Ethical Issues in….

• Eugenics
• Human Cloning
• Artificial Fertilization
• Genetic Engineering

Polly T. Chua-Chan, MD
• A couple in their 7th year of marriage,
wanting to have a child….
• Wife, 39 years old, Husband, 42 years old

• Tried fertility work up (hormone studies,

salphingogram, etc)…..

• Finally, she became pregnant, but after

chromosomal studies, the child she is bearing
has this…..
Trisomy 21
• WHAT ARE YOUR THOUGHTS?

• As a doctor, what can you advise the

couple?
 Ethical Issues in….
• Eugenics
• Human Cloning
• Artificial Fertilization
• Genetic Engineering

Polly T. Chua-Chan, MD
 EUGENICS
• Derived from the Greek eugenesia meaning “to
engender well”

• “The improvement of the human race by better

breeding.” (Charles B. Davenport (1866-1944)

• Better breeding involved using the known scientific

principles of heredity (Galton and Davenport)

• Positive Eugenics and Negative Eugenics

 POSITIVE EUGENICS
• refers to the body of knowledge that aims to
bring about the birth of healthy offspring

• Aims to modify an individual’s hereditary

characteristics by reworking the environmental
and social factors that influence one’s
development from the very moment of
conception  primarily hygienic (i.e. improved
living and working conditions; better nutrition;
protection of mother during pregnancy, delivery
and puerperium, a fit lifestyle)
 NEGATIVE EUGENICS
• Aims to check the conception of defective
offspring and the consequent transmission of
infectious diseases or hereditary defects.

• Special focus – disorders that are strictly

hereditary (albinism, alkaptonuria, Duchene’s
Infantile Muscular Dystrophy, Pseudo-
hypertrophic dystrophy, neurosis, manic-
depressive psychosis, schizophrenia, and
epilepsy)
 Ethical Standpoint
• Positive eugenics – licit

• Negative eugenics –
- Prohibition of marriage
- Sterilization
- Abortion
 Genetic Counseling and
Pre-natal Diagnosis
• Amniocentesis
• Fetoscopy
• Ultrasonography
• Funiculocentesis (extracts blood sample from
umbilical cord)
• Chorionic biopsy
 Remember:
• Consent of the parents for the procedure
• Adequately informed that the methods
employed safeguard the life and integrity of
the embryo and the mother
• Without subjecting them to disproportionate
risks
 Prenatal Diagnosis
• If Prenatal Diagnosis is directed towards its
safeguarding or healing as an individual
• Counseling
• Prepare the expectant parents of a special
child
 Prenatal Diagnosis
• If done with the thought of possibly inducing
an abortion
existence of a malformation of a
hereditary illness == death sentence
• Violation of the unborn child’s right-to-life
• An abuse of the prior rights and duties of the
spouses
 Biotechnology
Updates and New Developments
• The use of genetic manipulation in farming
• The use of plants as 'pharma' factories to
manufacture therapeutics

• Discovery of genetics and pharmacogenomics

for drug development
• Also to allow the prediction of the patient' s
response to various drugs as well as the onset
of individualized or 'designer drugs'.
The ability to analyze
real-time, large,
detailed data sets
allows researchers to
discover patterns that
may not be visible in
smaller sample sizes.
[Metamorworks/Gett
y Images]
• Ex Vivo Gene Therapy for Fabry Disease
• In Vivo Gene Therapy for Hemophilia
• In Vivo Gene Therapy for Gaucher’s Disease
At Stanford University, a
microfluidic chip has
been developed that
efficiently extracts sperm
from rape kit samples.
The chip’s channels,
which are coated with
Sialyl-LewisX, a
carbohydrate ligand for
sperm-egg binding, will
capture a perpetrator’s
sperm, but not a victim’s
epithelial cells, which are
easily washed away.After
sperm are captured on
the chip, they are lysed,
and sperm DNA analysis
commences.
 Biotechnology
Updates and New Developments
• Human stem cells could have their cellular
clocks reset by the cloning process, enhancing
opportunities to grow young cells, tissues and
organs for an aging population.

• The cellular clock could also be reset by

therapeutic cloning.
 Genetic Engineering includes:
- Genetic testing - Prenatal diagnosis
- Genetic screening - Genetic control
- In vitro fertilization - Embryo transfer
- Cloning - Sperm and zygote
banking
- Sex selection - Surrogacy
- Organ transplant
 Genetic Engineering
• Close to 2500 illnesses are genetic in nature
• “Genetic manipulation”
• Two Types:
- Therapeutic or corrective
- Constructive or creative
 Genetic Screening
• Geneticists estimate that every individual
carries from 4-8 defective genes of some kind.

