The basic concept of marriage
The virtue of the church's official statements is to provide the necessary guidance to all who participate in public debate. The main points or directions around which the discussions unfold are determined, regardless of their outcome. But the ethical position of the church does not excuse the need for further clarification; the positions taken by the church are not specific to any particular denomination and are not completely determined by the secular world view. Morality is universal and therefore allows universal communication.

One of the truths discussed in such discussions is the basic understanding of marriage and sexual intercourse.

Those who are convinced of the fundamental link between the fundamental aspects of reproduction and the institution of marriage use these principles in the drafting of protocols for homogeneous insemination. Reproductive medicine is linked by this logic; it cannot proclaim its own criteria or norms. Within this approach, extending protocols to quasi-homogeneous insemination becomes meaningless.
Responsibility for the social context of sexuality and reproduction is losing its meaning. The main criterion is taking care of the child, first of all - providing him with a family in the form of a stable heterosexual couple. This condition is most important for the formation and development of a mature and integral adult personality, as well as the formation of his identity. In this regard, a question arises for the doctor: regardless of the legality of the procedure, can such an assumption be interpreted as evidence of tolerance for responsibility? The main goal of modern reforms of legislation in the field of inheritance, partially related to this aspect, is to protect the rights of an illegally born child.

Ethical objections are heightened when the desire goes beyond such a socially approved position. And then it doesn't matter whether one of the parents or a homosexual couple expresses the desire to have a child. In any case, the desire is satisfied at the cost of the child. It should be noted that the supporting function of the social context is ignored; the child is deprived of protection.
This is observed if a woman, due to old age, partially or completely loses the ability to fulfill parental responsibilities. Parents exist for the child, not the child for the parents. This fundamental principle must be taken into account in each case.

Artificial insemination with donor sperm will continue to cause negative attitudes, as it is associated with insurmountable difficulties. Accusations of resemblance to "adultery" can be avoided, since this concept contains an element of betrayal on the part of the individual, and betrayal is not always applicable to a situation of artificial insemination. This limitation does not allow us to completely overcome all the counter-arguments presented above. They are born as a result of the separation of two concepts - the genetic and legal parent. From the point of view of the process of the birth of a child, the bodily and spiritual aspects of the relationship are separated, in connection with which there is a danger of introducing dualistic anthropology.

Undoubtedly, the child is faced with the problem of genetic identity uncertainty.
Does this lead to the formation of a subconscious fear of losing the sense of belonging to the family? Ultimately, the individual's self-awareness depends on knowledge of his own origin. It would be unfair to deny an individual the satisfaction of such a legal requirement, and society also experiences the negative consequences of such a refusal. In their perfectly understandable desire to have children, spouses should not ignore the social responsibility that is imposed on them at the birth of a child: the price for satisfying this desire is a complete loss of a sense of harmony.

The concept of adoption, which is actualized when discussing this issue, seems to be nothing more than a semantic trick. This concept provides for a completely opposite interpretation of the original concept: the child's complete loss of the opportunity to have true parents is interpreted as giving the child to an infertile couple. In such a situation, spouses should ask themselves the following question: is adoption in its classical understanding a full-fledged alternative to the desire to have a child of their own? Moreover, spouses can simply come to terms with the fate of an infertile couple.
Moreover, this approach helps to strengthen the marital relationship and release energy, which provides a closer and stronger interpersonal relationship that goes beyond the intimate aspects of marriage.

Reproductive medicine contains an open contradiction to the classical teaching of the church. This contradiction concerns the basic anthropology of the sexual act, first of all - the problem of the inseparability of its two symbolic meanings. For a long time, this problem has been the subject of ethical discussion, and in the scholarly circles of the church, a separate aspect of it, the responsibility of parents, is already being discussed. The question is: does the process of procreation, isolated from the dual meaning of sexual intercourse (which happens when using reproductive techniques aimed at eliminating the oppression of infertility), deserve such a condemnation? Does the understanding of the relationship between the expression of conjugal love and the willingness to artificial insemination become too limited if the phenomenological nature of intercourse becomes the main focus of the discussion?

One can state the belated establishment of the necessary differences in concepts as a result of theological ethical discussions. These discussions were aimed at formulating a more flexible interpretation of human activity itself. The notion of the exclusiveness of sexual intercourse is undoubtedly an important indicator, but in no way is it a criterion for its moral assessment. The latter requires taking into account all the variety of factors and circumstances. If spouses consciously agree with the potential consequences of artificial reproduction as a satisfaction of the desire to have children, then their decision should certainly be considered as a valid expression of conjugal love. The official teaching unites the two meanings of the sexual act, while the technical separation becomes a counterbalance to this desire for unification. Moral assessments of reproductive technology must take this into account. The interpretation of reproductive techniques as a technological threat to one of the most spontaneous human acts seems inadequate to the real state of affairs.

Caring for psychosocial well-being
The main goal of reproductive medicine institutions is the well-being of the child. At the same time, psychological and social factors must also be taken into account. One of them is the freedom of partners in deciding to seek help from a reproduction institute: spouses should not undergo reproductive procedures due to emotional or psychological pressure of any kind, otherwise the risk of negative consequences for the child will undoubtedly increase. Therefore, it is imperative that spouses carefully assess the possibility and adequacy of alternative solutions to the problem. Partners who can unbiasedly assess all possible alternatives develop a fuller understanding of their own desires for offspring and parental feelings.

In this regard, the advice of a qualified psychologist is very helpful, especially if infertility threatens the integrity of the marriage. In such a situation, the appearance of a child cannot completely solve the problem, especially since there is a danger of a sublimated, but quite real, disdainful attitude towards him. The latter, in turn, can have a negative impact on the subsequent development of the child. It is possible that expectations in a sublimated form are directed towards a child who, even with all possible efforts, will not be able to fully satisfy them. The undesirable consequences of such misconceptions can be seen in all aspects of the marriage relationship. A child will never become a "therapy" for an unstable relationship between spouses. Therefore, options should be considered at a deeper level; the satisfaction of the desire to have a child may well appear in a number of different ways spouses avoid the need for deeper emotional or psychological therapy. Nothing can replace such therapy in correcting emotional or psychological distress.

The moral assessment of surrogacy in its various manifestations is easier and does not require in-depth consideration of the problem. Pregnancy is not limited to physiological processes and, of course, should not be commercialized. A deep and intimate bond is established between a pregnant woman and an unborn child. This relationship cannot be broken off by a simple agreement immediately after childbirth without overtly violent methods. Moreover, one cannot ignore the fact that the resolution of possible conflicts due to such a gap becomes extremely difficult. Who should decide when there is a high risk of complicated pregnancy? Can the adoptive mother be fully responsible or is the genetic mother also entitled to participate in the decision-making and, if so, what is the extent of her involvement? Is it possible to foresee the potential risk by fixing the right of refusal in the contract form? Is it possible to formalize such a contract legally? In this regard, insoluble conflicts arise in relation to a child who, being involved in a situation, is completely deprived of the right to vote. Therefore, the moral aspects of the problem undoubtedly require further clarification.

Bodily integrity of the embryo
The logic of protecting human life is tied to the assessment of the embryo as a person. Responsibility for helping a weak and sick fetus depends on this statement. An ethical solution to the issue indicates, first of all, the responsibility of the doctor using the reproductive technique, as well as the biologist. This decision returns to the need for careful consideration of the term "logic". This means that the obligation to protect human life remains qualitatively unchanged at all stages of human development, since we are talking about what is called equal rights to life and protection from physical harm. The protection of life cannot be ranked - this would mean a gross violation of the logical meaning of the discussed concepts.

Many conclusions follow from the central thesis, all of which require further development... The encyclical "Evangelium vitae" discusses the problem of a "spare" embryo, which is assessed as a threat to the devaluation of the value of human life and the transformation of a person into an object for manipulation. Today it can be argued that advances in medical technology obviate the need for such interpretation. The requirement to transfer, if possible, all embryos created in vitro into the female body can be fulfilled, and therefore such concerns are allayed. It goes without saying that spouses must be prepared to accept multiple pregnancies should they occur. It is unacceptable to provoke at first dangerous situation, and then avoid its consequences, especially at the cost of violating indisputable human rights. No one has the right to deliberately deny an embryo the right to survive, even if the embryo created by "in vitro" technology is to receive a qualitative assessment. From the point of view of the obligation to maintain life, this criterion is of greatest importance. Determining the level of accuracy for assessing the potential survival of the embryo is a practical problem. The guiding principle when in doubt about viability is to give the embryo a chance.

