Chapter 13 :Reproduction: Assistance and Control Issues   

Section 1. Case Presentation

CASE PRESENTATIONS:

Cloning: Genetic Duplicates

Not Safe and Not Right???

Test Tube Baby: external fertilization and implantation - Summary by James Rowe, QCC, 2005

Louise Brown, born on the 25th of July, 1978, was the world’s first “test-tube” manner, that is say, she was conceived outside of the mother’s body and allowed to grow to the eight-cell level before being implanted into the womb. Developed by Robert Edwards and Patrick Steptoe, the procedure to do as such consists of harvesting an ovum from the mother’s ovary through a surgical procedure after giving her drugs to induce maturing of the egg cells, followed by artificially inseminating said ovum with the father’s sperm in a test-tube containing it and a soup of biochemical nutrients, before further being placed in another nutrient solution for roughly fifty hours until the embryo grown to an eight-cell stag, and then finally being implanted in the hormone prepared mother’s uterine wall. In the case of Louise Brown, the procedure was a success, although a week before the full nine months the baby had to be delivered via caesarian section in order to prevent Mrs. Brown’s development of the high-blood pressure related condition of toxemia from causing a stillbirth

As of 1998, Louise Brown works in a fast-food joint and is studying to become a school nurse, hopeful that she too will one day have children.

Multiple pregnancies: Fertility drugs - risk of abnormalities and deaths- Summary by James Rowe, QCC, 2005 

            On November 19th, 1997, Bobbi McCaughey gave birth to seven babies, a world record at the time. Yet this was not a simple “act of God”, but rather a result of her taking Pergonal, one of a slew of fertility drugs linked with a spike in multiple births. Working under the principle of inducing more than one egg to be released per menstrual cycle, these fertility drugs have the side-effect of presenting the opportunity for more than one of those eggs to be fertilized at the same time, which can lead to similar cases to Bobbi McCaughey and her septuplets. In fact, the usage of these drugs has, as noted, coincided with a spike in births consisting of three or more children (including other septuplets), the rate of which has quadrupled in the last thirty years. Wedded to this higher rate of multiple-births is the possibility for miscarriage, a rate of which is particularly high amongst quadruplets and quintuplets (25 and 50 percent), as well as premature birth, with the average triplets being born at 33.5 weeks and the average quintuplets at 31. Subsequently, if the children do not die, they are at risk for suffering the results of prematurity such as retinal damage, which can cause blindness, or brain-bleeding which can induce a bevy of problems, including damage to the brain, retardation, learning disabilities, impaired motor skills, chronic lung problems, and/or cerebral palsy.

            The main ethical concerns have centered around whether or not the parents and doctors can rightfully be considered to have upheld their responsibilities in allowing for a seven-baby birth to occur, a situation which could have potentially been avoided if the fertility drugs were stopped sooner, or could have been prevented from happening (as a seven-baby birth) via selectively aborting some of the babies, an option which the McCaugheys would not have done due to religious prohibitions on such a practice. Critics have also lambasted the McCaugheys for the exceedingly high medical bills which they cannot foot alone, which must somehow be paid by the state or the health-care system, a fact which is made worse by the reality that there are, perhaps, more constructive means which these funds could used for. Aside from these, there is also the consideration of whether or not (in)fertility clinics should be further regulated by the government, to perhaps impose greater restrictions on what could amount to an explosion of these multiple births which carry with them the aforementioned costs, both physical – to mother and child – and monetary.

Multiple pregnancies: Fertility drugs - risk of abnormalities and deaths- OCTO-Mom Case- Nadya Suleman- a woman who gave birth to 8 at once but has a total of 14 children!

Information gathered by:  Nicole Lipari, Kelly Phillips, Godfrey Aneke, Theresa Walling, Clara Shamatanga, Teresa Notaristefano (NCC, 2009)

