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.


Monday, April 16, 2007

Judge says accidental sperm donor has no right to know if he's a father

Posted by The Oregonian April 16, 2007 15:56PM
By Ashbel S. Green

A Portland man whose sperm was inadvertently given to a Salem-area woman has no right to find out whether he is a father, a Multnomah County judge has ruled.

Circuit Judge Henry Kantor said he was not finished writing his opinion, but wanted the parties to know his decision because it had been so long - nearly seven months - since they argued the case before him.The man, who sued for a paternity test under the initials M.H., claimed that he produced a sperm sample at Oregon Health & Science University's fertility clinic in September to impregnate his fiancee. The same day, a Marion County couple that had struggled to start a family was visiting the clinic. A mix-up occurred, and clinic workers gave M.H.'s sperm sample to the woman.

OHSU has apologized for giving the woman the sperm.

M.H. claims OHSU officials initially lied about what happened to his sample, only conceding later that they gave it away.

The woman claims OHSU officials tried to coerce her into having an abortion.

Since then, M.H. has filed two lawsuits: one to establish whether he is the father of a child and another to get $2 million from OHSU for emotional distress.

Jane Paulson, an attorney for M.H., declined to comment on whether her client would appeal.

Michael G. Smith, the attorney for the Marion County couple, praised the decision. He said he expected M.H. to appeal. "I think essentially what they would be doing is to ask the Oregon Court of Appeals to declare Oregon's artificial insemination statute unconstitutional, which is a tall order," Smith said




109.239 Rights and obligations of children resulting from artificial insemination; rights and obligations of donor of semen

109.243 Relationship of child resulting from artificial insemination to mother’s husband

109.247 Application of law to children resulting from artificial insemination

109.239 Rights and obligations of children resulting from artificial insemination; rights and obligations of donor of semen. If the donor of semen used in artificial insemination is not the mother’s husband:
(1) Such donor shall have no right, obligation or interest with respect to a child born as a result of the artificial insemination; and
(2) A child born as a result of the artificial insemination shall have no right, obligation or interest with respect to such donor. [1977 c.686 §5]

Note: 109.239 to 109.247 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 109 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.

109.243 Relationship of child resulting from artificial insemination to mother’s husband. The relationship, rights and obligation between a child born as a result of artificial insemination and the mother’s husband shall be the same to all legal intents and purposes as if the child had been naturally and legitimately conceived by the mother and the mother’s husband if the husband consented to the performance of artificial insemination. [1977 c.686 §6]

Note: See note under 109.239.

109.247 Application of law to children resulting from artificial insemination. Except as may be otherwise provided by a judicial decree entered in any action filed before October 4, 1977, the provisions of ORS 109.239 to 109.247, 677.355 to 677.365 and 677.990 (3) apply to all persons conceived as a result of artificial insemination. [1977 c.686 §7]

Note: See note under 109.239.


Wednesday, April 04, 2007

UK NGDT Chair Defends “Give a Toss” Sperm Donor Campaign

Recruiting sperm donors: why it's time for a new approach

Laura Witjens, Chair, National Gamete Donation Trust
April 4, 2007

The National Gamete Donation Trust (NGDT) has never believed that removal of anonymity in the UK caused the decline in sperm donor numbers. As we said in a previous BioNews commentary: 'It is important to remember that, with or without the removal of anonymity, there have never been enough gamete donors in the UK to meet the demand. One of the main problems continues to be lack of awareness' (BioNews, 7 August 2006).

In the same commentary we called for a 'can-do' attitude and referred to the clinics that have done well in recruiting. However, a year down the line we can only draw one conclusion. Whilst the model of donor recruitment of successful clinics can be emulated, it isn't. Furthermore, even at their most successful, it is highly unlikely that the handful of clinics that have done well in recruiting sperm donors would be able to satisfy the national requirement, which is estimated to be 500 donors at any given moment. There is a shortage and without a national approach we will continue to have one.

The Department of Health-funded 'Give Life Give Hope' campaign (2005), which coincided with the announcement of the removal of anonymity, allowed the NGDT to measure responses. We learnt that men who responded well to the campaign were in their thirties, avid users of the internet and hardly ever responded to just one message alone. We also learnt that getting the message across is a very expensive exercise. The advice we were given was that we should expect to spend on average £100,000 per year on public relations in addition to a skilled full time public relations staff member. A start-up advertising campaign would cost £500,000 for magazine advertising, £50,000 for radio and, if possible, TV at about £1m. Each year thereafter we should expect to spend £500,000.

So when we were approached by BDP Creative, who were interested in exploring and demonstrating the benefits of a digital viral marketing campaign, we were excited. It combined some of the points we had seen in the earlier campaign and it was aimed at our target market. They were looking for an interesting public service project to which they could bring their unique skills. Viral marketing facilitates and encourages people to pass along a marketing message. If a large percentage of recipients forward something to a large number of friends, the overall growth snowballs very quickly. If the pass- along numbers get too low, the overall growth quickly fizzles. For viral marketing to work, the initial message is required to capture the imagination of so many people that they pass it on to their friends by email. For marketing purposes, humour or eccentricity is often the key.

