Ethics Opinions

In handling patient data, individual physicians should balance supporting and respecting patient privacy with upholding their ethical obligations to the betterment of public health. The use of data for the benefit of public health should be treated as a form of public good in which the standards and values of health care should follow the data and be upheld and maintained. Those with access to datasets have a duty to uphold the ethical values of health care in which the data were produced.

Genetic testing is most appropriate when the results of testing will have meaningful impact on the patient’s care. It is important that patients always receive appropriate counseling. Physicians should not encourage testing unless there is effective therapy available to prevent or ameliorate the condition tested for.

Physicians may ethically provide genetic testing to inform reproductive decision making when the patient requests, but may also wish to offer broad screening to all persons who are considering having a child.

Patients who undergo genetic testing have a right to have their information kept in confidence, and a variety of state and federal laws prohibit discrimination by employers, insurers, and other third parties based on genetic information.

With the exception of genetic information (or material) collected under the jurisdiction of a coroner, medical examiner, or other medical legal officer, the release of genetic information from a physician’s records without the patient’s informed consent constitutes a breach of confidentiality. However, under limited circumstances, physicians may disclose such information to the criminal justice system.

Assisted reproduction offers hope to patients who want children but are unable to have a child without medical assistance. In many cases, patients who seek assistance have been repeatedly frustrated in their attempts to have a child and are psychologically vulnerable. Those patients whose health insurance does not cover assisted reproductive services may also be financially vulnerable. Candor and respect are thus essential for ethical practice.

Donating eggs or sperm for others to use in reproduction can enable individuals who would not otherwise be able to do so to have children. However, gamete donation also raises ethical concerns about the privacy of donors and the nature of relationships among donors and children born through use of their gametes by means of assisted reproductive technologies.

Therapeutic donor insemination using sperm from a woman’s partner or a third-party donor can enable a woman or couple who might not otherwise be able to do so to fulfill the important life choice of becoming a parent (or parents). However, the procedure also raises ethical considerations about safety for the woman and potential offspring, donor privacy, and the disposition of frozen semen, as well as the use of screening to select the sex of a resulting embryo.

Third-party reproduction is a form of assisted reproduction in which a woman agrees to bear a child on behalf of and relinquish the child to an individual or couple who intend to rear the child. Collectively, the profession should advocate for public policy that will help ensure that the practice of third-party reproduction does not exploit disadvantaged women or commodify human gametes or children.

Embryos created during cycles of in vitro fertilization (IVF) that are not intended for immediate transfer are often frozen for future use. Ethical concerns arise regarding who has authority to make decisions about stored embryos and what kinds of choices they may ethically make. Under no circumstances should physicians participate in the sale of stored embryos.