Abstract
Sometimes medical errors should not be disclosed. We report a case of semen samples exchange, during a homologous artificial insemination procedure, where a bioethics consultation was required. The bioethics consultation addressed ethical and legal elements in play, supporting non-disclosure to some of the subjects involved. Through a proper methodology, gathering factual and juridical elements, a consultant can show when a moral dilemma between values and rights—privacy versus fatherhood, in our case—is unsubstantial, in a given context, because of the groundlessness of the value or the right itself. However, being the error elicited by organizational factors, a broader ethical pronouncement was needed. Under such circumstances, ethical evaluation should engage in a sort of ‘ethical-based root-cause analysis’, linking ethical principles to quality aims and showing the opportunity to integrate ethical methodology in healthcare management. From this perspective, errors may become an incentive to promote high-quality organizations, attending to the central value of person even through the organizational process.
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Notes
Our aim is not to analyze ethical or legal issues in homologous or heterologous insemination. In our case, the HAI procedure is just a clinical circumstance, that arises challenges about error disclosure and organizational failures. Thus, for a general introduction on the topic, see: Andrews, L.B. 1987. Ethical and legal aspects of in vitro fertilization and artificial insemination by donor. The Urologic clinics of North America 14(3): 633–642. About the removal of anonymity from sperm donors: Burr, J.A. 2013. Anonymous or known donors? A brief discussion of the psychosocial issues raised by removing anonymity from sperm donors. Human fertility: journal of the British Fertility Society 16(1): 44–47. Several papers discussed the opportunity to disclose the gamete donation or the gamete donor's identity to donor-conceived children, and the related social and ethical problems: e.g. Greenfeld, D.A. 2008. The impact of disclosure on donor gamete participants: donors, intended parents and offspring. Current opinion in obstetrics & gynecology 20(3): 265–268). On the psychological harm of disclosure for donor-conceived children: Somerville, M. 2011. Donor conception and children's rights: “first, do no harm”. Canadian Medical Association journal 183(2): 280. Moreover, some authors argued that the donor may have a right to information about conceived children, but not the right to identify them: Raes, I. et al. 2013. The right of the donor to information about children conceived from his or her gametes. Human reproduction 28(3): 560–565. All these papers, anyway, are focused on the voluntary sperm donation, that is not applicable to our case.
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Acknowledgments
We thank the staff of Padua Bioethics Service for its continuous support, and Lucia Mariani for the editing.
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All the authors contributed to the paper and approved the version as submitted for publication. A.P. developed the medico-legal analysis for the Bioethics Service. M.C. wrote the paper, framing the analysis from an organizational ethics perspective. R.P. led the management of the case for the Bioethics Service, and revised the paper from a clinical ethics perspective.
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Colucci, M., Aprile, A. & Pegoraro, R. Evaluating non-disclosure of errors and healthcare organization: a case of bioethics consultation. Med Health Care and Philos 18, 607–612 (2015). https://doi.org/10.1007/s11019-015-9659-0
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DOI: https://doi.org/10.1007/s11019-015-9659-0