Dr. John Waterstone:

I am a medical doctor who has been working in assisted reproduction for 30 years. My specialist training took place in the NHS in London and I currently work in the HSE as a consultant obstetrician, as well as being the medical director of a large IVF unit. I am here today to represent the interests of the patients I care for. As president of the Irish Fertility Society, I have contributed to the submission to the joint committee made by the society and the majority of the views I will express today are shared by the majority of its members. I am very concerned that some elements of the Children and Family Relationships Act, although not implemented, and of the legislation which is now before the joint committee are insensitive to our patients’ needs and unreasonably coercive. I want to thank the committee for the opportunity to present my views today. I cannot overemphasise the vital role the committee plays if legislation is to result which is fit for purpose. A list of more specific technical issues is included in my opening statement but I do not have time to dwell on those now. However, I would be very happy to answer questions about them afterwards. I will only address key issues now.

With regard to the issue of statutory legislation versus practice guidelines, many clinical issues such as the number of embryos which can be transferred at a time in IVF treatment should be the subject of practice guidelines and not of statutory legislation, which is too inflexible. The guidelines involved are going to be formulated by the new regulatory authority, the assisted human reproduction regulatory authority, HPRA, which the draft legislation has proposed. This means that the composition of this new authority is important and it is important to consider how the functions of this new authority will overlap with the functions of the Health Products Regulatory Authority. The joint committee needs to understand that all IVF units in this country are already strictly regulated, licensed and inspected by the Health Products Regulatory Authority and it implements the EU tissues and cells directives. All the processes that take place in our IVF units and any adverse reactions that occur after treatment must be reported. Control is already very strict.

After a decade of activity, the HPRA has accumulated valuable practical experience with regard to inspecting IVF units. It is vital that the functions currently carried out by the Health Products Regulatory Authority are not duplicated by the new authority. Unnecessary duplication will generate unnecessary costs which are likely to be passed on to our patients and to the taxpayer. It is important that the new regulatory authority be effective and in order to be effective the exact composition of its 11 strong board members is vital. I would urge the joint committee to scrutinise carefully both the specifications for board membership and the manner in which people are appointed to that board.

The joint committee needs to know that assisted reproduction has become extremely commercialised and to understand that IVF treatment, even at the best of times, is expensive and often is not successful. Patients deserve safeguards which promote success and which protect against financial exploitation. An additional specific function of this new regulatory body which I have suggested is regulations to safeguard patients against financial exploitation and I am happy to dwell further on that issue afterwards.

With regard to restrictive human reproduction legislation and conscientious objection, in general in northern and western Europe the legislation concerning assisted reproduction has been restrictive, particularly with regard to financial compensation of egg and sperm donors and of surrogates and also with regard to anonymity versus identifiability of donors.

The committee should be aware that every year hundreds of thousands of European citizens travel to other jurisdictions in Europe and beyond to escape restrictions in their own countries. This huge amount of reproductive tourism exemplifies the fact that mechanisms to regulate assisted reproduction in Europe are failing citizens. The draft legislation before the committee, although in the main progressive, is restrictive with regard to egg and sperm donation and surrogacy. The danger is we may slavishly imitate mechanisms of controlling assisted reproduction that have already proved a failure in other jurisdictions. Unduly restrictive legislation will give rise to ethical dilemmas on my part and on the part of colleagues in assisted reproduction in Ireland because we may have conscientious objections to unreasonable restrictions on our patients' reproductive rights. Clinicians insist on our rights to such conscientious objections.

This brings us to Parts 2 and 3 of the Children and Family Relationships Act. Outsiders might wonder why two Acts are necessary to control assisted reproduction in Ireland. I am happy to go into the details of the history of how this came about. In retrospect, Parts 2 and 3 of the legislation are regrettable and only came about as a result of a lack of appropriate oversight in the Department of Justice and Equality. The legislation sets out to totally ban anonymous gamete donation in Ireland, to ban the payment of any sort of financial compensation to donors and to give the State the right to intervene and inform 18-year-old children who are the product of gamete donation that they were donor-conceived and to give them identifying details of the donor concerned even though it may be against the wishes of the parents involved. To me and my colleagues who think as I do, it is an unacceptable degree of coercion and is unconstitutional. I will not be able to comply with these stipulations on conscientious grounds.

Together with my colleagues in the Irish Fertility Society, including Jenny Cloherty who is sitting in the room today, we have the following view about how donor sperm and donor egg treatment should take place in this country. We feel that donor egg and donor sperm treatment are good things. They allow couples who would otherwise never have been able to enjoy the fulfilment of family life to have children and, as they are good things, we need to facilitate the process. We feel that in order to do so some degree of slight financial compensation is allowable and ethically justifiable for the donors concerned. We feel that gamete donation should be identifiable or anonymous; we feel that both are ethically acceptable. We support identifiable donation but we also think that people have the right to anonymous donation. It should be left up to the people concerned, the donors and recipients, to decide which form they want and which is appropriate for them.

We feel the parents of donor-conceived children should be very strongly urged to tell the children concerned as they grow up that they were donor conceived but we do not think it is the function or duty of the State to intervene and give the children involved that information. We certainly do not think it is the role of the State to forcibly intrude into the private family lives of citizens and to tell donor-conceived patients about the identifying details of donors against the wishes of the parents involved. We feel it is going too far. We strongly urge the committee to consider Parts 2 and 3 of the Children and Family Relationships Act and suggest they are replaced by more acceptable and workable legislation.

I urge the Joint Committee on Health to devise mechanisms for bringing the opposite sides of the coin together in this legislation. It should bring together representatives of the Department of Health, who drafted the legislation, and representatives of the IFS and the IOG, which Dr. Wingfield represents, so we have a coming together of the people who formulated the legislation and of the people who must apply it and who represent the patients whose lives would be impacted by the legislation. We urge the committee to take its time because it needs due consideration. The committee needs to ensure the issues concerned are given the consideration they deserve in order to bring about a better future for parents, families and children.