Newly released ethical guidelines from the Medical Council may already be inadequate to govern existing practice in modern fertility treatment. The guide, published yesterday, states that fertilised eggs must not be deliberately destroyed.
However, couples involved in the reproduction programme at the Rotunda Hospital in Dublin sign consent forms allowing the destruction of unused fertilised eggs after they have been frozen for five years.
Dr James Clinch, chairman of the council's ethics committee, said the guiding principle used in drawing up this section was that the destruction of human life was unethical.
"While you might freeze sperm and keep it for the donor or other recipient, once it is fused with an ovum, you set off on a stage which essentially results in a human being and to destroy that is wrong. If you freeze it you do not destroy it; intentional destruction is wrong." Dr Clinch said the guide's section on reproductive medicine was an effort to "look forward".
He said it was the council's view that if an ovum was fertilised it should be used for normal implantation. If you "deliberately destroy" fertilised ova it "could be grounds for complaint"
Asked about the freezing of zygotes, the initial form of human life, at the Rotunda Hospital, and their possible future destruction, Medical Council chairman Prof Gerard Bury said it was possible for anyone to produce "hypothetical scenarios" in relation to reproductive medicine. "The council has responsibility to be responsible for all disciplinary function. It cannot and will not prejudge situations or institutions." Dr Peter McKenna, Master of the Rotunda, said all the zygotes were collected and frozen with the intention of implanting them. "That underlines everything that we do. We do not collect or freeze zygotes for purposes other than implantation".
However, he said that when patients say they want to take this course the hospital cannot be held responsible for them changing their minds. They may separate or one may die. The programme was established nine months ago and so far this difficulty had not arisen. The couples sign a consent form specifying that they would accept the implantation of all frozen zygotes within five years or before the women reached the age of 45.
The Medical Council guide stated that there was no objection to the preservation of sperm or ova "to be used subsequently on behalf of those from whom they were originally taken". However, in in-vitro fertilisation, any fertilised ovum "must be used for normal implantation and must not be deliberately destroyed".
Referring to abortion, the guide also stated that the "deliberate and intentional destruction of the unborn child is professional misconduct". It said that should a child in utero suffer or lose its life as a side effect of standard medical treatment of the mother, then this is not unethical.
"Refusal by a doctor to treat a woman with a serious illness because she is pregnant would be grounds for complaint and could be considered to be professional misconduct."
Responding to questions about doctors giving advice on abortion, Dr Clinch said: "Giving advice is very different to doing something. What this says is to deliberately destroy a baby is unethical."
Prof Bury said that if the law in relation to abortion did become clearer "of course the council will re-examine where it stands". Asked about the Supreme Court ruling that abortion is lawful if there is a "real and substantive risk to the life of the mother", Prof Bury said it was the council's responsibility "to give ethical guidance to the profession". Legislation and the ways in which laws are interpreted and applied "is a different issue". The council is clear that "deliberate termination of pregnancy is unacceptable".
Some of the other changes to the guide for the medical profession cover withdrawal of service; permission from patients to allow the attendance of medical students; responsibility to trainees and junior doctors; the Internet; indicative drug budgeting; referral by GPs to specialists and confidentiality.
Dr Clinch said the guide was "not a legal document but an ethical document". The council received around 200 complaints a year. Of these, 10 per cent resulted in inquiries by the Fitness to Practise Committees and about half were found guilty of professional misconduct or unfit to practise.