Ethical constraints and dilemmas in the provision of in-vitro fertilization treatment in Ghana: from the perspectives of experts.
Assisted reproductive technologies
Commercialization of embryos
In vitro fertilization treatment
Informed consent
Reproductive ethics
Journal
BMC medical ethics
ISSN: 1472-6939
Titre abrégé: BMC Med Ethics
Pays: England
ID NLM: 101088680
Informations de publication
Date de publication:
17 Oct 2024
17 Oct 2024
Historique:
received:
05
07
2024
accepted:
04
10
2024
medline:
18
10
2024
pubmed:
18
10
2024
entrez:
17
10
2024
Statut:
epublish
Résumé
Infertility presents both medical and public health challenges, with in vitro fertilization (IVF) emerging as a prominent solution, particularly when other alternatives are exhausted. However, IVF treatment raises significant ethical questions that have been under explored in the Ghanaian context. This study aimed to explore ethical constraints and dilemmas in the provision of in vitro fertilization (IVF) treatment in Ghana. A descriptive phenomenological qualitative design was employed. Purposive sampling techniques were used to recruit 12 participants including ART experts from three in vitro fertilization (IVF) centres, ethicists and a legal practitioner. In-depth face-to-face interviews guided by an open-ended interview guide were conducted. Thematic analysis of the interviews was performed to identify major themes. Providing IVF treatment in Ghana raises several ethical issues, including inequitable access due to high costs and limited availability, which favour wealthier individuals and leave marginalized populations with fewer options. There are significant ethical considerations in balancing the potential benefits of successful IVF treatment outcomes against the health risks and emotional tolls on patients. Decisions about the fate of surplus embryos present moral dilemmas, including whether to preserve, donate, or discard them. Differing personal beliefs about the moral status of the embryo further complicate the ethical landscape. Ensuring informed consent is challenging due to the complex medical, ethical, and emotional implications of IVF treatment, potentially leading to compromised consent. Additionally, there are ongoing risks of breaches in confidentiality, given the sensitive nature of reproductive health data and the importance of protecting patient privacy. This study revealed that several ethical dilemmas confront both healthcare providers and couples in the process of IVF. There is an urgent need for the development of clear and uniform regulations to govern the practice of IVF treatment in Ghana, with further attention given to mitigating financial barriers and enhancing support systems for couples considering IVF treatment.
Sections du résumé
BACKGROUND
BACKGROUND
Infertility presents both medical and public health challenges, with in vitro fertilization (IVF) emerging as a prominent solution, particularly when other alternatives are exhausted. However, IVF treatment raises significant ethical questions that have been under explored in the Ghanaian context. This study aimed to explore ethical constraints and dilemmas in the provision of in vitro fertilization (IVF) treatment in Ghana.
METHODS
METHODS
A descriptive phenomenological qualitative design was employed. Purposive sampling techniques were used to recruit 12 participants including ART experts from three in vitro fertilization (IVF) centres, ethicists and a legal practitioner. In-depth face-to-face interviews guided by an open-ended interview guide were conducted. Thematic analysis of the interviews was performed to identify major themes.
RESULTS
RESULTS
Providing IVF treatment in Ghana raises several ethical issues, including inequitable access due to high costs and limited availability, which favour wealthier individuals and leave marginalized populations with fewer options. There are significant ethical considerations in balancing the potential benefits of successful IVF treatment outcomes against the health risks and emotional tolls on patients. Decisions about the fate of surplus embryos present moral dilemmas, including whether to preserve, donate, or discard them. Differing personal beliefs about the moral status of the embryo further complicate the ethical landscape. Ensuring informed consent is challenging due to the complex medical, ethical, and emotional implications of IVF treatment, potentially leading to compromised consent. Additionally, there are ongoing risks of breaches in confidentiality, given the sensitive nature of reproductive health data and the importance of protecting patient privacy.
CONCLUSION
CONCLUSIONS
This study revealed that several ethical dilemmas confront both healthcare providers and couples in the process of IVF. There is an urgent need for the development of clear and uniform regulations to govern the practice of IVF treatment in Ghana, with further attention given to mitigating financial barriers and enhancing support systems for couples considering IVF treatment.
Identifiants
pubmed: 39420330
doi: 10.1186/s12910-024-01113-0
pii: 10.1186/s12910-024-01113-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
114Informations de copyright
© 2024. The Author(s).
