by The Mennonite Central Committee Canada

MCC Occasional Paper, No. 17
July 1992

MCC Occasional Papers are a publication of Mennonite Central Committee (MCC). This series features manuscripts by MCC volunteers and staff on topics related to MCC programs and concerns. The papers do not necessarily reflect official MCC policy.

TABLE OF CONTENTS

• I. Introduction
• II. Fundamental Principles
  • 1. Equal Worth of Persons.
  • 2. Sanctity of the Person.
  • 3. Respect for Life.
  • 4. Justice for the Needy.
  • 5. Fidelity in Human Relationships.
  • 6. Reproductive Rights.
• III. Consideration of selected NRT's
  • A. In Vitro Fertilization (IVF)
  • B. Surrogacy
  • C. Artificial Insemination by Donor (AID)
  • D. Foetal Research
  • E. Genetic Manipulation
  • F. Prenatal Screening
• IV. Conclusions

I. INTRODUCTION

Mennonite Central Committee (MCC) Canada, an organization of Mennonite and Brethren in Christ churches in Canada, was founded in 1963 to establishing international programs of relief and development, although it carries out extensive service programs in Canada as well. MCC Canada attempts to put into practice the Christian imperative to love our neighbours. For us this means that all human beings, especially those most in need, represent claims upon us to justice and compassion. Our representation to this commission grows out of Mennonite and Brethren in Christ commitments to these and other fundamental Christian values and assumptions about the nature of the human person and the human community. We believe, however, that many, if not all, of these values and assumptions are widely shared in the Canadian community; it is in the spirit of this belief that we present our views to the Royal Commission.

We commend the Federal Government for establishing the Royal Commission on New Reproductive Technologies (NRT). In our view it is essential that the government take leadership in placing the development of new technologies of whatever sort under careful public scrutiny, and that it not shy from the task of placing these technologies under such legal limits as may be necessary to serve the public interest and preserve those values fundamental to the maintenance of a morally decent society. While technology can be a vital resource for the accomplishment of important human goods, we reject as naive the assumption that technology is in itself a benign or even neutral reality that leads to human detriment only when employed by those with evil intentions. History suggests that technologies tend to take on a moral dynamic of their own not always consistent with the values of the community in which they develop. They are not only molded by human will and social values; they often mold the values of the community fr om which they arise. We both control and are controlled by the technologies we create, not always to the end of moral progress. Nowhere is this more true than with the new reproductive technologies, where the technologies themselves threaten to redefine what it is to be human, or to be of equal value, as well as our understanding of primary relationships of family and parent, and even our relationship to our own bodies.

The issues involved in New Reproductive Technologies are profoundly public. They affect potentially every Canadian citizen, directly or indirectly, for they impinge upon the very character of the community in which we all live. Thus, it is essential that public consultation take place and that voices representative of the whole Canadian community be heard. We congratulate the thoroughness with which the Royal Commission is conducting public hearings and soliciting written submissions.

II. FUNDAMENTAL PRINCIPLES

At this outset of our submission to the Commission we would like to summarize some of the basic values and principles we believe to be potentially at risk in the development of the New Reproductive Technologies. Our affirmation of these values is rooted in our basic belief that all human beings are created by God, bearing the very image of the Divine, and as such are equal in dignity and worth. We believe that central to our moral task as members of the human community is the mutual concern we bear for each others' well-being. We affirm the essential role that technology plays in the alleviation of human suffering and the provision of basic human goods to all persons consistent with the resources of the planet. However, where technology is used in ways that threaten the access of all persons to these basic goods, where it undermines principle of the equal worth and dignity of persons, or where it creates the illusion of total human control over and responsibility for human destiny, we believe that it beco mes a destructive and morally corrupting force.

In light of these fundamental assumptions, we identify the following values and principles as especially germane to the assessment of the New Reproductive Technologies. We believe that these values are widely shared in Canadian society, and as such should be given great weight in the deliberations of the Commission:

1. EQUAL WORTH OF PERSONS. We affirm the principle of the equal worth and dignity of persons, regardless of race, sex, age, physical or mental ability, or any other characteristics of birth or social position. As technologies afford human control over genetic characteristics they create the tendency to demean those persons who retain "correctable" characteristics. When persons are the products of our technological interventions, we tend to view their "undesirable" characteristics as unfortunate human failures rather than as marks of their intrinsic worth as individuals.

2. SANCTITY OF THE PERSON. We affirm the absolute sanctity of the human person. This means that persons are not to be used or exploited as mere means to the purposes of others, particularly with regard to their fundamental interests and needs. For us this implies not only a commitment to nonviolence in human relationships, but also a rejection of institutions and practices that reduce persons to the status of objects for the pleasure or profit of others. If a technology leads to the treatment of persons or their bodies as commodities in the marketplace or as research material for technological progress, the sanctity of the person is seriously undermined.

