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Ethical Dilemmas in Fertility Counseling
BOOK REVIEWS Judith E. Horowitz, Joann Paley Galst, and Nanette Elster. Ethical Dilemmas in Fertility Counseling. Washington, DC: American Psychological Association, 2010. Price: $69.95.
Teri E. Robins, J.D., M.D. Normand Law Providence, Rhode Island
Just because we can, does that mean we should? Advances in assisted reproductive technology (ART) allow physicians to create families in ways in which people have only dared to imagine before. Through the use of donor eggs, donor sperm, and donor embryos and surrogate uteri, physicians can help intended parents have a baby that they have always wanted.
doi:10.1016/j.fertnstert.2010.06.003
But addressing the biologic issues can create psychologic issues that often go ignored. In an effort to ‘‘do no harm,’’ fertility practices are engaging the use of psychologists to address the complete health of the patient. However, not all psychologists have experience with ART and the issues that it generates. The authors of Ethical Dilemmas in Fertility Counseling have written this book to help guide psychologists as they work with their patients face the ethical issues that arise in the ART process.
Those of us working in the field of IVF, particularly in the area of third-party reproduction, do not often think about the mental, physical, and emotional challenges faced by gestational carriers (which the author refers to as ‘‘surrogates’’). In Birthing a Mother, Elly Teman examines surrogates and intended parents from an anthropological perspective, not a medical one. Her book looks at the feelings, emotions, and sociological systems in which surrogates and intended mothers find themselves.
The authors identify four key ethical concerns that consistently arise in the ART setting: access, religious beliefs, informed consent, and disclosure. They recognize that each psychologist comes from a different theoretical background, including behavioral, developmental, psychoanalytic, and others. Using these concerns and theoretical approaches, the authors present issues that patients, and their families, commonly face while going through ART. Specific chapters focus on subjects that include embryo disposition, multifetal pregnancies, oocyte donation and recipiency, embryo donation and recipiency, surrogacy, multifetal pregnancy, and issues of disclosure and third-party identification.
In writing her book over a period of 8 years, the author interviewed 26 surrogates and 35 intended mothers in Israel, where there are strict laws regarding third-party reproduction. Intended parents must all be heterosexual married couples, and unrelated surrogates must be single with at least one child. These in-depth interviews gave her unique insight into the social relationships that developed among the women involved. (The author, by her own admission, did not discuss these issues with the intended fathers.)
Most chapters follow the same structure. The authors provide a review of the medical, psychologic, and bioethical literature and applicable policies and legislation, if any, on the chapter’s topic. Then the authors present a clinical vignette which is discussed from all of the perspectives. At the end of each chapter, the authors present their conclusions and recommendations. They are careful to consider the four key ethical concerns for each vignette. They are also careful to consider the potential impact of the situation on the various parties and how psychologists must balance the patients’ needs and the directive to ‘‘do no harm.’’ Through their discussions, the authors present ART through the eyes of the donor, the recipient, the recipient’s spouse, the children of ART, and other affected parties. They remind practitioners that infertility is more than a biologic illness that can be cured through ART. The authors remind us that ART creates significant psychologic issues that have to be addressed if the cure will truly be a cure or if it will create a different illness that will then have to be treated. Ethical Dilemmas in Fertility Counseling is a good resource for physicians, psychologists, and other practitioners on how to take a more holistic approach to the treatment of fertility for more successful outcomes.
1170
Teman E. Birthing a Mother, the Surrogate Body and the Pregnant Self. Berkeley, California: University of California Press, 2010: 1–361. Price: $21.95.
The book is divided into four main parts, which examine different aspects of the surrogate process. In the first part, Dividing, the mechanism by which surrogates view themselves as pregnant is examined. The author looks at how surrogates are able to separate from the pregnancy and view it differently from when they carried their own child. Connecting, the second part of the book, looks at the relationship between the surrogate and the intended mother. The third part, Separating, evaluates the birth experience of these families and particularly the impact of the medical personnel on the families and surrogates. Finally, Redefining looks at the surrogate after the delivery and her self-portrayal as a ‘‘courageous heroine.’’ Some of the images in the book are quite helpful to understand the viewpoints of the women we deal with as assisted reproductive technology providers. The surrogates viewed themselves as a ‘‘greenhouse’’ or an ‘‘oven.’’ They often avoided maternity clothes as long as possible. The intended mothers, on the other hand, felt very connected to the surrogate, as well as the fetus. Ultrasound images, for example, were treasured by the intended mother far greater than how the average patient looks at those photos. This book is well written, and, although of interest to clinicians, its depth is probably more than most physicians would want to read. I found the actual quotes from the patient interviews to be
Fertility and Sterility Vol. 94, No. 3, August 2010 Copyright ª2010 American Society for Reproductive Medicine, Published by Elsevier Inc.
