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Centre Of Bioethical Research & Analysis (COBRA) resources:
Cobra Issue Guides

Reproductive Technologies

Contentious Issues in Reproductive Technologies

There are at least three kinds of procedure that tend to spark ethical debate.

Procedures intended to assist individuals or couples to conceive a child, e.g. artificial insemination, in vitro fertilisation (IVF) and surrogate childbearing.
Procedures intended to assess or promote the health of the embryo or foetus after conception, e.g. prenatal diagnosis, sex selection, embryo therapy and foetal surgery.
Research procedures that use human gametes, embryos, or foetuses, e.g. embryo experimentation and the use of foetal tissue transplants in the treatment of Parkinson's disease.

Reprogenetics: the shift from 'chance to choice'

Reprogenetics represents the increasing likelihood of being able to isolate genes that are implicated in diseases like Huntingdon's Chorea, cystic fibrosis, Duchenne muscular dystrophy, breast cancer, diabetes, deafness etc - and then to remove them from an embryo. For more on these types of issues see the guide to genetics.

In Vitro Fertilisation (IVF): 'curing childlessness'

Questions: Should doctors honour any request for assisted procreation? (E.g. a British woman, Patricia Rashbrook, used donor eggs and IVF to become pregnant at the age of 62 in 2006). Is the doctor's sole responsibility to assess medical issues and, if patients are medically suited for treatment, to conduct IVF in conformity with state of the art techniques? Or, have doctors got a specific responsibility that goes beyond respect for the autonomy of the woman or couple that asks for assisted reproduction?

Does the fact that patients need the assistance of doctors in reproduction create an extra moral responsibility on the part of those doctors?

Three models of decision making in assisted reproduction

The maximum welfare principle: we should not knowingly bring a child into the world in less than ideal circumstances. Since we can, to a certain extent, control the circumstances in which a child is made when the candidates are infertile, the idea is that we ought to restrict our co-operation to those cases that maximise the welfare of the child.

Problem: very few people live in ideal circumstances and so the principle seems to rule out almost everyone from seeking assisted reproduction.

The minimum threshold principle: a child should not be brought into the world, if and only if, it would have been better for it not to have been born at all.

Problem: some believe that this threshold is too low, sanctioning the birth of children whose prospects and opportunities, whether medically or socially, are dismal.
The reasonable welfare principle: a child can be brought into the world if the level of welfare that it is expected to achieve is reasonable, rather than optimal or minimal.

Problem: how do we decide what counts as denoting a reasonable level of welfare?

Question: does the difficulty in making judgements about quality of life, about what we should permit and what we should prohibit in terms of access to new reproductive technologies, recommend that we adopt either the maximum welfare or the minimum threshold principle?

Peter Singer: "the choice is up to us, both individually and collectively, to make an ethical decision about how we should use [new reproductive technology] or even not to use it at all. Each further development needs to be discussed on its merits".

Irish Context

The recent High Court case, MR v. TR IEHC [2006] 359 (15 Nov. 2006), raised basic moral and legal questions about the status of the human embryo in Ireland. A woman had brought a case against her estranged husband (and, in addition to others, the fertility clinic that was storing her embryos).

She argued that her former husband was obliged by the original consent form to allow her have the remaining frozen embryos implanted, and that Article 40.3.3 of the Constitution conferred a right on the embryos to be implanted and brought to life. Given the ambiguous terminology used in the Constitutional amendment that protects the right to life of the 'unborn', it is open to interpretation.

Originally intended to Constitutionally prohibit abortion, the amendment has significant implications for the practice of IVF and some other assisted human reproduction techniques, and embryo research. See the COBRA Issue Guide to Abortion, for more information and readings.

The High Court found that the consent given by the husband in the case was not legally binding, and dismissed this claim. The judge also ruled against the woman's second claim, stating that the right to life of the 'unborn' did not apply to embryos outside the uterus. This judgement is on appeal to the Supreme Court, which has yet to deal with the case. Once it gives a definitive interpretation of the Constitutional article in question, the legal and moral ramifications for the practice of assisted reproduction will be known.

The Commission on Assisted Human Reproduction (CAHR) published a report in 2005 after researching and debating the various issues that arise in assisted human reproduction and the associated technologies, with the aim of recommending regulatory approaches for this area medicine and research. None of the 40 recommendations have been implemented, and the it is expected that they will not be acted on until after the Supreme Court makes a judgement in the MR v. TR case and the Joint Oireachtas (Parliamentary) Committee can further report on the report, as suggested by the Minister for Health and Children, Mary Harney, T.D. in parliamentary debate.

Centre Of Bioethical Research & Analysis (COBRA) resources: Cobra Issue Guides