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Reproductive medicine

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Reproductive medicine Powered By Docstoc
					Reproductive medicine
Medical technology has increased reproductive choice the three main reasons
   1. the possibility of terminating a pregnancy
   2. the means of assisting conception
   3. the ability to investigate and help predict the likely healthy status and much more of
        the foetus

The ethics around reproductive choice

      Procreative autonomy -- the interests of parents
              Within that the human rights act is provision with regards to procreation.
              Accordingly, the state or professional interference should be kept to a
              minimum and exercised only in extreme situations. Essentially this means that
              couples have a right to procreate.

      The interests of the future child
               this is particularly relevant in assisted reproduction. Where as procreative
               autonomy is within the rights of couples, assisted reproduction is not. Should
               we have a view in the prevention of access to assisted reproduction on the
               basis of interests in the potential or future child.

      The interests of the state
               reproductive choices affect the composition of the future population.
               Therefore the state has an interest in what choices are made. Should parents
               have a say in situations that could affect the state, for example the selection
               of sex. Such interests may be relevant where the future child may require
               significant resources in the child care

      Preserving life
               central to the issue of termination is the morality of killing a foetus. Even if
               considerable weight is given to procreative autonomy, many would take the
               view that reproductive choice should not be enabled to killing an already
               existing foetus

Abortion (termination)

       At the heart of much of the debate around abortion, embryo experimentation and in
       vitro fertilisation is the question of the moral status of the embryo and foetus. Is it
       wrong to kill human embryos foetuses, and if it is, is that wrong significant enough to
       outweigh other goods?

       There are many different positions on this issue. What we all agree on is that there are
       very few justifications, if any, are killing a child or adult. Such killing is a serious
       wrong. The question is at what stage in the development of the human organism from
       egg to child does it become a significant wrong to kill the organism? Some will state
       that there is a point in the development process where it becomes wrong, others deny
       that there is any point at all.

               Views on determining the moral status of the embryo

                         1. The identity as a human organism
                               according to this view, there are essentially no good grounds
                               for according a different moral status to the human being at
                               different stages in its development. If it is wrong to kill the


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                      child then it would have been just as wrong to kill that child at
                      any stage in its existence. Most supporters of this position put
                      the moment at when the embryo obtains full moral status from
                      a developmental point at around about 14 days. the view that
                      an embryo, from the point of conception, has the same role
                      status as a child is sometimes called the right to life or the pro-
                      life position.
               2. The potential to be a person
                      the argument is based on the statement that if it is wrong to
                      kill a child then if you kill an embryo or foetus at any stage,
                      you are carrying out an act that will have the effect of the
                      potential future child not existing. You are in effect killing a
                      potential child.
               3. Identity as a person
                      an alternative to the pro life position as outlined in one above
                      is that the view of the moral status of the embryo depends
                      upon its properties, and not on its identity or potential. The
                      argument is based on the fact that a person is not the same as
                      a human embryo in. A person has certain characteristics. The
                      important moral issue is at what stage during development
                      does a human organism become a person.
                      There are many different answers to this question. Some will
                      say that a person must involve some degree of consciousness.
                      Conscious life, it is thought, or at least the perception of pain,
                      starts at about 24 weeks. Taking this view, a foetus less than
                      24 weeks does not have moral status.
                      But there was perception of pain indicate consciousness? Even
                      primitive animals feel pain and yet we do not give them the
                      status of human person in the terms of the morality of killing.
                      What is it that distinguishes a human being from a non-human
                      being such that one has a strong right to life and the other does
                      not. Some focus on mental capacity, others on the ability to
                      form relationships. Some religious traditions state it is the
                      point when the soul enters the body
               4. the value given to the human organism is crucial
                      some would argue that at birth, the infant takes on an
                      important social role and this justifies conferring moral status
                      (i.e. he the right to exist) on this basis, a strong prohibition of
                      killing infants is justified. It is for this reason that killing a
                      human infant or child with severe learning difficulties, is
                      morally more serious and killing an animal (such as an adult
                      ape) even if the nonhuman animal possesses more of the
                      morally important features of a person

Some circumstances and reasons for an abortion that might affect its ethical status
             the pregnancy is a result of rape
             a woman is only 16 years old
             having a child could interfere with the woman's career
             the woman would be a single mother and a very poor
             the couple already have three children
             the woman is depressed and feels unable to cope with motherhood
             prenatal testing has revealed that the trials will be severely
                handicapped
The legal status of abortion




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                o     The offences against the Person act 1861
                          this act remains the definitive law in England. It gives the statutory
                          grounds to the effect that abortion is a crime except where subsequent
                          legislation provides protection against criminal prosecution. It was
                          designed to tackle two main issues
                          a. backstreet abortions
                          b. the lack of clarity over the question of when a doctor could carry
                               out an abortion for the sake of the mother's health
                o     the abortion act 1967 as amended in 1990
                          the act gives a doctor who carries out the termination within the terms
                          of the act, immunity from prosecution. It does not decriminalise
                          abortion in general. Nor does it provide protection for anyone other
                          than the doctor.
                          A number of points need emphasis
                          a. prior to 24 weeks, a doctor may carry out a termination with the
                               woman's consent on very wide grounds. The majority of
                               terminations are carried out under this section.
                          b. After 24 weeks, termination is any lawful either to prevent risk of
                               considerable harm to the mother or the sake of the foetus
                          c. except in an emergency, two doctors are required to be of the
                               opinion that termination is justified
        Key points   in the law on abortion
               o      doctors may refuse to carry out an abortion on the grounds of conscientious
                      objection. The burden of proof lies with the doctor to show that he did
                      have a conscientious objection. Conscientious objection is not a defence
                      however if the termination is necessary to save the life or to prevent grave
                      permanent injury to the physical or mental health of the pregnant woman.
                o     The act does not give the woman the right to demand an abortion however
                      a doctor may be found negligent either are not advising a woman of the
                      possibility of a termination or for not carrying out a termination where
                      appropriate
                o     the foetus has no right to life. That is, its status in law is dramatically
                      affected by birth. The foetus cannot be the subject of child protection and
                      the children act
                o     a woman has a legal right to refuse an abortion
                o     the father of a foetus has no legal right to prevent a woman from having an
                      abortion and has no right to be consulted about it.

