The Moral Status of the Human Embryo February 7th 2023.pptx

The Moral Status of the Human Embryo Dr. Peter West-Oram Lecturer in Bioethics [email protected] Pronouns: He/Him 7th February 2023 Structure 1. 2. 3. 4. 5. 6. Learning Outcomes Why Moral Status? Summarise history of legislation Defining Moral Status Four Accounts of Moral Status Mitochondri...

The Moral Status of the Human Embryo Dr. Peter West-Oram Lecturer in Bioethics [email protected] Pronouns: He/Him 7th February 2023 Structure 1. 2. 3. 4. 5. 6. Learning Outcomes Why Moral Status? Summarise history of legislation Defining Moral Status Four Accounts of Moral Status Mitochondrial Donation/Transplant Learning Outcomes • Understanding of laws relevant to the embryo in medicine and research • Awareness of the main arguments about the moral status of embryos • Understand relevance of these arguments to medicine and research • Think about, and reflect on, your own moral position • Why Consider the Moral Status of the Embryo? Unresolved moral debates over the significance and status of human embryos • Views on this issue link in to views on other ethically contentious issues e.g. abortion, cloning, stem cell research • These debates are political as well as personal, national as well and individual. • Because this area of science and medicine is rapidly expanding there are new issues emerging all the time, e.g. Mitochondrial transplant, research, IVF... Asking The Correct Question • When does life begin? or • When does life become morally significant? or • What makes a life morally significant? History of Legislation • Report of the committee of Enquiry in to Human Fertilisation and Embryology 1984 • • Human Fertilisation and Embryology Act 1990 • • http://www.legislation.gov.uk/uksi/1991/1889/contents/made House of Commons Science and Technology Committee Human Reproductive Technologies and the Law, 2004-5 • • https://www.legislation.gov.uk/ukpga/1990/37/contents Human Fertilisation and Embryology Authority 1991 • • https://www.bioeticacs.org/iceb/documentos/Warnock_Report_of_the_Committee_of_Inquiry_into_Human_Fertilisation_and_Embryology_1984. pdf http://www.publications.parliament.uk/pa/cm200405/cmselect/cmsctech/7/7i.pdf Human Fertilisation and Embryology Act 2008 came into force October 2009 • https://www.legislation.gov.uk/ukpga/2008/22/contents • To keep up to date check in to http://www.hfea.gov.uk/ • The Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015 • • http://www.legislation.gov.uk/ukdsi/2015/9780111125816/contents HFEA – Guidelines on Surrogacy: https://www.hfea.gov.uk/treatments/explore-all-treatments/surrogacy/ Abortion Act 1967 “4. Conscientious objection to participation in treatment. (1)Subject to subsection (2) of this section, no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection: Provided that in any legal proceedings the burden of proof of conscientious objection shall rest on the person claiming to rely on it. (2)Nothing in subsection (1) of this section shall affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman. (3)In any proceedings before a court in Scotland, a statement on oath by any person to the effect that he has a conscientious objection to participating in any treatment authorised by this Act shall be sufficient evidence for the purpose of discharging the burden of proof imposed upon him by subsection (1) of this section.” https://www.legislation.gov.uk/ukpga/1967/87/contents Human Fertilisation and Embryology Act 1990 “38 Conscientious objection. (1)No person who has a conscientious objection to participating in any activity governed by this Act shall be under any duty, however arising, to do so. (2)In any legal proceedings the burden of proof of conscientious objection shall rest on the person claiming to rely on it. (3)In any proceedings before a court in Scotland, a statement on oath by any person to the effect that he has a conscientious objection to participating in a particular activity governed by this Act shall be sufficient evidence of that fact for the purpose of discharging the burden of proof imposed by subsection (2) above.” http://www.legislation.gov.uk/ukpga/1990/37/contents The Committee of Inquiry into Human Fertilisation and Embryology • Convened in July 1982, chaired by Dame Mary Warnock • “to examine the social, ethical and legal implications of recent, and potential developments in the field of human assisted reproduction” • Published The Warnock Report in 1984 • Explored the ethical considerations behind a range of issues in embryology, including; The ethical status of emerging reproductive technologies (IVF first successful in 1978) Donation, freezing, and use of eggs, embryos, sperm Surrogacy Research • Recommended the