HCA 3302, Critical Issues in Health Care 1

Course Learning Outcomes for Unit II Upon completion of this unit, students should be able to:

1. Critique arguments related to the impact of social factors that influence the U.S. health care system. 1.1 Determine the social factors impacting a current health care issue.

2. Defend an opinion on critical issues facing the U.S. health care system in the 21st century.

2.1 Summarize a current critical issue in health care. 2.2 Defend an opinion on a critical issue in health care from a research-based point-of-view.

7. Discuss common ethical principles applied to critical bioethical issues.

7.1 Recall common principles and theories of health care ethics.

Course/Unit Learning Outcomes

Learning Activity

1.1

Unit Lesson Chapter 3 Chapter 4 Unit II Scholarly Activity

2.1, 2.2

Unit Lesson Chapter 3 Chapter 4 Unit II Scholarly Activity

7.1

Unit Lesson Chapter 3 Chapter 4 Unit II Scholarly Activity

Required Unit Resources Chapter 3: The Moral Status of Gametes and Embryos: Storage and Surrogacy Chapter 4: The Ethical Challenges of the New Reproductive Technologies Unit Lesson In this unit, we will discuss critical issues for individuals. Particularly, we will learn about the moral status and ethical decisions surrounding gametes and embryos, the ethical challenges of new reproductive technologies, and spirituality in health care. Currently and in the future, this part of reproduction and prenatal care will continue to present critical concerns for health care providers who wish to be ethical and honor patient wishes. Ethical issues such as assisted conception, spirituality, and abortion, all related to health care, will continue to influence professional decision-making in health care in the future (Morrison & Furlong, 2019). Infertility and the use of reproductive technology is a growing trend. Currently, reproductive technology is not regulated by the government, but it is still a highly profitable endeavor because of the demand for it. It has been a trying task for health care decision-makers to ethically assess reproductive technologies (Morrison & Furlong, 2014).

Key Terms

UNIT II STUDY GUIDE Critical Issues for Individuals

HCA 3302, Critical Issues in Health Care 2

UNIT x STUDY GUIDE Title

These terms are used throughout this unit and you should familiarize yourself with their definitions:

• Embryo: the early stages of animal differentiation and growth; • Gametes: usually possessing haploid chromosomes, a mature female or male germ cell can initiate

formation of a new diploid through fusion with a gamete of the opposite gender; • Surrogacy: the action of being a surrogate mother; • Infertile: the inability to reproduce; and • Oocyte: an egg that has not matured, also known as a female gametocyte.

The Moral Status of Gametes and Embryos

Compared to other human body cells, human gametes have a unique status because only gametes have the reproductive ability to produce a new human life. They also carry an individual’s heritage. The earliest developmental stage of human life is the embryo. Embryos are created upon the union of the sperm and egg, which form a genetically unique individual. A common controversial issue is when an embryo is considered a human being and when it acquires moral status (Adelaide Centre for Bioethics and Culture, n.d.-a). Due to modern technologies, human embryos can be developed outside of the human body. This opens the possibilities of screening for genetic conditions as well as a number of ethical issues and decisions. Human embryos can now be screened, discarded, frozen, stored, and used for research and training (Adelaide Centre for Bioethics and Culture, n.d.-a). The moral questions arise from what should and should not be done with human embryos.

Reproductive Technologies Twelve months of actively trying to conceive and being unable to conceive is clinically accepted as infertility. When a couple is infertile and wants a child, often they will devote a large amount of resources and effort to have a biological child. Assisted reproductive technologies (ART) are medical interventions to help improve the chances of human conception for an infertile couple (Adelaide Centre for Bioethics and Culture, n.d.-b). According to the Centers for Disease Control and Prevention (n.d.), ART includes fertility treatments where eggs and embryos are used. This typically involves surgical procedures that remove oocytes (eggs) from a woman’s ovaries and combine them with sperm in a laboratory, then return the fertilized egg or eggs to a women’s body. ART also enables children to be conceived who may not have any genetic relationship to one or both of their parents (Adelaide Centre for Bioethics and Culture, n.d.-b). The terms associated with ART that you should be familiar with are the following.

• Artificial insemination: the unnatural insertion of semen into the oviduct or uterus; • In vitro fertilization (IVF): using a test tube or laboratory dish to fertilize an egg; • Gamete intra-fallopian transfer: by the means of laparoscope, an egg is obtained from an ovary,

combined with sperm, and inserted into a fallopian tube (Merriam-Webster, n.d.); • Gestational surrogacy: the action of a woman being a surrogate mother; • Gamete donation: the donation of sperm or eggs for others to use (American Medical Association,

n.d.); • Sex selection: the selection of the gender of a future child using preimplantation technologies (Ethics

Committee of the American Society for Reproductive Medicine, 2015); • Pre-implantation genetic diagnosis: a procedure conducted prior to implantation that can identify

genetic defects in embryos (American Pregnancy Association, 2012). Reproductive technologies can create ambiguity about how a person sees the nature of an embryo. If an ART involves a donor (see text below), then the donor abdicates their future responsibilities for their reproductive acts that enable the birth of their own biological children (Morrison & Furlong, 2019). Other reproductive ethical issues include the proper use of genetic diagnostic screening that is done pre- implantation into the women; storage, use, and destruction of unused IVF embryos; and research that includes the involvement of embryos. A main issue in ART surrounds the creation and destruction of embryos for research purposes. Bioethicists contribute to evaluations and ethical and moral guidelines of new techniques and technologies that involve ART (Adelaide Centre for Bioethics and Culture, n.d.-b).

