Ethical dilemmas in assisted reproduction; Perspectives from a developing country

摘要

Background: Ethical dilemmas continue to unfold as a result of the expanding roles of assisted reproduction. Understanding the basic ethical principles of Autonomy, Justice, Beneficence and Nonmaleficence as key components of practice when providing advanced fertility management cannot be over emphasized. Ethics simply refers to the moral principles that govern a person or groups behavior. It is also defined as a code of moral principles derived from a system of values and beliefs that help define the correctness of our actions. Critical opinions have been expressed in the area of commodification of human tissue. There are also growing concerns about cross border reproductive care and its implication on reproductive health.Since ethical dilemmas may not be resolved at once, continuous appraisal of the current situation with the aim of developing locally relevant ethical frames works is desirable. Examining these ethical concerns which confront our daily practices is not only pertinent but expedient as there has been a gradual expansion of assisted conception services in Nigeria.

Keywords- Ethics, dilemma, assisted reproduction

Résumé
Contexte: Les dilemmes éthiques continuent de se dérouler en raison des rôles croissants de la reproduction assistée. La compréhension des principes éthiques de base de l’autonomie, de la justice, de la bénéfique et de la non- maléfice en tant que composantes clés de la pratique lors de la gestion avancée de la fertilité ne peut pas être sur appuyée. L’éthique se réfère simplement aux principes moraux qui régissent un comportement de personne ou de groupe. Il est également défini comme un code de principes moraux dérivé d’un système de valeurs et de croyances qui aident à définir l’exactitude de nos actions. Des opinions critiques ont été exprimées dans le domaine de la marchandisation des tissus humains. Il existe également des inquiétudes croissantes concernant les soins de reproduction transfrontaliers et ses implications sur la santé reproductive. Comme les dilemmes éthiques peuvent ne pas être résolus à la fois, une évaluation continue de la situation actuelle dans le but de contribuer au développement de l’encadrement éthique approprié sur le plan local est souhaitable. L’examen de ces préoccupations éthiques qui font face à nos pratiques quotidiennes n’est pas seulement pertinent mais opportun; car il y a eu une expansion progressive des services de conception assistée au Nigéria.

Mots-clés: Ethique, dilemme, aide à la reproduction Paper presented at the Continuing Medical Education programme of Nigeria Medical Association, Oyo State Branch in March 2016

Correspondence: Dr. O.O. Obajimi, Department oif Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria. Email: gbolahanobajimi@gmail.com

pdf (英语)

参考

Giwa-Osagie O.F. ART in developing countries with particular reference to sub-Saharan Africa. Current Practices and Controversies in Assisted Reproduction. Report of a meeting on “Medical, Ethical and Social Aspects of Assisted Conception” WHO Geneva Switzerland, 2001; 23-30

Okonofua F. Infertility in Sub-Saharan Africa. Contemporary Obstetrics and Gynaecology for Developing countries. Edited by F.Okonofua and K.Odunsi. Published by Women’s Health and Action Research Centre, Benin City, Nigeria. 2003; 8: 128-156

Sule J.O, Erigbali P and Eruom L. Prevalence of Infertility in Women in a South Western Nigerian Community. African Journal of Biomedical Research. 2008;2:225-227

Robert K. Buying and Selling human eggs: infertility providers’ethical and other concerns regarding egg donor agencies. BMC Medical Ethics2016;17:1-10.

Prag P and Mills M.C. Assisted Reproductive technology in Europe. Usage and Regulation in the context of Cross-border reproductive care. Families and Societies. 2015;43:1-23

Levine A.D. Self- regulation, compensation and the ethical recruitment of oocyte donors. Hasting Cent Rep. 2010;40(2):25-36

Holwell E, Keehn J, Leu C.S, Sauer M.V and Klitzman R. Egg donation brokers: an analysis of agency versus in vitro fertilization clinic websites. J Repr Med 2014;59(11):534-541

The American Society for Reproductive Medicine Website. https//www.asrm.org/Accessed 3 December, 2016.

Standardization and Quality Control in ART. Proceedings of the 6th Annual Scientific Conference of the Association for Fertility and Reproductive Health, 28th -30th September, 2016. Port-Harcourt, Nigeria.

Lindsay Kamakahi v American Society for Reproductive Medicine. Order Denying Motion to Dismiss; United States District Court, Northern District of CA, Case no 3:11-CV1781. Filed 29 March, 2013.

Klitzman R and Sauer MV. Kamakahi v ASRM and the future of compensation for human eggs. Am J Obst Gyn 2015;213(2):186-187

Shahin A.J, Sayeeda S and Nahid Y. Ethical Issues in Assisted Conception. Bangladesh Med J 2009; 38(1) 31-34

ESHRE Task Force on Ethics and Law. “Ethical issues related to multiple pregnancies in medically assisted procreation”. Human Reprod 2003;18(9): 1976-1979

Discussion. An ethical debate: Should older Women be offered In-vitro fertilization? Br Med J 1994; 310:1455-1457

Baertschi B. The gift of human body’s products: philosophical and ethical aspect. Gynecol Obstet Fertil. 2014 Sep; 42(9):649-652.

Shenfield F, Pennings G, Cohen J, et al. ESHRE ETHICS and LAW Task Force. Taskforce 8: Ethics of medically assisted fertility treatment for HIV positive men and women. Hum Reprod. 2004;19:2454–2456.

Minkoff H and Santoro N. Ethical considerations in the treatment of infertility in women with human immunodeficiency virus infection. N Engl J Med 342:1748-1750.