Submission to Health Select Committee on Human Assisted Reproductive Technology Bill (2003)
Human Assisted Reproductive Technology Bill
Submission on behalf of the New Zealand Catholic Bishops Conference and The Nathaniel Centre – The New Zealand Catholic Bioethics Centre
Introduction
We welcome this opportunity to present a joint submission on The Supplementary Order Paper – Human Assisted Reproductive Technology Bill 2003. The New Zealand Catholic Bishops Conference speaks on behalf of the Catholic Church in New Zealand. The Nathaniel Centre – The New Zealand Catholic Bioethics Centre is an agency of the Bishops Conference. Its role is to address bioethical and biotechnology issues on behalf of the Catholic Church in New Zealand.
1. Developments in the field of reproductive technologies, and the opportunities derived from them, raise deep and important questions about the beginning of life.
2. From the moment of fertilisation an embryo "is already the human being it will always be and will only grow in size and complexity." In other words, there is no threshold that embryos cross to become human – there is rather a continuity to human existence. This belief lies at the heart of Catholic attitudes and responses to the use of artificial human reproductive technologies.
3. In acknowledging that a new human life begins at fertilisation we are also committing ourselves to providing for that unique individual the same safeguards and rights which furnish a necessary shelter within which we can develop our full human potential.
4. The Catholic Church believes that the use of assisted reproductive technology is only acceptable between a husband and a wife in very specific circumstances which assist the natural processes of reproduction and do not pose undue risks for parent or child. Meeting the needs of couples who are infertile is by itself not sufficient as a criterion for evaluating the use of particular technologies.
5. Technology is morally neutral. We recognise and welcome the remarkable advances in science and technology that contribute to improving the welfare of humanity and the world in which we live. Failure to embrace such developments, both now and in the future, would represent a moral failure in terms of our responsibility and stewardship for current society and for generations to come. 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.
6. A proper assessment of the uses of reproductive technology goes beyond "physical" risks and includes a consideration of the ethical, cultural, social and spiritual dimensions of our human nature.
7. We are particularly concerned about a trend within New Zealand to focus ethical debate only on the question of whether free and informed consent has been given. An over emphasis on the importance of consent, together with an over emphasis on the rights of adults, can mean that deeper ethical considerations are left unaddressed.
8. Our society is characterised by religious and moral pluralism. In order to bring together the various voices in the debate on human reproduction, a framework is required that offers stable reference points that can be accepted by all, independent of any particular faith or religious perspective.
We make the following specific points in relation to the proposed amendments to the Human Assisted Reproductive Technology Bill:
Part 1AA
Preliminary Provisions
Section 3; Purposes
9. We believe that, in addition to the purposes listed, it should be a stated intention of the HART Bill to establish the mechanisms for ensuring that appropriate public discussion and consultation are held with respect to guidelines relating to new issues.
Section 4; Principles
10. We commend the use of principles in the Supplementary Order Paper (SOP) as helping to establish an essential framework for decision making in the area of human assisted reproductive technologies. We make the following observations concerning the SOP principles.
11. 4(b) "Human health, safety, and dignity ..." Human health and safety are an expression of the innate dignity of the human person. We wish to see human dignity set down as a principle in its own right. [See paragraph below.]
4(c) " ... to make an informed choice to submit or to refuse to submit to the procedure or the research ..." The use of the word "submit" suggests coercion and paternalism. This is unhelpful.
4(d) "Donor offspring should be made aware of the genetic origins ..." Knowledge of genetic origins is an entitlement and not an option. We support the intent of the proposed legislation for clear records to be kept.
12. We see that the principles set out in the SOP are incomplete, and recommend they be supplemented by the following general principles. Many people, regardless of religious perspective, commonly accept these principles . They are:
a) Respect for the Intrinsic Dignity of Human Life.
By the term "intrinsic" we mean rights that exist quite apart from, and unrelated to, the circumstances of an individual's conception and birth or their ability to function.
b) Promotion of Human Health and Safety.
This principle is very often described in terms of the bioethical principles of beneficence and nonmaleficence. Beneficence highlights the positive obligation we have to advance the healthcare interests and welfare of others. The principle of nonmaleficence imposes the obligation not to harm a person or persons intentionally or directly.
[These two principles a) and b) would replace principle 4 b) of the SOP.]
c) Protection of the Vulnerable.
This calls for a recognition of those whose rights may be infringed or who may be exploited, especially those who cannot defend or speak for themselves.
d) Balancing of Individual and Collective Interests.
The notion that the common good of society will place restrictions on the pursuit of individual choices is a general principle that applies to the area of human reproduction as much as to other areas of society. This involves consideration of, and due respect for, the ethical, spiritual and cultural perspectives of Maori as well as all other groups.
e) The Non-commercialisation of Human Reproduction.
The starting point for Catholic-Christian discussions about human reproduction is the traditional, hallowed, philosophical and religious understanding of life as a sacred gift; ultimately a gift from God but also a testimony of the generous giving of spouses. The metaphor of life as "gift" proscribes any commercialisation of human reproduction.
f) Acceptance of Human and Material Limits.
This principle highlights the challenge of balancing access to services with responsible stewardship of goods and services.
13. Taken together with those set out in the SOP, we believe that these principles form a framework that will ensure the dignity and well being of human life are upheld, and the rights of individuals and the common good of society are balanced in a just and equitable way.
14. We note and strongly support the principle that all persons exercising powers or performing functions under the Act should hold the health and well-being of children born as a result of the performance of an assisted reproductive procedure to be paramount in all decisions.
15. The test of commitment to these principles is whether they can be translated into effective procedures, guaranteed under the Act, that ensure the ethical, spiritual, and cultural dimensions will be properly considered and respected. We see this as occurring, among other ways, through widespread and ongoing public consultation on key issues.
Part 1
Prohibited and regulated Activities
Subpart 1 – Prohibited actions
Section 7; Prohibited actions
16. With respect to Schedule 1, we support all of the prohibitions set out in the SOP.
i. Human cloning for reproductive purposes (producing children genetically identical to the cell donor).
ii. Creation of Human/non-human hybrid embryos for reproductive purposes
iii. The implantation of animal and hybrid embryos or foetuses into humans
iv. The implantation of human and hybrid embryos or foetuses into animals
17. We note with extreme concern that the proposed legislation would allow research on so-called "spare" embryos from IVF procedures and that it would also allow the creation of embryos for purposes of research (either by way of IVF or by way of "therapeutic cloning"). This is inconsistent with the principle of preserving and promoting human dignity as stated in section 4(b) of the SOP.
