O-217 Balancing ‘the desires of individuals’ against ‘the situation of the world as a whole’: (Re)considering planetary responsibilities in the context of assisted reproduction
Authors: Segers S 
Published: June 2023

Abstract

Study question
How do the moral reasons for offering access to assisted reproductive technology (ART) relate to ethical responsibilities generated by sustainability and planetary health duties?

Summary answer
If one accepts that both governments and medical professionals should yield to environmental sustainability, it is ethically pertinent to balance this against respecting reproductive autonomy.

What is known already
Respecting autonomy is a central ethical value in the context of reproduction, which, in the context of ART, is considered to generate a prima facie obligation to help people conceive a child in line with their personal goals. Arguments in terms of population ethics, use of planetary resources and climate change are traditionally not considered to counter arguments for access to ART relying on the reproductive autonomy of individuals. This may come under tension due to adjusted encouragements to physicians for being committed to sustainability as part of professional role responsibilities.

Study design, size, duration
A literature study of academic literature and institutional codes of conduct was performed to inventory how professional duties of physicians are being directed to encompass not only responsibilities towards individual patients, but also towards environmental sustainability. Consideration of earlier documents has shown that, sporadic objections notwithstanding, such arguments have mostly been morally inconsequential in the regulation and praxis of ART. This was critically evaluated against the backdrop of bioethical literature and ethical principles.

Participants/materials, setting, methods
Literature study; conceptual analysis; normative analysis.

Main results and the role of chance
Climate change and its future impact is on the political agenda as a shared responsibility of governments, industry, and citizens. This is seeping through into communiqués of professional medical bodies and codes of conduct. In the particular context of ART, this has recently led to several calls to recognize the impact of climate change on fertility. This has not (yet) led to an institutionalization of the more provocative claim, sometimes voiced in popular media, that fighting climate change may require restraints in the area of procreation. Nonetheless, claims that physicians have a responsibility to contribute to a sustainable healthcare sector at least require ethical attention in this regard, especially in view of observed shifts compared to canonic positions. Likewise, if we expect governments to take efforts to attain sustainability goals, this may evoke moral questions about possible tensions with moral commitments to offering access to assisted procreation. This contribution addresses (i) the limited critical stance towards beliefs that procreation is problematic from a planetary health perspective, and (ii) the need to scrutinize the ethical balance for reproductive health professionals between accommodating (individual) procreative goals and more global responsibilities towards the world at large.

Limitations, reasons for caution
This is an agenda-setting analysis, and so it is not meant to serve as an exhaustive discussion of these moral concerns. While attention for future impacts of climate change is gaining momentum in healthcare, controversial suggestions to cap procreation is largely still limited to lay contexts.

Wider implications of the findings
This analysis is meant to propel ethical reflection about the balance between global elements that may restrain individuals’ reproductive options. This puts into focus that moral considerations about individual and societal (and planetary) interests in the context of ART require continued specification and careful ethical deliberation.

Trial registration number
n/a