Would a mother be restricting the abnormal fetus of a life if she chooses to selectively terminate the fetus, or would she be benefitting the health fetus by giving it a better chance of living? These questions are usually on the minds of individuals who participate in fetal reduction. Multifetal reduction initially started out as means of managing pregnancies where carrying multiple embryos posed a high risk to both mother and fetuses. Initial concerns regarding technological advancements were led by matters of life and death and shifted toward acceptance. In today’s time, indications for multifetal reduction have changed from the crisis of “life and death” into the broader issues concerning quality of life.
This paper will explore the key concepts, decision making, a theoretical framework model and the significance of the decision in nursing when it comes to bioethical issues in multifetal reduction. It is important to consider the indications for multifetal reduction. Assisted reproductive techniques (ART) such as invitro fertilization-embryo transfer has significantly increased the rate of multiple pregnancies. The article brought out that indications for fetal reduction included the presence of 2 or 3 intrauterine gestational sacs, fetal reduction requested by the patient and family, no recent symptoms of threatened abortion, preoperative examination to exclude the presence of systemic and reproductive system infections, no surgical contraindication. Fetal reduction is a surgical procedure in which transvaginal aspiration method of embryo reduction without potassium chloride injection was used. It may be argued that fetal reduction should not be permitted in circumstances where patients and health care providers are aware of the risk associated with ART but decide to utilize them anyway. The decision to reduce one or more fetuses is complicated, and factors such as procedure risks, or loss of entire pregnancy can occur. Women are usually faced with this awful decision to consider terminating one or more fetuses to prevent mortality and/or morbidity.
The spectrum of Pro-Life and Pro-Choice plays a vital role in the discussion being made. Pro-Life views would have the mother lean towards keeping all fetuses despite the risk to her. Pro-Choice would have the mother lean towards aborting the abnormal fetus to improve the survival of the remaining fetus. A decision is needed in order to give the best outcome for whichever route the mother chose. In terms of the theoretical framework model, this particular bioethical issue aligns with the theme of “Systems approach.” Theorist, Betty Neuman noted nursing responds to individuals, groups, and communities, who are in constant interaction with environmental stressors that create disequilibrium. A critical element is the client’s ability to react to stress and factors that assist with reconstitution or adaption (Henderson, 1966, p.15).
The Neuman systems model consist of physiological, psychological, sociocultural, developmental, and spiritual factors. It also contains a basic core made of survival factors such a system variables, strength and weaknesses of the body systems, and genetics. This theoretical framework model is well suitable for this particular bioethical issue in which focuses on survival factors. Some patients undergoing multifetal reduction consider a survival outcome, and the benefits of saving .
This article particularly mentioned that psychological care is needed when it comes to the nurses’ role. Nurses are responsible for providing good preoperative psychological nursing, eliminating doubts and nervousness so that the patient can better cooperate during surgery. Patient who request or require vaginal multifetal pregnancy reduction may experience stress, anxiety, or other psychological symptoms. What about the moral principles of a nurse? Selective termination of multifetal pregnancy reduction are justifiable ethically, but may contradict the patients’ or health care professionals’ values. Are their beliefs taken into consideration when it comes to caring for patients who decide to have fetal reduction surgery? A nurse must understand their role in the matter, and make a clinical decision. They must be well informed to respond appropriately and safely.