A Summary of Key Points from Submission to Advisory Committee on Assisted Reproductive Technology [ACART] on the Use of Frozen Eggs in Fertility Treatment
Staff of The Nathaniel Centre
July 2008
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 used, must 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 but does not replace the conjugal act.
What ethical issues are relevant to using frozen eggs in fertility treatment?
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. While not condoning IVF, we recognise that the technology which allows eggs to be frozen and stored might mean there are fewer embryos that are frozen and stored. Therefore, we are not opposed to the use of frozen eggs on the basis that we believe it may 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". We agree with this assessment for reasons that include, but go beyond, the obvious clinical contraindications of egg freezing. We would like to see this procedure limited to those requiring it for "medical" reasons as opposed to "social" reasons.
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.
A Catholic approach to marriage, emphasising as it does the connection between the conjugal act and the transmission of human life, also rules out for moral reasons the reception of gametes from a third party.
Should the freezing of eggs become an established procedure?
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" 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". Therefore, while the available evidence may point to its safety, it has to be accepted that "a lack of data on outcomes for children born from eggs that have previously been frozen" means this technology remains largely experimental.
On that basis it seems premature to be declaring this an established procedure. It is our considered view, that for the time being, the use of frozen eggs for fertility treatment should occur against a background of ethical and medical oversight provided by a specialist Health Research Ethics Committee. There needs to be ongoing collection of data so as to better assess the outcomes and risks associated with the use of previously frozen eggs.
Should frozen eggs be able to be donated to others for use in fertility treatment?
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.
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. 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.
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.
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Staff of the Nathaniel Centre – July 2008
Submission on the Use of Preimplantation Genetic Diagnosis - Saviour Siblings
Staff of The Nathaniel Centre - July 2008
Issue 26, November 2008
A Summary of Key Points from Submission to Advisory Committee on Assisted Reproductive Technology [ACART] on Guidelines for Preimplantation Genetic Diagnosis (PGD) with Human Leukocyte Antigen (HLA) Tissue Typing (Saviour Siblings)
Vatican Updates Catholic Teaching on the Dignity of Human Life
John Kleinsman and Michael McCabe
Issue 27, April 2009
A long-awaited new Instruction, titled Dignitas Personae - The Dignity of a Person, was released by the Congregation for the Doctrine of the Faith in December 2008. The specific aim of the new Instruction is to update Catholic teaching on human procreation and research involving embryos and human gametes in light of new developments in biomedical technologies. Its stated purpose is twofold: to contribute to the formation of conscience, and to encourage ethical research that is respectful of the dignity of every human being from the first moment of existence. After a first part in which fundamental principles and assumptions of an anthropological, ethical and theological nature are recalled, Parts II and III deal systematically with specific applications relating to assisted human reproduction and research involving stem cells and human genetics.
Dignitas Personae: The Dignity of a Person
Issue 27, April 2009
Synopsis of the Instruction on Certain Bioethical Questions
The Instruction is written in three parts: the first recalling key anthropological, theological and ethical assumptions and issues; the second addressing new problems relating to human procreation; the third examining new procedures involving the manipulation of embryos and the human genetic legacy. It is preceded by a short introduction and finishes with a short conclusion.
Response to ACART [1] Draft Guidelines on the Use of Donated Eggs in Conjunction with Donated Sperm
Staff of The Nathaniel Centre
Issue 27, April 2009
Background
In August 2007 staff of The Nathaniel Centre responded to an ACART Consultation Document on various aspects of artificial reproductive technologies that included a question as to whether an embryo should be allowed to be created for reproductive purposes using a donated egg and donated sperm. While this particular procedure has been classified as an assisted reproductive procedure since 2005, there have never been any guidelines enabling the procedure to be approved by the Ethics Committee on Assisted Reproductive Technology (ECART).
