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Presentation at a Course on Application of Ethical Principles to Clinical Practice held at Faculty of Medicine, King Fahad Medical City 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
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
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.
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.