However, this paper then provoked a responding commentary by Dr Norbert Gleicher of Yale and New York, who attacks both the rationale and the ethics of the Quebec approach. First, he agrees that triplet pregnancies are a high risk to both mother and off-spring. But then he goes on to claim that both the risk to mother and babies, as well as the overall costs to the health system, of two serial singleton pregnancies are as great as, if not greater than, those of a twin pregnancy, implying that the gains of single embryo transfer are at best illusionary. Second, Gleicher objects to the intrusion of government into health care decisions on the grounds that this interferes with a patient's right to self-determination or "to choose". Indeed, Gleicher vociferously advocates the USA free market model over the European-style sympathy for government intervention in health care, his hope being "to keep government out of medicine".
This blast of free-market proselytizing is countered, appropriately from Europe, in a detailed response from Dr Yakoub Khalaf et al. of Guy's and Thomas' Hospital, London, who claim that practice should be based on solid data rather than personal judgment and proceed to dissect and question Gleicher's calculations on the relative outcomes of double versus serial single embryo transfer. They set the right of patient self-determination against a doctor's ethical duty to practice in the best interests of her patients, and not to acquiesce passively to requests she knows to be
|Contact: Gedis Grudzinskas|