Ethical Issues

Ethical Principles
Beneficence- To do good
Nonmaleficence- To do no harm

Autonomy- Right to refuse or choose treatment

Justice- Fairness and equality Veracity- To tell the truth

Confidentiality- To respect privileged information

Fidelity- Duty to keep Promise

Ethical Issues-Preconception
Genetic Testing
Creates important opportunities for assessment of genetic

risk and diagnosis Clinicians should be able to identify patients who are candidates for testing Should be tied to availability of interventions, including prenatal diagnosis, counseling, reproductive decision making, lifestyle changes, and enhanced phenotype screening

Ethical Issues- preconception

Genetic Testing Concerns
Disclosure of genetic information:
Proponents argue that

disclosure is acceptable if harm that is likely to occur is serious, immediate, and foreseeable Opponents argue that confidentiality of patients should be subject to stringent safeguards because of social consequences such as discrimination and stigmatization based on predisposing gene
http://autisticwisdom.blogspot.com/2010/06/genetic-testing-curse-or-blessing.html

Ethical Issues- preconception

Sex Selection
Practice of using medical techniques to choose sex of

offspring
May be used in prevention of sex-linked disorders May also be used in variety of social, economic, cultural, and

personal reasons.

Ethical Issues- preconception

Sex Selection Concerns
Proponents argue that ethics,

law, and social practice accord couples the rights to act on preferences for children of a particular gender Opponents argue that such techniques increase or reinforce gender discrimination, sex ratio imbalances and places emphasis on genetic characteristics rather than inherent worth

http://womansday.ninemsn.com.au/lifestyle/family/8206382/aussies-areagainst-sex-selection-report

Ethical Issues- preconception

Sperm Donation Concerns
Consanguineous conception: Different countries have guidelines for limiting the number of donor offspring International Federation of Gynecology and Obstetrics (FIGO) provides general guidelines on limiting number of offspring There is currently no federal or state law in United States limiting sperm donation

Ethical Issues- preconception

Sperm Donation Concerns
Risk of infection and genetics:
Medical evaluation and screening have been mandated for

donor to prevent transmission of sexually or genetic disorder to offspring

Donors must be healthy persons of normal reproductive age

free from sexually transmitted disease and hereditary disorders

Ethical Issues- preconception

Sperm Donation Concerns
Anonymous vs. Non-anonymous

sperm donations Proponents of anonymous argue that it beneficial to donor, recipients and offspring May subject child to social or psychological disorder Allows parent to maintain the issue of infertility private

Ethical Issues- preconception

Sperm Donation Concerns
Anonymous vs. Non-anonymous sperm donations
Proponents of non-anonymous donation argue that humans

have fundamental interest and legal rights to know their biological origins It invites open and honest communication with parents and offspring Not telling violates childs autonomy

Ethical issues- pregnancy

Prenatal diagnosis and

screening concerns
Proponents argue that testing is

a form of increased control over reproductive autonomy and privacy It enhances level of medicalization and surveillance during pregnancy

Ethical issues- pregnancy

Prenatal diagnosis and screening concerns
Opponents argue that it will put new pressure on women to shoulder the

responsibility for producing socially acceptable, productive citizens, and for disciplining their own bodies and laying them open to medical interventions and surveillance It portrays pregnancy as an inherently risky and perilous process that creates unrealistic pressures on women to emotionally bond with or disengage from their fetuses on cue and to keep their relationship to pregnancy tentative until tests come back negative

Ethical issues- pregnancy

Prenatal diagnosis and screening concerns Eugenics? Issues for future children
Concern for designer children leading to homogenization of

gene pool and elimination of diversity

Conditional love for children based on trait May lead to selective abortion

Ethical issues- pregnancy

Abortion
Termination of pregnancy by

the removal or expulsion of an embryo or fetus from the uterus, resulting in its death.
It can occur spontaneously due

to complications during pregnancy or can be induced.

http://www.100abortionpictures.com/Aborted_Baby_Pictures_Abortion_Photos/Enl argement.cfm?ID=37

Ethical issues- pregnancy

Abortion: Life versus Choice Debate focuses on politics and law: Should abortion be outlawed and treated like murder? Should abortion remain a legal choice available to all women? Is the fetus a person with rights? Is it ethical to force a woman to carry pregnancy to term? Does abortion treat the fetus in an unethical, callous way?

