write persuasive essay

0103 Final Exam Readings 1

Final Examination Readings

WRC 0103

Fall 2013

 Please write your name on the packet of readings you have downloaded from The Writing Program website.

o Bring this packet to the final exam. o You may underline, highlight, and annotate the readings. o You may not bring thesis statements, outlines, prewriting, or drafts in any form to

the exam.

 As you read, be aware that you will be writing a persuasive essay for your final.

 You may bring a Standard English dictionary, in print form, not electronic form, to the final. No translation dictionaries or translators will be allowed.

 Be sure to bring this Works Cited page to the final.

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 If you haven’t done so already, turn in 2 blank blue books to your instructor. o You will write your final essay in these blue books. o Your instructor will return them to you on the day of the final.

 Remember to write on only one side of each page.

 Write “Final Draft” on the cover of the blue book(s) you want your instructor to read and evaluate.

 After completing the final essay, turn in to your instructor o the reading packet o used blue books o the prompt

 Your final exam will be in the same room as your semester class has been held.

 Be sure to confirm the day and time of your final. You can o Check your syllabus o Check postings around campus o Check ASAP o Ask your instructor o Check outside The Writing Program office, NPB o Check on The Writing Program website: http://www.utsa.edu/twp/FinalExam.htm

0103 Final Exam Readings 2

Reproductive Technology

Encyclopedia of Contemporary American Social Issues

Ed. Michael Shally-Jensen. Vol. 4: Environment, Science, and Technology. Santa Barbara, CA:

ABC-CLIO, 2011. p1602-1607. COPYRIGHT 2011 ABC-CLIO, LLC Anne Kingsley

In 1978 Louise Brown became the first “test tube” baby to be born using in vitro fertilization

(IVF). Her birth marked the advent of a rapidly advancing reproductive science, and it also

became a testament to a changing concept of creation. Her birth was not only a moment of

celebration but also one of controversy. For some, IVF opposed traditional or religious beliefs

about family and reproduction. Conception took place outside the body and outside the family

and was altered through medical intervention. Many of the practices used in IVF and other

assisted reproduction technologies (ART) challenged what was commonly thought of as the

standard or normal family: one mother, one father, and children. A process such as egg or sperm

donation, both of which take a third-party donor to create a fertilized embryo that will then be

introduced into the female body using IVF, was therefore seen as counter to traditional family

ideology and practice.

The success of IVF, however, opened new possibilities in the treatment of infertility. Proponents

continued to see the practice as a means of conceiving a child where it otherwise may not have

been possible. Many women who sought the treatment also supported this notion, considering

the ability to conceive a child as their right. Today, the predominant public attitude toward

assisted reproduction has shifted from wavering opposition to general acceptance. It is widely

recognized and practiced as a standard treatment for infertility.

Choices and Controversies

The phenomenal increase in the number of babies born using alternative methods of fertilization

over the past 20 years testifies to the changing outlook on once controversial medical procedures.

Furthermore, the demand for reproductive options opens the door to more avenues of scientific

exploration to both refine existing reproductive technologies and search for new methods.

Accompanying the unprecedented rate of scientific growth, however, is a growing concern over

the extent of new plateaus in reproductive technology and their costs. As a result, a new set of

controversies and a new set of medical, ethical, and social questions have emerged to shape

debate over assisted reproduction.

The new story of reproduction is located at the intersection of shifting social values and a rapidly

advancing scientific understanding. New technologies afford women the decision to postpone

reproduction. Hypothetically, a woman in her thirties, working toward a successful career or

further education, is well aware that with each year the possibility of having a healthy child and

an uncomplicated pregnancy diminishes. She is also aware that alternative procedures such as

freezing one's eggs give her the tentative option of conceiving at a chosen future date. The

0103 Final Exam Readings 3

process does not guarantee reproduction, but it does open new considerations in terms of family

planning. In a society where fertility and pregnancy are at odds with “career ladders” for women,

proponents of new advancements in reproductive technology see it as affording more lifestyle

and body choices without sacrificing the desire to also have a family.

Yet skeptics argue that the original design of the fertility treatment was meant to offer infertility

options, not lifestyle choices. A controversy over age limits emerges in this conversation because

some critics worry how far medical practice will go to allow older women to conceive, even after

menopause. Since ART is a relatively unregulated field of practice, no restrictions in age exist

thus far. Many of these questions carry both scientific and social implications. On the one hand,

reproductive technology has allowed women at many age levels to conceive and start a family.

