Assisted Human Reproduction

1
Assisted Human Reproduction

• Philosophy 2803
• Lecture IX
• April 2, 2003
• Some material is based on a previous lecture
  prepared with Dr. Barbara Barrowman

2
Groupwork

• In late 2002, The Raelians, an until then obscure
  religious cult, announced that the first human
  clone had been born.
• The claim has been met with substantial
  skepticism and is almost certainly false.

3
Groupwork

• Nonetheless, as a result of the publicity
  surrounding this annoucement, the idea of
  reproductive cloning has been much debated.
• Almost everyone who has publicly expressed an
  opinion on this issue has condemned the idea.
• Your assignment Compose a list of the reasons
  you think lie behind this view.

4
Assisted Human Reproduction (AHR)

• Infertility affects about 330,000 couples per
  year in Canada
• Many technologies techniques are used in an
  attempt to help people (not necessarily couples)
  have children
• Many new technologies are being developed

5
Regulating AHR in Canada

• Some existing legislation applies to AHR
• E.g., Food and Drug Act, Human Tissue Acts
• However, there has long been a political
  perception that legislation specifically
  regulating AHR is needed.
• Preparing passing such legislation has proved
  extremely challenging.
• 1989-1993 Royal Commission on New Reproductive
  Technologies
• Final Report Proceed with Care (1993)
• Recommends banning human cloning, commercial
  surrogacy, and establishing a regulatory body to
  govern permissible AHR activities (like IVF)
• See readings for tonight (pp. 446-452)

6
Attempts at Regulation

• 1995 - Minister of Health introduces a voluntary
  moratorium on cloning and many other activities
  the Royal Commission objected to
• 1996 Bill C-47 proposes a series of
  prohibitions based on the voluntary moratorium
• Dies when parliament is dissolved for the 1997
  federal election
• Public consultation on the issue followed.
• 2001 Bill C-56 presents an updated version of
  C-47
• Dies when parliament is dissolved in September
  2002

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Bill C-13 (2002) Proposed Assisted Human
Reproduction Act

• Bill C-56 was reintroduced in October, 2002 as
  Bill C-13
• Expected to pass in the House of Commons this
  week (March 31 - April 4, 2003)
• Would prohibit certain activities
• Would create licensing regulatory scheme for
  other activities
• Would regulate privacy access to information
  issues
• Would create an expert regulatory agency

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The AHR Act

• A very broad range of topics is covered
• Some are relevant to next weeks class on
  genetics
• Many of the provisions of the AHR Act are based
  on moral claims
• some practices are simply unacceptable,
  because they're not consistent with human
  dignity, such as cloning a person and creating
  animal-human hybrids. Those are unacceptable,
  because they're just not consistent with human
  dignity." (Alan Rock, May 3, 2001)

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Some Proposed Prohibitions

• Creating a human clone for any purpose
• Creating an embryo outside a human body for any
  purpose other than creating a human being, or
  improving assisted reproduction procedures
• Maintaining an embryo outside a womans body
  beyond the 14th day of its development
• Identifying sex of embryo created for
  reproductive purposes, except for medical reason
  such as sex-linked disorder also attempting to
  influence sex

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More Proposed Prohibitions

• Creating human/non-human combinations for
  reproductive purposes
• Changing DNA of human sperm, egg or embryo so
  that the change can be passed to subsequent
  generations
• Paying a woman a financial incentive to be a
  surrogate mother (commercial surrogacy)
• Paying a donor for their sperm or eggs, or
  providing goods or services in exchange
• Selling or buying human embryos, or providing
  goods or services in exchange

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Proposed Regulation of Other Activities

• Forms of AHR that are not be banned will
  regulated
• The act would set up an independent regulatory
  body to oversee AHR in Canada
• In Vitro Fertilization would fall into this class
  of regulated activities
• Regulations would be set up governing the types
  of facilities that could carry out IVF, how human
  reproductive material must be stored handled at
  such facilities, etc.

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Controversy Over the AHR Act

• The act has been controversial on both legal and
  moral grounds
• We turn now to considering the moral status of
  AHR. Our main focus will be on
• In Vitro Fertilization (IVF)
• Paid Surrogacy
• Reproductive Cloning
• First, a couple of general points about AHR are
  worth noting

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Two Ethical Issues Raised by AHR in General

• Who should have access to AHR technologies?
• Only heterosexual couples? What about same sex
  couples? Single people? Surrogates?
• This debate connects with sensitive issues
  regarding the conception of a family
• Who should pay?
• MCP? The infertile couple/individual?
• Recall earlier class on the idea of health
• Is infertility a disease?
• If we pay for couples who are medically
  infertile, should we pay for everyone seeking
  IVF?

