Choosing Assisted Reproduction: Social, Emotional & Ethical Considerations

Presumably, these adoptions will be handled with complete openness because people recognize that it would be unconscionable to keep the truth from either the adoptees or their biolgical siblings, So what will it mean to parents when they see their adopted—out offspring struggling? Generations of adoptees have taught us that adoption is difficult, that questions of loss and identity inevitably arise, that those who lose their biological connection often struggle to make sense of their lives.

Just as adoptees have taught us about loss and identity, birthparents have poignantly described their own post-placement struggles. Multiply this by ten or twenty or fifty fold with our embryo cryo-parents. No doubt they will react all the more if there are problems within that family.

How will they handle their feelings within themselves and as a couple? Will these parents, who have suffered this disenfranchised loss, take it out on each other and what will this mean for their marriages? Questions abound; answers are absent. Adoption, as we have known it, is a solution to a social problem: Need cries out, adoption answers. In so doing, adoption serves the best interest of children—new lives are entering the world and without adoption, they would have no one to feed them, change them, love them, teach them.

It is difficult for me to view a cryopreserved embryo as having the same feelings, needs, destiny as a growing fetus. However, there are those who argue that life begins with fertilization, How then can they act in the best interests of their embryos? It seems to me that they face choices and the challenges of achieving truly informed consent. Each of their decisions represents a choice that I believe most everyone would regard as ethically and morally sound.

Couple A tried for several years to conceive. When several IVF cycles failed, they left treatment and sought adoption. A did not conceive and the couple went on to successfully adopt. Couple B had twins through IVF and when the twins were two years old, the parents decided that their family was complete.

However, they, too, felt responsibility for their frozen embryos. Unlike couple A, Couple B felt that they had to do everything in their power to offer the embryos life. In keeping with their beliefs and their faith, they underwent a transfer cycle. B did conceive but miscarried early in the pregnancy.

Couple C felt that they could never risk the possibility of having extra embryos to care for. Those of us who want to explore the promise of stem cell research, can feel sad that there are IVF couples who would choose other paths for their extra embryos.

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We might point out to them that these embryos might help save lives, including their own and those of their children. I have learned a lot of thing about IVF and medical tests; I have learned to discuss more freely my IVF attempts even with people outside the forum. The forum has made me feel proud for the hard fight that I have been giving and it has helped me many times when I feel weak to find my strength again and get back on my feet. It appears that the women participating in the IVF forums acquire a full range of experiences and emotions: These findings highlight how online medical communities can play a very important role in providing patients with information, help and emotional support.

Their offer of online self-help and social support has been dubbed virtual community care Burrows et al. The findings show the emotional impact IVF can have on its users. IVF is not just a medical solution to a biological problem. It is an extremely invasive procedure that is meant to solve a problem that has far-reaching personal, social and existential dimensions, and the procedure itself also has substantial impact on the lives and self-image of women and couples.

Emotions are often dismissed in decision making about medical and other technologies. They are seen as irrational distractions that blur the understanding of objective facts. However, recent emotion research shows that emotions are a source of practical rationality Damasio Emotions are appraisals, they show us what we value and draw attention to evaluative aspects of the world Scherer ; Frijda ; Lazarus ; Solomon ; Goldie ; Nussbaum ; Roberts ; Roeser Medical technologies such as IVF are not neutral tools; rather, they have an impact on the well-being of human beings, for better or worse.

They carry risks and benefits with them.

Assessing risks and benefits goes beyond measurable medical and technical data, it also involves moral and evaluative aspects Fischhoff et al. The benefits of IVF are obvious, but hard fully to grasp without understanding the emotions of a couple whose wish to have a child is finally fulfilled. Furthermore, the risks of IVF go beyond medical complications. The risks of IVF also concern the impact they have on the psychological and social well-being of women and couples and the people who care for them.

