HEALTH CARE ETHICS, 6 Edition

Harold W. Baillie, John McGeehan, Thomas M Garrett, Rosellen M. Garrett

Chapter 9

Ethics of the New

Methods of
Reproduction

Fr. Manuel B. Perez,

SJ, MD
© 2013, 2010, 2001 by Pearson Education, Inc. All rights reserved.
 Introduction

• New methods of reproduction have brought

blessings to childless couples without the
inconvenience of pregnancy, they also
have created ethical problems.
• Some find them unnatural or unsuitable for
human beings.
• They also create social problems to find the
real parents for the children to be cared for.

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 Surrogate Mother:

A woman who bears a child on behalf of a couple unable to have a

child, either by artificial insemination from the man or implantation of an
embryo from the woman.

© 2013, 2010, 2001 by Pearson Education, Inc. All rights reserved.

 Focus Question:

Should a single gay woman who wants to be a

mother expect her insurance company to pay
the costs for artificial insemination?

© 2013, 2010, 2001 by Pearson Education, Inc. All rights reserved.

 Artificial Insemination and the General Problems of
Assisted Reproduction

• This involves harvesting sperm and inserting it into the woman’s

vagina by means of a syringe.
• Artificial Insemination by Donor and the Unmarried Mother
• When the mother is not married, there can be questions as to
whether it is good to deliberately bring a child into a one-parent family.
• Artificial Insemination by Donor and Screening
• The health history of the donor should be an important part of the
screening process when considering donation.

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 Artificial Insemination and the General Problems of
Assisted Reproduction (cont.)
• Concealing the Donors
• Some governments have provided that when the husband agrees to
the donor insemination, there can be no paternity suit against the
donor.
• Artificial Insemination by Donor and the Danger of Incest
• When the sperm of a particular donor is used frequently in the same
geographic area, particularly in small areas, a danger of incest with
attendant genetic problems is created.
• The American Medical Association rules that physicians must take
steps ‘limiting the number of pregnancies resulting form a single dono
r’

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 In Vitro Fertilization
• Also known as test tube fertilization – is used when for one
reason or another the ovum of the woman cannot descend through
the oviduct in order to be fertilized.
• It involves treating the woman with hormones to stimulate the
production of the ova, taking the ova by a surgical procedure and
taking sperm from the husband or donor and bringing them
together in a Petri dish.
• The Discard Problem
• Arises from the fact that, in pioneering days of the procedure,
fertilized eggs when not introduced to the woman were either
discarded or used for experimentation.
• If you follow that belief that it becomes a life upon conception, this
idea holds on that discarding would be considered abortion and
experimentation would be human experimentation on an unwilling
patient – both of which have ethical issues.

© 2013, 2010, 2001 by Pearson Education, Inc. All rights reserved.

 In Vitro Fertilization (cont.)
• Rates of success
• There is a wide variety of success rates. A couple has the right to the
accurate information about the success rate of the institution and
physician whom they are dealing with.

• Frozen Embryos, Sperm Banks, and Social Issues

• Embryos are often frozen at the time of in vitro. The frozen embryos
are a reserve that can be used to avoid subjecting a woman to another
surgical procedure if the first in vitro fertilization is not a success.
• It can be used as a back up or by people who wish to postpone
reproduction for some time but worry that as they age, they will no
longer be able to naturally produce a child.

• Risk to the Mother and Child

• Risks to the mother include risks with hormone treatment, risks with
the surgery, anesthesia, damage to the uterus, etc.
• Risks to the child are still largely unknown.

© 2013, 2010, 2001 by Pearson Education, Inc. All rights reserved.

 Surrogate Mothers
• This is when you perform in vitro fertilization and then implant the
fertilized egg in the uterus of another woman, who will carry and
deliver the baby and allow the baby to be adopted by the couple
who supplied the egg and sperm.

• Responsibility for the Child

• Issues can arise in situations where an agreement is made, but
when the child is born, the parents intending to adopt do not wish to
anymore, leaving the surrogate with a child that they may not want.
• Laws need to be made more clear to mitigate these issues.

• Rights of the Surrogate

• Consideration must be given to the surrogate. If the surrogate
decides they do not wish to give up the child, the issue of blackmail or
coercion can arise in an attempt to get surrogate to give up the child.
• Laws need to exists to protect the surrogate in this case.

© 2013, 2010, 2001 by Pearson Education, Inc. All rights reserved.

 The Charge of Artificiality
•Those who condemn the new reproduction methods as artificial do
so because they believe it is inherently evil.

• Artificiality and the Family

• A social structure in society demonstrates several different forms of
the family
• Nuclear family: mother, father, child
• Corporate family
• Extended family
• Kibbutz or single-parent family

• When faced with a modest problem of a couple’s infertility,

the question then becomes the force of our ethical position in
the face of a medically correctable condition.
• We tend to look at the family situation when making
decisions, 2 parents vs. 1 parent, etc.

© 2013, 2010, 2001 by Pearson Education, Inc. All rights reserved.

 • Thus the idea of the family is more limited.
• Faced with the problems of a couple’s
infertility, the question becomes posed
with the ethical position in the face of the
medical correctible problem.
• A young married couple who wish to have
children is an ideal candidate for assisted
reproduction.

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 • But how far do we go in giving people
control over their biological nature?
• This problem of artificiality is also found not
only in new methods of reproduction, but
also in genetic research, transplants, and
even in cosmetic surgery.
• The question of limits goes beyond health
care ethics, but also in areas of ontology
and metaphysics.
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 The Ethics of Health Care Providers
• The health care provider should do what is medically indicated
given the consent of the patient.

• When people want alternative modes of reproduction out of

convenience then the issue of ethics comes up.

• Performing an operation to procure eggs for in vitro when no

health problem exists does not meet the requirements of
proportionality for a health care provider.

• It is not ethical for health care providers to facilitate adultery.

• Health Care providers would be unethical if they aided in the

reproductive activities of people who are unfit to be parents.

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 A Question of Distributive Justice
• The new modes of reproduction involve more risks to children and
society.

• They cost money and use scarce health care resources.

• Since these modes are not generally covered by health

insurances, they are limited to those in society that are
economically comfortable.

• This raises the question of social or distributive justice

© 2013, 2010, 2001 by Pearson Education, Inc. All rights reserved.

 Summary

• The new methods of reproduction currently

available stretch the meaning of the social
institution of the family and raise a wide
variety of ethical problems.
• Given the desire of most people to have
children, these medical advances will stay
with us.
• While natural law positions remain skeptical
others poses serious objections.
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 • Many of the basic problems arise with
artificial insemination and focus on the
usefulness of marriage in child rearing.
• Problems exists when either the donated
sperm or eggs are used.
• In vitro fertilization leads to difficulties with
the use of frozen embryos and concerns
with genetic screening and genetic
manipulation of embryos.
© 2013 Pearson Education, Inc. All rights reserved.
 • Surrogate motherhood, by separating
genetic and gestational roles of the mother
add to the confusion with questions to the
economic and social responsibility of the
child.
• At the heart of the problem is the society’s
changing understanding of the family.

© 2013 Pearson Education, Inc. All rights reserved.