Secondly, the access-to-care viewpoint synonymously supports the woman’s right to undergo IVF whilst providing an alternate perspective. The principles of beneficence entail that practitioners are ethically bound to act in the patient’s best interests and thus, obligated to help improve their situation (McNeill, Torda, Little, & Hewson, 2004). As such, autonomy and beneficence act in a cohesive manner in relation to IVF, as acting in the best interest of the patient may be equal to fulfilling the patient’s own desires. Consequently, the question of the extent to which medical professionals are obligated to help infertile women arises. In exploring this, the professional’s relationship to the woman must also be considered, where conflict arises between their role in complying with their patients wishes and their role as instigators of non-maleficence, in accordance with the basic medical ethics of ‘Primum non nocere’ (First, do no harm) (Harrison, 2007). Indeed, the stillbirth and antepartum complications in women over 35 (such as gestational diabetes, pre-eclampsia and hypertension) (Perla, 2001) resulting from parturition, exemplifies the fine balance between acting compassionately with regards to the patient’s wishes, and in showing regard for her wellbeing.
Although the human rights of parenthood inextricably link with the IVF treatment, a utilitarian ethics perspective should also be considered to view the holistic impacts of IVF. The idealistic outcome of a successful IVF pregnancy often overshadows the psychological impacts that stem from unrealistic expectations about treatment success (Peddie, van-Teijlingen, & Bhattacharya, 2005). When IVF treatment is unsuccessful, women are subjected to grief, in addition to a loss of self-esteem associated with their body image and motherhood status. This results in up to 25% of women reporting levels of depression after an unsuccessful IVF attempt and a reduced life satisfaction after more than three years of failed treatment (Hammarberg, Astbury, & Baker, 2001).
Undertaking IVF also results in higher rates of possible maternal complications such as pre-eclampsia; the primary complication being the 25% increased chance of multiple gestations (Leiblum, 1997). The mortality rate of IVF multiple births are also five times higher than for IVF single births (Berkhout, 1995) with multiple gestations subsequently increasing other risks, including preterm birth (29.3%) and low birth weight (36.3%); These elevated risks when compared to natural conception (FIVNAT, 1995). are also evident in the significant 30-40% higher rate of birth defects resulting from IVF conception (Hansen, Bower, Milne, Klerk, & Kurinczuk, 2005). Despite the assurance that the woman’s financial independency will provide the child with access to quality education and social wellbeing, the child’s psychological health must also be considered as we recognise the absence of a primary male figure in the child’s life.
The utilitarian view must also address the community impact of IVF. It’s estimated that the percentage of healthcare expenditure on Medicare for IVF is 0.25% (Norman, 2011), resulting in an average cost to Australian taxpayers of $30,000 per live birth through IVF in mothers between 30-33 years old and $187,000 for maternal ages of 42-45 years (Assisted Reproductive Technologies Review Committee, 2006). In the past there has been an increasing trend of Medicare expenditure for IVF from $25.6million in 1991 to $108.4 million in 2005, despite a recent cut of $50 million in the 2012 government budget for IVF (Assisted Reproductive Technologies Review Committee, 2006). Hence, the ethical question of whether the community should pay for IVF Medicare subsidies must be addressed.
In considering this ethical dilemma and the relevant perspectives, several clashing opinions and conclusions prevailed amongst group members. Some members asserted the importance of human rights and the patient’s wishes, provided that the child’s rights and wellbeing were not infringed. Others argued for the negative ethical implications including consequential health risks and outweighing of such rights by utilitarian consequence. Contrastingly, one member specifically opposed the entire scenario, protesting against the act of ‘playing God’ and expressing the necessity of a father figure. A conclusion was thus reached whereby the woman was permitted the right to IVF given the associated psychological and health risks of IVF to the child were addressed.
Rights of the Child:
Subsequently, the rights and interests of the potential child are also important in examining the ethics of IVF. The Australian Human Rights Commission takes a rights based approach in ensuring that the complete physical, mental and social wellbeing of the child is fulfilled. (Branson, 2011).