Websites containing Info on Octomom:

http://www.tmz.com/tag/Octomom/

http://www.nypost.com/seven/02072009/news/nationalnews/loony_octomom_153939.htm

http://www.nydailynews.com/gossip/2009/05/07/2009-05-07_operation_means_no_more_babies_for_octomom_nadya_suleman.html

http://noanimalleftbehind.blogspot.com/2009/02/octomom.html

http://www.newsweek.com/id/187344

http://www.eonline.com/uberblog/b102539_dr_phil-octomom_summit.html?sid=rss_topstories&utm_source=eonline&utm_medium=rssfeeds&utm_campaign=rss_topstories

http://en.wikipedia.org/wiki/Suleman_octuplets

http://www.time.com/time/nation/article/0,8599,1883663,00.html

http://www.mahalo.com/nadya-suleman

http://www.newsweek.com/id/187344

http://www.celebitchy.com/35708/octuplet_mom_nadya_suleman_before_plastic_surgery_gets_food_stamps_child_disability/

http://insidesocal.com/octorazzi/2009/04/no-april-fools---octomom-donation-website-gonetml

http://www.octomomma.com/

http://www.radaronline.com/exclusives/2009/06/worldwide-video-exclusive-octo-mom-donor-daddy-was-last-man-i-had-sex

http://news.softpedia.com/news/Nadya-Suleman-Admits-to-Exaggerating-About-Upcoming-Uterus-Surgery-111433.shtml

http://gosublogger.com/2009/02/nadya-suleman-had-plastic-surgery-video/

http://www.usmagazine.com/news/octo-mom-admits-fertility-treatments-were-irrational-2009103

http://www.radaronline.com/exclusives/2009/02/octomom-erupts-video-showdown-with-her-mom-over-babies.php

http://blog.zap2it.com/frominsidethebox/2009/05/octomom-show-wont-be-like-jon-kate-plus-8.html

http://pafamilylaw.foxrothschild.com/2009/04/articles/custody/thoughts-about-octomom/

http://www.nbcbayarea.com/news/entertainment/Octo-Mom-I-Screwed-Up-My-Life.html

http://abcnews.go.com/GMA/story?id=7011071&page=1

www.themedguru.com/articles/study_links_taller_women_with_multiple_births-732127.html<http://www.themedguru.com/articles/study_links_taller_women_with_multiple_births-732127.html>

www.ResponsibilityProject.com<http://www.ResponsibilityProject.com>

www.timesonline.co.uk/tol/life_and_style/health/article5627531.ece<http://www.timesonline.co.uk/tol/life_and_style/health/article5627531.ece>

www.foxnews.com/story/0,2933,490269,00.html<http://www.foxnews.com/story/0,2933,490269,00.html>

www.topix.com/forum/city/douglasville-ga/T98VEK6NFMLF65PH7<http://www.topix.com/forum/city/douglasville-ga/T98VEK6NFMLF65PH7>

www.msnbc.msn.com/id/29002731<http://www.msnbc.msn.com/id/29002731>

www.msnbc.msn.com/id/28948599<http://www.msnbc.msn.com/id/28948599>

www.neilmckentyweblog2.wordpress.com/2009/02/05/should-a-single-woman-have-14-kids

www.theroot.com/blogs/hardline/nadya-suleman-14-children-no-job-no-partner<http://www.theroot.com/blogs/hardline/nadya-suleman-14-children-no-job-no-partner>

www.answerbag.com/q_view/1276363<http://www.answerbag.com/q_view/1276363>

www.abcnews.go.com/Health/WomensHealth/story?id=6774471&page=1

www.huffingtonpost.com/2009/01/31/nadya-suleman-octuplets-m_n_162756.html<http://www.huffingtonpost.com/2009/01/31/nadya-suleman-octuplets-m_n_162756.html>

www.dailyemerald.com/news/2009/02/06/Opinion/Reality.Of.Raising.14.Children-3616937.shtml<http://www.dailyemerald.com/news/2009/02/06/Opinion/Reality.Of.Raising.14.Children-3616937.shtml>

www.newser.com/story/50430/mom-ill-raise-14-kids-on-student-loans.html<http://www.newser.com/story/50430/mom-ill-raise-14-kids-on-student-loans.html>

www.guardian.co.uk/world/2009/jan/31/octuplets-mother-california-fertility<http://www.guardian.co.uk/world/2009/jan/31/octuplets-mother-california-fertility>

www.nadyasuleman.com/2009/03/09/nadyas-second-publicist-quits-job/comment-page-1<http://www.nadyasuleman.com/2009/03/09/nadyas-second-publicist-quits-job/comment-page-1>

http://articles.lancasteronline.com/local/4/235066

http://news-briefs.ew.com/2009/05/octomom-taken-t.html

Info about the doctor:

http://strangeoc.freedomblogging.com/2009/02/06/octomom-doctor-under-fire/4558/

http://www.time.com/time/nation/article/0,8599,1883663,00.html

http://www.azcentral.com/arizonarepublic/opinions/articles/2009/04/02/20090402thurlets027.html

http://www.msnbc.msn.com/id/29331080/

http://strangeoc.freedomblogging.com/2009/02/06/octomom-doctor-under-fire/4558/

http://www.time.com/time/nation/article/0,8599,1883663,00.html

http://www.foxnews.com/story/0,2933,498306,00.html

http://womenshealth.about.com/b/2009/02/13/octo-moms-fertility-doctor-implants-at-least-7-embryos-in-49-year-old-woman.htm

