paolo grieco

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The assisted insemination

Thesis by comparison

Got again forefront since the law the Chamber passed, the topic of the assisted insemination it has started again in Italy a polemics of harsh tones, and as often happens, rather jade. As “Leadership Medica” is used to, in this survey about bioethics, we asked for their opinion some authoritative Catholics and supporters of laicism. Nevertheless the basic question is: at what extent is it legitimate to comply with the subjective will employing the means science put on disposal?

Genina Iacobone
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Interview to Professor G. B. Palermo

L.M. - Within which terms is the debate about the assisted insemination carried out in the United States?

Palermo - Infertility is a problem for some people and couples. It may result from sexually transmitted illness, some often-treatable glandular dysfunction and even from intensive psychological anxiety. About one of six couple in the United States are infertile (infertility is defined as not conceiving after trying for a year). It is reported that around 30,000 infants are conceived by donor sperm in the United States annually. Artificial insemination is a technological, reproductive procedure that is fairly common in the Unites States. The insemination may be of different types: the semen of the husband may be placed in a test tube with the ova (eggs) of the wife (in vitro fertilization) or the sperm and eggs of the couple are inserted in the woman's fallopian tubes (GIFT - gamete intrafallopian transfer or ZIFT - zygote intrafallopian transfer). The above is often done because of a husband's low sperm count or a wife's gynecological dysfunction. At times, the embryo (pre-embryo) is placed directly in the woman's uterine cavity (ET - embryo transplant). As long as these procedures take place between husband and wife no ethical question should be raised, since usually at the basis of the procedure there is a deficiency or physical abnormality which impedes desired procreation. In this case the artificial insemination should be looked upon simply as another form of the physical union between the two spouses, an extension of their physical union.
Ethical, and at times legal, problems arise in those case of artificial insemination by donor or in cases of surrogacy, i.e., when the product of conception will develop not in the uterus of the future mother but in that of a surrogate mother. This last possibility certainly creates myriad problems and in the United States cases have been reported in the media in which the offspring is being contended by various people who have participated in one way or another in the conception process. Little thought, unfortunately, might have been given to the children's right to be born this way, to their feelings about the confusing manner of their conception, to their allegiances to the various people involved and to their future right to access to information about their genetic background and mode of conception. Theologians of the Jewish and Christian faiths accept artificial insemination by the husband but do not accept donor insemination. In Judaism the child is usually considered to be the offspirng of the biological father, and the Catholic church views procreation without sexual union as unnatural. If artificial insemination by the husband is viewed as another form of sexual union of the husband and wife, and as an expression of their love, it should overcome the religious/theological prohibitions. Could humans be considered in a certain sense co-creators with God, without that being a sign of omnipotence, as some people say? The problems with artificial insemination arises when the biological semen or eggs, or organs (uterus), o a person other than the future parent (husband or wife) are used. Why do some people accept reproductive technology even though at times, in the hands of humans, it creates a great number of problems? People's increasing acceptance of these reproductive methods is probably due to recent, rapid technological advances in other field. This has made people feel almost omnipotent and willing to manipulate nature. Ad this takes place not only in the filed of human reproduction but even in the reported attempts to clone human beings, or to freeze oneself until “better” therapeutic times will arise, or even, in their omnipotent unethical belief, to dispose of non-productive people through the euphemistic method of euthanasia. People's emotional maturity does not go pari passu with their technological discoveries. The desire to overcome nature's constraints often make people unable or unwilling to anticipate the consequences of distorted pseudo-creativity. Genetic manipulation is born with the purpose of eliminating genetic or psychological/psychiatric illnesses in the near future. This may become a slippery slope toward all types of manipulation of embryos, in utero or in vitro. Ultimately, it will be a question of financial affordability. Of course, this would be unnatural, unethical and would be the forerunner of a new, strange morality.

L.M. - On your opinion the mother who bears a baby that will belong to other family, which psychic consequences will she have?

Palermo - I am not personally aware of any specific cases. However , the surrogate mother will naturally become attached to the product of other people's conception and by the mere fact that for a nine month period she will be the source of nourishment and budding life for the baby and she may come to believe herself to be the “real” mother of the child - while she is actually just as a participant in this strange drama. There have been reported cases in which the surrogate mother has claimed the baby as her own. At times, however, the surrogate mother is pleased to assist the infertile couple, possibly because she indirectly feels creative again.

L.M. - The assisted insemination bearers underline how donors must undergo an entire series of clinic tests to ascertain probable diseases? Which are the consequences it may come true in children born by the means of these methods and more in general inside the familiry formed by “heterogeneous” individuals?

Palermo - Yes, the donors are usually screened for various illness - organic and/or psychological. From a scientific point of view, it is quite possible to exclude donors or surrogates with psychological or genetic illnesses. Genetic choice for otherwise infertile, and even fertile, couples can help avoid those diseases which have been attributed to certain anomalies of chromosomes and genes. It is important to remember that the present-day technological advancement has not yet discovered the genes for all the illnesses we think may be genetically transmitted. Therefore, one may encounter big surprise yet.

L.M. - Finally, which is your experience in this delicate field?

