June 5th, 2020

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Professionally Responsible Referral for Assisted Reproduction
Authors:  Frank A. Chervenak, M.D., Sanja Kupesic Plavsic, M.D., Ph.D., and Laurence B. McCullough, Ph.D.
  Infertility is one of the most common clinical challenges faced by the practicing obstetrician-gynecologist. Referral to a specialist in reproductive medicine is often of clinical value. This paper provides an ethical framework for this referral process, based on the professional responsibility model of obstetric and gynecologic ethics. The professional responsibility model is based on the ethical concept of medicine as a profession, which requires obstetrician-gynecologists to make 3 commitments: to scientific and clinical competence, to making the health-related interests of patients primary and individual self-interest systematically secondary, and to sustaining medicine as a public trust for the benefit of current and future patients. We identify the implications of each commitment for professionally responsible referral of patients to specialists in reproductive medicine. Professionally responsible referral of patients for assisted reproduction encompasses distinctive ethical obligations, the fulfillment of which will prepare patients for cognitively and affectively demanding shared decision-making about this potentially life-altering form of gynecologic care.
Keywords:  assisted reproductive techniques; decision making; female; gynecologists; human rights; humans; infertility; liability, legal; models, theoretical; obstetricians; obstetrics/ethics; patient rights/ethics; personal autonomy; pregnancy; professional responsibility model of obstetric and gynecologic ethics; professionalism/ethics; referral
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