Submission on Aspects of Assisted Reproductive Technology (August 2007)

Question 1:
Do you agree that the following procedures should remain subject to guidelines developed by ACART, and review by ECART?

· clinic-assisted surrogacy
· embryo donation for reproductive purposes
· donation of gametes between certain family members
· certain uses of PGD?

Yes, we believe that the procedures listed should remain subject to guidelines developed by ACART, and review by ECART.

Explanation:

The use of the procedures listed above raises significant psycho-social issues. Technology, often unawares, introduces into the act of human life-giving various elements which do not sit well with the dignity of the human person. It is vital that as a society we take into account the effect of reproductive technologies on core societal values and the common good, including their potential to redefine certain fundamental under-standings around parenting and children. Meeting the needs of couples who are infertile is, by itself, not sufficient as a criterion for evaluating the use of particular technologies.

Given that the broader view of the ethical issues associated with assisted human reproduction is too often eschewed in favour of a narrow focus on the reproductive rights of adults, ethical oversight by ECART based on approved guidelines provides some assurance that the broader issues will be taken into account.

Question 2:
What are your views on the proposed guidelines for clinic-assisted surrogacy?

It is our firm view that the proposed guidelines for clinic-assisted surrogacy significantly widen the parameters within which surrogacy is considered acceptable. This causes us great concern.

Explanation:

We remain opposed to all forms of surrogacy because we believe that the overall well-being of children is compromised by arrangements under which a woman agrees to become pregnant for the purpose of surrendering custody of a child to be born. We also believe that the practice of surrogacy can place the health and welfare of women at risk.

While not condoning surrogacy we propose – in line with the current guidelines – that the following prerequisites be added to the first guideline as a way of limiting the harm associated with this procedure:

  • That at least one of the intended parents should be the potential child's genetic parent.
  • That the intended mother should have a medical condition (or medical diagnosis of unexplained infertility that has not responded to other treatments) that prevents her from becoming pregnant or makes pregnancy potentially damaging to her or the child. (We see nothing in the proposed guidelines that will prevent the possibility of surrogacy being employed for social reasons.)
  • That the intended parents be permanent residents in New Zealand (so as to prevent "reproductive tourism").
  • That a determination has been made that the would-be surrogate mother has completed her family.
  • We also believe that the guidelines need to emphasise:
  • That there is to be no payment for surrogacy other than reasonable costs related to pregnancy and childbirth.

Question 3:
What are your views on the proposed guidelines for embryo donation?

We believe that the proposed guidelines on embryo adoption ignore some key issues and need to be added to.

Explanation:

We are supportive of embryo adoption on the basis that unconditional respect for embryos created by IVF rules out all activities other than for the purpose of implantation and bringing to birth the human life that has already begun.

The health and well-being of children who are born as a result of the performance of an assisted reproductive procedure must be paramount in all decisions regarding embryo adoption.

We do not believe that embryo adoption should be limited to infertile couples with medical conditions precluding normal reproduction. All couples who otherwise meet the conditions for adoption should be considered as potential recipients. While the definition in the discussion document defines embryo adoption as the donation of 'surplus' embryos "to an infertile couple or person" (p. 10) we note with approval that the proposed guidelines do not seek to limit donation only to infertile couples.

More specifically, we argue that the proposed guidelines need to be added to or amended as follows:

  • We are concerned that the process around the "selection" of an embryo for adoption has the potential to encourage a "consumer" approach to the birth of children. Therefore, in line with principles (b) and (g) of the Hart Act, we think it is critical that it is donor couples who choose the potential recipients. This should be specified within the guidelines.
  • In line with all other adoption procedures, the ethics committee involved needs to receive confirmation that prospective parents have been thoroughly screened by the appropriate authorities.
  • In cases where one partner of a potential donor couple is deceased we believe that donation of that couple's embryos should be able to proceed without the prior written consent of the deceased person. To dictate otherwise would be out of step with what currently occurs as a matter of course; after a person's death the partner takes on all the legal responsibilities of the couple and makes decisions on the basis of what they believe to be in the best interests of their family. We regard this scenario as morally distinct from wanting to use the gametes of a deceased person to create embryos without their prior written consent.

Question 4:
What are your views on the proposed guidelines for donation of gametes between certain family members?

We are opposed to the donation of gametes between family members. Being aware that this procedure is already allowed in particular circumstances, it is our firm view that the revised guidelines should reflect the current guidelines. In their current form we fear that the proposed guidelines widen the circumstances in which gametes are able to be donated within families. Therefore, we argue that the proposed guidelines need to be added to.

Explanation:

We are opposed to the donation of gametes between family members because of the way it redefines traditional genetic relationships and because of the potential for identity confusion that too easily results. Relationships within families also complicate the processes for obtaining informed consent without coercion.

That said, we are aware that the present laws allow for this procedure in particular circumstances. Given this situation, the best way in which to protect the health and well-being of the children to be born, as well as donors and recipients, is for all such decisions to be subject to very specific guidelines and to be carefully scrutinised by an objective and independent ethics committee.

In their current form we fear that the proposed guidelines widen the circumstances in which gametes are able to be donated within families. Therefore, in line with the current guidelines we propose that the following prerequisites be added to the proposed guidelines:

  • That at least one of the intended recipients should be the potential child's genetic parent.
  • That "within-family gamete donation may only occur when there are medical conditions precluding normal reproduction in respect of the recipient couple or unexplained infertility that has not responded to other treatments" ("Guidelines on Within-family Gamete Donation, April 2005).

