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Ethicist says doctors are right to help couples with HIV have children

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Infertility specialists have the right to help couples with HIV have children, according to one ethical view. They, like all doctors, must “do no harm,” but ethical arguments exonerate them if the children are infected.

HIV infection in babies is a serious issue: most rapidly progress to AIDS and death or long term illness and poor quality of life until death in adolescence. So do the specialists’ actions constitute recklessness—conscious and unjustified risk taking?

The risk of HIV infection from an infected man to his female partner and children is negligible if assisted conception includes precautions like sperm washing whereas for an infected woman the risk of vertical transmission of HIV to the child is 1–2%. The risk of disease or disability with assisted conception in uninfected infertile couples is thought to be 3–5%, similar to that in the general population. Infertility specialists are not blamed for such outcomes, so they cannot be deemed reckless if the offspring are affected in HIV positive couples.

Fertility specialists’ input in assisted conception differs in fertile and infertile HIV positive couples. They are fulfilling their duty of care with fertile couples by cutting the risk of infection to the child and unaffected parent. They have a duty to help infertile couples, and their significant input with infertile over fertile HIV positive couples fulfils that moral obligation. They are responsible for any affected child, but there is no question of recklessness as the additional risk is so low.