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

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

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

SNUPPY

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

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” 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 8/22/02 abc news 8/22/02

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.

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

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

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

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.” “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 Chicago Sun Times 4/10/ 02

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

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

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

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