Question

You have read several articles and viewed a video which powerfully express the conflicting emotions which occur with regard to how parents view extra embryos after they have undergone the process of assisted reproduction. How could the process of IVF be improved to recognize this dynamic and improve the informed consent process?

Answer 1

Ans) Many laws and ethical documents in Australia, as elsewhere, instruct us that disembodied embryos created through IVF processes are not mere tissue; they are ‘widely regarded’ as unique objects of serious moral consideration with a ‘special status’ that commands ‘respect’.

- Australian ethical governance to document how this characterization came to pass. These ethical and policy documents characterize the embryo as an object of ideological compromise: not mere cells and not life, but a poorly bounded and endlessly contested something-in-between. I argue that the woman whose desire for a child or children created this embryo, and who inhabits the body to whom it may one day be returned, is an omission or at best an afterthought in such frameworks.

- Women patients about their sense of connectedness to their stored or discarded embryos, drawn from a larger study on decision making concerning patient's experience of decision making about IVF embryos.

- To illustrate their complex and contingent experiences of regard, kinship and connection with their embryos and to ask how we could reorient law and policy toward the concerns, needs, and desires of such women.

- Decisions about storage and destruction are critical conflict points that have triggered expressions of dismay by IVF participants when their feelings of connectedness with their embryos are disregarded. These are not the only areas in which ART law and policy prioritize a universalized and disembodied respect for the embryo over and above the feelings and wishes of those who created them, but they are the most acute and, particularly in the case of destruction, the most painfully paradoxical.

- Changing legal regulation and ethics governance to include the perspective of women patients on their IVF embryos is a slow endeavor. It is notable that the 2015 draft the NHMRC guidelines, for the first time in their 30 year history, drop the requirement of an embryo storage limit of 10 years. Yet they do so in a way that continues to sideline the woman undertaking treatment.

- First, the draft takes as a starting point the administrative priorities of the clinic in disposing of unclaimed embryos; and second, it prioritizes the scientific expertise of the clinic in determining viability. Only then does it go on to note that the duration of storage may also depend upon the ‘personal preferences’ of the couple.

- Developing ideas of relational selfhood, we are not obliged to treat woman and embryo as equal or to situate the embryo ‘as a rights bearing entity that requires protection’. We are obliged to ‘respond to female agency and embodiment formed through this complex (and sometimes uneasy) negotiation with a matrix of relations and familial possibilities—and, I would add, with imagined future possibilities and relations, including foreclosed and no longer possible futures, losses, and potentialities hitherto unimagined.

- An ethical framework premised on respect for the woman undertaking treatment must ask first what these relations mean to the woman and then seek to accommodate this meaning. I suggest that an embedded institutional structure, such as that in place in Australia for the past 25 years through the NHMRC, which legislatively mandates religious representation, and which does not require the embodied perspective of a woman patient, will continue to center abstract notions of regard for embryos at the expense of the needs of women who undertake IVF treatment.