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“Baby by Stealth” covers only one side of complex argument

March 23, 2010 6 comments

In her front-page National Post article, “Baby by Stealth”, journalist Kathyrn Blaze Carlson, suggests that a Canadian statute is causing Canadians to break the law. Quoting some professionals whose income is derived at least in part from assisted human reproduction, Carlson writes that the Assisted Human Reproduction Act is “forcing a slew of prospective parents underground”.

The article suggests that Parliament is wrong to treat people who just want to be a mom or a dad like criminals. But the one-sided argument hardly helps advance debate on this complex issue.

Regulating human reproduction in Canada has not been easy, especially for politicians who face re–election by citizens who can disagree fundamentally on reproductive matters.

Not surprisingly, every Canadian effort at regulation has been controversial. The Ontario Law Reform Commission bravely tackled the matter in 1982. But that all-male body recommended that “surrogacy” deals be enforced, even by taking a breast-feeding infant from its mother.

Canadian women reacted by lobbying for the federal Royal Commission on New Reproductive Technologies. It reported in 1993, after spending $28 million hearing from individuals and groups throughout the country and commissioning volumes of original academic research.

Despite the cost and the effort, it would be eleven years before Canada’s Parliament enacted the Assisted Human Reproduction Act.

And then in June 2008, the Quebec Court of Appeal decided that Parliament acted unconstitutionally regarding many statutory provisions because they concerned health – a matter within provincial jurisdiction. The Federal Government appealed to the Supreme Court, whose decision we await.

Meanwhile, the Federal Government has, since January 2009, had a duty to review the existing statute. It is unclear whether Prime Minister Harper’s government has even commenced the statutorily-required task.

This history can perhaps unite all Canadians in agreement on two points: it is difficult to pass legislation in a federation about matters as sensitive as whether people can buy semen, ova and embryos; and some Canadians are bound to feel badly treated by everyone’s best efforts to regulate assisted human reproduction.

So maybe we should not ask, “How can we make everyone happy?” but rather, “Whom should we worry about the most?”  Parliament admirably answered this question in 2004 when it recognized and declared that, “the health and well-being of children born through the application of assisted human reproductive technologies must be given priority in all decisions respecting their use”.

So what are the health and well-being interests of the children? Some reproductive technology providers say, “The children should be grateful to be alive.” In other words, they believe that the children’s interests are in being born and the consequences of the methods are irrelevant.

But many disagree. Some people conceived by third party gametes say that not knowing half of their identity creates a significant loss. Many claim that not only must they grieve this loss; they must defend the legitimacy of their grief – a double blow.

Some donor-conceived people compare themselves to adoptees whose loss is recognized. Adoptees are encouraged to seek their birth parents and are aided by government registries in their search. By contrast, parents who use third party gametes need not tell children the truth about their conceptions. Nor is anyone who knows the identity of the genetic parent required to disclose this fact to the child, even when the child becomes an adult.

Whilst the donor-conceived and adoptees arguably suffer similar losses in being separated from their genetic parents, adoptees can find resolution of the loss in the knowledge that the decision to surrender them for adoption was arrived at with great emotional difficulty, as a last resort. The donor-conceived, however, can find it much harder to find resolution of this deliberate separation of genetic and social parenting.

The donor-conceived can believe that their genetic parents were only interested in money, and gave no real thought to the children they were helping to create. They can be devastated by the full import of what their genetic parents did – that their parents were motivated by the money. A condition of the sale can be the promise of anonymity, but the donor-conceived can be severely affected by their inability to meet their genetic parents or even know their names.

Curiously, the National Post article seems to lament, “We see donors who originally thought they didn’t want to be very involved, but who then want increased involvement after the child is born.” How is parental involvement with his or her child a bad thing, even if it is inconvenient for the rearing parents? Children are usually glad to know and to develop a relationship with their genetic parents.

Parliament’s decision to ban the sale of semen, ova and embryos is bound not to make everyone happy. But insofar as it attempted to protect human reproduction from becoming a commercial enterprise, its motivation is honourable.

In the reproductive technology business, some people claim that adults have a right to have a child no matter what the cost. Parliament and Canadian legislatures have a moral duty to investigate the costs to prospective children and to take steps to reduce them.

When regulating assisted human reproduction, the health and well-being of children and prospective children must be given priority, even if commercial or other adult interests might incidentally be thwarted.

Dr. Juliet Guichon is Senior Associate in the Office of Medical Bioethics and a faculty member of the Department of Community Health Sciences in the University of Calgary Faculty of Medicine.

Fatal Lobby

Re: “Ottawa ‘has gone too far’ on flavoured smokes ban,” Feb. 20.

I was dismayed to read about the federal government being pressured to rescind the ban on flavoured tobacco by congressmen from Indiana, Kentucky and Virginia. Tobacco is the leading preventable cause of heart disease, stroke, emphysema and cancer, the four leading causes of death in Canada and the U.S. I am a specialist in lung diseases and see the devastating effects of the tobacco epidemic daily.

