Joint Ethico-Medical Committee
The Catholic Union of Great Britain
Guild of Catholic Doctors
Reply to the Human Fertilisation and Embryology Authority's
Public Consultation Document
Donated Ovarian Tissue in Embryo Research
We are grateful for the opportunity to contribute to the debate concerning the very important issues raised in the consultation document.
We welcome progress and technological advance in medical research, and consider that "science and technology are valuable resources for us when placed at our service and when they promote our integral development for the benefit of all." (Donum Vitae, Introduction, 2. Vatican Polyglot Press 1987)
However, as Catholics we also hold, along with many men and women of other faiths and of none, that there are certain principles, discovered with the aid of our reason from our nature as human persons, against which all human actions - including new therapeutic treatments - must be judged.
Among the principles we use in forming such judgements is that of the inviolability of innocent human life, which Catholics, along with many others, consider begins at conception.
Another such principle is the obligation to protect the integrity of married life and of the family. Because we regard the family as the first and vital unit of society, and the family as being constituted by a man and woman brought together in mutual love, (JEMC Submission to Warnock Committee, Catholic Medical Quarterly, May 1983, p 78) we are opposed to any procedures which involve the use of semen or ova obtained from any other person (outside the marriage) or the use of the reproductive organs of a woman not a party to the marriage. We hold that those couples who beget children must do so of their own genetic material and that gamete donation is contrary to the integrity of marriage. "Human fatherhood and motherhood are rooted in biology and at the same time transcend it". (Pope John Paul II, 'Letter to families' 9, Libreria Editrice Vaticana 1994)
Principles such as these are so basic to our essential structure as human persons that they cannot be set aside in order to achieve other goods however important these goods may be in other contexts.
At the same time, all children, however conceived, are to be welcomed into the human community. They may never be regarded as subordinate or products and must enjoy equality with their parents. But we must also stress that we do not believe anyone has a "right" to a child. Such a right "would be contrary to the child's dignity and nature. The child is not an object to which one has a right, nor can a child be considered as an object of ownership: rather, a child is a gift..." (Donum Vitae, II, 8) No person therefore can invoke any such right in order to demand every available aid science can offer to achieve the gift of having a child. (Submission to Warnock Committee, ibid) "What is technically possible is not [therefore] morally permissible" (ibid, Introduction, 4).
Catholics, no less than other men and women of good will, recognise the great pain caused to couples by infertility; and the Church has been clear in her support for medical research undertaken "with the aim of preventing the causes of sterility and of being able to remedy them so that sterile couples will be able to procreate in full respect for their own personal dignity and that of the child to be born." (Donum Vitae, II, 8). We consider that more emphasis should, in future, be placed on prevention of infertility, better understanding of reproductive life style and on the beneficence (or the lack of it) and cost effectiveness of fertility techniques.
(In the following text the letters (a) etc., refer to the questions in the HFEA Public Consultation Document, Paragraph 42.)
We believe that there could be legitimate reasons for the use of ova (non fertilised) for research. On the other hand we believe that, once conceived, experimentation on a zygote or embryo is permissible only when it is for the benefit of the individual zygote or embryo itself, which, of course, presupposes its intended survival. We note that 'research using human pre-embryos is not, and never has been concerned with the treatment of genetic disorders or chromosomal abnormalities. ('Progress' (Campaign for Research into Human Reproduction) in Freedom to choose: Research into infertility & congenital handicap.) We do not consider it ethically right to use any fertilised ovum for a non-therapeutic treatment or experiment, that is for any procedure which is not for the benefit if that particular zygote or embryo itself, or which is expected to be fatal.
(a) Thus, given that in our opinion ova should be used for research in very limited circumstances we do not recognise a need to seek an increase in supply. We also feel concern at a recently reported case where fertility treatment was offered free of charge to a woman in return for a supply of eggs. We consider this to be improper and a form of duress. We would not regard any sort of financial inducement as ethical. It must not be forgotten that ovarian hyperstimulation and the harvesting of eggs is not without risks to the donor and it is not clear how it would be decided which are the 'best eggs' to use for her own treatment and which to retain for research.
(b & c) Given our views as already stated we would accept the use of ova or ovarian tissue (but not fertilised ova) for certain types of laboratory research either from a live donor or, given their proper and informed prior consent to this specific use, from a dead individual. With respect to consent please see below at (h).