Maternal -- foetal relations

There have been a number of cases heard in the courts concerning the legality of enforcing a
Caesarean section on an unwilling woman. The issue is very complex however the Court of
Appeal in 1997 stated that

         "a competent woman, who has the capacity to decide, may, for religious reasons,
        other reasons, for rational or irrational reasons or for no reason at all, choose not to
        have medical intervention, even though the consequence may be the death or serious
        handicap of the child she bears, or her own death. In that event the courts do not
        have the jurisdiction to declare medical intervention lawful and the question of her
        own best interests, objectively considered, does not arise."

Although the courts have interpreted common law as giving a competent woman the right to
refuse treatment, they do fall over backwards to find the woman incompetent in order perhaps
to justify setting the foetus.




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Similar injuries to the foetus could be considered:
    o a woman who has disregard for her health, for example smoking, drinking, drugs, and
         the effect on the foetus
    o a woman who delays reproduction from for example aged 30 years to 40 years. The
         child has a very high risk of Down's syndrome that would not have occurred had the
         woman being younger.

Ethical considerations
    o autonomy. Such constraints infringe the woman's autonomy
    o privacy. The woman has the right not to have her body innovated or even touched
        without consent, in other words battery.
    o Foetal status. In English law the foetus has no status as a person until birth. The rights
        of a person (a woman) should not be subjugated to the rights, if any, of an entity that
        is not a person
    o public policy. The consequences of allowing foetal interests to affect the legal
        provisions for restraining people's behaviour is undesirable. Two separate pregnant
        women for behaviour that would be tolerated in men or in woman who are not
        pregnant

The state has intervened in constraining the pregnant woman's behaviour in the case of
thalidomide. This sedative had no significant adverse effects on mothers have is taken when
pregnant, it interfered with limb development. Rather than informing women of these possible
effects and allowing them to choose whether or not to take the sedative, the state banned it in
interests of future people.

Assisted reproduction

The first test-tube baby occurred in 1978. Some believe that IVF and related techniques are
always wrong. These arguments include:
   o killing embryos is wrong. Some types of fertility treatment involves the production of
        embryos that are subsequently not used in treatment and are destroyed
   o IVF is unnatural. There are problems with this approach, the first is what is natural
        and what is unnatural, the second is that much of medicine is unnatural, for example
        intravenous antibiotics for somebody with septicaemia.
   o IVF is harmful to marriage
   o IVF harms women. These arguments centred on claims that many controlled these
        technologies and hence control female reproduction. Furthermore, such technologies
        helped to perpetuate a view that women cannot be completely fulfilled unless they
        have children. Many women have take the opposite view and see the reproductive
        technology is a means to enhancing their freedom and choice

Examples of people who may seek IVF
    a single mother
    a couple, one of whom has a serious life-threatening disease
    a postmenopausal woman aged 50 years
    a woman of 35 who has undergone a premature menopause
    a couple, one of whom has had previous voluntary sterilisation
    a couple who have suffered the death of a child
    a same sex couple
    a couple who have had a child taken into care

There are three main interests that are important:
            1. the interests of the potential child
                       the law place the interests of the child that may result from assisted
                       reproduction as of paramount importance. The first is an analogy with



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                       adoption. Which parent is best able to provide for this baby. An
                       argument against this approach is that with adoption the baby exists
                       already. With infertility treatment, if help is refused, the child will
                       never come into existence. However the talk of the potential child is
                       not a meaningless discussion, should a couple be prevented from
                       conceiving on the basis that the child would suffer immensely, perhaps
                       from some dreadful genetic condition.
            2. The interests of the potential parent
                       fertility clinics are often faced with couples who want IVF although
                       there are reasons for thinking that this would not be in the parent's
                       best interests. One approach would be to explain the professionals
                       decision-making however if after due deliberation the couple still wish
                       to go ahead and will pay the costs, should the treatment to be
                       provided?
            3. Interests of the state
                       the state has interests in the people who are born even if the couple
                       are paying for the entire costs themselves. For example, the child
                       could have profound disabilities requiring considerable welfare
                       provision. Should lesbian couples have children? An argument for this
                       could be the state is condoning a former family life that it should not
                       condone.

Assisted reproduction and the law

The Human Fertilisation and Embryology Act 1990
       this authority regulates much of the provision for insisting reproduction. It covers the
       use of donated genetic material for example aches and sperm, the storage and the
       research. Under the act, if the couple are refused treatment by a licensed centre,
       reason must be given. Two principal grounds for refusal are that the couple may be
       medically unsuitable and secondly that it is not in the interests of the welfare of the
       potential child.

The Surrogacy Arrangements Act 1985
        the commercial basis and surrogacy is a criminal offence and therefore the facilitators
        of commercial surrogacy would be committing an illegal act. However the act
        specifically gives immunity to the actual parties themselves.




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