ESHRE on Reproductive Tourism: Be Nice
The European Society of Human Reproduction and Embryology (ESHRE) has just weighed in on reproductive tourism. The press release claims that "ESHRE sets standards for Cross Border Reproductive Care," which sounds promising. It lists what seem at first glance to be several sensible, if general, recommendations. Task force coordinator Dr. Françoise Shenfield is quoted:
"Doctors should consider the principles of beneficence and non-maleficence together and aim at producing minimal risks with a maximum chance of pregnancy."
Patients should receive "clear information," there should be "national registers of donors," legal advice should be given at home and abroad, clinics should follow up on children, and so on. Sounds good. Tell me more.
The actual Good Practice Guide is published in the ESHRE journal Human Reproduction, behind a paywall (abstract). It's less than three pages long. It does a fairly good job of identifying the issues, and lays out "operational principles" such as "equity, safety, efficiency, effectiveness (including evidence-based care), timeliness and patient centeredness." Who could argue? But there are difficulties. For instance, it asserts that:
Collaboration between the home practitioner and the receiving center offers the best chance of optimal care for the cross border patient. The only countries where this may pose a problem is where it is forbidden for doctors to give information about alternatives that are not legal in the country of residence of the patient.
Well, yes, that could be a problem. How should we deal with it? On that, the paper is — understandably, but regrettably — silent. And should a patient, donor, surrogate or other party run into a problem, what then? There is an entire section on the subject. This is it, in toto:
4. Redress
The clinic should provide the name of their ombudsman or the person to whom complaints should be addressed.
To be fair, there is one unequivocal recommendation, that in the case of surrogacy:
Single embryo transfer is the only acceptable option.
Beyond that, there are continual references to ESHRE's 2008 position paper [pdf], on "good clinical treatment in assisted reproduction." That in turn is largely observational rather than fully prescriptive. For instance, on the number of embryos to be transferred, it goes so far as to say that transfer of "three or four embryos should be discouraged" and notes that a "two embryo transfer policy is now common in most European countries" while elective single-embryo transfer "is today part of the embryo transfer policy (by legislation and/or guidelines/voluntary agreement) in five EU countries." (It would be marginally more useful if it specified which.)
The International Federation of Fertility Societies (IFFS) has welcomed the ESHRE paper, while noting that it is limited to the European context [pdf]. They call it "an important step down [the] road" to common global standards of care. To the extent that it demonstrates the difficulty of the issues, it is a step. But only a first step.
Previously on Biopolitical Times: