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Ethics & Morality

Ethics and Morality

It is usually a joy to help patients get something they really want, especially if the desire is to conceive a child. Keeping confidentiality is not something the practitioner would foresee as a problem. But what if it turns out that one partner (the father) is not eager to have another child, and moreover, he abuses drugs and alcohol? How good a father can we expect him to be?

Substance abuse usually gets worse if the person doesn't quit altogether. If the father continues to use cocaine and drink alcohol to the point of intoxication, addiction is likely to occur, and so far he has failed to show real signs of quitting. Does the practitioner share responsibility for how good a parent the father will be?

Is the child's need for an active, functioning father the responsibility of the practitioner that is helping the couple to conceive? Not only the new child brought in but also the 11-year-old child that is already is in the home, whose life will be further complicated by the appearance of a sibling, will stand to be affected by the father's problems. What about the mother's right to know the truth that her husband doesn't really want another child? She may be stuck with all the care and responsibility. Finally, the possibility of a genetic defect in the baby due to drug and alcohol abuse cannot be discounted. The husband's sperm does appear to have been affected in that he becomes more deficient after weekends spent drinking.

Ordinarily, deontology theory demands that the practitioner follow the rule of confidentiality. Duty-based ethics depend on obedience to the rules, and the practitioner has a duty to follow them regardless of outcome. In the duty-based model, an action can be moral even if the outcome is bad. In this case, the rules of confidentiality and autonomy would have to be obeyed regardless of the effect of not telling the wife and the bad effects on the child that might result.

Consequence-based theory demands that decisions be made on the basis of hat the outcome will be. The alternative chosen should be the one that produces the greatest benefit for the patients (in this case, there are two of them and a potential third) with the least amount of harm. Sometimes, it is hard to know what will happen, though, and practitioners need to have good reasons -- based on experience -- for choosing a course of action on the basis of what the consequences will be. We cannot really know for sure what will happen if this couple conceives. it's possible with a baby coming that the father will be inspired to quite cocaine and drinking; however, he has an eleven-year-old at home and apparently isn't worried that his drug habits may be making a negative impact on the older child, so it seems to optimistic to think he will be concerned about an impact on the baby.

Sometimes, it may be necessary to choose a course that is not in the best interests of the patient -- someone else's well being may be a consideration -- in this case, the other patient's (the wife) and the unborn child's welfare is at stake. Consequence-based ethics would demand that the practitioner have a discussion with the couple about the issue of combining parenthood with drinking and drugs.