Ethics of Reproduction Flashcards
What topics of reproductive medicine involve ethics?
- Terminations of pregnancy
- Contraception
- Prenatal testing and genetic testing
- Rights of women versus rights of their foetus
- Use of reproductive tissues in research
- Ethics of assisted reproduction
Is sex selection in IVF allowed in the UK?
Only if serious medical conditions are linked to gender
- e.g. if all males in the family have 50% risk of a serious illness
Is sex selection during IVF allowed in other countries?
Yes
Allowed in USA and countries in middle east/asia due to cultural beliefs
Many parties are involved in the ethical debate of assisted fertility. Name some of these parties.
The couple Sperm donor (sometimes egg donor too) Family of sperm donor Surrogate mother Family of surrogate mother The child / foetus The state / NHS / clinic
Why is the ethical debate of assisted fertility so complex?
All parties involved have different beliefs and different perceptions of risks/benefits
What law governs the rules on sexual offence/consent in Scotland?
Sexual Offences (Scotland) Act ‘09
Under what age can a teenager not consent to sexual activity?
<13 years
=> if told about this as a doctor you must report it to social services
What can 13-15 years consent to, and what can they NOT consent to under the law?
- cannot legally engage in sexual activity
- can consent to low level sexual behaviour as this is deemed “part of growing up” e.g. touching/kissing/conversation etc
What is different to sexual consent in comparison to consent to a procedure in hospital?
Sexual consent - uninformed (i.e. no forms to sign to say person understands)
=> known as a “free agreement”
When can a doctor provide contraception to a patient who is under 16?
- if they are deemed competent
- if the doctor provides enough info for the patient to give informed consent
Who else would the doctor prefer is involved if a patient under 16 is asking for termination of a pregnancy?
- partner/father of child
- responsible adult (not necessarily parent - can be older sibling, family friend etc - someone the child can confide in)
Children over what age are deemed competent?
> 16 years
When are children over the age of 16 deemed as NOT competent?
If they are between 16-18 with a mental disorder and the other party is in a position of trust over them (e.g. a teacher)
How do adults with incapacity make decisions regarding sexual activity?
They require an advocate
If a patient presents at the age of 16 asking for contraception or termination of pregnancy what should you always ask?
Age of initial engagement in sexual activity
Why may you require a chaperone in any examination with younger patients (i.e. under 18)?
Some patients may misinterpret what you are doing in the examination
=> chaperone protects yourself from illegality
What arguments may people have against assisted conception?
- harmful to women and their families
- not natural
- “playing god”
- artificially creates embryos which may be disposed of
What arguments are there for assisted conception?
- 1 in 6 couples have infertility problems
- 50% of those will require assisted conception
- Not just treatment for infertility but also fertility preservation
- Same-sex couples can benefit, single women and men can benefit
What two bodies have been involved in implementing fertility clinic licenses and recommendations to comply with the legal code of practice ?
The Warnock Committee
The Human Fertilisation and Embryology Authority (HFEA)
What is detailed in the HFEA code of conduct in regards to preimplantation tissue typing?
- available for treatment of an existing child who is affected by a serious or life-threatening condition
Where do the HFEA stand on 3 person IVF (egg from mother, sperm from father and mitochondria from 3rd party (2nd genetic mother))?
This is approved by the HFEA and can be used to treat serious mitochondrial diseases
What ethical issues are raised specifically when talking about infertility?
- Infertility = disease or variant of normal? (If considered a disease this may affect entitlement)
- Right to procreate? Is there a duty to help everyone conceive?
- Is it ever reasonable to refuse treatment? (e.g. welfare of child, obesity/smoking => increased harm to child)
- Who should fund treatment?
Funding for assisted conception varies across the NHS. TRUE/FALSE?
TRUE
- In England, only 1 cycle is funded by the NHS
- In Scotland, 3 cycles are funded by the NHS
What is meant by conscientious objection of a doctor?
Doctor can choose to opt out of giving certain treatments e.g. contraception, termination of pregnancy, referral to infertility clinic etc
When must a doctor with a conscientious objection have to deal with a termination of pregnancy?
If a patient is BLEEDING and it is an emergency, the doctor MUST treat this regardless of whether it could be due to a pregnancy termination
part of GMC guidance
What are the rights of the gamete/embryo itself?
- embryo research permitted up to 14 days
- abortion permissible up to 24 weeks (later if severely handicapped / risk to maternal life)
- infertility treatment can result in ‘spare’ embryos => ethical issues arise from storage, research and disposal of redundant embryos
How are ethical reproductive cases discussed at weekly MDT meetings in order to decide how to proceed?
- Is it legal?
- Is it practical?
- Do we have ALL appropriate information?
- Is treatment ethical for ALL PEOPLE involved?
OUTCOME = Often compromise between ideal clinical care and ideal ethical practice.
If a decision cannot be made at an MDT meeting about a particularly ethical case then what can be done?
It can be put to the Reproductive ethics committee who will aid in making a decision
OR
Hospital Legal Service can help as some cases may require legal advise
When is it legally possible to freeze a patients eggs?
- patients undergoing chemotherapy for cancer treatment
- patients about to undergo gender reassignment surgery
