Ethical Challenges for Embryos

Table of Contents

Week 2 Discussion: Ethical Challenges for Embryos

Review all Week 2 readings and resources for your discussion responses.

Minimum 300 words, APA format, 2 references

Note: Each student must also answer the question using the ethical theory: If your last name ends in L-R (# 2)

This week’s ethical questions are:

Who do you think should be the center of concern regarding the implementation of reproductive technology? What ethical theories support your answer?

Neonatal Ethics

Neonates are babies within their first twenty-eight days of life. Neonatal intensive care often caters for babies in one of three groups – premature babies with low birth weight, full-term babies born with acute conditions or babies born with congenital anomalies.

Ethical issues mostly surround decision making on behalf of neonates. Decisions involve the weighing up of treatment that is beneficial or futile, considering the individual’s short-term and long-term prognosis. Two main issues in the decision making process are the chance of surviving medical intervention and future quality of life.

The most famous case of neonatal decision-making involved Baby Doe. In 1982, Baby Doe was born with Down’s syndrome and a tracheal-oesophageal fistula. The parents chose not to consent to the baby having the fistula repaired in surgery, based on the child’s best interests and lack of quality of life associated with Down’s syndrome. Baby Doe eventually died of starvation.

Treatment may be obligatory, optional or futile. It is often the case when the prognosis of a newborn looks good, that the parents and physicians agree to treat accordingly. However, occasionally parents do not want their newborn to be treated and in these circumstances hospital ethicists are sometimes required to seek a court order to override the parent’s decision and initiate treatment. It is more controversial when the prognosis of a neonate is unknown and the parents with the physician are given the opportunity to discuss whether to treat or not. Bioethics addresses the parameters and obligations of those involved in the decision-making. Finally, there are cases when treatment is considered futile, yet the physician or the parents insist on treatment. Treatment in these situations is considered extremely burdensome and experimental and the chance of surviving treatment with any quality of life is small. Patient rights, parental rights and the duty of the physician are all considered in a bioethics evaluation.

Technology and medical interventions in the neonatal intensive care unit have developed at a steady pace over the past 40 years and with this development there have been joyful stories of recovery, but also saddening stories of severe disability. Bioethics can assist by addressing questions related to the regulation on use of experimental technological developments and by providing guidance in controversial situations.

Video: Buying Fertility on the Internet: fair play or risky business? Centre for Ethics in Women’s Health.

Contraception

The use of contraceptives – the deliberate interference with the natural process of fertility in order to prevent conception – is widespread across the global community. Hormonal contraceptives are considered convenient and effective methods of spacing children – or even not having children at all. Meanwhile, barrier methods of contraception are hailed as the answer to international problems such as Acquired Immune Deficiency Syndrome (AIDS) and other Sexually Transmitted Infections (STIs). Together, both methods allow individuals to exert full control over their reproductive lives. However, the effects of widespread contraceptive usage are perhaps not as clear as they first seem. Hormonal contraceptives come with their own health risks – some of which will remain unknown. They also raise a host of medical questions concerning their mechanism of action (how the contraceptive actually works) and whether or not contraceptives have an abortifacient effect (a drug which allows conception to occur yet renders the woman’s womb hostile to implantation – effectively, working as an early abortion). This is particularly problematic for Judeo-Christian or Islamic tradition where life begins at conception. Yet, the ethical questions arising from contraception are by no means confined to questions of health. The increased usage of contraception has contributed to a new understanding of the role of sexual intercourse, the family and the notion of responsible parenthood – all of which bear intimately on the functioning of society as a whole. Human Embryos and Gametes

Human gametes have a unique status compared to other human body cells. This is because it is only the gametes that have the reproductive capacity to form a new human life and in doing so carry an individual’s heritage to the next generation. Gametes therefore need to be treated in accord with this status and so there are particular ethical considerations that pertain to their use in reproductive technology programs as well as in research applications.

