on Reproduction Technologies J Blackmon Contents Introduction The Debate over RTs Areas for Ethical Debate Introduction Terminology and Concepts Reproductive Technology RT techniques which artificially assist reproduction ID: 263479
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Slide1
Frith on Reproduction Technologies
J. BlackmonSlide2
Contents
Introduction
The Debate over RTs
Areas for Ethical DebateSlide3
Introduction
Terminology and Concepts
Reproductive Technology (RT): techniques which artificially assist reproduction.
In Vitro
F
ertilization (IVF): Eggs are collected from the woman and mixed in a petri dish with sperm. Upon fertilization, embryos are placed in the uterus to establish pregnancy.
Intracytoplasmic
S
perm Injection (ICSI): A single sperm is injected into an egg.Slide4
Introduction
Terminology and Concepts
Preimplantation
Genetic Diagnosis (PGD): After fertilization and before implantation, embryos are tested for presence or absence of genes or chromosomes linked to various medical conditions.
Pronatalism
: An attitude or policy that encourages reproduction and promotes the role of parenthood.Slide5
Introduction
1978, first IVF baby born: Moral Outrage
Playing God: Only God should bring a human life into the world.
Roman Catholicism: IVF is wrong for two reasons.
IVF deviates from normal intercourse, separating the unitive and procreative aspects.
IVF introduces a third person, defiling the sanctity of marriage and family.
Public opinion of RT is of course relevant to whether it will be allowed, funded, or otherwise supported.Slide6
The Debate over RTs
Should we help the infertile?
What is infertility?
A disease?
A social problem?
Something else?Slide7
The Debate over RTs
Infertility is a disease.Slide8
The Debate over RTs
Infertility is a disease.
Then RTs help the infertile function as healthy individuals.
This would be supported by a wide definition of health: “a complete sense of wellbeing”. (WHO)
Disease is something which detracts from that “complete sense of wellbeing”.
Thus, infertility, insofar as it detracts from one’s complete sense of wellbeing, is a disease and should be a part of health care provision.Slide9
The Debate over RTs
Infertility is a disease.
An initial problem with the wide definition of health as “a complete sense of wellbeing”.
Construction noise next door might interfere with your yoga, but is there really a
disease
here?
The wide definition seems too wide.Slide10
The Debate over RTs
Infertility is a disease.
Then RTs help the infertile function as healthy individuals.
This would be supported by a wide definition of health: “a complete sense of wellbeing”. (WHO)
Disease is something which detracts from that “complete sense of wellbeing”.
Thus, infertility, insofar as it detracts from one’s complete sense of wellbeing, is a disease and should be a part of health care provision.Slide11
The Debate over RTs
Infertility is a disease.
Objection: Infertility has no single central cause; there is no specific condition to be cured. For this reason there is no single form of treatment.
Reply: So what? Diabetes, for example, has multiple forms of treatment. Instead of curing it, we manage its unpleasant effects. So, by parallel reasoning, we can manage the effect of infertility whatever its cause.
Frith
is rejecting the idea we must have a single central cause.Slide12
The Debate over RTs
Infertility is a disease.
Professor Edwards holds that genetic pressures incline us to want to reproduce.
Thus, having children is one of our basic natural needs—not a social construct.
If so, then infertility is a deprivation of a basic natural need.Slide13
The Debate over RTs
Infertility is a social problem.Slide14
The Debate over RTs
Infertility is a social problem.
On this view, there is no
prima
facie
warrant to make fertility a central aspect of health care provision.
Wanting to become fertile is like wanting to become taller.
Maybe instead you need counseling.
Or maybe the best way of addressing infertility is to correct the biases in society which promote
pronatalism
.
Consider parallels with other biological features.Slide15
The Debate over RTs
The Right to ReproduceSlide16
The Debate over RTs
The Right to Reproduce
Typically, the right to reproduction has been construed as a negative right.
Negative Right to X: The right not to have X interfered with against one’s will.
Positive Right to X: The right to have X made available to one.Slide17
Explanatory Interlude
Why were we talking about billboards?
What one person might call a negative right to X might be considered a negative right to not-X by someone else.
Do we have the right not to have to look at billboards?
D
o we have the right to put up billboards? Slide18
The Debate over RTs
The Right to Reproduce
Typically, the right to reproduction has been construed as a negative right.
If the right to reproduction is negative, then this protects the fertile from compulsory sterilization, but the infertile need assistance in order to become fertile.