Question 5:
What are your views on the proposed guidelines for uses of PGD that are reviewed by ECART?

The proposed guidelines are seriously lacking because they fail to limit the situations in which PGD may be used. More specifically, they fail to uphold two key notions that were identified when PGD was first approved in New Zealand. The effect of this would be to send out the (erroneous) message that the use of PGD poses few if any ethical issues, taking us a step closer to regarding this type of diagnosis as a 'normal' - and even desirable - part of IVF treatment.

Explanation:

Regarding our stance towards PGD, we reiterate what we have stated in earlier submissions:

(i) Embryo selection is unacceptable because it implicitly and explicitly devalues human life.
(ii) Allowing embryo selection for any reasons, including those related to the health of the child to be born, opens the way to significant pressure for eugenic or discriminatory activity.

While not condoning IVF, embryo selection, or embryo destruction, our comments on the proposed guidelines are made with the intention of limiting the harm. We are particularly anxious that current restrictions on the use of PGD not be relaxed in any way.

The use of PGD has social consequences resulting from the cumulative effects of people's individual decisions to use PGD. The social consequences of PGD impact on society in a way that goes beyond the intentions of individuals using the technology.

That the use of PGD in New Zealand has the potential to result in deleterious social consequences for our society was openly acknowledged by NECAHR in an earlier stage of public consultation when it noted that the purpose of guidelines is to "provide protection against potential misuse of the technology by prohibiting the use of PGD for non-medical reasons. In addition, the guidelines will only allow PGD to be carried out when there is a high risk of serious abnormality."

The notions that the use of PGD be limited to situations where there is a high risk of serious abnormality and that it be prohibited for non-medical reasons must be upheld in the revised guidelines. Therefore we wish to see the proposed guidelines supplemented by adding in the following prerequisites:

  • PGD may only be used in situations where there is a high risk of serious abnormality
  • PGD may not be carried out for social reasons, including sex selection
  • PGD may not be carried out to alter the genetic constitution of an embryo

We would also stress that recent research into the nature of early embryonic development up to the eight cell stage has raised significant concerns about the risks associated with embryo biopsy. In light of this we believe that PGD as a procedure needs to be reviewed on the basis of principle (a) of the HART Act; the health and well-being of children born as a result of an assisted reproductive procedure.

Question 6:
What are your views on the proposed guideline for PGD using HLA tissue typing?

Notwithstanding our opposition to the use of PGD, it is our firm belief that PGD using HLA tissue typing should continue to be restricted to those situations when PGD is needed to test the embryo for a familial single-gene disease or a familial sex-linked disease.

Explanation:

It is vital that as a society we take into account the effect of reproductive technologies on core societal values and the common good, including their potential to redefine certain fundamental understandings around parenting and children.

Using PGD in order to benefit solely the existing sibling of the potential child crosses a definite ethical boundary. The potential child is used as means to an end. Even when it is argued that the potential child is wanted for its own sake, the procedure introduces a "conditional" element into the existence of the child which sets up its own unique relational dynamics within the family; dynamics that could be to the detriment of the child already in existence and/or the child yet-to-be conceived.

There is a liberating truth in knowing the unconditional nature of our origins. We believe that the idea of a family as a place of unconditional love and acceptance needs to be protected by an understanding of belonging that is rooted in the notions of life as an unconditional gift. Seeing our children as "gift" defines our relationship with them in a very different way from seeing our children as products of conception created by adults and subject to the wilful manipulation of adults. PGD that uses HLA tissue typing involves a degree of instrumentalising of human reproduction that compromises the dignity of children and therefore the proper respect due to them. The liberating truth associated with the unconditional nature of our origins is threatened by the use of PGD with HLA typing.

The use of PGD is arguably pushing us further along that continuum which makes it easier to see our children more and more as artefacts and more difficult to dismiss the notion of children as "commodities".

Question 7:
What are your views on whether the use of PGD should be extended to allow the testing of embryos solely for tissue typing for an existing child with a disease?

As noted above we do not believe that the use of PGD should be extended.

Question 8:
Do the guidelines proposed in chapter 3 adequately address the needs, values and beliefs of Māori?

We defer to the views of Māori on this question while noting that within the Māori tradition there is a strong emphasis on the link between self identity, family and community conveyed by the notion of whakapapa.

Question 9:
What are your views on whether an embryo for reproductive purposes should be allowed to be created using a donated egg and donated sperm?

We are opposed to the creation of embryos for reproductive purposes using a donated egg and donated sperm.

Explanation:

We are first and foremost relational beings. The Catholic moral tradition regards the human body as a personal reality; as the sign and place of our relations and connection with others. It is not something that can be reduced to pure materiality. In other words, it is part of the wonderful mystery of being human that our self identity is intrinsically linked with our bodies and their genetic origins. It is for this reason that Catholic teaching on the transmission of human life centres on a commitment to holding together the genetic, gestational and social dimensions of family and parenting.

A very similar understanding of the importance of self identity through family and community is found in the Māori concept of whakapapa, a concept readily understood and embraced by most New Zealanders. "It is the genesis – the core, the nature, the history and the origins of a people. For none can move forward not knowing where they come from. Without a starting point there is no direction. Whakapapa is not only our past. It is the preciousness of who we are today and the promise of who we can become" (source: www.maori.co.nz/related_topics/whakapapa.html).

