A Higher Education Academy STEM event "Teaching Bioethics:Ethical aspects of innovations in biomedicine" took place at the University of Leicester (UK) in May 2012. In this keynote presentation, Anna Smajdor (University of East Anglia) led reflections on the implications of recent developments in fertility technology. Since In vitro fertilisation was first introduced in 1978, the potential applications have developed in ways that were not initially envisaged and we have ended up with complications defining “father” and “mother”. Similarly, who is the “patient” when a woman receives medical treatment to deal with the infertility of her partner (and why is this considered a “medical” treatment at all? Development of new technologies has moved way beyond the original expectation that IVF would be used in the context of a traditional family. New reproductive technologies, she argued, have blurred and stretched the obvious biological definitions of reproduction. For example, single mothers, same-sex couples and women beyond the menopause can all become parents. Preimplantation genetic diagnosis and the notion of saviour siblings allow for a certain degree of selection regarding the characteristics of the future child and we now stand on the brink of gametogenesis where it will be feasible to develop artificial gametes outside of the body.

1. Redefining reproduction
Dr Anna Smajdor
Lecturer in Ethics
University of East Anglia
Norwich
acsmajdor@yahoo.co.uk

3. Deconstructing the family?
• IVF couples get Viking sperm!
• Multiple mothers’ spare babies aborted
• No father required
• IVF twins with 5 parents
• The cloned baby with two mothers
- a selection of headlines from the Daily Mail

4. Snapshot from history
1884: William Pancoast of Jefferson Medical
College, Pennsylvania, performs 1st documented
artificiaI insemination in human beings
Male patient sought help for ‘infertile wife’
 Pancoast established problem was with the husband
 Wife was told she needed to undergo treatment
 Chloroformed in front of watching medical students
 Inseminated with sperm from a student
 9 months later, delivered a baby boy

5. Questions:
 Who’s the father?
 Who’s the patient?
 Did this procedure cure a medical condition?
 If not, why was a doctor performing it?
“What reasoning led physicians to assume that they
were providing treatment for infertility, when the
technical act they were proposing may be
understood as an alternative mode of conception
to heterosexual intercourse?”
Novaes SB. The medical management of donor insemination. In Danies K, Haimes E
(eds.) Donor Insemination: International social science perspectives. Cambridge
University Press. pp105-130. 1998. p.106.

6. Why the need to (re)define?
• Reproductive rights
• Reproductive needs
• Funding
• Legal questions:
• Defining parenthood/parental responsibility
Should some procedures – ie reproductive
cloning – be illegal? If so, why?

7.  1978: 1st IVF child born – no
Regulatory framework in place
 Public concern: ‘test-tube’ babies;
 Warnock report: to look into ethical/legal issues
o IVF to be allowed under licence
o Welfare of the child (+ need for father)
o Consent of both parents of vital importance
o Formation of the HFEA
 HFE Act passed in 1990
 Keeping IVF within a heterosexual
nuclear family paradigm

8. Unruly reproductive technology
Gamete donation; Surrogacy; PGD
Saviour siblings; sex selection;
same sex/single parenthood;
Postmenopausal motherhood; ooplasmic
transplant
IVF and reproductive technologies are unruly –it’s
hard to keep them within set clinical boundaries.
Continually developing new possibilities +
applications, raising new ethical + legal questions.
[Levitt M. Assisted Reproduction: Managing an Unruly Technology.
Health Care Analysis. Volume 12, Number 1. 2004.]
Future challenges: artificial gametes;
reproductive cloning

9. Biological parenthood
Gametogenesis – artificial gametes/gamete donation
Intercourse – reproductive tissue transplant
Conception – IVF
Gestation – surrogacy
Labour – surrogacy
Breastfeeding – bottle
Can all be undertaken by a variety of different people, in a variety
of places – outside or inside the body!
New reproductive technologies have dissolved
the biological boundaries to reproduction

11. Who is the ‘real’ mother?

12. Cloning = reproduction?
John Harris: the only good argument against it is
harm to the cloned child. If little/no harm caused,
cloning should be allowed...the right to clone could
be part of reproductive autonomy.
(quoted in science & technology report 2004-5)
World Health Organisation: cloning ‘replicates
individuals’, is contrary to human dignity and
integrity’
Public more accepting of cloning if provided to
infertile heterosexual couple.
Shepherd R, Barnetta J et al. Towards an understanding of British public attitudes
concerning human cloning. Social Science & Medicine. 65; 2; 377-392. 2007.

13. Interfering with nature
John Stuart Mill: two understandings
of nature:
1.‘Collectivename for everything which is’ (ie
everything is natural)
2.‘Thatwhich takes place without human intervention’
(ie everything we do is unnatural)

14. What is the symptom being treated in today’s
fertility clinics?
Infertility?
Non-conception?
The desire for a baby?
Problem – if desires are being treated, how do we make
distinctions between those we deem eligible and those we
don’t?

15. NICE guidelines for IVF
A woman is eligible for IVF if
o She has a male partner
o Who has a fertility problem (eg low sperm count)
o Even if she herself is in perfect reproductive health
o Need for treatment defined not by clinical facts
o But by the social tie – choice of partner
o Woman is treated, but she could have a child with someone
else
Compare with a woman who is physiologically identical
o Also in perfect reproductive health
o Also has chosen a partner with whom she cannot conceive
‘naturally’ – another woman
o Is not eligible for treatment – because of the social tie: choice
of partner. If she chose a different partner – she would be
eligible

16. Legislation & ethics at the new frontier
• Biological facts no longer serve to denote
legal/ethical/medical limits of reproduction
• Boundaries must be renegotiated,
acknowledging socially/moral component
• Pressure on current legal + regulatory
approaches – inconsistent and
discriminatory

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Times.
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