REPRODUCTIVE MEDICINE - MORAL, CONCEPTUAL AND ETHICAL CONSIDERATIONS

Human reproduction has always been a matter of philosophical interroga tions and controversies. This situation has been reinforced by the tec hnical evolution which has occured during the past years. Both hopes a nd concerns have been raised at the same time. Two recent advancements deserve consideration and are given as demonstrative examples: intrac ytoplasmic injection of spermatozoon, preimplantatory diagnosis. Their consequences are very important for both the medical and the philosop hical approach. One of the questions which arises at this occasion is to determine if research on pre embryos is legitimate or not. This evo lution has provoked some reluctancy and several criticisms concerning the future of the children obtained by such techniques: the risk of sl ippery slope, possibly leading to a form of eugenism, and the fundamen tal and philosophical problem of the status of the embryo. However, be hind these discussions a deeper and heavier controversial matter may b e discovered; it deals with the role and the responsibilities of the g overnmental power. An opposition does exist between two different perc eptions: on the one hand, the concept of a powerful governmental body, responsible for the respect of a statutory law, grounded on a sort of universal ethical rule, to be followed by all, a concept which bears the risk of totalitarism; on the other hand, the concept of a law with a limited responsibility to protect public order, allowing a normal s ocial life. Amongst the numerous responsibilities of the governmental power, one is often neglected, everywhere; its concerns the protection of the female life and health. Some examples are given. However the m ost frightening risk, much more dangerous than the frequently alleged risk of biological eugenism, is what can be called ''economical eugeni sm''. Again some examples are given, in all the systems of social prot ection. Submitted to ethical rules imposed by political and legal powe rs, and to the influence of economical forces, what will be the role a nd the responsibilities of the practitioner? Unfortunately the answer may be obvious: the only way is leading to a relinquishment of medical responsibility. Far away from the dialogue which was the rule of the ''dual relationship'' between the patient and the practitioner, away t oo from the more complicated situation of today, characterized by the intervention of ''third parties'', the evolution, probably unavoidable , appears to be towards the withdrawal of the psychological, moral, hu man and humanistic involvement of the practitioner, leading him or her to a technical role. The patient, him or herself, might become comple tely deprived of any role in the elaboration of decisions concerning h is or her health. The problem is undoubtly a major one. It could be fe ared that it is already too late to try to face the moral, cultural, s ocial and economical forces of the society with the help of medical et hics.