Issues on Artificial

Reproduction, its Morality and

Ethico-moral Responsibility of
Nurses
1. Artificial Insemination / Intrauterine Insemination ( IUI )
 The deliberate
introduction of sperm into
a female's cervix or
uterine cavity for the
purpose of achieving a
pregnancy through in vivo
fertilization by means
other than sexual
intercourse.
KINDS OF ARTIFICIAL
INSEMINATION

01 02
Homologous Heterologous (Artificial
(Artificial Insemination Donor—
Insemination AID)
Homologous—
AIH),
- a donor’s sperm is used
-the husband’s
 Using the husband’s sperm is by far the most
common and creates the fewest problems legally,
ethically, and morally.

 In some instances, the sperm from the husband and

the sperm from a donor with similar physical
characteristics are mixed together. As a result, if
conception occurs, the couple could easily believe it
was the husband’s sperm that was accepted by the
ovum.
Risks include:

1. Infection. There's a slight risk

of developing an infection as a
result of the procedure.

2. Spotting. Sometimes the

process of placing the catheter in
the uterus causes a small amount
of vaginal bleeding.

3. Multiple pregnancy.
7 Pros and Cons of Artificial Insemination

1. It makes breeding easy and is cost-effective.

2. It allows for genetic preservation.
3. It presents the capability to freeze sperm.
4. It makes remote mating possible.
5. It disturbs species and disrupts their natural habits.
6. It is not effective in other species.
7. It requires the use of anesthetics.
 Artificial insemination (AI) is the most
simple and oldest method in assisted
reproductive technology, which has a low
degree of complexity. Essentially, it
involves placing sperm -previously
prepared in the laboratory - in the female
internal genital tract without sexual
contact.
 AI carries the associated risk of multiple gestation
pregnancies, since before the procedure women
are given drugs that induce ovulation. This also
leads to the possibility of a superovulation
(ovarian hyperstimulation syndrome).

-If the fertilization of several eggs really occurs,

selective fetal reduction may be necessary, which
comprises a paradoxical situation for women
eager to have a child. Moreover, there must be
an informed consent signed by women providing
information on side effects of the technique, such
as nausea, vomiting, ovarian enlargement and
the possibility of occurrence of ovarian cysts.
 SOME ETHICAL ISSUES ABOUT AI…

 The first question that arises from assisted

reproduction is that it involves a type of
human procreation dissociated from
sexual partners. In addition, it is not
therapeutic in its nature and do not cure
infertility or reverse this situation.
 SOME ETHICAL ISSUES ABOUT AI…
 Several people consider that the concept of
family includes even those constituted by a single
woman and her children. Consequently, this
statement legitimizes the desire of single women
for assisted reproduction methods. This situation
creates a paradox since the right to reproduction
is not an exercise of individual persons, but of a
couple.
 SOME ETHICAL ISSUES ABOUT AI…
 An argument against AI of single women is the
welfare of the child, who has the right to fit into a
comprehensive family relationship (with a mother
and a father). Regarding the artificial
insemination donor (AID), important questions
arise. Should the identity of the donor who
provided sperm for couples be revealed? What
information will be given to the child in the future?
 SOME ETHICAL ISSUES ABOUT AI…
 The legal and ethical questions are amplified in
cases of post-mortem insemination, and sperm
donor replacement without the consent of the
spouse or steady partner. The son born after
post-mortem insemination is called posthumous
child. Defenders of this technique agree that the
sperm donor must leave a written approval for
the use of his sperm after his death. However,
others claim that the child loses his inheritance
rights. Another dilemma arises in cases of
divorce or separation of the couple before the
death of the father.
SOME ETHICAL ISSUES ABOUT AI…

