Reproductive Medicine and Ethics

2021/02/18

The field of reproductive medicine has developed rapidly in the less than half a century since the birth of the world's first IVF baby in the UK in 1978. This development was supported by the development and introduction of Assisted Reproductive Technology (ART). The fact that humans can now intervene in the birth of life, which used to be a natural process, has raised the question of how far intervention in life should be permitted. The rules that determine what is "permissible" among what is "possible" are the ethics of reproductive medicine.

The first basic principle of ethics in reproductive medicine in Japan today is to "respect individual freedom in decision-making regarding reproduction." The basis for this principle lies in the guarantee of reproductive health/rights for women and couples and respect for "patient rights," but if we go back further, it lies in the liberalism that has been inherited in Western society since the 19th century. According to liberalism, individuals have the right to self-determination regarding their own minds and bodies. It should be noted that such individual freedom is not unlimited, and society can restrict it if it causes "harm to others."

The second basic principle is to "prioritize the welfare of the child to be born." In Japan, medical care using ART is provided under the self-regulation of physicians in accordance with the announcements of the Japan Society of Obstetrics and Gynecology. For example, it is technically possible to have a child using embryos created through in vitro fertilization with both sperm and eggs provided by third parties. However, the announcements prohibit reproductive medicine through embryo donation and surrogate motherhood (surrogate pregnancy). The reason for this is that reproduction through embryo donation not only makes legal parent-child relationships unclear, but also poses a risk of adversely affecting the welfare of the child, such as making it difficult for the child to establish an identity during the developmental process and depriving the child of a stable upbringing environment if born with a disability.

The third basic principle is the "protection of human dignity." While it is technically possible to have a third party act as a surrogate for pregnancy and childbirth, surrogacy imposes physical and mental burdens associated with pregnancy and childbirth on women, and there is a risk that women will be treated only as a means to have a child. Treating people as objects is an affront to humanity and is not socially acceptable even if the individual consents. In this way, some ARTs create major problems not only for the patient but also for the child to be born, the family, and society as a whole, and such ARTs are considered to exceed the scope of infertility treatment.

In relation to reproductive medicine (infertility treatment), genetic testing performed before birth raises major issues from ethical and social perspectives. Specifically, these include maternal serum marker testing, amniocentesis, and so-called Non-Invasive Prenatal Testing (NIPT), which is currently in the research stage. These tests, which use fetal-derived cells contained in maternal blood or amniotic fluid, can diagnose genetic mutations and chromosomal abnormalities.

The ethical problem with these tests is how to respond when an abnormality is discovered. A very large number of couples choose abortion if the test results are poor. Behind this is the idea that the child to be born will be unhappy, or that raising a child with a disability or genetic disease will be a burden on the family. However, preventing the birth of a fetus on the grounds of a disability risks denying the right to life of persons with disabilities and promoting discrimination. In prenatal genetic testing, not only the pregnant woman, the child to be born, and the family, but also patients with genetic diseases, persons with disabilities, and the society that accepts disabilities are involved as "stakeholders."

Reproductive medicine has not only medical aspects but also ethical, legal, and social aspects. Should a child born through the donation of sperm or eggs be granted the "right to know their origins," or should the privacy of the donor be protected? Should women who cannot become pregnant or give birth by other methods due to congenital or acquired diseases, or sexual minorities such as LGBT individuals, be permitted to have children by receiving egg or embryo donations or by requesting surrogacy? Furthermore, if in the not-too-distant future it becomes possible for parents to design children with the characteristics they desire using various ARTs, as in the movie "Gattaca" (1997), would that be permissible?

The ethics of reproductive medicine may change depending on changes in society, progress in diagnostic and therapeutic methods, and the situation overseas. However, what is important is for everyone in society to think again about the basic human activity of reproduction. There are two important points to consider. First, think from the perspectives of the various people involved in reproductive medicine. Second, think about fundamental questions such as what human happiness is, how being a parent contributes to happiness, what a family is, and when human life begins. There is no "correct answer" like mathematics for ethical issues. We have no choice but to find our own answers through "a wide range of opinions and debates."