Gynecology
Access to services at assisted reproductive technology clinics: A survey of policies and practices,☆☆

https://doi.org/10.1067/mob.2001.111793Get rights and content

Abstract

Objective: Our goal was to investigate policy on patient access to services at assisted reproductive technology clinics in the United States. Study Design: Surveys asked about a variety of ethically and socially challenging cases and were mailed to directors of all Society for Assisted Reproductive Technology–associated assisted reproductive technology clinics. Results: Written policies on access to services are present at 40% of assisted reproductive technology clinics. Universal agreement was not found on any issue; 79% of clinics treat single women, 27% treat patients with a history of schizophrenia, 10% treat patients who use alcohol excessively, 7% treat human immunodeficiency virus–positive women, and 2% would treat patients previously convicted of child abuse. A breakdown of the responses indicated that some clinics are more permissive in terms of access to services than others, whereas some are more restrictive. Conclusions: The data demonstrate considerable variability in policy among clinics on most access-to-services questions. The results highlight the importance of ongoing discussion of the ethical and legal issues related to access and the need to develop consistent methods to deal with complex cases. (Am J Obstet Gynecol 2001;184:591-7.)

Section snippets

Methods

We sent a 20-minute survey to the directors of all 324 Society for Assisted Reproductive Technology (SART)–associated ART clinics in the United States. The survey was pilot-tested to ensure face validity with the help of 8 physicians and nurses who participate in infertility care. The study had the approval of our institutional review board and of the SART Research Committee.

The survey was divided into 5 parts, only 3 of which are presented in this report. The sections included are as follows:

Results

In the spring of 1998, surveys were sent to the directors of 324 SART-associated ART clinics. As a result of the first mailing, we received 82 responses (25%); the second and third mailings resulted in the return of an additional 102 surveys, for an overall response rate of 57%.

The surveys were sent to clinic directors. Of the 324 directors, 94% are MDs or MDs/PhDs, 4% are PhDs, and 2% are DOs. In most cases responses came directly from the directors; however, in some cases questions were

Comment

ART programs are frequently confronted with patients who exhibit behaviors or conditions that raise ethical and social concerns for providers. Information regarding how clinics handle these patients is scarce. In this study we sent surveys to the directors of all US ART clinics to determine their policies on access to services for patients with a variety of complex conditions and behaviors. Our results show a great deal of variability in clinic policy and procedures on these issues.

The

Acknowledgements

We thank Barbara Hillinger and Bonnie Bragg of the Dartmouth Ethics Institute for their excellent assistance with data entry, preparation of mailings, and other administrative aspects of this project.

References (12)

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    Although there is some theoretical discussion in the literature on the interrelation between access to assisted reproduction treatment and the principles of justice and equality (Coleman, 2002, 2002–2003; Crossley, 2005; Daar, 2008; Elster, 2005; Fong, 2000; Inhorn and Fakih, 2006; Sato, 2001; Rao, 2008; Riley, 2007) very few studies examine the practice of such technologies in light of these principles. Most of the existing studies focus on access to IVF in the US context (Gurmankin et al., 2005; Stern et al., 2001, 2002; Storrow, 2007), revealing a tendency to turn away candidates for IVF and assisted reproduction treatment on a somewhat arbitrary basis (Gurmankin et al. 2005) following vague professional guidelines (ASRM, 2004; Steinbock, 2005). In the UK the clinicians’ code of practice issued by the Human Fertilisation and Embryology Authority explicitly holds that assessment of the welfare of the child must be done in a non-discriminatory way, specifically on grounds of gender, race, disability, sexual orientation, religious belief or age (Human Fertilization, 2009).

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Supported by a grant (No. 250-176) from the Hitchcock Foundation, Dartmouth College.

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Reprint requests: Judy E. Stern, PhD, Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.

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