Contemporary ethical issues in third party assisted conception

Introduction: The last quarter century has witnessed remarkable changes in third party assisted conception practices. The historical domination of donor
insemination (DI) and ‘do it yourself’ surrogacy – both largely clandestine
practices - has been replaced by a considerably more varied range of options
involving donor sperm, eggs, and embryos and surrogacy that are available
to much wider range of involuntary childless people including single men
and women, same sex couples, post-menopausal women, widows using their
dead husband’s sperm and parents of deceased persons wishing to conceive
their grand-children. Furthermore, such practices have become increasingly
visible. Increased visibility is epitomised by the establishment of formal registers
of third party procedures in a number of jurisdictions; informal registers
established by service users and operating globally via the internet; legislation
enabling people conceived following a third party procedure to have information
about their donor; and the vocalisation of the interests of people conceived
as a result of a third party procedure (primarily DI). Both the
expansion of services and their increasing visibility have exposed a number
of ethical concerns and important questions over how to regulate such an
area in a morally pluralistic and globalised world.
Materials and Methods: The presentation is based on a review of policy documentation,
legislation, research studies, conference proceedings and media
accounts of third party assisted conception services in a variety of countries
(Europe, USA, Australia and Canada) over the last 20 years. The development
of mechanisms of regulation in this area will be charted to provide an overview
of current policy and legislation. The aim of this paper is to examine the challenges
of regulating such an area in the age of reproductive tourism, moral pluralism
and increasing globalisation.
Results: The significant ethical issues concerning third party assisted conception
will be reviewed: different forms of third party assisted conception;
the commercialisation of gamete procurement; the range of people who may
use third party procedures; the interests of different family members in families
built as the result of a third party procedure; and the interests of donors and surrogates.
Subsequently, the international legal response to these ethical debates
will be discussed The presentation will focus on the problems caused by the
lack of a cohesive regulatory response to these dilemmas by international legislations.
These include “reproductive tourism”, that enables people to circumvent
their own country’s ethical codes by travelling to receive treatment,
uncertainty over acceptable limits to the use of such procedures and welfare
of the child considerations.
Conclusions: The presentation will consider how bioethical principles can be
applied to practices in third party assisted conception in the context of moral
pluralism and globalisation. It will conclude by considering the feasibility of
developing and implementing an internationally agreed code of ethics for
health care professionals in this area.