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Assisted Human Reproduction*. Philosophy 2803 Lecture IX April 2, 2003 *Some material is based on a previous lecture prepared with Dr. Barbara Barrowman. Groupwork. In late 2002, The Raelians, an until then obscure religious cult, announced that the first human clone had been born.

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Assisted Human Reproduction*

Philosophy 2803

Lecture IX

April 2, 2003

*Some material is based on a previous lecture prepared with Dr. Barbara Barrowman


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Groupwork

  • In late 2002, The Raelians, an until then obscure religious cult, announced that the first human clone had been born.

  • The claim has been met with substantial skepticism and is almost certainly false.


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Groupwork

  • Nonetheless, as a result of the publicity surrounding this ‘annoucement’, the idea of reproductive cloning has been much debated.

  • Almost everyone who has publicly expressed an opinion on this issue has condemned the idea.

  • Your assignment: Compose a list of the reasons you think lie behind this view.


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Assisted Human Reproduction (AHR)

  • Infertility affects about 330,000 couples per year in Canada

  • Many technologies & techniques are used in an attempt to help people (not necessarily couples) have children

  • Many new technologies are being developed


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Regulating AHR in Canada

  • Some existing legislation applies to AHR

    • E.g., Food and Drug Act, Human Tissue Acts

  • However, there has long been a political perception that legislation specifically regulating AHR is needed.

    • Preparing & passing such legislation has proved extremely challenging.

  • 1989-1993: Royal Commission on New Reproductive Technologies

    • Final Report: Proceed with Care (1993)

    • Recommends banning human cloning, commercial surrogacy, and establishing a regulatory body to govern permissible AHR activities (like IVF)

    • See readings for tonight (pp. 446-452)


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Attempts at Regulation

  • 1995 - Minister of Health introduces a voluntary moratorium on cloning and many other activities the Royal Commission objected to

  • 1996 – Bill C-47 proposes a series of prohibitions based on the voluntary moratorium

    • Dies when parliament is dissolved for the 1997 federal election

    • Public consultation on the issue followed.

  • 2001 – Bill C-56 presents an updated version of C-47

    • Dies when parliament is dissolved in September 2002


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Bill C-13 (2002): Proposed Assisted Human Reproduction Act

  • Bill C-56 was reintroduced in October, 2002 as Bill C-13

  • Expected to pass in the House of Commons this week (March 31 - April 4, 2003)

    • Would prohibit certain activities

    • Would create licensing & regulatory scheme for other activities

    • Would regulate privacy & access to information issues

    • Would create an expert regulatory agency


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The AHR Act

  • A very broad range of topics is covered

    • Some are relevant to next week’s class on genetics

  • Many of the provisions of the AHR Act are based on moral claims

    • “… some practices … are simply unacceptable, because they're not consistent with human dignity, such as cloning a person and creating animal-human hybrids. Those are unacceptable, because they're just not consistent with human dignity." (Alan Rock, May 3, 2001)


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Some Proposed Prohibitions

  • Creating a human clone for any purpose

  • Creating an embryo outside a human body for any purpose other than creating a human being, or improving assisted reproduction procedures

  • Maintaining an embryo outside a woman’s body beyond the 14th day of its development

  • Identifying sex of embryo created for reproductive purposes, except for medical reason such as sex-linked disorder; also attempting to influence sex


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More Proposed Prohibitions

  • Creating human/non-human combinations for reproductive purposes

  • Changing DNA of human sperm, egg or embryo so that the change can be passed to subsequent generations

  • Paying a woman a financial incentive to be a surrogate mother (commercial surrogacy)

  • Paying a donor for their sperm or eggs, or providing goods or services in exchange

  • Selling or buying human embryos, or providing goods or services in exchange


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Proposed Regulation of Other Activities

  • Forms of AHR that are not be banned will regulated

    • The act would set up an independent regulatory body to oversee AHR in Canada

  • In Vitro Fertilization would fall into this class of regulated activities

    • Regulations would be set up governing the types of facilities that could carry out IVF, how human reproductive material must be stored & handled at such facilities, etc.


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Controversy Over the AHR Act

  • The act has been controversial on both legal and moral grounds

  • We turn now to considering the moral status of AHR. Our main focus will be on:

    • In Vitro Fertilization (IVF)

    • Paid Surrogacy

    • Reproductive Cloning

  • First, a couple of general points about AHR are worth noting


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Two Ethical Issues Raised by AHR in General

  • Who should have access to AHR technologies?

    • Only heterosexual couples? What about same sex couples? Single people? Surrogates?

    • This debate connects with sensitive issues regarding the conception of a family

  • Who should pay?

