Child-rearing ability and the provision of fertility services: an Ethics Committee opinion
Ethics Committee of the American Society for Reproductive Medicine
Committee members:Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Owen Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Susan Gitlin, Sigal Klipstein, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Ginny Ryan, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, …
Ethics Committee of the American Society for Reproductive Medicine (2017). Child-rearing ability and the provision of fertility services: an Ethics Committee opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2017.10.006
Ethics Committee of the American Society for Reproductive Medicine. Child-rearing ability and the provision of fertility services: an Ethics Committee opinion. Fertility and sterility. 2017. doi:10.1016/j.fertnstert.2017.10.006
Ethics Committee of the American Society for Reproductive Medicine. "Child-rearing ability and the provision of fertility services: an Ethics Committee opinion." Fertility and sterility, 2017.
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RRM Academy Synopsis
ASRM allows withholding care over well-grounded child-safety concerns
A 2017 ASRM Ethics Committee opinion holds that a program may refuse treatment when it has good reason to expect unsafe child care. It also holds that disability alone is no reason to deny fertility services.
Key Findings
The Committee holds that a program may turn away prospective patients when well-grounded reasons show they cannot give "minimally adequate or safe care" to a child.
Programs may treat patients who would benefit medically, the Committee says, except where "significant harm" to a future child is likely.
The Committee holds that providers are "not morally obligated" to refuse each patient whose case raises a question about risk to the child, and some will prefer to proceed.
The Committee advises written procedures: a joint assessment among program members, consultation with other professionals such as a mental-health professional if indicated, and documentation.
The Committee holds that disability alone is no ground for denial, and that decisions should rest on evidence, with no place for stereotype or prejudice.
Interpretation
The document is an ethics committee opinion approved by the ASRM Ethics Committee and Board of Directors. The Committee weighs the interests of future children, infertile patients and providers. The opinion reports no data and runs no analysis. The Committee says the opinion does not dictate one course of treatment in all cases. The Committee also observes that accurate predictions of parenting ability are hard to make. The reasoning draws on United States law. The 2017 version replaces the July 2013 version.
RRM Context
RRM principles include evaluating the couple and their circumstances before treatment. The opinion addresses which patients a program accepts. The Committee describes fertility services as services that treat or bypass the problems in the way of having children. IVF bypasses infertility and leaves the cause of failed conception unexplained.
Our editorial summary of this paper, not the article's abstract.
Abstract
Fertility programs may withhold services from prospective patients on the basis of well-grounded reasons that those patients will be unable to provide minimally adequate or safe care for offspring. This document was reviewed and updated; this version replaces the previous version of this document, last published July 2013 (Fertil Steril 2013;100:50-53).
Ethics Committee of the American Society for Reproductive Medicine, 2019
Ethics and Policy › Reproductive Ethics › Access to Treatment · Clinical Guidelines and Standards › Guidelines by Issuing Body › United States Professional Societies
Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Owen Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Susan Gitlin, Sigal Klipstein, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Ginny Ryan, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, 0000-0003-0284-2845
J Daar, J Benward, L Collins, Joe Davis, Joey Davis, J Davis, O Davis, L Francis, E Gates, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, Sue Gitlin, S Gitlin, S Klipstein, Barb Koenig, B Koenig, Andy Barbera, Drew Barbera, A Barbera, Larry McCullough, L McCullough, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, G Ryan, M Sauer, Becky Sokol, R Sokol, S Tipton, L Westphal
PMID 29202968 29202968 DOI 10.1016/j.fertnstert.2017.10.006 10.1016/j.fertnstert.2017.10.006 Ethics Committee of the American Society for Reproductive Medicine et al. 2017, Ethics Committee of the American Society for Reproductive Medicine 2017
