Chapter 13 :Reproduction: Assistance and Control Issues
|Section 5. Decision Scenarios
Summary of Methodology for Analyzing and resolving Cases involving moral dilemmas in Health Care:
Paradigm for the Method: http://depts.washington.edu/bioethx/tools/4boxes.html
Sample Case Analysis: http://depts.washington.edu/bioethx/tools/cecase.html
Introduction to Clinical Ethics, 4th edition using the case of Dax Cowart.:
For each of the scenarios you should consider how a person would reach a decision if that person were using the basic principles from EACH of the following traditions:
1. Cloning a replacement child
2.Reproductive Technology and risk of defective children
3. Purchasing Embryos: Babies for Sale!
4. Conditions on the use of the technology? Age limits, marital requirements?
5. Surrogate Mothers!: Prostitutes? Buying Babies?
6. AID and an unmarried woman
7. AI and "Designer" sperm: made to order babies!
8. Selling sperm: Rights and Duties of fatherhood?
9. Fertilized eggs: To whom do they belong? Are they children?
10.Age limit on use of technologies: AID
From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 . Page 725 Scenario # 1
“You’ve got to help us,” Clarence Woody said. “Keith is … was … our only child, and he meant the world to us. When the police came and told us he was dead, all Sara and I could think of was how we could get him back.”
“But you can’t get him back,” Dr. Alma Lieu said. “Even if we prepared one of his cells and implanted it in your wife’s uterus, the baby wouldn’t be Keith.”
“But he would be his genetic twin,” Clarence said. “He would be as close as we can get to replacing our son.” His eyes filled with tears. “Won’t you help us?”
From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 . Page 725 Scenario #2
“You realize that the drugs we’ll be using in preparing you for implanting the embryos will involve a slight but significant risk to any child you might have?? Dr. Aaron asked.
“I certainly didn’t,” Stephanie Dalata said. “You mean I might have a child with a birth defect?”
“You might,” Dr. Aaron said, “Or one who is premature or has a low birth weight. Or if we implant four embryos, all four of them might develop, and all the babies would be at risk”
“I don’t think you should go through with the treatments,” Alice Stimmons said. “If assisted reproduction is going to produce a child with a serious birth defect, it’s wrong.”
“I’m going to go ahead anyway,” Stephanie Dalata said. “I think it’s better for a child to have even serious defects than not exist at all.”
From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 . Page 726 Scenario #3
“I want to make this a straightforward business proposition.” Sam Witt looked across the table at Susan Becker. “Dorla and I think that Carolyn is a fine little girl. She’s healthy and strong, pretty, and smart as a whip.”
“Thank you for saying all those nice things about my daughter.” Becker frowned in puzzlement. “But what does Carolyn have to do with a business proposition?”
“This is a delicate matter.” Witt glanced down at his coffee, then looked up again. “I don’t want to get too personal, but I know that you and Joe had some problems having a kid.”
“That’s no secret.” Becker shook her head. “I’ve got scarred tubes, so we used in vitro fertilization. The embryo was cloned into six copies so if the first try didn’t work, we could do it again.” She smiled. “But the first try did work.”
“So you’ve still got five embryos on ice.” Witt leaned toward her. “That’s what I was talking about. Dorla and I want to buy one of them, and we’re prepared to pay you and Joe $15,000 for it.”
“Fifteen thousand dollars.” Becker sat up straight, her eyes opened wide. “But why? Why not have your own child?”
“We could but like I said, Dorla and I really like everything we see in Carolyn. We’re not so sure how things would turn out with our own kid, given our genetic backgrounds. There’s a lot of depression on my side, and the women in Dorla’s family have a high incidence of breast cancer.” Witt shrugged. “Let’s just say we want a daughter, but we also want some insurance to go along with her.”
“She would be just like Carolyn,” Becker said in a distracted voice. “But we could sure use the money.”
From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 . Page 726-27 Scenario #4
“I’m sorry we can’t help you,” Patricia Spring said. “But what you want is simply against our policy.”
