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The Paradox of Altruistic Gamete Donation and Surrogacy

The various forms of artificial human reproduction are, all of them, problematic; not least because they present all sorts of complex moral and legal issues. And this blog touches on such issues but, before going into the complexity, let us first have a little simplicity.

Let us, therefore, consider what appears to many to be the least problematic forms of artificial human reproduction: altruistic gamete donation and altruistic surrogacy. They are called ‘altruistic’ because they are the freely given gifts of women who seek no profit; women who simply want to do good, and who are under no pressure to do so.

Such an altruistic woman is Anne, a healthy young woman who donates eggs so that an infertile couple can have children. Let's suppose that no monetary exchange is involved, not even in the form of compensation for expenses, which is still a subtle form of exchange. Anne, remember, expects nothing in return from the couple. This is altruism, not commerce. Some people would find her action morally acceptable, even laudable; and they would see no good reason why it should not be considered perfectly legal.

Another such altruistic woman is Marie. Like Anne, Marie is a healthy young woman and absolutely altruistic. Anne acts as a surrogate mother for a couple because the woman who wants to become a mother cannot carry a pregnancy. Again, let's suppose that no monetary exchange is involved, not even in the form of compensation for expenses. Marie allows the use of her womb for mere altruism and expects nothing in return from the couple. Some people would find her action, too, to be morally acceptable; even laudable. This, too, they believe, should be perfectly legal.

Certainly, appropriate forms of regulation would be necessary in the cases of both, Anne and Marie, to anticipate and avoid possible conflicts that just might arise between the parties involved. But, in general, there are not many people who would find the actions of either Anne or Marie to be, in any way, dreadfully, seriously, problematic.

Now, let us imagine another healthy, young, and exceptionally altruistic woman, whom we shall call, for obvious reasons, Annemarie. Annemarie, in this imaginary case, both donates her eggs to, and, acts as a surrogate mother for, a particular infertile couple, the woman of which cannot carry a pregnancy. Annemarie does the same, and is the same, as Anne and Marie. The same: but, different.

Yes, here is the paradox: while some people would approve of the actions of Anne, and of Marie, the actions of Annemarie seem to them to be very different. Because very few people would consider the practice of conceiving and gestating a child with the deliberate intention to give the child away to a commissioning couple, even for purely altruistic reasons, to be either morally or legally acceptable. So, with Anne and Marie: not problematic. Yet, with Annemarie: so problematic.

What is so wrong in the case of Annemarie that is not seemingly wrong in the cases of Anne or Marie? If two actions are individually good, why are they not good when combined together?

The paradox obviously does not arise for those who do not consider gamete donation – that is the donation of either eggs or sperm - or surrogacy, (or both,) to be in any way acceptable. For others, the paradox is there.

Ova are donated with a view to generating children; and if a surrogate mother is needed to complete the process why shouldn’t she be the very same woman who donates the eggs?

Similarly, if an altruistic surrogate mother is doing something good, isn’t she doing something even better if she is also the altruistic donor? Would it be different if Annemarie donates her ova to one couple and acts as a surrogate for a different couple?

We can easily imagine all sorts of permutations and combinations of roles, genders, relationships, number of people involved, etc., between the process of gamete donation and surrogacy. We can easily imagine just how complex and problematic the whole business can become.

In the reality of the world out there, cases are usually much more complicated that those presented here in such a simplified way. But, even as we discuss clear cut simplified cases, sooner or later some contradiction appears; and it points to something seriously wrong with splitting up the normal, and naturally composite, action of becoming the mother and the father of a child.

Those who would defend altruistic gamete donation and surrogacy should, if they are being logical, also defend the practice of generating children with the purpose of donating them to couples. For that is the logic of it all. Somehow, we feel that there is more to this than cold logic; this does not feel right and proper.

And those who have no problems with some form of compensation (be it a fee, or expenses, or whatever) for gamete donation and surrogacy, should have no problem with turning the bringing of a child into this world into a commercial business.

We demand to know: Since when has treating children as commodities to be given is progress?






