**10. Cloning of human**

This involves the asexual reproduction of mammals by the technique of Somatic Cell Nuclear Transfer (SCNT). The birth of the first cloned mammal, sheep Dolly in 1997 using this technique represented a land mark development that unequivocally showed the possibility of replicating this asexual reproduction in man. Somatic cell nuclear transfer technology has however been shown to be associated with a high miscarriage rate and an overall low success rate. It is also fraught with high rate of complications such as the large

during the course of the pregnancy. This represents professional commitment to the ethical principles of beneficence, justice and non-maleficence. For example, the giving of episiotomy to a parturient woman to prevent a third degree laceration of the perineum upholds the ethical principles of beneficence, but when the episiotomy is given without prior administration of anesthetic agent, or is repaired without any, or is left un-repaired,

The ethical principles of justice also enjoins that all women should be treated equally and

The application of the knowledge of science to human reproduction falls within the purview of obstetrics and therefore obstetrics and gynaecological professionals should be mindful of the ethical implications of genetic studies, engineering and the application of genetics in

Gene therapy refers to the alteration of human DNA particularly for the purpose of alleviating disease burden in individual. There are three categories of alteration of human

 Genetic alteration of Somatic Cells to treat diseases – which raises ethical issues similar to that in experimental, therapeutic and human research, and therefore requires ethical review, informed consent, and the protection of confidentiality of the subject; If gene therapy studies are successful it is ethically permissible to apply such treatment to the foetus in-utero provided that the safety of the foetus is guaranteed and the autonomy of

 Germ line genetic alteration - involves the changing of the gamete of the individual which is consequently passed on to subsequent generations. There are presently no safe and reliable means of genetically altering germ cells – sperm, egg or zygotes derived from them, therefore any research proposal targeted at germ cell alteration is ethically

 Non – therapeutic genetic alteration (genetic enhancement) - involves insertion of a gene with the aim of improving the genetic makeup of a normal healthy gene. For example, the enhancement of colour, height or beauty. This technology has social implications concerning the weight between its potential risks and benefits to individual subjects. It therefore raises serious ethical questions that prohibit research

This involves the asexual reproduction of mammals by the technique of Somatic Cell Nuclear Transfer (SCNT). The birth of the first cloned mammal, sheep Dolly in 1997 using this technique represented a land mark development that unequivocally showed the possibility of replicating this asexual reproduction in man. Somatic cell nuclear transfer technology has however been shown to be associated with a high miscarriage rate and an overall low success rate. It is also fraught with high rate of complications such as the large

this will amount to violation of ethical principles of non – maleficence.

without discrimination in healthcare delivery to them.

**9. Genetics, oocyte and embryo research** 

**9.1 Human gene alteration** 

the woman is respected.

into its application on human subject.

not permissible.

**10. Cloning of human** 

disease management.

gene viz.

offspring syndrome and immune system failure. It is generally believed to be unsafe and therefore ethically not permissible for use in human reproduction. However, subject to strict observation of ethical guideline, research on human embryo stem cells from Somatic Cell Nuclear Transfer to produce various cell lines for the purpose of treatment of diseases is permissible.

