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Seeds: role-play, medical drama, and ethical exploration

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Seeds: role-play, medical drama, and ethical exploration

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Content  
 
 
 
SEEDS:
ROLE‐PLAY, MEDICAL DRAMA, AND ETHICAL EXPLORATION 
 
 
 
 
by
 
 
Nahil T. Sharkasi 
 
 
 
 
 
 
A Thesis Presented to the
FACULTY OF THE USC SCHOOL OF CINEMATIC ARTS 
UNIVERSITY OF SOUTHERN CALIFORNIA 
In Partial Fulfillment of the 
Requirements for the Degree 
MASTER OF FINE ARTS 
(INTERACTIVE MEDIA)

 
May 2010 
 
 
 
 
 
 
Copyright 2010 Nahil T. Sharkasi 

ii
Acknowledgements 
 
I would like to faculty, staff and students of the Interactive Media Division for 
their support of Seeds. Thank you to Fox Interactive for granting me the 2009 Fox 
Interactive Thesis Fellowship to fund this project. Thank you my advisors Tracy 
Fullerton, Laird Malamed, Steve Anderson, and Topper Lillian. Tracy, thank you for 
being my fairy godmother over the past three years and teaching me everything I know 
about game design. Laird, thank you for your critical insight, and excitement (and for 
saying that playing Seeds was the most fun thing you’d done all day). Steve, thank you 
for encouraging this idea from the beginning when it was, in fact, just a seed and 
nurturing it into it’s final being. Topper, thank you for your expertise and guidance on 
shaping the characters in Seeds who make this experience so compelling. 
Thank you to all the USC students, graduates, and friends who donated their 
time and talent to bring Seeds to life: Amy Akmal, Sama Al‐Wasmi, Michael Annetta, 
Sean Bouchard, Tristan Camacho, Emily Duff, Evan Greenstone, Gavin Keese, Garrick 
Lee, Nite Luo, Abier Sikta, Thenmozhi Soundararajan, Elizabeth Swensen, James Taylor, 
Diane Tucker, and Hartley Voss. 
Thanks to all the actors featured in Seeds: Anne, Apra, David Babbit, Wilson 
Better, Clara Clonch, Dominic Conti, Michelle Faraone, Jenni Fontana, Cassie Fliegel, 
Carolyn Grayber, Cupid Hayes, Sara Jester, Alphonso Jones, John Richard Lewis, Tushar 
Mali, Jhil McEntyre, Jeffrey H. Newman, B. Love Orr, Zandra Palma, Ashley Patterson, 
iii
Mariella Redlin, Richard Sabine, Patrick Stack, Vesna Tolomanoska, April Wade, 
Anastasia Washington.  
Thanks for Dr. Sangita Jindall for inspiring this work, and to the doctors and staff 
of California Fertility Partners.  
And finally thanks to my friends and family for their support and 
encouragement: my mother Magda Fehema‐Sharkasi, my father Dr. Tawfik Sharkasi, my 
brother Adam Sharkasi, and my sister in‐law Brittany Sharkasi. To the cousin mafia: 
Fairouz Fahema, Rihab Elhaj, Nawarah Khalil, Hiba Khalil, Iya Khalil, Abier Sikta, Mariam 
Ingersoll and Reem Khalil.
iv
Table of Contents 
Acknowledgements 
 
ii 
List of Tables 
 
v 
List of Figures 
 
vi 
Abstract 
 
vii 
Introduction 
 
1 
Project Overview 
 
4 
Goals and Measures for Success 
 
7 
User Experience & Methodology for Provoking Ethical Decision 
Making 
10 
Survey 10 
Challenge 13 
Response 13 
Evaluate 
 
14 
Mechanics of Ethical Evaluation 
 
17 
Ethics & Consequences 
 
25 
Enhancing Positive Play Experience 
 
28 
Development Process 37 
Prior Art Review 37 
Paper Prototype 44 
Digital Prototype 47 
Testing 
 
48 
Current Status & Next Steps 
 
50 
Conclusion 
 
52 
Glossary 
 
54 
Bibliography 55 
v
List of Tables 
 
 
Table 1: Weighting Decisions for Level of Impact 
 
18 
Table 2: Ethical Decision Making Weighting Matrix 20 
 
 
vi
List of Figures 
 
Figure 1: Main Game Interface 
 
4 
Figure 2: Survey Screen 
 
10 
Figure 3: Miracle Worker Play Pattern 
 
16 
Figure 4: Entrepreneur Play Pattern 
 
16 
Figure 5: ICSI Mini‐Game 
 
30 
Figure 6: Embryo Transfer Mini‐Game 
 
31 
Figure 7: IVF Mini‐Game 
 
32 
Figure 8: IUI Mini Game 
 
33 
Figure 9: Winter Show Playtest 
 
36 
Figure 10: Paper Prototype 
 
45 
Figure 11: Paper Prototype with Social Play 
 
45 
 
 
vii
Abstract 
 
In the field of fertility medicine, technology has vastly outpaced our ethical, 
legal, and social frameworks leaving us in a quagmire of gray morality. Seeds is a role‐
playing and simulation game about assisted reproductive technology and its effect on 
the shape of the 21
st
 Century. Players play the role of a fertility doctor and must make 
difficult ethical decisions through courses of treatment while balancing economic, 
emotional, and scientific concerns. With Seeds, the goal is to foster meaningful 
decision‐making that may echo from the game world into the real world by employing 
role‐play and creating a safe space for expression and exploration of ethical issues.  
 
 
1
Introduction 
Babies are in. Between the Octo‐mom, Jon and Kate, and the Jolie‐Pitt brood, baby 
stories are leading media sales (Washington). Often missing from these stories, 
however, is the ever‐increasing use of Assisted Reproductive Technologies (ART) and the 
ethical complexities that come with it. With new technological approaches to 
reproduction come emergent ethical situations. The field of fertility medicine is one 
area among many in the modern world where technology has vastly outpaced our 
ethical, legal, and social systems leaving us in a snarl of gray morality. We are becoming 
increasingly aware of the physical risks that come with the luxury to control the specific 
circumstances of the process of birth– chief among them multiple births and pre‐
maturity. The rapidly growing population of parents and caretakers of premature 
children, and children conceived using ART, face unique challenges. This game will 
illuminate some of the consequences of using ART for people facing some of the real 
challenges those technologies give rise to – as well as those who judge or moralize 
about those who use such technologies (Levitt).
At the core of each ethical conflict surrounding ART is the essential question of life 
and death that resonates intimately with each individual. Whether players have 
specifically considered this topic before or not, everyone has an opinion. The conflicts 
that arise from the availability of new reproductive technologies are receiving more and 
2
more coverage in popular media. While the drama of how many embryos to implant, or 
which donor to choose unfolds across news media, this project, Seeds, specifically 
explores what it would mean to more actively engage with these ethical situations.  
 Ethics Simulations are fast becoming a niche in the field of interactive media, and an 
increasingly necessary tool to navigate the murky waters left in the wake of speeding 
technological advancement. Ethics Simulation software is currently in wide use for 
training in corporate ethics, financial ethics, biomedical ethics, and many other fields.
Last year, the United States Office of Government Ethics developed their own ethical 
training software CD Rom based on their ethical training protocol (1). Like most ethics 
simulation software, this CD Rom uses some multimedia and limited interactivity to 
teach users a pre‐determined code of ethics, where law has already established the 
codes. For example, in a sexual harassment training simulation, the goal of the 
experience is to clarify the established right and wrong codes of behavior, even within 
socially ambiguous situations. In areas of emerging technology, however, there are 
many ethical questions to which a right or wrong has not yet been commonly agreed 
upon and codified by law. Whereas the goal of many current ethics simulations for 
established fields is to direct audiences to a ‘correct’ answer, role‐playing games can 
provide alternative ways of understanding and evaluating ethics (Simkins 70). I argue 
that there is an increasing need for a virtual space for ethical exploration that lets the 
user understand their own ethical decision‐making process and the implications of the 
3
choices they make to help navigate areas like ART where emerging technology yields 
emergent ethical conflict. 
 
