Question

Sally and Francesca are a married (lesbian) couple. They would like to begin a family. Both have blocked fallopian tubes and therefore cannot use artificial insemination. They have thought about adoption but would prefer to have a child who is related to them biologically. They have decided to avail themselves of in-vitro fertilization - with Sally being the donor and Francesca being the one who would carry the pregnancy to term. They have a friend who has agreed to be the sperm donor and also serve as a godfather/uncle to the children. The reproductive technologist has explained to them that in order to achieve a successful pregnancy they have to implant several fertilized ova, hoping one will attach to Francesca's uterus.

However, there is a possibility they could all attach (all four) and result in multiple pregnancy. This carries its own risks. Sally has other health complications, and can't be the gestating mother. Francesca as propensity for borderline high blood pressure. Thus - if there are multiple pregnancies - they will need to selectively abort some to achieve a successful delivery of the others. They ask for an ethics consultation to see what they should do. Pretend you are an ethicist and have been requested to provide an ethical consultation.

what issues might you raise and/or respond to that are present in this case? Are there ethical issues about a non-traditional couple parenting? Are there issues about selectively aborting some of the embryos? Are the use of reproductive technologies to replace natural procreation inherently problematic from an ethical perspective?

Answer 1

Issues in given scenario :

1.) Lesbian community parenting a children

2.) Both have undergone Tubectomy

3.) Sperm donor should remain confidential, not a friend

4.) Multiple pregnancy - Abortion of embryos

5.) Francesca - blood pressure - may result in pre exlampsia

Ethical issues for non traditional couple parenting :

Within the field of medically assisted reproduction, the welfare of the child is advanced as the major argument to decide the acceptability of certain applications

From the 1970s, several factors (increasing divorce rates, sexual liberation, etc.) contributed to a breakdown of the quasi monopoly of the stable heterosexual nuclear family. Until then, society as a whole enforced this standard, both through legislation and mores; deviations were not tolerated.

Lesbian parents transgress several boundaries simultaneously: ‘the ideological, because of its apparent flouting of the importance of fathers; the structural because of its advocacy of either one-parent or two-mother households; and the biogenetic, because of its avoidance of sexual intercourse’

Major problem - How capable would two men be at helping their adopted daughter with very female matters pertaining to growing up and maturing physically?

For daughters this is often an issue requiring ongoing support, communication, and sharing. It's not something men can just read up on in a book; it can be a delicate, personal matter, closely connected to a young woman's sense of self-identity, and it's reasonable to conclude that there are real advantages to the empathy shared between a mother and her daughter

And boys who grow up with lesbian parents, they do not have a father figure or male figure to follow. Studies show that many such boys turn out to be bisexual with female characteristics. This may not be true for all the children, but for some boys.

In the context of same-sex parenting, both the right of homosexual persons to build a family and the child's right to a good life can be respected by providing conditions of full equality and respect.

The well-being of the children would improve considerably were same-sex relationships legally recognized and socially respected, and were same-sex parents treated as adequate parents.

Issues about selectively aborting few embryos :

Multifetal pregnancy reduction (MFPR)

The ethical dilemmas of MFPR are closely connected to the problem of abortion. The main difference is that in the case of MFPR it is explicitly the intention not to terminate the pregnancy but to increase the chance of development of the remaining fetuses. Especially for higher order pregnancies, not performing a reduction will increase the risk of losing the pregnancy and all the fetuses. In that sense, the reduction is medically indicated. The first priority lies with the well‐being of the children that will be born.

Prevention of multiple pregnancies should be preferred to MFPR. Regardless of the information provided before the treatment, people may still experience the decision to reduce the number of embryos as psychologically and morally demanding. Patients who become pregnant after a long period of infertility attribute a high value to the embryos/fetuses and to the pregnancy. Even when neither the physician nor the couple has moral qualms about abortion, it is better not to bring people into a position where they have to take decisions that may endanger their project. Prevention is also preferable since there are indications that the original higher order pregnancy has detrimental effects (higher incidence of prematurity) on the development of the remaining fetuses that are carried to term even after the reduction.

MFPR is morally acceptable if the physician has acted according to the rules of good clinical practice and has tried to minimize the risk of a multiple pregnancy. The benefits for the remaining embryos of reducing a higher order multiple pregnancy exceed the disadvantages of carrying the pregnancy to term or risking miscarriage. With triplets, opinions vary according to personal experience and access to neonatal care. The reduction of twins to a singleton is acceptable in cases of maternal disease, poor obstetric outcome and compelling social and psychological reasons of the woman

Ethical Issues for artifical reproductive measures :

Defining initiation of life ethicalethically - Often surplus embryos are involved in process of IVF to substantially enhance the chance of pregnancy

Chromosomal and Other Congenital Defects - compared with couples who conceive spontaneously, for those who require IVF, babies are more likely to be born preterm, of low birth weight and to be a twin or higher order multiple than spontaneously conceived infants

Turning children into commodities -In vitro fertilization turns children into commodities

Older women being offered in vitro fertilization -One important concern on use of IVF on older women is based on the welfare of child as the age and health condition of old mothers to be may restrict them from being appropriate parents and this is often seen as infringement of the resultant child's rights

Religion: Objection to playing God - Technologies of assisted reproduction such as in vitro fertilization (IVF) have been controversial on religious grounds since their inception, but nonetheless, within Islam, Judaism, Confucianism, Hinduism, and most forms of Christianity,