03.-Assistance médicale à la procreation / Procreation assistance — CHURCH OF FRANCE / États généraux de la bioéthique — States General on Bioethics

http://eglise.catholique.fr/sengager-dans-la-societe/eglise-et-bioethique/comprendre-les-enjeux/

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Scientific and legal data :

Med­ical­ly Assist­ed Repro­duc­tion (MAS) refers to prac­tices aimed at the con­cep­tion of a child with­out the sex­u­al union of man and woman: insem­i­na­tion of a woman by her spouse or part­ner (AIC) or by a donor (DAI) in vit­ro fer­til­iza­tion with embryo trans­fer, in case of sperm fail­ure or egg dona­tion (IVF-ET involv­ing male and/or female gamete donation).

The first IVF birth was obtained in Eng­land in 1978 and in France in 1982. Accord­ing to the law, gamete dona­tion is free and anony­mous; today it is insuf­fi­cient to cov­er all requests.

In most IVF, sev­er­al human embryos are con­ceived. Those that are not trans­ferred into the wom­an’s uterus are frozen. In some cas­es, sev­er­al are trans­ferred into the uterus and then an “embry­on­ic reduc­tion” is per­formed to keep only one in the uterus, the oth­ers being destroyed.

In 2015, 24,839 chil­dren, or 3.1 per cent of births, were cov­ered by this scheme.

In cur­rent French law, PMA pur­sues a ther­a­peu­tic objec­tive: to avoid the trans­mis­sion of a seri­ous dis­ease or to com­pen­sate for a med­ical­ly diag­nosed patho­log­i­cal infertility[1]. It there­fore only con­cerns live, male and female cou­ples of child­bear­ing age who are the bear­ers of a “parental project”. The inabil­i­ty to pro­cre­ate of sin­gle per­sons, same-sex cou­ples, per­sons over the age of pro­cre­ation or the deceased is not patho­log­i­cal and is not intend­ed to be treat­ed by medicine.

Questions this raises:

With­out a father, by law. The exten­sion of the PMA to sin­gle women and wom­en’s cou­ples would amount to a pri­ori decree­ing the exis­tence of chil­dren with­out fathers: “In the parental frame­work result­ing from the choice of wom­en’s cou­ples and sin­gle women, the child would have, in its his­to­ry, no image of father, known or unknown, but only that of a donor. From a psy­cho­log­i­cal point of view, the respect due to the child and the con­struc­tion of his per­son­al­i­ty is seri­ous­ly wound­ed. From the point of view of soci­ety, where the role of par­ents is already dis­rupt­ed in many ways and author­i­ty is ques­tioned, this planned father­less­ness is prob­lem­at­ic. A minor­i­ty opin­ion of CCNE states that “the role of a father, in inter­ac­tion and coop­er­a­tion with that of the moth­er, is essen­tial in the con­struc­tion of the child’s per­son­al­i­ty and his rela­tion­ship to the diver­si­ty of soci­ety, includ­ing male-female otherness.

Inequal­i­ty. CCNE acknowl­edges that open­ing the PMA to all women would pro­duce inequal­i­ty: “Expand­ing access to the IAD could be at the ori­gin of “inequal­i­ties” for chil­dren born from such AMPs because they would be deprived of a father in the case of female cou­ples, of a father and of a dou­ble parental lin­eage in the case of sin­gle women[4].

It is false to say that there is “unequal treat­ment” between women who live in het­ero­sex­u­al cou­ples and who may have access to DAI for infer­til­i­ty rea­sons, and fer­tile women alone or in cou­ples. The Euro­pean Court of Human Rights val­i­dates French law: “The IAD is only autho­rised in France for the ben­e­fit of infer­tile het­ero­sex­u­al cou­ples, a sit­u­a­tion which is not com­pa­ra­ble to that of the applicants[women’s cou­ple]. It fol­lows, for the Court, that the French leg­is­la­tion con­cern­ing the DAI can­not be con­sid­ered to be at the ori­gin of a dif­fer­ence of treat­ment of which the appli­cants are victims.

Mer­chan­dis­ing the body. PMA for all women leads to the gen­er­al­iza­tion of gamete dona­tion, where­as dona­tions are already insuf­fi­cient. That is why some peo­ple advo­cate a solu­tion that would go from donat­ing sperm to sell­ing it, at the cost of aban­don­ing the prin­ci­ple of free[6]. In addi­tion, the mul­ti­pli­ca­tion of chil­dren born from semen would increase the risk of meet­ing and pos­si­ble inbreeding.

