A specialist in bioethical and legal issues involved in the medical care of newborns and the use of artificial reproductive technologies, Associate Prof Stephen (Van) McCrary, of Stony Brook University Medical Centre, New York, came to New Zealand under the Fulbright Specialists programme.
Prof McCrary, in an email response to questions, said an issue troubling some ethicists and physicians was anecdotal reports some women in New Zealand, denied Government funding for in vitro fertilisation procedures, were travelling to other developed countries, including the United States, where such services were more available with cash payments.
"Often, such women choose multiple-embryo transfer, which substantially increases the risk of multiple-gestation pregnancies yielding extremely low-birthweight infants who require expensive neonatal intensive care back home in New Zealand.
"Hence, high-technology medicine provided for cash in one country may drain public resources in another."
Prof McCrary, whose visit was hosted by the University of Otago's law faculty and centre for law and policy in emerging technologies, spoke in Dunedin, Wellington and Auckland last month, and also discussed neonatal intensive care practices and policies with some hospital paediatricians.
Responding to a question about laws related to assisted reproductive technology, Prof McCrary said the goal should be to properly balance reproductive freedom with the best interests of the resulting children.
Many developed countries had successfully accomplished this balancing process through reasonable regulation without affecting overall fertility rates.
He described the New Zealand approach as " middle of the road".
A common theme in issues raised with him during his visit was increasing concern from health providers about the allocation of scarce healthcare resources during the recession.
Among the issues explored by Prof McCrary in his presentations was the clinical, legal and policy implications of several high profile cases, including that of "Octomom" Nadya Suleman, an American woman who gave birth to octuplets last year after multiple embryo transfers.
The number of embryos transferred was outside the suggested voluntary guidelines of the American Society for Reproductive Technologies, although the society had a policy that strict limitations on the number of embryos transferred would not allow treatment plans to be tailored to the individual.
Some patients underestimated the health risks for multiple-birth children, both to the foetuses and the mother, he said.
In his presentations, Prof McCrary also discussed the use of clinical ethics consultations, a means of helping patients, families, healthcare providers and other involved parties, identify and work together to resolve ethical dilemmas in healthcare.
