Ethical Theory and Assisted Reproduction (HLTH 380) PDF

reproductive technologies Imagine the past of reproduction History of reproduction Desire to have children ○ Dominated Social status of parents ○ Having children is a gift, when didnt have children, seen as a punishment Women’s role in reproduction Women’s bo...

reproductive technologies Imagine the past of reproduction History of reproduction Desire to have children ○ Dominated Social status of parents ○ Having children is a gift, when didnt have children, seen as a punishment Women’s role in reproduction Women’s bodies as vehicles for reproduction ○ Womens fault if baby hasnt been produced Still stands in parts of the world if she doesnt have a male offspring ○ "Turn outward the woman's, turn inward, so to speak, and fold double the man's, and you will find the same in both in every respect." -- Galen, 2nd century A. D. Infertility treatments Historically people didnt know how women could have babies Sort of mystery Often times the womens organs are male organs that are inverted in The present of reproduction Individual choice and autonomy The impact of capitalism on assisted reproduction Women’s age at birth The market relations in reproductive technologies Consumerism Medical research in infertility ○ Ehical to sell sperm or eggs ○ Surrogacy for money or gift, is this okay? ○ Sperm donors and selection of genetics for baby Age at First Birth: Canada People are getting older Women are delaying childbirth and waiting before they have children provincial/territorial differences Huge variation in age of first birth and provinces Fertility rate declining Same level of reproduction—should have 2 children Before, nothing do do was but to hav children Europe has low fertility rate (italy, spain) Video: 57 and post menopause Ivf and donor egg Procreative liberty argument  Reproductive decisions are a matter of personal autonomy ○ There shouldnt be anyone to say what i can and cant do We cannot interfere with the decisions of others Harm Principle: – as long as there is no harm, the autonomy should be given to an individual ○ We usually give alot of decisions for personal autonomy ○ Only way we can limit personal capacity is by using the harm principle You cannot harm a child because the child would not exist ○ Giving a child a life is what matters most Terminal disease: would it be okay to say you cant have a child Age 14, can she have a child? Once you start limiting people, where do you draw the line? Another criticism: all based on the assumption that doesnt matter what happens to the child as it wouldnt have existed ○ Naturally its better to exist than not to esist? Not really true Critique of procreative liberty conceptualization of harm is problematic ○ The question of harm to children should be fundamental Marketplace ideology ○ The liberty of buying and selling Autonomy is the only moral principle ○ Benifenence or non-malfeasance is ignored Responsible parenthood ○ Are you fit to have a child? Bioethics of assisted reproduction Physical harm Immediate harm ○ Health risks associate with pregnancy and birth ○ Health risks associated with fertility treatments Risk to children are higher: with age, high chance of having children with defects Emotional harm ○ Quest for a child Consider how people feel about not having a child ○ Emotional coping with unsuccessful treatment Not enough to cover treatment 15k for unsuccessful attempts Stigma of infertility ○ Pressure to have a child Many cultures see kids as a blessing still Dont find a way to keep coping without having a kid Surrogacy or assisted technology Different connections between people who become participants ○ So whos kid is it? ○ Different approaches to right- could lead to legal battles Prioritize biology over all things: baby going to biological mom if she changes her mind Tightened laws in surrogacy where there is more children left if parents split for example biology>legallity Asymmetry, secrecy, anonymity  Asymmetry – one genetic and one social parent ○ Lesbian: biological mother would be prioritized Secrecy – keeping information about the reproductive history of children Anonymity – donor should remain anonymous ○ Some people dont tell children theyve been adopted until theyre old enough ○ Some donors have to or want to remain anonymous ○ Preserving rights of parent than child Violates the principle of nonmalfeasance in relation to the child ○ Ethically: the principle ○ Why do we prioritize the parent over children? What about predisposing diseases for the child? Sample question Which of the following is TRUE? (a) The selling of sperm is permitted in Canada (b) The selling of eggs is permitted in Canada (c) It is against the law in Canada to offer your services as a surrogate mother (d) Women are allowed to receive “gifts” for their reproductive work, but the actual selling of reproductive services is not allowed in Canada Comodification and objectification Market for sperm, eggs, surrogate services Objectification – the purchased services are being attached a certain value ○ Personal characteristics of a donor ○ Health status of a donor Feminist views Reproductive technologies are more harmful to women than to men  Andrews: FIRST POINT: BETTER FINANCIAL STABILITY Anderson: commodification is a problem ○ The value of women and their bodies is reduced fro tools for becoming babies ○ Assigning money tag is problem Raymonds: altruistic surrogacy is a problem ○ Women and relationships ○ Naturally leading to caring, when you allow this to happen, puts them in position where they have difficulty saying no ○ Someone who is close to you and asks about carrying