…the bridge clinic series
By Suzanne Oseahune
Ethics is a term used interchangeably with the science of morality, a body of knowledge that contains standards for value-based human behaviour.
Ethics examines the rational justification for our moral judgments; it studies what is morally right or wrong, just or unjust. In a wider sense, ethics reflects on our interaction with nature and with other people, on freedom, on responsibility and on justice.
Socrates (c470 – c350 BC) a Greek philosopher from Athens is credited as the founder of Western philosophy and among the first moral philosophers of the ethical approach which includes honesty, integrity, social responsibility, accountability, and fairness.
Medical ethics focuses on the obligations of the healthcare providers to the patient and the Corpus Hippocraticum, written by the ancient Greek physician Hippocrates (c450 – 380 BC), provides one of the first reflective codes of professional ethics.
The Hippocratic Oath, which specifies the principles of beneficence, non-maleficence, and the rule of confidentiality, has been adopted as a guide to conduct by the medical profession throughout the ages.
Most UK medical schools require their students to recite a variant of the Hippocratic Oath at graduation.
Nigerian medical schools also require their graduands to recite the Hippocratic Oath, much like medical schools in many other countries.
The Hippocratic Oath is a symbolic rite of passage that marks the transition from medical student to medical doctor. It represents the new doctor’s commitment to ethical medical practice, the welfare of patients, and adherence to a set of professional ethical standards that have evolved since the time of Hippocrates, who is often regarded as the “Father of Medicine.”
In contemporary practice, the exact wording and form of the oath can vary significantly from its original ancient Greek version, and many institutions have adopted modern versions that reflect changes in the practice and understanding of medicine.
These can include the Declaration of Geneva, the oath of the World Medical Association, or other tailored oaths that might incorporate elements more directly relevant to the societal, ethical, and professional issues faced by medical practitioners today.
In Nigeria, as in many countries, the recitation of the Hippocratic Oath or a similar ethical pledge is an essential part of the graduation ceremonies for medical students, emphasizing their entrance into the medical profession with a clear sense of ethical responsibility.
This tradition underscores the idea that practicing medicine is not only a matter of scientific or clinical skill but also involves a profound commitment to human rights, dignity, and ethical conduct in the treatment of patients.
The four basic principles of medical ethics are: autonomy, which is respect for the patient’s right to self-determination; beneficence, the duty to ‘do good’; non-maleficence, the duty to ‘not do bad’; and Justice, to treat all people equally and equitably.
As the medical sciences developed, new ethical issues have emerged, particularly in the field of reproductive healthcare.
Ethics in fertility care addresses the moral principles and values that guide the ethical decision-making processes in assisted reproductive technology (ART) treatments.
This includes considerations of an individual’s rights and autonomy, fairness in access to care, the well-being of the individuals involved, and the broader societal implications of fertility treatments.
Addressing the fundamental ethical principle of nonmaleficence, which highlights the rule of “do no harm,” professionals, particularly in healthcare, are required to avoid inflicting unnecessary harm or suffering on patients.
This principle extends beyond merely avoiding intentional harm; it also encompasses proactive steps to avert risks and safeguard individuals against accidental injuries. Serving as a cornerstone ethical guideline, it stresses the critical importance of carefully balancing any action’s possible advantages with its dangers, with the overarching goal of prioritizing others’ welfare.
At Bridge Clinic, we are committed to upholding this essential standard.
Another consideration in fertility care is the principle of autonomy. Individuals seeking fertility treatments should have the right to make informed decisions about their reproductive health, including the specific methods they wish to use.
This includes respecting their right to use donor gametes or embryos, choose a surrogate, or pursue potentially controversial procedures such as Preimplantation Genetic Testing (PGT) or sex selection.
Recently, a fertility charity in the UK, the Fertility Network claimed that women who freeze their eggs are being misled by some UK clinics about their chances of having a baby.
This was in reaction to a BBC analysis that found 41% of clinics offering the service privately could be breaching advertising guidance.
The watchdog, which sets ethical guidelines, says clinics “must not give false or misleading information”.
When a person wants to have a baby, the frozen eggs can be defrosted and used in fertility treatments, such as IVF. A successful pregnancy is not, however, guaranteed by the procedure.
Many clinics were advertising successful thaw rates of 80-95%. But these clinics did not make it clear that the chances of having a baby through this process are dramatically lower, a clear breach of the ethical principle of patient autonomy.
At Bridge Clinic, we uphold very high standards in data management and security of patient confidentiality in compliance with NDPR and ISO 27001. We have fulfilled, submitted and filed our assessment audits for 2024 through our Data Protection Compliance Organization (Jackson, Etti & Edu).
NDPR compliance means adhering to specific regulations around personal data protection in Nigeria, while ISO 27001 compliance involves implementing a broad information security management system recognized internationally.
Both aim to safeguard sensitive data, but they approach it from slightly different perspectives: NDPR focuses specifically on personal data protection, while ISO 27001 provides a framework for more general information security management practices.
Another important ethical principle is beneficence, which requires fertility care providers to act in the best interests of their patients.
This involves assessing the physical, psychological, and social well-being of individuals seeking fertility treatments and considering the long-term welfare of any children that may result from these treatments.
At Bridge Clinic, our team comprises a diverse array of professionals, including Doctors, Nurses, Embryologists, Counsellors, and our Customer Experience and Back-office team.
Collectively, we prioritize open communication and transparency, with a focused commitment to acting in the best interest of both patients and medical colleagues. This entails providing the highest quality services and support available to us.
Healthcare providers should ensure that patients are fully informed of the potential risks, benefits, and implications of different treatment options.
Fairness and justice are major ethical considerations in fertility care. Access to and affordability of fertility treatments can be major barriers for many individuals and couples.
Bridge Clinic, in collaboration with LASUTH via the Institute of Fertility Medicine, has successfully offered affordable IVF treatments as part of our CSR initiative to clients with limited budgets.
Ethical discussions often arise around issues such as prioritizing treatment for individuals with medical conditions affecting fertility, the allocation of limited resources, and the potential for exploitation in reproductive tourism and commercial surrogacy arrangements.
The ethics of fertility care also extends beyond individual patients to include considerations of broader social impact.
For instance, questions may arise regarding the consequences of certain procedures on the well-being of the resulting children or on the genetic diversity of future generations.
In Nigeria, there are at present no specific regulations guiding the ethical practices of fertility clinics.
Although the various medical sub-specialties have well established guidelines for the minimum standard of practice, these guidelines serve only as a reference point for practitioners and have no legal structure to uphold and enforce them.
Over its 25-year history, Bridge Clinic has embraced a self-regulatory approach as an IVF (In Vitro Fertilization) clinic, focusing on establishing and following internal standards and protocols aimed at upholding the utmost ethical practices, care quality, patient safety, and confidentiality.
The particulars of these self-regulatory measures may differ, but they generally cover a broad spectrum, including ethical standards, care quality, patient safety, confidentiality, adherence to regulations, ongoing enhancement, and engagement with both the public and professionals.
Managing ethical considerations in fertility care is a complex process which involves ongoing reflection, dialogue, and adherence to professional guidelines and legal frameworks, to ensure that fertility care practices align with the values and well-being of the individuals involved and society as a whole.
Written by Ojeifo-Idris, Suzanne Oseahune, Marketing & Communication Specialist Bridge Clinic Nigeria
