Dr. Luca Sabatini told the conference that interest in this subject had arisen because of a recent fraudulent attempt to obtain treatment in his clinic. “We discovered that a couple who were about to undertake the final step of an IVF treatment were not being honest with us. Luckily we were able to stop the treatment just in time”, he said.
The St Bartholomew’s hospital team surveyed 70 Human Fertilisation and Embryology (HFEA) licensed units, including both publicly funded and private clinics, in the UK. 45 responded, of which 37% had experienced or suspected cases of patient identity fraud. Overall, 53% of those surveyed felt that they did not have sufficient safeguards. Methods of checking identity varied widely, with one in four clinics not checking patient identity at all.
“Although identity fraud among patients is still a relatively infrequent event, it has important medico-legal ramifications”, said Dr. Sabatini.
“Our overwhelming feeling is that there are insufficient measures to protect the unit, the patient’s legal rights, and most importantly the future welfare and wellbeing of the unborn child.
“Fraudulent behaviour may be fuelled by financial pressures, as the cost of treatment is high and public resources are limited.
A patient may use a false identity in an attempt to have access to public funding from which he or she would otherwise be precluded. Or there may be more personal reasons, such as a change of partner during treatment. A considerable length of time may pass between the couples referral from the family doctor and the start of treatment, or during the fertility investigations which are necessary before treatment can commence. During this time a relationship break-up may occur, and one partner may try to continue the treatment with a different subject”, he said.
Or an individual or couple approaching the end of their reproductive biological options could use alternative routes to maximise the choice of parenthood. Sperm from a younger man could be substituted for an older one, for example, while maintaining the pretence that the older man will be the legal father.
Among the problems that could arise if identity fraud is practised, said Dr. Sabatini, is litigation between the IVF provider and the deceived partner who discovers the different genetic origins of the child. “As it is now clear that genetics play a large part in providing the blueprint for adulthood, it could also be potentially medically harmful for a person to have incorrect information about his genetic make-up.”
The team intend to send the results of their research to clinics in the UK and in Europe. They will carry out a further survey in a year’s time to see if changes in practice have occurred. “We hope to sensitise professional bodies in the UK and abroad and encourage them to setup study groups to identify solutions and evaluate the clinical, economic, social and ethical implications of this phenomenon”, Dr Sabatini said.
The team believe that there is a need for a standardised method of patient identification. This could involve methods already in use, such as identity cards or passports, or the introduction of special fertility identity cards.
“This needs considerable discussion among professionals, patients, legal and political bodies to ensure that personal and institutional rights are not affected”, said Dr. Sabatini. “However, given the implications for patients, clinics, and public funding, we think that it is essential that strict measures to verify identity are implemented as soon as possible.
“Such measures need to be Europe-wide; identity fraud cannot be confined by geographical boundaries. While the introduction of specific safeguards in a few European countries might decrease its occurrence in a particular region, it would most likely have the effect of increasing its frequency in countries where no legislation exists and where the problem has not yet been identified and addressed”, he said.