Towards
a Creative Response to Infertility
A
Detailed Response
of
the
Irish
Catholic Bishops Conference
to
the
Report
of
the
Commission
on Assisted Human Reproduction
Introduction
No reasonable person would question the very natural desire of a
couple to have a child who flows, as it were, from their own love. One can only
imagine the disappointment, and even perhaps the sense of failure, which many
couples experience when it is not possible for them to have a child. Against
that background, assisted human reproduction therapy, in its various forms, must
seem like a god-send.
The recommendations of the report of the Commission for Assisted
Human Reproduction extend well beyond the issue of infertility, and touch on a
wide variety of sociological and scientific issues which are, so to speak,
consequences of the availability of human gametes and human embryos generated by
assisted human reproduction. We will respond in some detail to each of these
recommendations. Before doing so we wish, without in any sense minimising the
complex emotions involved, to recall a number of key principles which underpin
the approach of the Catholic Church, among others, to all of these
issues.
a.
Key
Principles
The Catholic Church has a particular vision of human sexuality, which
is rooted in the understanding of the human person found in the Scriptures, as
well as in the natural law. This document is addressed primarily to those who
consider themselves members of the Catholic Church. We are confident, however,
that it will also be welcomed by many others who share our faith in the God of
Creation. Similarly, there will be many who, although they may not be religious,
will share the belief (which traces its roots to the philosophy of ancient
Assisted human reproduction gives rise to a number of issues which
have to do with fundamental human rights, issues such as respect for human life,
and respect for the family. In exploring questions such as these, the bishops
intend to engage in dialogue, not just with members of the Catholic Church, but
with Irish society as a whole.
i. The Right to Life
and Bodily Integrity
One of the fundamental rights promulgated in the Universal
Declaration of Human Rights is the right of every human being to life and bodily
integrity. [1] Although the right to life finds a particularly strong foundation in
Christian faith, it is a right which is acknowledged by people of all faiths and
none. In the final analysis, respect for the right to life is reciprocal in
nature. My requirement that my right to life should be respected by others,
logically implies that I should afford a similar respect to their right to life.
At what point should this respect begin? Biologically speaking, life
is a continuum. Genetically speaking, however, and in terms of philosophy, each
human life has a beginning, a point at which this distinct individual comes into
being. Genetic science has contributed to our awareness that each human being
has a unique identity, related to but distinct from either of his / her parents.
The obligation to respect life begins at the point when individual human life
begins, or even when there is a reasonable possibility that it may have begun.
Once fertilisation has been completed a new human being exists, and
this brings with it an obligation of respect. It is clearly in the interests of
justice and the common good that this obligation should be reflected in civil
law. Recent embryological studies indicate that fertilisation is a process
rather than an instantaneous event. The beginning of cell division marks the end
of this process. The stage prior to cell division is described as the pronuclear
stage. The question has been raised in recent discussions as to whether the same
respect should be afforded to the human embryo at the pronuclear stage, as is
afforded to the embryo at the two cell stage and later.
The process of the fusion of two gametes involves many minute stages.
When the acrosomal filament of the spermatozoon
touches the surface of the ovum, and the protective membranes are penetrated,
the parts of the plasmalemma of the spermatozoon and the egg, outside the
zone of contact, fuse together in a continuous sheet. The cytoplasmic contents of the two gametes are now in direct
continuity. Although the shape of the spermatozoon may yet be distinguishable,
the two gametes have at this stage become one single cell. [2]
The pronuclear embryo is clearly far more than a sperm cell and an ovum. It has an organic unity and
is, as one unit, oriented towards on-going development. It is also, of course,
biologically human. It has been possible for some years to successfully freeze
the human embryo at the pro-nuclear stage. It is worth noting, however, that it
has proved significantly more difficult to freeze the ovum without destroying
it. This
simple fact also serves to demonstrate that, by the pro-nuclear stage, very
significant development has already taken place, as a result of the fusion of
the sperm and the ovum. It has become a single organism, and has already begun
to develop.
Once fertilisation is complete, the organism has become a human
being. There is nothing else it can be. It continues to develop and grow, of
course. But all development or change necessarily involves some continuity;
something in which the change takes place. This “something” is the human
individual. It has its own genetically unique body. It has its own substantial
form, the human soul, which is its first principle of life. It is this principle
of life which facilitates and directs the development of the person throughout
the lifetime of the organism. [3]
In the final analysis, where doubt exists on the level of fact, the
integrity of conscience requires that the presumption be in favour of the life.
The classical example often cited is as follows: if a hunter hears a rustling
noise in the bushes, and is unsure whether it is a deer or another human being,
he must assume it is a human being, until such time as he can establish that it
is not. Similarly, we may accept the argument that there is scientific
uncertainty as to the precise moment when an individual human life begins. That
uncertainty, however, does not remove the obligation of care and respect for
what certainly has the potential to become, and may already be, a
distinct human individual.
ii. The
Right to an Identity of Origin
The Universal Declaration of Human Rights acknowledges the right of
men and women “to marry and to found a family.” [4] This is best understood as a right not to be prevented from
founding a family. It is not an absolute right to have children. As is clear
from the same article of the Declaration, the family as “the fundamental group
unit of society” is entitled to protection. This would include protection from
any form of reproductive therapy which, however well-intentioned, would have the
effect of weakening the bonds of family.
Parenthood is not simply a matter of life-giving. There is an
essential natural link between the life-giving role of parents, and their
responsibility to care for and educate their young. This on-going responsibility
of parents is not exclusive to the human species, but is found to a greater or
lesser degree in very many species of birds and animals. In human nature,
however, the period of time between birth and maturity is relatively longer than
in any other species. The process of growth to maturity involves far more than
mere survival. The human child is dependent on his / her parents for emotional,
spiritual, social, and moral formation. Inevitably some elements of the parental
role will be delegated to others (e.g., teachers), but the primary
responsibility rests with the parents. The only justification for permanently
handing this responsibility over to others would be the incapacity of a parent
to respond adequately to the needs of the child.
In recent years we have witnessed the phenomenon of a great many
adopted people who have wanted to discover who their genetic parents are, and
even to establish a relationship of some kind with these parents. This
phenomenon should not be seen in any sense as a denial of the goodness and
generosity of adoptive parents. It is simply an affirmation of the fact that, as
autonomous human individuals, our identity and our self-understanding is, to a
significant extent, dependent on our genetic origins.
Why should we assume that this desire to know who one’s natural
parents is any less likely to surface in people who are born following the
donation of sperm, or ovum, or both. The right to this information, later in
life, might well be found to conflict with the practice of guaranteeing
anonymity to donors.
Like all fundamental human needs, the need for on-going parenting,
and for a recognisable identity of origin, gives rise to a corresponding right.
This right has always been acknowledged by the Church, and is expressed in the
document Donum
Vitae.
