Wombs to let: £28,000

I suppose a baby factory is the obvious successor to the egg bank, but it wasn't something I was expecting to come across in last week's Metro.

 

The most ridiculous aspect (and now I've said that I am torn as to which bit is actually the most ridiculous) of this article is Dr Patel's claim that she is carrying out a feminist mission. As the Anscombe Bioethics Centre wrote in their review of the Human Fertilisation and Embryology Act:

 

Surrogate motherhood involves a further fragmentation and trivialisation of parenthood, in that a woman deliberately becomes a gestational mother with no intention of committing herself to caring for the child she gestates. This practice is exploitative of both the woman and the child, and damages the way conception and gestation are regarded in society as a whole. If surrogacy cannot be prohibited altogether (the option we would prefer), commercial surrogacy, at very least, should continue to be prohibited. We do not believe that agencies should be registered with the Department of Health, as the Brazier Committee recommends, as this would constitute official endorsement of such agencies. (An analogy might be with the case of prostitution: those opposed to prostitution are rightly unwilling to accept the official registering of brothels, as this effectively legitimises their existence.)

 

Dr Patel is clearly exploiting women; of the £28,000 a couple pay for a surrogate mother, the surrogate receives less than £5,000. For 9 months manual labour (a 'physical job') the mother earns approximately 73p an hour (based on a 40 week pregnancy). And paying a woman for the use of her body is definitely analagous to prostitution. But hey, at least facilities are sterile!

 

And then we have the desperate couples who choose this option and are willing and able to pay. Are they not also being exploited to a certain extent (albeit in a design of their own making)? This is not a good way to have a family: I know of one woman who regularly tells people how much her IVF twins cost her, apparently believing that their grades should be better than those of other children because they cost more. As they get older, will she dictate to them on the basis that she paid for them? Isn't that a form of slavery? As always it is the child who loses: exploited by both genetic and surrogate parents.

 

We are now way beyond the start of the slippery slope: there are those who are 'too posh to push', those who choose the gender or disability status of their children. It would not surprise me if there were also designer pregnancies, where the pregnancy happens to another person, whether a woman is fertile or not. Is this the new feminist ideal: the exploitation of one woman to spare another some nine months of inconvenience? Even organs are not commodities to be traded, selected, bought, sold or even rented, so why do we seem to think that children are?

A trip to the egg bank

On Tuesday the Mirror reported that an egg donor bank had opened in London; it has been operating on a trial basis since the beginning of the year. In my health news email digest, it stated that women would be able to choose characteristics of the baby, such as eye colour. (It has got a little more difficult to review these stories since the newspapers realised that people were accessing their articles free online and that they were clearly missing out and should start charging.)

 

Choosing eye colour might seem harmless enough, and I understand that a woman might well want a baby to bear some slight resemblence to her, but we have already seen the tragic consequences of sex-selection of babies, and allowing and encouraging any sort of picking and choosing definitely sets us on the path to designer babies. Having children is not a right, it is a privilege. Babies are not convenient: they do not sleep or smile or eat when we want them to, they are hungry and tired when we don't want them to be. They are people, and like all people they are creatures. We are created. We are fragile. We are dependent. There are some things that we don't get to choose because we are not in charge.

 

This was as far as I got when I actually went and read the Mirror's article. I was struck by the fact that the director talked about the 'needs' of people 'needing' donor eggs. Need is not the right word - children are a privilege, not a necessity. It would be more accurate to talk about desire and want. I also took note of the 53 year-old woman who said that she'd always wanted to have children but had never met the right person. There is in that statement a clear understanding that the 'right person' is a necessary part of the process of having children. There is no mention that she has now met that person, but she's decided to have a child anyway. In the same way that we have separated sexuality and procreation (see Humanae vitae and if you haven't read it, then read it) we have also separated the concepts of children and family. Sometimes there are ways of doing things which are just different. Other times there are right ways and wrong ways, and being created and finite we also don't get to choose what is right and what is wrong. We can choose whether to do right or wrong, between good and bad and frankly that is a complete misuse of the precious gift of our freedom. Right use of our freedom is using it to choose between good and better, not between good and bad.

