Description
In the plethora of ethical dilemmas in assisted reproduction, there is no doubt that the status of the embryo is at the core of most concerns, because of what it represents symbolically: life itself from syngamy for some, or the potential to become an individual1. In either case it is an entity worthy of respect,2 even though terminology appeared to have been used in order to defuse the strong emotions raised by related issues to assisted reproductive techniques, in particular research and the fate of spare embryos, when the term “pre-embryo” was coined.
Nevertheless, as practitioners, the duty of care both towards the patients and the future child (with the responsibility involved and possible conflicts) is often our first consideration, and we have a duty to respect the infertile patients, and to uphold their autonomy, which may (rarely) conflict with our duty to their potential offspring. This is particularly the case when complications follow treatment, as in the case of multiple pregnancy of a high order, and embryo reduction is contemplated, which indeed takes us back to the initial question of its status.
As it is impossible to cover all ethical dilemmas in the field even in books dedicated to the subject3,
selected topics are discussed in some depth: Intra Cytoplasmic Sperm Injection (ICSI) has already replaced several indications for sperm donation, and raises new issues, which differ from the problems encountered in sperm (and oocyte) donation. Both surrogacy and the question of consent for posthumous insemination are currently the subject of consultation documents from the DOH. Mention must be made of pre-implantation diagnosis as it represents both a new technique and a challenge in ethical terms. Finally, mention will be made of cloning with the Dolly experiment which has led to so much debate worldwide in relation to the field of reproduction.
