Beacon Section 5

Beacon Schools Project

Health Education Level 8 Planning Guide Section 5

Unit of work suitable for assessment with AS 3.4 Examine contemporary dilemmas or ethical issues in relation to Hauora/Wellbeing. *An ethical decision making model *Assisted reproductive technology

Achievement Standard Subject Reference

Health 3.4

Title

Examine contemporary dilemmas or ethical issues in relation to hauora/well-being

Level

3

Subfield

Health and Physical Education

Domain

Health Education

Re.g.istration date

Credits

21 October 2003

5

Assessment

Date version published

External

21 October 2003

This achievement standard involves examining contemporary dilemmas or ethical issues from differing perspectives and the implications of these on the hauora/wellbeing of self, others and society. Achievement Criteria Achievement

Achievement with Merit

Achievement with Excellence

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Examine contemporary dilemmas or ethical issues from differing perspectives.

•

Examine contemporary dilemmas or ethical issues from differing perspectives.

•

Examine, in depth, contemporary dilemmas or ethical issues from differing perspectives.

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Examine possible implications of the differing perspectives on the hauora/well-being of self, others and society.

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Examine, with supporting evidence, possible implications of the differing perspectives on the hauora/well-being of self, others and society.

•

Examine, in depth and with supporting evidence, possible implications of the differing perspectives on the hauora/well-being of self, others and society.

Explanatory Notes 1

This achievement standard is derived from Health and Physical Education in the New Zealand Curriculum, Learning Media, Ministry of Education, 1999; Level 8 achievement objectives from strands A, C and D.

2

Assessment will be consistent with, and reflect the underlying concepts of, hauora, health promotion, a socio-ecological perspective and the attitudes and values of: • a positive and responsible attitude to the well-being of self • respect for the rights of others • care and concern for other people in the community

•

social justice.

3

Dilemmas or ethical issues arise from the different perspectives individuals or groups have on health-related issues and include topics such as: • legalisation/decriminalisation of cannabis • abortion • adoption • the sex industry • euthanasia • reproductive technology • elective plastic surgery • pornography • parental rights and the treatment of children.

4

Examine includes both explanation and analysis. Explanation and analysis of implications for each perspective may include: • identification of the significance or importance of the issue/implications • positive and/or negative factors • and short-term and/or long-term impacts. The explanation/analysis must be justified by reasoned argument.

5

Examine in depth will require students to do one or more of the following for each of the different perspectives: • explore the complexities of situations • develop reasoned arguments • present accurate and detailed supporting evidence.

6

It is important that students present a balanced view of the different perspectives of each dilemma or ethical issue. They will not be required to personally support or justify their position on any issue.

Examine Contemporary Dilemmas or Ethical Issues in Relation to Hauora/Wellbeing. Introduction This unit of work is designed to be externally assessed using 3.4: Examine Contemporary Dilemmas or Ethical Issues in Relation to Hauora/Wellbeing Students should begin this unit of work with exploration of what constitutes a health related dilemma or ethical issue. A process/critical questions framework which can be applied generally to contemporary dilemmas or ethical issues is described. It is expected that teachers of Level 8 health education will explore dilemmas and/or ethical issues in most learning contexts used in their programme. It is vital that teachers consult the specifications for 3.4 to ensure that students are prepared with enough background depth of knowledge in the required specified contexts to be able to participate competently in the external assessment. The context for exploring ethical issues are outlined in this unit is Assisted Reproductive Technology (ART). The ability for students to explore issues from differing perspectives is emphasised, as is applying a critical questioning framework to ethical issues/dilemmas. Content will be consistent with and reflect the underlying concepts and level eight achievement objectives of the Health and Physical Education curriculum. It is essential that teachers inform students of the potential contexts for examining ethical issues as identified in the NZQA specifications for 3.4. Teachers should discuss with the class potential sensitivities of particular issues for students and negotiate which issues will be addressed. The purpose of this unit is to raise student awareness that there are always different perspectives around any contentious issue (as outlined in “The framework for addressing contemporary dilemmas and/or ethical issues”) and teachers should ensure that a safe supportive classroom environment is maintained regardless of the positions represented. Students should be fully aware of additional support available to them if needed.

