Group says shared-risk agreements are ethical

The ethics committee of the Birmingham, AL-based American Society for Reproductive Medicine (ASRM) concluded in September that shared-risk programs are ethical for some patients undergoing in vitro fertilization (IVF).

The group endorses the agreements provided certain conditions are met. In shared-risk agreements, patients initially pay higher fees for IVF. If a pregnancy or delivery is achieved, the physician keeps the entire fee. If the attempt at IVF is unsuccessful, however, the patient receives a monetary refund ranging from 90% to 100%.

Shared-risk is criticized as being potentially exploitative and misleading by some physician organizations, including the American Medical Association (AMA) in Chicago. The AMA Code of Ethics has a statement against the plans because they are contrary to the tradition in medicine against paying contingency fees. Plus, critics say, the plans are offered to a vulnerable patient group at a higher cost than normal IVF services.

The agreements, the ASRM committee suggests, are ethical options for patients who might not have health insurance that covers infertility treatments, provided that practitioners fully inform patients of expenses not covered in the shared-risk program, such as pre-treatment testing, consultation fees, and ovulation drugs.

ASRM’s committee also warned against shared-risk programs involving actions that might harm patients and any resulting fetuses. Patients and fetuses might be adversely affected, for example, from implanting multiple embryos to increase the chance for success. Patients should be informed about the potential conflict of interest, the committee stated.