The end of unsuccessful treatment in ART: emotional and ethical complexity in the doctor-patient relationship

In the context of Assisted Reproductive Technology (ART), the decision to end treatment should occur after a series of failed attempts and when the chances for a successful outcome are so low that it is in the patient’s best interest to stop any further attempt at it. Since there is not a defined biological endpoint, the decision is very complex and involves emotional and ethical dimensions. Patients are overwhelmed by all sort of emotions related to the acknowledgement that the pregnancy they hoped for might, eventually, never happen; at the same time, physicians may experience intense inner emotions (e.g., frustration, denial). The ethical aspect concerning the decision to end unsuccessful ART treatment gives rise to a dilemma between beneficence and patient autonomy and about equity. In these complex circumstances, the risk of over-persistence is significantly high, where the concept of “overpersistence” can be described as the circumstance where doctors and patients keep on insisting to continue ART treatment even when chances for success are very low or any at all. The authors here discussed the possibility that a more active role of clinicians in deciding when patients should stop treatment, a model that in oncology is called “palliative paternalism”, could be introduced in the ART context. Future research will be needed to further explore the issue in order to offer a greater support to patients undergoing several failed cycles of ART.