The child has the right to be conceived, carried in the womb, brought
into the world and brought up within marriage: it is through the secure and
recognised relationship to his own parents that the child can discover his own
identity and achieve his own proper human development. [5]
While the primary consideration must be the good of the individual
child, the close connection between genetic parenthood and the responsibility of
care is also in the interests of society, and this has long been recognised in
our social legislation. A stable family unit, founded on a commited relationship, plays a role of fundamental
importance to society. It is in the family first and foremost that children
discover their identity and their individuality, that they learn respect for
themselves and for others. It is in the family that cultural and moral values
are learnt. Any procedure which undermines the unity and integrity of the family
also damages the fabric of society, because the institution of the family is the
foundation on which society is built.
iii. The
Essential Meaning of Human Sexuality
Human sexuality is designed in such a way that the coming together of
man and woman as one flesh is both an expression of intimacy and
self-giving and the privileged context in which new life begins.
This is not simply a statement of religious belief. It is evident from any
realistic reflection on the facts of biology, physiology, and human
psychology.
It is arguable that the term reproduction is not the most
appropriate term to describe what happens
when a new human being comes into existence. The concept of
reproduction captures well enough the biological dimension of human
generation, but it is not really capable of expressing the mystery of
how man and woman, through their own human loving, co-operate with the
creative action of God. An alternative term, which may better express this personalistic dimension of human life-giving is
pro-creation.
Technology has an important contribution to make to almost every area
of modern medicine, including the treatment of infertility. There is a valid
distinction to be made, however, between
situations in which technology plays a supporting role, and situations in
which technology becomes dominant.
In every area of health-care, people express their frustration and discomfort
when they experience the intrusiveness of technology.
This is no less the case where the treatment of infertility is
concerned. The more dominant technology becomes, the more the personalistic dimension of human sexuality tends to be
separated from the act of life-giving,
and the more easily the creative act of God is obscured. We have to ask
ourselves whether a procedure which is completely controlled, which tends
towards predictability, and which may also be highly selective, is a true
expression of what human life-giving is about. Is the intrusiveness of
technology too high a price to pay?
Parents are naturally proud of their children; anxious about their
children, and sometimes disappointed in their children. In the final analysis,
however, children are not for their parents. Their value is in themselves, and
in their vocation as the sons and daughters of God who created them. There is a
risk, in all our relationships, that we seek to possess the one we love. It is
arguable that this risk is increased when technology becomes dominant, because
the child who is born has been carefully planned, with the outlay of
considerable emotional energy and economic resources. What if the end result
doesn’t measure up to our hopes and expectations?
The desire for success, both professionally and on a human level,
means that doctors and scientists are also liable to disappointment, although in
a different way. Once they have the possibility and the opportunity to intervene
in human reproduction, there follows a natural desire to improve things. In all
of this, the child who is born as a result of technological intervention is no
less worthy of love or respect than any other child. Nonetheless, technology, often unawares, introduces
into the act of life-giving elements which do not sit well with the dignity of
the human person.
iv.
Conscience
In the matter of assisted human reproduction, as in all other
matters, each individual must make and be guided by a judgement of conscience.
Conscience is sometimes taken to mean personal opinion, as opposed
to an official institutional position. Properly understood, however, conscience
is a judgement:
made about a particular situation,
against the background of one’s own value system or vision of
life,
based on the best available knowledge of the facts.
The capacity to know good from evil (or right from wrong) is a
natural quality with which all normally developed human beings are endowed. It
does not depend specifically on religious belief. The making of a judgement of
conscience does, however, presuppose some coherent set of values, or vision of
life. In the case of a believer, religious faith will be an important element in
that vision of life.
In so far as the quality of a judgement of conscience depends on the
level of information available, healthcare professionals have an obligation, as
part of their professional responsibility, to ensure that patients are fully
informed, in terms which they are capable of understanding. Couples whose
infertility is treated by I.V.F. are primarily concerned with having a child. To
that extent at least, it can be said that their set of values is oriented in
favour of life. It is important that couples, who are candidates for treatment,
be fully informed by the providers of the service, as to the implications and
consequences of I.V.F., both for the embryo and for themselves. It is only in
the light of such information that a fully free decision can be made about the
treatment being proposed.
While law is one of the elements which influence the judgement of
conscience of individual members of society, it is not the ultimate determinant
of conscience. It’s purpose is to ensure that the fundamental rights of some are
not infringed upon by the decisions of others. The right to freedom of
conscience is a fundamental human right, and is not restricted to private
individuals. Healthcare professionals, legislators, and others who serve the
public, have both a right and a duty to act in accordance with the judgement of conscience. This
judgement is rooted in truth, not in expediency, or in the dynamic of supply and
demand.
b. What
the Church asks of The Civil Authority
The Church addresses its teaching, in the first
instance, to her own members. She calls on those who are committed to following
Christ to respond to issues of fertility and infertility, and indeed to a whole
range of other human challenges, in a manner which is consistent with the
gospel.
The Church does not ask or expect the civil
authority to legislate in accordance with her teaching, but hopes that
legislators and all those who have an influence in the formation of public
policy will recognise that the common good, which is their specific
responsibility, can only be achieved when the rights of every human individual
and the rights of the family are fully respected.
The keynote
The
inviolable right to life of every innocent human individual and the rights of
the family and of the institution of marriage constitute fundamental moral
values, because they concern the natural condition and integral vocation of the
human person; at the same time they are constitutive elements of civil society
and its order. For this reason the new technological possibilities which have
opened up in the field of biomedicine require the intervention of the political
authorities and of the legislator, since an uncontrolled application of such
techniques could lead to unforeseeable and damaging consequences for civil
society.
The inalienable rights of the
person must be recognized and respected by civil society and the political
authority. These human rights depend neither on single individuals nor on
parents; nor do they represent a concession made by society and the State: they
pertain to human nature and are inherent in the person by virtue of the creative
act from which the person took his of her origin. Among such fundamental rights
one should mention in this regard:
a.
every human being's right to
life and physical integrity from the moment of conception until death;
b.
the rights of the family and
of marriage as an institution and, in this area, the child's right to be
conceived, brought into the world and brought up by his parents. [6]
We believe that there is indeed a need for legislation to
control the technology of assisted human reproduction. We are no less certain
that any new legislation which would permit these fundamental rights to be
eroded would ultimately be contributing to a serious decline in the standards of justice and equity in every
aspect of our civil society.
2.
The
Report of the Commission on Assisted Human
Reproduction
a.
A
Detailed Response to the Specific Recommendations [7]
1.
The
CAHR recommends that: A regulatory body should be established by an Act of the
Oireachtas to regulate AHR services in
Our
response: We would have no
objection in principle to the establishment of a body to oversee the
implementation of the law in respect of AHR. We believe, however, that the Oireachtas alone has the authority and responsibility to
make law and, especially in matters which concern respect for fundamental
rights, this authority and responsibility cannot be devolved to any other
agency.
2.
The
CAHR recommends: National
statistics on the outcome of AHR techniques in
Our
response: Accurate
information is always useful. We would point out, however, that positive
outcomes alone would not establish the goodness of an AHR
technique.
If statistics are to be compiled, they should
include - for purposes of comparison and indeed for purposes of objectivity -
statistics on all the available methods of dealing with infertility, including
approaches such as Napro technology (see Appendix 2).
In the final analysis, the best response to
infertility is prevention, for this reason, we would also recommend that
statistics should be compiled which indicate the proportion of cases of
infertility in which there is evidence of present or previously treated sexually
transmitted disease, previous use of chemical contraceptives and IUCDs, or previous abortion.
3.
