HAS 4400 Issues at the Beginning of Life

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HAS 4400Issues at the Beginning of Life

• Chapter Two

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The beginning of life?
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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

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

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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.

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• 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.

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• 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?

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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.

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

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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

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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

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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.

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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

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Abortion

• premature expulsion of the products of
  conception from the uterus.
• 1973 Roe v. Wade
• due process clause 14th Amendment
• 3 stage analysis
• 1st trimester-right of privacy precludes state
  regulation of abortions
• End of 1st trimester viability states could
  regulate to protect maternal health
• After viability states had a compelling interest
  in the life of the unborn child.

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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. 

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Other terms for PBA

• "dilation and extraction"
• "intact dilation and evacuation"
• "intact dilation and extraction" 

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Partial Birth Abortion
Artwork by Tanja Butler, used courtesy of
Heathers Place, 505-521-0105, pla_at_zianet.com.
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Partial Birth Abortion
Artwork by Tanja Butler, used courtesy of
Heathers Place, 505-521-0105, pla_at_zianet.com.
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Partial Birth Abortion
Artwork by Tanja Butler, used courtesy of
Heathers Place, 505-521-0105, pla_at_zianet.com.
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Partial Birth Abortion
Artwork by Tanja Butler, used courtesy of
Heathers Place, 505-521-0105, pla_at_zianet.com.
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Partial Birth Abortion
Artwork by Tanja Butler, used courtesy of
Heathers Place, 505-521-0105, pla_at_zianet.com.
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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.

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Prenatal Testing and Genetic Screening

• Amniocentesis
• Blood test for metabolic disorders
  (phenylketonuria)

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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.

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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 womans determination and
  choice.
• Abortion for mere convenience is morally wrong.

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AbortionElements of a middle ground (cont)

• 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.

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AbortionElements of a middle ground (cont)

• 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.

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AbortionElements of a middle ground (cont)

• 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.

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• "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

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Caring for Compromised Newborns

• Todays 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 .

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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.

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NICU

• Technological marvel
• lt 24 weeks, lt one pound
• 30,000 babies born 3 mos pre-term, ½ survive

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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.