Human embryos are human life at its earliest developmental stage. Upon union of egg and sperm a genetically unique individual is formed with the capacity to direct its own development and in the normal course of events be born as a child. The human embryo is human life at a vulnerable stage and with the advent of assisted reproductive technology, has become particularly vulnerable. Once conception and early embryonic development became possible outside of the human body, embryos could be screened for genetic conditions, discarded, frozen and stored, used for training purposes, or research with or without their destruction. The moral status of human embryos is the central question in determining what should or should not be done to them and it is a question that has been considered by philosophers for millennia. There are strongly polarized views on this question that have led to very different legislative regimes in different countries.

Video: Controversy over frozen embryos. Chicago Tribune.

Abortion

The matter of abortion, the quintessential bioethics topic, raises intensely personal issues for many people. It is a polarising and divisive issue that raises discussions about morals, science, medicine, sexuality, autonomy, religion and politics. A central matter is deciding what we can say about unborn children, initially known as embryos and later, foetuses. What is their moral status – how much do they matter and what are our obligations towards them? The matter of ‘personhood’ arises, as a philosophical and legal discussion about what rights to grant them.

‘Personhood’ aside, what is our relationship to them, all of us as members of the human family? Should their lives be protected, or should their mothers be allowed to make decisions about killing or protecting them? If killing is allowed, under what circumstances may it take place? If their lives are not protected, what kind of crime is it to perform an abortion on a woman without her consent, or to cause her to suffer a miscarriage?

The ethical aspect of abortion is related but distinct from the legal. Whether or not it is moral, should abortion be legal? Generally prohibited but with some exceptions? Should it be regulated? Publicly funded? Should doctors and nurses be able to object according to their conscience?

A less prominent but still important debate focuses on the reasons why women might seek abortion. Is it at all times a free choice, or are women responding to coercion in any way? Is it a free choice to seek abortion in desperation because of poverty, violence, or lack of support? What should be the community and policy response to women who feel unable to give birth to their children? And what is the role of the father in decisions about abortion?

Stem Cells

The promise of new therapeutic avenues for the treatment of a range of conditions has led researchers to consider the use of stem cells. These cells have the capacity to become some or even all of the 206 different cell types found in the human body. It has even been suggested that one day stem cells may be able to form whole organs and hence contribute to organ transplantation therapies. Stem cells come in a wide variety of types. Adult stem cells have been found in nearly every tissue of the human body, where they carry out a role in tissue regeneration. Embryonic stem cells are located in the human embryo at the blastocyst stage (5 to 6 days of age). Embryos at this age are often unwanted in reproductive technology treatment, and some parents have donated them for research. Cord blood stem cells are derived from the umbilical cord which is often still routinely discarded at birth.

The key ethical issues concern the destruction of human embryos for stem cell derivation. On the grounds that the human embryo is a human life with moral value justifying its protection, the extraction of embryonic stem cells is unethical. The use of adult stem cells and umbilical cord blood stem cells have generally been considered to be free of any particular ethical issues. In fact they have been applauded as ethically superior alternatives to the use of embryonic stem cells.

One limitation to the possible use of embryonic stem cells in therapy is that they will likely be rejected by the recipient. In an attempt to overcome this researchers are attempting to produce cloned human embryos to derive genetically near-identical stem cells for possible treatment.

Surrogacy

It is often a devastating and life changing experience for a woman to discover that for one reason or another she cannot become pregnant and have children of her own. In some cases, such as those involving repeated unsuccessful attempts involving assisted reproductive technology (ART) or having a non-functional uterus, the remaining option (besides that of adoption) for these women and their partners is surrogacy. However, a major concern with surrogacy is the potential harm that may be inflicted upon the surrogate mother and the child. There are a number of ethical issues relevant to this topic. The ideals and values we hold concerning liberty and autonomy, have to be weighed against other values such as informed consent, welfare and exploitation. Surrogacy, when occuring in the context of ART, is also an issue that forces us to reassess many concepts such as parenthood, family structure and best interests, which until the recent surge in the popularity of surrogacy, we took for granted.

Reference

Center for Bioethics and Culture. (2016). Retrieved from: http://www.bioethics.org.au/Resources/Resource%20Topics/Surrogacy.html

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