Case studies : Assisted Reproduction

This is a difficult subject because it involves reproductive issues. In our culture, reproductive liberty, the freedom to decide when and where to conceive a child is highly protected, and this can make these cases much more difficult.

Case 1

There are two types of surrogacy. One type involves a surrogate mother who uses her own egg and carries the baby for someone else. The other type is a “gestational surrogacy” in which the mother has no genetic tie to the child she carries. In the case presented, a gestational surrogate is used.

A woman, after a bout with uterine cancer had a hysterectomy (surgical removal of the uterus). Before, its removal, however, she had several eggs removed for possible fertilization in the future. Now married, the woman wishes to have a child with her husband. Obviously she cannot bear the child herself, so the couple utilizes a company to find a surrogate mother for them. The husband’s sperm is used to fertilize one of the wife’s eggs, and is implanted in the surrogate mother. The couple pays all of the woman’s pregnancy-related expenses and an extra $18,000 as compensation for her surrogacy. After all expenses are taken into account the couple pays the woman approximately $31,000 and the agency approximately $5,000. Though the surrogate passed stringent mental testing to ensure she was competent to carry another couple’s child, after carrying the pregnancy to term, the surrogate says that she has become too attached to “her” child to give it up to the couple. A legal battle ensues.

Questions for Case 1

· In the United States it is illegal to pay a person for non-replenishable organs. The fear is that money will influence the poor to harm their bodies for the benefit of the rich.

· Do you see a parallel between this case and this law?

· Can allowing surrogate mothers to be paid for their troubles allow poorer women to be oppressed?

· Does paying the surrogate harm her and/or the child’s dignity?

· Is it selfish/conceited for this couple to want children of their own genetic make-up?

· If yes, does this change if you can “easily” have a child? (Note: Over 100,000 children in the U.S. are waiting to be adopted. However, most are older, have several siblings, or have special needs.)

· On their website, the AMA says “that surrogacy contracts [when the surrogate uses her own egg], while permissible, should grant the birth mother the right to void the contract within a reasonable period of time after the birth of the child. If the contract is voided, custody of the child should be determined according to the child’s best interests.”

· Do you see any problems with this? (What’s a reasonable time? In a way can you steal the surrogate’s child?)

· One of the main arguments against the use of surrogate mothers is that carrying and giving birth to a child is such an emotional event that it is impossible to determine if the surrogate will be able to give up the child. Though adults enter into the contract, the child could ultimately suffer if a long custody battle ensues (as it could in states where surrogacy contracts hold no legal value, such as Virginia).

· With the possibility of such battles, do you think it is acceptable for parents to use a surrogate mother?

· Do you think that if the surrogate is awarded the baby, this could cause emotional harm to the child?

· Who do you think should receive the child, and why?

Case 2

A married couple wishes to have a child; however, the 32 year old mother knows that she is a carrier for Huntington’s disease (HD). HD is a genetic disorder that begins showing signs at anywhere from 35-45 years of age. Its symptoms begin with slow loss of muscle control and end in loss of speech, large muscle spasms, disorientation and emotional outbursts. After 15-20 years of symptoms HD ends in death. HD is a dominant disorder which means that her child will have a 50% chance of contracting the disorder. Feeling that risking their baby’s health would be irresponsible, the couple decides to use in vitro fertilization to fertilize several of the wife’s eggs. Several eggs are harvested, and using special technology, only eggs that do not have the defective gene are kept to be fertilized. The physician then fertilizes a single egg, and transfers the embryo to the mother. Approximately 9 months later, the couple gives birth to a boy who does not carry the gene for the disorder.

· Is this a case of eugenics? “Eugenics” is defined as “the hereditary improvement of the human race controlled by selective breeding” (dictionary.com)

· Would it be acceptable for the parents to select for sex as well, or should they only select an embryo that does not have HD? How would this be different?

· Is it ethical for this couple to have a baby when the mother could begin showings signs of HD when the baby is just a few years old?

· With this technology possible, would it be ethical for this couple to have a child without genetically ensuring it would not have the disease?

· What if we did not have this technology, would it be ethical for a known carrier to have a child? (If not, how far should this carry?

· A carrier for cystic fibrosis (which is recessive)?

· Weighing everything we have discussed, do you believe the couple acted ethically?

Case 3

Date: June 22, 2005. A 27-year-old man is brought into a New York City emergency room with a 101-degree fever, and what he believes is chickenpox (Varicella). After a brief examination, the 35-year-old physician is puzzled because the pox do not appear to be typical of the varicella-zoster virus. Worried, he calls in another physician for her opinion. She takes one look at the patient, determines he has small pox, and immediately orders him to be quarantined. She notifies the Centers for Disease Control and Prevention (CDC) and asks them what should be done. 
While doing background on the patient, he tells the physicians that he is a flight attendant and that he has flown to Orlando, FL, Los Angeles, CA, Chicago, IL, and Seattle, WA in the past few weeks while working. Though he is given excellent treatment, and had been in perfect health a few days earlier, the patient dies 7 hours after admittance to the hospital.

The CDC decides that mandatory small pox vaccines will be administered to all workers in the NYC hospital, and to all patients who were in the ER. His co-workers are all given mandatory vaccines as well, as are all people living in his apartment complex. They also ship stored quantities of the vaccine to all of the cities where the man had flown to for work. The vaccines are offered to citizens of these cities. Finally, all people, along with their families who had been on the man’s flights in the weeks preceding the appearance of the disease are forced to receive the vaccine. The flight attendant was most likely given small pox by a bio terrorist who flew on his plane sometime during the past week/week and a half. The terrorist would have been contagious but would not have shown symptoms. Virtually every person the man came into contact with would have gotten the virus.

· Is it ethical for the CDC to force people to get the vaccine?

· An LA woman on the flight is religiously opposed to vaccines. Under California law she can normally refuse vaccines on religious or personal grounds. However, the government says she must receive the vaccine or face mandatory quarantine. What do you think of this?

· Do you think that for more common diseases, for example measles, that it is ethical for the state to allow people to refuse vaccines (even for religious grounds)

· What if their refusal can harm others who cannot have the vaccine, such as people who are immunocompromised like AIDS patients?

· Is it ethical for someone to refuse the vaccine?

· You had driven down to Los Angeles 5 days ago to visit a friend for the weekend. While in town, you visited many tourist attractions. You are worried and you try to get the vaccine, but are denied it because of limited resources. What do you think of this?

· Citizens begin calling for the mandatory quarantining of people directly exposed to the victim, i.e those living in his apartment complex, those working in the ER, those who flew on the plane in the prior week. What do you think of this?

· The smallpox vaccine, like many other vaccines (example: oral polio vaccine) can actually transmit the virus to others. In light of this, is it ethical for people to get the vaccine? (Note: they are vaccinating those who may not want to be vaccinated)

· Today, should health care workers be allowed/forced to get the smallpox vaccine? What about non-health care worker citizens?