What is at stake in this question is the importance of genetic origins and affective relations in establishing enduring human relationships and in securing a healthy self identity. To approve of embryos being created from donated eggs and donated sperm is to disregard the critical importance of affective relations with the biological parents and extended family, and to act as if it is the nurturing role of parenthood that is most determinative.

Whatever people believe about the acceptability of IVF, a clear moral distinction exists between homologous IVF (where the gametes are sourced from both partners within the relationship) and heterologous IVF (where one or both gametes are sourced outside of the commissioning couple). This distinction rests on the fact that homologous IVF conserves the link between parenthood, family and genetic origins. We acknowledge that heterologous IVF is currently approved in New Zealand. However, we think it should remain limited to situations where one of the parents is genetically related.

There are occasions when, for the good of a child's welfare, the decision is made that they not be brought up within their family of origin or by one of their biological parents. Even then, the difficulties for adopted children and their parents are significant. To reluctantly accept that there are circumstances when we need to separate a child from their genetic family of origin is one thing. To set out to deliberately deprive children of this link for the sake of the needs of the adults involved is quite another. It is inconsistent with respect for the family and for the child. It is this distinction that makes the adoption of an already existing embryo morally distinct from the deliberate creation of an embryo from donor eggs and sperm.

Using donated sperm and a donated egg for reproductive purposes undermines the first principle of the HART Act; the protection of the health and wellbeing of children born as a result of assisted reproductive procedures. It also ignores the deeper cultural and spiritual reality of our human nature and thereby undermines principle (g) of the HART Act. Our commitment to upholding the Treaty of Waitangi demands that we give proper consideration to the concept of 'whakapapa'.

We recognise that the burden of infertility can be overwhelming for couples. They can be encouraged to look at the other options available, including adoption of children and embryo adoption.

Question 10:
Do you agree that embryo splitting requires no specific recommendation to the Minister of Health (which will mean that it is unable to proceed, although it will not be prohibited)?

We are strongly opposed to embryo splitting.

Explanation:

Embryo splitting is in essence nothing other than a form of human cloning.

The very act of cloning treats the procreation of a human being as an act of production, and reduces human life to the status of a 'thing'. We are opposed to all forms of cloning on the grounds that it is an affront to the intrinsic dignity of human life. There are also unknown and potentially serious risks associated with such procedures.

Human cloning would create a human being who deserves to be treated as our equal but in a way that undermines this equal dignity.

Question 11:
Do you agree that the import and export of donated in vitro embryos and gametes should be allowed, provided that the prohibitions and principles of the HART Act are met?

We believe that where there is sufficient proof of an existing and established relationship between the applicants and donated in vitro embryos and gametes, the importation or exportation of such could be approved in limited circumstances where the applicants, having already undergone IVF treatment in one country and having taken up residence in another country, wish to use the embryos or gametes for the purposes of having another child that is genetically related.

Explanation:

We do not approve of the use of IVF. It raises a number of significant ethical and moral issues related to the well-being of children – including the commodification of human life – and, in cases when couples are seeking to use donated eggs, issues related to the exploitation of women.

In general we think that the importation and exportation of in vitro donated gametes or embryos is open to significant abuse and may be difficult to regulate. In many countries, human eggs are readily able to be purchased. Given the well documented stories of exploitation of vulnerable women in order to gain eggs, we are particularly concerned about the importation of donated embryos from those countries where ethical oversight is less robust than it is in New Zealand.

We believe that it will be very difficult in some cases to verify that imported gametes or embryos meet the requirements that are part of the HART Act; for example verifying that the embryos or gametes concerned were truly "donated" and not provided under duress or purchased, and verifying information about donors. Without stringent regulations and adequate 'policing' of regulations we could inadvertently bring about the commercialisation of human reproduction in New Zealand in what would be a flagrant breach of the HART Act. We also believe that the importation of gametes and embryos could raise significant bio-security issues.

The comments that follow are made on the assumption that all bio-security needs can be met. They are also made with a view to restricting the importation and exportation of embryos and gametes to a very limited set of circumstances.

(1) In regard to the importation and exportation of donated embryos: We believe that this should be limited to cases where there is sufficient proof of an existing and established relationship between the applicants and the donated in vitro embryos. More specifically, the importation or exportation of such embryos could be approved in cases where the applicants, having already undergone IVF treatment in one country and having taken up residence in another country, wish to use donated embryos (i) for the purposes of having another child that is genetically related to any existing children, or(ii) for the purposes of having their first child in situations where previous attempts to implant embryos have failed and a number of embryos remain in storage. To allow the importing or exporting of existing embryos that are in storage for the purposes of having another child allows parents to exercise the moral responsibility they have towards the embryos that exist; the option that is most consistent with the unconditional respect due to the embryo.

(2) In regard to the importation and exportation of donated gametes:

We believe that this should be limited to cases where there is sufficient proof of an existing and established relationship between the applicants and the donated gametes. More specifically, the importation or exportation of gametes could be approved in cases where the applicants, having already received IVF treatment in one country and having taken up residence in another country, wish to use gametes for the purposes of having another child that is genetically related to any existing children. Alternatively, it should be possible for persons who for medical reasons have had their own gametes placed in storage to reclaim these gametes in cases where they now reside in another country.

