3. Reproductive medicine: ethical reflections

In this chapter we focus on the ethics of current developments in the context of human reproduction, ranging from preconception care to assisted reproduction, and from embryo selection to foetal therapy. What makes the ethical debate in this field so challenging is that many issues arise from the fact that the interests of several stakeholders beyond the patient may need to be taken into account. For instance: lifestyle choices in pregnancy are not just a matter of women’s autonomy, but also of parental responsibility. And in decision-making concerning genomic information the interests of family members may be at stake as well. Many of the issues that will be discussed in this chapter require further research of relevant empirical questions (preferences, impacts, etc.) as well as ethical analysis and societal debate. Although in some of these debates societal concerns about the ‘acceptability per se’ of a new development, such as germline genome editing (GLGE), may have to be addressed, ethical reflection and debate should not be regarded as limited to such questions. Beyond issues of acceptability, challenging ethical questions relate to the conditions under which a specific technology or intervention (such as preconception carrier screening) can responsibly be introduced and offered. In these debates, the input of all stakeholders (patients, professionals, society at large) is essential.