 Among the questions that artificial

insemination raises are:
 What are the criteria for choosing a

donor?,
 What is his relation with the unborn

child?,
 Should the husband or partner give a

formal consent that the woman will be

inseminated with donor semen?
SOME ETHICAL ISSUES ABOUT AI…
 It is a new type of family, a "pluriparental"
one, comprised of biological mother, legal
father, sperm donor (biological father) and
child. The inseminated woman is the
biological mother; consequently, her rights
and duties in relation to motherhood
remain unchanged. However, if the
woman is in a stable relationship and did
not ask her partner for his consent
regarding AI, she committed a serious
mistake. IS THIS CONSIDERED
ADULTERY?
2. In-Vitro Fertilization (IVF)
 Refers to the conception of a new
human life in vitro (in the glass) –
that is outside the reproductive
system of the woman.
 The union of between the sperm
and egg cells takes place in a test-
tube so that the baby conceived this
way is called test-tube baby.
IVF involves five steps:
Step 1: Stimulation
Generally, a woman produces one egg
during each menstrual cycle. IVF requires
multiple eggs to increase the chances of
successful fertilization. Fertility drugs will
be prescribed to you to boost the
production of eggs. During this process,
you will be monitored with regular
ultrasounds and blood tests to check your
hormone levels.
IVF involves five steps:
Step 2: Egg Retrieval
Egg retrieval is a minor surgical
procedure known as follicular aspiration.
You will be given anesthesia so that you
do not feel any pain during the process.
With an ultrasound guide, a hollow needle
is inserted into the vagina. Through
suction, the needle will suck the eggs and
fluid out of each follicle.
IVF involves five steps:
Step 3: Insemination and Fertilization
In this, the semen sample is collected from your
male partner. A skilled technician will put the
sperms with the best quality eggs in the
laboratory. This process is called insemination.
After storing eggs and sperms in a controlled
chamber within a few hours, fertilization occurs.
If the doctor feels there are fewer chances of
fertilization, then sperm will be directly injected
into the egg through intracytoplasmic sperm
injection - ICSI.
IVF involves five steps:
Step 4: Embryo Culture
The doctor will monitor the fertilized egg
to make sure it is growing properly. A
healthy embryo will be dividing actively
within five days. If there is any chance of
passing a genetic defect, an embryo can
be tested for the genetic disorder at this
stage.
IVF involves five steps:
Step 5: Embryo Transfer
Typically three to five days after fertilization, the
embryo is placed into a woman’s womb. A thin
tube (catheter) is used to insert an embryo into
the vagina and into the womb. When embryo
implants in the lining of the uterus and grow,
then pregnancy occurs. Sometimes more than
one embryo is placed in a woman’s womb, which
may lead to twins or triplets. How many embryos
need to be transferred is a complex decision and
it depends on a woman’s age and many other
factors.
Applicability of I.V.F
1.Women or wives whose fallopian
tubes are obstructed
2.Men or husbands who are
suffering from low sperm count
3.Couples who are infertile
4.Scientific experiment and
biological research
In Vitro Fertilization Pros and
Cons
The benefits of In Vitro Fertilization are:
• The best option for specific infertility

causes. The couples don’t have to waste their

time in other infertility treatments when the
causes include blocked fallopian tubes,
maternal age, reduced ovarian reserve, and
severe male infertility issues. In these cases,
IVF is the best treatment option.
• Increased chances of having a healthy

baby. When there is a chance of passing any

genetic disorder, pre-implantation genetic
screening in IVF makes it possible to choose a
healthy embryo.
In Vitro Fertilization Pros and
Cons
IVF is a medical procedure that involves few
risks and complications:
• Multiple pregnancies -this may result when

more than one embryo is inserted, which

increases the risk of low birth weight or
premature birth.
• Miscarriages or loss of a pregnancy -like

normal pregnancy IVF pregnancy also has a risk

of miscarriages.
• Ectopic pregnancy -when egg implants outside

the uterus it is called an ectopic pregnancy. 2% to

5% of women with IVF have an ectopic
pregnancy, where pregnancy cannot be
In Vitro Fertilization Pros and
Cons
IVF is a medical procedure that involves few
risks and complications:
• Ovarian hyperstimulation syndrome - Human

chorionic gonadotropin (HCG) is the injectable

fertility drug used to induce ovulation. During
this process, ovaries may become swollen and
painful, which is called ovarian hyperstimulation
syndrome.
• Stress -IVF can be physically, emotionally, and

financially draining, which may cause stress.

