Assisted fertilization: a comparative synthesis

Going into a comparative review of assisted fertilization means realizing how the same ethical-legal principles can translate into different cultural models. This does not affect the validity of these principles, but rather confirms their universality. The positions taken at an international, supranational or national level, relative to both the clinical and experimental aspects of reproductive technologies, reveal similarities and differences in some key points. They concern the interventions to be included in these technologies, the status, access, donation and conservation, as well as the production and possible uses of human genetic material. Even if, ultimately, what matters most is the political courage to intervene on this issue,

Introduction

Many countries have adopted legislation aimed at regulating assisted fertilization, while others, more reluctant to operate in this direction, have drawn up some recommendations or directives in this field. Despite the social, economic, cultural and political differences existing between the various countries, what emerges forcefully is the growing attention relating to human genetic material - and the affirmation of respect for it - as well as to the problems which, in a long-term perspective term, the use of such material implies for our concepts of human life, fertilization and the family. This concern directly affects the clinical and experimental aspects of assisted reproduction.

This essay focuses its attention on the official positions of the different countries. Initially we will briefly examine the topic of assisted fertilization from the point of view of international and supranational organizations in general, considering both governmental and non-governmental organizations positions. We will then go on to compare and contrast the national positions of various countries on the legal regulation of reproductive technologies with regards to the clinical aspects, specifically examining the problems related to terminological definitions, access to assisted reproduction techniques, donation, post mortem donation , the preservation of genetic material and anonymity. Later we will deal with the topics related to research,

International and supranational law

Given the rapidity with which progress and discoveries occur in the field of assisted fertilization, international positions necessarily take place within the framework of safeguarding human dignity. Human rights, which derive from his dignity, are inextricably linked to respect for the human body and its constituent parts, including cells and reproductive tissues. Although this is not directly related to assisted reproduction, respect for human genetic material is certainly evident in the preamble to the Universal Declaration on the Human Genome and Human Rights proposed by UNESCO (United Nations Educational Scientific and Cultural Organization). United for Education, Science and Culture), which declares that research on the human genome must respect human dignity and the rights of the individual. Accordingly, in relation to scientific research in the field of genetics the declaration states that "the benefits arising from advances in the fields of biology and genetics with respect to the human genome will be made available to all, with due consideration for human dignity and rights of each individual. [ ... ] Research will attempt to offer relief from suffering and to improve the health of individuals and of the entire human race" (art. 12 a, b in fine). It also states that "in no case shall research or its applications prevail over respect for human rights, fundamental freedoms and human dignity" (art. 10). in relation to scientific research in the field of genetics the declaration establishes that "the benefits arising from advances in the fields of biology and genetics with respect to the human genome will be made available to all, with due consideration for the dignity and human rights of each individual [ ... ] Research will attempt to offer relief from suffering and to improve the health of individuals and of the entire human race" (art. 12 a, b in fine). It also states that "in no case shall research or its applications prevail over respect for human rights, fundamental freedoms and human dignity" (art. 10). in relation to scientific research in the field of genetics the declaration establishes that "the benefits arising from advances in the fields of biology and genetics with respect to the human genome will be made available to all, with due consideration for the dignity and human rights of each individual [ ... ] Research will attempt to offer relief from suffering and to improve the health of individuals and of the entire human race" (art. 12 a, b in fine). It also states that "in no case shall research or its applications prevail over respect for human rights, fundamental freedoms and human dignity" (art. 10). the benefits of advances in biology and genetics relating to the human genome will be made available to all, with due consideration for the dignity and human rights of each individual. [ ... ] Research will attempt to offer relief from suffering and to improve the health of individuals and of the entire human race" (art. 12 a, b in fine). Furthermore, it states that "in no case will research or its applications shall prevail over respect for human rights, fundamental freedoms and human dignity" (art. 10). the benefits of advances in biology and genetics relating to the human genome will be made available to all, with due consideration for the dignity and human rights of each individual. [ ... ] Research will attempt to offer relief from suffering and to improve the health of individuals and of the entire human race" (art. 12 a, b in fine). Furthermore, it states that "in no case will research or its applications shall prevail over respect for human rights, fundamental freedoms and human dignity" (art. 10).

In Canada, the 1993 report of the Royal commission on new reproductive technologies clearly described the biological process. The stages of development begin with the zygote, i.e. the fertilized egg up to about 14 days after fertilization; then follows the embryo, up to the eighth week after fertilization, which then evolves into a fetus from the ninth week until birth (p. 148). Similarly, in Canada, Bill C-47, which was to become the Human Reproductive and Genetic Technologies Act, 1996, similarly defined the three stages of development mentioned above. , but referred to each of them as a human organism (paragraph 2). Following the calling of new elections in 1997, the bill lapsed.

The other countries considered provided definitions only for the term "embryo". In Germany, the Embryo Protection Act (1990) defined the embryo as "the fertilized and viable human oocyte from the moment of karyogamy, and furthermore any totipotent cell which, under the necessary conditions, is capable of dividing and to develop to give rise to an individual" (paragraph 8.1). The word "vital" refers to "the 24 hours following karyogamy unless before the expiry of this period it is determined that it is unable to develop beyond the single cell phase" (paragraph 8.2). In Switzerland, both the bill relating to the federal legislation concerning assisted fertilization (1996), both the ethical-sanitary directives on assisted fertilization (1990) of the Swiss Academy have defined the embryo as the product of fertilization up to the end of organogenesis, with the indication, in the directives, that it intended to refer to the initial stages prior to plant (No. 1.5). Finally, in Great Britain it was enshrined in the Human Fertilization and Embryology Act, 1990, that an embryo is "a living human embryo in which the process of fertilization is completed". The law, applicable only to ex uterus embryos, also specifies that fertilization is not complete until the appearance of a bicellular zygote (paragraph 1.1). Lastly, in the United States, the Human embryo research panel, set up within the The NIH (National Institute of Health) in 1994 defined a pre-implantation human embryo as an in vitro fertilized oocyte that has never been transferred or implanted in the uterus. The study group supported the view that pre-implantation human embryos should be given appropriate moral consideration as a potential human life form, even though they cannot be granted the same moral status as infants and children. . The directives issued in 1994 by the Ethics Committee of the American Fertility Society, however, preferred the use of the term "preembryo" for the phase that ends 14 days after fertilization, stating that the preembryo has a unique condition as fertilization assisted operates on it by isolating it and making it available to the observation or intervention differently than for more advanced embryos and fetuses. The Committee expressed the view that the pre-embryo, although it has no individual status, should nevertheless be accorded a special status as "it is a genetically unique living human entity which could become an individual if implanted and received in a receptive uterus". " (p. 32S).

In short, there are clearly terminological problems, as the term "embryo" often refers to the zygote, while to some it might seem that the term "preembryo" detracts from the 'human' dignity of the developing entity from the moment of conception onwards. Nonetheless, this excursus of definitions demonstrates both the divergences inherent in national legislations and the terminological 'manipulation' for moral and political purposes and furthermore prepares the way for understanding the diversity of points of view on access to assisted reproduction techniques.