4
Project Overview 
Seeds is a thought‐provoking, interactive experience that positions players at the 
center of bio‐ethical debate. Part serialized medical drama, part online role‐playing 
game, Seeds prompts players to assess their own beliefs to determine an ethical 
treatment solution using Assisted Reproductive Technology. Through engaging role‐play 
in which players treat and diagnose infertility using cutting‐edge and controversial 
technologies, players learn how each decision shapes their world and the fate of the 
characters in it. The goal of Seeds is to provide a compelling narrative environment that 
facilitates reflection and safe exploration of ethical issues. 
 

Figure 1: Main Game Interface 
 
5
Where Seeds differs as an exploration space from other ethical simulation software, 
is in the fact that the ethical code for the field of fertility medicine is emergent. In 
other, more established disciplines, where the ethical standards are widely known and 
agreed upon, the purpose of ethical training and simulation is simply to educate the 
users on those established ethical standards. In the United States, within the field of 
ART, a sharp distinction between right and wrong has not yet been fully established and 
codified by law. The primary need is to better understand the implications and 
consequences of ART, rather than to rain an audience on a code of ethical behavior.
Thus Seeds is designed more as a space for safe exploration of ethical issues than a 
simulation that drives players to arrive at a pre‐determined conclusion. The goal of 
Seeds is to spark an “aha!” moment that lets the user understand their ethical decision‐
making process and the implications of the choices they make. 
In creating the game system, I began with standard role‐playing game structures: 
many characters (patients), quests (treatments), resources (money) and inventory (eggs, 
sperm, embryos). In order to have face making personal, gut‐level decisions, I chose to 
create an embodied first‐person experience where the player puts him or herself in the 
decision maker’s shoes. Seeds begins with the premise that the player is a new doctor 
at a top fertility clinic. The player is asked by ‘The Board of Directors’ to take a survey as 
part of the new‐employee paperwork. The results of the survey cast the player as one 
of three profile types, described in detail below. Next, the game starts, and the player 
6
consults with patients, treats them and follows‐up with the results, making critical 
ethical decisions at each step of the way. Meanwhile the game system tracks each 
decision the player makes and evaluates it to see whether or not the player’s behavior is 
consistent with his or her beliefs as declared in the introductory survey. 
Rich characters and fictional worlds are the hallmarks of a role‐playing game. The 
narrative elements and structures of Seeds are borrowed from TV medical Drama. As in 
television series like Nip/Tuck or House, each episode presents two major narrative arcs 
commonly described as the ‘A Story Line’ and the ‘B Story Line’. The A Story Line always 
involves one or more of the main characters – the doctors, and the B Story Line involves 
the minor characters – the patients. As in the example of Nip/Tuck, the B Story Line is 
often thematically linked to the A Story Line in such that the narrative conflict presented 
by the patient characters mirrors challenges, or otherwise engages the dramatic conflict 
of the A Story Line. In adapting this narrative structure to a game, the player’s dramatic 
arc is the A Story Line, and the patients , the B Stories, serve to challenge and engage 
the player. This structure presented in an immersive first‐person experience deepens 
the player’s ethical involvement with the content. Further, the choice to use video to 
represent the characters, rather than avatars or 3D models, affects the player’s empathy 
and consequently his or her ethical behavior, serving the project’s goal of not only 
entertaining, but engaging the player’s ethics on ART (Griggs 1). 
 
7
Goal and Measures for Success 
When the goal of an interactive experience or game is more than to entertain, game 
designers often invoke the notion of ‘meaningful play.’ As described by games scholars 
Katie Salen and Eric Zimmerman, meaningful play “occurs when the relationships 
between actions and outcomes in a game are both discernable and integrated into the 
larger context of the game” (30). The communicative and persuasive power of a game 
lies in the game’s mechanics, or procedures (Bogost 28). While the in‐game procedures 
of Seeds are not faithful representations of what a doctor does, they are a comment on 
the mechanization of reproduction, and are prompts for ethical reflection on conflicts 
that are representative of conflicts outside the game world. Games scholar Miguel 
Sicart defines players of computer games as ethical beings interested in the actions and 
goals defined by a game’s design and therefore implicitly interested in “how that design 
can affect our moral fabric as ethical players” (24). Whereas meaningful play is 
contextualized within the “magic circle” of the game, meaningful decision‐making is 
about connecting the player as an ethical being to the game world’s actions and 
consequences.  
My goal with Seeds is to evoke not only meaningful play, but also meaningful 
decision‐making that may suggest parallels between the game world and the real world.
The strategy I employ draws parallels between the fiction and actions of the game world 
8
that exist within the magic circle to the conflicts and actions of the real world that the 
player inhabits. For my purposes, meaningful decision‐making is a necessary element of 
ethical reflection, and I contend that both meaningful play and meaningful decision‐
making are best fostered when contextualized within a rich and immersive narrative 
world.  
In order to address this objective, Seeds uses role‐play that involves the player’s own 
personal beliefs. The game system challenges those beliefs through traditional role‐
playing game mechanics. The decisions the player makes are then evaluated within an 
ethical framework that is constructed according to real ethical situations from the 
scholarly literature in this field of medicine. The result is an immersive narrative‐driven 
game experience that both educates and provokes thought without leading players to a 
predetermined resolution.
There are several user cues and behaviors that I use to evaluate whether or not each 
design decision serves the goals of the project. The first is a player’s desire to follow the 
story, to know ‘what happens next’ in each episode. This indicates player engagement 
and the success of a narrative‐driven play experience. The second cue I look for is the 
experience of the “yuck” factor or the “aha!” moment. The “yuck” factor is described in 
this field of medicine as the gut reaction against a particular decision, case, or 
procedure, and is a key factor used to determine the ethical soundness of treatment 
decisions (Kohl 237). Doctors rely on an elusive gut reaction to inform their ethical 
9
choices, and if the player experiences the same reaction, this indicates that the 
connection to the doctor role is successfully established. The final measure of success is 
the “aha!” moment. This is the most important indicator that the player has 
experienced a change in opinion or a moment of reflection on his or her stated beliefs.
This can occur early in game play if one of the early patients quickly prompts the player 
to behave differently than indicated in the intro survey, or it can happen later as a 
pattern of behavior develops over the course of many decisions, and the system points 
out to the player that his or her behavior is inconsistent with their player profile. If this 
information elicits an emotional response, or a pause where the player takes notice of 
what has happened, the methodology of the system has been successful. 
 
10
User Experience & Methodology for Provoking Ethical Decision‐making 
The methodology used in Seeds to elicit emotional response and ethical reflection 
has four parts. First, the game assesses the user’s ethical point of view; second, it 
challenges that stance through rich media; third, it solicits a response to that challenge; 
and fourth, it compares that response to the initially declared ethical point of view. 
 
