RBMOnline - Vol 4. No 1. 13–15 Reproductive BioMedicine Online; www.rbmonline.com/Article/340 on web 17 October 2001
Ethics Incest, gamete donation by siblings and the importance of the genetic link Guido Pennings is a senior research fellow at the Department of Philosophy of the Dutchspeaking Free University of Brussels (Belgium). He has published numerous articles on the ethical aspects of medically assisted reproduction. He is a member of several Ethics Committees among which are the National Advisory Committee on Bioethics and the ESHRE Ethics Task Force.
Dr Guido Pennings G Pennings Free University Brussels, Department of Philosophy, Pleinlaan 2, Lok. 5C442, B-1050 Brussels, Belgium. Correspondence: tel./fax +32 16 620 767; e-mail:
[email protected]
Abstract Recently, several requests have emerged in which women wished to be impregnated with donor eggs fertilized with spermatozoa of their brother. An important argument advanced against such applications is that it is a kind of incest. Four definitions of incest are reviewed in this article to evaluate the acceptability of these demands. The first three (sexual intercourse, reproduction with gametes of first-degree relatives and symbolic incest) do not apply to the cases. However, when the sister and her brother intend to raise the child as social mother and father, these requests should be considered as ‘intentional incest’. If the brother only functions as an uncle, the request of the woman resembles the currently accepted practice of oocyte donation from sister to sister. In that case, the wish to receive gametes from a first-degree relative is motivated by the wish to establish as far as possible a genetic link with the child.
Keywords: donor insemination, ethics, family donations, incest, sibling
Introduction New applications in the field of assisted reproduction constantly challenge existing paradigms. Three recent cases illustrate this point. France was shocked by the story of a 62year old woman who gave birth to a child conceived with the spermatozoa of her brother (Cohen, 2001; Coomarasamy, 2001). Since fertility treatment for postmenopausal women is forbidden by law in France, the couple went to the United States where they tricked the doctor into believing that they were married. At the same time, they had another embryo placed as a backup in a surrogate mother. The second child was born a few days after the first and they now make a family of four. Moreover, the mother and her brother, who are cohabiting in the parental home, have a history of domestic violence. The discussion of this case was not even finished when a somewhat similar case cropped up in the United Kingdom. Another French woman, 47 years of age, was referred to a London clinic for IVF treatment with donor eggs fertilized with her brother’s spermatozoa. The case was brought before the regulatory body for assisted reproduction in the United Kingdom (the Human Fertilisation and Embryology Authority
(HFEA)) which decided that the treatment is permissible if satisfactory consideration has been given to the welfare of the future child. In fact, conforming to its statutory task, the HFEA only checked whether the treatment was lawful and in agreement with the guidelines and code of practice of the Authority. The third case, again in the USA, was published almost simultaneously by Sauer (2001). A 51-year old lesbian woman asked the programme to consider her brother as a designated sperm donor. Since the psychosocial and legal problems were at least as important as the medical risks, a multidisciplinary team of physicians, lawyers and the Ethics Committee of the centre were involved in the evaluation of the case. The request was accepted and resulted in a singleton pregnancy.
Definitions of incest The media mainly focused on one particular aspect of the cases, namely that they amounted to incest (Meikle, 2001; Rogers, 2001). This label carries a very strong moral message. Few moral rules are so universally respected as the prohibition of incestuous relationships. Since no one would defend incest, it
13
Commentaries - Incest, gamete donation and the genetic link - G Pennings
forcefully directs peoples’ minds towards a condemnation of the applications. However, is the label correctly applied? The most general definition of incest is ‘sexual intercourse between persons regarded as too closely related to marry each other’ (Oxford Encyclopaedic English Dictionary). No such action is present in the aforementioned cases.
conceived. The commanding mother and not the surrogate has decisional authority over the child. Within this framework, incest can be defined as ‘the creation of a child by first-degree relatives with the intention to raise it together as mother and father’. It is appropriate to talk of incest if the intentional social parents are brother and sister.
Since medically assisted reproduction separates sexual intercourse from reproduction, maybe we should concentrate on the reproduction aspect. However, in all cases donor eggs are used by the recipient so that no procreation takes place with a combination of the gametes of first-degree relatives. If we approach these cases with a casuistic method, the absence of both sexual intercourse and genetically related gametes would force us to conclude that these cases better fit the paradigm of donor conception than the paradigm of incest. Since reproduction with donor material is acceptable, these cases would be acceptable too.
