In Vitro Fertilization

1. In Vitro Fertilization Historical Overview Immanuel Kant Christian Teachings Virtue Ethics Biblical Passages Arguments For/Against Key Issues Case Studies Utilitarianism Glossary

2. HistoricalOverview Brave New World Louise Brown Zoe Leyland Warnock Commitee Enoch Powell H.F.E.A. 1990 P.G.D Gender Selection NHS Funding IVF

3. HistoricalOverview • In 1932 the playwright and novelist, Aldous Huxley, outlined a dystopic vision of society in the Year of Ford 632 in his novel Brave New World. • Procreation, in the laboratory, was through the Bokanovsky process, a combination of in vitro fertilisation and cloning, “..a bokanovskified egg will bud, will proliferate, will divide. From 8 to 96 buds, and every bud will grow into a perfectly formed embryo, and every embryo into a full-sized adult. Making 96 human beings from where only 1 grew before. Progress.” Brave New World 1932 Aldous Huxley predicted his dystopic vision of in vitro fertilisation, cloning, the maturation of eggs in excised ovaries and artificial wombs would take 600 years to happen - A.F 632. Yet just 60 years on and in vitro fertilisation is widely practiced, with the cloning of animals and plants well established.

4. Brave New World • Defenders of IVF may comment that it is significant that Huxley’s portrayal of the impersonal nature of procreation, where sexual intercourse is exclusively recreational, with no procreative or unitive purposes, remains confined to the realm of fiction, in the year A.F. 632, and not to the world of I.V.F. 2005. • Opponents of IVF may argue that the access to sperm banks through the internet has led rise to organisations such as “Single Mothers - By Choice.”

5. HistoricalOverview Louise Brown 1978 • Louise Brown, born on 25th July 1978, was the world’s first ‘test-tube baby’. • Louise Brown’s birth, through the process of in vitro fertilisation, was a result of the pioneering work of Robert Edwards and Patrick Steptoe. The birth of Louise Brown was due to the pioneering work of Robert Edwards and Patrick Steptoe. Robert Edwards Patrick Steptoe

6. HistoricalOverview • In 1983 the first IVF baby, to be born from a frozen embryo, was born in Melbourne, Australia. • Professor Alan Toulson was responsible for pioneering the IVF programme which enabled David and Loretto Leyland to freeze some of their additional embryos, after the first attempt at IVF was not successful. • Of the 3 frozen embryos which were implanted for the second attempt at IVF one was successful, and Zoe Leyland was born. Zoe Leyland 1983 The freezing of human embryos means that the IVF process is less costly on couples, as a single harvest of 8 eggs may be fertilised, 3 eggs implanted, and additional frozen embryos used if the first attempt at IVF is unsuccessful. Equally, the freezing of embryos has called into question the dignity of human embryonic life and the question of their destruction after they five years.

7. HistoricalOverview • The Government established the Warnock Committee to examine issues of infertility and possibilities of embryo research. • The committee was chaired by the philosopher Mary Warnock, with a cross representation of medical, legal and theological experts. • The recommendations of the Warnock Committee become law in 1990, under the Human Fertilisation and Embryology Act. Warnock Committee Report, 1982-4 Dr Anne Maclaren, a key member of the Warnock Committee, suggested permitting research on pre-embryos (from conception until 14 days) as only after 14 days is the embryo unable to twin, and prior to 14 days there is no Central Nervous System. Embryo research was restricted to issues of fertility, infertility and contraception.

8. HistoricalOverview • In 1985 Enoch Powell, M.P., tabled a Private Members’ Bill, The Unborn Child, stating that “one may only create an embryo with the aim of implanting it into a specified woman.” • Enoch Powell represented pro-Life and the first reading of the bill in the House of Commons was successful by 157 to 82 votes. • However, opponents of the bill used stalling tactics and as a consequence the bill ran out of time and so never became law. Enoch Powell’s Private Members Bill 1985 The Welsh MP Dafydd Wigley’s two sons, born with a congenital disease, both died, in their early teenage years, just before Enoch Powell’s bill. As a consequence Dafydd Wigley campaigned against the bill, arguing that valuable embryo research into congenital diseases was for the common good.