3. RESPECT FOR LIFE. We regard human life as a gift of God, given to us not only for our own enjoyment but also for our stewardship. Human life, whatever its form or stage of development, is deserving of respect and nurture--never to be regarded as disposable by the individual or others simply insofar as it is a good to them. Reproductive technologies that regard living human organisms as merely disposable tissue whose personal identity is not yet fully formed (e.g., the foetus) or has been lost (e.g., the comatose) seriously erode this fundamental value.

4. JUSTICE FOR THE NEEDY. Our belief in equal worth of persons also leads us to a deep concern for justice for the poor and the oppressed. Particularly in matters that touch upon the distribution of such a basic good as access to health care, we affirm the principle of distributive justice "To each according to their needs." This means that the greater their health needs, the greater the moral claim upon society these persons have to health care. One of the major concerns raised by new, costly reproductive technologies is the question of their impact upon the availability of more basic health care to those who need it most. The concern for basic distributive justice demands that limits be placed upon the expenditures of ever-increasing portions of health care resources for higher-tech solutions addressing less basic human problems.

Much of the work of MCC Canada is devoted to serving people on the margins of human society. In working with such people one cannot help but realize that much pain and suffering in the world is the result of an unjust distribution of resources.

5. FIDELITY IN HUMAN RELATIONSHIPS. We believe in the vital importance of institutions such as the family in providing stable, caring contexts for the nurture of children. Reproductive technologies that divorce the reproduction and raising of children from these contexts by obscuring or confusing the roles of parent, child, or sibling, may undermine these institutions. A consequence may be that children are deprived of the stable, nurturing context they need in order to develop and to which they are entitled.

This does not commit us to the view that family relationships should be defined in natural or biological terms, or even necessarily in traditional social terms like the nuclear family. The roles of parent and child, husband, and wife are not primarily biological, but social and moral, relationships. Thus, we resist definitions of these roles suggesting that genetically related off-spring are more truly "children" than adoptive, or other non-genetically or non-biologically related off-spring. The genetically defined nuclear family model can be broadened to include other models, including the extended family, adoption and fostering.

6. REPRODUCTIVE RIGHTS. Though we affirm the value of stable social institutions such as the family for the nurture of children, we are skeptical of the many claims suggesting reproduction to be an essential human need or right. There are many pressures upon men, and especially women, in our culture to accept the belief that personal identity and fulfillment can only be fully realized through the bearing of their own children. Historically infertility has carried a strong social stigma. Women have often been regarded primarily in terms of their reproductive capacities. Men too, have frequently been regarded as inadequate if they are infertile. Infertility or childlessness has even come to be viewed as a "disease". Thus, there is strong social pressure on couples to bear children.

In its strongest form this view is asserted as a "right to reproduce." Such a "right" is often put forward, not simply as a claim to the non-intervention of society in the reproductive behaviour of persons, but as a positive claim upon society (reinforced by the definition of childlessness as a "disease") that it provide the health-care resources (i.e., reproductive technologies) necessary for the achievement of this reproductive goal. We fail to see the moral foundation for these views, but fear that their assertion is one of the strong pressures energizing the development and utilization of the highly costly NRT's.

III. CONSIDERATION OF SELECTED NRT'S

It is not our aim in this submission to make an exhaustive or complete assessment of the whole range of NRT's that are already being used or are on the horizon. Rather, we offer some observations on only a selected list of NRT developments that seem to us to raise serious issues in light of the values and principles we have cited above.

A. IN VITRO FERTILIZATION (IVF)

IVF is a high tech solution to the problem of infertility. It is a very expensive procedure and the success rates are, at least at the present level of development, very low. IVF is touted by the medical establishment as a "cure" for infertility, though in the technical sense it is not a cure since it does not reverse the biological dysfunction causing the infertility. We think this point is more than just definitional. To call IVF a "cure" for infertility is a subtle way of reinforcing the idea that it is primarily health care--that it is a treatment for the "disease" of infertility. Viewed this way, it becomes much more difficult to argue the case that IVF ought not to be part of the medical costs borne by the public through public health insurance plans. The strong interest of most people in having their own genetically related children contributes to the view of IVF as "basic health care."

We believe that there are serious issues of distributive justice involved in this conceptualization of IVF. If IVF, along with all the other increasingly costly medical technologies, continues to be paid for out of public funds, the added burden on the already strained public health care budget can only result in the further deterioration of the basic health care needed by most of the people most of the time for the health problems most threatening to their quality of life. In our view, IVF is certainly not basic health care, if health care at all.

