L8 (Theme 2): Assisted Reproduction: Social and Ethical Issues.

Question 1

define fertility problems

(pick 2 out of the multiple available)

Answer 1

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.

Question 2

What is the medical aspect of infertility

Answer 2

Infertility is sometimes a symptom of an underlying medical condition, and is addressed or resolved by treating the underlying medical condition. This seems uncontroversial.

Question 3

what is the social aspect of treating infertility

Answer 3

In other cases the objective of treatment is the birth of a child, not the removal of the medical problem. This seems like a strange use of medicine.

Question 4

what are the arguments for fertility treatment being a medical problem

Answer 4

Fertility treatment relieves the psychological suffering associated with infertility.

Question 5

what are the arguments against fertility treatment being a medical problem

Answer 5

In other cases, relief of psychological suffering is insufficient grounds for funding medical intervention e.g. cosmetic enhancement, tattoo removal.

Question 6

what is the social values of fertility

Answer 6

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).

Question 7

Arguments against the disease model

Answer 7

• 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

Question 8

does one have a right to ones desired life experiences

Answer 8

they don’t but why not resist or deconstruct the social norms, rather than fixing the person

Question 9

what is the IVF process

Answer 9

SLIDE 11

Question 10

what does IVF consider

Answer 10

Genetic gestational care-giving mother and genetic care giving mother .

Question 11

what are the objections to IVF

Answer 11

It’s not natural

catholic church- separation of sex and conception

moral status of the embryo ; surplus embryos

Question 12

what are the NICE recommendations for how IVF should be carried out

Answer 12

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.

Question 13

what about the influence of smaller groups such as CCGs (Clinical commissioning groups)

Answer 13

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:

• not having children already from both your current or previous relationships
• being a healthy weight
• not smoking
• falling into a certain age range (ie some CCGs only fund treatment for women under 35 )

Question 14

what are the distributive issues

Answer 14

Slide 14

Question 15

what are the non-economic considerations of IVF

Answer 15

A Woman’s ability to have a child

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.

stats for successful IVF fertilisation cycles with their own eggs-

• under 35<32.2%
• 38-39< 20.8%
• aged 45 and over < 1.9%

Question 16

what is the welfare considerations for IVF

Answer 16

previous convictions related to harming children;

• contact with social services over the care of existing children;
• serious violence or discordwithin the family;
• serious drug or alcoholabuse;
• serious mentalor physicalconditions; •

risk to the child of a serious medicalcondition

Question 17

Making ART access: does it need a father

Answer 17

There was a specific recommendation in the original HFE Act (1990)thatwhenprovidingtreatmentcliniciansshouldacknowledge ‘theneedforafather.’

but Commentators argued that this requirement is discriminatory, and ina2009review,theclausewasremovedfromtheHFEAct

In 2008, MPs voted against need for a father in IVF.

Question 18

what are the for points in regards to the welfare of the child assessment

Answer 18

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.

Question 19

what are the against points in regards to the welfare of the child assessment

Answer 19

The institution of the family has changed

potential for abuse and discrimination in making judgements

clinicians are not trained to assess such complex social situations

different attitudes of clinicians within different units lead to yet another lottery

Question 20

what is the -“A right to know” Law

Answer 20

In March 2005, the law changed to allow children conceived through the use of donor sperm and eggs to identify their genetic parents once they reach the age of 18.
).