The main ethical problems of IVF! What is IVF? Ethical problems in artificial insemination.

In vitro fertilization (IVF) in vitro fertilization) first used in 1978 in Cambridge; The first test tube baby was a girl, Louise Brown. In 1986, IVF was used for the first time in our country. The method turned out to be quite effective for both female and male infertility. Indications for IVF are not amenable therapeutic treatment infertility or diseases in which pregnancy is impossible without IVF.

Some facts about IVF and the use of ART in general. One in six sexual couples worldwide experience some form of infertility at least once during their reproductive life.

Physiological problems explain 20–30% of infertility in men, physiological problems in women – 20–35%, in 25–40% of cases both partners have problems, in 10–20% of cases the cause is not identified.

The need for assisted reproductive technologies (diagnostics and procedures) in the world is growing by about 10% annually.

Since 1978, more than 5 million children in the world have been born through IVF.

Every year, about 1.5 million IVF cycles are performed worldwide, which leads to the birth of approximately 350 thousand children.

Most ART use occurs in women aged 30–39 years.

Europe leads in ART procedures (55% of all cycles performed in the world).

In 2011, the most active European countries in performing ART were: France (85,433 cycles), Germany (67,596), Spain (66,120), Italy (63,777), UK (59,807), Russia (56,253).

To understand the ethical issues associated with IVF, it is necessary to know the technical features of this method. First, so-called ovarian hyperstimulation occurs, as a result of which several eggs mature in a woman at once (which does not happen in normal conditions). This is done in order to guarantee successful result. The eggs are then removed from female body, are fertilized, and the resulting embryos are grown outside the body for some time (in the so-called CO2 incubator). Afterwards, the embryo (usually several embryos) is transplanted (implanted) into the uterus.

If a multiple pregnancy occurs, then later a so-called reduction is carried out, i.e. destruction of excess embryos. It involves the destruction of the embryo in the uterine cavity under ultrasound guidance using a needle.

There is another option for IVF, when (if it is impossible to obtain an egg from a woman) a donor egg is used. Donation can be free of charge (as a rule, the donor is a relative or friend of the patient) or paid. This option is actually surrogacy in reverse.

The main moral problems associated with the use of IVF include the following.

• 1. The problem of extra embryos. Through hyperstimulation, it is possible to obtain several eggs at once (in some cases, up to 10 or more). As a result, excess embryos appear, which are then either destroyed or can be used in some way. But since the fetus is a human life, acute ethical problems arise regarding the permissibility of such procedures.
• 2. Possibility of manipulating embryos outside the body. Before transplanting the embryo into the cavity, so-called preimplantation (genetic) diagnostics are often carried out to determine the presence of genetic pathology in the embryo. It is also possible to determine the sex of the unborn child. One of the ethical problems associated with preimplantation diagnostics is the possibility of selection, as well as discrimination of embryos by sex and other characteristics.
• 3. Possibility of industrial use of embryos. Using the so-called cryopreservation of embryos (they are frozen and stored at liquid nitrogen temperature), they can be preserved outside the body for a long time. After thawing, they can be used: for implantation in other women, as well as for scientific (for experiments) or even industrial purposes (use of tissues, cells, extracts, etc.).

Theoretically, it is even possible for women to specifically cultivate embryos not for childbearing, but for other purposes (which gives rise to the problem of the “woman incubator”).

Due to the presence of tense moral issues, a number of countries have fairly strict legislation on IVF. In particular, the procedure for reducing excess embryos is prohibited or limited, the number of embryos implanted in the uterus is limited, and the use of donor eggs is prohibited (for example, in Italy, IVF is allowed only for married couples using their own gametes). And in countries such as Costa Rica and Germany, IVF is prohibited by law.

Discussions about IVF have led to the development of ethical recommendations designed to mitigate the moral problems associated with this method. Such recommendations include the following.

It is necessary to use gentle stimulation of ovulation (i.e., prescribing smaller doses of special drugs) in order to obtain as few eggs as possible (and, as a result, fewer extra embryos).

Excess embryos should not be destroyed, but transferred to others infertile couples, and it is recommended to do this not for money, but in the form of a free gift.

It is advisable to implant as few embryos as possible into the uterus to exclude multiple pregnancy.

It is preferable to use only the germ cells of the couple themselves and discourage gamete donation.

The cultivation and use of human embryos for industrial or other non-procreative purposes is unacceptable.

Before carrying out the IVF procedure, medical workers must thoroughly inform the woman (married couple) about the essence of this method, including technical features, as well as the associated risks and consequences of its use.

IN Russian Federation There are legal restrictions on the use of IVF. In particular, it is not allowed to choose the gender of the unborn child (except in cases of the possibility of inheriting a pathology associated with gender). No more than two embryos are allowed to be implanted into the uterine cavity (in as a last resort– three, with mandatory information about the risks). The decision regarding excess embryos must be made by the person who owns the embryos, with written consent. In case of multiple pregnancy, reduction is carried out with informed consent; The number of embryos to be reduced is determined by the woman, taking into account the doctor’s recommendations. The use of human embryos for industrial purposes is not permitted.

• Data from ESHRE - European Society of Human Reproduction and Embryology. URL: eshre.eu/Guidelines-and-Legal/ART-fact-sheet.aspx.

Ethical issues of IVF

The topic of this article is relevant and at the same time controversial. Because it is a rare woman who does not want to give birth to a child and strives to use every opportunity to make this happen. On the other hand, and even with donor cells - how ethical and moral is this? The ethical issues surrounding artificial insemination are troubling, and they face those who are considering using the IVF procedure.

Man is not only a biological being, but also a social one. Unlike an animal, a person does not just give birth to offspring and care for them, but instills in them culture, morality, and human qualities. Finally, a person has a conscience. But at the same time, people are all different. Therefore, there can hardly be a consensus on the issue of artificial insemination (AI).

If we consider a person from a materialistic point of view, then he is a representative of the animal world. Therefore, like any representative of it, it strives to prolong itself by giving birth to offspring. From this AI point of view, artificial insemination is a great good, since it makes it possible to improve human reproductive capabilities and increases the birth rate. And for a number of couples, this is the only opportunity to become parents.

But since a person is still not only a biological being, the question arises to what extent this is moral. After all, a human embryo is already a person, even if it only has one or a few cells.

Artificial insemination procedure

Artificial insemination is carried out in several stages:

— the fertilization procedure itself;

To obtain eggs, superstimulation of the ovaries is performed. hormonal drugs. This allows you to obtain several eggs at once. This is done by medical specialists, under local anesthesia. The follicle with the egg is removed transvaginally using a special needle. The degree of readiness of the follicle is determined using ultrasound.

A man collects sperm through non-sexual means (masturbation). It is also possible to use interrupted coitus.

After retrieval, the eggs are placed in a culture medium and sperm are added. After fertilization in this environment for 2-5 days, and then it is implanted into the woman’s uterus.

The attitude of representatives of religions to IVF

If for doctors AI is one of the medical procedures, then for an ordinary person doubts may arise about the ethics and correctness of artificial insemination. What do religious representatives say about this?

1. Catholicism.

It is definitely negative. The separation of sexual intercourse and the procedure for conceiving a child is considered unnatural and unacceptable.

1. Christian Orthodoxy.

If the wife's eggs are fertilized by the husband's sperm, after which fertilization occurs outside the woman's body and then the embryo is implanted into the same woman, there is nothing wrong with that. Such conception, the priests believe, does not violate the integrity of the marriage bond and is not much different from ordinary, natural conception.

Along with this, the options of germ cell donation, as well as surrogacy, break family ties. It is also unacceptable to receive large number embryos with their subsequent preservation and especially destruction. The human dignity of the embryo is recognized.

There are also Orthodox priests who do not accept artificial insemination in principle.

1. Judaism.

There is no clear assessment. On the one hand, you need to fulfill the divine principle of “be fruitful and multiply.” And, if it can destroy a family, then AI and the possibility of conception are better than suffering further.

On the other hand, fertilizing a wife's egg with another man's sperm is equivalent to adultery if the woman is married. If a woman is not married, the institution of family is violated.

Some Jewish clergy allow the procedure for couples who do not have children, while others categorically prohibit it.

How to be?

We think that in the most difficult situations there is a way out and a choice to act as ethically and morally as possible in relation to oneself and others, including the embryos that are obtained during AI.