Precisely on this point the first French case is very confusing. It looks as if the brother will indeed take the father role while the sister presents herself as the mother. Concerning the second case, no information is available on the presence of a partner or on the role of the brother in the life of the future child. In the third case, the situation is not very clear either. Although she is presented as ‘his single menopausal sister’, the woman is part of a long-term lesbian relationship with a woman of similar age who wished to assist in raising the child. Nevertheless, this partner is not recognized as such since only the sister, her brother and his wife were interviewed to ascertain their understanding of the process. Still, the interpretation of ‘intentional incest’ is largely discarded by stressing the fact that the recipient is a single woman and by mentioning that the brother has a family of his own. He is not creating a second family with his sister; he intends to assist her in creating her own family. Moreover, his possible adoption of the father role would only start in the event of the mother’s untimely death or severe disability, thus clearly indicating that he will not be the father as long as his sister assumes the mother role.
Some commentators have argued for a third definition of incest: although strictly speaking no real incest takes place, the application is a kind of ‘symbolic’ incest. This extension of the definition looks like an ad hoc adaptation just to make it fit better to the problem situation. They probably mean to emphasize that the brother takes the place that is normally occupied by the partner. Although we all understand this argument in a way, it reiterates a discussion on sperm donation that was abandoned 20 years ago. The traditional objection, especially from religious groups, was that donor insemination comes down to ‘symbolic adultery’. The sperm donor replaces the male partner. People who refer to incest in the cases above seem to be reinstating this old argument. However, the overwhelming majority of the population has left this line of thinking. Still, in other forms of familial donations of gametes, this interpretation has also been proposed. Lessor et al. (1990) suggested that women in the general population were less favourably disposed towards oocyte donation by a sister because they are more wary of the symbolic meaning of the reproductive connection between a sister-in-law and a husband.
14
Finally, there is a fourth definition which applies to the cases mentioned above. This definition, which could be named ‘intentional’ incest, fits with the concept of ‘intentional parenthood’ that is increasingly used to make sense of new treatments of assisted reproduction (Barton and Douglas, 1995). Very briefly, the concept refers to the idea that the parents are the persons for whom the embryos are created and who intend to raise the child. Intention is the most significant determining factor to decide moral and legal responsibility for the future child (Shultz, 1990). Of course, legislation differs from one country to the next and the rules on paternity in some countries, do not coincide with this framework (Ahuja and Symons, 2001, Sauer, 2001). Within the framework of intentional parenthood, physical and genetic links are no longer considered as relevant, or are accorded a secondary status. This principle underlies every form of gamete donation; the sperm donor is not recognized as the father and the oocyte donor is not looked upon as the mother. Even if known or identifiable, the gamete donor waives all parental rights and duties at the moment of the donation (Pennings, 1995). The rule of intentional parenthood implies that it is the couple for whom the embryos are made who should decide about their fate and not the gamete donor with whose material the embryos were
The condition that the brother should not function as the intentional social father fits into the general attitude taken in cases of known (familial) donations. The donor sister who donates oocytes to her sister is presented and should consider herself not as the mother but as a special aunt (Lessor, 1993). Known sperm donors to lesbian couples are sometimes given a special status comparable to an uncle or close family friend (Dalton and Bielby, 2000). In both situations, this special status intends to prevent a conflict between the intentional and social parent on the one hand and the genetic parent on the other. However, even if no partner is present, the brother should still be considered as a special uncle who served as a sperm donor.
