The Institute of Obstetricians and Gynaecologists officially represents obstetrical and gynaecological opinion in Ireland and promotes excellence in the areas of patient care and professional standards. We very much welcome the heads of the children and family relationships Bill and are delighted to have an opportunity to contribute our opinion. Our attention has focused on heads 1 to 30, inclusive, as they involve parentage issues relating to assisted human reproduction and surrogacy.
In response to publication of the heads of the Bill, an expert group of obstetrician gynaecologists was formed to compile a written opinion on behalf of the Institute of Obstetricians and Gynaecologists. However, fertility treatment is very much a multidisciplinary effort that includes not only doctors but also embryologists, nurses, counsellors and administration staff. Therefore, in order to obtain as wide an opinion as possible from assisted reproductive technology, ART, practitioners in Ireland, an invitation for input was extended to the Irish Fertility Society, the Irish Clinical Embryologists group, the Irish Fertility Counsellors Association, IFCA, the Irish Fertility Nurses Group, IFNG, and representatives of all long-established assisted reproduction units in Ireland. This document can, therefore, be regarded as representing a consensus opinion among all of these groups.
We were mindful of the report of the Commission on Assisted Human Reproduction in 2005, the Irish Fertility Society consensus on infertility and ART practice in 2011 and the recent Supreme Court and High Court judgments. While we welcome the heads of the Bill, we acknowledge the complexity of the issues involved and make the following 11 major observations. Other recommendations are included in our written report.
We identify the need for clarity in the medical terms used in the Bill. Clarity and accessible language are paramount in a complex medical area such as this. The term "conception" used in the Bill is vague, with no clear medical definition. In assisted reproduction, key events, including consent, happen at the time of sperm insemination in insemination cases and in IVF at the time of formation of an embryo but also at the time of its subsequent transfer to the uterus. We suggest, therefore, that throughout the document the term "conception" be replaced by clear time points relevant to the particular treatment being undertaken. Similarly, the term "human reproductive material", as defined in the Bill, is confusing. We suggest the terms "sperm", "oocyte" and "embryo" be used instead. We also stress that the legislation refers to the embryo only prior to implantation.
We believe the Bill should address the importance of counselling for persons undergoing assisted reproduction treatment. Professional counselling should be mandatory in cases involving donor conceptions and surrogacy.
We propose that the Bill address anonymity or non-anonymity of donors of sperm, oocytes or embryos. Whether gametes or embryos are donated on an anonymous or known basis, it should not affect legal parentage, but the right of children to access information on their genetic origins needs to be urgently considered.
We think the legislation should incorporate provisions for posthumous conception through assisted reproduction. This issue is of great concern to couples undergoing assisted reproduction. Several Irish ART clinics already provide this service. This is common practice in some European countries, including the United Kingdom. It is of particular relevance to those who have been diagnosed with cancer and wish to freeze sperm, oocytes or embryos.
We support a non-commercial approach to treatment, but propose that the Bill allow the payment of reasonable expenses to donors of sperm, oocytes and embryos.
We propose that in the Bill it be acknowledged that in cases of sperm, oocyte or embryo donation, there may be only one parent.
With regard to surrogacy, we propose that the Bill include a mechanism whereby potential surrogates and potential patients may access information on surrogacy services.
We propose that the Bill include cases where a child is conceived using a donated embryo or an embryo where the sperm and oocyte have both been donated by third parties.
We propose that the Bill include cases where a surrogate conceives using her own oocytes. There are several medical reasons for this on which we can elaborate.
The Bill should clarify the legal rights and obligations of all parties entering into a surrogacy arrangement regarding: (a) the right of the surrogate to dictate medical care for her and her foetus during the pregnancy; (b) legal responsibility for care of the child, including decision making and consent, during the interval from birth to the time of assignment of parentage; (c) responsibility for the care of a child born with a significant disability or foetal anomaly.
We believe the proposed penalties for offences in respect of payment for surrogacy may be unworkable.
My colleague, Dr. Mocanu, and I will be very happy to elaborate on these proposals. We thank the committee for giving us the opportunity to present these carefully considered views on behalf of our members and, more importantly, our patients and their current and future children. A major strength of our submission lies in the fact that it represents the considerable experience of a multidisciplinary group working at the coalface of assisted reproductive technology treatments in Ireland. We would be delighted to offer our services in the future to aid in the development of this much needed and much welcomed Bill. We realised there were some minor typographical errors in our original submission to the committee in February and have sent a corrected version to the secretariat for circulation to members.