ASSISTED reproductive technologies (ARTs) are technologies that are used to circumvent problems of infertility and are widely used in developed and some developing countries. Jamaican doctors prescribe fertility-enhancing drugs and intracytoplasmic sperm injection, which involves injecting a single spermatozoon directly into the female egg, and in-vitro fertilisation methods are currently available at the fertility clinic of the University of the West Indies. According to an article published in the West Indian Medical Journal in 2011, up to 15 per cent of all couples have difficulty conceiving naturally, and in a society such as Jamaica, childlessness is associated with significant social stigma, emotional trauma and strain on relationships.

However, while these reproductive technology methods create children that maintain a genetic link between the parents and their children, in some developed countries, sperms, eggs and wombs may be used from third parties who are not expected to play any role in the rearing of the children. In those countries, third party assistance is sometimes required by infertile heterosexual couples, but the technologies have also enabled same-sex couples and single persons to have children to whom they are biologically connected.

ETHICAL ISSUES

The more expansive use of these technologies has raised complex and thorny ethical issues, as they enable any prospective parents, regardless of age, sexual orientation or marital status, to have biologically linked children. Third party assisted reproduction in some developed countries increasingly involves the use of donated eggs, sperms, or gestational services, usually for a fee. Some heterosexual couples, single men, or gay male couples can achieve parenthood by using the services of a woman who provides both the genes and the gestation, and then surrenders the child at birth to those who intend to raise the child.

A thorny issue arising here is how should law and policy recognise and weigh the significance of genes and gestation, as well as post-birth child-rearing, in establishing parental rights and duties? The variety of options now available through these technologies enables as many as five people to play some sort of role in the conception, birth and raising of a child. A sperm and egg donor can each supply genetic material that can be fused and implanted into the womb of a third person, who will carry the resulting foetus to term. At birth, one or two more people can take custody of the baby and raise him or her throughout childhood.

Myriad relationships, roles and responsibilities may result from these collaborative arrangements that can create children with several people who could each claim some parental involvement in their birth and upbringing. According to research published by the Hastings Centre for Bioethics, the relatively large number of people who can now be involved biologically and socially in the creation of a child raises difficult questions about what sorts of collaborative arrangements should be permitted, who can participate in third-party reproduction as a provider and as recipient, how the market in reproductive services should be regulated, and what rights and duties should be recognised for collaborators with respect to the children that result.

As a society we need to deliberate and discuss the many issues arising from the creation of children and families using artificial reproductive technologies. Should the use of these technologies be left to the choice of individuals or the vagaries of the market? Should this matter be publicly debated?

NO LAW FOR THIS IN JAMAICA

No regulation currently exists in Jamaica for the oversight of these new reproductive technologies. While the Fertility Clinic at the University of the West Indies has its own policy guidelines, they cater to only heterosexual, married, infertile couples, freedom of work and of foreign investment in local health facilities allow other investors and fertility clinicians to practise medicine in accordance with their own values and beliefs. Without government regulation to enforce specific standards regarding the use of the new reproductive technologies, variability in the values and beliefs of different practitioners may allow persons turned down at one clinic to find another clinic or practitioner willing to provide them with the service they desire. We all should begin to debate this issue now.

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is a member of the Executive Council of RedBioetica UNESCO.