B991 Health and Social Care : Exploring the New Reproductive Technologies

Annotated Scrapbook

This article greatly interested me because of the promising and emerging reproductive technologies. According to this news article, Gametogenesis (IVG) is a promising method that poses a way to new therapies that unravel the mechanisms of genetic forms of infertility. It is a method of generating eggs from the pluripotent stem cells that are derived from adult body tissues. This leads to the creation of embryos from the gametes. However, the IVG raises legal and ethical issues that need to be addressed before this technique is used in human. The most far-fetched ethical issue is the emergence of concept of “designer babies” where the parents can choose their own embryos through the IVG that leads to the implantation of “ideal baby”. This is an ethical puzzle where the technique is risky and many ethical considerations associated with the technique. The authors argue that this technology might be successful that offers a way to deeper knowledge of human genetics. However, this technique might pose a way to make difficult decisions that draws line between eugenics versus alterations that put an end to the harmful conditions. It also raises questions of “embryo farming” where the embryos exacerbate concerns regarding the devaluation of human life. It also raises ethical concerns regarding the long term health effects and safety of the offspring that are being generated through the technique.

This article interested me as it focuses on the immense capability of IVG technology in the creation of babies, although it has ethical and legal implications associated with it. In this news article, the impact of reproductive technologies like IVG on the mechanism of reproduction and society as a whole is discussed. It is mentioned that this technology has great potential for the infertile couples who have no options as said by the reproductive scientist, Kyle Orwig at the University of Pittsburgh. However, IVG has great legal and ethical issues as mentioned in the paper of Science Translational Medicine by the scholars at Harvard and Brown University. There are ethical questions regarding the parental rights that are associated with these reproductive techniques. The medical law and society raises questions about the repercussions if the skin cells of one person are being stolen to make babies. This technique is giving the parents an opportunity to design their babies according to genetic modification and editing based on specific traits. Moreover, there are ethical questions regarding the employment of the IVG technology that would be safe enough to clear the obstacles to infertility. In one instance, if IVG employed for a polygamous, thruple relationship where they all are the genetic parents of the baby. However, if the embryo formed from the thruple splits during the process. In another instance, IVG allows single-parent to have babies where one person produces both egg and sperm. The question arises that is this application legal enough to be employed. So, there are many ethical and legal question associated with the technique of IVG.

This article interested me as it focuses on the ethical and legal issues illustrated by Stanford Professor focusing on reproductive technologies. In this news article, Stanford University, Law Professor Hank Greely discussed about the human reproduction technologies like IVG and the associated ethical and legal issues. It also discussed about the implications of the emerging technologies that are making changes in the human reproduction. As the parents are able to make decisions and choose specific traits ahead of time to make a combination of the genetic traits that the offspring would inherit have set up a quandary that the future generations are likely to face. The Law Professor says that it is not a science fiction where the specific characters are being decided about the future generation. He says that there are many legal issues and changes that need to be made so that the benefits are maximized and harms are being minimized in these reproductive technologies that make babies. In his article, he states that there are ethical issues where there is a requirement for documentation of the mechanism involving the provenance of the cells that are being used to derive sperm or egg. Moreover, there is no particular law book that could be referred regarding the complicated ethical and legal issues. In addition, fairness is another ethical issue where the people of the rich countries have access to the child-making process and others do not have the provision depicting international disparities.  

