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Original article

Vol. 140 No. 2728 (2010)

Differences and similarities in the attitudes of paediatricians, gynaecologists and experienced parents to criteria delineating potential risks for the welfare of children to be conceived with assisted reproduction

  • B Boehler
DOI
https://doi.org/10.4414/smw.2010.13064
Cite this as:
Swiss Med Wkly. 2010;140:w13064
Published
05.07.2010

Abstract

Question under study: Swiss legislation limits the provision of assisted reproductive medicine strictly to those infertile couples, who can guarantee the future welfare of their child. Daily practice often makes it difficult to balance between avoiding discrimination against infertile couples living in a borderline socio-economic or health situation on the one hand, and keeping to the stipulated maximal standards of future child welfare on the other. Obstetricians and neonatologists often criticise prior decisions made by physicians involved in reproductive medicine.

Methods: Based on existing regulations about child welfare and on experts’ opinions, thirteen hypothetical criteria for future well-being of children were formulated. These were presented to and assessed by 20 residents in obstetrics and gynaecology, 21 residents in paediatrics and 26 previously infertile couples having had children with the help of assisted reproduction.

Results: Although some criteria were rated more important than others, evaluation of the assessments did not reveal any statistically significant difference among the three assessing groups.

Conclusions: The lack of differences in the assessments of the hypothetical criteria among the three assessing groups related to the large variation in judgment among the various participants in each group, not to the acceptance or rejection of some of the criteria. The difficulty in defining applicable criteria for future child welfare is emphasised. A more individualised approach in the assessment of infertile couples is needed and must be implemented in the legal regulations.

References

  1. Swiss Law on Assisted Reproduction, Bundesgesetz über die medizinisch unterstützte Fortpflanzung. Available from: http://www.admin.ch/ch/d/sr/8/810.11.de.pdf; 2001.
  2. Germond M, Senn A. A law affecting medically assisted procreation is on the way in Switzerland. J Assist Reprod Genet. 1999;16:341-3.
  3. Preamble to the Constitution of the World Health Organization (WHO) as adopted by the International Health Conference, New York, 1946.
  4. Office of the UN High Commissioner for Human Rights. Convention on the Rights of the Child. Available from: http://www2.ohchr.org/english/law/crc.htm; 1989.
  5. Honsel, H, Nedim PV, Geiser T. Basler Kommentar zum schweizerischen Privatrecht, Zivilgesetzbuch I: Art. 1 – 456 ZGB. Helbing & Lichtenhahn, Basel. Second edition. ISBN: 3-7190-2028-2; 2002.
  6. Swiss Criteria for Adoption (Verordnung über die Adoptionsvermittlung, VAdoV). Available from: http://www.admin.ch/ch/d/sr/211_221_36/index.html; 2002.
  7. Mayring P. Einführung in die Qualitative Sozialforschung. Beltz-Verlag, Hemsbach/Bergstrasse, Germany, fifth edition; 2009.
  8. Leunens L, Celestin-Westreich S, Bonduelle M, Liebaers I, Ponjaert-Kristoffersen I. Cognitive and motor development of 8-year-old children born after ICSI compared to spontaneously conceived children. Hum Reprod. 2006;21:2922–9.
  9. Belva F, Henriet S, Liebaers I, Van Steirteghem A, Celestin-Westreich S, Bonduelle M. Medical outcome of 8-year-old singleton ICSI children (born ≥32 weeks’ gestation) and a spontaneously conceived comparison group. Hum Reprod. 2007;22:506–15.
  10. Bergh T, Ericson A, Hillensjö T, Nygren KG, Wennerholm UB. Deliveries and hildren born after in-vitro fertilisation in Sweden 1982-95: a retrospective cohort study. Lancet. 1999;354:1579–85.
  11. Lavery S. Preimplantation genetic diagnosis and the welfare of the child. Hum Fertil. (Camb). 2004;7:295–300.
  12. Tschudin S, Steimann S, Bitzer J, Hösli I, Holzgreve W, Elzi L, et al. Round-table multidisciplinary counselling of couples with HIV prior to assisted reproduction. Reprod Biomed Online. 2008;17:167–74.
  13. Golombok S. New families, old values: considerations regarding the welfare of the child. Hum Reprod. 1998;13:2342–7.
  14. Golombok S, Murray C, Jadva V, Lycett E, MacCallum F, Rust J. Non-genetic and non-gestational parenthood: consequences for parent-child relationships and the psychological well-being of mothers, fathers and children at age 3. Hum Reprod. 2006;21:1918–24.
  15. Reiter-Theil S. Dealing with the normative dimension in clinical ethics consultation. Cambridge Quarterly Healthcare Ethics. 2009;8(4):347–56.
  16. Pennings G. The welfare of the child. Measuring the welfare of the child: in search of the appropriate evaluation principle. Hum Reprod. 1999;14:1146–50.
  17. The Ethics Committee of the American Society for Reproductive Medicine (2004) Child-rearing ability and the provision of fertility services. Fertil Steril. 2004;82:564–7.
  18. ESHRE Task Force on Ethics and Law including Pennings G, de Wert G, Shenfield F, Cohen J, Tarlatzis B, Devroey P. (2007) ESHRE Task Force on Ethics and Law 13: the welfare of the child in medically assisted reproduction. Hum. Reprod. 2007;10:2585–88. –rearing ability and the provision of fertility services. Fertil Steril. 2004;82:564–7.
  19. Beauchamp TL, Childress JF, editors. Principles of Medical Ethics. New York: Oxford University Press; 2001.
  20. Troehler U, Reiter-Theil S, editors in collaboration with E Herych. Ethics Codes in Medicine: Foundations and Achievements 1947–1997. Ashgate, Aldershot; 1998.
  21. Coester M. Das Kindeswohl als Rechtsbegriff. Die richterliche Entscheidung über die elterliche Sorge beim Zerfall der Familiengemeinschaft. Habilitationsschrift, Universität Augsburg; 114; 1983.
  22. Sponsel R. Kindeswohl-Kriterien Deutschland. Internet Publicationen für Allgemeine und Integrative Psychotherapie. Available from: http://www.sgipt.org/forpsy/kw_krit0.htm; 2007.
  23. Fegert J. Basic Needs of Children. In: Salgo L, Zenz G, Fegert J, Bauer A, Weber C, Zitelmann M, editors.Verfahrenspflegschaft für Kinder und Jugendliche. Ein Handbuch für die Praxis. Bundesanzeiger, Cologne, Germany. ISBN: 3-7190-2028-2; 2002.