A non-debate in the Dáil about the Assisted Human Reproduction Bill

Last week, the Dáil began debating the Assisted Human Reproduction Bill but, in reality, there was no debate. Assisted Human Reproduction (AHR) poses many serious ethical and legal questions but very few objections were raised by our TDs. This is a typical pattern in these debates.

The Bill is very permissive and adult-centered in its inspiring philosophy, but almost all TDs who spoke wanted it to go even further. For instance, the Bill allows for non-commercial or ‘altruistic’ surrogacy, which is banned in 28 out of 44 countries in Europe. The main complaint is that the Bill does not also allow for commercial surrogacy arrangements undertaken in the few countries where paying a surrogate is legal. All European countries, with the exception of Ukraine, Russia and Belarus, ban commercial surrogacy but some TDs are not happy with this.

Deputy Emer Higgins (Fine Gael) said: “Sending people abroad for a service that we do not offer in Ireland sends a twisted message that is somehow wrong, however, it is anything but. We should be celebrating the advances in science and medicine, and the advances in society that allow us to create families in all kinds of ways.”

Most countries ban commercial surrogacy on the grounds that it commodifies children and exploits low-income women. 

The Bill permits non-commercial surrogacy in Ireland provided the embryo is created using an egg other than that of the surrogate mother herself. In other words, the woman who carries the pregnancy should not be genetically related to the child, because that would mean she has entered into a contract to hand over a baby at the end of nine months where she is both the birth mother and the genetic mother. This is called ‘traditional surrogacy’.

 

But this seems to be what Roisin Shortall, co-leader of the Social Democrats, wants Irish law to allow. She claimed that “the omission of this approach [‘traditional surrogacy’] from the legislation would exclude single people and couples who cannot produce sperm or eggs from surrogacy.” 

Even based on her own logic, this isn’t true. A person is allowed under the Bill and current practice to use the eggs or sperm of a third party to have a baby.

Although the Bill does not allow commercial surrogacy in Ireland, it does allow a surrogate mother to be paid “reasonable expenses”. This could include the likes of accommodation during the pregnancy and the birth, and any loss of income entailed in being a surrogate.

For some poor women it would be a good source of income being paid in this way during a 12-month period that, according to the Bill, would cover not only the pregnancy and some time afterwards, but the period when she was trying to become pregnant.

Only two TDs, raised some questions about the new proposed legislation.

Peadar Tóibín (Aontú) said we cannot have a situation where children do not have access to the information about their biological parents or the mother who carried them. He criticised surrogacy because it splits motherhood between up to three women, i.e. the surrogate, the commissioning mother, and possibly a third person, which is the woman who sold or donated her egg. This could easily present identity issues for the child.

Deputy Tóibín also criticised the Bill for allowing for the pre-implantation diagnostic and destruction of embryos of children with disabilities.

Catherine Connolly (Independent) showed more familiarity with the details of the Bill than anyone else who spoke. She denounced that aspects of the proposed legislation that permit a for-profit approach to AHR.

Deputy Connolly lamented that “the legal vacuum is bad enough, but we also have an information vacuum. … We are utterly reliant on the companies that are making a profit for the information [about AHR] and we do not know the outcomes of these procedures.“

While she welcomed the Bill, she presented some thoughtful criticism. “On the one hand, we have the Rapporteur’s report telling us about the damage caused to children and adults when the State stands by and allows their identity to be taken from them and then, on the other hand, we allow an ad hoc approach to assisted human reproduction in such a way that children born by means of it do not have access to their identity or where they came from.”

 

Quite so. and it will come back to haunt us, a point frequently raised by the Iona Institute. 

A landmark victory for a pro-life doctor

 

Dr Dermot Kearney is an Irish physician working in England. Through use of the Abortion Reversal Pill (APR) treatment, he has saved at least 20 babies who would otherwise have been lost to abortion. Abortion provider, Marie Stopes International, made a complaint against him to the General Medical Council, but the complaint was recently dismissed. In fact, it backfired, because the complaint ended up publicising the fact that the APR can be successful.

The Abortion Reversal Pill operates through the administration of the natural hormone progesterone to women who changed their mind after taking the first of two abortion pills.

Progesterone, which is used also to prevent miscarriages, helps to undo the effects of the first pill and increases significantly the chance of survival of the baby.

