FERTILITY ETHICS: Influential Panel Issues Report
"In a report being issued today," the New York State Task Force on Life and the Law "is urging sweeping changes in the regulation of new fertility technologies, including more steps to reduce the incidence of multiple births," the New York Times reports. The 24-member panel said physicians "providing infertility treatments must think more about the babies born as a result and avoid treatments that are more likely to produce so-called high-order multiple births -- pregnancies of three, four or more babies who are far more prone to devastating problems like retardation and blindness." The report notes that many women "are inadequately informed about the risks of fertility treatments and that couples are often not told enough about the costs of such therapies and their" low success rates. The panel recommends that physicians "talk with patients in advance about the possible need to abort one or more fetuses in a high-order multiple pregnancy." In cases where abortion "is not an option," the report says the "doctor and patient should consider other treatments, even if the chances of pregnancy are reduced." In a particularly important conclusion, the panel "rejected calls for legislation mandating health insurance to cover [fertility] therapies because it found 'no persuasive reason for giving' them special legal priority, given that" the country lacks a system for covering every citizen's health care costs.
The Times reports that the panel, comprised of "doctors, lawyers, ethicists, members of the clergy and others, has had unusual influence since its creation in 1985." While its recommendations "are not binding, even in New York, ... earlier recommendations have become part of state laws and United States Supreme Court decisions on defining death, withholding and withdrawing life support, organ transplantation and other issues of medical ethics." New York State Health Commissioner Barbara DeBuono said "she would immediately take steps toward implementing" the fertility recommendations, "starting with reviewing processes used to inform patients of all risks of the reproductive technologies." She said, "The technology is advancing faster than government officials, religious leaders and medical ethicists can keep up with ... and therefore many of the thorny ethical issues are being played out in the courts."
What The Panel Says
According to the panel members, their "main focus was to recommend 'laws that promote clarity about parental rights and responsibilities that protect the stability of the parent-child relationship.'" In addition to recommending that more information be provided to fertility patients, the panel said "the woman who gives birth" should be designated "the child's legal mother, even if it was conceived from an egg donated by another woman." Other recommendations include: "Requiring doctors to tell women if procedures are experimental"; "Not making embryos from donor sperm and eggs without the explicit permission of the individuals who intend the embryos for their own use"; and "[c]onducting research to determine the odds of consanguinity." In addition, the panel said current law should be changed "to make the husband of a married woman the legal father of any child conceived with donor sperm" and to "allow donors of semen and eggs ... to relinquish their parental rights and responsibilities at the time of donation." The group also said children born through fertility treatments "have a right to information about the medical and genetic past of the gamete donors, but do not have a right to know who" the donors were. To ensure the availability of such information, the panel "called for gamete banks to keep medical records for 60 years."
Reducing Multiple Births
The Times reports that one "pressing issue" the panel addressed "was the need to reduce the incidence of multiple births," in part because these children "are at increased risk of prematurity, low birth weight, life-long disability and death." Carl Coleman, the panel's executive director, said "many prospective parents did not know that they might face an agonizing decision like abortion to reduce the number of fetuses." Despite these concerns, the Times notes that the panel "opposed legislation limiting the number of embryos that doctors can transfer from the laboratory to a woman."
Kudos And Dissent
According to the Times, "[i]ndependent experts hailed the new report." Boston University School of Public Health medical ethicist George Annas said, "The panel's decision to make the child the primary focus was courageous and correct because up to now all of the focus in the United States has been on infertile adults and their physicians" (Altman, 4/29). But in a separate article, the New York Times notes that five of the panel's members filed dissenting reports. In one, four members "wrote that reproductive techniques are still experimental and lead to a higher proportion of congenital abnormalities." As such, they recommended against concealing the identities of "gamete donors" so that such "information may be utilized to prevent future consanguineous relationships." The four authors "also proposed that the number of embryos implanted in one woman be limited." The second dissention report, filed by patent lawyer John Murname, "recommended limiting embryo implantation to two to a woman and a ban on the abortion of excess fetuses 'except in those instances where the destruction of the unborn life is necessary to prevent the death of the mother'" (LeDuff, 4/29).