Ethical aspects of new assisted human reproduction technologies Agnes Dósa MD JD PhD New assisted reproduction technologies • artificial insemination – with the sperm of the husband/partner – with donor sperm (AID) • in vitro fertilisation • surrogate motherhood • PGD New assisted reproduction technologies • original goal: infertility treatment • today additional goals: – examining the child’s genetic features before implanting and selecting the embryo with the desired features (PGD, embryo surgery) – making childbirth possible for women who are not infertile (lesbian couples, single woman) Artificial insemination • is the process by which sperm is placed into the reproductive tract of a female for the purpose of impregnating the female by using means other than sexual intercourse • the oldest technique • easy to apply, few or no risks, not expensive, in many cases it solves the problem • two forms: – using the sperm of the spouse/partner AIH – using donor sperm AID AIH • Two major ethical problems – is it morally acceptable to separate the conception from the sexual intercourse? Catholic teaching says: no – how do we define the term „partner”? Does the partner and the spouse have equal rights? AID • Case: • Sarah and Joe are a married couple, Joe is infertile so they can only have a child if Sarah is fertilised with donor sperm • They undergo the AID procedure and get two healthy children AID - Case • They do not tell anyone that the children were conceived by AID • Joe is very proud of the children, and he is especially proud when neighbours say that they look pretty much like him • Sarah, her wife thinks that this is a lie and she feels uneasy with it AID - Case • Sarah would like to tell the children that they were conceived with AID • Joe never wanted to reveal it. The children can never learn the identity of the donor so it is of no use to tell them the truth Revealing the identity of the donor • Traditional approach: secrecy • 2/3 of the donors would step back if their anonymity was not guaranteed • but: genetic identity is an important part of identity • not telling the truth in the family has it’s burdens Revealing the identity of the donor • nowadays the trend is changing • Swedish example: sperm donation is not anonymous since 1985, the children have access to the personal data of their genetical father (age limit: 18 years) • at the beginning the number of donors decreased dramatically • later the donor pool changed (formerly students donating for money – now married men donating for altruistic purposes) Arguments for revealing the identity of the donor • the child has an interest in knowing his genetic origin • keeping the secret of the family puts a heavy burden on each member • if the donor is not anonymous, the family will feel compelled to reveal that the child was conceived with AID – no lies in the family Arguments for revealing the identity of the donor • modern technologies (DNA) make it easier to find out genetic origin • altruistic donation instead of financial gain Arguments for revealing the identity of the donor • society’s misconception: usually the woman is infertile – if AID is revealed, it makes it obvious that men are also often infertile • adoption: also changing, more open process AID • some countries followed the Swedish example (Australia, New -Zealand) and sperm donation is not anonymous AID • is it acceptable to make AID available for single women? • For lesbian couples? • What are the arguments for and against? Arguments • if single or lesbian couples can adopt a child – why prohibit AID? • many children (who were not conceived by AID) grow up in incomplete families • empirical data? Surrogate motherhood • Surrogacy is a method of reproduction whereby a woman agrees to become pregnant and deliver a child for a contracted party. Surrogate motherhood Two major forms: the woman delivering the child is partly the child's genetic mother (AID) the woman has not genetic link to the child, she carries the pregnancy to delivery after having been implanted with an embryo (IVF) Surrogate motherhood • the woman borrows her womb to the infertile couple • financial gain? • expoliting the woman? • does she know what she undertakes? • what if she does not comply with the rules? • what if she refuses to give the child to the genetic parents? • what if the child will not be healthy? Baby M • In the United States, the issue of surrogacy was widely publicised in the case of Baby M, in which the surrogate and biological mother of Melissa Stern ("Baby M"), born in 1986, refused to cede custody of Melissa to the couple with whom she had made the surrogacy agreement. The courts of New Jersey eventually awarded custody to Melissa's biological father William Stern and his wife Elizabeth Stern, rather than to the surrogate Mary Beth Whitehead. Legal aspects of surrogate motherhood - USA • In some states it is a crime - Arizona, Michigan, Utah, Washington • In some states it is permitted but not enforceable - Nebraska, Indiana • Strict conditions (e.g.no payment, just covering the costs) - Florida, California Legal aspects of surrogate motherhood - Europe Total ban: Austria, Germany, Sweden, Norway Permitted, but no payment: France, Denmark, Netherlands. Legal aspects of surrogate motherhood - Europe England: covering the costs permitted (reasonable) No regulation: Belgium, Finnland, Greece, Ireland Legal aspects of surrogate motherhood – main trends • Morally acceptable – if it is prohibited, the ban is justi fied with the difficulties of legal regulation • Mother: the woman who gives birth • Father: if the father of the surrogate mother consented to the procedure, he is the legal father Legal aspects of surrogate motherhood – main trends • But: they can hand over their parental rights to the genetic parents Legal aspects of surrogate motherhood – main trends The genetic parents get the parental rights if • the child lives with them • the mother consents (after 6 weeks) • no financial gain IVF • First baby born in 1978 • since then 300.000 babies worldwide • genetic disorders? Do we know? • ethically acceptable? • it depends on what we think of the moral status of the embryo PGD • preaimplatation genetic diagnosis • is it permissible to discard the not selected embryos? • is selection itself permissible?