The article I have chosen represents a conflict within the field of assisted reproduction and is between the two principles of patient autonomy and nonmaleficence. Before I delve into those aspects and why they relate to the article I am going to summarize the case. In this case a couple is presenting to an infertility clinic with the hopes of having a child despite both future parents having achondroplasia. They are aware of the risk of the child suffering from a still birth if his/her genetics are homozygous for achondroplasia. The doctor knowing this as well suggests preimplantation genetic diagnosis to reduce the chances of this happening and increase the chances that child will be born of normal stature. The couple then proceeded to inform the doctor that they wanted the doctor to help them in assuring that the child does indeed have achondroplasia, they wanted this so the child would be like them, and they would resonate better. This is where the conflict presents itself, according to the principle of autonomy the patients have the right to decide that they want their child to be born with achondroplasia if they have appropriate decision-making capability. However, on the other hand the physician has a right to uphold the ethical principle of nonmaleficence. In this case scenario I believe that the physician should decline the couple’s request to intentionally have a child born with achondroplasia, therefore placing nonmaleficence above patient autonomy.
The ethical principle of nonmaleficence is centered around the idea that the physician has a duty to do no harm to a patient. In this case scenario there would be no harm done to the couple presenting the request if it were to be carried out. However, there could be potential harm done to the child by having him/her born into the world with achondroplasia intentionally. One of the main affects it would have on the child relates to the child’s potential social life. Having achondroplasia could limit the child’s future opportunities due to his/her short stature. Another possibility is that the child may experience feelings of social isolation due to looking different from his/her peers. Looking beyond the social challenges this child may face there are also medical challenges that have a probability of occurring if the child is born with achondroplasia. Some of the medical complications the child may experience include arthritis, spinal stenosis, hydrocephalus, and sleep apnea just to name a few. Due to both the potential medical and social challenges the child may experience it is the physician’s duty to uphold nonmaleficence and deny the request of the patients. However, some may argue that nonmaleficence is not even put into play in this case scenario.
Based on the facts of this case few may argue that if the doctor does agree to help the couple intentionally give birth to a child with achondroplasia that the doctor is not causing direct harm to the child. Some may see it as the doctor simply implanting an already affected embryo therefore no harm is done and the ethical principle of nonmaleficence is not jeopardized. However, nonmaleficence not only applies to direct harm to a patient it also refers to the prevention of harm to a patient. Even though carrying out the couples wishes will not directly harm the embryo it may cause the medical or social challenges mentioned earlier which could have been prevented if the doctor refused. Therefore, to prevent future harm to the child through the possible social and medical challenges he/she may face the doctor must uphold nonmaleficence and deny the request. Another argument that cold present itself in this scenario is the couples right for autonomy. While the couple does have a right to choose and make decisions about their health care such as intentionally having a child with achondroplasia, the doctor also has a right to refuse. The couple is simply thinking about what is best for them by stating they want their child to be like them, instead of thinking about the well-being of the child. Therefore, the doctor must consider the well-being of the child by preventing possible future harm and denying the request of the couple.
In conclusion despite the couple’s ethical right to autonomy to decide soundly by opting to intentionally have a child with achondroplasia I believe the doctor should deny this request. The doctor has an obligation to nonmaleficence to the unborn child. The doctor must prevent any future harm that may come to that child whether said harm be of a social or medical nature. Upholding the ethical concept of nonmaleficence should be the doctor’s top priority in this scenario, he can do so by urging them to reconsider given the future harm it may cause their child. If the couple is still determined to make sure their child have achondroplasia despite hearing the potential harm it may cause their child, the doctor should respectfully decline their request, making the ethically righteous decision in allowing nonmaleficence to outweigh autonomy in this predicament.
References:
Kolthoff, M. (2007, September 1). Assisted reproduction and Primum Non Nocere. Journal of Ethics | American Medical Association. Retrieved June 19, 2022, from https://journalofethics.ama-assn.org/article/assisted-reproduction-and-primum-non-nocere/2007-09
Roland, J. (2017, July 25). Dwarfism: Types, causes, and more. Healthline. Retrieved June 19, 2022, from https://www.healthline.com/health/dwarfism#complications
Stone, E. G. (2018, October 22). Evidence-based medicine and bioethics: Implications for health care organizations, clinicians, and patients. The Permanente Journal. Retrieved June 19, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207438/
Varelius, J. (2006). The value of autonomy in medical ethics. Medicine, health care, and philosophy. Retrieved June 19, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780686/
What is nonmaleficence – meaning and definition. Pallipedia. (n.d.). Retrieved June 19, 2022, from https://pallipedia.org/nonmaleficence/