To broaden the parameters within which donated in vitro gametes and embryos might be imported and exported would take us a step closer towards the commodification of human life and could potentially undermine principles (b), (c), (d), (e) and (g) of the HART Act.

Question 12:
Do you agree that requirements for the import and export of donated in vitro embryos or gametes should be set out in guidelines developed by ACART, rather than regulations?

We believe that requirements for the import and export of in vitro embryos and gametes should be set out in regulations.

Explanation:

As explained above, there is a significant potential for people to abuse the right to import and export embryos and gametes. Associated with that, there are difficulties in verifying that imported embryos/gametes meet the requirements that are part of the HART Act. This is especially so in cases where they are sourced from countries where ethical oversight is less robust than it is in New Zealand.

We believe that the seriousness of inherent risks associated with the practice of importation and exportation of embryos and gametes, including the bio-security risks, make it more appropriate for the requirements to be set out in specific regulations rather than guidelines.

Question 13:
Do you agree that it is necessary to prescribe requirements for informed consent in regulations?

We agree that it is most desirable to prescribe requirements for informed consent in regulations under the HART Act.

Explanation:

The HART Act upholds the importance of informed consent. Arguments in favour of the use of assisted reproductive technologies often reflect the assumption that affective relationships with ones genetic family are less determinative for the well-being of the child than the nurturing parent relationship. In New Zealand the risks associated with severing the ties between children and their genetic origins (the donors of gametes) have been recognised in the HART Act by an absolute insistence that children born by way of assisted technologies have a "right" to knowledge about, and access to, their genetic origins.

This right can, in turn, only be upheld by an absolute insistence on the consent of all parties involved. We believe that this is best done by way of prescribing the requirements in regulations under the HART Act.

Question 14:
What specific requirements for informed consent would you like to see

The regulations must protect and enhance the rights of children to access information about their genetic origins.

We do not believe that donors of gametes should be able to withdraw their consent after embryos have been created on the basis that the embryo has a right to life.

Question 15:
Do you agree that, where written consent is not given prior to death, the use of gametes from deceased persons for reproductive purposes should be prohibited?

We concur with ACART's reasoning that the principle of informed consent prohibits the use of gametes from deceased persons where no written consent exists.

Explanation:

We agree that ACARTS proposed advice to the Minister is in accordance with principle (d) of the HART Act. To make allowance for a situation in which gametes might be used without specific consent undermines one of the critical foundational principles of the HART Act. It would also set a precedent which might be used to erode the application of the principle in other situations.

In addition we believe that consideration of the emotional and social health and well-being of any child or children born from such a procedure (principle (a) of the HART Act) also mitigates against the assisted conception of children in such circumstances.

Question 16:
Does the advice proposed in chapter 4 adequately address the needs, values and beliefs of Māori?

We defer to the views of Māori on this question. The only comment we wish to make is that, in our view, the principle of individual choice is sometimes used as an excuse not to take full account of Māori concerns, and as a reason for ignoring culturally different processes for obtaining consent.

Our obligations to the Treaty of Waitangi dictate that we look at the way in which the application of processes and guidelines surrounding the use of reproductive technologies may exclude a characteristically Māori approach to obtaining consent and/or undermine other key cultural values.

Question 17:
What are your views on the Tikanga outlined in Appendix 2?

We defer to the views of Māori on this question.

Question 18:
Are there any other Tikanga that ACART should take into consideration?

We defer to the views of Māori on this question.

Question 19:
Do you have any further comments to make that have not been covered in the questions set out above?

There have been many remarkable advances in science and technology that contribute to improving the welfare of humanity and the world in which we live. At the same time, many of the developments have the potential for adverse effects - for society as a whole, as well as for individuals and certain groups of individuals.

Developments in science and medical technologies have provided us with new means of having children. Many couples who were previously infertile are now able to have children. However, the use of assisted reproductive technologies has significant ethical implications. Firstly, use of the technologies has an effect on family dynamics, particularly the relationships between children and their parents. Secondly, the possibilities and choices generated by the technologies is redefining our understandings of pregnancy, parental responsibility, attitudes to children and understanding of families at a societal level.

Therefore, a proper assessment of the uses of reproductive technology includes a consideration of the ethical, cultural, social and spiritual dimensions of our human nature. It is for this reason too that certain decisions about the use of these technologies go beyond the rights of individuals to exercise their reproductive choices.

In light of that we wish to re-emphasise the importance of ongoing third-party oversight in the use of human assisted reproductive technologies. Greater availability and/or use and/or acceptance of particular technologies associated with human reproduction does not lessen the need for ethical oversight and scrutiny – greater use of these technologies demands more oversight as increased use has the potential to bring about a greater complacency about the social consequences of the various practices.

We endorse the need for robust guidelines and regulations and reiterate the importance of the role of, and work being done by, ACART and ECART.

 

Consultation on the Use of Frozen Eggs in Fertility Treatment: Discussion Document (2008)

The Nathaniel Centre welcomes the opportunity to comment on the use of frozen human eggs in fertility treatment.

Introductory Comments

A Catholic approach to the transmission of human life is characterised by two key beliefs: the dignity of the human person and, flowing from that, a belief that the context in which humans are conceived, and the means that are used, reflect this dignity. The conjugal act is seen as the only means that is wholly consistent with the dignity of the human child. The use of technology in human reproduction is assessed as upholding the dignity of the human person to the extent that it assists the conjugal act but does not replace it. Children must always be conceived in a way which shows that they are respected and recognised as equal in personal dignity to those who give life. This rules out all actions which in any way instrumentalise or treat the child as an object, whether intentionally or otherwise.

