Submission on Aspects of Assisted Reproductive Technology (August 2007)
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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".
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
What are your views on the Tikanga outlined in Appendix 2?
We defer to the views of Māori on this question.
Are there any other Tikanga that ACART should take into consideration?
We defer to the views of Māori on this question.
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.