Ethics of reproduction

Question 1

Why are reproductive issues so complex?

Answer 1

Reproductive autonomy
Involves multiple people, partner, other children etc
Fundamental values - sanctity of life
Opions are diverse and immovable
Religious component
Emotional
Children: expensive and time consuming
Significant resource implications

Question 2

How safe is abortion?

Answer 2

Abortion is a safe and common procedure
No matter the gestation abortion is safer for the mother than pregnancy to term.
No evidence that abortion results in poorer mental health outcomes, than if they had not had an abortion.

Question 3

What is the UK law regarding abortion?

Answer 3

Lawful up to 24 weeks if….
- needed to save the womans life
- needed to prevent permanenet mental or physical ilhealth of the woman or other children.
- substatianl risk that the child will be severly handicapped
Lawful after 24 weeks if ….
…. the continuation of pregnancy poses a greater risk than terimination on the mother life and the foetal has a fatal abnormality. Or if the foetus has Down Syndrome.
Two doctors need to sign to agree for the abortion to take place.

Question 4

As a medical professional what are your requirements when providing an abortion service?

Answer 4

May want to use conscientious objection - should have informed the practice manager and your team of this in the past so they can prepare
Must notify the Chief Medical Officer through Form HSA4 of every completed abortion within 14 days of the procedure.
Unless it is an emergeny, must ensure a second medical professional has agree that there is a legitmate and same reason for having an abortion.

Question 5

What is an abortion?

Answer 5

A spontaneous or induced termination of pregnancy before the featus reaches a viable age (20 weeks).
After 20 weeks it is a still birth.

Question 6

What are some different types of abortion?

Answer 6

Spontaneous - not medically induced
Induced - medical or surgical intervention
Complete - all tissue removed
Incomplete - only some tissue removed
Infected (septic) - uterus and any remaining production of conception become infected
Missed abortion - pregnancy lost but tissues of conception remain in the body.

Question 7

What is a threatend miscarriage?

Answer 7

Patient suffers abdominal cramps and potentially vaginal bleeding, this indicates an increased risk of a miscarriage.

Question 8

What is access to abortion services like in the UK?

Answer 8

Universal Access Policy
Abortions are funded by the NHS but 80% are contracted out by the NHS to private services
Private clinics are also available
Within five days to clinic then 10 days to time of appointment from request for abortion
Local services
Supportive environment

Question 9

What is the Northern Ireland abortion law?

Answer 9

Abortion is allowed before 12 weeks gestation when certified by one medical professional
Abortion is allowed after 12 weeks in severe cases where the foetus is hugely handicapped or has a fatal abnormality.
May legally travel elsewhere in the UK to have an abortion under different laws.

Question 10

What are the different methods of termination and when can they be used?

Answer 10

Medical Pill - 5-12 weeks gestation
Manual Vacuume Aspiration - 5 to 12 weeks
Surgical dilation and curretage 5 to 12 weeks
Induction of delivery - above 15 weeks
Surgical removal of foetus - above 22 weeks

Question 11

How does the medical abortion pill work?

Answer 11

Mifepristone 200mg, anti-progesterone, stops growth and causes to leave uterus lining
Misoprostol 400-800mg, vaginal.buccal, prostaglandin analogue, softens and opens the cervix, contractions to pass the pregnancy.
Can be taken at home
Must be followed with a pregnancy test to ensure it is complete.

Question 12

What are some of the suggestions for when life begins?

Answer 12

Conception
3 weeks the heart and brain begins to develop
6 weeks the heart beats
Youngest baby to survive was 21 weeks gestation
23 weeks - 30% survival
24 weeks - 40% survival
Full term - 40 weeks when exists independent of mother

Question 13

How long is gestation in humans?

Answer 13

Full term is 40 weeks.

Question 14

What do different people classify the status of the embryo as?

Answer 14

A potential human being
A possession of the mother
Full moral status in their own right
No moral status - can be sued for anything

Question 15

What is conscientious objection?

Answer 15

When a medical professional wishes not to perform a procedure due to personal beliefs.
They must refer the patient to alternative provider of care, cannot discriminate, harrass or imply judgement
Must provide emergency care if needed
Must continue to privde care pre and post the procedure.

Question 16

What are the different prenatal screening tests in the UK?

Answer 16

Combined test
QUAD test
NIPT

Question 17

What is the combined test in prenatal testing?

Answer 17

Blood tests for markers and scan of nuchal thickness (fluid at back of neck)
Risk of Down Syndrome, Patau and Edwards syndrome.
Done between 10 to 12 weeks

Question 18

What is the QUAD test in prenatal screening?

Answer 18

Done at 15 to 19 weeks
Blood test for markers of Down Syndrome
Predicts chance not confirmation

Question 19

What is a NIPT test in prenatal screening?

Answer 19

Non invasive prenatal testing testing
Tests for foetal DNA in the mothers blood
Looks for risk of Down Syndrome, Edwards Syndrome or Patau.

Question 20

What is 3T prenatal testing?

