In reproductive medicine we face ethical dilemmas regularly.  Nearly every week we navigate questions about treating when the chance of success might be futile, when the treatment might pose risk that exceeds the benefit, when patients ask for care that is outside of societal norms, and more.

Here are some scenarios we’ve encountered just in the past little while:

  • single male in his 70s wanting a child with an egg donor and surrogate
  • woman who wants to use sperm from the married man she is having an affair with
  • a man who has had a vasectomy without telling his wife
  • a woman whose risk of death in pregnancy is nearly 30% and she wants us to help her conceive
  • a couple we’ve helped conceive in the past but has terminated the pregnancy because the fetus was female

Now, many of these scenarios have a legally clear answer about permissibility, but ethically they are not as clear.

While we hand-wring over these requests for care, hold multidisciplinary discussions about them, reviewed them with lawyers and have even engaged medical ethicists from local hospitals, we eventually make the best decision we can.

I honestly like these scenarios as they challenge medicine, values, and the law.  They move our thinking forward and ultimately help make decision making in the future easier.

99% of our patients come without such dilemmas but these “out of the norm” scenarios seem to be happening more often.  It is possible politicians will legislate what we should do in such cases, but I doubt it. Politicians, wisely, tend to stay out of reproductive medicine, feeling as Pierre Trudeau did that there is “no place for the state in the bedrooms of our nation.”

What do you think?