Ethical Issues in Assisted Reproduction

Ethical Issues in Assisted Reproduction

Ethical Issues in Assisted Reproduction

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Ethical Issues in Assisted Reproduction - Conception Conundrums

  • Assisted Reproductive Technology (ART): All treatments or procedures that include the in vitro handling of human oocytes and sperm or embryos for the purpose of establishing a pregnancy.
  • Core Ethical Principles (📌 ABnJ):
    • Autonomy: Patient's right to self-determination.
    • Beneficence: Duty to do good; act in patient's best interest.
    • Non-maleficence: Duty to 'do no harm'.
    • Justice: Fair allocation of resources and treatment.
  • Informed Consent in ART: Must be comprehensive, covering procedure details, success rates, risks (e.g., multiple pregnancies, Ovarian Hyperstimulation Syndrome - OHSS), alternatives, and psychosocial implications.

    ⭐ Informed consent in ART must explicitly cover disposition of unused embryos.

Gametes & Embryos - Seed & Soil Stories

  • Gamete Donation (Sperm/Egg):
    • Anonymity vs. identity disclosure: Donor privacy vs. offspring's right to know.
    • Donor compensation: Altruistic; commercialization prohibited.
  • Embryo Donation:
    • Ethical framework for surplus cryopreserved embryos.
  • Cryopreservation Ethics:
    • Long-term storage, fate of unused embryos (donation, research, discard).
  • Moral Status of the Embryo:
    • Diverse views: property to potential life, influencing ART.
  • Preimplantation Genetic Diagnosis/Screening (PGD/PGS) Ethics:
    • Uses: Genetic disorders (e.g., Tay-Sachs), aneuploidy screening.
    • Concerns: Non-medical sex selection, 'saviour siblings', eugenics.

⭐ The ART (Regulation) Act, 2021 prohibits commercial gamete/embryo donation and strictly regulates PGD for specific genetic conditions.

Surrogacy Saga - Womb Wonders & Woes

  • Types of Surrogacy
    • Gestational Surrogacy: Embryo (from intended parents/donors) implanted in surrogate; no genetic link to child.
    • Traditional Surrogacy: Surrogate's egg fertilized; surrogate is genetic mother. (Generally not permitted/advised).
  • Ethical Quandaries
    • Commodification of child & womb.
    • Potential for exploitation of surrogate.
    • Balancing rights: surrogate, intended parents, child.
  • Legal Landscape: Surrogacy (Regulation) Act, 2021
    • Only altruistic surrogacy for resident Indian citizens; commercial banned.
    • Eligibility:
      • Intended Couple: Indian, married; wife age 23-50, husband age 26-55; medical need; no prior surviving child (exceptions apply).
      • Surrogate Mother: Close relative, married, has own child, age 25-35, altruistic basis, once in lifetime.

⭐ India permits only altruistic surrogacy for eligible Indian couples under the Surrogacy (Regulation) Act, 2021.

Surrogacy in India: Legal and Ethical Framework

ART Access & Law - Fair Fertility Frontiers

  • Guiding Framework: ART & Surrogacy Acts (2021) codify many prior ICMR ethical guidelines.
  • Justice & Access:
    • Tackles socio-economic & geographical access disparities.
  • Eligibility Criteria (ART Act, 2021):
    • Woman: Age 21-50 years.
    • Man: Age 21-55 years.
    • Applicable to married couples, single women (widows/divorcees).
  • Posthumous Reproduction:
    • Allowed with prior written consent of deceased partner/donor.
  • ART (Regulation) Act, 2021:
    • Regulates ART clinics/banks, mandates registration.
    • Patient rights: consent, confidentiality, redressal.
    • Clinic duties: standards, record-keeping.
  • Surrogacy (Regulation) Act, 2021:
    • Altruistic surrogacy only; commercial banned.
    • Eligibility criteria for parents & surrogate.
    • Establishes National and State Surrogacy Boards.

⭐ The ART (Regulation) Act, 2021 mandates National and State Boards for regulation of ART clinics and banks, and a National Registry.

High‑Yield Points - ⚡ Biggest Takeaways

  • Informed consent is crucial in ART, covering risks, success rates, and alternatives.
  • Gamete donor anonymity in India is standard, though ethically debated.
  • Commercial surrogacy is banned; only altruistic surrogacy is legal under the Surrogacy (Regulation) Act, 2021.
  • The welfare of the child conceived through ART is a primary ethical consideration.
  • Sex selection for non-medical reasons is strictly prohibited under the PCPNDT Act.
  • Ethical dilemmas surround the status and disposition of cryopreserved embryos.
  • Equitable access to ART and resource allocation are significant ethical challenges.
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Practice Questions: Ethical Issues in Assisted Reproduction

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A 27 -week pregnant woman with a fetus diagnosed with congenital anomalies is considering a Medical Termination of Pregnancy (MTP). Whose presence is not required for the authorization of MTP in this case?

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Flashcards: Ethical Issues in Assisted Reproduction

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What are the components of the antenatal combined test (first-trimester screening)?_____

TAP TO REVEAL ANSWER

What are the components of the antenatal combined test (first-trimester screening)?_____

PAPPA + hCG + nuchal translucency

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