Our immediate reaction was to be cautious. It was obvious to all of us that this was likely to be sensitive. Also, as was recognised in a BioNews commentary published on 20 March 2007, the NGDT has been working hard to change the image of sperm donation and has made real progress together with the clinics. We would not want to tarnish the good work that has been done and we continue to be involved with. However, as our discussions progressed, discussions which included parents of donor conceived children, we decided that it was worth trying. We felt that the opportunity to address such a wide and otherwise new audience and get over the message justified a slightly over the top approach. We have to communicate with potential donors in a way that reaches them as they are, not how we would like them to be. We wanted to harness the typical and immediate response of the general public to work to our advantage, rather than be put off by it.

The purpose of the new campaign is threefold. Firstly, we are hoping to raise awareness of the need for sperm donation amongst young men, particularly amongst those whom we cannot reach by our normal methods, in the hope that a proportion of the older ones, in their mid to late thirties, will come forward in the nearish future. Our second purpose comes from our observation that people try new and interesting activities because they have heard of them over a period of time from a variety of independent sources. Typically, we might have read an article about something; a little bit later we see a documentary on the subject so that when a friend raves about it we decide to give it a try. So our other purpose, and perhaps the most important, is to plant the seed of the idea amongst the target group so that if and when one or more further triggers arise during the next few years, the seed will germinate into the act of donation. Finally the third purpose was to generate a debate on the issues in the wider media.

We do not believe that this campaign affects the altruistic nature of donation, that is, the kindness of the kind man. No one will donate because they think our campaign is funny; only those who take the bait, read on and get the message. Potential sperm donors that contact the National Office receive a full information pack with practical, legal and medical information. Initial follow-up calls suggest that these men did get the message, and a substantial percentage have actually decided to go on and contact a clinic. Regardless of what message made the potential sperm donor contact a clinic or the NGDT, we believe a donor is a very special, caring and committed person.

Due to a variety of circumstances, there is a lot of talk, not enough action and little money for organisations like ourselves. We are therefore grateful to be given this opportunity by BDP Creative. This campaign - which has cost the NGDT, the sector and the tax payer no money at all - has spurred over 100 potential sperm donors (with an average age of 26.8) to contact the NGDT in just over two weeks. Clinics have reported an increase in enquiries as well. The campaign 'Give Life Give Hope', attracted the same number of enquiries in double the time.

Finally, we'd like to quote Richard, a DC father (who was asked his views as the campaign was developed): 'It is all very well pussyfooting around the subject matter, trying to avoid upsetting the sensitivities of those that do not approve of DC in principle or to look at the present situation and say that the NGDT are undoing years of work to remove the stigma of donating when the current shortage of donors does not directly affect you. The reality is that those many years of work have simply not delivered results'.

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NYMag: Israeli Donor Egg Farming

There is a shortage of Jewish in vitro eggs. Hopeful parents are turning to the Promised Land.

By Kira Peikoff
New York Magazine
April 9, 2007

Here’s a riddle for your rabbi: If your baby is born from in vitro fertilization, and the donated egg isn’t from a Jewish woman, is the baby really Jewish? Although different branches of Judaism have different answers—Reform says it’s about how the kid’s raised; Orthodox rabbis tend to believe a conversion is necessary—many parents want to make sure their child is a member of the tribe down to its DNA. The problem is there aren’t enough Jewish eggs to go around. So a new type of yenta has arrived on the IVF scene who finds suitable donors, usually from Israel, to match with Americans seeking to become pregnant.

According to the director of NYU’s egg-donation program, Dr. Frederick Licciardi, at his clinic last year, 43 of the 130 women waiting to receive an egg were Jewish, and yet only 19 of the 91 anonymous donors were even partially Jewish. “Americans are not donating at the rate they are needed,” he says. So the clinic allied with a Jewish egg-donor agency that recruits Israeli women, called the Ovum Donor Registry. Judi Fleishman, founder of the Manhattan-based agency, explains that in the early nineties, Fleishman’s doctor kept asking her if she knew of any Jewish egg donors, so she placed ads in Israeli newspapers, and 25 responded. In 1996, she signed a contract with NYU, which had opened its fertility center four years before. Fleishman, who is fluent in Hebrew, still advertises in Israeli newspapers but says 90 percent of her donors reach her through word of mouth from past donors. She’s worked with about 500 women to date.

Another director of a Manhattan-based Jewish egg-donor agency, Ruth Tavor, says hospitals suggested to her in 2002—when she was pregnant with a donated egg—that she start a Jewish-egg-recruiting business. Now her agency, New York LifeSpring, works with fifteen hospitals around the country, three of them in New York.

“So many centers are contacting me because I have access to Jewish donors,” says Tavor, who recruits Israelis exclusively. “Jewish women here, for some reason I don’t know, do not donate.” Fleishman has a theory. “Americans are very phobic about taking hormones—they do a disconnect between taking hormones and taking birth control.” (A donor takes a daily regimen of hormone injections to stimulate her ovaries to produce about fifteen eggs.) “It doesn’t have the stigma in Israeli society.”

Most Israelis travel for a year to South America or the Far East after their army service ends. Some young women stop in the U.S. along the way and donate. Many of the donors use their payment of $8,000 to help finance their studies once they return to Israel. Fleishman takes her cut—$3,500 per transfer—from the waiting couples, who pay roughly $30,000 in total for one cycle. One Israeli woman who donated twice through NYU notes that Israelis may identify more strongly with infertile couples because of their society’s strong pressure to reproduce, noting that “the state gives money to women who give birth.”

Neither NYU nor Fleishman or Tavor will accept or pay more money for Jewish eggs, but one unrelated college classified ad promises Jewish donors $20,000.

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