Medico-Legal Aspects of Reproduction and Parenthood by J. K. Mason

Author:J. K. Mason [Mason, J. K.]
Language: eng
Format: epub
ISBN: 9781138325265
Barnesnoble:
Publisher: Taylor & Francis
Published: 2020-06-30T00:00:00+00:00

8

The Infertile Man

Infertility in general

It is widely held that some 10 per cent of married couples who wish to have children are unable to do so by reason of infertility; the reasons for the condition are divided roughly equally between husband and wife. This morbidity is a source of considerable distress and it is not surprising that it promotes a great deal of research in academic departments of reproductive biology. This results in the development of techniques which are designed, in the main, to do no more than circumvent – or bypass – the fundamental defect which is the cause of the infertility.

It is important to bear in mind that such ruses constitute no more than a secondary extension of a standard therapeutic plan. Ideally, therapy restores a disease state to normal. The process of diagnosis may reveal a medical cause – often, in the case of infertility, in the form of a hormonal deficiency; substitution therapy would then be the first preferred treatment. Alternatively, the cause may be amenable to surgical correction, as, for example, when part of the genital tract has become blocked owing to an inflammatory reaction; another example would be attempted surgical reversal of a previous vasectomy or tubal ligation if so required when a patient’s reproductive status changes. It is only when the aptness of such routine treatments has been excluded, or when they have failed, that recourse will be made to ‘social’ treatments involving, inter alia, gamete substitution and, hence, the involvement of parties outside the immediate therapeutic circle. Such social treatments will inevitably impinge upon social policies and, by extension, on legal principles; the extent of this encroachment will be addressed in detail in this and the following chapter. The purpose of this preamble has been no more than to emphasise that they are treatments of a recognisable uninvited condition: childlessness due either to physiological or to pathological abnormality.1

Separation of medical and social treatments has two main consequences. First, it raises the question of whether the latter should be provided by a health service – or, put another way, can health purchasers justify the exclusion of treatments for childlessness from what they are prepared to provide?2 Secondly, the concept of social treatment immediately suggests that this is a matter which is beyond the exclusive control of the medical profession and is one which should be regulated by Parliament. As to the first, a good case can be made out that there is no distinction to be made as to need and, indeed that modern medical technology has, of itself, transformed an unfortunate social disability into a clinical need.3 Intervention in medical treatment by way of statute represents the careful balancing of the benefits to individual patients against the possible disadvantages to the social order: first, there must be a need to do so and, second, the public, through its legislators, must perceive the need to do so. The treatment of childlessness, or assisted reproduction, involves gross intrusion into personal privacy and the institution of marriage; by definition, it also results in the production of children by unnatural means.

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