Abstract
The question of the moral acceptability of infertility treatment to HIV positive persons raises a number of interesting ethical points regarding the responsibility of the infertility specialist for the outcome of his or her actions. The analysis of the physician's responsibility is conducted within the framework of accomplice liability. The physician is a collaborator in the parental project of the principals—that is, the intentional parents. Both causal contribution and intention are considered as elements of complicity. It is concluded that a two per cent risk of vertical transmission when the woman is HIV positive is insufficient to blame the infertility specialist who helps her to conceive. Helping an infertile HIV positive infertile couple to have a child does not constitute reckless behaviour. When the couple is fertile, infertility treatment is directed at risk reduction and falls under the physician's obligation to act in the best interests of his patients.
Full Text
The Full Text of this article is available as a PDF (86.4 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arras J. D. HIV and childbearing. 2. AIDS and reproductive decisions: having children in fear and trembling. Milbank Q. 1990;68(3):353–382. [PubMed] [Google Scholar]
- Auroux M. Faut-il traiter l'infertilité chez les couples dont l'un des partenaires est séropositif? Contracept Fertil Sex. 1999 Feb;27(2):118–120. [PubMed] [Google Scholar]
- Emanuel E. J., Emanuel L. L. Four models of the physician-patient relationship. JAMA. 1992 Apr 22;267(16):2221–2226. [PubMed] [Google Scholar]
- Frey R. G. Some aspects to the doctrine of double effect. Can J Philos. 1975 Oct;5(2):259–283. doi: 10.1080/00455091.1975.10716111. [DOI] [PubMed] [Google Scholar]
- Lyerly A. D., Anderson J. Human immunodeficiency virus and assisted reproduction: reconsidering evidence, reframing ethics. Fertil Steril. 2001 May;75(5):843–858. doi: 10.1016/s0015-0282(01)01700-9. [DOI] [PubMed] [Google Scholar]
- Olaitan A., Reid W., Mocroft A., McCarthy K., Madge S., Johnson M. Infertility among human immunodeficiency virus-positive women: incidence and treatment dilemmas. Hum Reprod. 1996 Dec;11(12):2793–2796. doi: 10.1093/oxfordjournals.humrep.a019212. [DOI] [PubMed] [Google Scholar]
- Pennings G. Measuring the welfare of the child: in search of the appropriate evaluation principle. Hum Reprod. 1999 May;14(5):1146–1150. doi: 10.1093/humrep/14.5.1146. [DOI] [PubMed] [Google Scholar]
- Savulescu J. Should doctors intentionally do less than the best? J Med Ethics. 1999 Apr;25(2):121–126. doi: 10.1136/jme.25.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Smith J. R., Forster G. E., Kitchen V. S., Hooi Y. S., Munday P. E., Paintin D. B. Infertility management in HIV positive couples: a dilemma. BMJ. 1991 Jun 15;302(6790):1447–1450. doi: 10.1136/bmj.302.6790.1447. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Spike J., Greenlaw J. Case study: ethics consultation. J Law Med Ethics. 1994 Winter;22(4):347–350. doi: 10.1111/j.1748-720x.1994.tb01318.x. [DOI] [PubMed] [Google Scholar]
- Thorp J. M., Jr, Wells S. R., Bowes W. A., Jr, Cefalo R. C. Integrity, abortion, and the pro-life perinatologist. Hastings Cent Rep. 1995 Jan-Feb;25(1):27–28. [PubMed] [Google Scholar]
- Wertz D. C., Fletcher J. C. Fatal knowledge? Prenatal diagnosis and sex selection. Hastings Cent Rep. 1989 May-Jun;19(3):21–27. [PubMed] [Google Scholar]