HAS 4400 Issues at the Beginning of Life Session Five Dr. Burton

Two inadequate approaches to alternative reproductive technology Conservative approaches –Adopts the biological integrity of the marital sexual act. Other end of the ideological spectrum –Any adult should be able to engage in any alternative reproductive procedure that technology can provide. Ethical positions should emerge from consideration for: –What will further the good of the potential child and the family. –Providing for appropriate social conditions –The present norms of reproduction and childbearing versus radical alterations. –“control of nature” often ends up producing increased control of some people by other more powerful people

Should we let the technological imperative (what can be done should be done) fueled by people’s desires decide whether a course of action is right or good?

Tactic by: those who urge permissive acceptance of all new reproductive technologies. Base arguments upon analogies from adoption or other childrearing arrangements arising from –Divorce, death, desertion or parental inadequacy.

Given the availability of current technology and relaxation of cultural norms. List the possible combination of parental relationships that could occur with the birth of a child.

Proposed ethical standard “It is ethically appropriate to use an alternative reproductive technology if, and only of, it make it possible for a normal, socially well-adjusted heterosexual married couple to have a child that could not otherwise have owing to infertility.”

“If we succeed in isolating sexual and reproductive acts from long-term personal responsibility, this moral abdication will increase existing problems within the culture.”

Abortion Elements of a middle ground There is a presumption against the moral permissibility of taking human life. Abortion is a killing act. Abortion to save the life of the mother is morally acceptable. Judgment about the morality of abortion is not simply a matter of a woman’s determination and choice. Abortion for mere convenience is morally wrong.

Abortion Elements of a middle ground (con’t) The conditions that lead to abortion should be abolished insofar as is possible. Abortion is a tragic experience to be avoided if at all possible. There should be alternatives to abortion. Abortion is not a purely private affair. Roe v. Wade offends many people. So did previous prohibitive laws.

Abortion Elements of a middle ground (con’t) Unenforceable laws are bad laws. An absolutely prohibitive law on abortion is not enforceable. There should be some public policy restrictions on abortion. Witness is the most effective leaven and the most persuasive educator concerning abortion. Abortion is frequently a subtly coerced decision.

Abortion Elements of a middle ground (con’t) The availability of contraception does not reduce the number of abortions. Permissive laws forfeit the notion of “sanctity of life” for the unborn. Hospitals that do abortions but have not policy on them should develop one. The “consistent ethic of life” should be taken seriously. When ever a discussion becomes heated, it should cease.

"If the deliberate extinguishment of human life has any effect at all, it more likely tends to lower our respect for life and brutalize our values." - Robert M. Byrn

Principles of ethics Autonomy –Freedom to make choices that do not violate other basic ethical requirements. –Respect for others independence Nonmaleficence –Do no harm –Respect for life Beneficence –Improve the condition of others with respect to virtue, intelligence or pleasure. –Always acting in the best interest of the patient Justice –Ensuring that pleasure or happiness are distributed in accordance with merit of the persons concerned. –Equality in access to healthcare.

Autonomy, Nonmaleficence, Beneficence, Justice A 33 year old blind woman who is a brittle diabetic is in the first trimester of a third pregnancy. In two previous pregnancies she suffered miscarriages. During the last miscarriage, which occurred at 28 weeks, she suffered severe hemorrhaging and required multiple transfusions. Her husband is concerned that this pregnancy will also be dangerous to her health and that she may not survive. He prefers that she not continue the pregnancy. Her physicians are also concerned that she is at great risk. They believe an abortion carries a lesser degree of risk to the patient but would remove the greater risk of trying to carry the baby to term. The patient is ambivalent about her situation. She has no children and wants badly to have a baby. However, she remembers her last experience with the miscarriage and is fearful that it will happen again.

Caring for Compromised Newborns Today”s technology allows us to intervene in the case of compromised infants and extend life far beyond that which would occur if we allow nature to take its course. “…expectant parents want Gerber babies, beautiful, bright, healthy ….”

Parental discretion vs. neglect Parental right to decide How do you define neglect? Comfort care vs. intervention Right to privacy encompasses parents’ reasonable decisions Infants right to life.

NICU Technological marvel < 24 weeks, < one pound 30,000 babies born 3 mo’s pre-term, ½ survive

Norms for premies Not wise to force treatment if the baby will have to rely on technology for entire life. If pain and suffering could not be alleviated, forego treatment If uncertain, err on the side of life. In ambiguous cases follow the instructions of the parents.

Case Study “Adam Ford” Page 81, Flynn text