Assisted Human Reproduction*
Philosophy 2803
Lecture IX
April 2, 2003
*Some material is based on a previous lecture
prepared with Dr. Barbara Barrowman
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.
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.
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
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)
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
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
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)
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
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
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.
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
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?
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%
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
Objections to IVF
§ Potential Physical
Harm to the Child
–
“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
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)
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
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?
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
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?
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?
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
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
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
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)
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)
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)
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
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.
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
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?
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?
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)
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?
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
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
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?