Hazel McHaffie

fertility treatment

Ethical challenges – did anyone press the pause button?

Well, the world may have been on pause this year, but ethical issues have still raised their heads above the parapet periodically. However, I suspect most of them were lost in the cacophony of sound relating to the pandemic, so to illustrate, I’ll share a selection from the past three months up till yesterday.

December
Sweden’s gymnastic federation has now ruled that young athletes under the age of 18 will be able to train and compete as whichever gender they choose to identify as. They will not need to provide a doctor’s endorsement or any evidence of gender dysphoria.

Following a landmark High Court ruling, in the UK, new guidelines have been introduced by the NHS that make it necessary for children with gender dysphoria to obtain a court order before they are legally allowed to take puberty blockers. It is felt that under 16-year-olds are highly unlikely to fully understand the long-term risks and consequences. However the Tavistock and Portman NHS Trust which runs the UK’s only gender identity development service has said it will appeal against this ruling.

`November
New euthanasia rules are being introduced in the Netherlands – a country already known for its liberal social attitudes. Doctors will now be permitted to spike patients’ drinks before lethal injections are administered, in cases where it’s impossible to obtain informed consent from a person with an advanced directive who has already expressed a wish for help to die when the time is right, but who might resist the final act. The change comes in the wake of a court case where a doctor in a nursing home secretly slipped sedation into coffee for a lady at an advanced stage of dementia. Opponents of euthanasia are understandably alarmed by this widening of the limits in the medical code.

The English Health and Social Care Secretary, Matt Hancock, spelled out confirmation that travelling abroad for assisted dying constituted a legitimate reason to break lockdown restrictions.

It was an accidental error that led to the Oxford/Astro-Zeneca vaccine against Covid-19 reaching 90% efficacy. About 3000 of the more than 20,000 volunteer trial participants had been given just half the dose they should have received according to the research protocol. The ‘correct’ dose achieved just 62% efficacy. A serendipitous result. And a lucky break for whoever was responsible for the mistake!

October
The Dutch government approved plans to allow euthanasia for terminally ill children under the age of 12 who are suffering hopelessly and unbearably. Objectors see the thin end of the wedge visibly widening.

Legislation to allow medically assisted death was passed by the New Zealand parliament last year, but lawmakers delayed implementing it until the public had had their say in a referendum.  Under this law, the End of Life Choice Act, a mentally sound adult who has a terminal illness with a life expectancy of less than six months, and who is experiencing unbearable suffering, can request a fatal dose of medication. New Zealanders have voted overwhelmingly to legalise this, which means the measure will now pass.

An angry backlash developed when the Women’s Prize for Fiction opened up its eligibility criteria to include transgender women.

Six consecutive days of protest followed a near-total ban on abortions in Poland by the constitutional court. A country of 38 million people, Poland already has some of the most restrictive abortion laws in Europe, and an estimated 80,000 – 120,000 Polish women travel abroad for terminations or seek illegal abortions each year.

The English government has been keen to make the process of applying for a Gender Recognition Certificate kinder, cheaper and less complicated. As part of a drive for greater equality, the Women and Equalities committee are in the process of examining whether the currently mandatory diagnosis of gender dysphoria should be dropped from the legal process of transitioning, whether transgender people should be required to live in their preferred gender for at least two years before formally transitioning, and how their rights can be better supported.

As it stands, parents in this country are allowed to terminate a pregnancy where the fetus has Down’s syndrome, at any point up to full term. Three adults with Down’s Syndrome are now launching a landmark legal challenge to the Government’s abortion legislation on the grounds that it makes them feel they shouldn’t exist and would be better off dead.

A former Public Health England medical director, Professor Paul Cosford, had never wanted to be a supporter of assisted dying, but after developing incurable lung cancer himself, changed his view and bravely declared his hand in the BMJ.

A poll of 29,000 BMA members found – for the first time – that a majority were in favour of medical professionals being able to prescribe life-ending drugs. The BMA’s position currently is that they are opposed to assisted dying.

A Dutch fertility doctor has been found to have fathered 17 children during the 1980s and 90s, with women who thought they were receiving sperm from anonymous donors.

September
After President Macron turned down his personal appeal for euthanasia, a Frenchman in his fifties, Alain Cocq, suffering from an incurable condition where the walls of his arteries stick together, announced he would refuse drink, food and medicine, and live stream his death. However Facebook said it would block this being broadcast on its forum. M Cocq subsequently said he had lost capacity for the fight, it was too difficult, and he accepted palliative care.

Last year staff at the Gender Identity Development Service raised serious concerns about safeguarding issues relating to the use of inhibitors and the speed or referral for treatment for young people. It transpired that England’s only NHS gender clinic for children knew about recommendations for puberty blockers from an internal review carried out 15 years previously, but failed to implement them. An independent review into these services is underway now to improve access to and delivery of support for these young people.

Who knew there were so many, huh? I shall never be short of material for my novels!

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A serendipitous find

Well, what d’you know?! In amongst the plethora of books the kind people of my neighbourhood are putting on the communal bookshelves, I found one that grabbed my attention. There, on the back cover – fertility treatment, human experimentation … wahey! My kind of key words!

And the author? Val McDermid, whose skill with words leaves me battling the green-eyed monster. This particular edition of Blue Genes might look as if it’s been dropped in the bath, and stuffed under a pillow, and bent backwards energetically enough to release the middle pages from their moorings, but it nevertheless did a wee detour into my hands, and I devoured it over two days. Pure diversion.

