Medical Ethics 2 Flashcards
Process of IVF
In Vitro Fertilisation
* Hormones used to stimulate egg production from ovaries
* Eggs are retrieved
* Mobile sperms are selected and injected into each egg
* 2-5 days later the fertilised eggs become embryos and 1-3 are placed in a thin catheter and inserted into the uterus
* embryos that aren’t transferred are frozen in liquid nitrogen, these can be used in subsequent cycles if the first attempt is unsuccessful
Scientific issues with IVF
- 1/7 couples in the UK have trouble conceiving
- IVF is successful for 29% of women under 35 and 23% of women 35-37
Legal issues with IVF
*clinics must decide whether couples will be suitable parents
*choosing sex of a baby using IVF is currently illegal
*since 2005, eggs and sperm cannot be donated anonymously
*if one partner removes consent to use their gametes, embryos must be destroyed
Political issues with IVF
*NHS recommended: women between 23 and 39 given 3 free cycles; women aged 40-42 given one
*41% of IVF treatments are funded by the NHS
*waiting times vary across the UK
*suggested age limit in England and Wales is 42 years old
Economic issues with IVF
- in 2018, the cost of one cycle was £5000 approximately
- the number of clinical commissioning groups offering the recommended three cycles has fallen from 16% (33) to 11.5% (24) in a year (2018)
- Croydon, in 2017, became the first London borough to stop funding IVF to save £836,000 annually
IVF by donor
- a woman may donate some of her eggs for another person’s treatment
- a man may donate sperm to fertilise donated eggs
- an embryo may be donated by another person
- risks: high blood pressure and preeclampsia are associated with IVF using donor eggs
IVF by family
- can help overcome infertility in both men and women
- can use donated eggs or sperm
- can help improve the chances of having a healthy baby
General arguments for IVF
- couples have a right to try for children, we should help those who are ill
- people could be saddened by infertility, Jesus would show compassion and heal
- ‘Go fourth and multiply’- using science to fulfil God’s plan
- doesn’t violate sanctity of life principle if no embryos are destroyed or if they only fertilise embryos they are going to implant
General arguments against IVF
- children are not a right but a gift
- IVF makes children like material possessions
- if embryos are destroyed, it violates the sanctity of life principle
- undermines sanctity and exclusiveness of marriage
- separates sex from reproduction- against natural moral law
- there are many children who need to be adopted
- costly with low success rates
- 1 Corinthians 10:23: ““Everything is permissible”- but not everything is beneficial. “Everything is permissible”- but not everything is
constructive.”
Catholic Church on IVF
- Humanae Vitae: a person must be respected as such from the very first instant of existence as a human being
- an unborn child must be the fruit of marriage
- IVF violates the rights of the child, perhaps depriving them of a relationships with their biological parents (hindering the maturing of their
personality) - it threatens the unity and stability of a family
- can lead to the destruction of life (violates SoL)
Church of England on IVF
- accepts it in all forms, including donation of gametes from third parties
- experimenting on ‘spare’ embryos is acceptable up until 14 days after fertilisation (primitive streak) (1984 report “Human Fertilisation and
Embryology”) - “We support the recommendation that research, under license, be permitted on embryos up to 14 days old and agree that embryos should
not be created just for scientific research” (Anglican report 1994)
Methodist Church on IVF
- believes it is right for scientists to try to learn more about causes and cures for infertility
- accepts using ‘spare’ embryos in medical research, but only before 14 days after fertilisation
Orthodox Church on IVF
- it is against IVF
- destroying embryos amounts to killing because human life, dignity and rights start at fertilisation
Cristobal Orrego
- a right is something tht is due to a person because that individual qualifies for it, so the question is do humans have the right to a child?
- A woman is a free agent, freedom including: a) a woman’s right to use her body as she sees fit; b) the freedom of choice. So, a woman
has the right to choose IVF if available - Natural rights: women feel a natural urge to be a mother, so denying motherhood to is against natural rights.