a child Chapter 5 : reproductive technologies Lauritzen cauptures the sense that having children is a matter of conscious choice Purpose of having children is to relieve suffering Technologiea ee often embraced by the infertile, because they restore the very element of personal control over preproduction that was lost along the diagnosis of infertility The rise of reproductive technologies IVF Selling reproductive materials is an altruistic act ○ An altruistic act is a voluntary action that helps another person or prevents harm to them, without any expectation of a reward or benefit to the actor Ethical issues that are arisen when someone has children ○ If theyre having children for the right reasons ○ Whats the ‘cure’? If they are provided with a child or is to fix the prevention of contraception so they can ahve a child? Or provide a social context in which individuals rae left as free as possible to pursue their own reproductive gaols regardless of age, marital status, sexual orientation ○ Social context within the society, is it moral in one culture Ex; in canada its prohibitted to purchase gametes, embryos, and surrogacy services  In the us, its a “consumer revolution” , where sperm banks and egg donors compete fpr the desires of demanding products to attract the highest prices Infertilitry and the desire to have children Whats the desire to cure infertility? ○ The nurturing of a child? The giving birth? The deirre of ones genes being carrie on in the future? To have a child with a particular person? The passage wonders why so much effort and money go into developing ways to help people have children with technology, instead of preventing infertility in the first place. It also suggests that the people creating these technologies might not just be trying to help others out of kindness. Worth 3 billion a year in the US Functions according to the norms of the free market Eggs range from 8k to 65 k depending on the qualities of the seller Sperm bancks include glossy catalogues Average sperm donor at a sperm bank is 209$ Canadien assited human reproduction act ○ Most provinces do not cover IVF ○ Although the fees are paid for the treatment and not the gametes, it is not always clear how those are different ○ To add, canadiens can easily access american treatment and clinics use the free markert for their gamestes Market plays cuha n important role in infertility treatment means there is less incentivive to prevent infertility rhan there is to devise methods of profiting from it Causes and conceptions of infertility Most common risk factors; SMOKING, DELATED CHILD BEARINNG, STDS, ALCOHOL USE, EATING DISORDERS, TOXIC AGENTS, STRESS, EMDICAL INTERVENTIONS, EXCESSIVE EXERCISE Infertility as a medical condition  However, an ambiguity immediately re- veals itself: is the solution to infertility to resolve the medical problems that make conception and gesta- tion difficult, or is it to ensure that infertile people end up with a child As callahan observves: one result of this is vagueness. Medical infertiity procedures dont address medical issues at all. ○ Leaves the infertile as they were ○ Those undergoing treatment find it diffictkt ti refuse any treatment The social dimensuon of infertility The notion that infertility has been successfully treated once a child has been born suggests that infertility can also be understood as a social condi- tion, one that can sometimes be alleviated through medical interventions and sometimes through so- cial practices. Freezing eggs because of the social part of wanting to finish education first A woman who bears an egg-donor child is encouraged to believe that carrying the fetus is the crucial component of mother- hood. But a woman who hires a surrogate to carry her fertilized egg to term for her is encouraged to think the opposite: that the important thing is the genetic link to the baby, and not the womb out of which the baby came. John A robertson - “ the presumptive primary procreative liberty ○ Decisions to have or to avoid having children are thus personal decisions of great import that determine the shape and meaning of one’s life. The person directly involved is best situated to determine whether that meaning should or should not occur. An ethic of personal autonomy as well as an ethics of community or family should then recognize a presumption in favor of most personal reproductive choices. ○ Robertson takes the argument a step further by asserting that it is worse not to exist than to exist with defects, even serious ones ○ Although procreative rights are not absolute, those who would limit procreative choice should have the burden of establishing substantial harm.... If an important reproductive interest exists, then use of the tech- nology should be presumptively permitted. Only substantial harm to tangible interests of others should then justify restriction. The procreative liberty argument and the harm principle  Proponents of the procreative liberty argument deem it inappropriate for others to make moral judgments about the reproductive choices made by others or for the state to interfere with those choices; they argue that any moral concerns raised must be justified on the basis of the Harm Principle, which holds that we should only interfere with the choices of persons when those choices are clearly harmful to others ○ The libertarian ethical view supports this argument. Libertarianism emphasizes individual freedom and autonomy, asserting that people should be free to make their own choices without interference unless those choices cause clear harm to others. This aligns with the Harm Principle, which restricts interference