BIOETHICS

Reproductive Freedom

Responsible Use of Assisted Reproductive Technologies Should Protect Women’s Rights

This article contains a correction.

Between the Octomom story and the TLC reality show Jon & Kate Plus 8, the past few weeks have brought an onslaught of accusations regarding parents exploiting their children for financial gain. Concern for the children of Nadya Suleman and Jon and Kate Gosselin has directed the majority of public and media fury toward fertility doctors.

The Suleman case in particular offers an opportunity to comment on the intersection of patient autonomy, medical decision-making, the role of the physician, obligations to society, and the welfare of the resultant children. It is only by looking at all of these stakeholders-the woman, the doctor, the resulting children, and society at large-that a consensus for appropriate and reasonable change can be reached.

Much of the media as well as other ethical analysts have considered only some of these stakeholders, often leaving out the rights of the woman. As Dr. Arthur Caplan wrote in The Philadelphia Inquirer, “With all due respect, the idea that doctors should not set limits on who can use reproductive technology to make babies is ethically bonkers”-an assessment Dr. Jonathon Moreno agreed with here at Science Progress. Of course, physicians are not mere technicians for hire that must willy-nilly obey their patient’s wishes.

But they are also not Gods that should be deciding who conceives and who may not. Anyone in the world can reproduce the “old-fashioned way,” so it seems unjust to post stringent screening requirements on those that are sadly unable to do so. By looking at all the stakeholders, it is clear that doctors need to strike a personal balance between helping their patients, making sound medical decisions (unlike Suleman’s doctor’s decision to implant six embryos simultaneously), understanding the societal costs of their actions, and keeping the resulting offspring’s welfare at the forefront.

Caplan also argues that our government should step in and regulate the Wild Wild West of the fertility industry, and is joined by others such as Yuval Levin. We agree with Moreno, however, who states that the American Society for Reproductive Medicine should strengthen its guidelines as well as the enforcement of its organizational policies, rather than resort to bulky legislation.

Allowing government’s heavy hand to further encroach on medical practice, particularly women’s health care, robs patients of their rights to make medical decisions and physicians of the ability to practice independently. And society will eventually have to pay the costs in both fiscal terms and in the resulting decreased quality of care. We already see an example of these undesirable effects of government regulation in the field of family planning services offered to women. An example includes the placement of arbitrary constraints on pregnancy termination services that leave many pregnant women diagnosed with fetuses that have anomalies, but without the option to terminate if they so desire.

American medicine already has in place several checkpoints (state licensing boards, professional organizational sanctions, and the National Practitioner’s Databank) to curb this sort of headline-grabbing behavior in the future. Utilizing these mechanisms more fully is the answer. Government oversight, such as that in the United Kingdom and Canada, has perks for sure-but so does government funding of assisted reproductive technologies, as is the case in these countries but not here in the United States.

Due to this lack of government funding in America, assisted reproductive technology, or ART, remains an elective procedure that only the wealthy can afford even while infertility greatly plagues the poor. Infertility does not recognize boundaries based on socioeconomic status. Reproduction is not and should not be a right solely of the rich. Physicians should not have to turn away a woman desperate to become a mother simply because she cannot pay the thousands of dollars ART often requires. Yet, the rest of society should not fund the exorbitant costs of poor medical decision making, such as the millions of dollars in neonatal intensive care unit bills that will result from the Suleman case, either.

A balance, then, must be reached. Patients, regardless of their ability to pay, should have the autonomy to make their own medical decisions such as whether to have or not have a child. Physicians should have the freedom to refuse a patient’s request if they feel the patient would be compromising the quality of life of the resulting child, but should not play God and set out on elaborate screening protocols to weed out “unfit” parents. Physicians should also prioritize the welfare of the resulting offspring and the safety of the patient. Finally, the American Society for Reproductive Medicine professional regulations are intended to guide physician action in this regard and should be followed, with strong repercussions if blatantly ignored.

With these guidelines in place, perhaps we can finally stop hearing about the seemingly magic number of eight children that draws public fascination and allows parents to exploit their children-whether through selling family pictures for $10 each, making reality TV entertainment, or receiving offers for pornography contracts.

Kavita R. Shah and Frances R. Batzer, MD, MBE are affiliated with Jefferson Medical College-Thomas Jefferson University.

Correction: An earlier version of this article incorrectly indicated that Yuval Levin wrote that the Centers for Disease Control and Prevention should oversee fertility industry practices. Levin did not argue that the CDC should assume this responsibility.

Tags: bioethics, reproductive health

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