Charles Blendon and Carla Neuman didn’t try to hide their disappointment. The San Diego Reproductive Clinic had been their last hope. They badly wanted to have a ch8ild but Carla’s fallopian tubes had been surgically removed as part of a successful effort to treat precancerous growths.
“In fact,” Patricia Spring continued, “you don’t meet at least two of our criteria.”
“We can afford to pay,” Charles said.
“That’s not it. First of all, Carla is forty-five, and we set forty as the upper limit. And second, you two aren’t married, and we require that the donor and the patient be husband and wife.”
“Who makes those rules?” Carla asked. “If we want to have a child, that’s our business and nobody else’s.”
“The clinic makes the rules,” Patricia Spring said. “You see, there is an increasing number of birth defects in older women. There are sound medical reasons for our criteria.”
“But what if we’re willing to take the risk?” Charles asked.
“You can’t take a risk that’s likely to affect a child.”
“But I’m willing to have tests,” Carla said. “And neither of us is against abortion. If there’s something wrong with the fetus, then I’ll have an abortion.
“And what sort of medical basis is there for the marriage requirement?” Charles asked. “It seems to me that the clinic is just imposing its own moral standards on Carla and me.”
“Look,” Patricia Spring said, “I know you’re both upset and disappointed. But the clinic operates in a community, and our criteria reflect both good medical judgment and the standards of our community.”
From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 . Page 727 Scenario #5
In January 1985 the British High Court took custody of a five-day-old girl, the first child known to be born in Britain to a woman paid to be a surrogate mother.
An American couple, known only as “Mr. and Mrs. A,” were reported to have paid about $7500 to a twenty-eight year old woman who allowed herself to be artificially inseminated with sperm from Mr. A. The woman, Kim Cotton, was prevented from turning the child over to Mr. and Mrs. A by a court order issued because of the uncertainty over the legal status of a surrogate mother.
The court permitted “interested parties, including the natural father” to apply for custody of the child. Mr. A applied, and Judge Sir John Latey ruled that the couple could take the baby girl out of the country because they could offer her the chance of “a very good upbringing.”
From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 . Page 727-28 Scenario 6
Dr. Charles Davis quickly scanned the data sheet on his desk, then looked at the woman seated across from him. Her name was Nancy Callahan. She was twenty-five years old and worked as a private conservator at an art museum.
“I see you aren’t married,” Dr. Davis said.
“That’s right,” Nancy Callahan said. “That’s basically the reason I’m here.” When Dr. Davis looked puzzled, she added, “I still want to have a child.”
Dr. Davis nodded and thought for a moment. Nancy Callahan was the first unmarried person to come to the Bayside Fertility Clinic to request AID. As the legal owner and operator of the clinic, as well as the chief of medical services, Dr. Davis was the one ultimately responsible for the clinic’s progress.
“You’re not engaged or planning to get married?”
“No, but I don’t want to rule out the possibility that I will want to get married someday.”
“Don’t you know anybody you would want to have a child with in the ordinary sexual way?”
“I might be able to find someone,” Nancy Callahan said. “But you see, I don’t want to get involved with anybody right now. I’m ready to be a mother, but I’m not ready to get into the kind of situation that having a child in what you call ‘the ordinary sexual way’ would require.”
“It’s just somewhat unusual,” Dr. Davis said.
“But it’s not illegal, is it?”
“No,” Dr. Davis said. “It’s not illegal.”
“So, what’s the problem? I’m healthy. I’m financially sound and mentally stable, and I’m both able and eager to accept the responsibility of being a mother.”
“It’s just that at the moment the policy of our clinic requires that patients be married and that both husband and wife agree to the insemination procedure.”
“But there’s nothing magical about that policy,” Nancy Callahan said. “It can be changed for good reasons, can’t it?”
“Perhaps so,” said Dr. Davis.