Ethical problems with artificial insemination exist because we are human beings, not animals or soulless beings. And to the question of whether or not to resort to the AI ​​procedure, let each of the women answer for herself...

16.03.2011

We bring to your attention a series of articles by Hieromonk Dimitry (Pershin) devoted to the problem in vitro fertilization: compliance with bioethical principles, consequences for mother and child, solving bioethical problems associated with IVF, using the example of Christian patients.

1. Introduction.
   • History of the issue.
   • Methods of assisted reproductive technologies.
   • Legal regulation in Russia.
2. The problem of non-compliance with the “do no harm” principle in IVF technology
   1. Negative consequences for women.
      • At the stage of ovarian hyperstimulation.
      • At the stage of ovarian puncture.
      • At the stage of embryo transfer into the uterine cavity, diagnosis and management of pregnancy and delivery (multiple pregnancy and embryo reduction)
   2. Negative consequences for a man.
      • semen collection
   3. Negative consequences for the child.
      • anomalies and pathologies
      • destruction at the embryonic stage of development
      • self-identity
      • the problem of “children of the afterlife”
   4. Negative consequences for the human population
      • genetic load
      • risk of consanguinity
3. The principle of “informed consent” in IVF technology.
4. Social aspects of moral and ethical problems of IVF.
   1. The principle of human honor and dignity in IVF technology.
   2. Commercialization of donation.
   3. Surrogacy
   4. Protection of the human embryo. (devaluation of the value of human life)
      • the problem of destroying “excess” embryos
      • the problem of cryopreservation of human life at the embryonic stage of development
      • a person at the embryonic stage of development as an object of experiment.
   5. Destruction of the traditional family.
      • the opportunity to get a child outside of family relationships
      • indirect support for same-sex cohabitation
   6. Eugenics
5. Solving ethical problems of IVF using the example of Christian patients. Minimization negative consequences IVF on the example of ethically correct legislation (on the example of Italian legislation).
6. Conclusion.

IN VITRO FERTILIZATION:

from medicine to bioethics

1. Introduction

Infertile marriage and childlessness are the pain of many families, as well as people who have not created their own families. Hence the popularity and demand for assisted reproductive technologies (ART), wide range which modern medicine offers. To assess the scale of progress in this area, it is enough to note that in the United States, from 1996 to 2004, the number of children born through ART doubled, and in 2004 they were already about 1% of the total number of children born1. It is obvious that a similar prospect awaits Russia. Since ART directly affects human life, the question arises about the legal and moral boundaries of their use. What are these boundaries? These are such fundamental norms of biomedical ethics as the principle of “do no harm”, the principle of informed consent, the principle of human honor and dignity, the moral and ethical responsibility of the medical community for the social and religious aspects of ART. The purpose of this article is to analyze from these positions one of the most widely used ART methods - in vitro fertilization (IVF).

Background

The first person conceived outside the human body was born in 1978. This was preceded by a series of discoveries, the first of which was Leeuwenhoek’s suggestion, made back in 1677, that conception occurs as a result of the penetration of sperm into a woman’s body. It was only in 1827 that the egg was described for the first time, and in 1891 the first successful embryo transplant was carried out, a transfer from one female rabbit to another. In 1893, the Russian scientist V.S. Gruzdev made a fundamentally important message that the usefulness of fertilization directly depends on the degree of maturity of the egg. And this was long before there was any suggestion that embryo transfer into the uterine cavity could be used to treat human infertility.

In subsequent years, the functions of the pituitary gland were discovered and the hormones it secreted were studied.

In 1930, Pincus first used the technology of surrogacy - the transfer of a fertilized egg into the uterus and the subsequent development of pregnancy, and in 1934 O.V. Krasovskaya was able to fertilize the egg in laboratory conditions.

In 1960, the laparoscopy method was widely introduced into clinical practice, and already in 1968 a method of egg retrieval was proposed.

1975 was a revolutionary year in the history of IVF. The founders of IVF are considered to be British scientists - embryologist Robert Edwards and gynecologist Patrick Steptoy. In the 60s, Edwards worked with tissue from human ovaries removed during surgery and in 1967 was able to achieve the first ever fertilization of a human egg in the laboratory. During these same years, Steptoy actively participated in the development of such a fundamentally new branch of surgery as laparoscopy. Early years collaboration were spent on developing a technique for obtaining eggs using laparoscopic access and determining the moment of the menstrual cycle most suitable for obtaining eggs, as well as on developing nutrient media necessary for embryo culture. In 1976, after several hundred unsuccessful attempts, they achieved the first induced pregnancy in a woman in history; unfortunately, this pregnancy turned out to be ectopic. However, 3 years later, the first test tube baby was born - Louise Brown.

In Russia, the first child, fertilized using IVF technology, was born in 1986. Preimplantation diagnosis became possible in 1989 genetic disorders, in which the removed part of the egg is examined.

In the early 90s, the ICSI technique was developed, which made it possible to achieve pregnancy even with extreme severe forms sperm pathologies. In addition, blastocyst cultivation methods have been improved. For older women reproductive age A manipulation has been developed that increases the likelihood of implantation, called assisted hatching.

Currently, ART methods include:

— AI (artificial insemination).

— ICSI (injection of sperm into the cytoplasm of the oocyte).

— Hatching (cutting the membrane of the embryo).

— Donation of sperm and oocytes.

- Surrogacy.

The IVF procedure consists of the following stages:

— selection and examination of patients;

Induction of superovulation, including monitoring of folliculogenesis and endometrial development;

— puncture of ovarian follicles;

— insemination of oocytes and cultivation of embryos in vitro;

— transfer of embryos into the uterine cavity;

— support for the luteal phase of the stimulated menstrual cycle;

— diagnosis of early pregnancy.

IVF is also possible in natural menstrual cycle, without inducing superovulation.

Indications for IVF are infertility that cannot be treated or the likelihood of overcoming it with IVF is higher than with other methods2. The effectiveness of the method is 25%3.

Legal regulation in Russia.

In Russia, the right to IVF is legislatively enshrined in Article 35 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, according to which “every adult woman childbearing age has the right to artificial insemination and embryo implantation,” as well as information about this procedure, “medical and legal aspects its consequences, […] provided by the doctor performing medical intervention" The use of ART methods in the treatment of female and male infertility is regulated by Order of the Ministry of Health of the Russian Federation dated February 26, 2003 No. 67.

Unfortunately, the low level of literacy of the majority of the population opens the door to various manipulations by advertisers who make commercial profit from human need and hopes by some means to get their own child.

What are these methods? Are they acceptable? What medical and other consequences can they have for a woman, man, child, family, society and doctor? What moral suffering can IVF cause? Is it possible to minimize all these risks and complications? Finally, what is the position of the Church here, which is all the more significant for domestic medicine since about 80% of the Russian population is baptized in Orthodoxy?

First of all, it should be noted that IVF is carried out in several stages, which, firstly, are fraught with negative medical consequences, and secondly, in some cases they allow the child to be involved in the process of “receiving” enough a large number of people claiming direct or indirect “parenthood”. In addition, there are long-term consequences IVF, which threaten both society as a whole and the life and health of its individual members.

1 See others: Reefhuis J., Honein M.A., Schieve L.A., Correa A., Hobbs C.A., Rasmussen S.A. and the National Birth Defects Prevention Study. Assisted reproductive technology and major structural birth defects in the United States // Human Reproduction Advance Access first published online on November 14, 2008.

http://humrep.oxfordjournals.org/cgi/content/full/den387v3

2 See other: Tuzenko. Collection of materials of the Church-Public Council on Biomedical Ethics.

3 Mykitiuk R., Nisker Jeff. Assisted reproduction / The Cambridge Textbook of Bioethics. Cambridge University press. 2008, p. 113.
CONTINUATION:

4. Social aspects of moral and ethical problems of IVF.

4.1. The principle of human honor and dignity in IVF technology.

According to the coined formulation of Immanuel Kant, a person can never be a means, but only the goal of human action. The Declaration of Helsinki expresses this ethical maxim as follows:

the interests of the patient always come before the interests of science and society (1.5).

