Medical Ethics Summary

Bianca Rasathurai. Due 11/06/18. Summary #6, pp. 327-331, 371-394, 467-477, 492-500, 951-952. LSCI 606, 8 a.m.

Society today utilizes reproductive technology such as contraception, eugenics and artificial insemination in order to achieve its ends. Every year, there are at least 350,000 babies born worldwide through the use of assisted reproductive technologies (ART). The birth of Louise Brown in 1978 was the catalyst for why over five million children have been conceived since 1978 using these technologies. In vitro fertilization (IVF) is the method of fertilization that is artificially performed in a test tube in a laboratory. IVF is performed by first giving a woman a reproductive hormone to cause her ova to mature. Several of her eggs are extracted from the ovarian follicles and placed in a solution to which sperm is added. Sperm cells will then penetrate multiple ova, fertilizing them, and the subsequent fertilized eggs are transferred to another solution in which they undergo cell division. The embryo (also called a zygote), is then transferred back to the woman (or to a surrogate), who has received multiple hormonal injections in order to prepare her uterus to receive the embryo. Since implantation does not guarantee that a fertilized embryo will attach to the uterine wall, IVF often involves the implantation of multiple embryos at the same time. However, there are several disadvantages that come with this process, one being that increasing the chances of multiple gestations can increase complications for both the woman and her fetus.

        Intracytoplasmic sperm injection (ICSI) is a technique used to decrease male infertility due to having a low quantity or quality of sperm. Partial zone dissection (PZD) is another technique used for male infertility, in which sperm passes through a protective membrane (zona) surrounding an ovum to aid in the entry of passing the sperm into the interior. DNA transfer involves replacing the nucleus of a donor egg with one taken from the intended mother, who is then implanted with the resulting embryo. Gamete intrafallopian transfer (GIFT) allows fertilization to occur inside a woman’s body by inserting both the ova and the sperm into the fallopian tubes through an abdominal incision. Intravaginal culture (IVC) is another attempt to bring assisted reproduction closer to natural fertilization. Controlled ovarian hyperstimulation (COH) involves administering hormones to stimulate egg production by the ovaries. New techniques to assist in reproduction are developing at a fast rate. The fact that so many techniques are now available implies that if one doesn’t work, prospective parents may try another one. Having too many options makes it hard for some people who would like to have children to stop trying, even after repeated failures to conceive a child. The most common reason people seek out assisted reproduction technologies is due to some form of infertility (can be either male or female), which is defined by failure to conceive even after a year of having unprotected sexual intercourse. Using these assisted reproduction technologies is not always the solution to every fertility problem, but it is the only solution sometimes possible in a large majority of cases. While heterosexual couples struggling with infertility issues constitute the largest population using IVF and ICSI, these technologies are also increasingly being used by singles and same-sex couples.

        The financial cost of using an assisted reproductive technology can range from $15,000 to $35,000, and a few people spend as much as $300,000. Only fifteen states in the United States require insurers to cover infertility diagnosis and treatment, and many people go deeply into debt to pay for them. The costs can be even higher when donated reproductive tissue or surrogates are involved.

Bonnie Steinbock argues that it is normal for parents to wish to prevent disability in their children. Steinbock examines the view that selective abortion on the basis of fetal abnormalities is a form of discrimination against the disabled. This perspective likes to acknowledge that prenatal screening and selective abortion embody the idea that the disabled are “better off unborn” and can be compared to terminating a pregnancy based on knowing the sex of the fetus. Steinbock rejects this perspective and believes that it is reasonable for parents to not want a disabled child in that they are genuinely trying to avoid heavy burdens for both themselves and the child. If abortion is considered morally acceptable, then Steinbock believes that it is no more discriminatory than taking other steps during a pregnancy (such as taking folic acid) to avoid giving birth to a child with serious disabilities.