Bioethics in India: Proceedings of the International Bioethics Workshop in Madras: Biomanagement of Biogeoresources, 16-19 Jan. 1997, University of Madras; Editors: Jayapaul Azariah, Hilda Azariah, & Darryl R.J. Macer, Copyright Eubios Ethics Institute 1997.
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27. Embryo Research - Its Relevance in the Changing Context of Social Medicine

DS. Sheriff, T. Manopriya & K. Asokan
VMKV Medical College, Salem - 636 308


Conducting research on embryos and finding a moral justification for continuing to do research on them needs a careful scrutiny. Such a scrutiny necessitates that one recapitulates the definitions of conception, person, probable person, potential person and neomorts. For ethics, laws and scientific pursuits must not become convenient ways to justify tampering reproduction, a natural process, which cannot without violation be disassembled and put together again. This will help minimize the moral fear that technology must not threaten family values by mechanizing reproduction and undermine its connection with sexual intimacy. Embryo research therefore must not become a tool for scientific manipulation of life and its genetic blue print.

Birth of over 2000 thousand babies by extracorporeal fertilization methods have made many to indulge in searching for a universal moral blue print for the approval of such artificial methods of reproduction. The definition of embryos does not entitle them to protection from laws as normal fully developed persons have. Human embryos being the probable persons need definite protection and ethical guidelines to safeguard their manipulation.

Procreation is said to be a fundamental right of a person. extracorporeal fertilization and uterine transfer of cleaving embryos are the most prevalent alternate methods of reproduction that help infertile couples to beget children. In vitro fertilization (IVF) is advocated as a method of treatment of infertility (Steptoe, 1986). Thus, legalizing such methods to bring them under legal surveillance requires proper focusing of such `needs'. In other words, it is stated that as long as these procedures prove beneficial to the recipients without affecting the moral fabric of society they live in such procedures may be allowed to be practiced (Andrews, 1986). Now it is quite evident that these methods of artificial reproduction form a quite a sensitive area in which ethical principles and legal considerations play a vital role. Approval of the practice of IVF and other technology-based methods of reproduction has resulted already in the creation of 2000 or more babies all around the world. In favouring these methods full considerations have been given to the right of barren couples to beget children. Such rights are not accorded to `embryos' as they are not yet fully developed 'persons'. Instead certain guidelines for a moral assessment of these reproductive technologies are formulated in countries where these procedures have become a routine medical practice. These guidelines recommend that embryos should be treated with respect, they must not be treated as inanimate objects, the embryos must not be subjected to manipulation in such a way to bring harm to the child to be ultimately created and they may be stored in proper milieu for a fixed period of time. More than these is not though to be required to protect embryos. The moral fear of eugenic manipulation or interspecies fertilization do not seem to have gained scientific claims to frame definite laws to protect there embryos.

The limitations to demonstrate life comprehensible to human other than electrical activity of brain has led to the definition of terms like person, fetus and embryos to suit the needs that arise time and again to frame such laws. One such vivid example as the deletion of the words fetal indications has led to the idea that embryo is not a full human person to allow legalizing abortion (Hill, 1986). This legalization of abortion was though to provide the freedom for both the woman and physician to carry out abortion on medical as well as on compassionate grounds with legal protection. Yet it is vital to understand giving definitions to tissues like embryos need to be given greater care and thought as they will remain as long as human race exists. As long as human race exists the will to better life, to provide better medical skills and procedures will remain. In such pursuits of practice of medicine, today's relaxation in limiting or defining the boundaries of manipulation will become the grounds for furthering more manipulation.

Once the technical know-how and the loopholes of legal protection are available the future uses or abuses may not be caused by the present day advocates of such technology. It may be true such moral distaste or fear do not sound scientific to warrant framing of definite laws or to define what is the jurisdiction of law in such matters like human embryos.