Man cannot be regarded as a means to any good ends. By abandoning this principle, humanity dooms itself to destruction, as has been proven by the experience of all totalitarian regimes of past centuries. Unfortunately, the phenomenon of “medical fascism” that took place in Hitler’s Germany may repeat itself. One of most important tasks biomedical ethics - to determine the boundaries beyond which morally unacceptable manipulations with a person begin, no matter what stage of his development he is at. If we turn to IVF technology, we see a number of situations in which a person’s honor and dignity are at risk. What are these situations?

4. 2. Commercialization of donation

— In the case of infertility treatment for a recipient with non-functioning ovaries, IVF of the oocytes of a woman who has agreed to become an egg donor can be performed. And this gives rise to another problem - the commercialization of donation. According to British researchers, in most countries, selling eggs to order allows donors to earn from $1,500 to $5,0001. However, this oocyte donation almost always means economic discrimination against those women who are forced to “give up their eggs to help their family or pay for school, or to exchange half of their eggs for the opportunity to benefit from IVF”2. Reproductive health becomes a commodity that a female donor is forced to sell, exposing herself to the serious risk that we wrote about above.

— If the donor is a man, the problem of commercialization of donation faces us with no less urgency. According to British researchers, its price is about $100. In this case, the most intimate and hidden side of human life - the miracle of marital communication and the conception of children in it - turns into a takeaway product, which undoubtedly humiliates human honor and dignity.

4.3. Surrogacy

In the absence or severe inferiority of the uterus infertile woman Another woman is brought in to carry the pregnancy to term—the so-called “surrogate mother.” This naming itself is a form of discrimination against a woman carrying a pregnancy. Sometimes a surrogate mother is compared to a wet nurse who helps a needy family for altruistic reasons, but we should not forget that “the difference in the intensity of the relationship between the surrogate mother and the fetus and the nanny and the child is still too great”3. Finally, there is a danger of turning surrogacy into a profession. During pregnancy, mother and child are in a state of constant communication; a deep psychosomatic connection arises between them, the rupture of which, due to contractual obligations, can lead to serious mental illness.

4.4. Protection of the human embryo (devaluation of the value of human life).

The value of human life is a constant value; it does not depend either on time, or on “superiority”, or on social origin, or on a person’s racial, national or religious affiliation. This is the position reflected in the Hippocratic Oath. This is the essence of the oath Russian doctor(Article 60 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens). No one can deny the fact that human life begins from the moment of conception. How protected this life is from the point of view of current legal norms is a question for the current legislation, but from a moral and ethical point of view, the status of a human embryo is undoubtedly different from the status of any organ, tissue or other part human body. The embryo is not part of the woman's body, being itself integral human body on early stage its development.

All this forces us to raise questions about the fate of human embryos obtained as a result of IVF. We have already written about two of them above:

— about the problem of destroying “excess” embryos;

— about the problem of cryopreservation of human life at the embryonic stage of development.

With which moral problems face both doctors and “customers” of IVF, one can, for example, judge by the questions that the staff of the English clinic Bourn Hall addresses to couples whose embryos are stored in this clinic:

— Should storage continue?

— Will there be a resumption of replanting frozen embryos?

— Would the couple be willing to donate embryos to research projects approved by the Independent Human Fertilization and Embryology Ethics Committee (HFEA)?

— Would the couple be willing to donate embryos for “adoption” to another infertile couple?

— Should embryos be thawed and disposed of?4

If you subtract the positive answer to the second question on this list, all other answers, whether positive or negative, will be morally flawed.

Thus, here we fix another problem generated by IVF: a person at the embryonic stage of development often becomes the object of an experiment.

In particular, in the case of surrogacy, the child becomes an object of biological manipulation: he receives the genetic component of his physicality from one person, and blood, nutrition and vital intrauterine support from a third party, the surrogate mother. He is treated as “a specimen of some animal, and not as a person who has the right to know his own parents and identify himself with them”5. The emotional experiences of the surrogate mother, who is used to carry the pregnancy, are transmitted to the child. And he experiences extreme stress after the surrogate mother hands him over to the “customers.” Breaking the closest psychosomatic connection that arose between them over time intrauterine development, does not pass without a trace for the child.

In addition, “one source of stem cells is embryos, created in the laboratory by fertilizing an egg in vitro. After the birth of the fetus in infertile people married couples the "residue" of excess embryos can be preserved in liquid nitrogen, and in some countries they can be used for research purposes with the informed consent of such couples. There are now thousands of such frozen embryos in laboratories (about 400,000 in the United States alone, according to a study completed in May 2003).”6 Can such an attitude towards human life at the embryonic stage of development be considered moral? I'm afraid the answer here is clear: No.

The Orthodox Church has always taught that human life begins at the moment of conception, when a sperm unites with an egg to produce a genetically unique living being. Condemning the banishment of fruits, St. Basil the Great (IV century) wrote: “Whoever deliberately destroyed the fruit will be subject to equal punishment with the murderer... and we do not distinguish whether the fruit was formed or not” (Rules 2nd and 8th). The Holy Fathers are unanimous that the human soul is formed at conception*. This idea finds clear liturgical expression in the feasts of the Conception of St. John the Baptist (September 24), Conception Holy Mother of God(December 8)* and the Lord Himself (Annunciation of the Most Holy Theotokos, March 25).

But the most inhumane thing is the creation of new human embryos with the initial purpose of their subsequent destruction during experiments: “the production of embryos with the purpose of using them in research projects has nothing to do with any others medical research, since in this case with organisms potentially capable of becoming full-fledged human personalities, are treated as mere objects, and not as something that has a purpose in itself.”7 Given that the authors of these words themselves consider themselves to be in the camp of researchers who share a liberal-pragmatic approach to the problems of bioethics, it is difficult to disagree with this conclusion.

4.5. Destruction of the traditional family.

IVF opens up the possibility of having a child outside of family relationships. Thus, the family in the traditional meaning of the word, which has developed over centuries within the framework of European civilization, is under threat. Alas, IVF technology provides indirect support various forms same-sex cohabitation. Rich homosexuals can afford to order an arbitrarily large number of children with the given parameters. Not to mention the fact that at the same time the rights of these children to normal family relationships, society itself, its values ​​and behavior scenarios are at risk. We see that certain medical procedures can be directly linked to major social shifts in society and culture.

4.6. Eugenics.

The opened possibility of pre-implantation diagnostics leads some researchers to the idea of ​​resuming eugenic experiments to improve the gene pool of humanity, condemned for Nuremberg trials. Already, the selection of embryos with certain parameters that make them suitable for implantation has become a routine procedure. How compatible is this practice with the idea of ​​the value of every human life, regardless of the circumstances of its origin and other parameters? Obviously, the answer to this question can also only be negative.

Russian position Orthodox Church

The position of the Russian Orthodox Church should be taken into account by practicing doctors, since for many patients it is decisive in matters of the moral acceptability of certain procedures. This position is shown in Basics social concept of the Russian Orthodox Church, adopted at the anniversary Council of Bishops in 2000. It is like this:

XII.4. The use of new biomedical methods in many cases makes it possible to overcome the disease of infertility. At the same time, expanding technological interference in the process of the origin of human life poses a threat to the spiritual integrity and physical health of the individual. The relationships between people, which have been the foundation of society since ancient times, are also under threat. The development of the mentioned technologies is also associated with the spread of the ideology of so-called reproductive rights, which is now being promoted at the national and international levels. This system views presupposes the priority of the sexual and social realization of the individual over concern for the future of the child, the spiritual and physical health society, about its moral stability. The world is gradually developing an attitude towards human life as a product that can be chosen according to one’s own inclinations and which can be disposed of on a par with material values.

In the prayers of the wedding rite, the Orthodox Church expresses the belief that childbearing is the desired fruit of a legal marriage, but at the same time not its only goal. Along with the “fruit of the womb for the benefit,” the spouses are asked for the gifts of enduring mutual love, chastity, and “unanimity of souls and bodies.” Therefore, the Church cannot consider paths to childbearing that do not agree with the plan of the Creator of life to be morally justified. If the husband or wife is unable to conceive a child, and therapeutic and surgical methods Infertility treatments do not help spouses; they should humbly accept their infertility as a special calling in life. Pastoral advice in such cases should take into account the possibility of adopting a child by mutual consent of the spouses. To acceptable means medical care Artificial insemination with the husband's reproductive cells can be considered, since it does not violate the integrity of the marital union, does not differ fundamentally from natural conception and occurs in the context of marital relations.

