HIGH SCHOOL BIOETHICS PROJECT

REPRODUCTIVE TECHNOLOGY

OVERVIEW LEARNING OUTCOMES

Assisted reproduction has become more widely 1. Understand the different technologies, how
used in recent years. The technological advance- they work and why they are used.
ments have widened the definition and possibility 2. Think critically about what characteristics and
of parenting. Career-oriented women, gay and les- genetic traits should be in the parent’s control.
bian couples, single mothers and infertile couples 3. Formulate ethical opinions on genetic control,
are among the people who may now become par- savior siblings and what to do with excess
ents. With the broadening possibility of becoming embryos.
a parent, should there be any restrictions or does
every one have the right to have children? How
much control should people have over the con- PROCEDURES AND ACTIVITIES
ception of their children and are there any scenari-
os in which the technologies should not be used? This unit uses a student-centered and interactive
What are some of the new ethical questions approach to teaching. Activities are designed to
resulting from the improvement in these technol- allow for a maximum degree of student partici-
ogies? This module will provide a background on pation and collaboration. Each activity is marked
some of these technologies and how they work, as an individual-, partner-, or group activity, or as
present some of the ethical questions, and facili- a teacher-directed class discussion.
tate the formulation of opinions about the issues.
The following icons are used to designate the
different types of activities:
CONTENTS

1. Introduction to Topic
2. Philosophical Dimensions Individual Activity
3. Reproductive Technologies
4. The Ethics of Offspring Selection Partner Activity
5. Savior Siblings
6. Excess Embryos Group Activity
7. In the News
8. Conclusion
9. References and Additional Resources
Teacher-Directed Class Discussion
1. INTRODUCTION TO TOPIC Basic Views

Natural Law View

This view comes from teachings of the Ro-
Students should answer these questions in- man Catholic Church. Natural law theory says
dividually at the start of the unit. The purpose that God embedded moral values in the natu-
of the activity is to collect the student’s indi- ral world, and so we are under an obligation to
vidual thoughts before being presented with respect the natural order of things. Under this
any information in the unit, so teachers should view, all technologies for controlling human
avoid answering too many questions about reproduction are wrong, for they subvert the
terminology that is used. natural order. Even though children are usu-
ally expected in marriage, if no measures are
1. What reproductive technologies, if any, “wrongfully taken” to frustrate the possibility
are you familiar with and do you have any of birth (such as contraception), the use of ar-
strong opinion about their use? tificial insemination or in vitro fertilization is in-
2. What characteristics would you want to be trinsically immoral. One reason for this is that
able to select in a child? Would this selec- most reproductive technologies separate the
tion be ethical? sex act from conception. The natural order is
3. Under what circumstances is it inappropri- such that conception and reproduction cannot
ate to use these technologies? Should we happen naturally without sexual intercourse.
place restrictions on science? Thus, it is wrong to separate the two. The
inseparability thesis prohibits sex that is not
open to reproduction (i.e. birth control) as well
2. PHILOSOPHICAL DIMENSIONS as reproduction that occurs without sex. Addi-
tionally, many of the technological processes
themselves involve another objectionable act.
For example, artificial insemination involves
masturbation, which is prima facie wrong.
The purpose of this section is to provide
Utilitarian View
students with a philosophical background to
Utilitarianism holds that the best course of ac-
help frame their decisions about the ethics of
tion is that which maximizes the overall good
these reproductive technologies.
of society. In this view, no reproductive tech-
nologies are in themselves objectionable. The
Information from:
ethical permissibility of reproductive technolo-
Munson Ronald. “Reproductive Control.”
gies in this view depends on the specific pro-
Intervention and Reflection: Basic Issues in
cedure and whether it is likely to lead to more
Medical Ethics. 8th ed. Belmont, CA: Thom-
good than not. It is reasonable to assume
son Wadsworth, 2008. 364-451.
that philosophers that hold this viewpoint will
likely approve of most, if not all procedures.
Fundamental Ethical Question: “Is it simply
Rule utilitarianism is a branch of the broader
wrong for us to use our knowledge of human
utilitarian view that deems actions as moral
biology to exercise power over the processes
if they follow a set of rules that lead to the
of human reproduction?” (Munson, 383).
greater good. Instead of looking at each situ-
ation independently, every case is assessed
by the same set of rules. A philosopher hold-
ing this view might oppose any or all of the
procedures. “If there is strong evidence to if their use stands at odds with competing
support the view that the use of reproductive values or principles. Most of the technologies
technology will lead to a society in which the listed below are unobjectionable because they
welfare of its members will not be served, help satisfy a shared desire and help a couple
then a rule utilitarian would be on firm ground in need, even if they violate the natural order of
in arguing that reproductive technology ought things or violate principles of justice.
to be abandoned” (Munson, 383).