 

It was at this point that I discovered the Telegraph's article on the same subject and realised how incredibly naive I am. It may be couched in terms of altruism, but this is not some benvolent institution, set up because of tragic needs which we cannot ignore (like, say, a food bank). The donors (something of a misnomer) will receive £750 for providing eggs. How long before we see young women funding their way thorough university by selling their eggs? And the profit margin is presumably quite high, as treatment (purchase of eggs) costs £10,000.

 

Whilst I have thrown words like right and wrong around, and asserted that children are a privilege and not a right, I do empathise with older women. And I do not wish to generalise or assume that it is only single women who seek IVF in later life, I know women who did not meet and marry their husbands until they were in their 50s and 60s and therefore never had children. My great uncle's second wife told me cheerfully that she had no regrets over not having met her husband sooner as he, a widower, had been married to someone else. There are also couples who are sadly, persistently infertile. Women are called to be mothers, whether biologically or spiritually, and the inability to answer that call for whatever reason must bring heartache. But we also need to remember that our actions always have consequences. The consequences of delaying children by prolonged, repeated use of contraceptives in order to advance a career, go on holiday more often and generally 'enjoy life' might be infertility. We are not in charge and we cannot have it all.

In the public interest: Law and the healthcare professional

As I understand it from a quick look at the coverage of the CPS's seemingly (wait for it) bizarre decision not to prosecute doctors involved in sex-selective abortions, apparently this relates to two doctors (abortionists) who were asked to carry out terminations on the grounds of the child's sex, but did not do so and were not planning to do so. Prosecution is deemed to be not in the public interest, and better dealt with by the GMC. My Hunt has apparently referred the case to the attorney general. Leaving aside the matter of whether doctors who have not and do not intend to carry out illegal activities need to be disciplined by their regulating body I have been thinking about law, what it is for, and how healthcare professionals should and do see it.

 

I may be naive, but I have come to the conclusion that any laws we have should, at root, be in the public interest. Whether they protect or promote the rights of a minority, the majority; or regulate the workings of organisations; or stipulate the responsibilities of groups and individuals, all laws serve the public interest. This is not to say that I think all of our laws are right merely because they are laws, but our elected officials have made these laws on our behalf, and therefore they (the laws) presumably exist because of a belief that they are needed and are in the public interest. Therefore it is no great leap to conclude that those who break laws are not acting in the public interest. And, because of the way that the law operates, those who break laws receive some form of punishment, and perhaps the opportunity for public atonement (damages) or rehabilitation depending on the circumstances. (These consequences are, in theory, also in the public interest.) A quick flick through 1897-1927 of the Catechism reassures me that I'm working along the right lines here.

 

It would seem, then, that prosecuting those who break laws is in the public interest, by virtue of what law itself is. I removed the word 'always' from that sentence because I can see that spending a large amount of public money prosecuting a child who stole a bag of sweets from a supermarket would not be, and there is such a thing as legitimate protest which often necesitates a certain amount of disruption. Of course, in this case the Abortion Act, which permits abortion, is an unjust law and therefore not binding in conscience as authority has broken down (cf. CCC 1903), but I don't think that this immorality clause applies to the parts of the Act which are morally right (that is, abortion is basically illegal, according to the rule of law). I am not a lawyer or a theologian and if anyone would like to expand upon, clarify, or correct any part of this they should do so and welcome.

 

As an undergraduate I sat through a lot of lectures on Law relating to Pharmacy. Pharmacists are the 'guardians of medicines' and therefore at undergraduate and registration level we are required to pass exams which require intimate knowledge and understanding of the law (it should be noted that while the university standard is 40% for a pass, for the pharmacy law exams it is higher - I think 70% but I can't actually remember). The Medicines Act 1968 arose following the scandal and tragedy of thalidomide; along with the four other Acts we studied, the majority of this law is about making sure that only the people who need and/or are entitled to possess lethal, or potentially lethal, substances are able to do so. For pharmacists, and by extension for other health professionals, the law is important. And not just the law directly relating to our work: last month a pharmacist was struck off for stealing controlled drugs (codeine, morphine) to feed his own addiction, but a pharmacy technician was also suspended from the register for benefit fraud.

