Medicine in the marketplace: clinician and patient views on commercial influences on assisted reproductive technology.
Siun Gallagher, Sara Attinger, Angie Sassano, Elizabeth Sutton, Ian Kerridge, Ainsley Newson, Bobbie Farsides, Karin Hammarberg, Roger Hart, Emily Jackson, William Ledger, Christopher Mayes, Catherine Mills, Sarah Norcross, Robert J Norman, Luk Rombauts, Catherine Waldby, Anusch Yazdani, Wendy Lipworth
Author Information
Siun Gallagher: Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia. Electronic address: siun.gallagher@sydney.edu.au.
Sara Attinger: Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Elizabeth Sutton: Monash Bioethics Centre, School of Philosophical, Historical and International Studies, Monash University, Clayton, Victoria, Australia.
Ian Kerridge: Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Haematology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Ainsley Newson: Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Bobbie Farsides: Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, UK.
Karin Hammarberg: Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Roger Hart: Obstetrics and Gynaecology, UWA Medical School, University of Western Australia, Perth, Western Australia, Australia.
Emily Jackson: London School of Economics Law School, London, UK.
William Ledger: School of Women's and Children's Health, University of New South Wales, Royal Hospital for Women, Randwick, New South Wales, Australia.
Christopher Mayes: Alfred Deakin Institute of Citizenship and Globalisation, Deakin University, Waurn Ponds, Victoria, Australia.
Catherine Mills: Monash Bioethics Centre, School of Philosophical, Historical and International Studies, Monash University, Clayton, Victoria, Australia.
Sarah Norcross: Progress Educational Trust, London, UK.
Robert J Norman: The Robinson Research Institute, School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia.
Luk Rombauts: Department of Obstetrics and Gynaecology, Monash University Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
Catherine Waldby: Research School of Social Sciences, ANU College of Arts and Social Sciences, Canberra, Australian Capital Territory, Australia.
Anusch Yazdani: School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Wendy Lipworth: Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia.
RESEARCH QUESTION: What are the views and experiences of patient and expert stakeholders on the positive and negative impacts of commercial influences on the provision of assisted reproductive technology (ART) services, and what are their suggestions for governance reforms? DESIGN: Semi-structured interviews were conducted with 31 ART industry experts from across Australia and New Zealand and 25 patients undergoing ART from metropolitan and regional Australia, between September 2020 and September 2021. Data were analysed using thematic analysis. RESULTS: Expert and patient participants considered that commercial forces influence the provision of ART in a number of positive ways - increasing sustainability, ensuring consistency in standards and providing patients with greater choice. Participants also considered commercial forces to have a number of negative impacts, including increased costs to government and patients; the excessive use of interventions that lack sufficient evidence to be considered part of standard care; inadequately informed consent (particularly with regard to financial information); and threats to patient-provider relationships and patient-centred care. Participants varied in whether they believed that professional self-regulation is sufficient. While recognizing the benefits of commercial investment in healthcare, many considered that regulatory reforms, as well as organizational cultural initiatives, are needed as means to ensure the primacy of patient well-being. CONCLUSIONS: The views expressed in this study should be systematically and critically examined to derive insights into how best to govern ART. These insights may also inform the design and delivery of other types of healthcare that are provided in the private sector.
