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ETHICS AND EMBRYOS

ETHICS AND EMBRYOS. Ruth Deech Gresham Professor of Law 2010. The Embryo. At 3 days At 5 days. The First IVF Baby. Born in England 1978 Sparked off global debate Became a nursery nurse Has her own child. The Warnock Report. 1984: people need principles Moral consensus Regulate

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ETHICS AND EMBRYOS

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  1. ETHICS AND EMBRYOS Ruth Deech Gresham Professor of Law 2010

  2. The Embryo • At 3 days • At 5 days

  3. The First IVF Baby • Born in England 1978 • Sparked off global debate • Became a nursery nurse • Has her own child

  4. The Warnock Report • 1984: people need principles • Moral consensus • Regulate • Human Fertilisation and Embryology Act 1990 • Anne was a member

  5. UK Human Fertilisation & Embryology Authority • Established by 1990 statute • Licences and monitors clinics, laboratories, IVF, embryo research • 21 members appointed after advertisement

  6. Benefits of regulation • Protection of the embryo • Welfare of the child • Record of treatments and donors • Control of market forces • Answerable and representative • Looking ahead

  7. The Realities of Regulation • The constraints of the legal framework • Resources need to enforce and defend in court • The power of the media and images • The pressure from politicians

  8. Ethics • Human dignity, worth and autonomy • The welfare of the potential child • Safety • Respect for the status of the embryo • Saving life through new technology

  9. Embryo research • Advances in the treatment of infertility • Causes of congenital disease • Causes of miscarriage • Techniques of contraception • Gene and chromosomal abnormalities • Development of embryo • Serious diseases

  10. Discovery of Stem Cells • James Thompson of Madison Wisconsin • Obtained stem cells from a human embryo • Research funded by Geron Corp • Patented by Wisconsin alumi

  11. What are Stem Cells? • Derived from early human embryos of a few days’ growth • Adult stem cells derived from bone marrow, skin, umbilical cord, blood • They are the origin of all our cells • Will help us to understand disease • Might make cells and tissue for transplantation and renewal

  12. Therapeutic cloning

  13. Stem cells • From embryos or adults • Totipotent and pluripotent • Grow new tissue • Bank stem cell lines

  14. Stem Cells and Cures • Nerve cells might cure Parkinson’s, Alzheimer’s, spinal cord injury, stroke • Embryo cells might help infertility • Heart muscle cells for heart disease • Blood cells for cancer, leukaemia • Skin cells for burns and wounds • Bone cells for osteoporosis

  15. The Ethical Debate • Catholic Church believes that life starts at conception • Cardinal Trujillo announced excommunication for stem cell research

  16. The Different Views • Christopher Reeve supported research • Jewish position that healing is an obligation • Many embryos are left to perish after IVF

  17. Supporters of Research I • Nancy Reagan and Michael J. Fox spoke up for it

  18. Supporters of Research II • John Kerry (with Mrs. Reeve) debated with President Bush • Presidents Ford, Carter and Clinton

  19. Presidential Ban on Funding • August 2001 President Bush announces ban on federal funding for stem cell research derived from embryos • Existing lines may be used • Private research unchecked

  20. Obama lifts ban • March 2009 ends Bush ban • NIH guidelines July 2009 http://stemcells.nih.gov/policy/2009guidelines.htm

  21. New rules • Federal funding allowed for surplus IVF and PGD embryo research • Donated after informed consent from donors • Pre-existing stem cells may be used if ethically obtained

  22. New limitations • No federal funding for research on animal-human embryos • Nor for cloned embryos • Nor for embryos created for research

  23. California • Proposition 71, 2004, state funding for stem cell research • California Institute for Regenerative Medicine • Independent Citizens’ Oversight Committee • Wider than national guidelines

  24. PGD

  25. Preimplantation genetic diagnosis • Unite sperm and egg in the laboratory • Fertilised egg grows to 8 cell size • Remove 1 cell and test for disease • Test also for compatibility (HLA)

  26. Screening • For beta thalassaemia in Cyprus, Iran • For Down’s Syndrome • Preimplantation or abortion • Breast and bowel cancer genes identified in the embryo

  27. The Hashmi Family • Zain suffered from beta thalassaemia and needed blood from a compatible sibling • Need an embryo free of the disease • Need an embryo that is also compatible

  28. Screening out Disease • Cystic fibrosis • Down’s Syndrome • Beta Thalassaemia (Greek for sea/blood) • Sickle Cell disease • Breast and Bowel cancer • Huntington’s disease • and more to come

  29. Society should adapt to the disabled They will be seen as unworthy There will be fewer Should be able to choose a deaf embryo Help and cure does not mean unworthiness Antidiscrimination laws and compassion have increased Every baby should be given the best chance and not predetermined Disability and screening

  30. Choosing the Sex of Your Children • The Mastertons had four boys and lost their only girl • Should they be allowed to use embryo selection to have another girl?

  31. Boy or Girl? • China – 117 boys to 100 girls • Right to only one child • Girls less likely to be registered

  32. Why so Few Girls? • Similar trend in India • Ultrasound scanning shows up sex • Female foetuses aborted • Can attitudes be changed?

  33. Medical Reasons for Sex Selection • Haemophilia and Duchenne’s muscular dystrophy affect only males • Autism? • If there is a family history of this, choose a girl • Achieved by preimplantation genetic diagnosis

  34. Non-medical Reasons for Sex Selection • Family balancing • Rebuild a family after the death of a child • Religious, cultural and economic reasons for wanting boys • Remove one cell from a 3-day old embryo • Analyse the chromosomes and DNA • XX = girl, XY = boy

  35. World’s oldest mother • Ms Bousada del Lara of Spain • Lied that she was 55 to get treatment at 66 • Gave birth to twin boys • Died of ovarian cancer when they were 2

  36. Fertility For Ever • Frozen eggs give hope to young cancer patients

  37. As Fertile as a Man • Career women can put their eggs on ice until the time and the man are right

  38. Becoming a Father After Death • Diane Blood took her husband’s sperm after his death from meningitis

  39. The power of the Image • Diane Blood and her baby • Sperm taken from dead father

  40. New British law • Animal-hybrid embryos • Two mothers

  41. Failure to regulate • Nadya Suleman gave birth to octuplets 2009 • Likely that 6 embryos were implanted and two split into twins • She used all 6 remaining from previous IVF treatment

  42. Two embryo rule • Suleman case led to Georgia bill to limit number, but this provision did not pass • HFEA limits embryos to two for women under 40 • Triplet rate has dropped since 2001

  43. Attitudes to regulation • Similarities to medical insurance v National Health Service contrast • Welfare of the baby v a woman’s “right” to be a mother • Everything that money can buy v medicine in the interests of the community • Commodity v dignity

  44. Sperm donation • HFEA Code rules; no payment other than expenses; children conceived after 2005 may be given identifying information when they reach 18

  45. Making money

  46. Global (In)Fertility: Anthropological Research on Assisted Reproduction Rayna Rapp, PhD Anthropology, New York University

  47. Anthropological Analysis of PGD, UK

  48. Infertility Treatment in Egypt Local Babies, Global Science By Marcia Inhorn

  49. Ultrasound in Canada Baby’s First Picture by Lisa Mitchell

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