Ethical Dilemmas in Fertility Counselling
Published by American Psychological Association
ISBN-10: 1433807602, ISBN-13: 978-1433807602
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This book provides a useful insight into some of the ethical issues potentially faced by mental health professionals working with people with fertility issues. The authors acknowledge they cannot provide definitive answers to some of the ethical questions they pose. Instead, they aim to provide a useful resource for mental health professionals, reproductive medicine and health physicians, and IVF clinic managers.
The emphasis upon 'ethical dilemmas' is excellently dealt with by the authors in their comprehensive introduction. Although the book focuses on North America, many issues discussed are transferable to other countries including the United Kingdom. But the reader needs to relate the material to their country's regulatory and ethical system and legislation because the authors draw upon American Psychological Association (APA) and American Society for Reproductive Medicine (ASRM) guidelines.
Chapter one considers psychological theories of distress and models of fertility treatment. It draws briefly upon grief, developmental, attachment, crisis, family systems, stigma and social exchange theories. Although a brief synopsis of theory, this provides information about the complex psychological issues with which people with fertility issues may have to contend.
This chapter is followed by seven dedicated to the ethical issues surrounding different treatment options. Each chapter is laid out in the same format to aid navigation through them. Topics in each chapter are: Medical background, psychosocial literature, bioethical perspectives, existing policies, and legislation. At the end of each chapter is a clinical vignette, which poses questions to mental health professionals.
Chapter two covers access to treatment and acknowledges that discriminatory attitudes about who is fit to parent continue to exist. In chapter three, the authors discuss the ethics of disposing of surplus embryos. Significantly, they examine how disagreement within a couple about embryo disposal can be ethically complex. Chapter four discusses multi-fetal pregnancies and the complex decisions people must make about fetal reduction.
Chapter five analyses the ethical issues surrounding egg donation for the donor and recipients, including egg sharing. The more complex ethical issues associated with egg sharing schemes in the UK are not covered. However, as the book is written from a North American perspective, the inclusion of egg sharing is to be applauded, even if key details have been omitted.
Chapter six addresses the ethics of sperm donation and recipiency, including anonymity. An interesting feature of this chapter was the clinical vignette about a son donating sperm to his father who is in a new relationship. The vignette gives an informative account of a complex ethical situation. It is told from the perspective of everyone involved including the father's existing children and his wife, who didn't know that he was contemplating using sperm donated by his son.
In chapter seven, the authors tackle surrogacy. This chapter is incredibly brief compared to other chapters and provides merely an overview of surrogacy. The vignette emphasises what might occur if a couple seeking a gestational surrogate received counselling from someone untrained in reproductive medicine. Nevertheless, this is an interesting example of the impact of restricted resources and a woman's ability to purchase the 'best' care.
Third-party identification and disclosure are discussed in chapter eight. The authors allude to the challenges faced by professionals working in this area, in particular, if a donor-conceived individual accidentally discovered the manner of their conception.
Finally, in chapter nine, the authors summarise what the future might hold for reproductive medicine and say mental health professionals, in particular, must 'care about the moral complexities arising from the medical-technical innovations in the field' (p.173).
This book provides a useful introduction to potential ethical issues when working with people with fertility problems and will be especially useful for mental health professionals. The use of clinical vignettes, while not providing definitive answers, offer a number of ways to consider the issues discussed.
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