Survey 

Figure 2: Survey Screen 
 
Upon starting the game, a new player’s first task is to complete a survey that 
assesses their general point of view on some key ethical issues surrounding Assisted 
Reproductive Technology. Based on the survey results, the player is assigned one of 
11
three player profiles: ‘The Entrepreneur’, ‘The Mad Scientist’, ‘The Miracle Worker’ – as 
well as a mission statement appropriate to that profile.  
 
– ‘The Entrepreneur’ believes fertility medicine is a service industry where the 
customer is always right. 
– ‘The Mad Scientist’ supports the advancement of science, experimental 
technologies, and research.
– ‘The Miracle Worker’ favors strong familial relationships.  
 
The main function of this survey is to calibrate the player’s ethical position in order 
to evaluate the decisions he or she makes, and to determine whether they are indeed 
consistent with their declared mission statement. This also allows the system to track 
whether or not the player has changed their mind over the course of play. The tertiary 
function of the survey is to prime the player to own the role and decisions he or she 
makes. Other details, such as creating an interface design that resembles a first person 
point of view to an office patient management system, also serve to support the 
player’s performance in the role. 
The survey contains 8 questions touching on the key areas of controversy in the field 
of Assisted Reproductive Technology as outlined in Ethical Issues in the New 
Reproductive Technologies, (Hull) and other literature. These topics include:
12
– Right to treatment – Is reproduction an inherent right? Should treatment be 
covered by insurance? Who sets the price for treatment? 
– Risky technologies – Should ART be regulated? 
– Donor anonymity – Does a donor’s right to anonymity trump a child’s right to 
know his or her biological origins? 
– Third party parents (donors, surrogates, gestational carriers) – what is the legal 
and social status of these individuals? Does a social, legal, or biological 
relationship take precedent? 
– How many embryos should be created in a course of treatment? How many 
should be implanted with each transfer? 
– When is the best time implant the embryos? An early, three day transfer is 
riskier. Waiting until blastocyst stage (five days) is safer but could ultimately 
lead to more disappointment. 
– Selective reduction ‐ is this practice ethical? Can you risk the life of one to 
save many, or many to save few? On what basis can we selectively reduce a 
pregnancy (gender, health, ease of access)? 
– What to do with leftover embryos? Can they be used for scientific research?
Should they be destroyed or kept frozen in perpetuity? 
 
 
13
Challenge 
Once the player’s profile is established, the system delivers custom content to 
challenge their particular stance. For example, if a player in the intro survey states that 
donor anonymity should be outlawed, once the game starts that player will receive a 
patient case with a compelling request for an anonymous donor. These cases are 
presented as integral stories told in three acts: 1) Consultation, 2) Treatment, 3) Follow 
Up, and presented using a variety of media. The first act of each patient case is told in a 
brief Consultation scene with actors playing the patients. The second act, Treatment, 
consists of interactive game play, and the third act, Follow Up, is told in images and text 
with mild interactivity. 
 
Response 
Once the player’s ethical stance has been assessed and challenged, the final step is 
to codify and systematize their reactions, and the risks and rewards associated with 
each decision. In considering Bartle’s four player types, Sicart assesses that players can 
only be motivated towards actions and goals that the game affords (94). Therefore, in 
designing customized reward systems and goals for each player profile type I designed 
not only a compelling play experience for each, but a moral universe that 
accommodates each profile’s point of view. In upholding the design goal of creating a 
safe space for ethical exploration, it is vitally important that the game’s reward system 
14
not reflect the designer’s own personal ethical stance. Rather than simply rewarding 
‘morality points’ for some actions over others, I created a system that is entirely context 
specific, ensuring that ethical decisions can be evaluated differently depending on what 
the player’s mission statement is. The player’s pattern of behavior is tracked and each 
decision is tallied into the score.  
 
Evaluate 
An essential part of the player feedback system is meaningful consequences for 
each action taken in the game. Each player action deserves an equal reaction from the 
game system, however all actions in Seeds are not weighted equally. The choice of 
whether or not to accept a patient is a personal choice made by the doctor and would 
only impact the doctor and the patient. Conversely, the decision of what to do with 
leftover embryos impacts not only the doctor and the patient, but the embryos 
themselves, adoptive families who would adopt embryos, scientists who would benefit 
from using those embryos in research, as well as having implications for the 
classification of embryos and the cessation of human life, which are ultimately 
government policy and legal issues. Each decision the player makes is evaluated for 
both its magnitude and directionality, and then compared to the profile type chosen by 
the player to see if the player’s pattern of behavior is consistent with his or her profile.
For example, a decision to support the donation of leftover embryos to scientific 
15
research favors the ‘Mad Scientist’ player profile, while a choice of an open donorship 
favors the ‘Miracle Worker’ profile. 
The game becomes more complex when players make choices counter to their 
declared profile and mission statement. Once the system satisfactorily tracks and 
evaluates each ethical decision, the next challenge is to provide feedback and 
consequences so that the player feels the weight of their actions in the world. Players 
receive feedback in the form of letters from the Board of Directors, which either 
congratulate them for upholding the mission statement or reprimand them for diverging 
from it. When a player’s decision pattern skews too far in one direction, the player is 
presented with consequences in the form of news events or correspondence from non‐
player characters, for example a headline related to recent game actions that may have 
positive or negative implications for the player. Again, it is important that the game not 
steer the player to make one decision over another, but provide an engaging 
environment to make different decisions and see the repercussions for those decisions 
in world. 
 
16

Figure 3: Miracle Worker Profile Figure4: Entrepreneur Play Pattern 

 
17
Mechanics of Ethical Evaluation 
I began crafting the game’s evaluation system by seeking out the ethical and legal 
frameworks currently in use in this field, such as the guidelines issued by the UK’s 
Human Fertilization and Embryology Authority (Deech and Smajdor 3). I found that 
ethical decisions are classified as having consequences in personal, professional, group, 
and government arenas (Hull 2). I decided to weigh each decision according to the 
sphere of influence where it was most relevant. The weight of the decision is 
determined by how many people it affects (table 1). 
 
18
Table 1: Weighting Decisions for Level of Impact 
Level of decision’s impact Point value weight
Government +4
Group +3
Professional +2
Decision For
Personal +1
Neutral 0
Personal ‐1
Professional ‐2
Group ‐3
Decision Against
Government ‐4
 
Each ethical decision point is tracked with three indices for each of the three profile 
types. The value of each decision is also weighted depending on which profile type it 
favors. The treatment phase of game play introduces the use of an ethical decision‐
making weighting matrix (table 2). The matrix assigns point values to each decision in 
the game according to level of impact of the decision, and which profile type it favors.
19
For example, a decision in favor of the ‘Mad Scientist’ profile that only has impact on a 
personal level is valued at +1 (a decision that just passes the ‘Yuck’ test), while a 
decision that impacts governmental policy, such as a life‐defining policy decision, is 
valued at +4. Conversely a decision that hinders the cause of the ‘Mad Scientist on the 
Government level would receive a ‐4, and a decision that doesn’t pass the Yuck test is 
given a ‐1. 
 