9. Socrates Says... Enoch Powell’s Private Members’ Bill • The defeat of Enoch Powell’s bill caused bitter controversy and debate, particularly between Enoch Powell and Robert Winston. • In the interim Robert Winston was able to show the success of IVF mothers and their babies, which won popular backing through the media. • As a consequence by 1990 the public were in favour of the proposed HFEA, which tabled the recommendations of the Warnock Committee report.

10. HistoricalOverview HFEA 1990 • Legalised in vitro fertilisation and research on human embryos up until 14 days after conception. • No human embryo should be kept alive outside of the womb after 14 days. • Complete anonymity for semen, egg or embryo donors. • The mother who gives birth is regarded as the mother; the donor has no rights or duties to the child. • Surrogate agencies are illegal. The Human Fertilisation and Embryology Act was passed on 24th April 1990 by a majority of 364 to 193 votes. The HFEA adopted the recommendations of the 1982-4 Warnock Committee report and was seen as a great victory by the IVF pioneers such as Professor Robert Winston.

11. HistoricalOverview • In the mid 1990s it became possible for embryos to be genetically screened, prior to implantation - the process known as PGD, pre-implantation genetic diagnosis. • PGD helps couples who carry inherited congenital abnormalities. Through the process of IVF several embryos may be screened, known as ‘genetic finger-printing’ and only embryos which are free of the congenital abnormality are implanted into the woman’s uterus. Pre-Implantation Genetic Diagnosis Although PGD is not widely available, and is at present quite expensive, it does offer couples, where one of the partners carries an inherited congenitall abnormality, the opportunity of having a baby which will be free from inheriting the genetic abnormality.

12. HistoricalOverview • In 2002-3 the Human Fertilisation and Embryology Authority (HFEA) conducted an official enquiry to assess whether public opinion was now in favour of IVF couples having the right to choose the gender of their children. • The MORI opinion poll of 13.1.2003 showed that the public was not in favour of gender selection; thinking that it was not natural to choose the sex of one’s baby and might cause an imbalance between boys and girls. Gender Selection HFEA, 2002-3 Under the chairperson’s leadership of Suzi Leather, the HFEA conducted an extensive survey of public opinion to assess whether gender selection for IVF couples should be legalised.

13. HistoricalOverview • In 2004 the Human Fertilisation and Embryology Authority (HFEA) proposed that every infertile woman, under the age of 40, should be entitled to NHS funding for one attempt at IVF treatment. • This proposal has corrected the ‘IVF post-code lottery’, where formerly NHS funding for IVF was dependent on the patient’s particular local health authority. Some local health authorities offered funding for IVF, whilst others did not. NHS Funding for IVF 2004 Although questions have been raised concerning the opportunity cost to health care expenditure it was agreed that every infertile woman under 40 should be entitled to receive NHS treatment for one attempt at IVF.

14. Case Studies Use of Foetal Eggs Donor Anonymity 62 Year old Mother NHS Funding for IVF? Egg Freezing 3 Biological Parents Lesbian Couple Gender Selection

15. CaseStudy: Using Eggs Aborted Foetal Eggs? • In 1991, due to a shortage of eggs to help infertile women, Professor Roger Gosden suggested the possibility of using eggs, from an aborted, foetus. • All the eggs that a woman will ever have are present at 10/11th weeks of foetal development. Foetal Eggs • Using eggs from an aborted foetus would not only help infertile women but research would also assist girls who are born infertile, e.g with Turner’s syndrome, who have to regularly take H.R.T. • The 1992 Criminal Justice Act made it illegal for eggs from an aborted foetus to be used to help infertile women.

16. Using Eggs Aborted Foetal Eggs? Do you agree with the 1992 Criminal Justice Act judgement? Questions to consider... • On what ethical principles do you approve / reject the use of eggs from aborted foetuses to help infertile couples? • What is in the best interest of the child? • What might be the psychological impact on the child to know that its grandmother aborted its foetal mother? • What is the financial opportunity cost of such research for society?

