Women Restrictions in accessing Assisted Reproductive Technologies (ARTs) - Essay Example

?An age restriction of forty years should be placed upon women in accessing Assisted Reproductive Technologies (ART’s). Analyse this ment, and present an ethical argument either in favour of, or in opposition to, an age restriction on access to A Introduction Assisted reproductive technologies (ART) are a group of medical processes that are used in order to assist a woman to get pregnant. There are many procedures used today like in vitro fertilization, gamete intra-fallopian transfer, artificial insemination, reproductive surgery and others, but most commonly assisted reproductive technology is associated with in vitro fertilization. The need for ART in Australia is rising over the years. In Australia and New Zeeland in 2008 there were 61929 assisted reproductive cycles which is 9% incensement from 2007 and 47% increase from 2004 (Yueping et al. 2010). As we can see, the trends of these procedures rise over the years which in the same time are a source of a debate over the public expends over these procedures. This is actually the source of the initiative to restrict the access for ART for women above the age of 40 years along with some other criteria. This however produces many ethical and social questions and some of them we will try to explore in this text. First topic In a study conducted by Georgina et al. 2005 it was found that average costs of chosen assisted reproductive technique for a live birth of a baby in Australia was 32 903 dollars, however these number are much different when compared within age groups. They found that in women below age of 30 years ART costs for a live birth event was approximately 24809 dollars and in the same time ART costs for live birth event in women above age of 40 was 97884 dollars. As we can see the differences are significant. The fact that ART services in year 2004 costs around 79 million dollars (less than 1% of total health expenses), however the constant rise of the trends for using of ART raised questions about ways to reduce the costs for these procedures. As we can see from the above example ART in women above the age of 40 at average costs significantly more when compared in women below the age of 30 years. In the same time the efficacy of ART in women above the age of 40 years is significantly smaller when compared with younger women. Only 6 percents of ART in women above 40 years old result in live birth compared to above 25 percents in women below the age of 30 years. In the same time pregnancies in women above age of 40 years are more prone to complications and risks for the mother and the health if the child as well. (Gilbert et al. 1999) (Bryant et al. 2005). This is why there are initiatives to limit the availability of ART procedures to women below the age of 40 years old. As we can see from above, finances and risk of complications are the main reasons for the initiative for restriction of ART in women above 40 years. There are several principles in the theory of ethics that are affected by the restriction of ART to women older than 40 years. One of them is the principle of beneficence which in the ethics is defined as a priority of “good” (Tassano 1999). At a first glance we can conclude that this restriction will deprive the younger patients from ART treatment by spending money and resources that can be used by the younger women. However as we have seen the expenses are small and doesn’t affect the quality of ART service for younger women, nor the quality of general health services in Australia. So in essence this restriction will not cause significant benefit for younger women or the general population. However it will reduce the grow-rate in Australia, which is already one of the lowest in the world. We can conclude therefore that this decision in essence is “bad” and in direct opposition with the principle of beneficence. From the standpoint of the individual women the above restriction is a restriction of their right as individuals to choose to have a child. In the same time by denying this right the above restriction also denies the principle of autonomy which is another principle defined in the theory of ethics (Tauber and Alfred 2005). The principle of autonomy is defined as the right of the individuals to make choice and decisions about their lives. Now as we mentioned above pregnancy in this population of women may be accompanied by medical complications that may affect the mother or the fetus. This means that at some point a pregnancy in women above the age of 40 may be dangerous, however every women, regardless of the age is subjected to tests in order to ensure that she is medically capable of conducting the ART and there is a minimal health risk during the pregnancy (Farquhar et al. 2010). Second topic Regarding the ANMC principles and the above mentioned restriction of ART for women over the age of 40 years and their right to have children we can postulate several questions that are important for the ethical implications for such a decision: 1. The right of these women to have a child and in the same times the right of the child to be born from a mother that is more than 40 years old. This is undeniable right. If there are no known medical conditions in the women that may result in increased chance for complications during the pregnancy or during delivery, than no one can deny the right of the women to become pregnant. This in the same time is in concordance with the Code of ethics for nurses in Australia, where it is stated as one of the key points: nurse values informed decision making. In here we can conclude that women over the age of 40 have the right to chose to become pregnant and a nurse should respect their decision and inform them about any possible health implications regarding that decision (ANMC 2005). This actually leads to the second ethical question: 2. Women above the age of 40 years are at increased risks for complications from the ART procedures and in the same time increased risk of complications during the pregnancy (Gilbert et al. 1999). This may be some ethical implication against the implementation of ART procedures on women above the age of 40 because of the risk for health complications. However experts concur that with careful medical examination and screening complications can be avoided and only the physically fit individuals will be eligible for implementation of ART. Again as we stated above, in the Code of ethics for nurses in Australia it is stated that nurse values informed decision making, and therefore a nurse should value the decision of the women that she wants to have a child. 