18. We strongly contend that germline genetic alteration needs to be included as a prohibited activity. The best opinions on this matter point to the fact that germ-line genetic alteration is both unsafe and impractical at this time, as well as having unknown consequences for subsequent generations. We acknowledge that the intention of germ-line genetic alteration is to affect patterns of genetically based diseases. However, we believe that the burden of proof regarding safety of such practices needs to remain with those who would advocate the use of such practices. We believe that such practices need to remain prohibited for the foreseeable future, that is, prohibited through legislation rather than being left at the discretion of any advisory body.
19. Consequently, to the list of prohibitions, we would want the following practices added:
a) Research on embryos left over from IVF programmes
b) Creation of an embryo solely for purposes of research
c) "Therapeutic cloning", i.e. embryo cloning for non-reproductive purposes (currently a matter for MAC to advise on)
d) Embryo splitting
e) Creation and use of hybrid embryos for non-reproductive purposes
f) The use of gametes derived from foetuses
g) Germline genetic alteration
Section 10; Duty to stop development of embryos outside human body after 14 days
20. Without condoning the practice of IVF, we wish to limit the harm caused by the creation of embryos that will never be implanted. Whatever the circumstances of its genesis all embryos are to be treated with absolute dignity and respect. Commitment to the intrinsic dignity of the embryo proscribes all activities on embryos already formed via IVF, other than for the purpose of implantation within the womb of its mother. The 14-day period is unnecessarily long for the purposes of fertility treatment and appears to be concerned with making provision for research and experimentation on embryos. As stated previously, this should be prohibited.
Section 11; Commercial supply of embryos or human gametes
21. The purchase, barter or exchange of human gametes and embryos is contrary to the principle of intrinsic human dignity. We support the prohibition of, and the proposed penalties for, the giving or receiving of valuable consideration for the supply of an embryo or human gametes.
Section 12; Status of surrogacy arrangements and prohibition of commercial surrogacy arrangements
22. We wish to state our opposition to all forms of surrogacy. We believe that the overall well-being of children is compromised when they become subject to any 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. We support the move that would seek to keep surrogacy arrangements from being made enforceable.
23. Within assisted human reproductive technologies there is a significant risk of the commodification of children and the reproductive capacities of women and men. The exploitation of children, women and men for commercial ends is an affront to the intrinsic dignity of persons, and therefore we welcome the prohibition of commercial surrogacy. In addition, the commercialisation of such activities is contrary to the well-established and accepted New Zealand practice whereby human organs and tissues are not sold or purchased and adoption is non-commercial.
Subpart 2 – Activities requiring approval of ethics committees
Section 14; Assisted reproductive procedures and human reproductive research only to proceed with prior approval
24. An over emphasis on the sufficiency of individual informed consent, as has been exemplified by a number of commentators with respect to recent debates in the bioethical area, reflects a failure to acknowledge the wider impact of technological interventions. This, in turn, often reflects a view of the human person that fails to properly acknowledge our inter-connectedness and the impact of our individual decisions on others. 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.
25. One of the less talked about implications of the use of assisted reproductive procedures is their potential to redefine our fundamental understandings of parenthood, children and our acceptance of human diversity. Consequently, decisions around the use of reproductive technologies are too important to be left entirely in the hands of individuals or couples without broader societal oversight and accountability. The proposed requirement that assisted reproductive procedures and human reproductive research must gain the approval of an appropriate ethics committee, reflects the implications which these issues have for the community as a whole, and of the need for limits. We strongly reject the view that the involvement of ethics committees in people's decisions to use assisted reproductive procedures represents an intrusion into the lives of adults.
Section 24: Designation of Ethics Committees
26. To meet international guidelines for research and practice, it is imperative that ethics committees must be "independent" of any undue political interference. The proposed legislation gives too much power to the Minister to appoint, designate, and terminate.
Subpart 3 – Advisory committee
Section 31; Advisory committee to be established
27. We support the establishment of an advisory committee. To avoid it being a minimal response in the implementation of reproductive technologies, this committee needs to be well resourced in order to carry out what is needed in the timeframe that the technology will force upon it.
Section 33; Appointment of members
28. In line with the principle of considering and respecting the different ethical, spiritual and cultural perspectives, we consider subsection (4) to be deficient in as much as it does not make direct provision for one or more members with expertise of a "spiritual" nature. Broad-based representation on the Ministerial Advisory Committee is essential and should include people with cultural and spiritual and ethical backgrounds. In its current form we do not believe that the legislation will achieve its stated aim of considering and respecting the different ethical, spiritual, and cultural perspectives in society.
29. With regard to the makeup of the Ministerial Advisory Committee we recognise the need for specialised knowledge in assisted reproductive procedures and human reproductive research. Nevertheless, there is the potential in the committee makeup for provider and researcher capture. The makeup of the committee must avoid any conflict of interest. We note that the National Ethics Committee on Assisted Human Reproduction (NECAHR) have made provision to appoint a specialist to advise, when necessary, on technical matters relating to assisted reproductive technology. This person does not take part in any decision making.
30. The fast developing nature of the technology and its potential to redefine fundamental understandings of parenthood and children calls for an advisory body that:
a) Is independent of any organisation or group of individuals that stand to benefit financially or in any other way from reproductive procedures/treatments or research.
b) Is broad-based in its make-up and includes representatives from the churches.
c) Is willing to balance the scientific imperative that holds that research must always proceed as quickly as possible.
d) Sufficiently recognises and takes into proper account the fact that risks and harms associated with assisted reproductive technologies apply as much to the "human spirit" (our ethical, cultural, social and spiritual dimensions) as to our physical well-being.
e) Will be subject to transparent accountability mechanisms.
Section 36; Advisory committee to provide specific advice
31. We wish to point out that there is an ethically relevant distinction between embryo donation to infertile couples and the donation of "spare" embryos for purposes of research. The proposed legislation, in its current form, does not make this differentiation. These two quite different types of activities need to be clearly differentiated within the act itself.