Kantian Ethics 3. REPRODUCTIVE TECHNOLOGIES

Kant’s ethical theory revolves around the idea
of the “Categorical Imperative.” Categorical
imperatives are good in and of themselves
and must always be followed. To put it more
simply, they are the “golden rules” of moral-
ity. The most fundamental categorical imper- The purpose of this activity is to provide students
atives is to never use someone as a mere with an overview of the technologies available
means but rather as a means to an end or an and their usages. This segment of the lesson
end in itself. The categorical imperative does could be used in conjunction with a lesson about
not provide grounds to reject reproduction the maturation of gametes, fertilization, and
technologies in general but “the maxim in- pregnancy. You could also assign different tech-
volved in each action must always be one that nologies to each student or group of students
satisfies the categorical imperative” (Munson, and ask them to present to the class what each
383). That is, each action must treat humanity technology involves, and how fertilization and
– whether in oneself or in one’s child – always pregnancy occur using each technology.
as an end in itself and never as means.
Artificial Insemination
Some cases of IVF, artificial insemination and A semen specimen is placed in a syringe that
cloning would be morally wrong – those that is attached to a catheter (a long tube). The
arguably create embryos simply as means of catheter is inserted into the cervical canal and
saving or curing other children (see “Savior the semen is slowly injected into the uterus.
Siblings” below). The overall success rate is 85-90%.