Références
Cox CM, Thoma ME, Tchangalova N, Mburu G, Bornstein MJ, Johnson CL, Kiarie J. Infertility prevalence and the methods of estimation from 1990 to 2021: a systematic review and meta-analysis. Hum Reprod Open. 2022;2022(4):hoac051. https://doi.org/10.1093/hropen/hoac051 .
doi: 10.1093/hropen/hoac051
Donkor ES, Naab F, Kussiwaah DY. I am anxious and desperate: psychological experiences of women with infertility in The Greater Accra Region, Ghana. Fertil Res and Pract [Internet]. 2017 Mar 16[cited 2023 Mar 1]; 3(1): 6. https://doi.org/10.1186/s40738-017-0033-1
Ofosu-Budu D, Hanninen V. Living as an infertile woman: the case of southern and northern Ghana. Reprod Health. 2020;17(1):69.
doi: 10.1186/s12978-020-00920-z
Chambers GM, Dyer S, Zegers-Hochschild F, de Mouzon J, Ishihara O, Banker M, Mansour R, Kupka MS, Adamson GD. International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology, 2014. Hum Reprod. 2021;36(11):2921–34. https://doi.org/10.1093/humrep/deab198 .
doi: 10.1093/humrep/deab198
Alhassan A, Ziblim AR, Muntaka S. A survey on depression among infertile women in Ghana. BMC women’s health [Internet]. 2014 Mar 10 [cited 2023 Mar 1]; 14(1): 42. https://doi.org/10.1186/1472-6874-14-42
Temitope L. A qualitative synthesis of the impact of infertility on the mental health of African women. African Journal of Reproductive Health [Internet]. 2022[cited 2023 Mar 1]; 26(12): 49–57. https://www.ajol.info/index.php/ajrh/article/view/239710
Njagi P, Groot W, Arsenijevic J, Dyer S, Mburu G, Kiarie J. Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review. Hum Reprod Open. 2023;2023(2):hoad007. https://doi.org/10.1093/hropen/hoad007 .
doi: 10.1093/hropen/hoad007
Ibrahim AH, Rahman NNA, Saifuddeen SM. Maqasid al-Shariah as a Complementary Framework for Conventional Bioethics: Application in Malaysian Assisted Reproductive Technology (ART) Fatwa. Science and Engineering Ethics [Internet]. 2018 Oct 1[cited 2023 Feb 14]; 24(5): 1493– 502.
Sunderam S, Kissin DM, Crawford SB, Folger SG, Jamieson DJ, Warner L, Barfield WD, Centers for Disease Control and Prevention (CDC). Assisted Reproductive Technology Surveillance - United States, 2013. MMWR Surveill Summ. 2015;64(11):1–25. https://doi.org/10.15585/mmwr.ss6411a1 .
doi: 10.15585/mmwr.ss6411a1
Arhin SK, Tang R, Hamid A, Dzandu D, Akpetey BK. Knowledge, Attitude, and Perceptions about In Vitro Fertilization (IVF) among Women of Childbearing Age in Cape Coast, Ghana. Obstetrics and Gynecology International [Internet]. 2022 Jul 7[cited 2023 Feb 14]; 2022: e5129199. https://www.hindawi.com/journals/ogi/2022/5129199/
Carson SA, Kallen AN. Diagnosis and management of infertility: a review. JAMA. 2021;326(1):65–76.
doi: 10.1001/jama.2021.4788
Pandian Z, Gibreel A, Bhattacharya S. In vitro fertilisation for unexplained subfertility. Cochrane Database of Systematic Reviews. 2015[cited 2023 Mar 1]; (11). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003357.pub4/full
Ombelet W, Onofre J. IVF in Africa: what is it all about? Facts Views Vis ObGyn. 2019;11:65–76.
