title: Child interests in assisted reproductive technology: how is the welfare principle applied in practice?
abstract: OBJECTIVE
  How is the welfare principle interpreted and practised and what meaning does it hold for health professionals who must apply it in assisted reproductive technology (ART)?
  
  
  CONCLUSIONS
  The welfare of a child is a meaningful concept to ART counsellors but it is also impractical when applied preconception.
  
  
  BACKGROUND
  Policy which promotes the interests of a child to be born is inconsistent between and within countries, and has been widely criticized as meaningless, as an unfair imposition and for its lack of clarity and inconsistent translation to ART practice.
  
  
  METHODS
  We conducted a qualitative study of ART counsellors in Australia and New Zealand in 2012. This study took an inductive approach.
  
  
  METHODS
  Thirty-two counsellors (15 psychologists and 17 social workers) participated in 6 focus groups. Vignettes were used to focus and stimulate discussion of how the welfare of all participants but especially the interests of a non-existent child were interpreted and operationalized in practice. Qualitative descriptive content analysis was used to analyse the data into themes.
  
  
  RESULTS
  Five themes emerged in the data: giving presence to the child that could be, balancing welfare interests, welfare concerns, balancing values and making a decision and screening and legal presumptions against treatment. Themes were validated according to qualitative research standards. The study showed that counsellors take the child welfare principle seriously but that the concept is indeed slippery and difficult to operationalize. Counsellors denied a role in screening patients for parenting fitness but were engaged in health care assessment of patients and these roles need further differentiation, clarity and research. Health care practitioners would benefit from a process that reviews decisions and clarifies professional values.
  
  
  CONCLUSIONS
  Participants were drawn from only two of the six Australian states and two territories.
  
  
  CONCLUSIONS
  The study provides insight and deeper understanding of how welfare principles play out in counselling practice, what gives them meaning and the difficulties of balancing various interests and values. Our findings have shown that the welfare of a child can be a meaningful concept to ART counsellors but that it can also be impractical and unclear. Despite differences in legislation among countries, our study contributes to the growing data and debate emerging from the USA and the UK.
  
  
  BACKGROUND
  This study was funded by a Flinders University Faculty of Health Sciences Grant. There are no conflicts of interest.
  
  
  BACKGROUND
  Not applicable.
authors.affiliation: School of Nursing and Midwifery, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia sheryl.delacey@flinders.edu.au.
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: de Lacey
authors.affiliation: School of Nursing and Midwifery, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Peterson
authors.affiliation: Bioethics Centre, Division of Health Sciences, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: McMillan
mesh_terms: D002648:Child; D002669:Child Welfare; D003657:Decision Making; D030881:Disclosure; D006801:Humans; D027724:Reproductive Techniques, Assisted / Q000941:ethics* / Q000331:legislation & jurisprudence
keywords: assisted reproductive technology; child welfare; counselling; ethics