Analysis of Health Policy Document: Assisted Reproductive Treatment Act - Term Paper Example

Analysis of health policy document: Assisted Reproductive Treatment Act Many health and social issues are politically contentious and often elicit ethical and moral dilemmas and questions. In most of such cases, it is not apparent on which is the most ideal way to approach or respond to the issue. Use of social and health policies is identified as one of the major approaches that the government utilizes to guide healthcare professionals and organizations on how to respond to such concerns. In nursing, social and health policy shapes and impacts on the nursing profession and more so the context that the nurses practice. In this paper, an analysis of the Assisted Reproductive Treatment Act 1988 is undertaken based on socio-political perspectives. Main health area of the policy The Assisted Reproductive Treatment Act 1988 is mainly focused on women health issues and specifically on women’s reproductive health. The policy seeks to determine who qualifies for assisted reproductive treatment among different classes of women with infertility problems. The policy also determines who qualifies to undertake such treatments registration requirements for ART providers, including eligibility criteria, mandatory conditions of registration, and mechanics of removal from Register and reinstatement on Register (The Assisted Reproductive Treatment Act 1988). It also provides for a donor conception register, and has record keeping and confidentiality provisions besides identifying the conditions that a patient must meet to qualify for treatment. This has resulted to discrimination against some women especially poor women, and those that are not in traditional family set up. Main stakeholders in the policy Women are key stakeholders in of the policy as the law affects their reproductive decisions either by denying or providing for conditions under which they can access assisted reproductive healthcare. Peterson (1999, p. 280) asserts that in Australia and other countries, some groups of women have been denied access to reproductive technologies and these include women who have certain disabilities, older women, heterosexual women, lesbians, single women, and poor women. Older women and those with disabilities are denied access to reproductive technologies on the basis of the effect it may have on the key stakeholders who are the children. Social concerns are often cited in policy formulation as a major factor shaping the policy with elements such as concerns that it is against nature and assertions that some women in unconventional families such as lesbians and single parents may not make good parents. Among the circumstances that are cited as qualifying for assisted reproductive treatment include infertility for the man and the woman who are living as either husband and wife or where there is a serious genetic risk. Such legal discourse shaping policies such as assisted reproductive treatment act and its provisions is representative of dominant power groups within the society which may act to either encourage or discourage consequential social adjustment (Peterson, 1999, p. 281). The recognition of children in the policy as key stakeholders is evident in section on welfare of the child where the policy states that the ‘welfare of any child born as a consequence of provision of assisted reproductive treatment in accordance with this act must be treated as being of paramount importance and accepted as a fundamental principle in respect of the operation of this act” (Assisted Reproductive Act 1988). This is based on the fears that there would be a risk of commoditization of children. Healthcare providers in areas concerned with reproduction are also key stakeholders as the policy provides guidelines on the expectations, qualifications and other standards that must be adhered to in case of healthcare providers and organizations that wish to provide assisted reproductive treatment. In part 2 of the law, it requires that individuals who provide reproductive treatment must do so only when authorized in accordance to regulations and penalties for failure to adhere to such regulations are stipulated in the policy. The policy dictates the conditions for eligibility, fees payable and the expected conduct of health professional intending to offer assisted reproductive treatment. The policy also outlines the accreditations, licenses and other requirements that a health practitioner must meet to qualify to provide reproductive assisted treatment and other conditions that may result to withdrawal of license and fines (Assisted Reproductive Treatment Act 1988). Donors are stakeholder as they provide the gametes that are used and a donor registry is kept and it must contain among other items the full names of the donor and an address, the person who received treatment from the donor and the child born from the outcome of the treatment besides other information that could be relevant (Assisted Reproductive Treatment Act 1988). Desired outcome of policy and reasons why the policy should be improved Assisted reproductive treatment act 1988 aims at providing solutions and answers to the issue regarding assisted reproductive treatment and these include concerns over the possible commoditization of children, welfare of children, and exploitation of women and devaluation of human life (Knopf and Snow 2012). The policy states that ‘…the welfare of any child born as a consequence of the provision of assisted reproductive treatment in accordance with this act must be treated as being of paramount importance , and accepted as a fundamental principle, in respect of operation of the act” (Assisted