0015-0282/$36.00 doi:10.1016/j.fertnstert.2010.05.036
Teri E. Robins, J.D., M.D. Normand Law Providence, Rhode Island
Just because we can, does that mean we should? Advances in assisted reproductive technology (ART) allow physicians to create families in ways in which people have only dared to imagine before. Through the use of donor eggs, donor sperm, and donor embryos and surrogate uteri, physicians can help intended parents have a baby that they have always wanted.
doi:10.1016/j.fertnstert.2010.06.003
But addressing the biologic issues can create psychologic issues that often go ignored. In an effort to ‘‘do no harm,’’ fertility practices are engaging the use of psychologists to address the complete health of the patient. However, not all psychologists have experience with ART and the issues that it generates. The authors of Ethical Dilemmas in Fertility Counseling have written this book to help guide psychologists as they work with their patients face the ethical issues that arise in the ART process.
Those of us working in the field of IVF, particularly in the area of third-party reproduction, do not often think about the mental, physical, and emotional challenges faced by gestational carriers (which the author refers to as ‘‘surrogates’’). In Birthing a Mother, Elly Teman examines surrogates and intended parents from an anthropological perspective, not a medical one. Her book looks at the feelings, emotions, and sociological systems in which surrogates and intended mothers find themselves.
The authors identify four key ethical concerns that consistently arise in the ART setting: access, religious beliefs, informed consent, and disclosure. They recognize that each psychologist comes from a different theoretical background, including behavioral, developmental, psychoanalytic, and others. Using these concerns and theoretical approaches, the authors present issues that patients, and their families, commonly face while going through ART. Specific chapters focus on subjects that include embryo disposition, multifetal pregnancies, oocyte donation and recipiency, embryo donation and recipiency, surrogacy, multifetal pregnancy, and issues of disclosure and third-party identification.
In writing her book over a period of 8 years, the author interviewed 26 surrogates and 35 intended mothers in Israel, where there are strict laws regarding third-party reproduction. Intended parents must all be heterosexual married couples, and unrelated surrogates must be single with at least one child. These in-depth interviews gave her unique insight into the social relationships that developed among the women involved. (The author, by her own admission, did not discuss these issues with the intended fathers.)
Most chapters follow the same structure. The authors provide a review of the medical, psychologic, and bioethical literature and applicable policies and legislation, if any, on the chapter’s topic. Then the authors present a clinical vignette which is discussed from all of the perspectives. At the end of each chapter, the authors present their conclusions and recommendations. They are careful to consider the four key ethical concerns for each vignette. They are also careful to consider the potential impact of the situation on the various parties and how psychologists must balance the patients’ needs and the directive to ‘‘do no harm.’’ Through their discussions, the authors present ART through the eyes of the donor, the recipient, the recipient’s spouse, the children of ART, and other affected parties. They remind practitioners that infertility is more than a biologic illness that can be cured through ART. The authors remind us that ART creates significant psychologic issues that have to be addressed if the cure will truly be a cure or if it will create a different illness that will then have to be treated. Ethical Dilemmas in Fertility Counseling is a good resource for physicians, psychologists, and other practitioners on how to take a more holistic approach to the treatment of fertility for more successful outcomes.
1170
Teman E. Birthing a Mother, the Surrogate Body and the Pregnant Self. Berkeley, California: University of California Press, 2010: 1–361. Price: $21.95.
The book is divided into four main parts, which examine different aspects of the surrogate process. In the first part, Dividing, the mechanism by which surrogates view themselves as pregnant is examined. The author looks at how surrogates are able to separate from the pregnancy and view it differently from when they carried their own child. Connecting, the second part of the book, looks at the relationship between the surrogate and the intended mother. The third part, Separating, evaluates the birth experience of these families and particularly the impact of the medical personnel on the families and surrogates. Finally, Redefining looks at the surrogate after the delivery and her self-portrayal as a ‘‘courageous heroine.’’ Some of the images in the book are quite helpful to understand the viewpoints of the women we deal with as assisted reproductive technology providers. The surrogates viewed themselves as a ‘‘greenhouse’’ or an ‘‘oven.’’ They often avoided maternity clothes as long as possible. The intended mothers, on the other hand, felt very connected to the surrogate, as well as the fetus. Ultrasound images, for example, were treasured by the intended mother far greater than how the average patient looks at those photos. This book is well written, and, although of interest to clinicians, its depth is probably more than most physicians would want to read. I found the actual quotes from the patient interviews to be
Fertility and Sterility Vol. 94, No. 3, August 2010 Copyright ª2010 American Society for Reproductive Medicine, Published by Elsevier Inc.
0015-0282/$36.00 doi:10.1016/j.fertnstert.2010.05.036