Klitzman Robert
a Department of Psychiatry and Director , Bioethics Masters & Online Course Programs, Columbia University.
AJOB Empir Bioeth. 2017 Oct-Dec;8(4):253-265. doi: 10.1080/23294515.2017.1394927. Epub 2017 Oct 23.
Many adults may make less-than-ideal parents, but important ethical questions arise concerning whether assisted reproductive technology (ART) providers should thus ever refuse treatment to certain patients, and if so, when, and how to decide.
In-depth interviews of approximately 1 hour each were conducted with 27 ART providers (17 physicians, and 10 other health providers).
Clinicians often struggle with whether to attempt to assess and predict patients' potential future parenting abilities, and if so, how, and how to proceed if doubts arise. Providers face profound ethical tensions between adults' rights to reproduce and best interests of the eventual children (i.e., to be born into "stable" homes), and questions about the extent of professional responsibilities toward potential parents versus toward future offspring. Providers generally feel uncomfortable with this role, and hence don't want it, partly since they lack training for it, but also because of inherent empirical and ethical uncertainties. Concerns about discrimination based on the mere presence or history of certain diagnoses or traits (e.g., single marital status or past depression) also arise. Clinicians frequently seek to resolve these tensions through various strategies-for example, referring these decisions to others; hoping that patients drop out of treatment; assessing and increasing social support (e.g., arranging for possible co-parents); assisting the patient psychotherapeutically; or seeking to communicate concerns to patients only indirectly or implicitly. Clinics vary in how they make and approach these decisions-whether they rely on a formal ethics or other committee.
These data, the first to explore several critical aspects of in vitro fertilization (IVF) providers' views and decision making about assessing the quality of patients' potential future parenting, have critical implications for future practice, education, research, and guidelines. Further empirical and normative scholarship and guidelines are needed to help clarify expectations, processes, and possible approaches to aid providers and patients.
许多成年人可能并非理想的父母，但辅助生殖技术（ART）提供者是否因此就应拒绝为某些患者提供治疗，若应拒绝，何时拒绝以及如何做出决定，引发了重要的伦理问题。
对27名ART提供者（17名医生和10名其他医疗服务提供者）进行了每人约1小时的深入访谈。
临床医生常常纠结于是否要尝试评估和预测患者未来为人父母的潜在能力，如果要评估，该如何评估，以及如果产生疑虑该如何处理。提供者在成年人的生育权与未来孩子的最大利益（即出生在“稳定”家庭）之间面临着深刻的伦理困境，同时也面临着对潜在父母与未来后代的职业责任范围的问题。提供者普遍对这一角色感到不适，因此不想要承担这一角色，部分原因是他们缺乏相关培训，还因为存在内在的经验和伦理上的不确定性。对于仅基于某些诊断或特征的存在或病史（例如单身婚姻状况或过去的抑郁症）而产生歧视的担忧也随之出现。临床医生经常试图通过各种策略来解决这些困境——例如，将这些决定交给其他人；希望患者退出治疗；评估并增加社会支持（例如安排可能的共同父母）；在心理治疗上帮助患者；或者仅以间接或含蓄的方式向患者传达担忧。不同诊所做出和处理这些决定的方式各不相同——无论他们是否依赖正式的伦理或其他委员会。
这些数据首次探讨了体外受精（IVF）提供者对评估患者未来潜在育儿质量的看法和决策的几个关键方面，对未来的实践、教育、研究和指导方针具有重要意义。需要进一步的实证和规范性学术研究及指导方针来帮助明确期望、流程以及可能的方法，以帮助提供者和患者。