Without knowing the emotions of IVF users, it is impossible fully to comprehend the impact that IVF has on people, positively and negatively. This suggests that it is highly important that the emotional concerns of women and men are taken into account in IVF treatment, health care and policy-making. IVF can be seen as a way to take control over nature and people who would otherwise not have children can possibly have them, which is a tremendous opportunity created by this technology. However, as we have seen, the negative effect of treatments and the emotional and psychological stress can be substantial.

In order to make the most of IVF technology, emotions should be taken into consideration and attention should be paid to how such emotions can inform policy and health care. The most difficult part is how to do this in practice. The internet and social media are extremely important ways of expression for people undergoing IVF treatments. It is important to analyze emotional concerns expressed in such media.

Of course the anonymity and privacy of the forums should not be threatened, but it should be possible to discern some general concerns that are shared by many IVF patients. The insights presented in this study and possible follow-up studies can inform professionals working with IVF patients about the experiences and emotions these patients undergo. Reading about the happiness of a couple that finally gets a child due to IVF provides for a thorough understanding of the positive value this technology can have.

On the other hand, reading about the suffering of women who undergo the strict regimen of IVF leads to compassion and can provide for support by partners, family and friends and to providing more pleasant conditions during the treatment by healthcare providers. It may lead to choosing slightly more expensive but less invasive treatments.

Understanding the pain and disappointment of women or couples whose invasive and costly IVF-treatment does not provide them with a pregnancy, or where an IVF-induced pregnancy ends in a miscarriage, can lead to more compassionate care by healthcare providers and family and friends. The emotions and concerns of the person who is a recipient of care should be taken into account by health care ethics committees. According to Held , care is primarily a relation in which caretaker and cared-for share an interest in their mutual well-being. Held and Noddings argue that in order for a relation to be labeled care, the caring effort made by the caretaker has to be appreciated and acknowledged as care by the person that is being cared-for.

The caring attitude has to be coupled with a concern for what the recipient needs and what she would define as care for her, as an individual.

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One has to particularly take into account the fact that women going through IVF are in a very vulnerable state, emotionally and physically, since they are going through a very demanding medical procedure that might be their only chance to achieve pregnancy and experience motherhood.

This requires an understanding and empathetic environment between the IVF health care providers and their patients. To analyze and include emotional concerns expressed in discussion forums in IVF-related health care could be a way to make IVF health care more compassionate and empathetic towards IVF patients. For example, a great source of disappointment for women going through IVF is the apparent lack of psychological support and guidance offered by the hospital or fertility center during the process of IVF.

Despite the obvious usefulness of the forums, face to face contact with a professional psychologist can be considered as a potentially positive and valuable service. It would, therefore, be a prudent move of the health care ethics committee to propose that hospitals and fertility centers employ the services of a licensed psychologist or trained social workers, who will be able to have personal contact with IVF users and individually evaluate their needs. Another source of uncertainty and frustration is the lack of full explanation of test results and diagnostic procedures, as well as insufficient transparency during the process of IVF from their doctors.

Such behavior can cause doubts on the part of the IVF users who were not pleased by their treatment and expected more detailed explanation. Also, quite often the overly optimistic attitude of doctors regarding the positive outcome of an IVF treatment could cause great disappointment and distress to the IVF users after a cycle failure, since the same previously optimistic doctors were not able to offer a satisfying explanation after the failure. It is perhaps useful for the health care ethics committees to point out that doctors should not assume that their patients lack the necessary knowledge to process medical information, nor should they neglect to offer full explanation of the process around IVF, tests performed and IVF failure rates.

Being open and honest with their patients will increase the feelings of trust and confidence of the patients and will lead to a better and fruitful cooperation. Health care ethics committees could also attempt to offer a possible positive improvement of the information offered by the IVF forums by requesting that one or more doctors, specialized in IVF and fertility problems, should participate in IVF and dispense medical advice, which would provide the forum members with medically correct and reliable answers, or could volunteer to certify the correctness of the medical information and articles provided by the forum.