- However: naturalistic fallacy. A natural urge does not equate to a natural right
- Some argue that motherhood is not a right but a liberty (a privilege). It can be withdrawn if society thinks it is being abused or is not in
the interests of the majority
Who has the right to a child (IVF)?
- in UK, treatment is restricted to those under 50, but elsewhere fertility treatment has been used on women up to 70. Some see this as
against nature - It may be wrong to allow parents to be very elderly or dead by the time their children are adolescents
- Should treatment be given to single women or lesbian couples: October 2009, the Human Fertilisation and Embryology Act was amended so clinics no longer have to consider the ‘need for a father’ when assessing suitability for treatment
- instead, people will be assessed on their ability to offer supportive parenting. Sexual orientation is no longer a factor in the eyes of the
law
Moral status of fertilised embryos (IVF)
- when eggs have been fertilised only 2 or 3 are implanted (the ones graded as best)
- unused embryos may be: frozen and made available for later implantation, used in medical research (and then destroyed within 14 days
of fertilisation) or donated to other women, or destroyed - returns to question of when personhood begins
Moral status of the biological father (IVF)
- UK clinics can only pay expenses such as travel and loss of earnings to the donor. This is not the case in other countries.
Commercialisation raises issues about the relationship of the donor to the child. - The right to know: children born using donor sperm may wish to know their biological father later in.
- Before 2005, donors could remain anonymous. Children born after this date have the right to access details about the donor when they
are 18 - However, donors can still refuse contact with their donor-conceived child which can be psychologically damaging
- Legally, donor fathers are not required to take on any responsibilities for their donor-conceived children, but this doesn’t rule out questions about moral responsibility
Surrogate mothers (IVF)
- A women may not want to give up a child she carried for 9 months- a unique relationship
- In England surrogacy is not recognised by law, so there can be no legally binding agreement drawn up- in two cases in the UK, the
courts ruled against the surrogate - gay couples may be granted permission to use a surrogate by NHS and social services. However, the birth certificates for an IVF child
can contain the name of a single woman or two women - does a child need a female role model?
- this can break the deontological principle of treating people as and end in themselves rather than a mere means
Payment to surrogate mothers (IVF)
- it is illegal to pay for a surrogate in the UK, but legal in the US
- is it morally acceptable to buy and sell part of the human body? Does this devalue human life, go against natural order, or allow risk for
exploitation? - Surrogacy should be seen as a job just as prostitution is (Cecile Fabre)
- as children are not harmed by there being a surrogate, it is arguably permissible
Costs and the NHS (IVF)
- Practicality: IVF is expensive and prone to failure. NHS has limited funding and other services need to be prioritised. Any treatment that is
not for bettering of ill health cannot be justified - Psychological effects: the effect of not being able to have a child could have long lasting consequences for individuals, e.g. clinical
depression. Help will then be sought from the NHS anyway
History of Genetic Science
- plants and animals have been selectively bred for centuries
- 1970s, scientists learnt how to move pieces of genetic material between species
- Dolly the sheep- the first animal to be successfully cloned in 1996
- Human Genome Project- completed in 2003, all 46 chromosomes in the human body were mapped
Concerns with genetic science
- Eugenics- producing a society through the promotion of higher reproduction of people with more desired traits. and sterilising/killing those
with undesirable traits - e.g., Hitler’s ‘Aryan Race’
- sanctity of life seems to be violated
- long term effects include narrowing the gene pool, which can lead to children being born with defects
Dolly the Sheep
- born July 1996 to three mothers (one provided the egg, the other the DNA and the other carried the cloned embryo)
- was created using the somatic cell nuclear transfer technique, where the nucleus from an adult cell is transferred into an unfertilised oocyte