Emotional support from the partner and family
can help you to go through the ups and downs of
fertility treatment.
Ethical issues IVF gives rise to:

1. The quality of consent obtained from the

parties.
2. The motivation of the parents.
3. The uses and implications of pre-implantation
genetic diagnosis.
4. The permissibility of sex-selection (or the
choice of embryos for other traits)
5. The storage and fate of surplus embryos.
Ethical issues IVF gives rise to:

 Many herald this as one of medical science’s great advances. For

others, it raises many concerns.
Several fertilized ova are usually returned to the uterus to
assure that at least one will survive. If more than one implant
successfully, it is possible for the mother to have multiple births.
Multiple births seldom go full term, resulting in financial and
emotional costs. When the number of implanted embryos is too
great, consideration is given to aborting several of them to
improve the chances of full development for the remaining ones;
this creates additional ethical dilemmas for the family.
Ethical issues IVF gives rise to:

 What should be done with fertilized ova that are not

returned to the uterus? (There are an estimated 100,000 to
200,000 such embryos in the United States.) Should they
be thrown away? Given to a donor? Used for research?
Should tax dollars be used to fund this type of research?
*If frozen, how long should they remain frozen? What
should be done with them at the end of that time? Is
discarding the embryos the moral equivalent to having an
abortion?
Ethical issues IVF gives rise to:

 Other concerns focus on the fear that PGD will be used to

make “perfect babies” or for sex selection, even when
there is not a medical reason (such as hemophilia, Tay-
Sachs, or sickle-cell anemia) for such action.
 In Vitro Fertilization A Louisiana couple decided, after the death of their 3-
year-old daughter from Tay-Sachs disease, not to risk having more children.
They learned that they both carried one copy of the Tay-Sachs gene, which
would result in a 1-in-4 chance of conceiving a child with the disease. Shortly
thereafter, the couple were notified that a procedure had been developed
through IVF and high-tech genetic testing (known as preimplantation genetic
diagnosis [PGD]) whereby technicians can remove one or two embryonic cells
from those fertilized in vitro and test for the harmful gene. This allows only
healthy embryos to be transferred back to the woman’s uterus. This
procedure resulted in the birth of a healthy child for this couple, and one who
is not a carrier of Tay-Sachs disease.
3. Surrogate Motherhood
 Surrogate mother- is a female who
carries a child in her womb for
someone else.

 There is a great deal of controversy

over some surrogate cases, because
there are not enforceable laws in
every state on surrogacy.
3. Surrogate Motherhood
 Many surrogate mothers wish to fulfill
the pregnancy in order to help a family
member or friend.

 It is against the law in most locations to

Become A Surrogate for financial gain.
Surrogacy types- Leading Surrogacy Center
1. Traditional AI is where the surrogate
donates her egg and is artificially
inseminated by the father’s sperm.
At birth, a stepparent adoption is
completed so the mother can legally
adopt the child.
Surrogacy types- Leading Surrogacy Center
2. Gestational pregnancy is where
an embryo from the biological
parents is implanted into the
surrogate via in-vitro fertilization.
The surrogate in this case is
sometimes referred to as the
gestational carrier or host.
Surrogacy types- Leading Surrogacy Center
3. Donor egg case is where an
anonymous egg from a donor
and the sperm of the intended
father are implanted into the
surrogate
REASONS OF SURROGACY
• Medical problems with your uterus
• You had a hysterectomy that removed
your uterus
• Conditions that make pregnancy
impossible or risky for you, such as
severe heart disease
REASONS OF SURROGACY
• Medical problems with your uterus
• You had a hysterectomy that removed
your uterus
• Conditions that make pregnancy
impossible or risky for you, such as
severe heart disease
HOW TO FIND SURROGATE MOTHER
 Friends or family. Sometimes you can
ask a friend or relative to be a
surrogate for you. It's somewhat
controversial. But because of the high
cost of surrogacy and the complex
legal issues it raises about parental
rights, a tried-and-tested family
relationship can be simpler to
manage.
HOW TO FIND SURROGATE MOTHER
• The American Society for
Reproductive Medicine accepts
certain family ties as acceptable for
surrogates. It generally discourages
surrogacy, though, if the child
would carry the same genes as a
child born of incest between close
relatives.
HOW TO FIND SURROGATE MOTHER
 A surrogacy agency. Most people use one
to arrange a gestational surrogate. There
are about 100 agencies now operating in
the U.S. They act as go-betweens.
 An agency helps you find a surrogate and
make arrangements. It also collects any
fees that get passed between you and the
surrogate, such as paying for her medical
expenses.
Having a surrogate mother can be
expensive. Costs vary depending on the
company you work with and if you use
your own donated sperm or egg. the total
cost on average for most surrogacy cases
about $12,000 in India, including all
medical expenses and the surrogate's fee.
In the U.S., the same procedure can cost
up to $70,000.
Assured Baby Plan: Get Baby or Money
Back
How to Choose
a Surrogate
SURROGATE MOTHER
You should choose a surrogate who:
• Is at least 21 years old