Marie Stopes International accused Dr Kearney of using the treatment without it being properly backed by evidence. They also accused him of ‘imposing’ anti-abortion beliefs on a patient.

As a result, Dr Dermot Kearney has been prevented from offering the APR treatment for an initial period of 18 months, later reduced to 9 months, but the investigation could not find a single woman speaking against Dr Kearney, despite treating dozens who had changed their mind after taking the first abortion pill.

Instead, a woman claimed that Marie Stopes International had twisted her experience with Dr Kearney to suit their complaint, and she felt pressured to criticise him.

“None of the women I helped complained to the GMC, and none of the families either. The women themselves were all very grateful, even when it didn’t work. I struggle to understand why some people oppose this treatment.”, said the doctor.

The General Medical Council dropped all sanctions against Dr Kearney, who can now provide APR treatment again.

This is an important victory because, as Dr Kearney explains in this video interview, his case refutes three common claims: women don’t regret having abortion, APR doesn’t work, and it is dangerous.

As mentioned, the complaint against him raised awareness of this life saving treatment and now more health professionals may well offer the service, not only in the UK but also in other countries.

In Ireland, in 2020, some doctors were attacked for using the Abortion Reversal Pill here and a HSE spokeswoman claimed that it is not a reliable medical practice.

The HSE website says: “Once you take mifepristone, the abortion will begin. It is irreversible. If you decide not to take the second tablet, there is a risk of harm to the foetus if you continue the pregnancy.”

The experience of Dr Kearney, and of other doctors who use APR treatment, shows that the effect of mifepristone is not irreversible and a percentage of babies can be saved with a prompt intervention. (The living proof is here).

Moreover, the General Medical Council’s examiners’ report states that: “there was no evidence to suggest that APR increases the risk of harm to a foetus.”

Following this case, the HSE should offer a similar service to women who regret taking the first abortion pill. There is no reason why those who claim being pro-choice should deny women this last choice.

Una soluzione alla «maternità surrogata» c’è: divieto totale

Dublino – A fronte della pressione per il riconoscimento della cosiddetta «maternità surrogata» nell’ordinamento giuridico del Paese, l’Oireachtas, il parlamento d’Irlanda, istituisce una Commissione speciale di esame. Ma l’ufficio del Procuratore generale, Paul Gallagher, che fornisce consulenza giuridica al governo, ha espresso parere molto critico, sottolineando i limiti etici della «maternità surrogata» commerciale attraverso un documento che ammonisce contro la mercificazione dei bambini, lo sfruttamento delle donne e, qualora proibita in Irlanda ma riconosciuta quando avviene all’estero, la creazione di un standard doppio.

«Se i contratti di surrogata commerciale vengono proibiti in Irlanda, a motivo delle preoccupazioni legate alla salute dei bimbi e delle madri», spiega il documento, «queste preoccupazioni emergono ancor di più nei confronti dei contratti stipulati al di fuori dello Stato. Riconoscere gli accordi commerciali stranieri, mentre si limita la maternità surrogata domestica ad accordi altruistici, e quindi offrendo più protezione alle donne irlandesi che a quelle straniere, creerebbe una dictomia nel diritto irlandese difficile da giustificare».

Argomentazioni analoghe sono del resto già state presentate da organizzazioni di ispirazione cristiana a difesa della famiglia, quali l’Iona Institute.

La «maternità surrogata» commerciale implica infatti il pagamento di donne bisognose, solitamente cittadine di Paesi poveri, affinché concepiscano e partoriscano per conto di una coppia, o di un singolo, che ha commissionato il bimbo. Spesso almeno uno dei gameti viene fornito dai genitori, ma a volte l’ovulo, o il seme, proviene da donatori, che vengono pure essi pagati o rimborsati. In Europa la surrogata commerciale è legale solo in Ucraina, Bielorussia e Russia.

Molti Paesi europei vietano del resto anche la surrogata cosiddetta “altruistica” poiché fa letteralmente a pezzi la maternità, coinvolgendo diverse donne e così creando possibili problemi di identità per il bimbo.

Ora, la proposta di legge che dovrebbe regolare la materia in Irlanda permetterebbe solo la surrogata “altruistica” mentre proibirebbe i contratti commerciali. Ma, per aggirare l’ostacolo, alcuni committenti si recano da tempo all’estero e oggi reclamano il pieno riconoscimento di queste nascite.