On the other hand, the increasing tendency to treat reproduction and conception as a medical

issue has changed the traditional social narrative of the family. As prevalent as many of these

controversies may be, their lack of resolution has not slowed the accelerating pace of further

research and development.

New advancements and research in assisted reproductive technologies seek to make existing

procedures more successful and more available to larger numbers of women. Newer processes

mark not only how far we have come but also how far we may yet go. Advancements in

reproductive technology create new controversies, many of which remain unaddressed.

Risks and Benefits

One of the predominant issues with infertility treatments is the long-term effect on both the

woman and the child. As standard as many of the procedures in ART are, long-term results are

relatively unstudied. After all, Louise Brown, who turned 30 in 2008, is still relatively young.

New measures are being taken to set up systems of surveillance that track and record the

progress, the effects, and the health of the constituents involved. Some critics question how far

we should advance medicine without knowing the full set of risks to mother and child.

Proponents of the advancement in reproductive technologies see such suspicion of potential risks

as a means of limiting female choice, undercutting the availability of IVF.

One of the known complications of ART is the predominance of multiple births. To ensure that

pregnancy takes place, multiple embryos can be placed within the woman's uterus, potentially

resulting in multiple births. Newer technologies can help predetermine healthy embryos, thus

reducing the possibility of multiple births before implantation takes place. Yet the same

technology used to prescreen the embryos can also be applied to screening for a predisposition to

genetic diseases and for sex. The prescreening allows the parents to make decisions before fetal

pregnancy occurs. The process of prescreening and selection of healthy embryos raises questions

about the role of medical selection and the alteration of life outside the body. Some critics fear

that the list of prescreening traits may grow longer, resulting in the institution of Brave New

0103 Final Exam Readings 4

World tactics, where “designer babies” and “designer families” are the results of “quality

control.”

Interestingly, one of the more pressing quandaries generated by ART is its proximity to cloning.

The laboratory techniques generated by ART are the same as those used in cloning. However, in

a process such as IVF, the fertilized egg is the result of two biological parents, whereas with

cloning, the cloned cell is the exact copy of one parent. Regulations controlling both cloning and

stem cell research may also pose restrictions to ART, given that all are seen as working within

the embryonic stages of life.

New advancements in reproductive technology carry risks along with the benefits. Although the

technology is often heralded as necessary progress, critics point out that progress must be

accompanied by bioethical responsibility. In other words, scientific research and its applications

must be carefully understood and monitored for its ethical and moral implications.

Bioethical Considerations

Much of the current controversy in ART involves larger institutional practices rather than simply

the medical procedures themselves. One such concern is the disposal of unused embryos. Here,

the controversy intersects with the dialogue concerning post-coital contraceptive practices (such

as the morning-after pill) and research practices in stem cell research—where does life begin?

Proponents see the unused embryos, especially in stem cell research, as an opportunity for

developing new treatments against disease. Opponents of using or destroying embryos, however,

express concern over the increased power for science to manipulate fundamental definitions of

life. Some critics even fear that the line between ethical and unethical practice gets ever more

slippery as the limitations of embryonic research are further extended. Thus, ART again comes

under scrutiny, requiring that more attention be given to regulations and limitations.

In order to address bioethical responsibility in assisted reproductive technology, some critics call

for new measures in regulation. Those who call for regulation wish to monitor research practices

more closely, including experimenting with new forms and methods of ART and medical

practices actively applying existing methods of ART. Some women fear that “regulation” will

equate to “restriction” of bodily rights, however, and certainly, determining bodily rights versus

moral concerns is a difficult process.

An issue that may be overlooked is the potential of politicizing infertility as discussions of

reproduction take place within scientific and political discourse. Reproductive technology, at one

point, opened up a new agenda for women wanting both family and career. It was seen as a

progressive move in the women's rights struggle. And yet, the politicization of the practice and

the resultant discourse on “property rights” in terms of the female body, and the objectifying of

women's bodies as a scientific or political event, may also be seen as regressive. It may be seen

as counterproductive, as a woman's body becomes a space of experimentation—a scientific

workplace.

