Ethical Issues of Human Reproductive Technologies

1. Ethical Issues of Human Reproductive Technologies Dr Chan Ho Mun Associate Professor Department of Public and Social Administration City University of Hong Kong 19 June, 2012

2. Human Reproductive Technologies (HRT) • Contraception: sex without procreation • HRTs: procreation without sex

3. Types of HRTs • Artificial insemination by husband (AIH) • Artificial insemination by donor (AID) • In virtro fertilization (IVF) • Egg donation • Embryo Donation • Surrogacy • New Genetics • Human Cloning • Stem Cell Research • Sex selection

4. Arguments for and against surrogacy

5. Contractarian Argument for Commercial Surrogacy • People have the right to procreation and to have a family. • Gestation can be regard as a service akin to baby sitting or rearing a child for some else. No buying or selling baby is involved. • Anyone with a sound mind should be allowed, with his/her informed consent, to enter freely into a contractual agreement.

6. Family-based Argument for Non-commercial Surrogacy • If the baby has no genetic ties with the commissioning parents, why not adoption? • Gestation is the defining criteria of mother-child relationship. The woman who gives birth to a baby is its mother even in the absence of genetic ties. This can protect the best interests of the child. Some feminist maintains that the pregnant woman is the first person who has an intimate relation with the child and so she deserves to have the baby. • Commercial surrogacy involves the buying and selling of baby. It should therefore be prohibited.

7. Family-based Argument With due respect to the parental right of the surrogate mother, contracts of surrogacy, commercial or non-commercial, should be unenforceable. The commissioning parents should follow a procedure similar to the adoption of baby. The surrogate mother should be given a grace period for changing her mind. Surrogacy should be permissible only if the baby has genetic ties with both commissioning parents and they are married.The result is better than adoption.

8. Best-interests Argument Against Surrogacy The arrangement based on the family argument does not serve to protect the interests of all the parties involved, including the baby, because the arrangement is unenforceable. What will happen if the commissioning parents change their minds after the baby is conceived? The surrogate mother is the true mother and has the responsibility to rear the baby even if she does not want to. Won’t the commissioning parents be very upset if the surrogate mother change her mind during the grace period.

9. Best-interests Argument Against Surrogacy What will happen if neither the surrogate mother nor the commissioning parents wants to keep the baby? The surrogate mother may have developed an emotional tie with the baby during pregnancy. Should she be allowed to visit the baby? Will it undermine the integrity of the new family if she does that?

10. The New Genetics

11. Gene Testing • Create unnecessary psychological distress. • Discrimination by employers and insurance companies. • Confidentiality and Privacy • Social stigmatization.

12. Prenatal Screening • Sex selection: Gender discrimination and imbalance of sex ratio unless it is done solely for therapeutic purpose (see the later notes for further discussion) • Discrimination: Lives of the disable are not worth living.

13. Genetic Engineering • Germ-line changes, unlike somatic modification, can pass onto the next generation and be with us forever. So germ-line changes could be very risky. • Genetic therapy *may* be alright (note that reproduction without sex or abortion is involved). • Is it a form of eugenics?Is genetic enhancement moral? • Dignity of a child: Parental love should not be based on the traits and the characters of a child. Children should not be treated as a means to please their parents.

14. Human Cloning

15. Two Techniques • Two techniques: • Embryo splitting • Nuclear substitution

16. Embryo splitting • The clone is usually used for tests of abnormality, and will be destroyed subsequently.

17. Nuclear Substitution • What is the relationship between the nuclear donor and the clone? • The same person? • (Technologically-aided and birth delayed) identical twins? • Siblings? • Parent-child? • Should a homosexual be allowed to use the technology to obtain his/her own child?

18. Nuclear Substitution • Is it moral alright for parents to clone their beloved children who die youngor provide organs for their siblings? • Should it be used as an infertility treatment or gene therapy if it is safe? • No third party is involved. • According to the parent-child ordinance in HK, whoever gives birth to a baby is its mother, and the husband who goes through the infertility treatment with her is his father. • Yet, human cloning has been banned by the HRT Ordinance.

19. Stem Cell Research

20. Three Types of Stem Cell • Stem cells: undifferentiated, multi-potent, precursor cells, capable of developing into virtually any body tissue. • Three types of stem cells: • Embryonic stem cells (ESC) • Fetal stem cells • Adult stem cells

21. Three Main Sources • Adult bone marrow and other types of cells. • Miscarried or aborted embryos/fetus; extra embryos left over from IVF. • Embryos from therapeutic cloning.

22. Potential Treatments • ESC is most promising for treatment, and therapeutic cloning can avoid the problem of immunological incompatibility. • Ethical issues: • Destroying an embryo to harvest ESC is equivalent to killing a child to obtain his organs. • Left-over from IVF are already there. • Therapeutic cloning: The embryo is not created for reproduction. • How about the wellbeing of many patients who may be cured by ESC research?

23. Sex Selection: Ethical or Unethical?

24. Scope of the Ethical Issues • A paradigm or type case in bioethics. • The moral controversies arising from sex selection covers most of the major ethical issues in regard to human reproductive technologies (HRT) because it is a form of genetic engineering and often involves the use of abortion, infertility treatment (such as artificial insemination and in vitro fertilization), human cloning and/or other HRT.

25. Arguments Against • Conservative arguments: • Abortion is morally wrong. • It is unnatural to separate sex from procreation. • Even early abortion is morally justified in some exceptional cases. The preference for children’s sex cannot serve as a justification for granting an exception. It does not meet the criteria for termination of pregnancy.

26. Arguments against • Biased sex ratio: • when the proportion of woman is lower, they “may be confined to traditional gender roles and excluded from high-status positions; • when their proportion is higher, misogyny increases, and women are likely to be exploited in sexual relationships and have difficulty in finding committed male partners.”* *Holmes, H. Q. “Choosing Children’s Sex: Challenges to Feminist Ethics’, in J. C. Callahan (ed.), Reproduction, Ethics, and the Law, Bloomington and Indianapolis: Indiana University Press, 1995, p. 149.

27. Arguments against • Sex discrimination: Children of different sexes should be treated equally. • Reinforces sexism and devalues women as a class

28. Arguments against • Dignity of a child: Parental love should not be based on the traits and the characters of a child. Children should not be treated as a means to please their parents (see arguments against genetic engineering).

29. Arguments for • Prevention of sex-linked diseases. • Parents have their rights to procreative choices and family planning. • The cultural condition or the individual situation may put a woman in a very difficult position if she cannot give birth to a child of the preferred sex (more dowry, getting a concubine, divorce, being abused, tortured or even killed…).

30. Arguments for • A feminist strategy for undermining patriarchy: • Choose to have boys and raise them as non-sexists • Choose to have girls so as to cut down the proportion of men, dissociate from the ruling sex class and establish all-female communities • The impact on sex ratio is largely uncertain if sex selection not for medical reason is legalized in developed countries.

31. Arguments for • Giving people incentives, e.g., tax deductibles, for choosing daughters. • Using a quota system to balance the sex ratio.

32. Some Reflections • The root of the problems is not technological. Sex selection per se is not unethical. Sexism is the source of the problem. • Yet unregulated use of the technology may reinforce the existing gender biases or make the situation even worse.

33. Some Reflections • It is often difficult to enforce the legal prohibition of sex selection not for therapeutic purposes. • The question of whether an all-or-nothing approach should be adopted deserves a more open discussion.