The
CAHR recommends: Longitudinal
studies of children born as a result of AHR should be established, in accordance
with standard ethical/legal requirements and with the consent of families, in
order to facilitate long-term monitoring.
Our
response: We accept that
this makes good sense from a scientific point of view. We would be concerned,
however, that such longitudinal studies should not contribute to making such
children feel that they are, in some sense, different or indeed inferior in some
way.
4.
The
CAHR recommends: Appropriate
guidelines should be put in place to govern the freezing and storage of gametes
and the use of frozen gametes. The regulatory body should, in accordance with
statutory guidelines, have power to address cases where gametes are abandoned,
where the commissioning couple cannot agree on a course of action, where couples
separate or where one or both partner(s) dies or becomes
incapacitated.
Our
response: Gametes are not
human beings and, while there are certainly moral questions related to their
being harvested outside the context of natural intercourse, there is no
particular reason why they should not be frozen once they have been harvested in
this If there is evidence that the subsequent use of frozen gametes
in AHR procedures increases the likelihood of abnormalities in the embryo, then
we believe they should not be used for AHR. We believe that respect for the
family and for the meaning of parenthood also requires that gametes which will
not be used to achieve a pregnancy by the couple from whom they have been
harvested should be destroyed.
5.
The
CAHR recommends: Superovulation
should be allowed according to well established clinical protocols. Appropriate
guidelines should be put in place by the regulatory body to govern
superovulation and the harvesting of ova following ovarian
stimulation.
Our
response: We recognise that
a common cause of
infertility in women is a disorder of ovulation. Where non-ovulation is at the
root of infertility, drug therapy is provided, using clomiphene citrate, or preparations of gonadotrophin, which stimulates the ovaries, and the woman
may achieve pregnancy without any further medical intervention. The use of clomiphene or gonadotrophin preparations assists rather than replaces the
natural reproductive function. Dr. Hilgers comments that most of the drugs currently
available have limitations as well as advantages. [8] Clomiphene citrate, for example, although it induces
ovulation, tends to inhibit cervical mucus. Medications such as Pergonal and Metrodin, which are
used to stimulate ovulation, are associated with high multiple births. Where
ovulation stimulation is being used, it is recommended that monitoring be
carried out, to prevent hyperstimulation of the
ovaries, which may lead to serious complications.
Any ethical evaluation of drug
therapy must take into account the likely effect of the treatment on the woman.
One concern we would have, given the emotions associated with infertility and
the desire for a child, would be that couples who had previously had IVF
treatment without success might persist with further attempts including the
associate superovulation and that the health of the
woman might be compromised.
Over and above this, the other ethical concern
associated with superovulation is that it tends to be
associated with the generation and subsequent storage of human embryos. Quite
frequently these embryos are subsequently designated as “surplus embryos,” a
designation which is then used to justify their donation to other couples, their
use for research, or ultimately their disposal.
6.
The
CAHR recommends: Service providers
should facilitate users who wish to avoid any treatment that might result in the
production of ‘surplus’ embryos.
Our
response: We agree
absolutely with this recommendation. In our view, many of the ethical
difficulties which arise in assisted human reproduction result from the decision
to produce so-called ‘surplus’ embryos. We have some reservations about the
terminology here. While some embryos may be surplus to the requirements of the
couple, we don’t believe that any human embryo can really be considered as surplus because each embryo is primarily
for itself, and not for anyone else.
7.
The
CAHR recommends: Appropriate
guidelines should be put in place by the regulatory body to govern the
fertilisation of ova.
Our
response: It is not clear
what this recommendation actually means. In the first place, it is not clear
whether this recommendation refers to the fertilisation of ova in vitro, or
whether it also includes intra uterine insemination. We assume that it doesn’t
refer to the fertilisation of ova in the course of the natural procreative
process. Will the guidelines refer to the professional qualifications of those
who will fertilise the ova, or the condition of the ova themselves, or the
procedures and technical standards to be observed?
8.
The
CAHR recommends: Appropriate
guidelines should be put in place by the regulatory body to govern the number of
embryos to be transferred in any one treatment cycle and when to transfer
embryos.
Our
response: We recognise that
the transfer of more than three embryos in one treatment cycle poses an
obstetric risk to the mother, and that the preferred option seems to be to use
two embryos. Clearly the health of the adult patient is more important than the
achievement of a pregnancy, and any imprudent obstetric risk should be avoided.
Any practice which involves the deliberate destruction of a human embryo is,
however, morally unacceptable and, in our view, constitutes medical malpractice.
This includes the so-called “reduction” in the number of pregnancies, or the
destruction of so-called surplus human embryos. We also note that, while
multiple transfers within reason) increase the chances of achieving a pregnancy,
they tend to reduce the survival rate of the individual embryo.
9.
The
CAHR recommends: Appropriate
guidelines should be put in place by the regulatory body to govern the freezing
of excess healthy embryos.
Our
response: As already
indicated above, we do not believe that embryos should be produced in excess of
the number that can safely be transferred in one treatment cycle. We do not
believe that frozen storage is consistent with the dignity of a human embryo. It
is too early yet to know for certain what long term impact freezing may have on
the physical (or even psychological) well-being of an embryo which is
subsequently implanted in the womb and born. Freezing may well be considered
preferable to the wanton destruction of embryos which might otherwise take place
and, in so far as the freezing of embryos is allowed by law, it must certainly
be regulated.
10.
The
CAHR recommends: *Appropriate
guidelines should be put in place by the regulatory body to govern the options
available for excess frozen embryos. These would include voluntary donation of
excess healthy embryos to other recipients, voluntary donation for research or
allowing them to perish.
Our
response: As already
indicated above, we do not believe that embryos should be produced in excess of
the number that can safely be transferred in one treatment cycle. Serious
ethical problems are associated with each of the three options proposed.
·
Use
for research: Biomedical
research is an essential element of healthcare, and contributes to the saving of
human lives on a daily basis. In the normal course of events, research
involving human subjects is classified under two headings, therapeutic (i.e.,
that which offers the prospect of benefit to the subject) and non-therapeutic
(i.e., that which holds no prospect of benefit to the subject). In cases where
research is therapeutic, and the patient is unable to give consent, this consent
may be given by his / her legal guardian. In the case of non-therapeutic
research, however, the person who is the subject of the research must be a
volunteer. [9] A human embryo, by definition, is
incapable of giving consent.
The right to conduct research is not an absolute right.
Irrespective of what positive law may decide, human embryos - as genetically
distinct individuals of the human species – have natural rights which cannot be
ignored. The end does not justify the means. The goodness of research is
vitiated when, as a necessary pre-condition, it requires the destruction of
human embryos.
·
Allowing embryos to perish: parenthood brings with it a responsibility of care. In
the normal course of events, we would always recommend that the implications of
this responsibility should be considered carefully before people become parents. In the
case of assisted reproductive therapy, fertilisation takes place in a laboratory
rather than in the mother’s body. This distancing of the embryo from its parents
does not, however, justify any abdication of the responsibility of care. The
parents and, together with them, the “quasi-parents” (those who assist them in
the process), have no less an obligation to care for the embryo and to provide
it with every possible opportunity of developing normally and coming to birth.
To suggest that the embryos are ‘surplus’ is disingenuous if we have been
responsible for the process which made them ‘surplus’ in the first
place.
