Ethical ASPECT of

reproduction system
dr. Ratih Yulistika Utami, M.MedEd
outline
• Surplus embryo (definition,
causes, ethical and law aspects)
• Sex selection (method, ethical
and law aspects)
• Abortion (definition,
classification, ethical and law
aspects)
Surplus embryo
 embryos resulting from the
DEfinition IVF procedure that are not
returned to the uterus
(genetical mother) for which
the embryo has no hope for
the future
 1) the impact of stimulation on the ovaries to get a
higher number of ovum, so that it becomes more
efficient to get good quality embryos and a higher
pregnancy success rate,
2) the mother does not want to get pregnant anymore
because of the success of pregnancy in the previous
IVF program, while still having frozen embryos at
causes the IVF Clinic,
3) the couple is divorced,
4) the embryos cannot be transferred to the mother due
to illness or accident,
5) for personal reasons, the mother does not want the
embryos transferred to her uterus, and
6) the mother dies.
 Permenkes no. 43 tahun 2015 pasal 14
The excess embryos are transferred to the
wife's uterus within 2 years at the most,
unless the married couple asks to extend
the embryo storage

law Peraturan pemerintah no. 61 tahun 2014

excess embryos can be extended every 1
year for the benefit of further pregnancies.
Pasal 43
Excess embryos are prohibited from being
implanted in the mother's womb if the
father dies or is divorced and is not allowed
to be implanted in another woman's womb/
surrogate mother.
what happens to
embryos that are not
extended in storage?
1. Embryo extermination.
2. Donate to infertile spouses to
get a pregnancy and a baby.
3. Donation for research (stem
cells, development embryos,
and organs) .
4. Donate for embryologist
candidate training or medical
students
 • Option 1
Which Who will be the executor? Isn’t
one do embryo a living thing?

you • Option 2
Surrogate mother? Legal
agree? aspects? Pregnancy readiness?

And • Option 3 & 4

Will the research be more
why? profitable for the embryo?
 Medical indication Patients
• Pregnancies preferences
program • Want to have
• Further children more
Four Box pregnancies than one child
• Donate for
methods infertile,
research
Quality of life Context
• High social • high income
status family or not
• Relieve stress • Cultural context
• Serenity  surrogate
mother
SEX SELECTION
Assisted reproductive technology (ART)

• A treatment for gametes (ovum, sperm) and embryos as an

effort to get a pregnancy outside the natural way, not
including human cloning or duplication.
• Can give opportunities for couples who are difficult to have
children or are infertile to have children so that their
reproductive rights can be guaranteed.
 Pasal 28B Undang‐Undang Dasar 1945.

Pasal 10 ayat (1) Undang‐Undang Hak

Reproduct Asasi Manusia Nomor 39 tahun 1999
tentang Hak Asasi Manusia (UU HAM)
 everyone who has the right to form a
ion right family and continue their offspring
through a legal marriage

Pasal 2 UU No. 1 Tahun 1974 tentang

Perkawinan (UU Perkawinan) 
Legitimate marriage
LAW
Pasal 40 PP No. 61 Tahun 2014 tentang
Pasal 127 ayat (1) dan (2) Undang‐Undang No.
Kesehatan Reproduksi à ART can only be done
36 tahun 2009 tentang Kesehatan à attempt
by a married couple who are bound by a legal
pregnancy outside of its natural way
marriage and experiencing infertility
2009 2014

2014
Pasal 1 angka 10 PP No. 61 Tahun 2014 à
definition of ART
 • Pasal 44 PP No. 61 Tahun 2014
ART for selecting the sex of the child is
SEX only intended for the second child and
furthermore, the intention is that the
SELECTI selection of the sex of the child can only

ON be done before the fertilization process

occurs by separating the x and y sperm.
 Sperm Pre-implantation
sorting Genetic
Sex Diagnostic (PGD)

selection
Process Before After fertilization
methods fertilization
Accuracy 75-80% Almost 100%
Cost Less More expensive
expensive
 Medical indication Patients
• X-linked preferences
disorders: • Family
Thallasemia, balancing
Four Box Duchen
Muscular
methods Distrophy
Quality of life Context
• Phsycological • Cultural context
aspect  paternalistic,
maternalistic
• Religious 
change takdir
• KODEKI 
ABORTION
definition
 • SPONTANEOUS ABORTION
classificat • PROVOCATION ABORTION
ion  MEDICINALIS
 CRIMINALIS
 Medical Patients
indication preferences
• Life • Rape victim
threatening
Four Box • Genetic
disorders
methods Quality of lfe Context
• Poor • Quality of
• Psychological: medical facility
trauma, • Religion: kill a
depression baby
• Children future • Cost 
life without a medical
dad insurance
 Pasal 75 UU No. 36 tahun 2009
1) Everyone is prohibited from having
an abortion
2) The prohibition as referred to in
point 1) can be excluded based on:

LAw a.Medical indication

b.Rape victim
3) Point 2) can be done after going
through pre-action counseling and/or
advisors and ends with post-action
counseling carried out by a
competent and authorized counselor
 PP 61 tahun 2014 pasal 31 ayat 1 dan 2
abortion may be performed with a
maximum fetal age of 40 days from the
first day of the last menstrual period..

