Fertility treatment when the prognosis is very poor or futile: 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, William Hurd, Sigal Klipstein, Laurence McCullough, Richard Reindollar, Ginny Ryan, Mark Sauer, Sean Tipton, Lynn Westphal, Julianne Zweifel, …
Ethics Committee of the American Society for Reproductive Medicine (2019). Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2019.01.033
Ethics Committee of the American Society for Reproductive Medicine. Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion. Fertility and sterility. 2019. doi:10.1016/j.fertnstert.2019.01.033
Ethics Committee of the American Society for Reproductive Medicine. "Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion." Fertility and sterility, 2019.
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RRM Academy Synopsis
Clinicians may ethically refuse futile fertility treatment, ASRM says
A 2019 ASRM Ethics Committee opinion holds that doctors may ethically refuse treatment with under a 1% chance of a live birth. It also holds that limited care may be offered for emotional benefit when risks are small.
Key Findings
The committee defines futile treatment as a "<1% chance" of live birth and very poor prognosis as odds of "1% to <5% per cycle."
The committee holds that refusing to offer, start, or continue treatment judged to have a <1% chance of success is "an appropriate exercise of professional integrity."
The committee finds that clinicians "may ethically offer" treatment they judge futile when risks are minimal and the patient wants a psychological benefit.
For very poor prognosis, the committee finds that clinicians "may justifiably proceed" on a limited basis and "may ethically refuse," if the decision is evidence-based.
The committee states that protecting success rates is "not an ethical basis" to refuse patients, and that financial benefit is "not an acceptable ground" for futile treatment.
Interpretation
The document is a professional-society ethics opinion. The committee gives reasoning and recommendations and reports no study data. Its futility and very poor prognosis cutoffs are definitions set for this statement. The committee cautions clinicians against assuming an individual's chances equal the group average. Committee members' views make up the document, which does not dictate an exclusive course of treatment. Examples cover IVF and insemination cycles, and each judgment rests on a clinician's estimate of the odds.
RRM Context
The futility test looks at the odds of a live birth from a proposed cycle. The listed criteria are sperm availability, the female partner's age, and a prior poor response. The opinion describes no evaluation of cause. Restorative reproductive medicine evaluates both partners before judging prognosis. The committee urges caution with ovarian reserve testing because its predictive capacity is limited. IVF bypasses the reproductive system without resolving why conception fails.
Our editorial summary of this paper, not the article's abstract.
Abstract
The Ethics Committee recommends that in vitro fertilization (IVF) centers develop patient-centered policies regarding requests for futile treatment. In most cases, clear communication can avoid a direct conflict, but clinicians ethically may refuse to provide treatment believed to be futile or to carry a very poor prognosis. In certain instances, clinicians may provide limited treatment which they judge likely to be futile, but must be vigilant in their presentation of risks, benefits, and alternatives. This version replaces the previous published draft of this name (Fertil Steril 2012;98:e6-9).
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, William Hurd, Sigal Klipstein, Laurence McCullough, Richard Reindollar, Ginny Ryan, Mark Sauer, 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, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, Sue Gitlin, S Gitlin, Bill Hurd, Will Hurd, Billy Hurd, W Hurd, S Klipstein, Larry McCullough, L McCullough, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, G Ryan, M Sauer, S Tipton, L Westphal, J Zweifel
PMID 30871767 30871767 DOI 10.1016/j.fertnstert.2019.01.033 10.1016/j.fertnstert.2019.01.033 Ethics Committee of the American Society for Reproductive Medicine et al. 2019, Ethics Committee of the American Society for Reproductive Medicine 2019
