Child interests in assisted reproductive technology: how is the welfare principle applied in practice?

Study Question: How is the welfare principle interpreted and practised and what meaning does it hold for health professionals who must apply it in assisted reproductive technology (ART)?

Summary Answer: The welfare of a child is a meaningful concept to ART counsellors but it is also impractical when applied preconception.

What Is Known Already: Policy which promotes the interests of a child to be born is inconsistent between and within countries, and has been widely criticized as meaningless, as an unfair imposition and for its lack of clarity and inconsistent translation to ART practice.

Study Design, Size, Duration: We conducted a qualitative study of ART counsellors in Australia and New Zealand in 2012. This study took an inductive approach.

Participants/materials, Setting And Methods: Thirty-two counsellors (15 psychologists and 17 social workers) participated in 6 focus groups. Vignettes were used to focus and stimulate discussion of how the welfare of all participants but especially the interests of a non-existent child were interpreted and operationalized in practice. Qualitative descriptive content analysis was used to analyse the data into themes.

Main Results And The Role Of Chance: Five themes emerged in the data: giving presence to the child that could be, balancing welfare interests, welfare concerns, balancing values and making a decision and screening and legal presumptions against treatment. Themes were validated according to qualitative research standards. The study showed that counsellors take the child welfare principle seriously but that the concept is indeed slippery and difficult to operationalize. Counsellors denied a role in screening patients for parenting fitness but were engaged in health care assessment of patients and these roles need further differentiation, clarity and research. Health care practitioners would benefit from a process that reviews decisions and clarifies professional values.

Limitations, Reasons For Caution: Participants were drawn from only two of the six Australian states and two territories.

Wider Implications Of The Findings: The study provides insight and deeper understanding of how welfare principles play out in counselling practice, what gives them meaning and the difficulties of balancing various interests and values. Our findings have shown that the welfare of a child can be a meaningful concept to ART counsellors but that it can also be impractical and unclear. Despite differences in legislation among countries, our study contributes to the growing data and debate emerging from the USA and the UK.

Study Funding/competing Interests: This study was funded by a Flinders University Faculty of Health Sciences Grant. There are no conflicts of interest.

Trial Registration Number: Not applicable.