The report of the human reproduction commission will encourage debate on how society deals with infertility, writes Carol Coulter
When Micheál Martin set up a commission to study issues surrounding infertility treatment, and report on the legal, social and ethical issues involved, Irish couples had already been receiving such treatment for decades.
When the Commission on Assisted Human Reproduction (CAHR) started its work, eight clinics were in operation, of which seven co-operated with it. By the time the report was completed there were nine.
None of them are subject to any statutory regulation. At the moment all offer insemination by the woman's husband, six of the eight who responded offer IVF treatment. Four offer IVF with donor sperm, and four also offer donor insemination. All the donated sperm is imported.
One offers ovum donation, either with or without IVF. They all offer the freezing of sperm. However, only one offers the freezing of ova or ovarian tissue, which is medically much less successful. Some freeze embryos, at various stages of development. Others do not.
The only regulation that operates in human infertility treatment is the code of ethics of the Medical Council, which does permit IVF and various techniques associated with it. It also allows for the donation of embryos. It does not permit any experimentation on embryos.
However, not everyone working in this area is a doctor, and covered by Medical Council code ethics. Some are nurses, others are scientists, and subjected to their own codes of ethics, but these may not accord with the Medical Council's code.
Of 52 jurisdictions surveyed by the commission, Ireland is among only 13 that have no regulation of this area. The majority of the rest have legislation, while some others have guidelines.
It is hardly surprising, therefore, that the commission has unanimously recommended the establishment of a statutory body to regulate all aspects of assisted reproduction. This would register clinics offering the service, lay down guidelines, and regulate various aspects of it. The need for regulation is likely to be widely accepted but it will be harder to reach a consensus on some of the more detailed proposals.
The commission acknowledges this in the report's section on ethical issues. It suggests that there will be differences of opinion in three areas: whether or not the basic act of human procreation is sacrosanct; whether or not the welfare of the child is best served within the traditional institution of the marital family; and whether or not the in vitro embryo (created through IVF) has absolute value from the moment of fertilisation, and is entitled to protection from that stage.
The CAHR commissioned a survey to test public attitudes on these questions. It found that the population at large is divided on the question of the action that may be taken with respect to the embryo. The same survey showed that people were also divided on whether infertility techniques should be available to single women, same-sex couples and older women.
About two-thirds were in favour of treatment being available to heterosexual couples in stable relationships. Small majorities of respondents also said they were in favour of donors being involved in infertility treatment, and in the use of surrogate mothers where necessary.
The commission pushed the boat out in that it made a number of radical recommendations that are sure to generate widespread debate. These include the suggestion that the embryo should only attract legal protection after implantation in a woman's womb (it feels that clarification on the constitutional position should be obtained either from the Supreme Court or by way of a referendum).
This proposal clears the way for a range of other proposals, including research on embryos, pre-implantation diagnosis to allow for selection in cases where there was a serious danger of congenital illness, and the disposal of surplus embryos. Legislating for such measures will prove politically contentious.