ethical dilemmas surround surrogacy and the donation of egg and/or sperm? Because surrogates are paid, is this a practice that exploits the poor, such as surrogate mothers in India? Why or Why not?
Egg donation and surrogacy raises ethical dilemmas on all four basic principles of medical ethics: autonomy, justice, beneficence, and non-maleficence.
Autonomy -- .
Consent has to be given freely and with full volition of the surrogate mother. Yet, most times, intense pressure is involved aside from the fact that poor women in India may capitulate to the need for money and be taken in by the huge sums offered. The emotional and medical pressures are immense, but these women are often grossly misinformed about the situation that they are bound to undergo. Their poverty hampers them from making the clear, informed decisions that they would otherwise need to in order to undergo the procedure. Whilst most egg donors in the U.S. receive around $4,000 as compensation, advertisements can range to as high as $100,000 for surrogate mothers with "desirable characteristics. Many of these individuals are young females who could have spent their time more productively and healthily other than carrying a fetus to term. In fact, studies have shown that women who are compelled to offer themselves out of financial reasons often suffer more emotional damage than those who do it altruistically.
Secondly, Artificial Reproductive Technology has become such a complex field that surrogates are unable to understand all the risks and possible treatments involved without a substantial background in biology. Individuals are, therefore, lacking in the required autonomy necessary for full informed consent.
Because of the shortage of egg donors, it is those who are wealthy who are pandered to and addressed rather than those who may need it more but come from lower socio-economic brackets.
Injustice is also existent in a second sphere: the medical profession must do all it can to help infertile people who wish to have children reproduce. What, however, occurs if the infertile couple is still unable to produce? Should doctors encourage them to seek donors, if by so doing doctors inadvertently violate the element of ethical autonomy mentioned above? This problem become aggravated when one considers that pressure may be placed on young, and disadvantaged females to bear children when these females may have been better served pursuing their career and/or going in for an education. Aside for which, these females will be pressurized to undergo medical risks, most of which will remain unknown to them. The ethical factor of injustice, therefore, applies.
Beneficence and non-maleficence.
The medical profession must constantly ensure that its practice is towards providing benefit to the patient and preventing injury form occurring. However, donors do not receive much, if any benefit at all from the invasive surgical procedure that not only provides them with no clinical benefit but may also harm them. Doctors and legislative bodies have to decide whether it is ethically justifiable to place a young, healthy female donor at risk of harm for the benefit of an older, infertile patient.
This issue is particularly problematic since there is growing concern over the side effects of ovulation enhancing drugs on donors. An increasing frequency of studies finds ovulation enhancing drugs to be linked with occurrence of ovarian cancer. Longitudinal studies still have to be conducted to arrive at definite conclusions according to the American Society for Reproductive Medicine.
Other side effects of ovulation enhancing drugs are ovarian hyperstimulation syndrome, lacerations, ovarian trauma, infection, infertility, and lacerations. Maleficence to donor seems to be a clear concern here, hence even though surrogates are paid; this practice may still exploit poor mothers in India especially since they are compelled to offer themselves for the sake of the money and are unaware of all the medical and emotional complications. (What Are the Ethical Concerns Regarding Egg Donation?)
2) Due to the high cost of fertility treatments, doctors often place multiple eggs back into the womb. Is selective abortion moral? If parents decide to give birth to all of them, does society have an obligation to help families with multiples who are born premature with defects or who are mentally retarded? If so, how?
The case of the Bobbi and Kenny McCaughey's septuplets was an instance in kind and this raised a flurry of debate. A Houston fertility patient exceeded that with octuplets. The ethical questions can be reinforced by asking whether doctors should medically allow older couples -- sometimes quite old -- who are unused to looking after children suddenly have so many children in one go. And what if they are poor. Or live in unhealthy social environment. These are only some of the ethical questions that surmount this issue.
The cost surrounding these babies too is immense. Doctors caring for the Houston octuplets estimated that the babies' care cost at least $2 million (about $250,000 per infant) whilst still in hospital, exclusive of the ongoing medical care that these babies would receive throughout their lives. Insurance coverage could either deny coverage or raise everyone else's insurance premiums, and given that the American welfare system is already in a great deal of trouble oftentimes not helping those who most need it, one may justifiably ask whether doctors should not perform selective abortion of eggs at the outset in order not to harm many other people later on (including these potential children themselves).
This is particularly so when considering that multiple births may well consequent in one or more handicaps. This only raises national medical expense and concern of parents aside from resulting in a potential life of ridicule and hardship for the child.
There are ways to avoid selective fetal abortion and Perloe mentions them. He also recommends that medical specialists conduct ongoing research on the subject and that they ethically inform their patients of what will be involved. On the other hand:
"While more than 50% of women pregnant with three or more embryos choose selective abortion, the experience is extremely traumatic. The risk of losing the remaining fetuses following selective reduction does exist. Selective fetal reduction should be considered only as a last resort. Physicians should diligently take every available precaution to avoid couples having to face this moral dilemma.
Bioethicists recommend that women who are unwilling to undergo selective fetal reduction should not be given the most powerful fertility drugs that can stimulate production of multiples. They also call for legislation requiring pregnancy termination in order to prevent deliveries of extreme multiples. (Perloe, (nd) )
3)Assess the ethical issues surrounding the medical challenges of supporting the life of extremely premature infants. Should extremely premature infants be saved at all costs? Who should make the decision for treatment when an baby is born extremely premature?
The crux of the issue is making the best decisions for the health and life of the kid. The problem is: who becomes the decision maker -- the doctor or the parents?
Another problem is that of resources, where great expense is allocated to saving the life of the child,; this expense, time, and response of nurses could well be distributed elsewhere to larger infants who need their care.
Nurses also find the work stressful, since many of the infants could - and often do -- deteriorate and die despite the intensive amount of work placed into resuscitating them. This is stressful o nurses as well as the appearance of the baby (Townshend 1990). As one nurse put it:
The really immature kids, the fetuses, shouldn't even be here. I mean they are not babies, so they don't belong in a nursery. It's not right to bring them here where we are required to poke and prod them to meet the standards of the unit, and it's not right that valuable time is taken away from…