New Reproductive Options: New Reproductive Options:

New Ethical QuestionsNew Ethical Questions

Dianne Bartels, RN, MA, PhDDianne Bartels, RN, MA, PhD

Center for BioethicsCenter for Bioethics

University of MinnesotaUniversity of Minnesota

ObjectivesObjectives

To examine the individual and social To examine the individual and social consequences of new biological consequences of new biological technologies by looking at reproductive technologies by looking at reproductive optionsoptions

To describe the range of current To describe the range of current reproductive technologiesreproductive technologies

To identify ethical questions that arise in To identify ethical questions that arise in the context of offering new reproductive the context of offering new reproductive optionsoptions

Reproductive OptionsReproductive Options

prenatal testingprenatal testing artificial insemination - by spouse or donorartificial insemination - by spouse or donor egg donationegg donation in vitro fertilizationin vitro fertilization pre-implantation genetic diagnosis (PGD)pre-implantation genetic diagnosis (PGD) surrogacy contractsurrogacy contract embryo adoptionembryo adoption cloning?cloning?

SNUPPYSNUPPY

Embryo AdoptionEmbryo Adoption

Embryo adoption - proposed as an Embryo adoption - proposed as an alternative after discussion of stem alternative after discussion of stem cell transplantation and cloning.cell transplantation and cloning.

A response to a question about A response to a question about whether existing IVF embryos are whether existing IVF embryos are really “spare” (unwanted) embryos.really “spare” (unwanted) embryos.

Embryo AdoptionEmbryo Adoption

Snowflake Embryo Adoption Program Snowflake Embryo Adoption Program promises to help genetic parents find promises to help genetic parents find a suitable home for their “pre-born a suitable home for their “pre-born children” giving genetic parents children” giving genetic parents “some control over their destiny”“some control over their destiny”

abc news email 8/22/02abc news email 8/22/02

Genetic testing now offers the option to test for susceptibilities to diseases like cystic fibrosis, breast cancer,or Fanconi’s Anemia; genetics will become the “new paradigm”for health care.

Prenatal testing is often the first application of new tests.

So, what tests should be done/allowed?

One moral question is whether the One moral question is whether the end, (e.g. having a healthy child) end, (e.g. having a healthy child) justify the means justify the means prenatal testing prenatal testing offering the choices about whether to offering the choices about whether to

continue a pregnancycontinue a pregnancy selecting embryosselecting embryos

Alzheimer DiseaseAlzheimer Disease

A 30 year old asymptomatic woman A 30 year old asymptomatic woman with a genetic mutation consistent with a genetic mutation consistent with early onset Alzheimer disease with early onset Alzheimer disease was identified by predictive testingwas identified by predictive testing

She requested and received PGD She requested and received PGD which resulted in the birth a child which resulted in the birth a child free of inherited predisposition to free of inherited predisposition to early-onset ADearly-onset AD

Boy conceived to be deaf at Boy conceived to be deaf at center of ethics uproarcenter of ethics uproar

““Taking the idea of genetic Taking the idea of genetic engineering to a whole new level [a engineering to a whole new level [a couple] deliberately have conceived couple] deliberately have conceived a deaf son because they think the a deaf son because they think the inability to hear is a ‘cultural inability to hear is a ‘cultural identity,’ not a disability.”identity,’ not a disability.”

Chicago Sun Times 4/10/ 02Chicago Sun Times 4/10/ 02

Does the child have a right to Does the child have a right to know?know?

In fact a majority of couples who In fact a majority of couples who have used gamete donation to have used gamete donation to conceive their children do not conceive their children do not intend to tell their children?intend to tell their children?

Ethical ChallengesEthical Challenges

Destruction of Embryos Destruction of Embryos Status of embryos (personhood)Status of embryos (personhood) Right to reproduceRight to reproduce Best interest of the child Best interest of the child

using a child as a means to another’s endusing a child as a means to another’s end was Adam Nash “born to perform”was Adam Nash “born to perform”

Commodification - product orientationCommodification - product orientation selecting traits of childrenselecting traits of children

Egg Donor NeededEgg Donor Needed

Large financial incentiveLarge financial incentive Intelligent, athletic egg donor needed/for Intelligent, athletic egg donor needed/for

loving familyloving family You must be at least 5’ 10’’You must be at least 5’ 10’’ Have a 1400+ SAT ScoreHave a 1400+ SAT Score Possess no family medical issuesPossess no family medical issues $50,000$50,000 Free medical screeningFree medical screening All expenses paidAll expenses paid

Ethical ChallengesEthical Challenges

Family and community responsibility Family and community responsibility to have a healthy childto have a healthy child to share genetic risk informationto share genetic risk information

Eugenics - harm to societyEugenics - harm to society discrimination against the disableddiscrimination against the disabled

Justice-resource allocationJustice-resource allocation 186,000,000 people in developing countries 186,000,000 people in developing countries

have little or no access to basic health carehave little or no access to basic health care 46 million people have little or no access to 46 million people have little or no access to

health care in the U.S. health care in the U.S. cost is prohibitive, here and therecost is prohibitive, here and there