    • MCP? The infertile couple/individual?

    • Recall earlier class on the idea of health

      • Is infertility a disease?

    • If we pay for couples who are ‘medically infertile’, should we pay for everyone seeking IVF?


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What is IVF?

  • In vitro = “in glass” as opposed to in vivo

  • Ova & sperm are collected (from the would-be parents or donors) & combined outside the body

  • If fertilization occurs, the fertilized ova are allowed to briefly develop and then either implanted in the would-be mother (or a surrogate) or stored for possible later attempts

  • In 1978, Louise Brown became the first baby born as a result of IVF.

  • Since then over 250,000 births worldwide

  • IVF outcomes

    • In U.K. (1998) live birth rate per IVF cycle = 15-17%


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Controversies about IVF

  • IVF was initially extremely controversial

    • Louise Brown’s birth was a subject of intense media & public attention

  • Many of the concerns raised about IVF mirror present concerns about other New Reproductive Technologies


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Objections to IVF

  • Potential Physical Harm to theChild

    • “It doesn’t matter how many times the baby is tested, they will never be certain the baby won’t be born without defect.” Leon Kass

  • Potential Psychological Harm to the Child

    • “What are the psychological implications of growing up as a specimen, sheltered not by a warm womb but by steel and glass, belonging to no one but the lab technician who joined together sperm and egg? In a world already populated with people with identity crises, what’s the personal identity of a test-tube baby?” Jeremy Rifkin


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Objections to IVF

  • Unnaturalness

  • Inconsistency with Human Dignity

    • IVF “deprives human procreation of the dignity which is proper and connatural to it” (Vatican Statement, 1987)

  • Playing God

    • “By acting in this way the researcher usurps the place of God” (Vatican Statement, 1987)


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Kinds of Objection

  • Notice that the objections just surveyed fall into 2 kinds:

    • Technical Objections

      • These could be met by regulating IVF to make it safe

      • Physical & Psychological Safety

    • In Principle Objections

      • These hold that IVF itself is morally objectionable. No amount of ‘tinkering’ can meet these objections.

      • Unnaturalness, Dignity


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Meeting the Objections

  • The technical objections to IVF have by now been met.

    • The process, while not foolproof, poses no particular physical nor psychological risks.

  • The in principle objections are just as strong or as weak as they ever were.

    • Should we be convinced by the in principle objections?


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Unnaturalness

  • Objections based on the idea of unnaturalness are generally very weak

  • Arguably, lots of things are unnatural, but not immoral (e.g., popsicles, glasses, CDs)

  • In order to make this sort of argument work, you need to say more about why the sort of unnaturalness represented by IVF is morally troubling.

  • But then it’s the extra stuff you say that will do the work in your argument, not the idea of unnaturalness itself.

  • On the whole, it’s best to simply leave claims about unnaturalness out of your arguments on this (or any other) issue


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Playing God & Human Dignity

  • Playing God

    • Arguments based on this will be as strong or as weak as our arguments for a particular conception of God

  • Dignity

    • Arguments based on this require us to explain our conception of human dignity and why IVF runs afoul of it.

    • Are there reasons for thinking IVF is incompatible with human dignity?


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A Further Issue: Surplus Embryos

  • IVF is expensive & there is no guarantee that the implantation of the embryo will be successful

    • Typically extra embryos are fertilized & stored for possible later attempts

  • What should be done with embryos no longer required by the donor couple for their own joint reproductive purposes?

    • What if the couple breaks up and one then wants to use a stored embryo?

    • What if the ‘parents’ die?

    • May the embryos be donated to other infertile couples?

    • May the embryos be used in medical research?

      • e.g., stem-cell research

    • May the embryos be destroyed?


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A Further Issue: Commodifying Reproductive Material

  • The points just raised suggest that we need to consider whether reproductive material is property or person (or something in between)

  • A Related Question: Should individuals be allowed to profit from the sale of sperm, ova or embryos?

    • E.g., a model advertising ova for sale on e-bay

  • It is generally argued that this is inconsistent with human dignity somehow

    • Is this true?

    • Considerations regarding commodification are also central to the debate on paid surrogacy


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Surrogate Motherhood

  • The practice of a woman bearing a child for the purpose of giving the child up to some other person or persons

  • The individual or couple to whom the s.m. will give the child up may or may not contribute reproductive material to the pregnancy

    • E.g., the s.m. may be implanted with an embryo produced by IVF


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Commercial Surrogacy

  • ‘Altruistic Surrogacy’

    • the s.m. is not paid, although she may be reimbursed for expenses

  • Commercial Surrogacy

    • The s.m. is paid

    • Sometimes a ‘broker’ does the job of finding a woman to serve as s.m.

