Transcript Ethical Issues of Human Reproductive Technology

Ethical Issues of Human
Reproductive Technologies
Dr Chan Ho Mun
Associate Professor
Department of Public and Social Administration
City University of Hong Kong
19 June, 2012
Human Reproductive
Technologies (HRT)
• Contraception: sex without procreation
• HRTs: procreation without sex
Types of HRTs
• Artificial insemination by husband (AIH)
• Artificial insemination by donor (AID)
• In virtro fertilization (IVF)
– Egg donation
– Embryo Donation
•
•
•
•
•
Surrogacy
New Genetics
Human Cloning
Stem Cell Research
Sex selection
Arguments for and
against surrogacy
Contractarian Argument for
Commercial Surrogacy
• People have the right to procreation and to have
a family.
• Gestation can be regard as a service akin to
baby sitting or rearing a child for some else. No
buying or selling baby is involved.
• Anyone with a sound mind should be allowed,
with his/her informed consent, to enter freely into
a contractual agreement.
Family-based Argument for Noncommercial Surrogacy
• If the baby has no genetic ties with the
commissioning parents, why not adoption?
• Gestation is the defining criteria of mother-child
relationship. The woman who gives birth to a
baby is its mother even in the absence of genetic
ties. This can protect the best interests of the
child. Some feminist maintains that the pregnant
woman is the first person who has an intimate
relation with the child and so she deserves to
have the baby.
• Commercial surrogacy involves the buying and
selling of baby. It should therefore be prohibited.
Family-based Argument
• With due respect to the parental right of the
surrogate mother, contracts of surrogacy,
commercial or non-commercial, should be
unenforceable.
• The commissioning parents should follow a
procedure similar to the adoption of baby. The
surrogate mother should be given a grace period
for changing her mind.
• Surrogacy should be permissible only if the baby
has genetic ties with both commissioning parents
and they are married. The result is better than
adoption.
Best-interests Argument
Against Surrogacy
• The arrangement based on the family argument
does not serve to protect the interests of all the
parties involved, including the baby, because the
arrangement is unenforceable.
• What will happen if the commissioning parents
change their minds after the baby is conceived?
The surrogate mother is the true mother and has
the responsibility to rear the baby even if she
does not want to.
• Won’t the commissioning parents be very upset
if the surrogate mother change her mind during
the grace period.
Best-interests Argument
Against Surrogacy
• What will happen if neither the surrogate mother
nor the commissioning parents wants to keep the
baby?
• The surrogate mother may have developed an
emotional tie with the baby during pregnancy.
Should she be allowed to visit the baby? Will it
undermine the integrity of the new family if she
does that?
The New Genetics
Gene Testing
• Create unnecessary psychological distress.
• Discrimination by employers and insurance
companies.
• Confidentiality and Privacy
• Social stigmatization.
Prenatal Screening
• Sex selection: Gender discrimination and
imbalance of sex ratio unless it is done solely for
therapeutic purpose (see the later notes for
further discussion)
• Discrimination: Lives of the disable are not worth
living.
Genetic Engineering
• Germ-line changes, unlike somatic modification,
can pass onto the next generation and be with
us forever. So germ-line changes could be very
risky.
• Genetic therapy *may* be alright (note that
reproduction without sex or abortion is involved).
• Is it a form of eugenics? Is genetic enhancement
moral?
• Dignity of a child: Parental love should not be
based on the traits and the characters of a child.
Children should not be treated as a means to
please their parents.
Human Cloning
Two Techniques
• Two techniques:
– Embryo splitting
– Nuclear substitution
Embryo splitting
• The clone is usually used for tests of
abnormality, and will be destroyed
subsequently.
Nuclear Substitution
• What is the relationship between the nuclear
donor and the clone?
– The same person?
– (Technologically-aided and birth delayed)
identical twins?
– Siblings?
– Parent-child?
• Should a homosexual be allowed to use the
technology to obtain his/her own child?