0103 Final Exam Readings 5

Another pressing issue as ART moves into the arena of private industry is the blurring of the

distinction between consumer and patient. Certainly, the capitalization of the reproductive

technology market raises some concerns. ART is a $3-billion-a-year industry at the intersection

of medical practice and private business.

Profit incentives facilitate the process of freezing, storing, and thawing eggs. That eggs have

become a commodity is evidenced by the advertisements that blanket college newspapers

offering to pay women for egg donations. For consumers, the concern or emphasis of the practice

is on product. For patients, there is not only the health and practice concern but also an emotional

concern. Skeptics say that a business is not equipped to handle a woman who, despite ART,

cannot conceive a child. They question whether a business attitude toward reproduction can

answer and identify her needs. Supporters of ART maintain that the right technology, even if

driven by economics, offers the best possible means of addressing infertility. On either side of

the issue, the word embryo, not just as a scientific term but as a business one as well, takes on

new connotations.

Many social implications result from considering fertility as a commercial business; one of these

is that fertility becomes a question of affordability. Access to treatment becomes a question of

who can pay and who cannot. ART procedures are extremely costly. The fee for freezing eggs

can be almost $10,000. The cost of hormone treatments to stimulate egg production can be

another $4,000. The future in vitro fertilization of the eggs will cost around $15,000 to $20,000.

Critics of the view that technology brings choice point out that financial cost can actually

eliminate choice.

For example, infertility rates are much greater outside the United States; yet, because of the high

cost, fewer people have access to the technology or treatment. In many countries, infertility

comes at the cost of social exclusion, raising questions, again, about the intention of ART to

provide an answer to a social need. Even inside the United States, many insurance policies do not

provide for ART, excluding families who cannot afford the thousands of dollars the treatments

often incur.

In addition, high costs do not necessarily equate to success. The process of assisted reproduction

can offer only a possibility of a healthy pregnancy, not a guaranteed assurance of conceiving a

child and bringing it to term. Less than half of the procedures performed result in infants carried

to term. Critics point out that there is no reimbursement financially or emotionally for

undergoing a process that fails in the end. At the same time, proponents maintain that ART

practices offer the best possible solution to infertility.

Conclusion

Public dialogue on reproductive technologies is both steeped in controversy and pressingly

necessary as our understanding and advancement of the science continues to move forward,

creating many medical, ethical, and social questions along the way. Do these technologies

0103 Final Exam Readings 6

oppose traditional family structures? Do lifestyle choices come at the cost of natural, biological

practice? What should be the limits of ART as the biological and ethical implications become

better understood? Whether for skeptics or for proponents, the advancement of reproductive

technology will certainly challenge the intersection of science and society as social and ethical

institutions come face to face with medical and scientific exploration.

The Ethics Of Reproductive Technology Debated

Tuesday 6 May 2008 - 4am PST

New advances in reproductive technology have pushed medical diagnostics to both theoretical

and practical limits, according to Mark Hughes, MD, PhD, director of Genesis Genetics Institute

in Detroit and director of the Applied Genomics Technology Center of Michigan, who spoke at

the opening session of The American College of Obstetricians and Gynecologists' (ACOG) 56th

Annual Clinical Meeting.

"The rapid growth and clinical adaptation of genetically based information and technology are

fundamentally changing the practice of medicine, especially for ob-gyns," said Dr. Hughes.

Because of these advances, there are technologies now available to couples wanting to avoid

inherited disease in their offspring even before a pregnancy begins.

"Knowing the roadmap of the human genome gives us powerful tools to help our patients in

ways we might barely have imagined just a few years ago," added Dr. Hughes. "In ob-gyn this

information presents especially complex practice dilemmas."

The field of reproductive medicine, perhaps more than any other field, is continually confronted

with ethical considerations. "Just because we technically can do something doesn't mean we

should," noted Dr. Hughes. "Through the ages, technology has been the fuel that drives the

engine of science, and science is the vehicle that propels the progress of medicine, and medicine

routinely drives us into bioethical corners.

"Preimplantation genetic diagnosis was invented 18 years ago, and it's come a mighty long way,"

said Dr. Hughes. "It is now possible to detect quite complex problems in the smallest unit of life

(one cell), in the smallest unit of inheritance (one gene), for the smallest part of a gene (one DNA

nucleotide), out of 3.3 billion letters that comprise the human genome. "Even in 100 years of

medical advances, diagnostics will not be smaller than examining-overnight-one molecule. The

technology itself will surely evolve with time, but we are now at the limits of the biology that

can produce severe pathology in our patients," added Dr. Hughes.