From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 . Page 728 Scenario 7
“My husband and I have talked over the matter in great detail,” Marge Gower said. “We don’t care about the sex of the child, but we know exactly the kinds of features we want.”
“Mrs. Gower,” Dr. Louise Singh said, “you’ve got to understand that we’re not running a mail-order-catalog business for babies.”
“I’m not trying to order a baby. I just want to tell you what I’m looking for in a sperm donor. I want somebody who is at least six feet tall, muscular-not fat-has light-colored hair and is very good looking. Also, I want some proof that he has a good sense of humor and is intelligent. He has to have at least a college degree. I’ll leave all the rest to you. I mean, things about health.”
“Thank you,” said Dr. Singh. “But I really don’t think I can go along with that.”
“Why not? If I were going to have a child in the usual way and I were deliberately going to get pregnant, I would certainly choose somebody like I described.”
“But you aren’t doing it in the usual way. You’re going to be using donor semen.”
“But who is going to choose the donor? You are, aren’t you?”
“I’ll select somebody from our list of applicants who resembles you and your husband in a general way.”
“I don’t see why you should have that kind of power,” Mrs. Gower said. “It’s going to be my baby so I think I have the right to say what the father should be like.”
“That’s against Reproductive Medicine’s policy.”
“Well, that’s too bad. Just tell me who to talk to to get the policy changed. I’m going to have a baby like my husband and I want. As long as I have to have artificial insemination, I want to get the most out of it.”
From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 . Page 729 Scenario 8
“I’m going to sell my sperm for the simple reason that I need the money,” John Lolton said. “It’s no big deal.”
“I think it is,” Jane Cooper said. “You seem to think it’s like selling your blood, but it isn’t. If somebody is transfused with your blood, that’s an end to things. But if a woman is inseminated with your sperm, a child may result.”
“I don’t have any responsibilities for what people do with my sperm,” Lolton replied. “It’s just a product.”
“Not so,” Cooper said. “It’s a product all right, but if it’s used in artificial insemination, that means that you’re the father of a child. And if you’re the father of a child, that means you have to be willing to accept responsibility for that child.”
“That is absolute nonsense,” Lolton said.
From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 . Page 729 Scenario 9
“I’m curious,” Lois Ramer said. “What happens to the eggs you take from me that get fertilized but not implanted?”
“We donate them to other women,” Dr. Martha Herman said.
“Oh,” Lois Ramer said, sounding
surprised. “I don’t want that to happen.”
From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 . Page 730 Scenario 10
“I’m going to be blunt about it,” Dr. Carl McKensie said. “You are fifty-five, and that’s too old to have a child.”
“You’re not trying to tell me it’s impossible, are you?” Kisha Clare asked. “I’ve read that you can use donated eggs and donated sperm to fertilize them outside the body, then implant them and have a normal pregnancy. I’m sure it’s expensive, but Tom and I have got enough money, and I want to have a baby.”
“Oh, it’s possible,” Dr. McKensie admitted, “but it’s a bad idea because you’ll be too old to take care of a child properly. When he starts first grade, you’ll be sixty-two, and when he graduated from high school, you’ll be seventy-four—if you’re still alive.” McKensie shook his head. “You should have thought of having a child earlier.”
“I had a career to work on and a lot of personal problems.” Clare frowned, remembering the long hours in the office and how relieved she was when she finally left her husband. “I can be a better mother now than I could have been when I was thirty or even forty. I’m financially secure, I’m happy with myself, and I really want a child.” She shook her head. “Statistically, I’m going to live for another twenty-five years, and that’s enough to raise a child.”
“But is it fair to a child to be raised by an old person?”
“Grandparents raise children all the time.” Clare glared at Dr. McKensie. “And men have children whenever they want to, no matter how old they are. They don’t have to get permission from some doctor.”
“But an older man can have children only if he has some younger woman as a partner.” Dr. McKensie glared back at Clare. “That way the child has one younger parent.”
“I think you’re discriminating against me,” Clare said in a flat voice.
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