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.go v/policy/2009guideline s.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. Disability and screening 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

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

48. Anthropological Analysis of PGD, UK

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

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

51. Technologies of Pregnancy in Israel and Japan

52. IVF in Israel

53. Health-Tourism.com IVF Vacation.com

54. Trends in crude birth rate, world and major areas, 1960-2020*

55. Inter-country adoption to selected receiving countries, 1995 to 2006

56. Number of ART cycles reported in US

57. Twins, by country

58. Multiple births in US, 1989-1999 Twins Triplets Quadruplets Quintuplets or more

59. Number of ova donations, by country

61. Daphna Birenbaum-Carmeli & Marcia Inhorn, eds

62. Destabilizations of Late Modernity (Birenbaum-Carmeli & Inhorn, eds) sex/ reproduction nature/ culture gift/ commodity informal/ formal labor biology/ sociality heterosexuality/homosexuality the local/ the global secular/ sacred

63. Useful Concepts Moral Pioneers Stratified Reproduction