20
Table 2: Ethical Decision Making Weighting Matrix. 
Decision Entrepreneur Mad 
Scientist
Miracle 
Worker
Accepting a patient*
∗
‐1/+1 ‐1/+1 ‐1/+1 1
Rejecting a patient* ‐1/+1 ‐1/+1 ‐1/+1
Prescribing experimental technology 0 +2 ‐2 2
Prescribing more expensive treatment +2 0 ‐2
Choosing Donor Anonymity 3 3 ‐3
Choosing Open Donorship ‐3 3 3
3
Choosing Delayed Disclosure 0 0 3
Harvesting the maximum number of gametes 3 3 ‐3 4
Harvesting the minimum Number of gametes ‐3 ‐3 0
Fertilizing the maximum number of eggs ‐3 3 ‐3 5
Fertilizing the minimum number of eggs 3 ‐3 3
Choosing 3 day transfer 3 ‐3 ‐3 6
Choosing blastocyst‐stage transfer 0 3 3
Choosing to selectively reduce a multiple 
pregnancy
4 4 4
Choosing not to selectively reduce a multiple 
pregnancy
0 0 ‐4
Reducing a multiple pregnancy to a single 4 0 4
7
Reducing a high‐order (quadruplets +) multiple 
pregnancy to low order multiples (twins, 
triplets)
4 0 4
Keep Leftovers Frozen 4 0 4
Donate to Science ‐4 4 ‐4
Donate to Adoptive Family ‐4 ‐4 4
8
Destroy 0 ‐4 ‐4
 
The first decision the player makes in consulting with a new patient is the 
decision to accept or reject the patient for treatment. The only information the player is 
given at that point is narrative information about the patient. The game is soliciting a 
pure ‘gut‐reaction’, and this decision should be made purely based on the player’s 

∗
 The specific value of these decisions depends on the nature of the patient case, and which profile would favor it. 
21
personal feelings. Since financial information does not factor into this decision, it can be 
classified as a decision that only affects the personal sphere. In applying the above‐
mentioned ethical framework as a weighting system, a personal decision has less weight 
than a professional, group or government decision. The “accept/reject” decision is 
weighted as either a positive or negative 1, given which profile type the case naturally 
favors. 
The second decision the player impacts on a professional level. After accepting a 
patient, the player must then prescribe a treatment. The player is given two options for 
treatment. Each is described in terms of how much revenue it will generate for the clinic 
and what the likelihood of success is. This decision is about balancing economic 
concerns and professional concerns, while still not violating a player’s personal gut 
choice that made them accept the patient in the first place. The choice of treatment is 
weighted at a positive or negative 2. 
Once a course of treatment is prescribed, the next set of decisions is about 
considering the family as a group. This is called the ‘Check List’ phase, and is where the 
player verifies that the patient has all the right components in order to proceed with 
treatment. The ethical decision point arrives if the patient requires the use of a sperm 
or egg donor, surrogate, or gestational carrier. When third parties are involved in the 
reproductive process, the consequences can often be unpredictable for the doctor who 
may, in some cases, be held responsible for facilitating the relationship. In the ‘Check 
22
List’ phase of the game, the patient has two ethical choices to consider: the donor 
agreement and the choice of donor. 
The donor agreement is the contract that details the relationship the donor is to 
have with his or her offspring. In the real world brokers, or agencies outside the medical 
establishment often negotiate this contract, but for the purposes of including this 
important ethical choice in the game, the player is asked to advise his or her patient on 
a donor agreement. The three choices are 1) anonymity, 2) open donorship, and 3) 
delayed disclosure. In choosing anonymity, the player is effectively placing the rights of 
the customers, the parents, above the rights of the child. This decision is weighted 
positively for the ‘Entrepreneur’ and ‘Mad Scientist’ profiles, because studies show that 
anonymity encourages donation (Mundy 181). In choosing open donorship, the player 
is supporting a child’s right to know his or her biological parent. This decision is 
weighted positively for the ‘Miracle Worker’ profile and negatively for the 
‘Entrepreneur.’ Choosing delayed disclosure is somewhat of a middle ground, it is 
considerate of a donor’s privacy for a limited time, but ultimately favors a child’s right to 
know his or her genetic origins. This third choice is weighted as a neutral for the 
‘Entrepreneur’ and ‘Mad Scientist’ and positively for ‘Miracle Worker.’ Regardless of 
the choice, the decision is based on a consideration of another person or small group, 
and is thus weighted with a positive or negative 3. 
23
Similarly, the decision of how many eggs to retrieve and fertilize, how many 
embryos to transfer, and when to transfer them is most relevant to the patient family as 
a group, so this decision is also weighted as a positive or negative 3. 
The decisions in the remaining portion of the treatment cycle, through the 
Conception and Results phases, are weighted the highest, with a positive or negative 4 
because of their relevance to an ongoing national dialogue on the nature of life and 
death, and have implications for policy decisions in those areas. These decisions are 
weighted much more heavily because of legal precedents that link fertility medicine to 
the abortion and end‐of life debates. 
One of the most common risks of Assisted Reproductive Treatment is the 
possibility of multiple pregnancy. When a patient has multiple embryos implanted 
successfully or an implanted embryo unexpectedly splits as becomes increasingly 
common with age (Mundy 273), the doctor and patient are faced with the difficult 
decision of selective reduction. They must consider, especially in the case of high order 
multiples, reducing the pregnancy to ensure the health of the mother and the remaining 
embryos. In the game, if a patient has a multiple pregnancy, the player has the choice 
to reduce or not, and is also asked on what basis to choose the fetuses that will be 
reduced ‐ gender, health, or location in the uterus. 
The final ethical decision in the treatment cycle comes up after a positive result 
is achieved from IVF treatment. As multiple embryos are often created in the process, 
24
the player must advise his or her patients on what to do with left‐over embryos. There 
are four choices: keep them frozen, donate them to science, donate them to adoptive 
families, or destroy them. Each choice has advantages and disadvantages for each 
profile type. For example, donating leftover embryos to adoptive families is favorable to 
the ‘Miracle Worker’ but not to the ‘Mad Scientist’ who would rather use the excess 
embryos for research. Destroying leftover embryos seems like a waste to the ‘Mad 
Scientist’ and the ‘Miracle Worker’, but to the ‘Entrepreneur’ it’s seen as the elimination 
of a liability. 
As compelling as these conflicts are, their presence alone is not enough to create 
ethical game play. Ethical actions and decisions must yield meaningful consequences in 
order for the player to engage in the conflict and feel the weight of his or her decisions. 
 
