret, you and I both owe it to our readers to be scrupulously accurate and evidence-based in everything we write; otherwise we are no better than angry tabloid columnists. Please keep this in mind when you write for a popular audience, for where the writing is not accurate or evidence-based, it misleads, which is exactly the opposite of education.

Warm regards,

6. [From Margaret Somerville] Your email makes me realize that there is an error in my previous email, the word ephemeral, which I am grateful to have pointed out, but there is no damage done as this was a private email to you and not a public document. I meant by it intangible, but nevertheless very serious harm, as should be obvious from the context, but, that said, it’s not the correct word to express that. Consequently, the rest of what you’ve written based on that word is completely wrong and in no way states what I think. I completely stand by what I said in my Globe Essay, as stated. For the record, I do believe that we will look back on widespread donor conception, especially that which is unacknowledged, as a great human tragedy of the 21st Century equivalent to the other tragedies I named.

As to your sanctimonious preaching, I’m surprised that you claim the title of public intellectual for yourself, I’ve always considered that a label that only others can bestow, and I must admit that I, for one, have never thought of you in that way.

7. Dear Margaret,

I have treated you politely and professionally, but also firmly, because good scholarship demands that we hold one another to the best standards of evidence. If the shoe were on the other foot, I would hope that you would debate firmly and hold me to the same standards—and I would hope that I have the grace to deal with it.

Regrettably, you aren’t showing that grace, for your last email is quite intentionally and gratuitously insulting. I regret that is your choice, but being that it is, I will not accede to your request that yours was a private email, since I think your way of addressing an intellectual debate is not acceptable.

Warm regards,

8. [From Margaret Somerville] Re your request for Joanna Rose’s thesis: I would have thought that you would know that it would be a breach of privacy and academic ethics, and legally prohibited, for me to share with another person a student’s thesis, especially one to which I only had access as the external examiner.

At which point Attaran finally realized he was not involved in a genuine intellectual discussion at all, and retorted:

9. Calm down, Margaret. You could always ask Ms. Rose’s permission.

To those intrepid readers who have ventured this far--congratulations!--I think this exchange should be held up as an exemplar (at least until the very end) of how to conduct oneself with grace and politesse when confronted with ignorance and superstition cloaked in ethobabble. We can all learn a lesson from it--myself included.
*1. Fertil Steril. 2006 Mar;85(3):610-8.

Egg donation parents and their children: follow-up at age 12 years.

Murray C, MacCallum F, Golombok S.

Family and Child Psychology Research Centre, City University, London, United

OBJECTIVE: To assess the quality of parenting and psychological adjustment of egg
donation families as the child approaches adolescence in comparison with donor
insemination (DI) and IVF families. DESIGN: A study of 17 egg donation families,
35 DI families, and 34 IVF families with a 12-year-old child. Standardized
interview and questionnaire measures were administered to mothers and children.
SETTING: Follow-up of families recruited from three assisted conception units in
the United Kingdom. PATIENT(S): Mothers and their 12-year-old children conceived
through egg donation, DI, and IVF. INTERVENTION(S): Mothers and children were
interviewed and administered questionnaires. MAIN OUTCOME MEASURE(S): Parents'
marital and psychological state, quality of parent-child relationships, father's
contribution to parenting, and children's socioemotional development. RESULT(S):
No differences were found between the egg donation and IVF families. The
differences between egg donation and DI families reflected lower levels of
sensitive responding of egg donation mothers toward their children compared with
DI mothers. Donor insemination mothers were more likely to be emotionally
over-involved with their child than egg donation mothers. The egg donation
children were well adjusted in terms of their social and emotional development.
CONCLUSION(S): The findings are discussed in relation to the different pattern of
genetic relationships between egg donation and DI families and the secrecy
surrounding the use of donated gametes to conceive a child.

PMID: 16500327 [PubMed - indexed for MEDLINE]

2. Child Dev. 1995 Apr;66(2):285-98.

Families created by the new reproductive technologies: quality of parenting and
social and emotional development of the children.

Golombok S, Cook R, Bish A, Murray C.

Child and Family Psychology Unit, City University, London, UK.