The critical essay

From the above mentioned annotated scrapbook, the news article by Sciencedaily, 2017 has been taken for the critical evaluation of the ethical and legal issues associated with the reproductive technology like In Vitro Gametogenesis (IVG). This article by Harvard Medical School states that the IVG technique is a promising and emerging technology that solves the genetic forms of infertility and paves a way to the emerging reproductive technologies. However, it has ethical and legal questions for the society before the implementation of this technique in the human patients as argued by the scholars. The IVG would replace the In Vitro Fertilization (IVF) as this technique is considered to be the next era in regenerative and reproductive medicine (Miller, Birch, Mauthner and Jessop 2012). This technique is greatly successful in mice where the scientists are successful in creating embryos in the lab by reprogramming of the adult cell that become an egg or sperm cell. It is a milestone that unravels the genetic forms of infertility and treatment of untreatable diseases. This technique also puts an end to the inexhaustible supply of embryonic stem cells that are lab-made and also in the therapeutic use being an alternative to supply of human embryonic stem cells that are limited due to regulatory restrictions and ethical considerations (Culley, Hudson and Van Rooij 2012).

Despite of the advantages of the IVG technology, there are many ethical and legal issues that are raised in context to the employment of the technique. Although, the technique holds potential to treat infertility and untreatable diseases, there are scientific ethical and legal issues regarding the rigorous protocols that are required to ensure the employment of the IVG. There are also ethical challenges regarding the protocol that the creation of reproductive cells through the IVG are free from genetic aberrations, threat to improper commercialization for large scale generation by using IVG and regarding creation of designer babies by preimplantation genetic screening. There are serious ethical issues regarding the implications of IVG by the scientists, policymakers, legal scholars, bioethicists and the public. As said by the dean of Harvard Medical School, George Q. Daley, the vital conversations regarding the implications of IVG needs to be addressed by engaging the public. There is a need to maintain the right balance between the core legal and ethical principles and scientific pursuits (Ettorre 2013).

Though, IVG has great potential to upend the traditional human culture elements like the understanding and occurrence of parenthood, it has scientific challenges, ethical perils and legal considerations. The perfecting of the technology before it goes for clinical trial is a challenging task for the researchers. The technique needs to be ensured that the original parent cells and the multipurpose cells that are being used for the technique needs to be free from any kind of epigenetic and genetic aberrations. There is legal issue associated with the IVG technique like the federal funding. This technique initially requires the generation and destruction of human embryos that are lab-made and derived from stem cells having scientific pursuits which might not be applicable for federal funding (Ross et al. 2013).

The “embryo farming” is another issue that raises ethical considerations. This technique readily generates multiple embryos that could reignite the concerns regarding “embryo farming” and human reproduction commodification (Sparrow 2013). The legal questions arises regarding the scrutiny of egg and sperm banks models by the state and federal department. There is also an issue related to the clinical use of the IVG widespread. The traditional practice of IVF that is used to screen the embryos for the genetic defects is already in use and with the unlimited IVG generated embryo supply; parents would select the embryos based on preferred genetic traits with IVF rather than IVG. Another ethical concern that arises is the technique that is employed in the IVG. The technique of direct gene modification through gene editing is more feasible than the CRISPR technology (Deonandan  Green and Van Beinum 2012). Hence, the germ cells that undergo gene editing for the genetic enhancement practice raise many ethical considerations.

The IVG increases the risk for surreptitious or unauthorized use of biological material like skin or hair cells that are required to generate human embryos. This possibility not only raises ethical issue but also legal questions that are worrisome and cutting the legal definition of core parenthood. According to Baruch, D'Adamo and Seager (2014) the IVG poses many ethical issues for the lawmakers and scientists as the technique provide opportunities for the older women to become mothers easily. The older women who delays pregnancy have a chance to become mothers for the first time and in instances where older women cannot conceive by using their eggs. This aspect raises ethical questions regarding the starting of family in their 40’ or 50’s by more and more older women. There are also ethical questions regarding the risk factor of the technique and the concept of “designer babies”. The parents have the opportunity to choose the embryo based on specific traits and have “ideal baby” which they want to get implanted (Davies et al. 2012).

