L8 Assisted Reproduction: Social and Ethical Issues Flashcards
Defining ‘infertility’ problems
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 gender(s) of prospective parent(s) or single status
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 - uncontroversial
In other cases, objective of treatment is birth of a child, not removal of medical problem - strange use of medicine?
Justifiable medical intervention?
Relief of psychological suffering
Fertility treatment relieves the psychological suffering associated with infertility
In other cases, relief of psychological suffering is insufficient grounds for funding medical intervention e.g. cosmetic enhancement, tattoo removal
Social values and fertility
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 could be a parent to any child not just biological one)
Infertility: arguing against disease model
Infertility is not a disease
But not being able to reproduce may cause distress as a result of:
- a woman’s inability to experience pregnancy and childbirth
- the inability to conform to the social norm of reproducing
Does the ‘right to found a family’ entail the right to have fertility treatment?
- Does this mean NHS should fund it?
One does not have right to ‘desired experiences’? Why not deconstruct social norms rather than fixing a person?
IVF: the basics
IVF challenges our ideas about parenting
Involves consideration of: genetic/gestational/care-giving mother and genetic/care-giving father
Objections to IVF
Not natural
Catholic church: separation of sex and conception
Moral status of embryo; surplus embryos
IVF NICE recommendations
NHS should offer 3 cycles of IVF to women aged between 23-39 who have an identified cause of their infertility problems or unexplained infertility for three years
How much does 1 cycle of IVF cost the NHS?
£3000
Clinical Commissioning Groups
CCGs have strict guidelines within their local jurisdictions
- ultimately, financial considerations prevail
CCGs have additional criteria you need to meet before you can have IVF on NHS:
- not having any children already
- being a healthy weight
- not smoking
- falling into a certain age range
In some cases, only 1 cycle offered rather than 3
Distributive issues
Women should get 3 cycles of IVF n the NHS but only 18% of CCGs offer this
50,000 women have IVF in the UK every year but only 40% is funded on NHS
Different costs in different parts of the UK
Non-econimic considerations
IVF - chance of success
Woman’s ability to conceive reduces with age
Low success rate means that the destruction of more implanted embryos.
Potential parents may be given false hope, and the distress of childlessness may be prolonged
ARTs on the NHS
The need for a father?
- commentators argues this was discriminatory and in 2009 removed from HFE act
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 risk of serious medical, physical or psychological harm to the child
Welfare considerations
Before offering treatment, clinics ask patients questions relating to the following issues:
- previous convictions related to harming children
- contract 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