Manipulations associated with the donation of germ cells violate the integrity of the individual and the exclusivity of marital relations, allowing the intrusion of a third party into them. In addition, this practice encourages irresponsible fatherhood or motherhood, knowingly freed from any obligations in relation to those who are “flesh of the flesh” of anonymous donors. Usage donor material undermines the foundations of family relationships, since it presupposes that the child, in addition to “social” ones, also has so-called biological parents. “Surrogacy”, that is, the carrying of a fertilized egg by a woman who, after giving birth, returns the child to the “customers”, is unnatural and morally unacceptable, even in cases when it is carried out on a non-commercial basis. This technique involves the destruction of the deep emotional and spiritual closeness established between mother and baby already during pregnancy. “Surrogacy” traumatizes both the pregnant woman, whose maternal feelings are violated, and the child, who may subsequently experience a crisis of self-awareness. From an Orthodox point of view, all types of in vitro (out-of-body) fertilization that involve the procurement, preservation and deliberate destruction of “excess” embryos are also morally unacceptable. It is on the recognition of human dignity even in the embryo that the moral assessment abortion, condemned by the Church (see XII.2).

Fertilization of single women using donor germ cells or the implementation of the “reproductive rights” of single men, as well as persons with so-called non-standard sexual orientation, deprives the unborn child of the right to have a mother and father. Use reproductive methods outside the context of a family blessed by God, it becomes a form of anti-Godism, carried out under the guise of protecting human autonomy and misunderstood personal freedom.

6. Conclusion

To summarize, the bioethical aspects of IVF largely coincide with the boundaries drawn in the Fundamentals of the Social Concept of the Russian Orthodox Church. Taking into account a number of reservations, IVF does not give rise to moral objections, but three points seem absolutely unacceptable:

1) Creation and destruction of “extra” embryos.

2) Surrogacy.

3) Donation of germ cells (third party in marriage).

But IVF can be done without these manipulations. Thus, such an approach to IVF does not cause insurmountable moral objections, in which:

1) only the parents’ germ cells are used (no third party donor, no choice of appearance and other parameters of the child)

2) all created embryos are not frozen or destroyed, but implanted. Accordingly, no more than 3 embryos are created and transferred.

3) they are all implanted into the mother (not the surrogate mother).

The ban on cryopreservation of embryos does not apply to the freezing of germ cells; it is completely acceptable.

But what to do if the parents, while performing IVF, once created and cryopreserved “excess” embryos, and now for some reason they are unable to implant them, carry them and give birth, but now they have already seen the light and feel the pain of their conscience for family lives immersed in a liquid nitrogen? According to Protopresbyter John Breck, the answer to this difficult question could be this: these embryos could be donated to infertile couples for “adoption” or “adoption.”

Here is what Protopresbyter John writes: “Despite the formal violation of the principle that there is no place for a third party in childbirth, such a gift can quite possibly be qualified as the transfer of an embryo to the “bearing” mother for adoption. In this case, the embryo receives the status adopted child, and the mother carrying it and her husband will be able to experience all the joys of pregnancy and childbirth. And although, according to Orthodox “understanding”, it is best to do without “spare” material from the very beginning (so that the spouses resorting to this procedure know for sure that not a single embryo will be subjected to destruction or unacceptable manipulation), such a transfer is ethically fully justified, that is, it agrees with by the will of God.

From here, apparently, we can conclude the following: where auxiliary reproductive technologies can help a childless couple consider the options they offer wisely and appropriately. No matter how unfortunate the death of many fertilized eggs in the early stages of the development of in vitro fertilization and similar procedures is, the current level of these technologies fully allows for the prevention of the appearance or adoption of “extra” embryos. And it seems that if you comply necessary precautions and the application of sound ethical criteria, recourse to some such procedures is entirely justified and not sinful.”8

Perhaps the most serious objection to IVF is the increase in statistics of diseases and pathologies in children. The fundamental norm of modern bioethics: it is unacceptable to experiment on a person without his consent. But in the case of IVF, this consent cannot be sought, since life itself arises as a result of it. Is it possible to consider the desire to have your child as a sufficient reason to put his health and life at risk?

Another objection, less significant, in our opinion, is the method of obtaining male germ cells.

However, both of these objections are not an unambiguous ban on IVF, as evidenced by the Fundamentals of the Social Concept of the Russian Orthodox Church. Overcoming the problem of infertility will always remain the focus of attention of doctors; It is important that the proposed methods do not go beyond basic bioethical principles. In this regard, it is quite remarkable the coincidence of the Christian approach to the problem of IVF, basic bioethical principles and the legal regulation of this problem, which was implemented in Italy, where IVF is carried out only for parents, on the basis of germ cells obtained from them, and without any discrimination embryos, which are all implanted into the mother.

Scheme

IVF in the light of fundamental bioethical principles

Violates the principles of bioethics:

• Germ cell donation
• Creation and destruction of “extra” embryos
• Surrogacy

Follows the principles of bioethics:

• Using only parental germ cells (no third party donor, no choice of appearance and other parameters of the child)
• All embryos created are implanted. No more than 3 embryos are created per attempt. Embryo reduction is not allowed
• All embryos are implanted into the birth mother.

Bibliography

Infertile marriage. Modern approaches to diagnosis and treatment. Ed. IN AND. Kulakova. - GEOTAR-Media, 2006.

Eugenics in discourse global problems modernity. M. RAS, Institute of Philosophy, 2005.

Human cloning. Unesco, 2004.

Treatment of female and male infertility. Assisted reproductive technologies. Ed. IN AND. Kulakova, B.V. Leonova, L.N. Kuzmicheva. M. 2005.

Newborns high risk. New diagnostic and healing technologies. Ed. IN AND. Kulakova, Yu.I. Barashneva. M., 2006.

Basics of perinatology. Textbook. Ed. N.P. Shabalova and Yu.V. Tsveleva. M., 2004.

Fundamentals of the social concept of the Russian Orthodox Church. M., 2000.

Prenatal diagnosis of hereditary and congenital diseases. Ed. E.K. Ailamazyan, V.S. Baranova. M., 2006.

Family in a post-atheistic society. Digest of articles. Kyiv, 2003.

Down syndrome. Ed. Yu.I. Barashneva. M., 2007.

In vitro fertilization and its new directions in the treatment of female and male infertility. Ed. IN AND. Kulakova, B.V. Leonova. M., 2004.
Balashov N., archpriest. Reproductive technologies: gift or temptation? / Orthodoxy and problems of bioethics. Church and Public Council on Biomedical Ethics. Vol. 1. M., 2001.

Brek I., protopresbyter. Sacred gift of life. M., 2004

Gerasimenko N.F. Complete collection federal laws on protecting the health of citizens. M., 2005.

Gorodetsky S.I. Stem cells - a gift or a misfortune? / Orthodoxy and problems of bioethics. Church and Public Council on Biomedical Ethics. Vol. 2. M., 2006.
Campbell A., Gillett G., Jones G. Medical ethics. M., 2004.

Kurilo L.F. Reproductive technologies and technologies for obtaining human embryonic stem cells as a branch of medicine / Orthodoxy and problems of bioethics. Church and Public Council on Biomedical Ethics. Vol. 1. M., 2001.

Ridley M. Genome: autobiography of a species in 23 chapters. M., 2008.

Sgreccia E., Tambone V. Bioethics. M., 2002.

Siluyanova I.V. Bioethics in Russia: values ​​and laws. M., 1997.

Willke D., Willke B. We can love them both.

Hen Yu.V. Eugenics project: “pro” and “contra”. M., 2003.

Elder K., Brian D. In vitro fertilization. M., 2008.
Harakas S.S. Contemporary moral issues. Facing the Orthodox Christianity. Minneapolis, Minnesota. 1982.

Macalia D. The right to life. The orthodox Christian perspective on abortion. Regina Orthodox Press. 2001.

Mykitiuk R., Nisker Jeff. Assisted reproduction / The Cambridge Textbook of Bioethics. Cambridge University press. 2008

Engelhardt H. Tristram. The foundations of Christian bioethics. Swets & Zeitlinger Publishers b.v. Lisse. 2000.

