| Background and ObjectivesAt present, the infertility rate increases due to environmental pollution, lifestyle changes and postponed age of marriage and maternity. WHO reports that 10% couples at childbearing age have infertility problem. It is estimated that there are 10 million households may have fertility problem in China with the figure 50～80 million in the word. Although it is not acute and fatal condition, but it become hot topics resulted as millions of families suffered which bring serious social problems. With the development of Human Assisted Reproductive Technology (including artificial insemination and in vitro fertilization, namely embryo transfer and its derivative technology),'infertility couples'have the chance to get a baby. At the same time, advance of the techniques have brought many ethical issues which challenge ethics and moral norms nowadays. It has become an important issue that how to reconciling this contradiction and resolve this crisis through standardizing service.Responding these issues, the international society introduces a number of laws and regulations. China had also issued "technical specifications, basic standards and ethical principles" on Human Assisted Reproduction in 2001 and revised in 2003. These laws and regulations standardize the practice of Human Assisted Reproductive Technology and minimize the negative effects of the technology.The objectives of this study include:To describe knowledge and belief of ethical principles among infertility patients and services providers in threeTo describe how those medical institutions implement the ethical principlesTo explore the methods that could optimize the effectiveness to the patients.MethodsThis study is a quantitative survey, which conducted a questionnaire. Target population:Healthcare providers in three hospitals of Shanghai who provide the services on Human Assisted Reproductive Technology that approved by the Ministry of Health and their infertility patients. Self managed Questionnaire:Demographics information of doctors and patients (age, occupation, education, etc.); perception of informed consent and ethics education by doctors and patients; doctors and patients' knowledge and belief on ethical principal and the hot issues. EPIDATA3.1 used to input the data and SPSS 13.0 to analyses.Results1. Both doctors and patients know less of the ethics principal and regulations of human assisted reproductive technology. The training to the healthcare providers and the ethics education to patients on ethics fall behind.According to the survey, we found 50% healthcare providers and patients can't provide the correct answer to the questions which cover seven important ethical principles of Human Assisted Reproduction in China.63.2% of healthcare providers didn't receive any form of ethics training. Only 26.6% patients and their relatives had ethics education and counseling when they visit doctors.2. The ethics committee in grass-root hospitals is incomplete for their composition, progress on the work, lack of standardized procedures and low effectiveness.To composition of ethics committee in three hospitals need to be improved for lack of psychologist and socialist refer to requirement by Ministry of Health and routine of international community.70.1% health services providers scored the performance of ethics committee in their own institutions as very good or relative good. Only 28.5% of them reported satisfaction for their own institutions on the performance of ethics committee working in the field of Assisted Reproductive Technology.3. The acceptance and satisfaction of informed consent implementation is not high. The effective of informed consent implementation need to be improved.The patients must understand related topics through informed consent by service providers before any procedures on human assisted reproductive technology could be actually handled according to the ethical principles issued by Ministry of Health. The survey showed that only 24.7% patients completely know treatment procedures, costs, adverse effect and other information.29.4% of them selected the item of "fully understand the relevant contents" after signed name on consent documents.58.9% reported that they were satisfied with the implementation of informed consent, with only 41.8% healthcare providers did so. 4. There are significantly different opinions on the hot issues related to reproductive ethics between doctors and patients. The laws and regulations need to be improved in order to guide the behavior of both sides.Survey shows that both perception and knowledge of doctors and infertility patients have difference on topics including the surrogate way to get children, the properness on usage of embryos for scientific research, should patents inform their children for the mode of nurture after insemination be obligated or not, and other hot issues of reproductive ethics.Suggestions1. To enhance the popularity of ethical knowledge in common people and to strengthen ethics education.. Discipline of medical ethics should be developed and strengthened. Medical ethics education should be carried out for all medical students in the college, especially to those in the internship phase. The continuing education of medical staff should include topics on ethics. Practical medical ethics guidelines and professional operational manual should be developed. The standardized training system on medical ethics should be established. Patients should receive ethic knowledge in multiple levels, through multiple approaches and with multiple forms. Set up the model for informed consent practice with good patient-doctor interaction to improve patient understanding.2. Ethics committee should be set up at all levels and functionalized their roles in healthcare organizationTo improve the organizational framework. The Ethics Committee should increase the number of non-medical staff and consider the beneficence of patients. Access system and audit standards for medical ethics committee should be drawn up, the registration of medical ethics-committee and ethics committee member qualification. Improve the working mechanism. Established by the hospital ethics committee, professional ethics working group composed of department liaison work ethic multi-level organization of work of Hospital Ethics Network. And the Office of the Permanent Hospital Ethics Committee, improve the working mechanism.3. Innovate ethics work with open-minded ideas and rigorous scientific attitudesTo help patients solve the ethical puzzles and problems through opening telephone hotline and setting up counseling clinics. To strengthen the supervision and review of the ethical evaluation on the spot. To further develop review system and relevant rules in details and regularly carry out investigations on patients to find the problem in ethics, and improve the services.4. Perfect relevant laws and regulations of human assisted reproduction It is better to speed up the legislative process by the National People's Congress for "Artificial Reproduction Act", and make sure it in accordance with the basic laws such as civil law. Improve human assisted reproductive Principles on Technology, Norms, Ethics, in particular provisions of protection of the rights of test-tube baby, the legalization of surrogacy and embryo disposition should be more detailed, clear and specific. |
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