Redefining reproductionRedefining reproduction

Dr Anna SmajdorDr Anna SmajdorLecturer in EthicsLecturer in Ethics

University of East AngliaUniversity of East AngliaNorwichNorwich

acsmajdor@yahoo.co.ukacsmajdor@yahoo.co.uk

Deconstructing the family?Deconstructing the family?• IVF couples get Viking sperm!IVF couples get Viking sperm!• Multiple mothers’ spare babies abortedMultiple mothers’ spare babies aborted• No father requiredNo father required• IVF twins with 5 parentsIVF twins with 5 parents• The cloned baby with two mothersThe cloned baby with two mothers

- a selection of headlines from the Daily Mail- a selection of headlines from the Daily Mail

Snapshot from history

Male patient sought help for ‘infertile wife’ Pancoast established problem was with the husband Wife was told she needed to undergo treatment Chloroformed in front of watching medical students Inseminated with sperm from a student 9 months later, delivered a baby boy

1884: William Pancoast of Jefferson Medical

College, Pennsylvania, performs 1st documented

artificiaI insemination in human beings

Questions:

Who’s the father? Who’s the patient? Did this procedure cure a medical condition? If not, why was a doctor performing it?

“What reasoning led physicians to assume that they were providing treatment for infertility, when the technical act they were proposing may be understood as an alternative mode of conception to heterosexual intercourse?”

Novaes SB. The medical management of donor insemination. In Danies K, Haimes E (eds.) Donor Insemination: International social science perspectives. Cambridge University Press. pp105-130. 1998. p.106.

Why the need to (re)define?Why the need to (re)define?

• Reproductive rights• Reproductive needs• Funding• Legal questions:

• Defining parenthood/parental responsibility

Should some procedures – ie reproductive cloning – be illegal? If so, why?

1978: 1st IVF child born – no

Regulatory framework in place

Public concern: ‘test-tube’ babies;

Warnock report: to look into ethical/legal issueso IVF to be allowed under licenceo Welfare of the child (+ need for father)o Consent of both parents of vital importanceo Formation of the HFEA

HFE Act passed in 1990

Keeping IVF within a heterosexual nuclear family paradigm

Unruly reproductive technologyUnruly reproductive technologyGamete donation; Surrogacy; PGDSaviour siblings; sex selection; same sex/single parenthood; Postmenopausal motherhood; ooplasmic

transplant

IVF and reproductive technologies are unruly –it’s hard to keep them within set clinical boundaries. Continually developing new possibilities + applications, raising new ethical + legal questions.

[Levitt M. Assisted Reproduction: Managing an Unruly Technology. Health Care Analysis. Volume 12, Number 1. 2004.]

Future challenges: artificial gametes; reproductive cloning

Biological parenthoodBiological parenthood

Gametogenesis – artificial gametes/gamete donationIntercourse – reproductive tissue transplantConception – IVF Gestation – surrogacy Labour – surrogacy Breastfeeding – bottle

Can all be undertaken by a variety of different people, in a variety of places – outside or inside the body!

New reproductive technologies have dissolved the biological boundaries to reproduction

Who is the ‘real’ mother?

Cloning = reproduction?Cloning = reproduction?

John Harris: the only good argument against it is harm to the cloned child. If little/no harm caused, cloning should be allowed...the right to clone could be part of reproductive autonomy.

(quoted in science & technology report 2004-5)

World Health Organisation: cloning ‘replicates individuals’, is contrary to human dignity and integrity’

Public more accepting of cloning if provided to infertile heterosexual couple.

Shepherd R, Barnetta J et al. Towards an understanding of British public attitudes Shepherd R, Barnetta J et al. Towards an understanding of British public attitudes concerning human cloning. Social Science & Medicine. 65; 2; 377-392. 2007.concerning human cloning. Social Science & Medicine. 65; 2; 377-392. 2007.

Interfering with nature

John Stuart Mill: two understandings of nature:

1.‘Collective name for everything which is’ (ie everything is natural)

2.‘That which takes place without human intervention’ (ie everything we do is unnatural)

What is the symptom being treated in today’s What is the symptom being treated in today’s fertility clinics?fertility clinics?

Infertility?