reproductive treatment act 1988). The policy intends to attain this end by restricting to whom the service should be given with the resultant solution of regulating and prohibiting assisted reproductive treatment to some classes of individuals. Assisted reproductive act 1988 stipulates that unmarried women, fertile women in heterosexual relationships, older women who may leave young children upon early death and disabled women whose ability to rear children may be questioned and lesbians whose family makeup diverges from what is considered as traditionally normal family may not be allowed to bear children using assisted reproduction technologies. The question of whether the desired outcome of optimal welfare for the child is attained through these provisions has remained debatable and this has raise grounds for the need for the policy to be improved. Among the concerns include how the policy determines who deserves to be a parent with the positioning of the traditional heterosexual family above other alternatives such as lesbian, single parenthoods and so on raising issues of equity (Engeli, 2009 p. 57). The issue of whether preserving traditional gender roles through use of the policy overweigh the need for reproductive freedom and what these options weigh on the consideration on the wellbeing of the child is a question that must be addressed. Perspectives of the policy in relation to structure-agency continuum Socio-political perspectives such as the structure and agency framework are recognized as a key understanding mechanism within social sciences (Aston 1999, p. 2). It is an approach that is used by social scientists to confront pressing social problems and issues that affect humans. It is based on the presumption that whenever individuals construct a notion of social, economic and political causality, they appeal to the structure-agency framework (Aston 1999, p. 2 ). This perspective recognizes that while structures do not control us completely, neither are humans completely free (Aston 1999, p.2). The framework is useful in analyzing policies such as the Assisted Reproductive Act 1988. In regards to the structure-agency continuum, there is evident that structure is imposed on how individuals make decisions regarding reproduction based on social factors. The policy focuses more on the structures of society and specifically on gender, disability, and class and less on the individual members of the society. From a social constructionist perspective, this is concerned with power relations and how the political effects of the knowledge that they produce depend upon culturally shared understandings reflecting dominant values and opinions representing and serving interests of relatively powerful groups with the risk of oppressing and excluding other groups (Blurr et al 2008, p. 34). From a structuralist feminism view, patriarchy is a key structural influence where systematic subordination and exclusion of women from different aspects of society is explained through structures set up by men (Aston, 1999, p. 5). From this perspective, the position of different women in the hierarchy based on such factors as class, age, education and marital status being indicative of individual’s position in society and relevant in shaping the assisted reproductive policy. This explains the focus of Assisted reproductive act 1988 on the women who should be allowed to undergo assisted reproduction at the exclusion of others such as lesbians, single mothers, poor and disabled women. The agency perspective assert that ‘agency stands for freedom of the contingency acting subject over and against the constraints that are thought to derive from enduring social structures” (Aston 1999, p. 5). In this regards, individuals may either act independently in opposition to the constraints imposed by structures or even reconstitute social structures through their choice of actions. The policy in regard to agency provides various constraints on women of various classes such as lesbians, disabled and the old denying them the choice to freely choose their actions by making them follow the dictates of social structure. Perspective of the policy in relation to illness/wellness continuum Policy analysis can also be undertaken in relation to the illness wellness continuum. Bunker & Rosdahl (2010, p. 54) posit that most people are not totally healthy at any one given time and an individuals health falls somewhere on a continuum ranging from high level of wellness to death. A state of wellness is symbolized by prevention of illness, good physical self-care, expression of emotion and appropriate stress management, concern of environment, and use of full intellectual capacity and so on. The Assisted Reproductive Act 1988 moves towards the illness end of the continuum the policy focused on treatment rather than prevention considering the disparity in resource allocation on treatment and prevention. The significant investments in research on artificial reproductive technologies is done to the detriment of less financially profitable projects such as treatment and screening for sexually transmitted diseases that can be used to prevent some cases of infertility and this has meant that the poor, less educated, suffer as their health needs are ignored as preferential treatment based on consumer demand from a minority of advantaged women (Peterson, 2005, p. 281). Bunker & Rosdahl (2010, p. 54) assert that the Maslow’s hierarchy relates to the health continuum and when people find their needs threatened or blocked, they move towards illness end of continuum and when their needs are met, they move towards the wellness end of the continuum. Among the factors that influence access to assisted reproduction