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Presentation at a medical ethics course held at Madina
October 29, 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.
·
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.