Reference no: EM131072538

Module - Home

BIOTECHNOLOGY AND REPRODUCTIVE RIGHTS
Modular Learning Outcomes
Upon successful completion of this module, the student will be able to satisfy the following outcomes:

Case

Explain the role that regulatory agencies should play in reproductive rights.

Identify and discuss the ethical principles that advocate for fairness in receiving fertility treatments.

SLP

Explore the ethical implications of abortion.

Discussion

Examine the ethical implications of abortion.

Module Overview

Reproductive Rights

Pursuant to the United States Constitution, individuals have certain guaranteed rights. Procreation is a guaranteed right. The guarantee extends to decisions regarding the social context within which one chooses to procreate, the number of children, and the partner. Two areas of ethical concern for healthcare providers are biotechnology and reproductive rights.

Reproductive rights recognize a constitutional right for the individual to control his or her method of procreation. Reproductive rights include the normal ethical protections extended to patients receiving other forms of healthcare services. One realm of reproductive rights involves methods for originating pregnancy. Assisted Reproductive Technology (ART) is the term that refers to the methods of "artificial" reproduction. Advances in technology have allowed couples to conceive and bear children using a multitude of non-traditional techniques.

What are the major types of procedures available today and what are some of the ethical issues associated therewith?

Intrauterine Insemination (IUI) - a procedure where the semen from the husband or a donor is treated in the lab in a manner that concentrates the motile sperm for insemination directly into the uterus. While this procedure does not present many ethical problems, there is a potential issue facing women over 40, whose success rate is lower than that of younger women. Should physicians perform these procedures, in light of the success rates, in lieu of more expensive procedures?

In Vitro Fertilization (IVF) - a procedure in which an egg is removed from a ripe follicle and fertilized by a sperm cell outside the human body; the fertilized egg is allowed to divide in a protected environment for about 2 days after which it is inserted back into the uterus. From religious perspectives, extracorporeal fertilization and use of donor gametes are unacceptable. In the U.S., the ethical implications of IVF are intimately linked with financial considerations. Women insist on transfer of an excessive number of embryos to ensure quick pregnancy. As evidenced by numerous cases, multiple pregnancies and premature births result from this approach. While insurance companies do not provide IVF coverage they will be forced to pay for the care and treatment of the premature births and potential life long complications.

Donor Eggs - used by women who cannot conceive viable pregnancies with their own eggs. This has allowed women well past the age of physiological menopause to conceive. Is it ethical to permit a 55 year old woman to conceive using donor eggs? What about a 60 or 65 year old? Is it ethical to forbid it? Should egg donors be anonymous? Should they be paid? If so, how much?

Surrogacy or Artificial Insemination (AI) - is categorized as either "traditional" or "gestational" surrogacy. In traditional surrogacy, the surrogate mother is inseminated with the semen of the future father. In gestational surrogacy, IVF embryos are transferred to the surrogate's womb. With AI, the surrogate is faced with giving up her baby. With gestational surrogacy, as seen in the case of Calvert v. Johnson, the surrogate may claim a maternal bond and refuse to give up the child.

The Debate

Generally, there are two approaches to the ethical assessment of the new technologies. First, the Conservative Approach emphasizes the biological integrity of human intercourse with in the social construct of marriage. According to Sydney Callahan: "In this 'act analysis,' no technological intervention in the sexual act is countenanced or approved for any reason."

The second approach, Autonomy of Individuals, focuses on reproductive rights and privacy of individuals and their desire for a child. Accordingly, with the protections of contractual rights and informed consent, any competent adult may engage in any ART procedure available.

Perhaps no topic has garnered more debate that abortion. The Autonomy perspective values a woman's right to choose. Conservatives oppose abortion based on the precept that the fetus is a person and deserving of basic human rights. The constitutional guarantees discussed earlier extend to the right of a woman to obtain an abortion. One definition of abortion is "the premature termination of pregnancy." Abortion is also defined as the expulsion or extraction of the products of conception from the uterus before the embryo or fetus is capable of independent life. Whether a fetus is a person or not is often the center of the abortion issue.

A second realm of reproductive rights is the freedom to terminate pregnancy through abortion. Some argue that abortion is immoral because it deprives the individual (fetus) of a future that he or she would otherwise have.

Others argue that while a fetus has some features of a "person," the fetus lacks other features; thus cannot be accorded the protections of a "person."

A third school of thought asks the question - not whether a fetus is a person; but - whether a person or not, do we have a right to do anything we want to the fetus? In other words, are there responsible actions that we can take relative to the fetus.

Which philosophical position do you agree with? Is any particular position more or less tenable in light of ethical theories and principles?

Ethical dilemmas arise when abortion is sought for specific selective reasons. An overwhelming number of people condone abortion for fetal deformities, defects or abnormalities. What message; however, does this send to the hundreds of thousands of disabled and handicapped members of society who lead productive and successful lives? What if the abortion is sought because the baby is a male vs. female, or vice versa (although history tells us that more girls are aborted than boys)?