Ross’s Ethical Theory IVF-In Vitro Fertilization

W.D. Ross’s ethical theory is based on the idea The woman is given reproductive hormones
that the only prima facie duty we hold is to pro- that cause the ova to ripen. Several mature
mote duties of beneficence. In other words, eggs are then taken and placed into a nutrient
we are obligated to help others better their solution to which sperm is added. The eggs
lives. Sometimes this might conflict with other that were able to fertilize are then placed into
important values or principles, for example, we another solution where they undergo cell
may have break a promise to meet our friend division. Once this is complete, the embryo
in order to help someone in need. Or we may is implanted into the uterus, usually 1-5 days
have to violate the natural order of things in or- after fertilization.
der to achieve some other good. Reproductive
technologies are ethical under this view when GIFT-Gamete Intrafallopian Transfer
they promote the well-being of others, even This technique is similar to IVF but instead
of waiting until an embryo is formed to put it
into the woman, the ova and sperm are insert-
ing directly into the fallopian tubes through an
incision in the abdomen. The fertilization then or not she wants to have an abortion. This pro-
takes place inside the woman’s body, rather cess allows women who do not produce viable
than externally. ova to use a donor egg but fertilization occurs
in the fallopian tube rather than in vitro.
ZIFT-Zygote Intrafallopian Transfer
The egg and sperm are fertilized outside the PZD-Partial Zona Dissection
body, and then the zygote is placed into the Involves using microtechniques to drill holes
woman’s fallopian tubes. This procedure reflects in the zona, the protective membrane of the
the view that the fallopian tube is the safest ovum, to make it easier for sperm to pass into
environment for embryo development. As in the interior. This reduces the egg’s resistance
natural reproduction, the embryo will travel to to penetration.
the uterus. Pregnancy begins when the embryo
implants in the uterus. Like GIFT (above), ZIFT ICSI-Intracytoplasmic Sperm Injection
more closely simulates a natural pregnancy, This technique can help 50-60% of infertile
since during natural fertilization, the zygote is men become fathers. Sperm is examined mi-
formed in the fallopian tube and then travels to croscopically and the best-shaped and most
the uterus within a few days of conception. active one is injected directly into the egg
cell. The technique identifies which sperm will
IVC-Intravaginal Culture most likely be able to fertilize an egg.
Mature ova are retrieved (using the same
technique as for IVF) and placed in a small CD-Cytoplasmic or Mitochondrial Transfer
tube. The tube is then inserted into the va- The cytoplasm (including mitochondria) is
gina and kept next to the cervix using a dia- removed from a younger donor egg and
phragm-like contraption. Normal intercourse injected into an older egg or an egg whose
can take place while the tube is in place. mitochondrial DNA are compromised. Certain
When intercourse occurs, it is hoped that diseases affect the mitochondria. Since mito-
ejaculated sperm will fertilize the eggs con- chondrial disease is passed from mother to
tained in the tube. After two days, the tube baby, some mothers decide to use mitochon-
is removed, the contents separated, and any drial transfer to make sure that their offspring
fertilized ova are transferred into the uterus. to not have the same disease. The egg creat-
ed with the mother’s nuclear DNA and donor
ULER-Uterine Lavage Embryo Retrieval cytoplasm is fertilized in vitro with sperm, and
Used by women who have a functioning then implanted into the gestational carrier
uterus but who are unable to ovulate or do not (usually that of the woman who provided the
wish to use their ova (e.g. she is the carrier of recipient egg and nuclear DNA). This is a very
a lethal gene). Another ovulating woman is in- new technique but data shows that this will
seminated with donor sperm and the fertilized increase the developmental success of the
egg is washed out of the uterus after around recipient egg. These have been called “three
five days, before it becomes embedded in the parent babies” since the resulting child has
uterine wall. Once retrieved, the embryo is DNA from three different parents: mitochon-
implanted into the woman being assisted. The drial DNA from the donor, nuclear DNA from
main issue with this treatment is the possibil- the egg, and nuclear DNA from sperm.
ity that the embryo might not be washed out
before it embeds on the uterine wall. If this Surrogacy
happens, the donor needs to decide whether Surrogacy is when the gestational carrier
differs from the parent who will raise a child.
Gestational carriers become pregnant through
 a myriad of ways: artificial insemination (when CHARACTERISTIC Yes No (because…)
the gestational carrier is also an egg donor), in
Eye Color
vitro fertilization, GIFT or ZIFT. Surrogacy allows
women who have non-viable uteruses to have Hair Color
children that are biologically related to them, as
the gestational carrier is often fertilized with an Sex
embryo created from the gametes of one or
Height
both of the parents who will raise the child.
IQ/Intelligence
Student Questions:
1. Which procedure seems to be the most Sexual Orientation
natural?
Down Syndrome
2. Did your thoughts on the role of the par-
ents change after learning about these Cancer Predisposition
technologies?
3. Do any of these technologies seem to be Alzheimer’s
controlling nature with too substantial an Disease Susceptibility
influence? Should some of them not be Obesity
permitted?
Near-Sightedness

4. THE ETHICS OF OFFSPRING SELECTION Children as Commodities?

or
Pre-implantation Genetic Diagnosis (PGD) pro-
vides IVF patients with the ability’ to choose
the embryo that is most desirable. PGD may In this activity, lead the class in discussions
be performed on an embryo before implanta- about the following topics:
tion when an embryo is created by IVF. Doc-
tors get a tiny sample and map an embryo’s a. Designer Babies
DNA to see if the embryo has a genetic de- Would the ability to select embryos that
fect or it will be more susceptible to particular have certain traits undermine the uncondi-
diseases in the future. Usually, many embryos tional love between parent and child? Would
are created at once during IVF. PGD allows it force parents to look at their children as a
parents to choose among embryos which designed product instead of a human being?
ones they want to implant. Parents may also
discover the sex of the baby, eye color, and b. Selective Abortion
other hereditary traits at this point. Which traits should legitimately be se-
lected against? Should parents be able
This activity will help the students think about to just “try again” and search for another,
what characteristics can ethically be selected “better” embryo to use if the disorder is
for and against. Students should complete the not fatal? Parenting is all about being pre-
chart individually and then discuss as a group. pared for anything that might happen. Why
should conception be any different? Would
selective abortion of embryos with disabil-
ities lead to further inequality and discrimi-
nation of existing people with disabilities?
 For more reading: accepts work pro bono and the obsessed
Sara decides to go to court to force Anna
Dreger, Alice, and Joseph A. Stramondo. “Se- to help her sister (http://www.imdb.com/
lective Parenting.” Bioethics Forum Blog. The title/tt1078588/)
Hastings Center, 23 Oct. 2007. Web.
This film accurately portrays the ethical is-
Lindemann, Hilde, “Shotgun Weddings” Bio- sues and family problems that result from
ethics Forum Blog, The Hastings Cetner, 08 decisions of savior siblings and should give
August 2007. Web. the class good background information.

