Reproductive Technologies

1. Reproductive Technologies Presentation by Paul J. Kelly, BS Research by Daniel G. Jenkins, MA

2. What Are Reproductive Technologies? • Reproductive technologies are technologies that are used to achieve pregnancy by artificial (or partially artificial) means. • These methods usually replace natural conception with artificial insemination or fertilizing an egg cell outside of the womb. • As a result, reproductive technologies can help prospective parents give birth if natural birth is not a possibility (i.e. infertile couples, gay and lesbian couples, single individuals, etc).

3. Why Study Reproductive Technologies? • Much like the issues concerning neuroethics, reproductive technologies (and the ethical issues associated with them) are on the cutting edge of modern medical science. • The use of reproductive technologies is becoming increasingly common, and so itis important for all medical professionals to have at least a baseline understanding of the main issues involved. • Also, the ethical questions related to reproductive technologies force us consider: • When can we justifiably create life? • Under what conditions is it ethical to bring a new life into this world? • Are there any conditions under which it would be unethical to bring a new life into this world?

4. Presentation Outline 1) Genetic Engineering • Argument in Support of Genetic Engineering • Arguments Against Genetic Engineering 2) In Vitro Fertilization (IVF) • Concerns Over IVF 3) Reproductive Cloning • Arguments in Favor of Reproductive Cloning • Arguments Against Reproductive Cloning

5. Genetic Engineering • Genetic Engineering is the direct manipulation of an individual’s genes with the aim of reducing the likelihood of developing a specific disorder or selecting for desirable characteristics. • Negative Genetic Engineering: An individual’s genome is modified in order to treatan underlying genetic disorder so that a normal trait can be expressed properly. • PositiveGenetic Engineering: An individual’s genome is modified in order to enhance functionality over and above what is normal. • While there is debate concerning negative genetic engineering, the majority of concern is focused on positive genetic engineering and the prospect of artificial biological enhancement.

6. Argument in Support of Genetic Engineering 1) Medical Benefits: • Genetic engineering might allow children to be created without genetic birth defects or the possibility of developing specific ailments throughout their lives. • It holds the promise of curing diseases like cystic fibrosis, autism, spina bifida, and could increase people’s immune systems. • It is speculated that genetic engineering could be used to change physical appearance, metabolism, and even improve mental faculties like memory and intelligence.

7. Arguments Against Genetic Engineering • The arguments against genetic engineering are essentially the same from our discussion on neuroethics. 1) Undermines Societal Values • Happiness and abilities gained through artificial means cheapen improvements gained without such assistance and could undermine society’s valuing of self-determination, hard word, and sacrifice. 2) Will Increase Inequality • Genetic enhancements will be highly expensive, making them only available to the extremely wealthy. If permitted, their use will exacerbate already existing inequalities between those who can afford such procedures and those who cannot. 3) Safety Concerns • Without a better understanding of the effects of genetic manipulation we cannot ethically permit its use.

8. In Vitro Fertilization (IVF) • Important terms: • In Vitro Fertilization (IVF): • Makes it possible to combine a sperm and egg outside the uterus, which can then be implanted and carried to term. • Pre-Implantation Genetic Diagnosis (PGD): • Allows detection of genetic mutations in an embryo before implantation, and improves the probability of developing healthy, viable offspring by allowing prospective parents to choose which embryo to implant. • Cryopreservation: • Allows egg freezing for women who desire to procreate later in life.

9. Some IVF Statistics • In 2000, the latest year for which statistics are available, about 35,000 American babies were born using IVF, accounting for 1 percent of all births in the United States. • There are currently more than 100,000 embryos in cryopreservation, and that number is increasing at a rate of 20,000 embryos per year.

10. Concerns Over IVF 1) The Health of the Child • The data concerning the health of children conceived utilizing IVF is not very clear, but some studies suggest that such children run the risk of: • Increased chromosomal anomalies • Birth defects • Low birth weight • An increased risk of developing certain diseases • Some argue that until we have more accurate longitudinal data about the effect IVF has on the resulting children we cannot ethically permit it to be used.

