Hazel McHaffie

sperm donation

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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Father to thirty?!

Wow! The garden has gone from nought to sixty in one fell swoop. Everything is burgeoning and sprouting and bursting into colour, the birdsong has racheted up to symphony standard, the sunshine exceeding the benefits of any pharmacological tonic.

I’ve been alternating writing indoors with reading outside (when I’ve not been weeding and pruning and artistically directing, or course!) and loving the exhilaration of both. So it’s probably not surprising that, surrounded by all this new life and activity, my mind instantly latched onto a report about a different form of creation: babies.

This week it’s been revealed that a diminishing number of sperm donors are fathering eye-watering numbers of children. Now, as long ago as sixteen years (can it really be?!) I wrote a novel about the risks of this phenomenon: Paternity, so it’s a subject I’ve thought about long and hard. But even for me the statistics were like a cold water douche.

Figures from the Human Fertilisation and Embryology Authority (HFEA) show that, in a period of 24 years (1991-2015):
17 British men have fathered at least 30 babies each,
a further 104 have fathered between 20 and 29,
1,557 between 10 and 19,
and more than 6,000 have created up to 9 babies.

Though these men are offering hope to many many childless women/couples, huge risks are inherent in such practices. Obvious ones are passing on undetected hereditary diseases and risks, and half-brothers and -sisters forming sexual relationships and procreating together. Donated sperm are currently tested for diseases such as HIV, hepatitis B and C, CJD, Huntington’s and cystic fibrosis, but not for genes indicating increased risk of cancers or Altzheimer’s. In the face of the latest statistics, campaigners are calling for more stringent enhanced screening to try to reduce the incidence of faulty genes being passed on, but representatives from the world of assisted conception caution that further screening could reduce the number of donors coming forward or being deemed eligible to donate, already worryingly low.

Research in this area is complicated, not only by the powerful emotions and opinions and ethics around infertility, but also by the fact that sometimes the full consequences of what is permitted in this area are not fully apparent until a generation or more has gone by – which is why I felt compelled to write a sequel to Paternity: Double Trouble. And once you start tinkering with genes it can be impossible to repair any damage done.

So, what d’you think? Just how much control or interference should there be? What are the rights and interests of the babies as well as the parents, donors and recipients? What makes a man a father? Which diseases are worse than non-existence? Who decides?

Now there’s a little package of ethical conundrums to conjure with while you watch birds and animals multiplying prolifically all around you! Welcome to my world!

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Moral obligation

Every now and then something crops up that challenges my thinking on ethical issues, and I’m reminded all over again that these questions are always evolving and it behoves me to stay on my toes and constantly revisit them.

This week it was a half day seminar on ‘Leaving your brain to science: Engaging with law and ethics’, organised by Edinburgh University. Now, although I’ve been immersed in the subject of organ donation for the last few years, as you know, I hadn’t explored giving the brain specifically, so I was intrigued to know what would emerge. I won’t bore you with the details, but I’d like to share something of the workshop that concluded the day.

It focused on moral obligation. We were given a collection of possible actions which might be of benefit to others and asked to rank them in order. At one end was ‘MORAL OBLIGATION’ which essentially meant the action is of recognised benefit to others with very little risk to oneself, making it something where there is a high level of obligation to carry it out (eg. on finding a fire one should summon the fire brigade). At the other end of the scale was ‘MORAL SUPEREROGATION’, meaning that the action might well be deemed praiseworthy, but it carries risks of such an order that there would be no obligation to do it (eg. rushing into a blazing building to rescue someone); it goes way beyond what might be considered a duty.

Rating moral obligationThe actions to be ranked were:

Live organ donation

Cadaveric organ donation

Egg donation

Sperm donation

Giving samples of tissue for research

Bone marrow donation

Donating the brain for research

Blood donation

How did YOU respond?Why don’t you try it yourself? Weigh up the potential benefits and costs and see where you feel a sense of duty/moral obligation takes YOU. You might well be surprised – as I was – at where ‘giving your brain after death‘ comes.

 

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