(d) With regard to foetal tissues, in our submission to the Polkinghorne Committee we expressed our concern that there appeared to be an irreconcilable contradiction between the need for living tissue for transplants and research and the need to be sure that the foetus is dead (and not merely dying or certain to die) before such tissue is removed. We agree with their conclusion that only tissue from a dead foetus is ethically available for use in therapy (Polkinghorne Code of Practice 1.1(b)), and believe that this applies equally to research. We strongly opposed the 'generation or termination of a pregnancy solely to produce suitable material' or transplantation activity which could interfere in any way with the timing or method of abortion (JEMC Submission to Polkinghorne Committee, CMQ, Nov 1988, p 169). (Polkinghorne Code of Practice 3.1, 3.2). As above, we do not accept research as legitimate if it involves fertilisation of foetal ova or ovarian tissue.
The harvesting of ova and ovaries from abortions will almost certainly necessitate such close cooperation between the parties involved (those performing the termination and those seeking to undertake the research) that it can be neither morally acceptable nor compatible with the Polkinghorne recommendations. We understand that foetal tissues required for the purposes in question can only be useful if obtained at particular stages of foetal development. Given the small number of such (relatively late) abortions, it will almost certainly be impossible to carry out such research (or treatment) without involvement in the whole process of abortion to an extent which we find unacceptable and which the Polkinghorne committee sought to exclude.
(e & f) We agree with paragraph 34 of the Consultation Document that 'donation of organs or tissue which could enhance the life of the recipient is quite a different matter from donation to create new life'. We do not consider the use of gametes from a party 'outside' a marriage to be acceptable. In addition an important difference between the donation of sperm and the donation of ova is the considerably greater risk entailed in the donation of ova. Furthermore, if such donations are to be permitted, we think it important to ensure that the donor is not closely related to the recipient's partner, in parallel to the way in which close degrees of kinship are currently an impediment to marriage.
(g) On the scientific level we agree with paragraph 22 of the Public Consultation Document about the risks of abnormality in a foetus which has been spontaneously aborted. There are also serious worries about the use of foetal ovarian tissue taken from induced abortions. These concerns have been variously expressed as 'missing a generation', 'escaping natural selection' and, by yourselves, as missing the 'pressures which govern survival and normal development to adulthood.' (Para 21). Put another way we note that foetal ovaries contain several million ova, of which only a few hundred will mature in normal adulthood to become available for reproductive purposes. The significance of this example of 'natural selection' is unknown and there is a serious risk of maturing imperfect or less perfect ova which 'nature' would otherwise have selected out.
On the social and moral level we believe that no one has the right to consent to the use of foetal tissue from a live foetus except in the interests of that foetus, and would therefore not consider permissible the use of foetal tissue from a live foetus, whether delivered or still in utero, for treatment of any kind. The foetus, alive or dead, is nobody's property and has its own inherent dignity. We consider consent to the use of the tissues of a dead foetus below, but would not find acceptable the use of foetal ova or ovaries for treatment. The use of these organs differs from that of the other organs of the body rather in the way germ line cell therapy differs from somatic cell therapy in genetic engineering. Unlike genetic engineering, however, it could never be argued that the use of foetal ovarian tissue was essential for the correction of a life threatening condition. As such, because future generations and not just individuals would be affected, not only would a much deeper level of scientific certainty be required but a much more strict understanding of the nature and need for consent is essential.
On a practical basis we, of course, consider the aborted foetus to be a human being. Some, however, argue for abortion on the grounds that the foetus has not (yet) achieved personhood. If that is the case it would seem to us bizarre and quite wrong that the child of the next generation should eventually be faced with the knowledge that it had been generated from someone (something) considered less than fully human (and see Consultation Document Para 23).
(h) The question of consent is one of the the most important aspects of this whole subject.
With respect to research we would, as at (b) and (c) above, accept the occasional use of ova or ovarian tissue (but not fertilised ova) for certain types of laboratory research either from a live donor or, given their proper and informed prior consent to this specific use, from a dead individual. However, we believe that it would be putting an unfair pressure on a young person (certainly one under 16), however mature, to seek to obtain consent to the use of their ova or ovarian tissue for such a purpose - quite apart from any risk of morbidity - and this should therefore not be countenanced.