Biotechnology

Biotechnology involves the manipulation of life. Two areas of biotechnology that prompt a plethora of ethical dilemmas and debates are genetic engineering and cloning.

Genetic Engineering

The American Heritage Dictionary defines genetics as, "The branch of biology that deals with heredity, especially the mechanisms of hereditary transmission and the variation of inherited characteristics among similar or related organisms."

Gene -- The fundamental physical and functional unit of heredity. A gene is an ordered sequence of nucleotides located in a particular position on a particular chromosome that encodes a specific functional product.

Gene mapping -- Determination of the relative positions of genes on a DNA molecule (chromosome) and of the distance between them.

Genome -- All the genetic material in the chromosomes of a particular organism; its size is generally given as its total number of base pairs.

Genome project -- Research and technology development effort aimed at mapping and sequencing some or all of the genome of human beings and other organisms.

Genetic engineering involves the alteration of genetic material in order to obtain desired characteristics. As a general proposition, prenatal diagnosis based on genetic testing is viewed positively. Genetic testing which allows prenatal diagnosis of fetal disorders cannot be anything but positive. Or can it? Do you see a risk of abuse with parents using prenatal testing in support of selective abortion? What if the abortion is based on the sex of the baby?

Cloning

Biotech research has attempted to perfect cloning in living organisms for over a decade. A clone is an exact copy made of biological material such as a DNA segment (a gene or other region), a whole cell, or a complete organism.

Cloning involves using specialized DNA technology to produce multiple, exact copies of a single gene or other segment of DNA to obtain enough material for further study. This process is used by researchers in the Human Genome Project, and is referred to as cloning DNA. The resulting cloned (copied) collections of DNA molecules are called clone libraries.

A second type of cloning exploits the natural process of cell division to make many copies of an entire cell. The genetic makeup of these cloned cells, called a cell line, is identical to the original cell.

A third type of cloning produces complete, genetically identical animals such as the famous Scottish sheep, Dolly.

Consider the ethical implications associated with the possibility of cloning human beings. Is the cloning of living organisms ethical? Should clones receive legal protection as human beings or exist solely for organ harvesting?

Proposals For Cloning

Proponents of Cloning have provided several proposals regarding the possibilities of cloning. These proposals range from possible medical/research benefits to environmental benefits.

The proposals include:

Cloning endangered species;
Cloning animals for research;
Cloning genetically engineered animals that produce valuable medicines or tissues;
Elimination of diseased mitochondria;
Cloning to solve reproductive problems;
Supplying tissues or organs for transplantation
Replacing a loved one.

The opponents of cloning have raised concerns about the procedure. The Center for Genetics and Society compiled the following list of arguments against cloning

Reproductive cloning would foster an understanding of people as objects that can be designed according to specific characteristics.

Reproductive cloning removes the sense of uniqueness of an individual.

Cloned children would at risk of mistreatment and constrained psychological or social development by the genetic donor.

Reproductive cloning is a risky procedure.

The acceptance of reproductive cloning could open the door for other dangerous applications of genetic engineering.

The debate is far from resolved, but the Center concludes that while cloning technology may improve our quality of life there must be safeguards in place to prevent this technology from causing harm.

Module - Background

BIOTECHNOLOGY AND REPRODUCTIVE RIGHTS

Required Reading
Bedford, E. L. (2012). Abortion: At the still point of the turning conscientious objection debate. HEC Forum, 24(2), 63-82.

Bellieni, C. and Buonocore, G. (2006). ASSISTED PROCREATION: TOO LITTLE CONSIDERATION FOR THE BABIES? Ethics and Medicine 22 (2), pg. 93.

Jedediah Purdy. (2006). The New Biopolitics: Autonomy, Demography, and Nationhood. Brigham Young University Law Review, 2006(4), 889-955.

Mallia, P.. (2010). Problems faced with legislating for IVF technology in a Roman Catholic Country. Medicine, Health Care, and Philosophy, 13(1), 77-87.

Newmeyer, T., Sandy, N. T., Jaworsky, D., Chihrin, S., Gough, K., Rachlis, A., . . . Mona, R. L. (2011). Case series of fertility treatment in HIV-discordant couples (male positive, female negative): The ontario experience. PLoS One, 6(9)

Optional Reading
Bancroft, E. (2010). Genetic testing for cancer predisposition and implications for nursing practice: narrative review. Journal of Advanced Nursing, 66(4), 710-737

Gable, L. (2010). Reproductive health as a human right. Case Western Reserve Law Review, 60(4), 957-996.

Rolison, J., Hanoch, Y., &Miron-Shatz, T. (2012). What do men understand about lifetime risk following genetic testing? The effect of context and numeracy. Health Psychology, 31(4), 530-533.