25
Ethics & Consequences 
Ethical game play arises when the game world responds to the player’s values, 
and the player is positioned within the “network of responsibility of the game”(Sicart 
159). Consequences tie the player to the game world and the network of responsibility.
The evaluation process described above is hidden from the interface, and feedback on 
the player’s ethical choices and behaviors is presented in terms of consequences.
Periodically throughout the game, when a pattern of behavior emerges (i.e., behavior 
favoring one profile becomes dominant), the player is given feedback about the 
decisions he or she has been making.
There are two tiers of consequences in Seeds: the player level and the level of 
the game world. On the player level, the system tracks the ethical decisions made in the 
game, and periodically assesses whether or not they are consistent with the player’s 
profile. If the two scores are consistent, and the player indeed is acting according to his 
or her stated beliefs, he or she is awarded a financial bonus from the clinic’s Board of 
Directors. If, however, the player’s pattern of decisions is inconsistent with his or her 
stated profile – if the self‐declared ‘Miracle Worker’ is behaving more like an 
‘Entrepreneur,’ for instance – the player takes a financial penalty accompanied by an 
admonition from the Board of Directors. This penalty or bonus is small and serves less 
26
to encourage or discourage specific choices, but rather to point out to the player what 
their beliefs and choices might look like if manifested in real scenarios.
The second tier of consequences is in the game world. ‘News Events’ arise 
periodically from the game world indicating what the world would be like if the 
decisions the player has supported were proliferated throughout society. For example, 
if a player consistently decides against anonymous donorship, he or she might get a 
News Event that anonymous donorship has been outlawed.  
An advantage of playing through different ethical decisions in a virtual space is 
the ability to compress time, and explore the diverse consequences of different choices.
In Seeds, the consequence of making one ethical choice over another is framed as 
pushing the game world’s ethical position towards the worldview of one of the profile 
types. I wanted to be careful not to impose my own opinions on the content, but to 
allow the player to use the game system to see what would happen if everyone in the 
world made the same decisions they had made in the game. Consequences in this game 
are not inherently positive or negative, but are relative to the player’s profile and the 
choices he or she has made.  
As a formal game element, consequences appear like chance cards in Monopoly.
Every so often, the player is dealt a ‘consequence event’ that carries a financial penalty 
or bonus, or other rule change. As a narrative element, it appears in the player’s in‐
game inbox as a news article, message from a colleague, or other correspondence. If a 
27
player consistently chooses an open donor agreement for his or her patients, he or she 
might receive a ‘consequence event’ with a headline declaring that Anonymous 
donorship has been abolished and subsequently the inventory of donors has decreased.
The system tracks which profile type the player is most closely following, and issues 
consequence events related to the worldview that each profile represents. For 
example, the ‘Entrepreneur’ favors a world with an unregulated fertility industry; the 
‘Mad Scientist’ favors a world with government funding for human embryo research; 
the ‘Miracle Worker’ favors a world with laws that support and protect children and 
families.
 
28
Enhancing Positive Play Experience 
By the time of the second round of playtests, I had incorporated all the ethical 
content points, but balancing the content with compelling game play remained a 
challenge. In the initial playtests of the paper prototype, I had set the probability of 
successful treatment in each patient case at 60% ‐ 90%. In reality IVF usually has a 30% 
probability of success per cycle. As much as ART has become a game of skill and 
resources, conception still holds an undeniable random element that needed to be 
represented in the system. The question presented itself: can a game still be engaging if 
there’s only a 30% chance of success? I went back to paper to try to solve this problem.
I tried a number of variations to simulate a 30% success rate and avoid frustrating game 
play. I tried a statistical 30% for each round over multiple rounds; I also tried increasing 
the probability slightly each round, so that by the fourth round, the player had a 75% 
chance of achieving a positive result. This solution was a little more satisfying to the 
player but still lacked a strong enough sense of agency. 
In the next iteration of tests, I tried a more nuanced approach to calculating 
success rate, where the specifics of the patient case are factored in with the user’s 
inventory (power ups) and experience (the player’s success rate). The quality of the 
sperm, egg, and womb each comprise 30% of this score; 5% was given to power‐up 
inventory items such as fertility drugs, new equipment, etc.; 5% was given to the 
29
player’s own success rate indicating the doctor’s experience in the game. This became 
known as the ‘Check List Score’ in the game. The science on infertility supported this 
breakdown, but it still didn’t give the player much agency.
To address the problem of user agency, I decided to introduce a series of skill‐
based mini‐games that simulate the various reproductive technologies featured in the 
game – In Vitro Fertilization (IVF), Intrauterine Insemination (IUI), and Intracytoplasmic 
Sperm Injection (ICSI). Each game presents a variation on a targeting or shooting 
mechanic, whether the player are targeting eggs in petri dishes, sperm cells under a 
microscope, or an egg traveling down a fallopian tube. The simple mechanic is a 
rhetorical comment on the mechanization of reproduction and makes players aware of 
the doctor’s hand in the reproductive process where ART is used(Bogost 28). Many 
commonly used game mechanics and genres can be read as allegories for reproduction, 
whether shooting at a target or a diminutive hero traversing an inhospitable 
environment in a side‐scrolling platformer (Roof 5).
The results of treatment would be decided by a combination of statistical data 
and performance, giving the player much more of a sense of agency than would a simple 
dice roll. The mini‐games also provide a break from the rhythm of the game, creating a 
more dynamic and varied experience. The success or failure of a patient’s treatment 
would be calculated by multiplying the mini‐game score by the ‘Check List Score’ 
30
mentioned above. The Check List Score was turned into a percent value that is used as a 
multiplier for the mini‐game scores.  

 
Figure 5: ICSI Mini‐Game – Player must “aspirate” or collect as many sperm cells as he or she can in the allotted time. 
 
31
 
Figure 6: Embryo Transfer Mini‐Game – Player must shoot the embryos at the targets to implant them in the uterus. 
 
The scoring system for each mini‐game is slightly different depending on the 
mechanic. The IVF mini‐game is an inverted shooting gallery where the player must 
inseminate eggs in Petri dishes as they move along a conveyor belt. In this case, the 
final results would be calculated as follows: if the patient’s checklist score is 85%, each 
of the Petri dishes that the player successfully targets would be given an 85% chance of 
survival. The system would generate random numbers for each, and calculate how 
many embryos were successfully created. 
32

Figure 7: IVF Mini‐Game ‐ Player must target the eggs in the Petri dishes moving along the bottom of the screen. 
 
The IUI ( also known as Artificial Insemination) mini‐game uses a more standard 
shooting mechanic where the player must target a single, slowly moving egg at the right 
time. Once again, the patient’s checklist score would be multiplied by the player’s 
accuracy score in the mini‐game, which would in turn be used to calculate final results.  
33

Figure 8: IUI Mini‐Game – Player must target the slowly moving egg in order to inseminate it. 
 
Another challenge of creating a positive play experience while staying true to the 
content and balancing the ethics goals of the project was providing rewards for each 
unique player profile. Player types and behaviors are dependent on the context, design, 
and affordances of the game (Sicart 94). It was insufficient to have money be the key 
scoring mechanism in the game and reward system. Further, it spoils the underlying 
evaluation mechanism if players’ behavior is motivated by anything other than their 
own ethical beliefs. If a player makes a choice that earns him or her more money in the 
game, it should be because that choice expresses the player’s point of view, not because 
earning the most money is the only way to ‘win’ the game or have a positive play 
34
experience. The ‘Entrepreneur’ player type would certainly play to earn the most 
money, but what would motivate the other two profile types? 
To address this, I incorporated other achievements and narrative rewards that 
would appeal to other player types. To appeal to the ‘Mad Scientist’ profile, the game 
rewards players with new gear and scientific honors. I adapted the content of what was 
the game inventory system into reward badges and achievements so this player profile 
could be rewarded with new equipment, technologies, and scientific awards. A ‘Mad‐
Scientist’ player who would be motivated by these rewards, rather than focusing on 
earning money to purchase these items and thereby behaving out of character, could 
focus on the aspects of game play that he or she finds compelling and subsequently be 
rewarded for that. 
Similarly to appeal to the ‘Miracle Worker’ player, I incorporated narrative 
rewards in the “Baby Wall” feature. Almost all fertility clinics display photographs of 
patients who have been successfully treated along with their new children. In the game, 
when a patient is successfully treated, their photos go up on the Baby Wall. Players can 
visit the Wall at any time and review their achievements. Clicking on the photos in the 
wall also reveals a flash‐forward‐style follow‐up that tells the final chapter in the 
patient’s story, so players can continue to visit with patients as time passes. This is also 
another way to illustrate consequences on a smaller scale than the formal consequence 
events, but still keeps the player involved with and responsible for these characters. 
35
Non‐player characters were also added to guide and frame the experience. The 
Board of Directors serves to keep the player in check with his or her decisions. The 
Nurse character is the player’s associate, and voice of the tutorial and help features.
She is also featured off camera in the consultation scenes to advocate for the player. 
The user interface of Seeds is presented as a first person view of an office, with 
interface elements representing items that might be commonly found on a doctor’s 
desktop such as and email inbox and patient files. The player is meant to feel like doctor 
and what he or she sees on screen is what the player character would see seated at his 
or her desk in the game world. In addition, during playtests and presentations, players 
have been given the option of wearing lab coats. The embodied first‐person experience 
increases the player’s subjectivization as the agent in the game, and thus increases the 
player’s installation in the player character role (Sicart 83). This subjectivization is key 
for both the ludic experience of the game, but also for the player to own his or her 
actions as an ethical player. 
36

