Cross-border reproductive care: an Ethics Committee opinion
Ethics Committee of the American Society for Reproductive Medicine
Committee members:Judith Daar, Jean Benward, Lee Rubin Collins, Joseph Davis, Leslie Franics, Elena Gates, Elizabeth Ginsburg, Sigal Klipstein, Barbara Koenig, Laurence McCullough, Richard Reindollar, Rebecca Sokol, Mark Sauer, Sean Tipton, Lynn Westphal, …
Ethics Committee of the American Society for Reproductive Medicine (2016). Cross-border reproductive care: an Ethics Committee opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2016.08.038
Ethics Committee of the American Society for Reproductive Medicine. Cross-border reproductive care: an Ethics Committee opinion. Fertility and sterility. 2016. doi:10.1016/j.fertnstert.2016.08.038
Ethics Committee of the American Society for Reproductive Medicine. "Cross-border reproductive care: an Ethics Committee opinion." Fertility and sterility, 2016.
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RRM Academy Synopsis
ASRM Ethics Committee says home doctors need not raise care abroad
The ASRM Ethics Committee's 2016 opinion on patients who travel abroad for ART holds that a doctor at home has no independent duty to raise care abroad, and must not misinform patients who ask. The report has no data of its own.
Key Findings
The committee holds that departure-country physicians have "no independent duty" to bring up care abroad, and "must not misinform" a patient who asks about ART options overseas.
The committee holds that destination-country physicians must follow local standards, laws and informed consent, and owe no duty to research or disclose nonmedical barriers a traveling patient may face.
The committee advises patients weighing travel to consult qualified legal experts, and encourages referral to legal and mental health professionals "when appropriate."
The committee names four drivers of travel: access, cost, regulation and privacy. A 2010 European survey it cites counted 24,000–30,000 cross-border cycles a year among 11,000–14,000 patients.
The committee holds that, where no duty to treat exists, a physician may decline a returning patient, provided the patient receives reasonable notice and a chance to find another willing provider.
Interpretation
The document is an ethics committee opinion. Its reasoning rests on informed-consent doctrine, with incidence figures drawn from other surveys. The committee calls the assumption that travelers would otherwise forgo care "reasonable, but unproven" and says travel volume is hard to estimate. The report presents no outcome data of its own for care abroad and cites literature reviews finding patient satisfaction generally high. The committee states that the document reflects members' views and is not the only approved standard of practice.
RRM Context
The opinion covers duties around travel for ART. ART bypasses infertility and leaves the cause unresolved. Restorative reproductive medicine starts by asking what is causing this couple's infertility. The opinion's own scope is disclosure, care standards and referral.
Our editorial summary of this paper, not the article's abstract.
Abstract
Cross-border reproductive care (CBRC) is a growing worldwide phenomenon, raising questions about why assisted reproductive technology (ART) patients travel abroad, what harms and benefits may result, and what duties health-care providers may have in advising and treating patients who travel for reproductive services. Cross-border care offers benefits and poses harms to ART stakeholders, including patients, offspring, providers, gamete donors, gestational carriers, and local populations in destination countries. This document replaces the previous document of the same name, last published in 2013 (Fertil Steril 2013;100:645-50).
Ethics Committee of the American Society for Reproductive Medicine, 2016
Ethics and Policy › Reproductive Ethics › Access to Treatment · Clinical Guidelines and Standards › Guidelines by Issuing Body › United States Professional Societies · Assisted Reproduction › Donor Gametes and Surrogacy › Surrogacy
Judith Daar, Jean Benward, Lee Rubin Collins, Joseph Davis, Leslie Franics, Elena Gates, Elizabeth Ginsburg, Sigal Klipstein, Barbara Koenig, Laurence McCullough, Richard Reindollar, Rebecca Sokol, Mark Sauer, Sean Tipton, Lynn Westphal, 0000-0003-0284-2845
J Daar, J Benward, L Collins, Joe Davis, Joey Davis, J Davis, L Franics, E Gates, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, S Klipstein, Barb Koenig, B Koenig, Larry McCullough, L McCullough, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, Becky Sokol, R Sokol, M Sauer, S Tipton, L Westphal
PMID 27678029 27678029 DOI 10.1016/j.fertnstert.2016.08.038 10.1016/j.fertnstert.2016.08.038 Ethics Committee of the American Society for Reproductive Medicine et al. 2016, Ethics Committee of the American Society for Reproductive Medicine 2016
