The medically assisted procreation raises new ethical questions

Publié le 31 Jan, 2008

Evaluation of the Biomedicine Agency


On 29th January 2008, the Biomedicine Agency drew up a balance sheet of the medically assisted procreation (MAP) in France. In 2005, 19,026 children were born with a MAP, which represents 1 child out of 40. 1,293 of them were conceived with a third donor. In other respects, at the end of 2005, we registered 141,460 frozen embryos conceived in vitro for 38,274 couples; 58% of them were subject to a parental project. The success rate of a MAP, in terms of births, is still around 20% per attempt.


Oocyte and sperm shortage


The Biomedicine Agency is worried about the “shortage” of gamete donation which generates sometimes the travel of some couples abroad. With this shortage, François Thépot, professor of embryology and cytogenetics and assistant to medical director of the agency, indicates that it authorised the oocyte direct donation and not obligatorily frozen. An information campaign will be launched in spring for the oocyte donation and in autumn for the spermatozoid donation.


Extending the access to MAP?


Today, the “physician for infertility” are faced with new demands coming from non planned social situations, due to disruption of the traditional family, to “the improvement of techniques (…) which opens the field of possibilities” and to “a different apprehension of the position of the patient who, particularly since the law of 4th March 2002, has more words to say”, explains Nicolas Foureur, physician in the clinical ethics Centre in Paris. These new demands (late, coming from homosexual couples, single women, from couples in which the man is a transsexual…) rise news questions regarding bioethics laws which governed the “treatment” of heterosexual couple sterility. Today, legal texts do not always clearly answer this question. The law of 6th August 2004 foresees that the MAP is accessible to a couple formed by man and woman, alive and in age to procreate. How to determine the limit age, for instance? Since a few years, an increasing number of men ask to freeze their sperm around 60 or 65 years-old, to “have a second life”. What to answer? For some physicians, like René Frydman, “the dominant element is the risk that presents a possible pregnancy, particularly after a certain age”. “As for the rest, I refrain from entering in what makes the desire of a child”. Others ask the opinion of the clinical ethics Centre or refer to a collegial decision. The question concerning the access to medically assisted procreation has to be discussed during the revision of the bioethics laws, foreseen in 2009.


Setting an approval?


Sophie Marinopoulos, psychoanalyst at the University Hospital of Nantes, estimates that “we will not have the choice to oppose such an enlargement because it is already possible, beyond the boundaries, for who wants it, to obtain a MAP”. Then she proposes to set a form of approval, like for abortion.


Globalisation of the MAP


In other respects, in various countries, the gametes and all the MAP techniques are freely sold, constituting a child market, already globalised. There is a large number of examples:  in the USA, sperm (USD 275,000 per dose), oocytes (from USD 2,500 to 50,000) can be bought, according to morphological and racial criteria of the “salesman”); in Ukraine, a surrogate mother rents her uterus between USD 25,000 and 45,000 … this market is estimated to USD 3 billions per year in the USA, without taking into account the rest of the world.


Should the MAP be financed?


Véronique Fournier, physician and director of the Cochin Centre for clinical studies, interviewed by the newspaper La Croix on 29th January 2008, wonders: “if we largely open the access to MAP, will this mean that the society supports this opening and that it is ready to finance it?” ”The question is to know what it is “fair” to spend at the ethical level for the MAP, compared to other health expenses.”


Sexuality and procreation


Since 1987, in the encyclical Donum Vitae, the Catholic Church was worried about the dissociation between sexuality and procreation generated by MAP. “By substituting a technical act to the embrace of bodies, we pervert the relation to the child: this one is not anymore a donation but something due”, explains Mgr Jean-Louis Bruguès, secretary of the Roman congregation for catholic education.

Another dissociation denounced by the Church: the one of kinship, when we resort to a third donor of sexual cells. Artificial insemination by donor (AID) “prejudices the rights of children, deprives them of the filial relation to their parental origin and can be an obstacle to the maturation of their personal identity”.


Loss in value of the embryo


The Church warns against the loss in value of the embryo, due to embryonic reduction and the use of “supernumerary” embryos.  “All happen as if the embryo which has no parental project has no value”, says Father of Malherbe, professor of bioethics in the Cathedral School. Nevertheless, the embryo is a fully human being and from his conception, “we have to recognise the right of the person among which the inviolable right to life”.

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