Figure 9: Winter Show Playtest 
 
37
Development Process 
This project has been through four phases of development. The first stage of 
development consisted of discovery and background research. The second phase 
involved the creation and testing of a paper prototype. The third phase of development 
saw the implementation of the system developed with the paper prototype in a digital 
form. The integration of the ethics methodology also happened in the second phase.
The fourth phase of development was about refining the digital prototype and testing 
the methodology.
 
Prior Art Review 
 
In conceptualizing Seeds as a hybrid between tv medical drama and online role‐
playing games it was important to incorporate elements from both genres. In 
considering the narrative elements of the game, I turned to the tv medical dramas 
Nip/Tuck. This show offers archetypal characters and often, ethical debate presented in 
the interplay between the “A” and “B” storylines. In addition to borrowing from these 
narrative structures, I was also interested in how the complicated relationships between 
characters found in large ensemble dramas can be illustrated, and how this data 
visualization task is often adopted by fan communities. For this, I turned to Heroes, 
38
Lost, and The L word. Like in The L Word, the complexity of the character relationships 
in Seeds is engendered by the very nature of content. 
• Nip/Tuck , F/X, 2003 – Present 
o Emmy and Golden Globe Award winning cable television series 
surrounding the ethics, controversy and drama of plastic surgery. Each 
episode of this procedural drama opens with a new patient consultation.
Dr. McNamara and Dr. Troy then play good‐cop/bad‐cop debating the 
merit of the case – Dr. McNamara promoting the ethical side, and Dr. 
Troy promoting the financial or ego driven reasons to take the case. The 
debate between the two doctors provides compelling dramatic conflict, 
especially in cases where one betrays the other.  
o www.niptuck.com 
 
• The L Word, Showtime Networks, 2004 – 2009 
o This primetime series about lesbians in Los Angeles used visual graphics 
to illustrate the relationships and connections between all the characters 
in the show. Commonly known as ‘The Chart’, this graphic was 
introduced in an episode where one character charted all her sexual 
partners, and their partners, tracing a path linking her to another 
character. The fan community took this and began making charts of their 
39
own and sharing them online. Showtime, developed this idea into a 
social networking site for fans of the show and their communities called 
ourchart.com, which was dismantled when the show finished its sixth 
season. 
o www.thelword.com 
 
In considering the formal elements of the game system I turned to casual online 
role‐playing games as well as console games based on soap‐opera and procedural tv 
drama. Role‐playing games, for instance, focus on developing characters through 
experience, accumulating wealth and status, and managing resources or inventory 
(Fullerton 416), and this seemed a natural genre choice for developing my game system. 
• Sharkrunners, Area/Code 2007 
o A fantasy‐career, role‐playing game with sporadic game play. Players 
assume the role of a shark researcher, charting a course through the 
Great Barrier Reef, chasing sharks in a giant game of tag. Players are 
alerted every several hours by email and are awarded with video upon 
completing a successful dive. This pattern suspends the players disbelief 
and adds to the authenticity of the player’s role as shark runner. The 
player is rewarded with video which increases authenticity of the 
experience and the player’s installation in the role. 
40
o www.sharkrunners.com 
 
• Mafia Wars, Zynga 2008 
o One of the most played games on facebook, Mafia Wars is a casual, 
massively multiplayer online role playing game, in which players level up 
through the ranks of the mafia, taking on various jobs, increasing their 
inventory of weapons and real estate, and battling friends and other 
mafias for supremecy. Mafia Wars leverages players’ facebook friends as 
resources in the game, creating a fun social and viral experience. The 
structure of “jobs” in Mafia Wars informed early design of patient 
treatments in Seeds. 
o http://www.zynga.com/games/index.php?game=mafiawars 
 
• Do I Have a Right?, OurCourts.org 2009 
o Browser based flash game aims to teach middle school students about 
their constitutional rights. Players run a law office, recruiting lawyers 
with expertise on certain constitutional issues, and match them to clients 
that come in to determine whether they have a case or not, and whether 
the case will be successful in court.  
o http://www.ourcourts.org/flashgames/dihar/index.html 
41
 
• NationStates, Max Barry 2002 
o An online management simulation game where players assume the role 
of a leader of their own country. Players design their nation, and then 
manage issues, uprisings, and crises.  
o www.nationstates.net 
 
• Trauma Center, Atlus 2005‐2008 
o Award winning Japanese game series for Wii and Nintendo DS where 
players take on the role of Doctor Derek Stiles, treating hospital patients 
and following the drama as it unfolds. This game incorporates 
sensationalized, soap‐opera style drama into the game play. 
o www.atlus.com/trauma_center/ 
 
• CSI: The Game Series, Ubisoft 2003‐2008 
o Adventure and Simulation game for PC and console that follows the 
procedural structure of the popular television series. This game 
simulates the use of CSI technology to place players in the role of a CSI 
detective.
o http://csi.us.ubi.com/ 
42
 
Further, in considering ways to explore the controversial subjects of ART and bio‐
ethics, in Seeds, encountered many different approaches, from the political, to the 
social, to the sensational.
• BioCom, Critical Art Ensemble 1998 
o A parody of a biotechnology company website which points out the 
terrifying absurdity of advancements in genetics and other biological 
engineering. The realistic style of BioCom’s web presence both serves 
the satire of the piece and compels viewers to dig deeper into the 
content. This style is also found in may Alternate Reality Games, and is a 
style I would use in Seeds to suspend users’ disbelief.  
o www.critical‐art.net/biotech/biocom/
 
• Donor Sibling Registry, Wendy and Ryan Kramer 2000 
o An online social network dedicated to connecting, educating, and 
supporting donor families. This site connects children conceived with 
donor egg or sperm with half‐siblings and genetic parents. This site 
would be an inspirational resource for narrative content, as well as a 
resource for observing what kinds of communication modes and patterns 
43
are used when trying to make connections between people in this 
specific context. 
o www.donorsiblingregistery.com 
 
