Ethical Considerations Arising from the Use of Assisted Reproductive Technologies

Abstract

The rapid growth of reproductive medicine has in many cases occurred faster than societies have been able to assimilate the changes and incorporate them into the social fabric. Oftentimes, the widespread use of reproductive techniques and fertility-enhancing medications has occurred before the ethical implications of these technologies have been considered. This article introduces ethical concepts that can be used as tools to understand the moral dilemmas inherent in the practice of reproductive medicine. These concepts are then used to form a framework for discussing specific ethically charged issues including the increasing prevalence of multiple pregnancies and the option of multifetal pregnancy reduction, ethical considerations in the prevention of ovarian hyperstimulation syndrome, and access to fertility treatments among different populations. Furthermore, considerations of when to offer these technologies and situations in which care may be refused are discussed. In closing, the role of ethics committees as an approach to navigating difficult clinical situations is introduced.

Keywords

ethics - informed consent - beneficence - justice - autonomy

• References

• 1 Riddle JM. Eve's Herbs: A History of Contraception and Abortion in the West. Cambridge, MA: Harvard University Press; 1999
• 2 Dondorp W, de Wert G. Innovative reproductive technologies: risks and responsibilities. Hum Reprod 2011; 26 (7) 1604-1608
• 3 ACOG Committee on Ethics. ACOG Committee Opinion No. 439: Informed consent. Obstet Gynecol 2009; 114 (2 Pt 1) 401-408
• 4 American College of Obstetrics and Gynecology. ACOG Committee Opinion No. 390, December 2007. Ethical decision making in obstetrics and gynecology. Obstet Gynecol 2007; 110 (6) 1479-1487
• 5 Miles SH. The Hippocratic Oath and the Ethics of Medicine. Oxford, UK: Oxford University Press; 2004
• 6 Beauchamp TL, Walters L, Kahn JP. Contemporary Issues in Bioethics. Belmont, CA: Wadsworth; 2007
• 7 Pennings G, Ombelet W. Coming soon to your clinic: patient-friendly ART. Hum Reprod 2007; 22 (8) 2075-2079
• 8 Jain T, Harlow BL, Hornstein MD. Insurance coverage and outcomes of in vitro fertilization. N Engl J Med 2002; 347 (9) 661-666
• 9 Gleicher N, Oleske DM, Tur-Kaspa I, Vidali A, Karande V. Reducing the risk of high-order multiple pregnancy after ovarian stimulation with gonadotropins. N Engl J Med 2000; 343 (1) 2-7
• 10 The ESHRE Capri Workshop Group. Multiple gestation pregnancy. Hum Reprod 2000; 15 (8) 1856-1864
• 11 ACOG Joint Editorial Committee. Multiple gestation: complicated twin, triplet, and high-order multifetal pregnancy. ACOG Practice Bulletin No. 56. American College of Obstetricians and Gynecologists. Obstet Gynecol 2004; 104: 869-883
• 12 ACOG Committee on Genetics. Perinatal risks associated with assisted reproductive technology. ACOG Committee Opinion No. 324. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005; 106: 1143-1146
• 13 Donohue PK, Boss RD, Shepard J, Graham E, Allen MC. Intervention at the border of viability: perspective over a decade. Arch Pediatr Adolesc Med 2009; 163 (10) 902-906
• 14 Evans MI, Britt DW. Multifetal pregnancy reduction: evolution of the ethical arguments. Semin Reprod Med 2010; 28 (4) 295-302
• 15 Pharoah PO. Risk of cerebral palsy in multiple pregnancies. Clin Perinatol 2006; 33 (2) 301-313
• 16 Bryan E. The impact of multiple preterm births on the family. BJOG 2003; 110 (Suppl. 20) 24-28
• 17 Klemetti R, Gissler M, Hemminki E. Equity in the use of IVF in Finland in the late 1990s. Scand J Public Health 2004; 32 (3) 203-209
• 18 Bitler M, Schmidt L. Health disparities and infertility: impacts of state-level insurance mandates. Fertil Steril 2006; 85 (4) 858-865
• 19 Pennings G, de Wert G, Shenfield F, Cohen J, Tarlatzis B, Devroey P ; ESHRE Task Force on Ethics and Law including. ESHRE Task Force on Ethics and Law 13: the welfare of the child in medically assisted reproduction. Hum Reprod 2007; 22 (10) 2585-2588
• 20 Rosner F. Hospital medical ethics committees: a review of their development. JAMA 1985; 253 (18) 2693-2697
• 21 Quinlan J, Quinlan JD. Karen Ann: The Quinlans Tell Their Story. New York, NY: Bantam Books; 1977