IVF is an advanced medical procedure for fertility problems. It is used to help infertile women bear children and on people with reproductive genetic issues. It is a complicated procedure. There are multiple benefits and risks involved in IVF. The process has generated many ethical issues both in the medical field and in the society at large. Nurses play an essential role in caring for patients with fertility problems. As a result, they also face ethical dilemmas that stem from the procedure. The principles of autonomy and non-maleficence are involved in making decisions on IVF treatment. Some patients request for transfer of two or more embryos against the established standards. Studies show that the transfer of more than one embryo is risky and can put the mother's health and the babies at risk. As a result, a nurse can be torn between respecting the patient's autonomy or adhere to non-maleficence.
Ethical Issues in In Vitro Fertilization
In the past few decades, fertility treatments have advanced, and today, women can have children through assistive reproductive technologies such as In Vitro Fertilization (IVF). IVF is a complex procedure that helps women with fertility issues or individuals with genetic issues. The IVF fertility treatment involves collecting eggs from ovaries and fertilizing them with sperm ( Klitzman, 2016 ). The fertilized egg/embryo is frozen and stored or transferred into the uterus. A full IVF cycle normally takes approximately three weeks. This form of treatment is considered the most effective type of assisted reproductive technology. It is also very expensive compared to other fertility treatments. Eggs and sperms can be collected from partners or from anonymous donors. Despite its major contribution to fertility, there are multiple ethical issues surrounding the technology. There are medical standards that must be ensured when considering and deciding on IVF. Apart from the benefits, such as the ability to have a child, there are risks associated with the procedure. The unique needs of individuals requiring IVF treatment present a challenge to nurses. One of the most common issues faced by healthcare professionals is the number of embryos that should be implanted. Medical standards require that one embryo is implanted to reduce the risks of complications. However, there are patients who demand that two or more embryos be implanted in order to reduce the risk of the procedure’s failure. This creates an ethical dilemma because the healthcare professional is torn between respecting the patient’s autonomy or uphold the principle of non-maleficence. This essay explores the ethical dilemma faced between autonomy and non-maleficence in IVF treatment.
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Ethical Issue
Nurses play an active role in planning and delivering nursing care to infertile patients in different health care facilities. The problem of infertility can be approached from a number of dimensions, including an ethical perspective. There are numerous ethical issues from a possible harm perspective that nurses face when providing care to fertility patients (King et al., 2017). When providing care, nurses must stick to the principles of autonomy, beneficence, non-maleficence, and justice, among others. In providing care for fertility patients seeking IVF treatment, the principles of autonomy and non-maleficence can conflict, causing an ethical dilemma.
Non- Maleficence
The principle of non-maleficence requires nurses and other medical professionals to do no harm or permit harm to be inflicted on a patient due to negligence. The principle is used as a threshold for medical interventions or treatments. If a particular treatment is likely to cause more harm than good, it should not be offered. If any harm is involved, it should be the least possible amount of harm in order to achieve a beneficial result. Therefore, the principles require nurses to consider harm and its possible effects on a patient when making decisions.
Autonomy
Autonomy means that a patient can make his/her own decisions without being influenced. Therefore, a nurse should provide a patient with all the information needed to make a decision regarding care. The principle of autonomy is upheld when a nurse acknowledges that a patient is a unique individual who possess an innate right to perspectives (King et al., 2017). A nurse should not influence a patient’s decision. He/she must encourage a patient to make his/her decision without being judged or coerced. A patient has a right to accept or refuse treatment.
Ethical Dilemma
Balancing the principles of non-maleficence and respect for autonomy can be a challenge in IVF treatment and care. If a 42-year-old woman likely to suffer from serious complications requests a transfer of two or more embryos during IVF despite the high risks involved, should the nurse try to convince her to have one embryo or should he/she respect the patient's choice regardless of them more harm than benefit involved? As a result of the risks associated with multiple births, existing IVF guidelines recommend transfer of one embryo ( Somigliana et al., 2015 ). This is the standard of care for patients with a good prognosis (Klitzman, 2016). Transfer of two or more embryos increases the risk of experiencing complications. According to Klitzman (2016), in IVF women, those carrying twins are 12 times more likely to have premature births compared to their counterparts with a singleton. Also, twins are 16 times more likely to weigh less and their possibility of developing respiratory complications increase by five times.