Secondo la legge, la donna che partorisce è la madre del bimbo che nasce. Quando ci si affida a un soggetto terzo, però, la donna in una coppia commissionante non risulta essere la madre legale del bambino. E nel caso i commissionanti fossero due uomini, quello non legato geneticamente al bambino non viene considerato padre dal punto di vista legale. In assenza però di una legislazione precisa in Irlanda i giudici decidono di volta in volta sui casi singoli.

Nel 2021, un rapporto del governo sulla protezione del bambino, affrontando le diverse forme di «riproduzione assistita», raccomandava il riconoscimento, da parte dell’Irlanda, della «maternità surrogata» avvenuta all’estero, qualora venissero soddisfatti alcuni criteri. Ma vietare alcune pratiche e poi riconoscerle legalmente solo perché avvenute all’estero è una contraddizione stridente.

L’ufficio del Procuratore generale suggerisce quindi alla Commissione parlamentare alcune soluzioni possibili.

Si potrebbe mantenere lo status quo e quindi quanti desiderino diventare genitori legali di bambini nati da accordi commerciali avvenuti all’estero, dovrebbero rivolgersi a un giudice che considererà i casi uno per uno.

Una seconda opzione potrebbe essere applicare a questi accordi internazionali gli stessi criteri che valgono per quelli nazionali. Quindi, solo quanti abbiano fatto ricorso alla «maternità surrogata» “altruistica” all’estero diverrebbero legalmente genitori in patria, mentre accordi di altro tipo non sarebbero riconosciuti.

Una terza opzione consisterebbe nel consentire la «maternità surrogata» commerciale in Irlanda, questo farebbe dell’Isola l’unico caso in Europa e non solo.

Infine c’è un’opzione che né questo documento né il progetto di legge considerano, benché sia la soluzione adottata in Germania, Italia, Francia, Spagna, Austria, Norvegia, Finlandia e in molti altri Paesi europei: vietare totalmente la surrogata in qualsiasi forma. Eviterebbe i problemi che ogni procedura, commerciale o “altruistica”, necessariamente comporta.

„Do-it-yourself“-Selbstmordpille in österreichischen Apotheken verkauft

In Österreich kann man die Selbstmordpille jetzt in Apotheken kaufen. In den wenigen Ländern, in denen dies erlaubt ist, findet der “assistierte Suizid” in der Regel in einem Krankenhaus oder Pflegeheim mit Hilfe von medizinischem Fachpersonal statt. Österreich hingegen hat diese tragische Geste zu einer ganz individuellen, privaten Entscheidung gemacht. Seit dem 1. Januar kann die tödliche Pille in Apotheken gekauft und zu Hause mit der einfachen Hilfe eines Familienmitglieds oder eines Freundes geschluckt werden.

Wer dauerhaft an einer Behinderung leidet, kann sich bewerben. Sie müssen also nicht unbedingt an einer unheilbaren Krankheit leiden oder sich im Endstadium befinden. Und auch Menschen mit Behinderungen können Rechtsmittel einlegen.

Das neue Gesetz folgt auf die Entscheidung des Verfassungsgerichts aus dem Jahr 2020, das Verbot des “assistierten Suizids” aufzuheben, weil es nach Ansicht des Gerichts gegen das Selbstbestimmungsrecht der Menschen verstößt. Wenn jemand sterben will und sich nicht selbst töten kann, hat er Anspruch auf den Beistand einer anderen Person, entschied das Gericht.

Nach dem neuen Gesetz müssen Personen, die Sterbehilfe wünschen, die Zustimmung von zwei Ärzten einholen, die ihren Zustand und ihre Wünsche feststellen. Ärzte müssen keine Psychiater oder Psychologen sein, aber sie sind verpflichtet, den Patienten über mögliche Alternativen zur Selbsttötung zu informieren, und einer von ihnen muss ein Palliativmediziner sein.

Nach einer Wartezeit von zwei Wochen bei Patienten mit einer Lebenserwartung von weniger als sechs Monaten bzw. zwölf Wochen bei Patienten, die sich nicht im Endstadium befinden, wird ein Anwalt oder Notar über den Antrag informiert, und der Patient kann die tödliche Substanz (Natriumpentobarbital) in einer dafür vorgesehenen Apotheke erwerben.

