Nursing in a Sociopolitical Context- Health Policy Analysis - Term Paper Example

NURSING IN A SOCIOPOLITICAL CONTEXT - HEALTH POLICY ANALYSIS Instructor Institution Date Introduction Conception in the previous centuries used to be a matter of gambling. If you conceived, you had to speculate whether the child was a boy or was a girl, whether he or she would be tall or short; dark or fair; whether the baby was healthy or whether he or she suffered from genetic conditions or disabilities. Fast-forward to the 21st century and the power of choice and certainty is in the individual’s hands. There has been tremendous evolution in reproduction technology. The doors were opened by the birth of the first test-tube baby, Louise Joy Brown, in Oldham in 1978 after years of research by Dr Bob Edwards and Dr Patrick Steptoe (Snow&Knoppf 2012,P.3) ). Since then, several assisted reproductive techniques have evolved including sperm donation, ova-donation, In-Vitro-fertilization, cyro-preservation of embryos, surrogacy amidst a host of many others( Chan and Ho,2006).The use of assisted reproductive issues have raised various bio-ethical, social and legal foundations. It has struck the very foundation of life and the structure of the family. It has challenged the very basic foundation of the society .Technology has taken the role of biology and medicine can control matters that were traditionally under control of the social domain like parental responsibility, child-birth and child-upbringing. In all matters pertaining to the child, the principle of the best interest of the child must be observed. It has been argued that some of the technologies used as means of assisted reproduction conflict with this principle. There has been need for a regulatory mechanism in terms of social policy and ethical guidelines due to the rapid evolution of assisted reproductive technologies and the consequential alteration of the family structure. Health professionals have been accused of being gate-keepers in that they now have power to determine, who can be and who cannot be a parent. In Australia, the social health policy on regulation of Assisted Reproductive Technologies is contained in The Assisted Reproductive Act of 1988.This paper contains an analysis of the policy and discusses its weaknesses and strengths.The respomnsibility to regulate assisted reproductive technologies in Australia falls with the respective states and not the central government. The Main Health Area:Reproductive Health The right to reproduce and the right to start a family are deemed to be inherent human rights. Infertile couples should have equal right of reproduction with those couples that are able to reproduce normally. Reproductive rights cover a wide range of issues most of which relate to having the power to exercising choice on reproductive decisions such as contraception and family planning. There are the rights of both men and women to choose whether or not to have children, when to have children and with whom (Downie 1988.P. 97). Individuals have the right to the highest available standard of reproduction without discrimination or violence. The right is both positive and negative. It is negative in that it requires privacy and non-interference from the state and it is negative in that it requires the state to provide the necessary resources for full expression of the right. The right to found a family is not a matter of individual autonomy because the concept is linked the society. Society has a role in facilitating reproduction to all people, including, the infertile who are disadvantaged in the reproductive sector (Bambra, Fox and Samuel, 2005, P. 185).This raises the ethical issue of whether the state should fund assisted reproductive healthcare for infertile couples. The Stakeholders The stakeholders in the health policy issue include the legal parents or the people who wish to reproduce, the sperm and ovum donors, surrogates, medical practitioners and the children born from the assistant technology. The Effect of The Policy The Act was enacted to control the issuance of licenses to practitioners offering Assistive Reproductive services, to enhance and increase opportunities for infertile people to access treatments, for purposes of reliable recordkeeping, and to provide for confidentiality for donors, recipients and children born from those arrangements. The Act set up a council to advise the minister responsible for health on the legal, moral, social and bio-ethical issues arising from assisted reproductive technologies. The policy restricted its use to treatment of infertile couples only. Assisted reproductive technologies are only to be offered if a woman appears to be infertile; if the husband or a man living with a woman set to become a mother is infertile; if there is risk that a fatal illness or sickness or a genetic disorder will be transmitted to the child if born naturally ;or if the donor ha died and before death of the donor, his semen or ovum had been harvested, an embryo had been created through assisted reproductive technologies and the donor had consented to the use of these materials upon his death; or on the basis of enforceable surrogacy agreements. Perspective in Relation to The Structure Agency Continuum The policy does not address the social structure effectively .It takes a biased approach towards some groups in the social structure set-up(Snow&Knoppf 2012 ).It addresses the disability of being infertile appropriately as it makes it possible for couples who are infertile to have access to the right to reproduction through assisted reproductive technologies. The gender issue is also well balanced because both infertile males and infertile females can access the treatment. People from all races and ethnic groups can access the treatment because there is no express prohibition in the policy against any racial or ethnic group. The policy fails to address the issues of poverty and social class stratifications in assisted reproductive technologies. Poor infertile couples cannot access assisted reproductive technologies because their cost is expensive and prohibitive. The policy dose not mandate the state or other appropriate stake-holders to fund the couples in need of such treatment yet the right to reproduce is a basic human right( Hashiloni, Kaplan and Rafid,2011,P.3046 ). By insisting that people who should access reproductive assistance should be in a marriage or similar arrangement, the policy wants to ensure that the basic family structure is maintained and is not alienated by assisted reproductive technologies. However this makes the policy discriminatory to singles, The LGBT (Lesbian, Gay, Bisexual and Transgender) Community and to all other people who may want a child but are not in a married relationship. A single infertile woman may want to have a child with an anonymous sperm donor and the policy should have addressed this particular issue. Perspective in Relation to Illness-Wellness Continuum The policy is anchored on treatment of existing infertility and the well-being of a child born out of assisted reproductive technology. It also advocates for early intervention in that an assisted reproductive technology