The genetic link The reason given by the women to opt for the use of their brother’s spermatozoa is to have a child that is genetically part of her extended family (Sauer, 2001). Most applications in the field of assisted reproduction demonstrate the great importance attached to the genetic link. The reasoning behind this choice would be that if it is not possible to share 50% of her genes with her offspring, 25% is better than nothing (since she theoretically shares 50% with her brother who in turn would share 50% with the resulting child). Once we focus on the importance of the genetic link, familial donations especially by sisters constitute the obvious point of reference. The London doctor who intends to treat the 47-year old French woman stated that for him the present case is not different from a woman receiving an egg donated by her sister (Sengupta, 2001). The comparison with known familial egg donation may indeed clarify the motive underlying the choice for the present construction. Women who prefer to receive the eggs donated by a sister are motivated by two reasons. Firstly, they want to know where the eggs come from in order to reduce the anxiety and tension caused by the non-acquaintance with the donor
Commentaries - Incest, gamete donation and the genetic link - G Pennings
(Pennings, 2000). This motive applies to most cases of known gamete donations. Recipients of donor spermatozoa also experience the fact that knowledge of the personality of the donor and liking him as a person are considerable advantages (Adair and Purdie, 1996). Secondly, oocyte recipients acknowledge the importance of the genetic link (Baetens et al., 2000). They share a common genetic heritage with their sisters and consequently will also share a genetic heritage with their children (Lessor, 1993). In contrast to the hostile reaction to the use of a brother as a sperm donor, the practice of sister to sister donation is approved by the general population (Lessor et al., 1990; Sauer et al., 1988). The reasons given for preferring a related oocyte donor did not generate negative reactions either. Then why would a similar reason not be accepted when a recipient who uses donor eggs prefers her brother as donor? Since we accept that very technical, costly and burdensome treatments are performed in order to establish a genetic link with one’s offspring, there is little reason to make an exception for this application. Moreover, these cases will be rare since at least three conditions have to be fulfilled before the request is acceptable: the woman has no usable oocytes, there is no male partner or he is azoospermic, and the woman has a brother who is willing to collaborate. It would be difficult to accept that, if she has a relationship with a fertile partner, she would prefer the use of her brother’s spermatozoa to her partner’s spermatozoa. In summary, the special request to use a brother’s spermatozoa will most likely be placed in the context of a demand by a single woman or by a lesbian woman in a lesbian relationship. If one already objects to the provision of medical assistance to single and lesbian people, one does not even have to think about the special requests analysed here.
Conclusion Four definitions of incest have been considered to evaluate the acceptability of a woman’s request for IVF with donor eggs fertilized with spermatozoa of her brother. The ‘sexual’, ‘reproductive’ and ‘symbolic’ definitions are not applicable. However, the fourth description which is linked to the notion of ‘intentional parenthood’ is retained. Cases in which the brother (who is the genetic father) intends to raise the child together with his sister amount to ‘intentional incest’ and should therefore be forbidden. In those cases where the brother would take the role of an uncle and not of a co-parent, the application can be accepted.
References Adair VA, Purdie A 1996 Donor insemination programmes with personal donors: issues of secrecy. Human Reproduction 11, 2558–2563. Ahuja KK, Symons EG 2001 Donor eggs and brother’s sperm: are the ethical concerns real? Reproductive BioMedicine Online 3, 4–5. Baetens P, Devroey P, Camus M et al. 2000 Counselling couples and donors for oocyte donation: the decision to use either known or anonymous oocytes. Human Reproduction 15, 476–484. Barton C, Douglas G 1995 Law and parenthood. London, Dublin, Edinburgh: Butterworths. Cohen J 2001 Conception and pregnancy stirs legal action in France. Reproductive BioMedicine Online 3, 87–88. Coomarasamy J 2001 Brother fathered 62-year-old’s baby. BBC News Online, June 20. Dalton SE, Bielby DD 2000 “That’s our kind of constellation” Lesbian mothers negotiate institutionalized understandings of gender within the family. Gender and Society 14, 36–61. Lessor R 1993 All in the family: social processes in ovarian egg donation between sisters. Sociology of Health and Illness 15, 393–413. Lessor R, Reitz K, Balmaceda J et al. 1990 A survey of public attitudes toward oocyte donation between sisters. Human Reproduction 5, 889–892. Meikle J 2001 IVF to give woman a baby by brother. The Guardian, August 27. Pennings G 1995 Should donors have the right to decide who receives their gametes? Human Reproduction 10, 2736–2740. Pennings G 2000 The right to choose your donor: a step towards commercialization or a step towards empowering the patient? Human Reproduction 15, 508–514. Rogers L 2001 Woman to have brother’s IVF child. The Sunday Times, August 26. Sauer M 2001 Donor eggs and brother’s sperm: creating genetic likeness in the conception of an unmarried menopausal woman. Reproductive BioMedicine Online 3, 19–20. Sauer MV, Rodi IA, Scrooc M et al. 1988 Survey of attitudes regarding the use of siblings for gamete donation. Fertility and Sterility 49, 721–722. Sengupta K 2001 Sister to be impregnated with her brother’s child at London clinic. The Independent, August 27. Shultz MM 1990 Reproductive technology and intent-based parenthood: an opportunity for gender neutrality. Wisconsin Law Review 1990: 297–398.
Nevertheless, the mix of familial and genetic roles should not be underestimated as a potential source of complications. All parties should be extensively counselled on the implications. Known donation of gametes, especially by family members, has to be carefully thought through to make certain that all people involved know how to position themselves towards each other and towards the child.
15
