Tenet of the American Nurses Association Code

¶ … tenet of the American Nurses Association Code of Ethics states, "the nurse provides services with respect for human dignity and the uniqueness of the client, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems." (Howard University) That seemingly simple statement puts nurses as well as other medical professionals in an ethical quandary when they consider the issue of in-vitro fertilization that results in a pregnancy with multiple fetuses. Even the presence of twins instead of a singleton presents extra risks for both mother and babies, and those risks rise dramatically as the numbers of babies increase. However, in the recent past, fertility experts have felt it necessary to implant multiple fertilized eggs because of a low success rate (Johnson, 1999).

One option when a multiple pregnancy presents clear risks, especially to the likely viability of all babies, is selective reduction. In selective reduction, some of the fetuses are aborted to allow the others a greater chance of survival with quality of life. While such an action is done in order to protect some of the fetuses, multiple ethical questions remain, including how to decide which embryos will be allowed to develop, and which allowed to terminate. At this point in time, doctors and parents may not know the sex of each embryo. It may be too early to determine if any of the embryos are at greater risk of being born with a significant defect than others.

Obviously, anyone who believes that life begins at conception will be opposed to selective reduction. However, other concerns could include the worry that in the futures, embryos will be chosen to develop or be aborted based on sex or even, some day, things as trivial as eye color.

Recent developments in-vitro fertilization may make the issue of selective reduction less prominent. Researchers have recently developed the ability to transfer the embryos on the fifth day after conception, when the fertilized egg has formed a blastocyst. This is significant because this is the stage of pregnancy when an embryo would normally implant itself at the uterine wall (Johnson, 1999). Success rates are higher, with the result that the numbers of multiple births when blastocysts are transferred on the fifth day are significantly higher than when pre-blastocyst stage embryos are transplanted on the third day, which has been the common practice. At three days, typically the embryo is still in the fallopian tube, and researchers speculate that this may be one reason for a high failure rate. Conversely, when fifth-day blastocysts are transferred, success rates climb, suggesting that fertility specialists and their patients might be better off to receive one or at the most two blastocysts. Unless one of the blastocysts split into identical twins, this would keep the number of babies to one or two, much more manageable than four, five, or even more.