current 14 day limit on research on embryos • Led to the 1990 Human Fertilisation and Embryology Act (HFEA) “The Warnock Committee”: Objective1 “Although the questions of when life or personhood begin to appear to be questions of fact susceptible of straightforward answers, we hold that the answers to such questions in fact are complex amalgams of factual and moral judgements. Instead of answering these questions directly we have gone straight to the question of how it is right to treat the human embryo.” Warnock 11.9 pg 60 What is Moral Status? “An entity has moral status if and only if it or its interests morally matter to some degree for the entity’s own sake.”2 1. Utilitarian: Having moral status means that one’s interests (extent, duration of pleasures/pains etc) must be factored into the utility calculations of other people/society as a whole. 2. Non-Utilitarian: Having moral status means that there are reasons, independent of the consequences, for treating an entity with respect, and acting in its interests. Warnock’s Position1 “there is no particular part of the developmental process that is more important than another; all are part of a continuous process, and unless each stage takes place normally, at the correct time, and in the correct sequence, further development will cease. Thus biologically there is no one single identifiable stage in the development of the embryo beyond which the in vitro embryo should not be kept alive.” Warnock op cit 11.19 pg 65 One Consideration on Warnock “producing watertight philosophical reasoning and dispensing moral expertise was not the committee’s self-stated mission. Instead, as Warnock herself argued, the aim was to facilitate a dialogue and process by which the plurality of dissenting moral views could somehow forge a workable policy decision.” “Thus, as Nelson comments, the choice of the 14-day cut-off “…did not reflect an overwhelming national feeling that individuation is an essential property of a member of the human species. On the contrary, utilitarian considerations concerning potential research benefits played an explicit role in the Committee’s judgment about this matter.” (1) 1. Chan S. A bioethics for all seasons. J Med Ethics. 2015 Jan 1;41(1):17–21. Life as a Continuum Five day old Embryo Foetus at 1012 weeks Formation of the Primitive Streak (Gastrulation) – day 1415 22 Week Foetus Embryo at 4 weeks Premature Newborn Rejecting Gradualism • “Human embryos deserve the same protection as all other human beings”, Pope Benedict XVI told an audience of scholars on February 27 2006. • "The love of God does not distinguish between the newly-conceived infant still in its mother's womb, the baby, the youth, the grown adult or the elderly, because in each of them He sees the sign of His own image and likeness," Account One: Biological Humanity3 We have moral status because we are HUMAN4 Advantage – Clear, simple statement of which entities have status, and which do not. But… What counts as a human life, and when does it start? Not just Human DNA – every individual cell in our bodies would qualify. “moment of conception”? – that “moment” is lengthy and complex Warnock’s “twinning argument” – Justification for 14 day limit on research Account Two: Personhood • Mary Elizabeth Warren5 - Persons have;      Sentience Rationality Capacity for moral agency Language Embryos lack these features Problem: Could exclude many we might want to say have membership of the moral community – quite a high standard for moral status Account Three: Interests Joel Feinberg6 • “Interest Principle”: Rights are intended to protect interests – rights holders must therefore be capable of having interests of their own. • Interests = having “stakes in things” 3 • To have interests an entity must be sentient = “the capacity for having experiences of any kind”3 • Not plants, rocks, inanimate objects. • Animals? Jeremy Bentham thought so • An embryo cannot be sentient – no nervous system, thus no awareness or experience • Is there a difference between taking an interest, and something being in something’s interest? Future Like Ours Don Marquis7 • According to Marquis, the interest view fails because it cannot explain why killing a person in a temporary coma is wrong They lack sentience, so apparently lack interests. But we don’t think killing them is moral. • While an embryo or foetus cannot take an interest in anything, it does have an interest in living out its future • Murder is wrong because it deprives the victim of their future – the same is true, according to Marquis, for an embryo or a foetus (maybe even eggs and sperm). BUT • We could argue that unlike an embryo, we can have interests which should be respected even if we aren’t fully conscious of them – the interest view does not require permanent, conscious awareness of our interests Does an embryo have moral status? 