ethical dilemma Beginning of life issues, abortion, fetal therapy, substance abuse, selective deduction, infertility treatment

1. BEGINNING OF LIFE ISSUES

3. MTP ACT SAYS THAT PREGNANCY CAN BE
TERMINATED IF
 When the health of the mother is in danger
 On humanitarian grounds
 Eugenic grounds

4.  Ethical issues with women
 Health: Both physical and mental health gets impacted
because of unwanted pregnancy.
 Rights and freedom:
 Bodily autonomy: Apart from losing reproductive choices,
restrictions on abortion might lead to illegal and unsafe
abortions.
 Right to Privacy.
 Ethical issues with the Family:
 Husband’s/In-laws choices: As both parents conceive a child,
abortion might have choices of both the parents involved.
 Conservative vs liberal values followed in a family have
differing opinions regarding abortions.

5.  Ethical issues with respect to fetus:
 Right to life: Abortion amounts to the murder of a living
being.
 Motherly care: it is a unique unspoken bond shared between
two lives, which cannot be questioned or regulated by laws.
 Ethical issues with respect to society in general
 Valuing life: State has the responsibility of valuing each life.
 Inclusion of all: Abortion should not become a mechanism of
social control for avoiding the appearance of differences or
disabilities.
 Provide better life for existing children: Many times parents
want abortion to be able to give a good life to existing
children instead of dividing their resources into more children.

6. AUTONOMY
 The first principle that a nurse should consider is autonomy,
which refers to the freedom of action.
 In the healthcare setting, it means allowing the patient to
make his/her own decisions.
 The nurse should encourage patient autonomy and promote
independent decision making. The patient should not be
pressured or influenced to make a decision .

7. FIDELITY
 The second ethical principles that nurses should consider
when resolving the dilemma is fidelity, which describes
the essence of truthfulness within the patient-nurse
relationship.
 In the abortion situation, the nurse should ensure that
he/she gives the client accurate and complete
information.

8. BENEFICIENCE
 The nurse should consider the principle of beneficence
which states that nurses must endeavor to do the right
thing. The actions of the nurse should bring the greatest
benefit to the patient

10. FETAL THERAPY
 Fetal therapy raises a number of ethical concerns, of which
the most obvious one is the balance between potential benefit
and harm for the fetus as well as for its mother.
 The proposed therapy should have a low risk of the fetus
dying or a low or manageable risk of the fetus or born child
getting a serous disease or disability
 The risk of maternal death and morbidity should be minimal.
 Respect for the autonomy of the pregnant mother
 Respet of the foetus as a patient

11. INTRAUTERINE TREATMENT FOR FETAL CONDITIONS
 To make decisions about whether to intervene, when to
intervene, and how to intervene, it is important to know a lot
about the ethics of foetal surgery. The decision to intervene
must pass three criteria
 Invasive therapy should have a high chance of saving a foetus's
life or keeping the baby-to-be
from getting a serious, irreversible illness, injury, or disability.
 Invasive therapy poses a low mortality risk and a low or
manageable risk of serious disease, injury, or disability to the
foetus and the child to be.
 The maternal mortality and morbidity risk is very low or
manageable. T
 he autonomy of the pregnant woman must be central to any
decisions regarding intervention, as she is assuming personal
risk with no potential personal benefit.

13.  Autonomy. Although legally the fetus is not a being with
rights equivalent to that of a pregnant women, it is a
human life worthy of respectful treatment. “Duties to the
not-yet-born, like duties to the already-born.
 When drug use is detected in women (during pregnancy
or not, if the drugs are illegal or not), the provider’s
primary obligation to the woman is to encourage and
assist her to obtain treatment.

14.  Justice. The fair allocation of resources for individual
and community needs is an ethical issue. Not only are
health care resources not available and allocated to all,
but we have to ask, have social resources such as jobs,
education, and housing been fairly and equally allocated
for all people

15.  Beneficence. Active goodness and kindness and
advocacy for the best interests of the patient are inherent
values assumed to be present in health care providers.
 Substance-using women, especially pregnant women,
have little access to prenatal care and even less access to
drug treatment.

17.  It is the process of reducing the multiple pregnancy by taking
out one or more of the fetuses.
 Multiple pregnancies of an order and magnitude higher than
twins involve greater danger for the woman’s health as well as
for the foetuses, which are likely to be delivered prematurely
with high risk of either dying or suffering damage
 When such pregnancies arise, it may be considered ethically
preferable to reduce the number of foetuses rather than risk

18. SELECTIVE DEDUCTION
 Clinical priority should be a focus on careful planning and
monitoring of infertility treatment for the reduction or
avoidance of multiple pregnancies.
 However, where such pregnancies arise, it may be considered
ethically preferable to reduce the number of fetuses rather than
to do nothing.
 Multifetal reduction is not medically considered as terminating
that pregnancy, but rather as a procedure to secure its best
outcome.
 Information provided must include the risks to mothers and
fetuses with and without fetal reduction, including spontaneous
miscarriage. Whether the couple decide to maintain or to
reduce high order multiple pregnancies, they should be assured
that they will receive the best available medical care.

