The cult of the family is so great in Georgia that 58 percent of the population, regardless of sex, think that being in an unhappy marriage is better than being unmarried – as shown by a survey conducted in 2013 by the public opinion research company ACT under the joint UN program "To Enhance Gender Equality in Georgia." The same society regards raising children to be the key purpose of the family. Some 96 percent of respondents in the ACT survey see motherhood as the most important role for women, whilst 85 percent view fatherhood in the same light. Against this backdrop, the Catholicos-Patriarch of All Georgia Ilia II – whom 95 percent of the population trusts according to a 2013 survey of the US International Republican Institute – used his Christmas epistle to address the issue of children born as a result of artificial insemination and surrogacy: "Can a family which raises a baby born by a surrogate mother be happy? This little one has been doomed to a lack of love, a lack of care, and solitude from the very beginning. Even if they grow up in prosperity, nothing can change the unrighteousness of their prenatal period and this will necessarily manifest itself at an adult age. Children born through artificial insemination will also be problematic as their lives have developed as a result of the destruction of numerous embryos."
This statement caused outrage among a segment of society and resulted in a rally being staged outside the Patriarchate. Proponents of the opinion expressed in the Christmas epistle have also emerged. To cut a long story short, this topic has become a subject of heated discussion, despite the fact that in vitro fertilization has been practiced in Georgia since 1999. In fact, this issue first became topical as early as 1978 when the first baby was born as a result of artificial fertilization in England. That was a period of extremely heated debates on the topic of in vitro fertilization. Back then, the protest was passionate and one could hear evaluations such as: "human-animal hybrids," "the rebirth of eugenics," "science has run amok," et cetera. While one segment of society viewed Louise Brown, the first "test-tube" baby, as the child of the century, another segment viewed her birth as a sign of moral collapse. The doctors involved came under scathing criticism and the Catholic theologians of Rome branded the issue as being against nature. However, none of the criticism was ever directed towards the child, who remained innocent in the eyes of society.
The thing that caused the most uproar in the Patriarch's Christmas epistle was the attitude towards children. People voiced their protest against the discrimination and stigmatization of children, they supported the right to motherhood and called for the humane treatment of the issue. In response to the protest rally, the Patriarchate released a statement which seemed to be designed to soften the opinions expressed in the Christmas epistle. In particular, the statement read: "a segment of society became irate about that passage [in the epistle] which refers to surrogate mothers and artificial fertilization. Some even considered that the Church is against children born in this way; which is absurd. Quite the opposite, these little ones require more warmth, love and blessing from the Church." A new form of discrimination thus emerged towards these children – positive discrimination. As psychologist Lela Khechuashvili explains: "Requiring more love than an ordinary child is a form of positive discrimination. Distinguishing still takes place. When you become distinguished, in either a negative or positive sense, it is bad as in both cases as you become stigmatized. All this gives birth to a whole set of new stereotypes, prejudices... Prejudice is the most dangerous phenomenon as it may inflame from a tiny spark."
So far, some five million babies have been born by in vitro fertilization worldwide. In vitro fertilization accounts from between one to two percent of the birth rate in developed countries. The first "test-tube" baby born in Georgia appeared in 2000. As reproductive health specialist Luda Barbakadze explains: "during in vitro fertilization, an egg cell is taken from a woman's body and fertilized by sperm outside her body in sterile conditions. The fertilized egg is then cultured from two to five days in a growth medium and thereafter transferred to the mother's uterus." In the case of surrogacy, a fertilized egg is transferred to the uterus of another, non-biological mother and after birth, the baby is given to the biological parents. Genetically, the baby is the child of that couple whose egg cell and sperm were used. According to Luda Barbakadze, "pregnancy occurs in some 35 percent of cases of in vitro fertilization but this indicator decreases thereafter for various reasons and, all in all, babies are born in 25 percent of cases." The service is expensive with the price varying from clinic to clinic. In vitro fertilization costs up to 10,000 GEL, whilst the service of a surrogate mother reaches 20,000 USD. Psychologist Lali Khechuashvili believes that "this is a very expensive service. The indicator of childbirth is so low that one may say that customers are paying for hope, a chance, and not for a real result. When a couple undertakes this risk and spends such a great deal of time and energy on having a child, in reality this very child is what brings happiness to them. Psychologically, it is less traumatic for parents to have a child by means of in vitro fertilization than to adopt someone else's child. There is nothing unethical in a couple creating a child through their own egg cell and sperm, their own genes, with the help of medicine. An ethical issue, however, may arise in the case of surrogacy and, even more so, in the case of adoption."
The thing that caused the most uproar in the Patriarch's Christmas epistle was the attitude towards children. People voiced their protest against the discrimination and stigmatization of children, they supported the right to motherhood and called for the humane treatment of the issue.
