Physicians’ Experiences with and Attitudes toward Non-Medical Sex Selection through Preimplantation Genetic Diagnosis

Non-Medical Sex Selection;Preimplantation Genetic Diagnosis;Medical Ethics;Qualitative;not listed

Harkavy, NinaErby, Lori ;

Johns Hopkins University

关键词: Non-Medical Sex Selection;    Preimplantation Genetic Diagnosis;    Medical Ethics;    Qualitative;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/38032/HARKAVY-THESIS-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Background: Preimplantation genetic diagnosis (PGD) is technology by which embryos, created through in vitro fertilization (IVF), can be screened for genetic conditions or traits before uterine implantation. Non-medical sex selection (NMSS) describes the use of PGD to choose the sex of a child for social, rather than medical, reasons. In the US, it is legal to use NMSS for ;;family balancing,” or the selection of an underrepresented sex in a family.Proponents of family balancing believe that NMSS is an expression of reproductive autonomy and is ethically acceptable on those grounds. Opponents often cite beneficence, nonmaleficence, and justice as the basis for concerns around NMSS.Physicians are thought of as gatekeepers to this technology, yet there is little research exploring the experiences and concerns of physicians around NMSS. Objective: This study seeks to describe the experiences of healthcare providers around PGD for NMSS, with a focus on potential ethical concerns, the decision-making process, and their views on future appropriate non-medical uses of PGD, if any. Methods: Semi-structured interviews were conducted with 8 OB/GYNs and 6 reproductive endocrinologists (REs) currently practicing in the US. Interviews focused on attitudes toward NMSS, implications of NMSS, decision-making, and non-medical trait selection (NMTS). The interviews were transcribed and subjected to thematic analysis using NVivo 9.0 qualitative software. Results: Findings from this study reveal the nuances of physicians’ attitudes toward NMSS as well as the values that drive these attitudes. Analysis revealed that most physicians opposed NMSS but would support their patients’ wishes because of the principle of autonomy. Autonomy was also a frequent cause of ethical dilemmas for physicians struggling with values. Not all physicians identified as gatekeepers for NMSS technology. Physicians expressed conflicting preferences about the ideal decision-making process, indicating that they wanted professional societies to make clear guidelines around NMSS, but wanting to preserve patient-provider decision-making. Lastly, physicians were mostly opposed to non-medical trait selection (NMTS) because of interference in nature, parenting norms, and the importance of valuing differences among people.Discussion: Physicians are experiencing ethical dilemmas around NMSS and NMTS. This insight should be used to inform policy around NMSS and PGD.