The first issue regarding the right of the child to grow up in a stable family unit opposes IVF, especially since the woman doesn’t have a partner/spouse. Critics may argue for the child’s right to grow up in a stable social family unit where both parents are present to care for the child’s wellbeing. Article 18 in the United Nations Convention on the Right of the Child also corroborates with the view that children should grow up in a stable family unit (UNICEF, 2013).
The consequentialist perspective similarly argues against the woman’s use of IVF with respect to the unborn child’s rights. The adverse consequences for children, mothers and society due to the absence of a father are apparent in that “over and above mother engagements, fathers’ supportiveness matters for children’s cognitive and language development … as well as children’s social and emotional behaviours” (Cabrera, Shannon, & Tamis-LeMonda, 2007).
However, proponents argue the right of the mother to reproduce, as discussed above, thus the mother’s rights may infringe on the child’s rights. Whether the mother’s right to reproduce and have a family precedes the child’s right to grow up in a complete family is an issue requiring careful consideration.
Critics also argue that the child has the right to know the identity of his/her father (or in this case, the sperm donor), implying that the state has a responsibility to ensure that the child is able to identify their biological origin. In Australia, legislation in the Victoria Infertility Treatment Act (2007) requires certain details of donors to be recorded and grants limited access rights to this information to children born as a result of reproductive technology. In other states, full anonymity of the sperm donor is no longer permitted, with laws introduced that recognise the child’s rights to disclosure of biological origin (Victorian Legislation and Parlimentary Documents, 2007).
The process of sperm donation and selection further poses an ethical dilemma regarding the possible commodification of embryos. IVF Australia’s sperm programs permit choice of a suitable donor by conducting a search under five categories; nationality, eye colour, hair colour, height bracket and treatment type (Virtus Health, 2013).
A rights-based perspective may argue against the woman’s right to select a sperm donor due to the potential threat it poses to the child’s right of psychological well-being. This process essentially reduces the donor-conceived embryo to a transaction commodity, thus negatively implicating the child’s identity (Shanahan, 2012). Although it is illegal to choose traits such as eye colour in the embryo, having choice in such characteristics in the donor may provide the woman with control over the unborn foetus that is outside the acceptable scope of a mother. Consequently, the child is at risk of being treated as a vehicle of parental satisfaction rather than a sentient life of its own.
Furthermore, more than one embryo is created per IVF treatment cycle so that the most adequate can be chosen for implantation (Doughty, 2012). The other embryos are frozen, and vulnerable to use, donation or disposal at the woman’s whim (Virtus Health, 2013). According to 2012 statistics, of the 3.5million embryos created since 1991 for IVF only 7% have been used (Doughty, 2012).
Such wastage of embryos contributes to opposing the woman’s right to a child through IVF from a sanctity-of-life perspective. From this standpoint, “human life must be respected and protected from the moment of conception”, alluding to the importance of recognising embryos as human children and according them equal rights to grow and develop (Human Family Foundation). Thus the manipulation and destruction of embryos consequent to IVF treatment violates the embryo’s right to be valued and protected as a sacred human life (O-Malley, 2004).
As it stands, there are no laws in Australia limiting the number of embryo’s created per cycle of IVF and their use. Legislation in Germany however prevents embryo wastage by restricting embryo creation to three per cycle, all of which must be used. The development of similar controls in Australia may legitimize the woman’s use of IVF from a sanctity-of-life perspective (Lenzen, 1996).
In analysing the ethical dilemma according to the child’s inherent rights, all members considered it vital that the unborn child know their biological origins and develop in a ‘loving family’. However, conflict arose over what this constituted, where some defined a stable family unit as one, containing both paternal and maternal figures, whilst others disagreed with this given the woman’s assumed social and financial stability. Similarly, whilst the importance of valuing human life was unanimous, there were disagreements over when an entity should be granted this status. That is, although it is wrong to destroy human life, should waste embryos be considered wasted lives?
Conclusion:
The right of the parent to have a child requires careful consideration, especially when it may compromise the rights of the unborn child as discussed in this report. It is important to note that one’s personal rights are not absolute; the rights of adults may not prevail over a child's right to identity and an optimal family environment. Furthermore, expensive and finite public resources are required to satisfy such a right of the individual, thus society has a role in determining whom access will be permitted to. Hence, proper legislation that takes into consideration all such factors may be integral to providing IVF as an ethically acceptable and beneficial service to individuals and society.