Preimplantation genetic diagnosis (PGD) is a reproductive technology used with an in vitro

fertilization cycle. It involves testing the genetic material of embryos to look for specific genetic

mutations or chromosomal rearrangements. It is generally used by patients who know they are at

risk of transmitting a genetic disease or chromosomal abnormality to their offspring.

0103 Final Exam Readings 7

For example, a couple could face a 25% or 50% risk of a producing a child with a particular

disease. This risk is not trivial, Dr. Hughes said, and many couples choose not to have children.

Other couples may accept this high risk and wait anxiously during the first months of pregnancy,

wondering if their fetus has cystic fibrosis, muscular dystrophy, hemophilia, or any one of

hundreds of genetic disorders.

"Their anxiety is significant. Do they want diagnostic testing such as chorionic villus sampling

(CVS) or amniocentesis, and what will they do with the information after they have it?"

commented Dr. Hughes. "By testing a fertilized egg prior to implantation, modern science can

now eliminate this risk and this stressful time for couples."

PGD has largely been used to help couples who suffer with infertility and for couples at risk of

having children with a heritable genetic disease. The concern now, however, is that the technique

might be used to select characteristics that range from less serious disease to purely matters of

preference, such as gender.

"Who decides what's ethical and what isn't?" asked Dr. Hughes. "It varies from one country to

the other." Dr. Hughes points out that while most people approve of a couple finding out before

implantation whether an embryo has a lethal disease, the discussion becomes murkier when it

concerns a non-fatal disease or condition or even gender.

The American College of Obstetricians and Gynecologists is the national medical

organization representing over 52,000 members who provide health care for women.

Taboo or Not? Reproductive Technology and the Changing Family

Stanford panel discusses the benefits and qualms with reproductive technologies, like in vitro

fertilization, and what the next generation can expect for its children.

Posted by Maggie Beidelman , a freelance journalist in the Bay Area. February 14, 2011

What does it mean for members of our society to practice technology-assisted reproduction, like

in vitro fertilization, asked a Stanford panel Saturday afternoon in Cubberley Auditorium.

For example, “It is now technologically possible, in principal, for a brother and sister to be born

80 years apart,” said panel moderator Bruce Goldman, a science writer at Stanford. What with

the increasing use of egg donors, gestation carriers and sperm donors, the concept of “normal” in

reproduction and sexuality has been altered.

The panel, which discussed the ramifications and benefits of such technology, followed a

performance of, “Taboos: When Harriet Met Sally,” a progressive play written by Carl Djerassi,

Ph.D., the inventor of the birth control pill and a professor emeritus of chemistry at Stanford.

0103 Final Exam Readings 8

When Harriet and Sally, a lesbian couple living in San Francisco, use the sperm of their

respective brother-in-laws to become pregnant, things go haywire. The meaning of “family”

changes. Gender roles and religious beliefs are questioned.

But the audience at Stanford was generally approving of the play—and, as one panelist noted, it's

probably because of where we live.

The panel discussion that followed, however, turned into a heated debate about the societal

implications and risks of reproductive technologies and the right to use them.

Since 1978, with the birth of the first baby who was created using in vitro fertilization (IVF)—

once called a “test tube baby”—the IVF method has been largely commended and largely

condemned.

“This new and mysterious form of laboratory reproduction, the mark of ethics is that it is

coherent,” said panelist Dr. William Hurlbut, MD, a physician and consulting professor of

neurology and neurological sciences at Stanford.

“We need to ask ourselves, is what we're doing medically sound, is it sound for our species ... or

society ... individual relations ... for the offspring?” asked Hurlbut.

But for some, the question isn't about changing nature—it's about assisting nature. “If you get a

cut on your arm, and you have a doctor sew it up, your arm still has to heal itself. The doctor's

stitches don't heal it. That's what we do—we're a helping hand,” said panelist Dr. Valerie Baker,

MD, a specialist in IVF technology.

“More what we try to do is help where nature had a problem, rather than try to make something,”

said Baker, medical director of the Stanford Fertility and Reproductive Medicine Center.

But even Baker warns to be weary with the technology. “Just because we can do it doesn't mean

we should do it,” she said.

“I don't think anyone chooses to have children through reproductive technology if they don't

have to,” said Melanie Thernstrom, who underwent several unsuccessful rounds of IVF and then

decided to use an egg donor and two gestational carriers to create her “twiblings,” which she

wrote about in a recent New York Times Magazine article.

After all, the costs of IVF are rather steep— including medications, embryologists,

ultrasounds—adding up to around $12,000 for one round.

But some families are willing go that far, and spend that much, for a child to call their own.

“I've never seen someone suffer as much, including cancer, as in infertility,” said Hurlbut.

"When you watch a couple going through the pain of infertility, it just wrenches your heart. You

realize how fundamental to our nature—physical, psychological—having children is.”

0103 Final Exam Readings 9

And as far as societal implications, panelist Hank Greely, JD, said it doesn't matter. “There is no

assured path of a happy family. I don't think there is a natural, single, one-size-fits-all family

structure out there,” said Greely, director of the Stanford Center for Law and the Biosciences.

In fact, 1.5 percent of babies in the United States were created by IVF, and that number is

growing, said Greely.

As the discussion rounded to a close, a man in a suit with a white beard hobbled up to the

microphone set in the audience for questions and caught everyone off-guard.

“I was disappointed in the direction this conversation went, because this is not at all what the

play intended,” Djerassi himself spoke into the microphone. “Your focus is on old hat—IVF—

there's nothing new about this.”

The real problem is, said Djerassi, “within the next 30 to 50 years, increasingly fertile people

will use IVF. The issue is why would fertile people use methods of assisted reproduction?”

Shouldn't we be worried about the potential for future IVF procedures to allow us to select

specific genes that we want in our children? Though it has not yet been discovered how to do so,

what if we could choose our child's intelligence, or gender identity, Goldman had asked earlier in

the discussion. The question hung on the audience like thick fog—no one had answered.

Djerassi continued. “If you can increase the biological clock of the well-educated, ambitious

woman by five years, that will have an enormous impact on a certain group of women. If you can

tell a woman, 'Store your eggs at age 20, for insurance'—the same for a man and his sperm—you

could get sterilized at age 20 and then birth control [Djerassi's very invention, which set the stage

for IVF] would really not become the future.”

The Ethical, Legal, and Social Issues Impacted by Modern Assisted Reproductive

Technologies

Paul R. Brezina * and Yulian Zhao Obstet Gynecol Int. 2012; 2012: 686253.

Published online 2012 January 4. doi: 10.1155/2012/686253

1. Introduction

ART is currently a commonplace technology that has successfully treated millions of infertile

couples the world over. However, the explosion of this technology has introduced a myriad of

new social, ethical, and legal challenges. This paper evaluates some of the most visible and

challenging topics in the field of ART and outlines the ethical, legal and social challenges they

introduce…

0103 Final Exam Readings 10

5. Financial Aspect for IVF Treatment

Perhaps one of the most obvious ethical challenges surrounding ART is the inequitable

distribution of access to care. The fact that significant economic barriers to IVF exist in many

countries results in the preferential availability of these technologies to couples in a position of

financial strength [19]. The cost of performing ART per live birth varies among countries [4].

The average cost per IVF cycle in the United States is USD 9,266 [20]. However, the cost per

live birth for autologous ART treatment cycles in the United States, Canada, and the United

Kingdom ranged from approximately USD 33,000 to 41,000 compared to USD 24,000 to 25,000

in Scandinavia, Japan, and Australia [14]. The total ART treatment costs as a percentage of total

healthcare expenditures in 2003 were 0.06% in the United States, 0.09% in Japan, and 0.25% in

Australia [4]. Some have maintained that the cost for these cycles pales in comparison to the

social advantages yielded by the addition of productive members of society [21]. This is

especially true in societies that have a negative or flat population growth rate coupled with an

aging population [21]…

8. Gamete Donation

The use of donor gametes, either in the form of donor sperm or donor oocytes, is commonplace

in ART. The use of donor sperm can be traced to the 1800's [36]. In the mid 1980s, oocyte

donation was introduced [36]. In recent years, issues surrounding the use of donor gametes have

become increasingly visible [37]. Women donating oocytes must undergo IVF. Due to the

inherent medical risks associated with IVF, including ovarian hyperstimulation syndrome and

surgical risks, a central concern of allowing women to be oocyte donors includes adequate

informed consent [37]. Consent, in addition to outlining these medical risks, should include

counseling regarding the emotional benefits and risks of donation with an emphasis that long-

term data regarding these risks are lacking [37]. Additionally, it is considered an ethical

prerequisite that oocyte donors participate voluntarily and without coercion or undue influence

