If people are believed to be incompetent to bring up children, is it ethical to turn them down for fertility treatments such as in vitro fertilization?

Doctors who provide fertility services must occasionally balance the right to bear children against the welfare of future offspring. In the medical journal Fertility and Sterility, the Ethics Committee of the American Society for Reproductive Medicine provides guidance on this quandary.

“It’s not a frequent issue, but the feeling is that every (fertility) program has had a concern of this sort at some time,” John A Robertson, Ethics Committee chair from the University of Texas School of Law in Austin, said in an interview with Reuters Health. “So how do you handle the issue if someone has perhaps some history of a serious psychological illness, or there is perhaps some child abuse or spousal abuse?”

The Committee recommends that programs adopt explicit policies and procedures to help determine when to withhold services if concerns arise regarding the child-rearing capabilities of prospective patients.

There should be clauses laying out the information and evaluation that will be required of patients, and to clarify conditions that would prohibit treatment.

Examples of conditions that would disallow treatment might include “uncontrolled psychiatric illness, substance abuse, on-going physical or emotional abuse, or a history of perpetrating physical or emotional abuse,” the authors write.

“But you do not want people acting out of stereotypes,” Robertson added. He noted that fertility clinics are subject to the Americans with Disabilities Act, which prohibits discrimination or denial of services on the basis of an individual’s disability.

The Ethics Committee’s document also states that physicians have the right to choose not to treat individuals if they believe they will be inadequate child-rearers, as long as the physicians comply with anti-discrimination laws. But they are also generally entitled to treat such patients if they so choose.

Robertson acknowledges that “there aren’t clear answers” to such a dilemma. “We’re just trying to give some guidance.”

SOURCE: Fertility and Sterility, September 2004.