bioethics and regulating reproductive technology dr heston kwong assistant director of health...
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Bioethics and Regulating Reproductive Technology
Dr Heston KWONGAssistant Director of HealthDepartment of Health, HKSAR2 July 2008
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Reproductive technology (RT) A complex and sensitive subject
Involves wide-ranging social, moral, ethical & legal implications
Moral consideration: respect of human life Personal autonomy, human integrity Basic community values such as family and
parental responsibility Child welfare
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Respect for Human Life
Centred on ‘parenthood’
When will become a person?
Judging from the ability to sense and value life?
Some laws and views: A fetus can possess difference rights as it moves towards birth
Some abortion law – ‘capable of being born alive’ & ‘viability’
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Personal Autonomy
Procreative autonomy
A right to control their own role in procreation unless the state has a compelling reason for denying them that control ?
A duty to supply a service on demand ?
Reproductive choice’s impact on others should not be ignored
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Ethics of Care
That moral reasoning is not solely or even primarily a matter of finding rules to arbitrate between conflicting interests?
Or try to find creative solutions that can remove or reduce conflict rather than simply ranking interests or setting one’s priority?
Priority is to foster dignity of individual and welfare of child
Intervention must avoid harm to human relationships
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Why regulate?
Neither against nor for, but should be safe
Informed choice
Child’s welfare
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Aim of regulation
To ensure the safe and informed practice of reproductive technology (RT)
In a way which respects human life, the role of family, the rights of service users and the welfare of children born through RT
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History
Donor insemination and artificial insemination by husband are available since 1970’s
IVF since 1986
1987, Committee on Scientifically Assisted Human Reproduction (SAHR) was established
Interim report on surrogacy and artificial insemination
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Recommendations by Ethics Committee Storage and disposal of embryos
Embryo research
Welfare of child
Posthumous use of gametes and embryos
Sex selection and use of fetal ovarian, testicular tissue in infertility treatment and research
Genetic manipulation the embryo research
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Council on Human Reproductive Technology (CHRT)
CHRT established under HRTO in 2001
3 statutory committees- Inspection Committee (2001) Investigation Committee (2001) Ethics Committee (2001)
3 working groups (WG)- WG on Code of Practice (2001) WG on New Development in RT (2001) WG on HRT Activities Information System (2005)
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Regulation of RT
Statutory provisions Human Reproductive Technology
Ordinance & Regulation
Code of Practice The Code of Practice on Reproductive
Technology and Embryo Research
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HRT Ordinance & Regulation
Regulate RT procedures Regulate the use of embryos and
gametes, for research and other purposes
Regulate surrogacy arrangements
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Activities that are prohibited Commercial dealings in gametes, embryos, fetal
ovarian or fetal testicular tissue
Sex selection achieved by RT - unless to avoid a sex-linked genetic disease
In connection with embryos, e.g. creation of embryo for research; cloning of embryo
Surrogacy arrangements on commercial basis
Using donated gametes in surrogacy arrangement
Provision of RT procedures to unmarried persons
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The Code or Practice
To supplement the statutory requirements in the HRT Ordinance and Regulation
Sets minimum standards which aim to support best clinical and scientific practice To safeguard the health & interest of service users To protect welfare of children born through RT
Will take COP into account when consider granting, renewal, variation, revocation or suspension of license
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Sex selection
NOT allowed for social reasons
Only for avoiding the birth of a child with severe sex-linked genetic disease
To prevent abuse, require not less than 2 registered doctors to certify the need
Report to CHRT within 3 months after the procedure
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Surrogacy NO commercial surrogacy
NO donated gametes in surrogacy arrangement
Counseling for commissioning couple and surrogate mother (and her husband, if any) doctors to explain medical implications and
consequences legal advisor to explain the legal implications social worker and/or clinical psychologist to
explain the social and moral impacts
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Surrogacy (cont’d) Assess suitability of surrogate mother by a
registered doctor not responsible for the RT for surrogacy
In assessing surrogate mother (and her husband, if any), welfare of child is of paramount importance
Report to CHRT within 3 months after the procedure
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Donation
Gametes/embryos from any single donor should not be used to produce more than 3 live birth events in Hong Kong
To minimize risk of inadvertent incest in the offspring
Report to CHRT within 1 week after the donor’s gametes/embryos are used and report any successful pregnancy and birth
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Register A CHRT keeps identifying information of donors, recipient
couples and children born from donated gametes/embryos for 80 years
Without disclosing the identity of the donor, an adult (aged 16 years or older) has the right to ascertain whether – he/she had been conceived from the donated gametes
as a result of RT procedure; or he/she and a person he/she proposes to marry might be
related
To avoid the possibility of accidental incest
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PGD NOT for selecting a baby with abnormality
or with some desired social, physical or psychological characteristics
Only for detection of serious genetic conditions or abnormalities that significantly affect the health of an individual who might be born
PGD + tissue typing will be considered by CHRT on a case by case basis
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Embryo research
To respect human life and protect dignity of human
NO creation of an embryo for research, keeping or using an embryo after the appearance of the primitive streak, combining human and non-human gametes/embryos, cloning, etc
Only essential embryo research will be granted
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Challenges Licence applications
Licensing system completely new system in Hong Kong
RT practitioners may not be familiar with requirements for submission of applications
Require clarifications/requests for supplementary information from applicants
May lengthen the licensing process
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Challenges
Unique local situationRT treatment process may be provided in
different premisese.g. AIH license : Assessment, counseling
and insemination in clinic while sperm-washing done in separate laboratory
e.g. Treatment licences: IVF centres with “satellite centres” / associated practitioners
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Challenges
Resources constraintManpower Time
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Challenges
RT is a fast developing area
New developments in RT
Need re-examining RT practices in view of changing societal norms, values and overseas trends
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Thank you!