Opinion | Sunday, 15 March 2009

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Regulating IVF

Government is still debating whether to allow, and regulate, IVF, while childless couples are resorting to this method in any case. MaltaToday asked three key exponents in their respective fields for their take on this controversial issue

Pierre Mallia

The government must now waste no time in legislating what is a legal vacuum. We have IVF available to patients but there needs to be some form of legal regulation to use the procedure only where appropriate. The majority of couples who resort to IVF would have been trying to have children for several years unsuccessfully. I have seen only one couple in my career where IVF was being used to bypass the conjugal act. No one had realised, including myself, after I had been their family doctor for several months, when on one particular home visit the woman burst out in tears and it transpired that they were trying to have a baby only because of family pressure. There seemed to be no attraction on the part of the husband, who preferred IVF as a cover-up rather than have sexual intercourse with his wife. For this reason it is imperative that all IVF couples have proper counselling by ethicists, who will certainly provide it even on a voluntary basis if need be.
Of course the government must legislate according to the normative values which the society holds. Although ethics is not a statistic and cannot be judged on majority criteria, one can speak of a norm of values of the society which is cultural and includes moral values upheld by the religion of the country. The latter certainly plays a centre-forward role here, although the full-backs and wings cannot be ignored.
The Church has recently (2008) reaffirmed its position that IVF and any technological intervention is illicit. Certainly the ecclesiastical authorities will not excommunicate any couple which opts for this technology; neither will it refuse to baptise the child. Whilst this is no indirect go-ahead, it is certain that doctors, who cannot be judgemental, will have to explain these positions and allow then the couple to make its ethical choices. Again, this is preferably done by ethicists who would be current in the legal and ethical positions. In my experience it seems that on a pastoral level many couples find a lot of support.
What is usually contended in IVF are moral values on two levels. The first is the bypassing of the conjugal act; the second the possibility of discarding embryos. Whilst the first certainly cannot be made illegal, the second can and the law should therefore regulate that, for example, embryos are not frozen, and that only one or two are fertilized at the same time. What will have to be accepted is that the miscarriages which result from IVF, which are foreseen but certainly not intended, are not seen as willed abortions, as then the law will be futile, contradicting the law on abortion. What will also have to be accepted is the technical discarding of unviable embryos. Here more expert advice might be necessary to confirm that what is being discarded are not embryos which simply have less of a chance, although statistics do probably come into it, but embryos which will be aborted anyway.
It is interesting that one objection to IVF used to be multiple pregnancies. On the other hand, medical methods seen as licit, such as the use of Clomiphene to stimulate the ovaries but which allow the couple to have normal intercourse, are more commonly known to result in multiple pregnancies. This proves that these arguments, pragmatic or consequential, if you may, cannot have weight on an argument against IVF, as what is fodder for the goose is fodder for the gander. But this is a technicality. What we should be aiming at is having a law which is worthy of a free country which respects moral choices of couples, but on the other hand respects the moral values of the society. Therefore I can only see the present government regulating in favour of the possible use of IVF for married couples, or for couples in a stable relationship, awaiting, for example, an annulment, which seem to take more time than is necessary. There may be objection in parliament to older couples coming from different marriages which have already produced children. There may also be objection to singles and perhaps to homosexual unions. The latter may produce issues relating to human rights, but as far as I know the majority of people seeking IVF technology are married couples, and as to the sanctity of the union being bypassed, I do not think that these couples lack this. They have been trying for several months if not years, and the sacrifice is so great physically and financially that only people really committed to each other are known to seek this method.

Pierre Mallia is Professor in Family Medicine, Patients’ Rights and Bioethics at the University of Malta; he is also Ethics Advisor to the Medical Council of Malta.