only to prevent harm to others. Most fundamentally, it draws on the concept of negative liberty, which is primarily concerned with the degree to which the institu- tions of the state can legitimately interfere with the choices made by citizens. The liberty to do as one wishes without the interference of others Thomas h. Murray the marketplace and values: ways of making babies ○ The desire to ease the sufferrning of infertility ○ In particular, do the values of the marketplace, with their exaltation of individ- ual liberty, control, and choice, endanger what we value in family life? ○ Liberty supports the right to avoid having children, but choosing to have a child involves creating unique and morally significant relationships, making it different from the choice not to have a child. ○ Negative liberty emphasizes freedom from interference and aligns with values like individualism, choice, and control, often framed through a market perspective where reproductive products and services are treated as property. ○ Family relationships, unlike market transactions, involve complex moral considerations, as children are not property, and the relationships between all parties in the reproductive process carry deeper ethical significance. ○ The purpose of having a child is to foster meaningful relationships between the child, their family, and the adults in their life, making procreative liberty more complex than other freedoms. Weakness of the procreative liberty argument Cohen argues that there is no way its better to be born in shit circumstances than not being born at all ○ Prior to conception, there is no one who waits to be brought into this world Murray argues  ○ “the values of the market- place are ill suited for nurturing the values, institu- tions, and practices that support the flourishing of children and adults within families.”35 Third, The procreative liberty argument places too much emphasis on autonomy, neglecting the need to balance it with principles like beneficence (doing good) and non-malfeasance (avoiding harm), suggesting that some assisted reproductive practices may raise moral concerns beyond individual rights. The issue is not about judging the motivations of those using assisted reproduction, but recognizing the societal bias against infertile individuals, who are unfairly questioned about their reasons for having children, unlike fertile individuals who aren't scrutinized in the same way. We should ask people who use technologies the same question of are you fit to have a child as we ask parents who have children on their own Ethical theory and assisted reproduction While the procreative liberty argument discussed above draws on concepts and principles derived from liberalism, assisted reproductive practices raise a number of ethical concerns, including the risk of physical harms, the severing of genetic and social connections, commodification, objectification, se- crecy, anonymity, and the potential harms caused by post-menopausal and multiple pregnancies that are not adequately accounted for in this approach Utilitarian concerns: Assisted reproductive practices are evaluated based on their potential to promote good (beneficence) and avoid harm (non-malfeasance) at both individual and societal levels. Kantian concerns: Some practices may treat people as means rather than ends or neglect personal duties to oneself. Virtue ethics concerns: These practices are examined in the context of a fulfilling life, the parent-child relationship beyond birth, and the implications of separating genetic, gestational, and social aspects of parenting. Practices like postmenopausal reproduction or posthumous conception may be seen as unnatural. Physical harms Ivf is invasive, may play with health The lack of monitor- ing means there is no consistency in the quality of care, and the result is far too many multiple preg- nancies and health problems in the children born of those pregnancies.”45 From a utilitarian perspective,these harms violate the principle of non-malfeasance on both an individual and a societal level. If women and  children suffer health problems as a result of these technologies, this is clearly harmful to them. And if society then has to cover their health care costs, this means that resources that could be used elsewhere—such as, perhaps, resources dedicated to the prevention of infertility—are unavailable Kantians point out that the lack of systematic records on the health effects of assisted reproductive technologies makes it hard to know their true risks and benefits. This lack of information prevents people from making fully informed and autonomous decisions, which also weakens the argument for procreative liberty Natural law theory and assisted reproduction Stoics introduced natural law Aristotle believed everything has purpose and excellence lies in performing that function well The Roman Catholic Church rejects reproductive technologies like IVF, artificial insemination, and third-party reproduction based on natural law theory. Natural law theory combines Stoic and Aristotelian ideas, asserting that humans should live according to rational laws that reflect natural purposes. St. Thomas Aquinas added a Christian perspective, saying that natural law leads to happiness, but ultimate happiness comes from communion with God, which requires Church guidance. Reproductive technologies violate natural law by separating the unitive (marital relationship) and procreative (reproduction) purposes of sexual intercourse, which should not be separated. Interventions by third parties (e.g., doctors, donors) violate the dignity of the child and treat them as objects rather than the product of a loving marital relationship. The deliberate severing of genetic and social ties IVF and reproductive technologies can sever genetic, gestational, and social ties, creating complex family structures. Adoption also separates genetic and social ties, but differs by not intentionally creating these separations. Assisted reproduction, especially with sperm and egg donations, can involve anonymous donors, leading to a lack of connection between the child and their genetic parent. Genetic ties are important to many people, and the desire to discover biological roots can be strong, leading to situations where children seek out their biological parents.  