In vitro fertilisation is now an established technique for treating some forms of infertility, yet it remains ethically controversial. New developments, such as embryo donation and embryo freezing, have led to further discussion. We briefly discuss the ethical aspects of IVF, focusing on the issues of resource allocation, the 'unnaturalness' of the procedure, the moral status of the embryo, surrogate motherhood, and restrictions on access to IVF. We argue that, on the whole, IVF is an ethically justifiable method (...) of assisting infertile couples. (shrink)

Technological advances in genetic testing have enabled prospective parents to learn about their risk of passing a genetic condition to their future children. One option for those who want to ensure that their biological children do not inherit a genetic condition is to create embryos through in vitro fertilisation and use a technique called preimplantation genetic testing to screen embryos for genetic abnormalities before implantation. Unfortunately, due to its high cost, IVF-with-PGT is out of reach for the vast (...) majority of Americans. This article addresses an issue that has been underexplored in the medical ethics literature: the lack of insurance coverage for IVF-with-PGT.Within the US system, a key concept in insurance is that of medically necessary care, which broadly consists of diagnostic services and treatment services. In this article, I argue that IVF-with-PGT could be classified as either a diagnostic service or as a treatment service. To make this case, I show that IVF-with-PGT is similar to other types of services that are often covered by US insurance providers. In light of these similarities, I argue that the current system is inconsistent with respect to what is—and is not—covered by insurance. To promote consistency and fairness in coverage, like cases should be treated alike—starting with greater coverage for IVF-with-PGT. (shrink)

ABSTRACT This article deals with a cluster of moral problems raised by the new techniques of human fertilisation. It is concerned primarily with the putative rights of embryos brought into being as a by‐product of the practice of in vitro fertilisation. In this connection it investigates the basis for the ascription of rights to entities and asserts the view that consciousness is a pre‐requisite for the possession of rights. It draws attention to the speciesism implicit in attitudes (...) of some of those who have contributed to the debate. It also examines other issues briefly, raising, for example, the question whether children by AID (or by in vitro fertilisation by donor) must be denied access to information about their genetic fathers; and looking at objections to the new techniques based on the so‐called unnaturalness of the procedures involved. (shrink)

Madison Kilbride recently argued that insurance ) should cover in vitro fertilisation with preimplantation genetic testing services for couples at high risk of having a child affected with a genetic condition. She argues that IVF-PGT meets CMS’s definition of ‘medically necessary care’, where such care includes ‘services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms’. Kilbride argues that IVF-PGT satisfies this definition in two ways: as a diagnostic tool and as a (...) treatment. Contradicting Kilbride, however, I argue that IVF-PGT provides neither diagnosis nor treatment under CMS’s definition. Thus, as long as we accept CMS’s definition of medically necessary care—which Kilbride does, explicitly—it follows that IVF-PGT does not count as medically necessary care. Still, there may be other reasons to conclude that IVF-Preimplantation genetic testing should be covered, and so, it would be a mistake to reject Kilbride’s conclusion altogether. The problem is simply that Kilbride’s argument—that the procedure should be covered because it is medically necessary per CMS’s definition—is not sound. I conclude by discussing a number of other genetic services that are not currently being covered despite the fact that they do seem to satisfy CMS’s definition of ‘medically necessary diagnosis or treatment’. These services, I argue, should be provided under CMS before we consider expanding coverage to include elective procedures such as IVF-PGT. (shrink)

There exists a derived negative right to procreative freedom, including a right to in vitro fertilisation (IVF) and to the exercise of selective techniques such as preimplantation genetic diagnosis. This is an extensive freedom, including not only the right to the exercise of a responsible parenthood, but also, in rare cases, to wrong decisions. It includes also a right for less than perfect parents to the use of IVF, and for IVF doctors to assist them, if they want (...) and can agree about the terms. (shrink)

