Observations on new reproductive technologies.

PIP: The abortion issue is polarized between 2 strong constituencies, one seeking maximum choice for the mother and the other for the protection of life of the unborn child. The issue here is the "conceptus", that is, the period of human development from conception to birth, usually occurring in the mother's body. One can be both prolife and prochoice, since neither life or choice is absolute in respect to the other. During pregnancy there is a interim functional connection between persons of 2 successive generations, therefore neither life nor choice can completely dominate without denigrating the other. In this situation they can be valued individually, but judgement as to their relative priority must be combined, especially if there is conflict. The status and nature of each must be defined to reach a balance. The conflicting issues must be dealt with in areas of contraception, in vitro fertilization, embryo transfer, cryopreservation, fetal therapy, transplantation of embryonic or fetal tissue, and experiments on fetuses and embryos. The current range of reproductive options is a result of years of research and medical change. A review should be made of everything scientifically known of the developing unborn before policy decisions are made. The differences between a pre-embryo, an embryo and fetus must be carefully weighed before setting standards on ethical treatment of the unborn in relation to abortion, or other reproductive interventions. A national commission could be set up to analyze current and new knowledge and make recommendations for public debate and formation of policy.^ieng

Current ethical issues in IVF.

This article has briefly reviewed the range of public policy issues and ethical questions raised with respect to IVF. It then discussed selected issues that are now under policy debate and decision. Given the wide acceptance of IVF as a medical procedure for married couples, what variants might also be ethically defensible? IVF for unmarried couples appears defensible under specific conditions that are equally applicable to married couples. Involvement of third parties (gamete donation and gestational surrogacy) is more complex and needs case by case examination. Sperm donation appears to generate little that is ethically new when coupled with IVF but requires the same care and concern as AID. Egg or embryo donation, however, does raise new ethical questions that need close attention and continuing analysis. Freezing of human embryos also breaks new ethical ground, particularly in the options it generates beyond a narrowly defined medical domain. Certain of these options are better not undertaken without further public policy decision. Improvement of current procedures and techniques through effective clinical trials can be ethically carried out in terms of scientific and medical perspectives. However, efforts in this direction will be more effective if undertaken within a public policy framework that clearly defines acceptability during a transitional period of confidence-building.

The early development of human embryos.

The development of the human embryo from the time of fertilization through the eighth post-fertilization week is described for medical policy purposes. During pre-implantation stages, differentiation occurs between precursors of embryonic and extra-embryonic structures. During implantation formation of a fore-hind axis begins within the inner cell mass. By the end of the eighth week, head, face, hands, and feet are suggestive as to species-recognition but not yet definitive. Data from laboratory studies of non-human mammalian embryos elucidate important aspects of human embryonic development.

KIE: A clinical description is provided of the development of the human embryo from the time of fertilization through the eighth post-fertilization week. Related data from studies of the development of nonhuman mammalian embryos are offered for comparative purposes. One conclusion drawn is that conception is the beginning of a new generation in the genetic sense and not the beginning of human life in any other yet demonstrated scientific sense. Other conclusions summarize what can be said on scientific grounds concerning the nature of the human embryo at particular stages between conception and the ninth week.

Gene therapy: proceed with caution.

KIE: On 6 February 1984 the Recombinant DNA Advisory Committee of the National Institutes of Health approved a recommendation that the committee provide prior review of research protocols involving human gene therapy. Grobstein and Flower trace the development of public policy in response to concerns about the dangers of gene therapy, especially as it applies to germ line alteration. They offer guidelines and propose principles for an oversight body to confront the immediate and long term technical, social, and ethical implications of human genetic modification. An accompanying article presents a plea for the development of gene therapy by the mother of three children who have sickle cell anemia.^ieng

External human fertilization: an evaluation of policy.

In vitro fertilization, in its first 5 years of use, has met minimum standards for efficacy and safety, as judged by published clinical reports. It is becoming more widely available as an approach for overcoming sterility in married couples and appears also to be gaining social acceptance in that context. Several technical options presented by the procedure, particularly storage of frozen embryos and embryo transfers involving third-party contributions, are less fully evaluated clinically and raise social, ethical, and legal questions that go beyond the original medical model for therapeutic intervention. The clinical success of in vitro fertilization and the options it affords call for careful policy consideration. Estimates of costs and of potential demand for and supply of services are provided and the current status of relevant policy in the United States and abroad is discussed.

KIE: A review is provided of developments in human in vitro fertilization (IVF) during its first five years. Efficacy, safety, costs, demand and supply, and feasible extensions of the basic procedure are discussed. The authors contend that, while Australia and Great Britain have made progress toward formulating public policy on IVF, efforts in the United States have not gone beyond a 1979 report and recommendations issued by the Department of Health, Education, and Welfare's Ethics Advisory Board. Given the ready clinical and public acceptance of IVF, there is need for an oversight mechanism at the federal level, perhaps via a forum concerned also with the overlapping area of human genetic intervention.

The moral uses of 'spare' embryos.

KIE: Questions are being raised about the morality of freezing spare human embryos and eggs, obtained by in vitro fertilization, for future use or experimentation. The author contends that it is difficult to maintain scientifically that a "multicellular individual," or person, exists prior to the eight-cell stage of division. Therefore, provided that the safety of the procedure can be established or if the risks are acceptable under a suitable protocol for informed consent, the use of previously frozen embryos does not raise issues different from those surrounding in vitro fertilization as such.^ieng