One of the implications of this is the need we have, emotionally, psychologically and spiritually to experience ourselves from our very origins as contingent beings; beings who came about in a fortuitous way conceived for no other reason than love, beings conceived in a way that is free from the manipulation of other persons. Technological interventions that allow parents to exercise ever greater control and dominance over the sorts of children that are born can put this very human quality of our existence at risk. A selfless love calls for parents to accept children as gifts without introducing a conditional element into their acceptance into a family.

The freezing of human embryos is always to be regarded as an affront to their innate dignity in so far as it suspends, and puts at risk, the inviolable right to life that is theirs simply by virtue of the fact that they are fully human. While not condoning IVF, we recognise that the technology which allows eggs to be frozen and stored might, in the foreseeable future, mean that there are fewer embryos that are stored in this way and also, ultimately, discarded.

A Catholic approach to marriage and procreation precludes the donation of gametes from a third party outside of the marriage relationship. The mutual and exclusive self-giving of the spouses that characterises the permanent and loving commitment at the heart of marriage calls forth a reciprocal respect that means couples recognise the right to become parents only through each other.

Question 1:
Given these risks and benefits, what is your opinion on ACART's proposed advice to the Minister of Health? Please give reasons for your views.

(See chapter 3 for a discussion of risks and benefits, and chapter 6 for the proposed advice.)

Any assessment of risks to the health and well-being of children must first take into account the physical risks associated with the use of a particular intervention. While it is stated that "the risks to a resulting child associated with the use of frozen eggs are no greater than the risks associated with the use of frozen embryos or [IVF] generally" (p. vi) we also note that there have only been a relatively low number of children born from frozen eggs and that "it is still a relatively new technique" (p. 13). Therefore, while the available evidence may point to its safety (p. 13), it has to be accepted that because there is "a lack of data on outcomes for children born from eggs that have previously been frozen" (p. 8), this technology remains largely experimental.

In other words, given the overall depth of the data available, it seems that at best ACART's view on the acceptability of the risks can only be provisional. On that basis it seems somewhat premature to be declaring this an established procedure.

It is our considered view, therefore, that at this time the use of eggs that have been frozen should reflect the way that we approach the use of other novel or innovative clinical practices; it needs to occur against a background of the sort of ethical and medical oversight that is provided by a specialist Health Research Ethics Committee. In the event that the relevant committee in question may not have the necessary expertise amongst its current members, there should be provision for its makeup to be complemented by persons with the appropriate scientific and medical background.

Question 2:
What is your view on the information that ACART suggests should be collected to monitor the use of frozen eggs in fertility treatment?

(See chapter 3)

In line with what we have said above, we agree that there needs to be ongoing and extensive collection of data so as to better assess the outcomes, and especially the risks, associated with the use of eggs that have previously been frozen. It is beyond the scope of our expertise to comment more specifically on either the nature or the manner of collection of this information.

Question 3:
Has ACART identified all the ethical issues relevant to the use of frozen eggs in fertility treatment? Do any of these issues affect ACART's proposed advice that the use of frozen eggs should be allowed in fertility treatment? If so, how?

(See chapter 5 for a discussion of the ethical issues, and chapter 6 for the proposed advice.)

The posthumous use of frozen eggs raises similar ethical issues to the posthumous use of frozen sperm. We regard the use of assisted human reproductive technologies in such circumstances as inconsistent with the dignity of the child because it intentionally deprives them of a relationship with a mother and a father for reasons that ultimately amount to the satisfaction of adult needs.

As noted above, a Catholic approach to marriage, emphasising as it does the connection between the conjugal act and the transmission of human life, rules out for moral reasons the reception of gametes from a third party.

While not condoning IVF, we can see that the use of egg freezing might lead to fewer embryos being stored. We are not opposed to it on the basis that it will limit the harm that is associated with the storage and subsequent discarding of human embryos that is a characteristic of IVF infertility programmes.

At the same time we remain particularly concerned that this technology might lead to a significant increase in women postponing pregnancy for "social reasons". We note that ACART considers the freezing of eggs as "at best a backstop measure for those who are at risk of losing their fertility altogether, and that it would be unwise for women to rely on egg freezing for social reasons" (p. 12). On the basis of a Catholic approach to the transmission of human life (briefly outlined above) we agree with this assessment for reasons that include, but go beyond, the obvious clinical contraindications of egg freezing.

Question 4:
Should the use of frozen eggs in fertility treatment become an established procedure? If not, why, and how should the use of frozen eggs be regulated?

We do not believe that the use of frozen eggs should become an established procedure at this particular point in time because we regard the use of this technology as still largely experimental. (See our answer given in Question 1 above.) For reasons related to a Catholic understanding of the transmission of life we also believe that this procedure should be limited to those requiring it for "medical" reasons as opposed to "social" reasons.

Question 5:
Should the use of frozen eggs in fertility treatment be limited to the individuals the eggs came from, or should frozen eggs be able to be donated to others for use in fertility treatment?