• However, since individuals usually have

different kinds of bad genes, the chance of
procreating children with a genetic disorder is
quite small. Nevertheless, it does happen.
 Genetic Screening
• In the medical context, genetic screening can be used
to obtain information for the treatment of genetic
disorders and to help prospective parents make
responsible decisions concerning child-bearing.
 Ethical Standpoint
• Interventions to the human embryo are licit if:
-respect the life and integrity of the human
embryo
-do not expose the embryo to
disproportionate risks
- aims to cure it
- to improve its health and chances for survival
• Parents must give free and informed consent
 Genetic Engineering
• Genetic interventions
- Genetic enhancement (e.g. hair color,
eye color, height, IQ, superhumans)
- Genetic disabling (e.g. slaves)

• Ethics –
- “haves” and “ “have-not”  access, inequity
- autonomy and social justice
 Human Cloning
• “clone” – botanical cutting that produces a
creature identical to the donor being, using
the genetic patrimony of a cell that came from
the donor to be “copied”

• Cloned individual – carbon copy of its donor

or progenitor
 Human Cloning
Procedure:
• A denucleatized ovule is inserted with a
reprogrammed nucleus from a somatic cell
• The end is to produce a cell that is capable of
embryonic development being the bearer of
the same genetic patrimony and traits of the
donor of the nucleus.
 Human Cloning
• A form of artificial reproduction that does
away with the participation of the male and
female gametes
• Fertilization is substituted by “fusing” a
nucleus that is extracted from a somatic cell of
the individual to be cloned, with a
denuclearized ovule (deprived of maternal
genome)
 Ethical Standpoint
• Ethically unacceptable
• The human being must be respected – as a
person – from the very first instant of his
existence”
• “twin fission”, cloning or parthenogenesis are
contrary to the moral law, since they are in
opposition to the dignity both of the human
procreation and of the conjugal union
 Ethical Standpoint
• Violation of human dignity to keep alive human
embryos, as well as embryos fertilized in vitro, as
disposable “biological material”, deliberately
exposing them to grave risk of death.
• Freezing of embryos – seriously exposes the
embryos to death or further manipulation and
deprives them of the possibility of developing
normally within the warmth of the maternal
womb
 Ethical Standpoint
• “Therapeutic” cloning
• 1st child – with defect
• Conception of the second child to save the 1st
child using the 2nd child’s genes

• It is unjust to give life to a human person, only

to kill him later (even if the goal is to restore
the health of others)
 Artificial Fertilization
• Artificial Insemination
-Homologous (spermatocyte comes from
husband)
-Heterologous (spermatocyte comes from a
donor other than the husband)
 Ethical Standpoint
• Its manipulative, artificial action threatens to
convert the human act of procreation into a
mere technique devoid of interpersonal
relations
 Ethical Standpoint
• “Improper” artificial insemination – dilatation
of the uterine cervix and the collection of
semen found in the vaginal recess and its
reintroduction into the uterus so that sexual
union can result in pregnancy.
 Ethical Standpoint
• If the technical means facilitate the conjugal
act or help it to reach its natural objectives,
then it can be morally acceptable.

