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Redefining reproduction
 

Redefining reproduction

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A Higher Education Academy STEM event "Teaching Bioethics:Ethical aspects of innovations in biomedicine" took place at the University of Leicester (UK) in May 2012. In this keynote presentation, Anna ...

A Higher Education Academy STEM event "Teaching Bioethics:Ethical aspects of innovations in biomedicine" took place at the University of Leicester (UK) in May 2012. In this keynote presentation, Anna Smajdor (University of East Anglia) led reflections on the implications of recent developments in fertility technology.

Since In vitro fertilisation was first introduced in 1978, the potential applications have developed in ways that were not initially envisaged and we have ended up with complications defining “father” and “mother”. Similarly, who is the “patient” when a woman receives medical treatment to deal with the infertility of her partner (and why is this considered a “medical” treatment at all? Development of new technologies has moved way beyond the original expectation that IVF would be used in the context of a traditional family.

New reproductive technologies, she argued, have blurred and stretched the obvious biological definitions of reproduction. For example, single mothers, same-sex couples and women beyond the menopause can all become parents. Preimplantation genetic diagnosis and the notion of saviour siblings allow for a certain degree of selection regarding the characteristics of the future child and we now stand on the brink of gametogenesis where it will be feasible to develop artificial gametes outside of the body.

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    Redefining reproduction Redefining reproduction Presentation Transcript

    • Redefining reproduction Dr Anna Smajdor Lecturer in Ethics University of East Anglia Norwich acsmajdor@yahoo.co.uk
    • Deconstructing the family?• IVF couples get Viking sperm!• Multiple mothers’ spare babies aborted• No father required• IVF twins with 5 parents• The cloned baby with two mothers - a selection of headlines from the Daily Mail
    • Snapshot from history 1884: William Pancoast of Jefferson Medical College, Pennsylvania, performs 1st documented artificiaI insemination in human beingsMale patient sought help for ‘infertile wife’ Pancoast established problem was with the husband Wife was told she needed to undergo treatment Chloroformed in front of watching medical students Inseminated with sperm from a student 9 months later, delivered a baby boy
    • Questions: Who’s the father? Who’s the patient? Did this procedure cure a medical condition? If not, why was a doctor performing it?“What reasoning led physicians to assume that they were providing treatment for infertility, when the technical act they were proposing may be understood as an alternative mode of conception to heterosexual intercourse?”Novaes SB. The medical management of donor insemination. In Danies K, Haimes E (eds.) Donor Insemination: International social science perspectives. Cambridge University Press. pp105-130. 1998. p.106.
    • Why the need to (re)define?• Reproductive rights• Reproductive needs• Funding• Legal questions: • Defining parenthood/parental responsibilityShould some procedures – ie reproductive cloning – be illegal? If so, why?
    •  1978: 1st IVF child born – noRegulatory framework in place Public concern: ‘test-tube’ babies; Warnock report: to look into ethical/legal issues o IVF to be allowed under licence o Welfare of the child (+ need for father) o Consent of both parents of vital importance o Formation of the HFEA HFE Act passed in 1990 Keeping IVF within a heterosexualnuclear family paradigm
    • Unruly reproductive technologyGamete donation; Surrogacy; PGDSaviour siblings; sex selection;same sex/single parenthood;Postmenopausal motherhood; ooplasmic transplantIVF and reproductive technologies are unruly –it’s hard to keep them within set clinical boundaries. Continually developing new possibilities + applications, raising new ethical + legal questions.[Levitt M. Assisted Reproduction: Managing an Unruly Technology. Health Care Analysis. Volume 12, Number 1. 2004.]Future challenges: artificial gametes; reproductive cloning
    • Biological parenthoodGametogenesis – artificial gametes/gamete donationIntercourse – reproductive tissue transplantConception – IVFGestation – surrogacyLabour – surrogacyBreastfeeding – bottleCan all be undertaken by a variety of different people, in a varietyof places – outside or inside the body! New reproductive technologies have dissolved the biological boundaries to reproduction
    • Who is the ‘real’ mother?
    • Cloning = reproduction?John Harris: the only good argument against it is harm to the cloned child. If little/no harm caused, cloning should be allowed...the right to clone could be part of reproductive autonomy.(quoted in science & technology report 2004-5)World Health Organisation: cloning ‘replicates individuals’, is contrary to human dignity and integrity’Public more accepting of cloning if provided to infertile heterosexual couple.Shepherd R, Barnetta J et al. Towards an understanding of British public attitudes concerning human cloning. Social Science & Medicine. 65; 2; 377-392. 2007.
    • Interfering with natureJohn Stuart Mill: two understandingsof nature:1.‘Collectivename for everything which is’ (ieeverything is natural)2.‘Thatwhich takes place without human intervention’(ie everything we do is unnatural)
    • What is the symptom being treated in today’s fertility clinics?Infertility?Non-conception?The desire for a baby?Problem – if desires are being treated, how do we make distinctions between those we deem eligible and those we don’t?
    • NICE guidelines for IVFA woman is eligible for IVF ifo She has a male partnero Who has a fertility problem (eg low sperm count)o Even if she herself is in perfect reproductive healtho Need for treatment defined not by clinical factso But by the social tie – choice of partnero Woman is treated, but she could have a child with someone elseCompare with a woman who is physiologically identicalo Also in perfect reproductive healtho Also has chosen a partner with whom she cannot conceive ‘naturally’ – another womano Is not eligible for treatment – because of the social tie: choice of partner. If she chose a different partner – she would be eligible
    • Legislation & ethics at the new frontier• Biological facts no longer serve to denote legal/ethical/medical limits of reproduction• Boundaries must be renegotiated, acknowledging socially/moral component• Pressure on current legal + regulatory approaches – inconsistent and discriminatory
    •  Bewley, S, M Davies, and P Braude. 2005. Which career first? British Medical Journal 331:588-589. Templeton, SK. 2006. Late motherhood as ‘big a problem’ as teenage mums. The Times. Schempf, Ashley H, Amy M Branum, Susan L Lukacs et al. 2007. Maternal age and parity-associated risks of preterm birth. Paediatric and Perinatal Epidemiology 21:1, 34–43. Deneux-Tharaux, C, M.H. Berg, M Bouvier-Colle et al. 2005. Underreporting of Pregnancy-Related Mortality in the United States and Europe. Obstetrics & Gynecology 106(4): 684 - 692. Hebert, PR, G Reed, SS Entman et al. 1999. Serious maternal morbidity after childbirth: Prolonged hospital stays and readmissions. Obstetrics and Gynecology 94(6):942–7.(p942). Grimes, DA. 1994. The role of hormonal contraceptives: the morbidity and mortality of pregnancy: still risky business. American Journal of Obstetrics & Gy- necology 170 (5S) Supplement: 1489-1494. Chadwick, R. 1992. Ethics, reproduction and genetic control. New York: Routledge (pxvi). Henderson, M. 2005. Trauma of infertility is worse than cancer, says Winston. The Times. Morgan SP. Is Low Fertility a Twenty-First-Century Demographic Crisis? Demography, Vol. 40, No. 4 (Nov., 2003), pp. 589-603 Hertzman, C, and M Wiens. 1996. Child development and long-term outcomes: a population health perspective and summary of successful interventions. Social science and medicine 43;7; 1083-1095