Unfettered Access to Assisted Reproductive Technologies - Assignment Example

Unfettered Access to Assisted Reproductive Technologies  Introduction Assisted reproductive technology (ART) refers to the methods explored to achieve pregnancy, either artificially or by use of partially artificial means1. Couples who are discordant due to certain communicable diseases such as AIDS may use ART to diminish the risks of an infection when they desire pregnancy and fertile couples may also utilize ART for genetic reasons. The common ART include in vitro fertilization, intrauterine insemination, intracytoplasmic sperm injection, and cryopreservation; the use of ART has been on a tremendous rise over the past few years. Over the years, there has been a marked increase in the use of reproductive technologies in aid of conception and childbearing, a phenomenon that has been attributed to the high incidences of success of reproductive technologies in aiding the birth of healthy babies. Similarly, the emergence and pervasiveness of the often called “non-traditional parent” population, mainly composed of the single mothers, same sex couples, as well as the old mothers’ population (white collar-professional women whose delayed child-bearing often leads to infertility) has increased demand for reproductive services. Consequently, the unprecedented increase in demand for reproductive services coupled with the emerging ethical concerns regarding this phenomenon has led to the need for formalized regulation of service delivery to alleviate the potential risks involved2. For instance, incidences of multiple birth pregnancies fuelled by desperate baby-crazed parents and malpractices of unethical physicians have raised concerns in the recent past thereby accelerating the calls for regulation. Nonetheless, several state actions aimed at regulating these services has further led to the emergence of numerous challenges in the form of restricted access to ART services, thereby denying certain groups of individuals’ their only chance of procreation and parenthood3. Such unequal access to reproductive assistance is totally unjustified given that it undermines individual’s procreation liberty; this paper explores the restricted access to ART services arguing that unfettered access to assisted reproductive technologies ought to be available to competent adults provided that this does not interfere with the rights of others. Background of assisted reproductive technology The advancement in reproductive technologies yields greater opportunities for infertile couples to navigate the anxieties and frustration wrote to them by the recognition of infertility. The World Health Organization recognizes that all individuals have a right to autonomy in reproductive issues, which implies that all individuals whether married or single have a fundamental right to make decisions on all matters of conception without any interference. This fundamental liberty also allows individuals, whether married or single, the basic right to make decisions concerning reproduction free of any sort of interference or coercion; in that respect, reproduction is underscored as a fundamental human right under these provisions. Statistically, the European Society of Human Reproduction and Embryology (ESHRE) report indicates clearly that nearly a total of 770 ART clinics initiated at least 324,238 ART cycles in the year 2002, and this figure represents a 59% rise from the 203,893 cycles initiated in the year 19974. Germany had the largest rate of ART in the European continent (85,000 treatment cycles), followed closely by France, which had 60,000 treatment cycles and the United Kingdom with its 37,000 reported treatment cycles. The attractiveness of in vitro fertilization (IVF) treatment in the UK is attributed to the rise of nearly 64 service centres in 1990, which treated nearly 10,000 patients giving for the about 1,443 children through the IVF method. The number of IVF centres in the UK has grown significantly from about 105 centres with nearly 30,000 patients being treated yielding about 8,000 births that have been conceived through the IVF method of reproduction. IVF in the United Kingdom is guided and regulated by the Human Fertilization and Embryology Authority (HFEA), which was mandated through the operationalization of the Human Fertilization and Embryology Act of 19905; this legislation aims at regulating the multiple birth pregnancy problems by limiting the number of embryos implanted among other issues. Given that procreation has long been recognized and treated as one of the fundamental human rights that each individual is entitled to, no one should be denied the chance to procreate6; there should be unfettered access to reproductive technologies that can help individuals overcome the infertility challenge. The introduction of third parties in what has traditionally been recognized as an intimate up-close two party relationship should not be a reason to deny anyone access to ART services, as long as the third parties are not harmed in any way by their willingness and decision to participate in assisted conception. The notion of procreation “as a basic civil right’ means that the state should not intervene or interfere in an individual’s natural capacity to procreate; denial of access to reproductive services is a prohibition that inevitably interferes with the individual’s ability to procreate with assistance. At the root of the emergence and widespread application of reproductive technologies is the problem of infertility, broadly framed as the inability to conceive or carry pregnancy to term7; individuals and couples seeking reproductive services are driven by the fundamental desire to sire children of their own. Often, infertility occurs at two levels thus giving forth functional infertility, which occurs when an individual experiences a malfunction in his/her reproductive tract, and structural infertility that results due to the social structure in which individual’s self-identify. In the context of functional infertility, women may be recognized as infertile if their ovaries are incapable of producing eggs or if their fallopian tubes cannot allow eggs to pass through to the uterus; moreover, the uterus should also allow the growing embryo to attach long enough for successful delivery. Men, on the other side, may be declared infertile if their sperm are not present in the seminal fluid or they are inadequate in numbers, or