• Has already given birth to at least one healthy baby so

she understands firsthand the medical risks

of pregnancy and childbirth and the emotional issues of
bonding with a newborn
• Has passed a psychological screening by a mental

health professional to uncover any issues with giving

up the baby after birth
• Signs a contract about her role and responsibilities in

the pregnancy, such as prenatal care and agreeing to

give you the baby after birth
SURROGATE MOTHER
• Surrogate should get a medical exam to check that she's likely to have a healthy, full-
term pregnancy. She gets tests that check for infectious diseases such
as syphilis, gonorrhea, chlamydia, HIV, cytomegalovirus, and hepatitis B and C.
• Surrogates should get tests to make sure they have immunity
to measles, rubella (German measles), and chickenpox.
• Also, you may want to ask that she get a medical procedure to visually "map" the
uterus, which can help the doctor check her potential to carry a pregnancy. A
surrogate mother should have her own doctor during pregnancy rather than use
yours.
COST OF SURROGACY
*The cost of surrogacy can range from $80,000 to $120,000. A lot of
different things go into the price, such as whether the surrogate has
her own medical insurance or whether you need to buy a surrogacy-
pregnancy policy for her.
RISKS BEING A SURROGATE MOTHER
 The biggest one is attachment to the unborn child- especially if the surrogate
is the egg donor. Surrogacy should be handled much like an adoption because
the baby must be relinquished at birth. If you are considering becoming a
surrogate mother, medical problems such as preeclampsia and other
concerns at labor and delivery should be discussed with your family doctor or
IVF specialist.
 Many states such as Michigan and the District of Columbia prohibit surrogacy
agreements; this can be difficult when working with an agency. Other states
may be accepting but have difficulty making legal binding agreements when
it comes to finalizing an adoption in surrogacy cases should a problem arise
with custody.
 LEGAL ISSUES WITH SURROGACY
 Parental rights aren't guaranteed after a surrogate pregnancy. The law continues to
change as reproductive technology and the very definition of a "parent" changes.
 There isn't a federal law on surrogacy and state laws vary. After a surrogate pregnancy in
some states, you may still have to pass adoption proceedings to gain legal custody of the
child. In other states, a "declaration of parentage" before birth lets you avoid having to
"adopt" the baby.
 To protect your rights as parents-to-be -- and the rights of the child you're hoping to have
-- hire an attorney who specializes in reproductive law in your state. He can write a
surrogacy contract that clearly spells out what everyone needs to do.
 A contract like that may help if legal issues come up after birth. It can also outline
agreements about a variety of possible scenarios with the pregnancy, such as what
happens if there are twins or triplets.
 LEGAL ISSUES WITH SURROGACY
 Parental rights aren't guaranteed after a surrogate pregnancy. The law continues to
change as reproductive technology and the very definition of a "parent" changes.
 There isn't a federal law on surrogacy and state laws vary. After a surrogate pregnancy in
some states, you may still have to pass adoption proceedings to gain legal custody of the
child. In other states, a "declaration of parentage" before birth lets you avoid having to
"adopt" the baby.
 To protect your rights as parents-to-be -- and the rights of the child you're hoping to have
-- hire an attorney who specializes in reproductive law in your state. He can write a
surrogacy contract that clearly spells out what everyone needs to do.
 A contract like that may help if legal issues come up after birth. It can also outline
agreements about a variety of possible scenarios with the pregnancy, such as what
happens if there are twins or triplets.
 LEGAL ISSUES WITH SURROGACY
 WHAT IF THE CHILD HAS CONGENITAL ANOMALY?

 How are these dilemmas to be solved? What is to happen to the child? Who
bears the responsibility?

