1 The Royal Children’s Hospital Melbourne
Five years ago in Victoria, eligibility for Assisted Reproductive Treatment (ART) was broadened to include anybody seeking treatment- regardless of whether their infertility was for ‘social’ or medical reasons. Coupled with substantial federal government subsidy of treatment, Victoria represents one of the most open and best resourced fertility systems in the world. While access to ART in Victoria is laudably equitable, concerns over child welfare, and capacity to parent, in a small number of cases persist at clinic-level among counsellors. Should an expressed wish to become a parent provide adequate grounds for treatment access? Or are identified and established patterns of behaviour known to have adverse infant welfare outcomes necessary limiting considerations when determining treatment access?
A novel way of thinking about this complex issue is to consider how we view those seeking treatment. Linguistic distinctions matter because they underpin the complex ethical issues that lie at the heart of ART access. Consider what the differing viewpoints might reveal;
Patient: Fertility clinicians hold a medical perspective and view those seeking ART as patients needing to be ‘cured.’ As such, treatment would hinge on whether they suffer medical infertility. Should the type of infertility make a difference to whether or not we treat?
Customer: ART clinics are commercial businesses, supported by significant government subsidy. As such, numbers count. Those seeking to use the services can be viewed as ‘clients’ or even ‘customers.’ This is a fundamental shift in perception away from the medical model of care. The ART customer is not somebody to be ‘fixed’, but somebody to be courted, appeased and given a good customer experience.
Applicant: Viewed in this way, the individual is seeking treatment that is not an automatic right or liberty. It is contingent upon satisfaction of criteria that may protect the interests of others. If no right is absolute, then the assertion of a reproductive right to treatment is only one of potentially myriad other considerations for the ART provider.
In this presentation I will argue that professional codes of medical and legal ethics, combined with social and moral responsibility for children should extend protection to those whose birth is the intended and foreseeable outcome of providing ART. The State owes a duty of care to any future child born of treatment, and it is reasonable for the State to view people seeking treatment as ‘applicants’ until serious child welfare concerns are discounted.
Georgina Hall is a PhD candidate at the Centre for Population and Global Health and Society, University of Melbourne. Her research interest is reproductive ethics, and in particular, the welfare and best interests of future children born of assisted reproductive treatment. Georgina is a former journalist who holds a Masters in Bioethics and has a background in clinical paediatric ethics as a foundation member of the Children’s Bioethics Centre at the Royal Children’s Hospital in Melbourne. She sits on the Clinical Ethics Committee of the Monash Health network and is involved with teaching ethics to medical students at Monash University.