Ethics of assisted reproduction for HIV concordant couples
GU Medicine and Communicable Diseases, Imperial College, Norfolk Place, London W2 1PG, UK
Email: g.p.taylor{at}imperial.ac.uk
Sir,
In the recent article on ethics of medically assisted fertility treatment for HIV-positive men and women (ESHRE Ethics and Law Taskforce, 2004
), the authors conclude that ‘...medical assistance to reproduction of HIV-positive people is ethically acceptable. For the time being, only cases of serodiscordant couples should be considered’.
If this statement were to be generally accepted, this would undoubtedly cause considerable distress to, and reduce the quality of life of, many HIV concordantly positive couples at a time of renewed hope and expectation. The statement is lacking in substantial support for this conclusion and is far too broad, in that it considers the prognosis of all patients with HIV to be equal, and makes sweeping comparisons of HIV with ‘cancer’ (which covers a broad range of conditions and prognoses) and cystic fibrosis. The authors consider that it is unethical to assist a couple infected with HIV to conceive at this time because it is possible that neither parent will survive to parent the child to adulthood. The dramatic increase in conceptions in HIV-positive women in the UK would indicate that the authors' view is not shared by these HIV-positive women, many of whom conceive on anti-retroviral therapy. Parenthood is important to these women.
The authors argue that the survival of these women, and their HIV concordant partners, is uncertain and therefore none should be considered for medically assisted reproduction. Is it ethical to paint with so broad a brush?
References
ESHRE Ethics and Law Taskforce (2004) Taskforce 8: ethics of medically assisted fertility treatment for HIV positive men and women. Hum Reprod 19, 2454–2456.
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