·
Donation to other recipients:
In many
jurisdictions, subsequent to I.V.F. or I.C.S.I., it is common practice for
surplus embryos to be used, with the consent of the natural parents, to provide
children for other infertile couples. It must be said at the outset, that to
allow surplus embryos to survive in this way is infinitely preferable to
disposing of them, or making use of them as objects of research. This is not to
say, however, that there are no ethical implications
involved.
The practice of placing an embryo or embryos in the uterus of a woman who
is not the natural mother, and in the care of parents who are not the natural
parents, does separate parenthood from the responsibility of care. It creates a
whole new complex relationship, in which family is redefined to include two sets
of parents. This inevitably gives scope for some confusion about the identity of
the child who will be born.
Parents may, of course, die or separate. Children may be born to and
brought up by single mothers. They may be adopted. None of these circumstances
lessens in any way the dignity of the child. There is a fundamental difference,
however, between responding constructively and lovingly to a child who already
exists (in or out of the womb) and deliberately creating a situation in which a
child’s sense of identity and family membership is blurred. What is significant,
once again, is the initial decision, to generate surplus embryos, a decision
which is taken in isolation from any coherent plan for the future personal care
of the human individuals concerned.
11.
The
CAHR recommends: The regulatory
body should, in accordance with statutory guidelines, have power to address
cases where embryos are abandoned, where the commissioning couple cannot agree
on a course of action, where the couple separates or where one or both
partner(s) dies or becomes incapacitated.
Our
response: Once again, this
recommendation presumes the production of embryos which are not transferred in
the same treatment cycle. Clearly, in circumstances such as those which are
described, somebody must be authorised to decide on the course of action to be
followed, and must be held legally accountable for such decisions. We believe
that such decisions cannot be merely pragmatic or prudential, but that they must
be informed by objective moral principles. The decisions and actions of any such
regulatory body must be accountable to the legislature and fully open to public
scrutiny.
12.
Counselling should be provided before, during and after
treatment to those considering AHR treatment so that they are adequately
informed of the risks involved, the potential benefits that may be obtained, and
the possibility of success in their particular situation. Suitably qualified
professionals should adequately convey the complex medical and scientific
ramifications of different treatment approaches in verbal and written
form.
Our
response: We recognise the
contribution which counselling can make to couples considering having a child,
and indeed to individuals who consider making any serious decision. The purpose
of counselling, as we see it, is to facilitate people in making a decision which
is truly free. We believe that such freedom goes hand in hand with truth. For
that reason we see no value in any form of education or counselling which
embraces feelings but excludes the essential facts about the nature of the human
embryo.
13.
The
CAHR recommends: It should be
obligatory for all recognised providers of AHR services in
Our
response: We agree that
written informed consent should be obtained for all procedures. In keeping with
good practice generally, participants would normally also be free to revoke
their consent. In the case of assisted human reproduction, however, a difficulty
arises in that, if a couple (or indeed one party) withdraws consent for embryo
transfer when fertilisation has already taken place, this withdrawal of consent
can have serious and perhaps even fatal implications for another human being.
This scenario is by no means unknown in other jurisdictions. We are not, of
course, suggesting that a woman should be obliged or forced against her will to
accept an embryo in her womb. We simply wish to point out, once again, that the
decision to generate embryos outside the womb, or to place them in storage,
makes them particularly vulnerable to the attitudes and the agenda of
adults.
14.
The
CAHR recommends: Best practice
infertility treatment guidelines should be developed for general practitioners
and gynaecologists working outside specialist clinics. These guidelines should
be reviewed on a regular basis.
Our
response: Best practice
guidelines should be in place wherever healthcare professionals work. It is our
view that the regulatory bodies of the healthcare professions are best placed to
develop these guidelines, the implementation of which would then be subject to
public scrutiny.
15.
The
CAHR recommends: Centres that
collect and store gametes and that generate and store embryos should be
regulated and licensed by the regulatory body. The regulatory body should lay
down quality assurance standards for such centres. Information on the range of
services provided by the specialist clinics should be available to the general
public.
Our
response: While not wishing
in any sense to convey approval for the storage of human embryos, we do accept
that any agency which is involved in the collection or storage of gametes or
human embryos should be well regulated and closely monitored. It is not clear
what “quality assurance standards” means in this context. If it includes the
suggestion that embryos should be subject to quality control and that those
which fall short of certain standards should be disposed of or used for
research, we would certainly be opposed to that.
16.
The
CAHR recommends: *The embryo formed
by IVF should not attract legal protection until placed in the human body, at
which stage it should attract the same level of protection as the embryo formed
in vivo.
Our response: As we stated quite categorically in our initial response to the report of the CAHR, this recommendation is totally unacceptable to us. No commission report can change the reality that the right to life belongs to all, irrespective of race, sex, religion or age.
This is not simply a matter of Catholic teaching. It concerns the common good of our society. While it is a responsibility in which all citizens have a share it is the specific responsibility of government, one which cannot be delegated to any other agency or commission. The common good is not simply the good of the state, or the good of the majority; it must take into account the good of all, collectively and individually, including human embryos. Advances in genetics and embryology serve to confirm that every human embryo is an individual human being. There is certainly no scientific or philosophical basis for distinguishing between an embryo in the womb, and one in a glass dish or in frozen storage. The recommendation of the Commission that “the embryo formed by IVF should not attract legal protection until placed in the human body” appears, therefore, to have a purely utilitarian and pragmatic motivation, namely to ensure that embryos are available for research, and to allow for the selective disposal of those embryos which do not measure up to certain standards. The notion that “the end justifies the means,” if accepted in principle, has implications which extend far beyond the issue of assisted human reproduction.17.
The
CAHR recommends: Services should be
available without discrimination on the grounds of gender, marital status or
sexual orientation subject to consideration of the best interests of any
children that may be born. Any relevant legislation on the provision of AHR
services should reflect the general principles of the Equal Status Acts 2000-4
subject to the qualifications set out in section 4.8.
Our
response: As we stated in
our original submission to the Commission, the nature of
human sexuality is such that it is the norm for a child to be born into a family
where he / she has a mother and father who are in stable relationship with one
another, and who are in a position to offer a stable environment in which the
child can grow and mature. This is why marriage is so fundamental to the
well-being of children and of society. It is not possible to guarantee
absolutely the stability or permanence of any human relationship. In so far as
it relates to the transmission of human life, however, we would have a serious
moral concern that this stability should not, by default, come to be regarded as
being in any sense optional. Any
legislation to provide for Assisted Reproductive Therapy (ART) should recognise
and protect the right of every child to be born to a mother and father who are
permanently committed to one another.
We have no difficulty whatsoever
with the concept of equal status in the sense that all human beings are equal in
dignity. We would point out, however, that all human beings are not the same.
Men and women, by virtue of their difference of sex have different roles and
responsibilities where reproduction and parenthood are concerned. We would also
argue that the argument for equal status will be more credible if fundamental
human rights are extended to the human embryo, notwithstanding its small size
and early stage of development.
18.
The
CAHR recommends: Where there is
objective evidence of a risk of harm to any child that may be conceived through
AHR, there should be a presumption against treatment.
