Should Clinicians Set Limits on Reproductive Autonomy?

Abstract

As a gynecologic surgeon with a focus on infertility, I frequently hold complex discussions with patients, exploring with them the risks and benefits of surgical options. In the past, we physicians may have expected our patients to simply defer to our expertise and choose from the options we presented. In our contemporary era, however, patients frequently request options not favored by their physicians and even some they've found themselves online. In reproductive endocrinology and infertility, the range of options that may be offered or that patients may themselves seek out is continuously widening. Physicians certainly seek to find the option that will result in the best outcome for their patients, but the information to guide us in achieving the best outcome can be vague or conflicting. Add to this the financial and emotional pressures bearing on patients seeking assisted reproduction. In this essay, I explore the extent to which clinicians in reproductive medicine should follow patient requests with which they disagree or instead try to persuade the patient to do something else or simply refuse outright to meet the request. And if persuasion is to be used, what would be legitimate methods? Clearly, coercion is unacceptable, but the line between persuasion and coercion can be elusive. At what point can or should clinicians resist such requests—and to what degree?

Situating commercialization of assisted reproduction in its socio-political context: a critical interpretive synthesis

“…Relatedly, it is observed that because ART treatment has a relatively high failure rate, is distressing for many, and is associated with significant drop-out rates, a patient-centred approach is crucial ( Dancet et al , 2011 ). Furthermore, it is noted that the ever-increasing array of treatment options and pressures upon couples makes the ‘best’ treatment in a specific situation difficult to ascertain ( King, 2017 ). For this reason, shared decision-making is seen as critical for ensuring that context-specific decisions are respectful of couples’ individual circumstances, which in turn leads to increased treatment variation ( Ezugwu and der Burg, 2015 ; Brabers et al , 2016 ).…”

The Future of Reproductive Autonomy

“…Yet it also has its critics, including several other authors in this special report. As Louise King considers, a bald, hands‐off approach to autonomy can sometimes have the effect of abandoning patients at just the moment when they most need guidance and advice . And as Kimberly Mutcherson argues, a hands‐off, negative‐rights approach can be insufficient to support a right as fundamental as the right to procreate, leading her to argue for a positive legal right to financial assistance for assisted reproductive technologies …”