While out of step with a Catholic understanding of marriage, we recognise that current procedures allow for couples to receive gametes donated by third parties. Our reasons for arguing that the use of frozen eggs should be limited to the individuals they come from are the same reasons we use to argue against the donation of any gametes by a third party; the mutual and exclusive self-giving of the spouses that characterises the permanent and loving commitment at the heart of marriage calls forth a reciprocal respect that means couples recognise the right to become parents only through each other.

Question 6:
Should frozen eggs be able to be donated for research purposes?

We uphold the principle enshrined in New Zealand legislation and culture, that transactions involving body tissue not be commercialised. On that basis we see no reason to oppose the donation of eggs for ethical research projects.

As we have stated on other occasions, research using gametes should be regulated through the development of guidelines and then allowed to proceed on a case-by-case basis having undergone appropriate ethical scrutiny and having received appropriate ethical approval. We would expect that such research would be governed by the same or very similar ethical provisions as applies to research on other types of human tissue.

We remain concerned about the very real potential for the exploitation of women that would result from an increased demand for human eggs for purposes unrelated to fertility treatment. Because the donation of frozen eggs presumably means that such eggs are no longer required for fertility reasons, this practice could, in theory, lessen the need to procure eggs in other ways.

We oppose all research using frozen eggs to create a human embryo.

We are also opposed to all research involving the fusion of human gametes with gametes of other species so as to create human-animal hybrid embryos.

 

Submission to ACART on the Use of Donated Eggs in Conjunction with Donated Sperm (March 2009)

Introductory Comments

We have laid out our opposition to the creation of embryos using donated eggs and donated sperm in an earlier submission to ACART and we summarise below what we have previously stated with a view to reiterating our absolute opposition to this procedure.

We are opposed to the practice of using donated eggs and donated sperm to create embryos on essentially two grounds; (i) it contravenes the right that married couples have to become parents only through each other, and (ii) intentionally depriving children of the close connection between genetic parenthood and the responsibility of care constitutes a serious offence against the dignity of the child.

Catholic teaching on the transmission of human life reflects a commitment to holding together the genetic, gestational and social dimensions of family and parenting. Our sense of personal well-being is linked with a healthy self-identity, something that is intimately tied in with a lived knowledge of our biological ties. This knowledge is put seriously at risk by arrangements that exclude children from growing up with the families of their biological origins. On this basis we believe that children have the right to grow up within the family networks that are generated by our biological ties. This right should only ever be compromised in situations where it is clearly in the interests of the child involved.

What is at stake in the debate about using donated eggs and sperm is nothing less than the importance of genetic origins and affective relations in establishing enduring human relationships and in securing a healthy self identity. T he Discussion document itself makes it abundantly clear that this particular procedure raises complex issues that impact directly on the identity and well-being of the children that result. To approve of embryos being created from donated eggs and donated sperm is to disregard the critical importance of affective relations with the biological parents and extended family. It remains our firmly held view that an honest appraisal of this procedure from the perspective of the child, one that keeps the interests and well-being of the child to the fore (as required by the HART Act), would rule out the use of donated eggs and sperm as a means of conceiving a child.

Whatever people believe about the acceptability of IVF, a clear moral distinction exists between homologous IVF (where the gametes are sourced from both partners within the relationship) and heterologous IVF (where one or both gametes are sourced outside of the commissioning couple). This distinction rests on the fact that homologous IVF conserves the link between parenthood, family and genetic origins. We acknowledge that heterologous IVF is currently approved in New Zealand. However, we think it should always remain limited to situations where one of the parents is genetically related.

We note that the New Zealand Guidelines on Surrogacy Arrangements (2007) require at least one of the intending parents to be the genetic parent of any resulting child. The reasons for this, which reflected the clear views of submitters, relate to the well-being of the child; above all they give concrete recognition to the absolute importance of the connection between self-identity, personal well-being and biological origins.

A decision to approve the intentional creation of embryos from donated eggs and donated sperm cuts right across this reasoning, and effectively severs the genetic dimension of parenting from the gestational and social dimensions. No other approved assisted reproductive technologies have previously gone this far. In this way, the approval to create embryos from donated eggs and sperm takes the use of assisted reproductive technology in New Zealand to a new place, one which places the well-being of children at greater risk than ever before.

Inevitably, the question will also then be asked as to why surrogacy arrangements should remain subject to the restriction that one of the intending parents must be the genetic parent.

To those who argue that "a genetic or gestational link is not necessary for a strong parent-child attachment" (see p. 10 of Discussion document) we would respond by saying that there is much more at stake in this matter than parent-child attachment. The key issue, we would argue, is the child's own sense of identity and well-being. Even in situations where adopted children and adoptive parents form close and strong attachments the personal emotional difficulties are often still significant. If the experiences of adoption have taught us anything then it is surely the fact that strong attachments between adopted children and their adoptive parents do nothing to displace the sense of loss of, and yearning for, connection with their families of biological origin.

The need to foster or adopt children highlights that there are occasions when, for the good of a child's welfare, the decision is made that they not be brought up within their family of origin or by one of their biological parents. In these situations the decision to adopt represents an act of outstanding generosity. To accept that there are circumstances when we need to separate a child from their genetic family of origin is one thing. To set out to deliberately deprive children of this link for the sake of the needs of the adults involved is quite another. It is inconsistent with respect for the child and it undermines the ideal of the family. It is this distinction that makes the adoption of an already existing embryo morally distinct from, and morally more acceptable than, the deliberate creation of an embryo from donor eggs and sperm.