32. Embryo selection is unacceptable because it implicitly and explicitly devalues life that is already weak and marginalised. Allowing embryo selection for any reasons, including those related to the health of the child to be born may actually open the way to significant pressure for eugenic or discriminatory activity. Persons with disabilities are a particularly vulnerable group who need protection. We note that very often their vulnerability derives from socially constructed perceptions of "normality" which rest on a shallow understanding of humanity. Persons with disabilities can lead full and satisfying lives and enrich the lives of those around them.
Section 37; Requirement to consult
33. We are extremely concerned that there is no obligation by the advisory committee to consult with the wider public, other than when it sees fit to consult, and only then with whom it sees fit to consult. This is inconsistent with what is happening in the environmental area. Given that the committee is charged with providing specific advice and issuing guidelines on matters relating to any kind of assisted reproductive procedures and human reproductive research, we believe that wide public debate and input is essential. The need for wide public consultation on issues in which the whole community has a stake must be an integral part of the legislation. It is unacceptable that the need to consult be left to the discretion of the advisory committee or the Minister.
Part 4
Information about donors of donated cells and donor offspring
34. The principle that we have a right to know our lineage or genetic heritage, and the requirement that the health and well-being of children be paramount, requires that legislation provide for the sharing of information between all those involved in any form of assisted reproduction. Where there is a conflict between the privacy rights of a donor and the rights of a resulting child to know its heritage, the rights of the child should prevail.
35. As a result of assisted reproductive technologies, a child may have as many as five "parents". Without condoning the practice, we believe that it is the right of children who are born by way of assisted reproductive procedures involving donor gametes to have access to full information about their origins. We note that the proposed legislation does not require donor offspring to be told about the circumstances of their conception, and accepts that the child's family may - or may not - share information at any stage. This right should not be at the discretion of parents. Research into the effects of adoption on children has taught us the negative effects of a system that is less than totally open from a child's earliest years on. In its current form this part of the SOP clearly falls short of the stated aim to uphold as paramount the principle that actions be guided by what is best for the child.
Section 38
Advisory committee to consider desirability of activities
36. The desirability of research, or its intended outcome, is not a sufficient determinant of what is ethical. This principle, often expressed in terms of the maxim 'the end does not justify the means', has been consistently upheld in our society. Lack of regard for this maxim has resulted in well documented abuse of human rights. We believe that the notion that research must proceed as quickly as possible must be challenged because such research may reflect values that are not balanced by ethical, cultural and spiritual concerns.
Submission to the Education and Science Select Committee on the New Organisms and Other Matters Bill (2003)
Issue 10, August 2003
Submission to the National Ethics Committee on Assisted Human Reproduction (NECAHR) on Embryo Donation for Reproductive Purposes (2004)
Submission to the Environmental Risk Management Authority (ERMA)"Consideration of Ethical Issues in HSNO Act Processes" (2005)
Submission on Human Tissue (Organ Donation) Amendment Bill (2006)
A Submission from The Nathaniel Centre – The New Zealand Catholic Bioethics Centre
Issue 19, August 2006
General Comments
We are called to show the utmost respect to a person's body at all times, including after death. This respect is an ongoing expression of the dignity owed to each person on the basis of our shared humanity. To desecrate or in some way to violate someone's body is simultaneously to desecrate and violate the person. A person's body is integral to, rather than incidental to, their personal identity. In New Zealand this responsibility is reflected in the longstanding current law which holds that no one can ever "own" the body of another.
In the Catholic tradition we believe that all human beings are created in the image of God. We speak of human nature as being corporeal and spiritual. Yet, while accepting such a distinction (sometimes expressed in terms of "body" and "soul") we reject any dualistic understanding of the human person. The body is not merely a vehicle or container for the person. Spirit and matter are not two natures united, but rather their union forms a single nature. We understand all life to be a gift that is entrusted to us from the Creator. The dignity accorded to human life can be understood as a direct response to the belief that life is a gift to be held in trust.
The donation of one's organs and tissue after death is a response that is consistent with the respect we are called to show towards our own life. Catholic statements and teaching on organ and tissue transplantation speak of it as a form of "self-giving", a selfless act of love modelled on, and motivated by, Jesus Christ's unselfish offering of his own life. For this reason, the donation of human tissue and organs is often referred to as an "enduring gift". No one should ever presume such a gift. Provoked by love, and freely offered, an act of tissue or organ donation can be seen as an expression of human solidarity that serves the common good.
Organ Donation and Consent
1. Nobody should be able to lay a claim to the body of another except on the basis that it has been "gifted". The gifting of human tissues or organs, either before or after death, is not something that anyone should feel obliged to do, or be pressured into in any way.
2. For this reason, the use of all or parts of a person's body should only ever be done with their explicit consent, or, where such consent has not been recorded, with the consent of next of kin or close family recognised as knowing the mind and intent of the person. We recognise and uphold the intent of the proposed Human Tissue (Organ Donation) Amendment Bill legislation to ensure that all consent is informed and free of duress.
3. From a moral standpoint we regard the donation of one's body as a "heroic action" and a rich gesture of generosity to fellow humans. The Catholic theological analysis of organ donation as an "enduring gift" highlights the respect given to informed individual choice. Those who are ultimately responsible for shaping legislation around tissue and organ donation must seek to preserve and promote such actions for what they truly are - rich gestures of generosity. For this reason we would be opposed to an "opt out" register based on "presumed consent". The onus is on our society to properly educate and inform persons and obtain their informed consent. We support the proposed Amendment Bill which emphasises the need for persons to "opt in".
Consent – Binding or Non-Binding:
4. In New Zealand, respect for the autonomy of the patient is a fundamental principle that informs the provision of healthcare in New Zealand. This principle is upheld in "The Code of Health and Disability Services Consumers' Rights". Right 7 spells out the "Right to Make an Informed Choice and Give Informed Consent". Right 2 upholds the "Right to Dignity and Independence". While recognising that the principle of autonomy exists alongside - and may at times be in tension with - other key ethical principles, we hold the view that proper respect for the dignity of a person normally implies that their expressed wishes as to what happens with their body after death would be upheld.
