Assisted reproductive technology, justice and autonomy in an era of COVID-19

Abstract

Fertility services were significantly curtailed or suspended as an initial response to the coronavirus pandemic earlier this year, following guidance from European Society for Human Reproduction and Embryology (ESHRE) and American Society for Reproductive Medicine (ASRM) as well as a General Direction (GD0014) issued by the Human Fertilisation and Embryo Authority (HFEA). It is difficult to argue with triage of medical care and resources in the face of anticipated overwhelming demand, however, this situation resulted in considerable distress, as evidenced by a change.org petition opposing ASRM recommendations, which has gathered over 21,000 signatures to date. Whilst halting assisted reproductive technology (ART) as the pandemic unfolded was ethical because public health goals superseded individual patient autonomy, the fertility sector now faces a greater challenge balancing ethical considerations in an era characterised by ongoing threat of Covid19. This article discusses justice and autonomy in the context of ART, potential conflicts and resolutions.

Assisted reproductive technology in Japan: A summary report for 2020 by the ethics Committee of the Japan Society of obstetrics and gynecology

“…The COVID‐19 pandemic affected ART treatment cycles worldwide by causing the cessation of new treatments, delays and postponements of treatment, and changes or interruptions of the stimulation protocols for couples undergoing ART. 22 , 23 , 24 , 25 , 26 , 27 In Japan, literature on the effects of the COVID‐19 pandemic on ART facilities, services, outcomes, and patients is limited and detailed analyses have yet to be conducted. However, the COVID‐19 pandemic was considered to have little effect on decreasing the total number of ART cycles implemented during 2020 compared with other European countries.…”

“…The COVID-19 pandemic affected ART treatment cycles worldwide by causing the cessation of new treatments, delays and postponements of treatment, and changes or interruptions of the stimulation protocols for couples undergoing ART. [22][23][24][25][26][27] In Japan, literature on the effects of the COVID-19 pandemic on ART facilities, services, outcomes, and patients is limited and detailed anal-…”

Efforts to Increase Understanding of COVID-19 Screening in Assisted Reproductive Technology Services

“…The ART program poses an ethical dilemma because not everyone has equal access to treatment. However, the COVID-19 pandemic's impact led to the restructuring of health services, canceling all ART interventions and fertility treatments, except for maintaining fertility in patients exposed to chemotherapy 20,21 .…”

Pandemics at Work: Convergence of Epidemiology and Ethics

“…A negative right is a duty by others not to be subjected to an action imposed by others. Mandatory quarantine is an example during pandemics (Martins da Silva & Campo-Engelstein, 2021). Caplan (2013: 2667), in writing about the right not to vaccinate, opines, “Liberty in regarding vaccination ends at the start of a vulnerable person’s body.” This notion reflects the sentiment of the harm principle posited by John Stuart Mill (1859/2003), in which individual liberties can be restricted to protect the individual and others.…”