REPRODUCTIVE TECHNOLOGY Assisted reproductive technology (ART) is a medical intervention developed to improve an infertile couples chance of pregnancy.

Infertility is clinically accepted as the inability to conceive after 12 months of actively trying to conceive. The means of ART involves separating procreation from sexual intercourse - the importance of this association is addressed in bioethics. Some techniques used in clinical ART include: artificial insemination; in vitro fertilisation (IVF); gamete intra-fallopian transfer (GIFT); gestational surrogate mothering; gamete donation; sex selection and pre-implantation genetic diagnosis. Issues addressed in bioethics are the appropriate use of these technologies and the techniques employed to carry out procedures for quality and ethical reviews. Assisted reproductive technology and its use directly impact the foundational unit of society the family. ART enables children to be conceived who have no genetic relationship to one or both of their parents. Children can also be conceived who will never have a social relationship with one or both of their genetic parents, e.g. a child conceived using donor sperm. Non-infertile people in todays society including both male and female homosexual couples, single men and women, and post-menopausal women are seeking the assistance of ART. Concerns in all situations include the child and his or her welfare, including the right to have one biological mother and father. The fragmented family created by ART can disconnect genetic, gestational and social child-parent relationships which have typically been one and the same in the traditional nuclear family. Other important bioethical issues include the appropriate use of pre-implantation genetic diagnostic screening, use, storage and destruction of excess IVF embryos, and research involving embryos. ART research requires human participants, donors and donated embryos, oocytes and sperm. Ethical issues that arise in ART research surround the creation and destruction of embryos. One approach in bioethics involves preserving justice, beneficence, non-maleficence and the autonomous interests of all involved. Bioethicists contribute to ethical guidelines and moral evaluations of new technologies and techniques in ART as well as to public discourse that leads to development of national regulations and restrictions of unacceptable practices. Artificial Insemination

Artificial insemination (AI) is the deliberate introduction of semen into a female's vagina or oviduct for the purpose of achieving a pregnancy through fertilisation by means other than copulation. It is the medical alternative to sexual intercourse, or natural insemination. Artificial insemination is a fertility treatment for humans, and is a common practice in the breeding of dairy cattle and pigs. Artificial insemination may employ assisted reproductive technology, donated sperm, and/or animal husbandry techniques. Artificial insemination is a means of attaining pregnancy not involving sexual intercourse. A couple having trouble getting pregnant can benefit from the exact timing and placement of the sperm. It can overcome instances where a woman's immune system can reject her partner's sperm as invading molecules.[1] In the case of an impotent male, donor sperm may be used. It is also a means for a woman to conceive when two women wish to parent a child, or a single woman does not have a male partner, when she does not want a male partner, or when a male partner's physical limitation impedes his ability to impregnate her by sexual intercourse. Women who have issues with the cervix such as cervical scarring, cervical blockage from endometriosis, or thick cervical mucus may also benefit from artificial insemination since the sperm must pass

through the cervix to result in fertilization. This method is often used for same-sex couples who wish to have a biological child. Lesbian(females) couples have a sperm donor. Gay(male) couples have an egg donor and a surrogate mother (similar to a birth mother). In Vitro Fertilization

In vitro fertilisation (IVF) is a process by which an egg is fertilised by sperm outside the body: in vitro. IVF is a major treatment for infertility when other methods of assisted reproductive technology have failed. The process involves monitoring and stimulating a woman's ovulatory process, removing ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium in a laboratory. The fertilised egg (zygote) cultured for 2-6 days in a growth medium and is then transferred to the patient's uterus with the intention of establishing a successful pregnancy. The first successful birth of a "test tube baby", Louise Brown, occurred in 1978. Louise Brown was born as a result of natural cycle IVF where no stimulation was made. Robert G. Edwards, the physiologist who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010. The term in vitro, from the Latin meaning in glass, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or petri dishes. Today, the term in vitro is used to refer to any biological procedure that is performed outside the organism it would normally be occurring in, to distinguish it from an in vivo procedure, where the tissue remains inside the living organism within which it is normally found. A colloquial term for babies conceived as the result of IVF, "test tube babies", refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry labs and biology labs. However, in vitro fertilisation is usually performed in the shallower containers called Petri dishes. One IVF method, autologous endometrial coculture, is actually performed on organic material, but is still considered in vitro. Surrogate Motherhood