Palermo - After such a reflection about the morality and ethics of artificial insemination, we should define the meaning of morals and ethics. Morals are values that are part of our social living, often derived, but not necessarily so, from religious tradtions. Ethics, instead, are the rules or standards governing the conduct of a person towards himself and others, and right or wrong behavior. Ethics change with changing times, while moral values tend to remain the same. However, during moments of social transition, as in present society, it seems that even basic, moral and social values are under attack. People manipulate their bodies and those of others, trying to achieve an illusory completeness, unable to accept their natural, God-given self with its positive and negative aspects. Does this signify that humankind is unable to accept its own impotence, and tries to play God and take from God, as Prometheus did, the fire of life?

Interview to Professor
Vittorio Rognoni

L.M. - Which is on your opinion the most serious problem the heterologous assisted insemination plants?

Rognoni - The embryos conservation. As a catholic I'm against the in vitro conservation of the remaining embryos. It could rise a market, a sale. A sterile couple could buy the embryos and then find a woman wanting to rent her womb.

L.M. - The medical class is aware of the ethical aspecst regarding the bioethics problem?

Rognoni - I would say that the 90% of the physicians are unrelated to ethic kind evaluations. The assisted insemination for them is a technique as others.

L.M. - Is there a problem of lack of training?

Rognoni - It concerns everyone: reporters, politicians, and physicians.
Before facing, even legislative level, such problems, it must be necessary a scientific debate to inform the public opinion about consequences - I don't mean the clinic ones, since risks are very low (the only one is the overstimulation) - but morals and ethical. What worries me is the lack of preparation of the family doctors.

L.M. - So you assert that following the advise of a family doctor a woman can go to the gynaecologist and say to him 'I want a baby “?

Rognoni - Just that. It will be necessary at least a psychological or a psychoanalytical procedure the people making requirements like these must undergo.

L.M. - You hear at television programme a physician ensuring fertility and listeners call him up, they run.

Rognoni - It rises a kind of frenzy to become mother, at all costs.

L.M. - Which definitive law will we have?

Rognoni - Who knows? There's a transversal majority. Someone of Rifondazione votes as Alleanza Nazionale. What worries me, and I say it again, is the lack of training about the problem, the shallowness it is faced with.

Interview to Professor Angelo Fiori

L.M. When we talk about the assisted insemination it seems that laymen get nervous and reject it. By a catholic point of view how do you evaluate this behaviour?

Fiori - Asserting that any medical act is legitimate by itself does not fit the bioethics principles on my opinion. Inseminating a woman with the seed of a man different from his husband means giving birth to a person who does not know his genetic origin, a very serious social problem.

L.M. Professor aren't we witnessing a phase wherein medicine lays stress on the consent? Everybody is talking about the necessity of an informed consent, it must be said everything.

Fiori - There's, it's true, a sort of exaggerated trend to consent, but in the field of the assisted insemination there is still much reticence, much inaccuracy.

L.M. For example?

Fiori - It is not said which risk women must face, as the hyperstimulation. It is not said that only a case out of four succeeds, with painful consequences even psychological and spending a lot of money.

L.M. Nevertheless in many countries abroad the assisted insemination is allowed.

Fiori - Let's do a banal example. If I use a donor's semen for an assisted insemination, I carry out only a clinic test of the donor, but not a DNA test. It would be impossible to carry out a genetic screening. A semen, be aware, that in France in given to 5 different women and that could provoke even an incest among brothers born from the same father and that could get married not knowing each other.

L.M. Maybe there's bad faith, maybe there are hidden interests by physicians...

Fiori - I've not said that. I only wonder why people are not informed.

L.M. Let's talk about the homologous insemination. The law that has been discussed has been passed at the Chamber at certain conditions, but Catholics opposite even this kind of artificial insemination.

Fiori - This is a religious kind problem. The Canon Law states that insemination must be the result of a human act. So it is obvious that Church, for whom marriage is a sacrament, is opposite to the homologous insemination.
It imposes it to believers, but at the same time it cannot be so strict as towards the heterologous one since here there are quite different concepts I've mentioned before.

L.M. Which will be the final routine of the law, on your opinion?

Fiori - I do not know. Our policy is so wavering. It makes paces forward and at the same time backwards.

L.M. Many people require safe laws for laboratories where insemination is supplied. Is it a right requirement?

Fiori - To supply assisted insemination it's enough a very simple laboratory equipped with a thermostat, a test tube, and a microscope. In other words it is not required a sophisticated technology. Which are the systems to carry out controls inside? Who wanted to offend against law could do it the most easy and possible way. My conviction -is that truth must be said to citizens.

Interview to Professor Carlo Augusto Viano

L.M. It is conjectured that a laic philosopher as you is critical toward the legislation passed at the Chamber about the assisted insemination

Viano - My opinion is that it must be legalised both the homologous insemination ant the heterologous insemination. I do not share the reasons of whom supports that the heterologous insemination is nothing but a therapy against sterility.
For me it is to be intended as an alternative method to procreate every one can apply for. But even admitting that it concerns a therapy, it is not admissible that a law must discipline it. Medical therapies are put into effect on the discretion of physicians.

