The IVF treatment debate

Comments made by Children's Commissioner Sonia Camilleri that in her view in-vitro fertilisation (IVF) should not be allowed in Malta have raised a hornet's nest. Here we read the Church's stand and the views of a woman - "Janet" - who underwent the treatment.

Hope of starting a family

"Janet" was the name given to the woman who testified before the Social Affairs Committee of the House of Representatives as a patient. Due to the private nature of the matter, her anonymity will be protected even here:

I was, to say the least, flabbergasted by the heading of The Times (May 27) that ran Children's Commissioner Opposes IVF. When I read the article I was utterly disgusted by what was reported as being said by the Commissioner.

I cannot believe that such an intelligent person deems that research in IVF procedures is still in its embryonic stage (excuse the pun). IVF has been practised worldwide for over two decades and by October 2004 there were at least 250,000 IVF children born in the US alone (as opposed to the 68,000 children quoted by Mrs Camilleri). I do not know how many decades, or centuries maybe, must elapse for Mrs Camilleri's satisfaction to accept the fact that IVF has been a breakthrough in scientific research and a means of hope for infertile couples.

It seems that Mrs Camilleri has done some sporadic research on the internet before appearing before the Social Affairs Committee. She states that "only one in 25 embryos created by IVF survived until birth". Unfortunately though, she did not provide statistics of how many natural abortions occur compared to the number of embryos that survive until birth. Should we stop these women from becoming pregnant because even in this case the trip inside these particular mothers' uterus is dangerous?

With regard to the indication that a higher rate of cancer and cerebral palsy is evident in IVF babies, it seems that the Commissioner has quoted a study carried way back in July, 2002. Another paper published on November 3, 2004 states that a number of studies are being carried out in order to verify this. The paper continues that "most (studies) are disturbing in some way; none seem conclusive; a few are contradictory". Furthermore, last October, the American Fertility Association launched Footprints, a study that will track the health and welfare of children conceived through IVF. This is the first longitudinal, prospective and scientific objective study to be carried out in this regard.

Mrs Camilleri is quoted as saying that "if the unborn child was able to speak, it would probably say: 'Leave me alone, are the natural dangers not enough?'" I believe that Mrs Camilleri should ask this question to the hundreds of thousands of babies who were actually born following IVF procedures. I seriously doubt whether any of them (unless suicidal) would tell her: "Yes I would have loved to be left alone and away from the natural dangers!" I further query why this question shouldn't be asked to all the embryos and not only to IVF ones - aren't the natural dangers there for Mrs Camilleri's children as much as for IVF babies? Or are the so-called "normal" babies unaffected by such dangers?

The Commissioner said she would only agree if the whole process was healthy and no child was lost. Who can ever guarantee that? Apart from being fortunate enough to have her own children by natural methods, Mrs Camilleri does not seem to know anyone who went through the ordeals of a miscarriage - no natural pregnancy can ever be guaranteed; why is Mrs Camilleri expecting otherwise from IVF?

A further attack is launched by the Commissioner on the IVF industry claiming it is convincing couples that IVF is the only method of conception. Does Mrs Camilleri sincerely believe that infertile couples do not do their homework as much as she had done before conceiving her children? Infertile couples do try all possible means prior to resorting to IVF. The latter is usually the last option to have one's own children but it is by no means a simple one. Apart from the obvious financial burden, IVF involves numerous medications - meaning that anyone who opts for IVF must be truly committed to having a baby.

Mrs Camilleri is quoted as saying that "one had to see how many of these families knew of natural technologies which would help them conceive". This comment is to say the least most insulting for the 20 per cent or more of infertile couples existing worldwide. Furthermore, I can hardly imagine any infertile couple not knowing about the "natural methods" while knowing and undergoing IVF treatment when the latter is a much more complex alternative. Besides, IVF may be still deemed as a natural method of conception since, in most cases, the only difference between a natural pregnancy and an IVF pregnancy is that fertilisation takes place outside the uterus, instead of inside.

Most insulting of all are Mrs Camilleri's blanket suppositions, among which the following: "... in many cases people did not try all natural methods. Many people never even tried natural methods ... Many couples went for IVF without knowing of the other methods. Even many doctors did not know about them". The Commissioner spoke as if she were an authority in this regard. I truly wonder whether Mrs Camilleri has ever spoken to one single couple who has resorted to IVF or to a gynaecologist about the same - her declarations and (unreasonable) reasoning indicate otherwise.