It is often a devastating and life changing experience for a woman to discover that for one reason or another she cannot become pregnant and have children of her own. In some cases, such as those involving repeated unsuccessful attempts involving assisted reproductive technology (ART) or having a non-functional uterus, the remaining option (besides that of adoption) for these women and their partners is surrogacy. However, a major concern with surrogacy is the potential harm that may be inflicted upon the surrogate mother and the child. There are a number of ethical issues relevant to this topic. The ideals and values we hold concerning liberty and autonomy, have to be weighed against other values such as informed consent, welfare and exploitation. Surrogacy, when occuring in the context of ART, is also an issue that forces us to reassess many concepts such as parenthood, family structure and best interests, which until the recent surge in the popularity of surrogacy, we took for granted.

CONTRACEPTION The use of contraceptives the deliberate interference with the natural process of fertility in order to prevent conception - is widespread across the global community. Hormonal contraceptives are considered convenient and effective methods of spacing children or even not having children at all. Meanwhile, barrier methods of contraception are hailed as the answer

to international problems such as AIDS and other Sexually Transmitted Infections (STIs). Together, both methods allow individuals to exert full control over their reproductive lives. However, the effects of widespread contraceptive usage are perhaps not as clear as they first seem. Hormonal contraceptives come with their own health risks some of which will remain unknown. They also raise a host of medical questions concerning their mechanism of action (how the contraceptive actually works) and whether or not contraceptives have an abortifacient effect (a drug which allows conception to occur yet renders the womans womb hostile to implantation effectively, working as an early abortion). This is particularly problematic for Judeo-Christian or Islamic tradition where life begins at conception. Yet, the ethical questions arising from contraception are by no means confined to questions of health. The increased usage of contraception has contributed to a new understanding of the role of sexual intercourse, the family and the notion of responsible parenthood all of which bear intimately on the functioning of society as a whole. ABORTION The matter of abortion, the quintessential bioethics topic, raises intensely personal issues for many people. It is a polarising and divisive issue that raises discussions about morals, science, medicine, sexuality, autonomy, religion, and politics. A central matter is deciding what we can say about unborn children, initially known as embryos and later, foetuses. What is their moral status how much do they matter, and what are our obligations towards them? The matter of 'personhood' arises, as a philosophical and legal discussion about what rights to grant them. 'Personhood' aside, what is our relationship to them, all of us as members of the human family? Should their lives be protected, or should their mothers be allowed to make decisions about killing or protecting them? If killing is allowed, under what circumstances may it take place? If their lives are not protected, what kind of crime is it to perform an abortion on a woman without her consent, or to cause her to suffer a miscarriage? The ethical aspect of abortion is related but distinct from the legal. Whether or not it is moral, should abortion be legal? Generally prohibited but with some exceptions? Should it be regulated? Publicly funded? Should doctors and nurses be able to object according to their conscience? A less prominent but still important debate focuses on the reasons why women might seek abortion. Is it at all times a free choice, or are women responding to coercion in any way? Is it a free choice to seek abortion in desperation because of poverty, violence, or lack of support? What should be the community and policy response to women who feel unable to give birth to their children? And what is the role of the father in decisions about abortion? BRAIN DEATH Brain death is a controversial issue that is often difficult for families to understand or accept. Palliative care interventions can help families to accept the death. However, delaying pronouncement of brain death may be detrimental to the family and lead to financial, ethical, and legal complications, including the potential for insurance fraud. We describe a case of brain death in which the passage of time along with continuation of life support without concomitant testing for brain death led to decreased acceptance of the patient's death by the family. Clinicians should weigh the risks and benefits of harm to the family when deciding how long to keep a brain dead patient on a ventilator. Pronouncement of death, which is good basic medical care regardless of the cause or mechanism of death, should not be delayed for family

