title: Restricting Access to ART on the Basis of Criminal Record : An Ethical Analysis of a State-Enforced "Presumption Against Treatment" With Regard to Assisted Reproductive Technologies.
abstract: As assisted reproductive technologies (ART) become increasingly popular, debate has intensified over the ethical justification for restricting access to ART based on various medical and non-medical factors. In 2010, the Australian state of Victoria enacted world-first legislation that denies access to ART for all patients with certain criminal or child protection histories. Patients and their partners are identified via a compulsory police and child protection check prior to commencing ART and, if found to have a previous relevant conviction or child protection order, are given a "presumption against treatment." This article reviews the legislation and identifies arguments that may be used to justify restricting access to ART for various reasons. The arguments reviewed include limitations of reproductive rights, inheriting undesirable genetic traits, distributive justice, and the welfare of the future child. We show that none of these arguments justifies restricting access to ART in the context of past criminal history. We show that a "presumption against treatment" is an unjustified infringement on reproductive freedom and that it creates various inconsistencies in current social, medical, and legal policy. We argue that a state-enforced policy of restricting access to ART based on the non-medical factor of past criminal history is an example of unjust discrimination and cannot be ethically justified, with one important exception: in cases where ART treatment may be considered futile on the basis that the parents are not expected to raise the resulting child.
authors.affiliation: Royal Women's Hospital, Parkville, Victoria, Australia. kara.thompson@trainee.ranzcog.edu.au.
authors.forename: Kara
authors.initials: K
authors.lastname: Thompson
authors.affiliation: Centre for Health and Society, The University of Melbourne, Melbourne, Australia.
authors.forename: Rosalind
authors.initials: R
authors.lastname: McDougall
mesh_terms: D002648:Child; D002649:Child Abuse; D002669:Child Welfare; D003415:Crime; D057237:Criminals; D026689:Ethical Analysis; D006297:Health Services Accessibility / Q000941:ethics* / Q000331:legislation & jurisprudence; D006801:Humans; D010290:Parents; D026684:Personal Autonomy; D046269:Reproductive Rights; D027724:Reproductive Techniques, Assisted / Q000331:legislation & jurisprudence*; D014739:Victoria
keywords: Access; Assisted reproductive technology; Child protection check legislation; Criminal; Ethics; IVF; Police check; Presumption against treatment