Introduction
Ethical dilemmas surround surrogacy and the donation of egg and/or sperm?
The Dilemma of surrogate mothers in India
Dilemma of multiple pregnancies from in-vitro conception
Conclusion
Abstract
This document contains an analysis of assisted reproduction practices, especially, with reference to India. The ethical implications will be thoroughly explored from the perspective of it being a dilemma whereby surrogacy involving the egg /sperm donation poses immense moral difficulties justifying the process. Recent developments reveal that the process presents a dilemma for surrogate mothers in India due to financial commitments and incidences of multiple pregnancies occurring from in-vitro conception.
Introduction
Since ethics is a moral philosophy it is culturally relative. This indicates that ethics in one profession is not the same universally. Moral conscience, however, is the main ingredient found in ethics internationally. Therefore, theoretically it is the process whereby a person or society systematizes, defends and recommends concepts pertaining to right and wrong behavior. Elder and Paul (2006) subsequently, argue that ethics should not be confused with compliance to social norms because many of social norms may be unethical. More importantly, rather the analysts defined ethics as a ‘set of concepts and principles that guide us in determining what behavior helps or harms sentient creatures’ (Elder & Paul, 2006, p 26).
Essentially, health care ethics pertains to practices, which are considered morally right or wrong. In theory health care ethics gathers its assumptions from definitions society give to the concept and interventions health care providers make, which may be considered ethical or unethical. One such intervention that has gained global attention is assisted reproduction. It is wide spread in both developing and developed countries. Doctors, infertility and adoption centers have offered various types of assisted reproductive services at exorbitant prices. They include surrogate mothers, in vitro conception and sperm donation. According to Elder and Paul (2006) again this practice may seems ethically acceptable by society and even health care professions. However, once it ‘helps or harms sentient creatures’ the ethical implications ought to be reconsidered (Elder & Paul, 2006)
Ethical dilemmas surround surrogacy and the donation of egg and/or sperm?
Gillian Tindall (2003) researched assisted reproduction and its ethical implications under the caption, ‘Mixed blessings: ethical issues in assisted conception’ and published her findings in Journal of Royal Society of Medicine. The researcher contended that assisted reproduction has been in many societies for nearly 25 years and the time has come for concerns related to its practices are addressed. As such, she began researching groups organized to voice their opinions regarding the ethical considerations involved in the issue. Speakers at a forum Tindall (2003) observed focused on ‘current statistics, hopes and recommendations, while members of the audience raised more controversial questions (Tindall, 2003, p 34).
These focus group discussions revealed that babies emerging from the assisted reproductive process tend to be exposed to more risk than naturally conceived births. This occurs at every stage of the fetal development. Most adversities have been detected in the multiple births phenomenon when embryos were planted directly into the uterine cavity. Further investigations reveal that even if these embryos from in-vitro implants develop into single pregnancies complications during pregnancy are more pronounced than in natural conceptions. Studies gave shown that in-vitro pregnancies pose increased risks of bleeding either during the first trimester, after or as abrupto placenta incidences. Incidences of hypertension, gestational diabetes as well as pre-eclampsia and eclampsia are known to increase. Ovarian hyperstimulation is another notable adversity found in assisted reproduction procedures (Tindall, 2003).
Other important issues raised related modern strategies adopted in the assisted reproductive science. Precisely, sperm injection—ICSI— has been transformational as a techniques in treating severe male subfertility. Researchers have discovered that the intervention actually doubled incidences of chromosomal malformations or abnormality. Assumptions are that this may be due eggs being fertilized by sperms, which may be immature would not have entered the environment naturally (Hansen et.al, 2002).
Researchers report from a recent Australian study1 that a double risk for complications in this assisted reproductive process exists. They contend that major defects are increased in this method than any other forms of assisted reproduction. Even though specific data was not revealed pertaining to the development of this phenomenon further confirmation by Melanie Davies, consultant obstetrician and gynaecologist, UCH as well as Neena Modi, consultant in neonatal paediatrics at Hammersmith Hospital, supported the study results by making references to it though subsequent studies conducted in the United Kingdom (Hansen et.al, 2002).
Ultimately, the ethical dilemma surrounds the morality of bringing people into the world that are unhealthy and at a greater risk of enjoying a poor quality of life as a consequence of mankind/ scientists interference with nature. The mixed blessing cited here lay in the fact that couples which have been diagnosed infertile are given an opportunity to become parents once they have the financial resources to undertaken these expensive procedures (Tindall, 2003). .
The Dilemma of surrogate mothers in India
Delhi IVF Fertility Research Center Birthplace of Joy has reported that internationally many people have chosen to India as their choice for surrogacy. Four reasons were highlighted for this development. First the price was very competitive in relation to developed nations such as United States of America, Canada and United Kingdom. Precisely it costs 20,000 US when done in India as compared to 50,000 US anywhere else in the World. Secondly they profess to have the best IVF doctors in the world, thirdly it is easy to find a surrogate mother and it is legal to conduct this business in India. Doctors and donors are less likely to be sued (Delhi IVF Fertility Research Center, 2013).
However, while this may be a thriving business in India health care industry the intervention is raising ethical concerns for young women living in poverty who are being exploited tom perform this low cost activity while fertility centers benefit financially from the business. A April, 2013 CBS Evening News Video exposes this crisis seeking ethical explanation (CBS, 2013).
Dilemma of multiple pregnancies from in-vitro conception
Another major ethical concern arising from assisted reproductive procedures are multiple pregnancies and prematurity. Suggestions from authorities responsible for assisted reproductive activities internationally have indicated that clinics, which implant mothers with extra eggs should be held responsible for the cost of caring for these extra babies and their prematurity complications. Evidently, this practice increases health care and social costs internationally (Wood et.al, 2000).
Conclusion
In concluding the reflection that ethics is a ‘set of concepts and principles that guide us in determining what behavior helps or harms sentient creatures’ (Elder & Paul, 2006, p 26) is embraced to summarize the dilemma of assisted reproductive practices. While it is a blessing concerns related complications of fetal abnormalities, maternal risks
References
Delhi IVF Fertility Research Center (2013).Why India for Surrogate. Retrieved on July, 11th
2013 from http://www.delhi-ivf.com/india_surrogacy.html
CBS (2013). India’s Surrogate Mothers Being Exploited? Retrieved on July, 11th 2013 from
http://www.cbsnews.com/video/watch/?id=50144661n
Hansen M, Kurinczuk JJ, Bower C, Webb S.(2002). The risk of major birth defects after
intracytoplasmic sperm injection and in vitro fertilization. N Engl J Med 346: 725-30
Paul, R., & Elder, L. (2006). The Miniature Guide to Understanding the Foundations of Ethical
Reasoning. United States: Foundation for Critical Thinking Free Press
Tindall, G. (2003). Mixed blessings: ethical issues in assisted conception. J R Soc Med. 96(1):
34–35.
Wood, S. Marlow, N. Costeloe, K., Gibson, A.T, Wilkinson AR. (2000) Neurologic and
developmental disability after extremely preterm birth. EPICure Study Group. N Engl
J Med 343: 378-84.