Prin­ci­ple of anonymi­ty. Today, anonymi­ty is a prin­ci­ple guar­an­tee­ing the pos­si­bil­i­ty of gamete dona­tion. There is only one excep­tion: ther­a­peu­tic neces­si­ty, which gives the doc­tor access to med­ical data con­cern­ing the donor but not to his identity[7]. This rule of anonymi­ty is “fal­la­cious” because it applies just as much to germ cells as to oth­er cells; how­ev­er, germ cells have a com­plete­ly dif­fer­ent voca­tion: the con­cep­tion of a new child[8]. This rule, spe­cif­ic to France, remains prob­lem­at­ic because it does not pre­vent pos­si­ble con­san­guini­ties. It is fur­ther under­mined by the pos­si­bil­i­ties offered by com­put­ers: thanks to soft­ware sold in the Unit­ed States, for exam­ple, it has been pos­si­ble to find the iden­ti­ty of an anony­mous sperm donor. Thus, the real ques­tion remains that of PMA with donor, a tech­nique that dis­so­ci­ates bio­log­i­cal kin­ship from social kin­ship: it does not respect the right of the child (see the card on gamete donation).

Selec­tion of indi­vid­u­als. Allow­ing insem­i­na­tion of non-ster­ile women would mean aban­don­ing the cur­rent ther­a­peu­tic cri­te­ria. PMA would then be acces­si­ble to all, includ­ing the most numer­ous numer­i­cal­ly fer­tile male/female cou­ples, who would con­sti­tute the ulti­mate tar­get of the large pro­cre­ation mar­ket: once the ther­a­peu­tic lock has been lift­ed, we will has­ten to offer tai­lor-made ser­vices to choose one char­ac­ter­is­tic for the child or avoid anoth­er. This could be the door to indi­vid­ual selec­tion or legal eugen­ics. It is under­stand­able that CCNE took the trou­ble to “request that access and fea­si­bil­i­ty con­di­tions be defined[9]” con­cern­ing the open­ing of the PMA to all women.

Anthropological and ethical visions :

Uni­ty of the human per­son. The LDC extend­ed to sin­gle women and female cou­ples com­pletes the dis­junc­tion between bio­log­i­cal fer­til­iza­tion and social kin­ship. If the human being is a social ani­mal, it is also a liv­ing body. To divide it in two, sep­a­rat­ing the rela­tion­ship of fil­i­a­tion from its bio­log­i­cal anchor­age, is an act of vio­lence against the uni­ty of the human per­son. This is a “uni­fied total­i­ty”, at once bio­log­i­cal, psy­cho­log­i­cal, spir­i­tu­al and social. Its har­mo­nious inte­gral devel­op­ment pre­sup­pos­es that these var­i­ous aspects are tak­en into account togeth­er and not sep­a­rat­ed or even opposed. Fil­i­a­tion must remain a bio­log­i­cal process, result­ing from the union of bod­ies, psy­chic, result­ing from a dif­fer­ence in gen­er­a­tion and sex­u­al dif­fer­ence, and social, rec­og­nized by the insti­tu­tions of the city.

The wed­ding. This exten­sion of the PMA to sin­gle women weak­ens the link between mar­riage and fil­i­a­tion. The insti­tu­tion of mar­riage is a nec­es­sary foun­da­tion of soci­ety and remains the respect­ful place in which a new human life is born[10].

Wel­com­ing a sit­u­a­tion is not orga­niz­ing it. Sin­gle women have often found ways to have chil­dren. But “if chil­dren who do not know their father and chil­dren raised by a sin­gle par­ent or in a homo­sex­u­al cou­ple have always exist­ed, there is a dif­fer­ence between “cop­ing” with such a sit­u­a­tion occur­ring in pri­vate life with­out hav­ing been planned or organ­ised by soci­ety, and insti­tut­ing it ab initio.

If we judge today severe­ly the times which tol­er­at­ed the igno­rance of the rights of some, in the gen­er­al indif­fer­ence, how can we resign our­selves to a law which ignores the rights of children?

Rights of the child. The Inter­na­tion­al Con­ven­tion on the Rights of the Child, signed and rat­i­fied by France, estab­lish­es the right of every child, as far as pos­si­ble, “to know and be cared for by his or her par­ents” (art. 7). To delib­er­ate­ly orga­nize the era­sure of the father is not com­pat­i­ble with this right. These chil­dren’s rights are bind­ing com­mit­ments for the State.

CCNE recog­nis­es the impor­tance of this: “While the’right to the child’ is often invoked in soci­etal demands, it has no legal basis; on the oth­er hand, a major eth­i­cal con­cern must be that of the rights of the child, in par­tic­u­lar that of locat­ing the child’s his­to­ry and fam­i­ly envi­ron­ment in rela­tion to the his­to­ries and fam­i­ly set­tings of oth­er chil­dren, what­ev­er the mode of pro­cre­ation from which it is derived[12].

