Ethical Problem or Dilemma the Thesis

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But "few states with mandatory insurance for IVF still require couples to undergo three cycles of ovulation induction and artificial insemination before IVF" thus encouraging the use of a technology more likely to result in multiple births (Roan, 2007, p.4).

When contemplating the use of fertility drugs or IVF, the American College of Obstetrics and Gynecology advocates discussing the possibility of selective reduction and the patient's comfort level with this practice before any procedures are performed. However, its guidelines, are not binding. For example, "the U.S. fertility industry has guidelines on how many embryos doctors can implant, with the number varying by age and other factors. The guidelines call for no more than one or two for a generally healthy woman under 35, and no more than three to five, depending on the embryos' maturity, for women over 40" (Watkins & Neergaard 2008). Eight embryos would be "well beyond" these suggestions, and clinics that clearly violate suggested policies can removed from the Society for Assisted Reproductive Technology, which in turn affects whether insurance covers their services. "But the guidelines do not have the force of law" (Watkins & Neergard 2008)

Analysis

Given the increasing costs of healthcare, a more utilitarian calculus of the use of that technology must be introduced -- relying upon the individual ethics of doctors is not enough. To reduce the costs and risks of fertility drugs and multiple births, what are now only suggested guidelines by the American Medical Association (AMA) must become mandatory. Doctors who violate those guidelines should lose the ability to practice their profession.

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A cost-benefit analysis of allowing patients to exercise their choice must weigh patient autonomy with the dangers high-risk pregnancies cause to society. Infants with severe health problems, high costs, and other dangers outweigh privacy concerns. If the AMA does not act, then legislative authorities must step in.

Single or competing theories

Does this mean that in a deontological sense that to behave as if setting law 'for all time,' one must permit regulation of abortion? Not necessarily. On a situational basis, one must look at the specific consequences of reproductive technology, specifically fertility drugs, from a health policy perspective, not privacy laws in the abstract.

Public-policy implications

If doctors will not regulate their profession's use of fertility drugs, the government may need to intervene -- however, there is the uncomfortable specter of such laws being challenged by the U.S. Supreme Court in terms of the questions they pose about private reproductive decisions. Demanding more comprehensive coverage by healthcare insurance companies for IVF technology, to reduce use of fertility drugs; mandating preliminary psychiatric screening of individuals seeking treatment; and other limits could be placed upon the technology within the guidelines of past legal precedents.

Normative conclusions

Assisted reproductive technology has a high risk of generating multiple pregnancies, and a high cost for society in terms of the education and medical support of children of multiple births. Thus greater regulation of such technology, such as fertility drugs, must be mandated, ideally by the medically profession itself, or by the U.S. Congress.

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