2. Debate/Discussion
5. SAVIOR SIBLINGS

Sometimes parents use reproductive tech- Students should read the following articles:
nology to conceive a child even when they
can have a child naturally in order to create a King, David, “Why We Should Not Permit
“savior sibling” for another child who has a Embryos to Be Selected as Tissue Do-
life-threatening disease. PGD also allows for nors,” Bulletin of Medical Ethics, Vol. 190
the possibility to screen for tissue matching, (2003): 13-15
typically to provide an existing child with the
genetic means to overcome a fatal disease. S. Sheldon and S. Wilkinson. “Should
Parents are typically encouraged to do ev- Saviour Siblings Be Banned?” Journal of
erything that is best for their children but is it Medical Ethics, Vol. 30 (2004): 533-537
possible to take it too far? Is it ethical to have
another child simply for the purpose of saving i. Consider this excerpt from the section
a current one? entitled “Means, Ends and Commodifi-
cation” in Munson’s book Intervention
1. To introduce this topic, watch the following and Reflection: Basic Issues in Medical
film: My Sister’s Keeper. Dir. Nick Cassave- Ethics:
tes starring Cameron Diaz, Abigail Breslin
and Alec Baldwin. A second more practical objection to this
argument is that it does not adequately
Storyline: In Los Angeles, the eleven-year- distinguish between creating a child as
old Anna Fitzgerald seeks the successful a savior sibling and creating a child for
lawyer Campbell Alexander, trying to hire some other ‘instrumental’ purpose-for
him to earn medical emancipation from example, completing a family, being a
her mother, Sara, who wants Anna to playmate for an existing child, saving a
donate her kidney to her sister. She tells marriage, delighting prospective grand-
the lawyer the story of her family after parents, or providing an heir. Perhaps
the discovery that her older sister Kate these things are different from creating
has leukemia; how she was conceived a savior sibling but, if they are the differ-
by in vitro fertilization to become a donor: ence isn’t that they are any less instru-
and the medical procedures to which she mental for in all these cases, the child is
has been submitted since she was five used as a means” (Munson, 417).
years old to donate to her sister. Campbell
ii. Split the class into two groups to de-
bate the following statement:
 7. IN THE NEWS
“Pre-implantation genetic diagnosis
(PGD) should not be used to find embry-
os to be savior siblings because this uses or
the child as a means rather than an end.”