• If the procedure were to replace the conjugal

act, then it is morally illicit.
 STEM CELL
• A stem cell is a cell whose job in the body is not yet
determined
• Every single cell in the body “stems” from this type of
cell
• Stem cells wait for signals to tell them what to
become
• When stem cells receive signals, it begins to
differentiate or gradually change into its destined
cell type
 STEM CELL
• The signal tells the stem cell to turn on certain genes
and make new proteins.
• These new proteins will make the stem cell to look
and act like the cell type it is supposed to become.
• By the time it finishes differentiating, it will have
stopped dividing too.
• The differentiation process helps cells specialize so
they can do their different jobs.
 TYPES of STEM CELLS
• EARLY EMBRYONIC stem cells –
The first step in human development occurs when
newly fertilized egg or zygote begins to divide,
producing a group of cells called embryo.
TOTIPOTENT – (total potential) stem cell that can
become ANY kind of cell in the body.
TOTI – “whole” or “total”
 TYPES of STEM CELLS
• BLASTOCYST EMBRYONIC stem cells –
Seven days after fertilization, the embryo forms a
hollow ball-like structure called a BLASTOCYST.
Embryos in the blastocyst stage contain 2 types
of cells:
1.Embryonic stem cells form the inner cell mass
fetus
2. Trophoblast cells  placenta
 TYPES of STEM CELLS
• BLASTOCYST EMBRYONIC stem cells –
Embryonic stem cells in the blastocyst are
PLURIPOTENT (more potential), having the
ability to become ALMOST ANY kind of cell in
the body.
Pluri – more or most
 TYPES of STEM CELLS
• FETAL stem cells –
After the eight week of development, the
embryo is referred to as the fetus. By this time,
it has developed into a human-like form.
Stem cells in the fetus are responsible for
the initial development of all tissues before
birth. PLURIPOTENT
 TYPES of STEM CELLS
• UMBILICAL CORD stem cells –
Blood from the umbilical cord contains stem
cells that are genetically identical to the
newborn child.
MULTIPOTENT ( much potential) they can
differentiate into only a limited range of cell
types.
MULTI – many or much
 TYPES of STEM CELLS
• ADULT stem cells –
“Adult” is misleading, because infants and
children also have them.
These stem cells reside in already-developed
tissues, directing their growth and maintenance
throughout life. MULTIPOTENT
Common locations: nerve, blood, muscle skin,
bones
• In vitro Fertilization
• Gamete Intrafallopian Transfer (GIFT)
• Surrogacy
 In Vitro Fertilization (IVF)
• Fertilization in vitro means fertilization “within
a glass”
• “laboratory fertilization”, “test-tube
fertilization”- performed in a petri dish or test
tube
• Conception outside the womb by artificial
means, “procreation without sex” or “baby
making without love making”
 In Vitro Fertilization (IVF)
Process
• Using laparoscopy, maturing ova are extracted from
the female’s ovary
• The ovum is then placed in a petri dish (test tube),
where it is fertilized by the husband’s semen
• After several days of growth in the test tube the
fertilized ovum or embryo is implanted in the wife’s
uterus
• The embryo burrows itself in the endometrium
• A normal pregnancy can be carried to term
 In Vitro Fertilization (IVF)
• No person outside the marriage is involved in
the product of fertilization because the
generative cells come from the husband and
wife themselves.
 Surrogate Motherhood (SM)
• “Surrogate” means substitute, Latin “surrogatus”, ‘in
place of another’
• Surrogacy is a biomedical technique whereby a
fertilized ovum is implanted into the uterus of
another woman who will carry the baby to term
either as a favor or for a fee.
• Financial arrangement – “womb for hire”, “rent a
womb” or “uterus for rent” business
 Surrogate Motherhood (SM)
• After delivery, per agreement, she would give the
baby to the couple who are the genetic parents of
the child.
• For the most part, surrogacy has fulfilled the dreams
of parenthood for infertile persons.
• But in some 5 to 10 % of such cases, the process
ends in legal wranglings and heartbreak for one or
both sides
 Surrogacy
• Contrary to the unity of marriage and to the
dignity of the procreation of the human
person
 References
• Monge, M, Ethics in Medical Practice, 1991
• General Ethical Guidelines for Reproductive Health, Health Professions Council of South
Africa, Guidelines for Good Practice in the Health Care Professions, Booklet 13, Pretoria May
2008
• Ethical Issues in Obstetrics and Gynecology, FIGO Committee for the Study of Ethical Aspects
of Human Reproduction and Women’s Health, Oct 2012
• CQ Researcher, May 15, 2009, Vol 19, No. 19, pp. 449-472
• David Koepsell, J.D., The Ethics of Genetic Engineering, August, 2007 Center for Inquiry
• Julie Aultman, Eugenomics: Eugenics and Ethics in the 21st Century, Genomics, Society and
Policy, 2006, Vol 2, No. 2, pp. 28-49
• John Woodward, 2005, Thomson Gale, The Ethics of Human Cloning
• Aurelia, Mitrut, P, Iovanescu, L, Ethical Considerations on Human Cloning, Current Health
Sciences Journal, Vol 37, No. 3, 2011
• Dickens, B, Ethical Issues arising from the useof assisted reproductive technologies, pp. 333-
348
• Human Genetic Engineeilng Current Science and Ethical Implications, Council for Responsible
Genetics