 A man paid a woman to be artificially inseminated with his sperm and to carry
his child. When the child was born with microcephaly (an unusually small
brain), the man rejected the infant, stating that he could not be the father. The
surrogate mother and her husband also did not want to accept the
responsibility for parenting the child.
Morality of Abortion, Rape and
other Problems Related to
Destruction of Life
 Many people view termination of life at any point after conception as
murder.
 The Roman Catholic Church firmly upholds its traditional position on
abortion.
 Many conservative Protestant Christian groups also are active in
opposing abortion.
 Some believe that although abortion is not desirable, under certain
circumstances it would be justifiable—for example, in cases of rape
or incest, or in instances where amniocentesis indicates that a fetus
would be born retarded or genetically defective. Others think that
early termination of a pregnancy might be acceptable, but that
termination after the 4th month would not be appropriate.
 As a nurse, these issues present some difficult questions you will
need to answer.:
 To what extent do you believe you can personally participate in
the abortion procedure?
 Would the stage of pregnancy and type of procedure make a
difference?
 As a nurse, you have the right to refuse, based on your own ethical

beliefs, to be involved in abortion procedures or the care of patients

seeking abortion.
 Employment in certain areas (eg, labor and delivery rooms), however,

may rest on the nurse’s willingness and ability to assist with abortions
and to give conscientious care to the patient who has had an abortion.
 Some religiously affiliated hospitals have elected to close their labor

and delivery services rather than perform abortions.

 As a nurse, these issues present some difficult questions you will
need to answer.:
 To what extent do you believe you can personally participate in
the abortion procedure?
 Would the stage of pregnancy and type of procedure make a
difference?
 As a nurse, you have the right to refuse, based on your own ethical

beliefs, to be involved in abortion procedures or the care of patients

seeking abortion.
 Employment in certain areas (eg, labor and delivery rooms), however,

may rest on the nurse’s willingness and ability to assist with abortions
and to give conscientious care to the patient who has had an abortion.
 Some religiously affiliated hospitals have elected to close their labor

and delivery services rather than perform abortions.

 Attention has been focused on incidents in which an abortion
was attempted toward the end of the 5th or 6th month of
gestation, and the fetus was born showing signs of life.
 Is the doctor or nurse obligated to try to keep the infant
alive? Is the doctor or nurse guilty of malpractice, or even
murder, if he or she does anything to hasten the infant’s
death? Should this infant be considered a human being? Does
the infant have “rights”? Does the mother have legal
possession of and responsibility for the child if, in fact, she
attempted to abort the fetus? This issue, like so many others,
probably will be settled in a court of law while we continue to
debate it ethically.
 The abortion issue also is complicated by consent problems.
Nurses practicing in areas that provide abortions to minors
must be concerned about parental consent and counseling
issues because of the wide variations in state statutes
governing abortions (Killion & Dempski, 2000).

 In the last few years, the abortion issue has been made more
complex by research that would use the fetal tissue resulting
from an abortion for stem cell research and therapeutic
purposes..
 Is abortion moral?

Is it against the natural law?

Is it against biblical principals?

 Rape
The penetration, no matter
how slight, of the vagina or
anus with any body part or
object, or oral penetration by
a sex organ of another
person, without the consent
of the victim.”
 MYTHS AND FACTS ABOUT RAPE AND
SEXUAL ASSAULT
Myth: You can spot a rapist by
the way he looks or acts.
Fact: There’s no surefire way to
identify a rapist. Many appear
completely normal, friendly,
charming, and non-threatening.
 MYTHS AND FACTS ABOUT RAPE AND
SEXUAL ASSAULT
Myth: If you didn’t fight back, you
must not have thought it was that
bad.
Fact: During a sexual assault, it’s
extremely common to freeze.
Your brain and body shuts down
in shock, making it difficult to
move, speak, or think.
 MYTHS AND FACTS ABOUT RAPE AND
SEXUAL ASSAULT
Myth: People who are raped “ask for
it” by the way they dress or act.
Fact: Rape is a crime of opportunity.
Studies show that rapists choose
victims based on their vulnerability,
not on how sexy they appear or how
flirtatious they are.
 MYTHS AND FACTS ABOUT RAPE AND
SEXUAL ASSAULT
Myth: Date rape is often a misunderstanding.
Fact: Date rapists often defend themselves
by claiming the assault was a drunken
mistake or miscommunication. But research
shows that the vast majority of date rapists
are repeat offenders. These men target
vulnerable people and often ply them with
alcohol in order to rape them.
 MYTHS AND FACTS ABOUT RAPE AND
SEXUAL ASSAULT
Myth: It’s not rape if you’ve had sex with the
person before.
Fact: Just because you’ve previously
consented to sex with someone doesn’t give
them perpetual rights to your body. If your
spouse, boyfriend, or lover forces sex
against your will, it’s rape.
.
 END
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