Interactive Handout: Right to a Child
March 24, 2011
Right to a Child
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Introduction – The Law
English law there is no unconditional, absolute right to reproduce, nor is there an absolute right to fertility treatment. The Human Fertilisation and Embryology Act (1990) restricts quite considerably access to fertility treatment. The Act has a ‘welfare of the child’ clause. This states that:
‘A woman should not be provided with infertility services unless account has been taken of the welfare of any child who may be born as result of the treatment, or of any other child who might be affected as a result of the birth’. HFEA (1990)
- Assess this view that the right to a child should be linked to welfare consequences.
| What are the implications for a doctor? (Compare this with the Abortion Act 1967). |
- During the passage of the Act, Lady Saltoun tabled an amendment to the Bill which said that no embryo should be replaced in the uterus of a single woman. Do you agree with her view?
- The amendment failed by one vote. But the Lord Chancellor commented: ‘It would be clearly unfortunate if this Bill was seen in any way to be conflicting with the importance we attach to family values”. What do you think he means by “family values”? Does this mean it’s unethical for a gay couple to seek a child by surrogate?
- In one year King’s College Hospital saw 1,500 patients and were concerned about 77 of them. Of these 46 were treated, 6 refused and another 25 had the decision postponed to be made at a later date. Does this indicate that fears of misuse of the welfare of the child clause are unfounded?
A postcode lottery?
Guidance issued by the health watchdog Nice says all infertile women aged between 23 and 39 should be able to get free fertility treatment on the NHS. It says women should get three cycles of IVF, in other words three attempts at treatment. But the guidance is not mandatory, and individual NHS trusts may decide not to implement it in full. Some primary care trusts have restricted access to fertility treatment, either by saying women can only have one or two cycles, or bringing down the maximum age. It has led to a huge postcode lottery, with just 30 per cent of PCTs offering three cycles. Some 23 per cent offer two and 47 per cent – almost half – give infertile couples only one chance. Daily Mail 28.6.10 Read more: http://www.dailymail.co.uk/health/article-1290002/NHS-offer-women-40-fertility-treatment-avoid-sued-age-discrimination.html#ixzz0tFiBoTMc
- Should every woman have a right to at least one cycle of IVF treatment on the NHS?
A real life case
A woman when younger, had three children and an abortion. The children were put into care, because she couldn’t cope. After a new start with a partner she asked for fertility treatment 25 years later. The consultant wanted to treat her, but the ethics committee refused. They argued that the social work team involved with the case thought it inadvisable to take such a risk, on the grounds that there may be problems after the child was born.
- Should this woman have been allowed to have a child?
Problems with the concept of a “right to a child”
Rights, in the context of reproduction, is a difficult concept. Rights imply that something ought to be the case: that we ought to have access to something where it is not actually the case. They are often described as ‘moral rights’. When people say ‘We should have the right to reproduce’ or ‘We should have the right to health care’ it is often in the absence of that being the case. The problem with a right to reproduce is that it implies that someone has a corresponding duty to provide for that right. But upon whom is it incumbent to ensure that that right is realised? If you are denied it, who do you blame? Where is your protection and who do you have recourse to? If you do not manage to reproduce through infertility treatment can you blame your doctor for failing in his duty to meet your right to reproduce? Juliet Tizzard http://www.prochoiceforum.org.uk/ri2.php
| Why is it suggested that the concept of a right to a child is problematic? |
The argument for equality and justice
The overwhelming majority of women who become mothers do so without having their moral worth scrutinised. Their affairs and innermost secrets remain private, unlike women seeking fertility, who are sometimes denied treatment because they are considered unsuitable as mothers. Yet an overwhelming majority of children are born to women whose suitability for motherhood is not tested. Moreover many of these women would not pass inspection of a hospital ethics committee or fulfil the criteria of health care purchasers.
Naomi Pfeffer http://www.prochoiceforum.org.uk/ri2.php
- Evaluate the argument for equal treatment of fertile and non-fertile women.