Background: Today in vitro fertilisation is a widespread and important technique of reproductive medicine. When the technique was first used, it was considered ethically controversial. This is the first study conducted of adult IVF-offspring in order to learn about their ethical opinions and personal attitudes towards this medical technology.Methods: We recruited the participants from the first cases of in vitro fertilisation in Germany at the Gynaecological Clinic of the University Hospital Erlangen. Our qualitative interview study consisted (...) of in-depth, face-to-face interviews with 16 adults who had been conceived by IVF. Our data was analysed with methods of Grounded Theory.Results: For these adults, the most important factor influencing their personal attitudes towards IVF was the knowledge that they were deeply wanted children. The artificiality of their conception seemed irrelevant for their ethical opinion. All participants mentioned that it was important for them to be informed about the circumstances of their conception by their parents.Conclusions: IVF seems to be a medical technique which, although it affects intimate aspects of human existence, can be integrated into the lives of the affected persons without any great difficulties. The findings suggest that parents should inform their children about their fertilisation at an early age and as part of a process over time, not only on a single occasion. Physicians should advise IVF-parents accordingly. (shrink)

ZusammenfassungEines der medizinischen Felder, in dem die ethische Diskussion um die „wunscherfüllende Medizin“ am intensivsten geführt wird, ist die Reproduktionsmedizin, die die Erfüllung des „Kinderwunsches“ verspricht. Strittig ist besonders, ob Sterilität als Krankheit definiert wird, die eine medizinische Intervention rechtfertigt, ob sich aus der Sterilität oder Infertilität lediglich ein Abwehr- oder auch ein positives Anspruchsrecht auf medizinische Ressourcen ergibt, ob legitime Fortpflanzungsmedizin Grenzen hat. Nach einer Übersicht über Eckpunkte der nationalen und internationalen Debatte beschreiben wir im zweiten Teil Ansichten zum (...) Status ungewollter Kinderlosigkeit, zum Recht auf Fortpflanzungsmedizin und zur möglichen Legitimität ihrer Begrenzung anhand der Ergebnisse unserer vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Studien. Während der letzten fünf Jahre haben wir u. a. Paare mit und ohne Sterilitätsproblematik sowie verschiedene Expertengruppen qualitativ und standardisiert befragt. Die stark divergierenden Auffassungen konfrontieren wir im dritten Abschnitt mit internationalen Standards, zum anderen mit dem „Capability-Ansatz“ und dem freiheitsfunktionalen Liberalismus von Sen und Pauer-Studer. Dies ergibt, dass die Bereitstellung verschiedener Möglichkeiten der In-vitro-Fertilisations-(IVF-)Behandlung nicht lediglich einen Wunsch auf Elternschaft erfüllt sondern als die gesollte Erfüllung eines normativen Bedürfnissanspruchs begriffen werden muss. (shrink)

ZusammenfassungEines der medizinischen Felder, in dem die ethische Diskussion um die „wunscherfüllende Medizin“ am intensivsten geführt wird, ist die Reproduktionsmedizin, die die Erfüllung des „Kinderwunsches“ verspricht. Strittig ist besonders, ob Sterilität als Krankheit definiert wird, die eine medizinische Intervention rechtfertigt, ob sich aus der Sterilität oder Infertilität lediglich ein Abwehr- oder auch ein positives Anspruchsrecht auf medizinische Ressourcen ergibt, ob legitime Fortpflanzungsmedizin Grenzen hat. Nach einer Übersicht über Eckpunkte der nationalen und internationalen Debatte beschreiben wir im zweiten Teil Ansichten zum (...) Status ungewollter Kinderlosigkeit, zum Recht auf Fortpflanzungsmedizin und zur möglichen Legitimität ihrer Begrenzung anhand der Ergebnisse unserer vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Studien. Während der letzten fünf Jahre haben wir u. a. Paare mit und ohne Sterilitätsproblematik sowie verschiedene Expertengruppen qualitativ und standardisiert befragt. Die stark divergierenden Auffassungen konfrontieren wir im dritten Abschnitt mit internationalen Standards, zum anderen mit dem „Capability-Ansatz“ und dem freiheitsfunktionalen Liberalismus von Sen und Pauer-Studer. Dies ergibt, dass die Bereitstellung verschiedener Möglichkeiten der In-vitro-Fertilisations-(IVF-)Behandlung nicht lediglich einen Wunsch auf Elternschaft erfüllt sondern als die gesollte Erfüllung eines normativen Bedürfnissanspruchs begriffen werden muss. (shrink)

In vitro fertilisation (IVF) daily practice reveals that couples are willing to take greater risks than doctors if there is a higher chance of pregnancy. Arising from this is a frequently addressed issue regarding the embryo transfer strategy: single or double embryo transfer? The dilemma is faced by patients, as well as physicians, who are caught between the possibility of no pregnancies at all and facing the prospect of iatrogenic twin gestation. How could the couple's preferences concerning how (...) many children they would like be taken into account in determining the number of embryos transferred? How should the physician exercise his medical responsibility towards his patients and the unborn child? An effective approach could be to enhance a couple’s autonomy by advocating a medical beneficence that incorporates patients’ values. This can be achieved through a case-by-case approach in a deliberative process of decision-making which includes real patient-centred communication. (shrink)

In an article in an earlier edition of the Journal of Medical Ethics (1) Dr Iglesias bases her analysis upon the mediaeval interpretation of Platonic metaphysics and Aristotelian logic as given by Aquinas. Propositional forms are applied to the analysis of experience. This results in a very abstract analysis. The essential connection of events and their changing temporal relationships are ignored. The dichotomy between body and soul is a central concept. The unchanging elements in experience are assumed to be more (...) real than the actual world of experienced process. Such a view makes the analysis of the temporal factors in experience impossible. Its abstractness is quite unsuitable for the analysis of the ontological structure and development of the neonate from fertilisation to birth. A N Whitehead made the notion of organism central to his philosophy. He refused to place human experience outside nature, or admit dualism. His philosophy of organism is an attempt to uncover the essential elements connecting human experience with the physical and biological sciences. Time, change and process are, in his view, more real than the static abstractions obtainable by the use of the fallacy of misplaced concreteness. Use of the latter negates the essential connectedness of events and the importance of temporarily and change (2). In this paper I argue that the embryo, being an organism, is not analysable in terms of thinghood. It is a process. To apply Aristotelian logical concepts to it is to distort the real nature of the datum. (shrink)

In this paper, we will discuss the prospect of human reproduction achieved with gametes originating from only one person. According to statements by a minority of scientists working on the generation of gametes in vitro, it may become possible to create eggs from men’s non-reproductive cells and sperm from women’s. This would enable, at least in principle, the creation of an embryo from cells obtained from only one individual: ‘solo reproduction’. We will consider what might motivate people to reproduce (...) in this way, and the implications that solo reproduction might have for ethics and policy. We suggest that such an innovation is unlikely to revolutionise reproduction and parenting. Indeed, in some respects it is less revolutionary than in vitro fertilisation as a whole. Furthermore, we show that solo reproduction with in vitro created gametes is not necessarily any more ethically problematic than gamete donation—and probably less so. Where appropriate, we draw parallels with the debate surrounding reproductive cloning. We note that solo reproduction may serve to perpetuate reductive geneticised accounts of reproduction, and that this may indeed be ethically questionable. However, in this it is not unique among other technologies of assisted reproduction, many of which focus on genetic transmission. It is for this reason that a ban on solo reproduction might be inconsistent with continuing to permit other kinds of reproduction that also bear the potential to strengthen attachment to a geneticised account of reproduction. Our claim is that there are at least as good reasons to pursue research towards enabling solo reproduction, and eventually to introduce solo reproduction as an option for fertility treatment, as there are to do so for other infertility related purposes. (shrink)

