Voluntary licensing authority for IVF calls for statutory body.
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"Selective pregnancy reduction" is a medical procedure used to reduce a multiple pregnancy, often a multiple pregnancy induced by in vitro fertilization or drug therapy. In such instances, healthy embryos are sacrificed in order to maximize the chances of survival of the remaining embryos or to allow the mother to choose the number of babies she wishes to deliver. Physicians appear to rely on Roe v. Wade in assuming the legality of the procedure, although such an assumption may be erroneous. Rather than continue to implant an excessive number of pre-embryos, the American Medical Association and the Association of Obstetrics and Gynecology should adopt guidelines similar to those established by the Voluntary Licensing Authority in London, which limit the number to be inserted to a maximum of three. Careful ultrasound monitoring could ensure that no more than three embryos implant when fertility drugs are used. Such practices would help physicians avoid the many moral, ethical, legal, and philosophical problems caused by selective pregnancy reduction.
In the United Kingdom there have been few committees or commissions dealing specifically with biomedical ethics, and where such bodies have been set up they have merely reported on a specific topic and then disbanded. However, there may well be standing committees in the future, of which the Voluntary Licensing Authority for Human In Vitro Fertilisation and Embryology is a precursor. This paper surveys the work of three special committees or working groups which have reported in the period 1970 to the present. Of these the Warnock Committee is by far the most important, and the issues which it raises are discussed with specific reference to the place of philosophers and theologians on such bodies. It is concluded that, although there has been some movement in the UK toward the utilization of those with special skills and knowledge in the field of bioethics, much more could be done in this regard.
As a result of the birth of Louise Brown, the Government, in 1982 set up the committee of Inquiry into Human Fertilisation and Embryology (The Warnock Committee). This committee made a number of recommendations including one that recommended the setting up of a body to regulate these procedures. The Medical Research Council and the Royal College of Obstetricians and Gynaecologists in the interim set up a voluntary body to regulate the centres doing IVF. This was called the Voluntary Licensing Authority (VLA) for Human in-vitro Fertilisation and Embryology. Centres were visited and licensed. This body regulated the centres until the statutory body the Human Fertilisation and Embryology Authority (HFEA) was formed in 1990.
In order to assess the major biological and clinical factors which influence the outcome of both IVF and GIFT, the results of a large GIFT series performed in this unit have been analysed over a time interval when two different policies have been in force as to the number of oocytes that should be transferred. The reason for using GIFT data, as opposed to IVF, is simply because it is more difficult to adversely affect the outcome of GIFT treatment, as opposed to IVF, and hence this allows more critical appraisal and interpretation of results. The GIFT series to be described was conducted between March 1986 and October 1987, when a flexible policy on the number of oocytes for transfer was in operation. Since then a fixed policy has been in force at the request of the Hospital's Ethics Committee and the Voluntary Licensing Authority (now the Interim Licensing Authority), whereby three, or exceptionally four, oocytes are transferred irrespective of individual patient's circumstances because of concern about the relative risk and sequelae of multiple pregnancy and selective reduction of pregnancy. I still believe, however, that some infertile couples have a lower chance of pregnancy with assisted, or natural conception and also a lower risk of multiple pregnancy and that it is therefore important to assess the biological and clinical factors influencing fecundity in order to formulate appropriate treatment policies.
IVF makes possible research on human oocytes, human fertilization, and the early stages of human development in vitro. On ethical grounds, such research should not be motivated by curiosity alone but should be directed toward the promotion of human welfare. Possible objectives include the alleviation of infertility, the regulation of fertility through new contraceptive approaches, and the diagnosis of genetic and chromosomal defects during the preimplantation period. Research on the IVF conceptus in Britain today is all carried out under license, and a complete list of projects under way is available from the Voluntary Licensing Authority. At present the projects are mainly concerned with infertility problems, in particular with improving the success rate of IVF as a therapeutic procedure. Contraceptive development is only just beginning to take advantage of the new opportunities available. Research tomorrow is likely to be focused much more on the possibilities of early diagnosis of genetic diseases and chromosomal abnormalities, and could also shed light on the generation of some of these abnormalities during the process of fertilization.
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Three kinds of ethics committees should be distinguished, the mandatory local hospital or clinic-based committee, the statutory national committee set up to issue licences, or survey issues highlighted by local committees, or in the national press, reporting to Parliament, and publishing annual reports; and the committee established either temporarily or on a permanent basis to examine outstanding and general problems in the morals of medical practice and research, and to advise Ministers as to possible changes in the law. At all levels, such committees will be concerned with moral problems, and can never, therefore, be expected to come up with uniquely 'correct' solutions. Nevertheless they are essential both to reassure the public and to give guidance to the medical profession, both in clinical practice and research. Such committees should, at all levels, have a non-medical chairman, and a high proportion of 'lay' members. They must have regard to common moral sentiments, and to what will be morally acceptable in the country as a whole (though they can never hope for total agreement with their conclusions). Their recommendations, being in the sphere of public rather than private morality will be as far as possible the outcome of consensus, without which legislation is not possible.
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This article presents findings and recommendations of an international conference held in Cairo, Egypt in 2003 concerning issues of ethical practice in how information is provided to and by medical practitioners. Professional advertising to practitioners and the public is necessary, but should exclude misrepresentation of qualifications, resources, and authorship of research papers. Medical institutions are responsible for how staff members present themselves, and their institutions. Medical associations, both governmental licensing authorities and voluntary societies, have powers and responsibilities to monitor professional advertisement to defend the public interest against deception. Medical journals bear duties to ensure authenticity of authorship and integrity in published papers, and the scientific basis of commercial advertisers' claims. A mounting concern is authors' conflict of interest. Mass newsmedia must ensure accuracy and proportionality in reporting scientific developments, and product manufacturers must observe truth in advertising, particularly in Direct-to-Consumer advertising. Consumer protection by government agencies is a continuing responsibility.
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