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- The Roman Catholic Church argues that IVF treatment “entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person. Such a relationship of domination is in itself contrary to the dignity and equality that must be common to parents and children”. Catechism para 2376
What do you think the church means by that last sentence?
Ethical Concerns
Different fertility treatments raise different moral concerns. Here we consider three more to add to the welfare of the child and issues of equality mentioned above:
- Embryo wastage: abortion by stealth? If eggs are fertilised to create embryos and then the embryos, implanted in the womb, are aborted, the moral issue becomes identical to abortion.
If embryos are frozen and then later disposed of, this raises sanctity of life issues.
- Surrogate parents: issues of parenthood and identity. If surrogate parents are used, the mother is no longer the natural mother.
If sperm donors are used, then the father is no longer the actual father.
- The cost of fertitility treatments represents money which could have been spent elsewhere in the health budget. Is a child a need? Is a child a right? Is it the same right as the right of a cancer patient to treatment?
Roman Catholic Church
Roman Catholic view:
IVF and AI – acceptable, only if:
No “spare embryos” are created.
No third parties are used.
They do not replace sex within marriage.
Artificial Insemination – acceptable, only if the husband’s sperm is used.
Pope Paul VI has taught that there is an “inseparable connection, willed by God, and unable to be broken by man on his own initiative, between the two meanings of the conjugal act: the unitive meaning and the procreative meaning.”A human being comes into existence at the moment of fertilization of an ovum by a sperm. This fact has been recognized by the science of Human Embryology since 1883, and is still acknowledged today. The Church teaches that a human being must be respected-as a person-from the very first instant of his existence as a human being, and therefore, from that same moment, his rights as a person must be recognized among which in the first place, is the inviolable right of every innocent human being to life. The Church also teaches that from the moral point of view a truly responsible procreation must be the fruit of marriage.
This particular doctrine [of “observing the natural law“], often expounded by the magisterium of the Church, is based on the inseparable connection, established by God, which man on his own initiative may not break, between the unitive significance and the procreative significance which are both inherent to the marriage act. The reason is that the fundamental nature of the marriage act, while uniting husband and wife in the closest intimacy, also renders them capable of generating new life—and this as a result of laws written into the actual nature of man and of woman. And if each of these essential qualities, the unitive and the procreative, is preserved, the use of marriage fully retains its sense of true mutual love and its ordination to the supreme responsibility of parenthood to which man is called. We believe that our contemporaries are particularly capable of seeing that this teaching is in harmony with human reason. Humanae Vitae 1968
- Summarise the official Catholic View
The Church of England
IVF is acceptable in all its forms, including the donation of eggs and sperm by third parties.
Experimenting on “spare” human embryos is acceptable up to 14 days after fertilisation, because up to 14 days a foetus can split into two and form twins. Therefore, it is not really a human life until 14 days.
”“We support the recommendation that research, under licence, be permitted on embryos up to 14 days old and agree that embryos should not be created just for scientific research.”
- Summarise the Church of England’s view on fertility treatment.
- “God knit me together in my mother’s womb, I am fearfully and wonderfully made”. Psalm 139.6
- Does this have implications for the sanctity of human life? See Psalm 139 verse 6
Exercise: research these treatments and explain the process used.
Processes available
When problems are diagnosed, fertility treatments depend significantly on the type of problem. A woman with scarring in the may undergo surgery to remove scarring and increase chances of pregnancy. As women age, age of ova also can affect ovulation in a healthy woman, meaning that women may not always ovulate at predictable times or eggs may not be viable.When problems are diagnosed, fertility treatments depend significantly on the type of problem. A woman with scarring in the may undergo surgery to remove scarring and increase chances of pregnancy. As women age, age of ova also can affect ovulation in a healthy woman, meaning that women may not always ovulate at predictable times or eggs may not be viable.When problems are diagnosed, fertility treatments depend significantly on the type of problem.
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In some cases, fertility treatments involve injection of fertility medications to boost ovulation and cause women to release possibly more than one egg per month. These medications are usually hormone based, and they do have some unwanted side effects, like weight gain, skin breakouts, and instability of mood. Many women feel these side effects are worth the price.