Women with a multiple pregnancies are most likely to experience eclampsia, and their risk of pre-term rapturing of membranes increases by eight times (Klitzman, 2016). Besides, they are most likely to give birth through a C-section. Existing evidence indicates that SET success in IVF has increased enormously in the past decade, while more severe complications associated with the implantation of more than one embryo continue to grow. Findings of a study conducted by La Sala et al. (2016) in Italy show that perinatal complications in twin pregnancies increased by 31.8 times when compared with single pregnancies. In addition, transferring two or more embryos in women above the age of forty does not improve the possibility of having a live birth ( Lawlor & Nelson, 2012 ). Age is an important factor in IVF.
Based on the evidence evaluated, the transfer of more than one embryo increases the risk of developing major complications for both the babies and the mother. Besides, being more than forty years old, it would be futile to have more than one embryo transferred because it is of no benefit to the patient. Healthcare professionals can deny patients treatment if it is futile (Aghabarary & Nayeri, 2016) . The idea of futile medical care attracts different points of view. As a result, the concept can cause a lot of challenges between a patient and healthcare provider. A doctor has the authority to declare treatment futile after considering factors such as the goals and medical state of a patient. Treatment can be regarded as unproductive if it breaches the ethical principles of medicine. Nurses play a crucial role in handling the issue of futile therapy with their patients.
If the nurse respects the patient’s autonomy and allows the IVF patient to continue treatment, he/she will have allowed the patient the right to self-determination. However, if the principle of non-maleficence is implemented in this case, the patient’s right to self-determination would be denied. Patient have a right to make decisions about their treatments. A nurse should not violate the principle of respect for autonomy in order to prevent harm or promote beneficence (doing well). The duty of the nurse is to provide adequate information on the risks and benefits associated with the transfer of more than one embryo to the patient and propose the best approach based on the existing evidence and practice standards. It is the duty of the patient to decide on whether to accept to have one or more embryos transferred after the necessary information is given. In contrast, the principle of non-maleficence requires the nurse to avoid intentional or unintentional harm on the patient. By allowing the patient to have more than one embryo transferred, the nurse will have allowed possible harm on the patient despite knowing that such a procedure can cause complications, and it is futile in increasing the possibility of having a live birth in women above the age of 40 years. These conflicting viewpoints place the nurse in a dilemma because both approaches are right based on medical ethics. He/she is obligated to respect the autonomy (self-determination) of the patient and at the same time uphold non-maleficence (do no harm) as well as beneficence (do good) in this situation.
Conclusively, IVF is a fertility treatment that uses technology to implant an embryo in a woman’s uterus. Compared to other assisted reproduction technology methods, IVF is more effective. However, there are risks associated with the procedure. The severity of the risks and possible complications increase with the transfer of more than one embryo. The standard recommendation is one embryo. However, some women or couples request two or even three embryos transferred to increase their chances for live birth. Existing evidence demonstrates that the transfer of more than one embryo does not improve the chances of live birth, especially in women above forty years. It only increases the risk of severe complications. Nurses face an ethical dilemma in situations where they are required to respect their patients' autonomy and at the same time stick to the principle of non-maleficence. They are torn between intentionally allowing patients to be harmed by the procedure that is most likely to cause more harm than benefits or turn out futile or have them denied the treatment, violating patient autonomy.
References
Aghabarary, M., & Nayeri, N. D. (2016). Nurses' perceptions of futile care. Holistic Nursing Practice , 30 (1), 25-32. doi:10.1097/hnp.0000000000000128
King, L. P., Zacharias, R. L., & Johnston, J. (2017). Autonomy in tension: Reproduction, technology, and justice. Hastings Center Report , 47 , S2-S5. doi:10.1002/hast.788
Klitzman, R. (2016). Deciding how many embryos to transfer: Ongoing challenges and dilemmas. Reproductive Biomedicine & Society Online , 3 , 1-15. doi:10.1016/j.rbms.2016.07.001
La Sala, G. B., Morini, D., Gizzo, S., Nicoli, A., & Palomba, S. (2016). Two consecutive Singleton pregnancies versus one twins pregnancy as preferred outcome of in vitro fertilization for mothers and infants: A retrospective case–control study. Current Medical Research and Opinion , 32 (4), 687-692. doi:10.1185/03007995.2015.1136602
Lawlor, D. A., & Nelson, S. M. (2012). Effect of age on decisions about the numbers of embryos to transfer in assisted conception. Obstetrical & Gynecological Survey , 67 (5), 288-289. doi:10.1097/ogx.0b013e3182547161
Somigliana, E., Benaglia, L., Paffoni, A., Busnelli, A., Vigano, P., & Vercellini, P. (2015). Risks of conservative management in women with ovarian endometriomas undergoing IVF. Human Reproduction Update , 21 (4), 486-499. doi:10.1093/humupd/dmv012
