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Submission from CMF to the HFEA on Tomorrow's Children - A Consultation on Guidance to Licensed Fertility Clinics on Taking Into Account the Welfare of Children to be Born from Assisted Conception

Published: 7th April 2005

General

1. Please give any general comments you might have about the current guidance in the code of practice regarding welfare of the child assessment.

Our submission is based on the following presumptions:

• The welfare of the child clause must be maintained. We would prefer to see it strengthened to emphasise that the welfare of the child takes precedence over the desires of potential parents seeking treatment.
• Marriage is the ideal context for the raising of children. Although we recognise that many single parents and those in non-married partnerships do a very good job we believe that infertility treatments should only be available for married couples.
• The child's 'need for a father' was specifically cited in the Human Fertilisation and Embryology Act in reference to child welfare. This cannot (and should not) be removed from the guidance without direct intervention from parliament.
• Children are gifts to be cherished, not commodities to be chosen. The use of reproductive technology is not a right but a privilege that brings with it serious responsibilities.
• Infertility treatment should be aimed at restoring lost function. It is not about extending natural reproductive boundaries. We do not believe therefore that infertility treatments should be available to post-menopausal women or the unmarried, whether single or in non-married partnerships. We also have grave misgivings about the use of donor gametes (as they violate the marriage bond) and any human embryo freezing, disposal or experimentation (as it fails to show the utmost respect for human life).

In light of the recent report from the House of Commons Science and Technology Committee into Human Reproductive Technologies and the Law, which recommended the abandonment of the welfare of the child principle, we are unclear of the impact of this current consultation. We reject the arguments in the relevant paragraphs (91-107) of the new report and would oppose their incorporation into new legislation.

HFEA Chair Suzi Leather has said that the HFEA's regulatory role is to 'ensure that the public interest is safeguarded, the sector is accountable and standards are maintained'. Fulfilment of this role requires maintenance of the welfare of the child clause. Furthermore, more long-term studies of the children born as a result of assisted reproduction are required before any firm conclusions can be drawn about how well they do in different 'family' arrangements.

As a general rule we believe that the same principles applying to the approval of adoption of babies or children should apply to couples seeking to adopt embryos or use donor gametes.

Enquiries to be made

2. Which of the following options best reflects your view on the enquiries that clinics should be expected to make in order to gather relevant information for the welfare of the child assessment?

e) Information about risk factors provided by the patient, plus follow-up to the GP and other agencies [as necessary] routinely.

Reason

Based on our primary assumptions, there should be assessment of the couple seeking assisted reproduction. This needs to involve GP follow-up in order to gain an outside perspective on the couple; information provided solely by the couple will not be sufficient. Other agencies should be approached freely as deemed necessary.

The NHS is currently moving towards a situation where: '…every patient's medical and care records will be held electronically and will eventually be available securely online. The information will be safely and easily accessible to healthcare professionals and patients, whenever and wherever it is needed.'[1] Relevant information will therefore be more readily accessible to clinics.

3. Do you think that refusal by a patient to give consent for a centre to contact their GP should be taken into account when deciding whether or not to provide treatment?

a) Yes

Reason

Refusal could indicate that the couple are hiding information that might lessen their chances of being approved for treatment. This information may well be relevant to the welfare of the child assessment.

Factors to be taken into account

4. Which of the following options best reflects your view on the factors that should be taken into account during the welfare of the child assessment?

c) Risk factors for medical, physical and psychological harm and social circumstances should be taken into account.

Reason

Society accepts that a person's welfare goes far beyond medical and physical 'health'. As the World Health Organisation's definition of 'health' recognises, health also involves psychological, social and spiritual factors. These factors must be taken into account if a full assessment of the welfare of the child is to be made. Looking beyond mere medical factors provides a more wholistic approach to the assessment – for the parents, any existing children, and any future child.

5. Would you welcome guidance from the HFEA on how to take into account the factors mentioned above?

a) Yes

Reason

Clinics need specific encouragement and guidance on how fully to assess couples presenting for treatment. Guidance is also necessary to discourage discrepancies in standards of care between the various clinics. Guidance on the welfare of the child clause should be included in the Codes of Practice.

