THE KIDS ARE ALL RIGHT meets KRAMER VS KRAMER: Cell, Reproductive Science and Bioethics

I saw THE KIDS ARE ALL RIGHT in July of 2010.  Annette Bening was a highlighted guest at the Mill Valley Film Festival the following October. I suspected it would be an Oscar contender and so might not need the support of this blog to get into the teaching dialog in bioethics.  I couldn’t help noticing that as a bioethicist my take was different from the reviewers I read.

THE KIDS ARE ALL RIGHT is a movie beautifully acted by leads Annette Bening and Julianne Moore. They are two women married to each other who co-parent two children (Mia Wasikowska and Josh Hutcherson). The children seek out their biological father (Mark Ruffalo). The father is a womanizing habitually single man who gets his come uppings from the mothers, the children and his current bed partner and longtime friend (Yaya DaCosta).  THE KIDS ARE ALL RIGHT is about an average, upper middle class, American, nuclear family undergoing changes.  

There is no progressive politic in this film; neither feminist, racial, gender or even sexual, no call to action other than to hold onto your family tight and ride the roller coaster. It is a statement of facts of this family, presented as blithely as the reality that the sun rises in the east.  Writer-director Lisa Cholodenko shows craftsmanship in not cluttering the presentation with exposition. What buys our attention is the bioethical-cultural C change inherent in this narrative. 

Forty years ago, the characters and premise of the KIDS ARE ALL RIGHT would have given worldwide viewers whip lash.  Of the Mom’s in this film, one is a woman gynecologist.  Back in the day gynecology was considered a surgical subspecialty solidly dominated by men.  Informed consent only really hit real world medicine about thirty years ago. In THE KIDS ARE ALL RIGHT even the anonymous sperm donor has the opportunity to give informed consent before being contacted by his genetic daughter. Adopted children only recently have hope of routinely identifying their biological parents, it makes sense that this right should extend to genetic parents as well.  

Sperm banks differ in how they select donors.  One cryo-bank accepts only donors who attend or have graduated from a four year university, are tall, trim, heterosexual and between 19 and 34. Another bank only takes sperm from Nobel Prize winners. Newer sperm banks seek more eclectic gene pools. We like to think this diversity is an effort to avoid any appearance of supporting eugenics.  The genetic Papa in the KIDS ARE ALL RIGHT is a college drop-out and cook with a preference for meaningless sex. He is flawed like most people.  We gather from his comments that he may have fathered more than ten children by sperm donation for money.  Currently there are restrictions for number of children a sperm donor may parent. Fathering less than 10 children by sperm donation seems to statistically limit accidental marriage possibilities between siblings. Payment for sperm donation still occurs. You can’t buy babies but you can buy the stuff they are made of.   

Sperm donors and client parent rights are usually established via written informed consent that is signed by the client and surrogate. The informed consent is verified by the client's doctor. The principle of informed consent is a device of the medical ethical principle of autonomy.  It was the 1974 Belmont Report on the Protection of Human Research Subjects, the federal government's procedural response to the US Public Health Service Syphilis Study at Tuskegee, that established informed consent as a norm in both research and clinical patient interaction. 

Deep in the narrative of THE KIDS ARE ALL RIGHT lays the story of Baby M. In 1988, the New Jersey Superior Court awarded custody of “Baby M” to a couple named Stern under a “best interest of the child analysis”.  This analysis attempts to circumvent the commodification of children whilst recognizing the contractual relationship between clients who employ surrogates and their gene donors. This court’s analysis validated the surrogacy contract between Mary Beth Whitehead, the genetic mother of “Baby M,” and the Sterns, the client parents. However, buried in the best interest of the child decision, there may be a bias against Ms. Whitehead’s potential of being disabled by Multiple Sclerosis and her circumstantial psychological unbalance.  Informed consent is used as evidence of a fiscal contract in surrogacy.  It is a twist in clinical ethics that a device to insure autonomy can inadvertently lead to human commodification.   Commodification of human beings is of particular concern to groups of people, and their offspring, who have historically or currently been bought and sold. 

In THE KIDS ARE ALL RIGHT, two children result from cell science. Cell Science has led to extraordinary technological advances including fertility surrogacy, vaccines, and most prominently the human genome project.   Completed in 2003, the Human Genome Project (HGP) was a 13-year project coordinated by the U.S. Department of Energy and the National Institutes of Health. Its goals were to identify the 20-25,000 genes in the human DNA, determine the sequence of billions of base pairs, store the information in databases, improve data analysis, transfer technologies to the private sector, and address the ethical, legal and social issues that arise from genetic  technologies.

Not the least of ethical concerns related to cell science and its offsprings, reproductive technology and the Human Genome Project,  is the origins of the cells used to develop them.  Much of what we know of cell science derives from cells taken from an African American woman named Henrietta Lacks. In the 1950s, Mrs. Lacks resided in Baltimore. She was born from tobacco sharecropper slave roots in Clover, Virginia.  Her cells were taken from her during a biopsy for cancer. They were used for research purposes without her permission.   Her cells were named HeLa. HeLa became the first human cell line to grow in-vitro. HeLa is the origin of billions of dollars reaped by  private technology companies.  Neither Mrs. Lacks and her family, nor anyone else who has their tissue taken in medical procedures, has the legal right to consent or veto how their tissue is used once extracted.  

Generally there is no legal support for extending personal or family autonomy to the tissue of a person, unless it is to be implanted in a living recipient. Tissue routinely excised in medical procedures provides its source no legal assurance to partake in revenue that is generated by the use of their body part.  If there is no informed consent, there is no contract to be legally upheld. Like Mrs. Lacks, anyone's human body parts can be scattered across the world. This lack of wholeness, particularly at the point of death, is more than fiscally important in many cultures.  

THE KIDS ARE ALL RIGHT signifies an advance in human consciousness as regards same sex relationships and marriages.  KRAMER VS KRAMER premiered in 1979, creating a shock wave in its conclusion.  Mrs. Kramer (Meryl Streep) is a Lesbian.  Mr. Kramer (Dustin Hoffman) is inconsolable. The two enter a bitter divorce and custody battle underpinned by the emergence of their gender preferences.  The battle outed the gay parent on screen for the first time in history. However, Kramer vs. Kramer also highlighted the capacity for parents to show love for their children despite personal issues between themselves. They do the right thing; Mr. Kramer, Mrs. Kramer and her lesbian partner find a way to raise the child.  In THE KIDS ARE ALL RIGHT, the gender preferences of the moms are hardly a question in contrast to KRAMER VS KRAMER.  Ethical conflicts of reproductive technology and challenges of honesty between family members are correctly more important in THE KIDS ARE ALL RIGHT.

The Kids Are All Right.  35 mm. Directed by Lisa Cholodenko. USA. 2010. Focus Films. (106 min)

Kramer vs. Kramer.  35 mm. Directed by Robert Benton. USA. 1979. Columbia Pictures. (105 min) 

For further information:

http://www.kylewood.com/familylaw/babym.htm. In the Matter of Baby M., 109 N.J. 396. 1988.

Skoot, R. The Immortal Life of Henrietta Lacks. Random House Inc.., New York.  2010, 2011