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The health of children conceived by assisted reproduction technologies
  1. Vic Larcher
  1. Correspondence to:
    Vic Larcher
    Great Ormond Street Hospital NHS Trust, Great Ormond Street, London WC1N 3JH, UK; larchv{at}gosh.nhs.uk

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The provision of assisted reproduction technologies needs to operate within a defined ethical framework that safeguards the welfare of all concerned

Assisted reproduction technologies (ART) account for the conception of around 1% of children born in the UK each year (over 10 000 children).1,2 The primary purpose of ART is the treatment of infertility and the conception and safe delivery of healthy children with the potential to become healthy adults, but some techniques permit embryo selection and testing.3,4 As the range, application and success rates (live births per treatment cycle) of ART have increased, so their consequences for the children produced have become more apparent. Since paediatricians have moral obligations to maximise children’s welfare and to act as their advocates,5 they may have reasonable concerns about the health and welfare of the increasing number of children conceived by ART.

THE OBLIGATION TO CONSIDER THE HEALTH OF CHILDREN CONCEIVED BY ART

Children born alive have full protection in law that imposes enforceable duties, including that of meeting children’s health needs, on those with parental responsibility.6 Although this legal protection does not generally extend to embryos and foetuses, those who provide ART have ethical and legal duties to consider the welfare of children born as a result (the welfare principle).7 This duty can be interpreted as being limited to considering whether there are any adverse factors which might preclude a particular couple from becoming parents. However, the welfare principle also entails consideration of what adverse health outcomes for children may be associated with use of ART and how they should be ameliorated.

HEALTH OF FUTURE CHILDREN AND PARENTAL FACTORS

Desperation associated with infertility may lead would-be parents to take risks with both their own and their future child’s health,8 but these – and professional discomforts about their motivation to become parents – may be insufficient reasons to deny them ART. However, because …

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