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

7. 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

8. The AHR Act • A very broad range of topics is covered • Some are relevant to next week’s 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)

9. 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 woman’s 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

10. 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

11. 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.

12. 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

13. 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?

14. 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%

15. Controversies about IVF • IVF was initially extremely controversial • Louise Brown’s birth was a subject of intense media & public attention • Many of the concerns raised about IVF mirror present concerns about other New Reproductive Technologies

16. Objections to IVF • Potential Physical Harm to theChild • “It doesn’t matter how many times the baby is tested, they will never be certain the baby won’t 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, what’s the personal identity of a test-tube baby?” Jeremy Rifkin

17. 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)

18. 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

19. 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?

20. 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 it’s the extra stuff you say that will do the work in your argument, not the idea of unnaturalness itself. • On the whole, it’s best to simply leave claims about unnaturalness out of your arguments on this (or any other) issue

21. 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?

22. 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?

23. 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

24. 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

25. 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

26. 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 Women’s 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)

27. 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 don’t? • 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)

28. 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. (Today’s CBC Radio News)

29. A Big Question • Under what conditions, is it inappropriate to treat something as a commodity? • Why do we view some payments for use of one’s body as appropriate and others as inappropriate? • Prostitute • Surrogate mother • Professional Athlete • Labourer

30. 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 adult’s cell • The ova would then be stimulated so that it develops into an embryo.

31. 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

32. What’s 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?

33. 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?

34. 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)

35. 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 didn’t 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 man’s cells?

36. 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

37. 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

38. 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?