Assisted Reproduction: Social and Ethical Issues Flashcards
1
Q
Defining infertility
- Many definitions, both … and …:
- Inability of a woman of “…-… age” to become pregnant after a specified period of attempting to conceive.
- Repeated loss of pregnancy due to …
- Loss of ability to conceive due to previous … treatment.
- Inability to conceive due to … of woman.
- Inability to conceive unassisted due to … of prospective parent(s) or … status.
A
- Many definitions, both physical and social:
- Inability of a woman of “child-bearing age” to become pregnant after a specified period of attempting to conceive.
- Repeated loss of pregnancy due to miscarriage.
- Loss of ability to conceive due to previous medical treatment.
- Inability to conceive due to age of woman.
- Inability to conceive unassisted due to sex of prospective parent(s) or single status.
2
Q
Infertility: medical or social problem?
- Infertility is sometimes a symptom of an underlying medical condition, and is addressed or resolved by treating the underlying medical condition. This seems uncontroversial.
- In other cases the objective of treatment is the birth of a child, not the removal or amelioration of the medical problem. This seems like a strange use of medicine.
- Is this a justifiable goal of medical intervention?
A
3
Q
Social values and fertility
A
- Value placed upon procreation in and of itself.
- Strong social norms around reproducing, and devaluing/stigma of
- childlessness, especially for women.
- Importance placed on parenting (although one could argue that one can become a parent to any child, not just those one gives birth to).
4
Q
Infertility: arguing against the disease model
- Infertility, in and of itself, is not a disease.
- Diseases cause physical or psychological discomfort or reduce one’s projected lifespan.
- Yet not being able to reproduce may cause distress as a result of either:
- (a) a woman’s inability to experience … and …;
- (b) the inability to conform to the … norm of …
A
- Infertility, in and of itself, is not a disease.
- Diseases cause physical or psychological discomfort or reduce one’s projected lifespan.
- Yet not being able to reproduce may cause distress as a result of either:
- (a) a woman’s inability to experience pregnancy and childbirth;
- (b) the inability to conform to the social norm of reproducing.
5
Q
IVF: the basics
- IVF challenges our ideas about …
- Involves consideration of:
- genetic/gestational/care-giving mother, and genetic/care- giving father.
- Objections: It’s not “natural”!
- … church: separation of sex and conception.
- … status of …; surplus …
A
- IVF challenges our ideas about parenting.
- Involves consideration of:
- genetic/gestational/care-giving mother, and genetic/care- giving father.
- Objections: It’s not “natural”!
- Catholic church: separation of sex and conception.
- Moral status of embryo; surplus embryos.
6
Q
NICE recommendations - IVF
- NHS should offer … cycles of I VF to women aged between …-… who have an identified cause of their infertility problems or unexplained infertility for … years.
A
- NHS should offer 3 cycles of I VF to women aged between 23-39 who have an identified cause of their infertility problems or unexplained infertility for two years.
7
Q
Clinical commissioning groups - IVF
A
- Whilst NICE lays out guidelines to make recommendations about who should be offered IVF, CCGs may have stricter guidelines within their local jurisdictions.
- Ultimately, financial considerations prevail.
8
Q
Distributive issues - IVF
A
9
Q
Non-economic considerations - IVF
- Low success rate means the … of more implanted …
- Potential parents may be given false hope, and the … of childlessness may be prolonged.
A
- Low success rate means the destruction of more implanted embryos.
- Potential parents may be given false hope, and the distress of childlessness may be prolonged.
10
Q
Who should be allowed to access IVF on the NHS?
A
- Are there particular groups who should be given privileged access?
- Are there particular groups/situations for which access should be limited/denied?
- Whose best interests are paramount?
- How does this compare to procreation without ARTs?
11
Q
The need for a father?
A
- There was a specific recommendation in the original HFE Act (1990) that when providing treatment clinicians should acknowledge ‘the need for a father.’
- “To judge from the evidence, many believe that the interests of the child dictate that it should be born into a home where there is a loving, stable, heterosexual relationship and that, therefore, the deliberate creation of a child for a woman who is not a partner in such a relationship is morally wrong. […] [W]e believe that as a general rule it is better for children to be born into a two-parent family, with both father and mother …” (Warnock Report, 1982).
- Commentators argued that this requirement is discriminatory, and in a 2009 review, the clause was removed from the HFE Act.
12
Q
Revoking the need for a father?
- In 2008, MPs voted … need for a father in IVF.
- Iain Duncan Smith led a cross-party bid, claiming that the absence of a father had a “detrimental effect” on a child, and was ..
A
- In 2008, MPs voted against need for a father in IVF.
- Iain Duncan Smith led a cross-party bid, claiming that the absence of a father had a “detrimental effect” on a child, and was defeated by 292 votes to 217.
13
Q
HFEA “Welfare of the child” consideration
- The welfare of the child consideration requires that prior to being offered treatment, clinicians must assess patients in terms of … of serious medical, physical or psychological harm to the child.
A
- The welfare of the child consideration requires that prior to being offered treatment, clinicians must assess patients in terms of risk of serious medical, physical or psychological harm to the child.
14
Q
Welfare considerations - IVF
- Before offering treatment, clinics ask patients questions relating to the following issues:
- previous convictions related to … …;
- contact with social services over the care of existing children;
- serious violence or discord within the family;
- serious … or … abuse;
- serious … or physical conditions;
- risk to the child of a serious medical condition
- (HFEA, 2013, http://hfeaarchive.uksouth.cloudapp.azure.com/www.hfea.gov.uk/1414.html).
- Fair enough, deeply unfair, or just really tricky? Where do you stand?
A
- Before offering treatment, clinics ask patients questions relating to the following issues:
- previous convictions related to harming children;
- contact with social services over the care of existing children;
- serious violence or discord within the family;
- serious drug or alcohol abuse;
- serious mental or physical conditions;
- risk to the child of a serious medical condition
- (HFEA, 2013, http://hfeaarchive.uksouth.cloudapp.azure.com/www.hfea.gov.uk/1414.html).
- Fair enough, deeply unfair, or just really tricky? Where do you stand?
15
Q
For and against the welfare of the child assessment - IVF
A
-
For the welfare of the child assessment:
- Responsibilities to potential child.
- Responsibilities to society, including taxpayers and social services.
- The opportunity to prevent ‘harm.’
- Protect the family as a valuable social institution.
-
Against the welfare of the child assessment:
- • Fertile parents do not have to justify their ability to be parents. The need for intervention should not be used as an excuse for interference.
- Potential for abuse and discrimination in making judgments.
- Clinicians are not trained to assess such complex social situations.
- Different attitudes of clinicians within different units lead to yet another lottery.
- A person should not be denied aspects of citizenship based on their past.
- Existence is preferable to non- existence?