A major obstacel to the study of mammalian development, and to the practical application of knowledge gained from it in the clinic during therapeutic in vitro fertilisation and embryo transfer (IVF‐ET), is the propensity of embryos to become retarded or arrested during their culture in vitro. The precise developmental cell cycle in which embryos arrest or delay is characteristic for the species and coincides with the earliest period of embryonic gene expression. Much evidence reviewed here implicates free (...) oxygen radicals (FORs) in the process of arrest. Thus, studies on the development of mouse preimplantation embryos in vitro have shown that (i) FORs are elevated in vitro, but not in vivo, at the time at which embryos become arrested or delayed, (ii) systems for removing reactive oxygen species to limit the formation of hydroxy radicals are present, although they have not yet been assessed quantitatively and may differ qualitatively from those in adult cells, (iii) metabolic and possibly genetic adaptations to oxidative damage are evident, (iv) published procedures for overcoming in vitro arrest are explicable in terms of FOR‐mediated damage or responses and (v) the arrest or delay of most embryos in vitro can be reduced or prevented experimentally by addition of metal chelators to limit hydroxy radical formation and lipid hydroperoxidation. (shrink)

The Human Fertilisation and Embryology Act 2008: a missed opportunity?Amel AlghraniCorrespondence to Dr Amel Alghrani, Institute for Science, Ethics and Innovation, Centre for Social Ethics and Policy, School of Law, University of Manchester, Oxford Road, Manchester, M13 9PL; [email protected] 16 September 2009 Accepted 24 September 2009 Regulating reproduction is no easy feat. In the past three decades we have witnessed a reproductive revolution and great strides have been made to alleviate the effects of infertility. Reproductive advances such as in- (...) class='Hi'>vitro fertilisation , sex selection, reproductive cloning and embryo selection for the purpose of creating “saviour siblings” have all emerged as part of a rapid and ever-changing branch of medicine, each promising to upset the status quo and transform human reproduction.Following much activity in this area, the lengthy process of updating the legislation is now complete. The Human Fertilisation and Embryology Act 2008 received Royal Assent on 13 November 2008. The majority of the HFE Act 2008’s amendments will come into force in October of this year, with the exception of the provisions pertaining to parenthood, which commenced in April 2009. Welcoming Royal Assent, Professor Lisa Jardine, Chair of the Human Fertilisation and Embryology Authority, stated:“This is a momentous day for the HFEA and for those with fertility problems. The regulatory system that has served us so well has been renewed. Parliament has provided a clear framework for the future and a solid base on which to regulate 21st century practice within 21st century law.”1However, as scientific endeavours into developments such as artificial gametes, womb transplantation and ectogenesis continue apace, it could be argued that Jardine was perhaps overly optimistic about the achievements of the new legislation. The HFE Act 2008 is an amending statute, and as Jackson 2 notes “much of the regulatory architecture” in the 1990 legislation “remains intact”. In retaining the architecture of the 1990 legislation, and merely amending or adding certain provisions, has the government missed an ideal opportunity to consider how to equip the regulatory framework for the next phase/era of assisted reproduction?The next …. (shrink)

IVF as lottery or investment: contesting metaphors in discourses of infertilityThis paper reports an aspect of a poststructural feminist study in which I explored the discursive formations within which women for whom in vitro fertilisation (IVF) was unsuccessful constitute themselves. In my exploration I draw on data from interviews with women who discontinued infertility treatment, print media material and infertility self‐help books. Specifically, I highlight a metaphor of lottery in discourses of infertility, arguing that it is hegemonic and (...) showing how when women are situated as gamblers, the metaphor is instrumental in polarising them into ‘winners’ or ‘losers’ in relation to the subjectivity of motherhood. I further deconstruct these subjectivities, showing how ‘winners’ are valorised and ‘losers’ are pathologised. But importantly, I show how infertile women who are not mothers resisted locating themselves as ‘losers’ in a metaphor of lottery and instead situated themselves in a contesting metaphor of investment as diligent ‘workers’ and as active agents in choosing the best employment of their bodily and monetary resources. This paper therefore amplifies the marginalised perspective of infertile women who are not mothers. (shrink)