In the most accurate definition, the category "personality" can be used in relation to the embryo, even at the very first stages of its formation. Thus, the embryo gains independence and, therefore, the refusal to experiment with human material is justified. The concept of the individual has never been limited to the exclusive means of achieving the ultimate goal of independence from one's own "I". This version of the categorical imperative determines the activity of researchers who share the anthropological premises mentioned above. The right to take root in the bodily integrity of the embryo in the early stages of its development should be considered precisely in this aspect. Intentional violation or ignorance of the bodily integrity of the embryo is unacceptable, since in this case the child, regardless of his condition - the first one affected by the therapy process - completely loses its significance as an absolute priority in achieving the set goal. The unambiguity of such a position can determine strict restrictions on the activities of the researcher, so one cannot speak of an individual's acceptance of a possible risk if the individual does not express free and informed consent. Undoubtedly, the position of the embryo in this aspect remains the weakest and most vulnerable.

This is followed by a conclusion about the inadmissibility of genetic manipulation of the embryo. This claim is based on the concept of the right to genuine genetic inheritance, which is directly related to the potential for treatment of the embryo. In this regard, not only the consequences of such studies are touched upon, but also the need to protect against dangerous eugenic views. Manipulations previously performed on embryonic material, such as mixing sperm from different donors, are becoming the subject of similar concerns. If such a method is the only way to avoid the transmission of genetic defects, spouses must decide for themselves whether the price for their own offspring is too high. Obviously, this reasoning also applies to the donor gametes.

It can be argued that the absolute genetic identity cannot be fully verified, and medical technologies only speed up the natural process and nothing more. Such an objection does not seem convincing, since the alleged risk is not only deliberately provoked, but also precipitated. The question of the validity of similar concerns in cases of sex determination based on eugenic indications remains open, since it is difficult to agree with the opinion about the harm to the embryo due to such procedures. A specification of any kind - subject to stringent constraints - must take into account the uncertain danger of an uncontrolled breach of the safety barrier.

Another aspect is the expanding application of the microinjection technique (intracytoplasmic sperm injections; ICSI) in cases of male infertility. It can be assumed that the procedure is manipulative: the doctor randomly selects sperm cells and injects them into the egg, whereas in natural conditions it is impossible to control which of the many incoming sperm will reach the egg. This fear is unfounded, since the selection is not purposeful. Moreover, if this were possible, then such assistance in natural conditions would only be beneficial in achieving this goal, since it could help increase the chances of pregnancy. This would prevent congenital anomalies without breaking the law and accusing them from the standpoint of the naturalistic concept of the individual with the corresponding eugenic views. Such procedures could also contribute to the abandonment of heterogeneous insemination, and none of the manipulative use of these procedures can discredit their adequate and legitimate application.

Responsibility for bodily integrity includes the obligation to minimize the risk to life as much as possible. The medical researcher and clinician work with natural material that is not only available for empirical scientific evaluation; they also bring additional insights into the data that go beyond the empirical indicators and humanize them. The criterion for making a decision is not Nature itself, but the original concept of the individual. It is in this perspective that the problems of risk to life, which necessarily arise, are solved. Therefore, it can be considered fully justified not to freeze fertilized eggs (cryogenic canning) - except for the pronuclear stage - due to the disproportionately high risk to the well-being of the unborn child. It is impossible to completely prevent all risk factors: from this point of view, Nature itself is indicative, which is always ambivalent and constantly associated with risk. Theological morality accepts this: its mental categories cannot and do not hide the obvious facts of reality.

Bioethics

Bioethics is closely related to environmental ethics, sometimes they are identified. Bioethics can be viewed as a new, original direction in ethics, associated with major discoveries in biology, leading to a change and clarification of such fundamental concepts as personality, life, death. The revolution in biology entailed problems that have always been the greatest mystery: these are the issues of the birth of a new life, the concept of erotic love and childbirth, the problem of attitudes towards death and understanding of life itself.

Humanity is currently ready to subordinate the living forces of nature to its control, but at the same time it goes beyond the limits of traditional moral values. The task of bioethics is to determine the boundaries of the use of new instruments of life and death, to protect human rights from the "games of reason" associated with intellectual self-confidence, excessive ambitions and commercial interests of the "servants" of science.

The main research areas of the biological nature of man: behavior modification using "shock therapy", genetic engineering, surrogacy, cloning, ethics of abortion, organ transplantation, sale of children, sex change, artificial life extension, euthanasia.

The emergence of bioethics should date back to 1965, when the Institute for the Study of Social Ethics and Life Sciences was opened in the United States in Hastington (Hastington Center), where they began to conduct active biological research related to the problems of life and death. Since these studies raised many ethical issues that require special consideration, this moment can be considered the moment of the emergence of bioethics.

One of the first directions that identified new problems and had very far-reaching consequences - behavior modification (Behavior Modification), known in the United States as "brainwashing", but in our country as "zombie". The first experiments consisted in the fact that electrodes were sewn into the subject's brain and an electric current was passed through them at the right moment in order to influence the change in the subject's behavior in the desired direction. Thus, along with other values, the moral autonomy of the individual was destroyed, and the very concept of the personality as an autonomous subject, or a free individual, changed. These programs were effective in the treatment of mental disorders, they helped the mentally ill in carrying out externally rational actions that did not involve independent thinking. Nowadays, the most widely used method of behavior change with the help of "shock therapy", carried out by the media, including advertising. "Shock therapy" today has a powerful psychological impact, causing stress, doubt in generally recognized cultural values, frustration.

The subject of bioethics includes various areas of research related to issues of life and death, organ transplantation, the use of animal organs, as well as questions of health or the right to refuse medical care for religious or cultural reasons. Some consider bioethics as including all the problems of the relationship between medicine and biology, others reduce it to the ethical aspects of the application of new technological innovations in the treatment of people.

The broadest interpretation connects the subject of bioethics with the ethical assessment of any actions that may harm living organisms, i.e. those who are capable of experiencing fear.

Moral dilemmas of bioethics

The most complex and controversial issues of bioethics are associated with the problem of death: euthanasia, abortion, organ transplantation, and attitude towards defective newborns.

The dilemma of euthanasia ("good" death ). Can death be good? This refers to an easy, painless death, death like falling asleep. There are two types of euthanasia: active (actions that contribute to a quick and painless dying) and passive (refusal of treatment, failure to provide timely necessary medicine, etc.). Active euthanasia of terminally ill and suffering people is carried out in hospices - special hospitals.

Euthanasia can also be voluntary or involuntary. Involuntary euthanasia is equal to murder, voluntary - to suicide. How to treat euthanasia? There are strong arguments in favor of euthanasia (the main one is to alleviate the suffering of hopelessly sick people), but no less weighty are the arguments against euthanasia (they are associated, firstly, with significant changes in the doctor's image, and secondly, with the known facts when terminally ill people recovered). Different countries and cultures deal with this dilemma differently.

The problem of determining the moment of death. The emergence of effective life-supporting technologies (for example, a ventilator) has revealed a problem: how long should a patient's life be prolonged, in particular if his consciousness is irretrievably lost. This situation can create a conflict of interest between doctors (who diagnosed brain death) and the patient's relatives who believe they are alive. Patient representatives, for example, may insist on the continuation of life-sustaining treatment that doctors believe is futile; or, on the contrary, patients (their representatives) may demand the termination of medical procedures, which they consider degrading the dignity of the dying person. Is this person alive and what is a living person, and even more broadly - a living being? There is no clarity on these issues. Lawyers make their own clarification: anyone who arbitrarily takes on the role of a murderer, even if he is guided by mercy and compassion, wanting to save from unnecessary suffering, is subject to punishment. Such situations have led to a revision of the criteria for determining the moment of death. In addition to the traditional criteria - irreversible cessation of breathing and (or) blood circulation, which can now be artificially maintained - the criterion of brain death has been applied. The death of the brain means that the patient has lost the ability to think and feel, he cannot think and understand, cry, rejoice. In the Netherlands, a law was passed in 1992 giving patients the right to discontinue life-prolonging treatment. For this it is necessary that: 1) the patient is mentally sane; 2) experienced pain and repeatedly demanded euthanasia; 3) his attending physician consulted with another physician regarding his condition. Thus, the right to death was legalized. In 2002, such a law was adopted in Belgium. The right to die speaks of the fear of such a vegetative existence that degrades human dignity. Not death, but this existence is considered as the most terrible thing that can happen to a person - this is the loss of himself, the loss of his own dignity.