Nuclear Substitution
• Is it moral alright for parents to clone their
beloved children who die young or provide
organs for their siblings?
• Should it be used as an infertility treatment
or gene therapy if it is safe?
– No third party is involved.
– According to the parent-child ordinance in HK,
whoever gives birth to a baby is its mother, and the
husband who goes through the infertility treatment
with her is his father.
– Yet, human cloning has been banned by the HRT
Ordinance.
Stem Cell Research
Three Types of Stem Cell
• Stem cells: undifferentiated, multi-potent,
precursor cells, capable of developing into
virtually any body tissue.
• Three types of stem cells:
– Embryonic stem cells (ESC)
– Fetal stem cells
– Adult stem cells
Three Main Sources
• Adult bone marrow and other types of
cells.
• Miscarried or aborted embryos/fetus; extra
embryos left over from IVF.
• Embryos from therapeutic cloning.
Potential Treatments
• ESC is most promising for treatment, and
therapeutic cloning can avoid the problem of
immunological incompatibility.
• Ethical issues:
– Destroying an embryo to harvest ESC is equivalent to
killing a child to obtain his organs.
– Left-over from IVF are already there.
– Therapeutic cloning: The embryo is not created for
reproduction.
– How about the wellbeing of many patients who may
be cured by ESC research?
Sex Selection: Ethical or
Unethical?
Scope of the Ethical Issues
• A paradigm or type case in bioethics.
• The moral controversies arising from sex
selection covers most of the major ethical
issues in regard to human reproductive
technologies (HRT) because it is a form of
genetic engineering and often involves the
use of abortion, infertility treatment (such
as artificial insemination and in vitro
fertilization), human cloning and/or other
HRT.
Arguments Against
• Conservative arguments:
– Abortion is morally wrong.
– It is unnatural to separate sex from
procreation.
• Even early abortion is morally justified in
some exceptional cases. The preference
for children’s sex cannot serve as a
justification for granting an exception. It
does not meet the criteria for termination
of pregnancy.
Arguments against
• Biased sex ratio:
– when the proportion of woman is lower, they
“may be confined to traditional gender roles
and excluded from high-status positions;
– when their proportion is higher, misogyny
increases, and women are likely to be
exploited in sexual relationships and have
difficulty in finding committed male partners.”*
*Holmes, H. Q. “Choosing Children’s Sex: Challenges to Feminist Ethics’, in J. C.
Callahan (ed.), Reproduction, Ethics, and the Law, Bloomington and Indianapolis:
Indiana University Press, 1995, p. 149
.
Arguments against
• Sex discrimination: Children of different
sexes should be treated equally.
• Reinforces sexism and devalues women
as a class
Arguments against
• Dignity of a child: Parental love should not
be based on the traits and the characters
of a child. Children should not be treated
as a means to please their parents (see
arguments against genetic engineering).
Arguments for
• Prevention of sex-linked diseases.
• Parents have their rights to procreative
choices and family planning.
• The cultural condition or the individual
situation may put a woman in a very
difficult position if she cannot give birth to
a child of the preferred sex (more dowry,
getting a concubine, divorce, being
abused, tortured or even killed…).
Arguments for
• A feminist strategy for undermining
patriarchy:
– Choose to have boys and raise them as nonsexists
– Choose to have girls so as to cut down the
proportion of men, dissociate from the ruling
sex class and establish all-female
communities
• The impact on sex ratio is largely
uncertain if sex selection not for medical
reason is legalized in developed countries.
Arguments for
• Giving people incentives, e.g., tax
deductibles, for choosing daughters.
• Using a quota system to balance the sex
ratio.
Some Reflections
• The root of the problems is not
technological. Sex selection per se is not
unethical. Sexism is the source of the
problem.
• Yet unregulated use of the technology
may reinforce the existing gender biases
or make the situation even worse.
Some Reflections
• It is often difficult to enforce the legal
prohibition of sex selection not for
therapeutic purposes.
• The question of whether an all-or-nothing
approach should be adopted deserves a
more open discussion.