19.  Valid informed consent
 Full disclosure
 Respect autonomy of patient
 Beneficience and non maleficience

20. MANDATED CONTRACEPTION
 The Constitution of India recognises "Reproductive
rights as the fundamental right of on individual to decide
whether to reproduce and have reproductive health.
 This may include an individual's right to plan a family,
terminate a pregnancy, use contraceptive learm about sex
education in public schools and gain access to
reproductive health services

21.  An ethical approach to the provision of sterilization
must, therefore, promote access for women who wish to
use sterilization as a method of contraception, but at the
same time safeguard against coercive or otherwise unjust
uses.
 This Committee Opinion reviews ethical issues related to
the sterilization of women and outlines an approach to
providing permanent sterilization within a reproductive
justice framework that recognizes that all women have a
right to pursue and to prevent pregnancy.


22.  Respect for an individual woman’s reproductive autonomy
should be the primary concern guiding sterilization provision
and policy.
 Coercive or forcible sterilization practices are unethical and
should never be performed.
 Health worker should should provide pre sterilization
counseling that includes a discussion of a woman’s
reproductive desires and places her wishes at the center of care.
 In appropriate cases, sterilization of a male partner should be
discussed during pre sterilization patient counseling as an
option with fewer risks and greater efficacy than female
sterilization.

23.  It is ethically permissible to perform a requested sterilization in
nulliparous women and young women who do not wish to have
children. A request for sterilization in a young woman without
children should not automatically trigger a mental health
consultation.
 Obstetrician–gynecologists should consider the role of bias in
counseling and care recommendations and avoid actions based on
biases about race, ethnicity, socioeconomic status, sexual orientation,
and motherhood, which can, despite best intentions, affect
interpretation of patients’ requests and influence provision of care.
 If individual physicians or institutions will not provide sterilization
because of personal religious beliefs or institutional policy, patients
must be informed as early as possible and provided with an
alternative form of contraception that is acceptable to the patient or
be referred elsewhere for care.
 When difficulties in meeting a postpartum sterilization request are
anticipated and sterilization is desired by the patient, transfer of care
for the remainder of pregnancy should be offered.

25.  Infertility is a disease of the male or female reproductive
system .it is defined as the in abilty to get pregnant after
12 months or more of regular unprotected sexual
activity(WHO).
 According to the utilitarian theory more well being
should be created or more unhappiness should be
avoided by providing assisted reproductive technology

26. LEGAL AND ETHICAL ISSUES RELATED TO INFERTILITY
TREATMENT ARE:
 Medical problems in children born by ART
 Children born by ART have a higher percentage of adverse
medical effects than those conceived naturally.
 Thus, these children have higher rates of prematurity and low
birth weight as well as an increased risk of birth defects
especially cardiac malformations and chromosomal
abnormalities than children conceived naturally.
 Medical problems in mothers who use ART
 A majority of adverse medical events that occur in women who
use ART seem due to the greater number of multiple
pregnancies that occur in them since, as has already been
mentioned, obstetric problems are known to be more common
in multiple compared to singleton pregnancies

27.  Ethical problems related to frozen surplus embryos from
ART
 In order to improve this, a large number of embryos are
typically produced, usually between 10 and 12, of which 1 or
2 are transferred and the rest frozen.
 there are four solutions for these embryos: (a) leave them
frozen indefinitely; (b) use them for biomedical
experimentation; (c) thaw them and let them die; and (d)
adoption.

28.  Use of pre implantation genetic diagnosis in IVF:
ethical assessment
 PGD is a laboratory method especially directed to the
genetic study of embryos before they are transferred and,
therefore, before implantation in the uterus. The aim of
this procedure is to determine if the embryos have a
genetic or chromosomal abnormality, or if they are
carriers of a genetic risk factor of disease,

29.  Ethical problems arising from donor gametes in IVF,
especially the right to privacy of donors and of children to
know their parents
 From a bioethical point of view there are a number of issues
with respect to whether the donation of gametes, both eggs
and sperm, should be anonymous or not.

30.  Paying surrogates
 Maximum number of embryos implanted
 Use of stored sperm or embryos after the death of a
partner