treatment include age, income and education level with possible interpretation that ART services are predominantly used by older professional women who chose to delay childbearing for career advancement. However, the fact that research has indicated that those in lower socioeconomic groups have higher rates of infertility due to poverty, poor nutrition, increased infection rates from infectious diseases and sexually transmitted diseases such as Chlamydia means that they are in need of the services than the preceding groups (Peterson, 2005, p. 281) By restricting different classes of women from accessing assisted reproductive health results to a blockage of the women’s needs and subsequently placing them on the end of illness continuum. Priority areas that would result to an effective response to the health problem and acknowledgement and lack of in the policy Among the priority areas that should be addressed to effectively respond to the problems associated or expected from assisted reproductive treatment include addressing ethical issues regarding the use of the technologies such as commoditization of children and children’s welfare and issue of equity in access of treatment. In the current policy, the welfare of the child is mentioned as a critical consideration although the provisions on how this should be attained is a product of a subjective social construction of what is an ideal family and this is founded on social and cultural values and subsequently not adequate as a base for securing the welfare of the child (Blyth et al 2008 33). Fathalla, 2002 (p. 3) argues that despite the scientific progress on ART, the issue of making ART widely available and affordable for all remains critically important. Additionally, the obvious discrimination of some classes of women is an issue that has been particularly vocalized based on issues of equity with feminists declaration that this represents continued embodiment of patriarchal policies denying women a free will to determine their reproductive rights (Aston, 1999, p.4). The policy should therefore as a priority address equity issues and remove clauses that are not proved to be essential for the well being of the child while avoiding being discriminative against some classes of people, which it has failed to address adequately. Blyth et al (2008, p 33) suggests that this can be attained by interrogating current provisions and removing vague and subjective questions. Blyth et al (2008 p. 32) suggest that removal of provisions with references to a child’s need for a father is necessary as it is not essential in outcome of children’s welfare assessments and these provisions are used to weed out ‘unfit parents’, which is a social construction attribute based on a traditional view of what constitutes a notion of stable family setup. Instead, clinics responsibility to take account child’s welfare should be removed and instead where concerns arise regarding any child born from the treatment, social services should be alerted. Such factors include convictions for harming children, family discord and serious violence, circumstances that may lead to inability to care for child, or cause harm to child and ability to meet child’s needs where a mother does not intend to raise the child with support of a father. Additionally, a more reasonable and practical system for assessing child welfare should be undertaken and this should be predicated on evidence that a child born as a result of treatment would face serious, physical, medical and psychological harm. How the policy promotes participatory care within the normal social contexts of communities and individuals The policy does not promote participatory care within the normal social contexts of communities and individuals. The fact that the policy is delivered top down leaves the patients with very little room to influence the treatment outcome or even the decisions. For instance, through discrimination against some classes of women, denies them not only the opportunity for treatment but also a voice to determine their own treatment decisions. In order to promote participatory care, a patient review panel that provides patients with opportunities to air their views would be essential besides enhancing equity through ensuring that different social groups are not discriminated against. References Blythe, E, Burr, V & Farrand, Abigail 2008, ‘ Welfare of the child assessments in assisted conception: A social constructionist perspective’ , Journal of Reproductive and Infant Psychology, vol. 26, no. 1, pp . 31- 43. Willems, DL 2001, ‘ Balancing rationalities: gatekeeping in health care ’ , Journal of Medical Ethics, 27, p p . 25- 29. Engeli, Isabelle. The challenges of abortion and assisted reproductive technologies in Europe. 2009. Comparatve European Politics , 7, 56-74. Aston, Ben. What is structure and agency? How does this framework help us in political analysis. Approaches to political analysis. Agency, Structure and Social Chance, 19:3, 1999, p.139. Peterson, M. Assisted reproductive technologies and equity of access issues. J Med Ethics 2005; 31: 280-285. Germov, J 2011, Ch. 2, ‘Theorizing Health: Major Theoretical Perspectives in Health Sociology’ in Second Opinion: An Introduction to Health Sociology, 4th edn, J, Germov (ed), Oxford University Press, Melbourne, Australia. Bunker, Caroline, Rosdahl, Mary. 2010. Textbook of basic nursing. Wolters Kluwer Health. Fleming, Steven Simon, Cooke. Textbook of assisted reproduction fro scientists in reproductive technology. Vivid Publishing. 2009. Fathalla, Mahmoud. Current practices and controversies in assisted reproduction.(ed). Current challenges in assisted reproduction. World Health Organization, 2002. Read More