5. In reshaping the legislation relating to organ donation after death, we wish to highlight the importance of giving proper consideration to the cultural and religious diversity of New Zealanders. The dominant model of informed consent upon which health-care decisions in New Zealand are made is largely premised upon particular cultural assumptions about personal identity and well being in which the person is defined first and foremost as an 'individual'. These assumptions are somewhat inconsistent with other cultural understandings in which an individual's personal identity is more strongly tied to the family or whanau group to which they belong. The differences in assumptions provide for different approaches to personal decision making, which at times can set up a tension. While the strong presumption should always be to act in favour of an individual's expressed wishes, we would be uncomfortable with a legal framework that ruled out absolutely a family's rights to veto their loved one's wishes. A system that seeks to resolve this tension by creating an automatic legislative preference for one set of cultural or religious assumptions over another is arguably unfair. We see that the application of the principle of informed consent within different cultural and religious frameworks provides one of the greatest challenges in shaping the new legislation.
6. The existence of an individual's clearly stated wish to be an organ donor creates a strong moral claim in favour of carrying out those wishes. At the same time, the medical process of obtaining the organs necessarily changes the natural dynamics that surround the death of a loved one. As a result, the actualising of a person's decision to be a donor makes significant additional demands on a person's family / next of kin, especially when it is filtered through the lens of anticipatory grief. The needs of family and loved ones also matter. The benefit of not departing from current best practices around organ donation (whereby health professionals will only proceed if there is family or next-of-kin approval) is that there is a guaranteed incentive to work closely with, and be sensitive to the multiple needs of the family of the deceased person.
7. One of our concerns is that there may not be the same incentive for health professionals to work alongside the grieving family if future legislation was to insist on an absolute presumption in favour of acting on the dead person's wishes regardless of her/his family's approval.
8. We wish to see the appointment of independent personnel, specially trained in grief and trauma and with specialised knowledge about the process of organ donation, to manage the process around organ donation. Such people are already working successfully in many hospital environments world-wide. The advantage of such personnel, apart from being specially trained, is that they are not involved in decisions around care and treatment options, and nor are they involved in the actual transplantation process. Thus there exists a clear separation between those assessing the likelihood of death and those involved in any subsequent harvesting of organs. They can address the particular grief needs of the deceased person's family/next-of-kin without having any perceived agenda. This system would also assuage the identified – and understandable - hesitation of some ICU doctors to approach families for consent.
9. The wishes of the deceased are paramount, and an individual's wishes should be upheld in all but exceptional circumstances. In cases where the family of a would-be donor object on cultural or religious grounds, it would be part of the role of the trained and independent personnel to work with the family. It should be their starting presumption that the issue would be resolved in favour of the individual's wishes. We believe such a process would in most cases resolve family/next-of-kin concerns while upholding the express wishes of the deceased, bringing about a win-win situation.
10. Nevertheless, in the face of continued cultural and/or religious objections we believe that the legislation should provide a degree of ethical and legal space for the wishes of the family to prevail. Respect for cultural and spiritual values is a strong aspect of New Zealand culture and is enshrined in many important pieces of legislation relating to health and welfare. Furthermore, to insist otherwise, that is, to provide for absolutely no circumstances in which the family could over-ride the deceased wishes, could, in the long-term, have a negative effect on the overall willingness of some individuals belonging to certain groups to become donors.
11. While much has been made of the fact that the current legislation allows family members to over-ride the expressed wishes of family members, it is our understanding that it has not been established that this is necessarily a significant factor in New Zealand's low rate of organ donation. In our opinion, making all New Zealander's more aware of, and educating and informing them about, the issues surrounding organ donation are the key factors in positively influencing the rate of donation in New Zealand.
12. The importance of keeping family closely involved in the decision making at all points becomes all the more evident when one considers that a sustained campaign to increase donor rates has the potential – even if unwittingly – to change the dynamic around end of life decision making. With a more focused drive to source organs comes an increased risk of abuse; that is, decisions being made that may not, in the first instance, be in the best interests of the critically ill/dying person. It is never permissible to bring about or hasten the death of a person for the purposes of retrieving organs, even when this is done to prevent the death of other persons. The input of the family remains an integral part of the care of the person and a key to ensuring that good decisions are made, and the risks of abuse minimised.
13. Furthermore, the necessary participation of family and loved ones in the decision whether or not to withhold or withdraw treatment or life-sustaining equipment is part of the process of organ donation. This means that the family are already intimately involved in the process of organ donation. Good legislation will take this reality into account as opposed to presenting the decision about organ donation as a 'stand alone situation' that should be managed quite apart from what precedes and follows it.
Systemic Issues:
14. Mindful of the relatively low rates of organ donation in New Zealand, we recognise the need for individual New Zealander's to be encouraged to think more seriously about their own willingness to act as donors. Education programmes integrated into the health curriculum could provide an important means for achieving this. Effective marketing strategies such as have already been undertaken by the Ministry of Health on various issues may also be an effective strategy. The proper resourcing of these campaigns requires a certain amount of political will. A higher level of awareness among New Zealander's will hopefully mean that more and more people will have discussed their decision to be a donor with family and next-of-kin at the time when they make their informed choice and well before the actual circumstances in which their decision needs to be effected.
15. We agree strongly that the current process, whereby individuals record their consent to be an organ donor at the time they renew their driving certificate, is inadequate and ineffective. This is the case not least because the option of becoming a donor is presented in a way, at a time, and in a place where there is insufficient time and information for people to make a properly considered choice. The setting up of the Organ Donation Register as specified in section 4B seems a suitable and robust means for people to have their wishes recorded.
16. We also believe that the relatively low rates of organ donation in New Zealand may reflect inadequacies within the current health system such as a shortage of available ICU beds. Issues such as these are of a more systemic nature. Once identified, they are also best dealt with through political means.
Conclusion
A comparison of New Zealand organ and tissue donation rates with other countries shows that we have one of the lowest donation rates in the world. We support efforts to increase the rates of organ donation in New Zealand. The nature of organ and tissue donation is that it is a "gift" and the processes around organ and tissue donation must respect this absolutely. Respect for a person's autonomy suggests a strong presumption to act in accordance with an individual's expressed wishes. The dynamics around end of life decisions, not to mention the needs and grief of family and next-of-kin, require that they remain closely involved in the process and that all attempts be made to ensure their support for a person's wishes to be a donor.