Dilemmas of transplantation. Organ transplantation involves taking them from a donor who has been diagnosed as having brain death; at the same time, the less time has passed since the moment of death, the higher the probability of successful transplantation. In this regard, fears began to arise in society that the extension of the recipient's life could be provided at the cost of accelerating (or hasty ascertaining) the donor's death. As a reaction to these fears, the norm was adopted - brain death should be ascertained by a medical team independent of those involved in the procurement and transplantation of organs. However, in some countries, organ transplants are prohibited (in Muslim countries and in Japan) because they believe that murder is taking place. The need for donors is becoming more and more acute. In this regard, the question arises: is not advanced science moving towards anthropophagy? And shouldn't ethics provide a compelling alternative to this process?

Dilemmas of artificial human reproduction, including in vitro fertilization and surrogacy. For example, the Russian Orthodox Church is very actively opposed to IVF, considering this procedure very dangerous for the health of the mother, as well as inhumane, since it involves manipulating human embryos, some of which are doomed to death. As a result, the problem of establishing criteria for accurately determining the beginning of human life as the moment at which the developing organism is considered by both doctors and future parents as a moral subject becomes relevant and far from the generally accepted solution. No less complex contradictions leading to revolutionary transformations of the traditional family arise in connection with the expanding practice of surrogacy.

As a result of these practices, traditional relationships between parents and children, between a man and a woman (artificial insemination, surrogacy, same-sex marriage) are destroyed. A blow is being struck at the most fundamental beliefs and values \u200b\u200bthat underlie all cultures that have existed until now.

The problem of using stem cells for research and therapeutic purposes, especially embryonic stem cells. On the one hand, the use of such cells removed from embryos is especially convenient and promising from the point of view of researchers; on the other hand, viable human embryos have to be killed to obtain them.

The problem of genetic improvement of human nature. Genetic engineering, gene diagnostics can act not only as gene therapy aimed at curing genetically determined pathologies of the body, but also for "improving" a person (the so-called liberal eugenics). The possible risks associated with the creation and spread of genetically modified organisms - viruses, bacteria, plants and animals - in the environment remain unclear.

Is it possible for the sake of science to conduct experiments on humans? This issue received an unequivocally negative decision in all countries, which was reflected in the Nuremberg Code of Ethics (1948). An ethical review mechanism has been developed to protect test subjects research project... Another mechanism designed to protect the health, rights and dignity of patients is the informed consent of the subject. Any research can be carried out only after competent, voluntary, informed and explicit consent has been obtained from the subject. The subject in a form understandable to him is provided with the necessary information about the objectives of the study; about possible benefits and the risks associated with his participation in research; about alternative methods of diagnosis or treatment (as long as the subject is a patient, and the research is aimed at testing a new method of diagnosis or treatment), as well as his right to terminate his participation in the research at any time. At present, the norm of informed consent is applied in carrying out any medical intervention in general, carried out not only for research, but also for therapeutic purposes. All deviations from this norm (the consent of not the patient or the subject himself, but his representatives when he is incompetent; intervention without consent in an emergency, etc.) are also ethically and legally regulated.

The cloning dilemma. Sharp discussions, and then the adoption of political and legal documents to ban cloning, gave rise to the appearance in 1997 of the first cloned animal - Dolly the sheep. In this regard, the object of regulation is the possible application of cloning technologies to humans. Opponents of cloning believe that such experiments are ethically unacceptable, since the patient (future clones) did not consent to the experiment, and if we put ourselves in the shoes of these people, then the answer to the question of whether we want to be in their place will be far from unambiguous ... Many people would not like to be clones. It is not clear how the behavior of the clone humans will change.

Proponents of cloning argue that the development of science should not be stopped, especially since we do not yet know all the possible prospects that may be associated with cloning. Nevertheless, almost all countries of the world (with the exception of China) have signed a ban on experiments on human cloning.

An insoluble contradiction between proponents of modern biotechnology and opponents. The more power a person acquires as a result of the development of biotechnology, the more dangers arise both for his existence (environmental, demographic, medical problems) and for his essence. Some of the latest advances in medicine (for example, new reproductive technologies), which have a good goal - the reconstruction of health, lead to the destruction of humans as a biological species. In this area (as in many others), a person fell into a situation of sliding down an inclined plane with the risk of falling into the abyss: creating unprecedented benefits and methods of protection, scientific advances increase dangers, create new threats and risks, multiplying the degree and scale of the new possible evil. This applies to geneticists modeling genetically modified objects, to doctors trying to influence heredity, neuroscientists creating happiness pills, programmers modeling a human cyborg.

What will the person of the future be like? This question has become a moral dilemma today. Modern high-tech medicine creates more and more opportunities for "improving" human nature, but they cause side effects in the form of degradation of natural abilities, when instead of one simple problem, several much more complex ones arise (the effect of a severed dragon's head). PD Tishchenko showed on the material of reproductive medicine that biological reconstruction leads to deconstruction and destruction. Genetic experiments lead to such changes in human corporeality, as a result of which what F. Fukuyama warns about: "We will mix human genes with genes of so many species that we will no longer understand what a person is," they also lead to transformations in human relations, "we may find ourselves on the other side of the barrier between human and posthuman history and not even see when we have crossed the divide, because we will no longer understand what it is about."

Humanity can lose many moral values \u200b\u200band moral feelings, finding itself "on the other side of good and evil", in an unpredictable and dangerous world. Already now we can talk about a "new revaluation of values", as a result of which humanity, love, cordiality, loyalty and family ties become redundant. If earlier children were born as a result intimate relationships men and women, bound by love, emotional affection, tenderness and respect for each other, today children can be born to order, like pies in a dining room.

Genetic transformations carried out by modern medicine pose a threat to the devaluation of the human body and life itself, the threat of human transformation into biomass. In the context of these threats, risks and new dangers, modern bioethics and environmental ethics are developing, posing the problem of protecting a person, his rights and freedoms, as well as limiting strategies for manipulating his body.

Biomedical Ethics - Tutorial (Aseeva I.A.)

Lesson 6.New reproductive technologies: humanitarian expertise

Ethical aspects of artificial insemination.

In Vitro Fertilization and Moral Issues.

Moral dilemmas of surrogacy.

Religion and problems of human reproduction.

Literature

Bartko A.N., Mikhailova E.L. Biomedical ethics: theory, principles and problems. Part 2. M., 1996.

Bioethics: problems, difficulties, prospects / Materials of the "round table" // Problems of Philosophy. 1992, no. 10; Philosophy questions. 1994, no. 3.

Vlasov V.V. Fundamentals of Modern Bioethics. Saratov, 1998.S. 55-66.

Ivanyushkin A.Ya. and other Introduction to bioethics. M., 1998.S. 222-241.

Siluyanova I.V. Bioethics in Russia: values \u200b\u200band laws. M., 1997.S. 105-122.

Topics of essays and reports

Artificial insemination: pros and cons for a person, family, society.

The consequences of in vitro fertilization for the health of children.

Psychological problems of surrogacy.

Religion's attitude to new reproductive technologies.

Ethical aspects of artificial insemination

New technologies of human birth are among the most discussed problems of bioethics. Each of them generates its own block of medical, legal, ethical issues, most of which do not have a generally accepted solution. The main point in the debate is the definition of the period at which the embryo can be considered a creature with all human rights. As a rule, the following options are offered: the moment of fusion of male and female germ cells; 14th day intrauterine development - the beginning of the formation of the primary strip, elements of the nervous system; 30th day - the beginning of differentiation of the central nervous system; 7-8 weeks, when the embryo begins to respond to irritation; 30th week - the beginning of brain activity. Each of these milestones is substantiated by rather serious argumentation, as a boundary of a person's formation.

