A bioethical evaluation of postmodern medical practices in human reproduction

Advances in biomedicine and health technologies have reshaped, fundamental concepts such as life, vitality, the body, death, and reproduction. This transformation has given rise to various ethical concerns and dilemmas regarding the use of these technologies. Postmodern medical practices related to reproduction necessitate comprehensive ethical debates that extend beyond individual preferences. Within the scope of this thesis, four practices are examined as postmodern medical practices related to reproduction: preimplantation genetic diagnosis, mitochondrial replacement therapy, surrogacy, and artificial womb. The primary aim of this thesis is to identify and analyze the ethical issues raised by these four practices. In the thesis, literature review and normative analysis methods were used in line with the subject and purpose of the study. For each of the four practices, the ethical arguments of three ethicist who criticize and defend the practice are presented; these arguments are evaluated in line with the biomedical ethical principles (respect for autonomy, non-maleficence, beneficence, and justice) put forward by Beauchamp and Childress (2017). Based on these arguments, the ethical debates surrounding postmodern reproductive practices can be categorized as follows: Based on the bioethicists arguments, the ethical debates surrounding the four postmodern medical practices related to reproduction revolve around the following themes: Ethical debates related to preimplantation genetic diagnosis revolve around issues such as social and moral structure, human nature, inequalities and social justice, the commodification of children, medicalization, eugenics, freedom and choice in reproductive decisions, and instrumentalization. Ethical debates in the context of mitochondrial replacement therapy include medicalization, eugenics, potential harms and risks, exploitation, the social value of the practice, the distribution of public resources, commodification, commercialization, reproductive rights and freedom, individual and social benefits, the value of the desire for genetic ties, and the three genetic parents. Ethical debates surrounding surrogacy focus on issues such as commodification, dehumanization, commercialization, instrumentalization, inequalities and justice, moral degradation, exploitation, consent and informed consent, reproductive rights and freedoms, the benefits and harms of surrogacy, and women's well-being. Ethical debates regarding artificial womb technology revolve around topics such as reproductive autonomy, reproductive rights and freedoms, the value of gestational ties, inequality and justice, gender inequality, human nature, and the reproductive rights of of samesex and transgender couples. In the ethical debates surrounding these four practices, some common themes stand out, such as medicalization, commodification, dehumanization, instrumentalization, human nature, autonomy and social pressure, justice and inequalities in access, commercialization, and exploitation. These themes not only reflect individual-level ethical concerns but also point to macro-level implications for healthcare management, policymaking processes, and the equitable use of public resources. In addition to ethical issues, developments in reproductive technologies also raise various structural challenges in healthcare management. In this context, this thesis evaluates the technologies in question in line with ethical principles and provides health managers and policymakers with an analytical framework for value issues that may be encountered in the process of regulating and implementing these technologies, as well as a conceptual basis for designing a value-based health system based on ethical principles.