The creation of families by means of the new reproductive technologies has raised
important questions about the psychological consequences for children,
particularly where gamete donation has been used in the child's conception.
Findings are presented of a study of family relationships and the social and
emotional development of children in families created as a result of the 2 most
widely used reproductive technologies, in vitro fertilization (IVF) and donor
insemination (DI), in comparison with control groups of families with a naturally
conceived child and adoptive families. The quality of parenting was assessed
using a standardized interview with the mother, and mothers and fathers completed
questionnaire measures of stress associated with parenting, marital satisfaction,
and emotional state. Data on children's psychiatric state were also obtained by
standardized interview with the mother, and by questionnaires completed by the
mothers and the children's teachers. The children were administered the
Separation Anxiety Test, the Family Relations Test, and the Pictorial Scale of
Perceived Competence and Social Acceptance. The results showed that the quality
of parenting in families with a child conceived by assisted conception is
superior to that shown by families with a naturally conceived child. No group
differences were found for any of the measures of children's emotions, behavior,
or relationships with parents. The findings are discussed in terms of their
implications for understanding the role of genetic ties in family functioning and
child development.

PMID: 7750366 [PubMed - indexed for MEDLINE]

3. Hum Reprod. 1996 Oct;11(10):2324-31.

The European study of assisted reproduction families: family functioning and
child development.

Golombok S, Brewaeys A, Cook R, Giavazzi MT, Guerra D, Mantovani A, van Hall E,
Crosignani PG, Dexeus S.

Family and Child Psychology Research Centre, City University, London, UK.

Findings are presented of a European study (conducted in the UK, Italy, Spain and
The Netherlands) of family relationships and the social and emotional development
of children in families created as a result of the two most widely used
reproductive technologies, in-vitro fertilization (IVF) and donor insemination
(DI), in comparison with control groups of families with naturally conceived
child and adoptive families. Mothers of children conceived by assisted
reproduction expressed greater warmth towards their child, were more emotionally
involved with their child, interacted more with their child and reported less
stress associated with parenting than mothers who conceived their child
naturally. Similarly, assisted reproduction fathers were found to interact more
with their child and to contribute more to parenting than fathers with a
naturally conceived child. With respect to the children themselves, no group
differences were found for either the presence of psychological disorder or for
children's perceptions of the quality of family relationships. The findings
relating to the quality of parenting and the socio-emotional development of the
children were similar in each of the four countries studied.

PMID: 8943550 [PubMed - indexed for MEDLINE]

4. J Fam Psychol. 2007 Jun;21(2):278-87.

Parenting and child development in families with a child conceived through embryo

MacCallum F, Golombok S, Brinsden P.

Department of Psychology, University of Warwick, Coventry, United Kingdom.

Concerns have been raised regarding the potentially negative effects of
conception using donated embryos on parenting and child development. Findings are
presented of an exploratory study of families with a child conceived through
embryo donation. Twenty-one embryo donation families were compared with 28
adoptive families and 30 in vitro fertilization families on standardized
interview and questionnaire measures of the parents' marital and psychological
state, the quality of parent-child relationships, and the child's development. In
all 3 groups, the children were aged 2-5 years. The differences indicated higher
emotional overinvolvement and defensive responding in the embryo donation
families, along with greater secrecy about the child's origins. The children were
not at increased risk of psychological problems. The study provides interesting
but preliminary findings on parent-child relationships and child development in a
new family form.

PMID: 17605550 [PubMed - indexed for MEDLINE]

5. J Child Psychol Psychiatry. 1999 May;40(4):519-27.

Social versus biological parenting: family functioning and the socioemotional
development of children conceived by egg or sperm donation.

Golombok S, Murray C, Brinsden P, Abdalla H.

Family and Child Psychology Research Centre, City University, London, UK.

By investigating egg donation families, donor insemination families, adoptive
families, and families created by in vitro fertilization, the aim of the present
study was to examine parents' emotional well-being, the quality of parenting, and
childrens' socioemotional development in families with a child who is genetically
unrelated to the mother or the father. The differences that were found to exist
between families according to the presence or absence of genetic ties between
parents and their children reflected greater psychological well-being among
mothers and fathers in families where there was no genetic link between the
mother and the child. The families did not differ with respect to the quality of
parenting or the psychological adjustment of the child.