Readings in biomedical ethics. A canadian focus. Ed. by Eike-Henner W. Kluge. University of Victoria, 1993.
FOOTNOTES
1Mykitiuk R., Nisker Jeff. Right there. P. 114.

3Sgreccia E., Tambone V. Bioethics. M., 2002. P. 251.

4Elder K., Brian D. In vitro fertilization. M., 2008. P. 189.

5Sgreccia E., Tambone V. Bioethics. M., 2002. P. 250.

6Human cloning. Unesco, 2004. P. 13.

* The traditional name of the holiday is “The Conception of the Holy Righteous Anna,” when the Most Holy Theotokos was conceived.

7Campbell A., Gillett G., Jones G. Medical ethics. M., 2004. P. 147.

8 Brek I., protopresbyter. Sacred gift of life. M., 2004. P. 161.

Another modern reproductive technology is in vitro fertilization (IVF - in vitro fertilisation), otherwise called "in vitro fertilization and embryo transfer"(IVF and PE). The idea of ​​fertilization outside a woman’s body arose in the last century, and its practical implementation began in the 40s of the 20th century, when American scientists carried out “in vitro conception.” However,

nascent life succeeded only within a few hours. The honor of creating the 1VF method belongs to the English embryologist R. Edwards and obstetrician-gynecologist P. Steptoe. Complex philosophical, moral and other questions accompanying the use of this new technology of human reproduction were vigorously discussed already at the stage of experimental development of the method. In 1971, the British Medical Research Committee refused to fund the program of R. Edwards and P. Steptoe, considering their research to be contrary to ethical standards After the moratorium on the development of the IVF method was lifted in 1975, 10 years of research by R. Edwards and P. Steptoe ended with the introduction of this method into practice, and in July 1978, the first “test tube baby”, Louise Brown, was born at the Cambridge University Clinic.

Domestic scientists began to master the method of IVF and ET in the 70s, especially actively in the Laboratory of Clinical Embryology of the Scientific Center of Obstetrics and Perinatology of the Russian Academy of Medical Sciences. It was here in 1986 that the first “test tube baby” in our country was born.

The indication for the use of IVF and PE is primarily absolute infertility women (for example, if she does not have tubes or ovaries). According to the calculations of domestic experts, in Russia there are approximately 3 million women of childbearing age suffering from absolute infertility.

In fact, all phases of the IVF and ET method involve difficult moral issues. The “Regulations on in vitro fertilization and embryo transfer” 1, adopted in 1987 by the World Medical Association (WMA), states that the use of IVF and ET is justified when other methods of treating infertility (medical, surgical) have proven ineffective. Here we see a completely understandable desire to limit clinical practice related to intractable moral and ethical issues.

The strength of the instinct of motherhood, the tenacity of many women who for years have steadfastly endured the suffering and hardships associated with infertility treatment, are well known. Moreover, the strict ethical obligation of the doctor is to fully and adequately inform the patient about the seriousness of the risks accompanying the use of the IVF and ET method. Only under this condition will the informed consent obtained from the woman (or from the spouses) to use the method be morally significant.

In the process of IVF and PE, a whole series of manipulation of eggs and sperm until their fusion. Is this even acceptable? gamete manipulation person? Already in the “Regulations” of the Military Medical Academy it is noted that the IVF and ET method is generally justified, since “it can be useful both for individual patients and for society as a whole, not only regulating infertility, but also contributing to the disappearance of genetic diseases and stimulating fundamental research in the field of human reproduction and contraception." In strictly ethical terms, the use of this method of combating infertility must also be interpreted as the inalienable right of a woman (spouses) to enjoy the benefits of scientific progress (Article 27 of the Universal Declaration of Human Rights and Article 15 of the Covenant on Economic, Social and Cultural Rights).

A little over a day after fertilization (zygote formation), the first division in the life of a new biological formation into 2 blastomeres occurs, and by the end of the third day 8 blastomeres (cells) are already formed. In accordance with the recommendations of the domestic Instructions for the use of the IVF and ET method, stages 2,4,8 blastomeres are considered optimal for transfer to the uterus.

At this stage, doctors move from manipulating gametes to manipulations with embryos. At the same time, one has to face the same philosophical and moral questions that have a long tradition of discussion in connection with artificial termination of pregnancy: “What is the ontological and moral status of the embryo?”, “At what stage of development of the fetus should it be considered a human being?”, “ To what extent does he have human rights? These issues were discussed in the previous chapter in connection with the issue of abortion. Now we note that in a situation where embryos are created artificially and when they have to be subjected to various influences, the moral, ethical and legal problems of the status of embryos acquire many specific features.

It has already been said in Chapter VII that in the literature on bioethics, different answers are given to the question of at what stage of development of the embryo it should be considered a human being. The variety of criteria indicates that the question of

The ontological and moral status of the embryo cannot be decided today without taking into account modern data on human embryogenesis. It seems to us that the position according to which the embryo (starting with the zygote) has a special ontological and moral status is justified. This means that the human embryo, as noted earlier, is in a certain sense the bearer of human dignity.

First, the embryo is not just part of a woman's insides. Such an outdated view of its nature is still professed by those doctors who, for example, justify the use of abortive tissues for any purpose they need by the fact that these tissues “disappear anyway” and that in medicine it is customary to use any removed organ for scientific or educational purposes patient.

Secondly, the special ontological status of the embryo, which we have we're talking about, lies in the fact that its very existence is a link in the application of the infertility treatment method (the clinical method as a synthesis of scientific knowledge and technology). The artificial path of origin of the embryo becomes an organic moment of its existence (just as the state of “brain death” is of iatrogenic origin, i.e., it is a consequence of the resuscitation actions taken by the doctor). Then the special moral status of the embryo is determined by the ethical and legal standards for the use of this therapeutic method. For example, according to modern ethical and legal standards, manipulations with a human embryo in vitro are permissible only until it attaches to the wall of the uterus, while in a certain sense it does not yet represent a biological integrity.

This extremely important circumstance is reflected in modern terminology - many experts call the embryo before the 14th day of development a “pre-embryo” or “early embryo”. Removing one or two blastomeres from him, for example, to determine sex or the presence of a chromosomal or gene mutation, does not have a damaging effect on subsequent development.

New ethical questions are also raised by the real the ability to choose the gender of the child, occurring in cases of IVF and PE. In this regard, the “Regulations” of the WMA states: “The WMA recommends that doctors refrain from interfering in the reproductive process in order to select the sex of the fetus, if this is not done for

"To avoid the transmission of serious sex-linked diseases." Unfortunately, the regulatory documents regulating this practice in our country do not reflect the issue of choosing the sex of the fetus.

As is known, by stimulating hyperovulation, doctors are able to extract several (sometimes up to 10 or more) eggs from a woman’s body. To increase the likelihood of fertilization, all eggs undergo insemination, and most of them become zygotes. Approximately on the 3rd day after fertilization the next the most important stage- transfer of the embryo into the uterus. To increase the chance of pregnancy, several embryos are transferred into the uterine cavity. Despite the restrictions provided, the risk of multiple pregnancy remains many times greater than with natural conception. The requirement of bioethics is strict here too: the patient and spouses must be informed about the degree of risk of multiple pregnancy.

In order to avoid the negative consequences of multiple pregnancies, which can be especially dangerous when using IVF procedures, an operation called "embryo reduction". In other words, if after transfer to the uterus more than three embryos implant at the same time, some of them are aborted. This practice, however, is considered legally or ethically unacceptable in some countries. In fact, it turns out that treatment, the purpose of which is to overcome infertility and ensure the development of a new life, leads to the artificial termination of these new lives themselves. Therefore, according to, for example, German law, “anyone who transfers more than three embryos to a woman in one cycle” is subject to imprisonment for up to three years or a fine. The French National Ethics Advisory Committee noted in 1991 that embryo reduction should not serve to legalize the irresponsibility of a doctor using the method of artificial insemination.

There is a lot of controversy regarding future the remaining so-called "excess" fertilized eggs(they can last for a very long time). If pregnancy does not occur immediately, they can be used in subsequent cycles. If pregnancy occurs, then the “excess” fertilized eggs turn out to be literally “extra”. Boo-

The future of these “extra” embryos can develop in three ways.

They may be thawed and die.

"Extra" embryos can be donated.

"Excess" embryos can be the object of scientific research.

