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Vexation Of Viability Uhsa


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Vexation Of Viability Uhsa

  1. 1. The Vexation of Viability: Arbitrary or Valid? (Legal and Ethical Issues in Assisted Reproductive Technologies) Linda MacDonald Glenn University Health Sciences Antigua Health Care Ethics and Law
  2. 2. Linda MacDonald Glenn, JD, LLM <ul><li>Assistant Adjunct Professor, University of Vermont, School of Nursing and Allied Health Sciences and Alden March Bioethics Institute, Albany Medical Center </li></ul><ul><li>Former Senior Fellow, Institute for Ethics, American Medical Association.* </li></ul><ul><li>LL.M. in Biomedical Ethics from McGill University, Montreal, Canada </li></ul><ul><li>Biotechnology at the Margins of Personhood: An Evolving Legal Paradigm in the Journal of Evolution and Technology, Vol. 13, Mar 2003, available at </li></ul><ul><li>In a former life, trial lawyer and advocate. </li></ul>Linda MacDonald Glenn
  3. 3. Purposes of Presentation <ul><ul><ul><li>Current developments in biotechnology and assisted reproductive technologies </li></ul></ul></ul><ul><ul><ul><li>Ethical and legal considerations </li></ul></ul></ul><ul><ul><ul><li>Developments in the law </li></ul></ul></ul><ul><ul><ul><li>Legal and ethical implications </li></ul></ul></ul>Linda MacDonald Glenn
  4. 4. Part 1 – Current developments in biotechnology and assisted reproductive technologies (ARTs) Linda MacDonald Glenn
  5. 5. A reproductive history <ul><li>1677: Human sperm discovered by student of Antonij van Leeuwenhoek, inventor of the microscope. </li></ul><ul><li>1780: Italian priest and scientist Lazzaro Spallanzani develops first artificial insemination techniques using dogs. </li></ul><ul><li>1785: Scottish surgeon John Hunter attempts first human artificial insemination, resulting in birth of a child same year. </li></ul><ul><li>1827: Human female egg discovered by Prussian embryologist Karl Ernst von Baer. </li></ul><ul><li>1843: Physician Martin Berry discovers that fertilization begins when sperm enters ovum . </li></ul>Linda MacDonald Glenn
  6. 6. Reproductive history, continued <ul><li>1890: Walter Heape of England conducts successful “embryo flushing”, then transferring a rabbit embryo to foster-mother where normal development continues. </li></ul><ul><li>1960: FDA approves sale of Enovid, first commercial birth control pill. </li></ul><ul><li>1969: Robert Edwards of England successfully fertilizes human egg outside female body. </li></ul><ul><li>1978: Louise Brown, the original &quot;test-tube baby,&quot; is born in Cambridge, England. </li></ul><ul><li>1981: First fish – a golden carp – is cloned in China. </li></ul>Linda MacDonald Glenn
  7. 7. Reproductive history continued… <ul><li>1996: First adult mammal a female sheep named Dolly is cloned in Scotland. </li></ul><ul><li>1997: Japanese scientists announce they have sustained a goat fetus for several weeks in a artificial womb </li></ul><ul><li>1999 : Fertility experts in England declare male pregnancy theoretically possible. (IVF techniques can be used to induce an ectopic pregnancy by implanting an embryo and placenta into the abdominal cavity, just under the peritoneum – delivery through Caesarean section) </li></ul><ul><li>2000 – POP! appears on WWW </li></ul>Linda MacDonald Glenn
  8. 8. Linda MacDonald Glenn
  9. 9. Linda MacDonald Glenn
  10. 10. Reproductive history continued… <ul><li>2001: Advanced Cell Technology announces cloning of human embryos. </li></ul><ul><li>2002 : Dr. Hung-Ching Liu of the Weill Medical College at Cornell University announces she has gestated embryo for six days in artificial womb. </li></ul>Linda MacDonald Glenn
  11. 11. The Advent of Ectogenesis and/or the Artificial Womb! Linda MacDonald Glenn
  12. 12. Implications of Creating Artificial Wombs and new ARTs <ul><li>Further advances in ARTs could result, in new survival rates for premature babies; </li></ul><ul><li>An incubator capable of preserving a 10-week-old fetus might be capable of handling a one-week-old embryo. </li></ul><ul><li>Following fertilization in a petri dish, a growing embryo might be placed directly into the artificial womb. </li></ul><ul><li>Could also result in a new definition of “viability” ! </li></ul>Linda MacDonald Glenn
  13. 13. Part 2 – Ethical and Legal Considerations Linda MacDonald Glenn
  14. 14. Some Historical Perspectives the Moral Status of the Embryo,Viability, and Personhood <ul><li>In the middle ages, a fetus was not considered alive until “the quickening” </li></ul><ul><li>Saints Thomas Aquinas and Augustine did not see early fetus or embryos as persons. </li></ul><ul><li>Not until 17 th century, when scientists thought they saw a “tiny man” under the microscope did the Church take the position that life starts at conception. </li></ul><ul><li>The Church never returned to earlier position </li></ul>Linda MacDonald Glenn
  15. 15. Historical Perspectives continued… <ul><li>Spectrum of beliefs about when life, moral status, and personhood begins: </li></ul><ul><ul><li>From fertilization (religious groups say “conception”) </li></ul></ul><ul><ul><li>From implantation </li></ul></ul><ul><ul><li>From 14 days after fertilization (primitive streak and twinning) </li></ul></ul>Linda MacDonald Glenn
  16. 16. Historical Perspectives continued… <ul><li>“ Brain birth,&quot; analogous to brain death at the other end of life. </li></ul><ul><li>“ Viability” - capable of surviving outside the mother's womb </li></ul><ul><li>Actual birth – not until the child is born </li></ul><ul><li>Beyond birth – high standard for personhood </li></ul>Linda MacDonald Glenn