if they fail to deliver the sperm into the reproductive tract of females; similarly, in case of surgical removal of reproductive organs or their failure due to medical treatments like radiation therapy, then both men and women may be functionally infertile. Structural infertility affects single individuals and same sex couples who, besides their desires for parenthood and conception cannot do so through natural means, and can only do so through assistance. Given the statistical evidence of a fast growing rate of demand for ART services, it is not unusual to expect the existence of an unfettered market for ART, where prospective patients can easily access these reproductive services from willing providers. Contrariwise, the provision of highly specialized services such as these that involve conception and birth of a child is highly restricted due to numerous factors, which are further accentuated with regards to assisted reproductive technologies8. Two kinds of barriers to ART have been identified so far, and these are the direct and indirect limitations to the access of ART services by potential patients desiring pregnancy by these methods. The direct barriers to ART services take the form of operational legislation or policies that prohibit service providers from offering ART to certain target populations; for instance, laws that limit ART services to married couples do hinder unmarried individuals who desire pregnancy from accessing ART services. Similarly, the high costs of ART services is also a direct barrier that prevents many infertile couples from accessing ART services; generally, the direct barriers to ART have been designed either intentionally or unintentionally to control or reduce access to ART services9. The indirect barriers to access of ART services are as a consequence rather than as a goal of deliberate actions as in the cases of discrimination and sexual stereotyping that hinder treatment-seeking populations from accessing the desired ART services. For instance, as a consequence of the disparities in insurance coverage and the high cost barriers, ART remains a private health service that is delivered at a fee and is largely accessible only to white middle class infertile couples. Furthermore, infertile low-income and racial or ethnic minorities are unable to access ART services due to social, structural as well as ideological barriers to effective medical care; for instance, in the U.S., African American communities regard the country’s health system with high suspicion and distrust due to past experiences of racism and discrimination. Whereas cost and racial barriers may impede access to ART services by unmarried individuals, single women and same sex couples face further restrictions in the form of provider discrimination against single and gay women’s access to treatment. Documented cases of service providers’ refusal to grant ART services to single and lesbian women abound largely due to the silence or ambiguity of medical antidiscrimination laws with respect to marital status or sexual orientation. An increasingly hostile statutory environment that attempts to limit access to ART services only to married couples exists in most countries with the exception of a few such as Belgium, Canada, Finland, Spain and Greece. In the UK and Canada, the sale of gametes is prohibited under the law, thus, egg-seeking women are forced to travel all the way to Spain and the U.S., where such services can be accessed. Donor tracing schemes in the UK is a common phenomenon due to an acute shortage of donor sperm following the passage of tracing laws that make it hard for women seeking pregnancy to find donors in the UK. Unfettered access to assisted reproductive technologies ought to be available to competent adults provided that this does not interfere with the rights of others since the numerous barriers to ART greatly grieves the affected populations by depriving them the right to procreate. The denial of the right to procreate through the numerous barriers to access of ART services affects not only the deprived individuals alone, but also a host of several others in the ART world including the providers, children and the society at large. The barriers to ART services cluster along demographic lines thereby affecting the service-seeking population based on their socio-economic status, race, ethnicity as well as marital status and sexuality. Human beings are naturally inclined to reproduce and feel proud of their reproductive capabilities and products, thus, procreation becomes of central importance to the overall human experience. In that respect, an attempt to deny any person the opportunity to procreate through both deliberate and unintentional barriers to ART greatly impacts one’s self-worth as a person in the world; reproductive experiences are core to personal understanding of meaning and identity. Consequently, denying anyone access to ART services on the basis of personal characteristics beyond their control is to impose on them a self-defining experience, which equally translates to not only denying them respect but also self-worth. ART present a lawful means through which infertile individuals irrespective of their personal characteristics can procreate and sire children of their own, thus, the denial of these services is not warranted on any justifiable grounds10. Reduced or restricted access to ART services inevitably imposes childlessness on individuals, which eventually leads to the increased feelings of disappointment and worthlessness. These are further accentuated by the difficulties in alternative routes to parenthood such as adoption, which presents further drawbacks to those seeking parenthood; for instance, despite that demand for healthy infants exceeds supply by far, state agencies restrict placement of infants to married couples thereby excepting singles or same sex couples from adoption11. In that respect, adoption does not provide reprieve for ART denials since it only works for a select few infertile individuals, mostly married couples who may have adequate income to afford adoption but not enough for ART treatment. The devastating harm of forced childlessness imposed on older, single women, same-sex couples as well as racial and ethnic minorities of lower socioeconomic statuses cannot be mitigated by adoption. The unprecedented rise in the number of ART cycles inevitably indicates a higher utilization of these services by