Abstract
BackgroundProfessional guidelines have addressed ethical dilemmas posed by a few types of nontraditional procreative arrangements (e.g., gamete donations between family members), but many questions arise regarding how providers view and make decisions about these and other such arrangements.MethodsThirty-seven ART providers and 10 patients were interviewed in-depth for approximately 1 h each. Interviews were systematically analyzed.ResultsProviders faced a range of challenges and ethical dilemmas concerning both the content and the process of decisions about requests for unconventional interfamilial and other reproductive combinations. Providers vary in how they respond — what they decide, who exactly decides (e.g., an ethics committee or not), and how — often undergoing complex decision-making processes. These combinations can involve creating or raising the child, and can shift over time — from initial ART treatment through to the child’s birth. Patients’ requests can vary from fully established to mere possibilities. Arrangements may also be unstable, fluid, or unexpected, posing challenges. Difficulties emerge concerning not only familial but social, combinations (e.g., between friends). These arrangements can involve blurry and confusing roles, questions about the welfare of the unborn child, and unanticipated and unfamiliar questions about how to weigh competing moral and scientific concerns — e.g., the autonomy of the individuals involved, and the potential risks and benefits. Clinicians may feel that these requests do not “smell right”; and at first respond with feelings of “yuck,” and only later, carefully and explicitly consider the ethical principles involved. Proposed arrangements may, for instance, initially be felt to involve consanguineous individuals, but not in fact do so. Obtaining and verifying full and appropriate informed consent can be difficult, given implicit familial and/or cultural expectations and senses of duty. Social attitudes are changing, yet patients’ views of these issues may also vary, based on their cultural backgrounds.ConclusionsThese data, the first to examine how clinicians make decisions about unconventional reproductive arrangements, highlight several critical ethical questions and ambiguities, and variations in clinicians’ responses. While several professional guidelines exist, the current data highlight additional challenges, and have vital implications for improving future guidelines, practice, education and research.Trial registrationNot applicable.
Highlights
Professional guidelines have addressed ethical dilemmas posed by a few types of nontraditional procreative arrangements, but many questions arise regarding how providers view and make decisions about these and other such arrangements
Requests for several additional types of reproductive arrangements have been described, including gamete donations between various combinations of family members, such as to and from male and female siblings, and mothers and daughters serving as surrogates for each other [3] — that I here term “unconventional.”
Providers varied in how they responded to such requests — what they decided, who exactly decides, and how. These combinations can create and/or raise the child, and can shift over time — from initial Assisted Reproductive Technologies (ART) treatment through the child’s birth. Requests for these arrangements can vary from fully established to mere possibilities
Summary
Professional guidelines have addressed ethical dilemmas posed by a few types of nontraditional procreative arrangements (e.g., gamete donations between family members), but many questions arise regarding how providers view and make decisions about these and other such arrangements. Requests for several additional types of reproductive arrangements have been described, including gamete donations between various combinations of family members, such as to and from male and female siblings, and mothers and daughters serving as surrogates for each other [3] — that I here term “unconventional.”. These various unconventional types of combinations have received far less attention, and may present challenges that both resemble and differ from each other. As more individuals seek ART and as costs of gamete (especially egg) donation and gestational surrogacy remain relatively high, such patients will no doubt increasingly continue to seek cheaper, unconventional approaches
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