Controversial moral and ethical issues: the legal status of the human embryo; the competence and permissible limits of manipulations with sex cells and human embryos for medical, medical and research purposes. The problems of donor and recipient anonymity are widely discussed in the literature; the ability to obtain information about the donor and recipient; parental rights of donors of germ cells and embryos; the right of adult children to have information about the "biological father".

Human reproduction technologies are as follows:

artificial insemination - artificial insemination with the sperm of a husband or donor;

in vitro fertilization - fertilization outside the body with subsequent transfer of the embryo into the woman's uterus;

"Surrogacy" - the egg of one woman is fertilized outside the body, and then the embryo is transferred into the uterus of another woman for gestation.

In vitro fertilization can be homologous, the sperm of the husband, and heterologous, the sperm of the donor. The same classification applies to the ovum. With homologous fertilization, the egg is implanted in the woman from whom it was taken, with heterologous - in another woman.

Homologous fertilization with successful development of the fetus does not give rise to special problems. Since biological and social parents are the same, there is no conflict with the traditional moral principles of family relations.

Heterologous fertilization, on the other hand, raises many complex questions that require ethical analysis and the development of certain legal norms.

The donation of genetic material is significantly different in status and consequences from the usual blood donation, which is unconditionally recognized as moral. There are opposite opinions regarding sperm and egg donation. On the one hand, any donation in medicine is considered an act of charity. In this case, barren families acquire the meaning of life and happiness - they have children. It is beneficial for society as well. As a solution to the problem, it seems rational to offer to extend laws on blood and organ donation to gamete donation. The World Medical Association could act as an initiator by adopting a special decree. In this case, gamete donation would acquire the status of therapeutic assistance and, as a natural consequence, would become free and anonymous.

On the other hand, one cannot ignore the arguments of the opponents of this type of donation, they may have rational aspects. Artificial insemination, they believe, is an irresponsible attitude to the highest gift of every healthy person - to participate in the creation and prolongation of life. This is a way to deceive nature, to hide your physical inadequacy. This is dangerous for society and future generations, because it is impossible to guarantee to prevent the participation of persons with mental, sexual, hereditary defects.

The most thought-out scheme for donating genetic material is as follows: only men with children can become donors; artificial insemination is carried out only for medical reasons and only for heterosexual couples; all donors are screened for sexually transmitted diseases. A genetic analysis of gametes is mandatory to establish possible chromosomal diseases. These rules actually apply in some European countries. The solution to many of the problems associated with sperm donation is complicated by the lack of legal and moral status of gametes.

In Vitro Fertilization and Moral Issues

Among new reproductive technologies, a special place is occupied by in vitro fertilization with embryo transfer. The indication for use is the absolute infertility of a woman. The scale of the problem is indicated by the numbers - in Russia, approximately 3 million women of childbearing age suffer from absolute infertility.

Almost every stage of the IVF method requires solving complex moral problems. Is manipulation of human gametes permissible in principle? What is the status of the embryo? Is gender choice justified? How to deal with excess fertilized eggs? Can “extra embryos” become donation material, an object of scientific research? A number of these and similar issues continue to be actively discussed, some have been resolved by law and in the resolutions of V.M.

So in the "Regulations on in vitro fertilization and embryo transplantation", adopted by V.М.А. in 1987 it is said that the use of IVF is justified when other methods of fertility treatment are ineffective. This method 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. From an ethical standpoint, the IVF method is justified, because it realizes the inalienable right of a woman to be a mother, to have a child.

And, nevertheless, comprehensively and objectively analyzing the problems of new reproductive technologies, one cannot fail to note the grave negative consequences of their use. Examination of children born as a result of in vitro fertilization and artificial insemination forced specialists to draw the following very serious conclusion: "Each of the methods of artificial insemination increases the risk of perinatal pathology and severe neurological disability from childhood."

Moral dilemmas of surrogacy

The legal and ethical difficulties of surrogate motherhood clearly demonstrate the following fact: a child born in this way may have 5 parents: 3 biological (male sperm donor, female egg donor, female womb donor) and 2 social (who made the order). In addition, the need for social control at each stage of surrogacy is dictated by the danger of the commercialization of childbirth. Unfortunately, in Russian legislation, there is no legal regulation of any problems of surrogacy.

In the context of democratization and the expansion of human rights, the desire of representatives of sexual minorities to have children acquires a specific relevance and need for discussion.

Religion and problems of human reproduction

The Church also defines its attitude to new reproductive technologies. For Catholicism, there is no subject for discussion, the situation is initially clear. Proceeding from the traditional for Catholics concept, unbroken natural law, the attitude towards artificial insemination is negative.

In Orthodoxy, the consideration of the problems generated by new reproductive technologies is much more differentiated. Artificial insemination of an unmarried woman is condemned based on the interests of the child, because he is deprived of the opportunity to be raised in a full-fledged family and the father is unknown. Artificial insemination of a married woman without the consent of her husband is unacceptable, since lying destroys the bonds of marriage. With the consent of the husband, some church leaders consider this procedure possible. Others consider it unacceptable for any conception outside of natural sexual intercourse. Fertilization with donor sperm is a particularly serious objection: alien intrusion into the marriage relationship destroys marital fidelity.

However, some reputable theologians consider artificial insemination to be quite an appropriate way to use medical knowledge, which allows Christian marriage to realize one of the main goals of procreation.

As for surrogate motherhood, the Christian religion is completely unanimous in its condemnation of this innovation, and the arguments are serious. The application of this method neglects the deepest, ancient spiritual, emotional connection that arises between the mother and the baby from the moment of conception. Indeed, the implications of this gap have not yet been fully explored. And another argument - a child born to a surrogate mother is doomed to an identity crisis, who is his real mother.

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On the topic: Moral and ethical aspects of new reproductive technologies.

Introduction:

In vitro fertilization is one of the most pressing problems of modern biomedical technologies. This method allows you to give the joy of motherhood to women who were doomed to infertility before its appearance. He appeared in 1978 at the Bourne Hall Clinic (Cambridge, England). The physician R. Edwards and the embryologist P. Stepto managed to combine the egg with the sperm in a test tube. An embryo appeared, which was transferred into the uterine cavity of a woman suffering from absolute infertility. The development of pregnancy was practically no different from the usual case, and nine months later a girl was born, who was named Louise Brown. A new era has begun in the treatment of infertility.

Artificial insemination is a treatment for infertility of both male and female. They are based on three approaches. The first is the artificial insemination of a woman with the sperm of her husband or donor. Then, in vitro fertilization of an in vitro oocyte obtained from a woman after hormonal stimulation, followed by transfer (transplantation) of a developing embryo into the womb. And, finally, bearing an embryo (fetus) by the so-called "surrogate mother".

Human Cloning - To date, the question of whether our nation will be allowed or prohibited from using cloning technology to produce offspring as a result of public comment remains open. In this regard, time is our ally, as it will allow new data to be collected from animal experiments that will provide a basis for assessing the safety and effectiveness of this procedure in humans, as well as more fully discussing ethical and social issues at a national level.

Main part:

IVF ethical issues

IVF is not a natural (artificial) method of conception. Many world religions believe that the IVF method violates human rights and, accordingly, is unacceptable for the believer.

So, according to its "Social Concept", the Russian Orthodox Church disapproves of methods of treating infertility, in which the death of embryos occurs, as well as the use of someone else's eggs or a surrogate mother.

“The use of donor material undermines the foundations of family relationships, since it presupposes that the child, in addition to 'social', also has so-called biological parents. “Surrogate motherhood”, that is, bearing a fertilized egg by a woman who returns the child to “customers” after giving birth, is unnatural and morally unacceptable ... ”1

However, the fertilization of the wife's egg with the husband's sperm is considered by the ROC to be quite acceptable.

The Catholic Church is more strict about IVF and does not recognize reproductive technologies in any way.