Submission from The New Zealand Catholic Bishops’ Conference and The Nathaniel Centre on The Use of Gametes and Embryos in Human Reproductive Research: Determining Policy for New Zealand (2007)
The Use of Gametes and Embryos in Human Reproductive Research: Determining Policy for New Zealand
Submission from The New Zealand Catholic Bishops' Conference and The Nathaniel Centre
Introduction
Life and physical health are precious gifts that have been entrusted to us. We have a responsibility to take care of them while taking into account the needs of others and the common good. Concern for the health of its citizens requires that society work assiduously to support all persons to live fulfilled lives. To this end the Catholic Church recognises the importance of, and is committed to, ongoing research into human health and well-being.
All research on human beings must be subject to respect for the dignity of human life. Science and technology must be ordered to the well-being of human kind from which they take their origin and development. The purpose of human research and an awareness of the ethical limits of research are grounded in, and remain at the service of, the integral good of human beings. Actions that are of themselves contrary to the dignity of persons cannot be legitimated in the name of research or experimentation. "The Church respects and supports scientific research when it has a genuinely human orientation avoiding any form of instrumentalization or destruction of the human being." (Pope John Paul II, Address to the Pontifical Academy for Life, February 24, 2003)
The question is whether our technical progress will be guided by an equally advanced sense of the dignity of each and every human life. Human society only benefits from research that reflects good science and good ethics. The debate over the use of embryos for research highlights a paradox: Whether or not we should destroy human life in its earliest and most vulnerable form in the cause of following our deeply humanitarian impulses to reduce suffering and find cures to human diseases.
This introduction outlines the context in which we offer the following comments on the proposed guidelines for the use of gametes and embryos in reproductive research within New Zealand.
Executive Summary
The question that stands at the heart of the debate about embryo-destructive research is whether or not it is ethical to achieve a good outcome using bad means – in this case the destruction of pre-nascent human life. Catholic teaching provides clear guidance on this question and the stance taken by the Catholic Bishops of New Zealand in their submission is summarised below. The position is essentially a positive one that argues an alternative way forward based on sound principles that reflect a rich understanding of the human person, a desire to protect and promote human dignity and a deep commitment to research and healing.
Only interventions which respect the life and integrity of the embryo and are directed towards its well-being are morally licit. All other research or interventions on embryos should be prohibited. We oppose the deliberate creation of embryos for embryo-destructive research. We also oppose the use of so-called "surplus" IVF embryos for embryo-destructive research.
In the case of embryo-destructive research carried out in the name of finding cures, the means actually contradicts and undermines the end or outcome being sought – human life is destroyed in the name of preserving human life.
Other alternatives to embryo-destructive research exist. Real progress that is genuinely "therapeutic" has been, and continues to be, made with 'adult' stem cells. Progress is also being made in sourcing pluripotent cells that exhibit the same behaviours as ESC's but which can be obtained without the need to destroy human embryos.
We consider that the inviolable dignity of the human embryo is sufficient reason for us as a society to step back from embryo-destructive research. However, even leaving aside the controversial question of the moral status of the embryo, it is our considered view that taking proper account of all other relevant moral factors, it is not possible to create a sufficiently persuasive - let alone substantially persuasive - moral account necessary to justify allowing the practice of embryo-destructive research in New Zealand.
The divide in the debate surrounding the use of embryos in research is sometimes falsely presented in terms of those in favour of progress and those against. This is a misrepresentation. Our stance against embryo-destructive research reflects a positive commitment to uphold the inviolable dignity of human life. Research that does not uphold human dignity will not ultimately advance human well-being.
A recommendation by ACART in favour of embryo-destructive research would be a recommendation for New Zealanders to cross a fundamental moral line never before crossed: permitting the direct killing of human life in its earliest and most vulnerable stages in the name of medical 'progress'.
New Zealand is currently in a unique position of being able to exercise moral leadership by rejecting embryo-destructive research and supporting stem cell research.
Research using gametes should be regulated through guidelines and then allowed to proceed on a case-by-case basis with appropriate ethical scrutiny. Particular regard needs to paid to informing women of the risks associated with egg donation and to protecting them from exploitation. The commodification of human life is also of concern.
1. What are your views on research, or aspects of research, using gametes?
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 uphold the principle enshrined in New Zealand legislation that transactions involving body tissue not be commercialised. We are 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. The potential for exploitation is there whether or not women are remunerated for their tissue. Egg donation carries very high risks and there needs to be very specific protocols developed to protect women donors. In particular, consent must be sought in a non suggestive and non coercive way that ensures women are fully informed of all the consequences and risks. Even benign appeals to a woman's altruistic nature can be coercive, especially when the health of other family members is involved and egg donation is presented as a necessary step towards therapies.
We are also concerned that an increased demand for human gametes, and eggs in particular, might contribute – even unintentionally – to furthering the commodification of human life.
We are opposed to any research with gametes that results in the creation of an embryo that would then be destroyed for the reasons we outline in answer to question 2 (see below).
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. Such research raises profound questions regarding the identity and moral status of the new life forms.
2. What are your views on research, or aspects of research, using embryos?
It is our strongly held view that all research, or aspects of research, using embryos should be prohibited. The reasons for our view are as follows:
i. Human embryos are a part of the human family and deserve the same level of respect that is due to all human beings.
The desire to carry out research on human stem cells originates from a concern to better understand the human body, alleviate disease and improve people's quality of life. Without doubt, this desire is grounded in the integral good and well-being of human beings. The debate about the use of embryos in human reproductive research is not a debate about the merits of stem cell research. There are ethical and unethical ways to conduct stem cell research and the question is to which category a particular technique – the destruction of living embryos for their cells – belongs.
Neither is the debate about when human life begins. It is an accepted biological fact that a human life begins when a human embryo is created, irrespective of the means by which it was created. We were all once embryos! Proponents and opponents of embryo-destructive research agree that the dilemma associated with research on human embryos is the destruction of developing human life. The ethical questions centre on the sort of respect we should accord human life; in particular whether it is ethically consistent to accord a different level of respect to humans in the earliest stages of life, as well as whether there are ever factors that mitigate the respect due to human life at any stage of development.
The belief held by some that the life of a human embryo matters less than other human life at a more developed stage may reflect the fact that it is largely invisible – it isn't missed as other human beings can be missed. Yet even at the four cell stage, an embryo is not simply a collection of cells that happen to be contiguous. These cells are a human embryo, a new human individual and part of the human family. Embryos become children in the same sense in which children become adults, not by some addition to what they are, but simply by developing further as the kind of beings they already are.