[38]. Some have expressed concern that financial compensation of oocyte donors may lead to

exploitation as women may proceed with oocyte donation against their own best interests, given

the inherent medical risks involved [39]. The concept of commodification, that any “buying or

selling” of human gametes is inherently immoral, is an additional argument used against

remunerating women serving as oocyte donors [39]. Due to the substantial controversy

surrounding oocyte donation, especially the amount of financial compensation may be given to

an oocyte donor, federal regulations governing this practice are constantly evolving and differ

substantially from country to country [39].

Another ethical and legal issue surrounding the use of donated gametes is to what extent the

anonymity of the donor should be preserved. The issue of anonymity as it relates to gamete and

embryo donation is emotionally charged. Indeed, the ability of human beings to know their

genetic roots is universally important, at the core of self identity. Either egg and sperm donors

may choose to or not to be anonymous, though the vast majority in both groups generally

0103 Final Exam Readings 11

chooses anonymity [40]. The American Society for Reproductive Medicine has identified four

levels of gamete donor information sharing depending on the wishes of the donor and recipient

parties [37]. Recently, however, there is, increasing consideration of the rights of offspring as it

relates to donor gametes and anonymity [40]. Advocates for allowing either gamete donors or

their offspring to break anonymity cite the medical advantages of sharing medical information

with their genetic offspring, in the case of the donor, or learning about their genetic history

directly, in the case of offspring [41, 42]. Others simply argue that both donors and offspring

have an inherent right to meet and develop a relationship [43]. Recent court rulings suggest that

these rights will become more visible in the future. For example, in the British case Rose v

Secretary of State for Health [2002] EWHC 1593, the court ruled that based on the Human

Rights Act, donor offspring could obtain information about their genetic parents despite

previously established anonymity [43]. The ethical and legal issues surrounding anonymity and

gamete donation are sure to be a centrally debated issues within the field of ART for the

foreseeable future.

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9. Embryo Donation

IVF cycles often result in couples transferring several embryos and cryopreserving other

embryos produced by the cycle, presumptively for the purpose future pregnancy. However, in

many instances, these surplus embryos are never used by the genetic parents and therefore are

stored indefinitely [44]. The number of such embryos stored internationally is surprisingly high.

In the United States alone, it is estimated that over 400,000 embryos are currently cryopreserved,

many of which will not be used by their genetic parents [44]. The ethical and moral issues

surrounding how to deal with these surplus embryos have been the source of much debate. In

general, four possible fates for these embryos exist [44]:

1. thawing and discarding,

2. donating to research,

3. indefinite storage,

4. donating the embryos to another couple for the purposes of uterine transfer.

All of these strategies have staunch supporters and detractors. Not surprisingly, there are a

myriad of laws in different countries governing many aspects of how a human embryo that has

been cryopreserved may be handled [44, 45]. The use of embryos for the purpose of research,

specifically as it relates to human stem cells, has also been a source of fierce debate

internationally and has resulted in substantial regulation that varies substantially from nation to

nation [46–49].

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0103 Final Exam Readings 12

10. Surrogacy and Gestational Carriers

Another topic of ethical, social, and legal debate surrounds the use of surrogacy and gestational

carriers. Surrogacy is defined as a woman who agrees to carry a pregnancy using her own

oocytes but the sperm of another couple and relinquish the child to this couple upon delivery

[50]. A gestational carrier, by contrast, involves a couple who undergoes IVF with their genetic

gametes and then places the resultant embryo in another woman's uterus, the gestational carrier,

who will carry the pregnancy and relinquish the child to this couple upon delivery [50].

Currently, the use of gestational carriers is far more common than that of surrogates [50].

As with donor gametes, surrogates and gestational carriers are subject to significant medical and

emotional risks from carrying a pregnancy and undergoing a delivery [50]. As such, extensive

counseling and meticulous informed consent are required [50]. Some also are concerned that the

use of surrogates and gestational carriers is a form of “child selling” or the “sale of parental

rights” [51]. Additionally, the rights of the surrogate or gestational carrier to not relinquish the

infant following deliver are not well described [50]. In fact, legal precedent in some states within

the United States has actually upheld the right of a birth mother, regardless of genetic relation to

the child, to retain parental rights despite the existence of a preexisting gestational carrier

contract [50].