The child is not a right, but a “gift”. The real suf­fer­ing that con­sti­tutes the absence of a child does not allow it to be trans­formed into a right that it would be law­ful to claim before society[13]. For his serene devel­op­ment, the child needs to be received as a gift[14].

Ref­er­ences :

Bruno Sain­tôt, “How med­ical­ly assist­ed is pro­cre­ation? Les répons­es para­doxales des vis du CCNE”, Études, Sep­tem­ber 2017, n° 4241, p. 38.
Aude Mirkovic, “L’élar­gisse­ment de l’as­sis­tance médi­cale à la pro­créa­tion (AMP)”, Médecine et droit, Feb­ru­ary 2018.
Con­gre­ga­tion for the Doc­trine of the Faith, Instruc­tion Dig­ni­tas per­son­ae, 8 Sep­tem­ber 2008.

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[1] L’article L2141‑2 du Code de san­té publique stip­ule : « L’assistance médi­cale à la pro­créa­tion a pour objet de remédi­er à l’infertilité d’un cou­ple ou d’éviter la trans­mis­sion à l’enfant ou à un mem­bre du cou­ple d’une mal­adie d’une par­ti­c­ulière grav­ité. Le car­ac­tère pathologique de l’infertilité doit être médi­cale­ment diagnostiqué. »

[2] CCNE, Avis n° 126 du 15 juin 2017 sur les deman­des socié­tales de recours à l’assistance médi­cale à la pro­créa­tion (AMP), p. 22.

[3] CCNE, ibid., p. 49. Avis minori­taire signé par 11 mem­bres du CCNE sur 40 membres

[4] CCNE, ibid., p. 19.

[5] CEDH, 15 mars 2012, n° 25951/07, Gas et Dubois c/ France, § 63.

[6] Si les gamètes peu­vent être ven­dus, pourquoi pas les organes ? Cela serait con­traire à la notion de don d’organes, qui doit demeur­er altru­iste. Voir Code civ­il, art. 16–6 ; Code de la san­té publique, art ; L.1211–4, al. 1^er

[7] Code de la San­té publique, art. L. 1211–5, al. 2.

[8] Voir JR Binet, Droit de la bioéthique, LGDJ, 2017, p. 249–251.

[9] CCNE, Avis n° 126, op. cit., p. 27 et 28.

[10] Cf. Con­gré­ga­tion pour la doc­trine de la foi, Instruc­tion Dig­ni­tas per­son­ae, 8 sep­tem­bre 2008, n. 6 : « Le mariage et la famille con­stituent le con­texte authen­tique où la vie humaine trou­ve son orig­ine. En son sein, la vie provient d’un acte qui exprime l’amour réciproque entre l’homme et la femme. Une pro­créa­tion réelle­ment respon­s­able vis-à-vis de l’enfant qui va naître «doit être le fruit du mariage». » L’InstructionD onum vitae est ici citée.

[11] CCNE, Avis n° 126, op. cit., p. 20.

[12] CCNE, Avis n° 126, op. cit., p. 43. Il est intéres­sant de lire la suite de l’Avis du CCNE.

[13] Cf. Instruc­tion Dig­ni­tas per­son­ae, n. 16 : « L’Église recon­naît la légitim­ité du désir d’avoir un enfant, et com­prend les souf­frances des con­joints éprou­vés par des prob­lèmes d’infertilité. Ce désir ne peut cepen­dant pass­er avant la dig­nité de la vie humaine, au point de la sup­planter. Le désir d’un enfant ne peut jus­ti­fi­er sa «pro­duc­tion», de même que celui de ne pas en con­cevoir ne saurait en jus­ti­fi­er l’abandon ou la destruction. »

[14] Con­gré­ga­tion pour la Doc­trine de la Foi, Instruc­tion Don­um vitae, 22 févri­er 1987 : « Tout être humain doit être accueil­li comme un don et une béné­dic­tion de Dieu. » (II, A,1) Quelle que soit la manière avec laque­lle il a été conçu, « tout enfant qui vient au monde devra cepen­dant être accueil­li comme un don vivant de la Bon­té divine et être éduqué avec amour » (II, B,5). « Un droit véri­ta­ble et strict à l’enfant serait con­traire à sa dig­nité et à sa nature. L’enfant n’est pas un dû et il ne peut être con­sid­éré comme objet de pro­priété : il est plutôt un don – le plus grand et le plus gra­tu­it du mariage. » (II, B,8)

[1] Par la géné­tique, on étudie le génome et son envi­ron­nement biologique. Cet envi­ron­nement a une telle influ­ence sur l’expression des gênes (et non sur leur struc­ture interne) qu’il mérite d’être étudié pour lui-même : c’est l’épigénétique.
[2] Fusion homme-chemin, ce qui est encore plus que l’hybridation homme-machine.