17. CaseStudy: 62 Year Old IVF Mother • In 2000 an Italian doctor, Professor Severino Antinori, was approached by a 62 year old French woman, hitherto childless, and asked if he would help her have a baby, through IVF, using a donated egg and donated semen. • Professor Antinori refused, concerned about the 62 year old woman’s psychological condition. • The woman then went to Los Angeles, where she successfully applied for IVF treatment, using the donated sperm and egg. • The 62 year old woman successfully gave birth to a baby boy.

18. 62 Year Old IVF Mother Was the successful IVF of the 62 year old French woman morally right? You may wish to know.... • The donated sperm was from her brother. (Not mentioned at the time of applying for IVF treatment.) • At the same time as her treatment, as a fail safe measure, the woman paid a surrogate mother to be impregnated from donated sperm (also from her brother) and egg. A baby girl was successfully born. • “It seems that the motive for having these two babies was so that the estate should not pass out of the immediate family.” (Mary Warnock, Making Babies, p.48) • The French woman and her brother are bringing up the two children together.

19. CaseStudy: Egg Freezing? • In 2002 Emily Perry was born through I.V.F., the first case of a baby being born from her mother’s previously frozen egg. • Dr Gillian Lockwood said, “Egg freezing may come to be seen as the ultimate kind of family planning.” • Should egg freezing be encouraged for women who wish to pursue their career and who want to postpone having a baby. • Freezing one’s eggs whilst one is young may have additional advantages, though equally there may be unknown long term complications?

20. CaseStudy: I.V.F. Gender Selection? • In 2003 H.F.E.A. ruled against gender selection through IVF. • There are fears that there might be gender discrimination against embryos: currently 120 boys are born to every 100 girls in China and India. • However, many people consider that there is nothing wrong in choosing the gender of one’s child. As Dr John Harris argues, “Either such traits such as hair colour, gender and the like are important or they are not. If they are not important why not let people choose. And if they are important, can it be right to leave such important matters to chance?” (Clones, Genes and Immortality, p.191)

21. I.V.F. Gender Selection? Is Gender Selection Really Wrong....? • Imagine you have two children, both girls, and yet you and your partner would really like to have a baby boy. • Boys and girls are different - and you think a boy would enrich your lives and that of your family. • As a loving parent you do not see children as ‘commodities,’ (you love both your two girls). • Equally you are aware just how expensive raising children can be... • Is the right for gender selection, through IVF, so unreasonable / immoral?

22. CaseStudy: Donor Anonymity? Morally should sperm and egg donors have the right to anonymity? • In 2004 the Human Fertilisation and Embryology Authority granted children conceived from donated sperm and eggs the right to trace their biological parents. • It was considered that at the age of 18 years an adult has the right to know their genetic identity. • The decision by HFEA in 2004 was a change from the 1990 HFEA which guaranteed the anonymity of egg and sperm donors. • The 2004 legislation is not retrospective, so protects the anonymity of egg and sperm donors prior to 2004.

23. CaseStudy: N.H.S. Funding of I.V.F.? Should the N.H.S. fund I.V.F. treatment for women under 40? • In 2004 the Human Fertilisation and Embryology Authority (HFEA) proposed that every infertile woman, under the age of 40, should be entitled to NHS funding for one I.V.F. treatment. • This proposal has corrected the ‘IVF post-code lottery’, where formerly NHS funding for I.V.F. was dependent on the patient’s particular local health authority. Only some local health authorities offered funding for I.V.F. • However, fertility is not an illness. • Should NHS funding go to help people who are actually ill, leaving infertile couples the option of paying privately for fertility treatment if they so desire?

24. CaseStudy: Baby with 3 Biological Parents • In 2006 scientists are to carry out the first British experiments on human embryos that would create a baby with three biological parents - two mothers and a father. • The aim eventually is to use the technique to overcome a form of inherited disease resulting from damage to the tiny ‘power-houses’ or mitochondria of the cell, which are inherited from the mother. • Mitochondria disorders cause major health problems in children, many of whom die prematurely as they are unable to provide the energy for growth and development. Test-tube Baby Three Biological Parents Scientists intend to use two eggs because they want to produce an egg with healthy mitochondria by taking the cytoplasm from a donor woman and combining it with the nucleus of an egg taken from a woman with mitochondria disease who wants to have her own genetic baby.