HCA 3302, Critical Issues in Health Care 3

UNIT x STUDY GUIDE Title

From the ethical principles discussed in Unit I, the ethical principles of justice and fairness are ones to consider in regard to reproductive technologies. Additional ethical concerns regarding reproductive technology are justice, fairness, and the exposure of risks to the fetus. Additionally, many people believe that the use of reproductive technology is an individual choice that should not be regulated by the government.

Surrogacy Surrogacy may be an option for infertile couples who want to have a child. In the mid-1970s, the first legal surrogacy agreement was passed, and in the United States in 1980, the first paid traditional surrogacy was done. The first successful egg donation pregnancy occurred in Australia in 1983, and the first gestational surrogacy occurred in the United States in 1985 (Barry, 2011; Modern Family Surrogacy Center, n.d.). Surrogacy contracts should be used and developed with caution. A surrogate mother has the obligation to protect the life that may result from the surrogate pregnancy as well as fiduciary duties. However, if the surrogate mother’s life is in jeopardy, she may retain the legal right to elect abortion. Several court cases have dealt with surrogate contract disagreements as well as with surrogate mothers who do not cut ties with the child after birth.

Donors Individuals can donate sperm, embryos, eggs, or gestation wombs as part of collaborative reproduction. There is a market for each of these items as brokers, clinics, and individuals advertise and sell these in a very competitive market (Morrison & Furlong, 2019). Brokers have physical catalogs of donor profiles that individuals can read to select a donor. As infertility has increased, the use of infertility clinics and ARTs has grown to a multibillion-dollar business. A moral issue arises when an individual chooses to donate an egg, sperm, and other biological matter, so the individual is not merely a donor but is selling genetic and bodily resources. There has been little analysis as to the psychology and morality of the donors and what he or she is doing (Morrison & Furlong, 2019).

Storage Used in livestock industries, laboratory animal breeding, the conservation of endangered species, genetic conservation, and now for human medical practice, sperm and embryos can be frozen for later use (Trounson & Dawson, 1996). The freezing of sperm is a safe and effective way to use sperm for later insemination. The freezing of sperm for conception at a later time is an option for male individuals who may have to undergo a medical treatment that may make them infertile. For women, embryos can be frozen and used for in vitro fertilization to help improve the chances of conception or to conceive at a later time. The freezing of human embryos has brought about new ethical dilemmas regarding use or misuse. Individuals who participate in the freezing of sperm or embryos may forget about, ignore, or not care about the frozen specimens, which leave medical teams in a legal predicament as to what to do with the specimens. Sperm, oocytes (eggs), and embryos can be donated for use by other human beings, destroyed by choice of the donor, or donated to research. Further, legal disputes can develop in cases of divorce, separation, or death (Trounson & Dawson, 1996).

Conclusion Along with natural conception, assisted reproductive technologies are part of the landscape of the creation of human beings in this century. Assisted reproductive technologies and each component that goes along with the technology (embryo, gametes, sperm, etc.) complicate the moral community as the reproductive technologies call for moral and ethical decisions to be made. Scientific knowledge has bought about new techniques and technologies to assist with infertility dysfunctions, but along with these techniques and technologies, also comes an ethical assessment (Morrison & Furlong, 2019).

References

Adelaide Centre for Bioethics and Culture. (n.d.-a). Human embryos and gametes. http://www.bioethics.org.au/Resources/Resource%20Topics/Human%20Embryos%20and%20Gamet es.html

HCA 3302, Critical Issues in Health Care 4

UNIT x STUDY GUIDE Title

Adelaide Centre for Bioethics and Culture. (n.d.-b). Reproductive technology.

http://www.bioethics.org.au/Resources/Resource%20Topics/Reproductive%20Technology.html American Medical Association. (n.d.). Gamete donation. https://www.ama-assn.org/delivering-

care/ethics/gamete-donation American Pregnancy Association. (2012). Preimplantation genetic diagnosis: PGD.

https://americanpregnancy.org/infertility/preimplantation-genetic-diagnosis/ Barry, V. (2011). Bioethics in a cultural context: Philosophy, religion, history, politics. Cengage. Centers for Disease Control and Prevention. (n.d.). What is assisted reproductive technology?

https://www.cdc.gov/art/whatis.html Ethics Committee of the American Society for Reproductive Medicine. (2015). Use of reproductive technology

for sex selection for nonmedical reasons. Fertility and Sterility, 103(6), 1418–1422. Merriam-Webster. (n.d.). Merriam-Webster.com dictionary. https://www.merriam-

webster.com/dictionary/gamete%20intrafallopian%20transfer Modern Family Surrogacy Center. (n.d.). The history of surrogacy.

https://www.modernfamilysurrogacy.com/the-history-of-surrogacy Morrison, E. E., & Furlong, B. (Eds.). (2014). Health care ethics: Critical issues for the 21st century (3rd ed.).

Jones & Bartlett Learning. Morrison, E. E., & Furlong, B. (Eds.). (2019). Health care ethics: Critical issues for the 21st century (4th ed.).

Jones & Bartlett Learning. Trounson, A., & Dawson, K. (1996). Storage and disposal of embryos and gametes. British Medical Journal,

313(7048), 1–2.

Course Learning Outcomes for Unit II
Required Unit Resources
Unit Lesson
Key Terms
The Moral Status of Gametes and Embryos
Reproductive Technologies
Surrogacy
Donors
Storage
Conclusion
References