The technique also encompasses ethical considerations on harmful conditions and eugenics, religious or moral grounds. There is devaluation of life as the “embryo farming” spectre is raised through the technique of IVG. Another immediate concern is about the safety and health outcomes that are related with the safe use of the technique in humans. The technique needs to be studied about the potential health impact of the generated offspring which is also an ethical consideration. The clinical trials need to be robust and large before it is conducted on any human. According to Brezina and Zhao (2012) the technique of IVG also raises challenging issues for the people with disabilities. When the technique involves the adult cells from disabled people, it lowers the interest of research and social support. For example, if a family of heritable dwarfism and deafness chooses an embryo because of deafness as it is inherited in their family and they want to preserve the culture of deafness in their family from the genocide, then there are ethical considerations involved in the technique. Despite of the potential of the family to choose a corrected embryo, the family preferred to choose the embryo over deafness and this poses legal considerations about the validity of the reproductive technique, IVG (Palacios-González, Harris and Testa 2014).

IVG holds tremendous potential to produce eggs or sperms with the actual need for any reproductive organs that are functioning and for the patients who have lost their reproductive function. It also has power to currently revolutionise the technique of in vitro fertilization by supplying enormous eggs that are drug-induced and surgically harvested at great expense and in very small quantities (Bourne, Douglas and Savulescu 2012). The technique also provides eggs that can generate personalized embryonic stem cells for the future use in the medical field. This could also harness the existing technology of creating stem cells by the process of transferring nucleus from one the mature body cells to an enucleated egg cell. However, this technique also holds ethical concerns that are magnified in a way with the application of the technique. According to Overall (2012) many people oppose the concept of creating embryos in the lab for therapeutic use or research and in the technology that is involved in the IVG that is not easily done in the laboratory hold ethical and legal questions.

As the reproductive technology of IVG holds many ethical and legal issues, it requires the medical ethics and principles to address these issues. The ethical theories that are utilized in the bioethics addresses the questions by explaining the reason why the issue have been regarded as ethical and the course of action needs to be taken in order to mitigate the ethical and legal issue. The reproductive ethics is involved with the human reproduction and issues related to beginning-of-life such as assisted reproductive technologies like In Vitro Gametogenesis and preimplantation genetic diagnosis (Mansour et al. 2014). The ethical issues involves the concerns regarding the technology introduction in the reproductive process, potential for abortifacient, distinctions between procreation and reproduction, oocyte and embryo preservation and issue with sex selection. The Principle of Procreative Beneficence (PB) holds the ethical consideration that a couple who is planning to have a baby should have enough moral reason for the adoption of this technology, IVG. The offspring that would be generated through this process should experience the greatest health and mental well-being with the best chance in life (Dondorp et al. 2012).

The Research Ethics Committee (REC) reviews the research studies that ensure local and international accepted ethical standards. The REC’s main responsibility is to evaluate the protocols of the research that is aimed at safeguarding the well-being and rights of the participants (de Jong, van Zwieten and Willems 2012).  It also ensures that research risk is minimized with anticipated benefits and adequate plans that involve the informed consent of the patients. They also assess the confidentiality of the participants who are taking part in the research (Sullivan et al. 2013).

Moreover, the ethical issues are also addressed in the process that the parents should not select the embryo based on perfectionism that is considered to be highly unethical. There are many ethical principles that area involved in the use of reproductive technologies in clinical research and practice. The application of ethical principles should be applied to the research that involves human embryos in the reproductive technologies (Baylis 2013). The legislation involves the informed consent that is required before the application of the method in accordance with the guidelines of the Research Involving Human Embryos Act (RIHE). For using the reproductive technologies, the ethical basis of guidelines recognize the basic principles and motives that acknowledge human goods promoting utilitarianism, moral evaluation of the acts and its consequences. It also takes into consideration the character traits or virtues that visualize and facilitate conduct in the technology with the recognition of the ethical questions along with political and social questions (Kuhse, Schüklenk and Singer 2015).