Ethical Issues:

http://www.examiner.com/x-2134-DC-Ethical-Issues-Examiner~y2009m2d14-Octomoms-pr-flack-surprised-at-death-threats-Despicable-but-not-surprising?cid=exrss-DC-Ethical-Issues-Examiner

http://mattandvicky.wordpress.com/2009/02/26/infertility-treatments-ethics-the-octomom/

http://www.associatedcontent.com/article/462840/life_saving_support_for_premature_infants.html

http://healthcareorganizationalethics.blogspot.com/2009/05/octomom-ethics-and-health-care-limits.html

http://www.publicradio.org/columns/marketplace/tradingfloor/2009/03/from-octomom-to-new-medical-ethics-laws.html

http://www.washingtontimes.com/news/2009/feb/04/octo-mom-gives-birth-to-fertility-ethics-debate/

http://www.daily49er.com/opinion/octo-mom-shows-need-for-fertility-ethics-1.1481028

http://open.salon.com/blog/heather_michon/2009/02/02/the_sorry_tale_of_the_octomom

http://media.www.leprovoc.com/media/storage/paper453/news/2009/03/25/Viewpoint/octoMom.Raises.Multiple.Ethical.Questions.And.Considerations-3686643-page2.shtml

http://www.surrogacyissuesblog.com/2009/06/05/friday-legal-update-exclusive-experts-respond-to-octo-moms-sperm-donor-confession/

Postmenopausal Motherhood: Sex bias or physical threats to woman and child  Summary by James Rowe, QCC, 2005 

Motherhood After Menopause 

            Then sixty-three-year-old Arceli Keh gave birth to a healthy baby girl in 1996, a process which was induced via artificial insemination and only after she lied about her age to the clinic, which usually only accepts 45 year olds for such a procedure. Though not intending to do as such, Keh would become the oldest woman to ever give birth at the time, although slightly-younger women have similarly given birth after menopause before her. In fact, in the year 2000, there were 255 births to women aged 50-54, up from 174 in 1999. This increase may in part be due to infertility clinics changing policies that restrict in vitro fertilization to 40-45 year olds, the impetus of such were prior conceptions that older women may not be able to capable of sustaining their health through pregnancy or even being successful, which a study in 2002 seems to now put into question.

            Critics of these artificially-induced menopausal pregnancies affirm that owing to the scarcity of donor eggs, younger mothers ought to be given primacy, as well as noting that younger parents are better equipped for handling the rigours of early childhood, as well as being less likely to die or become impaired during the child’s youth. Those for this position, however, cite that it is somewhat a correction of nature to allow for older women to bear children, precisely because men have no limit to the age at which they can impregnate a woman, linking such prohibitions against women being able to do as such to underlying sexist notions. Moreover, defenders also affirm that youthful parents are not always better, either mentally, physically, nor monetarily as older parents, nor must they younger parents prove their capacity to be parents before older parents must.

            Although as unlikely it is that menopausal women will ever desire to be pregnant en masse, the ethical debate will likely persist. 

selective reduction: Therapy or evil?

New Data: Older Fathers-sperm is now linked to defects in children, including shizophrenia

Embryos in Court: Who owns embryos? Does sperm source/egg source have a right not to be a father/mother?

Father shopping: Sperm by Mail - catalogue of sperm source- shipment by mail-Summary by James Rowe, QCC, 2005 

Delivery for Ms. Jane Doe! Sperm! 

            It has become the case in recent years that many commercial sperm banks now go as far as to allow prospective buyers – who will need a doctor to request the sperm for them – to browse through the history, appearances, interests, race, blood type, level of education, hair colour, and appearance. Some services even offer photographs of the donors themselves, or allow the donors to write an essay or letter about themselves, to be viewed or read by the woman interested or the child produced form such a union, even if the donor desires to remain anonymous. 