(developing egg cell) that has had its nucleus removed - the hybrid cell is ten stimulated to divide by an electric shock, and when it develops into a blastocyst it is implanted into a surrogate mother
- she was capable of reproduction, having had 6 lambs
- developed arthritis at 4, despite this being associated with old age
- she died at 6, half as young as sheep of her breed normally do, but this is not unusual for a sheep kept inside
Potential effect of cloning sheep
- we could resurrect extinct species and help breed endangered ones
- could produce food
- could eliminate diseases such as cancers
-however - Dolly was the only lamb out of 227 to survive to adulthood
- Wilmut, who led the team that created Dolly, announced in 2007 that the nuclear transfer technique may never work for humans
- 2003, Human Genome Project was competed, so we have the knowledge needed to clone us, but many object
Therapeutic Vs Reproductive cloning
-Therapeutic
* embryonic stem cells produced for use in replacing or repairing damaged tissues or organs, achieved by transferring a diploid nucleus from a
body cell into an egg, the nucleus of which has been removed
* an embryo develops in laboratory conditions
* creates embryonic stem cels used to treat diabetes and Alzheimer’s
-Reproductive
* deliberately produces genetically identical individuals; each newly produced individual is a clone of the original
* an embryo develops under uterine conditions
* important for harvesting stem cells that can be used to study embryonic development
-The main difference is that therapeutic is used for treating diseases while reproductive is used to harvest stem cells to study embryonic
development
British Humanist Association (2003) on Embryo research
“At the early stage where research is focused, an embryo has few of the characteristics
we associate with a person…its cells have not yet begun to form into specialist cells that would form particular parts of the body…an early stage
embryo cannot suffer”
Joint Committee on Bioethical Issues of the Catholic Bishops of Great Britain (1987) on Embryo Research
“The fact that some days elapse before
one can identify which cells will become placenta and which ‘embryo proper’ in no way justifies the claim that during those days there is something
other than an individual”
Genetic Engineering
Argued to be a continuation of what breeders had been doing for centuries and what nature does anyway, but others call it playing God and unnatural
Uses tissues and cells (mainly stem cells) from embryos to repair damaged tissues/organs. This destroys the embryo.
UK law prohibits embryo experimentation past 14 days, placing human embryos into animals, and human cloning
The Human Fertilisation and Embryology Authority allows embryo research for the following purposes:
-Advances in fertility treatment
-Increasing knowledge of congenital diseases
-Increasing knowledge about the causes of miscarriage
-To develop forms of contraception
-To develop means of detecting chromosome abnormalities
Designer Babies
human genes can be selected for removing genetically inherited diseases (such as Huntington’s or Cystic Fibrosis), genetic
conditions (such as Down’s syndrome), creating healthy babies or selecting the sex of the baby (which is illegal in the UK).
Requires IVF to select a desired embryo and discard the others
2002, Michelle and Jayson Wittaker asked the Human Fertilisation and Embryology Authority if they could genetically select an embryo which
would be a match for their son who had a life threatening blood disorder. They were refused because it was not a hereditary condition and went to
the USA for IVF.
2003, the Hasmis had a son with a rare blood disorder who urgently needed a bone marrow transplant. They were granted permission to select an embryo after many months discussing with courts.
Embryo Research
- aims to find cures for serious illnesses using tissue from embryos
- most concentrate on stem cells and regenerative medicine (repair of damaged organs and body parts)
- Stem cells have the potential to specialise into any other type of cell
- Tw0 broad types of stem cells: embryonic (are isolated from the inner cell mass of blastocysts) or adult (which are found in various tissue)
- there is debate surrounding the use of embryo stem cells, less so about adult stem cells
Where do embryos for research come from?
