Thousands of childless families now have children courtesy of in-vitro fertilisation, but the Catholic Church would like to have the process banned. That pressure must be resisted, argues Dr Fergus O'Ferrall
The report of the Commission on Assisted Human Reproduction, when published, will confront the Irish people with a clear choice: whether to prohibit or promote assisted human reproduction (AHR) services. The arguments for prohibition were set out by Father Kevin Doran, secretary of the Irish Catholic Bishops Committee on Bioethics, (The Irish Times, February 19th) and in much starker terms in the submission made in December 2001 to the Commission by the Irish Episcopal Conference.
The Adelaide Hospital Society, in its submission called for the promotion and development of AHR services. Many thousands of children have been born in Ireland and elsewhere through assisted human reproduction, particularly in-vitro fertilisation (IVF). This represents, an enormous positive advance in respect of the problems associated with infertility.
Unlike the Episcopal Conference, the society believes that AHR services are now part of normal healthcare and ought to be provided as an essential and standard service by our public health services free at the point of need.
The Catholic Bishops' submission recommends that:
o Research on embryos "should be prohibited by law".
o Donation of human reproductive material or human embryos "should be prohibited by law".
o Storage of embryos "should be prohibited".
o "Deliberate destruction of human embryos should be prohibited."
If these recommendations are accepted the provision of AHR services would be effectively ended in the Republic. Indeed the bishops' submission questions whether what they term "assisted reproductive therapy" (ART) "should be regarded as healthcare in the ordinary sense of the word, and therefore as something to which citizens have a right just as they have a right to other forms of healthcare".
In a significant concluding paragraph they state: "The crux of the matter is that, while infertility is often a grave disappointment and even a source of stress for couples who wish to have a child, it is not a life-threatening illness.
"In the context of limited healthcare funding, and in particular when there are lengthy waiting lists for life-saving treatment it is hard to see how the State could justify diverting limited resources to the provision of assisted reproductive therapy. The alternative scenario is not ideal either, because if ART is not publicly funded, then it becomes a privilege of the wealthy."
Citizens might study that paragraph carefully. It reveals an impoverished concept of health and wellbeing and a reliance on an argument from health economics for "rationing" healthcare. Are the bishops supporting a parsimonious attitude by the State in respect of healthcare expenditure so as to close down our existing AHR services such as those provided by the Rotunda Hospital?
The Adelaide Hospital Society, in its submission, sought for a new caring vision in our health services.
Do we as a society understand and take seriously the pain and suffering of infertility? Having children is such a fundamental need for human beings that fertility services contribute significantly to the development of a caring society.
It is regrettable that any responsible organisation, let alone a church, would propose that the State should close the AHR services in Ireland, knowing that these services are much sought after by responsible parents, and are approved by many thoughtful and responsible organisations, including many other churches.
There is a clear need to regulate the provision of AHR services. It is not practicable to legislate for every aspect of AHR which can arise. The Adelaide Hospital Society therefore recommends the establishment by law of a Permanent Commission on AHR with the power to regulate practices and a remit for regular public consultation on future possible developments. The majority of its members should be women and lay people and it should be so composed that it would command the confidence of both the general public and the professions. On the "key issue" raised by Father Doran concerning the status of the human embryo, the society would wish to affirm two sets of facts: Firstly, that the product of the coming together of human sperm and ovum is obviously itself human.
It is also distinct in that it has the beginning of an existence independent of the parents contributing the sperm and egg. It is, thus, morally in a different category from body tissue of either parent such as a blood cell, a finger or a tumour.
Secondly, that there is the undeniable fact that this combination of cells has to undergo considerable biological development before it becomes even potentially capable of human consciousness and, therefore, of human identity.
The development of the embryo into a human person is a gradual process and there is no easy way of saying that before some point the embryo is not a person and after that point it is a person. However, implantation and the appearance of the so-called primitive streak 14 days after conception are regarded as highly significant steps.
It is now quite widely and conservatively accepted that at this 14-day stage it becomes certain whether any unborn human or humans are being formed and it becomes possible to speak of a biological entity capable of carrying human consciousness, conscience and identity. Research on human embryos is a more difficult matter for Irish people than AHR. The society submits that it is both essential and proper for research to be undertaken on embryos or pre-embryos up to 14 days under strict licensing and control from an appropriate authority, such as the proposed commission. This occurs in other jurisdictions in respect of research into fertility, miscarriages, contraception, congenital diseases and for detecting genetic abnormalities.
Stem cell research using stem cells derived from embryos may have enormous potential as a source of new therapies for currently incurable disorders, including Parkinson's disease, Alzheimer's disease, spinal cord injuries and many more (see Stem Cell Research: Medical Progress with Responsibility, Department of Health, UK, June 2000). The potential therapeutic benefit from embryonic stem cells significantly outweighs that from stem cells from other sources.
Not to engage in such research, or to ignore it, would be both irresponsible and a serious abdication of proper investigation and care for the health and wellbeing of people. Father Doran points out that "large numbers of embryos (often 11 or 12) are generated in any one treatment cycle", raising the question of what is to be done with the "surplus" embryos. There are three alternatives:
(1) Disposal.
(2) Frozen storage for possible future use, including adoption.
(3) Immediate use for research.
The society believes that an ethical case for permitting research on "surplus" embryos can be safely made in certain strictly prescribed circumstances.
This ethical case rests on the fact that there is no conflict here between the right to life of the individual (because the early embryo is not a person) and the good of the community (represented by the potential benefits of the proposed research).
The good of the community should prevail because the "surplus" embryo will have no prospect of any life beyond that which it already has. It may be adduced, in addition, that purpose is given to it by research which benefits humanity.
The early embryo is not a person: it is quite unreal to speak of the presence of a distinctive human persona prior to "individualisation" at about 15 days. The respect due to very early embryos is different in kind and character to that which is later accorded to the foetus as it matures and becomes capable of being born and is accorded the respect due to the human person.
Many Christians believe that it is proper to carry out research on very early embryos. Indeed, some moral theologians in the Catholic tradition adopt it (see, for example, Father Paul Surlis, "Catholics can disagree on stem-cell research", The Irish Times, August 17th, 2000). IVF could not have been introduced without research on embryos and continued research is most likely to lead to both improvements in IVF and other key aspects of medicine.
There is no doubt that AHR raises continuing perplexing choices. People often have a tendency to hope that such choices can be resolved by turning to some simple standard or by absolutist prohibitions. The status of the unborn human has been the subject of such hopes.
However, at the end of all our respectful listening and reflection, it has to be recognised that in a democracy individual citizens have to make choices based on the best evidence available; as citizens we have to take responsibility for those choices as they relate to real people and their reasonable needs.
The society believes that the promotion and development of fertility services as part of our healthcare provision should be continued so that Irish people can make their own choices considering a wide range of evidence including, if they choose, that which is provided by their religious advisers.
Dr Fergus O'Ferrall is director of The Adelaide Hospital Society; he is co-editor with Kenneth Kearon of Medical Ethics and the Future of Healthcare (The Columba Press, 2000). The Society's submission to the commission can be viewed at: www.adelaide.ie