Mother Shopping: Eggs by Internet - website with photos of egg source- shipment by mail

Surrogate Pregnancy: Buying and selling a baby?- Summary by James Rowe, QCC, 2005 

Surrogate Pregnancy and a Court Battle: The Case of Mary Beth Whitehead and Baby M 

            On the 30th of March, 1986, William and Elizabeth Stern were given a baby born from Mary Bet Whitehead three days earlier. This would not necessarily be remarkable, save for the simple fact that Whitehead had served as a surrogate mother, having underwent artificial insemination by William’s sperm under the auspices that she would give up the child to William and Elizabeth and never claim parental rights in exchange for 10,000 dollars and a photograph and a letter dealing with the happenings of the year annually. All would go well until Whitehead suffered, in essence, an emotional breakdown, and desperately desired the child, even refusing to give it back when the family gave her the child for one week to satisfy her emotional urges, a situation that required police intervention. A case would be put before the Superior Court of New Jersey.

            The trial was without legal precedent and went on for seven weeks, with Whitehead her self arguing the legitimacy of surrogacy legitimacy on the ground of it being against public policy on selling babies, with William Stern hoping to have a legal decision support the upholding of surrogacy contracts, arguing that like all other contracts it must be upheld. On top of this, the judge in this case had to consider the “best interest of the child”, a nebulous provision in New Jersey law which had never been applied to such cases before. On the 31st of March, 1987, the judge would rule for the Sterns, allowing Elizabeth to immediately sign the documents that would give her parental rights.

            An appeal to this case was made before the New Jersey Supreme Court, and on the 3rd of February, 1988, the New Jersey Supreme Court unanimously overturned the prior decision, on the foundation that it violated state adoption laws by allowing for payment for the child, although it would allow for surrogacy agreements to be valid so long as there was no money involved and the parental rights were voluntarily given up. Yet very importantly, the court would allow custody to be given to the Sterns, allowing such to stand due to the fact that, “their household and their personalities promise a much more likely foundation for Melissa to grow and thrive.” This most assuredly was due to Whitehead having divorced her husband three months prior, and now being romantically involved with one Dean Gould, had become pregnant. Yet even if custody was given to the Sterns, Whitehead was allowed to remain the legal mother of Melissa, with the court ordering a lower one to deal with the matter of visitation rights for her. 

Gestational Surrogate Changes her Mind: Whose baby is it?- Summary by James Rowe, QCC, 2005 

When a Gestational Surrogate Changes her Mind 

            A medically necessitated hysterectomy that left intact her ovaries, did not take away from Crispina Calvert, of Orange County, California, the desire to have a child, and owing to this, and for 10,000 dollars, they arranged for Anna Johnson to act as a surrogate for an implanted embryo solely the genetic material of Crispina and her husband Mark. All would not be well, however, as in the seventh month, Johnson changed her mind and a legal battle ensued.

Differing from the Mary Beth Whitehead surrogacy case precisely because of the fact that the surrogate was not the biological parent at all, it would bring up the new question of whether or not a person, who having no biological stake in the child, could rightfully proclaim any connection with it. The California Superior Court would answer “no” to this question, and in October of 1990, ruled that only the biological parents had any right in this case to the child. Moreover, justice Parlow would even go onto say that this was not a case of baby selling, as it were, declaring, “I see no problem with someone getting paid for her pain and suffering. There is nothing wrong with getting paid for nine months of what I understand is a lot of misery and a lot of bad days. They are not selling a baby; they are selling pain and suffering.”

Ethical considerations afoot in this case mostly centred on the notion of surrogacy itself, with critics proclaiming it as exploitive of women, specifically the poor, as well endangering the surrogate to the health hazards of pregnancy. Defenders counter that a woman is free to enter into the contract and is no more compelled than anyone else who enters into a contract, and the inherent dangers of pregnancy can be considered analogous to the dangers of other jobs, differing only in the manner which such injuries could be sustained. The matter of parenthood is also debated and to the extent which a carrier, but not a genetic contributor, of a child may rightfully proclaim to a “parent”. Ruling on the matter as a whole, the Ethics Committee of the American Fertility Society has affirmed opposition to surrogate pregnancy which is not related to medical reasons. This would not be the case with Mrs. Calvert, who had a physical reason to look for surrogacy, but would be the case were someone to look to surrogacy out of sheer convenience or another non-medical reason, although one needn’t be physically incapable of having the child to be counted as having a medical reason to pursue it, which may be the case in such instances as diabetes or uncontrollable high blood pressure.     The contentious matter of surrogacy, both in this case and in Whitehead’s, is surely to rage for many a year as an ethical consideration. 

Gestational Surrogate

Surrogates in 2009

Changes over the last two decades

 

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