- have been spontaneously aborted- consent given by the mother- death is accidental and unavoidable
- left over from fertility programs and are surplus after IVF maybe
- specifically produced for research- donation eggs/sperm
- on embryos which will be returned to the mother- after they have received gene therapy to replace defective genes
[find issues]
PGD/PID
Preimplantation Genetic Diagnosis
* PGD is considered another way to prenatal diagnosis
- when used to screen for a specific genetic disease, its main advantage is that it avoids selective pregnancy termination as the method makes
it highly likely that the baby will be free of the disease under consideration - PGD thus requires IVF to obtain embryos for evaluation
- involves removing a single cell from the embryo after 5 days and testing on that cell. They check for genetic conditions known in the family or
the sex or even if the child can help treat a sick sibling - armed with this information the couple will decide whether to implant the embryo
Saviour Siblings
- a child born to produce stem cells to save the life of a sibling
- regulated by the Human Fertility and Embryology Association
- not born to help parents, specifically siblings
- HFEA Criteria: condition must be life threatening, must be hereditary, all other methods have tried and failed, no danger to the health of the
foetus, parents must have counselling, they must take part in research
Catholic Church on Embryo Research
- rejects anything that involves destroying a life because of the sanctity of life principle
- because the embryo qualifies as a human being, the Church opposes research using embryonic stem cells
- however, because adult stem cells do not depend on the destruction of a life to be used and can also save lives
- U.S. conference of Catholic Bishops: “the Church favours ethically acceptable stem cell research…We must respect life at all times, especially
when our goal is to save lives.”
Sex Selection
same same objections as IVF- means some embryos are discarded
Genetic Testing
- as in testing for genetic diseases, for example, whether a patient is carrying the gene which produces breast cancer or sickle cell
anaemia - usually only gives a probability of developing the disorder and is subject to laboratory error
- ethical question of whether results should be totally private
- question of whether non consenting family members should be informed of results
Genetic Screening
- done on sections of the population who are known to be at risk
- can encourage changing lifestyles to reduce danger of the disease
- could lead to discrimination: Jewish committee in New York hoping to prevent Ashkenazi Jews who carry the Tay-Sachs gene from
marrying - could also lead to abortions- implications, slippery slope, what could become grounds for abortion (aggression gene?)
Gene Therapy
- correcting, altering or replacing genes
- has been successful in some cases but has caused issues (sickle cell anaemia which is prevalent among afro-caribbeans, the gene
can really harm a few but gives immunity to malaria) - problem of increasingly frequent discoveries of diseases with genetic bases, what to screen for
The Alteration of Human Genes
- used to target somatic (body) cells, in which the patient’s genome is changed or to gametes, in which they’re changed to pass
changes on to future generations - Germ Line therapy: often confused with genetic selection but is not being investigated in larger animals or humans
- ethically questionable, implications for what mankind becomes
- alteration of somatic cells raises few ethical questions and can treat fatal diseases though, when gene therapy is used on a foetus,
there is a slippery slope argument to be made with normal inherited characteristics (obesity, below-average intelligence, poor eyesight)
becoming grounds for alteration or abortion - could create inequality, rich become more genetically rich too
- many diseases involve many genetic combinations and the environment also
Natural Law approach to Embryo Research
- all things have a telos, and human rationality can find this and judge what is right from it
- primary precept of self preservation may lead to secondary precept of ‘no embryo research’ as this destroys life
- however, by preserving life, embryo research could be justified by the same precept
Utilitarian approach to Embryo Research
- does not accept absolute value and sanctity of life, attempts to assess each situation to find happiness for a majority
- requires an understanding of the future, but it is difficult to determine whether embryo research will be worth the lives lost
- however, could be argued that it is in the interests of the majority to destroy a few embryos now to save lives in future
- hedonic calculus can only be applied to those who suffer, but embryos don’t
Deontological approach to Embryo Research
- the categorical imperative: always applies, treating others as an ends always
- both genetic engineering and embryo research are difficult to universalise; e.g. create embryos for stem cell research- universalised
