Asking the inconceivable? Physician-patient conflict regarding the utilization of assisted reproductive technologies (ARTs) by HIV-seropositive couples: Medical, ethical and legal considerations.

摘要

First recognized in 1981, human immunodeficiency virus type 1 (HIV-1) continues to foster considerable medical and ethical debate among physicians with regards to treatment options in reproductive medicine. During the first decade of the HIV/AIDS epidemic, fear of viral transmission prompted many physicians to refuse to treat non-HIV-related conditions in infected individuals. In the last decade, long-term prognosis for HIV-infected individuals has risen dramatically, fuelled by the development of potent antiretroviral therapies. Given their improved state of health, an increasing number of infected individuals, many of whom are heterosexual adults of reproductive age, are requesting the use of assisted reproductive technologies (ARTs) to achieve pregnancy, either as a result of infertility factors, or as a means to diminish the risk of transmission to the uninfected partner. Although the medical community now considers HIV a chronic, manageable illness, many practitioners, citing the potential transmission of the virus to the uninfected partner and/or to the couple's offspring, as well as concerns for the psychosocial well-being of the child-to-be, continue to strongly discourage such couples from proceeding with reproductive care, even denying access in certain circumstances. However, continual advances in the treatment and prognosis of infected individuals, as well as a considerable decrease in the risk of vertical transmission, have called into question the systematic medical recommendation against the provision of ART services to HIV-affected individuals. This research examines the medical, ethical and legal aspects regarding the use of ARTs by HIV-affected couples, focusing on the professional role obligations of the providing physician. Although the risk remains that any child of such a couple could be born with or become infected with HIV, an ethical and legal analysis of this debate demonstrates that such a practice violates respect for patients' medical autonomy, specifically with regard to reproductive decision-making, and infringes upon the legal rights of the couple and the woman's rights with respect to reproductive autonomy. Moreover, the harms which may result are not sufficient to justify the categorical exclusion of individuals from ART services on the basis of HIV-seropositivity.