ETHICAL APPRAISAL OF TWO/DUAL/TWIN BIOMEDICAL ISSUES/CONCERNS/EVOLUTIONS/DISCOVERIES: IN-VITRO FERTILIZATION AND SURROGATE MOTHERHOOD
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TABLE OF CONTENTS
Table of contents
- Clarification of terms
- History of In-Vitro Fertilization (IVF)
- Causes of Infertility
- Why people go for In-Vitro Fertilization (IVF)
- Procedures and processes involved in In-Vitro Fertilization
Issues in In-Vitro Fertilization (IVF)
2.1 Medical issues in In-Vitro Fertilization
2.2 Legal issues in In-Vitro Fertilization
2.3 Moral Issues in In-Vitro Fertilization
2.4 Religious Issues in In-Vitro Fertilization
2.5 Arguments in Favour of In-Vitro Fertilization
2.6 Arguments Against In-Vitro Fertilization
Ethical Appraisal of In-Vitro Fertilization
3.1 Appraisal based on Teleological theories of Egoism, Altruism, and Utilitarianism
3.2 Appraisal based on Deontological theory with special reference to Immanuel Kant’s Deontological theory
SUMMARY AND CONCLUSION
Like a never-ending flow of a river, science keeps reinventing, renovating, and updating itself continually, thereby, captivating us with technologies which provide novel options that are non-existent before. The recent development in science have opened up unimagined possibilities, especially in the area of Biomedical Sciences in a number of ways. The breakthroughs recorded have somewhat aided in solving most of man’s problems including those of infertility. The need to contend with the problems of infertility, as well as unbridled appetite for knowledge, research and other related issues have engendered different forms of “Assisted Reproductive Technology” among which is In-Vitro Fertilization (IVF). In-Vitro Fertilization as one of the ground-breaking fields in Biomedical Sciences, is a kind of ectogenesis, which is a method of achieving fertilization outside the natural environment.
It seems humans derive happiness in reproducing their own kind. There is no gain denying the fact that children compliment the joy in a marital home. Unfortunately, when this is not forthcoming, some couples resort to Assisted Reproductive means such as In-Vitro Fertilization (IVF) to achieve the happiness derived in having one own’s biological child. For Aristotle, “all studies and undertaken are directed to the attainment of some good… for both the multitude and persons of refinement speak of it as happiness”. Banejee (online ) observes that:
As problems of infertility and sterility become more common, people are turning to science for solution and no amount of failure can deter them from trying any possible means of satisfying their creative urge, the urge of giving birth that is deeply entrenched in their hearts….
Buttressing further, The New International Version of the Bible states (580 ), “there are three things that are never satisfied, four never say ‘Enough’ the grave, the barren womb, land which is never satisfied with water, and the fire which never says Enough” (Proverbs 30:15-16). Infertility has a number of causes both known and unknown.
Note, if after one year of regular sexual intercourse without the use of birth control, a woman is unable to get pregnant, infertility is suspected. Today a number of infertile couples have attained the status of parenthood through In-Vitro Fertilization. But before embracing the new technology with open arms, we need to consider its impacts in the society. The question we should ask ourselves is: does the workability or possibility of a certain technological procedure make it ethically right? There are a number of medical, legal, moral and religious issues associated with IVF.
In view of the forgoing, the major objectives of this research is to do an ethical appraisal of the issues involved in In-Vitro Fertilization. Other objectives include:
- To state some causes of infertility that seem hitherto unknown to some stakeholders.
- To explain why some people go for in-vitro fertilization.
- To explain some processes and procedures in in-vitro fertilization that are morally unacceptable.
- To state reasons why in-vitro fertilization should not be taken as the best option for children ownership.
This work is organized into four chapters so as to capture some vital issues needed in this essay. Chapter one deals with the general introduction; chapter two discusses some issues in IVF as well as argument in favour and against IVF; chapter three on it own focus on the main topic of our research which is the ethical appraisal of IVF, while chapter four which is the last chapter, is the summary and conclusion of the essay.