Dr Lisa Bridle on mothers of children with Down syndrome
Our main feature is a wonderfully inspiring piece written by disability advocate and mother Dr Lisa Bridle. Lisa, reflecting on the birth of her son Sean as well as the stories of other mothers of children with Down syndrome, raises a number of key questions about the increasingly routine practice of prenatal screening and diagnostic testing. The mothers whose stories are recounted want the public to know that having a child with a disability is not a tragedy and that disability does not come to dominate their lives. The able-bodied must not have the final word on the 'problems' of disability.
Submission to ACART on extending the storage period of gametes and embryos
Preamble:
The Human Assisted Reproductive Technology Act 2004 (the HART Act) sets a maximum storage period of 10 years for sperm, eggs and embryos unless the Ethics Committee on Assisted Reproductive Technology (ECART) approves extending the storage period. Parliament recently amended the HART Act to clarify that the 10-year period begins from 2004 or later, depending on when the gametes or embryos were first stored. This applies even where gametes and embryos were stored before 2004.
The amendment also clarifies the powers of ECART and the Advisory Committee on Assisted Reproductive Technology (ACART). When deciding applications for extending the storage period of gametes and embryos beyond 10 years, or beyond an approved extended storage period, ECART must use guidelines issued by ACART.
In February 2010 ACART released its proposed guidelines on extending the storage period of gametes and embryos and invited interested parties to respond.
Introductory comments:
In order to avoid a statement of an explicitly philosophical nature, Catholic teaching refrains from defining the embryo as a person. However, as science demonstrates, there is undoubtedly a personal presence at the moment of the first appearance of a human life and a continuity in development from that point on. We hold that such continuity does not allow for positing either a change in nature or a gradation in moral value for the entire span of that individual human life. On this basis the question arises: "How can a human individual not be a human person?" It would never be made human if it were not human already.
Therefore, we reason that the embryo is to be respected and treated as a person from the moment of conception. It follows from this that the rights accorded to a person must be recognised from that same moment. Chief among those rights is the inviolable right of every human being to life, that is, the right not to be killed.
Because it interrupts the natural continuity in development, the cryopreservation of embryos represents an affront to their innate human dignity. Furthermore, it also exposes them to serious risks of physical harm and even loss of life given that a high percentage do not survive the process of freezing and thawing.
In addition, the storing of embryos means that their future (their right to life) becomes subject to decisions made by others; firstly those responsible for bringing about the human life, the commissioning parents in conjunction with the fertility clinics; secondly the state, when regulations (such as those governing the length of time embryos may be stored) mean that an embryo's right to life can also become dependant on various forms of legal concession. It is ethically inconsistent that a fundamental right becomes contingent on concessions, legal or otherwise, conferred by others.
Such regulations, even when they are well intentioned, can easily add to the injustice associated with storing embryos because they may well constitute a further obstacle to the embryo being able to continue on its rightful path of human development. The shape of the regulations may also present a direct obstacle to parents who are genuinely committed to implanting their stored embryos, as well as confusing the question of who is ultimately responsible for their welfare.
Taking into account all of the above, the question of further extending the storage period of embryos poses a unique moral dilemma from our perspective. On the one hand it can only be interpreted as the continuation of a serious injustice because it involves an ongoing risk to their viability and obstructs their right to develop. On the other hand, we recognise that in certain circumstances extending the storage period may be what is required to ensure that particular embryos are given a chance to live the life that is already rightfully theirs.
We accept that by seeking to extend the period that embryos may be stored, the proposed guidelines are, at least in part, designed to make additional provision for embryos to be implanted and to continue the path of their development. To this extent, and while it is regrettable that there are so many embryos in storage, we appreciate that robust guidelines have the potential to impact positively on what will still remain, at best, an unjust situation.
Obviously, the moral issues that characterise the storage of gametes differ because of the differing moral status of gametes when compared to embryos.
Responsibility for making applications to ECART for extending the storage of gametes and embryos:
In light of their moral status, we are concerned about the question of who is morally responsible for particular embryos. In the first instance we believe that it is the commissioning parents who are responsible. It is therefore most appropriate that they should be able to initiate and empower the application process and be perceived as doing such.