The use of ancestry DNA tests can reveal hidden biological connections, creating ethical issues for both donors and offspring who were promised anonymity. Kantians may question whether children produced through these methods are treated as ends in themselves or as tools for the adults' desires. Virtue ethicists may challenge whether practices that deliberately separate genetic and social ties align with family norms and the virtues of responsible parenting Asymmetry and secrecy Utilitarians may focus on whether secrecy and asymmetry in reproductive technologies cause harm. Virtue ethicists question if secrecy undermines the purpose or goal (telos) of the family. For Kantians, secrecy is problematic because it involves lying, which goes against the Categorical Imperative (moral law). Lauritzen argues that secrecy creates a relationship built on a lie, especially in a family setting. Kantians may accept asymmetry if both parents agree, but cannot accept secrecy in the process. Anonymity Anonymity in Assisted Reproduction: Donor identity is kept secret to protect donors and recipients from legal and social issues. Ethical Concerns: Anonymity may harm children, as they can't know their genetic parent, leading to identity and emotional struggles. Kantian View: Anonymity may violate ethical principles, as it doesn’t treat children as ends in themselves and may not respect their right to know their biological origins. Virtue Ethics: Practices protecting donors from responsibility might not be seen as virtuous, as they avoid moral accountability. Global Trends: Some countries are moving away from anonymity by creating donor registries, but Canada and the U.S. still maintain it. Commodification and objectification Commodification can lead to objectification \ Katians have an issue as children are a means of an end to themselves Dont know what pros and cons to weigh in terms of utilitarian view point Feminist concerns about assisted reproductive practices Anderson - children nor womens reproductive capacities are appropriate to commodify - a kantian approach ○ Altruistic surrogacy 9where no money is involved, can be ethically acceptab;e) Andrews - its legitimate for women to sell their reproductive services Raymond - even altruistic surrogacy raises serious ethical concearns ○ ​In short, Raymond believes, altruistic surrogacy reinforces women’s inequality just as much as commercial surrogacy does, and in an even more insidious way: Andrews: Surrogacy aligns with women’s right to control their bodies but risks reducing women to "breeding machines." Commercial surrogacy should be allowed, as banning it undermines feminist progress in areas like abortion and contraception. Arguments against surrogacy (symbolic harm, risks to women, risks to children) often rely on outdated, demeaning views of women’s decision-making abilities. Anderson- kantian Opposes commercial surrogacy because it commodifies women’s reproductive capacities and children. Believes reproductive labor and children should be valued with respect, not treated as market goods. Argues surrogacy undermines emotional bonds and exploits women by discouraging maternal connections during pregnancy. Raymond: Opposes both commercial and altruistic surrogacy, seeing both as reinforcing gender inequality. Altruistic surrogacy creates social pressure for women to sacrifice themselves, reinforcing traditional roles and exploitation. Believes the expectation for women to provide reproductive "gifts" perpetuates inequality and their treatment as a "breeder class." Cross border reproductivecare and the baby manji case Summary:  Assisted reproductive practices pose ethical dilemmas, challenging traditional concepts of parenthood by separating conception, gestation, and nurturing. Ethical considerations are deeply tied to social contexts, requiring attention to societal factors influencing reproductive decisions. The procreative liberty argument advocates for complete reproductive freedom but relies on an individualistic autonomy model, which is inadequate for reproductive decisions involving multiple parties. A key tension exists within the procreative liberty argument: ○ It rejects government interference in reproductive choices but relies on state oversight (e.g., courts) to enforce surrogacy contracts. ○ This creates a contradiction between opposing interference and demanding legal protections. The Buzzanca case highlights this tension, demonstrating that state involvement shapes reproductive choices regardless of whether surrogacy is legalized or banned. The central ethical question is not whether the state should interfere, but rather what forms of interference are justified and the reasoning behind them. The Procreative Liberty Argument in Reproductive Technologies What It Stands For Reproductive decisions are matters of personal autonomy and should not be restricted by others or the state. Rooted in negative liberty: freedom from interference by institutions or external forces. Supported by the Harm Principle: individuals should be free to make choices unless those choices clearly harm others. Asserts that creating life (even in challenging circumstances) is better than non-existence, emphasizing the moral significance of providing life. Promotes individual rights in choosing to have children through assisted reproductive technologies (ART), regardless of societal or ethical concerns. Arguments Against Procreative Liberty Conceptual Critiques Inadequate Definition of Harm: Critics argue the focus on the absence of harm overlooks the broader implications for children, society, and families.  