Ethics of Reproduction

Question 1

What issues arise when considering reproduction?

Answer 1

-Reproductive autonomy-personal choice
-Involves others – partner, foetus, future child
-Fundamental issues-sanctity of human life
-Opinions can be diverse & immovable
-Religious component
-Emotional
-Children = time & financial investment
-Significant resource implications

Question 2

What is abortion?
Is it safe?

Answer 2

= termination of pregnancy
= safe regardless of gestation - no evidence shows implications upon poorer mental health by opting for abortion

Question 3

When is abortion lawful?

Answer 3

*Any gestation
-If necessary to save life of woman
-If necessary to prevent permanent physical or psychological injury to pregnant woman
-If is risk child would be seriously disabled

*Up to 24 weeks
-If continuing pregnancy = greater risk than if terminated - i.e., physical or mental health of woman or her mother dusting children or other family

Question 4

What provisions must be satisfied for carrying out abortions?

Answer 4

England - med practitioners MUST legally notify Chief Medical Officer through Form HSA4, of every abortion have performed within 14 days of procedure

-Unless emergency abortion is needed - termination otherwise requires 2 med practitioners to certify they are of same opinion & grounds for abortion meet that of one’s required

Question 5

Define abortion.

Answer 5

Controversial - spontaneous or induced termination of pregnancy before the fetus reaches a viable age

Question 6

Who carries out abortion in UK?

Answer 6

-NHS funded - but 80% contracted out
= England
-Through BPAS = NI
-No private clinics in NI but are in England

Question 7

What is the most common form of abortion method?

Answer 7

Medical abortion pill

-Mifepristone 200mg oral, anti-progesterone
-Misoprostol 400-800mg, vaginal/buccal, prostaglandin analogue
-5-12 weeks
-Can take at home
-Check urine pregnancy test to ensure complete

Question 8

What are some surgical options for abortion & when can they be done?

Answer 8

-Manual vacuum aspiration (5-14 weeks)
-Surgical dilation and curettage (5-12 weeks)
-Induction of delivery (>15 weeks)
-Surgical removal of fetus (fetocide ≥22 weeks)

Question 9

When does life begin?

Answer 9

Question 10

What is the status of an embryo?

Answer 10

???
-Foetus = no legal rights
—> unborn baby doesn’t become separate person with legal rights until are born & draw breath
-So = moral dilemma - should women really be allowed to form decisions regarding their unborn baby?
—> should termination be lawful?

Question 11

What is conscientious objection?

Answer 11

-Drs can choose not to be involved in services/procedures on personal moral grounds
-Must be done in advance - make seniors/employers aware prior
-BUT - cannot refuse future treatment of people who e.g., has received abortion in past & must provide emergency care
-Cannot stop people accessing services or leave them with no other option

Question 12

Name some prenatal screening tests & what they test for.

Answer 12

*Combined test
—> blood test markers & scan nuchal thickness
Calcs chance of:
-Downs = T21
-Patau = T13
-Edwards = T18

*QUAD test
-Blood test for markers for Downs risk only
-High chance defined as >1/150

*Triple blood test
-Alpha-fetoprotein
-Human chorionic gonadotropin
-Unconjugated estriol
= all measured

Question 13

What are 2 forms of invasive prenatal screening?

Answer 13

*Chorionic villus sampling = weeks 9-14
-Transabdominal method = needle inserted through tummy - remove placenta tissue
-Transcervical method = for Celts through cervix to remove placenta tissue
—> analyse baby’s DNA by assessing placenta tissue

*Amniocentesis = weeks 14 onwards = rush of miscarriage
-Insert needle through tummy to remove amniotic fluid sample

*Anomaly scan = weeks 18-21
-Structural abnormalities
-May suggest syndrome

Question 14

Why are some ethical considerations when conducting prenatal screening?

Answer 14

-Informed choice
-90% of those identified with Trisomy 21 elect for termination (i.e., Down’s)
-About 50% of expected no. of people with trisomy 21 in pop
-“I’m sorry your baby has Down’s”
-Challenges of having a child with disability
-Family/society pressure

Question 15

What is the legal position of prenatal screening?