According to the encyclical Humanae vitae II: "artificial insemination is contrary to the unity of the marriage union, the dignity of the spouses, the parental vocation and the right of the child to be conceived and produced in marriage and as a result of this marriage" 2

Among followers of Buddhism, there is no single point of view on IVF. The traditional sangha considers it unacceptable, while some schools welcome the idea that women can become mothers through it. 3

The main ethical issues associated with IVF:

Dissociation of conception

According to the views of most religions, IVF disrupts the normal course of conception. In this case, sexual intercourse is replaced by technical actions. Sperm is obtained through masturbation, which is considered a sin in many religions. Sexual intercourse and fertilization are separated in time, and parents are not even present when their child is conceived.

All this transforms the child in the eyes of believers from a gift from God into a thing obtained by technical actions. It is made “to order”, and in case of discrepancy it can always be “reduced” (deleted) on time.

Violation of the rights of the child

It is not parents who are involved in conceiving a child, but a medical worker, 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 its right to life. The child becomes the subject of a contract and sale.

Mother's rights violation

In the case of using a surrogate mother, she is deprived of her natural right to raise and educate a child born in the womb and born by her. There is a gross violation of the natural law: the one who gave birth is the mother. It turns out that you can bear 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 gives rise to concepts such as biological and genetic parents. This is a violation of the natural course of things and the family. The use of donated eggs and sperm is actually considered adultery in marriage, which is religiously unacceptable.

The embryo problem

The IVF process neglects the embryo's natural right to life as a little man at an early stage of development. With IVF, a better embryo is inevitably selected for transplantation into the uterus. Excess embryos, especially if they are “low quality”, are destroyed, regardless of their chromosome set and viability.

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

Ethical issues in artificial insemination

Are the questions asked by many ethical: the early embryo is the beginning of life or the beginning of the life of a person, an individual? Is the early embryo a mass of undifferentiated cells or a soul? Can biological criteria be applied to the concept of the soul, or is it the concept of morality, ethics? If life is sacred, then the moral dilemma of determining the status of a human embryo is hopeless. It is known that at the two and four-cell stage, blastomeres are pluripotent (each blastomere is capable of developing independently into an embryo and is totipotent (each of the blastomeres has the ability to become either an embryo or an extraembryonic tissue). It is known that monozygous twins can develop from one blastomere that is split into 2 blastomeres, fertilized, egg, each blastomere from which enters the embryo on its own development.

Is the conception of an embryo a case of many random or unrealized possibilities (due to natural selection at the level of gametes, zygotes, embryos, etc., discussed above) or a gift from God (the dogma of predestination)? Is it ethical to discuss the human embryo's right to life and not talk about protecting the animal's right to life? When discussing the medico-biological, moral and ethical aspects of determining the limiting age of the embryo acceptable for use in an experiment, the world's leading embryologists usually call the period from the moment of fertilization (zygote stage) to the 14th day of development (before the formation of the primary stripe and the appearance of elements of the nervous system) or until the 30th day of development (the beginning of differentiation of brain structures). It is noted that the human embryo in the in vitro system is not a legal entity

has no protection. The embryo is a public object belonging to the suppliers of gametes, and they (or their heirs) decide the fate of the embryo, although one cannot speak of ordinary, in the conventional sense, property. L. Butnefelder believes that the beginning of life, like its end, cannot be regarded as a point (moment) in time, but as a process. The need to distinguish between the genetic uniqueness of the embryo (from the zygote stage) and ontogenetic individuality when the primary stripe appears is emphasized.

Most of the specialists participating in the discussion of this problem are physicians, biologists, philosophers, sociologists, lawyers, given the impossibility at present to resolve the issue of the status of the human embryo and the impossibility (inexpediency?) To stop the use of ART and some aspects of biotechnology (animal cloning, etc.) but not a person), take a moderate position. According to the latter, the beginning of life is based on the nature of successive biological processes, and the protection of the human embryo is relative to the degree of its development.

The main theses of this position are as follows:

1) the sperm and the egg are living organisms of high complexity, and fertilization leads to the development of a new living organism of even greater complexity.

2) the differences between gametes and embryos are rather in degree (complexity) than in principle (of their construction); fertilization does not create a drastic change forcing to ascribe an absolute value or an unconditional right (for example, to life) to the egg from the moment of fertilization,

3) the pre-embryo deserves protection, which does not imply an absolute right to life.

4) the embryo has the right to life, but this right can be denied in certain, but strictly reasoned situations (late abortions, etc.)

5) ethically acceptable in vitro studies on embryos up to the 14th day after fertilization.

Let us briefly consider the arguments in favor of this gradualistic position, formulated in the report of Professor G. Hermeren:

o physiological - the pre-embryo does not have a brain and nervous system, no personality characteristics: self-awareness, rationality, a sense of morality, autonomy, etc.

o psychological - the ability to feel pleasure and pain, appearance and properties, opportunities develop in the embryo (fetus) gradually.

Individuality - fertilization does not mean the formation of an individuality yet, several individuals can develop from a zygote. What criteria can be used to assert that a fertilized egg and a child born (from it) are the same individual? The probability of the formation of a new personality is very small due to the large number of situations that are introduced into this process, and it decreases as development progresses. Due to advances in knowledge, including biological knowledge, standards of ethical rules may change, including regarding the status of the embryo. There is a gradual decrease in the dependence of the embryo on the mother, a certain increase in its autonomy as the pregnancy progresses. The argument of succession is genetic, but with the inclusion and exclusion of certain links (regulation) and the possible occurrence of mutations. The argument is genetic: variations at the genetic level in alleles or products of gene expression make it difficult to define an entity as a genetically human being. The argument of interests is the physiological conditions of development for the embryo and fetus, which may not coincide with the plans of the mother. IVF Arguments: There are important differences between in vitro and invivo embryo development, such as the inability to form a primary streak in vitro. The scientific value of in vitro studies on embryos (up to the 14th day of development) is beyond doubt, etc.

These and many other issues are widely discussed in many countries. The problems of biomedical ethics in reproduction and, first of all, about the status of the embryo are just beginning to rise in our country.

A wide discussion with the involvement of physicians and biologists, philosophers and sociologists, lawyers and theologians of the problem of the status of a human embryo, held in the world in recent years, testifies to the complexity, inconsistency, today - the insolubility of the issue of determining the status of a human embryo. As noted, the definition of criteria for moral status is a philosophical problem. After that, empirical and scientific problems arise - what stage of the formation of a human embryo meets these criteria: genetic, biological, personal, interests, opportunities? It is impossible to stop the use of ART for a number of reasons, but information is accumulating about negative aspects and the need for more control over medicine and health protection of the population as a whole. This was discussed at the World Bioethics Congress (1996), on the 50th anniversary of the Nuremberg trials of fascists. There is a need for a comprehensive discussion and determination of the status of a human embryo, the creation of appropriate international rules for the effective licensing of institutions and specialists involved in ART, in the field of biotechnology, genetic engineering, and regular monitoring of their work by independent organizations. It is necessary to expand the scope of morality and observe the main thesis “do no harm”.

2. Moral and ethical aspects of preimplantation diagnosis of genetic diseases.

In recent years, methods have been developed that make it possible to diagnose the presence of chromosomal abnormalities and some gene mutations in one cell from a living human embryo during an IVF program to embryo transplantation, as well as to determine the sex of a pre-implantation embryo at the stage of 8 blastomeres in order to eliminate male embryos in the presence of X- linked diseases. Technically, such diagnostics (cytogenetic, molecular-cytogenetic, molecular-genetic, biochemical) are performed either on polar bodies isolated from oocytes during ovulation after hormonal stimulation, or on a cell separated from a cleaving embryo before its implantation. When a disease is detected, such embryos are eliminated, which helps to reduce the number of abortions and miscarriages. In addition, preimplantation diagnostics of the embryo opens up the possibility of using IVF methods in patients who are at risk of developing congenital anomalies in the offspring.

In a critical review devoted to the possibilities of preimplantation diagnosis of gene diseases through the study of enzymes, it is noted that, in addition to the need to use effective methods biopsy of cells from the embryo and the reliability of these methods, which do not disrupt implantation and subsequent development, it is necessary to possess accurate methods of biochemical diagnostics. The success of the latter depends on modern ideas about the primary gene defect leading to the disease under study, and information about the time of expression of the corresponding genes in human ontogenesis. In addition, the similarity of the enzymes of the mother and the embryo causes great difficulties in interpreting the results of such an analysis. These moments do not yet allow us to classify the approaches of preimplantation biochemical diagnosis of hereditary human diseases as promising.

