Ivf

On February 12, 2006, CBS News released a report "A Surplus Of Embryos", which reported that currently there are over 400,000 frozen human embryos in storage in the United States. Correspondent Leslie Stahl noted in the article that more embryos are created than are needed and they are now the subject of a national controversy. (CBS, 2006)

This same topic was the subject of a survey by the Institutes of Health, Health Care Policy and Aging at Rutgers, the State University of New Jersey. Three hundred forty one IVF clinics were asked about the management and disposal of frozen embryos. The study found that the options given to couples for their embryos includes continual cryopreservation, donation to research, donation to other couples, and disposal. There is some thought that IVF clinics place the decision about the responsibility for the embryos with the couples to prevent future complaints and lawsuits. Currently the American Society of Reproductive Medicine guidelines do not have specific criteria for disposal practices other than to urge informed consent, nor are there "meaningful" federal laws governing this area". (Gurmankin, A, 2004).

Many ethical and legal issues surround the unanswered question of what to do with unused embryos. Nanette Elster, a reproductive law expert and Assistant Professor at the University of Louisville Institute for Bioethics, Health Policy and Law mentions four possible choices couples have regarding their stored embryos. "Couples can opt to leave them in storage, donate them to an infertile couple, donate them to research, or allow them to thaw and be destroyed." (Mayes, 2003) Each of these options is accompanied by a variety of ethical considerations. An over abundant number of stored embryos is not practical or economical. Do clinics have the right to decide which embryos are accepted for continued storage?

For many people, one of the ethical issues that pertain to the storage of frozen embryos includes whether or not the embryo is considered to be human life. Social discourse has conflated questions concerning abortion, embryonic stem cell research, therapeutic cloning, and even embryo disposal, with discussion often reflecting confusion among the complex factors surrounding all of those subjects. One author, at least, has proposed that a wider context exists: the evolution of social values from the submersion of individualism to the community's interests that has prevailed since the Enlightenment and the beginning of the Industrial Revolution, towards a more recent and still nascent understanding of personhood that increasingly values autonomy and individuality. (Dolgin, 2004) The Catholic Church, for example, has consistently opposed the creation of embryos outside of the human body. (Boston Globe, 2006)

Few state laws regulating embryo donation exists to provide guidance for the donation of embryos to infertile couples. The lack of legal guidelines for the storage, use, and disposition of embryos in many states, is concerning and questionable, considering that embryos are potentially human life. Society has the responsibility to protect individuals from the loss of embryos without their consent. However, society's responsibility to limit procreation of family members is taboo. Some states require the informed consent of donor parties to include disposition of stored embryos. (National Conference of State Legislatures, 2007)

All theories have strong, as well as, adverse points; therefore, no one theory provides all the answers to ethical dilemmas. The ethical theories used in developing the embryo storage policy are Utilitarianism and Ethics of Care. These theories provide a comprehensive and compassionate approach to alleviate limited storage capacity experienced at IVF clinics.

Utilization of the Utilitarian approach states that the right action will produce the most happiness and common good for the community in which the end will justify the means. Beauchamp and Childress (2001), suggest the principle of utility "asserts that we ought always produce the maximal balance of positive value over disvalue (or the least possible disvalue, if only undesirable results can be achieved)." (p. 341) Furthermore, the utilitarian stance objectively assesses the interests of everyone affected by the decision with the goal of promoting welfare. Unfortunately, this approach alone will alienate many IVF clients as it appears harsh and provides them with little autonomy in making decisions regarding their embryos.

If the Ethics of Care approach were solely used, it would cause the closure of clinics as expansion for embryo storage would be impossible. The common morality theory by W. Frankena and W.D. Ross states that beneficence and justice are the two major principles of morality. (Beuchamp & Childress, 2001) The theorists claim that acts, motivation and character may be right or wrong, but that good should be greater than evil. (2001)

Ethically sound decision-making involves applying many moral principles, rules, and virtues. In addition to the moral virtues outlined by the Code of Ethics (ANA, 2001), such as respect for autonomy, nonmaleficence, beneficence, and justice, caring is also a vital moral principle important to the foundation of morality. According to Watson (1998), "A transpersonal caring relationship in which the nurse is able to assess and apprehend the experience of another, to feel a union with the other and to take care of the other's needs epitomizes an ethic of care." (Havens, 2000) In order to optimize the proposed recommendations, it is crucial that IVF staff act in a caring manner while anticipating the needs of the clients.

Proposal Research: Storage of Frozen Human Embryos in an IVF Facility

➢ Role: Clinical Systems Manager (new position) - IVF Unit of Women's Health Division;

➢ Develop Proposal to:

o Manage current inventory;

o Accommodate new embryos;

o Keep IVP Service in business.

➢ Qualifications for position:

o RN with Master's Degree;

o Staff RN in IVF Unit since inception - 10 years;

➢ Issues at stake:

o Need to identify personal values and ethical perspectives;

o Frozen embryo storage currently at capacity;

o Need for storage space for new embryos;

o No possibility for additional