Answer 15

-Supreme court affirmed compensation for certain cases of wrongful birth - i.e., babies born with disability parents not made aware of during pregnancy
—> must meet certain conditions
-Not giving all info to pregnant woman prior to birth - need info to make informed choice whether to continue pregnancy
-Not explain testing properly
-Not explain outcomes of diagnosis
-Lab errors

Question 16

What are some methods of assisted reproduction?

Answer 16

-Intrauterine insemination
-IVF

Question 17

Issues surrounding assisted reproduction?

Answer 17

-Is subfertility a medical problem?
-Should it be publicly funded?
-Variations in access across country

Question 18

What are the NICE guidelines surrounding assisted reproduction?

Answer 18

Woman under 40 should be offered 3 cycles of IVF if:
-Trying to get pregnant for 2 years
-Using artificial insemination to get pregnant & not worked after 12 cycles (at least 6 of these should have been intrauterine insemination)

Question 19

How many embryos are transplanted during IVF & why?

Answer 19

Single - max = 2
—> in past many implanted = multiple births = risky

Question 20

What can be done with embryos?

Answer 20

-Transfer/transplant
-Donated to others
-Used for research or training (with consent)
-Destroyed - ethics!!!

Question 21

Ethical consideration during assisted reproduction?

Answer 21

-Expensive resources
-Unused embryos may be destroyed
-Basic human right to have children?
-Priority treatment for infertile patients?
-Cannot discriminate but what about suitability of parent?
Illnesses/disabilities/social circumstances/criminal record?
-Suitability not assessed for those who reproduce without assistance

Question 22

What does the HFEA (Human Fertilisation & Embryonic Authority) recommend regarding assisted reproduction?

Answer 22

-“A woman shall not be provided with treatment services unless account has been taken of the welfare of any child who may be born as a result of the treatment ( including the need for a father), and of any other child who may be affected by the birth”
-2008 Changed “need for father” to “need for supportive parenting”
-Presumed supportive parents in absence of reasonable cause for concern

Question 23

Give 2 types of preimplantation genetic screening.

Answer 23

-Preimplantation genetic screening = identify is embryo genetics are generally normal - no. chromosomes
-Preimplantation genetic diagnosis = look for specific genetic abnormalities in embryo DNA - i.e., screen embryos for particular genetic disease

—> so can select embryos with ‘best’ genetic make-up - implant unaffected embryo

Question 24

Ethics of preimplantation genetic diagnosis?

Answer 24

-IVF
-Selecting against disability-right or wrong?
-Wrongful birth?
-Protecting a child from a life with illness?
-How do we define a significant disability or disease?
-Is this definition best made by a parent who has suffered with the diagnosis?
-Equality Diversity -Inclusion
-Slippery slope? - Where do we stop?

Question 25

Legalities of surrogacy?

Answer 25

-The surrogate mother is treated legally as the mother of the child (HFEA Act 2008)
-Commissioning parents gain custody by adoption or by gaining a parental order

Question 26

Questions that arise from surrogacy.

Answer 26

-Access
= not available on NHS - privately funded
-Effect on surrogate-means to end?
-Paying for services?
-Effect on child? But that child could otherwise not have existed
-What if surrogate wants to keep the child?
-What if the child is born with disabilities/illnesses?

Question 27

Access to sperm/egg donation?

Answer 27

NHS or private

Question 28

Reasons behind sperm/egg donation?

Answer 28

-Alturism?
-Financial?
-Ego?
-Should donors be paid/paid in kind?

Question 29

Questions that arise from sperm/egg donation.

Answer 29

-Selecting donor?
-Donors wanting to see children?
-Children wanting to see biological parent
-Children’s right to a mother & father?

Question 30

What is mitochondrial donation?

Answer 30

Question 31

Is mitochondrial donation ethically acceptable?

Answer 31

-Involves IVF
-What to tell child?
-‘3rd parent’ DNA is not nuclear so not contributing to personality etc
-3 parents???
-Unknown outcomes? -‘Frankinscience’?
-Interfering with germ-line