We believe that the current wording of the guidelines, insofar as it focuses largely on the role of fertility clinics and researchers, fails to adequately highlight the primary moral responsibility of the commissioning parents. In line with this we believe that all applications relating to the storage of embryos and gametes for fertility reasons need to be in the name of the commissioning party rather than the clinic.
That said, we understand that from a pragmatic point of view it is best that the application process be managed by a clinic because of their access to key information as well as in the interests of consistency. In other words, our criticism is not so much about the process being suggested as it is about the presentation of the process and its implications for people's understanding of what is at stake.
In the case of gametes being held for research purposes, we are happy that researchers take responsibility for any application for extending the storage of gametes knowing that the consent of the donors is integral to this process. Our stance on this reflects the fact that the reasons for such an application are ultimately for the benefit of the researcher rather than the donor. This makes such an application different in essence from any application to extend the storage of embryos as well as different from applications to continue storing gametes for fertility reasons.
Reasons ECART may approve extending the storage of gametes and embryos:
We note positively that the guidelines anticipate couples with 'surplus' embryos created from their own gametes seeking an extension period for the purposes of finding and donating their embryos to a suitable couple.
In line with our introductory comments we agree that the reasons for extending the storage of gametes and embryos must be limited to those individuals seeking fertility preservation in cases where the initial reasons for storage relate to an underlying medical need. We understand, and approve of the fact, that this will rule out those seeking fertility preservation for 'insurance' or 'lifestyle banking' reasons. To act otherwise would only lead to the untenable situation where we would have even more embryos being created and stored for reasons of personal convenience, exacerbating further what is already a problematical state of affairs.
We also approve of the fact that the guidelines rule out extending storage in cases where treatment is prohibited or precluded at the time of an application for extending storage. Again, to act otherwise would only lead to greater numbers of stored embryos unlikely to be implanted.
Informed Consent Requirements:
We wish to make the observation that the provisions around gaining consent from gamete donors for extending the storage of embryos unintentionally create a situation where commissioning couples (whom we argued earlier should have primary moral responsibility for embryos in storage) may be prevented from exercising their rightful parental responsibility.
We foresee situations where couples desiring a child, perhaps wanting a full sibling for other children, and with a keen sense of accountability for the embryos in their care, find themselves unable to carry through their parental commitment because of an inability to make contact with, or otherwise gain consent from, those who originally provided the gametes. Even while we uphold the importance of consent as a key principle in ethical decision making, such a situation strikes us as patently unjust, both from the perspective of the embryo and the commissioning parents. It creates an impossible hurdle to life for the embryo while also creating (abandoning) a particular class of embryo for whom no-one is able to be responsible. It also frustrates the would-be parents whose desire to have a child, which was the source of the original consent sought, has remained singularly constant.
On the other hand, we recognise that giving birth to children who may not be able to ever contact their biological parent or parents (or whose biological parents may not want contact) is also patently unjust and something that would impose a burden on any child that came to be born.
This is a good illustration of the way reproductive technologies have the ability to fracture the inherent relational integrity that should exist between parents and children. It also illustrates some of the unintended and undesirable consequences associated with separating the genetic, gestational and social dimensions of parenting, something that characterises many assisted reproductive procedures. More particularly, it highlights for us the contradictions and inconsistencies inherent in allowing heterologous IVF (i.e. relying on sperm and/or ova donation), something that we have previously stated we are strongly opposed to.
While hoping that honest reflection on the consequences of using heterologous IVF may discourage its use, we acknowledge that the practice has already been embraced by some in our society. Without wanting to further encourage its use in any way, and mindful of the situation we have described above, we suggest that ACART advocate that provision for extended storage of embryos be included as a standard part of the original consent sought from gamete donors.
Book Review - The ethics of abortion: Women's rights
John Flynn LC provides a broad overview of the key arguments offered by Christopher Kaczor in his book, The ethics of abortion: Women's rights, human life and the question of justice. While religion provides cogent arguments against abortion, the case as to why it is ethically unjustifiable can also be made on philosophical grounds.