Reflection:
Our group aimed to explore the ethical and legal issues associated with the clinical scenario through cultural, social and economic facets. We considered two ethical issues through various lenses to gain a holistic view of the topic, aspiring also to improve our teamwork capabilities.
Our methodology involved gaining a contextual understanding of the IVF process as a fertility treatment in Australia before distributing specific responsibilities. In particular, dividing our report into and forming subgroups within the project tasks allowed for specialized research and idea development.
As our group had the privilege of working together during the Foundations course, we were able to cooperate better after understanding each other’s working styles. However, there were weaknesses we attempted to improve upon. In our previous collaboration, member roles were not clearly defined, with different people taking initiative when the opportunity arose. This time around, our roles were more harmonious as we each took turns in leading, listening and building up other’s ideas. This was clearly shown when we examined the first draft report together. We were able to discuss critically how each of our parts could be improved and also agreed to take turns in refining the report.
However, complications still arose due to conflicting opinions regarding the two ethical dilemmas. In particular, whilst the importance of sanctity-of-life was unanimous, our individual definitions of human life were incongruent. As we could not simply settle these conflicting perspectives, we decided to discuss the basis behind them, allowing us to identify sensitive areas and thus prevent further conflict.
Despite our weaknesses and the difficulties encountered, we felt our overall cohesiveness was a strength that allowed us to work efficiently and produce a consistent and focused report. Consequently, we achieved our ultimate aim to improve our teamwork capabilities through exploring the ethics of IVF in relation to the clinical scenario.
Appendix – References:
Assisted Reproductive Technologies Review Committee. (2006). Report of the Independent Review of Assisted Reproductive Technologies. Canberra: Australian Government: Department of Health and Ageing.
Balfour, C., & Leader, W. (2013, May 25). IVF Treatment in Bundoora for Couples from Melbournes North. Retrieved June 11, 2013, from Herald Sun: http://www.heraldsun.com.au/leader/north/ivf-treatment-in-bundoora-for-couples-from-melbourne8217s-north/story-fnglenug-1226649940256
Berkhout, R. (1995). Perception of the Multiple-Parenting after in vitro Fertilization (IVF): an Exploratory Study. Amsterdam: Vrije University.
Branson, C. (2011, July 26). A National Approach to Child Rights. Retrieved June 10, 2013, from Australian Human Rights Commission: http://www.humanrights.gov.au/news/speeches/national-approach-child-rights
Cabrera, N. J., Shannon, J. D., & Tamis-LeMonda, C. (2007). Fathers’ Influence on Their Children’s Cognitive and Emotional Development From Toddlers to Pre-K. Applied Development Science, 11(4), 208-213.
City Fertility Centre. (2009). IVF Process. Retrieved June 10, 2013, from City Fertility Centre: http://www.cityfertility.com.au/IVF-Process
Department of Human Services. (2013, February 6). Medicare Safety Net. Retrieved June 10, 2013, from Human Services: http://www.humanservices.gov.au/customer/services/medicare/medicare-safety-net?utm_source=medicare&utm_medium=error-page&utm_campaign=transformation
Doughty, S. (2012, December 31). 1.7 Million Embryos Created for IVF Have Been Thrown Away, and Just 7 Percent Lead to Pregnancy. Retrieved June 10, 2013, from The Daily Mail: http://www.dailymail.co.uk/news/article-2255107/1-7-million-embryos-created-IVF-thrown-away-just-7-cent-lead-pregnancy.html
FIVNAT. (1995). Pregnancies and Births Resulting from in vitro Fertilization. Fertilty and Sterility, 64(4), 746-756.
Hammarberg, K., Astbury, J., & Baker, H. (2001). Women’s Experience of IVF: a Follow-up Study. Human Reproduction, 16(2), 374-383.
Hansen, M., Bower, C., Milne, E., Klerk, N. d., & Kurinczuk, J. J. (2005). Assisted Reproductive Technologies and the Risk of Birth Defects - a Systematic Review. Human Reproduction, 20(2), 328-338.