practitioner can intervene where there is danger of transmission f a fatal genetic defect or illness to a child and use a technology such as Pre-Genetic Diagnosis (PGD), also known as offspring engineering to prevent the transmission so that the baby can be born healthy (Snow&Knoppf 2012,P.5). Priority of The Policy The priority of the policy should be the best interest of children conceived and delivered through assisted reproductive technologies. The policy has addressed this issue by proclaiming in the pre-amble to the act that in all assisted Reproductive procedures, the best interest of the child shall be of paramount consideration. To achieve this there must be intensive, regulation of assisted reproductive technologies centers and practitioners. The policy has been successful in enforcing this priority. For a person to practice assisted reproductive technologies he or she has to be authorized by The Minster in charge of health. The approval can be varied or cancelled by the minister on any ground he deems fit (Bambra, Fox and Samuel, 2005).Under section 16, a healthy practitioner who fails to comply with the provision is guilty of a criminal offence and is liable t a fine of $120 000.The health practitioner must hold a license to practice medicine and must comply with all the requirements required for accreditation. The person must specify the type of reproductive assistance technology he or she will be providing and shall only offer such treatment to infertile couples and where he baby is at risk of being born with a genetic defect. Contravention or lack of compliance with the stipulated provisions will lead to the revocation of a license of n assisted reproductive technology facility (Bambra, Fox and Samuel, 2005). To further protect the best interest of the child, the policy requires that a donor conception register should be maintained in relation to birth of a child under the procedures. Section 15 of The Act further provides that the register is to contain the full names of the donors and their contact addresses; The full names of the recipient of the donated gametes; and full names of children conceived from the procedure. The certificate is to be used in legal proceedings for enforcement of rights and liabilities. Under section 17 of The Act, all records are to be kept and maintained efficiently. The centers are to be inspected regularly b authorized personnel to ensure that they comply with the set standards The identity of the donor is to be kept confidential and is not to be revealed unless the donor consents or as authorized by the court of law or under the act. However the policy failed to address the issue of parental responsibility hih is pertinent to the best-interest of the child.it does not spell out the guidelines to be used inderermining who the legal parent is nd who should exercise parental responsibility over such a child(Snow & Knoppf 2002) Participatory Care The policy does not promote social care in the social contexts of individuals or communities because it’s main emphasizes on regulation and accreditation (Chan and Ho, 2006, P. 371). The Australian Health care system has been described as a federal structure with both private and public responsibilities (Belcher, 2011).The challenges facing the system are due to ideological disparities between the leading political parties in Australia. The common wealth government exercises important role both in terms of leadership and financing the health sector. It’s the major source of funds through The Pharmaceutical Benefits Scheme and The Repatriation Pharmaceutical Benefits( Belcher,2011,P.377 ).They also offer Specific Purpose Payments to state and territories; and Medicare for treatment by general practitioners and for services delivered by nurses on their behalf. There is also free medical care for patients who cannot access public health care, generally known as “public hospitals patients (Belcher, 2011).Unfortunately these provisions do not cater for reproductive health care and the policy should be amended to include them. Conclusion Infertility is a medical condition like any other and needs to be accorded due attention and consideration. Access to assisted reproductive healthcare should be a concern of every social or public health policy( ).The common wealth government passed The Prohibition of Human Cloning Act and The Research Involving Human Embryos Act in 2002(Snow&Knopf 2002,P.18)to further regulate the sectir in response to emerging trends.The acts further harmonized implementation and harmonization of the plicy throughout Australia.The fact that reproductive issues are mostly in the private domain should not be a ground of exclusion of the role played by the state or the public in ensuring (An effective health policy on assisted reproductive technologies should access the issue of the appropriate level of technological intervention; The person responsible for determining application of that technology; Whether everyone should have an equal opportunity to access these services; and the effect of the technologies on the child and the entire society. The state should increase funding towards disadvantaged couples in need of assisted reproductive technologies.(Whitehead,1990)Information about the technologies should be dispersed to all sector of the society including rural areas through public awareness forums. Public guidelines should be formulated on who should access the services because currently the decision is left to the discretion of individual practitioners. Public opinion and should be sought in all assisted Reproductive Technology programs. References Bambrai, C., Fox, D. and Samuel, A. (2005) Towards a politics of health. Health Promotion International, 20: 2, Oxford University Press.pp 187-192 Belcher, H 2011, Ch. 18, ‘Power, Politics and Health Care’ in Second Opinion: An Introduction to Health Sociology, 4th edn, J, Germov (ed), Oxford University Press, Melbourne, Australia.pp 376-386 Chan, C. & Ho, P. (2006) Infertility, assisted reproduction and rights. Best Practice & Research Clinical Obstetrics and Best Practice Gynecology, 20:3.pp 369-380 Daniels. and Taylor, K.(1993) .Formulating selection policies for assisted reproduction. Society, Science and Medicine.37:12, pp 1473-1480. Hashiloni, Y., Kaplan, A., and Rafid, S (2011) The fertility myth: Israeli students’ knowledge regarding age-related fertility decline and late pregnancies in an era of assisted reproduction technology Human Reproduction .Reproduction Journal 26:11.pp. 3045– 3053 Snow,D. and Knopff,R.( 2012 ) Assisted Reproduction Policy In Federal States: What Canada Should Learn From Australia.The School of Public Policy.SppResearch Papers.University of Calgary.5:12.PP Kloczko,A. Infertility Treatment and Assisted Reproductive Technology: Legislative and Policy Reform in New South Wales.Retrieved From: http://sydney.edu.au/law/tlc/docs/2209200613294720lkb23.pdf COOKE, S., & FLEMING, S. D. (2009). Textbook of assisted reproduction for scientists in reproductive technology. Fremantle, W.A., Vivid Publishing. GERMOV, J. (2005). Second opinion: an introduction to health sociology. South Melbourne, Vic., Australia, Oxford University Press. Read More