To claim that a four-celled embryo is a human being clearly takes us beyond the level of empirical observation. However, to judge something solely at the 'material' level ("it is only a clump of cells") is to ignore the fact of what something is – in this case it omits an important truth about embryos in the same way that the statement 'I am sitting on a collection of timber and steel' omits the crucial truth that I am sitting on a chair. In other words, that a particular statement is strictly speaking accurate may not reflect its adequacy in describing the full reality of the situation.
The common understanding of person in our culture has been shaped by modern philosophies' emphasis on self-consciousness as the mark of personhood. A much older understanding of person, however, locates personhood in the dignity of a being's rational nature, irrespective of whether that being is conscious at a particular phase in his or her life. According to this traditional view there is nothing problematic about saying that an unborn child or a persistently unconscious patient is a person, for they are truly our fellow human beings. The key to understanding what a human embryo is lies in the connection that exists between a human embryo and an adult member of the human species.
The Catholic position accords unconditional respect for human life at all stages of its development. In calling for unconditional respect Catholic teaching is being absolutely consistent. It holds that without exception the living embryo has, from the moment of fertilisation, an absolute right to life. A life is begun which is neither that of the father nor the mother. It is already the human being it will always be and will only grow in size and complexity. On that basis all embryos are entitled to be granted a place in the human family and treated with the same respect as persons.
ii. Support for embryo-destructive research is based on a flawed understanding of human dignity as externally conferred rather than being an intrinsic characteristic of human life.
Arguments in favour of embryo-destructive research are premised on the belief that embryos possess varying degrees of moral status depending on the circumstances. The highest status is reserved for the 'wanted embryo in the womb'. Equally a very high value is attached to the 'wanted unfrozen embryo outside of the womb' because the parents have done so much in order to have it. The 'wanted frozen embryo' enjoys a mixed status – it is wanted but not wanted just yet.
The 'unwanted frozen embryo' has a certain status as a potential object for donation or research, and if the parents agree then its status can change from being unwanted (by them) to being wanted by others. In fact its status is reduced to that of 'experimental laboratory material'. If not wanted by others for research then it appears to have even less status or no status at all.
However, there is something inherently illogical about this rationale - the varying degrees of status belie the scientific fact that all embryos are biologically and ontologically the same kind of being, all members of the human species. Our common biological origins and shared ontological nature highlight the moral inconsistency of according embryos varying degrees of status and rights based on human subjective preference.
We can only justify such a range of 'status' if we are prepared to accept that human dignity and moral principles can be reduced to matters of preference, subjective opinion and even convenience. To take such a stance is to countenance an approach to bioethics that elevates personal choice and personal preference over a principled and objective approach to decision making.
From a Catholic perspective it is not so much a question of a different calculation of the amount of respect due to embryos as it is a question of the type of respect that is due. Catholic teaching believes that human dignity must be based on an 'intrinsic' respect; that is a respect which is independent of all factors or conditions that are extrinsic or external to the embryo including what ever subjective value might be attached to it by the couple whose gametes have contributed to the creation of the embryo.
Ultimately, to abandon an intrinsic understanding of human dignity and make it contingent on subjective preference is to destroy the foundation upon which universal human rights are based.
iii. There is no precedent for the introduction of embryo-destructive research in New Zealand, despite claims that the availability of abortion provides a precedent.
It has been argued that if we do not allow destructive embryonic research then, logically, we also have to repeal the abortion laws. In other words, the availability of abortion is seen as setting a moral precedent for embryo-destructive research; as an indication that our society already accepts that pre-nascent human life may be terminated for good reason.
At first glance we might be inclined to agree with the sentiments of the argument on the basis that there is a direct link between the two issues – the direct killing of unborn human life. That said, the question invites a deeper consideration.
The way in which the abortion laws in New Zealand work is to recognise certain situations in which the mother's rights have precedence over the rights of the embryo/fetus. In other words, current laws governing abortion in New Zealand do not extinguish the rights of the embryo / fetus. Rather, they confirm the existence of embryonic / fetal rights. That is, when considering legislation and/or regulations involving embryo-destructive research, the current legal situation reinforces the existence of such rights as the starting point for any debate. What is at stake is the moral significance of those rights in the face of society's desire to develop new cures – a very different moral dilemma from the typical abortion scenario.
A critical difference is the status of the 'second party'. Abortion is a procedure which is reluctantly allowed to proceed in very limited circumstances on examination of the particular situation by a competent authority. In a paradoxical way the application of abortion law in New Zealand actually confirms that the norm is for human life, once conceived, to be born, not destroyed. Abortion is an exception to the norm in cases where it is deemed that there is a proven disadvantage to the mother and it is tolerated as a way of preventing specific harm to a specific person in a specific situation – essentially the mother. It is quite another thing to allow the destruction of pre-nascent human life for a cause that is only potentially related to the generic good of society sometime in the future.
Consequently, it does not immediately and automatically follow that we should equate the rights of a woman wanting an abortion with the needs of society to carry out stem cell research. That conclusion remains to be debated. Embryo-destructive research is not a logical consequence of the current abortion laws in New Zealand.
iv. Embryo-destructive research is unethical because the means employed is in conflict with the end that is sought.
The dilemma posed by embryo-destructive research comes about because of an apparent conflict between two key values; the desire - indeed responsibility - we have of curing terrible illnesses and diseases versus the need to show respect to human life in all its stages.
Moral theories offer various ways of resolving such conflicts. One approach that is favoured in our society today is to evaluate the competing values in terms of 'cost' and 'benefit'. For many people, the payoff of developing cures that could benefit millions is seen as being worth the cost – in this case the lives of a few (perhaps unwanted) human embryos. The ethical dilemma is presented in fundamentally numerical terms. This cost-benefit analysis reflects a desire to produce the best outcome and to maximise benefits – commonly referred to as the utilitarian principle. In simple terms 'the end justifies the means'.
It is over-simplistic to say that we are concerned about saving human lives and that this is sufficient justification for destroying human embryos. This is not an adequate ethical description of what is actually happening. It is inadequate because it ignores the deeper meaning of the action. Actions chosen as the means to an end have a meaning and moral quality of their own, independent of the circumstances or outcome, and not reducible to the outcome. The deeper meaning of what is happening is revealed by a closer analysis of the 'intent' and 'content' of the actions of those involved in embryo-destructive research.