The burden of infertility can indeed be overwhelming for couples. In situations where neither of the partners can provide the gametes for IVF, other options exist including adoption of children and the adoption of 'surplus' embryos. While the context within which they were created means that the adoption of spare embryos is morally distinguishable from the use of donated sperms and eggs, they are in all other respects virtually indistinguishable since in each case the intending parents are not the genetic parents of a resulting child.

We recognise that in formulating this Discussion document ACART have made a significant attempt to consider the issue from the perspective of the child that is to be conceived. We note that in formulating its preliminary position that the procedure of using donated eggs and sperm not extend to surrogacy arrangements, ACART have concluded that "the complexity of the arrangement does not provide sufficient safeguards for the wellbeing of the potential child" (p. 11). We agree with this position, but fail to see how giving proper consideration to the child's wellbeing does not bring ACART to make the same determination in all cases of using donated eggs and sperm. This seems totally inconsistent. Nowhere is it spelled out in the document how, ethically speaking, ACART have arrived at the determination that the safeguards are sufficient in one set of circumstances but not in the other.

In conclusion, then, we respectfully submit that in its consideration of the well-being of the child (as demanded by the HART Act) ACART has, by its decision to recommend the use of donated eggs and sperm, failed to give it the ethical weight demanded by an authentic concern for the dignity and well-being of the children who will potentially be born by way of this procedure. We believe, therefore, that any advice given by ACART to the Minister approving in principle the use of donated eggs and sperm should be urgently reviewed in line with the first purpose of the HART Act which is to "[take] appropriate measures to protect and promote the health, safety, dignity, and rights of all individuals, but particularly those of women and children in the use of [assisted reproductive procedures]" (Part I: Preliminary provisions (a) )

Questions on the draft guidelines

Question 1 (Whether the procedure could involve a surrogacy arrangement):

The paper presents ACART's proposal and another point of view about whether the use of donated eggs with donated sperm could involve a surrogacy arrangement (page 10).

(i) ACART is proposing that the use of donated eggs with donated sperm in conjunction with a surrogacy arrangement should not be permitted.
(ii) However, ACART has noted a view that the guidelines should enable, in exceptional circumstances, the use of donated eggs with donated sperm in conjunction with surrogacy.

Do you agree with (i)?
Or do you agree with (ii)? If you agree with (ii), what content would need to be in the guidelines?
Or do you have a view that is different to either (i) or (ii)?

In line with the arguments made in our Introductory comments (above), we agree whole-heartedly with the reasoning given by ACART that the use of donated eggs with donated sperm in conjunction with a surrogacy arrangement should not be permitted. The additional complexity of the arrangement constitutes an even greater increase in the likelihood of adverse risks to the well-being of the child.

To think that the use of donated eggs with donated sperm in conjunction with surrogacy might be allowed in "exceptional circumstances" would be to allow the notion of reproductive autonomy to completely over-ride concerns for the wellbeing of any child that might be born. Yet, the adverse risks are the same for any potential child irrespective of the circumstances of the commissioning couple. Therefore, the circumstances of the couple are, from an ethical perspective, irrelevant in terms of protecting the rights and promoting the well-being of children. It is logically inconsistent to argue otherwise, because then there no longer exists any reasonable basis upon which to argue that the practice in question could not be allowed in any circumstances!

Question 2 (Whether there should be a limit to the number of siblings):

ACART is proposing (page 13) that the use of donated eggs with donated sperm should be limited to producing full genetic siblings in no more than two families. Do you agree with this position?

The existence of full genetic siblings in more than two families would be highly undesirable for the reasons given. At the same time, if it is the case that healthy embryos that have been created will not be available for adoption because of the two family rule, this creates a new situation of injustice. The right to life of the human embryo then becomes subject to what is in many ways an arbitrary decision, even though it appears as a response to genuine concerns regarding the medical, psycho-social and genetic risks associated with relationships between adults with genetic parents in common.

These additional dilemmas only serve to show that, while the decision to allow the use of donated eggs and sperm may arise from a genuine and simple concern to alleviate infertility problems for couples, the practice inevitably leads us into, and opens up, a 'moral maze'. This, in itself, highlights yet another significant reason why we should not approve of this procedure in the first instance.

Question 3 (Informed consent and decision making):
ACART's thinking to date on consent and decision making is set out from page 15.

Do you have any comments about the issues raised in this section?
Do you have any comments about how consent and decision making in relation to the use of donated eggs and donated sperm should be managed?
Should the guidelines on donated eggs with donated sperm include specific provisions about informed consent, withdrawal of consent and decision making?

We believe that egg or sperm donors should not be allowed to withdraw their consent once an embryo has been created. Catholic teaching holds that human life begins at the point of fertilisation. From that point on the embryo needs to be afforded the same dignity and right to survive as a person. We believe this on the basis of the continuity of human existence – an embryo is already the human being that it will always be. To allow donors to withdraw their consent after the embryo has been created would be to tolerate a situation where the inviolable right to life was made subject to the preferences of other persons.

To focus on the limits for withdrawing consent essentially frames the responsibilities associated with the transmission of human life in a negative way. It is a disturbing feature of the use of assisted reproductive technologies that we find ourselves increasingly defining human relationships of care in such a minimalistic and legalistic way. Rather than stipulating the limits of 'withdrawal of consent', the guidelines should somehow stipulate and promote the positive duties of care that are a consequence of the generation of any new human life.