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What is IVF?

• In vitro in glass as opposed to in vivo
• Ova sperm are collected (from the would-be
  parents or donors) combined outside the body
• If fertilization occurs, the fertilized ova are
  allowed to briefly develop and then either
  implanted in the would-be mother (or a surrogate)
  or stored for possible later attempts
• In 1978, Louise Brown became the first baby born
  as a result of IVF.
• Since then over 250,000 births worldwide
• IVF outcomes
• In U.K. (1998) live birth rate per IVF cycle
  15-17

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Controversies about IVF

• IVF was initially extremely controversial
• Louise Browns birth was a subject of intense
  media public attention
• Many of the concerns raised about IVF mirror
  present concerns about other New Reproductive
  Technologies

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Objections to IVF

• Potential Physical Harm to the Child
• It doesnt matter how many times the baby is
  tested, they will never be certain the baby wont
  be born without defect. Leon Kass
• Potential Psychological Harm to the Child
• What are the psychological implications of
  growing up as a specimen, sheltered not by a warm
  womb but by steel and glass, belonging to no one
  but the lab technician who joined together sperm
  and egg? In a world already populated with
  people with identity crises, whats the personal
  identity of a test-tube baby? Jeremy Rifkin

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Objections to IVF

• Unnaturalness
• Inconsistency with Human Dignity
• IVF deprives human procreation of the dignity
  which is proper and connatural to it (Vatican
  Statement, 1987)
• Playing God
• By acting in this way the researcher usurps the
  place of God (Vatican Statement, 1987)

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Kinds of Objection

• Notice that the objections just surveyed fall
  into 2 kinds
• Technical Objections
• These could be met by regulating IVF to make it
  safe
• Physical Psychological Safety
• In Principle Objections
• These hold that IVF itself is morally
  objectionable. No amount of tinkering can meet
  these objections.
• Unnaturalness, Dignity

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Meeting the Objections

• The technical objections to IVF have by now been
  met.
• The process, while not foolproof, poses no
  particular physical nor psychological risks.
• The in principle objections are just as strong or
  as weak as they ever were.
• Should we be convinced by the in principle
  objections?

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Unnaturalness

• Objections based on the idea of unnaturalness are
  generally very weak
• Arguably, lots of things are unnatural, but not
  immoral (e.g., popsicles, glasses, CDs)
• In order to make this sort of argument work, you
  need to say more about why the sort of
  unnaturalness represented by IVF is morally
  troubling.
• But then its the extra stuff you say that will
  do the work in your argument, not the idea of
  unnaturalness itself.
• On the whole, its best to simply leave claims
  about unnaturalness out of your arguments on this
  (or any other) issue

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Playing God Human Dignity

• Playing God
• Arguments based on this will be as strong or as
  weak as our arguments for a particular conception
  of God
• Dignity
• Arguments based on this require us to explain our
  conception of human dignity and why IVF runs
  afoul of it.
• Are there reasons for thinking IVF is
  incompatible with human dignity?

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A Further Issue Surplus Embryos

• IVF is expensive there is no guarantee that the
  implantation of the embryo will be successful
• Typically extra embryos are fertilized stored
  for possible later attempts
• What should be done with embryos no longer
  required by the donor couple for their own joint
  reproductive purposes?
• What if the couple breaks up and one then wants
  to use a stored embryo?
• What if the parents die?
• May the embryos be donated to other infertile
  couples?
• May the embryos be used in medical research?
• e.g., stem-cell research
• May the embryos be destroyed?

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A Further Issue Commodifying Reproductive
Material

• The points just raised suggest that we need to
  consider whether reproductive material is
  property or person (or something in between)
• A Related Question Should individuals be
  allowed to profit from the sale of sperm, ova or
  embryos?
• E.g., a model advertising ova for sale on e-bay
• It is generally argued that this is inconsistent
  with human dignity somehow
• Is this true?
• Considerations regarding commodification are also
  central to the debate on paid surrogacy

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Surrogate Motherhood

• The practice of a woman bearing a child for the
  purpose of giving the child up to some other
  person or persons
• The individual or couple to whom the s.m. will
  give the child up may or may not contribute
  reproductive material to the pregnancy
• E.g., the s.m. may be implanted with an embryo
  produced by IVF

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Commercial Surrogacy

• Altruistic Surrogacy
• the s.m. is not paid, although she may be
  reimbursed for expenses
• Commercial Surrogacy
• The s.m. is paid
• Sometimes a broker does the job of finding a
  woman to serve as s.m.
• The AHR would ban Commercial, but not Altruistic,
  Surrogacy

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Objections to Commercial Surrogacy

• Commodification of Children
• The premise of commercial preconception
  contracts is that a child is a product that can
  be bought and sold on the market. (452)
• The Royal Commission declared this to be
  repugnant. (452)
• Commodification of Womens Reproductive Function
• A preconception contract obliges the gestational
  mother to sell an intimate aspect of her human
  functioning (452)
• Such arrangements place women in the situation
  of alienating aspects of themselves that should
  be inherently inalienable. (452)

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More Objections to C.S.

