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Health concerns in the unregulated context

Ruth Macklin bioethics
My name is Ruth Macklin. I am a professor of bioethics at the Albert Einstein College of Medicine, in the Bronx of New York. I’ve been associated with various programs with assisted reproduction and in fact in my own institution we have an ethics advisory group that meets with the clinicians who actually provide these services. The cases are all very interesting and what we do, we are an advisory committee, we don’t make decisions but it gets us to think hard about all of the issues. One of the main issues is how regulated donation of gametes, that is eggs and sperm, should be.
Many people would like to have a free for all and say there shouldn’t be regulations, we should be allowed to do what we want but there are very good reasons for having some sort of regulation. Perhaps, the best reason, in today’s world where there is so much knowledge about genetics is to try to make sure that whether it is an egg donation or sperm donation that heritable diseases are not passed onto children. So there are always questions and questionnaires and medical examinations to ensure that the procedures are safe for the children who will likely be born of these techniques.
One of the issues that came up particularly in an era of sexually transmitted infections and particularly with HIV was the importance of not transmitting through a sperm donor for example transmitting to the partner if the sperm in fact has been infected. So this is a safeguard. It protects both the welfare of the recipient and the future child and it is certainly better than having something unregulated where there may be risks, health risks in particular, either immediate health risks or risks in the future.

Ruth Macklin is a principal collaborator of The Ethics Centre at the Institute for Women’s Health, UCL and a Professor of Bioethics, Albert Einstein College in New York. She is one of the founders of the field of bioethics, and has published widely, especially in reproductive ethics.

In this video, she describes two of the key worries that have been raised when people exchange gametes outside of the regulated framework of fertility clinics. These are the worry around sexually transmitted diseases, and the issue of hereditary conditions.

Sexual health concerns are particularly worrisome when it comes to natural insemination, meaning when normal intercourse is the way in which the donor-conception is planned. These worries do not completely disappear in the case of artificial insemination, as the sperm itself can carry bacterial and viral infections.

Additionally, there is the concern that the donor could be the carrier of a hereditary disease. This might be known to the donor, or it could be that the donor is a carrier of a disorder that they were not aware of. In the regulated clinic context, genetic screening is available and there is a chance such a disorder would have been picked up.

For discussion: Do you think the health concerns involved are enough to warrant more regulation in this area? Are such arrangements any different from dating apps such as Tinder, which are increasingly used for non-committed, sexual encounters?

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