Eines der medizinischen Felder, in dem die ethische Diskussion um die „wunscherfüllende Medizin“ am intensivsten geführt wird, ist die Reproduktionsmedizin, die die Erfüllung des „Kinderwunsches“ verspricht. Strittig ist besonders, ob Sterilität als Krankheit definiert wird, die eine medizinische Intervention rechtfertigt, ob sich aus der Sterilität oder Infertilität lediglich ein Abwehr- oder auch ein positives Anspruchsrecht auf medizinische Ressourcen ergibt, ob legitime Fortpflanzungsmedizin Grenzen hat. Nach einer Übersicht über Eckpunkte der nationalen und internationalen Debatte beschreiben wir im zweiten Teil Ansichten zum (...) Status ungewollter Kinderlosigkeit, zum Recht auf Fortpflanzungsmedizin und zur möglichen Legitimität ihrer Begrenzung anhand der Ergebnisse unserer vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Studien. Während der letzten fünf Jahre haben wir u. a. Paare mit und ohne Sterilitätsproblematik sowie verschiedene Expertengruppen qualitativ und standardisiert befragt. Die stark divergierenden Auffassungen konfrontieren wir im dritten Abschnitt mit internationalen Standards, zum anderen mit dem „Capability-Ansatz“ und dem freiheitsfunktionalen Liberalismus von Sen und Pauer-Studer. Dies ergibt, dass die Bereitstellung verschiedener Möglichkeiten der In-vitro-Fertilisations-(IVF-)Behandlung nicht lediglich einen Wunsch auf Elternschaft erfüllt sondern als die gesollte Erfüllung eines normativen Bedürfnissanspruchs begriffen werden muss. (shrink)

In a well known story Derek Parfit describes a disconnection between two entities that normally (in real life) travel together through space and time, namely your personal identity consisting of both mind and body. Realising the possibility of separation, even if it might never happen in real life, new questions arise that cast doubt on old solutions. In human reproduction, in real life, at present the fetus spends approximately nine months inside the pregnant woman. But, we might envisage other possibilities. (...) Historically, the first era is the normal conception inside the woman, the growth of the fetus in the womb and then, after nine months, birth and the appearance of a new individual. The second era is In Vitro Fertilisation (IVF). The fetus starts outside the woman as a fertilised egg, moves to the body of the woman and spends nine month there, where the body of the woman and the fetus travel together in space-time to separate at birth. In the third era of reproductive ectogenesis, the two never travel together. The fetus spends its gestational time entirely outside the woman’s body. We have two entities separated in space-time the whole time. The intimate connection consisting in the fetus being a part of the woman’s body is gone. (shrink)

We welcome Ms Smajdor’s critique into our investigations of expected future tax gains to the state from children conceived by in vitro fertilisation .1 To better inform the JME readership, we wish to correct some misinterpretations of our research by Smajdor, and to highlight some weaknesses of current IVF funding policies.Our investigation sought to establish the long-term net tax contribution from an IVF-conceived child, assuming that the child was average in every respect .2 We conducted this analysis on (...) the basis that IVF, and other assisted reproductive treatments, are unique among all medical interventions—unique in the sense that their success leads to the creation of human life; a life that would not have existed had the technology not been available and accessible to couples willing to undergo treatment. Hence, this method provides us with an opportunity to explore lost tax revenue to the state resulting from children that have not been born due to limited public access to IVF treatments currently observed in the UK and many other countries.In our investigations, the costs of IVF were treated as an investment in human capital with future long-term cost and revenue implications for the state. Our evaluation ignored the many humanistic reasons for offering IVF treatment to infertile couples and concentrated solely on the possible economic benefits.3 The perspective of the analysis was that of the state; hence …. (shrink)

