I move: "That the Bill be now read a Second Time."
I thank the Minister for coming to the House and I thank the Leader, Senator Cassidy, for arranging this debate. Lest there be any apprehensions about the Bill, it is a conservative measure and an attempt to introduce legislation in a field of medicine which is not covered adequately by legal regulations. It is far from what could be described as a liberal Bill. I seek to tighten up the regulations because, currently, anyone can set up a clinic and work independently or in association with people in another country in the field of assisted human reproduction.
I am aware that the lack of legislation in this regard has caused considerable concern to Ministers for Health over the past number of years. The Medical Council guidelines are insufficient because they do not have legal standing and many people involved in assisted human reproduction are not medical practitioners. They are physiologists, embryologists, etc., and the guidelines do not cover them.
I thank all those who have helped me in the preparation of the Bill, particularly Dr. David Tomkin and Adam McAuley for their invaluable legal advice and I am glad that they are present. The input of all other interested parties, such as patients, doctors and lawyers, has made it possible to bring forward this Bill, which I hope will satisfy all concerned. It can cover all sides of the debate – pro-life, pro-choice, pro-patient and pro-medical profession.
Assisted human reproduction or in vitro fertilisation, as it is commonly called, has been successfully practised in Ireland for many years. Shortly after the technology became available, clinics attached to maternity units in some hospitals were set up, with infertile couples here as anxious to avail of these treatments as those in other countries. Many more clinics have been established in recent years, some of which are associated with clinics in Great Britain. They do not need to report their practices or techniques, keep records or inform anyone about their charges or the number of patients they treat. This is undesirable and I hope my Bill is supported. Earlier there was a call for a register in connection with the national beef assurance scheme, yet this serious area of medicine is unregulated.
The Medical Council has recognised IVF for treatment in certain cases of infertility and has included ethical guidelines, drawn up by the Institute of Obstetricians and Gynaecologists of the Royal College of Physicians, in its advice to doctors on medical practice. The guidelines which affect IVF and artificial insemination by donor are as follows. With regard to artificial insemination by donor there is no objection to the preservation of sperm or ova to be used subsequently on behalf of those from whom they were originally taken. Doctors who consider assisting with donation to a third party must have regard to the biological difficulties involved and pay meticulous attention to the source of the donated material. Doctors who fail to counsel both the donor and recipient thoroughly about the potential social, medical and legal implications of such measures and the possible consequences for the would-be parents and the baby could face disciplinary proceedings.
IVF techniques should only be used after thorough investigation has failed to reveal a treatable cause for the infertility. Prior to fertilisation of an ovum, extensive counselling and discussion is essential. Any fertilised ovum must be used for normal implantation and must not be destroyed deliberately. These are the Medical Council guidelines. All societies have an interest in this area of medicine from medical, ethical and financial points of view. In most countries where assisted reproductive technologies are practised, some sort of regulations, either by legislation or licensing procedures from the central body, have been put in place to deal with the many legal problems which arise from this technology.
This Bill provides that the assisted human reproduction process shall be governed by principles which are determined, not just by one sector of the community – the medical sector – but by agreement among all the participants so that, as human reproductive technology develops and changes, the principles applied will be conservative and up-to-date.
As I stated earlier, there are legal, medical, ethical and financial matters to be considered. The Bill calls for the establishment of a register of practitioners of assisted human reproduction. This would be established and maintained by the Minister. Those who are not on the Minister's register would not be allowed to practise. There are penalties for those who offend and the register is open to public scrutiny so that the techniques provided, the number of people treated and the costs are known. Approximately 10 per cent of Irish couples may have infertility problems, although a large number of people are affected by this area of medicine. We must take into account that this area of medicine is not covered by the health service, and in some cases large amounts of money are borrowed by patients who wish to get the treatment. We must ensure ethical and medical standards apply to those who say they are providing the treatment.
The Minister would be advised by an ethical committee –"ethical" is built into the Bill. The committee would be broad based, comprising ten persons, three of whom would be appointed by the Minister. These people, I hope, would have some experience, successful or otherwise, of the whole process of reproductive technology as consumers or patients, whichever one prefers to call them. Their advice would be invaluable to any committee. The Irish Patients' Association and the National Infertility Support and Information Group are most insistent that such people should be on the committee. I support this. Two members of the committee would be doctors appointed by the Medical Council. These would be people of good standing and preferably with experience in the field. I would like one to be a person with experience in medical ethics. It has been pointed out to me that this is a matter about which some people believe they know a lot without having done much study on the subject. One would be appointed by An Bord Altranais, again experience in the area would be useful. Two would be appointed by the Higher Education Authority. These would be people with expertise in the technology. I have pointed out that physiologists and embryologists can be some of the most important people at laboratory level involved in this technique, and I believe ethical standards are important at laboratory level and not merely at clinical level. I believe most Irish people feel the same. A person with a genetics background would also be useful. The last two members of the committee should represent the diverse moral views held in Ireland. Because of the high esteem in which I hold the Cathaoirleach of the Seanad, I have suggested he should make the nominations. Having known previous Cathaoirligh, we have always had people who would be suitable to make such nominations.
I hope this committee aids the Minister in formulating what should be public policy in this private area, which has so many social and ethical implications. It is unlikely that we will introduce exactly the same legislation or regulations as other countries, but we could look at the legislation in other jurisdictions. I would be grateful if we could avoid concentrating on the legislation that applies in the United Kingdom, no matter how good we may think it is, because it may not satisfy our needs.
We must ensure all those involved in providing treatment are properly qualified to do so. There is no stipulation at present that this must be the case. It has been suggested to me that the medical guidelines are good enough, but since people other than medical practitioners are involved in the treatment, this is not the case.
The initial in vitro fertilisation technologies were developed to enable women who produced ova but whose fallopian tubes were blocked so that the ova could not reach the uterus and subsequent fertilisation by sperm to occur, to have those ova fertilised in Petri dishes, not in a test tube as is frequently said, and to have those fertilised ova placed back in the uterus. This was just a technical procedure. This initial simple technology has been superseded by the most sophisticated techniques. I have avoided specifying technology in the Bill because it changes so rapidly that I do not want us to be in a position where new technology would be introduced and we would not be in a position to deal with it. Without making a bad pun, who could have conceived a year ago that cloning would be available? It is incredible. However, we know that internationally human ova have been cloned. It will be for the Minister and his broad based committee to decide what is acceptable for Ireland.
Section 13 mentions surrogacy contracts because these do not involve technology but legal contracts. Any contract made by a couple with a woman to bear their child should be considered unenforceable. In other countries where laws equivalent to the sales of goods Acts have been applied to cases where the gestational mother – the woman who bore the child – decided to keep the child, there have been traumatic court cases, sometimes involving the mother fleeing with the child. This must be avoided.
In Irish law, paternity is determined by blood link. There has been confusion regarding paternity in other jurisdictions if paternity is not blood linked. This Bill clarifies the position with regard to assisted reproduction and brings it into line with other more advanced democracies such as the United States, where experience has shown that confusion can arise if paternity is not blood linked. I have, therefore, included section 14 to ensure it is clear that the donor of either spermatozoa or ova does not have the rights or responsibilities of a parent.
As the Minister is aware, and as an editorial in today's Irish Medical Times stated, legislation in this area is urgently needed. My Bill is a modest proposal. I do not pretend it will solve all the ethical dilemmas surrounding assisted human reproduction. While the guidelines of the Medical Council are useful, they have no legal standing and we have no idea whether they are violated. I do not wish to cast aspersions on anyone working in the field, but clarity is needed. I hope the Minister will allow me to recommend the Bill to a special committee of the House.