Our
response: We agree. We find
it curious and illogical, however, that the concerns of the Commission do not
extend to the risk of harm to the embryo, that vulnerable human being who, as a
result of AHR may be used for research or allowed to
perish.
19.
The
CAHR recommends: Donation of sperm,
ova and embryos should be permitted and should be subject to regulation by the
regulatory body.
Our
response: This matter has
been substantially addressed under the hading of CAHR Recommendation No.10
(above). In so far as donation of sperm, ova and embryos is permitted it should
be regulated by law in accordance with the common good.
We believe, however, that the donation of
embryos and gametes is inconsistent with respect for the
family and the identity of origin of the child. It fundamentally changes the
meaning of parenthood by separating life-giving from the responsibility of care.
It also raises serious questions about the “identity” of the child and his / her
access to information about that identity.
In recent years we have witnessed
the phenomenon of a great many adopted people who have wanted to discover who
their genetic parents are, and even to establish a relationship of some kind
with these parents. This phenomenon should not be seen in any sense as a denial
of the goodness and generosity of adoptive parents. It is simply an affirmation
of the fact that, as autonomous human individuals, our identity and our
self-understanding is, to a significant extent, dependent on our genetic
origins.
We cannot assume that this desire to
know who one’s natural parents is any less likely to surface in people who are
born following the donation of sperm, or ovum, or both. We note that a right to
this information, later in life, might well be found to conflict with the
current practice of guaranteeing anonymity to donors.
Our
response: Taking account of
our response to CAHR Recommendations 10 and 19 (above) we believe that
ambivalence or uncertainty on the part of donors can only give rise to problems
for any children who are born arising out of donation. We agree that donation
should certainly not take place in the absence of fully informed consent.
Our
response: In so far as
donation of sperm, ova and embryos is permitted this recommendation makes
practical common sense. A good deal hangs on the interpretation of the word
“appropriate.” It would be inappropriate is guidelines or limits were to become
a vehicle for eugenics or social engineering.
Our
response: We agree in
principle. We recognise, however, that this natural right of children is not
without implications for the husbands / wives and other children of donors,
especially in cases it has not been previously discussed. We refer to our
earlier comments and to our belief that children should be born into a family in
which the social parents are also the genetic parents.
Our
response: We
agree.
Our
response: This
recommendation would appear to assume that it is the intent of all parties “that
the donor will not have any legal relationship with the child and that the woman
who gives birth to the child will be the child’s mother.” This would appear to
be a reasonable assumption, but it may not always be the case.
We accept that the law must, for the sake of the
child, recognise certain individuals as having parental rights and
responsibilities. When genetic parents abdicate these rights and
responsibilities the law must make appropriate provision in the best interests
of the children.
We would point out that there is a fundamental
difference between a situation in which children are adopted or taken into care
in circumstances in which the natural parents are unable to provide adequately
for their needs and donation when individuals choose to become the natural
parents of children for whom they will have no further responsibility.
Our
response: While this
recommendation does not resolve our concerns about donation per se, it does make practical common
sense. The alternative would place the child at a disadvantage within the family
home, and would probably undermine the stability of the partnership between the recipient and
her partner.
Our
response: While this
recommendation does not resolve our concerns about donation per se, it does make practical common
sense. Any alternative would place the child at a disadvantage within the family
home.
Our
response: While this
recommendation does not resolve our concerns about donation per se, it does make practical common
sense. Any future contact between the child and his / her natural parents should
be at the initiative of the child, having reached the age of majority.
Our
response: We agree. We are
of the view that any other children of a donor also have the right at least to
be made aware, when they reach an appropriate age, that they have other
siblings. Among the reasons for this are the genetic implications of
inter-marriage between close relations.
Our
response: Once people
donate embryos or gametes, they have abdicated their parental responsibilities.
It would seem inappropriate that they should at the same time retain parental
rights.
In so far as this recommendation refers to the
use of embryos for research, we wish to refer at this point to our response to
CAHR recommendation no.34 below.
Our
response: Surrogacy
compounds the ethical difficulties associated with assisted human reproduction.
We note that, in recommendation No.26 the Commission proposes that, in the case
of ovum donation “the gestational mother should be recognised as the legal
mother of the child and her partner, if any, should be recognised as the child’s
second legal parent.” In this case, presumably, the opposite would be the case,
and the gestational mother, contrary to common perception, would not be
recognised as the legal mother of the child. The net effect of these
recommendations is to suggest that children are property the control and
ownership of which can be agreed between adults, in a manner approved by law. We
argue, on the contrary, that children are persons in their own right, whose
primary purpose is not the fulfilment of their parents.
Our
response: Taking account of
our response to CAHR recommendation no.30 (above), we have nothing further to
add under this heading.
Our
response: We
agree.
Our
response: Taking account of
our response to CAHR recommendation no.30 (above), we have nothing further to
add under this heading.
Our
response: It is frequently suggested that destructive research on human embryos
can be justified by the prospect of developing new responses to infertility or
to the causes of genetic abnormality, or the possibility through stem-cell
research of developing new treatments for a wide variety of diseases.
The value of an embryo is not dependent on why
it was generated, on the purpose which we assign to it, or on how we feel about
it. As we stated in our submission to the CAHR, a human
embryo is the new organism which comes into existence at fertilisation. This
organism is not simply a collection of cells, but a genetically distinct human
individual, “which is oriented towards further development.” [10] Its value derives from its nature. The
fact that some embryos are already in storage and may otherwise be destroyed
does not in any way lessen their intrinsic value. The problem begins, as we have stated
above, with the decision to generate more embryos than can be safely transferred
in one treatment cycle.
In addition we wish to point out that, in the normal course of
events, research involving human subjects is classified under two headings,
therapeutic (i.e., that which offers the prospect of benefit to the subject) and
non-therapeutic (i.e., that which holds no prospect of benefit to the subject).
In cases where research is therapeutic, and the patient is unable to give
consent, this consent may be given by his / her legal guardian. In the case of
non-therapeutic research, however, the person who is the subject of the research
must be a volunteer. [11]
A human embryo, by definition, is incapable of
giving consent.
We wish to re-iterate in the strongest possible
terms our belief that the human embryo must be regarded
as a subject and not an object. It is an end in itself, and not a means to an
end. Embryos ought not to be used as raw material for
research, however beneficial that research may appear to be. The
fundamental issue at stake is that of respect for human
life.
Our
response: Human Cloning is the laboratory production of a genetic copy of
another human being. We believe that all human cloning should be prohibited.
While this recommendation of the CAHR is framed
as a prohibition of “reproductive” cloning, it is clearly intended to allow for
so called “therapeutic cloning.” We wish to point out that human cloning,
irrespective of its ultimate purpose, would always be reproductive in that the
immediate result of cloning would be the generation of a human embryo. Any
distinction between “therapeutic” and “reproductive” cloning is purely
spurious.
Cloning is most frequently associated with the provision of human
embryos for research. Stem-cells,
which are very versatile, are taken from the embryo in the hope that they can be
used to treat people suffering from a range of conditions such as Alzheimer’s or
Parkinson’s Disease. In this context, cloning is generally referred to as
therapeutic cloning. It is clearly not therapeutic in the sense understood by
the Declaration of Helsinki, because any therapeutic outcome is for the benefit
of the other person involved; and the embryo is inevitably destroyed in the
process. The possibility of achieving a good outcome for another person does not
justify treating the embryo a means to an end, rather than as a human subject.
