Ethical obligations in fertility treatment when intimate partners withhold information from each other: 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, Susan Gitlin, Elizabeth Ginsburg, Sigal Klipstein, Laurence McCullough, Richard Paulson, Richard Reindollar, Ginny Ryan, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, Julianne Zweifel, …
Ethics Committee of the American Society for Reproductive Medicine (2018). Ethical obligations in fertility treatment when intimate partners withhold information from each other: an Ethics Committee opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2018.06.043
Ethics Committee of the American Society for Reproductive Medicine. Ethical obligations in fertility treatment when intimate partners withhold information from each other: an Ethics Committee opinion. Fertility and sterility. 2018. doi:10.1016/j.fertnstert.2018.06.043
Ethics Committee of the American Society for Reproductive Medicine. "Ethical obligations in fertility treatment when intimate partners withhold information from each other: an Ethics Committee opinion." Fertility and sterility, 2018.
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RRM Academy Synopsis
ASRM says clinicians may decline care when withheld facts risk harm
A 2018 ASRM Ethics Committee opinion holds that clinicians must keep confidence when no harm is in prospect, and may refuse care when withheld facts risk harm.The committee says clinicians should decline to treat when nondisclosure makes full informed consent impossible. It covers couples where one partner withholds health facts.
Key Findings
The committee says physicians are "both ethically and legally bound" to keep a patient's confidence about a partner, except as otherwise provided by law, such as state reporting rules.
Clinicians are "ethically obligated to decline" care when informed consent cannot be given, because the patient would face risks that cannot be disclosed without breaching confidentiality.
When withheld facts might have let a couple avoid treatment, the committee writes that clinicians "may ethically decline" to treat. Elsewhere it says they "may choose to offer" services.
If a male partner withholds his HIV status and insists on using his own sperm, the committee says the clinician "should decline treatment."
Where disclosure would not change the treatment and the treatment will not harm either partner or offspring, clinicians "may provide care" without full disclosure between the partners.
Interpretation
The document is an ethics committee opinion. Its reasoning draws on bioethics principles and earlier ASRM opinions, and it reports no patient data or outcomes. The committee calls it a service to members that does not dictate an exclusive course of treatment. Scenarios include infectious disease, genetic carrier status, health conditions that raise pregnancy risk, and information that could have let a couple avoid treatment. The conclusions state what clinicians may, should or must do.
RRM Context
The opinion describes couples as a treatment dyad and weighs informed consent from both partners. Restorative reproductive medicine shares that principle and evaluates both partners before treatment. Several examples are findings a full evaluation can surface. Anabolic steroid use that lowers sperm count, a previous vasectomy and a tubal ligation are each named as information that might have let a couple avoid treatment.
Our editorial summary of this paper, not the article's abstract.
Abstract
Clinicians should encourage disclosure between intimate partners but must maintain confidentiality in cases where there is no prospect of harm to the partner and/or offspring. In cases where one member of a couple refuses to disclose relevant health information to the other partner and there exists a risk of harm to the unaware partner and/or offspring, clinicians may refuse to offer care and should decline to treat if full informed consent is not possible due to lack of disclosure.
Ethics Committee of the American Society for Reproductive Medicine, 2016
Ethics and Policy › Informed Consent › Consent Gaps · 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, Susan Gitlin, Elizabeth Ginsburg, Sigal Klipstein, Laurence McCullough, Richard Paulson, Richard Reindollar, Ginny Ryan, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, Julianne Zweifel, 0000-0003-0284-2845
J Daar, J Benward, L Collins, Joe Davis, Joey Davis, J Davis, O Davis, L Francis, E Gates, Sue Gitlin, S Gitlin, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, S Klipstein, Larry McCullough, L McCullough, Rick Paulson, Dick Paulson, Rich Paulson, R Paulson, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, G Ryan, M Sauer, Becky Sokol, R Sokol, S Tipton, L Westphal, J Zweifel
PMID 30196947 30196947 DOI 10.1016/j.fertnstert.2018.06.043 10.1016/j.fertnstert.2018.06.043 Ethics Committee of the American Society for Reproductive Medicine et al. 2018, Ethics Committee of the American Society for Reproductive Medicine 2018