1. 2. 3. 4. Human Biology – Yes Personhood – No Interests – No Future Like Ours - Questionable Mitochondrial Donation: A Case Study “Three person babies” – a response to mitochondrial disease. Recently made legal in the UK – a world first. 3rd February 2015: https://publications.parli ament.uk/pa/cm201415/ cmhansrd/cm150203/de btext/150203-0002.htm #15020348000001 https://www.theguardian.com/science /2013/jun/28/uk-government-ivf-dna-t World’s first “three parent baby” born 6th April 2016: https://www.newscientist .com/article/2107219-ex Perspectives on Mitochondrial Donation Future Generations – mitochondrial transplant will affect the children of the babies born as a result of the donation. Designer babies? http://www.theguardian.com/commentisfree/2013/jun/28/three-parent-ba bies-blade-runner Religious opposition due to destruction of “donor” embryos: http://www.bbc.co.uk/news/health-31044255 Concern over “rushed” vote: http://www.theguardian.com/science/2015/jan/31/scientists-church-engla nd-dna-trials-mitochondrial-gene-therapy Cost – is there a right to be pregnant/have genetically related children? One Argument in Favour: Robert Winston • "Transfusing mitochondria is not unlike transfusing red blood cells in a case of severe anaemia - the main difference being that the mitochondrial treatments last into future generations. • "As an Orthodox Jew, my religious tradition sees no objection to using science in this way. If mitochondrial treatments could prevent disease, this is to be celebrated as we are using the God-given intelligence afforded us. • "We are not altering a child's characteristics, nor enhancing humans in any way. The scientists are merely trying to ensure that a crippling and sometimes fatal disease is prevented and that future generations will not suffer this horrific sadness." http://www.telegraph.co.uk/news/science/science-news/11383004/Threeparent-baby-technique-no-more-sinister-than-blood-transfusion-says-Rob ert-Winston.html Thinking About Your Practise • You have a right to conscientiously object to participating in many legal, medical services relating to fertility – Abortion Act, HFEA. BUT, you must be able to justify your decision to do so, if you choose to conscientiously object • However, you cannot “abandon” your patient – you must refer them to an alternative provider • You need to be aware of the law, so you can advise your patients appropriately. • Your colleagues may not share your position, how will you manage your relationships with them? • How will you manage your relationships with your patients? Bibliography 1. Warnock M, Strategy and Information Directorate Human Fertilisation and Embryology Authority,. REPORT OF THE COMMITTEE OF INQUIRY INTO HUMAN FERTILISATION AND EMBRYOLOGY [Internet]. London, UK: Houses of Parliament; 1984 [cited 2018 Jan 17]. Report No.: 9314. Available from: http://hfeaarchive.uksouth.cloudapp.azure.com/www.hfea.gov.uk/2068.htm l 2. Jaworska A, Tannenbaum J. The Grounds of Moral Status. In: Zalta EN, editor. The Stanford Encyclopedia of Philosophy [Internet]. Spring 2018. Metaphysics Research Lab, Stanford University; 2018. Available from: https://plato.stanford.edu/archives/spr2018/entries/grounds-moral-status/ 3. Steinbock B. Moral Status, Moral Value, and Human Embryos: Implications for Stem Cell Research. In: Steinbock B, editor. The Oxford Handbook of Bioethics. Oxford University Press; 2009. Available from: https://dspace.sunyconnect.suny.edu/handle/1951/52173 4. Winfield N. Pope says pre-implanted embryo is sacred. Associated Press [Internet]. 2006 Feb 27 [cited 2018 Jan 22]; Available from: http://archive.boston.com/news/science/articles/2006/02/27/pope_says_pre _implanted_embryo_is_sacred/ 5. Warren MA. On the moral and legal status of abortion. The Monist. 1973;57(1):43–61. 6. Feinberg J, in Schafer-Landau R. The rights of animals and unborn generations. In: Ethical Theory: An Anthology. Oxford, UK: Wiley-Blackwell; 2013. p. 372–80. Further Reading http://blog.wellcome.ac.uk/2012/01/20/a-good-concept-science-mitochondrial-dna/ http://www.bbc.co.uk/news/av/health-31060365/church-of-england-on-three-parent-bab ies-concerns https://www.theguardian.com/science/2013/jun/28/uk-government-ivf-dna-three-people https://www.theguardian.com/society/2016/dec/04/row-over-allowing-research-on-28-d ay-embryos https://www.nice.org.uk/guidance/cg156/chapter/Recommendations#access-criteria-for -ivf https://www.hfea.gov.uk/treatments/embryo-testing-and-treatments-for-disease/mitoch ondrial-donation-treatment/ https://wellcome.ac.uk/what-we-do/our-work/mitochondrial-donation