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| Amber Easton |
There are many ethical dilemmas surrounding the protection of human life, and this protection must be established for all stages of them. The issue arises due to the debate over when human life begins, but this information has been well known for over 75 years. Human life begins at conception, from the moment the sperm meets the egg. This fact is established in the 23 Carnegie Stages written by a branch of the National Institute of Health. These embryonic stages are reviewed and verified annually by a global committee of expert human embryologists, known as the Federative International Programme for Anatomical Terminology (FIPAT) (Funk, 2028), and for over 75 years these stages have remained unchanged. Therefore, the same protection that is justly given to the most maturely developed individual, should also be given to the most delicate and youngest of humans. Artificial reproductive technologies have been the cause of a growing ethical issue regarding the protection of hundreds of thousands of the most delicate of humankind.
In Vitro fertilization (IVF) has become a successful alternative option for families and individuals who wish to have a child of their own but are experiencing infertility issues. IVF is a procedure that is done by taking eggs from a woman and fertilizing the egg with a sperm cell in a petri dish. This fertilization creates an embryo which is allowed to grow and develop in the dish for about 5 days, at which time it is either implanted into the mother’s uterus where it can continue to develop and grow or it is frozen in a process called cryopreserving (Boys and Walsh, 2017). According to the Center of Disease Control and Prevention, in 2018 there were 306,197 assistive reproductive cycles performed. This resulted in 73,831 live births and 103,078 eggs or embryos cryopreserved for later use. It is estimated to be well over one million embryos currently frozen in the United States today (National Embryo Donation Center, n.d.). This number of frozen embryos is steadily growing with approximately one third of these being abandoned (Pflum, 2019). This has created an ethical dilemma on what to do with the large number of abandoned embryos.
There are several reasons for the large number of frozen embryos. One, is that during the IVF process, the woman takes medications that cause her body to ovulate. This stimulation of ovulation produces many eggs. According to Staphanie Boys and Julie Walsh, the numbers produced can range on average anywhere from 10 - 40 eggs. Due to the high cost of the medication to produce additional eggs and the uncertainty of the expensive procedures, many of the eggs are fertilized for use. This results in many embryos being left over from IVF procedures. The parents of these embryos must then make decisions about what to do with the remaining embryos. Their choices range from implanting them and having a larger family than first intended, keeping them cryopreserved indefinitely, adopting them to another family, donating them to research (stem cell, or training purposes), or thawing them (preventing further development and disposing of them) (Boys and Walsh, 2017). Another option is known as “compassionate transferring” (Riggan and Allyse, 2019) this is a procedure in which the embryo is implanted into the mother’s infertile uterus or vagina which will lead to an intentional miscarriage of the embryo.
Reasons for abandonment of embryos range greatly due to family situations. One scenario is that once a family has their desired number of children, the embryos that are not being used are frozen. This costs patients anywhere from $500.00 and upwards to $1,200 annually to keep their embryos cryopreserved (Boys and Walsh, 2017). Clients either choose to stop paying or can’t afford to continue to pay for the storage of their embryos leaving them abandoned. Others parents might move and neglect to forward their mailing address, so they no longer receive bills and information from the fertility clinics where their embryos are being stored. These growing numbers of abandoned embryos leaves ethical decisions up to fertility clinics and healthcare workers.
So the ethical questions are; what to do with this high number of cryopreserved embryos? Whose decision is it to make when it comes to abandoned embryos? What is the ethical action to take with them, and finally how to prevent these numbers from continuing to grow?
Relation to Nursing Code of Ethics Provisions
American Nurses Association Code of Ethics provision 1 pertains greatly to this ethical dilemma. Through showing compassion, respect and dignity to all patients from the very youngest to the oldest. Nurses will be able to anticipate issues that may arise from certain decisions. By having a knowledge base of what the client is dealing with, and the current situation of the great number of cryopreserved embryos, nursing staff will be able to better educate their patients on considerations for the future. Through the expression of dignity and respect to the client, the client will feel as though they are being well cared for and will have more success in dealing with difficult decisions (American Nurses Association, 2015).
