Ethics of Reproduction

Question 1

What topics of reproductive medicine involve ethics?

Answer 1

• 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

Question 2

Is sex selection in IVF allowed in the UK?

Answer 2

Only if serious medical conditions are linked to gender

- e.g. if all males in the family have 50% risk of a serious illness

Question 3

Is sex selection during IVF allowed in other countries?

Answer 3

Yes

Allowed in USA and countries in middle east/asia due to cultural beliefs

Question 4

Many parties are involved in the ethical debate of assisted fertility. Name some of these parties.

Answer 4

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

Question 5

Why is the ethical debate of assisted fertility so complex?

Answer 5

All parties involved have different beliefs and different perceptions of risks/benefits

Question 6

What law governs the rules on sexual offence/consent in Scotland?

Answer 6

Sexual Offences (Scotland) Act ‘09

Question 7

Under what age can a teenager not consent to sexual activity?

Answer 7

<13 years

=> if told about this as a doctor you must report it to social services

Question 8

What can 13-15 years consent to, and what can they NOT consent to under the law?

Answer 8

• 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

Question 9

What is different to sexual consent in comparison to consent to a procedure in hospital?

Answer 9

Sexual consent - uninformed (i.e. no forms to sign to say person understands)
=> known as a “free agreement”

Question 10

When can a doctor provide contraception to a patient who is under 16?

Answer 10

• if they are deemed competent

- if the doctor provides enough info for the patient to give informed consent

Question 11

Who else would the doctor prefer is involved if a patient under 16 is asking for termination of a pregnancy?

Answer 11

• partner/father of child
• responsible adult (not necessarily parent - can be older sibling, family friend etc - someone the child can confide in)

Question 12

Children over what age are deemed competent?

Answer 12

> 16 years

Question 13

When are children over the age of 16 deemed as NOT competent?

Answer 13

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)

Question 14

How do adults with incapacity make decisions regarding sexual activity?

Answer 14

They require an advocate

Question 15

If a patient presents at the age of 16 asking for contraception or termination of pregnancy what should you always ask?

Answer 15

Age of initial engagement in sexual activity

Question 16

Why may you require a chaperone in any examination with younger patients (i.e. under 18)?

Answer 16

Some patients may misinterpret what you are doing in the examination
=> chaperone protects yourself from illegality

Question 17

What arguments may people have against assisted conception?

Answer 17

• harmful to women and their families
• not natural
• “playing god”
• artificially creates embryos which may be disposed of

Question 18

What arguments are there for assisted conception?

Answer 18

• 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

Question 19

What two bodies have been involved in implementing fertility clinic licenses and recommendations to comply with the legal code of practice ?

Answer 19

The Warnock Committee

The Human Fertilisation and Embryology Authority (HFEA)

Question 20

What is detailed in the HFEA code of conduct in regards to preimplantation tissue typing?

Answer 20

• available for treatment of an existing child who is affected by a serious or life-threatening condition

Question 21

Where do the HFEA stand on 3 person IVF (egg from mother, sperm from father and mitochondria from 3rd party (2nd genetic mother))?

Answer 21

This is approved by the HFEA and can be used to treat serious mitochondrial diseases

Question 22

What ethical issues are raised specifically when talking about infertility?

Answer 22

• 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?

Question 23

Funding for assisted conception varies across the NHS. TRUE/FALSE?

Answer 23

TRUE

• In England, only 1 cycle is funded by the NHS
• In Scotland, 3 cycles are funded by the NHS

Question 24

What is meant by conscientious objection of a doctor?

Answer 24

Doctor can choose to opt out of giving certain treatments e.g. contraception, termination of pregnancy, referral to infertility clinic etc

Question 25

When must a doctor with a conscientious objection have to deal with a termination of pregnancy?

Answer 25

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

Question 26

What are the rights of the gamete/embryo itself?

Answer 26

• 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

Question 27

How are ethical reproductive cases discussed at weekly MDT meetings in order to decide how to proceed?

Answer 27

• 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.

Question 28

If a decision cannot be made at an MDT meeting about a particularly ethical case then what can be done?

Answer 28

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

Question 29

When is it legally possible to freeze a patients eggs?

Answer 29

• patients undergoing chemotherapy for cancer treatment

- patients about to undergo gender reassignment surgery