A close scrutiny at the outcome of these procedures will reveal that the success rate of these procedures are quite low when compared to the protocol the participants undergo. Though the result in such procedures are rewarding in the form of having babies they have certain limitations which many do not give more thought. In such areas one cannot wait for statistically significant disadvantages to be elucidated to take concrete steps to reorganize the whole thinking on these procedures. These processes are reported to have risks of multiple pregnancy, with major and minor anomalous birth defects and invariably the adoption of Cesarean section to deliver such babies. Apart from that to make these methods more successful it was though necessary to understand biochemical mechanisms that underlie the development of embryos and the receptivity of uterus. That means subjecting human embryos to further research (Steptoe, 1986). The advocates of use of freeze-thawing as method of storage of embryos report that such a procedure helps to overcome certain risks of preterm labour followed by a three fold increase in prenatal mortality. Multiple pregnancies, presence of pelvic inflammatory disease or sometimes the IVF procedure carried out itself act as other risk factors implicated in such perinatal mortality (Wood et al., 1985). Freeze-thaw technique is reported to be more beneficial to provide IVF more efficiently. At the same time out of three embryos preserved in such a way only two survive. In the surviving embryos half of the cells are damage. Such a damage is not reported to be a risk or to interfere with its fertilizability. The chemical preservative dimethyl sulphoxide used is proved to be harmless. But it has been reported to cause haematuria as a result of nephrotoxicity in experimental animals when used as an analgesic (Haigler and Spring, 1981). It is also reported that most cells in early embryos are ionically coupled before they are connected by circulatory system. This type of ionic and metabolic coupling is reported to be essential for distributing nutrients as well as for cell positioning (Warner, 1981). There are no sensitive methods to monitor this metabolic coupling activity of cells in the embryo or methods to show that subjecting embryos to extreme temperature fluctuations or preserving in chemical preservatives do not disturb these cell organization in the embryos. Thus it is too early to suggest that these methods are metabolically safe or the birth of babies too small in number to suggest that these methods do no harm embryos. Abortion is a natural means to get rid of abnormal fetuses in a woman. These methods do not have such means to short abnormal fetuses, or it is ethical to subject the developing embryos to continuous monitoring of its well-being. It is thus, not justified to state that mere moral distaste alone will not be sufficient to warrant framing laws to protect embryos. Embryos are microscopic lives. They need legal protection like any other fully developed persons. Such claims seem reasonable (Sultan Sheriff a & b, 1986). It becomes a major issue for fresh discussion by the people involved in medicine, health and law. The ethical issues that follow what will happen to the embryos after the expiry of storage period (disposal or for further research), how qualified the medical personnel to involve themselves in procedures related to human life with respect to their moral outlook and vision of events to come out of such artificial endeavours and how are we justified to create babies with pre-selected artificial parents, remain the bone of contention between pro-lifer advocates and pro-choice advocates.

References
1. Andrews, L.B. (1986): Legal and ethical aspects of new reproductive technologies. Clin. Obs. Gynec., 29:190-204.
2. Haigler, H.J. and Spring, D.D. (1981): EMSO (dimethyl sulfoxide), morphine and analgesis. Life Sci., 29:1545-1553.
3. Hill, E.C. (1986): Your morality or mine? An enquiry into the ethics of human reproduction. Amer. J. Obs. Gynec., 154:1173-1180.
4. Steptoe, P. (1986): The role of in vitro fertilization in the treatment of infertility: Ethical and legal problems. Med. Sci. Law, 26:82-84.
5. Sultan Sheriff, D. (1986a): Human embryo research-is it ethical? Postgrad. Med. 80:204-209.
6. Sultan Sheriff, D. (1986): Embryo research. Brit. J. Hosp. Med., 32(June):381.
7. Warner, A.E. (1981): The early development of the nervous system. In British Society of Developmental Biology Symposium 5 (Garrod, D.K., Feldman, J, eds.) Cambridge University Press, pp. 109-127.
8. Wood, C., Downing, B.G., Leeton, J., Talbot, J.M. and Trounson, A. (1985): Clinical implications of the use of freeze-thaw and donor oocyte embryo transfer. Med. J. Aust., 143:338-341.


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