Ethical decision making resources • • • •

‘Resolving ethical dilemmas in the classroom’, Educational Leadership, Dec98/Jan99. Vol.56 Issue4 p38 (included in the Beacon Level 8 folder). www.globalethics.org/. www.josephoninstitute.org/MED/MED-whatsethics.htm www.ethicsforschools.org

Assisted Reproductive Technology Resources Essential Resource •

Protecting our Future: the case for greater regulation of assisted reproductive technology (1999) Edited by Sandra Coney and Anne Else. This is a NZ resource available from www.womens-health.org.nz. It is a discussion document that comprehensively covers ART issues from NZ perspective. It also has overseas information.

Recommended Resources (teacher use) •

Singer D., and Hunter M. (Eds), (2003) Assisted Human Reproduction: Psychological and ethical dilemmas. Whurr Publishers, London & Philadelphia.

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http://www.newhealth.govt.nz/necahr.htm National Ethics Committee on Assisted Human Reproduction website (NZ).

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www.bioethics.org.nz A range of information, resources and links about bioethics.

Recommended Resources (classroom use) •

www.ethicsforschools.org/news/index.htm Website has extensive archive of news clippings on a variety of ethical issues.

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Gattaca (1997 movie). DNA engineering is the norm in society and naturally born individuals are stigmatized in society and given only menial jobs. One such person strives to make it into space.

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Designer Babies (Time article). Article about choosing egg donors online (Beacon Folder Level 8)

A framework for examining contemporary dilemmas And/or ethical issues. Dilemmas and ethical issues are not usually about right versus wrong; rather they are about right versus right depending on whose perspective the dilemma/ethical issue is examined from. At all stages of the process students should use relevant researched information and data to respond to each of question.

Steps in a process. 1. Identify the issue/dilemma 2. Identify who are the stakeholders – individual, family, whanau, community, society. 3. For each stakeholder, describe • their perspective the values and beliefs that underpin their perspective. How do these compare with the values the curriculum promotes for enhancing health/well-being? • Within each perspective, whose rights are being considered –why – how? • Within each perspective, whose rights are being compromised – why –how? • What are the short term and long term implications /consequences for each stakeholder/perspective in relation to both individuals and communities considering the following aspects: (i) Social (ii) Economic (iii)Health and public safety (iv)Human rights/social justice Who benefits and who is disadvantaged, how and why? 4. Where appropriate, also take into account the following paradigms • • • •

Truth vs loyalty Individual vs community Short term vs long term Justice vs mercy

5. Personal reflection about the issue/dilemma: Consider which of your personal values, beliefs and life experiences have contributed most significantly to your decision/choice about this issue/dilemma.

Unit Outline: Assisted Reproductive Technology (ART) Resources will need to be available for students to access accurate information. Protecting our future (1999) is essential as a comprehensive New Zealand resource for this purpose. Learning Activities Suggested sequence and learning outcomes for students to explore the issues surrounding Assisted Reproductive Technologies (ART) are outlined below. 1. Fact finding - knowledge of ART procedures used in New Zealand and overseas. What is ART? What technologies are available or commonly used in NZ? Overseas? For each technology briefly outline the procedure and note possible problems/issues that could arise from the use or misuse of this technology 2. Identifying and describing the determinants of ART use. Main determinants of ART use are Infertility and Access to ART. 

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Infertility - The accepted definition of infertility is: ‘The failure to conceive within 12 months while having unprotected sex’ (Protecting our future). Do you think this is an appropriate timeframe? Why/Why not? - Identify the causes of infertility. You will need to consider the following factors for men/women (individuals and groups)  Environmental  Personal health (and illness)  Personal lifestyle factors Access to ART - Who can access ART in NZ? Overseas? - What barriers to access are there in NZ? Overseas? How could these barriers be overcome to ensure equity of access to ART (social justice). - Is there any access to ART in developing (third world) countries? - What human rights issues arise from the situation in such areas of the world?

