Loading presentation...
Prezi is an interactive zooming presentation

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Ethics in Re

No description
by

Lana Lotter

on 25 March 2014

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Ethics in Re

Agenda
1. Various assisted reproductive technologies
2. Ethical issues in assisted reproduction
3. The ethics of assisted reproduction
Surrogacy
HIV concordant/discordant couples
Ova/sperm donation
4. Research project: ova/sperm donation by students
5. The group's opinion/conclusion
6. References

Assisted Reproductive Technologies
Ovulation induction
Artificial insemination (IUI)
In-vitro fertilisation
IVF with egg/sperm donor
Gamete Intrafallopian Transfer (GIFT)
Surrogacy
Preimplantation genetic diagnosis
Sex selection
Ethics & Surrogacy
Assisted reproduction in HIV
Discordant/concordant couples

The aim of assisted reproduction

PMTCT

Available options for HIV+ males and HIV- females

Options for HIV+ females and HIV- males


Ethical issues in
sperm & ovum donation
Research Project
Ethical issues in Assisted Reproduction
Distributive justice
Pre-implantation diagnosis/sex determination
Multiple pregnancies
What happens to the fertilised eggs that are not used?
Ethical issues surrounding ova/sperm donation
Informed consent
Impacts the AUTONOMY of the donor
Remuneration
Technical procedure not always fully understood

Assisted Reproduction
& Ethics

Assisted reproduction
& religion
Do you think assisted reproduction should be available to all?

Would you consider donating your ova/sperm?
Types of surrogacy









Types of arrangements
Altruistic
Commercial


Ethical considerations in Surrogacy
AUTONOMY

BENEFICENCE

Risks and benefits of assisted reproduction in HIV positive couples
Possible risks








Possible benefits
Decreased HIV infection in uninfected partners and children
Promotion of safe intercourse
Psychological benefits to the couple
Meeting the needs of HIV positive patients

Ethical consideration
Autonomy of the parents
Beneficence
Non-maleficence
­

Justice





“Everyone has the right to have access to health care services, including reproductive health care.”
Informed consent
Disclosure or non-disclosure of donor's identity
Invasive procedures in a healthy woman without clinical gain to herself
Amount of donations possible
Posthumous sperm retrieval

Disclosure or non-disclosure of donor’s identity
Autonomy

Right of the donor to remain anonymous

VS

Non-maleficence
Child not knowing their biological parents
- Identity struggles
- Absent family medical history
Ethical issues regarding donor conception
Invasive procedures in a healthy woman without clinical benefit
Beneficence
Benefit to infertile couple
VS
Non-maleficence
Risks associated with invasive procedures like ovum donation

Becoming an ova donor...
Advertising
Pre-screening
Questionnaire
Psychological evaluation
Physical examination & Blood tests
Informed consent
Ovarian stimulation and ova retrieval
Fertilisation and implantation
Only 6 pregnancies allowed per donor
Becoming a sperm donor...
Advertising
Pre-screening – sperm sample analysis
Questionnaire
Informed consent
Sperm donation (130 straws, 13 ejaculations
Only 6 pregnancies allowed per donor


Surrogate mothers
Commissioning couples
Child
Commissioning couple
Surrogate mothers
NON-MALEFICENCE
Surrogate mothers
Commissioning couples
Child
JUSTICE
Surrogate mothers
Child
Source: National Health Act 61, S. 27, 1st Sess. (2003)
Amount of Donations
Beneficence
Helping multiple couples

VS

Non-maleficence
Many children sharing DNA
Increase in recessive mutations and diseases
Increased risk of unintentional incest

Posthumous
sperm retrieval
Autonomy of the diseased
- Informed consent
View of the National Health Act

Research Question
Is it ethical to target students for ova/sperm donation?
Literature Review: the use of University Students as Ova and Sperm donors
Target Age Group: 21-24 yo
Ideal Donor Characteristics...
- Female
- Male
- Both

Literature review: Ethics regarding
ovum
donation from a young population group

Advertisements
Donor motivation (e.g. high cost of tuition)
Lack of proper counseling
Target groups

Ethics regarding
sperm
donation from a young population group

The risk to financial incentive ratio
Targeting the financial vulnerability of men
Less emphasis on the altruistic reasoning


“ Sperm banks treat men more like employees who are expected to clock in on a regular basis and sperm donors respond by calling the money ’income’ or ‘wages’.

Research Assignment
Aim:
to get an indication of the perceptions of students surrounding the issues of assisted reproduction, financial incentives and the intentional targeting of students in donor recruitment
Method:
Cross-sectional study
Sample:
63 third year medical students
Statistical analysis:
Excel

Findings:

Laws & Regulations
Consent
Remuneration
Central data bank
Live births
STD's
Anonymity

Egg source
Sperm source
Uninfected partner
Unborn child
Public
Rights based justice
Distributive justice
Research Assignment: Student sample
54% of students: donation = morally right
57% of students found it ethical that they are the targeted population in donor recruitment programs



No: “Students may be more eager to receive money”

59% found it not unethical to provide financial incentive to potential donors
90% agreed that the judgement of students could be clouded by such incentives
69% believed that students would be at risk of psychological complications regarding their decision to donate later in life
44% of students say they would donate
2 out of 63 MBChB III students have donated sperm/ova before


“Yes, if it was easy to donate an ovum like sperm. However, it requires an operation, so no.”