It is presumed that theoretically-wise, this work shall be relevant to students, scholars, policy makers, married couples, those about to tie the nuptial knot and the entire reading public who deserved to be informed of the growing trend in the Biomedical field. It would also be practically relevant/ beneficial to scientists, researchers, and medical practitioners, so as to maintain a reasonable limit and be ethically guided in their practice. The scope of this work shall be within the realm of biomedical ethics. The philosophical methods to be employed in this research work shall mainly be those of analysis and criticism.
1.2 CLARIFICATION OF TERMS
Ethical is an adjectival form of the noun ‘Ethics’. Etymologically, ethics is derived from the Greek word “ethos” which is synonymous with ‘Moral’, both connoting customs, habits and accepted way of behaviour of a community or an individual. Beyond etymological definition, the word ethics has been variously defined by philosophers, as such, there is no univocal definition to the term. This problem emanates from the fact that the discipline (Philosophy) of which ethics is the offshoot equally lacks univocal/universally accepted definition. For Oke and Esikot, ethics can be viewed as “a normative science of human conduct”. Stressing further, Oke and Esikot maintain that:
Ethics is normative in the sense that it deals with the standard or principle of right and wrong behaviour. It attempts to explain, state and often time urge obedience to a rule. It is a science because, it is principle-governed endeavour and attempts a systematic study of human conduct. Its study represents an intellectual enterprise, a rational inquiry into human actions and affairs in the hope of gaining knowledge (1-2).
Moreover, ethics has been defined by Lacey as “an inquiry into how men ought to act in general, not as a means to a given end, but as an end in itself” (60). In the same vein, Echekwube in Iroegbu and Echekwube (29) defines ethics as “the branch of philosophy that studies the action of human person relative to right or wrong. It has to do with the reflected doings and morality of the human person.” For Ozumba (4) ethics can be defined as “that branch of philosophy known as moral philosophy, or philosophical thinking about morality”. In the same token, T.R. Machan defines ethics as “The study of whether there are any value each and every person should pursue, whether there is a set of virtues as a code of principle of conduct for everyone, and what these are if they do exist” (30). Norman Shields sees ethics as “conscious and purposeful behaviour which is concerned with the obligations and rules that relate to it” (9). In the same token, Encyclopedia of Philosophy (379) also states that ethics is “the branch of philosophy that tries to understand a familiar type of evaluation: the moral evaluation of people’s character traits, their conduct, and their institutions” Uduigwomen (1) observes that, “ethics deals with the problems or questions which normally arise in everyday life, unlike many other branches of philosophy which deal with abstract problems”
Fertilization according to the American Heritage Medical Dictionary (200) is “The union of male and female gametes to form a zygote…” In the same vein, concise medical dictionary (274) defines fertilization as “the fusion of a spermatozoon and an ovum”. According to Churchill Living Stone Medical Dictionary (192), Gamete as mentioned in the first definition of fertilization refers to “the male or female reproductive cell with the haploid chromosome number, oocyte or spermatozoon”. Zygote on its own is – the cell formed by the union of the two gametes, especially a fertilized ovum before cleavage.
Originally, the word “In-vitro” according to Merriam Webster Dictionary (online) is derived from the Latin ‘In-Vetro’ which means ‘in glass’. According to Esikot (70-71), the term In-Vitro is used because, “early biological experiment including cultivation of tissues outside the living organism from which they came were carried out in glass containers such as beakers, test tubes or Petri dishes”. From the above etymological meaning, it now seems lucid why ‘In-Vitro Fertilization’ is literary defined as ‘Fertilization in glass’. However, in contemporary usage, the phrase has been expounded beyond literary definition. According to Medical dictionary (online), In-Vitro fertilization (IVF) is, “a procedure in which eggs (ova) from a woman’s ovary are removed… fertilized with sperm in a laboratory procedure, and then, the fertilized egg (embryo) is returned to the woman’s uterus.” In the same vein, English Oxford Dictionary online states that “it is a medical procedure whereby an egg is fertilized by sperm in a test tube or elsewhere outside the body”. In the light of this, Encyclopedia Britannica defines it thus:
In-Vitro Fertilization (IVF) also called test tube conception is a medical procedure in which mature egg cells are removed from a woman, fertilized with male sperm outside the body, and inserted into the uterus of the same or another woman for normal gestation.