Concerning treatment, notwithstanding our views on the use of gametes outside marriage (at (g)), if such treatments are to be carried out we believe that the consent of a live donor of ova or ovarian tissues must be fully informed and entirely free. That for cadaveric donation would equally need to be prior, specific, and fully informed: on account of its serious genetic, familial and social ramifications we do not believe this is a decision which could be taken by another party, and therefore consider it essential for the deceased to have given prior consent to this particular use of their body. In other words carrying a donor card would not be sufficient unless specifically endorsed to cover this use, even if the next of kin or proxy chose to interpret it in this way. Furthermore, in a matter of such deep psychological, emotional and social significance, no one under the age of 16 should be allowed to consent, either in person or by anyone acting on their behalf, whether contemporaneously or in advance, to ovarian donations, either from herself or from another. (We have, however, no objections to autologous transplants from minors taken, for example, prior to chemotherapy, as described in Consultation Document Para 13.b, 3rd sentence).
With regard to the use of foetal ova or ovaries we do not consider, since it could never be to the benefit of the foetus itself, that anyone has the right to consent to their donation for fertility treatment. As we have said, we are also deeply concerned lest any proposal for or suggestion of such use should ever be used as a reason for or justification of termination of pregnancy. We would regard it as very objectionable that someone who has consented to the death of their own child (foetus) should be allowed to surrender that aborted foetus to be the genetic mother of future children.
Should it ever happen that such donations were to be countenanced, we note that the Polkinghorne Commitee recommended (3.10) that the consent of the woman should be obtained, and that it should be sought separately from and subsequently to any decision about termination, lest the decision itself be swayed by secondary considerations (Polkinghorne 2.6, 4.1, 4.2, 4.3, 4.6, 6.5, 6.6). There are good reasons for accepting their view that any consent should be general (ibid 4.2, 4.6, 6.3), but we do not consider that a general consent (even one which referred to ovarian usage) could ever be sufficiently informed to be valid. A specific (fully informed) consent would seem to us to be necessary for the use of foetal ova and ovarian tissue, but this is rightly (in our opinion) excluded by the Polkinghorne Code of Practice. Thus, if this is properly followed, it would seem to us that legitimate consent could not be obtainable for the transplantation of foetal ova and ovarian tissue. Although we understand that the father has no legal standing in the matter (Consultation Document Para 32) we would consider that not only should he be consulted in any matter involving his genetic material but that his consent ought also to be sought.
We agree with paragraphs 39 & 19 of the Consultation Document that, if ovarian donations are to be permitted, some record of the source of any donated ovarian tissue would be essential in order to avoid genetic confusion. This would apply to foetal as to adult sources, but the Polkinghorne Code of Practice (3.6-3.9) offers a way in which this could done.
We recognise, in principle, the desire to undertake certain types of research on human ova and ovarian tissues. We believe that such use requires the fully informed and specific consent of the donor, whether at the time or, in the case of cadaveric donations, by way of advance instructions. We consider it improper duress to attempt to seek the consent of a minor, certainly one under 16 however mature, to the use of such tissues (whether from herself or another) and we believe foetal tissues can only be used when the foetus is certainly dead. Our fundamental objection to the deliberate ending of the life of any fertilised ovum remains, and for this reason we cannot accept any research which involves fertilisation.
In the case of treatment we consider the use of such tissues to be contrary to the nature of marriage. However, if such use is to be allowed we hold that an adult donor would have to have given fully informed and specific consent to such use, whether at the time or, in the case of cadaveric donations, previously in writing. In addition, we consider that it would never be proper to expect a minor, certainly one under 16, to give consent to such use, whether on her own behalf or on behalf of another (except in respect of autologous transplants). We consider foetal ovarian tissue donations for treatment to be excluded on account of the medical (chiefly genetic) risks involved, the social ramifications for any future offspring and the ethical impossibility of obtaining valid consent.
Lord Craigmyle, President of the Catholic Union of Great Britain
Anthony P. Cole, Master of the Guild of Catholic Doctors
I.M.Jessiman, Chairman of the Joint Ethico-Medical Committee
8th June 1994