11. Concerns Over IVF 2) The Health of the Mother • The health of the mother can be adversely effected both during the harvesting of eggs and throughout the course of pregnancy (especially if it results in multiple-births). • The hormone treatments used to increase the number of eggs available for harvest can give rise to: • Emotional disturbance • Hypertension • Nausea • Vomiting • Excess fluid in the abdomen • Abdominal pain

12. Concerns Over IVF 3) Risk of Multiple Births • It is routine to implant multiple embryos in order to maximize the probability of a successful live birth. • In the event of a multiple birth, children are often born early or with low birth weights, and a significantly greater risk of congenital birth defects like cerebral palsy, blindness, and other physical and mental handicaps. • Only 15% of single-born babies require neonatal intensive care, while 78% of multiple-birth children do. • In one out of every five triplet pregnancies, and in one out of every two quadruplet pregnancies, at least one child has a serious long-term handicap. • Some have argued that because of these dangers permitting the implantation of multiple embryos is ethically negligent. • There are currently no laws in place in the United States limiting the number of embryos that may be implanted.

13. Concerns Over IVF 4) Selective Abortion • Selective abortion is when, in the case of a multiple pregnancy, a genetic analysis of developing fetuses is taken, and the information gained from the procedure is used to determine which of the developing fetuses to carry to term and which to abort. • Leon Kass, former Chairman of the President’s Council for Bioethics, argues that selective abortion involves a qualitative assessment of fetuses that threatens the moral equality of all human beings, and that the practice will result in a negative view of anyone suffering from a genetically-based abnormality. • Critics of this position argue that it is morally wrong to produce children that have overwhelming genetic risk, and that every parent has a duty to provide their child with as healthy a life as possible.

14. Concerns Over IVF 5) Financial Cost • In 2000, 35% of births from IVF in the United States were multiples, ten times the national average for natural multiple births. • As a result, the financial burden created by multiple births is extremely high. • For reference, it is ten times more expensive to deliver twins than a single-birth, and that amount increases steadily for even higher number births. • In the year 2000, assisted reproductive technologies cost the American public an estimated $640 million dollars. • Furthermore, since such technologies are so expensive, the question arises as to whether or not IVF ought to be offered in a universal healthcare system, and, if so, how many attempts ought to be covered?

15. Concerns Over IVF 6) Already Enough Children • Some have argued that IVF is ethically unjustified because it diverts attention from already living people to whom we are obligated. • They claim that we should not artificially create additional children when there are millions of children already existing who lack loving homes. • They claim that the money, time, and medical expertise currently be spent on helping infertile couples conceive a child could be better used in treating already existing children and finding them safe and healthy homes. • Statistics show that individuals interested in IVF are usually not interested in adoption, but we can still ask the question whether or not they should be.

16. Concerns Over IVF 7) Sperm Identification and Record-Keeping • Although a rare problem, mistakes have occurred in the past in identifying and tracking sperm through the phases of collection, storage and fertilization. • An example of this was when a Florida woman undergoing IVF gave birth to a child of a different race.

17. Reproductive Cloning • Reproductive cloning allows for the creation of a new organism that is genetically identical to a single parent, akin to creating an identical twin of a different age.

18. Arguments in Favor of Reproductive Cloning 1) Biologically Related Children • It would allow everyone, even infertile couples or single parents, to have biologically related children. • For example, if a man was infertile he could generate a clone, thus having an offspring that is genetically identical to him.

19. Arguments in Favor of Reproductive Cloning 2) The Perfect Donor • Cloning would also allow the creation of an individual who would be a perfect donor match for a person needing an organ donation to live. • For example, if a child needing a bone marrow transplant was cloned, the cloned donor would be an ideal match for transplantation.

20. Argument Against Reproductive Cloning 1) Too Dangerous • Due to the inefficiency of animal cloning (only about 1 viable offspring for every 100 experiments) and the lack of understanding about reproductive cloning, many scientists and physicians strongly believe that it would be unethical to attempt to clone humans. • Even out of the limited number of successful animal clones, 30% of them die prematurely from infections, diseases, and other complications. • Also, because of the limited variety of animals successfully cloned, scientists have no idea how cloning could impact a human child’s mental development. • With so many unknowns concerning reproductive cloning, attempting to clone humans at this time is generally considered to be too dangerous and, as a result, ethically irresponsible.

21. Conclusion • Reproductive technologies have enabled millions of people to have biological children who otherwise would not have been able to do so. • However, as with most technological advancements in the medical field, we should be cautious about what procedures we endorse and their potential ethical implications.