title: Attitudes on access to services at assisted reproductive technology clinics: comparisons with clinic policy.
abstract: OBJECTIVE
  To determine the opinions of assisted reproductive technology (ART) clinic directors on access-to-services issues and to compare these opinions with policy at ART clinics.
  
  
  METHODS
  Survey sent to ART clinic directors.
  
  
  METHODS
  Academic medical center, university-based ethics institute.
  
  
  METHODS
  None.
  
  
  METHODS
  None.
  
  
  METHODS
  Assisted reproductive technology directors' opinions about access to services are related to specific clinic policies. Access issues examined include patient attributes (marital status, age, sexual preference), patient behaviors (substance abuse, psychiatric history, child abuse), number of cycles, and types of procedures offered (surrogacy, cloning, ova cryopreservation, ART for HIV-positive individuals).
  
  
  RESULTS
  Provider opinion was more restrictive than clinic policy in 19 of 20 categories measured. The largest difference between opinion and policy was seen on the question of setting restrictions as to age of the male partner. About 20% of directors think that surrogacy for convenience should be allowed: about 10% of directors think cloning of human beings should be offered.
  
  
  CONCLUSIONS
  The opinions of ART directors on access to services are more conservative than clinic policies. Contributing factors may include respect for patient autonomy; fear of litigation; policy that reflects a continuum of beliefs among providers; and economic pressure to offer a broad range of procedures.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. judy.stern@dartmouth.edu
authors.forename: Judy E
authors.initials: JE
authors.lastname: Stern
authors.forename: Catherine P
authors.initials: CP
authors.lastname: Cramer
authors.forename: Andrew
authors.initials: A
authors.lastname: Garrod
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Green
mesh_terms: D001291:Attitude of Health Personnel; D004992:Ethics, Medical; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D027724:Reproductive Techniques, Assisted / Q000592:standards*