Another Gray Area in Healthcare: Ethics and the Law how they effect their decisions Toni M. Cunningham HCA 322: Health Care Ethics and Medical Law Professor West January 2, 2009 Ethical and legal concepts, including specific federal regulations, required of healthcare organizations to ensure the delivery of high quality healthcare that protects patient safety
Imagine this, you are fertility doctor who in the past had helped a twenty-six year old, single woman to have six babies; and now at the age of thirty-three years old that same single woman whose children are now between the ages of two and seven walks into your office and says “I am ready for my next baby”, (her last six embryos are in your possession). What would you do? What would you say to her?
The first time you saw her she was a young, unmarried, college student, gainfully employed with cash and now still unmarried, but this time she is unemployed, living with her six children and her parents, no stable source of income, planning to return to college to finish her Masters degree after she has the next baby; but still she has the cash. What would you do? Do you have any responsibility other than helping a patient have a baby? Is there a process to qualify for this procedure? Is there a questionnaire that must be filled out?
Are there any psychological tests that must be passed? In this paper I am going to cover these issues and many more as we all try to understand why a doctor would help a single, unemployed woman to have fourteen children when we are in a recession or if it is his place to decide or is his job just to serve? Fertility doctors around the world are stunned by the actions of one particular Doctor in California; the way he runs his clinic, how he handles the in vitro process, and his thought process as to who he will help or not are now all in question.
The American Society for Reproductive Medicine states “when dealing with the single individual doctors still have the professional autonomy and an obligation to treat everyone equally”. They believe that doctors do have an ethical duty to treat people with equal respect regardless if they are married or not, and added that single, gay or lesbian should receive the same respect married couples receive.
The only cases that should be dismissed are those where there is serious doubt about whether a person would be a fit parent, in their research the society has found no reasons a doctor should deny services to an unmarried or homosexual persons except the reason stated above and that reason should be reviewed in all cases Fertility and SterilityVol. 86, No. 5, (2006). According to the society the doctor in question followed to the letter their obligation to the patient on the basis of marital status, but what about the fact that the patient has no means to support the children? Does a doctor have the right to refuse this type of service?
Let us see what the Ethical committee has to say about this. The Human Fertilisation and Embryology Act in the United Kingdom stated that “Treatment services should not be provided unless account has been taken of the welfare of any child who may be born as a result of treatment. ” In the United States the Ethics Committee agrees that the wellbeing of the children is one of concern and that it should be taken into consideration before the in vitro process begins, there is a but to their beliefs because of the constitutional rights of American citizens to bear and rear children an ethical paradox could be created.
The constitution does protect the reproductive rights of citizens and bans the act of discrimination on the basis of race, age or religion, but the federal and state anti-discrimination laws has left a gray area to assist physicians when they don’t want to take on a patient; as long as the private sector physician does not impermissibly discriminate under these laws, he or she may choose not to accept a fertility patient without violating that erson’s constitutional rights. Fertility and SterilityVOL. 82, NO. 3, SEPTEMBR (2004) Concerns about a child’s future well-being is a valid reason for not providing infertility treatment, Fertility and SterilityVOL. 82, NO. 3, SEPTEMBR (2004), the welfare of the child is one that doctors should always taken into to consideration, can the patient create a stable environment, does the patient have the means to take care of the child or children financially?
If not should the doctor be able to make all of us responsible for this child? Due to the fact that the mother doesn’t have an income is going to place the needs of all fourteen children plus mom on the taxpayer; making all the death threats and angry comments on her website understandable. We all know that violence is never right; nevertheless the public anger is coming from their concern for these children and for their own pocket.
Pozgar and Santucci in their book titled Legal and Ethical Issues for Health Professionals covers artificial insemination, test tube babies and sterilization but no where did they dare to touch the in vitro process, I reviewed several books regarding the law and ethics in healthcare and none of the authors really ventured to give an opinion which led me straight to the ethics committee of the reproduction where we could obtain this information in its entirety. Not taking anything away from the other authors, there is not a lot of information available because of so many new procedures being introduced.
