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Sunday, April 27, 2014

Uterus Transplants for Transgender Women?


Clinical researchers in Sweden have been busy with a project to transplant uteruses into women who cannot gestate children of their own.  They carried out 9 such transplants in early 2014.
 
 http://www.theguardian.com/society/2014/jan/13/womb-transplants-success-swedish-project

Apparently, some of these transplants have failed, but researchers have carried out embryo transfers with some of the women, in order to secure a pregnancy for them.

If uterus transplants are successful in women, would this kind of assisted gestation work for others, for men or transgender women? I am working on an analysis of this question, which is not ready for public presentation yet, but if anyone wants to contact me about it, feel free.

In the main, some of the key questions are these:  If uterus transplant proves safe and effective for women, would there be any morally significant reason why men or transgender women should not be eligible for the same opportunity for gestation?

Getting to that point of safe and effective uterus transplants for those parties would require a focused line of research, over and above the study of uterus transplantation for non-transgendered women.

Now, some commentators object to the idea that the state has any duty to sponsor research of this kind. They would limit all publicly-funded fertility research to sex-typical ways of having children, which they construe as the basis of reproductive rights.

This objection has no force at all against privately-funded research. If private researchers want to pay for this research, they get to decide how to spend their money.

In any case not all social expenditures are responses to ‘rights’ properly speaking. The state spends lots of your money doing things that you don't have a 'right' to, such as beautification projects. Do you really have a right to a beautiful park system?  The state must spend its money wisely, of course, but if someone makes the case that it would raise the overall welfare of transgender women as a class to enable them to gestate, well, it would hard to say that the state should never spend its money that way.

Monday, February 3, 2014

The $$$ You Owe Others if You Have an Abortion



Suppose you’re looking forward to your first grandchild. 

Suppose your daughter or daughter-in-law chooses to terminate the pregnancy.  All your hopes sand expectations are dashed! 

Suppose you’re the father, and the woman pregnant by you also chooses an abortion. 

Have you been wronged?  Does a woman having an abortion owe her boyfriend or husband or parents or anyone else with an interest in your pregnancy anything? 

One legislator in Wisconsin thinks so.  He’s introduced a bill that would compensate would-be grandparents if an abortion gets in the way of their having grandchildren.

Craig Klugman gives all the details about this overreach of the law here:  http://www.bioethics.net/blog/page/2/

Synthetic Gametes: Sperm from Women, Ova from Men.



Researchers have successfully created ova from male laboratory animals and sperm from female laboratory animals.  These synthetic gametes have been used to create live offspring, making male mice the mothers of the pups and female mice their fathers. 

From the first signs of success in this venture, researchers and commentators have speculated that what’s possible for laboratory mammals could be possible for human mammals as well. Some research has gone forward on this front, namely deriving male gametes from cells derived from females and deriving female gametes from males. It does appear that this prospect may be more difficult for humans than it was for mice. 

Some commentators have nevertheless speculated that this technology could be used by same-sex couples who wish to have children genetically related to them both, without relying on a third party for ova or sperm.  

Almost predictably  – given the history of medicine’s treatment of homosexuality  – some commentators rushed to proclaim the need for careful study of this use of synthetic gametes and possibly regulate it as well, in the name of protecting children.

In a recent analysis, I document the challenges in bioethics to the idea that two men or two women are fit to be parents, first of all, and that synthetic gametes raise a level of concern for same-sex couples that they do not raise for others. Opposite-sex couples turning to synthetic gametes to overcome their infertility? Well, that idea is embraced with open arms. Same-sex couples? Well, some commentators think this raises red flags all over the place.


(If you don’t have access to the site, email me, and I’ll get a copy of it to you.)

Saturday, March 9, 2013

Can Nature be a Conscientious Objector?



It is a standing Catholic doctrine that the conception of human beings should take place only in the context of acts of intercourse between married, opposite-sex partners.  Maybe some Catholic practitioners can find some wiggle room in the Church’s declarations, but that usually requires some creative interpretation of texts such as Donum Vitae (1987) which declares the “right of every person to be conceived and to be born within marriage and from marriage.” (The emphasis here is in the original.)  If we go with the spirit of these texts, the Church declares that the front line of fertility treatments offered today are sinful. Inasmuch as the Church makes a case that there is a separate, philosophical basis for these declarations, these fertility treatments are also supposed to be immoral as well.