The forum could also be divided into two sections, one that is accessible for everyone, including doctors, and one that is only accessible to forum members. For the forums, this could be a step in offering quality medical information, since many of the forum users, although grateful for the variety of medical information, appear to be unsure about the trustworthiness of the source and therefore, do not use the medical information offered in the forums.

A certified doctor offering information in IVF forums would improve the trust and willingness of the users to consider the medical information and even incorporate it into their therapy plan. Thus, before deciding to integrate the help of a doctor on an IVF forum, there should be a careful evaluation of the feelings and possible reactions of the forum members to such a possibility. The emotional impact of infertility can be devastating for women, and even though the use of IVF can assist them in realizing their wish for a child, its strict administration and its physical and psychological impact can cause a new set of problems, not just for the women, but for their partners and social circle.

Choosing assisted reproduction: social, emotional and ethcial considerations

Participating in IVF-centered forums is credited with offering women an enormous amount of information and support, helping them with taking important medical decisions and giving them a safe solace where they can express themselves among fellow IVF patients and feel understood and supported, in a way that perhaps compensates for the lack of support and understanding in their private lives. These emotional needs and concerns expressed in IVF forums could be instrumentally used by health care ethics committees, in order to promote measures that can aid IVF health care professionals in offering more patient-oriented care and support for women going through IVF.

Taking the emotional needs of IVF patients into account can help in creating a more balanced and supporting relationship between IVF users and their physicians, as well as providing them with information and support specifically tailored to their personal needs. The authors would like to thank the women members of Dutch and Greek IVF forums that kindly agreed to participate in the research by filling out the questionnaires.

Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author s and source are credited. National Center for Biotechnology Information , U. Published online Aug 6.

Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Women who suffer from fertility issues often use in vitro fertilization IVF to realize their wish to have children. Emotions and expectations can run high and the whole process leaves the women exhausted and disheartened, as well as causing rifts in the relationship with her partner and social circle, as many of the women of the survey reported: Dutch user Psychologically, the hormones make you very irritable and reacting strange to everything.

Greek user For other women, however, the experience of IVF was more mixed, since they did not gain only negative experiences, but also positive ones, like adopting a healthier lifestyle and getting closer to their partner: Dutch user It was positive. Support from Family and Friends Going through IVF can be a very private and delicate issue; some of the couples that are busy with an IVF treatment prefer to keep this fact to themselves; others decide to share the news with selected members of their family and social circle. But once this line of thought is laid bare, it is readily seen to be unwarranted.

The fact that the help of clinicians and their technology is required for procreation by IVF is, for those who need it, a misfortune to which the proper response is sympathy and reassurance, not the critical judgment that their course of action is morally unacceptable. The objection arises from the fact that the collection of unfertilized eggs from a woman before IVF is a difficult and intrusive process, requiring the administration of powerful and potentially dangerous drugs to stimulate the ovaries.

It is therefore standard practice to collect more eggs than are required for one cycle of IVF, and to use the extra eggs to create more embryos so that they can be frozen for use in further cycles of IVF treatment. The normal practice is that the couple decide what to do with these embryos, and most couples choose to dispose of them.

It is, however, this practice of disposing of spare embryos that conservative moralists take to be reprehensible. Unlike the previous point, this is not an objection to IVF as such. It is perfectly possible to perform IVF without creating spare embryos, and there are some clinics where this is routine practice. The reason for the normal practice is, as explained above, that there are good reasons for minimizing the episodes of egg collection undergone by a woman embarking on IVF treatment.

One might still wonder whether one could not just freeze the extra eggs collected, rather than fertilize them before freezing them as extra embryos; for disposing of spare eggs is not as morally contentious as disposing of spare embryos. Unfortunately this option is not, at present at least, practicable because embryos survive the freezing and thawing process reasonably well, but eggs do not—although some work suggests that there are ways of achieving improved results in this regard [ 3 ].