Kate Brannigan is a private investigator whose life is disintegrating all around her.
a) She’s on the verge of buttoning up a case of fraudulent exploitation of bereaved people, posing as a new widow herself, when the supposed deceased man erupts into the scene at precisely the wrong moment, and blows her case to kingdom come.
b) Her partner in the firm, Bill, is selling out and she can’t afford to buy his share of the company.
c) And she discovers her best friend, Alexis, has been concealing a massive secret about the child she’s having with her lesbian partner, Chris.

Now she’s suddenly deep in an investigation where one of the chief protagonists is lying murdered on her own kitchen floor.  Her name’s Dr Sarah Blackstone, a leading gynaecologist, specialising in sub-fertility in Leeds. Her picture’s in the paper. Or … is it? Not according to Alexis, who identifies the murdered woman in the photo as Dr Helen Maitland, the Manchester specialist who helped her towards her dream of parenthood. So why has this doctor been practising under two different names? And why has she been killed? And why has she adopted the name of a real live medical colleague high-profile enough to have published extensively on recent advances in gene replacement therapy? And just how far is someone pushing at the frontiers of what is allowable in fertility treatment?

Criminal, legal and ethical quagmires aplenty. My kind of territory. What a treat!

And all delivered with Val McDermid’s customary brio. I don’t want to deliver any spoilers but I can share a few literary gems with you:

Ironing out the problems in my relationship with Richard would have taken the entire staff of an industrial laundry a month. It had taken us rather longer.

Alexis grinned and blew a long stream of smoke down her nostrils. Puff the Magic Dragon would have signed up for a training course on the spot.

As well as the red-rimmed eyes and the stubble, a prospective employer had to contend with a haircut that looked like Edward Scissorhands on a bad hair day, and a dress sense that would embarrass a jumble sale.

… a three-bedroomed semi with a set of flower beds so neat it was hard to imagine a dandelion would have enough bottle to sprout there.

The devil finds work for idle hands; if you can’t manage any other exercise, you can always push your luck.

Treasures one and all.

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Justice, rights, entitlement

The latest casualty of the coronavirus lockdown in this country is fertility care. As of Wednesday of this week, no new patients will be accepted, and even those in mid-treatment, those for whom this is their last hope, those who will be too old to qualify or stand a chance of success by the end of lockdown, will not now receive the necessary procedures towards which they’ve been working for so long. Yet another tragedy. More heartbreak. More hopelessness.

Which brings my thoughts to the ethical issues around assisted conception …

It’s now fifteen years since I wrote Double Trouble, a book about surrogate pregnancy. Fifteen years! Yoiks. But as with so many ethical dilemmas in medicine, the issues are still relevant today.

I was fascinated then, to watch the serialised BBC1 drama, The Nest, which finished this week, about a very wealthy but childless couple, Glasgow property tycoon Dan and his beautiful pampered wife Emily, who decide to go down this route. Click on the picture for the official trailer.

All attempts at IVF have proved unsuccessful. Dan’s sister has already tried to carry a baby for them but miscarried. They have one precious embryo left. One. Only one more chance. Emily meets the troubled teenage Kaya when she accidentally knocks into her in her car. Kaya sees an opportunity to get out of her impoverished life, and offers to be a surrogate for them in return for £50K. But as the story unravels we find that Kaya has secrets in her past and a very dubious pedigree indeed …; the would-be father Dan is something of a rough diamond too, dealing with a lot of shady characters and skullduggery …; Emily is single-minded about motherhood and what she wants, but privately troubled by the morality of what they are doing – always setting herself up as ‘the principled one‘ according to her sister-in-law. No-one in the UK will implant the last embryo. However, the Dochertys can well afford to go abroad for the simple procedure, and they do so.

On the face of it everyone stands to win. Kaya will be set on her dreamed-of pathway to becoming a successful business woman, able to ‘go on a plane, have one of these pull-along cases‘. The wealthy couple get their hearts’ desire. Better yet, surrogate and intended parents establish a relationship, even friendship. Kaya moves in with the Dochertys and gets a taste of a life of privilege. The baby will not only be much wanted, but will have every advantage money can buy.

Naturally – this is, after all, fiction, drama, a series requiring cliff hangers – things go pear-shaped. Relationships get confused. Loyalties are divided. Dubious and unsavoury motives emerge. But the underlying questions and challenges remain pertinent.

Is parenthood a right?
Is ‘want’ the same as ‘need’ in childbirth terms?
Payment for this service in the UK is forbidden. Should it be?
How binding should a contract between intending parents and surrogate be?
Should private arrangements for surrogacy be permitted?
Does a woman have the right to do whatever she likes with her own body?
What constitutes ‘reasonable expenses’?
Should those with the wherewithal be allowed to circumvent ethical and medical guidelines?
Does using someone far less powerful in this way constitute exploitation?
In the event of a dispute about whose baby it is, whose rights should take precedence, and who should decide?
What if the child is damaged/imperfect/not what was expected? Should the contract still stand? Who should accept responsibility for him/her?
What of the baby’s rights?
How much of its origins should a child be told?

Back to the drama … enter Kaya’s long-estranged mother, who encourages her to renege on the contract, hang on to the baby, become a mother herself, a better mother than she has been. But Dan already loves this child. Even when he finds out she is not his genetically, she’s still his daughter in his heart. The Dochertys call in their lawyer; the case goes to court. It’s left to the judge in the Family Court to put things into perspective – severely castigating their self-serving recklessness, the complete imbalance of power, the undesirable qualities on both sides. But, she says, at the end of the day it’s not a question of how she would judge them; it’s about what is in the baby’s best interests.

Contrary to expectation, there is a happy ending to this story, and both sides demonstrate they’ve learned important lessons about what matters in life. But the drama perfectly illustrates the power of fiction to challenge us to think about what society today should endorse, and how far the law can go in dealing with the fine nuances of moral questions in assisted reproduction. Well done, screenwriter Nicole Taylor.

 

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