In embryo-destructive research there is a lack of congruence between the means employed and the outcome or end that is sought? The 'intent' of the action and the 'content' of the action are at odds with one another. In fact there is a contradiction – human life is destroyed in the name of saving human life.
For any action to be ethically acceptable there has to be consistency between what is done – the means – and the reason it is done - the end.
v. To the extent that we are prepared to look at early human life in a more utilitarian and commodified way we are more likely to view and treat other human life in such a way.
"But they are going to be destroyed anyway!" This line of reasoning is used to justify research on embryos that are 'left over' from fertility treatments. Those who argue this way sometimes draw a parallel with the practice of organ donation; in giving its life for the sake of others an embryo's existence is given meaning and value. Its proponents argue that such an outcome appeals as a moral choice because it confers a reason for existence on the embryo, casting its death as an altruistic and salvific act and giving some value to its (otherwise meaningless) life.
This argument ignores any difference between what philosophers refer to as 'evil done' vs. 'evil suffered'; a distinction that rests on the moral importance of intention. If a person is run over and accidentally killed by a vehicle and another person is deliberately killed by another vehicle, it is not untrue to say that the outcome is exactly the same – in each case a dead person. However, at the moral and legal level we do not regard the two incidents in the same way because intention matters. It is always bad when a human being is killed, but it is worse when their death results from the deliberate and evil will of another. In other words, the moral evil of murdering someone is a greater threat to human dignity and society than is the physical 'evil' of death alone. In the same way, just as it is ethically inadequate to judge these two incidents simply from the perspective of what is lost, so too it is inadequate to count and compare the lives of embryos lost while assuming that how they are lost somehow does not matter.
While embryos created for IVF and held in storage are eventually going to perish this is not the same as intentionally destroying them. (The same logic applies to those who argue that the high natural attrition rate of embryos in utero somehow makes it acceptable to intentionally kill embryos.) To consider that there is no ethical distinction between allowing embryos to die and intentionally destroying them is to fail to take proper account of the moral harm associated with the deliberate destruction of human life; in particular its wider repercussions and consequences for the way we look at all human life.
What might be the wider repercussions? Firstly, it is a fundamental axiom of morality that all our actions are self-reflexive; that is to say, what we do reflects back on ourselves; we become what we do. Our actions have either a positive or a negative effect on our moral sensibilities, both individually and collectively. Once we recognise that all our actions shape our characters - either positively or negatively - we can also recognise that there are some things we should never do simply because they will damage our moral character and the moral underpinnings of our society.
To the extent that we are prepared to adopt a utilitarian approach to the status of human life in embryonic form, we are more at risk of perceiving and treating other human life in a utilitarian manner.
vi. Because the proposed benefits of embryonic stem cell research are at best hypothetical and indeterminate, there is no basis for even a utilitarian rationale in favour of embryo-destructive research.
Even a cursory analysis of the New Zealand discussion about the use of human embryos as a source of stem cells shows that the promise of beneficial treatments remains uppermost in people's minds. A recent Sunday Star Times article is typical of the way the debate has been carried out in New Zealand: "Embryonic stem cells have the potential to turn into any other cell in the human body ... and hold the promise of astonishing new disease therapies" (Sunday 18 Feb 2007). In that same article the chair of ACART suggests that the dilemmas posed by the use of human embryos can be resolved by a process of weighing up and comparing the benefits versus the harms.
Our own position (as already noted) is that utilitarianism cannot offer an adequate framework for resolving the ethical dilemmas associated with the deliberate destruction of human life. We recognise that not everyone is prepared to accept that this is the case. Nevertheless, without yielding our own moral ground, we fail to see that any real or meaningful comparison of "benefits" and "risks" is able to be made at this point in time given that there is no tangible evidence of outcomes, and given the general consensus that the clinical benefits could be a decade or more away.
To this end, we were somewhat surprised (and concerned) that the ACART discussion document continues to refer to SCNT as "therapeutic cloning". In overseas literature there has been a deliberate move to re-label such cloning, many preferring to use the term SCNT. Using the term "therapeutic" provides an inaccurate description of what is actually happening and reinforces the mistaken impression that such experiments are therapeutic in nature. In short the term conceals rather than reveals what is really happening.
If alternatives exist that will enable stem cell research to continue without the need for further destruction of embryos – and they do – then, from a purely utilitarian perspective, it would seem imperative that there be specific evidence of additional benefits to justify the immense additional "harm" associated with the destruction of human life. Lack of such evidence renders the utilitarian calculation impotent. From a strictly rational point of view it is irresponsible, and therefore unethical, to follow a path that results in extra harm in the absence of any tangible evidence of additional benefits.
We make this point not to imply that evidence of such benefits would legitimise embryo-destructive research, but simply to emphasise that, for those who subscribe to utilitarianism, an honest utilitarian calculation cannot currently be made in support of such research.
Recent comments made by eminent stem cell researchers not averse to embryo-destructive research highlight the uncertainty surrounding the prospects of therapies. Alan Trounson, an eminent Australian scientist involved in stem cell research, has been quoted in a Nature Medicine article as saying: "The so-called therapeutic cloning to my mind is a non event." In terms of developing therapies or cures he has said that "it's just not realistic." ("Scientists seek simple remedies to cloning conundrums". Nature Medicine. May 2005, p. 459.) In the same article a prominent US cloning researcher, Jose Cibelli, professor of animal biotechnology at Michigan State University concurs: "I can predict that therapeutic cloning is going to be obsolete." In a similar vein Lord Winston, a pioneer of fertility research in the UK who has pushed for embryo-destructive research, has admitted that in the 2001 debate in the UK the immediate potential of embryonic stem cells was exaggerated. He has described the debate surrounding embryo stem cells as a case study in scientific arrogance and the dangers of 'spinning' a good story and has commented: "I view the current wave of optimism about embryonic stem cells with growing suspicion" (The Guardian, September 5, 2005).
