Bioethics in practice: Addressing ethically sensitive requests in a Dutch fertility clinic

This article provides insight into how ethically sensitive requests for the use of assisted reproductive technologies (ARTs) are dealt within the daily practice of a Dutch fertility clinic. The findings presented are part of an ethnographic study conducted in this clinic from September 2003 until April 2005. Information for this article was gathered by attending the multidisciplinary ethics meetings and conversations with clinic staff. By looking at 'bioethics in practice', this article provides insight into the complex and dynamic interplay between particular couples' situations, contextual features, bioethical principles, doctors' subjective feelings and views, and the employment of medical practices. Our study suggests that personal views to a certain extent inform the agenda of the ethics meetings, but in the end neither these views nor bioethical principles fully determine the decisions made. Clinic staff members employ routine medical practices with the intention to carefully resolve ethically sensitive cases. These practices include: collegial consultation, searching for scientific evidence in the literature, obtaining more medical information, offering medical tests, referring couples to other clinics and ensuring informed consent. Rather than examining hypothetical cases, which evoke principles, observations of practices regarding real life cases of which many details are known, allowed us to identify the influence of routine medical practice on ethical decisions. Despite initial concerns from the side of the medical professionals (some of which might be regarded as paternalistic), at the end the reproductive autonomy of most couples seeking ARTs was not jeopardized. The format of the multidisciplinary ethics meetings seems to be promising as it provides a space for clinic staff members to express and reflect on their subjective views and feelings of unease regarding certain requests for ARTs, while at the same time it diminishes the risk that decision making is (too heavily) shaped by these feelings and views.