 

Healthcare professionals make life and death decisions on an hourly basis. Sometimes we pharmacists may not even realise the import of our actions, as we re-write the scrawled prescription, annotate the dose, check the patient's allergy status, cross off the duplicated items and manage the drug interactions (collectively known as 'supporting safe and effective prescribing'), but they really are that serious. We need laws which help us in and underpin those decisions because of the magnitude of those decision and the power we derive from our ability to make them. If laws are, in themselves, in the public interest then flagrant disregard of those laws by the very people who should be serving the public, in their capacity as healthcare professionals, is a grave matter indeed. Given that it is held that such people must respect the rule of law outside their professional field in order to function with integrity within their field, then surely a breach of law which impacts directly on their practice must be prosecuted in the public interest and for the public good.

Keeping up with life

The Daily Mail (not my favourite source of healthcare/science, or indeed any other kind of news, but anyway) reports a worrying trend in the number of women taking stimulants in order to cope with life.

Aside from the fact that Ritalin and friends are not licensed for the treatment of ADHD in adults (ie their safety and efficacy in this group of patients is not proven) and that buying medicines on the internet is a stupidly dangerous thing to do there are some other concerning aspects.

The women taking these drugs are obviously experiencing extreme pressure to perform and conform, but more seriously still we can see a tendency to measure people by what they do. We are not ourselves, or what we eat, but what we do. This is massive problem because if you cease to "do" then you also cease to "be". In the case of the students using these drugs, their measure of themselves is how well they perform in exams: I am only as good as my exam results. Others struggle with the demands of juggling work and family life, or long hours and pressure to meet targets. But where is the weakness in admitting that something is hard? There is also, as so often with mental health, a reduction of the human person to the merely biological.

According to the article, women aged 25 to 34 are the most stressed demographic group in the country. No surprises there: we are the group who first experienced student loans, SATs at 7, 11 and 14 years, league tables, contraceptives for all, abortion virtually on demand... We have grown up being encouraged to turn down children in favour of career success, with the advice that giving up work for motherhood makes you a failure, that instant gratification is our right and we are also the generation whose parents lapsed in their religious pratices meaning that many of us have never stepped foot inside a church. We started life with the understanding that, as women, we would have to fight tooth and nail to be recognised as good enough and we have arrived at adulthood finding that most of the work has been done.We have moved on from the time where everything was blamed on our parents not giving us enough attention. Now we are our bodies. We have been formed by secularism and individualism and taught that an expensive pair of shoes can solve all our probelms.

We were promised the world, and the world turned out to not be worth the paper it was written on. Only God's promises are worth trusting, and the majority of this group have no idea what they are.

If you don't want to fall down the slippery slope, don't go near it

Apparently we could soon have three-person IVF. At first I thought this had something to do with the three-person civil union which has been recognised in Brazil. But no, this is an entirely differnt kettle of ethical fish (dophin-friendly tuna, perhaps?). Genetic manipulation could result in babies with DNA from 3 different adults. Leaving aside the issue of IVF itself, the suppoosed medical benefits would theoretically be the elimination of genetic mitochondrial disorders.

The Nuffield Council on Bioethics highlight a number of ethical concerns but have given this proceduce the ethical OK - so long as it is medically safe - but Human Genetics Alert (a secular, independent public interest watchdog group) is concerned about the procedure leading to demand for genetic designer babies. They argue in favour of abortion on the basis that "the foetus is part of the mother's body" (a topic for another time methinks) but are against sex-selection because it smacks of discrimination and eugenics.

Frankly, I think they are right to be concerned. Despite being illegal, it has been demonstrated the sex-selective abortions are taking place for purposes of "family balancing" throughout the UK, (ie 'I can only afford to have two children and I've already got a girl so I need a boy this time'). Talking about the slippery slope may be a cliche but it should be obvious by now that if it is possible to abuse a technique in some way, then people will find a way of doing it whether within or without the law. With sex-selective abortion we have seen a step towards designer babies; with the ability to add the DNA of a third person into the mix, how long will it be before parents decide that they need their child to be taller, thinner, smarter, faster or better looking than all the others in their classroom.