We are also concerned that discussion surrounding the issue of human
cloning has not kept up with developments in medical research. Stem cells reside
in human bone marrow, which has a long history in the successful treatment of
leukaemia, and also in umbilical chord blood. It is now widely recognised that
these “adult” stem cells have an advantage over embryonic stem cells in the
healing process since they are destined to this purpose. Embryonic stem cells, by contrast, are
destined to divide until a whole new organism is created and their versatility,
often hailed as an advantage, can also lead to unpredictable outcomes.
The use of human bone marrow is tried and tested; it is known to be
safe. In addition, the taking of a bone marrow sample is much easier than
extracting stem cells from embryonic tissue. The procedure involving bone marrow
can be taken out of the laboratory and into clinical trials immediately, which
is not the case for embryonic stem cells. Bone marrow cells have been
re-injected into people who have suffered damage to heart muscle, and have been
shown to bring about a significant improvement. A further advantage in using a
person’s own bone marrow stem cells is that there is no risk of
rejection.
Research and subsequent treatment involving stem-cells from bone
marrow can be carried out without the destructive consequences entailed by
embryo research and the extraction of stem cells from embryos. [12]
We repeat here the recommendation which we made
to the government in December 2003 that Ireland should take a lead in advocating
that the EU should give significant research funding to adult stem-cell
research, which is very promising and which carries with it none of the ethical
difficulties associated with research involving human embryos.
Our
response: The report of the CAHR (page VIII)
specifically identifies regenerative medicine with therapeutic cloning, and goes on to say that it
involves the creation of a cloned embryo using non-diseased donor cells from a
patient with a degenerative disease or disorder. The objective is to use the
cloned embryo to generate a stem cell line immortalising those cells) that, in turn, can be used to
generate a particular tissue for treatment of the disease in
question.
As indicated in our response to CAHR
recommendation no.35 (above), we fully support he development of medical
treatments which are consistent with the life and dignity of the human person.
We are, however, implacably opposed to the development of medical treatments
which are dependent on the exploitation and destruction of human embryos.
Regenerative medicine in so far as it involves the use of human embryos should
not be permitted.
Our
response: We
agree.
Our
response: We agree that
preconception sex selection should not be permitted for social reasons. We note
the growing tendency to distinguish between conception and fertilisation, and to
identify conception with the implantation of the embryo in the uterus. We have
no wish at this point to enter into a discussion about the precise use of the
term “conception.” We wish to state
quite clearly, however, that the selective or deliberate destruction or disposal
of human embryos at any stage, either before or after implantation, is grossly
immoral, irrespective of the reason.
Our
response: We agree. We
would be opposed, however, to the subsequent use for reproductive purposes of
gametes on which research had been carried out.
Our
response: Pre-implantation
genetic diagnosis can only reduce the risk of genetic disorders if it allows for
the possibility of destroying embryos which are diagnosed as unhealthy. As
stated in our response to recommendation no.38 (above) the selective or
deliberate destruction or disposal of human embryos at any stage, either before
or after implantation, is grossly immoral, irrespective of the
reason.
It will inevitably be argued that, if AHR
technicians knowingly transfer a genetically abnormal embryo to the mother’s
womb, they would not be acting in the best interests of their patient and would
expose themselves to the risk of litigation. We would simply point out that this
difficulty arises precisely because people seek to replace the natural
procreative process rather than to assist it. This dilemma exposes a fundamental
flaw in IVF and related technologies.
b.
Some Brief Comments on the
Fundamental Vision and Methodology of the Commission on Assisted Human
Reproduction
1.
In her
introductory comments, the Chairperson of the Commission, Prof. Donnelly remarks
that “in our emerging multicultural society it is unlikely that any one set of
ethical/moral principles could be completely acceptable to all. In making its
recommendations the Commission sought to put forward a framework broad enough to
be generally acceptable to all individuals and groups in society.” This
statement does not take account of the fundamental question as to whether some
ethical / moral principles part of the foundation on which society, however
multicultural, is built? The
Commission begins its deliberations by accepting that everything is a matter for
political compromise. Some of the
implications of this assumption become clear as the document proceeds to draw
conclusions.
2.
The Report
consistently accepts the usage whereby procedures which neither cure nor improve
the condition of infertility are
described as ‘treatment.’ Interventions such as IVF are not ‘treatments’ in the
sense that the problems underlying the infertility remain untreated.
3.
The Report consistently,
from the very beginning, refers to embryos as ‘surplus’. We would question how the Commission can
then claim to show the slightest respect for those, whose views it purports to
consider later in the report, who see the human embryo as entitled to the respect due to every living human
being?
4.
The report, on Page xii, notes that Article 40.3.3 of
the Irish Constitution provides constitutional protection for the ‘unborn’ and
then goes on to say that “It is not clear whether protection applies from fertilisation or from some subsequent point in the process.
This lack of clarity has implications for the provision of AHR services in
5.
The
report, again on Page xii, states that “the
evidence from the surveys indicates that public opinion ranges from total
opposition to all forms of AHR on the one hand to uncritical acceptance of any
assistance that science can give to infertile people on the other. Two main
intermediate positions on that continuum were identified. We would point out
that the use of the term ‘continuum’ is inappropriate. There is no continuum, but rather a complete contradiction,
between those who recognise the
fertilised embryo as
entitled to the respect due to every human being and those who do not.
6.
The
report tells us, on Page xiii, that “the
Commission took the view that the welfare of the child should be a primary
consideration in the provision of AHR services. In fact, the welfare of the
child was a major factor in the Commission’s thinking on the need for statutory
regulation of AHR services.” This formulation shows how far the Commission is
from any understanding of, not to speak of respect for, those who believe that
the first requirement of the welfare of the child is that he or she should not
be deliberately ‘allowed to perish’.
7.
In describing how the commission
when about its work, the report describes (on page 3) the holding of a large
public conference in February 2003, at
Appendix
1:
Original Submission to the
Commission on Human Reproduction
by the Irish Episcopal Conference – December
2001
We believe that Assisted
Reproductive Therapy (ART) should be regulated by law, in order to protect both
the right to life of the unborn and the unique status of the family founded on
marriage. We welcome this opportunity to make some recommendations to the
Commission.
For general background, we refer the
Commission to the recent publication Assisted Human Reproduction, Facts
and Ethical Issues, [13] which has already been sent to you
for your consideration.
We wish to make the following
specific observations and recommendations:
A.
Research involving Human Embryos:
i
Ethical background (general)
A human embryo is the new organism
which comes into existence at fertilisation. This organism is not simply a
collection of cells, but a genetically distinct human individual, “which is
oriented towards further development.” [14] Research on human embryos is frequently
motivated by the desire to understand and to be able to respond to the problem
of infertility, or to the causes of genetic abnormality. It is felt that this
possible benefit to humanity provides a justification for the destructive
consequences for the embryo itself, of research. The human embryo must, however,
be regarded as a subject and not an object. It is an end in itself, and not a
means to an end. The fundamental issue at stake is that of respect for human
life.