would mean no more babies - embryo research arguably uses people as a means to an end
- emphasis on duty rather than compassion and emotion means consequences are ignored, so it is the intrinsic morality of an action
that counts rather than potential lives saved
Virtue Ethical approach to Embryo Research
- person centred rather than focusing on act or result
- Celia Deane-Drummond: attempts to apply virtues of prudence, justice, fortitude and temperance to medical issues
- virtue of compassion could be used to show embryo research as good (compassion for those suffering)
- emphasises that our actions are not in a vacuum but affect and influence those around us
- Alasdair MacIntyre: people are basically communitarian and communities are held together by the virtues they encourage- however
this can be limiting; even liberal communities may put belonging before being and exclude others - so, virtue ethics needs to consider the virtues emphasised by the community of humankind
Jonathan Glover (Matters of Life and Death)
- addresses issues of both pro and anti abortion positions
- concludes a foetus is a person at conception but the right to abort lies with the mother
- to deny women freedom of choice with regards to their foetuses is unjust- an unpleasant 9 months of unwanted pregnancy won’t be
worse than the following years of rearing an unwanted child - abortions can maintain functional families and curb overpopulation
- anti-abortionists ignore the issues that come with putting a child up for adoption
- advancements in medical technology make the viability of the foetus a redundant way of determining its status
- the continuous nature of pregnancy and variability of viability makes conception the clearest defining moment of personhood
- identifies three objections to murder: takes away autonomy, removes the victims future, and effects others with a relation to the victim
- the foetus has no autonomy, and the rights and autonomy of the mother override those of the foetus. The foetus reduces the mother’s
freedom in the years of life she is due
Glover and Consequences in ‘Causing death and saving lives’ 1977
- human life is not sacred in of itself
- claims instead it is wrong to destroy worthwhile lives when the individual has a desire to continue living
- implies consequences need to come into consideration
- ‘double effect’: distinguishes between positive actions with bad consequences and omissions of acts which have bad consequences
- Glover disagrees: if an omission can be as bad as an act then failure to save others from famine is akin to murder
- leaves abortion at the same level as contraception; the foetus has no desire to live so existing human life comes foremost, if a child is
unwanted or handicapped its life is not worthwhile (though this does not equate handicap with a lack of a worthwhile life)
The legal reasons for having an abortion
- the mothers life is at risk
- the mothers mental or physical wellbeing is at risk (can allow for abortion at any stage)
- tests show the baby is physically or mentally disabled
- thee is a risk of harm to existing children
needs to be accepted by 2 doctors fewer than 24 weeks after conception
pills and abortions
- morning after pill- takes up to 72 hours after sex
- abortion pill- used in the first 7 weeks (up to 10 weeks)
- ‘vacuum aspiration’ abortion- a tube sucks out the contents- before 14 weeks
- dilation and evacuation partial birth abortion- usually used in later pregnancies (if the foetus is abnormal or mothers life is at risk) after
14 weeks
Luke 1:44
“As soon as the sound of your greeting reached my ears, the baby in my womb leaped for joy”
Jeremiah 1:5
“Before I formed you in the womb I knew you”
Feminist position on abortion
Some have argued that there are other compelling reasons to permit abortion in all, or almost all, cases, not just when there is certain risk to the mother.
- The feminist position begins from the historical experience of female suppression and a patriarchal society, and the role of religion in that history.
- Women were subordinated within the family and had their freedom limited by the constraints of motherhood and the unreliability of contraception.
- Women’s roles have primarily been defined in terms of motherhood and it was only towards the latter end of the 20th century that women in large numbers began to have equal legal rights and equal opportunities in employment.
- MARY ANNE WARREN believes women should have the RIGHT to abort unwanted pregnancies at any time.
- It should become part of their RIGHT TO LIFE given to them by the HUMAN RIGHTS ACT. If not undesirable consequences would follow, such as dangerous illegal ‘backstreet’ abortions and even women self harming.
- Before the legalisation of abortion women have paid a terrible price. WHO estimates that unsafe abortions kill 200,000 women per year
Warren on abortion
Warren maintains that abortion must be permissible to guarantee women’s human RIGHTS OF LIFE.
SELF-DETERMINATION: the process by which a person controls and directs their life.
Without the option of abortion women are still subject to the oppression of the past.
