nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Wednesday, May 26, 2010

Update On Ethics Of Fertility Treatment And Multiple Births

Specialty group says "no regulation needed" despite a lot of issues left unresolved.

A short time ago I posted on the ethical issues with fertility treatments that result in high-multiple births where the infants are at risk of complications and death.

A major organization, ASRM (American Society for Reproductive Medicine), has met to consider how to regulate the fertility industry (see here from the LA Times Booster Shots blog, May 25).  Their conclusion:  we don't need no stinking regulations.  We just need to cover these couples with fertility insurance (rarely covered now), and there will be no need to attempt multiple embryo implants to increase the success rate.  On the issues of fertility drugs which might cause multiple births, the decision is to just not use them, always go for implants.

Implants don't always succeed.  Some women require several attempts, and in some cases the treatment is futile--but you'll only know that when you try many times (and you may be left with fertility drugs as the only alternative.)

So, we're talking about a treatment that is expensive--even one time--and very expensive, adding up the multiple attempts needed in some cases.

Do "reproductive rights" include our obligation to pay for couples to be able to have children--when it works?  Note, if we cover fertility treatment in an insurance plan, this will distribute the cost across every participant who pays premiums, with each payer experiencing little change in premium (even though the procedure is expensive).

What do we do with those premium-payers who do not wish to subsidize a couple's desire to have children?  Not having children isn't a disease that "requires" treatment.  Some say child-bearing and child-rearing are essential parts of human well-being.  Others would disagree.  Still others would say, "If it means so much to you, there are many children out there for adoption."

This brings up another wrinkle to the reproductive rights debate:  are we obligated to provide an opportunity for "children" or must it be "blood-related offspring?"  Some would prefer not to have children if they can't be genetic parents.

And what about those situations where embryos are donated because the woman has no viable eggs, or the sperm come from a donor because the man is infertile?  And all the other combinations of donors, genes, and techniques in-between?  Are we morally obligated morally to provide all that?

Is there a line beyond which society has no obligation to provide someone with the child-rearing experience?

And none of the discussion above addresses concerns where, without regulations, doctors or patients could pursue their own desires.  A worst case would be the couple who finds a doctor to give them multiple embryos, intending to have multiple births, despite the risk to the infants.

The ASRM has not solved the problems.  Their "let's all just pay for it" decision provides a neat solution that gets them paid for doing a lot of fertility work, but kicks the can down the road on the complexity of issues involved.

Doc D

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