We cannot refrain from noting the irony, if not outright contradiction, in an emerging social policy that defines both infertility and fertility as health problems, to be "cured" by the respective "treatments" of IVF and abortion. It is our considered view that in most, though certainly not all, of these cases, the problems are not ones of health, and the interventions are neither treatments nor cures.

We do not hold the view that IVF is an inherently unethical procedure or that its availability and utilization serves no public good. However, we do see aspects of the procedure that require careful scrutiny and regulation. One of these has to do with the fact that the procedure currently involves the fertilization in vitro of more eggs than are re-implanted, producing the so-called "spare embryo" problem. We believe it is important that the legal and moral status of these embryos be clearly defined in a way that protects them from abuse. They ought not to be treated as mere "human tissue" or property (even of the parents), which could be bought and sold, used as research subjects, or utilized for any ends other than re-implantation into the mother's uterus with the aim of being brought to full term. The law must insure that IVF not become a production source for a market in human embryos.

Another aspect of the "spare embryo" problem of ethical concern involves the fact that there must be a selection among the fertilized eggs in vitro of those to be reimplanted. How should this choice be made? Because it is relatively easy to do a genetic analysis of each embryo, it is possible to base the selection on its genetic characteristics. Should only the males (or females) be picked? The blue-eyed ones? Of course, as our genetic knowledge increases, the range of choice widens, and the greater becomes our power to "engineer" the characteristics of our children. This is part of the larger problem of genetic engineering, but it is unavoidable in IVF since a selection must be made. We believe that it is important to prevent all forms of eugenic preference from entering into this decision, including sex selection. A random selection mechanism may seem too radical a solution to this problem, but it would be preferable to unrestrained genetic choice. The more we exercise control over the geneti c shape of our children, the more difficult it becomes to value individuals for their intrinsic worth as gifts of God, and the greater the tendency to value them on the basis of how closely they approximate a genetic ideal.

Some of the procedures and drugs used in IVF are highly invasive in the woman's body. The long-term health risks to both the mother and to the children conceived through IVF are still largely unknown. If the drugs used for fertility and ovulation induction increase the health risks of women and children it is essential that these risks be established and that they be communicated clearly to those who request IVF.

We are also concerned about the emotional and mental health of women and couples who participate in IVF programs. The media gives extensive coverage to the "success" stories. We are all touched by the photographs of smiling mom and dad with babe-in-arms but what about the many couples who undergo this highly invasive procedure and who go home empty-handed? Some studies indicate that as many as 80% of women who undergo IVF do not become pregnant and of the approximate 20% who do, many are unable to carry the pregnancy to term. Given that the actual "success" rate is very low and the emotional and physical trauma of the procedure very substantial, it is important that we have a reliable picture of the emotional and mental consequences for those who experience failure, and that these risks be communicated clearly to prospective participants in IVF.

RECOMMENDATIONS RE IVF

1. We do not call for a ban on IVF, but we urge that it be subjected to a number of very clear restrictions. We believe that IVF can serve an important interest of infertile couples for whom other options such as adoption are not available or acceptable.

2. We urge that IVF not be classified as a health care procedure to which anyone has a positive right from public funds. Given the expense involved in the procedure, it places too great a burden upon already overburdened health care budgets, to the detriment of basic health care. We would like to see more public money channeled into research into causes of and prevention of both male and female infertility.

3. We recommend the strict regulation by law of uses made of the "spare embryos" commonly produced in the IVF process. In particular we are concerned that IVF not be permitted to become a source for the marketing of embryos in any fashion or for any purpose. The only purpose justifying their retention is their future re-implantation in the mother in subsequent attempts to produce a pregnancy.

4. We recommend the strict regulation by law of the manner in which embryos are selected for re-implantation. Genetic selection should be permitted, if at all, only for the purpose of screening for serious genetic defects.

5. Given the many risks involved in the procedure, especially to women, we recommend that the public have ready access to information about both the risks and success rates of the procedure, and that these risks be communicated clearly to prospective users of IVF. The risks and stress associated with IVF and other technologies dealing with infertility make a strong case for the establishment of independent counselling and support resources for infertile couples considering their use.

Surrogacy is emerging in our society as a partial genetic solution to female infertility, just as artificial insemination by donor (AID) is a partial genetic solution to male infertility. They both provide couples with the opportunity to have children who are genetically related to at least one partner. Surrogacy, however, can be combined with IVF procedures to allow the implantation into a surrogate of eggs fertilized by both husband and wife, producing a fully genetically related child.