PMID: 10357159 [PubMed - indexed for MEDLINE]

6. Hum Reprod. 1997 Jun;12(6):1349-59.

Donor insemination: child development and family functioning in lesbian mother

Brewaeys A, Ponjaert I, Van Hall EV, Golombok S.

Department of Obstetrics, Gynaecology and Reproductive Medicine, University
Hospital, Leiden, The Netherlands.

Findings are presented of a comparative study investigating the family
relationships and the emotional and gender development of children raised in
lesbian mother families. A total of 30 lesbian mother families with 4-8 year old
children created as a result of donor insemination (DI) were compared with 38
heterosexual families with a DI child and with 30 heterosexual families who had a
naturally conceived child. A variety of assessment measures, including a
standardized interview and questionnaires from the parents and psychological
testing of the child were used to collect the data. The quality of the couples'
relationships and the quality of the mother-child interaction did not differ
between lesbian mother families and either of the heterosexual family groups. The
quality of the interaction between the social mother and the child in lesbian
families was superior to that between the father and the child in both groups of
heterosexual families. Childrens' own perception of their parents was similar in
all family types; the social mother in lesbian families was regarded by the child
to be as much a 'parent' as the father in both types of heterosexual families.
With regard to their emotional/behavioural development, boys and girls raised in
lesbian mother families were well adjusted and their gender role development did
not differ from that of children raised in heterosexual families. These results
indicate that child and family development in lesbian mother families is similar
to that of heterosexual families.

PMID: 9222029 [PubMed - indexed for MEDLINE]

7. Child Dev. 1998 Apr;69(2):443-57.

Psychosocial adjustment among children conceived via donor insemination by
lesbian and heterosexual mothers.

Chan RW, Raboy B, Patterson CJ.

Department of Psychology, University of Virginia, Charlottesville 22903-2477,

This study examined the relations among family structure (e.g., number of
parents, parental sexual orientation), family process (e.g., parents'
relationship satisfaction, interparental conflict), and the psychological
adjustment of children who had been conceived via donor insemination. The 80
participating families, all of whom had conceived children using the resources of
a single sperm bank, included 55 families headed by lesbian and 25 families
headed by heterosexual parents. Fifty families were headed by couples and 30 by
single parents. Participating children averaged 7 years of age. Results showed
that children were developing in normal fashion, and that their adjustment was
unrelated to structural variables such as parental sexual orientation or the
number of parents in the household. These results held true for teacher reports
as well as for parent reports. Variables associated with family interactions and
processes were, however, significantly related to indices of children's
adjustment. Parents who were experiencing higher levels of parenting stress,
higher levels of interparental conflict, and lower levels of love for each other
had children who exhibited more behavior problems.

PMID: 9586218 [PubMed - indexed for MEDLINE]

8. Hum Reprod Update. 2001 Jan-Feb;7(1):38-46.

Review: parent-child relationships and child development in donor insemination

Brewaeys A.

Netherlands Institute of Social Sexological Research, Utrecht.

The present article reviews the empirical research regarding the parent-child
relationships and the development of children in donor insemination (DI)
families. Over the years, follow-up studies have appeared sporadically and,
despite the varying quality of the research methods, preliminary findings have
emerged. Heterosexual DI parents were psychologically well adjusted and had
stable marital relationships. DI parents showed a similar or higher quality of
parent-child interaction and a greater emotional involvement with their children
compared with naturally conceived families. The majority of studies which
investigated several aspects of child development found that, overall, DI
children were doing well. Findings with regard to emotional/behavioural
development, however, were divergent in that some studies identified an increase
of such problems while others did not. A steadily growing group within the DI
population is lesbian mother families. More recently, follow-up studies have been
carried out among DI children who were raised from birth by two mothers. Despite
many concerns about the well-being of these children, no adverse effects of this
alternative family structure on child development could be identified. As the DI
children in all investigations were still young, our knowledge about the
long-term effects of DI remains incomplete.

PMID: 11212073 [PubMed - indexed for MEDLINE]

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