Diane Blood's husband was on a life-support machine when sperm was coaxed from his body, frozen and then stored in the hope she could conceive the child they had always wanted. The authorities, however, refused her permission. It took her more than three years after his death to contest the decision in the British courts, and finally discover that she could circumvent the judgment by actually conceiving the baby in a different country. She joyously gave birth to a boy in 1998.
The Blood case is a perfect example of the exceptional difficulties faced in trying to balance compassion and ethics when the subject in question is human reproduction. It is also extreme. Yet the one factor which links it to the problems facing all infertile couples is the issue of time - endless waiting, endless hoping against hope and a whole lot of money spent in the process.
Fertile people find it hard to understand how basic to personal identity is the capacity to have a baby with someone you love. Infertile people try to explain that each missed opportunity is a cause of genuine grief. You imagine your child somewhere out there waiting for you to reach her or him, so you are willing to risk almost everything to achieve that end. Infertile people are desperate people, and for just that reason they are extremely vulnerable to exploitation.
However, far from treating them with a wraparound system of compassion and understanding, the medical establishment as a whole has been as reluctant to address their needs in a corporate way as it has been willing to take the hundreds of thousands of pounds they spend every year in fees to hospitals, consultants and laboratories. In this, it is effectively supported by State inaction. Judging by the collision of two recent events - the Institute of Gynaecologists and Obstetricians' report published last week, and the defeat of Senator Mary Henry's private member's Bill on assisted reproduction - the situation has become even worse. The report confirmed that the medical profession can't be expected to solve complex human questions on its own, although it did include an inappropriate assumption of exclusive ownership where the discussion of reproductive rights is concerned. The defeated Bill was sent down with the promise that the Government would set up channels to discuss the issue - this, presumably, when pig-flying season comes to pass.
The urgency of this debate happens not only because infertility is becoming a more common problem for many reasons - delayed age of conception, environmental factors - but because the technology of human reproduction has developed faster than the space race, faster than military weaponry, faster almost than our capacity to understand it. The possibilities range from cloning to egg donation to surrogate motherhood, along with the concomitant rights and responsibilities of everyone involved.
Here, the debate is incorrectly tangled up with that of abortion, which makes it even less likely to progress and further marginalises the legitimate needs of infertile people. The sector is ripe for abuse. A number of procedures and legal queries are not now regulated, nor are all practitioners of assisted reproduction subject to public scrutiny. As things stand, Irish people are already availing of egg donation services in the UK.
The question is not what is acceptable to the medical profession, but what is best for ordinary people and for the rights of children born from such procedures. There are some complex issues of medical law which need addressing, but for people who are infertile, basic problems matter too. Neither the VHI nor BUPA will admit the cost of mainline infertility treatment to their services, nor will the Revenue Commissioners allow many such procedures to be claimed against tax.
Medical-card holders find themselves on waiting lists comparable to those for cardiac surgery, and those living far from the few hospitals which provide a service must in addition pay the heavy costs of transport and overnight accommodation. When test-tube procedures are indicated, bills of more than £2,500 each time are indicated: with the take-home baby rate still reaching only 15 per cent of procedures in the best hospitals, trying for a child in this way can mean extreme financial strain. Meanwhile, people are getting older. For every month which passes when the infertile couple put their relationship to the test by making love to timetables, the chances of conception become even slimmer.
Unless your ultimate mission is theological point-scoring, questions which liberate or restrict any citizen's right to have children and regarding their responsibilities to those children, are ones which don't require a degree in medicine or science to discuss. What they do require are acts of imagination as we try to anticipate the human consequences of such conceptions. Children born through full or part donorship may want access to their genetic records, including the names of their genetic parents. Genetic parents may try to enforce rights of access or custody which are hostile to the child's welfare.
Practical matters arise too. Restrictions on the length of time during which eggs can be stored raise harrowing questions of disposal and retrieval and, although it may be gender-friendly to imagine women in their 50s becoming mothers by the use of donor eggs, there are implications for other organs in their bodies.
Some infertility is temporary - John Lennon solved his problems by cutting back on cigarettes and other substances, after which his son Sean was conceived. Some is avoidable, but with almost no education about risk factors, like the use of IUDs, people who have contraceived throughout their 20s and early 30s can find themselves unexpectedly childless as they approach their 40s - by which time they are considered too old to adopt, even if that option were available to all. Nor is it routine to advise men with testicular cancer that they could save their sperm for future use.
Technology is a means, not an end. However complex this technology, the ethics are not in themselves a subject which needs to be medicalised. The UK debate, kick-started by the birth of Louise Brown and subsequent problems with surrogacy, was formally led by the eminent philosopher Mary Warnock, now Baroness Warnock. That meant the tension between technological possibilities and human responsibilities was kept in check.
We can't hope to control all the situations which will arise from reproductive technology, which is why legislating for the whole panoply of possibilities is doomed to failure. What we can do is to place infertile couples and their future children at the centre of this debate and support them there, instead of keeping them at the fringes where they have no choice but to spend, spend, spend.