This week’s discussion highlighted the role that provider morals can play in this arena, but now we will consider how best to understand and respect patient morals, while also addressing the many ethical complexities raised by assisted reproduction.
After several years of struggling with infertility and multiple, failed artificial insemination attempts, Sara and John recently underwent in-vitro fertilization (IVF). In hopes of increasing the odds of pregnancy, Sara asked her physician, Dr. Jones, to implant three embryos, leaving a further twelve embryos in storage. At their latest doctor’s appointment, Dr. Jones informs the couple that Sara is pregnant with quadruplets, noting that occasionally, as is the case here, one embryo splits, causing twins. Dr. Jones warns Sara and John about the risks associated with carrying the pregnancy to term since a quadruplet pregnancy significantly increases morbidity and mortality for the mother and dramatically increases the likelihood of preterm labor, low birth weights, and infant mortality. In the interest of Sara’s health as well as that of the other fetuses, Dr. Jones recommends that Sara undergo a procedure to abort two of the four babies (i.e., selective termination). There are no policies in the hospital that address this practice.
(More about this type of scenario can be found in this NY Times article: Grievous Choices on Risky Path to Parenthood http://www.nytimes.com/2009/10/12/health/12fertility.html?pagewanted=all&_r=0)
Sara and John are incredibly upset to hear this news, particularly because Sara says that nobody informed her about the possibility of this occurring, despite having met with both Dr. Jones and a psychologist prior to undergoing IVF. Sara refuses to undergo the selective termination, despite her impression that John might prefer her to do so. She feels that life begins at conception and that it would be immoral to undergo the termination. Tragically, five months into the pregnancy, Sara goes into labor prematurely, losing all of the babies. She is still in recovery, but has expressed an interest in attempting IVF again.
You are the VP for nursing in the assisted reproduction unit. In the interest of avoiding such a tragedy in the future, your CEO has asked you to brainstorm ideas for ways that your department can avoid such tragic situations in the future. In no more than 400 words, discuss the following issues:
- When should assisted reproduction patients be informed about the risk of multiple births? What would good informed consent need to address?
- If a patient, like Sara, expresses an unwillingness to undergo selective termination in the event of a multiple pregnancy, should she be permitted to receive ART? Under what circumstances?
- Sara has embryos in storage which either need to be maintained or disposed of. Why is it important to discuss this issue with Sara and her husband?
All sources, including course materials, must be cited in text in APA style. Remember that course materials need not be included in your references page, but all other references must be.