• Inconceivable, NBC 2005 
o A primetime television drama based around the lives of doctors, 
psychologists, and patients at a fertility clinic. The show was canceled in 
its first season. Critics described it as overly sensationalist and highly 
exaggerated, but without the wit or sex appeal of Nip/Tuck (Smith). 
o http://www.imdb.com/title/tt0460089/ 
 
Finally, in considering approaches to ethical game play in Seeds, I examined the 
following games which are often cited as works that present the player with a moral 
challenge or choice.  
• Black and White, Lionhead Studios 2001 
o The quintessential “God game” in which players rule over the world of 
Eden. The world and creatures in it evolve and change depending on the 
player’s benevolent or evil actions. This game allows players to 
experience moral choice and consequences in a rich virtual environment. 
o http://www.lionhead.com/BW/Default.aspx 
44
 
• BioShock, 2K Games 2007 
o Often cited as a game that features ethical choice, BioShock asks players 
to make choices about resources that are veiled as moral choices by the 
game’s narrative. The player must harvest a resource “ADAM” from Little 
Sisters, half‐dead little girls. The player is given the choice to kill the Little 
Sisters for resources or save them for fewer resources.
o www.BioShockgame.com 
 
Paper Prototypes 
The first iteration of Seeds was developed as a paper prototype that was played 
by teams with an emphasis on discussion and cooperative decision‐making. The goal 
was to see if the narratives I had collected based on research with fertility specialists 
and patients were compelling enough to sustain engagement in the system. My focus 
was on the potential for episodic narrative and dramatic suspense to motivate game 
play.  
45

Figure 10: Paper Prototype Figure 11: Paper Prototype with Social Play 

In the first playtest, three teams of two people each played. I asked them first to 
agree on a name for their clinic and a mission statement. Asking players to first agree 
on something helped established a core game mechanic and inviting them to customize 
their clinic added a sense of ownership that I felt would add to the weight of the 
choices. 
Each team was asked to keep track of their revenue and success rate. On each 
turn I distributed a folded slip of paper to each team. The first paper revealed the first 
act of each patient story, the Consultation. It also indicated a dollar amount for revenue 
and a percentage for the probability of success. The teams were asked to read the 
consultation and decide whether or not to take the case. If they decided not to take the 
case, it was thrown into the center for another team to pick up. After they made their 
decision, I dealt them another patient. The turn lasted five minutes, and scores were 
46
tallied at the end. At the end of the turn, each team calculated the revenue they had 
received from each patient, and then began “treatment”.  
In this early paper prototype, treatment consisted of a random draw of a coin 
out of a bag, given the statistical probability for success for that patient. The treatment 
phase introduced a branching narrative, where the next act of the story was revealed 
and would be different depending on positive or negative results. After all the patients 
in the round were treated, I assessed which team had earned the most money, and 
which team had the highest success rate. I rewarded the winning teams with ‘follow up’ 
points, limited resources they could use in subsequent rounds to reveal the final act of 
each patient arc. The goal here being that players would seek the ‘follow up’ points so 
that they could learn the final act of each story.
The results of this early play test supported my assumptions about player 
engagement in ethical decision making. In deciding whether to accept or reject 
patients, players were considering the mission statement they had declared during 
game set up, and basing their decision on those criteria. This was an important moment 
that informed the use of mission statement and the design for the decision evaluation 
system in the final digital game. Players were indeed engaging in social discussion 
within the team. Players also found the narratives compelling, and were successfully 
motivated by the desire to reveal each successive act of the patient’s story. 
47
One unanticipated mode of play emerged out of the discussion of patient 
stories. Players began to discuss other similar stories that they had heard in the news. I 
asked them to write down the stories in the same format as the patient profiles and I 
added them to the deck for the next round of play testers. As a result, the addition of 
user generated content feature was subsequently incorporated into the final design. 
 
Digital Prototypes 
The first playtests confirmed that the content I had gathered was compelling, 
and it did map well onto a game system. The system that emerged began to seem more 
and more like a role‐playing game system. I chose to incorporate more elements from 
this game genre, adding an inventory of machines, drugs, and technologies that could 
improve the probability of successful treatment. Inventory items could then be 
purchased with the money earned. I also defined the three specific aforementioned 
player roles, each with their own mission statement, and unique ability.
This increased detail and specificity made for more interesting game play, but it 
did not address issues of player agency, and ethical choice. The random assignment of 
positive or negative results of treatment left players feeling unsatisfied. After 
researching the subject further, I agreed that the simplicity of basing the success/failure 
outcome of treatment on one statistic was both unsatisfying and untrue to the 
sophistication of the science and system I was attempting to model. I did not want to 
48
simply create a management simulation about running a fertility clinic. I wanted to 
incorporate ethical decisions and consequences into the game’s core mechanic. My 
next step was therefore to increase the complexity of the treatment phase of the game 
to match the content, specifically by including all the key ethical decisions that a doctor 
and patient would have to consider in the course of fertility treatment. 
 