In general, when discussing the problems of pre-implantation diagnostics, the authors emphasize the urgent need for research on human embryos not only to improve the IVF technique, but also for the further development of methods for identifying and overcoming genetic defects.

When conducting preimplantation diagnostics, it is suggested to follow the ethical principles formulated by the US National Commission on Medical Ethics:

o respect for the individual's right to choose one or another method of diagnosis and treatment;

o safety of the applied approaches for the patient's health;

o availability and objectivity of information on all issues of interest to the patient.

While not challenging the value of IVF and preimplantation diagnostics, some authors express concern that research and experimentation on human embryos could lead to the emergence of a new form of eugenic selection, genetic engineering and cloning in humans. The term "cloning" means obtaining identical offspring (or copies) without sexual reproduction. In principle, with a natural menstrual cycle and using the IVF technique, the reproductive efficiency of offspring is low: 30 - 40% of the number of conceptions, respectively, an average of 12% of the number of eggs with IVF. The heterogeneity (primarily genetic) of the composition of germ cells in general, and in particular of ovulated oocytes, is well known. Of the majority of ovulated oocytes, full-fledged offspring do not develop, which reflects the manifestation of natural selection at the level of gametes, zygotes, fruits, etc. Therefore, obtaining 4 identical embryos from one egg after IVF, for example, when it is split into 4 blastomeres (completely with equal potencies for development), leads to a significantly higher frequency of pregnancy. This approach has been used successfully in animal husbandry. The application of cloning techniques to humans raises numerous moral and ethical issues, which are discussed at the joint annual conference of the American Fertility Society and the Canadian Fertility and Andrology Society.

Overseas, researchers follow the American Fertility Society's Ethics Guidelines (1986) and the Society for Human Embryology and Fertilization (formerly UK Joint Voluntary Licensing Committee) guidelines for their work. These guidelines reflect the requirements for experiments on the human pre-embryo (pre-implantation, up to 14 days of development):

1) justification of the need to use the human embryo (for example, the planned information cannot be obtained in experiments on animals);

2) pre-embryos are intended for research by their donors;

3) research must meet certain ethical requirements.

It is emphasized that cloning on adults is impossible for any species. It is necessary at all levels to discuss emerging problems more broadly, to inform society about the goals of such experiments. When developing and adhering to the principles of working with human embryos and monitoring their implementation, the danger of an arbitrary choice of genetic material (sex cells, embryos, the use of blastomeres for cloning) should be completely excluded. N.P. Bochkov notes that "the proposal to use genetic engineering to 'improve' human nature on an expanded scale can never and under no circumstances be accepted ... A proposal of this kind is nothing more than an updated version of eugenics ...".

3. Moral and ethical aspects of cryopreservation of human germ cells and embryos.

No less contradictory opinions of scientists about deep freezing of embryos.

A.O. Trounson notes that with IVF, there may be more developing embryos than it is possible to transplant them to a woman at one time. The author believes that the remaining unused embryos should be cryopreserved. The use of embryo cryopreservation allows a woman to perform PE in the next ovarian cycle without stimulating oocyte ovulation with hormones. This provides a greater likelihood of the onset and development of pregnancy due to the greater physiology of the cycle.

Further improvement of the technique of freezing 4- and 8-cell human embryos that developed after IVF of ovulatory oocytes, the onset of pregnancy in women after thawing of embryos and PE indicate the success and prospects of using this approach in the treatment of infertility in humans. But at the same time, these successes give rise to many questions and problems that become the subject of wide discussion among scientists, politicians and the public.

It is emphasized that for those who consider the moment of fertilization to be the beginning of a person's life, freezing of embryos is an unacceptable action and represents an insoluble ethical problem.

Special literature discusses the fate of frozen embryos. It is possible for a married couple to refuse implantation after IVF and cryopreservation of the embryo due to changed circumstances. In such cases, the question arises for doctors: destroy the embryo or transplant it to another woman. The use of the technique of cryopreservation of human embryos creates broad prospects for embryo donation. The feasibility of such a donation is widely discussed. Some researchers believe that if there is no need for “extra” embryos during IVF, the only way out is to cryopreserve them. Such embryos should only be used for implantation purposes.

The question of the maximum shelf life of cryopreserved embryos is independent. Long periods of time make possible situations in which there is no need to transplant a given embryo to its genetic mother. It is feared that, despite the absence of a mutagenic effect of the cryopreservation process, background radiation during long-term storage of frozen embryos may induce mutations. The duration of storage in the state of cryopreservation of a human embryo is named - from 2 to 10 years.

The Voluntary Association of Experts on In Vitro Human Fertilization and Embryology at the Royal College of Obstetrics and Gynecology (UK) has developed a number of the following recommendations:

§ The length of time the embryo remains in cryopreservation should be determined by the time required to achieve a specific goal, for example, while a married couple (gamete donors) plans to carry out the next PE.

§ The issue of further storage of the cryopreserved embryo should be reviewed 2 years after the embryo is frozen, and its storage period in general should not exceed 10 years.

§ Embryos obtained from gametes of one married couple should not be used for other spouses (in order to limit the birth of children weaned from their genetic parents).

§ Unclaimed embryos (up to 14 days of development) can be used for certain scientific purposes.

§ The opinion was expressed that the duration of cryopreservation of human sex cells and embryos and their further fate are determined only by their owners.

§ All actions with embryos (including cryopreserved ones) should be under the supervision of local ethical committees and expert associations.

4. Ethical aspects of "surrogacy".

A woman who, for some reason, is not able to bear a fetus, uses another healthy woman for this purpose, in whose uterus a fertilized egg is placed. Once in the press, a message flashed that one mother, whose daughter had to amputate the uterus as a child, decided to carry her daughter's fertilized egg. For the child she was born, she was both a "surrogate" mother and a grandmother. "Surrogacy" seems to be so widespread in American life that the writers of two popular television series - "Santa Barbara" and "Dynasty" - included this problem in the plot of their works. It should be noted that the usual cost of such a procedure is at least $ 30,000-50,000, which makes it not very affordable.

As in any business, "surrogate motherhood" has its supporters and opponents. Some believe that it can be a blessing, others believe that a woman's ability to bear children should not be traded. Difficult ethical issues arise when a child with developmental disabilities or twins is born. Often the family will only accept the "good" child. There are cases when both women participating in this procedure do not feel responsible for the further fate of a child born with any pathology. Sometimes there is an asymmetry in the relationship between the adoptive mother and her husband, the biological father. In this connection, the 39th World Medical Assembly in Madrid (1987) adopted the Declaration on Artificial Insemination and Organ Transplantation.

5. The woman's right to be an egg donor and recipient.

Before the application of cryopreservation of oocytes, it was possible to transplant donor eggs left unused for the donor in the IVF program and with the consent of the donor - to another woman as fertility care. At present, the source of female germ cells for the IVF program in cases of impossibility of obtaining them from the recipient herself is the collection of oocytes with the consent of the woman during her sterilization; finding the oocyte donor by the recipient itself; obtaining oocytes from healthy women who agree to donate oocytes for altruistic motives. It is believed that in these cases, donation should be anonymous. In addition to health and age, the prerequisites for oocyte donors are the presence of at least one child and the consent of both spouses. A warning was expressed about the possibility of losing personal responsibility for the unborn child in such situations.

When discussing the moral and ethical aspects of reproductive technology, it is necessary to take into account the psychological and psychiatric problems of recipients and donors of oocytes, who often develop psychological distress. Emphasis is placed on the need to conduct appropriate and individual work of a psychiatrist with patients.

In the legal system of most countries, there is no definition of the status of donor gametes. Such gametes can be considered either as an integral part of the human body (and then they are objects of law), or they should be taken as an autonomous unit and as an independent subject of law.

As one of the options, according to foreign experts, the laws on blood donation and organ donation can be applied to gamete donors. If these laws are adopted in relation to gametes and their donation, then for donors there will be such conditions as free and donation as therapeutic assistance (which is the case in France). Legislative acts on the donation of gametes are imperfect; their further development is necessary with a broad discussion of many aspects of this problem in society: determination of the "status" of gametes; legality, regulation and nature of their use for medical and scientific purposes; gamete donation rules; society's attitude to gamete donation; relationship between legal and biological kinship in donation; bilateral anonymity of the procedure, etc.