In the normal course of events,
research involving human subjects is classified under two headings, therapeutic
(i.e., that which offers the prospect of benefit to the subject) and
non-therapeutic (i.e., that which holds no prospect of benefit to the subject).
In cases where research is therapeutic, and the patient is unable to give
consent, this consent may be given by his / her legal guardian. In the case of
non-therapeutic research, however, the person who is the subject of the research
must be a volunteer. [15] A human embryo, by definition, is incapable of
giving consent.
ii.
Research and the Cloning of Human Embryos
Cloning is frequently associated
with stem-cell research. Human Cloning is the production of a genetic copy of
another human being. Stem-cells are versatile cells in the body which are able
both to reproduce themselves and to produce more specialized cells. One possible
motivation for human cloning is the possibility of using the new embryos to
obtain human stem-cells, for the treatment of people suffering from a range of
conditions such as Alzheimer’s or Parkinson’s Disease. In this context, cloning
is generally referred to as therapeutic cloning. It is clearly not therapeutic
in the sense understood by the Declaration of Helsinki, because any therapeutic
outcome is for the benefit of the other person involved; the embryo is
inevitably destroyed in the process. The possibility of achieving a good outcome
for another person does not justify treating the embryo a means to an end,
rather than as a human subject.
We are concerned that discussion
surrounding the issue of human cloning has not kept up with developments in
medical research. Stem cells reside in human bone marrow, which has a long
history in the successful treatment of leukaemia. It is now widely recognised
that these stem cells have an advantage over embryonic stem cells in the healing
process since they are destined to this purpose, while embryonic stem cells are
destined to divide until a whole new organism is created. This may explain why a
high incidence of tumours has been noted when embryonic stem cells have been
used. By contrast, the use of human bone marrow is tried and tested; it is known
to be safe. In addition, the taking of a bone marrow sample is much easier than
extracting stem cells from embryonic tissue. The procedure involving bone marrow
can be taken out of the laboratory and into clinical trials immediately, which
is not the case for embryonic stem cells. For example, in the last few months,
bone marrow cells have been re-injected into people who have suffered damage to
heart muscle, and have been shown to bring about a significant improvement. A
further advantage in using a person’s own bone marrow stem cells is that there
is no risk of rejection.
Research and subsequent treatment
involving stem-cells from bone marrow can be carried out without the destructive
consequences entailed by embryo research and the extraction of stem cells from
embryos.[16]
iii.
Recommendations
Ø
Medical intervention on human embryos should
only be permitted if it is designed to protect the life and health of the
specific embryo being treated. At the present state of scientific knowledge,
research involving human embryos is non-therapeutic in nature, (i.e., it offers
no benefit to the individual embryo, but rather involves the destruction of the
embryo for the sake of advances in medical science).
Ø
The production of embryos specifically destined
for research is unethical and should be prohibited by law.
Ø
The cloning of human embryos for so-called
therapeutic purposes e.g. stem-cell research should be prohibited by
law.
B.
Donation of Human Reproductive Material / Embryos
The donation of human reproductive
material generally takes place in the context of the treatment of infertility,
e.g., where the husband’s sperm is deficient, or where there are difficulties
relating to ovulation on the part of the wife. Depending on the circumstances,
sperm cells, ova, or indeed complete human embryos are donated. These donations
may, at times, be associated with the payment of money.
i.
Ethical background
A donor of human reproductive
material or of an embryo, while remaining in a very real sense the parent of any
child who is born as a result of this donation, no longer has any possibility of
exercising parental responsibility.
Every child has a right to an
identity of origin, i.e., to know who are his / her parents. This is
increasingly recognised in the management of adoption. This right of children
would necessarily conflict with any attempt to guarantee the confidentiality of
donors of reproductive material.
The donation of human reproductive
material or embryos introduces an additional relationship into the social
structure of the family. When biological parenthood is separated from social
parenthood, this has the capacity to introduce a lack of clarity into the
identity of the child. It may well be argued that this is substantially what
happens in the case of adoption, or remarriage after the death of a spouse. The
fundamental difference, however, is that in these circumstances people are
responding to a situation which has already arisen. By contrast, the donation of
reproductive material sets out to create that situation.
ii.
Recommendations
Ø
In the treatment of infertility, the donation
of human reproductive material or human embryos should be prohibited by
law.
Ø
In cases where the donation of reproductive
material or embryos has already taken place, the right of a person to know the
identity of his / her biological parents should take precedence over the right
to confidentiality of the donor.
C.
Committed Relationship
i
Ethical background
The nature of human sexuality is
such that it is the norm for a child to be born into a family where he / she has
a mother and father who are in stable relationship with one another, and who are
in a position to offer a stable environment in which the child can grow and
mature. This is why marriage is so fundamental to the well-being of children and
of society. It is not possible to guarantee absolutely the stability or
permanence of any human relationship. In so far as it relates to the
transmission of human life, however, we would have a serious moral concern that
this stability should not, by default, come to be regarded as being in any sense
optional.
We have already referred to the
ethical issues associated with the cloning of human embryos for research or
“therapeutic” purposes. We would also have many serious moral concerns about the
prospect of using cloning as a means to transmit human life. We believe that,
quite apart from any concern about the reliability or safety of such a
procedure, the cloning of human beings would reduce human procreation to the
level of a manufacturing process. It would conflict with the dignity of the
person, and would fundamentally alter the meaning of parenthood.
ii.
Recommendation
Ø
Any legislation to provide for Assisted
Reproductive Therapy (ART) should recognise and protect the right of every child
to be born to a mother and father who are permanently committed to one
another.
Ø
The cloning of human embryos for the purposes
of reproduction should be prohibited by law.
D.
Storage and Disposal of Human Reproductive Material /
Embryos
i.
Ethical Background
The storage of human reproductive
material / embryos most commonly arises, either with reference to donation or
with reference to research. As there is no ethical difficulty per se with
research involving sperm or ova, so there is no ethical difficulty with the
storage of same, for research purposes, provided the appropriate consent has
been obtained.
The storage of sperm and / or ova,
for the future reproductive use of those from whom they have been obtained may
be seen as desirable in certain medical circumstances, as for example prior to
radium treatment or chemotherapy. This possibility, however, raises important
ethical issues, to which reference has been made in the booklet Assisted
Human Reproduction: Facts and Ethical Issues. [17]
The ethical discussion of the
storage of embryos should be guided by the fundamental principle that the
relationship between parents and their embryo is one of guardianship rather than
one of ownership. The storage of embryos is most frequently proposed because of
the fact that, in the course of fertility treatment, more embryos are produced
than can be used safely in one treatment-cycle. The hope is that these embryos
can be used in the future if the first treatment is unsuccessful, or if the
couple wish to have another child at a later stage.
It seems to us, however, that there
is no practical way to protect the right to life of these embryos other than by
ensuring that they are replaced in the mother’s body in a location where they
are likely to survive. Any other course of action leads to a very real ethical
dilemma. Once embryos are placed in storage, the possibility must be taken into
account that they will remain in storage because of a change of circumstances or
a change of mind on the part of the couple. Because of such a possibility,
legislation in other jurisdictions tends to make provision for the disposal of
these embryos, or for their donation to other couples, or for their use in
research. [18] We have already addressed the
issues of research, and of donation. The perceived need to provide for the
disposal of human embryos after a set period of time has elapsed highlights our
conviction that the production and storage of surplus embryos raises insuperable
ethical problems.
ii
Recommendations
Ø
The storage and disposal of human sperm or ova,
if permitted by law, should be governed by appropriate legislation.