Going further, Hart David and Jane Norman (406) see In-Vitro Fertilization (test tube babies) as involving “the fertilization of human oocytes In-Vitro”. Furthermore, Ijezie (147) sees it as, “the fusion of the human reproductive cells outside the woman’s body. According to Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, In-Vitro Fertilization is seen as “the process by which conception takes place in a laboratory medium…”. For Iroegbu (599) Fertilization In-Vitro or In-Vitro Fertilization is, “the bringing about of the same process of conception, but no longer through the natural process of coming together in a copulation act of parents, but rather, by an artificial process” (599). Still on In-Vitro Fertilization, Susan Sherwin (581) contends that, “In-Vitro Fertilization is the technology responsible for what the media like to call test tube babies. It circumvents, rather than cure a variety of barriers to conception….” For John Robertson (569), “IVF treats infertility problems by bypassing the natural place of fertilization in the fallopian tube”.
From the foregoing, it is deducible that In-Vitro Fertilization is both a form of ectogenesis and ‘Assisted Reproductive Technology (ART). According to Wikipedia, the Free Encyclopedia, ectogenesis (from the Greek ecto, ‘outer’, and genesis) is “the growth of an organism in an artificial environment outside the body in which it would normally be found, such as the growth of an embryo… outside the mother’s body….” The term was coined by the British Scientist J.B.S. Haldane in 1924. On the aspect of ‘Assisted Reproductive Technology, Internet Scientific Publications has it that, ‘Assisted Reproductive Technologies include any fertilization involving manipulation of gamete/embryos outside the human body and the transfer of gamete/embryos into the body”. Kumar, Pratap and Malhotra, Narendra opined that, Assisted Reproductive Technology is not new, but rather, the techniques have been established in Animal husbandry (699).
1.3 HISTORY OF IN-VITRO FERTILIZATION (IVF)
Although In-Vitro Fertilization (IVF) is used widely for a variety of purposes, it is often not appreciated how this technology was developed. A large number of experiments beginning in 1878 contributed to the first successful reports of In-Vitro Fertilization over 75 years later. The discovery of sperm capacitation in 1951 was central to the development of In-Vitro Fertilization technology, and it was rapidly followed by the first convincing reports of In-Vitro Fertilization in several species. The ability fertilize oocyte In-Vitro has allowed advances to be made into understanding the mechanisms involved in fertilization and early development, and In-Vitro Fertilization now supports reproductive biotechnology in animal and in humans.
In-Vitro Fertilization and embryo transfer in the human is built upon extensive basic research done by many investigators in reproductive biology for over a century. Robert Edwards built on this earlier work, making major scientific contributions (culled from Article of Early History of In-Vitro Fertilization by Bavister, B.D.; 2002).
Prior to 1978, women without functioning fallopian tube were largely considered to be sterile by the physicians. At least one patent fallopian tube is necessary for natural fertilization of an oocyte by sperm In Vivo. In the past, many women with damaged tubes resort to reparative surgery, or tuboplasty in the hopes of re-establishing a conduit for gamete to transit. Unfortunately, often these surgeries failed.
In the late 1970’s, Lesley Brown, a patient with nine years of primary infertility secondary to tubal occlusion, sought the assistance of Patrick Stepoe and Robert Edwards at the Oldham General Hospital in England. At that time, fertilization of oocyte outsides the human body, a process known as In-Vitro fertilization (IVF), was considered entirely experimental and when attempted, had only resulted in miscarriages and unsuccessful pregnancy in the fallopian tube. Without using medications to stimulate her ovaries, Lesley Brown underwent Laparoscopic egg retrieval, with her single egg fertilized in the laboratory, and later transferred back into the uterus. The embryo transfer resulted in the first live birth from In-Vitro Fertilization, a daughter Louise Brown, who was born in July 1978 (culled from Jeff Wang and Mark V. Saucer – review on IVF; 2006). Stressing further on the historic development of In-Vitro Fertilization, Encyclopedia of Bioethics by Warren Thomas Reich explains:
In the early phases of IVF development, this was carried out with the aid of the laparoscope. The procedure required general anesthesia and involved placing a telescope through the umbilicus for visualization of the pelvic structures. The oocytes were obtained by needle aspiration. Today, Ova are obtained by ultrasound – guided transvaginal aspiration. This procedure can be done without general anesthesia, and the overall approach to In-Vitro Fertilization is greatly simplified (2209).