The one thing that was consistent was the bill of patient’s rights to be in control of their own care and to have a choice of their healthcare provider, and to have all their information held in the utmost confidence. Pozgar, G. D. & Santucci, N. (2005), The hospital where the octuplets were born were not required by any law to let the public know about these births and couldn’t have made any reference to them without the permission of the mom, so when most heard the announcement of the multiple birth the thoughts were one of compassion for a couple and all the challenges that were before them.
There were offers from baby companies that usually come to the aid of families that have multiple deliveries, talk shows and publication reporters offering large sums of money were on the hunt for the name of this woman. A week later all hell broke loose, offers of baby goodies disappeared, and those large offers from the media started to dry up. This woman is an unemployed, single mother of fourteen kids and lives on her parents in a small house in a nearby city. How could this happen did she understand the risk in multiple deliveries, the doctor said yes, the doctor even though they haven’t talked directly to he media has sent a statement regarding the consultation of this women and that he explained the process in full detail, he said he implanted six embryos both times he saw the patient. According to other physicians they would never implant more than 4 in women under thirty-five years of age. So why would this doctor go against what the board had advised fertility doctors to do? Maybe his moral values came into place or religious reasons not allowing them to terminate some of the embryos; know one really knows what the doctor’s reasoning was because they are not talking, leaving us all to wonder why.
It can’t be due to confidentiality because the mom is on the cover of several magazines, and she is showing up on television and using the internet to solicit donations. If she is talking I am sure she wouldn’t mind the doctor sharing what his opinion is on her having fourteen kids and the fact that he is responsible for it happening. Although a strong ethic urges physicians to treat all persons in need, physician and professional autonomy is also an important value.
Ordinarily, physicians are free to decide whether to enter into a doctor–patient relationship with a patient, and once in it, whether, with adequate notice to the patients, to terminate that relation. Unless the conditions of their employment require otherwise, physicians providing fertility services are generally free not to provide those services to individuals as they choose, subject only to federal and state laws against unjustified discrimination on the grounds of race, religion, ethnicity, or disability. Physicians faced with individuals or couples whom they have strong reasons to believe may be seriously deficient.
Professional autonomy thus has two aspects. It entitles physicians to choose not to treat persons whom they think will be inadequate child-rearers (as long as they comply with anti-discrimination laws). It also generally entitles them to treat such patients if they choose. Others might point to the significant costs and burdens that children with greatly diminished welfare impose on others. In addition, it is difficult to understand how a person’s interest in having children is rationally served in cases where the situation is not one of a prepared and stable environment.
These are not easy decisions to make and providers and law-makers are advised to be cautious when they make them, the question still remains this young women’s obsession to being a mother (taken from her mothers statement) should it fall on taxpayers or maybe we could make the doctor responsible since he did have a choice to do that second round even though he knew that there were already six children, two with special needs that needed to be taken care of. References Pozgar, G. D. & Santucci, N. (2005), Legal and Ethical Issues for Health Professionals, Sudbury, MA: Jones and Bartlett Publishers.
ISBN: 9780763752385 Miller, Rebecca C. Hutton, (2004), Problems in Health Care Law Edition: 8, Published by Jones & Bartlett Publishers, ISBN 0763727725, George D. Pozgar, Nina M. Santucci, (2007), Legal Aspects of Health Care Administration Edition: 10, illustrated Published by Jones & Bartlett Publishers, ISBN 0763739278, Fertility and Sterility Vol. 86, No. 5, November 2006 Access to fertility treatment by gays, lesbians, and unmarried persons, The Ethics Committee of the American Society for Reproductive Medicine, http://www. asrm. org/Me-dia/Ethics/ethicsmain. tml, Retrieved February 10, 2009 Copyright ©2004 American Society for Reproductive Medicine Fertility and Sterility VOL. 82, NO. 3, SEPTEMBER 2004 Child-rearing ability and the provision of fertility services, The Ethics Committee of the American Society for Reproductive Medicine, http://www. asrm. org/Media/Ethics/childrearing. pdf Retrieved February 12, 2009 Copyright ©2004 American Society for Reproductive Medicine[pic][pic][pic] ———————–  United Kingdom spelling of Fertilization.  A seemingly contradictory statement that may nonetheless be true.