Answer 20

Tests blood for alpha-fetoprotein (risk of neural tube defects or Down syndrome) , human gonadotropin (ectopic pregnancy) and unconjested estriol (uterus health).

Question 21

What is chorionic villus sampling?

Answer 21

A type of invasive prenatal screening
Placental tissue is samples either transabdominally or transcervically under the guid of an ultrasound scanner.
Done at 10 to 13 weeks
Looks for genetic or chromosomal conditions

Question 22

What is amniocentesis?

Answer 22

A prenatal screening process
Needle is inserted through the abdomen to extract amniotic fluid
Done from 14 weeks onwards
Has a risk of miscarriage 1 in 100
Checks for genetic conditions, chromosomal conditions, infection and lung development. Is definitive results.

Question 23

What is an anomaly scan in prenatal screening?

Answer 23

Done between 18-21 weeks
For structural abnormalitites or markers
MAy suggest a syndome
Done by ultrasound.

Question 24

What are the ethical considerations around prenatal screening?

Answer 24

Informed choice
90% of those identified with Down Syndrome terminate their pregancny - eugenics
Image of children and the parents of children with disabilities that could have been screened for.
Family and societal pressure forces a termination based on test results.

Question 25

What is the legal position of prenatal screening?

Answer 25

Supreme court affirmed that compensation is available in the cases of wrongful birth for the costs of bringin up a disabled child if the claimant can proove they have suffered a failure of care.
Failure of care includes
- not being given all the information to make an informed decision to have a termination
- not providing appropriate access to testing
- not explaining the outcome of a diagnosis
- lab errors.

Question 26

What is meant by a wrongful birth?

Answer 26

When a child who underwent prenatal screening and was not identified to have a risk of a disability is born with that disability.

Question 27

What are some statistics regarding the prevalence of infertility?

Answer 27

One in seven couples find achieving a pregnancy difficult
Half of women saw coping with infertility as the most upsetting experience of their life.

Question 28

What are the different forms of assisted reproduction?

Answer 28

IVF
Surragacy

Question 29

What are the NICE guidelines on IVF?

Answer 29

If you are a woman aged under 40 you should be offered 3 full cycles of IVF if:
you have been trying to get pregnant through regular unprotected sexual intercourse for a total of 2 years or
you are using artificial insemination to conceive and you have not become pregnant after 12 cycles – at least 6 of these cycles should have been using intrauterine insemination.

Women over forty will be offered one cycle of IVF under the same circumstances and a risk discussion with the doctor

The number of cycles from the NHS deducts the number from private clinics

IVF will be offered immediatly if tests show you will not respond to other fertility methods.

Question 30

What is artifical insemination?

Answer 30

When sperm is aritifically delivered to the cervix or utuerus to increase chance of preganancy.

Question 31

What are some regulations around IVF?

Answer 31

Human Fertility and Embryology Act 2008 and Authority
Strictly regulated
Only a maximum of two embryo transfers per cycle
The remaining embryos can be frozen for future use, donated, used for research or are destroyed

Question 32

What are some ethics surrounding assisted reproduction?

Answer 32

Expensive
What happens to unused embryos?
Basic human right to have children
Priority access to infertile parents
Cannot discriminate - yet guidance on the suitability of the parent.

Question 33

What are the HFEA recommendations on the suitable ness of a parent requesting IVF?

Answer 33

The welfare of the child must be considered, mother must show evidence of supportive parenting (not neccessarly a father).
All parents are presumed reasonable expcet when there is evidence that they are not.
This allows same sex couples and single parents to have children.

Question 34

What is preimplanatation genetic screening?

Answer 34

Screen embryos to ensure 23 pairs of chromosomes and the sex chromosomes are normal in shape.
No aneuploidy (abnormal chromsomes)
In haploid cells or embryo before used for implantation

Question 35

What is preimplanatation genetic diagnosis?

Answer 35

In haploid cell or embryo before implantation
Tests for genetic disorders that the parents are identified risks of.
Only done in specific conditions when their is a greater risk.
Used for over 600 genetic conditions of single genes.

Question 36

What are the ethics of preimplanation genetic diagnosis?

Answer 36

Wrongful birth risk
Discrimination against disability - how do we define a disability?
Equality Diversity and INclusion
Slippery slope - select for gender

Question 37

Give an overview of the surrogacy process?

Answer 37

Not offered on the NHS
Surrogate mother is treated at the legal parent, commissioning parents must gain cutody by adoption ot parental order
Very complicated legal process

Question 38

Give an overview of sperm/egg donation.
What are the ethical issues?

Answer 38

NHS or private
Reason for donation - alutrism, financial, ego
Selecting donor
Relationship between donor/child
Childs right to a mother and a father
Paid for expenses and cost of treatment

Question 39

How does mitochondrial donation work?

Answer 39

Donor and mother egg are fertilsed by sperm (often same donor)
The donors nuclear DNA ins removed and the mothers egg inserted into the cell, hence has healthy mitochondrial DNA
Then implanated into the mother by IVF