Welfare of the child assessments for particular treatments

6. Which of the following options best reflects your view on the assessment that should be carried out during donor conception treatment?

b) When patients are having donor conception treatment, the same welfare of the child assessment as patients using their own gametes should be used. However, donor conception patients should receive extra information and preparation for becoming the parent(s) of a donor conceived child.

Reason

The same assessment should be made, but the fact that the couple will be using donated gametes is a key factor in that assessment.

We expressed our views on donor-assisted conception in the consultation carried out by the HFEA in February 2005 on The Regulation of Donor Assisted Conception.[2] We have concerns about donor assisted conception as it introduces a third party – whether anonymously or not – into the procreative relationship. We therefore do not uphold gamete donation in principle.

However, we recognise that it will proceed in some cases and are therefore concerned for the welfare of children born from donated gametes. The recent changes to remove donor anonymity are welcomed and must be upheld. We note the recently expressed intention of 'ManNotIncluded' to import gametes and exploit a 'loophole' in the new regulations by not having the gametes frozen in the UK, but only 'thawing'. This loophole should be closed. The children born of such imported gametes would have no chance to trace their biological roots. Allowing such activities to continue contradicts the regulators' expressed intentions.

Counselling of couples receiving donated gametes is imperative. These couples must be encouraged to be open with their children about the donation. To encourage secrecy would make a mockery of the new regulations on anonymity. Similarly extra care should be taken over donating embryos to couples, and encouraging openness within those situations. In adoption procedures it is recognised that the medical histories of biological parents (especially with respect to inherited diseases) are crucial to any assessment. Children who are unaware of the medical histories of biological parents are accordingly gravely disadvantaged.

7. If you opted for either 6 b) or c), what kind of assessment and/or preparation for donor conception patients is desirable?

Their likelihood to be open with the child about its origins. The attitude of both parties to donation – particularly the man if sperm is being donated as men are more likely to want to withhold such information. The fact that the child is derived from donated gametes should be marked on the medical notes along with any relevant issues from the medical histories of biological parents. The family's GP would therefore know and be able to counsel the parents as they bring the child up. Literature encouraging and helping parents to be open with their children would be helpful.

8. Which of the following options best reflects your view on the assessment that should be carried out for patients undergoing unlicensed treatments in licensed clinics?

Reason

If our concern is for the welfare of children, this applies equally to licensed and unlicensed procedures.

9. Please give any general comments you might have about the welfare of the child principle and its interpretation in clinical practice.

The fact that there are presently discrepancies between clinics and postcode regions in standards of care provided should prompt us to ensure that the highest possible standards are applied everywhere.

As stated above, as a general rule we believe that the same principles applying to the approval of adoption of babies or children should apply to couples seeking to adopt embryos or use donor gametes.

We quote from Section 1 of the Adoption and Children Act 2002:

(2) The paramount consideration of the court or adoption agency must be the child's welfare, throughout his life.
(4) The court or adoption agency must have regard to the following matters (among others) –
(c) the likely effect on the child (throughout his life) of having ceased to be a member of the original family and become an adopted person…
(e) any harm (within the meaning of the Children Act 1989 (c.41)) which the child has suffered or is at risk of suffering,
(f) the relationship which the child has with relatives, and with any other person in relation to whom the court or agency considers the relationship to be relevant, including –
(i) the likelihood of any such relationship continuing and the value to the child of its doing so,
(ii) the ability and willingness of any of the child's relatives, or of any such person, to provide the child with a secure environment in which the child can develop, and otherwise to meet the child's needs,
(iii) the wishes and feeling of any of the child's relatives, or of any such person, regarding the child.
(8) For the purposes of this section –
(a) references to relationships are not confined to legal relationships,
(b) references to a relative, in relation to the child, include the child's mother and father.

For further information:

Steven Fouch (CMF Head of Communications) 020 7234 9668

Media Enquiries:

Alistair Thompson on 07970 162 225

About CMF:

Christian Medical Fellowship (CMF) was founded in 1949 and is an interdenominational organisation with over 5,000 doctors, 900medical and nursing students and 300 nurses and midwives as members in all branches of medicine, nursing and midwifery. A registered charity, it is linked to over 100 similar bodies in other countries throughout the world.

CMF exists to unite Christian healthcare professionals to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.