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Conceptualising a Child-Centric Paradigm

Do We Have Freedom of Choice in Donor Conception Reproduction?

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Abstract

Since its inception, donor conception practices have been a reproductive choice for the infertile. Past and current practices have the potential to cause significant and lifelong harm to the offspring through loss of kinship, heritage, identity, and family health history, and possibly through introducing physical problems. Legislation and regulation in Australia that specifies that the welfare of the child born as a consequence of donor conception is paramount may therefore be in conflict with the outcomes. Altering the paradigm to a child-centric model, however, impinges on reproductive choice and rights of adults involved in the process. With some lobby groups pushing for increased reproductive choice while others emphasise offspring rights there is a dichotomy of interests that society and legislators need to address. Concepts pertaining to a shift toward a child-centric paradigm are discussed.

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Notes

  1. While it is assumed in general society that the average citizen is and has typically been able to enjoy this freedom of procreation, this has not always been uniformly acknowledged or applied. For example, forced sterilisations have occurred around the world, mainly in the 20th century. Some forced sterilisations were a direct result of a flawed and discriminatory eugenics-based approach to try to “improve” a society’s gene pool; others have been carried out in a related vein under different circumstances, including the sterilisation of HIV-positive women in South Africa; forced sterilisations in China, according to Amnesty International, following the adoption of the one-child policy; and involuntary or coerced sterilisation of people with disabilities, a subject that is currently before a Senate Inquiry in Australia. Thus, in past and current human societies, procreative freedom may be available only in certain jurisdictions to those deemed “fit” to enjoy it.

  2. Donor conception refers to a method of reproduction whereby a third-party’s gametes are used to create a pregnancy. This circumvents infertility rather than treating the cause of it. The use of donor sperm is widely acknowledged to have been first performed by a physician in 1884 (Gregoire and Mayer 1965); however, the use of donor sperm as a fertility treatment became mainstream practice with the introduction of fertility clinics starting predominantly in the 1960s and 1970s. The first pregnancy established from a donor embryo was recorded in 1983 (Trounson et al. 1983), and the first successful birth from a donor oocyte was reported in 1984 (Lutjen et al. 1984).

  3. The notion of access to a medical health history does not necessitate that family members have immediate access to a relative’s medical records; rather, by virtue of their relationship and interactions with each other, they will in many instances be privy to information about a relative’s health, especially when illnesses are particularly severe. For example, most immediate family members will be aware if their close relative has had a history of heart attacks, stroke, or even diabetes, among other major health problems. That said, in Australia, the Privacy Act 1988 (Cth) does allow for the disclosure of a person’s private medical information to relatives if the life or health of those relatives is threatened by the lack of this information (Adams 2012). Without a mechanism whereby life-threatening information can be disclosed to donor offspring, the provisions of the Privacy Act cannot be implemented. Such concerns were highlighted in the Victorian Law Reform Committee’s inquiry into donor conception (VLRC 2012), whereby case studies were presented before the committee as examples of how the deprivation of such information and the means to disseminate it has adversely affected individuals.

  4. In general, a person’s medical information is treated as private; however, as stated in the previous footnote, the Privacy Act 1988 (Cth) does allow for the disclosure of a person’s medical information in certain situations, although the information disclosed is restricted to that which is vitally important. The release of medical information does not necessarily breach any agreements of anonymity if the information is de-identified, which is also specified as a recommendation of the NHMRC guidelines on the “Use and Disclosure of Genetic Information to a Patient’s Genetic Relatives Under Section 95AA of the Privacy Act 1988 (Cth)” (2009). As such, without identifying information the donor’s private and family life are not intruded upon. The release of medical information in this instance could be restricted to that which is pertinent to the welfare of the offspring such as those illnesses known to have a familial link.

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Competing Interests

The author is an advocate of and lobbies for the equitable treatment of donor-conceived individuals.

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    Damian H. Adams

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Adams, D.H. Conceptualising a Child-Centric Paradigm. Bioethical Inquiry 10, 369–381 (2013). https://doi.org/10.1007/s11673-013-9454-7

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