So, reproduction must be understood in a positive sense, if it is to be protected as a right.Slide19
The Debate over RTs
The Right to Reproduce
John Robertson (1994): Procreative liberty is the freedom to decide whether or not to reproduce. Someone has a right to something if it is required for procreation. Thus, we have the right to RTs. [66]
This effectively turns the negative right to reproduce into a positive right: Once infertility is understood as standing in your way of the right to decided whether to reproduce, and an RT is understood as providing a requirement for reproduction, you have a positive right to that RT.Slide20
The Debate over RTs
The Right to Reproduce
Procreative Autonomy (PA): Personal reproductive decisions should be free from interference unless they will cause serious harm to others.
For example, Julian
Savulescu
promotes PA.Slide21
The Debate over RTs
The Right to Reproduce
Some feminists have replied (to the advocacy of RTs as enabling PA) that RTs comes with their own pressures, and that women do not freely choose as a result.
Women are pressured by society, partners, and family to make use of RTs. Thus, on this view, RTs actually influence and
constrain
choice.Slide22
Areas for Ethical DebateSlide23
Areas for Ethical Debate
Regulation
of
RTs
Treatment of Embryos
Donation of Gametes
Social Egg FreezingSlide24
Areas for Ethical Debate
Regulation of RTs
In the US there is no overarching framework; states and regulatory guidelines direct policy.
The ASRM considered further regulation in 2009, but reported that because RTs are “one of the most highly regulated of all medical practices in the United States”, no further regulation was needed.
We currently have a regulatory system that
Frith
describes as consisting of three levels, involving multiple agencies and various degrees of power.Slide25
Areas for Ethical Debate
Regulation
of
RTs
The Dilemma of Multiple Embryo Transfer
In many cases, transferring multiple embryos significantly increases the probability of a successful pregnancy.
However, it also significantly increases the probability of a multiple pregnancy, thus increasing the probability of pre-term births and consequent health risks to those babies.Slide26
Areas for Ethical Debate
Regulation
of
RTs
Other Areas of Possible Regulation
Age Limits
Welfare of ChildSlide27
Areas for Ethical Debate
Treatment of Embryos
Typically, IVF produces many embryos and spare ones are frozen or used in future research.
How long should embryos be stored?
Who owns them in the event the parents die or part ways? Who decides what to do with them?
Consent agreements may help. But the technology is changing rapidly and unpredictably. How much help a consent form can provide
is unclear.Slide28
Areas for Ethical Debate
Treatment of Embryos
How should embryos be relinquished?
Frith
sees a continuum with anonymous relinquishment at one end and conditional relinquishment at the other.Slide29
Areas for Ethical Debate
Treatment of Embryos
How should embryos be relinquished?
Anonymous Relinquishment: As with gamete donation, the donors would have no role in deciding who the recipients can be. Recipients could get information about health and physical characteristics of the donors.
Conditional Relinquishment: Donors can vet and choose their recipients, and they can negotiate terms of information exchange, contact, and involvement in the child’s life.Slide30
Areas for Ethical Debate
Treatment of Embryos
How should embryos be relinquished?
Is conditional relinquishment
adoption
?
The ASRM argues this is a misleading term, for it implies that the embryo is a “fully entitled legal being”, and this, as ASRM argues, leads to “a series of procedures that are not appropriate.”
Frith
argues that the question of relinquishment cannot be decided by the question of personhood. [71]Slide31
Areas for Ethical Debate
Donation of Gametes
Donor Anonymity
Paying Donors Slide32
Areas for Ethical Debate
Donation of Gametes
Donor Anonymity
Does the donor offspring have a right to
identifying
information about their gamete donor?
Having this information is thought to be essential to a person’s wellbeing.
However, making it available creates a disincentive for many would-be donors.Slide33
Areas for Ethical Debate
Donation of Gametes
Paying Donors
Paying people to donate gametes can create an inappropriate motivation, and it can exploit the poor who would be more susceptible to financial inducement.
However, forbidding payment to donors deprives them of a source of income.Slide34
Areas for Ethical Debate
Social Egg Freezing: Eggs can be frozen as ‘an insurance policy’ against age-related decline in fertility.
In favor:
Reproductive autonomy
Gender Equality
Example in Cancer Treatment
More Practical than Embryo FreezingSlide35
Areas for Ethical Debate
Social Egg Freezing: Eggs can be frozen as ‘an insurance policy’ against age-related decline in fertility.
Against:
Over-
medicalizing
False HopeSlide36
Questions
What is infertility: disease, social problem, or something else?
Should people be free to freeze gametes or embryos for possible later use in attempted pregnancy?
Is anyone disempowered by IVF or other RTs?
Should gamete donors be anonymous to any future children?
Should gamete donors be paid?