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Reproductive Medicine
Issues over rights to control their body, in-vitro fertilization, preimplantation genetic diagnosis.
by Arthur L. Caplan, Glenn McGee
Many new questions of medical ethics have occurred as a result of developments in reproductive medicine. Most of the issues concern the rights of humans to control both their bodies and the embryos that can be created from their sex cells.
In the 1960s the development of the birth-control pill raised ethical issues, especially for people whose religions forbade the use of artificial birth control. In 1973 the Supreme Court of the United States legalized abortion with its landmark Roe v. Wade decision. Controversy surrounding the ruling, including discussion of the origins and meaning of personhood, the rights of the fetus and pregnant women, and the role the state should play in reproductive decisions, have kept abortion a volatile political and ethical issue into the 1990s. In the 1980s French researchers developed RU-486, a drug that can induce abortion without invasive procedures. RU-486 has contributed to the heated debate about the morality of abortion and is still awaiting approval from the Food and Drug Administration in the United States.
Infertility is also an important area of medical ethics. Many couples who are unable to have children turn to fertility-enhancing technologies for help. Artificial insemination (introduction of semen into the cervix through technical means rather than sexual intercourse) raised new ethical issues about how potential parents should choose sperm or egg donors, on what basis and with what assurances of privacy should donors be recruited, and whether donors are entitled to parental rights or financial compensation.
In 1978 the birth of the first so-called test-tube baby (a method in which fertilization of the ovum with sperm was conducted in a laboratory and the resulting embryo was subsequently implanted in the mother's uterus), was an important technological breakthrough. It was soon followed by the development of a variety of other in vitro fertilization (IVF) techniques. Not surprisingly, in vitro fertilization has raised significant ethical questions, including some about the safety and access to the costly technique. Because the IVF procedure may not be successful, doctors may fertilize and implant more than one embryo to increase the chances of success. Some experts have raised concerns about this practice because it increases the incidence of multiple births, which can create a health risk for both mother and babies, and place a heavy burden on the parents. When multiple pregnancies result, doctors can abort one or more of the embryos to improve the chances that the others will survive, but this raises additional ethical issues related to abortion. Questions have also arisen over what to do with fertilized eggs that are not implanted and the fate of human embryos if the couples who created them died, become incapacitated, or no longer want to have children.
The debate is further complicated by the use of tissues and organs from aborted fetuses for research or transplantation. Disputes about the ethical acceptability of using human embryos, either those frozen at infertility clinics or donated solely for experimentation in biomedical research has led to ethical and public policy debate about the moral status of embryos. Similar questions arose when scientists announced in 1998 that they had learned how to grow human embryonic stem cells in the laboratory. These cells can develop into almost any type of cell in the human body, and may one day lead to advances in transplantation and other medical fields. However, research on stem cells raises difficult ethical questions because the cells can only be obtained from human embryos.
Advances in prenatal diagnostic techniques such as genetic testing in the 1960s and 1970s made it possible to test a fetus (and more recently an embryo) for genetic diseases, such as sickle-cell anemia, and other disorders prior to birth. These techniques, including amniocentesis and chorionic villus sampling, led to discussions about the morality of using medicine to end pregnancies based on the predicted disability and quality of life that the baby might face. An experimental technique known as preimplantation genetic diagnosis could help couples avoid facing this difficult decision. This technique enables doctors to analyze the genetic material of embryos created through IVF before they are implanted in a woman's uterus. Only healthy embryos are then implanted. A related technique enables doctors to determine the sex of the baby before the embryos are implanted. Couples at risk of passing on a genetic disorder that affects males may choose to have a female baby. However, prenatal information, preimplantation genetic diagnosis, and sex selection could one day be applied to such traits as personality or intelligence, raising additional ethical questions about the rights of parents to design their descendants.
Posted: 2004-06-07 |
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