T2 L8 Assisted Reproduction : Social and Ethical Issues Flashcards
What are the various definitions of infertility?
-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.
Describe the arguments for infertility being a”medical” or a “social” problem?
Medical : infertility is a symptom of an underlying medical condition, and is addressed or resolved by treating the underlying medical condition.
Social : objective of treatment is the birth of a child, not the removal of the medical problem. This seems like a strange use of medicine. Is medical intervention justifiable?
What are the psychological arguments for treating infertility?
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.
Treating people for infertility due to psychological suffering may not address the underlying symptoms.
What are the social values around 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 can become a parent to any child, not just those one gives birth to).
FOOD FOR THOUGHT: Is the patient distressed because they cannot have a child or are they distressed because of the social stigma they encounter which makes them feel like happiness is not possible without a child?
What is the argument against infertility being a disease?
- Infertility (in and of itself) is not a disease
- Diseases cause physical/psychological discomfort and can reduce a person’s expected lifespan
HOWEVER
- Infertility can cause distress due to:
a) a woman’s inability to experience pregnancy/childbirth
b) the inability to conform to the social norms of reproducing
BUT one does not, in general, have a right to one’s desired life experiences
Does the clause in the Universal Declaration of Human Rights on the “right to found a family” entail the right to have fertility treatment?
Not necessarily.
The “right to found a family” was included in the human rights declarations due to eugenics and forced fertilisation. It was a way of saying never again must the government interfere with a person’s decision and ability to have children of their own.
How does IVF challenge our ideas about parenting?
It involves consideration of;
- genetic/gestational/care giving mother
- genetic/care giving father
What are the objections to IVF?
- It is not “natural”
- Catholic church : IVF separates sex and conception
- Moral status of embryo/ embryo surplus (for those that believe that life begins are conception)
What are the NICE recommendations for IVF treatment?
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.
What effect do CCGs have on IVF treatment?
CCGs impose stricter rules within their jurisdictions on who is entitled to IVF. They may have additional criteria a woman has to meet before she is considered for IVF.
E.g. not having any children (from previous or current relationships), being a healthy weight, not smoking, falling into a certain age range (e.g. some CCGs only offer treatment to women under 35 years)
CRITIQUE: There is a form of control issued by the CCG on who can have IVF that may not be there if these people had naturally conceived (e.g. their weight and smoking status)
What are the distributive issues of IVF treatment?
Some NHS trusts offer more IVF cycles than others.
NOTE: Families often move to areas that gives them a higher chance of being offered more cycles on IVF treatment. Others resort to private IVF treatments.
What are the non economical considerations for IVF?
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. This an extremely taxing process for a woman. They take several hormone to stimulate their ovaries and they can as a result have underlying health issues.
If a woman (aged between 43-44) only has a 5% chance of being pregnant, is it justifiable to treat them and make them undergo such a taxing process?
Who should be allowed to access Artficial Reproductive Technology (ARTs) on the NHS?
Are there particular groups who should be given privileged access?
Are there particular groups/situations for which access should be limited/denied?
Whose best interests are paramount?
How does this compare to procreation without ARTs?
What is the argument that limits who is entitled to ARTs?
The need for a father
There was a specific recommendation in the original HFE Act (1990) that when providing treatment clinicians should acknowledge ‘the need for a father.’
“To judge from the evidence, many believe that the interests of the child dictate that it should be born into a home where there is a loving, stable, heterosexual relationship and that, therefore, the deliberate creation of a child for a woman who is not a partner in such a relationship is morally wrong. […] [W]e believe that as a general rule it is better for children to be born into a two-parent family, with both father and mother …” (Warnock Report, 1982).
This requirement was seen as discriminatory, and in a 2009 review, this clause was removed from the HFE Act.
Which MP was in support of the “need for a father” argument?
Iain Duncan Smith
He led a cross-party bid, claiming that the absence of a father had a “detrimental effect” on a child, and was defeated by 292 votes to 217.