In case of premature ovarian depletion (germ cells), in the absence of ovaries and in some other situations, the IVF program allows such women to become pregnant and bear a child using a donor egg. Ethical issues arising in such cases and legal issues are discussed. It is necessary to develop principles of germ cell donation that would minimize or prevent completely the development of commercialization in the donation of germ cells and embryos. In recent years, the world literature discusses the possibility and legality of using immature female reproductive cells from fetuses during abortion.

6. Moral and ethical problems of artificial insemination (AI).

As noted above, the solution to the problems associated with egg and sperm donation is complicated by the uncertainty of the status of gametes (regarding their donation) and, in part, an ambiguous understanding of the goals of using methods of reproductive technology.

Several approaches to the use of donor sperm have been worked out:

§ intra-cervical insemination (the most common method),

§ intrauterine insemination,

To date, there has been a noticeable progress in the development of artificial methods of insemination with the husband's sperm, improving in vitro parameters of the husband's sperm and its fertilizing ability. With retrograde ejaculation, a favorable prognosis for the onset of pregnancy was noted with intrauterine IS, and unsatisfactory results - with oligo- and asthenozoospermia. With oligospermia, it is recommended to select the most motile spermatozoa and transfer them into the uterine cavity using a transcervical catheter or into the fallopian tubes during laparoscopy. Currently, the world is increasingly using methods of micro-fertilization - fertilization with one sperm by artificially passing it through the transparent membrane of the egg (which is "drilled" mechanically or with the help of enzymes) or direct injection of the sperm into the cytoplasm of the egg (using a micromanipulator). These approaches have given birth to hope for fertility in many patients with infertility and severe astheno- or oligozoospermia. One of the developments in reproductive technology recent years are (for patients with azoospermia due to non-reconstructive obstruction of the reproductive tract) micro-puncture and collection of sperm from the epididymis or testicle, followed by the introduction of sperm or haploid spermatid into the spouse's egg and transplantation into the uterus. The following problems are widely discussed in the literature: anonymity of the donor and recipients; the opportunity for couples who have used donor sperm to obtain information about the donor; parental rights of germ cell donors and embryos; the right of adult children to have information about the "biological father"; age limit for sperm donation.

In France, there are more than 20 AI centers, united in the Federation for the research of cryopreservation of eggs and sperm. Semen selection is guided by the following principles:

1) only men with children can become donors;

2) AI is carried out for medical reasons;

3) AI is carried out only for heterosexual couples;

4) all donors are screened for sexually transmitted diseases.

A number of indicators have been added to this list, obtained as a result of the analysis of the genetic aspects of gamete donation (carried out by the Federation's Genetic Commission since 1983): the type of inheritance of the identified genetic disease, the absence of chromosomal abnormalities, the timing of disease expression, penetrance, etc. For example, 3.2 % of male donors and 2% of female donors were “rejected” based on the results of genetic screening.

Such a system for examining gamete donors can become an example and a mandatory system when organizing AI centers in Russia. At the present time, one can note an unsatisfactory, incomplete examination of gamete donors in our country.

7. Ethical aspect in choosing the sex of the child.

Many researchers and public organizations do not recommend that specialists positively decide on the choice of the sex of the child without a medical indication (for example, the presence in the family of a disease associated with sex - Duchenne myodystrophy, X-linked mental retardation and etc.). Free choice of the sex of the child can lead to a change in the natural sex ratio. In India, the sex of the child is determined prenatally in order to eliminate female fetuses.

A campaign was launched to discuss the correctness of this path, a negative attitude was expressed to the determination and selection of the sex of the fetus without a medical indication. In China, a ban has been introduced on the identification (with ultrasound) of the sex of the fetus without medical indications.

In Russia, there are medical institutions where it is possible to determine the sex of a developing child, and parents can preserve the pregnancy with the desired fetus by gender. In our country, this issue requires an urgent settlement with the involvement of physicians and biologists (as well as geneticists, evolutionists) in the discussion.

Thus, the diversity and contradictory opinions on the use of methods of reproductive technology in order to solve the problem of childbirth for persons with infertility should be considered only in combination with legal and moral and ethical problems with the involvement of, in addition to gynecologists, andrologists, embryologists, geneticists, psychiatrists, bioethics, lawyers, sociologists, theologians, while studying public opinion.

All of the above problems of reproductive technology seem to be less important and priority in comparison with those issues that sex therapists and psychiatrists face every day when admitting patients with problems in the field of sexual behavior and reproduction. In a large number of cases, patients with such problems reveal an unfavorable environment (social, psychological) during pregnancy or in the mother in childhood (single-parent family, lack of care and attention to the child from the parents, overprotection of parents, etc.).

Ethical Issues in Human Cloning

Moral and ethical questions include the following: is it moral that a person appears artificially, and not naturally; whether people have the right to create their own kind (putting themselves in the place of nature), etc. Legal issues include the following: to prohibit or not to prohibit this procedure, to impose a temporary ban, legislative regulation of the legal status of clones, regulation of the cloning procedure. As we can see, legal issues are divided into initial (is cloning allowed?) And derivatives, i.e. arising after human cloning is allowed, cloning will begin (i.e. there will be a need to regulate the procedure itself, for example, questions: how should a person's consent to cloning be formalized, are there groups of people who should be prohibited from cloning) and clones will begin to appear people (the legal status of clones, in particular, recognizing a clone as equal to a person, however, the principle of humanism and equality is already able to answer this question in the affirmative.).

Now we can talk about cloning as a fait accompli. Suffice it to recall the world famous sheep Dolly1, cloned in 1996.

As with any work, we'll start with a definition. What is cloning? The very terms clone, cloning were originally used in microbiology and breeding, and later in genetics. Now these terms are used in colloquial speech and are not highly specialized. The term "cloning" itself means the exact reproduction of an object an indefinite number of times. Objects resulting from this action are called "clones". Human cloning refers to the ability to create a human clone that will reproduce a human donor not only externally, but also at the genetic level. However, some individually defined traits in the donor person and in the clone will differ, for example, the capillary patterns of the fingers. In this case, the donor can be not only a currently existing person, but also our ancestor (if he can have DNA). Cloning can be divided into two types. Firstly, this is therapeutic cloning, as a result of which the development of the emerging embryo stops after 14 days, and it itself is used to obtain stem cells. The period of 14 days is due to the fact that in the future the human personality begins to manifest itself, expressed in particular in the appearance of the rudiments of the nervous system2. Secondly, this is reproductive cloning, as a result of which a human clone appears. This type of cloning is prohibited in most states, including Russia and the United States.

It is interesting to look at the results of public opinion polls. One poll in the USA3 showed that 68% of Americans approve of cloning to create stem cells if the cells were used to treat a disease, i.e. endorse therapeutic cloning. This result is due to the fact that stem cells, individually selected for a particular patient, reduce the risk of rejection. However, a survey related to reproductive cloning shows completely different results. In Russia, such a survey was conducted in May 1997 by the Institute for Sociological Analysis. The results of the survey showed that 55.5% of respondents were against human cloning and only 24% answered this question in the affirmative, and even then under certain conditions4. In most cases, people are driven by fear, which is inspired by science fiction, they believe that clones will enslave people and the like.

