REGULATION AND LEGISLATION
Despite the ECASRM recommendations, no mandates have emerged and the application of these recommendations remains solely at the discretion of individual fertility providers and programs.
In contrast, the United Kingdom passed the Human Fertilisation and Embryology Act of 1990, which states that no woman shall receive treatment without considering the welfare of the child who may be born as a result.15 Application of this viewpoint was noted, however, even prior to passage of this legislation. In 1988, a British court upheld an ethics committee decision to deny in vitro fertilization treatments to a woman with a criminal record of prostitution who had been turned down for adoption.16
Campbell asserts that children are "gifts," and as such, we have a moral duty to care for them.17 This includes not only would-be parents but also providers of fertility services and society, which must create a legislative framework within which reproductive medicine is practiced.17
CONCLUSION
In the United States, procreation and access to fertility
services are considered rights from both a legal and cultural perspective. The right to procreate has been established within the framework of the US Constitution, and infertility is viewed as a medical condition that providers are obligated to treat. Based on current ethical guidelines, providers who offer fertility services have a moral and professional obligation to ensure parental fitness to care for any children conceived through medical treatments. Recommendations call for screening of all patients desiring infertility treatment and for those whose fitness is deemed questionable to undergo more rigorous investigation.
Despite such attempts to account for the welfare of the child produced via infertility treatments and other ethical considerations, no mandate or legislation to that effect has emerged, and individual clinics may choose their own criteria. This process may include or exclude persons in an unjust manner. In fact, the lack of regulation may result in the production of offspring who ethically should not have been born. The opposite is true as well. Based on discriminatory criteria, some individuals may be denied access to fertility services and thus never bear the children who ethically and legally had the right to be born. In light of this, setting minimal regulatory or legal standards should be considered. Beyond that, the practice of reviewing the medical, psychological, emotional, and social situations of those seeking fertility assistance is not only ethical, it is the medical professional's duty. Doing so assures the best possible care to the patient, the unborn child, and society. JAAPA
Torry Cobb practices in the Department of Neurologic Surgery at the Marshfield Clinic, Marshfield, Wisconsin. The author has indicated no relationships to disclose relating to the content of this article.
REFERENCES
1. Nunley WC Jr. The slippery slopes of advanced reproductive technologies: Presidential address. Am J Obstet Gynecol. 2004;191(2):588-592.
2. Purdy L. Women's reproductive autonomy: medicalisation and beyond. J Med Ethics. 2006;
32(5):287-291.
3. Lieman HJ. Do I get to decide who should have a baby? Am Fam Physician. 2003:67(5):1139-1143.
4. Ethics Committee of the American Society for Reproductive Medicine. Child-rearing ability and the provision of fertility services. Fertil Steril. 2004;82(3):564-567.
5. Courtwright AM, Doron MW. Is restricting access to assisted reproductive technology an infringement of reproductive rights? Virtual Mentor. 2007;9(9):635-640.
6. Widdows H, MacCallum F. Disparities in parenting criteria: an exploration of the issues, focusing on adoption and embryo donation. J Med Ethics. 2002;28(3):139-142.
7. Griswold v Connecticut, 381 US 479 (1965).
8. Skinner v Oklahoma, 316 US 535 (1942).
9. Gerber v Hickman, 103 F Supp 2d 1214, 1216-1218 (ED Cal 2000).
10. State v Oakley, 629 NW2d 200 (Wis 2001).
11. Humphrey M, Humphrey H, Ainsworth-Smith I. Screening couples for parenthood by donor insemination. Soc Sci Med. 1991;32(3):273-278.
12. Ethics Committee of the American Society for Reproductive Medicine. Access to fertility treatment by gays, lesbians, and unmarried persons. Fertil Steril. 2006;86(5):1333-1335.
13. McGregor J, Dreifuss-Netter F. France and the United States: the legal and ethical differences in assisted reproductive technology (ART). Med Law. 2007;26:117-135.
14. Sauer MV. American physicians remain slow to embrace the reproductive needs of human immunodeficiency virus-infected patients. Fertil Steril. 2006;85(2):295-297.
15. Office of Public Sector Information. Human Fertilisation and Embryology Act. Chap 37 §26(2). http://www.opsi.gov.uk/acts/acts1990/Ukpga_19900037_en_1.htm. Accessed May 18, 2010.
16. R v Ethical Committee of St Mary's Hospital (Manchester), ex p Harriot 1 FLR 512 (1988).
17. Campbell AV. Reproductive medicine: the ethical issues in the twenty-first century. Hum Fertil. 2002;5(1 suppl):S33-S36.