Saturday, October 05, 2013

Should we do IVF for patients who have a poor chance of success ?


Infertile patients often come with unrealistic expectations about their chances of success with IVF treatment . As a doctor , I used to straightaway tell them NO, since I felt their chances were very poor and that the treatment would be futile . I was surprised when recently a patient with a high FSH level came to me for IVF treatment. I suggested she opt for donor eggs but she counter questioned me and asked if I was refusing to treat her. She was very clear that she didn't want to try donor eggs. She said she could afford the IVF treatment and was intelligent enough to know that her chances were slim. She felt that her only hope left was IVF, and despite knowing that her chances were poor, she wanted to take a chance and try the treatment. Since there were no risks to IVF treatment, why was I refusing to listen to her  request. Wasn't it unethical to say no to her, as this would be preventing her for exercising her right of making autonomous decisions for herself.

Seen in this light, this was a perfectly reasonable request from an intelligent and independent woman who had made her own decisions for herself all her life . She was very practical and down to earth.  Even if the treatment failed, it would help her in attaining emotional closure , because she would have peace of mind that she had tried every option available to her.

On her part, she just needed help from an IVF specialist and I couldn't find a good reason to refuse to help her.  As a doctor I was pretty confident she wouldn't grow any eggs and even if she did, her chances of getting pregnant were less than 1 % in my opinion. My job was to be honest with her , and inform her about her chances of success so that she could make a well-informed decision after being aware of all her options. Despite knowing all the facts, if she then still wanted to continue with the treatment, I couldn't justify saying no to her. However a colleague of mine was very critical about my decision. According to him, as a medical professional, I should decide if a patient's request is reasonable , and if it wasn't, I shouldn't treat her , knowing her chances were poor.

What would you do if you were her doctor ?

2 comments:

  1. Recently, I read a BMC article where they explained a case of a patient who refused to have blood transfusion after an accident. Doctors watched him die in front of their eyes and their hands were tied because of the concept of patient autonomy. I was shocked to read this.Isn't it utter foolishness? In such a scenario, who knows best what to do - doctors or a patient? I think doctors must have done their duty according to their medical values and I still wonder what stopped them to do so! I strongly feel that doctors must first respect their knowledge, expertise and medical values before allowing patients to act on their own understanding.

    The scenario you have explained is not identical to what I have mentioned above but very similar. Although there is no danger to the life of your patient if you do IVF on her, you fail to respect your own medical values and expertise if you treat her!

    If I were you, I will explain her clearly my stance and will refuse to treat her because I will respect my knowledge and medical values in the first place. Human brain is very strange, it will always believe in miracles and your patient is expecting such a miracle to happen. If I treat her, it does mean that I am allowing some "lay" person (a person who do not have sound medical knowledge) to influence my knowledge as a doctor! This just means I am not respecting myself or my education.

    Dr, you must understand that patient autonomy is not unlimited. Your medical values and ethics should come first even if the therapy you offer do not harm your patient in any way. You should put yourself first and then your patient. If I were a doctor I will definitely do so.

    ReplyDelete
  2. Anonymous10:02 PM

    What if that 1% chance materialize and she gets pregnant why should someone deny her that chance??

    ReplyDelete

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