Assisted reproductive technology (ART) is rightfully considered to be the most important breakthrough in science since for many decades they have now been able to solve infertility problems. These methods turn the desires of many couples into reality and help them to become parents and not only that, ART is used to diagnose and prevent congenital genetic diseases too. In other words, through the use of pre-implantation diagnostic methods, genetic medicine is able to minimize the birth of sick children.
However, all these issues require the protection of personal autonomy, the principles of freedom and human dignity, and imply legal liability.
A year ago (February 15, 2019), a law was passed in Andorra defining the legal framework of ATR within the framework of bioethics … (Llei 12/2019, del 15 de febrer, qualificada de tècniques de reproducció humana assistida). The law refers to the UNESCO Universal Declaration of Human Rights, which prohibits actions harmful to human dignity (including the prohibition of “therapeutic cloning” and a moratorium on the use of similar side methods to create human embryos for the sole purpose of conducting medical research). Thus, the law provides for the protection of human life in its various phases, including embryonic, which also implies a restriction on the receipt of fertilized eggs, which can be implanted in each cycle, in order to avoid excessive cryopreservation of embryos, if possible.
Andorra held the first conference on “ATR in the Principality of Andorra” (“La reproducció assistidaal Principat d’Andorra”). Dr. Josep Argemí Renom, a specialist in pediatric endocrinology with more than 40 years of experience (his main specialization is growth pathology and childhood obesity), was invited as the main speaker. He is a professor of pediatrics at the International University of Catalonia (UIC, Universitat Internacional de Catalunya), Doctor of Medical Sciences of the University of Navarra and since September 2010, he has been the director of the Institute for Advanced Studies in Bioethics of the UIC.
Following the conference, Josep Argemí answered our questions regarding ethical aspects, as well as the future development of assisted reproductive technologies.
What is bioethics and what is the role of bioethics in your research?
Bioethics is a field of interdisciplinary research relating to the moral aspect of human activity in medicine and biology, which was formed in the middle of the 20th century at the intersection of philosophy, jurisprudence and the natural sciences. Modern bioethics is an actively developing scientific branch. It has many directions: environmental bioethics or ecological bioethics, medical bioethics, clinical bioethics, etc.
What are the latest assisted reproduction technologies currently in use and what are the indications and contraindications for using these technologies?
There are at least 16 ways to create a human embryo artificially. Currently, the debate lies in the attempts of some researchers to change the genome of germ cells, that is, gametes and embryos. Although in their view, the goal is to prevent genetic diseases, there is a widespread belief that the reproduction of embryos with modified genes is a red line that should not be crossed because it affects what mainly defines our species as homo sapiens.
You spoke about assisted reproduction in the Principality of Andorra. Are there any prospects for opening specialized clinics in the principality?
As far as I understand, no.
How is the issue of using assisted reproduction methods controlled by the European Convention on Human Rights, the European Court of Human Rights and the laws of Andorra?
The ethical problem of any law on assisted reproduction is that it introduces the following definition – people begin to exist already during fertilization. Therefore, embryos should be treated with the same dignity as a born person. The law prohibits the handling of embryos as certain “products.” At the same time, it is worth noting that the Andorran law is a guarantee in the sense that it does not allow a banal, scientific and economic approach to this issue.
Regarding statistics, how many couples today use assisted reproduction services? For what reasons do they use them (infertility, the prevention of hereditary diseases or for choosing the sex of the child)?
The main reason for resorting to assisted reproduction is couple infertility, which is becoming an increasingly common disease in various aspects of the Western world’s modern lifestyle: delayed motherhood, sexually transmitted diseases, and environmental pollution, etc. Some people also use these methods to have children without a partner, for example, single people or same-sex couples. In some cases, embryo selection is allowed to make sure that it does not have a pathological gene. Choosing the sex of the child is prohibited by law.
How do you predict that assisted reproduction technologies will develop in the future?
In the short term, modern methods will be improved in an attempt to solve the serious problem of the accumulation of frozen embryos. In the long run, however, I hope that they will be replaced by more environmentally friendly methods, such as the so-called “NAPRO” (natural reproduction). This technology is based on the diagnosis of the most fertile periods of the menstrual cycle of women. There will also be a decrease in cases of male and female infertility due to both improved prophylaxis (a healthier lifestyle) and treatment.
Interview: Irina Rybalchenko