ETHICS AND EMBRYOS

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ETHICS AND EMBRYOS

• Ruth Deech
• Gresham Professor of Law
• 2010

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The Embryo

• At 3 days
• At 5 days

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The First IVF Baby

• Born in England 1978
• Sparked off global debate
• Became a nursery nurse
• Has her own child

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The Warnock Report

• 1984 people need principles
• Moral consensus
• Regulate
• Human Fertilisation and Embryology Act 1990
• Anne was a member

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UK Human Fertilisation Embryology Authority

• Established by 1990 statute
• Licences and monitors clinics, laboratories, IVF,
  embryo research
• 21 members appointed after advertisement

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Benefits of regulation

• Protection of the embryo
• Welfare of the child
• Record of treatments and donors
• Control of market forces
• Answerable and representative
• Looking ahead

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The Realities of Regulation

• The constraints of the legal framework
• Resources need to enforce and defend in court
• The power of the media and images
• The pressure from politicians

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Ethics

• Human dignity, worth and autonomy
• The welfare of the potential child
• Safety
• Respect for the status of the embryo
• Saving life through new technology

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Embryo research

• Advances in the treatment of infertility
• Causes of congenital disease
• Causes of miscarriage
• Techniques of contraception
• Gene and chromosomal abnormalities
• Development of embryo
• Serious diseases

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Discovery of Stem Cells

• James Thompson of Madison Wisconsin
• Obtained stem cells from a human embryo
• Research funded by Geron Corp
• Patented by Wisconsin alumi

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What are Stem Cells?

• Derived from early human embryos of a few days
  growth
• Adult stem cells derived from bone marrow, skin,
  umbilical cord, blood
• They are the origin of all our cells
• Will help us to understand disease
• Might make cells and tissue for transplantation
  and renewal

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Therapeutic cloning
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Stem cells

• From embryos or adults
• Totipotent and pluripotent
• Grow new tissue
• Bank stem cell lines

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Stem Cells and Cures

• Nerve cells might cure Parkinsons, Alzheimers,
  spinal cord injury, stroke
• Embryo cells might help infertility
• Heart muscle cells for heart disease
• Blood cells for cancer, leukaemia
• Skin cells for burns and wounds
• Bone cells for osteoporosis

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The Ethical Debate

• Catholic Church believes that life starts at
  conception
• Cardinal Trujillo announced excommunication for
  stem cell research

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The Different Views

• Christopher Reeve supported research
• Jewish position that healing is an obligation
• Many embryos are left to perish after IVF

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Supporters of Research I

• Nancy Reagan and Michael J. Fox spoke up for it

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Supporters of Research II

• John Kerry (with Mrs. Reeve) debated with
  President Bush
• Presidents Ford, Carter and Clinton

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Presidential Ban on Funding

• August 2001 President Bush announces ban on
  federal funding for stem cell research derived
  from embryos
• Existing lines may be used
• Private research unchecked

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Obama lifts ban

• March 2009 ends Bush ban
• NIH guidelines July 2009 http//stemcells.nih.gov/
  policy/2009guidelines.htm

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New rules

• Federal funding allowed for surplus IVF and PGD
  embryo research
• Donated after informed consent from donors
• Pre-existing stem cells may be used if ethically
  obtained

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New limitations

• No federal funding for research on animal-human
  embryos
• Nor for cloned embryos
• Nor for embryos created for research

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California

• Proposition 71, 2004, state funding for stem cell
  research
• California Institute for Regenerative Medicine
• Independent Citizens Oversight Committee
• Wider than national guidelines

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PGD
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Preimplantation genetic diagnosis

• Unite sperm and egg in the laboratory
• Fertilised egg grows to 8 cell size
• Remove 1 cell and test for disease
• Test also for compatibility (HLA)

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Screening

• For beta thalassaemia in Cyprus, Iran
• For Downs Syndrome
• Preimplantation or abortion
• Breast and bowel cancer genes identified in the
  embryo

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The Hashmi Family

• Zain suffered from beta thalassaemia and needed
  blood from a compatible sibling
• Need an embryo free of the disease
• Need an embryo that is also compatible

