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Deconstructing the family?

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

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Deconstructing the family?

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  1. Redefining reproductionDr Anna SmajdorLecturer in EthicsUniversity of East AngliaNorwichacsmajdor@yahoo.co.uk

  2. 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

  3. Snapshot from history 1884: William Pancoast of Jefferson Medical College, Pennsylvania, performs 1st documented artificiaI insemination in human beings Male 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

  4. 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.

  5. Why the need to (re)define? Reproductive rights Reproductive needs Funding Legal questions: Defining parenthood/parental responsibility Should some procedures – ie reproductive cloning – be illegal? If so, why?

  6. 1978: 1st IVF child born – no Regulatory framework in place • Public concern:‘test-tube’ babies; • Warnock report:to look into ethical/legal issues • IVF to be allowed under licence • Welfare of the child (+ need for father) • Consent of both parents of vital importance • Formation of the HFEA • HFE Act passed in 1990 • Keeping IVF within a heterosexual nuclear family paradigm

  7. Unruly reproductive technology Gamete donation; Surrogacy; PGD Saviour siblings; sex selection; same sex/single parenthood; Postmenopausal motherhood; ooplasmic transplant IVF 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

  8. Biological parenthood Gametogenesis – artificial gametes/gamete donation Intercourse – reproductive tissue transplant Conception – IVF Gestation – surrogacy Labour – surrogacy Breastfeeding – bottle Can all be undertaken by a variety of different people, in a variety of places – outside or inside the body! New reproductive technologies have dissolved the biological boundaries to reproduction

  9. Who is the ‘real’ mother?

  10. 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.

  11. Interfering with nature John Stuart Mill: two understandings of nature: • ‘Collective name for everything which is’ (ie everything is natural) • ‘That which takes place without human intervention’ (ie everything we do is unnatural)

  12. 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?

  13. NICE guidelines for IVF A woman is eligible for IVF if She has a male partner Who has a fertility problem (eg low sperm count) Even if she herself is in perfect reproductive health Need for treatment defined not by clinical facts But by the social tie – choice of partner Woman is treated, but she could have a child with someone else Compare with a woman who is physiologically identical Also in perfect reproductive health Also has chosen a partner with whom she cannot conceive ‘naturally’ – another woman Is not eligible for treatment – because of the social tie: choice of partner. If she chose a different partner – she would be eligible

  14. 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

  15. 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

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