So the issue of the status of the embryo and what it implies for our treatment of an embryo cannot be side-stepped in this way. The central issue here is whether something that has the potential to become, after implantation and successful pregnancy, a human infant and then a normal human adult has the same fundamental moral status as an infant. The main alternative view is that moral status depends on the actual capacities of the being, which starts life as an embryo, and then, if it implants, becomes a foetus and, after birth, an infant.

In this latter view, the early embryo does not, at this stage of its development, have the moral status that it later acquires as it develops capacities such as sentience, consciousness and agency. It is not possible to pursue here all the intricacies of this debate to a reasoned conclusion.

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The first view has the considerable merit of simplicity, but the implication that an early embryo makes the same moral claim on us as a newborn infant is hard to accept; and the thesis that potentiality alone confers moral status does not sit well alongside the discovery of the reproductive potential inherent in almost any somatic cell.

The alternative view is more complex, but coheres with our ordinary attitude to the significance of the development of a human being's capacities and abilities, which leads us, for example, not to attribute criminal responsibility to children. A compromise position, which I myself favour, recognizes that the genetic identity of an early human embryo gives the embryo a modest moral status as the blueprint for a new human life, although not the status of a person comparable with that of an infant.

With this third view, it is morally legitimate to dispose of spare embryos: But their disposal is nonetheless regrettable. Other things being equal, it would be better if the practice of IVF could be refined in such a way as to reduce the number of spare embryos created, without imposing extra risks and distress on women who already have much to endure. I turn to consider the ethical issues, which arise from the new possibilities that are dependent on IVF.

Reproduction without sex: social and ethical implications

The isolated cell is then tested for the presence or absence of some previously identified genetic condition. This technique requires a high degree of skill and sophisticated equipment. PGD is a method of selecting which embryos to place in a woman, and thus equally a method of rejecting embryos because they are thought to be unsuitable. It is, therefore, a way of determining which embryos are to have a chance of becoming children if they implant successfully and which embryos are not to have this chance. As such it gives rise to significant social and ethical considerations concerning the role of human intervention in determining which kinds of children are to be born or not born.

We encounter positive eugenics proper where embryos are selected on the basis of genetic predispositions that are wanted for their own sake. In the early years PGD was mainly used to enable parents to avoid having children with serious early-onset inherited disorders such as Tay—Sachs disease.

Only those who hold that all human embryos have the moral status of a person will find it unacceptable that parents can take steps not to implant an embryo with the genetic basis for Tay—Sachs disease; others will judge that it is morally unacceptable that parents should be denied the opportunity to avoid having a child with Tay—Sachs disease. So with respect to these cases, the positions taken largely follow those already explored. PGD has recently been extended to conditions such as bowel cancer and breast cancer. This extension is not problematic.

Human welfare generally, as well as that of future children, is enhanced by relieving families of the anxiety that they might pass on a predisposition to these aggressive hereditary cancers. But as we look forward to further developments of this kind, we need to ask what are the limits to the use of PGD? One limit is set by genetics: But further limits can be set by us. One issue arises from the fact that some genes giving rise to serious disorders are recessive. The question that arises is whether it is acceptable to use PGD to exclude not only embryos that are liable to a serious disorder, but also those embryos that are carriers for the condition.

Some argue that the disposal of embryos just because they are carriers places too low a value on the potential human life embodied in an embryo.

Reproduction without sex: social and ethical implications

However, once one appreciates that it is generally couples who are already using PGD to avoid having a child with a serious disorder who also wish to avoid having children who are carriers of the disorder, it is difficult to see any good reason for not permitting them to rank the embryos that are to be implanted, with those which are not carriers at all as their preferred embryos. So far I have discussed cases in which PGD is used to enable parents to avoid having a child with a serious genetic disorder.

This use is primarily negative. What about positive uses, in which PGD is used to select a child of a specific kind? As the selection of the implanted embryo is guided by the medical needs of the affected child it gives rise to the objection that the resulting child's existence is being valued primarily as a means to improve the welfare of its sibling, and not for its own sake. So although this use of PGD requires oversight, it is in principle acceptable.