3. Describing a range of issues that arise from the use of ART. There are many complex issues surrounding the use of ART for both individuals and society. Identify and describe some of these issues in the following contexts:  Biological issues  Medical issues  Psychological issues  Social issues  Legal issues (including human rights) What issues surrounding ART are specific to Maori people and Pasifika people in NZ. How could these issues be addressed so their cultural beliefs are not compromised? 4. Short term and long term implications of ART for individuals and society. Using the same contexts as outlined above, identify short and long term implications of ART for both individuals and society. For example: Context

Individual Society Short term Long term Short term Long term Medical Medical Risks to health Resources, Funding, intervention training, money resources, required staffing  How could these implications affect a person’s hauora?  Who is advantaged by the use of ART (how and why)?  Who could be disadvantaged (how and why)? 5. Potential ethical issues arising from the use of ART. From the implications you have identified above, and any other knowledge you have gathered about ART, make a list of all the ethical dilemmas you think could arise through the use of ART. Refer to List A below, and use these ethical dilemmas for a neutral chair debate or continuum activity to enable students to acknowledge differing perspectives on a range of issues associated with ART. For this style of activity, students will have to adopt a position on the issue/dilemma. Students should use the critical questions from the ethical decision-making process to analyse the issue/dilemma and to justify their response. Alternatively, students could be required to use the ethical decision making framework to present an argument from both/several perspectives. In addition, use the attached scenarios to engage students in exploring the ethical issues associated with ART.

List A: Contemporary dilemmas and ethical issues associated with ART

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It is better to be born with a disability than not be born at all.

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Parents should have the right to choose the sex of their child.

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Should homosexual people be eligible for ART?

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Should a single parent be eligible for ART?

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Parents having children through ART should be screened for their ability to provide a stable environment.

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Deaf parents should be able to select a child for deafness if they believe deafness defines their identity and they want a child who fits into their lifestyle.

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Parents have the right to request embryos are screened for intelligence and other desirable characteristics.

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Parents have a right to keep an ART child’s parentage and manner of birth secret from the child.

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An embryo has the right not to be born.

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Should surrogate mothers be paid for providing their body for a childless couple to have a child?

SCENARIOS for Dilemmas and ethical issues associated with ART From www.ethicsforschools.org Deaf lesbian couple opt for a deaf child A deaf lesbian couple in the USA have deliberately opted to have a deaf child by choosing a friend with familial deafness as a sperm donor. The couple have the legal right to procreate with whomever they want, and in this respect the case raises no new difficulties. It has, however, sparked discussion over the extent to which such freedom of choice can be exercised using fertility technologies, which were initially developed to help couples avoid hereditary disease. Members of the deaf community often find that deafness defines their cultural identity and see signing as a sophisticated form of communication. Having adapted their lives to deafness they may want a child who will easily fit into that lifestyle. Some couples have expressed a desire to use preimplantation genetic diagnosis (PGD) to select a deaf child - a process that many would see as a perversion of the technology's purpose. Alternatively, a deaf couple in Australia have been allowed to screen out IVF embryos that carry a gene for deafness, a decision that has been criticised by ethicists there because it discriminates against deaf people and could pave the way for other extensions of PGD. (BMJ 2002;325:771-3, J Med Eth 2002;28:284-8, news.com.au 2002;21 September)

