Crumlin referrals for embryo screening halted on legal advice

Our Lady’s Children’s Hospital in Crumlin, Dublin, stopped referring patients abroad for a controversial reproductive treatment after receiving legal advice that the referrals could be unconstitutional.

Staff at the National Centre for Medical Genetics, which is based at Crumlin, had to cease direct referrals for pre-implantation genetic diagnosis (PGD), though they are allowed to provide patients with information about services overseas.

PGD is used in conjunction with IVF to screen embryos for genetic disorders. Only those embryos diagnosed as free of a specific disorder are implanted into a woman to try to achieve a pregnancy. Controversially, the embryos that are not implanted in the woman are destroyed.

The centre stopped referring women abroad in 2006 and still adheres to this policy, even though two private clinics in the Republic have since been licensed to sample embryos as part of a PGD service.

The centre is under the governance of the hospital, which is chaired by the Catholic Archbishop of Dublin. Staff say the current chairman, Dr Diarmuid Martin, who has been in place since 2004, has never interfered in the centre’s work.

A spokeswoman for Crumlin said the genetic centre does not offer a PGD service, but a consultant geneticist may “assist” with referring patients abroad “where appropriate”. “The hospital is not funded to provide a pre-implantation genetic diagnosis service,” she added.

PGD advice

In practice, staff cannot make direct referrals but may point out to patients where PGD is being offered. Patients can then make their own arrangements with these clinics, which may ask the centre for genetic details and a confirmation of diagnosis.

Earlier this month, The Irish Times reported that the hospital had told staff at the centre it will henceforth operate as a department and must no longer use the "national" designation. Staff and patient groups, who say the centre is chronically underfunded, are opposed to this move. Labour TD Anne Ferris, in letters to Minister for Health Leo Varadkar, has described the change of designation as the "back-door privatisation" of a national service and has expressed concern over possible "ethos conflicts" arising from the move by the "privately run" Crumlin hospital.

Up to 2006, the centre referred women seeking genetic screening of their embryos to clinics in the UK or Belgium. PGD was typically used where couples had one child with a birth defect and wished to avoid this re-occurring in a further pregnancy. The embryos that are not implanted in the womb are destroyed, or used for research and then destroyed.

Application for treatment costs

The hospital became aware that staff were referring patients abroad for the procedure after an application was made to have the overseas medical costs of a patient covered by the HSE. This prompted the hospital to seek a legal opinion from barrister Shane Murphy.

Mr Murphy reviewed documentation from Guy's and St Thomas's Hospital in London, a leader in the field, and came to the conclusion that PGD "inevitably and necessarily involves the destruction of human embryos".

The destruction of embryos in this process would be unlawful in Ireland and would appear to involve a violation of Article 40.3.3 of the Constitution on the right to life, he advised.

Mr Murphy said the centre could reduce the risk of liability by ensuring that staff did not write referral letters for patients to centres providing PGD in other countries. However, they could provide basic information to patients about the nature of a genetic disorder. This should state that the service is not available in the Republic.

The Health Products Regulatory Authority said it has licensed the Beacon Care Fertility clinic and Cork Fertility Centre to sample eggs and embryos for the purpose of carrying out PGD. "Currently, these tests are carried out at specialised laboratories located outside Ireland," it stated.