Gerrits T. Assisted reproductive technologies in Ghana: transnational undertakings, local practices and more affordable IVF. Reprod Biomed Soc Online. 2016;2:32–8.
doi: 10.1016/j.rbms.2016.05.002
Asplund K. Use of in vitro fertilization—ethical issues. Upsala Journal of Medical Sciences [Internet]. 2020 Apr 2[cited 2023 Feb 10]; 125(2): 192–9. https://doi.org/10.1080/03009734.2019.1684405
Kuivasaari-Pirinen P, Koivumaa-Honkanen H, Hippeläinen M, Raatikainen K, Heinonen S. Outcome of assisted Reproductive Technology (ART) and subsequent self-reported life satisfaction. PLOS ONE[Internet]. 2014 Nov 13[cited 2023 Feb 23]; 9(11): e112540. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0112540
Bazzaco AA, Valelongo PO, Miziara ID, Barbosa CP. Understanding about free consent in assisted reproduction techniques. Revista Bioética. 2014;22:134–44.
doi: 10.1590/S1983-80422014000100015
Dieke AC, Zhang Y, Kissin DM, Barfield WD, Boulet SL. Disparities in assisted Reproductive Technology utilization by race and ethnicity, United States, 2014: a Commentary. Journal of Women’s Health [Internet]. 2017 Jun [cited 2023 Mar 3]; 26(6): 605–8. https://www.liebertpub.com/doi/full/ https://doi.org/10.1089/jwh.2017.6467
Hiadzi RA, Woodward B, Akrong GB. Ethical issues surrounding the use of assisted reproductive technologies in Ghana: An analysis of the experiences of clients and service providers. Heliyon [Internet]. 2023 Feb [cited 2023 Feb 23]; 9(2): e13767. https://linkinghub.elsevier.com/retrieve/pii/S240584402300974X
Busardò FP, Gulino M, Napoletano S, Zaami S, Frati P. The Evolution of Legislation in the Field of Medically Assisted Reproduction and Embryo Stem Cell Research in European Union Members. Zollner U, editor. BioMed Research International [Internet]. 2014; 2014: 307160. https://doi.org/10.1155/2014/307160
Cudd A, Eftekhari S, Zalta EN, Nodelman U. Contractarianism. 2021.
Bodea C, LeBas A. The origins of Voluntary Compliance: attitudes toward Taxation in Urban Nigeria. Br J Polit Sci. 2016;46(1):215–38. https://doi.org/10.1017/S000712341400026X .
doi: 10.1017/S000712341400026X
Kimball A. The seed: infertility is a feminist issue. Coach House Books; 2019 Apr. p. 10.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.
doi: 10.1093/intqhc/mzm042
Neubauer BE, Witkop CT, Varpio L. How phenomenology can help us learn from the experiences of others. Perspect Med Educ. 2019;8:90–7.
doi: 10.1007/S40037-019-0509-2
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative research in sport. Exerc Health. 2019;11(4):589–97.
doi: 10.1080/2159676X.2019.1628806
Dörfler V, Stierand M, Bracketing. A phenomenological theory applied through transpersonal reflexivity. J Organizational Change Manage. 2021;34(4):778–93.
doi: 10.1108/JOCM-12-2019-0393
Maeda E, Jwa SC, Kumazawa Y, Saito K, Iba A, Yanagisawa Sugita A, Kuwahara A, Saito H, Terada Y, Fukuda T, Ishihara O. Out-of-pocket payment and patients’ treatment choice for assisted reproductive technology by household income: a conjoint analysis using an online social research panel in Japan. BMC Health Serv Res. 2022;22(1):1093. https://doi.org/10.1186/s12913-022-08474-5 .
doi: 10.1186/s12913-022-08474-5
Barbagallo F, Cannarella R, Crafa A, La Vignera S, Condorelli RA, Manna C, Calogero AE. The impact of a very short abstinence period on assisted reproductive technique outcomes: a systematic review and meta-analysis. Antioxidants. 2023;12(3):752. https://doi.org/10.3390/antiox12030752 .
doi: 10.3390/antiox12030752
Keller E, Botha W, Chambers GM. What features of fertility treatment do patients value? Price elasticity and willingness-to-pay values from a discrete choice experiment. Appl Health Econ Health Policy. 2023;21(1):91–107.
doi: 10.1007/s40258-022-00764-7
Keller E, Botha W, Chambers GM. Does in vitro fertilization (IVF) treatment provide good value for money? A cost-benefit analysis. Front Global Women’s Health. 2023;4:971553. https://doi.org/10.1016/j.fertnstert.2015.02.018 .
doi: 10.1016/j.fertnstert.2015.02.018
Margalit Y. Scarce Medical resources—Parenthood at Every Age, in every case and subsidized by the state? 9 Netanya Acad. L Rev 2014; 191 (Heb.).
Holley SR, Pasch LA, Bleil ME, Gregorich S, Katz PK, Adler NE. Prevalence and predictors of major depressive disorder for fertility treatment patients and their partners. Fertil Steril. 2015;103(5):1332–9.
doi: 10.1016/j.fertnstert.2015.02.018
Maroufizadeh S, Ghaheri A, Almasi-Hashiani A, Mohammadi M, Navid B, Ezabadi Z, Samani RO. The prevalence of anxiety and depression among people with infertility referring to Royan Institute in Tehran, Iran: a cross-sectional questionnaire study. Middle East Fertility Soc J. 2018;23(2):103–6.
doi: 10.1016/j.mefs.2017.09.003
Omani-Samani R, Ghaheri A, Navid B, Sepidarkish M, Maroufizadeh S. Prevalence of generalized anxiety disorder and its related factors among infertile patients in Iran: a cross-sectional study. Health Qual Life Outcomes. 2018;16:1–5.
doi: 10.1186/s12955-018-0956-1
Reupert A, Maybery D, Nicholson J, Göpfert M, Seeman MV, editors. Parental psychiatric disorder: distressed parents and their families. Cambridge University Press; 2015 Jul. p. 9.
Campbell L, Poon AW. Parenting challenges for persons with a serious mental illness. Mental health and social work. 2020:457 – 74.
Mohammadzadeh E. P151: emotional disorders and anxiety during IVF-Treatment. Neurosci J Shefaye Khatam. 2014;2(3):175.
van den Akker O. Emotional and psychosocial risk associated with fertility treatment. Reducing risk Fertility Treat. 2015;79–96. https://doi.org/10.1007/978-1-4471-5257-6_5 .
Malina A, Pooley JA. Psychological consequences of IVF fertilization–review of research. Ann Agric Environ Med. 2017;24(4):554–8.
doi: 10.5604/12321966.1232085
Wells KJ, Gordon JR, Su HI, Plosker S, Quinn GP. Ethical considerations for informed consent in infertility research: the use of electronic health records. Adv Med Ethics. 2015;2.
Kaur N, Ricciardelli R. Negotiating risk and choice in multifetal pregnancies. Soc Sci Med. 2020;252:112926.
doi: 10.1016/j.socscimed.2020.112926
Soave I, Marci R. Regulation, data management, informed consent, and legal issues for ART. In Management of infertility 2023 Jan 1 (pp. 405–9). Academic.
Faver A. Whose embryo is it anyway? The need for a Federal Statute enforcing frozen embryo Disposition contracts. Family Court Rev. 2017;55(4):633–47.
doi: 10.1111/fcre.12309
Simopoulou M, Sfakianoudis K, Giannelou P, Rapani A, Maziotis E, Tsioulou P, Grigoriadis S, Simopoulos E, Mantas D, Lambropoulou M, Koutsilieris M. Discarding IVF embryos: reporting on global practices. J Assist Reprod Genet. 2019;36:2447–57.
doi: 10.1007/s10815-019-01592-w
Lockwood GM. Whose embryos are they anyway? In Contemporary ethical dilemmas in assisted Reproduction 2021 Sep 22 (pp. 3–11). CRC.
Goedeke S, Daniels K, Thorpe M, Du Preez E. The fate of unused embryos: discourses, action possibilities, and subject positions. Qual Health Res. 2017;27(10):1529–40. https://doi.org/10.1177/1049732316686759 .
doi: 10.1177/1049732316686759
Balakrishnan P, Balu N. Commercialisation of human embryos and stem cells. Int J Health Sci. 2022;4703–16. https://doi.org/10.53730/ijhs.v6nS1.5896 .
Legge M, Fitzgerald R. Valuing embryos as both commodities and singularities. New Z Med J (Online). 2016;129(1431):80.
Adamson GD, Rutherford AJ. Commercialization of in-vitro fertilization. In-Vitro Fertilization: Pioneers’ History. 2018 Jun 14.
Anton R. On the future advances in engineering and in-vitro culture of human embryos [Internet]. 2016 https://mpra.ub.uni-muenchen.de/id/eprint/71450 Accessed 13 March 2023.