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Euthanasia is promoted under the disguise of neutrality

Last week, a spokeperson for Fianna Fáil told the Medical Independent that they would not oppose the referral of assisted suicide to a Citizens’ Assembly for further discussion. Delegating the debate to an unelected body means that neither Fianna Fáil, nor any other major party, is not actively opposing the introduction of legislation that could legalise euthanasia and assisted suicide. (1)

In 2017 the Oireachtas Joint Committee on Justice and Equality considered possible recommendations on legislating in favour of euthanasia andassisted suicide. They heard from a number of experts, and the strongest opposition to the introduction of new liberalising laws came from the representatives of the medical profession and of disability advocacy groups. (2)

Des O’Neill, professor of medical gerontology at Trinity College Dublin, said “We have to send out a message to people of disability of whatever age that our impulse is to care, to cure sometimes, to relieve often and comfort always.” (3)

Dr Regina McQuillan of the Irish Association of Palliative Care said: “Suicide is rightly considered a blight on society and there are many efforts made to reduce it. That there are some people for whom suicide is considered appropriate may suggest that there are people whose lives are not deserving of the same level of protection.” (4)

At the end of the hearings, the Committee did not achieve a clear consensus. Accordingly, they did not recommend legislative change. Instead, they urged the Houses of the Oireachtas “to consider referring the issue to the Citizens’ Assembly for deliberation”. (5)

But why should a non-representative body, with no specific expertise, discuss and recommend vicariously, when there was no majority in the Oireachtas Committee in support of the change?

Political parties cannot stay neutral and delegate to others such a critical debate. Even small changes must be opposed or they will have catastrophic effects.

We can learn from the experience of other countries that the legislation on these issues is usually introduced on some limited ground (for terminally ill patients, for instance) but, with time, it becomes more and more liberal. Once the general principle that doctors should not participate in procuring death is eroded, it is difficult to change the trend and go back.

Psychiatrist Mark Komrad has said, “Several governments, in the last two decades, have invited and permitted physicians to transgress the prohibition against killing their patients. … Originally, the class who can be voluntarily killed or helped to suicide was limited to those at the very end of life. However, principles of justice have made it very difficult to limit such procedures to that category of people. The more experience a country has with such practices, the more the horizon of eligibility has expanded far beyond extreme end-stage cases. … The so-called “choice“ that is offered to the suffering to end their lives is a pseudo-choice, filtered through a physician’s own values, and commonly forced, by having very limited choices in other domains — economics, social support, healthcare, etc. It is unjust, and therefore impossible, in a democratic society, to limit these procedures to some — like the terminally ill — but refuse it to others — like those with chronic physical and psychiatric disabilities. Yet, it signals that chronic disability and its sufferings might constitute a “life not worth living.” (6)

The pressure on doctors to support and participate in euthanasia and assisted suicide is growing everywhere.

In October 2018, at the General Assembly of the World Medical Association (WMA), representatives from Canada and the Netherlands attempted to change the WMA code of ethics, which has always condemned the participation of physicians in procuring death through direct euthanasia or providing drugs for suicide. (7)

During the debate, all sort of euthanasic practices were rejected and eventually the proposal has been withdrawn, reiterating the WMA’s long-standing opposition to procuring death.

This debate, though, continues on national level.

The Royal College of Physicians (RCP), in the UK, has recently dropped its opposition to assisted dying in a surreptitious manner that has attracted strong criticism. They are now neutral on the issue and will not officially engage in public discussions but how they have arrived at this position appears to be despicable. (8)

In 2014, 57.6% of the RCP membership opposed a change in the law that would legalise assisted suicide. In January this year, after announcing the third poll on this topic among its members since 2006, it was decreed that a 60% majority was needed to stop changing the RCP position to non-opposition. This means that even if 59,9% were against the change, it would have occurred nonetheless. Such a majority was even more difficult to achieve as three options were given (yes, no or neutral), while the previous vote was binary (yes or no).

A group of members of the RCP have challenged them in court, arguing that “the use of a ‘super-majority’ vote on such issues is without precedent in professional organisations in the UK. They have said that it appears to be a tactical move to give a strong boost to the campaign to change the law on assisted suicide. The largest euthanasia lobby group in the UK has previously identified the opposition of medical bodies as a key obstacle to changing to law. Two well-known patrons of this organisation, and active campaigners for legalising euthanasia, are on the RCP Council – the internal body driving the RCP poll.” (9)

In spite of the robust protestation, the poll was carried out in February and found that 43.4 pc were opposed adopting a pro-assisted suicide policy, 31.6 pc were in favour and 25 pc were neutral. This means that even though the majority of the voters were against, the Royal College of Physicians will now be neutral on the matter.

In this case, as with the Joint Committee referral to the Citizens’ Assembly, we see that even when there is no clear majority in support for a significant change, certain issues are considered so important by a minority that they have to be promoted, under the disguise of neutrality, until they are accepted.





Notes
(1) medicalindependent.ie/ff-would

(2) ionainstitute.ie/assisted-suic

(3) ionainstitute.ie/oireachtas-co

(4) ionainstitute.ie/assisted-suic

(5)
data.oireachtas.ie/ie/oireacht

(6) alexschadenberg.blogspot.com/2

(7) ionainstitute.ie/world-medical

(8) bbc.com/news/health-47641766

(9) cmfblog.org.uk/2019/01/16/why-

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