The thought of reproducing should come with no obstacle and negative condensations, but if you have genetic disease predisposition as in Sickle Cell trait or homozygotic Sick Cell disease, it poses a challenge. Sickle Cell disease patients or carriers (sickle cell trait [SCT]) face the challenges of making informed reproductive health decisions or face the suffering of baring SCD children. The offspring of SCD or SCT parents are sir come to complication such as painful vaso-occlusive crisis, frequent hospitalizations, shock, pulmonary embolization and much more. Still many decide to proceed and have offspring.
This dilemma came to my attention while in clinical rotations where I was assigned a 4 years old girl admitted with vaso-occlusive crisis and dehydration as an exacerbation of SCD. This patient was one of four siblings for the same mother and father but was not the only sibling with the disease. It is said that the chances of bearing a child with SCD from the same SCT parent are 25% but not in this case. It purposes the dilemma with SCT parents still choose to have children still knowing or not knowing the medical challenges their children will face.
Nurses can be placed in an ethical distress when presented with similar scenarios. The nurse must promote health, safety and advocate for the future suffering SCD child. It is a dilemma because the ultimate decision would bring pain and suffering to a child when it could have been prevented by the SCT or SCD parents. That is why the American Nurses Association (ANA) (2015), Code of Ethics for Nurses, was put in place to help distinguish and implement a guild line to help nurses cultivate excellent dispositions of character and conduct even in the line of ethical distress (ANA, 2015). Within these set codes of ethics, a nurse must implement in this particular situation beneficence and nonmaleficence to society as a whole in the prevention of harm and pain to future SCD patients. The nurse must provide virtue and keep the human excellence that enables us to be good human beings.
The best outcome of this dilemma comes from providing vast knowledge to the SCD or SCT patients and parents. As stated in Hockenberry, Marilyn, & Wilson (2014), Wong’s Nursing Care of Infants and Children, 10th Edition, teaching them of the negative outcome their children will sir come such as frequent hospitalization for life, vaso-occlusive crisis, and pain management might help put into perspective the life of their offspring will have (Hockenberry, Marilyn, & Wilson, 2014).
The childbearing age women also need to be fully aware of the complications sickle cell status will have on their pregnancy and the potential physical consequences to herself. According to Gallo et al. (2015) Reproductive decisions in people with sickle cell disease or sickle cell trait, informing them on how to share their sickle cell status with their partners and to consider choosing a partner with normal hemoglobin will reduce the burden of sickle cell disease on their children (Gallo et al., 2015). There are also other options with modern science that can be educated on.
According to Wilkie et al. (2013), Reproductive Health CHOICES for Young Adults with Sickle Cell Disease or Trait, utilize in vitro fertilization with preimplantation genetics or fetal prenatal testing for SCD is now an option (Wilkie et al., 2013). Also if sexually active people with SCD decide to avoid conception, they can be educated on the available options for contraception. Another point made in Wilkie et at., (2013) people with SCD or SCT who decide to forgo the options for biological children but want to be parents can consider non-childbearing parenting options such as adoption or foster-parenting (Wilkie et at., 2013). The point is that they should be educated and hope they make the best-informed consideration.
In summery SCT and SCD population baring children with SCD is a dilemma on its own but still can be addressed with ethical guidelines as in those presented in the ANA (2015) Code of Ethics for Nurses. Also, to find the best outcome of this dilemma comes from providing vast knowledge to this population. Where the African descent (1 in 12 carriers of SCT in the US) should be implemented with reproductive choices that are consistent with their parenting plans. There is a strong need to reduce transmission of the disease by educating young people of their sickle cell status before a pregnancy, to share their sickle cell status with partners and to consider choosing a partner with normal hemoglobin to reduce the burden of sickle cell disease on their children.