The issue of the fate of “excess” embryos in the IVF and ET program has been repeatedly reflected in both international and many national ethical and legal normative documents. Special Resolutions of the European Parliament adopted in 1988, in particular, prescribe that “in vitro fertilization, the number of fertilized eggs does not exceed the capacity of the uterus and that the preservation of viable embryos in cryogen is resorted to only when, due to certain circumstances, arising during fertilization, it is impossible to introduce the embryo into the uterus immediately." The Russian “Instructions for the use of IVF and ET in the uterine cavity for the treatment of female infertility” (1993) unfortunately leaves the question of the fate of “excess” embryos without attention.

Serious moral problems in the use of the latest human reproduction technologies are associated with the health status and indicators of physical and mental development of children born through artificial insemination. Finally, is there a risk of abnormalities occurring in the offspring of “artificial” children?

According to some foreign literature data, a comparison of the use of IVF and ET methods and natural conception revealed an increase in risk. The number of miscarriages increases by 2-3 times, ectopic pregnancies - by 2-5 times, multiple pregnancies - by 20-27 times. In more than half of the cases, children conceived in vitro are born by cesarean section; their risk of prematurity is increased by 3 times, and the risk of birth defects is increased by 2 times.

The practice of artificial human reproduction poses difficult questions And about the social and legal status of a child born through artificial insemination or IVF and ET. The simplest situation, of course, is homological fertilization, when the biological and social parents of the child coincide and the question of the child’s legitimacy does not arise at all. However, even in such cases there is a danger of discrimination against children who

came into the world through artificial conception. In this regard, the “Regulations” of the WMA (1987) emphasize: “The doctor must act primarily in the interests of the child who will be born as a result of the procedure.” Here it is necessary to once again emphasize the importance of the rule of confidentiality in relation to any medical interventions in reproductive processes, but in particular methods of artificial insemination.

As for heterologous fertilization, when one or both of the child’s “social parents” do not coincide with his “biological parents,” the issue of donor anonymity poses another difficulty. Isn't the anonymity of the donor a violation of the rights of the unborn child?

Slovak lawyers J. Drgonec and P. Hollender rightly noted: “Medicine began to perform artificial insemination before special legal regulation appeared.” Until the end of the 80s, a child born as a result of artificial insemination with donor sperm was considered illegitimate in some countries (Switzerland, Italy, etc.). Currently, many countries have adopted a legal norm according to which a man who has given voluntary informed consent to artificially inseminate his wife does not have the right to challenge paternity of a child conceived in this way. In 1990, a similar norm was introduced into Russian legislation.

The consent of spouses to the use of artificial insemination methods in some countries is formalized by their separate statements. In Russia, each spouse puts his signature on a common statement. In medical practice, there are cases when a woman applied to the artificial insemination center with a request to perform artificial insemination with donor sperm, but secretly from her husband. In the practice of French doctors, there was a case when a man of African descent approached them with a request to carry out artificial insemination of his two wives "with Donor sperm, who, however, would believe that homological artificial insemination had been performed. No matter how convincing the moral arguments in favor of" holy deception" in such cases, both professional ethics and the letter of the Law (and for many also the requirements of religious morality) do not allow the use of artificial insemination methods without the consent of both parties to the marriage.

One of the difficult questions that arises when donating eggs is whether Who exactly should be considered the mother of the child born. The literature presents three possible answers to this question: the mother is always the woman who gave birth to the child; the parent is recognized as the mother only if the egg used belongs to her; a woman who donors an egg is recognized as a mother along with the woman who gave birth to the child. According to the existing laws in this regard in a number of countries (Bulgaria, some states of Australia, etc.), a mother is recognized as a woman who gives birth to a child. According to Russian legislation, on the contrary, the mother of a child is not considered to be a woman donor of an egg, but a woman who has given written consent to the implantation of an embryo (see Article 51, Part 4 of the Family Code of the Russian Federation).

Most liberal legislation allows "question upon request" (in a small group of countries)

Laws permit abortion quite freely for numerous medical and social reasons (in six countries: England, Hungary, Iceland, Cyprus, Luxembourg, Finland).

Quite strict laws allow abortion only under certain circumstances: threat to physical or mental women's health, incurable fetal defects, rape and incest (in Spain, Portugal, Poland and Switzerland.

Very strict laws that either prohibit abortion altogether or allow it in exceptional cases when pregnancy poses an immediate threat to the woman's life (in Northern Ireland, until recently in the Republic of Ireland and Malta).

If we talk about the world as a whole, in 98% of countries abortion is allowed in order to save a woman’s life, in 62% - in order to preserve her physical and mental health, in 42% - in cases of pregnancy after rape or incest, in 40% - due to fetal defects, in 29% - for economic and social reasons, in 21% - at the request.

Abortion is legal in the vast majority of countries, but the conditions under which it is legal vary from place to place. According to a 2013 UN report, almost all countries (about 98%) allow abortion if necessary to save the woman's life.

In Russia, activists have repeatedly called for stricter laws on abortion

Laws that do not provide for such exceptions have been adopted in Malta, Nicaragua, the Dominican Republic and the Republic of El Salvador. Until recently, Ireland was one of the countries with a complete ban on abortion; life-saving abortions were allowed there in 2013.

In addition, almost 70% of countries allow abortion to preserve a woman's physical and mental health. Abortion after rape is legal in approximately 60% of countries, and more than 30% of countries allow abortion for social or economic reasons (poor financial conditions, disability, etc.).

In the United States, Texas is the strictest country when it comes to abortion; it has managed to introduce severe restrictions on abortion operations. The authorities did not restrict women's right to abortion, but only seven clinics were allowed to perform operations. The constitutional right to abortion was established in the United States in 1973.

According to the UN, in 30% of countries, including Russia, a woman’s desire is sufficient for an abortion. Abortion can be done free of charge in the first 12 weeks of pregnancy at the request of the woman, and during the next 16 weeks the pregnancy can be terminated for special indications.

In most European countries, a woman's desire is also sufficient for an abortion in the first weeks of pregnancy, but these do not include, for example, Spain, Portugal and Finland. Russia has one of the most liberal laws on abortion. Article 36 of the “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” allows “abortion upon request” up to 12 weeks of pregnancy, for social reasons - up to 22 weeks, for medical indications- regardless of the stage of pregnancy.

The child is protected from the moment of conception:

In 1987, the World Medical Association adopted a Statement on In Vitro Fertilization and Organ Transplantation (6), which called on all physicians to act ethically by showing due respect to the embryo from its inception.

Similar norms protecting the child’s right to life are enshrined in the fundamental laws of a number of states and are increasingly reflected in national legislation at lower levels. For example, in the United States, the State Children's Health Insurance Program (SCHIP) has defined a child since 2002 as “an individual under 19 years of age, including the period from conception to birth.” Accordingly, unborn children are treated as citizens entitled to health insurance and medical care.

However, in most cases, the declared noble principles remain only on paper. The rights of an embryo to life and birth are protected to some extent only by the current legislation of Germany, France, Italy and Portugal.

According to Russian laws, a person acquires legal capacity solely by virtue of birth. So, paragraph 2 of Art. 17 of the Constitution of the Russian Federation states: “Fundamental human rights and freedoms are inalienable and belong to everyone from birth.” In other words, before birth, a child has no rights and is in no way protected by law from attacks on his life.

In France, a child's life is protected by law after 10 weeks of pregnancy. In Denmark - after 12 weeks. In Washington state, life was protected after 16 weeks, and in Sweden - after 20 weeks. In New York, this limit was 24 weeks, and in England - 28. Currently, in the USA, life is legally protected only after birth (data from 1994)

Arguments of supporters and opponents of abortion

There are “pro-abortion” people. This is i.e. people who are in favor of allowing abortion, including those who would not be able to make such a decision themselves, but believe that a pregnant woman expecting a child has the right to choose for him.

The main argument of abortion supporters is the issue of women's rights. They believe that it is a woman, as a mother, who has the right to choose the birth of a child. They also believe that abortion should be available at the request of the mother at any time during pregnancy. Of course, in some ways, abortion supporters are right, if we take into account abortions performed after cases of rape of women, after cases of incest; or in case of threat to the mother's life during childbirth.

