Hum. Reprod. Advance Access originally published online on April 5, 2007
Human Reproduction 2007 22(8):2346-2348; doi:10.1093/humrep/dem067
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Letters to the Editor |
Independent counselling on embryo donation for infertility patients
National University of Singapore, 5 Lower Kent Ridge Road, 119074 Singapore, Singapore
E-mail: denhenga{at}nus.edu.sg
Sir, A key issue of contention in reproductive ethics is the perspective that human life begins at the onset of fertilization (Young, 1994
; Sullivan, 2003), so that the disposal of surplus frozen embryos, not otherwise donated to other infertile couples, would represent wanton and willful destruction of human life. This view is commonly held by adherents of the Christian faith, in particular those affiliated with the Roman Catholic Church (de Rosa, 2005). With clinically assisted reproduction becoming more readily available worldwide, there is growing controversy (Coleman, 1999; Pachman, 2003) over increasing numbers of surplus embryos in cryostorage.
The aim here is neither to dispute nor debate legal, ethical and moral issues pertaining to the ‘personhood’ of frozen surplus embryos and the viewpoint that human life begins at fertilization. Instead, the focus is on a more pertinent ethical problem at hand, which is the potential exploitation and manipulation of this contentious issue to encourage and solicit embryo donation from former patients who have attained reproductive success.
In many countries where commercialization of human gametes is banned, there are extremely few non–patient donors willing to donate altruistically without receiving substantial financial remuneration (McMillan and Hope, 2003), particularly in the case of oocyte donors who face much inconvenience and pain, as well as potential health risks during ovarian stimulation and surgical retrieval of oocytes (Hyun, 2006; Pearson, 2006). Under such circumstances, embryo donation may be the only way out of childlessness for some couples, due to the non-availability of either donated sperm or eggs (Heng, 2007). In most cases, the only means of procuring donated embryos is to persuade former patients to donate their surplus frozen reproductive material in cryostorage, after successful fertility treatment.
Nevertheless, it must be noted that most former patients are not psychologically comfortable in begetting unknown biological offspring, which is often visualized as siblings of their legitimate children (McMahon et al., 2003; Bangsboll et al., 2004; Nachtigall et al., 2005; Hammarberg and Tinney, 2006). In countries where donor anonymity has been abolished and disclosure is possible after children born of donated oocytes and embryos have attained a certain age i.e. 18 years old (Hampton, 2005; Janssens et al., 2006), the situation can be even more psychologically disturbing for prospective donor couples.
Hence, a possible strategy to persuade former patients to donate for the treatment of other infertile couples may be to convince them that their surplus frozen embryos are in fact ‘living entities’ with a manifest right to be born and to lead a full human life (Young, 1994; Sullivan, 2003; May, 2005; de Rosa, 2005). In the case of the lay patient not well-acquainted with medical embryology, there is little awareness that frozen cleavage-stage or blastocyst embryos are in fact just a clump of cells with little physical resemblance to the human form. Instead, the common perception of prenatal life is the visual image of the advanced fetus within the mother's womb (as vigorously promoted by pro-life campaigners), with well-formed miniature head and limbs that bears a striking resemblance to the post-natal human form. This misinformation may somehow be perpetuated by the flashy and eye-catching anti-abortion advertisements often put up by the pro-life lobby (Jones and Henriksen, 1987; Boucher, 2004). A psychological ‘guilt-complex’ can thus be imposed on former patients, who are led to believe that disposal or termination of their surplus frozen embryos is willful and wanton destruction of human life, morally equivalent to clinically induced abortion.
The pertinent concern here is of medical professionals attempting to exploit this contentious issue to encourage and solicit donation from their former patients. It must be noted that even if embryo commercialization is prohibited and no profit is allowed to be made directly from the transaction of frozen embryos between donor and recipient, there is still much opportunity for profit-making in medical fees arising from laboratory and clinical services rendered to the recipient (Heng, 2006). In fact, it is possible that the ‘sale’ of donated embryos may be ‘disguised’ as substantially increased medical fees, at a premium above that billed to other patients for utilizing their own embryos in a self-freeze–thaw embryo transfer cycle.
Hence, there is a likelihood that medical professional may be motivated financially, rather than by their own personal moral or religious convictions, in attempting to impose upon their former patients the viewpoint that frozen embryos are ‘living human entities’ with a manifest right to be born. Very often, formerly infertile couples who have attained reproductive success feel an overwhelming sense of gratitude to the fertility doctor who previously oversaw their treatment. Hence, there is a risk of medical professionals exploiting the doctor–patient fiduciary relationship (based ultimately on goodwill and trust) to exercise undue influence on their former patient's decision to either terminate or donate their surplus frozen embryos (Heng, 2006).
It is therefore imperative that medical professionals should be strongly discouraged or even disallowed to share with their patients, their own personal viewpoints on the ‘humanity’ of frozen embryos and their attendant right to life. What is needed is independent professional counseling. Furthermore, such counselling should be available to infertile patients at the onset of their treatment so that they will be prepared in advance and able to make an informed decision on their surplus frozen embryos, without any undue influence from medical professionals and healthcare institution that may harbor conflicting interests and ‘hidden agendas’ (Heng, 2006).
References
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