Ethics

Case Study 2: Selective Abortion and IVF

Case Study Assignments (45 points each, see rubric)

Greg and Abigail Grossman, an older couple who were patients of Mrs. Clemmons (a nurse in a clinic specializing in assisted reproduction) were finally successful in their third attempt at IVF. Mrs. Grossman’s pregnancy test was positive 2 weeks after the procedure, and her hormone levels were very high, indicating that more than one embryo was viable. Indeed, by the fourth month of pregnancy, five fetuses could be seen on ultrasound and all seemed to be developing normally. The clinic had followed the usual procedure of implanting more than one embryo in order to increase the chance that at least some would survive. Although implanting as many as five is uncommon, some people wanting to increase the probability of at least one successful pregnancy do transfer that many, especially if the woman is older and previous attempts have failed.

At this point, the clinic physician recommended that the Grossmans reduce the pregnancy to two fetuses to ensure their survival, to prevent the birth of premature infants needing costly neonatal nursery services for weeks after the birth, and to avoid potential harm (cardiac overload) to Mrs. Grossman. The procedure would be a selective abortion of three of the fetuses.

The Grossmans were horrified by this information and did not know what to do. They asked Mrs. Clemmons to help them make their decision. To be honest, she found it very hard to see couples faced with this type of choice. She shared their grief when they failed to become pregnant through sometimes several IVF procedures. Each IVF attempt was hard on the woman’s health, hard on the marriage relationship, and expensive. Many couples used their retirement savings or took huge loans to pay for the treatment and then had no idea how they would pay for the child’s college education. Once a woman became pregnant, it seemed a cruel twist to then recommend killing some of the fetuses so that others would have a better chance at healthy births—especially when it took such a great effort to have any fetuses in the first place! She found the potential for selective abortion one of the most undesirable aspects of IVF. Even though this possibility was explained to couples before beginning IVF, she had not observed one case in which a couple who made the decision to selectively abort did not experience serious emotional trauma and did not later question their decision. Two of the clinic’s couples had, in fact, lost their remaining fetuses a few weeks after selective abortions procedures. How could Mrs. Clemmons best help the Grossmans through this difficult decision?

1. If a couple could make a selective abortion choice based on sexual preference, what would prohibit some other couple from making a selective abortion choice based on genetic endowments such as blue eyes and blond hair, or mental intelligence?

2. What role should nurses have in discussing the limits of technological advances and the morality of their uses?