But let's not forget about the other side, the so-called "anti-abortionists" who oppose the pro-life movement. There are also disagreements among them. For example, some people may consider themselves “anti-abortion” even if they are “pro” of certain types. For example, the cases of abortion caused by violence or incest that we have already discussed. They believe that in these cases it is necessary to protect the physical and mental health of the expectant mother.

The main argument that opponents of abortion give to its supporters is: “What are the rights of the unborn child?” This question, of course, can be interpreted in different ways, depending on what time you start counting the origin of life. Most opponents of abortion believe that the life of the unborn child begins at conception and, therefore, no type of abortion should be allowed.

Many of them also believe that religion plays a big role in the debate about banning abortion. The same Christians claim that the Bible says that God knows the soul of every person before he is born. Consequently, a person’s soul, his personality, is born before he is born, and, observing the commandment “Thou shalt not kill,” they call abortion the murder of a person.

Also, in addition to the issue of rights, there are other arguments in the debate about prohibiting or allowing abortions that should not be left aside.

If the government of the country where the pregnant woman is located does not allow abortion, then women have to independently find ways to terminate the pregnancy for various reasons. And since abortion procedures are illegal in this case, the government and medical professionals cannot monitor compliance with the conditions for abortions. This is a huge problem for women seeking an abortion. They must agree to "underground abortions." That is, abortions without appropriate qualified medical care and equipment. Many women died before the abortion procedure was legal in many countries.

Under what circumstances does a doctor have the right to refuse an abortion?

Russian legislation does not provide for the right of a doctor to refuse to terminate a pregnancy.

Enshrined in Art. 58 “Fundamentals of Legislation on the Protection of the Health of Citizens of the Russian Federation” the right of the attending physician to refuse “observation and treatment” of the patient can be exercised only if the following grounds exist. Firstly, such a refusal is permissible only if the patient does not comply with the instructions and internal regulations of the healthcare facility. Secondly, a doctor’s refusal to observe and treat a patient should not threaten the patient’s life or the health of others. It is obvious that the doctor’s reluctance to kill a nascent life does not fit into the framework outlined by law for refusing to “observe and treat the patient.” The fact is that in the case of abortion, we are not talking about “treatment” of the patient, but about medical intervention, the possibility of refusal by the doctor is not regulated in the Fundamentals.

The direct right of a doctor to refuse to perform an abortion is enshrined in paragraph 6 of the WMA Declaration “On Medical Abortions” (Oslo, August 1983, amended in November 1983), according to which “if personal convictions do not allow the doctor to perform a medical abortion, he must transfer the patient to a competent colleague.” However, the indicated source, the Declaration on Medical Abortion, is ethical, not legal. However, in our opinion, there are well-known legal grounds for a doctor’s refusal to perform an abortion. The fact is that in domestic legislation there is a permissive principle, by virtue of which “everything that is not directly prohibited by law is permitted.” In other words, refusal to perform an abortion is not an illegal act, since such refusal is not prohibited by the current legislation of the Russian Federation. However, failures of this kind do not occur in medical practice.

Formation of human organs

1 month (1-4 weeks).

Day 1 - fertilization.

Day 4 - the embryo consists of 58 cells and enters the uterus. The fetus and umbilical cord will develop from only 5 cells. The remaining 53 cells are needed to nourish the fetus.

Day 7-8 - implantation (usually in the area of ​​a vessel lying on the surface).

Days 7-14 are the first critical period.

Day 9 - the fertilized egg is surrounded on all sides by the mucous membrane of the uterine cavity.

Day 15 - the fetus develops a notochord and a primitive intestine.

13-18 days - villi form between the walls of the uterus and the outer membranes around the embryo. The formation of the amniotic sac begins, and the placental circulatory system develops.

Day 17 - the fetus reaches a length of 2.5 mm. Its body is arched and resembles the letter C.

Day 18 - the primitive heart begins to contract.

3-6 weeks - the second critical period.

2 month (5-8 weeks).

Day 20 - the rudiments of the spinal cord and brain appear.

Day 24 - the rudiments of ears, eyes, thyroid gland, liver, lungs, and intestines appear.

5 weeks - the umbilical cord appears.

Day 28 - the embryo has grown to 5-8 mm. The head is at a right angle to the body, future ears and eyes are marked with seals, there is a small tail, gill slits; on the limbs you can see future fingers.

5-6 weeks - limbs are actively developing.

24-40 days - active formation of the heart and organs of vision.

6 weeks - the embryo reaches 15 mm, the tail lengthens and bends.

7 weeks - the rudiments of teeth are formed. 8 weeks - hands and feet are well formed.

Day 28-49 is the greatest sensitivity to chemicals and poisons.

By the end of the second month, the fetus has a human face. The eyes move somewhat closer. They do not yet have eyelids and look huge. A very convex forehead, a large mouth, but lips are already appearing. The head straightens, the tail disappears, the limbs quickly develop, and the bends of the elbows and knees are already visible. The stomach and intestines take their final shape. The cloaca is divided into two openings. The respiratory apparatus develops. The brain and heart are similar to the organs of an adult. The embryo straightens up. A neck appears, gill slits disappear, and a tubercle appears between the lower limbs - the basis for the development of the genital organs. The embryo reaches a height of 3-4 cm and a weight of 5-9 g. The total volume is about the size of a chicken egg. A face with a flattened nose and protruding lower jaw. The central nervous system develops. The spinal cord groove closes. 97% of the embryo is water. A two-month-old embryo is called a fetus.

3 month (9-12 weeks).

From the third month, the fetus's balance organ, the vestibular apparatus, begins to function. The more the mother moves, the better he develops. The skin of the fetus is glassy transparent. Upper limbs grow faster than the lower ones. The three-month-old fetus takes on a characteristic human appearance. Its length is 9 cm, weight 45 g. The head and neck are straightened, making up half of the entire length. Well formed face. Blood vessels are visible under the skin. The fetus looks skinny, bones and muscles stand out under the skin, which does not have a fat layer. The fetal skeleton is completely cartilaginous. The skeleton and muscles are so pronounced that the fetus makes its first movements - moves its arms, legs, clenches its fists, opens its mouth, swallows, and tries to make sucking movements. The fetal heartbeat can be heard - it is almost twice as fast as that of the mother.

10 weeks - the genitals of boys and girls begin to differ.

12 weeks - vocal cords appear. The eyes come closer together, the eyelids appear, and the eyeball, the mouth becomes smaller, the nostrils are wide apart, the ears look like two slits. The ends of the fingers harden. The liver and kidneys develop significantly. The first hairs appear - above the upper lip and above the eyes.

During the day, the baby grows on average by 1.8 mm and gains 1.4 g in weight!

4 month (13-16 weeks).

Until 15-16 weeks there is active brain growth, which slows down the growth of the entire body.

4 months is the third critical period of fetal development. A lack of vitamin E can cause miscarriage.

15 weeks - the male sex hormone - testosterone - begins to be produced. Women's - a little later. The differentiation of the genital organs ends. The internal genital organs are already partially formed.

In the fourth month, the color of the fetal skin changes. The glassy-whitish color becomes dull red. Small hairs appear on the skin.

A four-month fruit has a length of about 16 cm, weight about 120 g. The hand of a four-month fruit is 1.4 cm.

Until the beginning of the fifth month, the main site of hematopoiesis is the liver, which grows very early and is already capable of accumulating glycogen and producing bile.

The proportions change. The head appears smaller in relation to the body than before. The sebaceous and sweat glands and kidneys begin to function.

Meconium accumulates in the intestines.

Daily weight gain is 2.6 g, height gain is 2.5 mm.

5 month (17-20 weeks)

Mainly formed nervous system, respiratory, hematopoietic and digestive organs. Marigolds begin to grow on the hands and feet. Deposition of subcutaneous fatty tissue is noticeable, with the exception of the face, so the skin on the face of a five-month-old fetus is wrinkled, which gives it the appearance of an old man. By this time, the sucking reflex arises. The growth of the head slows down and it already makes up a third of the length of the fetus. The hairs on the head begin to grow.

The length of the fetus is on average 25 cm, weight 300-400 g. The fetal heartbeat begins to be heard with a regular stethoscope.

By this period, the mother's weight increases by approximately 4 kg.