• Potential Harm to the S.M.
• It has been reported that 10 of S.M.'s suffer
  sufficient grief from giving up the child to
  require therapy.
• Notice that this might also apply to altruistic
  surrogacy.
• Potential Conflict Between Surrogate and Would-Be
  Parent(s)
• What if the surrogate decides she wants to keep
  the child?
• What if the would-be parent(s) decide they dont?
• Again, this might also apply to altruistic
  surrogacy
• Concerns About Who Will Become a S.M.
• Will s.m. prey on socioeconomically
  underprivileged women? (453)

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Some Responses

• the ethical status of a child has nothing to do
  with who engendered it or how it was brought
  about. its ethical status lies in the fact that
  it is a person. (CMA, 455)
• Commercial surrogacy may be described as an
  exchange of considerations for services rendered
  namely the gestational service itself. (CMA,
  455)
• It is unrealistic to expect that many people will
  be inclined to be s.m.s without payment.
  (Todays CBC Radio News)

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A Big Question

• Under what conditions, is it inappropriate to
  treat something as a commodity?
• Why do we view some payments for use of ones
  body as appropriate and others as inappropriate?
• Prostitute
• Surrogate mother
• Professional Athlete
• Labourer

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Human Cloning

• For our purposes, to clone someone is to make a
  genetic copy of him/her
• There may be a variety of ways of doing this
• The way generally focused on today is by
  replacing the nucleus of an ova with the nucleus
  of an existing adults cell
• The ova would then be stimulated so that it
  develops into an embryo.

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Therapeutic vs. Reproductive Cloning

• Therapeutic Cloning vs. Reproductive Cloning
• Therapeutic producing a clone as a source of
  material for experiment and/or treatment
• Some moral issues differ depending on the type of
  cloning being discussed
• Our focus will be on reproductive cloning

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Whats So Bad about Reproductive Cloning?

• Some typical concerns
• 'It's unnatural.'
• Playing God
• Dignity Issues
• What is the moral status of clones?
• Risks to the clone
• Problems with the motivation of the person being
  cloned
• Who would the parent be?
• Note that reasons 1-4 are in principle concerns
• 5 is a technical concern
• What about 6 7?

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Technical Concerns about Cloning

• Technical concerns about the potential risk to
  the clone seem very real currently
• E.g., problems with Dolly the sheep
• Suppose they could be solved
• Are the in principle objections to human
  reproductive cloning convincing?

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In Principle Concerns about Cloning

• Similar comments apply to the unnaturalness
  playing God concern as before
• The moral status of clones
• Would clones be people like you and me?
• Would clones have souls?
• This objection is less often discussed than it
  once was
• These days the worry is sometimes that clones
  would not be accorded their proper moral status
  (which seems to be a technical concern)

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The Motivation of Those Being Cloned

• Some claim that to want to clone yourself is to
  have a morally bad motivation.
• Perhaps it's unacceptably vain.
• Perhaps it involves seeing a clone as a means to
  an end, not as an entity that is valuable in and
  of itself
• Must it involve this?
• Imagine a heterosexual couple who wanted a child
  they were biologically related to, but suppose
  the woman had a genetic condition she didnt want
  to pass on
• Would it be wrong for them to use an ova from the
  woman and insert a nucleus from one of the mans
  cells?

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Who Would the Parent Be?

• Both a legal and a moral question
• Would the clone be a child or a sibling of the
  person cloned (or neither)?
• The category of parent has both biological and
  social elements
• At the very least, reproductive cloning would
  seem to call for some reflection of the idea of
  parenthood

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Dignity Issues

• Does cloning someone inherently disrespect the
  clone?
• Will clones always (or almost always) be created
  simply as a means to some end?
• E.g., reproducing a loved one, a great leader, an
  athlete, producing a source for a transplant

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A Final Question

• Opposition to IVF declined substantially after
  the birth of Louise Brown.
• Is it reasonable to think that opposition to
  reproductive cloning would diminish if a healthy
  human child was born as a result of reproductive
  cloning?