The ethical principles also encompasses that the researchers and clinicians should include their standard operating procedures in compliance with the ethical guidelines. The ethical principles for the clinical practice must respect the participants, acknowledge the welfare and interests of the offsprings as well as the psychological welfare and long-term health effects of the participants and the gamete donors. The principles also include the respect for the human embryos as different community hold different views about a human embryos moral status. There should be effective, consistent and open decision-making among the clinicians in the practice. There should also be high quality research that complies with the legislation (Inhorn and Patrizio 2015).

In United Kingdom, the Health Research Authority - REC provides information and ethical guidelines for human research that involves human embryos and in addressing the raised ethical issues. The Code of Human Research Ethics in United Kingdom set out principles that need to be followed by the researchers and research involving human embryos. The respect for autonomy, dignity and privacy of the individuals needs to be maintained. There should be adherence to the moral rights which is an essential component for the maintenance of dignity of the persons. The ethics standards involve the respect for autonomy with cultural considerations and a clear duty towards the individuals.  There should be privacy and confidentiality of the participants who are involved in the research involving human embryos (Greaney et al. 2012). In the reproductive technology like IVG, the researchers should maintain confidentiality and privacy of the participant’s information so that there is no discrepancy regarding the genetic information. In addition, there should be scientific integrity that validates integrity, quality and contribution to understanding and knowledge development (Creswell 2012). The ethical standards also need to be met that ensures scholarly and scientific validity with robustness and high quality. The potential risks that are involved with the reproductive technology should be taken into consideration and addressing of the quality of the scientific protocol is also important.

The ethical principles also involve social responsibility that is involved in context to human society. The researchers should acknowledge the social structures and societal needs that measure the benefits that are related to the interventions and research. The researchers should also take into consideration the integrity and dignity of the individuals contributing to the ethical theory of ‘common good’ (Iacono and Carling?Jenkins 2012). There should be maximization of the benefits and minimization of the potential harms that are associated with the physical, mental and psychosocial well-being of the people. The principle also involves the avoidance and minimization of the risks that are associated with the reproductive technology. The technique of IVG involves potential ethical and legal issues regarding the associated health hazards and risks that involve the participants and the offsprings that are to be generated through the process. The technology might have long-term health effects on the participants that also pose a ethical consideration that is being addressed by the ethical standards. From the inception to the dissemination, the researchers should look into the health impact and outcomes that is associated with the reproductive technology (Hammersley and Traianou 2012).

According to the Code of Human Research Ethics, the researchers should also follow the ethical guidelines that consider the line between the costs of the participant versus the societal benefits. There is great difficulty in maintaining this balance that might pose a threat to the research involving human embryos and reproductive technologies.  Therefore, these guiding principles help to address the ethical and legal issues that arise in the reproductive technologies involving human embryos (Harriss and Atkinson 2013).

Form the above critical essay, it can be concluded that the reproductive technology like IVG holds tremendous to create babies and generate embryos through the fusion of egg and sperm cells. The press cutting from the Harvard University School states that this technology utilizes human skin or hair cells to generate embryos. It is a promising technique that is considered to be a boon for the infertile couples or for the people who have lost their reproductive organs and inability to reproduce. It put an end to the inexhaustible embryonic stem cells for the therapeutic use and research. Despite of the advantages that this technique holds, it raises many ethical and legal issues regarding the research protocols, potential risks and long-term health effects of the participants and of the generated offsprings. The ethical guidelines play an important role in addressing the ethical issues and in testing the authenticity and validity of the research involving human embryos and reproductive technologies.

References:

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Baylis, F., 2013. The ethics of creating children with three genetic parents. Reproductive biomedicine online, 26(6), pp.531-534.

Bourne, H., Douglas, T. and Savulescu, J., 2012. Procreative beneficence and in vitro gametogenesis. Monash bioethics review, 30(2), p.29.

Brezina, P.R. and Zhao, Y., 2012. The ethical, legal, and social issues impacted by modern assisted reproductive technologies. Obstetrics and gynecology international, 2012.

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