THE BRIDGE CLINIC LEADS DEBATE ON ETHICS OF IVF
•Chukwu
A working paper has been developed from a think tank session organised by The Bridge Clinic, Nigeria's foremost In-Vitro Fertilisation (IVF), clinic, which saw stakeholders in IVF, including gynaecologists, psychiatrists, midwives, clerics and other medical practitioners in Lagos appraise ethical issues, surrounding the IVF treatment in Nigeria.
The working paper summarises the deliberations of the diverse group of stakeholders, who were tasked with the responsibility of developing and submitting unanimous positions to guide decision-making within the moral frameworks of the Nigerian society due to the absence of any regulatory framework in Nigeria to control the expansion of IVF technology.
The session saw a deliberation on ten (10) key questions bordering on ethical considerations and regulation: Is IVF ethical? Is ICSI ethical? Is gamete donation ethical? Is gamete donation with the spouse partner's consent ethical? Is surrogacy ethical? Is treatment of couples infected with the Human Immunodeficiency Virus (HIV) ethical? Is treatment for the purposes of sex selection ethical? Is treatment of unmarried couples ethical? Is treatment of single women ethical? Is treatment of same-sex couples ethical?
In response to the questions, Most of the participants, except the Catholic Church, agreed that IVF is ethical based on various grounds; mostly because it presents families with the opportunity and satisfaction of procreation, although the need for legislation, statutory regulations and enforcement of compliance by IVF practitioners would empower and protect patients' rights. It was also concluded that gamete donation is ethical as long as it has been established that the couple have no chance of achieving a pregnancy with their own gametes and with the consent of the partner.
On the surrogacy debate, all participants concurred on the complexity of surrogacy arrangements and concluded that surrogacy is not unethical but the legal and social implications must be addressed to protect the rights of the commissioning couple, the surrogate and the child, for these reasons surrogacy arrangements should be purely altruistic and not based on financial remuneration.
On whether it was ethical to treat HIV infected couples, medical practitioners concluded that treatment of infected couples was ethical as science had enabled procreation at minimum risk of transmission of infection to the child; highlighting the need for proper counselling of discordant couples. On sex selection, the unanimous submission was that sex selection for social reasons was unethical.
For treatment of unmarried couples, it was unanimously considered to be unethical. However, although it was recognised that many single mothers have successfully brought up their families and even within polygamy played significant roles, participants differed on the treatment of single mothers, adding that it was unethical because it would support a position that challenges the sanctity of the matrimonial union.
Addressing the last question, the general response was that it was extremely unethical and unacceptable in the Nigerian context. The need for both a maternal and paternal figure in a child's life was buttressed to protect the child's psychological as well as mental development.
In conclusion, there are no right or wrong answers with ethical considerations, only viewpoints. The working paper presents a position that captures the Nigerian societal perspective on ethical issues, and will provide a framework for decision making for both couples who require treatment as well as the providers of treatment.
Furthermore, it is expected that this paper will provide a platform to initiate discussions on the need for a legislative structure to regulate the provision of IVF services in Nigeria, which will be pursued at the next session tagged 'Think Tank 2 expected to hold before the year runs out'.