considerations. Risk management should be involved early in the decision process, if life support is withdrawn without the family's assent. Persistent Vegetative State (PVS) A vegetative state can be defined as "a clinical condition of unawareness of self and environment, in which the patient breathes spontaneously, has a stable circulation, and shows cycles of eye closure and opening [that] may simulate sleep and waking" [Working Group of Royal College Physicians, "The Permanent Vegetative State," The Journal of the Royal College of Physicians 430 (1996): 119-21]. Since patients in such a state sometimes show behavior that could be interpreted as evidence of consciousness, the diagnosis is not always self-evident. Additionally, the condition of being in a vegetative state is similar to that of other conditions that involve the absence or partial absence of awareness of self and the environment, such as coma, locked-in syndrome and akinetic mutism. The Multi-Society Task Force on PVS (MSTF) has recommended the use of seven clinical criteria in making the diagnosis. It also has been suggested that these criteria be reviewed through neurologic examinations repeatedly. According to the MSTF and the American Neurological Association, the vegetative state has to have endured for at least one month in order for it to be considered persistent [The MultiSociety Task Force on PVS, "Medical Aspects of the Persistent Vegetative State," New England Journal of Medicine 330 (1994): 1572-79; ANA Committee on Ethical Affairs, "Persistent Vegetative State: Report of the American Neurological Association Committee on Ethical Affairs," Annals of Neurology 33 (1993): 386-90]. Some clinicians make a distinction between a persistent vegetative state and a permanent vegetative state based on the duration of the vegetative state, but there is little difference in the prognosis and the ethical considerations remain very similar, if not identical. [Gastone, CG, "Persistent Vegetative State: Clinical and Ethical Issues," Theoretical Medicine 18 (1997): 221-36.] Euthanasia Euthanasia is the intentional and painless taking of the life of another person, by act or omission, for compassionate motives. The word euthanasia is derived from the Ancient Greek language and can be literally interpreted as good death. Despite its etymology, the question whether or not euthanasia is in fact a good death is highly controversial. Correct terminology in debates about euthanasia is crucial. Euthanasia may be performed by act or omission - either by administering a legal drug or by withdrawing basic health care which normally sustains life (such as food, water or antibiotics). The term euthanasia mostly refers to the taking of human life on request of that person the euthanasia is voluntary. However, euthanasia may also occur without the request of person who subsequently euthanasia is nonvoluntary. Involuntaryeuthanasia refers to the taking of a persons life against that persons expressed wish/direction. Central to discussion on euthanasia is the notion of intention. While death may be caused by an action or omission of medical staff during treatment in hospital, euthanasia only occurs if death wasintended. For example, if a doctor provides a dying patient extra morphine with the intention of relieving pain but knowing that his actions may hasten death, he has not performed euthanasia unless his intention was to cause death (Principle of Double Effect). Euthanasia may be distinguished from a practice called physician-assisted suicide, which occurs when death is brought about by the persons own hand (by means provided to him or her by another person). All practices of euthanasia and physician-assisted suicide are illegal in Australia.

Blood Transfusion The physician should obtain the patient's informed consent before administering blood products. This includes explaining to the patient the relative benefits and risks of receiving and not receiving the blood product, as well as any reasonably viable alternatives.

It may be helpful to compare the risks of receiving the blood product with other risks surrounding the patient's medical treatment. Substitute consent must be obtained for incompetent patients according to provincial or territorial laws. Generally, in emergency situations where treatment is necessary to preserve the life or health of the patient and consent is not available (because the patient is unconscious or otherwise unable to consent) the physician may administer blood products (and any other treatment) necessary to preserve the life or health of the patient. Exact provisions will vary by province and territory. This does not apply if the patient has expressly refused the treatment before becoming incompetent.

A competent adult is entitled to refuse or cease any treatment for any reason. Parents ordinarily have the responsibility to provide consent on behalf of their young children; however, it is highly unlikely that parents can refuse life-saving treatment for their children. Physicians may not simply override a parent's refusal; recourse must be through the relevant children's aid society. Although it is legally clear that a mentally competent adult is entitled to refuse any medical treatment, including a blood transfusion, physicians have a responsibility to ensure that the refusal is truly informed and voluntary. In the case of adults who were once competent, but have become temporarily or permanently incompetent, substitute consent laws, generally, provide that their prior wishes regarding treatment decisions should be respected to the extent that they are known or can be determined. Many judgement calls arise in the day-to-day practice of all physicians. These judgements require awareness and respect for legal and ethical considerations, but above all, they require an empathetic understanding of the patient and his situation.

