Getting happy and healthy children is the ultimate goal of most married couples, bringing them the most joy. Unfortunately, some parents cannot give birth to children without any disabilities due to infertility or genetic abnormalities (Asplund, 2020). Assisted reproductive technologies are techniques that help individuals to acquire children without having to engage in sexual intercourse. Advancements in assisted reproductive technologies have resulted in the creation of preimplantation genetic diagnosis (PGD), which allows married couples to screen for any congenital anomalies to get healthy infants. However, some people may want to have a genetic connection with their infants and choose the abnormal embryos. Healthcare personnel may have ethical dilemmas when advising such couples on the best decision to make. This project will use the IDEA ethical decision-making framework to identify the moral issue, determine the ethically relevant principles, explore available options, and implement the most morally justifiable decision.
Achondroplasia is a rare autosomal dominant disorder that affects several people in the world today. It is caused by gene mutations in the FGFR3 gene (Pauli, 2019). Individuals with this gene have short stature (dwarfism) due to abnormalities in bone growth that disrupt the cartilage’s changing in the long bones of the legs and arms to bones. Persons with dwarfism have unique features, including short stature, protruding forehead and reduced range of motion at the elbow joint. Other medical concerns in people with dwarfism include high tendencies to have obesity, ear infections, sleep apnea, spinal lordosis, and spinal stenosis (Pauli, 2019). PGD is a treatment option for preventing dwarfism as it involves the harvesting of the woman’s ovum before fertilizing it with the man’s sperms through intracytoplasmic sperm injection. However, the parents may not choose normal embryos because of fears of raising a child who is different from them.
Ethical Concerns of PGD
Apart from the cost and the invasive nature of PGD during embryo biopsies, other ethical issues are raised concerning PGD. Firstly, in as much as no embryos are destroyed, the other abnormal embryos not picked by the couple may go to waste as no one may choose to adopt them. According to critics, life begins at conception hence they may view this practice in the same context as abortion as it results in the loss of life (Dondorp & de Wert, 2019). Secondly, others criticize selective implantation as it discriminates against the other abnormal embryos hence hindering genetic diversity. Proponents of this idea believe that it goes against the essence of parent-child bonding. Advocates and people living with disabilities view PGD as being discriminative to disabled individuals. However, while acknowledging this claim, bioethicists feel that the desire to have normal children solely lies with the parents.
IDEA Model in Ethical Decision Making
During their day-to-day practice, nurses encounter numerous ethical dilemma instances that require effective decision-making. The IDEA model of decision making enables step by step approach for nurses and other healthcare practitioners to settle on sound decisions that may impact patient care. This model stands for the actions to be taken in decision-making. These are; identifying the facts, determining the relevant ethical principles, exploring the options, and acting. This model also takes into play five conditions during decision making. These conditions are empowerment, publicity, relevance, revisions, and compliance (Klitzman, 2017). Nurses can follow these systematic approaches and needs to resolve their ethical problems when the couple chose the abnormal embryos.
The first step in this ethical decision-making model is identifying the facts surrounding the PGD process. The nurse practitioner needs to familiarize with the reasons why the couple decided to engage in this procedure in the first place. Furthermore, it is imperative to ascertain the goals of the therapy and the probability of achieving success. Additional information about the benefits or harms involved in this process is necessary for the nurse to settle on a viable decision. The nurse should uphold the principle of doing no harm to the clients. All decisions made should be for the benefit of the couples while respecting their right to making self decisions following the principle of autonomy. PGD helps to prevent the incidence of termination of pregnancy (Dondorp & de Wert, 2019). The nurse should be conversant with the couple’s preferences, outside influence from family or friends, and their own beliefs about the client’s wants. The nurse should educate the clients about the procedure and the its benefits and harms is important for their decision making. Effective empowerment of the clients with information about the advantages of PGD and practicing proper communication is necessary for this stage of ethical decision making.
The second step involves determining the relevant ethical values and principles of both parties. The nurse needs to have an open discussion with the clients to identify their most important values in deciding for the embryo to choose. The possibility of raising a child who may have a different appearance can make some parents choose abnormal embryos. Other women may feel that they may have problems during the delivery of a regular-sized baby. The nurse should respect the patient’s right to make informed self decisions. The principle of beneficence should take an integral part during the discussion. The nurse should ensure that the decision agreed upon with the couples is in line with the current evidence-based rationales on the PGD.
The third step touches on the exploration of other alternative plans of action that the couple may take. Brainstorming and interdisciplinary collaborations are effective in coming up with viable alternative measures ideal for the couple. The selected alternative options should be in tandem with the organization’s goals and objectives and the couple. All options raised have to comply with the state and countries’ laws and regulations. The most ethically justifiable option is to be settled on by the involved parties. The selected plan of action should be subjected to numerous revisions to consider other newer options. The generation of multiple high-quality alternatives is essential in promoting the selection of the most significant decision.
The last step in this model of decision-making is acting. The most viable action that was settled on during the third stage is implemented mutually by the nurse. Effective collaboration with the clients will promote the success of the implementation of this goal. The nurse should ensure that the selected idea is workable and realistic (Dondorp & de Wert, 2019). Furthermore, both partners should be comfortable with the decision. In cases of conflicting opinions about the final consensus, the team should go back to the drawing board to identify the other possible alternatives. Additional evaluation of the process of decision-making by the parties involved or utilizing a neutral third person who is unaffiliated in the discussion is required.
References
Asplund, K. (2020). Use of in vitro fertilization: Ethical issues.Upsala Journal of Medical Sciences, 125(2), 192–199. Web.
Dondorp, W., & de Wert, G. (2019). Refining the ethics of preimplantation genetic diagnosis: A plea for contextualized proportionality. Bioethics, 33(2), 294–301. Web.
Klitzman R. (2018). Challenges, dilemmas and factors involved in PGD decision-making: Providers’ and patients’ views, experiences and decisions.Journal of Genetic Counseling, 27(4), 909–919. Web.
Pauli, R. M. (2019). Achondroplasia: A comprehensive clinical review.Orphanet Journal of Rare Diseases, 14(1). Web.