Harrison, C. (2007, May). Primum non nocere is only the beginning. Paediatrics and Child Health , 12(5), 379-380.
HCF. (2013). IVF Procedures. Retrieved June 9, 2013, from HCF Healthtopics: http://healthtopics.hcf.com.au/IVFProcedures.aspx
Huggies. (2013). IVF Cost. Retrieved June 9, 2013, from Conception: http://www.huggies.com.au/conception/ivf/cost
Human Family Foundation. (n.d.). Families Shaping Culture for the Dignity of the Human Family. Retrieved June 10, 2013, from Human Family Foundation: http://www.rc.net/org/humanfamily/ivf.html
Kahn, J. (2010, October 4th). The Ethics of In Vitro Fertilization. (R. Siegal, Interviewer)
Leiblum, S. R. (1997). Infertility: Psychological Issues and Counselling Strategies (2nd ed.). New Jersey: John Wiley & Sons Inc.
Lenzen, W. (1996). Value of Life Vs. Sanctity of Life - Outlines of a bioethics that does without the concept of Menschenwurde. In K. Bayertz, Sanctity of Life and Human Dignity (pp. 51-53). USA & Canada: Kluwer Academic Publishers.
Marcus, S. F., & Brinsden, P. R. (1996). In-vitro fertilization and embryo transfer in women aged 40 years and over. Human Reproduction Update, 2(6), 459-468.
McNeill, P., Torda, A., Little, J., & Hewson, L. (2004). Ethics Wheel. Sydney, NSW , Australia.
Monash IVF. (2012-2013). What Are The Costs. Retrieved June 9, 2013, from Monash IVF: http://monashivf.com/treatment/vic/what-are-the-costs/
NHMRC. (2013, May 1). Assisted Reproductive Technology (ART). Retrieved June 9, 2013, from National Medical Health and Medical Research Council: http://www.nhmrc.gov.au/health-ethics/australian-health-ethics-committee-ahec/assisted-reproductive-technology-art/assisted-
Norman, R. J. (2011). The Power of One and its Cost. Medical Journal of Australia, 195(10), 564-565.
O-Malley, S. P. (2004). In Vitro Fertilization: Ethical Implications and Alternatives. Retrieved June 10, 2013, from Life Issues: http://www.lifeissues.net/writers/oma/oma_01invitro.html
Peddie, V. L., van-Teijlingen, E., & Bhattacharya, S. (2005). A Qualitative Study of Women’s Decision-making at the End of IVF Treatment. Human Reproduction, 20(7), 1944-1951.
Perla, L. (2001). Is In-Vitro Fertilization for Older Women Ethical? A Personal Perspective. . Nursing Ethics , 8(2), 152-158.
Shanahan, A. (2012, January 21). IVF is not a Treatment but Provision of a Commodity. Retrieved June 10, 2013, from The Australian: Opinion: http://www.theaustralian.com.au/opinion/columnists/ivf-is-not-a-treatment-but-provision-of-a-commodity/story-fn562txd-1226249710890
The United Nations. (1948, December 10). Full Text. Retrieved June 1, 2013, from The Universal Declaration of Human Rights: http://www.un.org/en/documents/udhr/index.shtml
UNICEF. (2013, April 4). A Simplified Version of the United Nations Convention on the Rights of the Child. Retrieved June 9, 2013, from UNICEF: http://www.unicef.org.au/Discover/What-we-do/Convention-on-the-Rights-of-the-Child/childfriendlycrc.aspx
Victorian Assisted Reproductive Treatment Authority. (2012, November 27). Possible Health Effects of IVF. Retrieved June 10, 2013, from VARTA: http://www.varta.org.au/secure/downloadfile.asp?fileid=1004671
Victorian Legislation and Parlimentary Documents. (2007). Infertility Treatment Act 1995 Version No. 31. Victoria: State Government of Victoria.
Virtus Health. (2013). Medicare Rebate. Retrieved June 8, 2013, from IVF Australia: http://ivf.com.au/ivf-fees/ivf-costs