25. Baby with Three Biological Parents? Is the agreed research moral? You may wish to know.... • Although the 1990 HFEA prohibits “altering the genetic structure of any cell while it forms part of an embryo” the appeal committee heard that the phrase “genetic structure” has no precise scientific meaning. • Pro-Life opponents said the license for research was a step towards designer babies and, with two mothers’ threatened the family unit. • The research team at Newcastle University does not intend to apply for permission to use the technique for reproductive purposes until embryonic tests have shown the technique to be effective and safe.

26. CaseStudy: Lesbian Rights for IVF Should an unmarried lesbian couple have the right to I.V.F. treatment, through Artificial Insemination by Donor? Issues to consider may include: • The equality of rights for all citizens. • Application of natural law? • The changing nature of the family. • The importance, or otherwise, of a father within the family. • The best interest of any future child.

27. BiblicalPassages Roman Catholic approach to scripture Genesis 38:10--12 Biblical Fundamentalist approach to scripture Exodus 20:13 Liberal / Protestant approach to scripture Matthew 7:12 Genesis 1:26-27 Romans 5:3-4 Genesis 2:24 1 John 4:16 Genesis 16:1-2

28. BiblicalPassages Roman Catholic Approach to Scripture “For the fact is that truth is differently presented and expressed in the various types of historical writing, in prophetical and poetical texts, and in other forms of literary expression.” (The Catechism, The Holy Spirit, Interpreter of Scripture) “To discover the sacred authors’ intention, the reader must take into account the conditions of their time and culture, the literary genres in use at that time, and the modes of feeling, speaking and narrating then current.”

29. BiblicalPassages Roman Catholic (1) Be attentive to the content and unity of the whole Scripture. (2) Read scripture within the living tradition of the whole church. (3) Be attentive to the analogy of faith - i.e. coherence of truths within the whole plan of Revelation. “God is the author of sacred scripture, divinely revealed realities inspired by the Holy Spirit.” (Catechism, Article 3) Significantly the Catechism states that to interpret scripture correctly one must:

30. BiblicalPassages Roman Catholic Approach to Scripture “It is the task of the exegetes (one who explains or interprets) to work, according to these rules, towards a better understanding and explanation of the meaning of Sacred Scripture..” (The Catechism, The Holy Spirit, Interpreter of Scripture) There are 4 senses in which scripture may be interpreted: 1. Literal sense. 2. Allegorical - interpreting events symbolically. 3. Moral - how scripture helps people behave justly. 4. Anagogical - view events by how they lead people on towards their true Christian home

31. BiblicalPassages Biblical Fundamentalist Understand scripture as the unerring word of God As reason was corrupted by the Fall, human beings are dependent on God’s Revelation, through scripture. Biblical Fundamentalists adopt a literal approach to scripture.

32. BiblicalPassages A Liberal Approach A liberal approach to scripture emphasises: (1) The context in which scripture was written and (2) A holistic understanding of the meaning of scripture as a whole, not seeing one verse in isolation. Liberal Christians regard scripture as being the revealed word of God, written by human beings, who sometimes made mistakes due to their social and cultural background.

33. BiblicalPassages Genesis 1: 26-27 “Then God said, “Let us make man in our image, in our likeness, and let them rule over the fish of the sea and the birds of the air..” “So God created man in his own image, in the image of God he created him; male and female he created them.” • Roman Catholic interpret these verses as meaning that human life is a gift from God and is absolutely sacred. • Human beings do not have a right to have children.

34. BiblicalPassages Genesis 2: 24 • Roman Catholic interpret this verse as showing that procreation should take place through the conjugal act. “a man will leave his father and mother and be united to his wife and the two will become one flesh.”

35. BiblicalPassages Genesis 2: 24 • The Church of England however interpret the ‘one flesh’ as the life of the new child which may be born. • Thus procreation may be through IVF, it is not exclusive to the conjugal act. “a man will leave his father and mother and be united to his wife and the two will become one flesh.”