L.M. - If sterility is not a disease, the physician is to use technical means on request of a person, beyond his own tasks.

Viano - Now we have the possibility to use techniques that are not strictly related to recovery. It's given birth with medical assistance, but the childbirth is not a disease, it's a phase of life.

L.M. - Is there the risk that a woman first wants a baby, and later, with advances of sciences, she wants him fair hair and blue-eyed or not?

Viano - I think this problem will be the next year's problem. We must be ready to face this occurrence.

L.M. - Which way? By a prohibition?

Viano - Usually prohibition endures very little. It has been observed that the most effective way to prevent the market of organs for transplants was that of intensify donations. Maybe this could be a way out.

L.M. - Assisted insemination is always a way to concept against nature. Do you agree with this point?

Viano - I really do not know what it may mean natural or unnatural. The concept of nature has changed following the choices taken and by scientific progress.

L.M. - On consequence, on your opinion, also the concept of family has changed.

Viano - Sure. That family is based on the human nature - everybody is free to believe it - is not a scientific proposal. What is family? All concepts have changed, even that of procreation.

L.M. - The fixed point in you position is that at the end of the twentieth century all the traditional concepts about nature, family, disease are not anymore valid.

Viano - Yes, mainly it must be allowed to be more than one, according to the everyone's opinion. Why should we not let people having freedom in behaviour?

L.M. - Professor, a laic trend, rather considerable, supports that the Catholic Church must consent to the birth control. But it is required the absolute freedom to have babies by the assisted insemination. Isn't it a contradiction?

Viano - As a laic I require the church to use the propaganda means and not restrictive laws. Surely the problem of the demographic boom can carry heavy consequences on the future of human kind, it would create indigence and hunger. But women asking for assisted procreation belong to those countries where births are decreasing.

L.M. - But can a woman ask for applying for the assisted insemination for an hysteria motion for a frustration?

Viano - It could be. No technique is immune from mistakes. The same happens in the family. How many babies are born by chance, not wanted?

Interview TO Professor massimo Reichlin

LM: Concerning bioethics Italy is accused of being a conservative country too much bound to the Catholic Church. Is this assertion exact?

Rechlin - The fact that many countries have already passed laws concerning the assisted insemination does not mean there's unanimity of views. For example England and Spain have adopted a more permissive juridical setting allowing also single women, without husbands, to apply for the assisted insemination.

LM: But after proving sterility...

Reichlin - Not necessarily. Law shows no distinction on that matter. In England there's a Central Authority determining the different protocols according to the case.

LM: Which are the most much-discussed points?

Reichlin - For some authors the assisted insemination is a new and different way to become parent. The morality of the procedure is given by the fact that a person acts in an autonomous way, he wants a baby at all costs and takes the responsibility of that, of his own choice.

LM: So it is not discussed the naturalness or not of the assisted insemination system.

Reichlin - The stress lies on the subjectivity, on the freedom in choosing of the individual. Others bear that this freedom in choosing is a real right. Naturally for someone it concerns an unacceptable position since it avoids standing the comparison with the other's right, of the offspring born in these conditions.

LM: Do only the Catholics opposite the assisted insemination, as asserted by press, or are there critical positions towards the assisted insemination even from laic students?

Reichlin - There are strong perplexity mainly in the psychology and psychoanalysis field. If we want to quote someone we can refer to the works of Silvia Vegetti Finzi, laic and not believer writer, coming from the Freudian school, that have underlined in many articles and books the problems related to this way of becoming parents.

LM: Let's image the case of two lesbians...

Reichlin - Sure this case conflicts are deeper. Bu still I want to remember an author as Daniel Callahan, one of the founders of the Hastings Centre, a bioethics centre among the most important world-wide. This very authoritative laic student has expressed strong perplexity about the heterologous insemination. Donor is motivated to supply his semen, but he does not take any responsibility for the son that will be born.

LM: But, they say they are not paid

Reichlin - Donors are university students or unemployed, rarely someone says to do it for the good a human kind.
Nevertheless it does lack also the student's spirit and all that turns the act of procreation a trivialness.

LM: There's also the problem of embryos, a serious problem that must be safeguarded by law.

Reichlin - In England it is allowed the so-called waste of embryos. Embryos can be employed for the scientific experimentation even to create other embryos. In Germany instead the law forbids the overproduction of embryos in relation with those necessary for each centre. It's fundamental to respect the human embryo and the German law is opportune.

From the interviews the experts have given us it arises two opposite positions. Obviously the balance is in the middle and it must take in account some special cases and prevent excesses. As regards to the assisted insemination, it may be accepted, on our opinion, if a young couple wanting to have children applies for all the possible means to achieve their purpose. Less justified is the heterologous insemination since it in time may carry existential problems to the baby that will be born. The matter is too complex and it's impossible to take into account all aspects that surely can change into a great social problem. An important legislative aspect is property-hereditary kind. Which right does a child born by the mean of the heterologous method have to inherit the father's property? These are themes that we cannot deal with by following ideological trends, but with the entire good sense the man does not have on disposal today.

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