Cultural, economic, social, and political changes during the late 1800s through the early 1900’s

• • Justice: Issues of justice arise when sterilization is pressured or coerced, especially among vulnerable populations (e.g., individuals with disabilities, minorities, or those in poverty). Historically, forced sterilization has been a grave ethical violation. Ensuring genuinely informed consent, free from coercion, is paramount.
  • Integrity of the Body: Some ethical frameworks raise concerns about altering the body’s natural procreative capacity when there is no direct medical pathology. However, modern ethical thought generally prioritizes individual autonomy over this concern in voluntary non-therapeutic sterilization.
  • Principle of Totality/Integrity (Catholic Perspective): From a Catholic bioethical perspective, non-therapeutic sterilization is generally considered morally illicit as it intentionally renders a healthy organ infertile, thereby violating the principle of totality which states that all parts of the body exist for the good of the whole and should not be mutilated unless necessary for the health of the whole.

Principle of Double Effect; Explain:

The Principle of Double Effect is a moral reasoning framework used to evaluate actions that have two effects: one good/intended effect and one bad/unintended (but foreseen) effect. For an action to be morally permissible under this principle, four conditions must typically be met:

1. The act itself must be good or at least morally neutral. The action taken cannot be inherently evil.
2. The agent must intend only the good effect, not the bad effect. The bad effect can be foreseen, but it must not be the goal or purpose of the action. It is tolerated as an unavoidable consequence.
3. The good effect must not be achieved by means of the bad effect. The bad effect cannot be the cause of the good effect.
4. There must be a proportionate reason for allowing the bad effect. The good effect must be significant enough to justify permitting the bad effect; the benefits must outweigh the harms.

Example: Administering high doses of pain medication to a terminally ill patient (good effect: pain relief) where a foreseen but unintended side effect is hastening death (bad effect). If the intent is solely pain relief, the act itself is good, the good is not caused by the bad, and the pain relief is a proportionate reason, then the action may be considered morally permissible under this principle.

Bioethical Analysis of:

• Ectopic Pregnancy:

  • Situation: An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube. This is a non-viable pregnancy that poses a severe, life-threatening risk to the mother due to rupture and hemorrhage.
  • Bioethical Analysis:
    • Principle of Double Effect: This principle is often applied here. The direct intent of treatment (e.g., surgical removal of the fallopian tube or administration of methotrexate) is to save the mother’s life by removing the life-threatening pathology (the ectopic pregnancy). The foreseen but unintended consequence is the death of the embryo.
    • Direct vs. Indirect Abortion: From a perspective that opposes direct abortion, the treatment of an ectopic pregnancy is generally considered ethically permissible because it is not a direct attack on the life of the embryo for its own sake. Instead, it is a necessary medical intervention to save the mother’s life from a condition that is inherently fatal to both mother and fetus if left untreated. The embryo cannot survive in an ectopic location anyway.
    • Maternal Autonomy and Beneficence: The mother’s life is in imminent danger, and respecting her right to life and applying the principle of beneficence (doing good for the patient) necessitates intervention.
    • Non-maleficence: The treatment prevents severe harm or death to the mother.

• Cancerous Reproductive System with Pregnancy:

  • Situation: A pregnant woman is diagnosed with cancer in her reproductive system (e.g., cervical, ovarian, uterine cancer) that requires immediate, aggressive treatment (e.g., chemotherapy, radiation, surgery) that would likely harm or terminate the pregnancy.
  • Bioethical Analysis: This is an extremely complex and tragic situation, often requiring difficult choices:
    • Maternal vs. Fetal Life: The primary conflict is often between saving the mother’s life (by treating the aggressive cancer) and preserving the life of the fetus.
    • Principle of Double Effect: If the primary intent of the cancer treatment is to cure or manage the mother’s cancer, and the loss of the pregnancy is a foreseen but unintended consequence, then the principle of double effect might apply, making the treatment ethically permissible, even if it leads to fetal loss.
    • Maternal Autonomy: The pregnant woman’s autonomy is paramount. She has the right to make informed decisions about her own body and life-saving treatment, even if those decisions impact the pregnancy. Respect for her choice is crucial.
    • Beneficence and Non-maleficence: The physician’s duty is to act in the best interest of the patient (the mother) and to prevent harm. Delaying cancer treatment could be fatal to the mother.
    • Fetal Viability and Best Interest: The stage of pregnancy (fetal viability) significantly impacts the ethical considerations. In later stages, efforts might be made to delay treatment until the fetus can be delivered via C-section, or to administer treatments that are less harmful to the fetus, if possible. If the fetus is viable, the ethical dilemma deepens, but the mother’s life usually takes precedence in life-threatening situations.
    • Informed Consent: Providing comprehensive and compassionate counseling to the pregnant woman and her family is essential, explaining all options, risks, and potential outcomes, and supporting her decision.

In Vitro Fertilization (IVF):

• Process: IVF is an assisted reproductive technology (ART) used to help people with fertility problems conceive. The general steps include:

  1. Ovarian Stimulation: The woman is given fertility drugs to stimulate her ovaries to produce multiple eggs.
  2. Egg Retrieval: Once the eggs are mature, they are retrieved from the ovaries using a needle guided by ultrasound. 3. Sperm Collection: A sperm sample is collected from the male partner or a donor.
  3. Fertilization (In Vitro): The eggs and sperm are combined in a laboratory dish (in vitro, meaning “in glass”) to allow fertilization to occur. Sometimes, a single sperm is injected directly into an egg (Intracytoplasmic Sperm Injection – ICSI) to aid fertilization.
  4. Embryo Culture: The fertilized eggs (now embryos) are cultured in the lab for a few days to allow them to develop.
  5. Embryo Transfer: One or more viable embryos are transferred into the woman’s uterus using a thin catheter.
  6. Pregnancy Test: After about two weeks, a pregnancy test is performed.
  • Additional Steps:
    • Embryo Freezing: Excess viable embryos can be frozen for future use.
    • Preimplantation Genetic Testing (PGT): Embryos can be tested for genetic abnormalities before transfer.

• Bioethical Analysis of IVF: IVF raises several significant bioethical considerations:

  • Status of the Embryo: A central debate revolves around the moral status of the embryo created outside the body.
    • Pro-life/Conservative View: Views the embryo as a human life from conception, possessing full moral status. Therefore, the creation of supernumerary embryos (more than needed for transfer), their potential destruction, freezing, or selection (e.g., PGT leading to discarding affected embryos) is seen as morally problematic.
    • Liberal/Gradualist View: Views the embryo’s moral status as developing gradually. Concerns may still exist, but there’s more acceptance of practices like embryo freezing or PGT if the intent is to achieve a healthy pregnancy.
  • Creation of Supernumerary Embryos and Their Fate: IVF often results in more embryos than are transferred. The fate of these “excess” embryos (freezing, donation for research, thawing and discarding) is a major ethical dilemma.
  • Selective Reduction: If multiple embryos implant, couples may face the decision of selective reduction to reduce the number of fetuses to improve the chances of survival and health for the remaining ones. This is ethically fraught, as it involves the termination of a developing life.
  • Genetic Selection/PGT: While PGT can prevent the transfer of embryos with severe genetic diseases, it raises concerns about “designer babies,” discrimination against those with disabilities, and the potential for selecting for non-disease traits.
  • Third-Party Reproduction (Donor Gametes/Surrogacy): When donor sperm, eggs, or embryos are used, or when a surrogate carries the pregnancy, questions arise about parentage, the rights of all parties involved, and the potential psychological impact on the child and all individuals.
  • Access and Justice: IVF is expensive and often not covered by insurance, leading to disparities in access based on socioeconomic status. This raises questions of justice and who has the right to access such technologies.
  • Commodification of Life: Some argue that the commercial aspects of IVF, especially with egg/sperm donation and surrogacy, can lead to the commodification of human life and reproductive capacities.