Dr David Adamson on the Varying Moral Values of Patients in Reproductive Care

David Adamson, MD, FRCSC, FACOG, FACS, a reproductive endocrinologist, surgeon, founder, and CEO of ARC Fertility, emphasizes the existence of valid differences in opinion among patients regarding reproductive care. Adamson, a past president of The American Society for Reproductive Medicine, discusses how physicians must consider these variations when adhering to professional guidelines in fertility care.

Transcript

What are some key ethical considerations that practices should keep in mind when providing care to patients undergoing fertility treatments, and how can they navigate potentially challenging situations while adhering to professional guidelines?

That's a really important question. The first reason that it's important is that ethics and morality are obviously somewhat subjective, although it is certainly arguable—and I would make the argument—that there are some immutable human ethics and human morality that we all have to share. But it's important to recognize that there are cultural differences around the world, and so what might be acceptable, very acceptable. in some cultures, is not acceptable in others, and you don't have to go very far. Because even in our country, here, it's very clear, if you look at the exercise of reproductive rights for women and choice that there are some very significant differences of opinion within our own country about what's ethical or what's moral when it comes around to the issue of pregnancy and termination of pregnancy.

In ART [assisted reproductive technology], we don't deal with that directly, but indirectly, because we're dealing with embryos, it is an issue. Is it reasonable to freeze embryos and is it reasonable to discard embryos? And is it reasonable to discard embryos that are normal as opposed to abnormal? And how do you deal with embryos that we're not sure if they're normal, or abnormal, they're mosaics and it's not clear what their reproductive potential is? So, it's important to understand, first of all, I think, that there are legitimate differences of opinion about what's ethical or what's moral. And I think as physicians, we really have to accept that each of our patients is different.

Now, that said, again, I do think there are some fundamental human ethical and moral situations. And I'm, personally, of course, a very strong believer in reproductive rights for women and for men, which means they should have the right to determine the autonomy of their body and their reproductive choices when to have a baby, when not to have a baby, or what have you. But that's my view of it. I obviously feel very strongly about it, many others do. But it is important for us all to recognize there can be differences of opinion.

The first is to recognize potential differences of opinion. Many of these differences of opinion do come around the moral status of the embryo. And so I think it's important for patients and doctors to think about how they do think about the moral status of the embryo. Is someone comfortable discarding an embryo if it's apparently a healthy embryo, but they've had their babies? They should be thinking of this when they are planning on creating embryos. Are they going to be comfortable to donate embryos to someone else? Do they think it's acceptable to discard an embryo based on the gender of that embryo? Some people think that's acceptable and others think it's not acceptable whatsoever. The American Society of Reproductive Medicine has come out and said that they don't believe that sex selection based on the embryo being male, female, or potentially other, is appropriate, and yet some people do it.

So I think the first thing is to recognize that there are probably some human, strong, immutable standards, but not even everybody agrees with that. Patients and doctors need to understand that for the patients. They need to be thinking about where they stand on these issues because, almost invariably, when they go to their physicians and start to talk about care, ethical situations will come up that they have not thought about before. And so it's important for them to be prepared to listen and learn about that.

From the doctor point of view, I think it's essential that they give the patient informed consent, that they tell them about the different options that they have, but also about the the consequences of those options down the road. If you do this, what are you going to do down the road if scenario A, B, or C comes up?

A final comment about the ethics and morals is I think that for almost all patients it can be very, very helpful to see a professional mental health counselor to help them assess these decisions. They're not easy decisions. They're intellectual decisions, but they're based on people's values. And these values, of course, are based on their life and their social upbringing, and their religion and their culture and everything else. And often there's conflicts between, "Well, this part of me says, I should do that, but based on that, I should do this. I really want a baby, but it's going to create that situation and what does my partner think?"—if they have a partner. And so mental health professionals can be very helpful, because they're objective and they're knowledgeable about these issues to help guide people through it. And of course, with their physician, they need to really, really discuss it as well. So those would be my thoughts around the ethics and standards.