Marcia C. Inhorn, PhD, MPH and Pasquale Patrizio, MD, MBE
Low-cost in vitro fertilization (LCIVF) is better than no infertility treatment in countries that prohibit adoption and third-party reproductive assistance.
AMA J Ethics. 2018;20(3):228-237. doi:
10.1001/journalofethics.2018.20.3.ecas1-1803.
The physician must help patients understand that all options—further testing, surgery, no action—carry risks and benefits. Disclosing the statistical probability of injury and other possible outcomes might help, but it can also hinder the process.
After assessing the reasons for a patient’s unrealistic hopefulness in the face of clear understanding, a clinician may believe that significant harm will come to the patient if he or she does not acknowledge the seriousness of the illness.
Patients seeking IVF are highly motivated to become parents and may wish to preserve financial resources for surrogacy or adoption should IVF not succeed, so risk sharing appeals to them, which makes its high cost especially problematic.
One strategy is to determine “triggers” that alert the primary clinician that the patient has a high symptom burden or difficulty coping with the diagnosis, prognosis, or treatment plans and should be offered palliative care services.