The disconnect that exists between the picture of individualised cures painted by those pushing for embryo-destructive research, and the lack of evidence that sick people will ever benefit from stem-cell research, remains of very real concern to us, as does the lack of awareness of that disconnection in the general media and public perception. The net effect of this is to exploit the emotions of many patients and their families. The existence of the disconnect threatens to undermine the integrity and value of the public consultation process currently being undertaken in New Zealand. While the ACART discussion document warns that "[an] appropriate degree of caution is therefore necessary in discussing the potential benefits of this research" (n. 88) it appears that it is the prospect of therapies that continues to be used to drive public opinion about the merits of embryo-destructive research.
If contemplating relaxing a legislative ban on SCNT, or the creation of embryos specifically for embryo-destructive research, it would at this point in time be grossly misleading – if not unethical – if ACART's advice to the Minister was argued on the basis of unproven potential for therapeutic outcomes.
vii. Other ethical alternatives to embryo-destructive research exist and New Zealand has a unique opportunity to exercise leadership by taking a principled stand in favour of stem cell research AND the dignity of human life.
In recent years there has there has emerged a growing body of research that is focused on developing cells with the abilities of those derived from embryos, but without the need to harm human embryos. The new avenues include the reprogramming of adult cells to function like embryonic stem cells, deriving pluripotent cells from testes and the discovery of cells with seemingly pluripotent abilities in the placenta, human cord blood and amniotic fluid. On top of that, progress continues in the field of adult stem cell research, including promising studies that are challenging the long held paradigm that adult stem cells have undergone an irreversible process of terminal differentiation. In other promising research carried out in 2006 Japanese scientists Kazutoshi Takahashi and Shinya Yamanaka have produced pluripotent stem cells by introducing four key factors into mouse cells under specific culture conditions; a process that totally bypasses the use of eggs and the creation of embryos.
When other alternatives exist we have an ethical obligation to follow those alternatives.
New Zealand has, over the years, consistently shown moral courage and leadership by taking principled stands on a host of issues related to upholding human dignity and advancing human well-being. Research that does not uphold human dignity will not ultimately advance human well-being. We need to foster and support stem cell research in New Zealand that is ethical and that promotes human dignity even while it seeks to serve the greater common good. Ample opportunity exists for us to do. We have the opportunity to make a significant contribution to advancing the causes of human health and well-being without resorting to the deliberate and intentional destruction of human life in embryonic form.
3 . The discussion paper outlines a number of possible sources of gametes and embryos for use in research. What are your views on the use of these sources?
All sources of embryos should be prohibited. We oppose all forms of embryo-destructive research as noted above.
The donation of gametes would need to be governed by strict procedures that uphold the key principles that form the basis of all health research ethics review in New Zealand. As noted in our response to Question 1 we are particularly concerned about the potential exploitation of women as a source of eggs, as well as the risks to women inherent in obtaining the eggs.
The HART Act requires ACART to give advice specifically on the genetic modification of gametes and embryos and the import and export of gametes and embryos.
4. What are your views on genetic modification of gametes?
We believe that the genetic modification of gametes should be subject to a lengthy moratorium.
We believe that this question has huge implications for society. It is too important and too complex to be dealt with in such a cursory fashion in a document that is arguably focussed on a range of other ethical dilemmas. The ethical issues associated with this question warrant a discussion document and full and substantial public consultation in their own right.
It is questionable whether at this time we possess the wisdom and maturity to handle such technology wisely and safely.
5. What are your views on genetic modification of embryos?
Genetic modification of embryos should likewise be subject to a lengthy moratorium.
The only basis on which we would ever consider that it might acceptable to genetically modify a human embryo would be in circumstances where it was done as a therapeutic intervention that was aimed at the prevention of serious hereditary diseases and specifically carried out in the interests of the embryo in question and prior to it being implanted. In other words such interventions would need to uphold the inviolable dignity of all human life as expressed in our response to Question 2 above.
6. What are your views on the import and export of gametes?
We think it is acceptable that the import and export of gametes should be regulated through the development of guidelines and then assessed on a case-by-case basis.
That said, New Zealand must not compromise its stance against the commercialisation of body tissue including gametes. A fundamental premise of research in New Zealand is that the tissue is donated by people who were fully informed, and who gave their full consent as part of a process that was free from any sort of coercion. This should remain a condition of using gametes in research, whether that research is based in New Zealand or overseas and whether the gametes were sourced in New Zealand or overseas. Our commitment to the non-commercialisation of tissue should mean we reject the importation of all tissue obtained in a commercialised manner.
One of the challenges facing researchers who import gametes is the difficulty in verifying the manner in which tissue was obtained overseas. Given the potential for exploitation of women in order to gain eggs, we are particularly concerned about the importation of eggs from other countries where ethical oversight may be less robust than it is in New Zealand.
Similarly the export of gametes raises ethical as well as cultural and spiritual issues. It is questionable whether the provisions upon which tissue is donated will always be upheld by researchers in other countries.
7. What are your views on the import and export of embryos?
The import and export of embryos should be prohibited. We are opposed to all embryo-destructive research and therefore oppose the import and export of embryos for research purposes.
8. Principle (g) of the HART Act states that the different ethical, spiritual, and cultural perspectives in society should be considered and treated with respect.
We are interested in your views on how this principle could be incorporated into New Zealand's policy position on gamete and embryo research.
What are your views on how this principle could inform ACART's advice to the Minister, and, if research does proceed in some form, how it could be reflected in guidelines?
New Zealanders hold various ethical, spiritual and cultural beliefs which influence their views regarding the use of human embryos in research. Nevertheless, we believe that there is a clearly identifiable common core of values that form part of most people's world view. We identify the values relevant to this discussion as: a concern to find cures and advance medical research; a commitment to uphold human dignity and promote respect towards human life; a commitment to show appropriate respect to human life in its earliest forms; and a strong sense of stewardship of, and respect for, all life forms and the environment.
These core values which characterise the various ethical, spiritual and cultural perspectives of New Zealanders can best be respected by a policy position that promotes only stem cell research using pluripotent cells obtained by means that do not require the destruction of human life in its most basic form.
It is possible to foster and support stem cell research in New Zealand that is ethical and that promotes human dignity even while it seeks to serve the greater common good. As noted above, research that does not uphold human dignity will not ultimately advance human well-being. New Zealand researchers are already renowned for their groundbreaking work with adult stem cells.
New Zealand has the opportunity to continue making a significant contribution to advancing the causes of human health and well-being in the field of stem cell research without resorting to the intentional destruction of human life in embryonic form.
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.