What’s a conscientious physician to do, if he or she finds that they want to observe this interpretation? Some commentators and physicians now declare that the pathway to fertility lies through Natural Procreative Technology (NPT). These commentators and physicians advise that clinicians be look-out for underlying causes of fertility and treat those rather than deploy donor gametes, IVF, embryo transfer, and other treatments in order to give people the child they want. NPT is, therefore, a call to treat underlying disorders insofar as they stand in the way of conception through acts of intercourse between married, opposite-sex partners. 
Advocates of NPT don’t simply offer this approach to infertility as one option among others. They assert the desirability of identifying and reversing the causes of infertility as the only approach that is consistent with the rights of children to be conceived in marriage as well as the rights of men and women to become fathers and mothers only through one another and only through acts that are unitive of body and soul.  

There are no guarantees, of course, that these approaches must succeed. Not all treatment will lead to success in having a child. For those people who pursue this approach, they can either accept their fertility as a kind of spiritual opportunity for religious growth or they will face anew the question of whether to seek out donated gametes, IVF, embryo transfer, or whatever other techniques will help them have a child.

Advocates of NPT invokes ‘personalism’ as one basis for their objection to most assisted reproductive treatments, but there is no reason to accept their interpretation as the one and only interpretation of what it means to be married or to have a child. Advocates of NPT fall back on one interpretation of human relationships and treat that interpretation as somehow an expression of human nature as such. 

Most people who are looking for help in having children do not seek out clinicians for lessons in the metaphysics of human nature. They hope to enrich their lives by having a child, upon whom they can confer benefits. For most people these ethical reasons outweigh the metaphysical interpretations of others. People are free, of course, to interpret their infertility – even if it continues after treatment to restore fertility – as religiously and morally valuable. Physicians are also generally free to decline to offer certain treatments altogether. Treating these freedoms as concordant with nature itself, however, goes too far since we cannot know nature except as an interpretation.  And when it comes to having children and entering into relationships, one interpretation does not fit all.

See:  B.E. Jemlka, D.W. Parker, R. Mirkes, “NaProTECHNOLOGY and Conscientous OB/GYN Medicine,” Virtual Mentor – American Medical Association of Ethics,  2013 (15): 213-219.

Friday, December 14, 2012

Rolling back promises of anonymous donation




Over the years, a lot of donors have offered their sperm for fertility purposes on the condition that their identities remain anonymous.

This practice, for oocytes as well, has not proved popular in all quarters, since information about the genetics of the donors can be useful in the medical care of children born with those gametes. Not only that, but information about the identity of the donors can be useful in the psychological development of the same children.

Some jurisdictions have moved to make certain information about donors available to children born with their gametes.  That changes the terms of donation in the future, but it does little to resolve matters for those conceived with anonymous gametes.

Some advocates want to roll back confidentiality agreements entirely.  For example, Damian Adams and Caroline Lorbach have said this: “Donor conception practices in Australia have left thousands of donor-conceived people, their families and gamete donors bereft of information. The lack of a nationally timeline-consistent approach to information access has driven these people to seek support and information from self-help groups, online communities and even their own DNA.” They argue that “current practices continue to fail donor-conceived people, their families and gamete donors.” They want “all donor offspring” to have “the right to know their genetic family history,” otherwise “they will continue to suffer discrimination, and potentially risk psychological and physical trauma. “ (See ‘Accessing donor conception information in Australia,”  At:  http://sites.thomsonreuters.com.au/
journals/2012/06/15/journal-of-law-and-medicine-update-june-2012/

By contrast to a Law Reform Committee recommendation to roll back the rule of confidentiality that governed gamete donation for many men in Victoria, Guido Pennings argues that undoing the terms of donation – namely, overriding the promise of anonymity – will undermine trust, do damage to donors and their current families, and drive gamete donors away in the future.

He also describes this ‘right to know’ movement as part of a larger ideology, namely a certain normative understanding of what families are and how they should be constituted. Throwing up obstacles to gamete donation, he thinks, serves to discredit gamete donation and opens the door to not only disclosure of donor identity but to donor responsibility for the children as well.  It’s an interesting interpretation of the right-to-know movement that leaves very little room for anonymity.   (See Guido Pennings. How to kill gamete donation: retrospective legislation and donor anonymity. Human Reproduction 2012 (10): 2882-2885.)