Regulation of reproductive technologies is long overdue

After extensive fact finding and public consultations across the country, the Royal Commission on New Reproductive Technologies made its policy recommendations to the federal government a decade ago. It strongly recommended that certain practices (human cloning, selling eggs, commercial surrogacy) should be prohibited, and that a national regulatory body should be set up to oversee and set standards in this rapidly growing field. Although Bill C-13 (1) would have accomplished this goal and was approved by the House of Commons, it was awaiting its third and final reading in the Senate when Prime Minister Chrétien prorogued Parliament in December 2003 and Bill C-13 died. As a result, 10 years after the Commission's report, there is still no legislation in place. The Royal Commission had documented an inequitable patchwork of standards and uses in this field, with clinics and practices ranging from exemplary to harmful. Since then, the field has burgeoned, with more reproductive technologies being possible; therefore, it is even more urgent to put regulations in place to protect the health and safety of Canadians. The proposed Bill C-13 had dealt with the area of reproductive technologies in a balanced and humane way, and its provisions probably reflected what most Canadians would like to see. It certainly would have helped protect the health and safety of thousands of Canadians who use infertility treatments each year. Canadians using these technologies to build their families need to be confident that the technologies are being provided in a regulated environment, with assurance that standards of service provision, information disclosure and record-keeping are being met, and that they are not being exploited. Bill C-13 would have set up a regulatory body to do this. An advantage of such a national regulatory body is that although the legislation would require clinics to have a license, the specifics of the policies to be complied with to hold that license could be adjusted without having to change the law. This flexibility is important in a field where knowledge changes rapidly and unanticipated issues often arise. The adoption of Bill C-13 would have meant that facilities providing reproductive technology treatments such as in vitro fertilization (IVF) would have had to meet standards that were in the best interest of patients. This includes standards requiring full disclosure of understandable information on risks and benefits, and of good data collection and appropriate record-keeping so that reliable information on outcomes of treatments could be given to people considering having them. It is important to collect information on the health of children who were born after the use of reproductive technologies because this can be fed back to help shape practices. For example, about four in 10 infants born after IVF are part of a multiple pregnancy – with its attendant risks – and changes in the number of embryos transferred may reduce this number. Another example where health information on children is badly needed is after intracytoplasmic sperm injection. As well as regulating some practices, Bill C-13 also prohibited activities such as making human embryos using all forms of cloning, either for reproduction or research. It provided that embryos could be made only by bringing egg and sperm together, and apart from reproduction, could only be made to ensure that doctors learning to use IVF and related techniques were providing safe and effective treatments. However, Bill C-13 permitted research in licensed facilities with embryos no longer needed for treatment. The progenitors must not have wanted to donate them to others and must have permitted this use in writing. The research that would have been permitted included taking stem cells from the embryos, preventing their further development. According to current knowledge, work with embryo-derived cells could help us learn how to induce stem cells to differentiate, and this knowledge could then be applied to adult-derived cells. Most scientists think work with cells derived from both sources (adults and embryos) is needed if the best progress toward therapies for diseases such as Parkinson's and diabetes is to be made. Bill C-13 would have clarified the field for stem cell researchers and would have allowed important studies to move forward. It seems uncaring not to allow research that may eventually give many people a chance for treatment when these particular embryos are destined to be discarded anyway. Although individuals who use reproductive technologies directly are a minority, how they are used influences social attitudes and values. For example, decisions on whether to do human reproductive cloning should not be made preemptively by a group who ignores the wishes of the rest of the community, and most Canadians do not want to see a society in which young women can be induced to take health risks to sell their eggs. The national regulatory body would have provided an ongoing focal point for public participation and input, as technological capacities continue to grow rapidly, posing new policy choices. We have been publicly discussing what should be done in this area for over a decade and a half, and unlike many other developed countries, Canada still has a policy vacuum. No policy is a policy – it means the market will decide – and leaving reproductive technology policy to the market is likely to result in the commercialization and exploitation of reproduction. If regulation is not put in place, it leaves citizens vulnerable and the public interest undefended. It is much more important to get regulatory oversight established than to delay legislation over particular specifics. It was in the proposed legislation that it would be revisited after three years. So, if a review of its operation suggested that it be fine-tuned or altered, that could then be done. The lack of regulation in Canada to deal with this topic puts the health of women and children at risk. I hope Bill C-13 is reintroduced and passed quickly because it provides a much needed framework to deal with far-reaching policy choices.

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