Modern science has reached a stage within the area of reproductive medicine, that challenges practitioners and their clients to face many ethical considerations when moving forward in the quest to have a child. The limited options that were available to individuals and couples 25 years ago did not create the kind of ethical dilemmas we face today. No one would have predicted that a child could potentially have five parents: the intended mother, the intended father, the egg donor, the sperm donor and the gestational carrier. That concept, during the early years of assisted reproductive technology, would have been considered science fiction and today it is just one of the magical advances individuals and couples have to choose from.
Some of the other leaps in assisted reproductive technology include having a child for a woman over the age of 50 with the use of egg donation, homosexual and lesbian individuals and couples having children through egg donation and surrogacy and having a child after death with the use of frozen sperm or eggs. These concepts are in use today and require in depth consideration of the considerable ramifications that can affect a much wider circle than just the individual or couple using assisted reproductive technology.
We first begin by identifying the reason/s for infertility as that determines the direction and individual or couple needs to take in order to have a child. Depending on the options available, and there are many, we then look at viability, practicality and then identify if there is an ethical dilemma. An example of this may occur when a woman diagnosed with infertility wants to use an egg from another family member such as a sister, niece or cousin. It may seem selfless and logical to implement this decision but there may be hidden issues that could cause potential harm. The donor may feel coerced or guilty or there may be financial incentives, all of which need to be explored before any further steps are taken. Another example is when a prospective parent is of an advanced age, increasing the potential that a parent will die while the child is still young. Looking beyond the immediate need to have a child to a future that may be compromised is a way to incorporate ethics in to the assisted reproductive arena.
The next step involves gathering as much information as possible about the situation at hand so as to make an informed and ethical decision. Using the in-family egg donation example above, a practitioner needs to help the parties involved make the best decision for themselves, the donor and the child. The practitioner can help shed some light on to concepts that were not previously considered such as, will the donor have a say in decisions about the child? Will the parents insist that the conditions under which the child was conceived be kept secret? What are the ramifications of offering money for egg donation to someone in financial need? As this information is gathered, the parties involved have the opportunity to look at and understand that they may or may not be making the best ethical decision for themselves, their family or their child.
After information is gathered and all parties understand the complexities of the situation, options are then identified with the goal that everyone can agree on the best path to take. For couples, one partner may be rooted in one ideology while the other wants to try something different. For individuals, it is important to focus on finding a viable and dependable support system that fosters the long term emotional and physical health of both parent and child.
There are so many things to consider with the use of assisted reproductive technology and being open to the scientific options as well as the ethical dilemmas, enables the potential for more holistic choices. Once all the options are explored, it is then time to make the decision to move forward and sometimes that means opting to remain childless. There is no way to predict the long term outcome of a decision fraught with challenging ethical issues but without consideration of those issues, there is certainly more potential for long term harm.