Ethics Opinions

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.

In light of the physical risks of somatic cell nuclear transfer, ongoing moral debate about the status of the human embryos, and concerns about the impact of reproductive cloning on cloned children, families, and communities, reproductive cloning is not endorsed by the medical profession. Should reproductive cloning at some point be introduced into medical practice, however, any child produced by reproductive cloning would be entitled to the same rights, freedoms, and protections as every other individual in society.

The Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice.

Although often thought of primarily for terminally ill patients or those with chronic medical conditions, advance care planning is valuable for everyone, in order to ensure that their own values, goals, and preferences will inform care decisions when they cannot speak for themselves. Physicians should routinely engage their patients in advance care planning but should be sensitive to each patient’s individual situation and preferences when broaching this topic.

Advance directives are tools that give patients of all ages and health status the opportunity to express their values, goals for care, and treatment preferences to guide future decisions about health care. Advance directives also allow patients to identify whom they want to make decisions on their behalf when they cannot do so themselves. However, an advance directive never takes precedence over the contemporaneous wishes of a patient who has decision-making capacity.

Physicians are not required to offer or to provide interventions that, in their best medical judgment, cannot reasonably be expected to yield the intended clinical benefit or achieve agreed-on goals for care. Respecting patient autonomy does not mean that patients should receive specific interventions simply because they (or their surrogates) request them.

When a terminally ill patient experiences severe pain or other distressing clinical symptoms that do not respond to aggressive, symptom-specific palliation, it can be appropriate to offer sedation to unconsciousness as an intervention of last resort.

Euthanasia is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Euthanasia could readily be extended to incompetent patients and other vulnerable populations. Instead of engaging in euthanasia, physicians must respond to the needs of patients at the end of life.

Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must respond to the needs of patients at the end of life.