In the words of Beauchamp and Walters, “the birth of Louise Brown in Lancashire, England in 1978, inaugurated a new era in the history of reproductive technologies”. They assert that “Louise had not been conceived inside her mother’s body but in Petri dish where eggs removed from her mother had been mixed with sperms from her father….”
1.4 WHY DO PEOPLE GO FOR IN-VITRO FERTILIZATION (IVF)
The main reason why people go for in-vitro fertilization is because they see it as an option in solving the problem of childlessness. Some infertile couple have had their biologically related children through In-Vitro Fertilization means. Moreover, some couples that are able to conceive normally opt for in-vitro fertilization to avoid transferring any birth or genetic defect to their child, since the procedure allows for Preimplantation Genetic Diagnosis (PGD) which screens and identifies chromosomal deficiencies in an embryo before it is implanted inside the uterus. PGD enables the doctor to screen and identify embryos with genetic problems. After this, he (the doctor) can then transfer only the healthy embryos that do not contain identified problems to the uterus. Moreover, In Vitro Fertilization addresses infertility issues. IVF was traditionally used to help men and women address infertility issues. Women with missing, damaged, or blocked fallopian tubes were some of the first patients to carry successful IVFs. The egg is fertilized outside the female body and then placed inside the uterus for a more likely implantation. Many men with both known and unexplained infertility issues have benefited from In-Vitro Fertilization, especially in combination with intracytoplasmic sperm injection (ICSI). ICSI targets and extracts a single sperm from a sample and injects it into the egg’s cytoplasm for optimal fertilization rates. In many cases, in-vitro fertilization combined with ICSI is the only way for men with a low sperm count to still be able to biologically father a child. Testicular sperm aspiration can be performed on men who can’t ejaculate sperm, including those with irreversible vasectomies, testicular cancer survivors, and men with low or no sperm count, blockages, and other conditions.
Many couples choose in vitro fertilization because it helps them conceive more quickly at a time that’s right for them. In the same vein, people go for IVF because it gives couples more control over factors such as spacing out children, being pregnant at the right time, and even when a child will be born. Furthermore, in IVF, frozen eggs and/or sperm can be used, giving people the ability to save their healthy eggs or sperm for future use. In the same token, IVF makes pregnancy after menopause possible because, the uterus can still carry a pregnancy to term after a woman’s reproductive cycles have ended
With IVF, anyone can have a baby. In-Vitro Fertilization makes it possible for nearly any individual or couple to have a baby, regardless of familial status or sexual orientation. Single women and men, gay and lesbian couples, and couples who’ve had hard time conceiving have all used in-vitro fertilization as a way to have a child.
An Egg Donor can be used in cases where the woman has a low ovarian reserve or have eggs of poor quality. In other cases it would be a requirement – as for a gay couple wishing to start a family. (Culled from Smotrich, David B. “Why Choose IVF?”).
Furthermore, some women undergo IVF in order to preserve their egg/embryos against cancer treatment that could harm their fertility. Buttressing this point, Mayo Clinic Staff (online) explains:
If you’re about to start cancer treatment such as radiation or chemotherapy – that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use. Women who don’t have functional uterus or for whom pregnancy poses a serious health risk might chose IVF using another person to carry the pregnancy (gestational carrier). In this case, the woman’s eggs are fertilized with sperm, but the resulting embryos are placed in the gestational carrier’s uterus.
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