Gamete donor anonymity should be maintained Government proposals to remove gamete donor anonymity were rejected by doctors at the annual conference of the British Medical Association in Harrogate this July. The availability of infertility treatment in the UK is limited by a shortage of donated gametes. The current system for donations enables complete donor anonymity, so long as the donation is through a licensed fertility clinic. This protects donors from responsibility towards any future child that may be born from the donated material. However, there have been calls from some campaigners to remove this clause and instead give children the legal right to trace their genetic parents. The fear that removing donor anonymity would reduce the number of donations may be unfounded. When Scandinavian countries removed anonymity from their schemes there was an initial drop in donations, followed by a return to normal levels in the long term. However, questions remain about the extent of information that children should have access to. Since 1991 the HFEA has collected information from donors so that future children will have access to limited data. The removal of anonymity would enable actual identification of parents, with the prospect of a 'knock on the door' in future years. Dr Mohamed Taranissi of the Assisted Reproduction and Gynaecology Centre in London believes that there are genetic reasons for knowing the identity of the donor. This would not place any responsibility on donors towards the child, but simply give the child access to their genetic make-up. Such access may be particularly helpful for disease studies. Any change to the law would not be retrospective but would only apply to future donors. (bbc.co.uk 2002; 16 May, Guardian 2002; 5 July)

'Designer baby' given the go ahead A family from Leeds has been given permission to create a baby who will act as a

bone marrow donor for their first child. Shahana and Raj Hashmi's son Zain suffers from thalassaemia, and without a bone marrow transplant, his outlook is bleak. No compatible donor has been found within the family or in the national pool. The couple will undergo conventional IVF treatment but the embryos will be screened twice prior to implantation: once to make sure that any baby will not suffer from thalassaemia and once to make sure the baby would be a compatible donor for Zain. Assuming all goes well with the pregnancy, when the compatible baby is born, blood will be taken from its umbilical cord and frozen. Cells from this blood will provide the replacement for Zain's bone marrow. Screening embryos in this way has drawn criticism from the pro-life lobby. Peter Garrett, a spokesperson for the charity Life, said: 'Should we allow a child to be manufactured in order to serve the medical needs of an older brother? Whilst the term 'designer baby' is often overused, it is all too appropriate in this case.' Also of concern is the destruction of other embryos, many of them completely healthy, in order to select the desired match. Following the landmark ruling, six more couples registered at the Park Hospital Centre for Assisted Reproduction in Nottingham have revealed their plans to select embryos in a similar fashion. They all have children with illnesses whose only chance of survival is the birth of a brother or sister who can act as a donor. It is likely that many more couples will follow suit in the next few years, despite the government's insistence that the decision would not set a precedent. Simon Fishel, director of the Park Hospital clinic, insisted that the door had now been opened for other parents. 'It was an ethical precedent, and the authority has for the first time set the strict criteria by which other cases will be considered,' he said. 'We have half a dozen other patients who are keen to go forward. I would be very surprised if I haven't put in another application within three months.' (Guardian 2002; 23,24 February)

Genetic offspring for gays The team that cloned 'Dolly the sheep' is researching a way of enabling male homosexual couples to have children that are their genetic descendants. The main problem that they are encountering is a way of manipulating 'imprinting', a process whereby the parental origin of a gene is marked. However it may be possible to replace DNA from a donated egg with that of a sperm and then maternally imprint it. It would then be able to develop if fertilised with sperm from the partner. (Telegraph 2000; 26 September)

US doctors approve sex selection for non-medical reasons The American Society for Reproductive Medicine has ruled that helping couples to select the sex of their babies for 'gender variety' is proper and ethical. In a letter of advice to an infertility specialist, John Robertson, acting chairman of the society's ethics committee, stated that it was acceptable for a couple to choose an embryo of the opposite sex to an older sibling. Until now, the society, which sets the rules for reproductive medicine in the US, has allowed the practice only to avoid certain sex-linked genetic traits. The technique that would be used is pre-implantation genetic diagnosis, the same as is used to select embryos where children are at risk of a sex-linked genetic disorder. Embryos are tested outside the womb to determine which are male and which are female. The ruling represents a change in opinion since as recently as 1999, when the Society discouraged its members from using this method simply because a couple wanted a boy or a girl. The code of practice of the Human Fertilisation and Embryology Authority in the UK states that 'Centres should not select the sex of embryos for social reasons'. A spokesman said that this policy was made after a consultation exercise in 1993 when most respondents felt that sex selection should not be made for social reasons or for 'family balancing'. (BMJ 2001;323:828)

