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11.- Don de gametes / Donation of gametes — CHURCH OF FRANCE / États généraux de la bioéthique- Which world do we want for tomorrow? The brave new world…

11.- Don de gametes / Donation of gametes — CHURCH OF FRANCE / États généraux de la bioéthique- Which world do we want for tomorrow? The brave new world…
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State of play

The “dona­tion of gametes” is the con­tri­bu­tion made to a cou­ple by a third of its own gametes so that, thanks to these donat­ed gametes, a child is con­ceived for this couple[1]. This con­tri­bu­tion, reg­u­lat­ed by the law of 29 July 1994, is pos­si­ble for med­ical­ly assist­ed pro­cre­ation in two sit­u­a­tions: the risk of trans­mis­sion to the child or to a mem­ber of the cou­ple of a par­tic­u­lar­ly seri­ous dis­ease; the cou­ple can­not pro­vide the gametes nec­es­sary for the con­cep­tion of a child. Dou­ble dona­tion of gametes (sperm and oocyte) is pro­hib­it­ed: the child must be bio­log­i­cal­ly linked to at least one mem­ber of the couple.

From the 1970s onwards, dona­tion was con­sid­ered for the pur­pose of car­ry­ing out an MQP for the ben­e­fit of a cou­ple, with­out tak­ing its con­se­quences for the child into con­sid­er­a­tion. Only the preser­va­tion of the cou­ple’s inti­ma­cy with their child was impor­tant, with­out the exter­nal father or moth­er break­ing it off. Hence the anonymi­ty of the gift that pro­duces the era­sure of these, which has not been dis­cussed as such.

Because of anonymi­ty, nei­ther the donor, nor the recip­i­ents, nor the child knows their respec­tive identities[2]. In case of ther­a­peu­tic neces­si­ty for the child born from such a dona­tion, the doc­tor may access non-iden­ti­fy­ing med­ical infor­ma­tion relat­ing to the donor[3].

The Nation­al Con­sul­ta­tive Ethics Com­mit­tee (CCNE) notes that “the long prac­tice of CECOS as well as an old­er tra­di­tion con­cern­ing blood and human organ dona­tion has led to the accep­tance of the prin­ci­ple of anonymity”[4]. The prac­tice for blood and organs has been applied to gametes which, how­ev­er, have a spe­cif­ic and unique voca­tion: the pro­cre­ation of a new human being. This essen­tial dis­tinc­tion does not seem to have been ful­ly con­sid­ered, even though our law leg­is­lates gamete donation.

Stim­u­lat­ed by the prac­ti­cal pos­si­bil­i­ties of know­ing the bio­log­i­cal or genet­ic trac­ing between gen­er­a­tions, the first donat­ed chil­dren, now adults, put pres­sure to know their ori­gin. This has called into ques­tion the prin­ci­ple of anonymi­ty. How­ev­er, with each leg­isla­tive revi­sion, this prin­ci­ple has been main­tained because its lift­ing cre­ates as many dif­fi­cul­ties as it solves.

Elements of discernment

The dona­tion of gametes car­ries out the con­cep­tion of this child by delib­er­ate­ly exclud­ing one of its par­ents in favour of a par­ent of inten­tion, which deprives the child of a bio­log­i­cal basis of its fil­i­a­tion. It denies the uni­ty of the per­son in its bio­log­i­cal, psy­cho­log­i­cal, social, spir­i­tu­al dimensions.