Das Gesetz erlaubt es einer dritten Person, dem Suizidwilligen bei der letzten Handlung zu helfen. Diese Person ist in der Lage, die tödliche Substanz rechtmäßig zu verabreichen, auch wenn der Patient aufgrund der Krankheit seine Entscheidungsfähigkeit verloren hat. Der Selbstmord erfolgt zu Hause oder an einem anderen vom Patienten gewählten Ort.

Es gibt keine Fristen für die Einnahme oder Rückgabe der Pille. Die einzige Einschränkung betrifft die Erlaubnis zum Erwerb des Stoffes, die auf ein Jahr begrenzt ist; danach müssen Sie einen neuen Antrag stellen.

Die Namen der Apotheken, die die tödliche Pille verkaufen, werden nicht veröffentlicht, sondern nur durch den Anwalt oder Notar bekannt gegeben. Das Gesetz erlaubt weder die Werbung für Dienstleistungen, die bei der Selbsttötung helfen, noch die Gewinnerzielung aus diesen Dienstleistungen.

Minderjährige und Menschen mit psychischen Störungen haben keinen Zugang dazu, aber früher oder später werden diese Schutzvorkehrungen aufgehoben, wie es in Belgien und den Niederlanden geschehen ist, die Euthanasie und “assistierten Suizid” zunächst nur für begrenzte Fälle einführten, dann aber die Praxis auf breitere Kategorien ausweiteten.

Im Westen wurde der Selbstmord überall entkriminalisiert, aber in der Regel wird er durch Präventionskampagnen und psychiatrische Hilfe für diejenigen, die sich selbst verletzen wollen, bekämpft. Die Entkriminalisierung beruht auf dem Grundsatz, dass Menschen, die einen Selbstmordversuch unternehmen, Hilfe und keine Strafe brauchen. Gleichzeitig wird der Selbstmord stigmatisiert, weil das Leben ein primäres und schützenswertes Gut ist und die Selbsttötung nicht nur negative Auswirkungen auf die eigene Person, sondern auch auf andere hat. Kurz gesagt, sie steht im Widerspruch zum Gemeinwohl.

Stattdessen geht das neue österreichische Gesetz von der Annahme aus, dass die Selbsttötung nicht nur erlaubt, sondern sogar erleichtert werden soll. Jeder, so heißt es, macht von seinem eigenen Leben, was er will und kann sich dann auch den Tod geben und der Staat muss nichts tun, sondern jedes Hindernis beseitigen.

Schließlich ist sie vollkommen kohärent. Wenn die Selbstbestimmung, die als total und unverantwortlich verstanden wird, zum absoluten Prinzip wird, gibt es keinen Grund mehr, das “Recht auf Selbsttötung” auch denjenigen zu verweigern, die nicht an einer Krankheit leiden.

Organisationen wie Exit International haben sich bereits dafür eingesetzt, dass jeder geschäftsfähige Erwachsene Zugang zum “assistierten Suizid” erhält, und das jüngste österreichische Gesetz ist ein klarer Schritt in diese Richtung. Und man wird sich nicht wundern, wenn in einigen Jahren die wenigen Beschränkungen, die es heute gibt, vollständig aufgehoben werden.

The review of the operation of Ireland’s abortion law

 

The Minister for Health has invited members of the public and organisations to submit their opinions on how the current abortion law is operating. It is not a review of the law per se but how it is being implemented from day-to-day. Obviously, all pro-life groups would like the law to be reversed completely, but taking into account the limitations of the review, here are some areas we think the Government should examine as a matter of urgency.

1. End ‘DIY’ abortions

In March 2020, Minister for Health, Simon Harris, introduced remote consultation for the duration of the Covid-19 public health emergency. Women requesting abortions are examined on the phone or online and then they take the abortions pills at home.
As the emergency is now ended, this provisional measure should be discontinued.
The British government has announced that in-person consultations will resume soon because DIY at-home abortions are more difficult to monitor and more dangerous. An estimated 10,000 women in England who used the pill by post ended up receiving hospital treatment due to complications between April 2020 and September 2021.
The HSE has admitted that it is not collecting data on complications arising from at-home abortions and some women could even be subject to coercion. At-home abortions and remote consultations should be ended.