Medical Practitioners’ Perspective


Sperm/ova donation


Sperm/ova donation amongst students

Conclusion
Would you donate your ova/sperm?
Our opinion:
- Is it ethical?
- Advertising
- Process
- Other options?
Bibliography
1. Asghari F. Ethical Issues in Surrogate Motherhood. Journal of Reproduction and Infertility. 2008;9(1):30-35.
2. Ameling R. The business of egg and sperm donation. Scholars strategy network. [Online] 2013 [access 2014, March 13]; Available http://www.scholarsstrategynetwork.org/sites/default/files/ssn_key_findings_almeling_on_egg_and_sperm_donation.pdf
3. Chang L. Assisted reproduction [Online] 2008 [access 2014, March 15]; Available: http://www.webmd.com/baby/healthtool-assisted-reproduction
4. Children's Act 38, Section. 9, 1st Sess. (2005)
5. Daniels KR, Lewis GM. Donor insemination: The gifting and selling of semen. Social science and medicine.[Online]1996 [access 2014, March 14]; 42(11), 1521–1536; Available: http://www.sciencedirect.com/science/article/pii/0277953695002510
6. Daniels KR, Hall DJ, Semen donor recruitment strategies—a non-payment based approach. Journal of Human Reproduction [Online] 1997 access 2014, March 14] 12(10) 2330–2335; Available: [
http://humrep.oxfordjournals.org.ez.sun.ac.za/content/12/10/2330.full.pdf+html
7. Dyer SJ, Kruger TF. Assisted reproductive technology in South Africa: First results generated from the South African Register of Assisted Reproductive Techniques. South African Medical Journal. 2011;101:167-170.
8. Estes SJ, Ginsburg ES. Use of assisted reproduction in HIV and hepatitis infected couples. Uptodate;[Online] 2014 [access 2014, March 17]; Available: http://www.uptodate.com/contents/use-of-assisted-reproduction-in-hiv-and-hepatitis-infected-couples?
9. Inhorn MC. Making Muslim babies: IVF and gamete donation in sunni versus shi’aislam. Electronic Journal of Culture, Medicine and Psychiatry [Online] 2006 [access: 2014, March 17]; 30(4); Available: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705533/
10. Milbank J. The ethics of sperm donation. BioNews Issue 513. 22 June 2009. http://www.bionews.org.uk/page_46109.asp
11. Moodley K. ASSISTED REPRODUCTION IN HIV-POSITIVE COUPLES. Bioethics unit – Tygerberg devision. University of Stellenbosch. [Online] 2007 [access 2014, March 16]; Available: http://academic.sun.ac.za/stellmed/cpd/Default.aspx

“Some people are comfortable, but I’m not. Even though I really would be grateful if someone donated for me.”
"Guys just want to give their sperm away and get their money"
Source: Delivery man official trailer (2013). Available from youtube.com
R6000
R5000
Source: Interview with Greg at Aevitas Fertility Clinic.
Source: Ethical issues regarding donor conception. Available from youtube.com
Source: Inside egg donation. Available from youtube.com
Roman Catholic
Jewish
Islam
Protestantism

Source: Children’s Act 38 of 2005, chapter 19 (ss 292-303)
Yes: “Students, especially medical students, have a broader baseline of why it is needed- research, helping others to reproduce- the decision is therefore more informed”
No: “Students may be more eager to receive money”
Bibliography (cont.)
12. Nienaber A. ‘The grave’s a fine and private place’: A preliminary exploration of the law relating to posthumous sperm retrieval for procreation. 2010. University of Pretoria.[Online] [access 2014, March 17]; Available: http://repository.up.ac.za/bitstream/handle/2263/17228/Nienaber_Grave's(2010).pdf?sequence=1
13. Nosarka S, Kruger TF. Surrogate motherhood. South African Medical Journal. 2005 Dec;95(12):942, 944, 946.
14. Parker MJ.Till Death Us Do Part: the ethics of postmortem gamete donation. Journal of Medical Ethics. 2004;30:387-388
15. Schenker JG. Assisted reproductive practice: Religious perspectives. Reproductive Biomedicine Online [Online] 2005 [access 2014, March 17]; 10(3); Available: http://web.a.ebscohost.com.ez.sun.ac.za/ehost/pdfviewer/pdfviewer?vid=3&sid=2daf533e-5a1e-4e2a-87b7-40439d4b9073%40sessionmgr4004&hid=4204
16. Schneider J. Fatal colon cancer in a young egg donor: a physician mother's call for follow-up and research on the long-term risks of ovarian stimulation. Fertility and Sterility. [Online] [access: 2014, March 15] 2008;90(5); Available: http://www.ncbi.nlm.nih.gov/pubmed/18314117
17. Shenfield F, Pennings G, Cohen J, Devroey P, de Wert G, Tarlatzis B. ESHRE Task Force on Ethics and Law 10: surrogacy. Journal of Human Reproduction. 2005 Oct; 20(10):2705-7. Epub 2005 Jun 24.; ESHRE Task Force on Ethics and Law
18. Sperm Donation. The centre for Bioethics and culture network. [Online] [access 2014, March 15]; Available: http://www.cbc-network.org/issues/making-life/sperm-donation/
19. Spriggs M, Charles T. Should HIV discordant couples have access to assisted reproductive technologies? Journal of Medical Ethics. 2003;29:325–329
20. Storck S. In Vitro Fertilization (IVF) [Online] 2012 [access 2014, March 15]; Available:http://www.nlm.nih.gov/medlineplus/ency/article/007279.htm
21. The National Health Act 61 of 2003.A guide- Second edition. Berger J, Hassim A, Heywood M, Honermann B, Krynauw M, Rugege U, editors. CONTROL OF USE OF BLOOD, BLOOD PRODUCTS,TISSUE AND GAMETES IN HUMANS. Cape Town: Siber Ink CC; 2013. pp. 81-95.
22. Unknown Author. Infertility Treatment: An Overview [Online] [Access 2014, March 16] Available: http://www.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/Outline.htm
Full transcript