In most situations associated with assisted human reproduction, the providers of the gametes assume responsibility for the care of embryos that are created on the basis of their biological connection to the embryo. However, the use of donated eggs in conjunction with created sperm makes it quite unclear who has ultimate responsibility of care for the embryos created. On the one hand, the context of decision making surrounding the donation of gametes works against donors recognising and acting on the moral commitment that is a consequence of their biological link to the embryo.

On the other hand, the lack of any biological connection between commissioning parents and embryos produced using donated eggs and sperm means that the basis (and therefore motivation) for their duty of care to the embryos created for them can be reduced to something quite 'tentative'; tentative because it is essentially founded on, and therefore dependant on, nothing more than an ongoing desire for a child. The more tentative nature of this relationship, and the different ways in which we are coming to regard the relationships between embryos of differing origins and couples, are already evident in current ACART Guidelines: The "Guidelines on Embryo Donation for Reproductive Purposes" (17th November 2008), for example, specifically exclude couples from donating embryos not created from their own gametes, and thereby make a clear differentiation between the moral authority of the two sets of parents. The effect of this, overall, is to make certain embryos more vulnerable than others even though, ontologically speaking, they all share the same moral status and the same right to life.

This, in turn, is likely to lead to the unacceptable situation whereby many more embryos will be simply 'abandoned' and fertility clinics find themselves having to assume 'guardianship' because of their custodial role in storing the embryos; yet another example of the 'moral maze' that will result if approval is given for embryos to be created using donated eggs and donated sperm.

Question 4 (Issues of particular interest to Māori):

ACART has noted on (page 17) some issues that may be of particular interest to Māori. Are there other Māori issues and perspectives that should inform the guidelines?

We defer to the views of Māori on this question while noting that within the Māori tradition there is a strong emphasis on the link between self identity, family and community.

Question 5 (The draft guidelines):

The draft guidelines are set out from page 20. Are these draft guidelines appropriate for managing the use, for reproductive purposes, of embryos created from donated eggs with donated sperm?

We have no specific comments to make on the proposed guidelines.

Question 6 (The discussion paper, including the draft guidelines):

Do you have any other comments or suggestions about either the draft guidelines themselves or the associated discussion?

We note that there have been a number of studies carried out recently which highlight that the practice of donating eggs to help infertile couples comes with both psychological and physical risks. Counselling for the women involved in egg donation should cover these potentialities.

 

Submission to ACART on the Use of In Vitro Maturation (March 2009)

Question 1:
Given the identified risks and benefits, what is your opinion on ACART's proposed advice to the Minister of Health?

(See chapter 3 for a discussion of risks and benefits, and chapter 6 for the proposed advice.)

It is our considered view that IVM remains a novel procedure. We note, in particular, that "IVM compromises subsequent embryo development rates [and that] the reasons for this are complex and not yet fully understood" (p. 5 of Discussion document). While current indications are that "the rate of congenital abnormalities appears consistent with that of IVF generally [and while] physical and neurological development appears consistent with that of IVF generally" (page 6, emphasis added) we note the tentative nature of these conclusions. The relatively small number of births worldwide (300 to 400 babies), and the fact that IVM is "rarely practised" in most countries (p. 3), surely mean that conclusions about the safety of the procedure safety can be nothing other than tentative at this stage.

We conclude, therefore, that it is premature to declare that the risks associated with IVM "fall within a level of risk that is acceptable in New Zealand" as stated by the HART Act. On that basis we think it is still premature to classify the practice as an "established procedure". The use of IVM requires more intense monitoring than is demanded by the classification of a practice as an established procedure. It is our view that IVM should be treated as innovative practice and subjected to a level of ethical review and ongoing oversight that is consistent with the introduction of other innovative health procedures in New Zealand.

We note that ACART is currently seeking further clarification as to whether or not it is an option to treat such a procedure as an innovative Act.

Question 2:
Has ACART identified all the ethical issues relevant to the use of IVM in fertility treatment? Do any of the identified, or any other ethical issues, affect ACART's proposed advice that the use of IVM should be allowed in fertility treatment? If so, how?

(See chapter 5 for a discussion of the ethical issues, and chapter 6 for the proposed advice.)

Aside from issues relating to the safety of the procedure, we do not see that IVM creates any other significant ethical questions not already raised by the use of IVF.

Question 3:
Should the use of IVM in fertility treatment become an established procedure? If not, why, and how should the use of IVM be regulated?

As outlined in Question 1 (above) we think it is premature to classify IVM as an "established procedure".

Question 4:
Should the use of in vitro matured eggs in fertility treatment be limited to the individuals the eggs came from, or should the eggs be able to be donated to others for use in fertility treatment?

We note that a precedent already exists for women to donate their eggs to other women for the purposes of fertility treatment. Our reasons for opposing the donation of eggs by one woman to another are the same as for all other instances of egg donation: the nature of marriage means couples recognise the right to become parents only through each other. We believe strongly that it is also in the interests of a child to be born into a family where its parents are the biological parents.

We understand that egg donation is already allowed in New Zealand under certain circumstances. On the basis that the live birth rate with IVM is significantly less than with conventional eggs, it strikes us that couples would be ill-advised to undertake IVF procedures using donated eggs matured in vitro.