New Reproductive Options: New Ethical Questions

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New Reproductive Options New Ethical Questions

• Dianne Bartels, RN, MA, PhD
• Center for Bioethics
• University of Minnesota

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Objectives

• To examine the individual and social consequences
  of new biological technologies by looking at
  reproductive options
• To describe the range of current reproductive
  technologies
• To identify ethical questions that arise in the
  context of offering new reproductive options

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Reproductive Options

• prenatal testing
• artificial insemination - by spouse or donor
• egg donation
• in vitro fertilization
• pre-implantation genetic diagnosis (PGD)
• surrogacy contract
• embryo adoption
• cloning?

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SNUPPY
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Embryo Adoption

• Embryo adoption - proposed as an alternative
  after discussion of stem cell transplantation and
  cloning.
• A response to a question about whether existing
  IVF embryos are really spare (unwanted)
  embryos.

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Embryo Adoption

• Snowflake Embryo Adoption Program promises to
  help genetic parents find a suitable home for
  their pre-born children giving genetic parents
  some control over their destiny
• abc news email 8/22/02

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Genetic testing now offers the option to test
for susceptibilities to diseases like cystic
fibrosis, breast cancer, or Fanconis Anemia
genetics will become the new paradigm for
health care.
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Prenatal testing is often the first application
of new tests. So, what tests should be
done/allowed?
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• One moral question is whether the end, (e.g.
  having a healthy child) justify the means
• prenatal testing
• offering the choices about whether to continue a
  pregnancy
• selecting embryos

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Alzheimer Disease

• A 30 year old asymptomatic woman with a genetic
  mutation consistent with early onset Alzheimer
  disease was identified by predictive testing
• She requested and received PGD which resulted in
  the birth a child free of inherited
  predisposition to early-onset AD

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Boy conceived to be deaf at center of ethics
uproar

• Taking the idea of genetic engineering to a
  whole new level a couple deliberately have
  conceived a deaf son because they think the
  inability to hear is a cultural identity, not
  a disability.
• Chicago Sun Times 4/10/ 02

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Does the child have a right to know?

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

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Ethical Challenges

• Destruction of Embryos
• Status of embryos (personhood)
• Right to reproduce
• Best interest of the child
• using a child as a means to anothers end
• was Adam Nash born to perform
• Commodification - product orientation
• selecting traits of children

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Egg Donor Needed

• Large financial incentive
• Intelligent, athletic egg donor needed/for loving
  family
• You must be at least 5 10
• Have a 1400 SAT Score
• Possess no family medical issues
• 50,000
• Free medical screening
• All expenses paid

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Ethical Challenges

• Family and community responsibility
• to have a healthy child
• to share genetic risk information
• Eugenics - harm to society
• discrimination against the disabled
• Justice-resource allocation
• 186,000,000 people in developing countries have
  little or no access to basic health care
• 46 million people have little or no access to
  health care in the U.S.
• cost is prohibitive, here and there