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RRM Academy Synopsis
ASRM committee backs equal services for single and LGBT patients
In a 2021 opinion that replaces its 2013 one, the ASRM Ethics Committee says programs should treat single, unmarried and LGBT patients like married heterosexual couples when picking services. It weighs child welfare, civil rights law and clinician conscience.
Key Findings
The committee says programs should give single people, unmarried couples, and diverse sexuality and gender (DSG) individuals and couples the same services as married cisgender heterosexual couples.
The committee says studies of children raised by same-sex parents indicated overwhelmingly that parental sexual orientation did not adversely affect them, though many studies were small and fewer covered same-sex male parents.
The committee says programs may decline on the grounds used for married couples: serious, substantiated doubts about child-rearing fitness, or a service, such as egg donation, the program does not offer.
If a married patient presents as single or with a non-spouse partner, the committee says providers may ethically refuse treatment without assurance that the spouse knows and does not object.
The committee believes services should be consistent across patients despite clinician objections, including religious ones. It cites a 2008 California Supreme Court ruling against refusing a lesbian patient on religious grounds.
Interpretation
The document is an ethics opinion from a professional body. It reasons from cited research and law and reports no new data. The committee calls many of the child-welfare studies small and notes that some investigators presented data suggesting worse outcomes for children with same-sex parents, and judges that the larger body of studies outweighed those data and left the concern unsupported. The opinion covers program access to assisted reproduction services in the United States. The committee states that other plans of management may be appropriate.
RRM Context
Restorative reproductive medicine looks for the cause of infertility and treats it. That principle applies to single people and same-sex couples with a diagnosable cause. The opinion covers which assisted reproduction services programs offer. Evaluation before treatment falls outside it.
Our editorial summary of this paper, not the article's abstract.
Abstract
This statement explores the implications of reproduction by single individuals and unmarried couples and pertains to diverse sexuality and gender (DSG) or cisgender heterosexual persons. The statement concludes that individuals and couples should have access to fertility services irrespective of marital status, sexual orientation, or gender identity. This document replaces the previous version of this document entitled "Access to fertility treatment by gays, lesbians, and unmarried persons: a committee opinion", published in December 2013 (Fertil Steril 2013;100:1524-7).
Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, 2024·Fertility and sterility
Planned oocyte cryopreservation is an ethically permissible procedure that may help individuals avoid future infertility. Because planned oocyte cryopreservation is new and evolving, it is essential that those considering using it be informed about the uncertainties regarding its efficacy and long-term effects. This replaces the document of the same name, last published in 2017.
Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, 2023·Fertility and sterility
Building families through the adoption of children has been supported by human society throughout history. The ethical appropriateness of patients donating embryos to other patients for family building, or for research, is well established and is affirmed by this Committee. The use of the term ''adoption'' for embryos is inaccurate and should be avoided. This document replaces the ASRM Ethics Committee statement by the same name, last published in 2016.
Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, 2021·Fertility and sterility
In the United States, economic, racial, ethnic, geographic, and other disparities prevent access to fertility treatment and affect treatment outcomes. This opinion examines the factors that contribute to these disparities, proposes actions to address them, and replaces the document of the same name, last published in 2015.
Ethics Committee of the American Society for Reproductive Medicine, 2021·Fertility and sterility
This statement explores the ethical considerations surrounding the provision of fertility services to transgender individuals and concludes that the denial of access to fertility services is not justified.
Ethics Committee of the American Society for Reproductive Medicine, 2015·Fertility and sterility
This statement explores the ethical considerations surrounding the provision of fertility services to transgender individuals and concludes that denial of access to fertility services is not justified.
Policy and Regulation · Access and Coverage Policy
Van Der Poel S et al., 2018·Fertility and Sterility
There are reports that define the significant unmet need for access to fertility care and infertility interventions for heterosexual couples - those who experience involuntary childlessness and who desire a biological child. This need for access to care rarely measures those couples in non-heterosexual relationships, single individuals or in key/neglected populations. This disparity in recognition of need, and resultant lack of access to care is glaring. Universal access and attainment of the highest standard of care requires the provision of high-quality information and services that fulfills, protects and respects all individuals. The objective of this study was to identify the key principles that support access to fertility care and infertility interventions, and to provide a human rights framework to guide processes during the development of draft recommendations to the World Health Organization (WHO) for clinical practice. To evaluate the public health and human rights and gender impact on infertility, a literature review and systematic analysis were conducted to look at the following questions. What are the existing policies, public health directives and research evidence gaps impacting gender and human rights in the context of involuntary childlessness and infertility; and, What human rights principles guide the development and implementation of fertility care and infertility related laws, policies and systems? A detailed search strategy in collaboration with the WHO-HQ librarian, introducing various combinations of a predetermined set of terms was undertaken to identify primary literature, systematic reviews and gray literature, including documentation regarding current status of human rights and gender equality within policy and practices. Using the search strategy defined, we were able to identify 488 articles and documents, of which 102 were found appropriate. They were then categorized using 9 principles previously identified by WHO and used to address the topic of contraception. From this process, we generated a list of 12 principles which will be presented that cover issues such as non-discrimination, non-stigmatization as well as informed-decision making and autonomy, sharing of benefits and ensuring provision of care that includes the recognition of the health and well-being of the parent or parents as well as the children born. During the systematic review of the published data and evidence for the development of draft clinical recommendations to be presented to and for the World Health Organization consideration, it was clear that a human rights framework was required. Our systematic review process used research and policy evidence to support the development of a framework of principles that can better ensure different human rights dimensions are clearly and systematically integrated into the provision of fertility care information and fertility interventions and services.
Ethics Committee of the American Society for Reproductive Medicine, 2015·Fertility and sterility
In the United States, economic, racial, ethnic, geographic, and other disparities exist in access to fertility treatment and in treatment outcomes. This opinion examines the factors that contribute to these disparities and proposes actions to address them.
Ethics and Policy › Reproductive Ethics › LGBTQ Rights · Clinical Guidelines and Standards › Guidelines by Issuing Body › United States Professional Societies
Sigal Klipstein, Ricardo Azziz, Katherine Cameron, Judith Daar, Joseph B. Davis, Ruth Farrell, Elizabeth Ginsburg, Mandy Katz-Jaffe, Jennifer Kawwass, Robert Rebar, Mary Samplaski, Peter Schlegel, David Shalowitz, Chevis N. Shannon, Sean Tipton, Lynn Westphal, Julianne Zweifel, 0000-0003-0284-2845
S Klipstein, R Azziz, Kathy Cameron, Kate Cameron, Katie Cameron, K Cameron, J Daar, Joe Davis, Joey Davis, J Davis, R Farrell, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, M Katz-Jaffe, Jen Kawwass, Jenny Kawwass, J Kawwass, Bob Rebar, Rob Rebar, Bobby Rebar, R Rebar, M Samplaski, Pete Schlegel, P Schlegel, Dave Shalowitz, D Shalowitz, C Shannon, S Tipton, L Westphal, J Zweifel
PMID 33906744 33906744 DOI 10.1016/j.fertnstert.2021.03.034 10.1016/j.fertnstert.2021.03.034 Ethics Committee of the American Society for Reproductive Medicine et al. 2021, Ethics Committee of the American Society for Reproductive Medicine 2021