Teenager wins damages for ‘wrongful birth’ Judges from the highest French appeal court ruled that a handicapped teenager was entitled to damages for having been born. In a decision that opened the way to suits for ‘wrongful birth’, the court accepted the argument of Josette and Christian Perruche that doctors should have advised the abortion of Nicolas, their 17-year-old son, who was born deaf, badly mentally handicapped and nearly blind. The couple from Paris launched their case more than a decade ago after it emerged that Mme Perruche had suffered from rubella during pregnancy in 1982, causing her son’s disabilities. A doctor and a laboratory accepted that their tests on her had failed to diagnose the disease. She had requested an abortion in the event that she had been suffering from rubella. The ruling was denounced last night by France’s main pro-life group as a dangerous precedent that created ‘institutional eugenics’. The court was ‘implying to all handicapped people that their life is worth less than their death’, the Alliance for the Right to Life said. Some medical authorities were also appalled by the implications of the decision, which they said would expose doctors to the threat of American-style lawsuits after the birth of handicapped children. Several US courts have awarded damages against doctors after the birth of handicapped children. (Times 2000; 18 November)

Assisted Reproductive Technology (ART): Glossary Artificial Insemination (AI) Any procedure in which human sperm are introduced into the reproductive tract of a women by a non-coital method other that as part of an IVF procedure, including artificial insemination by husband (AIH) or donor (DI). Assisted Reproductive Technology (ART) Includes a range of methods used to circumvent human infertility. The practice of ART involves social issues of eligibility, surrogacy, consent for posthumous use, genetic diagnosis and selection and gene therapy, and storage of gametes and embryos. Cryopreservation A technique for preserving tissue through freezing. It is used to preserve embryos for transfer at a later date. Embryo An egg that has been fertilized by a sperm and that has undergone one or more divisions. Fertilization The penetration of the egg by the sperm and resulting fusion of genetic material that develops into an embryo. Gamete A reproductive cell, either a sperm or an egg. Gamete intrafallopian transfer (GIFT) An ART procedure that involves removing eggs from a woman’s ovaries, combining them with sperm, and using a laparoscope to place the unfertilised eggs and the sperm into the woman’s fallopian tubes through a small incision in her abdomen. IVF procedure An ART procedure that involves removing eggs from a woman’s ovaries and fertilizing them in the laboratory. The resulting embryos are then transferred into the woman’s uterus through the cervix. Ovarian stimulation The use of drugs to stimulate the ovaries to develop follicles and eggs. Pre-implantation genetic diagnosis (PGD) Use of genetic testing on one or two cells taken from a live early-stage embryo created by in vitro fertilisation. The procedure is usually carried out in order to determine whether the embryo is affected by a serious genetic disease. An unaffected embryo is implanted in the uterus and allowed to develop to term. Using preimplantation genetic diagnosis to determine the sex of an embryo conceived by IVF is

ethically acceptable, but only if the aim is to avoid the transmission of genetic disorders. Surrogate An arrangement where someone other than the intended mother of the child undertakes the pregnancy. Traditional (Straight) surrogacy:- The surrogate uses her own egg fertilised with the intended father's sperm. This is done by artificial insemination using a syringe. Gestational (Host IVF) surrogacy:- The surrogate carries the intended parent's genetic child conceived through IVF, for which specialist doctors are needed. For this treatment the infertile woman must still have working ovaries. Zygote intrafallopian transfer (ZIFT) An ART procedure in which eggs are collected form a woman’s ovary and fertilized in the laboratory. A laparoscope is then used to place the resulting zygote (fertilized egg) into the woman’s fallopian tubes through a small incision in her abdomen.