1. Introduction to Reproductive Ethics James J. Hughes Ph.D. Executive Director, Institute for Ethics and Emerging Technologies

2. Reproductive Rights? Bodily autonomy Women’s rights Rights to what? Balancing mother’s interests with father’s, child’s, family’s, society’s interests Rights from, rights to

3. Contraceptive Freedom Uncoupling sex and reproduction Comstock laws (1873) banning distributing of contraceptives or contraceptive information U.S. Supreme Court case Griswold v. Connecticut (1965) struck down Comstock laws in CT & MA for married couples. Eisenstadt v. Baird (1972) extended to unmarried persons as well.

4. Rights to What? Not be raped Choose to reproduce or not To contraception To abortion, selective or other reason To fertility assistance To genetic choice To public financing of choices

5. Prenatal Diagnosis Prenatal Counseling Pre-implantation Genetic Diagnosis Chorionic Villus Sampling (CVS) Ultrasound Amnioscentesis Sperm sorting Home tests Risks of amnio False negatives and false positives Disability rights/eugenics complaints

6. Abortion Rights 1973 – Row v Wade Trimesters and viability Hyde Amendment (1976) bans public financing Do reasons matter? Health, rape, incest What is legitimate regulation of safety? What is legitimate informed consent? Pre-abortion counseling, trans-vaginal ultrasound Access for minors

7. Abortion Milestones

8. Catholic Doctrine A child has rights from conception A child has the right to be conceived in a sex act, nurtured in the womb, born, and raised by male and female married parents. Forbids contraception, abortion, in-vitro fertilization and all ARTs, all interventions in reproduction

9. Who Has Interests? Legal persons Future persons Potential persons? Personhood Psychological vs. biological Embryo Fetus Preemie Newborn

10. Does Body Autonomy Trump? Waking up attached to a VIP

11. Baby K: Anencephaly Born in 1992 with anencephaly and placed on a ventilator.anencephaly Hospital personnel urged a DNR order and to discontinue ventilator treatment for Baby K.DNR order Mother refused to permit either. The hospital filed suit to get permission to refuse treatment. The court sided with mother, and denied hospital right to determine that treatment was futile or inhumane

12. Using Embryos in Research Using human embryos in research Embryonic stem cells Leftover embryos from IVF Embryo tissue from abortions (Financial incentives for abortions?) Risks from purchased eggs

13. In Vitro Fertilization Artificial insemination by husband or donor In virtro fertilization (IVF) Egg or embryo donation

14. Sperm Banks and Egg Sales Should individuals be allowed to profit from the sale of sperm, ova or embryos? Many countries ban sperm and egg sales Austria and Italy ban all egg and sperm donations for IVF. Germany and Norway ban donating eggs, but not sperm. Mandating disclosure of identity

15. Fertility Clinics Risks of ovulation induction Informed consent about success rates What should be done with gametes/embryos that are no longer required by the donor couple for their own joint reproductive purposes? Who should control their use?

16. Lesbian and Single Women France and Italy forbid IVF and artificial insemination for lesbians and single women Switzerland requires couples to be married Sweden requires a one year stable relationship

17. Surrogate Motherhood Commercial surrogacy banned in Europe and Canada Developing world surrogates Mary Beth Whitehead (1986) and Baby M Genetic claim Birth mother claim Contract claim Best interest of child claim

18. NICUs, Artificial Uteri Neonatal intensive care units (NICUs) Medical futility vs. Baby Doe protections Moving line of viability Artificial uteri

19. Designer Babies Rights of parents to genomic choice Parents trusted with best interests of child Ensuring best fit of parents and child Burdened expectations

20. Procreative Beneficence If you have a reproductive choice you are obliged to choose the child with the best possible chance of fulfilling the widest range of life’s possibilities Also “procreative altruism” – an obligation to have the best child for the community Julian Savulescu

21. Sex Selection Sperm sorting Prenatal diagnosis and selection Family balancing versus patriarchy Rights of “missing girls” versus their reluctant mothers Infanticide versus abortion Alternative solutions: women’s education

22. Eugenics Selective breeding applied to humans, with the aim of improving the species. Popular in US & Europe in early decades of the 20th century Now associated Nazi Germany.

23. States with Eugenic Laws

24. Reproductive Cloning Methods Natural twinning Induced twinning Nuclear transfer Arguments Safety to mother(s) and child Right to uniqueness Instrumental parenting

25. Germline Therapy Are we obliged to protect human genomic diversity? Isn’t it better to pass a better genome to your children? With syn-bio no sequence is ever really “lost.” Mitochondrial transfer: nuclear transfer to embryo with healthy mitochondria

26. Genetic Enhancement Transfer of desirable existing traits from other human genomes …from animals …from novel sequences To enhance Health, beauty and longevity Physical and mental abilities

27. Review Expanding frame of reproductive rights to include positive claims to technological enablement Contraceptives Prenatal Diagnosis Abortion rights, fetal personhood debate In-vitro fertilization Sperm banks and egg sales Fertility clinics Lesbian and single women access Surrogate motherhood

28. Review NICUs and artificial uteri Designer babies Procreative beneficence Sex selection Eugenics Reproductive cloning Germline therapy & mitochondrial transfer Genetic enhancement

29. For more information Institute for Ethics and Emerging Technologies ieet.org These slides: http://ieet.org/archive/20140402ReproEthics.ppt Me: james.hughes@trincoll.edujames.hughes@trincoll.edu