Ethical issues in assisted reproduction

Abstract

Eligibility for state funded ART is not uniform throughout the world. In UK access to publicly funded ART is often restricted to couples and single women fulfilling certain criteria, agreed locally comprising of: female age, body mass index (BMI) and smoking status. Restriction in provision, based on lifestyle choices, is in conflict with ethical principles of patient autonomy and justice. In some countries access is restricted to only married couples while in others legislation permits treatment to same sex couples and single women. In UK equality legislation forbids discrimination against individuals on the grounds of sexuality. The upper age limit of women receiving treatment varies throughout UK with the majority of clinics offering treatment up to the age of 46e50 for self-funded patients but only to the age of 40 for publicly funded patients. Similarly, upper limits for female BMI vary from 30 to 35 kg/m. Access is often restricted to nonsmokers. Restrictions are also based on lifestyle factors among women and are founded on the premise that treatment would be less effective in older, obese and those who smoke. They also take account of issues to do with the welfare of unborn children. These restrictions have resulted in many older women seeking treatment abroad. Denial of access to treatment arguably conflicts with Article 8 of the European Charter of Human Rights which articulates the individual’s rights to respect for private life and reproductive freedom. Furthermore Article 9 of the Charter of Fundamental Freedoms of the European Union incorporates the Right to found a family. This does not equate to a right to fertility treatment but suggests equal access in principle where such access is available. Denial of treatment to patients with a very poor prognosis may be justifiable on a utilitarian basis but