Currently, an obstacle to human cloning can be considered:

1. Technological difficulties, due to the fact that the cloning technology is not yet developed, as a result of this, a large number of unsuccessful attempts occur. In addition, there is one significant limitation to cloning, namely, not the possibility of repeating consciousness;

2. Socio-ethical aspect, i.e. due to the fact that the technology, as already mentioned above, is not developed, there is a high probability of the appearance of a large number of defective clones - the appearance of persons with genetic mutations, etc. And this in turn is a threat to the entire human species;

3. Ethical and religious aspect. Most religions have a negative attitude towards human cloning, for example, the Russian Orthodox Church does not oppose research in this area, but opposes human cloning. This is due to the fact that man is a "creation of God", man cannot put himself in the place of God and create clones for himself, because this is pride, and it is, as you know, punishable. The legend of the tower of Babel, described in the Bible, serves as a vivid example of this, the punishment then was the confusion of languages;

4. From the point of view of the biological safety of the species, this issue is also quite controversial. We have already talked about the possible mutations that can occur due to the "rawness" of the cloning technology itself;

5. Public opinion. In our report, we have already cited the results of sociological surveys, from which it is clear that society does not object to therapeutic cloning (despite the fact that there are ethical problems there too, caused by whether the embryo is considered the beginning of a person's life, the formation of his individuality or not), but strongly against reproductive cloning;

6. The last and most important obstacle, at least in the opinion of the author, is legal prohibitions. Such a ban exists in Russia, it was imposed by the Federal Law of May 20, 2002 No. 54-FZ "On the Temporary Ban on Human Cloning" 5. The term of this ban is set at five years. It has been extended this year.

Conclusion:

As already mentioned, a number of moral and ethical problems arise that do not yet have an unambiguous solution. The following are most actively discussed in the media, in society and in the church.

Opponents of surrogacy believe that it turns children into a commodity, creating a situation in which rich people can hire women to carry their children. They also argue that motherhood becomes a contractual work in this case, so the pursuit of benefits may prevail here over considerations of benefits for the contracting parties.

Hence the related and actively discussed within the church the problem of strengthening dehumanization and immorality in society, undermining many moral foundations, including the sanctity of marriage and family.

There are fears that some surrogate mothers may be psychologically traumatized by the need to give up her “her” child born for 9 months, even if at first it seemed to her that she would be able to part with such a child without any special worries. And such cases are not uncommon.

Also important are the issues of the child's psychological adaptation in this situation: should the child be informed about the way of his birth, whether his relationship with a surrogate mother is possible or impossible.

What can you say about this? Yes, serious problems - both medical and moral and psychological - do exist. But their gradual solution and overcoming is a natural way of entering into our daily life those new technologies that - at the global level - help humanity to exist, and at the private level - to be parents who have the happiness of holding their long-awaited and beloved child in their arms.

List of references:

FOUNDATIONS OF THE SOCIAL CONCEPT of the Russian Orthodox Church: XII. Bioethics problems. ECO.

Encyclical Humanae vitae of Pope John Paul VI

Russian Buddhists are not unanimous in their views on IVF technology

Yarovinsky M.Ya. "Lectures on the course" Medical Ethics ", 2000

Pokrovsky V.I. "Biomedical Ethics", 1997

Lopukhin Yu.M. "Bioethics. Vestn. RAMS ", 1993.

"Bioethics: principles, rules, problems", 1998

Euthanasia

The question of the acceptability of voluntary withdrawal from life is becoming more and more urgent - as the technical possibilities of preserving the "life of the body" grow - with a completely possible "brain death".

Homotransplantation and allotransplantation

Lifetime organ harvesting

In Russia, intravital organ harvesting (mainly kidney) is allowed only from the next of kin, with the mutual consent of the participants.

Using organs from deceased people

The sooner the organ of a donor who has died for any reason is transplanted, the higher the chances of success of the operation. However, the procedure for fixing death and its criteria are still the subject of discussion.

In Russia, a practice has been adopted in which if a person or his relatives did not speak out directly against the possibility of using organs after death, he is considered a potential donor.

The most difficult issue remains trust in the services that ensure organ harvesting (control over the absence of abuse - precedents of bringing sick donors to death, failure to provide adequate assistance to a potential donor, and even removal of organs from healthy people under the pretext of certain artificially imposed operations by a doctor are considered potentially dangerous ).

Xenotransplantation

Organ transplants from animals can be negatively assessed by certain religious denominations or their representatives. In particular, for one reason or another, the tissues and organs of a pig may be unacceptable for Muslims or Jews, and cows for Hindus. Also, xenotransplantation has been criticized by animal rights activists and people, who consider this practice unethical towards animals.

Abortion

The question of the possibility of medical abortion, of admissibility, is decided by law, in different countries in different ways, depending on the secular or religious nature of the state. Orthodoxy, Catholicism and Islam deny the possibility of abortion, even for medical reasons.

In most secular states, it is believed that the bodily autonomy of a woman gives her the right to dispose of her body, and the emergence of a new personality with rights occurs at the time of birth. Therefore, in all developed countries, abortion is allowed.

Stem cells

In some cases, embryonic tissues are used to obtain stem cells (most often, either the SC of the patient himself or undifferentiated blastocyst cells are used). In some countries the use of abortion material for this purpose is prohibited, in other countries only the use of tissues grown in vitro is explicitly allowed.

Clinical trials

Conducting clinical trials of new drugs and vaccines is necessary to improve the methods of therapy, to search for the most effective drugs.

Previously, such tests were not as large-scale as they are now, and doctors had less doubts about the possibility of manifestation of certain side effects or complications.

Modern pharmacology has gained considerable experience in the direction of conducting evidence-based and ethical clinical trials. The formation of this experience was also influenced by the lawsuits of patients, volunteers, and other categories of subjects, which were recorded over the past 50 years.

Currently, the main requirement for participation in the tests is to obtain the so-called. “Informed consent” of the patient or volunteer.

Surrogacy

Surrogacy technology is prohibited in some countries (Germany), but it is allowed in Russia and Ukraine. Each country has specific features of legislation that regulate this practice in different ways.

Eugenics

A significant part of the problems are associated with the potential for making certain decisions based on data on the human genome, or individual results of biometric tests. These data constitute a medical secret, and there are a number of concerns about their "misuse", in particular - to take these data into account when insuring, when hiring.

The possibility of prenatal diagnosis of certain characteristics of the embryo (gender, markers of hereditary diseases, markers of the presence of isozyme systems, etc.) today really provide a way to change the pool of natural human genes.

Conclusion

For a long time, religious and secular prohibitions have been imposed on some of the most important types of medical practice. Such prohibitions primarily related to the study of the internal structure of the human body - anatomy. For centuries, doctors were not allowed to perform autopsies. Herophilus, who violated this taboo, was despised by fellow citizens, christened a "butcher" and more than once wanted to expel from the city. But it was Geraphil who made serious discoveries in the field of anatomy, he invented many methods of surgical treatment of diseases. Many scientists have suffered in trying to overcome public misunderstandings. The ban on opening a person's body has remained in the medieval past.

But there are many other examples when doctors had (and still have to) face a fear of new things, a lack of understanding of their ideas. The first attempts at blood transfusions, organ transplants, preventive vaccinations and brain surgeries, and artificial insemination came under fire of public opinion. Medicine will continue to develop, and, like hundreds of years ago, each of her new step will give skeptics reason to doubt the correctness of the chosen path.

However, a smart containment strategy is useful in many ways for any science, and especially for medicine. In the modern world, such a brake is the laws that establish the rules for using the achievements of science.

State laws today help to resolve many disputes between society and the Church, on the one hand, and medicine, on the other. Society questions the moral permissibility of abortion. A law is being created, which says who and when is allowed an abortion, and when it is strictly forbidden to do it. People are worried about the problem of euthanasia. Dutch law stipulates the conditions under which euthanasia is possible. In Russia and many other countries, "voluntary death" is prohibited by law.

Society was divided again: it is unable to unequivocally solve these and many other problems of ethics. And doctors themselves often do not know exactly “what is good and what is bad”. The development of medical technology presents medicine with ever new ethical problems that are not easy to solve. The search for the right decisions, the development of new criteria for ethics is a lot of constant work, and it must be done, because otherwise scientific progress may, imperceptibly for us, turn into a regression of humanity.

List of references:

1. A. Ya. Ivanoshkin "Professional ethics in medicine". M. 1990

2. "Deontology in medicine". Ed. Petrovsky B.V. M., 1988.

3. On the basics of medical deontology / Under total. ed. Tadzhieva K.T., Pripisnova V.I. Dushanbe, 1981.256 p.

4. Deontology in medicine: In 2 volumes. Vol. 1. General deontology // Belorusov O.S., Bochkov N.P., Bunyatyan A.A. / Ed. Petrovsky B.V. M .: Medicine, 1988.352 p.

5. Matveev V.F. Fundamentals of Medical Psychology, Ethics and Deontology: Textbook. M .: Medicine, 1989.176 p.