Adoption is that alternative to having a child that is blessed by the Patriarch: "Adopting children is desirable. This is a great blessing. In this case, a special prayer is read for them." This alternative is not very available in Georgia. Of the up to 1,200 children under state care only 20 are healthy and qualified as fit for being adopted. The number of those willing to adopt, meanwhile, reaches 3,000. The Head of the Guardianship, Child Care and Social Programs Department at the Social Service Agency of Georgia, Eka Saneblidze, says that "the reform of the child care system, which is being implemented, is focused on ensuring that all children grow up in their biological families; but the reform, of course, includes other directions too: foster care, guardianship, and adoption remain in force, though they are viewed as secondary alternatives and are used if we fail to strengthen a biological family." Apart from the 20 children mentioned above, there are up to another 45 children with the same status whose adoption is impeded by various health problems. According to Eka Saneblidze: "such children are not available for adoption in developed countries, for example in Scandinavian countries, because they are not rejected by their biological families." Georgian society, however, tries to hide children with various health problems or disabilities and the state has yet to ensure the appropriate infrastructure for their movement; no one wants to adopt such children. Moreover, children in Georgia are discriminated not only by the state of their health but also by their gender – according to the data of the Parliamentary Assembly of the Council of Europe, Georgia is among the top four countries, along with Albania, Armenia and Azerbaijan, with the highest indicators of selective abortions. If naturally 106 boys are born per 100 girls, this ratio in Georgia stands at 111 boys to 100 girls.
While we in Georgia are engaged in debating the "problematic" nature of test-tube children, trying to figure out what gender we prefer and, in general, how to become parents, developed countries enjoy the happiness of healthy children born by in vitro fertilization and are interested in the ethical or scientific issues related to this topic.
In vitro fertilization has opened up the path towards pre-implantation genetic diagnosis (PGD), which has not yet been introduced in Georgia. PGD implies the genetic diagnosis of embryos created through in vitro fertilization before transfer into a mother's uterus. Embryos are studied microscopically for various genetic diseases or defects and only those embryos free from such genetic defects are implanted into a uterus. This method of diagnosis allows for the elimination of more than 100 different genetic diseases and defects. The first PGD was conducted on an embryo from a couple suffering from cystic fibrosis in October 1989 with the aim of selecting a healthy embryo. The result proved successful and a healthy girl was born in 1990.
The further development of this area of medicine requires performing experiments on embryos. Research is conducted on those embryos no longer needed during in vitro fertilization and which have been frozen. The research of embryos offers great potential for making medical discoveries, curing thus far incurable diseases and creating new methods of treatment. However, research carried out on embryos has not been welcomed and broad ethical debates are under way on the issue. One group advocates for the right to life, basing their stance on the belief that the life of a human starts once an egg cell is fertilized. Consequently, they perceive an embryo as a human being with all attendant rights. In their opinion, experiments which may endanger egg cells are tantamount, in terms of ethics, to the research carried out in Nazi concentration camps. For the proponents of the pro-life concept it is not important how beneficial the research of embryos may ultimately prove to be for mankind. They think that research must not be conducted if it results in risks to or the destruction of embryos.
Another, a pro-choice group believes that a fertilized egg cell is not yet a human being, but a potential human being. As such, they argue about as to when an embryo may be viewed as a human. The options are many: when an embryo starts taking a human shape; when it starts showing signs of life; at the moment of birth.... They support the use of embryos in research if they help develop medical knowledge and improve people's lives. Followers of this opinion fear that if the population opts for the pro-life concept, which says that the personal qualities of a human being start upon fertilization, it will endanger women's access to abortion and contraception.
Regardless of ethical dilemmas, the world is approaching a point in technology whereby people will have the possibility to select and transfer desirable genes to their children. Children who are born as a result of the selection of genes are called "designer" babies. Genetic engineering experiments have already been successfully completed on mice – with various types of mice having been created through implanting certain genes in the genetic code.
Thus, if in vitro fertilization was initially applied only to tackle the problem of infertility, it now allows, with the help of PGR, the selection of a desirable embryo which will not have any genetic defects. The future of all this is that by applying the same principle people will be able to select an embryo that is not only healthy, but also has the desired genes that dictate the child's appearance or other qualities. However, society will find it difficult to agree on the essence of "desirable." Such a criterion simply does not exist. No matter how the notion of what is "desirable" is formulated, it will inevitably represent the inclinations of individual societies. Yet another step towards creating a designer baby might be the possibility that genetic engineering will not only be used to fight diseases, but will also, when further developed, be used to extend life expectancy, improve the level of intellect, increase muscle mass.... All this will open the path towards fundamental changes to the human race. The altered genes will ultimately not only be found in those children born through these procedures, but will also be found in every subsequent generation.
It must be noted, however, that biological qualities mainly depend on the interaction of numerous genes, whilst the activity of genes depends on various processes taking place both inside the body and in the surrounding world. This means that scientists cannot fully predict how the modification of this or that gene affects the qualities of people and other organisms. A universally acknowledged ideal of biological perfection does not exist.