Overemphasis on Autonomy: Neglects other ethical principles like beneficence (doing good) and non-malfeasance (avoiding harm). Moral Relativism: Assumes that all reproductive choices are equally valid without addressing societal or ethical norms. Marketplace Ideology: Treats reproductive choices like market transactions, commodifying children and reproductive processes. Practical Concerns Physical and Emotional Harms: ○ Health risks associated with IVF, surrogacy, and multiple pregnancies. ○ Emotional distress from unsuccessful treatments or societal pressure to have children. Commodification and Objectification: ○ Assigning monetary value to sperm, eggs, and surrogacy reduces human elements to market goods. ○ Undermines the intrinsic value of family relationships and child-rearing. Anonymity and Secrecy: ○ Ethical dilemmas arise from anonymous donors, secrecy about origins, and prioritizing parental rights over children's rights. Philosophical Weaknesses Utilitarian Critique: ART should promote good outcomes for all, but the risks and costs (e.g., societal healthcare burden) often outweigh the benefits. Kantian Critique: ART can treat individuals (women, children) as means to an end rather than respecting their intrinsic value. Virtue Ethics Critique: Focus on autonomy neglects considerations of what constitutes a good life and responsible parenthood. Societal and Cultural Implications Bias in Reproductive Desires: Fertile individuals are not questioned about their motives for having children, but infertile individuals face scrutiny. Social Context of Infertility: Treating infertility as purely a medical condition ignores its social dimensions (e.g., stigma, gender inequality). Power Dynamics: Wealth and privilege shape access to ART, creating ethical disparities. Key Questions Raised Where should the line be drawn in restricting reproductive choices? How should we balance individual rights with societal and ethical concerns?  Should parenthood be regulated to ensure responsibility and reduce harm? How can ART be ethically regulated without commodifying human life? Utilitarians' Primary Arguments: Maximizing Well-Being: Utilitarians focus on the consequences of actions, aiming to maximize happiness and reduce harm. They would assess reproductive technologies based on their ability to increase overall well-being (e.g., helping people have children and fulfill their desires). Beneficence and Non-Malfeasance: Utilitarians apply the principles of beneficence (doing good) and non-malfeasance (avoiding harm) when evaluating reproductive practices. Technologies that increase positive outcomes and minimize harm would be supported. Balancing Benefits and Risks: Utilitarians argue that if assisted reproduction leads to more benefits than harms (on a societal or individual level), it should be encouraged. However, if significant harm is involved, it may be rejected Kantians' Primary Arguments: Respect for Persons: Kantians emphasize treating individuals as ends in themselves, not merely as means to an end. Assisted reproductive practices should not exploit or manipulate people for others' desires. Autonomy and Duty: Kantians believe that individuals have duties to themselves and others, and these duties should guide decisions. Reproductive technologies should respect these duties, and people should not be pressured into using them. Informed Decisions: Kantians argue that people need sufficient information to make autonomous decisions. Without clear, accurate data on the risks and benefits of reproductive technologies, individuals can't make informed choices, thus undermining their autonomy. The Categorical Imperative is a central concept in the ethical philosophy of Immanuel Kant. It is a principle that dictates how individuals should act morally, regardless of personal desires or outcomes. Kant proposed that we should act only according to maxims (rules or principles) that we could will to be universal laws. In other words, we should behave in ways that we believe everyone should behave in similar situations. There are several formulations of the Categorical Imperative, but the two most famous are: 1. Universal Law Formula: "Act only according to that maxim whereby you can at the same time will that it should become a universal law." This means you should  only act in ways that you would be okay with everyone else acting in the same way. 2. Humanity Formula: "Act in such a way that you treat humanity, whether in your own person or in the person of another, always at the same time as an end, and never merely as a means." This emphasizes respecting people as valuable in themselves, not just using them to achieve your own goals. Essentially, the Categorical Imperative is a way to ensure that actions are ethically justifiable, respecting the dignity and rights of all individuals. What you need to know for the exam: All concepts and definitions Procreative liberty arguments and criticisms of these arguments Ethical theory and assisted reproduction