The development of in vitro fertilisation (IVF) as a treatment for human infertilty was among the most controversial medical achievements of the modern era. In Ireland, the fate and status of supranumary (non-transferred) embryos derived from IVF brings challenges both for clinical practice and public health policy because there is no judicial or legislative framework in place to address the medical, scientific, or ethical uncertainties. Complex legal issues exist regarding informed consent and ownership of embryos, particularly the use (...) of non-transferred embryos if a couple separates or divorces. But since case law is only beginning to emerge from outside Ireland and because legislation on IVF and human embryo status is entirely absent here, this matter is poised to raise contractual, constitutional and property law issues at the highest level. Our analysis examines this medico-legal challenge in an Irish context, and summarises key decisions on this issue rendered from other jurisdictions. The contractual issues raised by the Roche case regarding informed consent and the implications the initial judgment may have for future disputes over embryos are also discussed. Our research also considers a putative Constitutional 'right to procreate' and the implications EU law may have for an Irish case concerning the fate of frozen embryos. Since current Medical Council guidelines are insufficient to ensure appropriate regulation of the advanced reproductive technologies in Ireland, the report of the Commission on Assisted Human Reproduction is most likely to influence embryo custody disputes. Public policy requires the establishment and implementation of a more comprehensive legislative framework within which assisted reproductive medical services are offered. (shrink)

Reproductive health technology allows married couples who experience infertility to have a child through assisted reproductive technology (ART), such as the in vitro fertilisation (IVF) process. The transfer of the extracted embryo to the woman’s womb is called surrogacy technology (gestational surrogacy). The legality of the practice of surrogacy is still questionable, both on a national and international level. This research discussed the legality of surrogacy in some religious countries, focusing on Indonesia. This research used normative juridical research (...) methods or literature review through a comparative religion-legal approach. This study indicated that most do not have a specific legal instrument regarding surrogacy practice. International law also does not have a standard legal instrument regarding the legality of surrogacy. Legality is determined by each religious country’s national laws and customs. For example, Indonesian law prohibits this practice implicitly under Law No. 36 of 2009 concerning health. The United Kingdom legalised surrogacy through the Surrogacy Agreement Act 1985, which was amended to the Human Fertilization and Embryology Act 2008, Greece through the Greek Legislation Law 3089/2002 and Law 3305/2005, and India through the 2019 Surrogacy Regulation Bill. Those countries have their limitations and characteristics that rule surrogacy. Surrogacy is indeed a technological advancement in the health sector. However, for countries that are influenced much by religion, technological advances sometimes conflict with the culture and the belief that has long been followed by most of the population. For Indonesia, the largest of Sunni Islam ruled surrogacy against the law. Next, Iran, as a Shia Islam country, ruled that surrogacy is a legal action.Contribution: The research provided information and knowledge regarding the different settings of surrogacy practice. Most religious countries bravely rejected or put strict limits on the practice of surrogacy. (shrink)

The majority of embryos created in natural reproduction die spontaneously within a few weeks of conception. Some have argued that, therefore, if one believes the embryo is a person (in the normative sense) one should find ‘natural’ reproduction morally problematic. An extension of this argument holds that, if one accepts embryo deaths in natural reproduction, consistency requires that one also accepts embryo deaths that occur in (i) assisted reproduction via in vitro fertilisation (IVF) and (ii) embryo research. In (...) a recent paper in this journal, Timothy Murphy criticises both the initial argument and its extension. Murphy argues that double-effect reasoning can justify embryo deaths both in natural reproduction and IVF, but not in embryo research. Thus, according to Murphy, one can, without being inconsistent, (1) believe the embryo is a person and accept natural reproduction and IVF, and (2) accept natural reproduction and IVF, while rejecting embryo research on the ground that it involves embryo deaths. I show that Murphy's argument is problematic because double effect cannot justify embryo deaths in standard IVF practices. The problem is that the proportionality criterion of double effect is not met by such practices. Thus, Murphy's argument fails to support (1) and (2). An implication of his argument failing to support (2) is that it does not defeat the position I have defended in the past—that if one accepts standard IVF practices one should also accept embryo research, including research with embryos created solely for that purpose. (shrink)

