Procreative Autonomy Versus Beneficence in Assisted Reproductive Technologies

2020 ◽  
Vol 12 (1) ◽  
pp. 25-30
Author(s):  
Sorin Hostiuc ◽  
Keyword(s):  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Competing Values ◽  
Medical Risk ◽  
Procreative Beneficence ◽  
Present Information ◽  
Ethical Conflicts ◽  
Bioethical Issues ◽  
Procreative Autonomy ◽  
Prospective Parents

Since its beginning, healthcare has focused its attention on helping patients become healthier and live longer. One of the areas in which medical technology has made impressive strides is assisted reproductive technologies. Some bioethical issues are common to most or all of these newer reproductive technologies. The uncertainty of long-term risks posed by reproductive technologies generate potential challenges to the values of beneficence and non-maleficence and strain the already divisive dichotomy between procreative autonomy and procreative beneficence. Procreative autonomy and procreative beneficence are both important values that physicians and prospective parents ought to evaluate when considering the use of assisted reproductive technologies. However, the moral prescriptives associated with each value may diverge and conflict with one another; when this occurs, minute arguments may shift the balance between them. For physicians, prioritizing the value of procreative autonomy or procreative beneficence mainly influences the way in which they choose to present information–that is, whether they are directive or non-directive when consulted about family-planning options. Assisted reproductive technologies have dramatically increased the range of choices available to prospective parents, and this breadth of choice may lead to potential ethical conflicts between the competing values of procreative autonomy and procreative beneficence. In the following article, we will address this friction, focusing our attention on normative considerations related to medical risk management and the telos of the prospective child.

The epigenetic effects of assisted reproductive technologies: ethical considerations

2017 ◽  
Vol 8 (4) ◽  
pp. 436-442 ◽  
Author(s):  
M.-C. Roy ◽  
C. Dupras ◽  
V. Ravitsky
Keyword(s):  
Ethical Issues ◽  
Assisted Reproductive Technologies ◽  
Late Onset ◽  
Reproductive Technologies ◽  
Evidence Base ◽  
Parents And Children ◽  
Children Health ◽  
Health And Disease ◽  
Ethical Tension ◽  
Prospective Parents

The use of assisted reproductive technologies (ART) has increased significantly, allowing many coping with infertility to conceive. However, an emerging body of evidence suggests that ART could carry epigenetic risks for those conceived through the use of these technologies. In accordance with the Developmental Origins of Health and Disease hypothesis, ART could increase the risk of developing late-onset diseases through epigenetic mechanisms, as superovulation, fertilization methods and embryo culture could impair the embryo’s epigenetic reprogramming. Such epigenetic risks raise ethical issues for all stakeholders: prospective parents and children, health professionals and society. This paper focuses on ethical issues raised by the consideration of these risks when using ART. We apply two key ethical principles of North American bioethics (respect for autonomy and non-maleficence) and suggest that an ethical tension may emerge from conflicting duties to promote the reproductive autonomy of prospective parents on one hand, and to minimize risks to prospective children on the other. We argue that this tension is inherent to the entire enterprise of ART and thus cannot be addressed by individual clinicians in individual cases. We also consider the implications of the ‘non-identity problem’ in this context. We call for additional research that would allow a more robust evidence base for policy. We also call upon professional societies to provide clinicians with guidelines and educational resources to facilitate the communication of epigenetic risks associated with ART to patients, taking into consideration the challenges of communicating risk information whose validity is still uncertain.

scholarly journals Ethical-anthropological dilemmas of gamete and embryo donation: commodification, altruism, morality, and the future of the genetic family

2020 ◽  
Vol 24 (1) ◽  
pp. 113-124
Author(s):  
Larisa P. Kiyashchenko ◽  
Svetlana A. Bronfman ◽  
Farida G. Maylenova
Keyword(s):  
Social Relations ◽  
Assisted Reproductive Technologies ◽  
Developed Countries ◽  
Reproductive Technologies ◽  
Hereditary Diseases ◽  
Specific Situation ◽  
Technical Equipment ◽  
Heterosexual Couples ◽  
Wide Range ◽  
Ethical Conflicts

