The Legality/Ethics of Donation/Surrogacy

HCR 210 Ethics for the Healthcare Professional Learning Objectives: • Explain sexual privacy issues and be familiar with the ethical principles surrounding refusal or conscience legislation and emergency contraception provisions in the law • Become familiar with the ethical issues of reproductive health Disclaimer: • We will be discussing sensitive topics on which you may have strong personal opinions • Your personal opinions may be different from your fellow classmates or myself • I encourage you to share your opinions and engage in polite discussions exploring the ethics of reproduction • Please note that this is meant to be a safe and inclusive learning environment The Legality/Ethics of Donation/Surrogacy What Do You Think? A. Surrogacy is always unethical regardless of the situation B. Surrogacy is ethical in certain situations C. Surrogacy is always ethical regardless of the situation D. I do not have an opinion on surrogacy The Legality/Ethics of Donation/Surrogacy Do you agree or disagree with these statements from the textbook? (Full text available on page 82). Develop your argument, using ethical theories and principles to defend your answer. Clinical Scenario Father A and Father B decide that they want to have a child. They decide to use Father A’s sperm as the donor sperm. They ask their friend, Mother A, to donate her ovum for their new child. While Mother A agrees, she does not want to carry the baby. After looking for several months, they find Mother B, who agrees to carry the child. After the child is born, Mother A decides that she would like to play an active role in raising the child, which Father A and Father B never agreed to and feel uncomfortable with. What is the most ethical solution? I (Personally) Disagree with the Textbook Second Disclaimer: these are my personal viewpoints • It is okay if you disagree with my viewpoints, or disagree with the textbook • The purpose this class is to talk about opposing viewpoints in a safe and polite environment • There is no “right” answer in ethics I (Personally) Disagree with the Textbook Things I Agree With: • There are many ethical, legal, social, and psychological considerations with surrogacy and donation of gametes • There can be a tricky slippery slope when “selling” human products, especially if it is unregulated or underregulated • Risk of abuse and misconduct, especially towards women who are in low socioeconomic status • The main consideration should always be the health and safety of the child I (Personally) Disagree with the Textbook Things I Disagree With: • Assumes that gamete donors, gestation surrogates, and traditional surrogates are all ethically similar • Uses strong, shocking language to appeal to righteousness o This is can be considered a logical fallacy Ø assumption that prostitution, traditional surrogacy, and gestation surrogacy are ethically similar I (Personally) Disagree with the Textbook Things I Disagree With: • Assumes that biological parents should always be responsible for their offspring o In this instance, is giving your child up for adoption also unethical? • Makes the argument that sexual relationships should not occur outside of “committed loving relationships” o Assumes that this viewpoint is the same for everyone • Makes a blanket statement that donors, gestational surrogates, and traditional surrogacy are always wrong I (Personally) Disagree with the Textbook American College of Obstetricians and Gynecologists’ Committee on Ethics 2016 opinion, reaffirmed in 2019: • Traditional surrogacy is not addressed however it is noted that it is more ethically and legally complex • Gestational surrogacy should be limited to situations in which biological gestation is either impossible or medically contraindicated • Parents (both gestational and social) should seek advice from legal counselling • Parents (both gestational and social) should seek advice from mental health counselling • There should be a formally documented gestational surrogacy contract I (Personally) Disagree with the Textbook Beneficence There can be “good” in donation/surrogacy – for example, you are helping create a life and can be assisting with other people who are struggling to conceive. Nonmaleficence Stopping people from being able to have children via donation and surrogacy can be considered “doing a harm” if it brings mental/psychological damage to the potential parents. I (Personally) Disagree with the Textbook Autonomy Be respectful of the rights of the future child, potential parents (biological, gestation, and social). Justice • Procedural: Provides an alternative for non-heterosexual couples, or other couples who are unable to conceive. • Distributive: Who deserves the right of “parenthood”? Ethical Theories How could you use the different ethical theories to support or not support reproductive surrogacy? • • • • • • Deontology Consequentialism Natural Law Virtue Ethics Authority Based Ethics Ethical Egoism Surrogacy Laws • Laws regarding the legality of traditional surrogacy and gestational surrogacy vary state to state • In Arizona, surrogacy is technically legal but contracts are illegal (both traditional and gestational) o Surrogate mothers are considered the legal mother of the child • In some states, compensated surrogacy is legal (California) o Considered payment for time, lost wages, and travel expenses rather than ”paying for a baby” • In other states, surrogacy is legal but compensated surrogacy is illegal “Designer” Babies Genetic Testing via Amniocentesis • Removal of fluid from the amniotic sac to test for chromosome abnormalities (such as Down Syndrome), neural tube defects, and other genetic disorders • Accuracy rate is 98-99%, however does not test for severity • Typically occurs during weeks 14 to 20, although can occur as early at 11 weeks *Note that amniocentesis can also be used to test for things other than genetic testing such as fetal lung maturity or uterine infections in the third trimester Non-Invasive Prenatal Screening • Also called non-invasive prenatal testing • Able to use blood drawn from the mother to test for small fragments for cellfree DNA • Can be used to test for chromosomal disorders (Down syndrome) and other genetic diseases (cystic fibrosis) • Accuracy depends on the test for the individual diseases Ethics of Prenatal Screening What do you think about the implications of prenatal screening? Do you agree or disagree with prenatal screening? Selection for Traits with IVF Selection for Traits with IVF $2,200 $2,100 $400-800 CRISPR • “Cluster of regularly interspaced palindromic repeats” • Used by bacteria to destroy the DNA of viruses and other foreign bodies (confer bacterial immunity to viruses) CRISPR • Can theoretically be used as a “genome editing tool” or ”gene scissors” to select for traits • When combined with IVF, can possibly be used to cure diseases • In March 2020, CRISPR technology was used for the first time on humans in the United States at the Casey Eye Institute at Oregon Health & Science University • Experimental treatment for genetic disease Leber congenital amaurosis 10 via delivery of CRISPR drug directly into the eye which will then correct the gene error CRISPR • However, there is also a push and resultant fear that it may be used to create “designer” babies CRISPR • In 2018, Chinese scientist He Jiankui claimed to have created the world’s first CRISPR edited embryos (Lulu and Nana) who were born in October of that year • Attempted to give the girls genes resistant to HIV however violated legal guidelines prohibiting use of CRISPR on human embryos • This raised many ethical considerations, especially given He Jiankui’s unethical scientific practices What ethical principles did he violate? The ethical dilemma of designer babies by Paul Knoepfler What Do You Think? A. There is nothing wrong with modifying or selecting for the DNA of fetuses B. It is okay to modify or select for the DNA of fetuses in certain circumstances such as illness C. It is immoral to modify or select for the DNA of fetuses in all situations D. I do not have an opinion on this Questions? Assignment No assignments! Have a wonderful week.