Most people think tobacco-related diseases are primarily diseases of the elderly, but young people are also affected. One of my saddest memories was my last visit to a 38-year-old patient dying from lung cancer who was reading a pamphlet titled, How To Tell Your Young Children That You Are Dying. She had started smoking in junior high with friends and was unable to quit. Flavoured tobacco, not just the candy-flavoured types, but those blended to reduce the harshness of some tobaccos only have one purpose — to hook young people.

Once people are hooked, they will smoke anything to get their nicotine fix. These politicians are beholden to the tobacco industry and its lobby and don’t focus enough on the devastating effect tobacco has on Canadians and their families. Nor do they care about its huge costs to our healthcare system.

Non-smokers are also hurt by tobacco’s health consequences. A doctor’s office or a hospital bed used by a smoker only delays access to, and increases wait times for, non-smokers when they need health care.

Stephen Field, MD, Calgary Stephen Field is a clinical professor of medicine at the University of Calgary medical school

© Copyright (c) The Calgary Herald

Teaching hospitals and consent

From Tuesday’s Globe and Mail Published on Tuesday, Feb. 02, 2010 12:00AM EST

Re Time To End Pelvic Exams Done Without Consent (Life, Jan. 28): Medical students would not “parade” into the operating room after a gynecologic procedure is finished, to undertake a pelvic floor examination on an anaesthetized woman. The usual practice is for a single medical student to be present throughout as a member of the surgical team.

In Calgary, patients give written consent for medical students to be involved in their surgical care, including medically necessary examinations, and patients are specifically informed before surgery, by the surgeon, that they may be examined by a trainee. If a patient objects, their wishes are honoured.

A medical student can only undertake a pelvic exam if the exam is required as part of surgery and the student is part of the surgical team.

Dr. Sara Wainberg’s paper discussed women’s attitudes to pelvic floor examinations being undertaken by medical students, in relation to consent. The concern expressed by a number of scholars is whether implicit consent for pelvic-floor exam under anesthetic, by a trainee, as recommended by the Society of Obstetricians and Gynecologists of Canada guidelines, is sufficient.

Implicit consent should be supplemented by the surgeon explicitly informing the patient that she may be examined by a trainee, as stressed by the guidelines. Of paramount concern is the need for medical students to learn basic examination techniques in a safe, well supervised setting. In the case of pelvic examination on an anaesthetized woman, it is also important to ensure the patient is adequately informed.

Sue Ross, director of research; R. Douglas Wilson, head, Obstetrics and Gynecology, University of Calgary

Faculty of Medicine professor awarded national research chair

Dr. Lynn McIntyre (front row, third from left) with five other researchers awarded chair in New Perspectives in Gender, Sex and Health from CIHR.

Dr. Lynn McIntyre (front row, third from left) with five other researchers awarded chair in New Perspectives in Gender, Sex and Health from CIHR.

A UCalgary Faculty of Medicine professor and researcher–whose passion for eradicating global food insecurity has taken her as far away as Bangladesh to study the issue–has been awarded a research chair in New Perspectives in Gender, Sex and Health by the Canadian Institutes of Health Research (CIHR).

As part of research chair program created by the CIHR’s Institute of Gender Health (IGH), Dr. Lynn McIntyre, professor, Department of Community Health Sciences, was awarded the chair along with five other leading health researchers from across Canada.

“The chairs are producing cutting-edge research with enormous potential to improve the health of Canadians, such as Dr. McIntyre’s research on hunger and food insecurity domestically and internationally,” says Dr. Joy Johnson, Scientific Director of the Institute of Gender and Health. “Her work focuses on women and children, the most frequent victims of food insecurity both in Canada and in other countries.”

McIntyre’s work–which is in line with the first Development Millennium Goal of halving world hunger by 2015–took her to Bangladesh where she studied hunger amongst both urban and rural populations.

During the in-depth study, McIntyre spoke to groups of highly vulnerable woman, living on less than one dollar a day and responsible for providing for their families. The intense field work included door-to-door recruitment and speaking to these women about food insecurity and hunger in various remote locations and in the slums of Dhaka.

In Bangladesh to present findings

Her principal finding was a need for a whole person development approach–a readjustment of available health care services to ensure they meet the needs of these women and others like them. McIntyre is currently in Bangladesh sharing her findings with government officials and non-profit agencies.

“The women have told me, ‘We knew when we met you that you were going to do something for us,’ and I am doing my best to bring improved understanding to those who really can do something for millions of women like them,” says McIntyre.

Closer to home, McIntyre is part of a study looking at social policies in Canada created between 1996 and 2006, focusing on their impact on national food insecurity. She’s also working with Alberta Health Services as they begin investigating the impacts of food insecurity on their patient population, the first clinical site in Canada to do this.

The IGH created the research chair program to expand and strengthen research capacity relevant to gender (socio-cultural experiences), sex (biological factors) and health in Canada. It is intended for health researchers who have developed a reputation for excellence in research, and to support outstanding research programs that enhance the health of Canadians.