Beginning of Life: Ethical
Perspectives
SPECIFIC RECOMMENDATIONS ON
REPRODUCTIVE ISSUES
BY THE CANADIAN MEDICAL ASSOCIATION
SOCIAL CONSIDERATIONS
- That society recognizes that the right to
have children is a socially guaranteed right and not a duty; that this right
finds its basis in the fact of social membership itself and, therefore, is
not absolute; and that it is subject to the limiting conditions that affect
all other socially grounded rights.
- That the right to have children should be
seen as the right to take advantage of the opportunity to function in
parental capacity, where it is an underlying assumption of this notion that,
in the normal course of events, this opportunity will arise because of the
exercise of normal biological functions.
- That the possibility of taking advantage of
this opportunity may shift as the resources and abilities of society change.
- That the right to have children (in the
sense indicated) be seen as subject to certain preconditions.
- That these preconditions center in the
capability of individuals to make reasoned choices and to function in a
parental role.
- That society should assist handicapped
persons, who have the capacity to parent, but who can exercise that capacity
only with societal assistance.
- That the concept of a family be defined
functionally as a basic social unit that may include children.
- That the child is entitled to the same
respect and to the same treatment as all other persons.
- That if developments in the domain of
reproductive technology cannot sustain such a perspective, and if these
developments reduce the child to the status of an object, or they require
that those who are involved adopt an instrumentalistic outlook toward
children, such developments should not occur.
- That prospective parents should be counseled
to exercise responsibility in having children.
PROFESSIONAL CONSIDERATIONS
- That the profession of medicine should not
necessarily be considered the only body involved in the development or
delivery of techniques of assisted reproduction.
- That medical exclusivity should extend only
as far as it relates to matters that fall within the domain of medical
practice as defined in terms of the physician-patient relationship.
- That qualified physicians engaged in
providing assistance in the realm of new reproductive technologies should
not refuse to provide these services on the basis of criteria that involve
discrimination.
- That the techniques of assisted reproduction
should be developed with due regard to the rights and the welfare of all
members of society.
- That these should only be employed with full
awareness of the fact that the long-term consequences of such technology
cannot as yet be foreseen.
- That there should be a balanced societal and
professional approach that would include an examination of the social forces
that in some cases underlie the desire to have biologically related
children.
HEALTH AND INFERTILITY
- That infertility be defined functionally as
the inability of someone to engender children during a stage of their life
when biologically this should be impossible.
- That in keeping with this definition,
infertility be seen as a condition of ill health.
- That it be accepted that the significance of
infertility as a condition of ill health is shaped by societal and cultural
interpretations.
- That in keeping with the association’s
understanding of the nature of health, the treatment of infertility should
be considered a health service.
- That there should be coordinated and
ethically, as well as scientifically, valid research on a national scale
into the nature, causes, and means of prevention of human infertility.
- That as a matter of fundamental principle,
the development and availability of techniques of assisted reproduction
should come as close as possible to allowing individuals who happen to be
infertile to achieve biological parenthood the way in which it occurs in the
normal course of events.
- That the use of techniques of assisted
reproduction should remain voluntary.
- That access to socially funded programs of
assisted reproduction should be determined solely by equitable criteria that
find their basis in health reasons rooted in the health status of the
individual; and that socially funded access should not become an instrument
of furthering economic plans or privately held values, but should be in
keeping with the rationale underlying access to existing health care
services.
- That the new reproductive technologies
should never be seen as an avenue of first choice when it comes to having
children, but should be evaluated in the light of alternatives open in the
normal course of events.
- That the development and use of these
technologies should always preserve the dignity of the human person.
EVALUATION
- That the various methodologies currently
being used in assisting reproduction be evaluated as to scientific validity
and effectiveness.
- That any new methodology or regimen of
assisted reproduction be evaluated for scientific validity and ethical
acceptability in the same way in which pharmaceuticals are currently
evaluated before being recognized as acceptable in the health care setting.
ACCESS
- That assisted reproductive services should
be available to all members of society on an equitable basis.
- That access to publicly funded assisted
reproduction services be only on the condition that it is a health
service and not a matter of private choice.
- That if the need for access to these
technologies is the result of a voluntary decision that reflects a matter of
private choice and not the result of an attempt to correct an inequitable
situation, the service should be privately funded.
- That the criteria of access to assisted
reproduction services should include the criteria that are considered
socially appropriate for deciding whether applicants for adoptions will be
deemed suitable parents in a given case.
- That if the reason why certain people cannot
have biological offspring is by its nature irremediable regardless of
technology, then society cannot be expected to attempt to provide a remedy.
GAMETE DONORSHIP
- That gamete donation should be a privilege
that is open to every adult and competent member of society, subject only to
those medical criteria that are appropriate for determining the health
status potential of the donated gametes.
Reprinted from:
Monagle, John F., Thomasma, David C., (1995).
Genetics and Reproduction. Medical Ethics. Policies, Protocols, Guidelines
& Programs (1:3)