36. BiblicalPassages Genesis 16: 1-2 • The Hebrews considered children were a sign of God’s blessing. • As a patriarchal society one lived on through one’s children. • It was accepted practice that a maidservant could be used as a surrogate mother. • Therefore it is difficult to apply the context to surrogacy today. ‘Now Sarah, Abraham’s wife, had borne him no children. But she had an Egyptian maidservant, Hagar, so she said to Abraham, “The Lord has kept me from having children. Go, sleep with my maidservant; perhaps I can built a family through her.”’

37. BiblicalPassages Genesis 38:10-12 • Christians who adopt a literalist approach to scripture argue that Onan’s sin of masturbation shows that the act is condemned by God and is immoral. However..... “Onan... spilled his seed on the ground... what he did was wicked in the Lord’s sight; so the Lord put him to death”

38. BiblicalPassages Genesis 38:10-12 • To read the passage carefully shows that Onan’s brother, Er, had died and as his brother he was obliged to sleep with Er’s wife - so as to provide her with children. • Not wishing to do this Onan ‘spilled his seed” so he could not have sex with his brother’s wife - thus his ‘sin’ is not that of masturbation but one of disobedience. However.... on closer inspection such an interpretation is clearly inaccurate as it does not consider the whole passage, and the context.

39. BiblicalPassages Exodus 20: 13 • Roman Catholics believe that believe human life is absolutely sacred from the moment of conception. Therefore the killing of ‘spare’ embryos and experimentation is morally wrong. • The Church of England consider that prior to 14 days the pre-embryo is not an individual and lacks a primitive streak so IVF does not violate the right to human life. “You shall not kill.”

40. BiblicalPassages Matthew 7:12 Protestants consider that the Golden rule of Jesus suggests that compassion should be shown to those who are infertile and so would support IVF treatment. ‘Always treat others as you would like them to treat you.’ (Otherwise known as The Golden rule of Jesus)

41. BiblicalPassages Romans 5: 3-4 Although suffering is not a good it does nevertheless produce character. The suffering caused by infertility may help adults to think through their roles and wider contributions to society. “We know that suffering produces perseverance; perseverance character; and character, hope.” (St Paul)

42. BiblicalPassages 1 John 4: 16 The Situation ethicist, Joseph Fletcher, argued that as God is love Christians should show compassion and care for those who are suffering from infertility and so agree to the legalisation of IVF. “God is love.”

43. BiblicalPassages 1 John 4: 16 However, Roman Catholics would apply this passage by stating that Christians should show love to the unborn child, from the moment of conception, and therefore oppose IVF treatment which destroys ‘spare’ embryos. “God is love.”

44. Glossary A.I.D. Gamete A.I.H. H.F.E.A. 1990 Conjugal Act H.F.E.A. 1991 Egg Donation In Vitro Fertilisation Embryo Magisterium Embryo Freezing P.G.D.

45. Glossary Pre-embryo Surgical Sperm Recovery Surrogacy Warnock Committee Zygote

46. Glossary A.I.D. (Artificial Insemination by Donor) The sperm of an anonymous donor is used to fertilise the woman’s eggs which are then artificially inseminated into the woman’s uterus. A.I.D. may be used if the male partner is found to be sterile. Or it may be used for women where there is no male partner.

47. Glossary A.I.H. (Artificial Insemination by Husband) A.I.H. is thought to increase the chances of conception by inserting the sperm directly into the woman’s uterus. e.g. in certain cases of female infertility, such as cervical hostility, the male sperm is damaged or destroyed by antibodies in the cervical mucus. The sperm of the husband / partner is used to fertilise the woman’s eggs which are then artificially inseminated into the woman’s uterus.

48. Glossary Conjugal Act The Roman Catholic Church objects to IVF as it is a violation of the unitive and procreative meaning of the conjugal act. Sexual intercourse between husband and wife.

49. Glossary Egg Donation The collection of eggs from one woman and the implantation of these eggs into the infertile woman. Egg donation is similar to A.I.D. but runs a greater risk due to the need for surgical collection.

50. Glossary Embryo The developing human individual from approximately 14 days to the eighth week of gestation. Whilst the term pre-embryo refers to the moment from conception to 14 days, it is now widely accepted that the term embryo includes from conception until 8 weeks of the gestation period.