Report on Donor Conception

source: http://www.nuffieldbioethics.org

A special Working Party of the Nuffield Councilk on Bioethics has published its report "Donor conception: ethical aspects of information sharing" which considers the interests of people affected by donor conception and makes recommendations about what can be done to support, encourage and empower those making decisions about the sharing of information.

Here is an extract from the introduction:

The task for this Working Party has been to consider questions of information sharing in practices of donor conception in the UK. Its primary focus has thus been on issues of privacy, openness, and access to information, and the implications of each of these for the individuals, families and groups affected by donor conception. While its remit was not to investigate the ethics of donor conception  per se, the Working Party nevertheless received evidence of a wide range of views and attitudes towards the use of donated gametes as a means of creating families. At one end of the spectrum, some people, including some donor-conceived adults, believe that donor conception should not be allowed at all. Both this view, and the opposing one that donor conception is a legitimate means of creating a family and of having children of  'one's own', hinge on the relative significance placed on biological or 'blood' connection between parents and  their children. This issue of the significance of biological connection in family relationships, and in the identity of the individual, has also proved to be central to questions about whether donor-conceived people should always be informed about the means of their conception, how much information about their donor they should be able to obtain, and whether they should be able to find out the identity of their donors, with the possibility of such identifying information leading to contact.

References to 'disclosure' in the context of donor conception tend to conflate two separate issues: 'openness' by parents about the use of donor gametes in conception (donor-conceived people knowing about the circumstances in which they were conceived), and access to information (identifying or non-identifying) about the particular donor. It is, however, very important that these two issues should be distinguished. It is possible for a parent to be open with their child in the context of anonymous donation. It is not, however, possible for a donor-conceived person to exercise any entitlement to information about their donor in the  absence of information about the circumstances of their conception. It should also be noted that, in contemporary social life in the UK,  'openness' has acquired positive connotations and is axiomatically thought to be desirable. The Working Party has been compelled to think carefully about the language it uses in order to convey not only the complexity of the issues raised in sharing information in the context of donor conception, but also the diversity of views and opinions on its implications.

These issues have been contentious for many years, as the Working Party's factfinding meetings and responses to its call for evidence have illustrated. The Working Party is acutely aware of how many, potentially competing, interests are at stake ± and of how much these issues matter to those whose lives are affected by donor conception. Because of the variety and complexity of these views, the Council, in establishing this enquiry, sought to provide a forum where  all voices could be heard; and it was felt that this would best be enabled through consultation rather than seeking to represent this vast spectrum of opinion on the Working Party itself.  Input from as wide a range of interested and concerned individuals and organisations as possible was thus sought through an open call for evidence, an online survey, a series of face-to-face meetings, and external review of the draft report by diverse stakeholders. [...]

As noted above, the Working Party has been primarily concerned with the UK. It should be noted however that there are other, and different, regulatory and ethical regimes across the world which inevitably impact upon the UK. Not only might ethnic ally diverse populations within the UK be informed by cultural and ethical imperatives in their countries of origin, but people regularly opt to travel overseas for fertility treatment, and it is also possible to import gametes to treatment in a UK clinic. In addition, UK regulatory frameworks do not cover the  'informal' arrangements people make outside the clinic to donate and acquire sperm both in the UK and abroad. The Working Party is aware that there are distinctive national IVF and donor conception cultures that are emerging and changing, [reference ommitted]  and that this needs to be kept in mind in any discussion of donor conception and information sharing whose primary focus is the present situation in the UK.

 Additionally, you can find the quick guide to the report here.

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See a blog entry by Dr Rhona Knight on Nuff' said who, via an extract from the foreword of the report, reflects on the creation of the report and outlines some of its main findings.

Ethics of Vaccination in Humanitarian Crisis

In the April issue of the Bulletin of the World Health Organisation (Vol. 91 No. 4) Keymanthri Moodley et al. published the article "Ethical considerations for vaccination programmes in acute humanitarian emergencies". The analysis deals with ethical questions of vaccination raised by humanitarian crisis through considering a couple of key issues: beneficience and human rights, non-maleficence, distributive and procedural justice, informed consent and, finally, research.

Here is the abstract:

Humanitarian emergencies result in a breakdown of critical health-care services and often make vulnerable communities dependent on external agencies for care. In resource-constrained settings, this may occur against a backdrop of extreme poverty, malnutrition, insecurity, low literacy and poor infrastructure. Under these circumstances, providing food, water and shelter and limiting communicable disease outbreaks become primary concerns. Where effective and safe vaccines are available to mitigate the risk of disease outbreaks, their potential deployment is a key consideration in meeting emergency health needs. Ethical considerations are crucial when deciding on vaccine deployment. Allocation of vaccines in short supply, target groups, delivery strategies, surveillance and research during acute humanitarian emergencies all involve ethical considerations that often arise from the tension between individual and common good. The authors lay out the ethical issues that policy-makers need to bear in mind when considering the deployment of mass vaccination during humanitarian emergencies, including beneficence (duty of care and the rule of rescue), non-maleficence, autonomy and consent, and distributive and procedural justice.