ART and, in particular, IVF and ICSI, are essentially a laboratory experiment, but which, due to its specificity, goes beyond the disciplinary boundaries, explicitly acquiring an ethical-axiological dimension in the interaction zone of the members of a particular community involved in child-bearing. At the same time, it is noted that the activity and choice of a way to solve problems with childbirth has a characteristic severity, due to the traditions and level of civil and social maturity of a country, due, among other things, to the level and achievements of technical equipment in this industry of knowledge and practice. According to foreign studies, about half of all subfertile people (having problems with childbirth, but potentially able to become parents) in developed countries are trying to overcome their infertility with the help of medicine, and research data indicate that the proportion of such individuals is growing. The most difficult problems of reproduction are associated with low quality of oocytes (eggs) or low ovarian reserve (both age and hereditary, as well as associated with past diseases or iatrogenic); aspermia and deep teratozoospermia (the presence of only pathological forms of sperm in the ejaculate), can not give hope to a couple (or individual) to have genetically related offspring. However, donor programs create additional opportunities for social (non-biological) motherhood / paternity. Donation of oocytes (ova) is found in ART programs at least 3 times more often than donation of spermatozoa (for heterosexual couples, but not for single women). At the moment, donation of gametes and embryos raises a number of ethical, legal, medical and socio-psychological issues that require competent support from experts of a wide range of specialists, as well as competent, non-commercial, primarily due to the interaction between donors and recipients. The analysis of possible modifications of family and kinship ties is based on the idea of transforming social relations, in which assisted reproductive technologies (ART) play a fundamental role, building a system of “new kinship and new family.” By entering into the intimate process of the birth of life and acting as a regulator of the composition of participants in this process through the stimulation of responsibility to present and future relatives, reproductive technologies affect the initial moral requirements in the community, redefining universal values based on the specific situation. Scenarios of childbearing through ART with the involvement of additional participants (donors of sperm, oocytes or embryos) are possible in the context of the legal field, but legally fixed anonymity of the donor (except for the relative of the recipient) leaves many unresolved issues related to the problems of hereditary diseases, genetic abnormalities and epigenetic changes; in addition, there is a problem associated with the possibility of unintentional incest, as well as the difficulties of the child’s self-identification and the closeness of his genealogy. Solutions to these issues are postponed until later, thereby initiating future dramatic situations, ethical conflicts and dilemmas with a poorly predictable positive outcome.

Unique benefits of ectogenesis outweigh potential harms

2019 ◽  
Vol 3 (6) ◽  
pp. 719-722
Author(s):  
Evie Kendal
Keyword(s):  
Genetic Engineering ◽  
Women's Rights ◽  
Ethical Issues ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Women’S Rights ◽  
Reproductive Autonomy ◽  
Parents And Children ◽  
Safety Risks ◽  
Prospective Parents

This article will consider some of the ethical issues concerning ectogenesis technology, including possible misuse, social harms and safety risks. The article discusses three common objections to ectogenesis, namely that artificial gestation transgresses nature, risks promoting cloning and genetic engineering of offspring, and would lead to the commodification of children. Counterbalancing these concerns are an appeal to women's rights, reproductive autonomy, and the rights of the infertile to access appropriate assisted reproductive technologies. The article concludes that the unique benefits of promoting the development of ectogenesis technology to prospective parents and children, outweigh any potential harms.

Re-imagining Reproduction: Unsettling Metaphors in the History of Imperial Science and Commercial Surrogacy in India

Somatechnics ◽  
2015 ◽  
Vol 5 (1) ◽  
pp. 88-103 ◽  
Author(s):  
Kalindi Vora
Keyword(s):  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
The Body ◽  
Body Parts ◽  
Colonial History ◽  
Women's Bodies ◽  
Commercial Surrogacy ◽  
Art Practices ◽  
History Of ◽  
Travel Industry

This paper provides an analysis of how cultural notions of the body and kinship conveyed through Western medical technologies and practices in Assisted Reproductive Technologies (ART) bring together India's colonial history and its economic development through outsourcing, globalisation and instrumentalised notions of the reproductive body in transnational commercial surrogacy. Essential to this industry is the concept of the disembodied uterus that has arisen in scientific and medical practice, which allows for the logic of the ‘gestational carrier’ as a functional role in ART practices, and therefore in transnational medical fertility travel to India. Highlighting the instrumentalisation of the uterus as an alienable component of a body and subject – and therefore of women's bodies in surrogacy – helps elucidate some of the material and political stakes that accompany the growth of the fertility travel industry in India, where histories of privilege and difference converge. I conclude that the metaphors we use to structure our understanding of bodies and body parts impact how we imagine appropriate roles for people and their bodies in ways that are still deeply entangled with imperial histories of science, and these histories shape the contemporary disparities found in access to medical and legal protections among participants in transnational surrogacy arrangements.

The role of the growth hormone in assisted reproductive technologies cycles

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 6-8
Author(s):  
Andrey Y Romanov ◽  
Anastasiya G Syrkasheva ◽  
Nataliya V Dolgushina ◽  
Elena A Kalinina
Keyword(s):  
Growth Hormone ◽  
Live Birth ◽  
Ovarian Stimulation ◽  
Assisted Reproductive Technologies ◽  
Polycystic Ovary ◽  
Live Birth Rate ◽  
Reproductive Technologies ◽  
Blood Levels ◽  
Main Research ◽  
Poor Ovarian Responders

The paper analyzes the literature data on the use of the growth hormone (GH) in ovarian stimulation in assisted reproductive technologies (ART). Routine use of GH in ovarian stimulation in patients with a normal GH level does not increase pregnancy and childbirth rates in ART. Also, no benefits of using GH have been identified for patients with polycystic ovary syndrome, despite the increase in insulin and IGF-1 blood levels. The main research focus is to study the use of GH in patients with poor ovarian response. According to the meta-analysis conducted by X.-L. Li et al. (2017), GH in ovarian stimulation of poor ovarian responders increases the number of received oocytes, mature oocytes number, reduces the embryo transfer cancellation rate and does not affect the fertilization rate. The pregnancy and live birth rates are significantly higher in the group of GH use - by 1.65 (95% CI 1.23-2.22) and 1.73 (95% CI 1.25-2.40) times, respectively. Thus, it is advisable to use GH in ovarian stimulation in poor ovarian responders, since it allows to increases live birth rate in ART. However, further studies should determine the optimal GH dose and assesse it`s safety in ART programs.

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