#### **11. Human embryo and gamete research, sale and donation**

Apart from the human embryo, stem cells can be obtained from cord blood, the foetus or adults. It can also be obtained from supernumerary embryos at the blastocyt state, in IVF cycles and embryos created de novo from donated gametes. Stem cell studies may be useful in the treatment of many diseases and also in the improvement of the management of infertility. Ethical questions arise in the use of human embryos produced solely for the purpose of research. This can be permitted only if it is not possible to obtain the information sort for, from research on existing supernumerary embryos. Gametes collection for research must be preceded by specific informed consent. Supernumerary embryos from IVF programmes can be used for research only following the consent of the recipients of the resulting embryo. Women particularly the more vulnerable should not be coerced or induced to donate oocyte or embryo for research. A research ethical review is necessary prior to the employment of human embryo for the purpose of research. Donations of gametes and embryos for the purpose of pregnancy and child birth should be on humanitarian basis rather than on commercial consideration, although reasonable compensation for legitimate expenses is allowable. On no account should genetic materials be sold as a profit making venture (Int. J. Gynecol. Obstet, 1994). The donation of genetic materials - egg, sperm or pre – implantation embryo has been used for the treatment of infertility, ovarian failure, severe rhesus iso-immunization, achievement of post menopausal fertility, habitual abortion etc. Such a donation and accompanying child created from it not only have profound ethical implications but are also associated with legal, cultural, moral and religious questions. The child, the recipient couple and the donor all have interest that need to be taking into consideration as well as protected. Different countries have cultural or legal provisions that determine qualification for donation of genetic materials as well as regulate the relationship between the social and the biological parents, the fate of the genetic material (whether for banking or disposal), the protection of the child's interest, and in particular the record keeping rules. The donation of genetic material should be accompanied with informed and written consent of the donor, the recipient and recipient's lawyer. It must be ensured that genetic material donors are normal, healthy and without diseases such as genetic disorders and sexually transmitted infection. Donors of genetic materials should be anonymous and confidentiality should be maintained except when permission for disclosure has been granted. Members of the recipient team should not be donors, nor should genetic materials be obtained from dead persons unless a written consent had been given prior to death. Genetic materials should not be donated for the purpose of extending natural reproductive life span. Donation from one donor should be limited to avoid the danger of consanguinity or incest in the future. habitual

Bioethics in Obstetrics 307

be associated with multiple pregnancy, particularly of the higher other variety. Obstetrics and gynaecological professionals involved in assisted reproduction should therefore aim at achieving singleton pregnancies and furthermore clearly inform their client and other interest group such as the press that multiple pregnancies arising from assisted reproduction constitute a complication rather than a fit. Where multiple pregnancies especially of the higher order variety occur, it is ethically preferred to reduce the number of foetuses than leave them alone, since this will increase the chances of survival and success of

Termination of pregnancy can occur for variety of reasons. When pregnancy termination occurs before the age of viability of the foetus, it is regarded as abortion. Abortion can occur as a natural process in which case it is regarded as spontaneous abortion or otherwise as a forced procedure regarded as induced abortion. Induced abortion is usually performed for unwanted pregnancy. When performed in countries where the law permits, it is regarded as legal abortion, while it is illegal or criminal if carried out where the law does not permit abortion. In some countries abortion law is restrictive, abortion being allowed under certain circumstances such as for the purpose of saving the life of the mother. In countries where the law does not permit abortion or where the law is restrictive, unsafe abortion is usually of high incidence. Virtually all forms of abortion, but in particular induced abortion are fraught with ethical challenges. A woman with an unwanted pregnancy particularly for strong reasons will go to any length to seek for the termination of such pregnancy – even at

The ethical question is, should her autonomy not be respected by obliging her with a safe

A further question that often arises and is capable of throwing the health practitioners into serious ethical dilemma concerns the identity of the foetus that the pregnant woman seeks to abort. Does the foetus not constitute a being albeit incapable of autonomy and therefore vulnerable, whose autonomy needs to be protected, or should the fate of the foetus be allowed to be solely dependent on the decisions of the mother? These ethical questions are applicable to several issues in obstetrics that may constitute danger to the foetus or the

**16. Prenatal diagnosis and termination of pregnancy following the procedure**  Prenatal diagnosis is becoming an increasingly important component of obstetrics care, to identify in –utero, diseases of the foetus and their severity, that may require genetic engineering, future life style adjustment or termination of pregnancy. Prenatal diagnostic procedure requires prior counseling and informed consent of the woman. The woman is also required to state in advance any information that she would not want to be given

Prenatal diagnosis provides information as to foetal diseases that may permit termination of pregnancy in countries where the law permits. The ethical challenges raised however is related to how one determines the degree of the severity of the disease or abnormality and

the assisted reproduction.

the risk of losing her life.

mother or both.

termination of the unwanted pregnancy?

following the procedure for example the sex of the foetus.

**15. Termination of pregnancy** 