individuals with functional infertility that desire pregnancy; for instance, the U.S alone recorded a one hundred percentage increase in the number of ART cycles initiated from 1996 to 2005. Single or unmarried women and lesbian couples are the highest users of ART services as the primary means of achieving pregnancy and parenthood, thus, the growing use of ART services indicates a genuine desire for pregnancy and parenthood, which is a very fundamental need. In that respect, unfettered access to assisted reproductive technologies should to be available to these competent adults provided that this does not interfere with the rights of others, to fulfil their basic need of pregnancy and desire of parenthood respectively12. Furthermore, the increase in utilization of ART services indicates impressive success rates and a shift in the demographics of women that are ready and willing to conceive regardless of their personal characteristics. Women’s chance of giving birth reduce considerably as they age and given that white-collar professional women often defer procreation until later in life, their chances and hopes of ever becoming pregnant are considerably narrowed in the late fourth decade of their lives. However, such women can find reprieve in the use of ART services since statistical evidence over several decades has shown that biological parenthood even after infertility is achievable. The maximum number of embryos transferred is determined by the patient’s age among other critical patient as well as embryo characteristics, while considering the numerous odds of achieving pregnancy and the risks involved in each decision13. Usage of ART services has great potential for alleviating the need for pregnancy among the white collar-professional women whose delayed child-bearing could be a potential cause of infertility. In that respect, unfettered access to assisted reproductive technologies should to be available to competent adults seeking pregnancy as long as it does not interfere with the rights of others. The emotional and psychological stigma associated with recognition or diagnosis of infertility is so immense for both men and women that it could trigger other severe psychological issues such as depression, and demoralization. Unfettered access to ART services would greatly ease the infertility stigma that affects the many patients diagnosed or recognized with infertility problems. The so called non-traditional prospective parents including single individuals and same sex couples should be able to access ART services to ease their anxieties due to denied parenthood. The inability to conceive is indeed a medical illness that can be alleviated effectively through ART and the unfettered access to these services would guarantee childbirth and parenthood for the many unmarried women and same sex couples seeking pregnancy. The emergence and pervasiveness of the so-called “non-conventional parents” such as single women and lesbian parents who require assistance in conception necessitates the provision of unfettered access to assisted reproductive technologies. Lesbian couples and single women are competent adults that should be assisted to conceive as long as this does not interfere with the rights of others. Parenthood for single women and unmarried women is highly desired and the denial of assistance in conception would lock out the huge population of competent individuals seeking conception. A huge population of women in the older and unmarried populations require assistance in conception and the use of artificial insemination or IVF is not only necessary, but also the main means of reproduction14. Older women nearing the age of forty and same sex couples have no chance of procreation unless with aid, thus, the ever growing number of the ‘non-traditional parents’ requires unfettered access to assisted reproductive technologies to facilitate conception and parenthood respectively. The increase in the population of third party collaborators such as gamete donors (both men and women who are willing to donate their sperm and egg respectively) as well as women who are willing to serve as gestational carriers to aid in the conception process is a positive indicator of widespread acceptance of the service. Older women benefit greatly from the implantation of donor eggs from much younger couples, which increases their chances of giving birth; the use of third party collaborators greatly increases opportunities for all individuals wishing to procreate but cannot do so in the absence of assistance. Reproductive technologies vary greatly, from the most basic assistance to the more invasive IVF procedure to the most high-tech fusion of donor gametes as well as gestational services, though at high financial and emotional costs. The high financial and emotional costs associated with ART services are great deterrents to prospective parents; biological parenthood for a host of subgroups among the functionally infertile group remains largely inaccessible despite the myriad opportunities presented through reproductive technologies. For instance, older women over forty years, both men and women with disability, HIV infection, or unmarried individuals as well as same sex couples have often been denied access to reproductive services. It is highly unjustified to deny individuals access to services that would guarantee biological parenthood, particularly if the same services are available to a limited minority population that can afford them. In that respect, unfettered access to assisted reproductive technologies ought to be available to competent adults regardless of their personal characteristics since this does not in any way interfere with the rights of others. State action that yields numerous inhibitions in the form of wealth status, race and ethnic minority barriers to access of assistance in conception through reproductive technologies place unwarranted burden on individuals’ right to procreate. For instance, limiting ART to married couples only inevitably places an undue burden to the rights of unmarried individuals’ ability to procreate and to achieve parenthood. Singling out unmarried individuals for unequal treatment in the context of reproduction is a great violation of their fundamental human right of procreation15; furthermore, it is a great violation of the right of privacy. Individuals, whether married or not, have the right to privacy which excludes government interference