Michael Asciak

When I was a medical student 27-odd years ago, a senior doctor of the day asked me if I would wish to take part in a sperm donation programme, to be rewarded with a small fee, on which (in those times) I would usually subsist on for three or four months!
When I graduated and started work as a general practitioner, I started to get patients with hyperstimulation complications and multiple pregnancies which were evidently the result of any IVF programme carried out anywhere, but which was also taking place in Malta.
The bottom line is that IVF, or in-vitro fertilisation, has been practised in Malta for quite some time now with no legal safeguards to protect any possible abuse to human life or the environment into which it is born. I am not trying to belittle the efforts of the practitioners concerned or the problems faced by barren couples. However, it is clear from my experience that, as is the case in other countries in Europe and elsewhere, Malta should have its own framework legislation to regulate the procedures connected with the technique in order to avoid abuse.
The Social Affairs Committee of the House of Representatives (HOR) presented a very detailed report in 2005, which should serve as a very solid basis for discussion and the enactment of any new law and the Bioethics Consultative Committee (BCC) is in fact working on the basis of those very recommendations in that report.
Any such legislation should concentrate on two main precepts. First, that human life should be protected and respected from its earliest stages of physical development. There is a major consensus that life in Malta ought to be respected from conception (or fertilisation) as stated in the HOR report and the BCC will be coming up with a definition of the beginning of human life based on these lines.
The second precept is that any new human life that is brought into this world ought to be received into a stable family environment which is able to provide for the welfare and positive long term development of such a child. This of course includes the family as understood by present Maltese culture and also other stable relationships where the duties of the parents are specifically defined by law.
It is of course the uppermost thought on the BCC’s mind, that any law would be able to survive the legal scrutiny by any court, whether foreign or local, as being in accordance with a liberal democratic way of life, but respecting the principle of subsidiarity as befitting any nation state.
The law will also cover other current issues in biotechnology where the two abovementioned precepts may be compromised. These include surrogacy, embryonic stem cell research, the production of chimeras and hybrids, the cloning of human beings, experimentation on human embryos, genetic testing and eugenic selection, liability issues and other issues that need to be addressed in the beginning of the 21st century, the so called century of biology.
As in any such work in bioethics and biotechnology, not all people will agree with the recommendations put forward, but the BCC will strive to provide recommendations which provide a high order of consensus among the population in general and the recipients and practionioners of the science and art of medicine and biotechnology.

Dr. Michael Asciak MD, M.Phil. is Chairman of the Bioethics Consultattive Committee

Michael Farrugia

Over the last 60, 70 years, there have been great acheivments in medical science. It is hoped that further acheivments in the medical field will lead the general population to lead a healthier life, with a better quality of life. It is hoped that we will be able to treat certain illnesses instead of delaying the process, and others we will be able to prevent, while the lack of organs for donation will be something of the past.
Childless couples amount to about 10% of all couples. Science has given a possibility to a percentage of these couples to be able to concieve. For this reason and many other ethical reasons, countries where there are the facilities of artificial insemination and procreation have adopted legislation to regulate the whole process. Worldwide, there are different regulations on this subject according to the beliefs of the legislature and the traditions of the country.
In Malta, IVF has been practiced for several years. Yet we do not have any legislation to regulate the process. This is unacceptable. Even more so, when at Mater Dei Hospital we have all the latest facilities to be able to perform IVF, yet it is not done because of the lack of legislation.
About two years ago the Social Affairs Committee of the House of Representatives held a substantial number of meetings on the subject, but the final recommendations were never discussed. Lately, in the Social Affairs Committee, there have been further hearings and in the coming weeks it is expected that further discussions on the subject are to take place. Over six months ago, the present committee presented the Minister of Social Policy with a document highlighting the discussion that had taken place during the previous legislature.
It’s time for action. There is an urgent need for the subject to be regulated by the necessary legislation and for government to be able to give the opportunity to couples to be able to concieve under the NHS. The process is expensive, so most childless couples who can benefit from IVF can’t afford it. In most instances the success to concieve is not immediate and the process has to be repeated a number of times. This is not equity.
Now the government is said to be ready to put forward the draft legislation in the coming months. It is important that there is free discussion and that at parliamentary level we discuss the subject from the legal and ethical perspective. It is important that when the draft law is out, all, including the church, from the moral aspect, speak out with an open mind. But finally, parliament has to legislate for the general good of all.
The most important thing is that we will have a law which is practical not theoretical. A law that gives a satisfactory success rate which at the same time poses the least risk to the mother. A law which is ethical to the human being but at the same time realistic. A law which really gives childless couples a real opportunity to be able to concieve through the use of their sperm and ova. In the meantime, government should immediately move forward the necessary legislation regarding cohabiting couples, as has been recommended in the last discussions of the Social Affairs Committee, to prevent any complications when in parliament we are to discuss artificial insemination and procreation and other legislations.

Dr Michael Farrugia is a Labour MP and spokesman on health

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