Ø
In any form of ART steps should be taken to
avoid the production of more human embryos than can be safely transferred to the
womb of the mother in any one treatment-cycle.
Ø
The deliberate destruction of human embryos
should be prohibited.
Ø
Any fertilised ovum should be used for normal
implantation. [19]
Ø
The storage of embryos should be
prohibited.
E. The Allocation of
Resources
The regulation of assisted
reproductive therapy gives rise to the question of whether ART should be
regarded as healthcare in the ordinary sense of the word, and therefore as
something to which citizens have a right, just as they have a right to other
forms of healthcare, according to the general principles of distributive
justice.
The crux of the matter is that,
while infertility is often a grave disappointment and even a source of stress
for couples who wish to have a child, it is not a life-threatening illness. In
the context of limited healthcare funding, and in particular when there are
lengthy waiting lists for life-saving treatment, it is hard to see how the state
could justify diverting limited resources to the provision of assisted
reproductive therapy. The alternative scenario is not ideal either, because if
ART is not publicly funded, then it becomes a privilege of the
wealthy.
We would strongly recommend that, in
so far as the state sees fit to make resources available to this area of
healthcare, serious attention needs to be given to identifying the causes
(including social or life-style causes) of infertility; and to treating
infertility itself, rather than simply to the facilitation of circumventive
procedures.
ENDS
Appendix
2 : (NAPROTechnology – An Effective and Ethical Response to
Infertility)
NaProTechnology is not so much
a particular treatment, as an approach to treatment, which incorporates elements
of fertility awareness, surgery, and drug therapy. The term NaProTechnology refers to the use of Natural Procreative Technologies. To
quote one of the leading proponents of the approach:
It (NaProTechnology) can be defined as a science which
devotes its medical, surgical and allied health energies and attention to
cooperating with the natural procreative methods and functions. When these
mechanisms are working properly, NaProTechnology works co-operatively with them. When
these mechanisms are functioning abnormally, NaProTechnology cooperates with the procreative
mechanisms in producing a form of treatment which corrects the condition,
maintains the human ecology and sustains the procreative potential. [20]
An essential element of NaProTechnology is to identify the time of fertility,
using a variation of the ovulation method, CrM NFP, so that couples whose fertility is low
have the optimum chance of achieving a pregnancy. This is effective in treating
both male and female infertility. Where particular defects are identified, which
can be treated by surgery or drug therapy, the aim of NaPro Technology is to do
this without suppressing or destroying the procreative system or
dynamic.
A primary goal is to make treatment couple-centred. The husband and wife attend medical
consultations together and work on this project as a team, hoping to realise their ultimate goal of achieving a successful
pregnancy. Treatment is reserved for married couples to protect the best
interests of the child and promote a secure family life. NaproTechnology
does not claim to be able to resolve infertility in every situation, but it has
been used very successfully to treat couples who have previously had up to
eight unsuccessful attempts at IVF or multiple
recurrent miscarriages.
Like
any form of treatment, NaproTechnology does make demands on the couple. Because of
its focus on the natural process, however, it is possible to sustain treatment
over a period of time, sometimes even 12 to 18 cycles. The goal is to achieve a pregnancy, but
not at any price, and certainly not at the expense of the couple’s health,
relationship or psychological well being. It seems that, even when couples do
not achieve a pregnancy, NPT frequently helps them to adjust to and accept
involuntary childlessness, which may be the final outcome despite the best
attempts.
Further information on this approach the fertility care and the
treatment of infertility can be found on the web at http://www.fertilitycare.net/
.
We would strongly recommend that funding be made available for
further research into the potential of natural procreative therapies, and for
the further development of existing NaPro technology
services.
[1]
United Nations Organisation. Universal Declaration of Human Rights.
[2]
Balinski, B.I. An Introduction to Embryology.
[3]
It will be helpful to deal briefly with some of the arguments put forward
by those who suggest that it is not necessary to afford personal
rights to the embryo until some weeks after
fertilisation.
Totopotentiality of cells: It is
not clear until the pregnancy is established, which cells will actually become
the embryo, and which will become the placenta, chorion etc. This is not particularly relevant to the issue
of respect. All of the cells are essential to the existence of the embryo at the
time. Equally none of the cells which are present in the first few days survive
through to birth. Personal identity is not dependent on the survival of
individual cells.
Twinning and Re-combination: It is argued that, in the early days
of pregnancy, the organism may divide and / or re-combine. The organic mechanisms of monozygotic
twinning are not fully understood, but there are good indications that they are
genetic, and that certain organisms contain the potential for this kind of
twinning, ab initio. A new human organism, on coming into existence,
would have its own substantial form (or soul). The soul is, of course, a
metaphysical rather than a physical reality, and is not itself subject to the
laws of biology.
The death of any living creature involves the separation of body and
soul. It is reasonable to suggest that, on the “death” of a twin in the very first days
after fertilisation, biological material may be absorbed by the remaining
organism. The possibility of twinning and re-combination does not change the
reality that the early embryo (or zygote) is a living being, generated and
growing as a whole. The so-called primitive streak simply marks the latest stage
at which monozygotic twinning can take place. If, as suggested above,
monozygotic twinning is genetically based, then we have no reason to believe it
hasn’t begun earlier, simply because we haven’t seen it
earlier.
.
[4]
Universal Declaration of
Human Rights, # 16.
[5]
Congregation for the
Doctrine of the Faith. Donum Vitae
(Instruction on Respect for Human Life in its Origin and on the Dignity of
Procreation), # 1.
[6]
ibid., Ch. 3
[7]
The CAHR
has used an asterisk (*) to denote those recommendations which were not
unanimous.
[8]
cf. , Thomas W. Hilgers, Medical
Applications of Natural Family Planning.
[9]
cf. Declaration of Helsinki, revised 1975 (Introduction; I.11; and III.2)
[10]
Australian Senate Select Committee, Human Embryo Experimentation in
[11]
cf. Declaration of Helsinki, revised 1975 (Introduction; I.11; and III.2)
[12]
cf. Linacre Centre. Cloning and Cell Stem Research: (A submission to the
House of Lords Select Committee on Stem-Cell Research). June
2001.
[13]
Bshops’ Committee for Bioethics. Assisted Human
Reproduction, Facts and Ethical Issues.
[14]
Australian Senate Select Committee, Human Embryo Experimentation in
[15]
cf. Declaration of Helsinki, revised 1975 (Introduction; I.11; and III.2)
[16]
cf. Linacre Centre. Cloning and Cell Stem Research (A submission to the
House of Lords Select Committee on Stem-Cell Research). June
2001.
[17]
Irish
Catholic Bishops’ Committee on Bioethics,
[18]
cf. Mary Warnock (Ed.). A
Question of Life.
[19]
cf
The Medical Council, Guide to Ethical Conduct and Behaviour, 1998,
#26.4
[20]
Thomas W. Hilgers, Medical Applications of Natural Family
Planning.