2. Collect proper abortion data

The official annual report of the Minister of Health about abortion gives almost no details about the socio-economic characteristics of who is having terminations.
In line with what is common practice in other countries, the HSE should record at least the same details collected by the UK Department of Health, i.e. age, marital status, ethnicity, number of previous births and abortions, complications, methods of terminations.
Those details are commonly gathered for policy planning and for international comparison. The review that the Minister is undertaking would be much more accurate if there was a proper mechanism in place to collect such data.

3. End misleading information about prenatal tests

The tragic case of baby Christopher, who was aborted after his parents were incorrectly told that he suffered a fatal condition, highlighted the flaws in prenatal screening tests and false claims made about their accuracy.
A recent report in the New York Times confirmed that tests for foetal abnormalities are often unreliable as they give too many false positives.
Irish parents are often still offered those prenatal tests without a proper explanation of their inaccuracy and limits. The current review should address this because accurate information in these cases can be literally life-saving.

4. Investigate permitting abortion reversal pills

What is currently offered to women who change their minds after having taken the first abortion pill? There is evidence that it is possible to reverse the effects of the first pill, before taking the second one, and in the UK, Dr Dermot Kearney has successfully provided Abortion Pill Reversal treatment to a number of women.
In 2020, some Irish doctors were attacked for using the Abortion Pill Reversal protocol here and a HSE spokewoman claimed that it is not a reliable medical practice. But this month the UK General Medical Council dismissed complaints against Dr Kearney and allowed him to continue offering reversal medication.
Ireland needs at a minimum to investigate allowing something similar to take place here.

5. Investigate reports of babies born alive after abortion

Doctors performing late-term abortions have indicated that in some cases the babies are delivered alive and left to die. This needs to be investigated as a matter of urgency.These incidents have caused conflicts between those doctors and neonatologists, according to a study. The legislation and the HSE guidelines have not made sufficiently clear what qualifies as a fatal foetal abnormality. It allows broad interpretation and causes conflict between specialists.

6. Require proper counselling during the three-day waiting period

In 2020, 20pc of women who had an initial consultation with a doctor about having an abortion changed their minds and did not proceed with it. This indicates that the three-day reflection period could be saving lives. It allows women to have more time to decide what they really want to do. If proper counselling was required with the first consultation, even more lives would be possibly be saved.

New assisted reproduction legislation will allow use of gametes from deceased person

The new assisted reproduction legislation will allow the use of sperm or eggs from a deceased person. Fatherless children will be created intentionally.

The Irish government has approved the publication of the Assisted Human Reproduction Bill 2022 that will legislate for issues such as IVF, gametes donation, surrogacy.

The Bill is extremely problematic from an ethical point of view. For instance, it provides for posthumous assisted reproduction, which is the use of gametes (sperm or eggs) of a deceased person.

The final text of the Bill is not available yet but, based the previous draft, posthumous assisted reproduction will be permitted if a person has consented to use his sperm or her eggs when dead.

The law will also allow those gametes to be retrieved from the body of the dead person, if necessary, when the person has consented to it in advance.

Only the surviving partner of the deceased person can use the gamete, according to the Bill, and only after one year from the death.

This raises important ethical question. (It also complicates and delays the administration of estates on death https://www.irishexaminer.com/business/arid-20457958.html )

How is it in the interest of children to be deliberately conceived when their father or mother is already dead? The whole Bill favours and accommodates the desires of the adults over the child’s best interest.

What is even more shocking is that the law permits the use of the gametes of a dead person together with gametes coming from a sperm donor or an egg donor.

This means that not only one of the parents is already dead before the child is even conceived, but the child will be separated also by the other genetic parent. So, it will be legal for someone who is not even genetically related to the child to decide to create an orphan. How can this be in the best interest of the child?

No one should have a right to deliberately generate an orphan and this the reason why posthumous assisted reproduction is banned in many European countries such as France, Germany, Italy, Sweden, Finland, Hungary.

But Ireland has taken the most liberal and adult-centred approach, avoiding any debate on the morality of such arrangements.

The same could be said about many other provisions of this new law, such as surrogacy for example.

According to the new law, the person who uses the gametes of her deceased partner must be a woman, as she has to carry the pregnancy.  

This means that this provision will be used mainly by women using their dead partner’s sperm but nothing prevents a woman in a lesbian relationship from using the eggs of her deceased partner and carry the pregnancy herself. In this way, the resulting child will be denied both biological parents and will be intentionally created and brought up by someone with whom she, or he, has no genetic connection.

Again, how is this in the best interest of a child?