The purpose of this section is to present the

6. EXCESS EMBRYOS students with actual news stories about ethical
issues involving reproductive technologies while
also having them formulate their own opinion
about different topics. Split the class up into
or equal groups, one for each article (or have them
choose an article, depending on the size of the
Ask students to read: class). They should read and prepare a presenta-
Gurmankin, Andrea D., Dominic Sisti, and Ar- tion for the class that includes the following:
thur L. Caplan. “Embryo Disposal Practices in • Brief summary of the story
IVF Clinics in the United States.” Politics and • How it relates to the topics learned in this
the Life Sciences 22.2 (2004): 4-8. section
• Their personal opinion on the topic
One of the main ethical issues involved with
IVF and PGD treatments is the existence of 1. Meet the Twiblings
excess embryos. The most plausible options http://www.nytimes.com/2011/01/02/
to solve this problem include: cryopreser- magazine/02babymaking-t.html
vation (freezing), donating the embryos for 2. IVF Lottery Raises Eyebrows in U.K.
reproductive use by other couples, disposal, http://abcnews.go.com/Health/ivf-lottery-
or donation for scientific research or training raises-eyebrows-uk/story?id=14021901
There are as many as 400,000 frozen embry- 3. Who’s on the Family Tree? Now It’s Com-
os in storage in the US alone. plicated
http://www.nytimes.com/2011/07/05/
Have everyone choose a partner to discuss us/05tree.html
the following questions: 4. The Two-Minus-One Pregnancy
1. What is the best option for dealing with http://www.nytimes.com/2011/08/14/mag-
excess embryos? azine/the-two-minus-one-pregnancy.html
2. Is it ethical to dispose of the excess em-
bryos?
3. What should be done if the couple gets 8. CONCLUSION
divorced? Who should get the rights to the
embryo? Teachers should have students return to the
4. What should be done if both members of original questions:
the couple die? Who should get the rights to 1. Do you have any strong opinions about the
the embryo? use of certain reproductive technologies
learned about in this lesson?
Krimmel, Herbert T. “The Case against Sur- 2. Of the characteristics you stated you
rogate Parenting.” The Hastings Center 13.5 would want to be able to select, would the
(1983): 35-39. Web. selection be ethical?
3. Under what circumstances is it inappropri-
ate to use these technologies? Should we
place restrictions on science?
 Based on the activities of the unit, have their Padawer, Ruth. “The Two-Minus-One Preg-
answers changed? nancy.” The New York Times Magazine.
10 Aug 2011. Web. http://www.nytimes.
com/2011/08/14/magazine/the-two-minus-
9. REFERENCES AND ADDITIONAL one-pregnancy.html
RESOURCES
Ravitsky. Vardit, Autumn Fiester. and Arthur L.
Dreger, Alice, and Joseph A. Stramondo “Se- Caplan. The Penn Center Guide to Bioethics.
lective Parenting.” Bioethics Forum Blog. The New York: Springer Publishing, 2009. Print.
Hastings Center, 23 Oct. 2007. Web.
Sheldon, S. and Wilkinson, S. “Should Saviour
Fiore, Kristina. “IVF Lottery Raises Eyebrows Siblings Be Banned T Journal of Medical Eth-
in U.K.” ABC News 8 July 2011. Web. http:// ics, Vol. 30 (2004): 533-537
abcnews.go.com/Health/ivf-lottery-raises-
eyebrows-uk/story?id=14021901 Themstrom, Melanie. “Meet the Twiblings.”
New York Times Magazine 29 Dec 2010. Web.
Gurmankin, Andrea D., Dominic Sisti, and Ar- http://www.nytimes.com/2011/01/02/maga-
thur L. Caplan. “Embryo Disposal Practices in zine/02babymaking-t.html
IVF Clinics in the United States.” Politics and
the Life Sciences 22.2 (2004): 4-8. Web. Veatch. Robert M. “Human Control of Life:
Genetics, Birth Technologies and Modifying
Holson, Laura. “Who’s on the Family Tree? Human Nature.” The Basics of Bioethics. 2nd
Now It’s Complicated.” New York Times ed. Upper Saddle River, NJ: Prentice Hall, 2003.
4 Jul 2011. Web. http://www.nytimes. 148-66. Print.
com/2011/07/05/us/05tree.html
Acknowledgements
King, David, “Why We Should Not Permit Em- Support for the High School Bioethics Project
bryos to Be Selected as Tissue Donors,” Bulle- at NYU School of Medicine was provided by
tin of Medical Ethics, Vol. 190 (2003): 13-15 the Squire Foundation.

Krimmel, Herbert T. “The Case against Sur-

rogate Parenting.” The Hastings Center 13.5
(1983): 35-39.

Mappes, Thomas A., and David DeGrazia. Bio-

medical Ethics. Boston: McGraw-Hill, 2006.

Munson, Ronald. “Reproductive Control.”

Intervention and Reflection: Basic Issues in
Medical Ethics. 8th ed. Belmont, CA: Thom-
son Wadsworth. 2008. 364-451. Print.