Adopted by the 39th World Medical Assembly
Madrid, Spain, October 1987
and rescinded at the WMA General Assembly,
Pilanesberg, South Africa, 2006
In-Vitro Fertilization and Embryo Transplantation is a medical
technique which is available for the treatment of infertility
in many parts of the world. It has the potential to benefit both
individual patients and society generally, not only by the alleviation
of infertility, but also by the possible avoidance of genetic
disorders and by enhancing fundamental studies of human reproduction
and contraception.
The WMA urges physicians to act ethically and with appropriate
respect for the health of the prospective mother and for the embryo
from the beginning of life. To assist physicians in recognizing
and following their ethical obligations, the WMA has promulgated
this statement.
From the ethical and scientific viewpoint, medical assistance
in human reproduction is justified in all cases of infertility
which do not respond to classical drug or surgical treatment with
specific reference to:
- immunological incompatibility
- irreversible obstacle to contact between male and female
gametes
- infertility for unknown cause
In all these cases, the physician can only act with the full
informed consent of donors and recipients. The physician must
always act in the best interest of the child to be born of the
procedure.
It is the physician's responsibility to provide the patients,
at their own level of comprehension, with sufficient information
about the purpose, methods, risks, inconveniences and disappointments
of the procedure, and to obtain from the patients their informed
consent to the procedure. As in any type of elective procedure,
the physician must have adequate specialized training before undertaking
the responsibility of performing the procedure. The physician
must always comply with all applicable laws and regulations as
well as the ethical requirements and the professional standards
established by the National Medical Association and other appropriate
medical organizations in the community. The patients are entitled
to the same confidentiality and privacy as is required with any
medical treatment.
When IVF techniques produce excess ova which will not be utilized
for the immediate treatment of sterility, their use must be determined
in agreement with the donors; excess ova can be:
- destroyed
- cryopreserved
- fertilized and cryopreserved
Scientific knowledge concerning maturation, fertilization and
first stages of pluricellular development processes is still in
an early stage. It is therefore appropriate to continue study
and experimentation of the physical and chemical phenomena in
this field strictly in accordance with the Declaration of Helsinki,
and with the written consent of the donors.
RESEARCH
The technique of in vitro fertilization and embryo transplantation
can also be useful in research directed towards a better understanding
of how genetic defects arise and are transmitted, and how they
might be prevented or treated. Profound moral and ethical implications
may arise for both the physician and the patient. The physician
should not violate his personally held moral principles and must
be sensitive to, and respect, the moral and ethical principles
held by patients. The physician has a greater responsibility to
communicate fully with the patients who will participate in the
research effort and the informed consent of those patients must
meet the requirements of law as well as the special level of professional
responsibility dictated by ethical standards. The principles of
the World Medical Association's Declaration of Helsinki will apply
to all clinical research in respect to in-vitro fertilization
and embryo transplantation, as well as all problems that arise
out of such clinical research.
The World Medical Association recommends that physicians refrain
from intervening in the reproduction process for the purpose of
making a choice as to the foetus' sex, unless it is to avoid the
transmission of serious sex-linked disease.
DONATION
The technique of in-vitro fertilization and embryo transplantation
creates the possibility of donation of ova, sperm, and embryo,
so that the biological donors may not be the parents of the child
produced by this procedure. Such use of donated gametes or embryo
may present serious legal, moral, and ethical issues for both
patients and physicians involved in such in-vitro fertilization
and embryo transplantation procedures. The physician must observe
all applicable laws and ethical restrictions imposed by the National
Medical Association or other appropriate medical organizations.
The physician must also be sensitive to, and respect, the moral
and ethical principles of patients, and refrain from the use of
donated gametes or embryos when it would conflict with legal or
ethical restrictions or the moral principles of the patients.
The physician has the right to refuse any intervention he or she
deems unacceptable.
The technique of cryo-preservation increases the availability
of gametes and embryos for donation. Where permitted, if one or
more donors of gametes, or the donors of an embryo, will not be
the functional parent(s) of the prospective child, the physician
must obtain assurance that the recipients will accept full responsibility
for the unborn child and that the donors will renounce all rights
or claims to the unborn child without prejudice to the rights
of the child when born.
In the case of an adult woman who is without a uterus, the use
of the so-called method of substitute or surrogate motherhood
may be used unless prohibited by applicable laws or the ethical
rules of the National Medical Association or other appropriate
medical organizations. Free and informed consent must be obtained
from the parties who are participating in any way in such substitute
or surrogate method. There are legal, ethical and moral implications
in the use of such method of substitute or surrogate motherhood
and the physician must recognize them and consider them as part
of any decision to use such method.
The preceding paragraph is not intended to endorse the so-called
"Surrogate Parenting" arrangement by which a woman agrees,
for a fee, to be artificially inseminated with the sperm of a
man for the purpose of conceiving a child who will be adopted
by the man and his wife.
Any commercialization by which ova, sperm, or embryo are offered
for purchase or sale is expressly condemned by the World Medical
Association.
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