in issues that are so profoundly personal as the decision to bear children; in that respect, the state has no jurisdiction on matters as fundamentally private as conception. Consequently, unfettered access to ART services should be granted to all competent individuals regardless of their personal characteristics as preventing individual’s access to effective assistance in conception is tantamount to affronting their right to privacy. The discriminatory policies that are at the heart of private practices in the arena of reproductive technologies greatly inhibit single women’s potential to bear children of their own through assistance. Health plans that adopt a “married only” stance with regards to provision of ART services greatly infringe on the procreation liberty of the single women desiring assistance with conception16. The discriminatory policies that limit ART services to married couples only places an undue burden on single individuals to seek out-of-plan treatment for assisted conception thereby undermining their fundamental right to procreate. The denial of equal access to public goods and services on the grounds of immutable characteristics is indeed an affront to personal dignity, particularly given that individuals are entitled to civil rights under the constitution. All persons irrespective of their immutable characteristics are entitled to the full benefits and enjoyment of services and goods; single and same sex parent studies are also entitled to the same benefits of goods and services enjoyed by their married and heterosexual counterparts. Numerous studies exploring parentage by the so called “non-traditional parents” confirms that children generally progress equally well or equally badly under the custodianship of both heterosexual and same sex couples, contrary to previous distrust and suspicion of these non-traditional parents’ child-rearing potential. On that basis, the unfair denial of reproductive services on the basis of an individual’s sexual orientation cannot be justified under any circumstances given that it is a direct affront to individual’s civil rights guaranteed under the constitution. Common law and the bioethics principles reaffirm the pre-eminence of patient autonomy, particularly with regards to medical decision-making and as such, these values inevitably extend and apply to decision-making in the area of assisted conception17. The rights granted to patients through common law and the principle of self-determination in medical decision-making safeguards not only the physical health of patients but also their basic self-worth as independent human beings. Procreation does advance one’s intrinsic self-worth as a free individual and, whereas fertile individuals positively exercise their right to reproduce as independent moral agents, the infertile population lacks the capacity to exercise this right due to the limitations exerted by ART service providers18. The inability of the infertile groups to make independent procreation decisions owing to the control of ART services by service providers is not only a deprivation of parenthood, but also a deprivation of human dignity that often underscores procreative decision-making. Ultimately, unfettered access to assisted reproductive technologies should be available to competent adults so long as this does not interfere with the rights of others since the central motivation that prompts the search for conception assistance is the natural desire for procreation and parenthood. Procreation has long been recognized as one of the fundamental human rights for the purpose of perpetuating a race while both common law and bioethics principles recognize the pre-eminence of patient autonomy particularly with regards to medical decision-making. Whereas the fertile populations possess the natural capacity to exercise these fundamental rights and privileges under the protection of the law, the infertile population can only do so through reproductive assistance. Nonetheless, accessibility to reproductive assistance is highly limited to a few individuals due to numerous barriers that have traditionally disadvantaged a huge population of service seekers. The high costs of reproductive services coupled with systemic barriers inherent in legislation that limits reproductive assistance to married couples only and discriminative policies of private actors have resulted to undue service denials even to competent individuals. The so-called “non-traditional parents” such as single mothers and same sex couples are the most affected by reproductive service denials since most service providers often adopt a “no singles” policy stance, which automatically locks out the unmarried women population. Same sex couples too have fallen victim of such discriminative policies that fail to recognize this group’s potential to raise children just like their heterosexual counterparts, thereby denying them access to conception assistance19. ART promises to alleviate the profound psychological burden imposed on individuals diagnosed with functional infertility and the corresponding burden of infertility stigma that inevitably arises from the same knowledge of inability to procreate. Denial of access to ART services due to immutable personal characteristics such as sexual orientation or marital status is thoroughly devastating to individuals because it not only denies them their fundamental right to procreate, but also denies them dignity and self-worth as independent individuals. Overall, every person must be allowed to exercise their fundamental procreation liberties by being granted free and equal access to reproductive assistance regardless of their immutable physical characteristics provided this does not in any way interfere with the rights of others. References “Assisted reproductive technologies: A guide for patients.” (2011). American Society for reproductive medicine patient information series. Available at: http://www.reproductivefacts.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/ART.pdf “Making Babies: Reproductive decisions and genetic technologies.” (2006). Human Genetics Commission. Available at: http://newbornbloodspot.screening.nhs.uk/getdata.php?id=11404 Adekile, O. (2012). Financial Access to Reproductive Technologies: Options and Issues for Reproductive Rights in Nigeria. British Journal of Arts and Social Sciences 5(2): 293-306. Charo, R. Alta. (2002). 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