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Screening out Disease

• Cystic fibrosis
• Downs Syndrome
• Beta Thalassaemia (Greek for sea/blood)
• Sickle Cell disease
• Breast and Bowel cancer
• Huntingtons disease
• and more to come

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Disability and screening

• Society should adapt to the disabled
• They will be seen as unworthy
• There will be fewer
• Should be able to choose a deaf embryo

• Help and cure does not mean unworthiness
• Antidiscrimination laws and compassion have
  increased
• Every baby should be given the best chance and
  not predetermined

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Choosing the Sex of Your Children

• The Mastertons had four boys and lost their only
  girl
• Should they be allowed to use embryo selection to
  have another girl?

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Boy or Girl?

• China 117 boys to 100 girls
• Right to only one child
• Girls less likely to be registered

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Why so Few Girls?

• Similar trend in India
• Ultrasound scanning shows up sex
• Female foetuses aborted
• Can attitudes be changed?

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Medical Reasons for Sex Selection

• Haemophilia and Duchennes muscular dystrophy
  affect only males
• Autism?
• If there is a family history of this, choose a
  girl
• Achieved by preimplantation genetic diagnosis

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Non-medical Reasons for Sex Selection

• Family balancing
• Rebuild a family after the death of a child
• Religious, cultural and economic reasons for
  wanting boys
• Remove one cell from a 3-day old embryo
• Analyse the chromosomes and DNA
• XX girl, XY boy

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Worlds oldest mother

• Ms Bousada del Lara of Spain
• Lied that she was 55 to get treatment at 66
• Gave birth to twin boys
• Died of ovarian cancer when they were 2

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Fertility For Ever

• Frozen eggs give hope to young cancer patients

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As Fertile as a Man

• Career women can put their eggs on ice until the
  time and the man are right

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Becoming a Father After Death

• Diane Blood took her husbands sperm after his
  death from meningitis

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The power of the Image

• Diane Blood and her baby
• Sperm taken from dead father

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New British law

• Animal-hybrid embryos
• Two mothers

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Failure to regulate

• Nadya Suleman gave birth to octuplets 2009
• Likely that 6 embryos were implanted and two
  split into twins
• She used all 6 remaining from previous IVF
  treatment

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Two embryo rule

• Suleman case led to Georgia bill to limit number,
  but this provision did not pass
• HFEA limits embryos to two for women under 40
• Triplet rate has dropped since 2001

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Attitudes to regulation

• Similarities to medical insurance v National
  Health Service contrast
• Welfare of the baby v a womans right to be a
  mother
• Everything that money can buy v medicine in the
  interests of the community
• Commodity v dignity

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Sperm donation

• HFEA Code rules no payment other than expenses
  children conceived after 2005 may be given
  identifying information when they reach 18

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Making money
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Global (In)Fertility Anthropological Research on
Assisted Reproduction

• Rayna Rapp, PhD
• Anthropology, New York University

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(No Transcript)
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Anthropological Analysis of PGD, UK
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Infertility Treatment in Egypt
Local Babies, Global Science By Marcia Inhorn
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Ultrasound in Canada

Babys First Picture by Lisa Mitchell
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Technologies of Pregnancy in Israel and Japan
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IVF in Israel
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Health-Tourism.com
IVF Vacation.com
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Trends in crude birth rate, world and major
areas, 1960-2020
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Inter-country adoption to selected receiving
countries, 1995 to 2006
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Number of ART cycles reported in US
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Twins, by country
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Multiple births in US, 1989-1999
Twins Triplets Quadruplets Quintuplets or
more
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Number of ova donations, by country
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Number of ova donations, by country
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Daphna Birenbaum-Carmeli Marcia Inhorn, eds
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Destabilizations of Late Modernity
(Birenbaum-Carmeli Inhorn, eds)

• sex/ reproduction
• nature/ culture
• gift/ commodity
• informal/ formal labor
• biology/ sociality
• heterosexuality/homosexuality
• the local/ the global
• secular/ sacred

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Useful Concepts

• Moral Pioneers
• Stratified Reproduction