6 month (21-24 weeks)

The kidneys begin to secrete urea into the amniotic fluid and uric acid. The fruit is covered with thin, delicate hairs - lanugo. A layer of subcutaneous fat is formed - the fetus becomes “more beautiful”. Length growth slows down, but weight gain accelerates. By the end of the month, the fruit weighs 600-650 g and is about 30 cm in length. The fetal hand is 2 cm. The face becomes more defined, the eyebrows are clearly visible, the pattern of the nose is drawn out more clearly, the ears become larger, the neck lengthens. The child wakes up and falls asleep.

Weight gain - about 10 g per day!

7 month (25-28 weeks)

By the end of the seventh month, the length of the fetus is 35 cm, weight - 1300 g. Hair disappears on all parts of the body except the head. By this time, fetal development is basically complete, in boys the testicles descend into the scrotum, are well formed and the eyes open. The hair on the head is about 0.5 cm long. The fetus can still freely change its position. The fetus can hear, has visual perception, and can suck its own finger.

Weight gain - 25 g per day!

8 month (29-32 weeks)

In the eighth month, the layer of subcutaneous fat becomes even thicker. The skin takes on a lighter shade. The rate of brain development up to 33 weeks is faster than body growth. By the end of the month, the fruit reaches an average length of 40 cm and a weight of 1700 g.

9 month (33-36 weeks)

In the ninth month, the fluff that covered the baby’s skin also disappears. The layer of subcutaneous fat grows, the skin becomes even. Taking on a beautiful pink color. Brain growth slows down. But the growth of the cerebellum accelerates (therefore, premature babies are often clumsy for a long time.) By the end of the month, the child takes up fertilized egg constant position, more often with the head down. On average, a child weighs 2800, height is 46 cm. The heart beats at a speed of 120-140 beats per minute. The liver and lungs are maturing.

10 month (37-40 weeks).

By the end of the month, the fruit reaches an average of 52 cm and 3500 g. The length of the marigolds is longer than the tips of the fingers.

Arguments for a woman who wants to have an abortion

If you have an abortion, you will harm yourself more and take a person’s life.

Talk about the consequences

Possible childlessness

You can give birth and give it up for adoption to childless people

Artificial insemination

Ethical issues when artificial insemination

Questions of the ethics of artificial insemination are problems of attitude towards the beginning of human life. But if in the case of an abortion the doctor and the woman enter into a moral relationship with human life, even for a period of several days, weeks, months, then in the case of artificial insemination this relationship is not so much with the beginning of an already existing life, but with the possibility of its very beginning. And if abortion, contraception, sterilization are a struggle against the emergence of human life, then artificial insemination is a struggle for the possibility of its emergence.

Main ethical problems of IVF technology– this is the problem of the death of excess human embryos, the problem of the impact of the IVF procedure on a woman’s health, the problem of the identity crisis of a child born in a test tube, the problem of surrogacy and the most important problem - the destruction of the traditional family. Artificial insemination technology inevitably leads to the destruction of the traditional family.

Violation of children's rights

It is not the parents, but a medical worker who participates in the conception of a child, and therefore he cannot fully be called the child of his father and mother, especially if donor materials were used. If the criteria are not met, the living embryo is destroyed and a new one is transplanted, which violates his right to life. The child turns into an object of contract and sale.

Violation of mother's rights

If a surrogate mother is used, she is deprived of her natural right to raise and raise a child carried in the womb and born by her. There is a gross violation of the natural law: whoever gives birth is the mother. It turns out that you can carry and give birth to a child, but not be his mother!

The problem of biological and genetic parents, undermining the foundations of the family

IVF leads to the emergence of such concepts as biological and genetic parents. This is a violation of the natural course of things and the family. The use of donor eggs and sperm is actually considered adultery in marriage, which is unacceptable from a religious point of view.

The embryo problem

In the IVF process, the natural right of the embryo to life as a little person at an early stage of development is neglected. With IVF, a better embryo is inevitably selected for transplantation into the uterus. Excess embryos, especially if they are of “low quality,” are destroyed, regardless of their chromosomal composition and viability.

The embryo can be sold, donated or destroyed at the request of third parties, and also used for scientific or medical purposes.

Countries that allow artificial insemination, pros and cons

Due to the numerous moral, ethical and religious aspects of this issue, the national legislation of most countries restricts surrogacy. In some countries (France, Germany) it is completely prohibited.

For residents of France, surrogacy is illegal because it contravenes adoption laws. It is not allowed in countries where the Catholic Church is traditionally strong.

In Germany, it is a crime to attempt to “carry out artificial insemination or implantation of a human embryo into a woman (surrogate mother) who is willing to give up her child after birth.” Here it is criminal to be both the doctor performing the procedure and the surrogate mother herself. Intended parents are exempt from liability.

The same bans apply in Greece, the Netherlands, Norway, Switzerland, and Spain. Other countries only prohibit commercial surrogacy agreements and do not allow consideration under such agreements. This is Canada. Israel, Great Britain, Victoria (Australia), New Hampshire and Virginia (USA).

In Canada, a surrogacy contract is not legally binding, although it is not prohibited by law and is carried out by private agencies. However, legal claims on this issue are not considered in Canada, as well as in the UK.

Finally, third countries limit the use of reproductive technologies in connection with surrogacy (Denmark, Norway, Sweden).

Currently, the majority of infertile couples of childbearing age are allocated state quotas for the IVF procedure, This method of infertility treatment is available to everyone who needs it.

Of course, those married couples who hope to become parents only through IVF ardently support this method of infertility treatment. Doctors - gynecologists, as well as geneticists - share the same opinion - in the IVF process the whole biological material undergoes very thorough medical examination , and the birth of babies with genetic disorders, hereditary diseases or other pathologies is excluded.

Pregnancy and childbirth of a woman who became pregnant as a result of an IVF procedure, no different from the pregnancy of a woman who became pregnant naturally.

However, the progressive direction of medicine - in vitro fertilization - also has opponents. For the most part, IVF procedures are opposed religious representatives of different faiths , including Orthodox activists. They consider this method of conception barbaric and unnatural.

In addition, as a result of growing embryos, some of them subsequently die - and this is unacceptable, in the opinion of church representatives, because it is the murder of already conceived children.

Stages of artificial insemination

The IVF process consists of several stages.

1. Comprehensive examination of the couple. Before starting treatment, it is worth finding out what the causes of the problem are. Some types of infertility do not require IVF; drug or surgical treatment is sufficient; it also happens that conception is impossible in principle, no matter how hard you try.

2. If IVF is advisable, the woman is prescribed hormonal drugs to stimulate the growth and maturation of several follicles containing eggs in the ovaries (usually 1-2 eggs mature in one monthly cycle). Ovarian stimulation is needed to obtain a supply of embryos for transfer to the uterus.

3. After the follicles have matured, eggs are removed from them under anesthesia with a special needle under ultrasound control. At this point, the man needs to donate sperm. If its production is impaired, sperm are obtained by puncture or biopsy of the testicle.

4. In the embryology laboratory, a suspension of sperm is prepared, which is used to fertilize eggs located in a special nutrient medium. In case the sperm cannot penetrate the egg, there is again a solution: ICSI (intracytoplasmic sperm injection). Using a glass microneedle, a single sperm is injected into the egg under a microscope.

5. The fertilized eggs are placed in an incubator where embryo development begins. On the third day, when the embryos consist of only eight cells, they are transferred using a catheter into the woman's uterine cavity for gestation. Typically, several embryos are placed in the uterus (according to Russian law, no more than three) to increase the likelihood of pregnancy.

Child identity crisis

“Surrogacy” (carrying a fertilized egg by a woman who, after giving birth, returns the child to “genetic parents”), even in cases where it is carried out on a non-commercial basis, is unnatural and morally unacceptable. Traumatizing both the pregnant mother and the child, this method neglects the deep emotional and spiritual closeness that is established between mother and baby during pregnancy and provokes an identity crisis in the child (which mother is the real one?).

The use of this technology gives rise to a significant number of contradictions. For example, one cannot help but say that ART complicates the mechanism of self-identity in a child, which can subsequently lead to an identity crisis. A situation is possible when a “split into “biological” and “social” occurs. In the case of in vitro fertilization, there are variations when one of the parents is duplicated or both. Since implantation of a fertilized egg can occur both in the uterus of a future social mother and in the uterus of a surrogate mother, combinatorics is supplemented by one more element, thus, it is possible that the child will have two fathers and three mothers. Three mothers and one father, or two on each side, etc.