LAW PP 61 tahun 2014 pasal 34 ayat 2

In addition, there must be a certificate
from a doctor stating the gestational age
that corresponds to the time of the rape as
well as a report from police investigators
and psychologists stating that the incident
was purely an incident of rape.
 PP 61 tahun 2014 pasal 35 ayat
1
Rape victims must also get
quality, safe and responsible
abortion services
LAW
KUHP Pasal 346-350
Penalties for perpetrators and
people who assist with abortion
 • Qs. An Nisa: 93
“Dan barang siapa yang membunuh seseorang mukmin
dengan sengaja maka balasannya adalah neraka
Jahanam, dan dia kekal di dalamnya, dan Allah murka
kepadanya dan melaknatnya serta menyediakan baginya

Islam
adzab yang besar”
• Qs. Al Isra: 31
“Dan janganlah kamu membunuh anak-anakmu karena

perspectiv takut melarat. Kamilah yang memberi rezeki kepada

mereka dan kepadamu juga. Sesungguhnya membunuh
mereka adalah dosa yang besar”

e
• Qs. Al Maidah:32
“Barang siapa yang membunuh seorang manusia, maka
seakan-akan dia telah membunuh manusia
seluruhnya....”
• Qs. Al Isra:33
“Dan janganlah kamu membunuh jiwa yang diharamkan
Allah melainkan dengan alasan yang benar”
islam
perspective
• DThe embryo is a living
thing, but it is not blown
by the spirit until 120 days
after conception. After 120
days, the embryo becomes
"human".
 Discussion forum rules

Read these three cases You will discuss in Use four box methods as
because we are going to group for 15 minutes and a tool to discuss the case
discuss it later on present your results for 5
discussion forum minutes
 A 34-years-old woman came to Clinic
with her husband to do a pregnancy
program because she has been married for
10 years but has not yet had children.
After examining the couple, the doctor
recommended IVF. Ovun and sperm have
Case 1 been taken, but when the embryo was
implanted into the uterus, the patient had
an accident. The accident resulted in
death.
As a doctor, how do you handle the
embryo? Why?
 A 38-year-old woman came to Clinic with her
husband to plan her first pregnancy. They have
been married for five years and are desperate for
having failed two inseminations. They asked the
doctor to use the update technology to have a
boy because her husband is Batak tribe. The risk

Case 2 of their wife's age is also a consideration for

them to have a boy from this first pregnancy.
They cover all the costs necessary for the
program. The doctor explained that he would do
IVF and PGD to get the male gender.
Explain your point of view as a doctor related to
this case!!
 A 17-year-old girl was brought by her
mother to the hospital for a pregnancy
check. Her mother said that an unknown
man raped her daughter, after that she has
refused to talk. When the doctor
examined the patient, she said that she
Case 3 wanted to keep the pregnancy, but she
does not have cost to deliver and raise the
baby and her parents does not want to
handle it. She kept silent because she had
no choice rather than follow her parent’s
decision.
What should you do as a doctor?
 Note:
Please be well-prepare for the discussion forum
because there will be a pre-test and post-test!!!
references
• Budiyanti, RT. 2015. Aspek Etika Pre-implantation Genetic Diagnosis (PGD) pada Teknologi Bayi Tabung.
CDK: 42(7), p 542-44.
• Budiyanti RT, Lumbanraja AD. 2020. Perbandingan Hukum Pemilihan Jenis Kelamin dengan Reproduksi
Bantuan di Indonesia dan Inggris. SOEPRA Jurnal Hukum Kesehatan: 6(1), 33-44.
https://doi.org/10.24167/shk.v6i1.2627
• Dewanto A, Hanoum IF, Suryaningtyas DA, Widad S, Yudhitama I, Fatmala DG, et al. Studi Pendahuluan
tentang Perspektif Ilmuwan Islam dan Katolik dalam Dilema Etika Surplus Embrio serta Opsi Pemecahan
Masalahnya. JEKI. 2018;2(2):79-86. doi: 10.26880/jeki.v2i2.20.
• KUHP Pasal 346, 347, 348, 349, dan 350.
• Maruqq L, Atkinson MN, Fernandes A. 2014. The Five-Box Method: The “Four-Box Method” for the
Catholic Physician. The Linacre Quarterly:81(4), p.363–371.
• Peraturan Pemerintah No.61 tahun 2014
Thank you
If you have inquiries, contact
me at ratihyulistika@umsu.ac.id