I thank the Minister for Health for coming to the House tonight. The matter before the House is the need for the Minister to set up a commission to bring forward best practice in the area of medically assisted reproduction.
The advance made in the past 20 years in medically assisted reproduction has brought the joy of children to many couples who in the past would have remained childless. Initially, the procedures were quite simple; but during the past 20 years treatments have evolved which have medical, ethical, social and legal implications. Irish centres for medically assisted reproduction have a success rate which compares with the best international ones. However, despite our long experience in this field we have not, as pointed out by Dr. David Tomkin and Dr. Patrick Hanafin in their recent book on Irish medical law, any legislation in this area. At present we rely on doctors, counsellors and scientists following the extralegal guidelines set down by The Medical Council. These have mainly been put forward by the Council of the Institute of Obstetricians and Gynaecologists and most of the doctors involved in the fields of medically assisted reproduction would be members of the institute.
Without any legislation in this area we must rely on these guidelines and foreign legal decisions as to what the law here would be if we had any. This is an unsatisfactory situation and I suggest that the Minister for Health set up a commission to advise him on legislation which is appropriate in this area. As well as legal and medical input, it should include lay people, particularly those who have been involved in treatment. Assistance from the members of the Association for the Improvement of the Maternity Services would also be invaluable.
Legislation in this field varies from country to country and from restrictive legislation, which is often brought about by a call from the public for legislation when something startling happens — for example, in Italy the extension of motherhood to those well beyond the menopause, to little legislation in other places. Without going into details about the legislation in other countries, the report by the committee chaired by Dame Mary Warnock in Great Britain is well known and led to the Human Fertilisation and Embryology Act, 1990.
The application of assisted contraception techniques, such as in vitro fertilisation, gamete interfallopian transfer, surrogate motherhood, etc. are complex, social, emotional and ethical problems. Questions must be asked about some of the procedures — for example, are they safe and ethical? Should “can” necessarily mean “should” or “ought”?
While there are few legal prohibitions on aspects of assisted reproduction in the United Kingdom, other countries are more restrictive. France and Norway, neither of which are known as illiberal countries, have quite restrictive legislation. The various treatments are evolving so rapidly that the legislation needs to be kept under constant review.
I suggested a commission because a wide range of views are needed on this subject, which not only concerns the couple involved and the medical team but also the child born following treatment, and society. At present we are failing to accept responsibility for regulating treatments, although we are aware they are being carried out here, or for Irish citizens in clinics in Northern Ireland or Great Britain. The revelation in the press recently that an Irish woman had gone to England to have treatment to enable her to act as a surrogate mother for an Irish couple who live here should make us realise that the use of advanced technology highlights the legal difficulties which could occur in such situations.
The lack of financial equity as regards treatment is important. An initial costing exercise was carried out years ago in St. James' Hospital and a submission was sent to the Department of Health regarding the funding of a national unit. However, little has been heard from the Department. At present the overall cost of a treatment cycle is approximately £1,500. Medical card holders are treated free because the fees of private patients are increased sufficiently to enable this to happen. While infertility may not be regarded as an illness, it seems inconsistent not to facilitate treatment for those of less adequate means, given our emphasis on the value of the unitary family. Private patients can reclaim fees against income tax and money spent on drugs is refunded by the health boards. However, the huge financial cost for young couples means that the State has a responsibility to carefully monitor the clinics where this treatment is carried out. Who is measuring the take home baby rate, as it is called? Is self-monitoring suitable?
Issue Ireland was formed last December by Irish couples with infertility problems to try to improve the situation. The main concern is that information should be easily available about what is on offer here and where treatment can be got abroad and its cost. A licensing authority is urgently needed. While I have no evidence of malpractice, we are dealing with vulnerable people who require the State to monitor the clinics they attend. The extra legal guidelines of The Medical Council should be replaced by laws. These guidelines exclude unmarried couples which causes great difficulties in a State without divorce.
Egg donation is forbidden, but we have approximately 700 women with Turner's Syndrome in this country who cannot produce eggs but could otherwise become mothers if donated eggs were available. Donor sperm appears to be available to help married and unmarried couples for artificial insemination, but cannot be used by married couples for in vitro fertilisation. Freezing of embryos is not allowed, but eight or nine eggs are normally produced by hyperstimulation. Since three is the optimum number to put in the uterus to allow for implantation, the rest must be placed in the cervix because it is essential that they are used. This is a waste of the fertilised eggs. This means that the woman must undergo further hyperstimulation which is medically dangerous and costs £1,200 or £1,500 for another cycle.
This area of medicine should be regulated here for ethical, medical, physical and legal reasons. I urge the Minister to set up a commission to assist him to do so.
