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Presentation at a medical ethics course held at the
Security Forces Hospital Riyadh May 14, 2015 by Professor Omar Hasan Kasule Sr.
MB ChB (MUK). MPH (Harvard), DrPH (Harvard) Chairman of the Ethics Committee
King Fahad Medical City.
Reproductive
issues
·
Assisted reproduction
·
Contraception
·
The permissible reversible
contraceptive methods for males
·
Permissible reversible
contraceptive methods for females
·
Abortion
·
Gender selection
·
Gender correction / change
operations
·
Menopause
·
Onco-fertility
Case Scenario - 1
An infertile couple
was in the midst of an IVF procedure when the husband died soon after his semen
was frozen. The wife wanted to obtain the semen and have a baby by a surrogate
mother. A former wife also wanted the semen because she had a girl with
leukemia who needed a compatible bone marrow donor, preferably a sister.
Case Scenario - 2
A recently married
woman continued taking oral contraceptives prescribed for menstrual
irregularities. Her husband wanted his wife to discontinue her contraception because
he wanted to start a family immediately, but the wife refused.
Case Scenario - 3
A 14 year-old girl
was admitted to the hospital for an abortion. She was two months pregnant from
what she claimed was rape. The family was distraught and wanted the doctors to
carry out the abortion immediately. The physicians were reluctant because there
was no medical reason.
Case Scenario - 4
A couple who had
eight girls in successive pregnancies desperately wished a boy. They decided to
try IVF with selection of male gametes. The obstetricians refused because there
was no medical indication since the couple had no problem in conceiving.
Case Scenario - 5
A child whose
external appearance was female and had been brought up as a girl was taken to
the hospital at 14 years of age because of delayed menstruation. The internal
gonads and chromosomal patterns were male. The parents wanted a gender
reassignment operation to conform to the genetic profile. The child refused to
change from her familiar female identity.
Case Scenario - 6
A middle-aged woman
without any medical condition asked her physician for hormonal treatment to
appear younger. The physician refused because he judged the risk of
cardiovascular and cancer complications to be more than the benefits.
Case Scenario - 7
A 14 year-old girl
with cancer requiring chemotherapy was advised to have her ova removed and put
in cold storage for the duration of the treatment. Her parents refused the
procedure because they did not believe in IVF and she was not yet married.
Ethical issues in
artificial reproduction -1
·
In vivo insemination
·
In vitro fertilization
·
Disputes about parenthood
·
Frozen sperms, ova, and embryos
·
Masturbation
·
Pre-implantation genetic diagnosis
·
Selective fetal reduction
Ethical issues in
artificial reproduction -2
·
Embryo splitting
·
Developing embryos for non-IVF
purposes
·
Using embryos for cloning
·
Mixing of gametes or embryos
·
Commercial trading in sperms,
gametes, or embryos
·
Use of gametes from cadavers or
post-mortem insemination or IVF
Confidentiality issues in
teenagers
·
Confidentiality - the
importance of confidentiality to adolescent patients, the practicalities of
offering and maintaining confidentiality, and the consequences of failure to do
so.
·
Doctor-patient relationship
- the ethics of the patient-doctor relationship, boundaries and strategies for
susceptible situations.
·
Gillick competence: the child
could consent to contraceptives if she understood the medical treatment
involved (test of Gillick competence) and that the parents could not veto her
decision. A child who is Gillick competent can prevent parents viewing her medical
records without her consent.
Confidentiality
issues in teenagers… con’t.
·
Fraser criteria: the young person
cannot be persuaded to inform their parents. The young person is likely to
begin, or to continue having, sexual intercourse with or without contraceptive
treatment. Unless the young person receives contraceptive treatment, their
physical or mental health, or both, are likely to suffer. The young person's
best interests require them to receive contraceptive advice or treatment with
or without parental consent.
Case Scenario - 1
A 14-year old school
girl with painful and irregular menstrual periods saw a school physician who
prescribed oral contraceptives to regularize the period. She refused saying
that if her parents found out they would suspect that she was engaged in
illicit sexual relations. She only agreed to take the treatment when the
physician promised that he would not disclose the information to school
authorities or parents without the patient's permission.
Case Scenario - 2
A 15-year old girl
asked a private gynecologist for an abortion after missing her period following
a rape by a person close to her family. She asked the gynecologist to keep it a
secret from the parents because if they knew they could kill her or kill the
rapist.
Case Scenario - 3
A 13-year old
teenager with a foul smelling vaginal discharge went for treatment at the
school clinic and asked the nurses not to disclose the condition to her parents
because they would suspect her of having sexually transmitted infections.