In French law, this does not seem to be a prob­lem, so much fil­i­a­tion is not reduced to bio­log­i­cal: adop­tion is the vis­i­ble sign; but also, the “pre­sump­tion of pater­ni­ty” which des­ig­nates the hus­band as father and the recog­ni­tion by a man of a child as his own is not ver­i­fied. Yet this link is not indif­fer­ent. Three sit­u­a­tions, among oth­ers, show this:

If parent­age is estab­lished with­out ver­i­fi­ca­tion, it is pre­sumed to cor­re­spond to bio­log­i­cal real­i­ty. If this is not the case, it can be chal­lenged in court and destroyed: when two men claim pater­ni­ty of the same child, the judge decides in favour of the bio­log­i­cal father.
The impor­tance of the bio­log­i­cal link in parent­age is revealed by the legal­ly repara­ble harm result­ing from the acci­den­tal exchange of chil­dren at birth: this harm is obvi­ous: it is not indif­fer­ent to being the prod­uct of one or another.
In med­ical­ly assist­ed pro­cre­ation, harm is rec­og­nized to cou­ples who suf­fer a hos­pi­tal error in the use of gametes or the allo­ca­tion of embryos. If it is true that the genet­ic link may appear sec­ondary, even indif­fer­ent, in mat­ters of parent­age, why do these cou­ples claim harm? The Agence de la bio­médecine notes that, in almost all cas­es, these cou­ples pre­fer abortion.
Faced with these ques­tions, CCNE con­sid­ers that “eth­i­cal reflec­tion must exam­ine the mean­ing of human gen­er­a­tion, in par­tic­u­lar with the help of the human sciences”[5]. To do this, two aspects must be con­sid­ered: on the one hand, secre­cy and, on the oth­er hand, the ori­gin itself.

For secre­cy, eth­i­cal reflec­tion is tough. It would be an “injus­tice” (CCNE) to hide a child’s mode of con­cep­tion from them. To reveal it to him is to try to give mean­ing to his beget­ting and run the risk of see­ing him run up against the anonymi­ty which pre­vents him from know­ing his bio­log­i­cal origin.

For beget­ting, it is use­ful to think from the right of the child[6], from het­ero­sex­u­al­i­ty where the com­ple­men­tar­i­ty of the mas­cu­line and fem­i­nine is played out, from the sym­bol­ic val­ue of the gen­er­a­tions, and from the uni­ty of the per­son where bio­log­i­cal, phys­i­cal, psy­che, social, cul­tur­al and spir­i­tu­al are unified.

 

Lift­ing of anonymi­ty. Some believe that com­pen­sat­ing for the removal of the bio­log­i­cal link by lift­ing the donor’s anonymi­ty. Would the iden­ti­ty infor­ma­tion be suf­fi­cient? Accord­ing to the law, knowl­edge of bio­log­i­cal iden­ti­ty both for chil­dren exchanged at birth and for cou­ples in MPA process­es under­go­ing gamete error, does not erase the harm suffered.

In the end, gamete dona­tion rais­es a sim­ple ques­tion: is it impor­tant, or not, to be bio­log­i­cal­ly derived from some­one? The law express­es an unease when it pro­hibits the dou­ble dona­tion of gametes: if the bio­log­i­cal link is impor­tant, how can the child be deprived of it, if only in a branch? If it’s not, why demand it in one of the branches?

CCNE notes that “the con­quest of genealog­i­cal traces by a grow­ing num­ber of our con­tem­po­raries shows enough that this need to become affil­i­at­ed with an ances­try is far from hav­ing dis­ap­peared with time. By mak­ing us exist as a link in a fam­i­ly chain, the fam­i­ly tree mod­er­ates the irra­tional­i­ty of our pres­ence in the world”[7].

These few exam­ples show that the bio­log­i­cal ref­er­ence is impor­tant. This is all the more true since the protests of the first gen­er­a­tion from dona­tions no longer allow us to act as if gamete dona­tion had no con­se­quences for the child. More­over, com­put­er tools now allow her to find her anony­mous sire.

The rights of the child. From the legal point of view, the use of gametes out­side the cou­ple does not seem com­pat­i­ble with respect for the rights of the child. Indeed, arti­cle 7–1 of the Inter­na­tion­al Con­ven­tion on the Rights of the Child, rat­i­fied by France, estab­lish­es “the right of every child, as far as pos­si­ble, to know his or her par­ents and to be brought up by them”. How­ev­er, the orga­ni­za­tion of gamete dona­tion by law cur­rent­ly pre­vents chil­dren from know­ing their bio­log­i­cal father or mother.