"IVF does not cure infertility" further confirms that Mrs Camilleri did not even know what she was talking about. IVF is not about curing infertility for which there are other treatments available, it is about conceiving. Furthermore, as far as I know, infertility means "the inability to reproduce" - if IVF manages to break through this line then it has cured the infertility of a couple, even though for a temporary period. Apart from this fact, as far as I know (being a lay person), in some cases, such as endometriosis (which is considered as a cause of infertility in most couples), conception, even as a result of IVF, can be a possible cure.

While respecting Mrs Camilleri's personal opinion, though I am concerned that the Children's Commissioner should express such selfish remarks, I strongly condemn her attitude towards infertile couples. Certainly it is not up to her to state when a person should accept the fact that s/he cannot have children, especially if science has advanced to such a stage that offers other options for one's problems.

If Mrs Camilleri accepts the fact that she is neither tall nor slim, infertile couples do not simply sit and stare abandoning all their hopes of starting a family.

The Church's stand

Charles Buttigieg, public relations officer at the Archbishop's Curia, says:

Reading the news item (May 28) on the subject of in-vitro fertilisation (IVF) one might end up getting the wrong impression that the Church in Malta gave its blessing to whatever is taking place in this area.

It is indeed unfortunate and strange that, from two Maltese bishops' statements on the subject, respectively of 1,350 words and 300 words, the report in question limits itself to reproducing just part of the introductory paragraph of the first statement.

It is the strong view of the Catholic Church that discarding "superfluous" embryos from IVF and the use and killing of embryos for stem cell research constitute a practical and terrible affront against the dignity of human life and right to life.

In their first statement, issued on February 4, our bishops discuss the pros and cons of assisted reproductive technology and pre-natal general diagnosis. The bishops emphasise the need for proper and strong regulation in the area of assisted reproductive technology (Art) to ensure that no space is permitted for actions that go against the human being and the family. They explain that in Art, as it developed up to now, the rights of neo-conceived human beings are not protected well enough and the door is open for all kinds of abuses.

Then, in a second statement, issued on March 8, the bishops make it clear that whenever a Catholic is asked whether experiments on embryos can be considered acceptable, for those who want to embrace the teaching of the Church the answer has to be a clear "no".

The full texts of these two statements are available on the website run by the public relations office of the Archbishop's Curia at www.maltachurch.org.mt

In the meantime, also in view of certain comments and arguments being put forward, it should be clear for one and all that the Catholic Church considers it morally illicit to produce and/or use living human embryos for the preparation of embryonic stem cells.

The reasons behind the Church's stand, as expressed in a Pontificia Academia Pro Vita Declaration on The Production And Scientific And Therapeutic Use Of Human Embryonic Stem Cells (August 25, 2000), are the following:

1. On the basis of a complete biological analysis, the living human embryo is, from the moment of the union of the gametes, a human subject with a well defined identity, which from that point begins its own coordinated, continuous and gradual development, such that at no later stage can it be considered as a simple mass of cells.

2. From this it follows that as a human individual it has the right to its own life; and therefore every intervention which is not in favour of the embryo is an act which violates that right. Moral theology has always taught that in the case of ius certum tertii the system of probabilism does not apply.

3. Therefore, the ablation of the inner cell mass (ICM) of the blastocyst, which critically and irremediably damages the human embryo, curtailing its development, is a gravely immoral act and consequently is gravely illicit.

4. No end believed to be good, such as the use of stem cells for the preparation of other differentiated cells to be used in what look to be promising therapeutic procedures, can justify an intervention of this kind. A good end does not make right an action which in itself is wrong.

5. For Catholics, this position is explicitly confirmed by the Magisterium of the Church which, in the Encyclical Evangelium Vitae, with reference to the Instruction Donum Vitae of the Congregation for the Doctrine of the Faith, affirms: The Church has always taught and continues to teach that the result of human procreation, from the first moment of its existence, must be guaranteed that unconditional respect which is morally due to the human being in his or her totality and unity in body and spirit: "The human being is to be respected and treated as a person from the moment of conception; and therefore from that same moment his rights as a person must be recognised, among which in the first place is the inviolable right of every innocent human being to life" (Donum Vitae, I,1).