Additionally, the nursing code of ethics provision 8 also relates to this ethical concept. It is imperative that nurses maintain universal rights of health for all (American Nurses Association, 2015). Nurses and healthcare workers must practice by the non-malfeasance principle, which means to do no harm. By respecting the right of all humans, regardless of their developmental state, it will ensure that appropriate care is provided for all patients. This includes the care for both the parents and the children, even if those children are immaturely developed and in an embryonic phase. It is important that nurses who are dealing with clients who are undergoing IVF consider the consequences of poorly educating patients resulting in further complications to families and the healthcare industry.
Impact on Nursing and Patient Care
There is great debate over when human life begins, and for individuals who understand that life begins at conception this is a terrible injustice to hundreds of thousands of individuals. This will impact many patients who have IVF after they discover that they have to make an incredibly difficult moral decision with their remaining children. These decisions will impact these families for the remainder of their lives, either by increasing their family members or by choosing other fates for their children. The decision may cause incredible joy, guilt or sadness for the parents of these embryos.
This may also impact nurses, through the care for families who have fertility problems. This ethical impact will be greatest for nurses who deal with women's health and fertility the most. This is because they will be most responsible for properly informing their patients about these difficult choices, and it may cause great moral conflicts for nurses who feel a responsibility for the lives of the embryos. For those families who get to adopt children through this process of IVF surplus. Nurses and families get the great privilege of aiding in the rescue of children who might have otherwise bleak endings, as well as being able to help with the correction of this growing ethical dilemma.
Factors that Impact this Dilemma
The main factors that impact this dilemma are the views of when human life begins. These differing views and understandings will be the deciding factor of life or death for hundreds of thousands of frozen embryos. Another important factor is how healthcare workers educate patients on future decision making and how to prevent this issue from growing.
Possible Solutions
Some possible solutions for this issue are better education for patients prior to the IVF process. This will help clients to be better prepared in the event that they have to make a decision regarding a surplus of embryos. Embryonic adoption needs to be part of the education and options for patients considering this alternative reproduction. Another solution is to limit the number of embryos created for clients and make it mandatory that all embryos that are created are implanted and given the right to full development. This would elicit more thought from parents and doctors who are undergoing or performing artificial reproductive technologies. As for the hundreds of thousands of frozen embryos, a time limit should be set on how long individuals may keep them frozen, indefinitely should not be an option. This indefinite cryopreservation of embryos only passes the responsibility of care and decisions making onto the future generation. Once the allotted time for this is up, the embryos should be placed up for adoption.
Impact on My Future Nursing Practice
Before studying this ethical dilemma, I believed that artificial reproductive technologies were 100% innocent and without any ethical fault. Now that I have studied this it has come to my attention that even through the joy of becoming a parent, this procedure can leave individuals with feelings of loss and guilt. This will impact my future nursing practice through better understanding of the loss and moral guilt that parents may experience through IVF. It will also impact me to become more educated on technologies that seem to be completely innocent and without any negative consequences, so that I can make sure that if I am responsible for educating on that particular technology I have the ability to fully inform my patients about that procedure.
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References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/
Boys, S. and Walsh, J. (2017). The dilemma of spare embryos after IVF success: Social workers’ in helping clients consider disposition options, 18(2). 583-594. DOI:10.18060/21551
Centers for Disease Control and Prevention (CDC). (2020). Assisted reproductive technology (ART). https://www.cdc.gov/art/artdata/index.html#:~:text=Based%20on%20CDC's%202018%20Fertility,and%2081%2C478%20live%20born%20infants.
Funk, C. (2018). Nonprofit works to fill the knowledge gap on human embryology. https://lozierinstitute.org/nonprofit-works-to-fill-the-knowledge-gap-on-human-embryology/
National Embryo Donation Center. (n.d.) What we do. https://www.embryodonation.org/#:~:text=That%20surplus%20is%20estimated%20at,do%20with%20their%20remaining%20embryos.
Pflum, M. (2019). Nation’s fertility clinics struggle with a growing number of abandoned embryos. https://www.nbcnews.com/health/features/nation-s-fertility-clinics-struggle-growing-number-abandoned-embryos-n1040806
Riggan, K. A., Allyse, M. (2019). ‘Compassionate transfer’: an alternative option for surplus embryo disposition. Human Reproduction, 34(5), 791–794. https://doi.org/10.1093/humrep/dez038
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Amber Easton April 10, 2021
Nursing Program, Western Wyoming Community College
Ethics Paper--Nursing 1200
