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IVF and bioethics… November 24, 2011

Posted by WorldbyStorm in Bioethics, Science, Social Policy.
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Interesting editorial in the Irish Times about IVF this week. That said, there are a couple of assumptions I’d be a little hesitant about…

There’s little to quibble with the following:

THE FIRST live birth following in-vitro fertilisation (IVF) just over 30 years ago marked the start of a reproductive revolution. It involved fertilising a woman’s eggs with sperm, before transferring them back into the uterus a few days later. Today, assisted human reproduction in Ireland is a booming industry.

Though I’m never keen on the latter way of formulating it – though as I’ve noted previously there have been iniquities in relation to tax reliefs for people undergoing IVF [as with many medical procedures] where relief is at higher or lower rates, or at least was until recently, and therefore made what are by any measure expensive procedures prohibitively expensive for many – not least because IVF is not a one-shot event but something that is more akin to a process which may require multiple tries and even then with no guarantee of success.

Couples are increasingly choosing to have children later in life, which increases the likelihood of fertility problems. Restrictions on international adoption mean that many would-be parents are exploring other ways of having a child.

I wonder if that’s the dynamic at play? I suspect many go from IVF to adoption when the former proves unsuccessful. In other words IVF is now overwhelmingly likely to be the first port of call. Indeed it makes sense, infertility is in essence a medical problem and embarking on IVF comes on foot of referrals by family doctors when people discover that despite their own efforts pregnancies aren’t taking place.
In any event we’re now at a place where…

…up to 3,000 children are born here each year thanks to IVF and other high-tech interventions.

Actually some of them are probably quite low tech. IUI is fairly straightforward and more on this low-tech aspect in a moment. But note the following:

Yet there are no laws to regulate the industry. Ireland is almost alone in Europe in failing to provide any legislation or meaningful regulation. This gap is leaving many families, children and clinicians caught in a complicated web of legal and ethical uncertainty. As documented in Carl O’Brien’s 21st Century Baby series in this newspaper, the legislative gaps mean we have stateless children born by surrogacy with no legal parents; hundreds of children born as a result of anonymous donor sperm or eggs who will never know their genetic parents; parents who are forced to go abroad for donor assistance due to the State’s failure to provide any certainty for potential donors here.

I’m not entirely sure if that’s correct either. The absence of a framework doesn’t necessarily mean that there are impediments in all cases. Take donor eggs. It is possible to conceive using donor eggs in this state, but the supply is limited and often restricted to close friends or family assisting those seeking donor eggs. What is more likely to happen is that those who go down that path go to Europe [sometimes the Irish clinics will have programmes that facilitate precisely that] and even in that instance the issue of genetic parentage is open to question. For example a number of European states which allow donor eggs and sperm only do so under strict anonymity, so even if legislation changes here that will have no impact at all on that particular facet of the issue.

Indeed it is the this transnational element that perhaps points up how everything has changed and changed utterly. A world of Ryanair flights and much less expensive procedures than even a decade ago makes national decisions or approaches on this somewhat moot.

Which of course is not to say there should be no national policy frameworks. As the IT notes:

It is now over a decade since the government established the Commission on Assisted Human Reproduction to advise on how the area could be regulated. Six years ago, the group issued a series of considered recommendations. The government of the day pledged to introduce legislation as a priority issue. But there is still no sign of these proposed regulations.

I felt at the time, and still do, that one of the reasons for the non-appearance of those regulations was that it was easier for an intrinsically socially conservative party [in the main] like Fianna Fáil to duck the issue rather than confronting it head on. Not least because IVF and reproductive technologies not merely raise the ire of traditionalist religious of various stripes but also some aspects of conflict with some progressives. That doesn’t surprise me, this area is fraught with contradiction, paradox and profoundly difficult questions for many.

I mentioned earlier this year in comments to this post about Everything Conceivable: How Assisted Reproduction is Changing Men, Women and the World – by Liza Mundy which I found a fascinating and in parts deeply thought-provoking text about where reproductive technologies are leading us us. I probably take what might be regarded as a libertarian view on these issues not least because I suspect that these technologies, as the Irish Times itself notes, are already fundamentally reworking and reshaping our societies in small but significant ways, but also because I don’t believe they can be rolled back. What’s most amazing is that far from the image of these as being near-NASA like technologies of incredible fragility and contingency the reality is that they’re sturdy, easy to replicate and, as noted by Mundy in her research, can be practically established out of any shopping mall were the need to arise [indeed in the US which is almost entirely unregulated in this area that’s often precisely where they do operate out of]. Indeed much of the ‘aura’ of immanence I suspect comes from the perception – not entirely incorrectly either – that this is dealing with the fundamentals of life rather than the techniques themselves which in some respects are remarkably mundane from ground level.

Not that I entirely agree with the following either.

In addition, scientific advances are allowing forms of family life that were never possible before: single women or men who have decided, in the absence of a partner, to have a child, or gay couples who are co-parenting. The lack of a debate surrounding support for these family units means we have yet to face up to what, in time, may become one of the most socially influential technologies of the 21st century.

While obviously agreeing with the latter contention I’m dubious about the former. A small statistic perhaps brings home a reality that was often not faced up to …

Up to one in 10 men is not the true father of the children they think are theirs, according to new research by Biosciences, one of the leading DNA testing organisations.

What does that prove? That human relationships are complex affairs and that mon “conventional” family building has been going on for decades, centuries, and more power to people’s elbows too in that regard. And while the advent of these technologies has obviously assisted that, and perhaps may have the benefit of finally seeing them regarded as “conventional”, it’s only adding to something that was in play whether societies were willing to acknowledge that or not. Indeed as with too much there’s far too much of a tendency to see the past in a remarkably undifferentiated and un-nuanced fashion in these matters. And children and parents manage, in general to muddle along.

None of which is to dispute the conclusion of the IT editorial.

We urgently need our legislators to stop burying their heads in the sand and face up to how society is changing. Its failure to do so means that legal and ethical uncertainty will continue to be a gnawing source of stress for parents, and vulnerable children will be caught up in the fallout.

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