Ethical issues- pregnancy

Abortion Prolife
Argue that abortion is

murder and should be illegal

ethical obligation to the fetus unethical, callous way

Pregnant woman has

Abortion treats fetus in an

http://02varvara.files.wordpress.com/2008/04/benjamin_ruskie.jpg

Ethical issues- pregnancy

Abortion- Prochoice
Argue that people have

ethical claim to personal, bodily autonomy Women do not have the duty to be pregnant against their will It is unfair to children to bring them into a world where they are not wanted

Ethical issues- pregnancy

Pregnancy and Mental illness
Mental illnesses occur among women in the reproductive

period
Illnesses include bipolar disorders, psychotic depression,

schizophrenia and other psychotic disorders

Mental disorder and treatments pose serious risks to

mother and fetus

Ethical issues- pregnancy

Pregnancy and Mental illness Concerns
Whether to continue or terminate pregnancy? Impaired decision making? Issues of autonomy?

Solution: It is important for clinicians to educate their patients regarding the issues of becoming pregnant while being on medication and options for planning pregnancy

Ethical issues- pregnancy

Pregnancy and Alcohol and Drug dependency Risk of fetal alcohol syndrome:
Should society force drug abusing pregnant women who

abuse drugs to have an abortion? Should states prosecute pregnant drug users for separate crimes beyond illicit drug use like child abuse? Does the fetus have the right not to be subjected to life damaged by alcohol and drug exposure?

Ethical issues- pregnancy

Pregnancy and Alcohol and Drug dependency Three approaches toward remedy:
Punishment- rejected because it is immoral and impractical Treatment- treats addiction as individual, medicalized health

problem rather than social problem

Empowerment best approach to foster reflective sense of

collective influence over social conditions of ones life

Ethical issues- pregnancy

Commercial preconception arrangements (Surrogacy)
A woman is paid to conceive and bear a child to hand

over to someone else to raise

Concerns:
Ability of the surrogate woman to make an informed

choice Exploitation of womans vulnerability due to poverty May create social harms by diminishing the dignity of reproduction and undermining societys commitment to the inherent value of children

References
Baird, P. (1996). Ethical issues of fertility and reproduction. Department of Medical Genetics, 47, 107-116. Retrieved from www.annulreviews.org Desai, G., & Chandra, P., (2009). Ethical issues in treating pregnant women with severe mental illness. Indian Journal of Medical Ethics , 2(6). Retrieved from http://www.ijme.in/172ar75.html Gong, D., Liu, Y., Zheng, Z., Tian, Y., & Li, Z. (2009). An overview on ethical issues about sperm donation. Asian Journal of Andrology, 11, 645-652. Retrieved from http://www.nature.com/aja/journal/v11/n6/full/aja200961a.html

Kukla, R., & Wayne, K. (2011). Pregnancy, birth, and medicine. Stanford Encyclopedia of Philosophy. Retrieved from http://plato.stanford.edu/entries/ethics-pregnancy/ Kundan, P. (2011). Ethical issues on abortion. Retrieved from http://www.buzzle.com/articles/ethical-issues-on-abortion.html

Photo / Image References

[Abortion image]. Retrieved from http://www.100abortionpictures.com/Aborted_Baby_Pictures_Abortion_Photos/Enlargement. cfm?ID=37 [Amniocentesis image]. Retrieved from http://www.fotosearch.com/LIF001/9981f_hr/ [Genetic testing image]. Retrieved from http://autisticwisdom.blogspot.com/2010/06/genetictesting-curse-or-blessing.html [Photo of baby.] Retrieved from http://02varvara.files.wordpress.com/2008/04/benjamin_ruskie.jpg [Pregnant choice image]. Retrieved from http://www.fotosearch.com/CSP299/k2995127/

[Right vs. wrong image]. Retrieved from http://www.fotosearch.com/CSP648/k6488472/

[Sex selection image]. Retrieved from http://womansday.ninemsn.com.au/lifestyle/family/8206382/aussies-are-against-sexselection-report [Sperm and ovum image]. Retrieved from http://www.fotosearch.com/CSP169/k1698007/