Men may also take medication to boost sperm count. Medications used may result in pregnancy, but also carry a higher rate of both miscarriages and multiple births. In men, temporary feminizing characteristics may occur.
When injections and other methods still do not result in pregnancy, couples may look to in vitro fertilization in order to achieve pregnancy. In this procedure, eggs and sperm are harvested from the couple, and then combined to create an embryo. At the appropriate time of the month, several embryos are injected into the uterus.
In vitro fertility treatments are highly expensive. Usually one round of in vitro injection costs about £8,000. Others believe in vitro compromises ethical issues that have not been thoroughly resolved. For example, since more than one embryo is implanted, this significantly increases the risk of heavy multiple births.
Since many in the public have registered concern of fertility treatments that result in extra embryos, some in stem cell research are now making efforts to harvest stem cells from elsewhere, eg from umbilical cord blood. At some time in the near future, the use of embryos to harvest stem cells may no longer be an issue.While a woman can usually carry twins or even triplets to full term, a greater number of babies means greater health risks to all the unborn children. In these cases, doctors may strongly advise aborting some of the embryos. This position is thought by many to be a violation of religious ethics. As well, such fertility treatments often create embryos which will never be implanted, and so must be destroyed. Some people believe that the creation of such embryos with no intent to give them a chance of life is morally wrong. Others worry about these embryos being donated and later exploited for the purpose of stem cell harvesting.
Exercise: for a case study on the ethics of surrogacy and the 1987 case of Baby M go to
Exercise: complete the following table
| Fertility treatment
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Side-effects (risk) | Cost (£) | Moral implications |
| IVF
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| Surrogacy
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| AID
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| Genetic screening
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| Fertility drugs
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Some key facts to consider:
- 20% of couples conceive immediately, but 14% have fertility problems which mean they have not conceived after two years (the definition of infertile).
- NHS treatment is allowable after three years if there is a 10% or more probability of success.
- One cycle of IVF costs £5,000- £10,000. A couple can have three cycles.
- About 30,000 couples a year go through IVF treatment, 25% on the NHS.
- The oldest mother to conceive by IVF was 62 years old.
- Louise Brown was the first “test tube baby” (1978).
- IVF births constitute 1% of all births every year.
- Chance of success from any one cycle is 24% (so 76% of couples endure the pain of failure).
Source: http://www.nhs.uk/chq/Pages/889.aspx?CategoryID=54&SubCategoryID=127
Further reading
For an excellent discussion by three doctors go to:
http://www.prochoiceforum.org.uk/ri2.php
Wikepedia has a well sourced summary
http://en.wikipedia.org/wiki/In_vitro_fertilisation
Exercise: summarise the ethical implications of different fertility treatments from different theoretical perspectives:
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Natural Law
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Kant | Bentham’s utilitarianism | Mill’s utilitarianism | Situation ethics | Divine Command theory | ||
| IVF |
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Surrogacy
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| AID
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| Fertility drugs
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| Genetic screening of embryos
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Self test 1: Explain the Following Terms
| IVF treatment
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| AID
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| surrogacy
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| embryo
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| infertitility
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| designer babies
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| right to a child
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| welfare clause (1990 Act)
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Self test 2: issues to analyse
- It is possible for a child to have three mothers: a genetic mother (i.e., the one who supplies the egg); a birth mother (i.e., the woman who carries the child and gives birth to it); and a nurturing mother (i.e., the woman who raises the child as her child). Does this matter?
- Does the motive of the surrogate mother have any bearing on the ethics of surrogacy?
- Contrast the Roman Catholic and Anglican views of in vitro fertilisation. Is religious ethics the best approach to solving issues of a right to a child?
- Is the right to a child the same as a right to life? Or a right to cancer treatment? In what ways might it be different?
- Is there any ethical significance to the cost of IVF treatment? How many cycles of treatment should an infertile couple receive?
- Should all women be treated equally irrespective of their background or the possibility of a child being happy? Who should decide?
Film Clips
| My Sister’s Keeper
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| Gattaca
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