I am delighted to have this opportunity to speak to the Joint Committee on Health about the general scheme of the assisted human reproduction Bill 2017 and I thank the Chairman and the committee for inviting me to speak. I am a consultant in Holles Street hospital and the clinical director of Merrion Fertility Clinic, which is affiliated to Holles Street hospital. I was a member of the commission on assisted human reproduction, which produced its report in 2005, and I am delighted to see that except for the proposals on parenthood in surrogacy the draft Bill accords with the recommendations of the commission.
Before I talk about specifics of the proposed Bill, I will mention some important issues related to infertility and assisted human reproduction. The first thing I want to say is that the experience of infertility is one of the most distressing and painful experiences one can have. People who have not been through it often do not appreciate it and can be relatively unsympathetic.
For many years now, infertility has been recognised by the World Health Organization and other medical bodies as a medical condition. Assisted human reproduction is a medical treatment. It is not an optional luxury. IVF is probably one of the greatest medical advances of our time. Sadly, however, assisted human reproduction is an area of medicine that has become extremely commercialised, partly due to the lack of public funding in countries such as Ireland and partly due to the involvement of multinational commercial companies in the area. Merrion Fertility Clinic, where I work, is the only not-for-profit fertility clinic in Ireland and the only one linked to a public teaching hospital. We definitely need more public engagement in this area. People with infertility are often desperate to have a child and this makes them very vulnerable. They are vulnerable to financial exploitation and to spurious treatments with no proven value and they are vulnerable in our courts. For all of these reasons we need legislation.
The Institute of Obstetricians and Gynaecologists has made a submission to the Joint Committee on Health regarding the Bill. I chaired the working group, which prepared the institute document and I have authority to present that opinion, which mirrors my own. I have also submitted the institute's submission to the committee.
It is impossible in five minutes to cover everything in the Bill but I will outline some of the key issues that concern us. Assisted human reproduction is one of the most rapidly evolving areas of medicine and science so it is important that any legislation we introduce is not overly prescriptive and that it does not prevent future adaptation to new medical developments, which are happening all the time in this area. Particularly in the context of the forthcoming referendum on the eighth amendment, it is important that assisted human reproduction treatments are not confused with those of early pregnancy. Assisted human reproduction concerns only the in vitro or pre-implantation embryo to which Article 40.3.3° of the Constitution does not apply.
We all agree it is essential to avoid multiple pregnancies following assisted human reproduction treatments. However, the recommendations in the Bill regarding the number of embryos to transfer are not entirely appropriate and we would like to discuss it further. It is suggested that a person can donate gametes - that is, eggs or sperm - at the age of 18 but cannot receive treatment until the age of 21. We recommend that those ages are reversed.
We are delighted to see that posthumous assisted reproduction is being legislated for. The proposal, however, allows this only for women and we feel it is discriminatory to men. A surviving male partner should be allowed to use his deceased female partner’s eggs or their joint embryos, if she consented to this prior to her death.
Counselling is an essential part of assisted human reproduction treatment and must be encouraged. However, in line with international opinion we do not agree it should be mandatory for everybody having AHR treatment. It should only be mandatory in cases of donor-assisted conception, posthumous assisted reproduction or surrogacy or where health care staff have particular concerns about a patient’s emotional well-being.
We agree that a pre-implantation genetic diagnosis should be allowed. Pre-implantation genetic screening should also be included and, while it is a very new technique, mitochondrial donation should not be banned.
With regard to surrogacy, it is clear to us that the restrictive provisions proposed would mean that the demand for surrogacy by Irish citizens would not be met by domestic surrogacy. Irish patients will continue to travel overseas and bring their children home to Ireland. The legal position of these children and their intended parents is not addressed in the Bill. We believe it should be. A worrying suggestion made in the Bill is that professionals not be allowed to aid people in planning surrogacy abroad. I would certainly find it unethical as a doctor not to be able to help my patients in that regard and suspect counsellors and lawyers would feel in a similar way. Regarding the legal parenthood of children born after surrogacy, we support the recommendation of the Commission on Assisted Human Reproduction that the intended parents, rather than the birth mother, be the legal parents from the outset. We also make other suggestions to protect the health and legal status of the surrogate.
Regarding donor conception and surrogacy, I personally wholeheartedly support the view that a donor-conceived person has a right to know his or her biological parent. However, with regard to the proposed national surrogacy register and the donor conception register under the Children and Family Relationships Act, we are totally opposed to the notion that a donor-conceived person who applies for a birth certificate would be told by the State that he or she was donor conceived without ever seeking that information. We believe that would be irresponsible, dangerous and a gross invasion of privacy. It is important that donor conception and surrogacy services be provided altruistically and non-commercially. However, if we want them to be available in Ireland, as we do, we need to look at ethical ways of encouraging the practice.
I will stop there, but in the institute's document there are other suggestions relating to age limits for treatment, storage limits for gametes and embryos, consent procedures and the proposed regulatory authority. My colleagues and I in the Institute of Obstetricians and Gynaecologists hope we can have an input into the final Bill, as we are the doctors most intimately connected with this issue and who will need to deliver the services to be provided.