Testing
In testing my methodology for ethical game play, I looked behavioral cues to 
further support what research suggests – that role‐play and emotional engagement with 
rich content is a sound strategy for encouraging ethical reflection. If, upon responding 
to the ethical challenges each patient posed, players developed a play pattern that was 
inconsistent with their profile type, and the players recognized their behavior in the new 
play pattern, I would know that the system was working. I watched for the ‘aha’ 
moment, where players may change their opinions about Assisted Reproductive 
Technology or learn something new about their own beliefs. 
Proof of concept for this project came early on during the paper prototyping 
phase. During a playtest, a player self‐identified as an ‘Entrepreneur,’ believing solidly 
that, like any other medical service, fertility medicine was primarily a business. She 
began by accepting all lucrative patients regardless of their low probability of success.
By the fifth patient, her behavior suddenly changed, and she began rejecting patients 
49
with low probabilities of success, stating that she was “feeling like slime” for taking 
advantage of patients and giving them false hope. The player confessed to changing her 
mind about one aspect of Assisted Reproductive Technology.  
During a later playtests of the digital prototype, one player exhibited a stuggle 
with the introduction survey. With each question, she vocalized what she thought the 
“correct” answer was, though her personal opinion differed. This illustrates a 
recognition of an ethical debate with multiple valid points of view. This player was 
profiled as a ‘Mad Scientist’ upon starting the game. After losing money early in the 
game, she began to consistently prescribe the more expensive treatments. Her play 
pattern cast her as the ‘Entrepreneur’ profile type. Similarly, another playtester who 
was profiled as a ‘Miracle Worker’ type at the start of the game, found herself playing 
more like the ‘Mad Scientist’, when she wanted to her patient to donate her leftover 
embryos to science, rather than have them adopted. 
As players are confronted with more developed characters, rendered in video 
and images, as well as text, players were less inclined to reject patients casually 
illustrating an emotional connection to the characters and the ethical struggles they 
present. Where players do consistently reject patients, it is because of a clearly stated 
moral objection. This at least proves that players are ethically engaged in the content. 
50
Current Status & Next Steps 
The highest priority in designing the digital game is highlighting the ethical 
decisions and engaging ethical reflection. A single player game positions the player as 
the sole agent in the system, increasing the relevance of the player’s ethical agency and 
his or her ties to the system (Sicart 163). In order to focus on this goal, and contain the 
scope of the project during the third stage of development, I decided on a single player, 
time‐based system and limited the degree of granularity of the content I would 
represent in the game to the eight aforementioned decision points and three 
treatments: IVF, IUI, ICSI. In future iterations of this project, the goals would also be 
served by re‐incorporating social or cooperative play as well as increasing the quantity 
and granularity of content. 
Future possibilities for expanding the experience include further developing the 
player profile types, and the narratives featured in the game. The three profile types 
currently featured in the game represent the over arching archetypes and viewpoints in 
this field of medicine. Expanding upon these three roles and increasing the level of 
detail and nuance would enrich the experience. Further, developing the patient 
characters and their narrative could also increase empathy for the characters and enrich 
the experience. Also, as the methodology for ethics evaluation continues to be 
51
rigorously tested, it may prove useful to apply this methodology to other fields of study 
with emergent ethical conflict, such as financial ethics or military ethics. 
52
Conclusion 
Three opposing forces frame the ethical issues surrounding Assisted Reproductive 
Technology: scientific advancement, economic constraints, and patients’ desires (Hull).
Technology allows us to create life in ways that have never before been possible, 
however the long‐term risks involved in using this technology are not fully understood.
The fertility industry is largely privatized and unregulated. Profit motives lead to rapid 
growth and sometimes irresponsible and reckless treatment of patients. Also, as a 
consumer industry, doctors are often compelled to honor patients’ requests, even 
where they conflict with the patients’ best interest. These three forces map very clearly 
onto traditional role‐playing game elements. Players earn money by treating (or 
cheating) patients. Doctors advance science by taking risks, and putting your patient 
first may help or hurt you. Each patient the player treats presents a unique ethical 
conflict, and within each treatment cycle the player must make an array of decisions 
ranging from choosing donors to what to do with left over embryos. Regardless of what 
a player’s ethical stance is upon entering the game, there is enough provocative 
material to challenge a wide range of beliefs. Also, knowing the player’s profile allows 
us to customize the experience so that that we can challenge their specific beliefs. 
Further, few of the currently available ethics simulation software products take 
advantage of the natural affordances of interactive digital media and the game literacy 
53
of modern audiences. In role‐playing games, players advance through experience, 
accumulating wealth and status, while managing resources. Map the real world 
concerns of growing a business and personal character growth to this type of framework 
and you have a natural fit for an ethics simulation game. In this case, however, rather 
than ‘leveling‐up’ the status of your player character, you would be developing your 
own moral character. Interactive media is commonly used for placing the user in 
another character’s shoes, to experience his or her world and conflicts from a designed 
point of view. As a passive spectator it is easy to pass judgment on the right or wrong 
choice, or the obvious ethical choice given a particular narrative. Actions, however, 
speak louder than words, and I have observed that when directly faced with a conflict, 
people will often behave differently than their previously stated intentions. Ethical 
choices are simply easier said than done.
As the ethical complexity of our world increases, so does the need for our 
instructive and entertainment media to engage that complexity. For centuries people 
have used drama to engage and discuss ethical struggle. Interactive media has the 
capacity to not only involve us directly in the drama, but more deeply into the ethical 
conflict. By feeling, rather than watching, the dramatic tension over these ethical 
questions, we may better prepare ourselves to answer these questions when we come 
to face them in our own lives. 
54
Glossary 

ART Assisted Reproductive Technology 
 
 
Embryo Transfer A step in the IVF process in which one or more embryos 
are placed in the uterus with the intent to establish a 
pregnancy. 
 
 
Gestational Carrier A woman who carries an embryo to full term pregnancy, 
but is not biologically or legally related to the child.  

 
IVF In vitro fertilization is a process in which eggs are 
fertilized outside the womb. 
 
 
IUI Intrauterine Insemination, also known as Artificial 
Insemination, is a process in which sperm is placed into 
the reproductive tract with intent of establishing a 
pregnancy. 
 
 
Selective Reduction The termination of one or more fetuses in a multifetal 
pregnancy. 
 
 
Surrogate A woman who serves as both the egg donor and the 
Gestational Carrier. 

 
55
 
Bibliography 
 
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Cambridge, MA: The MIT Press, 2007. Print. 
 
Deech, Ruth & Smajdor, Anna . From IVF to Immortality: Controversy in the Era 
of Reproductive Technology. Oxford, UK: Oxford University Press, 2007. 
Print. 
 
Dewolf Smith, Nancy (September 29, 2005). “Love and Infertility, Death and 
Degradation.” Wall Street Journal: 29 September 2005: Television. Web.  
 
Fullerton, Tracy. Game Design Workshop. Burlington, MA:Morgan Kaufmann 
Publishers, 2008. Print. 
 
Griggs, Jessica(February 2010). “Even in the Virtual World, Men Judge Women 
on Looks.” New Scientist Magazine February 2010: Tech. Web.  
 
Hull, Richard T. Ethical Issues in the New Reproductive Technologies, Second 
Edition. Amherst, NY: Prometheus Books, 2005. Print. 
 
Kohl, Beth. Embryo Culture: Making Babies in the 21
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 Century. New York, NY: 
Farrar, Straus and Giroux, 2007. Print. 
 
Levitt, Pat (USC Zilkha Neurogenetic Institute). Email Interview. 3 February 
2010. 
 
Mundy, Liza. Everything Conceivable: How Assisted Reproduction is Changing 
Our World. New York, NY: Anchor Books, 2007. Print. 
 
Roof, Judith. Reproductions of Reproduction: Imagining Symbolic Change. New 
York, NY: Routledge, 1996. Print. 
 
Salen, Katie and Eric Zimmerman. Rules of Play: Game Design Fundamentals.
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Sicart, Miguel. Ethics of Computer Games. Cambridge, MA: The MIT Press, 2009. 
Print. 
 
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Abstract (if available)

Abstract In the field of fertility medicine, technology has vastly outpaced our ethical, legal, and social frameworks leaving us in a quagmire of gray morality. Seeds is a role-playing and simulation game about assisted reproductive technology and its effect on the shape of the 21st Century. Players play the role of a fertility doctor and must make difficult ethical decisions through courses of treatment while balancing economic, emotional, and scientific concerns. With Seeds, the goal is to foster meaningful decision-making that may echo from the game world into the real world by employing role-play and creating a safe space for expression and exploration of ethical issues.

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Asset Metadata

Creator Sharkasi, Nahil T. (author)

Core Title Seeds: role-play, medical drama, and ethical exploration

School School of Cinematic Arts

Degree Master of Fine Arts

Degree Program Interactive Media

Publication Date 05/06/2010

Defense Date 03/30/2010

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag art,assisted reproduction technology,bio-ethics,ethics,ethics simulation,fertility,medical drama,Medicine,OAI-PMH Harvest,role-playing game,rpg,serious game

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Fullerton, Tracy (committee chair), Anderson, Steven F. (committee member), Lilien, Topper (committee member), Malamed, Laird (committee member)

Creator Email nahilshark@gmail.com,sharkasi@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-m3026

Unique identifier UC1481931

Identifier etd-Sharkasi-3676 (filename),usctheses-m40 (legacy collection record id),usctheses-c127-331913 (legacy record id),usctheses-m3026 (legacy record id)

Legacy Identifier etd-Sharkasi-3676.pdf

Dmrecord 331913

Document Type Thesis

Rights Sharkasi, Nahil T.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Repository Name Libraries, University of Southern California

Repository Location Los Angeles, California

Repository Email cisadmin@lib.usc.edu