Ethical Issues of Reproduction

HCR 210 Ethics for the Healthcare Professional Learning Objectives: • Explain sexual privacy issues and be familiar with the ethical principles surrounding refusal or conscience legislation and emergency contraception provisions in the law • Become familiar with the ethical issues of reproductive health Disclaimer: • We will be discussing sensitive topics on which you may have strong personal opinions • Your personal opinions may be different from your fellow classmates or myself • I encourage you to share your opinions and engage in polite discussions exploring the ethics of reproduction • Please note that this is meant to be a safe and inclusive learning environment Ethical Issues of Reproduction Different Types of Parents Genetic mother: Mother who donated genetic material (ovum) to create child Gestational mother: Mother who carries child to term and delivery Social mother: Mother who raises child Genetic father: Father who donated genetic material (sperm) to create child Social father: Father who raises child Does the technician who assists with in vitro fertilization count as a parent? Clinical Scenario Father A and Father B decide that they want to have a child. They decide to use Father A’s sperm as the donor sperm. They ask their friend, Mother A, to donate her ovum for their new child. While Mother A agrees, she does not want to carry the baby. After looking for several months, they find Mother B, who agrees to carry the child. After the child is born, Mother A decides that she would like to play an active role in raising the child, which Father A and Father B never agreed to and feel uncomfortable with. What is the most ethical solution? Ethical/Legal Questions • • • • Who are the parents in this scenario? Who is legally responsible for the child? Who gets to make medical decisions about the pregnancy? Who gets to make medical decisions regarding the child when the child is still unborn? • Who gets to make medical decisions regarding the child after the child is born? Ethical/Legal Questions Should a pre-embryo, embryo, or fetus be given status as a “human being,” and where along this process does this classification occur? Ethical/Legal Questions This is the main argument that occurs between groups that identify as “pro-life” and “prochoice.” What Do You Think? A. Abortion is always unethical at all stages of the trimester and under all circumstances; it should be illegal B. Abortion is ethical up to a certain trimester, or under certain circumstances; it’s legality should be dependent on the circumstances C. Abortion is never unethical; the decision should be between the healthcare provider and potential parents only and not a question of legality D. I do not have an opinion on the ethics/legality of abortion Humanist vs Personalist Are these “humans”? Are these “persons”? Humanist vs Personalist Humanist: Prioritizes biological/genetic features Personalist: Prioritizes social role; entities that can have social relationships Humanist vs Personalist The “tentative” pregnancy: Women may not fully acknowledge that they are pregnant until ultrasound and/or amniocentesis demonstrate a viable fetus. Do you consider ultrasound images as the “first baby photo”? Humanist vs Personalist Example of proposed law in Mississippi 2011: What would it mean if this definition of a “person” was accepted? Failed to pass. Roe v. Wade • Case in 1970s • Woman in Texas (called Jane Roe in protection of her identity) vs Henry Wade (district attorney of Dallas County in Texas) • By Texas law, abortion was illegal unless the mother’s life was in danger • Roe argued that this was unconstitutional and violated her right to privacy • Roe won the case (7-2) • States cannot rule whether or not a woman can abort her pregnancy during the first trimester (decision is made between woman and her healthcare provider) • States can impose regulations in the 2nd and 3rd trimester • Most states do not allow abortions in the 3rd trimester (once the fetus is considered viable) State laws regarding abortion during Roe v Wade Abortion Laws (During Roe v Wade) • Each state had different laws regarding the circumstances when abortion was considered legal; had to comply with allowing abortions at <13 weeks • In Arizona, abortion was legal under the certain circumstances (including some requirements not listed): o Must have medical evaluation by physician (does not include nurse practitioners, physician assistants, or nurse midwives) o Medical evaluation must be in-person (telemedicine not accepted) o All women must have a mandatory ultrasound prior to abortion; the physician must offer the patient the option to view the image o Minor’s must obtain the consent of their parents o Prohibits abortions performed for purpose of sex and race selection Abortion Laws (After Roe v Wade) • Roe v Wade was overturned by the Supreme Court in June, 2022 on the basis that it was not “deeply rooted in this Nation's history or tradition” and it was unknown until Roe v Wade • Every state now has the authority make their own laws regarding abortion • Several states have a full ban on abortions with no exceptions for rape or incest • Several states have bans which are temporarily blocked (including AZ) • Several states have a gestational limit on when abortion is legal • Several states legal but limited or fully legal abortion Case Study You are a member of the ethics committee belonging to a county hospital. The county hospital is in a state which has a 20-week limit on when an abortion may occur. You are asked to advise on a case in which a patient has been asking for an abortion. The patient is a 26 year old female with no past medical history who was told by her physician that her child’s brain had not developed properly. Once the patient gives birth, it was predicted that the best-case scenario would be that the baby would suffer from continuous seizures until eventual passing (likely within a couple of days). None of the physicians within the facility feel comfortable performing an abortion this late in the trimester, especially since the mother is beyond 20 weeks. What is the most ethical action in this scenario? Case Study Use the ethical principles: • Beneficence • Nonmaleficence • Autonomy • Justice Use the ethical theories: Deontology, consequentialism, ethical egoism, natural law, virtue ethics, authority-based ethics Case Study You are a pharmacist working in a retail clinic. One day, your patient asks to fill a prescription for an abortion-inducing medication. This medication and its use in this state are legal; however, filling this prescription would go against your moral and religious beliefs. What should you do? Case Study Use the ethical principles: • Beneficence • Nonmaleficence • Autonomy • Justice Use the ethical theories: Deontology, consequentialism, ethical egoism, natural law, virtue ethics, authority-based ethics Case Study • 8 states have laws requiring pharmacists to fill prescriptions regardless of their beliefs: CA, IL, ME, MA, NV, NJ, WA, WI • 7 states have laws allowing pharmacists to refusing filling prescriptions, but they cannot obstruct the patient from receiving the medication: AL, DE, NY, NC, OR, PA, TX • 6 states have “conscience clause” laws which allow pharmacists to refuse to fill prescriptions due to concerns of religious or moral beliefs and do not include protections for the patient such as requirement to refer to transfer the prescription: AZ, AR, GA, ID, MS, SD Assignments No assignments this week.