Non-conception?

The desire for a baby?

Problem – if desires are being treated, how do we make distinctions between those we deem eligible and those we don’t?

NICE guidelines for IVFNICE guidelines for IVFA woman is eligible for IVF ifo She has a male partnero Who has a fertility problem (eg low sperm count) o Even if she herself is in perfect reproductive healtho Need for treatment defined not by clinical factso But by the social tie – choice of partnero Woman is treated, but she could have a child with someone

else

Compare with a woman who is physiologically identicalo Also in perfect reproductive healtho Also has chosen a partner with whom she cannot conceive

‘naturally’ – another womano Is not eligible for treatment – because of the social tie: choice

of partner. If she chose a different partner – she would be eligible

Legislation & ethics at the new frontierLegislation & ethics at the new frontier

• Biological facts no longer serve to denote legal/ethical/medical limits of reproduction

• Boundaries must be renegotiated, acknowledging socially/moral component

• Pressure on current legal + regulatory approaches – inconsistent and discriminatory

Bewley, S, M Davies, and P Braude. 2005. Which career first? British Medical Journal Bewley, S, M Davies, and P Braude. 2005. Which career first? British Medical Journal 331:588-589.331:588-589.

Templeton, SK. 2006. Late motherhood as ‘big a problem’ as teenage mums. The Templeton, SK. 2006. Late motherhood as ‘big a problem’ as teenage mums. The Times.Times.

Schempf, Ashley H, Amy M Branum, Susan L Lukacs et al. 2007. Maternal age and Schempf, Ashley H, Amy M Branum, Susan L Lukacs et al. 2007. Maternal age and parity-associated risks of preterm birth. Paediatric and Perinatal Epidemiology 21:1, parity-associated risks of preterm birth. Paediatric and Perinatal Epidemiology 21:1, 34–43.34–43.

Deneux-Tharaux, C, M.H. Berg, M Bouvier-Colle et al. 2005. Underreporting of Deneux-Tharaux, C, M.H. Berg, M Bouvier-Colle et al. 2005. Underreporting of Pregnancy-Related Mortality in the United States and Europe. Obstetrics & Pregnancy-Related Mortality in the United States and Europe. Obstetrics & Gynecology 106(4): 684 - 692.Gynecology 106(4): 684 - 692.

Hebert, PR, G Reed, SS Entman et al. 1999. Serious maternal morbidity after Hebert, PR, G Reed, SS Entman et al. 1999. Serious maternal morbidity after childbirth: Prolonged hospital stays and readmissions. Obstetrics and Gynecology childbirth: Prolonged hospital stays and readmissions. Obstetrics and Gynecology 94(6):942–7.(p942).94(6):942–7.(p942).

Grimes, DA. 1994. The role of hormonal contraceptives: the morbidity and mortality Grimes, DA. 1994. The role of hormonal contraceptives: the morbidity and mortality of pregnancy: still risky business. American Journal of Obstetrics & Gy-necology 170 of pregnancy: still risky business. American Journal of Obstetrics & Gy-necology 170 (5S) Supplement: 1489-1494.(5S) Supplement: 1489-1494.

Chadwick, R. 1992. Ethics, reproduction and genetic control. New York: Routledge Chadwick, R. 1992. Ethics, reproduction and genetic control. New York: Routledge (pxvi).(pxvi).

Henderson, M. 2005. Trauma of infertility is worse than cancer, says Winston. The Henderson, M. 2005. Trauma of infertility is worse than cancer, says Winston. The Times.Times.

Morgan SP. Is Low Fertility a Twenty-First-Century Demographic Crisis? Morgan SP. Is Low Fertility a Twenty-First-Century Demographic Crisis? Demography, Vol. 40, No. 4 (Nov., 2003), pp. 589-603 Demography, Vol. 40, No. 4 (Nov., 2003), pp. 589-603

Hertzman, C, and M Wiens. 1996. Child development and long-term outcomes: a Hertzman, C, and M Wiens. 1996. Child development and long-term outcomes: a population health perspective and summary of successful interventions. Social population health perspective and summary of successful interventions. Social science and medicine 43;7; 1083-1095science and medicine 43;7; 1083-1095