  • The AHR would ban Commercial, but not Altruistic, Surrogacy


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Objections to Commercial Surrogacy

  • Commodification of Children

    • “The premise of commercial preconception contracts is that a child is a product that can be bought and sold on the market.” (452)

    • The Royal Commission declared this to be “repugnant.” (452)

  • Commodification of Women’s Reproductive Function

    • “A preconception contract obliges the gestational mother to sell an intimate aspect of her human functioning” (452)

    • Such arrangements “place women in the situation of alienating aspects of themselves that should be inherently inalienable.” (452)


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More Objections to C.S.

  • Potential Harm to the S.M.

    • It has been reported that 10% of S.M.'s suffer sufficient grief from giving up the child to require therapy.

    • Notice that this might also apply to altruistic surrogacy.

  • Potential Conflict Between Surrogate and Would-Be Parent(s)

    • What if the surrogate decides she wants to keep the child?

    • What if the would-be parent(s) decide they don’t?

    • Again, this might also apply to altruistic surrogacy

  • Concerns About Who Will Become a S.M.

    • Will s.m. “prey on socioeconomically underprivileged women”? (453)


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Some Responses

  • “the ethical status of a child has nothing to do with who engendered it or how it was brought about. … its ethical status lies in the fact that it is a person.” (CMA, 455)

  • Commercial surrogacy may “be described as an exchange of considerations for services rendered: namely the gestational service itself.” (CMA, 455)

  • It is unrealistic to expect that many people will be inclined to be s.m.’s without payment. (Today’s CBC Radio News)


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A Big Question

  • Under what conditions, is it inappropriate to treat something as a commodity?

    • Why do we view some payments for use of one’s body as appropriate and others as inappropriate?

      • Prostitute

      • Surrogate mother

      • Professional Athlete

      • Labourer


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Human Cloning

  • For our purposes, to clone someone is to make a genetic copy of him/her

  • There may be a variety of ways of doing this

  • The way generally focused on today is by replacing the nucleus of an ova with the nucleus of an existing adult’s cell

  • The ova would then be stimulated so that it develops into an embryo.


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Therapeutic vs. Reproductive Cloning

  • Therapeutic Cloning vs. Reproductive Cloning

    • Therapeutic = producing a clone as a source of material for experiment and/or treatment

  • Some moral issues differ depending on the type of cloning being discussed

  • Our focus will be on reproductive cloning


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What’s So Bad about Reproductive Cloning?

Some typical concerns:

  • 'It's unnatural.'

  • Playing God

  • Dignity Issues

  • What is the moral status of clones?

  • Risks to the clone

  • Problems with the motivation of the person being cloned

  • Who would the parent be?

  • Note that reasons 1-4 are in principle concerns

    • 5 is a technical concern

    • What about 6 & 7?


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    Technical Concerns about Cloning

    • Technical concerns about the potential risk to the clone seem very real currently

      • E.g., problems with Dolly the sheep

    • Suppose they could be solved

      • Are the in principle objections to human reproductive cloning convincing?


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    In Principle Concerns about Cloning

    • Similar comments apply to the unnaturalness & playing God concern as before

    • The moral status of clones

      • Would clones be people like you and me?

      • Would clones have souls?

      • This objection is less often discussed than it once was

      • These days the worry is sometimes that clones would not be accorded their proper moral status (which seems to be a technical concern)


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    The Motivation of Those Being Cloned

    • Some claim that to want to clone yourself is to have a morally bad motivation.

      • Perhaps it's unacceptably vain.

      • Perhaps it involves seeing a clone as a means to an end, not as an entity that is valuable in and of itself

    • Must it involve this?

      • Imagine a heterosexual couple who wanted a child they were biologically related to, but suppose the woman had a genetic condition she didn’t want to pass on

      • Would it be wrong for them to use an ova from the woman and insert a nucleus from one of the man’s cells?


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    Who Would the Parent Be?

    • Both a legal and a moral question

    • Would the clone be a child or a sibling of the person cloned (or neither)?

    • The category of parent has both biological and social elements

    • At the very least, reproductive cloning would seem to call for some reflection of the idea of parenthood


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    Dignity Issues

    • Does cloning someone inherently disrespect the clone?

      • Will clones always (or almost always) be created simply as a means to some end?

      • E.g., reproducing a loved one, a great leader, an athlete, producing a source for a transplant


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    A Final Question

    • Opposition to IVF declined substantially after the birth of Louise Brown.

    • Is it reasonable to think that opposition to reproductive cloning would diminish if a healthy human child was born as a result of reproductive cloning?


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