Jill Knight
MP, House of Commons debate 1966: “Babies are not like bad teeth to be jerked out just because they cause suffering. An unborn baby is a baby nevertheless”
“…surely as a healthy, living baby it has a right not to be killed simply because it may be inconvenient for a year or so to its mother”
Thomson’s ‘People Seeds’
Imagine if people were born from seeds which fly around and can end up in your house
You would put protective screens in front of your windows to prevent them from landing in your house
If they found a hole in the screens on a day you had the windows open, would you have an obligation to look after the seeds which came in?
Pregnancies from consensual sex, like opening the window, can legitimately be terminated
Thomson’s ‘chocolate’
An older brother is given chocolate and told it is only for him
The younger brother asks for some chocolate, although the younger brother has not right to it
Because the younger brother has no right to the chocolate, it is not immoral to withhold it from him
It would be morally good to share, though there is no obligation to
Genesis 4:1
“Adam lay with his wife Eve, and she became pregnant and gave birth to Cain. She said, “With the help of the LORD I have brought forth a man”
Job 1:21
“Naked I came from my mother’s womb and naked I will depart. The LORD gave and the LORD has taken away’ may the
name of the LORD be praised”
Religious perspectives on abortion (general)
- conservative religious traditions are deontological and absolutist and find statements to support a complete bam on abortion
- others are more proportional and are willing to allow it in certain situations
- some give more authority to the individual religious leaders to be advisory on moral issues but not binding on all believers
Catholic Church on abortion
- it is wrong to abort because all human life is sacred. Even if there was rape, a foetus should not pay for somebody else’s crime
- Humanau Vitae (a papal encyclical letter): Pope Paul VI emphasised that human life is sacred. However, this is not an ex
cathedra expression of infallibility that has to be accepted by all catholics - the newly fertilised egg is a potential human, and it would be wrong to deny them of life (an atheist could also agree on this)
Aquinas and Double Effect
-an action may be permitted if:
* the action is moral
* the person doing it intends the main effect of the action to be good rather than bad
* there is another, unavoidably bad effect which also results from the action
-might justify abortion in the case that a pregnant woman would die otherwise, for example, because of a cancer in the womb
* could also justify euthanasia to prevent pain for a dying person by shortening their life
- although, the death of the foetus is only permissible because it is the second effect of the removal of the fallopian tube.
Vardy
and Grosch point out that new laser technology will directly kill the foetus rather than destroy the fallopian tube, meaning the
death of the foetus is not the second effect but the action itself
Church of England on Abortion
- opposes abortion but accepts that there are circumstances when it is morally acceptable
- leaves believers to make decisions using their own conscience
- these include when the pregnancy threatens the life of the woman, rape, or the child will be born severely handicapped
Weak Sanctity of life principle and abortion
- the advances of medical science have made boundaries between life and death flexible
- it is not clear what constitutes an independent life and there may be situations where abortion is morally justified
- proponents of the weak sanctity of life principle tend to balance the Bible’s pro-life teachings with Jesus’ emphasis on love and
compassion as a justification for abortion in certain cases
Pope John Paul II (1995)
“the result of human procreation, from the first moment of its existence, must be guaranteed that
unconditional respect which is morally due…his rights as a person must be recognised, among which in the first place is the inviolable right of every innocent human being to life”
Orthodox Church and Evangelic Protestants on abortion
- both oppose abortion because God is the author of life
-David Smith identifies four principles that broadly summarise the Christian absolute rejection of abortion - God alone is Lord of life and death
- humans have no right to take life
- human life begins at conception
- abortion at any stage is murder of an innocent
Liberal protestants on abortion
- oppose abortion in principle and advocate the preservation of life
- but allow abortion in some situations, such as prior to the formation of the nervous system and brain, situations where the
mother’s life is threatened, rape or incest, or when the mother’s mental or physical health is endangered - The Episcopal Church: a US branch of the Anglican church which takes a pro-choice stand supporting a woman’s right to
choose and opposing government action that limits a woman’s right to choose
