‘I WANT A CHILD!’ CONCERNING PROBLEMS OF INFORMED CONSENT IN FERTILITY TREATMENT

Abstract

The author demonstrates with the help of a case study how one can miss the complex subjectivity of a patient and potentially damage her, if the basis for therapeutic action consists in an understanding of informed consent reduced purely to conscious factors. In the context of a painful gynaecological infection the patient had been asked about her potential wish to have children. Until then this had not been a preoccupation of hers, but now having ‘a child’ seemed to epitomize to her a life without injustices, disadvantages, restrictions and so on. On one level she ‘sensed’ the illusionary character of this ‘solution’, while on another level she insisted on its concrete realization. The medical offer of IVF treatment, although formally in accordance with informed consent, did not take into account this split psychic situation and thus precipitated unforeseen complications.

Acknowledgement

The author would like to thank Reiner Winkler for providing translation services.

Notes

1. As Faden and Beauchamp have shown in 1986, there are differing opinions regarding the historical origins of informed consent: while Pernick suggests that ‘truth‐telling and consent‐seeking have long been part of an integral medical tradition’ (p. 580), Katz, on the other hand, argues that informed consent came into being only by the late 1950s/early 1960s. Faden and Beauchamp point out that these two apparently contradictory statements can be reconciled if one considers that earlier a model of charity and care was predominant, whereas nowadays the model of patient autonomy has taken over (p. 59).

2. A so‐called Consultation Service within the German Health System provides, if necessary, the opportunity to involve a colleague from a different discipline to clarify specific clinical questions.

3. I do not generally write reports for patients in psychotherapy or psychoanalysis with me. Moreover, I also had the impression that on one level the patient ‘knew’ about the damaging effect of a report which would have to make a case for a renewed IVF treatment as ‘medically indicated’. It is usually the case that three IVF treatments are covered by the medical insurances, while any further attempts have to be paid for privately. The patient realistically estimated the cost to be about 5000 Euros.