Table of Contents
One of the areas of scientific studies that has gained so much advancement from modern research is genomics. Through genomics, health practitioners understand the structure and function of genomes, based on which they are able to undertake procedures to solve critical health problems (Rudolph & Möhler, 2014). Fertility is one area that genomics has been used to render interventions such as In Vitro Fertilization (IVF) to women seeking to make babies. In this paper, a case of how an IVF procedure went wrong and resulted in a legal battle is analyzed. It is generally envisioned that should all next best practices and caution have been observed, the problems that rose from the IVF would not have occurred. What is more, there are now opportunities with health information systems (HIS), particularly the use of informatics that can help in avoiding some of the common problems that arise from procedures such as IVF. The place of informatics and how nurses can adopt its usage are also discussed in the paper.
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Description of Case Study and Potential Mistakes
The case is about a 40 year old single Caucasian woman, Ms. Gens who with her partner decided to have a child through IVF. The process therefore involved getting sperm donated to the sperm bank. As a Caucasian woman, Ms. Gens had a preference for sperm donated from a Caucasian man who that her child would also be of Caucasian phenotype. Unfortunately, after delivery, Ms. Gens found that the baby rather had a very distinctive Asian phenotype look. When she first queried, the physician denied, claiming the donor was a Caucasian but DNA test proved otherwise. What is more, the baby was found to have Down syndrome. Currently, Ms. Gens and her partner has sued for 10 million dollars as the sperm bank has admitted to mix-up. Indeed the most potential mistake was that little or no genomics checks were done before the IVF to ascertain the nature of genomes of the sperm being donated. Another potential mistake is that there was ineffective record keeping at the sperm bank, giving rise to the mix-up that was confirmed.
Identified Indicators and What Could Go Wrong
There are scientific researches to show that parents whose children are affected with Down syndrome could be genetically normal, which means a mother does not necessarily have to have the disease to transfer to her child (Torre et al., 2014). In the present instance therefore, there is the possibility that Ms. Gens who is currently 40 contributed to the Down syndrome in the baby. In the same breadth, the likelihood of the disease coming from the sperm donor is also very high. In a more scientifically and evidence based position, it is important to appreciate that the extra chromosome that leads to Down syndrome occurs by chance (Rudolph & Möhler, 2014). In this case also, it is important to note that in mothers aged 40 to 45, the chances of contributing to Down syndrome is 3% but only 0.1% in 20-year-old mothers (Torre et al., 2014). This is also another major indication that Ms. Gens who is 40 years could have contributed to the Down syndrome.
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Physician’s Incomplete Information
As much as Ms. Gens could have contributed to the Down syndrome in her baby, the fact of gross negligence of duty, characterized by incomplete information usage by the physician cannot be overridden. This claim is made against the backdrop that in almost all cases, detection of Down syndrome is possible during pregnancy when mothers go for prenatal screening (Hill et al., 2013). Should the physician have carried his roles adequately and conducted all necessary tests and checks, it is likely that accurate information would have been given to Ms. Gens for her to take decision about the baby at a very early stage of the pregnancy. Indeed a study by Hill et al (2013) confirmed that most pregnancies diagnosed with Down syndrome are terminated. Consequently, Ms. Gens only needed the complete and right information to take decisions about whether to terminate the pregnancy or keep it. Currently, there is no cure for Down syndrome and so it means Ms. Gens does not have any means of correcting the mistake of the physician, including the fact that the baby is of Asian descent.
Bioinformatics, Biomedical Informatics, and Computational Biology
Bioinformatics, biomedical informatics and computational biology are all advanced technological systems that help to make the work of nurses more effective and efficient today (McGonigle & Mastrian, 2014). it is important to note that as far as nursing informatics is concerned, technological advancements are not limited to only few areas of practice but that in sperm banks also, they are used. As noted by Nagle et al. (2014), nursing informatics basically concerns with the combination of nursing science, computer science, and information science. Already, sperm bank nurses are supposed to have gone through the necessary academic training to gain competence in nursing science. The outfits in which they work are therefore expected to provide a working environment that incorporates computer science and information science to attain the standard of nursing informatics. Today, some of the commonest technologies that consist nursing informatics in sperm banks include data infrastructure, clinical information systems, electronic health records, and computerised physician order entry (CPOE) (McGonigle & Mastrian, 2014).
From the types of information technology listed above as part of the nursing informatics used in sperm banks, it can be deduced that the focus of the facilities have been to ensure information delivery can be as perfect, efficient, effective and accurate as possible. In relation to the current case, there are three main ways in which nursing informatics could have been used to save or help the situation. First is the fact that data infrastructure could have been used to preserve information about all men who donate sperm to the bank. Such information could include their demographic and genetic details. The second is that CPOE could have been used in detailing Ms. Gens about the genetic information of her baby while she was still keeping the pregnancy. Indeed, this could have helped in avoiding both the problem with the genotype and Down syndrome. Finally, the electronic health records and clinical information systems could have both help in keeping full records of both sperm donors and mothers seeking IVF procedures.
Sperm Banks DNA Tests on Donors
The issue of donor anonymity remains very controversial in the U.S with no clear regulations or laws, enforcing donors to disclose their identities. It is however important to state that there are several advocacies among civil society groups and other non-state actors (NSAs), seeking to champion the practice of genetic testing for donors. Genetic testing is simply the practice of engaging in DNA testing on donors and keeping their genetic data in systems that makes it possible for either the mothers or babies conceived with donor gametes to trace donors (McGonigle & Mastrian, 2014). one group in the U.S that has constantly pushed for regulations to make DNA testing compulsory is the Donor Sibling Registry. In actual fact, due to the availability of cheap and more detailed technology to undertake testing, the Door Sibling Registry actually hold that donor anonymity no longer exists in the country. It is said that in the U.S, there are currently “over three million people have already used direct-to-consumer genetic testing” (Donor Sibling Registry, 2017).
Some countries and states have taken the issue of DNA testing for sperm donors very far by banning donor anonymity all together. Some of these countries and states are “Austria, Finland, Germany, The Netherlands, New South Wales, New Zealand, Norway, Sweden, Switzerland, UK, Victoria and Western Australia” (Donor Sibling Registry, 2017). In Germany, the Sperm Donor Registry Act was passed in May 2017 to enforce DNA testing among donors. Certainly, in the current case, there are a number of issues that could have been cleared should DNA testing and proper information keeping of donor data have been done. For example if DNA testing was done, there would have been proper labelling of the sperm from the donor to set the tone in using nursing informatics, if available to keep proper records of the sperm. Indeed, this is a situation that could have contributed in avoiding the mix-up that the facility reported.
While advocating the use of nursing informatics within sperm banks, it is important to stress that the processes and procedures that go into it will not be complete if the nurses do not have the right forms of training and skills to operate and use the technologies provided (Collins, 2016). For this reason capacity building for the nurses is a very important requirement when introducing nursing informatics within sperm banks and all other health facilities. The capacity building programs must focus on developing the right skills and competencies among the nurses when it comes to the use of all the types of technologies identified earlier. That is, nurses ought to be abreast with the use of data infrastructure, clinical information systems, electronic health records, and CPOE. There should be regular hands-on practice that ensures that each nurse can independently operate the information systems they are provided. Such hands-on practices are necessary in ensuring that all forms of inefficiencies that could arise from the use of nursing informatics are avoided (Nagle et al., 2014).
It is important to observe that when using nursing informatics and a nurse does not have the right skills and competencies to operate information systems, the kind of mistakes that occurred in the case could be repeated. With such mistakes repeated, the informatics can be said to have been rendered totally useless. Apart from the need to abreast nurses with usability skills, it is also important to ensure that the ethical roles of nurses are taught and applied. While using information technology, nurses ought to be aware of both legal and ethical principles that guide their conduct. For example the nurse has a role to protect the anonymity and confidentiality of sperm donors even when they undertake DNA testing (Collins, 2016). that is, the fact that people have take DNA tests does not mean their data should be made available in the public domain without their consent. The same level of ethical consideration ought to be taken for mothers seeking children also. as part of ethical practices, patients should be allowed to choose the sperm bank and donor of their choice without making choices for them. They must also be made to sign unto consent forms.
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The Couple’s Potential Legal Case and Summarization
With regards to all the key points outlined above, it would be pointed out that there was one main legal issue that arise from the entire case, which is negligence of duty. Negligence is therefore the potential legal case that the couple can bring against the sperm bank as a whole and the physician as a person. In U.S tort law, there a duty of care, which is a form of legal obligation binding an individual, particularly a professional to adhere to standard of reasonable care when they are engaging in acts that can possibly cause harm to another person (Jacoby & Scruth, 2017). Refusal to adhere to this comes with serious legal implications, based on which negligence of duty has been selected as the potential legal case that the couple can put up. There are a number of elements of negligence claims that can be specifically identified or associated with this case. They include duty of care, breach of duty, and factual causation. However, no evidence can be given to intention and/or malice and physical harm.
Technological advancements are important to all fields of health science, including sperm bank services. with advancements in health science, scientists now have a better understanding of genomics and how to use nursing informatics to preserve data accurately on sperms to avoid mistakes. In the case presented, most best practices that could have been followed were neglected. There was also gross negligence of duty, which emanated mainly from the disregard of use of the right forms of technologies in getting things done correctly. In the current circumstance, avoidable mistakes have already been committed, including irreversible ones such as the Down syndrome in the baby from the sperm donor. It would therefore be concluded that allowing the law to take its course by compensating Ms. Gens seems the only viable way possible. Going into the future, it is expected that sperm banks will not find themselves paying so huge from lawsuits when such amounts could have been used to equip and upgrade into nursing informatics, while giving nurses the right training to use technology.
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- Collins, S. (2016). Nursing Informatics Competencies: Psychometric Validation, Dissemination, and Maintenance of Self-Assessment Tool for Nurse Leaders. In Nursing Informatics, 4(5), 710-712.
- Donor Sibling Registry (2017). DNA Testing. Retrieved August 8, 2017 from https://www.donorsiblingregistry.com/helpful-info/dna-testing
- Hill, M., Fisher, J., Chitty, L. S., & Morris, S. (2013). Women’s and health professionals’ preferences for prenatal tests for Down syndrome: a discrete choice experiment to contrast noninvasive prenatal diagnosis with current invasive tests. Obstetrical & Gynecological Survey, 68(3), 171-173.
- Jacoby, S. R., & Scruth, E. A. (2017). Negligence and the Nurse: The Value of the Code of Ethics for Nurses. Clinical Nurse Specialist, 31(4), 183-185.
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- Torre, R., Sola, S., Pons, M., Duchon, A., Lagran, M. M., Farré, M. & Pujadas, M. (2014). Epigallocatechin‐3‐gallate, a DYRK1A inhibitor, rescues cognitive deficits in Down syndrome mouse models and in humans. Molecular nutrition & food research, 58(2), 278-288.