Another central concern surrounding the use of surrogates and gestational carriers is the

possibility that financial pressures could lead to exploitation and commoidification of the service

[50–53]. The mean compensation for a gestational carrier in the United State in 2008 was

estimated at approximately $20,000 [50]. In contrast, a gestational carrier in India receives an

average of $4,000 for the same service [52]. Regulation of surrogates and gestational carriers

varies widely from nation to nation and even within regions of individual countries [50, 52–56].

Due to these financial and legal considerations, international surrogacy has emerged as an

emerging industry, especially in developing nations [52]. This practice has exacerbated the

already difficult ethical and legal issues surrounding gestational carriers [52]. At the present

time, issues surrounding issues of individual rights, commoidification, exploitation, citizenship

of the offspring of international gestational carriers, and even fair trade are largely unresolved

internationally [52, 55].

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11. Possible Deleterious Effects of ART

There are questions that remain outstanding regarding the use of IVF. Conflicting data exists

about the risks of IVF on the developing embryo. Multiple studies have failed to find a clinically

relevant association between IVF or embryo cryopreservation and adverse maternal or fetal

effects [57–59]. Other studies have suggested that infants of IVF pregnancies may be at a small

but statistically significant increased risk for rare epigenetic and other abnormalities [60–62].

0103 Final Exam Readings 13

Despite this controversy, there is a general consensus that IVF confers a small but measurable

increased risk for a variety of congenital abnormalities including anatomic abnormalities and

imprinting errors as compared to the general population [63]. Some maintain, however, that this

is secondary to an increased baseline risk for these problems in the population of infertile

patients [63]. Regardless of the cause, this small increased risk, while statistically significant

with extremely large sample sizes, will likely not be a powerful enough factor to dissuade

infertile couples from pursuing parenthood through IVF.

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12. Conclusion

ART has emerged as one of the most widely adopted and successful medical technologies in the

last century. While giving hope to millions of couples suffering from infertility, ART also has

presented new ethical, legal, and social questions that society must address. Many countries have

taken steps to regulate certain aspects of ART. Specifically, what regulations and laws should be

in place for ART reporting, social inequities that may arise from financial barriers to ART,

genetic testing, emerging laboratory techniques that have improved embryo and gamete survival

when cryopreserved, and an individual's right to their genetic offspring in the setting of gamete

or embryo donation are aspects of ART which will become increasingly controversial and

debated into the future.

However, the lion's share of ethical and legal questions that exist surrounding ART have yet to

be resolved. Society must reconcile how to fund ART in a responsible and equitable manner to

increase access to care. Additionally, the myriad of unresolved issues surrounding gamete and

embryo donation must be addressed in greater detail in future social and legal dialogues.

ART is a field that is dynamic and ever changing. In areas of ART such as preimplantation

genetics, new technologies continually change the capabilities of ART. Due to the rapidly

evolving nature of the ART, legislation is often unable to keep pace and address all of the ethical

and legal issues that are constantly emerging in the field. It is therefore incumbent upon

physicians to continually monitor these issues and ensure that ART technologies are offered and

delivered in a manner that balances patient care with social and moral responsibility.

0103 Final Exam Readings 14

Works Cited

American College of Obstetricians and Gynecologist. "The Ethics Of Reproductive Technology

Debated." Medical News Today. MediLexicon, Intl., 6 May. 2008. Web.

2 Dec. 2013.

Beidelman, Maggie. “Taboo or Not? Reproductive Technology and the Changing Family.” Palo

Alto Patch. Patch Media, 14 Feb. 2011. Web. 22 Nov. 2013.

Brezina, Paul R., and Yulian Zhao. "The Ethical, Legal, and Social Issues Impacted by Modern

Assisted Reproductive Technologies." Obstetrics and Gynecology International 2012

(2012) Web. 2 Dec. 2013.

Kingsley, Anne. "Reproductive Technology." Encyclopedia of Contemporary American Social

Issues. Ed. Michael Shally-Jensen. Vol. 4: Environment, Science, and Technology. Santa

Barbara, CA: ABC-CLIO, 2011. 1602-1607. Gale Virtual Reference Library. Web. 27

Nov. 2013.