Ethical Conflicts in Regulating the Start of Life

ETHICAL CONFLICTS IN REGULATING THE START OF LIFE ELINA HEMMINKI, PAlVI SANTALAHTI, * and PEKKA LOUHIALA t Introduction New technology has expanded the possibilities for regulating life and death, and difficult ethical and social problems have been created. In the case of very ill elderly people, questions of heroic treatment, lengthening of life, and euthanasia are formulated relatively uniformly, even though they are largely unresolved. However, in the creation of life, a common scene for ethical questions has not even been defined. Various technological interventions in the reproductive process have become very common, starting from pre-pregnancy treatments and in vitro fertilization to intensive care of newborns. In most Western countries the times of natural creation of new human life are past, having been replaced by technological regulation, and more interventions are to be expected. The ethical problems of this new technology have been discussed, but usually separately for each intervention. The purpose of this article is to propose combined discussion of ethical standpoints in judging different interventions in the beginning of life. As examples, we examine abortion, prenatal screening of the fetus (called fetal screening in the following) , in vitro fertilization (LVF), and intensive care of preterm infants. Ethical Issues ofIntervention ABORTIONS In discussions of termination of pregnancy when a child merely is unwanted , the main ethical question has been the start of life: when do cells and tissues become a human being or a person? If fertilized egg cells or National Research and Development Centre for Welfare and Health, Health Services Research Unit, P.O. Box 220, 00531 Helsinki, Finland. *Department of Public Health, University of Turku tDept. of Public Health, University of Helsinki© by The University of Chicago. AU rights reserved. 0031-5982/97/4002-0992$01.00 586 Elina Hemminki, Päivi Santalahti, and Pekka Louhiala young fetuses are defined as human beings, many contraceptive methods (e.g., intrauterine devices and morning-after pills) and all abortions are morally wrong. Only the threat to the mother's life is an argument strong enough to overcome the ethical problems of destroying an (unborn) human being. However, because an embryo or a very young fetus is not capable of living outside the mother, it has been argued that it is not a human being in a morally relevant sense, but part ofits mother's body. This reasoning does not, however, answer the question of when a fetus becomes a human being. The problem is intensified by new technology which allows very young fetuses to survive. SCREENINGS AND SELECTIVE ABORTIONS By a selective abortion, we mean that in general a child is wanted, but not the kind of child which is going to be born. This selection may be by gender, which is a common practice, for instance in India [1] . In developed countries the reason for selective abortion is usually related to the health of the future child, with many countries instituting programs to screen for malformed fetuses or fetuses with genetic defects [2] . More of this can be expected with the expansion of gene technology. The discussion of the ethics of screening and selective abortion has focused on the rights of parents to have healthy children, on the rights of disabled persons (are they less valuable and more expensive than other persons?), on unintended effects of screening procedures, and on the general threat of eugenics as an ideology [3-5] . NEONATAL INTENSIVE CARE With the newest intensive care technology, younger and younger infants spontaneously born too early can be kept alive. Although most infants of less than 22 gestation weeks or with a birthweight of less than 50Og still die, some do live. And the proportion of infants 22 to 28 weeks (or 500 to 999g) surviving has been increasing [6-8]. Concern has been raised over the fact that many of the infants kept alive exhibit disabilities, some of which are serious [9] . Additional concern has focused on the cost of treatment, both of intensive care itself and of treatment of the long-term consequences [10]. Although the balance between additional surviving healthy infants and additional disabled infants saved is highly positive, with far more healthy survivors [11], the absolute numbers of disabled children may have increased...