Dysthanasia The dysthanasia (also known as bitterness or aggressive therapy, as it takes into account the suffering of the dying) is to use all means possible, be provided or not to delay the advent of death, although there is hope of healing. It is therefore the opposite of euthanasia. There have been cases of dysthanasia especially people of high political relevance.Antidysthanasia is known as the attitude of rejection dysthanasia, which in some cases becomes a support for euthanasia and other in defense of orthothanasia. Both States and the various medical associations have developed laws or codes governing when medical action can be considered overkill. The dysthanasia is the complete opposite of euthanasia, it is the opposition that has the patient, family and even doctors to die. Despite all the complications that may arise around a disease,

can be considered dysthanasia an opportunity for those who do not want to die, but it is important that the society that supports human rights in all its features, is dysthanasia considered a "Overkill" against the patient, usually because the patient and subjected to a series of actions that cause suffering beyond measure. 's dysthanasia cruelty is not medical, but if it is clear that this process slows the rest the patient alone, there are cases in which the patient wanted to stop going through all that's happening with death and prevented. From this matrix is generated opinion establishing two camps, the first is in favor of rest and a high of suffering, and the other is the exhaust all possibilities to live and to overcome the disease. The dysthanasia when applied in diseases that have no cure loses some sense presented, the effect that medication can have on the patient's health is zero or negative, however, he continues to manage any method for improvement. In these cases euthanasiawould apply, but not done, then it dysthanasia. This method of " Survival "is applied to people who are important to any institution, they may be, from families to governments, which should not a personality of these dies, the dysthanasia may seem selfish, perhaps because a person exercising functions in society can be met by a healthy one, but in this case also associated religious beliefs on certain occasions "Extreme", and that when we speak of an impossibility to live and not allowed eternal rest we are talking about a decision away from reason and consistency with the nature of each. God's timing is perfect and nothing will change. If the expression is not popular in Latin America, with the exception of Brazil, it is interesting that Aurelio dictionary of the Portuguese language, defines "dysthanasia" as "slow death, anxious and much suffering." It is a neologism from the Greek, where the Greek prefix dys has the meaning of "bad act." Therefore, etymologically, means dysthanasia exaggerated prolongation of agony, suffering and death of a patient. The term can also be used as a synonym for waste treatment, which results in a slow and prolonged medically death, very often accompanied by suffering. conduct in this life extends itself, but the process of dying. In the European world discussing therapeutic obstinacy (L'acharnement thrapeutique) in the United States of medical futility (medical futility), treatment futile (futile treatment) or simply futility (Larousse: "minor, trivial") . most popular speaking is the issue as follows: How long should prolong the process of dying when there is no more hope of life or that the person be healthy again, and all therapeutic effort it really only slows the inevitable, and prolongs the agony and human suffering? Who are interested in keeping the person "living dead"? Orthonasia a system wherein kids are educated about death as a component of life, to allow them to integrate healthy outlooks toward death in their coping repertoire. Psychology Dictionary: http://psychologydictionary.org/orthonasia/#ixzz2iYvIiIrF Organ Donation Modern surgical techniques have made it possible for someone to have diseased or damaged organs or tissues replaced with healthy ones from a living or dead donor. When the donor is living, there are naturally many limits on what can be transplanted, and organs like kidneys are the most common, followed by the transplantation of sections of liver and lungs. Major organs taken from a dead donor include the heart, lungs, kidneys, and liver, and tissues include bone, corneas, skin, and heart valves. One of the central ethical questions is the determination of

death. People who are on life support may be eligible for organ donation and important questions arise about correctly determining when they are actually dead before organ procurement can proceed. Other important ethical questions include who is eligible to receive an organ; how organ waiting lists are structured; should payment be permitted for organs and tissues; should reproductive organs and tissues be permitted for transplant; should face transplants be permitted; how religious and cultural sensitivities should be handled; confidentiality and privacy of donor and recipient; ensuring genuine informed consent; and, how should family conflicts about donation be handled? Cloning Any discussion about cloning needs to begin with careful definitions. Cloning can occur at the level of DNA, at the level of the single cell, or at the level of the whole organism. Typically, ethical attention is focused upon cloning in the context of the genetic copying of a whole organism. While the cloning of non-mammals has occurred in research contexts for many years, the cloning of the first mammal, Dolly the sheep, surprised many in the scientific community. What quickly followed was the cloning of other species and intense speculation about the possible cloning of humans. Cloned human embryos have been produced, but there are no reliable reports that any have been implanted in a womans uterus, let alone developed to birth. Cloning to birth has come to be called reproductive cloning, whereas cloning embryos so that their stem cells may be extracted for possible research or therapeutic use has come to be called therapeutic cloning. The key ethical issue with therapeutic cloning is the moral status of the cloned embryo, which is created solely for destruction. The ethical issues with reproductive cloning include genetic damage to the clone, health risks to the mother, very low success rate meaning loss of large numbers of embryos and fetuses, psychological harm to the clone, complex altered familial relationships, and commodification of human life.