Nei­ther full adop­tion nor child­birth under X makes it pos­si­ble to put into per­spec­tive the exclu­sion of one of the child’s par­ents by donat­ing gametes. Indeed, the pos­si­bil­i­ty offered to a woman to give birth in secret is in the child’s inter­est by pro­tect­ing him against the risk of infan­ti­cide or aban­don­ment. And if full adop­tion is an obsta­cle to the child’s orig­i­nal fil­i­a­tion, it is in his inter­est: to give him a fam­i­ly when he is deprived of it by the mis­for­tunes of life.

For gamete dona­tion, it is the oppo­site: it frag­ments the child’s fil­i­a­tion by oust­ing one of his bio­log­i­cal par­ents to sat­is­fy the adult’s desire. This desire for a child, how­ev­er legit­i­mate, is lim­it­ed by respect for the rights of the child, since “the best inter­ests of the child must be a pri­ma­ry con­sid­er­a­tion”, accord­ing to the Inter­na­tion­al Con­ven­tion on the Rights of the Child (art. 3–1).

Feb­ru­ary 2, 2018

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  1. Art. L. 12441 du Code de la san­té publique. Voir J.-R. BINET, Le droit de la bioéthique, LGDJ, 2017, p. 246–251.

[2] Art. 16–8 du Code civ­il repris à l’article L.1211–5 du Code de la san­té publique : « Le don­neur ne peut con­naître l’identité du receveur, ni le receveur celle du don­neur. Aucune infor­ma­tion per­me­t­tant d’identifier à la fois celui qui a fait don d’un élé­ment ou d’un pro­duit de son corps et celui qui l’a reçu ne peut être divulguée. »

[3] Art. L. 1244–6 du Code de la san­té publique.

[4] Avis n° 90 du 24.11.2005, p. 12. Les Cen­tres d’étude et de con­ser­va­tion des œufs et du sperme humains (CECOS), créés en 1973, ont mis en place la règle de l’anonymat qui, 20 ans après, a été inté­grée à la loi du 29.07.1994. Le CECOS con­naît l’identité du don­neur et cer­taines de ses car­ac­téris­tiques ; il s’arrange pour que l’enfant, issu du don, soit adéquat au cou­ple receveur. Ensuite, « l’anonymisation du dossier, imposée par la loi, sera faite et va ren­dre « sans iden­tité » ce qui est par­faite­ment iden­ti­fié, faisant du don­neur un dis­trib­u­teur trans­par­ent de « pro­duit géné­tique » » (ibid., p. 13).

[5] Avis n° 90, p. 5. « La dis­so­ci­a­tion quelle qu’elle soit entre la dimen­sion biologique et la dimen­sion sociale de la fil­i­a­tion n’est jamais anodine. […] Le bien de l’enfant est pour le moins bous­culé par ces dis­so­ci­a­tions où la pri­or­ité sem­ble être don­née à la notion de « pro­jet parental » qui con­fisque à son seul prof­it le statut de l’enfant. » (ibid., p. 23 et 26).

[6] Cf. Con­gré­ga­tion pour la doc­trine de la foi, Instruc­tion Don­um vitae, 22.02.1987, note 32 : « Il est légitime d’affirmer le droit de l’enfant à avoir une orig­ine pleine­ment humaine grâce à une con­cep­tion con­forme à la nature per­son­nelle de l’être humain. La vie est un don qui doit être accordé d’une manière digne aus­si bien du sujet qui la reçoit que des sujets qui la transmettent. »

[7] Avis n° 90, p. 6. L’ultime con­clu­sion du CCNE sem­ble faire fi des objec­tions éthiques qu’il met pour­tant en lumière.

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