3. However regardless of the previous, some may argue that health care resources that are spend on these older women actually deprive the younger patients from ART treatment. Women above the age of 40 have fewer chances to conceive and deliver a live baby after ART procedure (Bryant et al. 2005). In the same time costs for live birth at this population is much higher compared to younger women (Georgina et al. 2005). Compared to Australia New Zeeland has introduced some criteria for eligibility for ART procedures. In New Zeeland for example there are established criteria for ART procedures like age, marital status, health issues etc. In Australia there are not specific criteria, but the discussion is made on an individual basis. In a study conducted by Farquhar et al. 2010 it was found that this resulted in healthier pregnancies and better outcome of the pregnancies in New Zeeland compared to Australia. This is a legitimate question but in the same time strikes at the core of the first question-the right of the women to have a birth at age 40. However as we will see in the next section, or the section about the social implications of pregnancy above the age of 40 years, the benefits of ART procedures in this population may overwhelm the negative effects on the health resources. Social implications As we mentioned above pregnancies of women above the age of 40 years have social implications also, and some ethical, moral and practical questions may arise for this aspect also. So the question arises does this give us the right to deny the right of these women to have a child. Over the years Australia had one of the lowest birth rates in the developed countries. Actually statistical data show that Australia has birth rates below the required minimum for renewal of the population since the beginning of 1970’s in the previous century. Statistical data also show that the birth rates since 1990’s of the previous century vary between 1.7 and 1.8 which is very low birth rate (Matthew et al. 2008). As we can see on the Figure 1, birth rates in Australia decreased Figure 1. – trends of birth rate in Australia (Matthew et al. 2008) over the years, however we can see a trend of increase in the birth rates at the population of 35-39 years old, but also in the population of women above the age of 40 years old. In general on the image we can see that the birth rates in women bellow age of 30 years old is constantly decreasing over the recent years and in the same time the birth rates of women above the age of 30 years old, including women above 40 years old is constantly increasing (Matthew et al. 2008). Based on this data we can conclude that denying the right of these women access to ART procedures will further reduce the birth rate in Australia. So the question is not only ethical but in the same time has practical implications. As we mentioned above at a first glance it seems that ART procedures are very expensive and that a significant reductions of the health care expanses can be achieved on a national level with introduction of criteria for eligibility for ART procedure. However as we mentioned above ART services in year 2004 cost around 79 million dollars or less than 1% of total 8.9 billion dollars of MBS benefits paid in year 2004. As we can see it is impossible to conduct significant savings based on these information’s. But here also is the question does this costs reduction overwhelms the individual ethical implications of this decision and in the same time the social implications of this decision? So based on Code of ethics for nurses in Australia and one of the key postulates of this code: Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing, we can conclude that restriction of the ART services to women above the age of 40 is opposite to the Code of ethics for nurses in Australia and is not in the spirit of the ethics that is represented by this code. Conclusion Based on the above and the data that are presented we can conclude that age restriction of 40 years upon women in accessing Assisted Reproductive Technologies have some important ethical, individual and social questions. It is undisputed right for women to have a child above the age of 40 if there are no risks for her health or the health of the child. In the same time the unborn child has the right to be born from a mother above the age of 40. In the same time considering the benefits of pregnancies in women above the age of 40 on the total birth rate in Australia (which has one of the lowest birth rates in the world), we can conclude that reasons for such restrictions are purely economical. Now regardless of the fact that it is impossible to achieve significant savings on a national level we must ask the question: what is the price of the human life? And yes the answer is - it is beyond measurement. We have no right to deny any women above the age of 40 from her right have a child. References: Yueping Alex Wang , Georgina M Chambers , Elizabeth A Sullivan (2010), Assisted reproductive technology in Australia and New Zealand 2008 , Australian Institute of Health and Welfare , Canberra , Cat. no. PER 49 , September 2010 , ISBN 978-1-74249-051-9 , available online at:www.npsu.unsw.edu.au Georgina M Chambers, Maria T Ho and Elizabeth A Sullivan (2005), Assisted reproductive technology treatment costs of a live birth: an age-stratified cost–outcome study of treatment in Australia, eMJA Rapid Online Publication 19 December 2005, MJA 2006; 184 (4): 155-158 Bryant J, Sullivan E, Dean J (2005), Assisted reproductive technology in Australia and New Zealand 2002. Assisted Reproductive Technology Series No. 8. Sydney: Australian Institute of Health and Welfare, National Perinatal Statistics Unit, 2004. (AIHW Catalogue No. PER 126.) Available at: http://www.npsu.unsw.edu.au/art8high.htm (accessed Dec 2005) Farquhar CM, Wang YA, Sullivan EA (2010), A comparative analysis of assisted reproductive technology cycles in Australia and New Zealand 2004-2007, Hum Reprod. 2010 Sep;25(9):2281-9. Epub 2010 Jul 22, PMID: 20650968 Matthew Gray, Lixia Qu and Ruth Weston (2008), Fertility and family policy in Australia, Australian Institute of Family Studies, February 2008, 42 pp. ISBN 978-1-921414-01-5. ISSN 1446-9863; ISSN 1446-9871, available onilena at: http://www.aifs.gov.au/institute/pubs/rp41/rp41.html#figure3 Gilbert WM, Nesbitt TS, Danielsen B (1999), Childbearing beyond age 40: pregnancy outcome in 24,032 cases, Obstet Gynecol. 1999 Jan;93(1):9-14, PMID: 9916947 Code of ethics for nurses in Auatralia (ANMC) (2005), Australian Nursing & midwifery Council, Revised in 2002. Reprinted in February 2005, ISBN 978-0-9775108-7-0, available online at:http://www.nrgpn.org.au/index.php?element=ANMC+Code+of+Ethics Tassano, Fabian (1999). The Power of Life or Death: Medical Coercion and the Euthanasia Debate. Foreword by Thomas Szasz, MD. London: Duckworth, 1995. Oxford: Oxford Forum, 1999. Tauber, Alfred I (2005). Patient Autonomy and the Ethics of Responsibility. 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