HAS 4400Issues at the Beginning of Life

Chapter Two

The beginning of life?

Two inadequate approaches to alternative reproductive technology

• Conservative approaches– Adopts the biological integrity of the marital sexual act.

• Other end of the ideological spectrum– Any adult should be able to engage in any alternative

reproductive procedure that technology can provide.

• Ethical positions should emerge from consideration for:– What will further the good of the potential child and the

family.– Providing for appropriate social conditions – The present norms of reproduction and childbearing versus

radical alterations.– “control of nature” often ends up producing increased control

of some people by other more powerful people

Should we let the technological imperative (what can be done should be done) fueled by people’s desires decide whether a course of action is right or good?

Tacticby:

those who urge permissive acceptance of all new reproductive technologies.

• Base arguments upon analogies from adoption or other childrearing arrangements arising from

– Divorce, death, desertion or parental inadequacy.

Given the availability of current technology and relaxation of cultural norms.

Consider the possible combination of parental relationships that could occur with the birth of a child.

• Married Man and Woman Natural Birth• Married Man and Woman Adoption• Single Mother• Single Father• Married Man and Woman w/Surrogate Mother• Married Man and Woman w/Sperm Donor• Gay Couple w/ Surrogate Mother• Gay Couple w/Sperm Donor• Multiple spouses• Cloning?

Proposed ethical standard

“It is ethically appropriate to use an alternative reproductive technology if, and only of, it makes it possible for a normal, socially well-adjusted heterosexual married couple to have a child that could not otherwise have owing to infertility.”

“If we succeed in isolating sexual and reproductive acts from long-term personal responsibility, this moral abdication will increase existing problems within the culture.”

Contraception• Adults

– 1965 Griswold v. Connecticut• Minors

– 1980 Doe v. Irving, 1985 Jane Does v. Utah Dept of Health

• Litigation (Product liability, inadequate warning of risks)– Negligently prescribe a contraceptive– Negligently insert a contraceptive device– Fail to give adequate information concerning potential

side effects– Fail to monitor a patient at risk

Voluntary Sterilization

• Adults

• Spousal Consent

• Minors (varies from state to state)– Getting a court order would be prudent– Federal funds cannot be used to sterilize

minors.

• Conscience Clauses

Involuntary Sterilization

• 1st group “Eugenic” Sterilization– Individuals believed to transmit hereditary

defects.– Most states have repealed.

• 2d group– Severely retarded, Sexually active, unable to

use other forms of contraception and unable to care properly for their offspring.

Assisted Conception

• Artificial Insemination– Spousal consent– Donor is not responsible for child support

• Surrogate Mothers• In Vitro Fertilization

– 1983 California couple die in Chile w/2 frozen embryos in Australia

– 1989 Tennessee divorce dispute

Abortion“premature expulsion of the products of conception

from the uterus.”1973 Roe v. Wade

due process clause – 14th Amendment3 stage analysis

1st trimester-right of privacy precludes state regulation of abortionsEnd of 1st trimester – viability: states could regulate to

protect maternal healthAfter viability states had a compelling interest in the life

of the unborn child.

Partial-Birth Abortion Ban Act

President Bush signed the Act into law on November 5, 2003

The bill bans "partial-birth abortion," it legally defines a partial-birth abortion as any

abortion in which the baby is delivered "past the [baby's] navel . . . outside the body of the mother," OR "in the case of head-first presentation, the entire fetal head is outside the body of the mother,“

The bill allows the method if it was ever necessary to save a mother's life. 

Other terms for PBA

• "dilation and extraction"

• "intact dilation and evacuation"

• "intact dilation and extraction" 

Partial Birth Abortion

Artwork by Tanja Butler, used courtesy of Heathers Place, 505-521-0105, pla@zianet.com.

Artwork by Tanja Butler, used courtesy of Heathers Place, 505-521-0105, pla@zianet.com.

Partial Birth Abortion

Artwork by Tanja Butler, used courtesy of Heathers Place, 505-521-0105, pla@zianet.com.

Partial Birth Abortion

Artwork by Tanja Butler, used courtesy of Heathers Place, 505-521-0105, pla@zianet.com.

Partial Birth Abortion

Artwork by Tanja Butler, used courtesy of Heathers Place, 505-521-0105, pla@zianet.com.

Partial Birth Abortion

The arguments continue.

• June 2004: U.S. District Judge Phyllis Hamilton issued a permanent injunction against enforcement of the ban with respect to the groups that filed that lawsuit. 

• August 26, 2004: U.S. District Court in the Southern District of New York issues ruling.  

• September 8, 2004: Federal court in Nebraska issues permanent injunction.

Prenatal Testing and Genetic Screening

• Amniocentesis

• Blood test for metabolic disorders (phenylketonuria)

Wrongful: Conception, Birth, Life Suits

• Wrongful conception– Unwanted pregnancy results from medical negligence

– A fetus with a genetic defect is conceived after the parents were not informed or were misinformed of the risk of the genetic condition.

• Wrongful birth– Birth follows medical negligence

– Unsuccessful sterilization or abortion

– Abnormal child who would have been aborted if

• Wrongful life– Children with genetic defects claiming they were injured by

being born.

AbortionElements of a middle ground

• There is a presumption against the moral permissibility of taking human life.

• Abortion is a killing act.• Abortion to save the life of the mother is

morally acceptable.• Judgment about the morality of abortion is not

simply a matter of a woman’s determination and choice.

• Abortion for mere convenience is morally wrong.

AbortionElements of a middle ground (con’t)

• The conditions that lead to abortion should be abolished insofar as is possible.

• Abortion is a tragic experience to be avoided if at all possible.

• There should be alternatives to abortion.• Abortion is not a purely private affair.• Roe v. Wade offends many people. So

did previous prohibitive laws.

AbortionElements of a middle ground (con’t)

• Unenforceable laws are bad laws.• An absolutely prohibitive law on abortion is

not enforceable.• There should be some public policy restrictions

on abortion.• Witness is the most effective leaven and the

most persuasive educator concerning abortion.• Abortion is frequently a subtly coerced

decision.

AbortionElements of a middle ground (con’t)

• The availability of contraception does not reduce the number of abortions.

• Permissive laws forfeit the notion of “sanctity of life” for the unborn.

• Hospitals that do abortions but have not policy on them should develop one.

• The “consistent ethic of life” should be taken seriously.

• When ever a discussion becomes heated, it should cease.

"If the deliberate extinguishment of human life has any effect at all, it more likely tends to lower our respect for life and brutalize our values." - Robert M. Byrn

Caring for Compromised Newborns

• Today”s technology allows us to intervene in the case of compromised infants and extend life far beyond that which would occur if we allow nature to take its course.

• “…expectant parents want Gerber babies, beautiful, bright, healthy ….”

Parental discretion vs. neglect

• Parental right to decide

• How do you define neglect?

• Comfort care vs. intervention

• Right to privacy encompasses parents’ reasonable decisions

• Infants right to life.

NICU

• Technological marvel

• < 24 weeks, < one pound

• 30,000 babies born 3 mo’s pre-term, ½ survive

Norms for premies

• Not wise to force treatment if the baby will have to rely on technology for entire life.

• If pain and suffering could not be alleviated, forego treatment

• If uncertain, err on the side of life.• In ambiguous cases follow the

instructions of the parents.