New Reproductive Options: New Ethical Questions

1. New Reproductive Options: New Ethical Questions Dianne Bartels, RN, MA, PhD Center for Bioethics University of Minnesota

2. Objectives • To examine the individual and social consequences of new biological technologies by looking at reproductive options • To describe the range of current reproductive technologies • To identify ethical questions that arise in the context of offering new reproductive options

3. Reproductive Options • prenatal testing • artificial insemination - by spouse or donor • egg donation • in vitro fertilization • pre-implantation genetic diagnosis (PGD) • surrogacy contract • embryo adoption • cloning?

5. SNUPPY

6. Embryo adoption - proposed as an alternative after discussion of stem cell transplantation and cloning. A response to a question about whether existing IVF embryos are really “spare” (unwanted) embryos. Embryo Adoption

7. Embryo Adoption • Snowflake Embryo Adoption Program promises to help genetic parents find a suitable home for their “pre-born children” giving genetic parents “some control over their destiny” • abc news email 8/22/02

10. Genetic testing now offers the option to test for susceptibilities to diseases like cystic fibrosis, breast cancer, or Fanconi’s Anemia; genetics will become the “new paradigm” for health care.

11. Prenatal testing is often the first application of new tests. So, what tests should be done/allowed?

12. One moral question is whether the end, (e.g. having a healthy child) justify the means prenatal testing offering the choices about whether to continue a pregnancy selecting embryos

14. Alzheimer Disease • A 30 year old asymptomatic woman with a genetic mutation consistent with early onset Alzheimer disease was identified by predictive testing • She requested and received PGD which resulted in the birth a child free of inherited predisposition to early-onset AD

15. Boy conceived to be deaf at center of ethics uproar • “Taking the idea of genetic engineering to a whole new level [a couple] deliberately have conceived a deaf son because they think the inability to hear is a ‘cultural identity,’ not a disability.” • Chicago Sun Times 4/10/ 02

16. In fact a majority of couples who have used gamete donation to conceive their children do not intend to tell their children? Does the child have a right to know?

17. Ethical Challenges • Destruction of Embryos • Status of embryos (personhood) • Right to reproduce • Best interest of the child • using a child as a means to another’s end • was Adam Nash “born to perform” • Commodification - product orientation • selecting traits of children

18. Egg Donor Needed • Large financial incentive • Intelligent, athletic egg donor needed/for loving family • You must be at least 5’ 10’’ • Have a 1400+ SAT Score • Possess no family medical issues • $50,000 • Free medical screening • All expenses paid

20. Ethical Challenges • Family and community responsibility • to have a healthy child • to share genetic risk information • Eugenics - harm to society • discrimination against the disabled • Justice-resource allocation • 186,000,000 people in developing countries have little or no access to basic health care • 46 million people have little or no access to health care in the U.S. • cost is prohibitive, here and there