Sunday, April 29, 2007

Ethics: Mother and sister, mother and grandmother

Margaret Somerville,
Citizen SpecialPublished: Friday, April 27, 2007
Page a15 / arguments

Now that human eggs can be frozen, the effects of gamete donation on the resulting children are the subject of an overdue debate

Last week it was announced that a Montreal woman, Melanie Boivin, hadundergone ovarian stimulation and had her ova (eggs) frozen for possiblefuture use by her daughter, Flavie, who has Turner's syndrome and who willbe infertile as a result. While Melanie's action was done entirely out oflove for her child, if Flavie uses those ova she would give birth to herhalf-brother or half-sister, and the child would be the son or daughter andgrandchild of Melanie.

The media reported this case on two fronts: The scientific focus was therecent "breakthrough" of being able to freeze human ova.

The ethical issues this raises was the other focus. Leaving aside for themoment the most fundamental question of whether any gamete donation isethical, here's a sampling of some ethics questions I've been asked in thepast few days.

If a young man is infertile and his wife fertile and they belong to acultural group in which genetic relationship is very important, is itacceptable for the man's father to donate sperm to inseminate his son'swife? This would result in the same genetic relationship on the male side as would result on the female side in the Boivin case.

I would argue that both are ethically unacceptable, but if the male donationis seen as acceptable, consistency seems to require, at least at firstglance, that the female donation be treated in the same way.

Is one problem here that it's a parent donating to a child? What about theother way around -- a daughter donating ova to her mother who hasexperienced premature menopause? If we accept that gamete donation can beethical in some circumstances, would it be ethical for a brother to donate sperm to a brother, or a sister donate ova to a sister? Or is any donationbetween close relatives unethical?

An obvious case of such ethical unacceptability would be a brother donatingsperm for his sister's use. This would not be incest, because that requiressexual intercourse, but the vast majority of people would see it asethically wrong, quite apart from the genetic risk involved for theresulting child. But how should we view these other "related donor" casesand do they all raise the same ethical issues?

For instance, is a man donating sperm for his son's use ethically differentfrom a woman donating ova for her daughter's use? The wider question thatraises is: Are there ethically relevant differences between male and femaledonation of gametes? And the even wider one: Is gamete donation itselfethically acceptable?

Let's start with the last question, whether gamete donation, in general, isethically acceptable.

"Anticipated consent" is an emerging doctrine in ethics. It requires us toask whether we can reasonably anticipate that the persons most affected bywhat we plan to do would, were they able to decide, be reasonably likely togive their consent. The answer we are now getting from many people conceivedthrough gamete donation is that they would not have consented.

They believe that an ethical wrong was done to them -- especially if thedonation was anonymous -- and that society was complicit in that wrong byproviding its resources to make their conception through gamete donationpossible. Some people respond that many children conceived naturally don'tknow who their father is or are reared in a family where their mother'shusband is not their genetic father, so why is sperm donation an ethicalproblem?

The reason is society's intentional involvement in their conception in thatway. This complicity requires society to ethically justify the outcome forthe child. Because ova donation can never occur naturally and alwaysrequires technological intervention, unlike "private" sperm donation,society will necessarily be complicit in it, and therefore must ensure suchethical justification is present.

That being said, might there be differences between sperm donation and ovadonation that are ethically relevant? Children conceived through spermdonation have life handed on to them through the natural process ofconception and birth. That is not true of ova donation, because the gestational mother is not the biological mother, a situation that couldnever occur naturally.

Usually, the nearer we are to the natural in using the new science, thefewer ethical difficulties we are likely to encounter. This distinction issometimes summed up as the difference between repairing nature when it failsand doing what is impossible in nature.

In a broad sense, all children are conceived by "sperm donation," whichmight explain why we have not analysed the ethics of such donation asclosely as perhaps we should have. Sometimes, further scientificdevelopments cause us to revisit practices that we have regarded asethically settled and identify further ethical questions that need to beaddressed.

I believe ova donation is doing that in relation to sperm donation, at leastregarding the conditions under which it should be allowed. For instance,there is a growing international consensus that anonymous gamete donation isunethical and should be prohibited. To the contrary, the Canadian AssistedHuman Reproduction Act makes it a crime, with heavy penalties, to disclosethe identity of gamete donors without their informed consent.

The fertility industry -- a $5-billion (U.S.) per year business in theUnited States -- is strongly opposed to prohibiting either anonymous gametedonation or payment of gamete donors, because such prohibitions can decreaseaccess to gametes. Yet, strikingly, altruism is used as a major marketingtool to recruit donors. I suggest that emphasis helps to suppress moral intuitions donors may experience about the ethics of what they are doing inrelation to their resulting child. What is clear is that without payment,whether in cash or kind, many people -- in particular, women -- are not willing to donate.

Other, more general, questions I was asked in relation to freezing ovaincluded whether women would now store ova as teenagers in order to attaintheir career goals before having babies in their 50s. The companion commentwas invariably, "If men in their 70s can father a child (and usually CharlieChaplin and Pierre Elliott Trudeau were mentioned as examples), what's wrongwith a woman being a new mother at that age? Isn't preventing women fromfreezing their ova to use at any time during their lives, discrimination onthe basis of sex and age?"

I would argue, again, that there is a difference ethically between thatwhich happens naturally (old-age fatherhood) and that which is impossiblenaturally and requires a technological intervention to do an end run aroundnature (old-age motherhood).

Sometimes scientific advances solve some ethical problems rather than -- or, as well as -- creating new ones, and that is true of freezing ova. Just aswe've been able to freeze sperm for young men whose fertility is threatened by cancer treatment, we can now freeze ova for young women in the same circumstances. That will avoid the ethically troublesome situation of havingto create an embryo in order to preserve a young woman's opportunity to haveher own genetic child and heartbreaking situations such as that of theBritish woman who stored embryos created with her partner's sperm beforecancer treatment that left her infertile. Her partner later withdrew hisconsent for her use of the embryos and the European Court of Human Rights,the final court of appeal, consistent with all the other courts which heard the case, has just ordered them destroyed.

Ova freezing is just one more example that raises the broad question: Howshould we deal ethically with scientific advances in reproductivetechnologies? I propose that all these technologies must be ethicallyevaluated primarily through the lens of the children who will result from their use.

That lens requires that, at the very least, we first do no harm to thosechildren; that we respect their fundamental human rights to come into beingfrom natural biological origins; and that we act in their "best interests,"in particular, in preserving their natural genetic relationships.

Except for concern about physical risks to children from using reproductivetechnologies, the focus up to now has been almost entirely on the rights ofadults, who want to have a child, to use these technologies -- that is, onlythe adult lens has been used. That has caused a failure to consider, in thedepth and breath required, both what ethics requires with respect to thechildren conceived through the use of reproductive technologies and thefundamental human rights of those children with respect to their coming into being.

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