  17. 17. Joseph Fletcher’s 15 Propositions for Personhood <ul><li>1. minimum intelligence, </li></ul><ul><li>2. self-awareness, </li></ul><ul><li>3. self-control </li></ul><ul><li>4. a sense of time </li></ul><ul><li>5. a sense of futurity </li></ul><ul><li>6. a sense of the past </li></ul><ul><li>7. the capability of relating to others, </li></ul><ul><li>8. concern for others, </li></ul><ul><li>9. communication </li></ul><ul><li>10. control of existence </li></ul><ul><li>11. curiosity, </li></ul><ul><li>12. change and changeability </li></ul><ul><li>13. balance of rationality and feeling, </li></ul><ul><li>14. idiosyncrasy </li></ul><ul><li>15. neocortical functioning </li></ul>Linda MacDonald Glenn
  18. 18. Part 3 – Developments in US Law Linda MacDonald Glenn
  19. 19. US case law… <ul><li>American case law has been grappling with the question of fetal and embryonic life for over a hundred years; </li></ul><ul><li>Dietrich v. Inhabitants of Northampton , Supreme Court of Massachusetts, 1884 </li></ul><ul><li>Prior to 1973, many states outlawed abortion after “quickening” </li></ul><ul><li>1973 – Roe v. Wade excludes 1 st and 2 nd term fetuses as “persons” under statutory or constitutional protection, citing viability as the drawing line between appendage and person . </li></ul>Linda MacDonald Glenn
  20. 20. US case law continued… <ul><li>1989 – Webster v. Reproductive Health Services – majority from 7-2, down to 5-4, with court indicating willingness to overturn Roe v. Wade </li></ul><ul><li>1992 – Planned Parenthood of Southeastern Pennsylvania v. Casey, Governor of Pennsylvania </li></ul>Linda MacDonald Glenn
  21. 21. US case law continued… <ul><li>2000 – Stenberg v. Carhart – Viability is not the issue; unconstitutional because of lack of exception to preserve the health (not just life) of the mother. </li></ul><ul><li>Court’s decision can be likened to Judith Jarvis Thomson’s “In Defense of Abortion” (case scenario of unconscious violinist) - you cannot force someone to sacrifice their health or life. </li></ul>Linda MacDonald Glenn
  22. 22. US case law, continued… <ul><li>Thomson offers an analogy: imagine that you were knocked unconscious, hooked up to a famous violinist who must depend on you for life support for the coming nine months. </li></ul><ul><li>Thomson maintains that you would be m orally justified in unhooking yourself, even if it resulted in the death of the violinist. </li></ul><ul><li>By analogy, a pregnant woman is justified in “unhooking” herself from the fetus, even if doing so results in the death of the fetus and even if the fetus is a person. </li></ul>Linda MacDonald Glenn
  23. 23. US case law continued… <ul><li>In sum, Judith Jarvis Thomson’s argument against restrictive regulation of abortion rests on three ideas: </li></ul><ul><li>First, restrictive regulation severely constrains women's liberty. </li></ul><ul><li>Second, severe constraints on liberty may not be imposed in the name of considerations that the constrained are not unreasonable in rejecting. </li></ul><ul><li>Third, the many women who reject the claim that the fetus has a right to life from the moment of conception are not unreasonable in doing so. </li></ul>Linda MacDonald Glenn
  24. 24. US case law, continued <ul><li>From property to quasi-property to quasi-personhood? </li></ul><ul><li>Frozen embryos cases: </li></ul><ul><li>Davis v. Davis (Tennessee) </li></ul><ul><li>A.Z. v. B.Z. (Massachusetts) </li></ul><ul><li>J.B. v. M.B. (New Jersey) </li></ul>Linda MacDonald Glenn
  25. 25. US law continued … <ul><li>Legislation: </li></ul><ul><li>“ Unborn victims of crime act” </li></ul><ul><li>Another attempt to ban so called “partial-birth” abortion, with no health exception. </li></ul>Linda MacDonald Glenn
  26. 26. Part 4 - Legal and Ethical Implications Linda MacDonald Glenn
  27. 27. Legal and Ethical Implications <ul><li>Further advances in ARTs, particularly the advent of the artificial womb, will force us to re-evaluate the difficult issues of when life and personhood begins and the moral status of the fetus and embryo. </li></ul><ul><li>These advances will likely re-define the abortion debate* and make Roe v. Wade moot. </li></ul><ul><li>* One can always hope that this could this lead to an agreement that transcends the abortion debate? </li></ul>Linda MacDonald Glenn
  28. 28. Legal and Ethical Implications <ul><li>As assisted reproductive technologies advance, the courts will determine where these beings fall on the property – quasi-property – quasi-person – personhood continuum . </li></ul>Linda MacDonald Glenn
  29. 29. Linda MacDonald Glenn For the future: Expect intense cross-disciplinary debate, discussion, as new assisted reproductive technologies appear.
  30. 30. Thank you for attention! <ul><li>For Bibliography and References feel free to contact me at: </li></ul><ul><li>[email_address] </li></ul>Linda MacDonald Glenn
  31. 31. Future case scenario <ul><li>Mr. and Mrs. D came into a fertility clinic; they have several embryos frozen for future use, to be implanted into either the husband (a male pregnancy) or an artificial womb; both husband and wife agree that in the event of death or divorce, the embryos may be donated to another couple or used for research. Several years later, the artificial womb or male pregnancy technology is perfected, but the couple divorces ... </li></ul>Linda MacDonald Glenn