This paper discusses two proposals to the US President’s Council on Bioethics that try to overcome the issue of killing embryos in embryonic stem cell research and argues that neither of them can hold good as a compromise solution. The author argues that the groups of people for which the compromises are intended neither need nor want the two compromises, the US government and other governments of countries with restrictive regulation on ES cell research have not provided a clear and (...) sound justification to take into account minority views on the protection of human life to such a considerable extent as to constrain the freedom of research in the area of stem cell research, and the best way to deal with these issues is to accept that many people and most governments adopt a gradualist and variable viewpoint on the human embryo which implies that embryos can be sacrificed for good reasons and to try to find other, less constraining, ways to take into account minority views on the embryo. Finally, another more efficient and time and money sparing compromise will be proposed for those who accept IVF, a majority in most societies.STEM CELL RESEARCHStem cells are widely believed to represent one of the greatest promises for medicine and biomedical research in the coming century with hopes raised for treatments for common diseases and conditions, including neurological disease or injury, diabetes, and myocardial infarct. At present there are three main lines of stem cell research, namely on stem cells originating from early in vitro embryos, left over from infertility treatment, or especially created for research through in vitro fertilisation or cell nuclear transfer cells), on cord blood derived stem cells, and on stem cells from more developed tissues or organs from foetuses …. (shrink)

In this paper we comment on the changes in the provision of fertility care in Australia, New Zealand and the UK to illustrate how different funding arrangements of assisted reproductive technologies (ART) shape the delivery of patient care and the position of fertility nursing. We suggest that the routinisation of in vitro fertilisation technology has introduced a new way of managing the fertility patient at a distance, the distal fertility patient. This has resulted in new forms of organisational (...) routines in ART which challenge both traditional forms of nursing and advanced nursing roles. We discuss the consequences of this increasingly globalised approach to infertility through the lens of three national contexts, Australia, New Zealand and the UK to unpack the position of nursing within the new forms of organisational routines. (shrink)

Evidence suggests that one reason doctors provide certain interventions in assisted reproductive technologies (ART) is because of patient demand. This is particularly the case when it comes to unproven interventions such as ‘add‐ons’ to in vitro fertilisation (IVF) cycles, or providing IVF cycles that are highly unlikely to succeed. Doctors tend to accede to demands for such interventions because patients are willing to do and pay ‘whatever it takes’ to have a baby. However, there is uncertainty as to (...) what moral weight should be placed on patient‐led demands in ART, including whether it is acceptable for such demands to be invoked as a justification for intervention. We address this issue in this paper. We start by elucidating what we mean by ‘patient‐led demand’ and synthesise some of the evidence for this phenomenon. We then argue that a doctor's professional role morality (PRM) yields special responsibilities, particularly in commercialised healthcare settings such as ART, because of the nature of professions as social institutions that are distinct from markets. We argue on this basis that, while there may be reasons (consistent with PRM) for doctors to accede to patient demand, this is not always the case. There is often a gap in justification between acceding to patient‐led demands and providing contested interventions, particularly in commercial settings. As a result, acceding to demand in such settings needs a strong justification to be consistent with PRM. (shrink)

Mitochondrial replacement therapy requires oocytes of women whose mitochondrial DNA will be transmitted to resultant children. These techniques are scientifically, ethically and socially controversial; it is likely that some women who donate their oocytes for general in vitro fertilisation usage would nevertheless oppose their genetic material being used in MRT. The possibility of oocytes being used in MRT is therefore relevant to oocyte donation and should be included in the consent process when applicable. In present circumstances, specific consent (...) should be obtained. However, once MRT becomes more routine, such consent could be incorporated into the general consent process for oocyte donation. The reported lack of proper consent for MRT from the oocyte donor in the first baby born via the technique is an ethical failing and should be corrected in any future practice of MRT. (shrink)