The public image of surrogacy, sometimes reinforced by media accounts, presents the uterine mother as motivated by an altruistic desire to assist the childless couple. It would be unacceptable to public sentiment to focus on the economic motivation. Yet the fact remains that surrogate contracts to date are very much monetary transactions. Couples contract through lawyers to pay a woman for the use of her uterus and also, in the usual case, for the purchase of an ovum, to bring to term a healthy child claimed by the couple. The contract typically involves the waiver by the uterine mother of all rights with respect to the child. Often it also provides for the right of the couple to refuse the child if it is born with genetic or other congenital defects.

We have serious reservations about the possibility of ethically acceptable surrogacy arrangements. Paid surrogacy arrangements are caught on the horns of a dilemma. If they are arrangements into which the surrogate enters with complete autonomy and without exploitation, a question remains whether the baby itself has become a commodity that is being bought by the couple and sold by the surrogate. Since, in the normal case of AID surrogacy the contracting couple is receiving for its payment, not only the services of the surrogate, but also her contributed ovum. It is hard to accept the argument that she is being paid only for her services, and that the child itself has not become a marketable commodity. Insofar as it has become such a commodity, the child is seriously dehumanized. It is reduced to the status of a mere object, a piece of property that can be exchanged if the price is right.

Nothing makes this more evident than the clause often included in surrogacy contracts which relieves the contracting couple from any responsibility to take custody of the baby if it is not delivered to them in "good condition" (i.e., free of undesirable characteristics). Nothing can be a greater denial of the inherent dignity and worth of persons than such a practice. While this represents the extreme case, we believe it is merely the logical conclusion of a mindset already present in the practice of marketing the baby. Even if one were to accept the argument that surrogacy contracts are simply a "payment for services rendered," and that the baby is therefore not being bought and sold, a more fundamental problem remains. Perhaps one of the most offensive aspects of paid surrogacy is the fact that it involves a decision by the surrogate to, indeed, conceive a child either wholly or primarily for the purpose of financial remuneration. Surrogacy thus undermines that moral virtue by which women and men desire the creation of children for the sake of the child himself or herself, which makes the child a true object of love, and not simply a means to the accomplishment of self-interest.

There is good reason, however, to doubt the total voluntariness of the surrogacy arrangement. It is not women in comfortable financial circumstances who are most likely to rent their wombs and supply gametes to childless couples. This seems to be corroborated by the actual experience with surrogacy arrangements so far. The fact that there is a pattern emerging of middle and upper-middle class couples contracting with lower class women for surrogacy should be a signal that these contracts have an intrinsically exploitative quality. Thus there is reason to fear that surrogacy arrangements exploit either the child, by making it into a market commodity, or the surrogate mother, by taking advantage of her circumstances, if they do not exploit both.

Surrogacy arrangements run the risk of dehumanizing women in other ways. In a surrogacy arrangement, even if it is by voluntary contract, the woman enters into a role which tends to reduce her to her reproductive functions, in a kind of temporary throwback to the most exploitative, sexist, and patriarchal social structures. That these arrangements ignore the full human dimensions of the uterine mother is poignantly evident in the increasing numbers of cases where they become emotionally attached to the children they carry and request either full or partial custody. It does not solve the problem to insist that "a contract is a contract" and that the uterine mother therefore has no rights to the child. The situation raises serious question about the validity of these kinds of contract. There is in law the concept of the "unconscionable contract." Surrogate contracts seem to us to be of this genre.

Neither does it solve the problem to recommend, as does the Ontario Law Reform Commission, that such conflicts over rights to surrogate-produced children should be resolved according to the best interest of the child, regardless of the contract. This approach, while it at least has the merit of taking children's interests seriously, still ignores the interests of the uterine mother, among which is the maternal bond she has developed with her own genetic offspring.

We also wonder about the effects surrogacy arrangements may have upon the children involved. How do other children of a uterine mother feel when they watch their own sibling being turned over to others in a financial transaction? And what about the long-term emotional and spiritual well-being of the children of surrogacy arrangements themselves? We do not claim to know the answers to these questions, but they demand answers before surrogacy becomes accepted as commonplace in our society.

RECOMMENDATIONS RE SURROGACY

1. In light of the already well-publicized experience with surrogacy contracts, and the risk that these arrangements seriously compromise the dignity and well-being of both the uterine mother surrogate and the children produced, we believe that surrogacy contracts ought not be legally recognized and enforced, and that such arrangements involving payment for services be considered a form of baby-marketing prohibited by law.

The major concerns we have about the practice of AID are similar to those we raised about surrogacy. As surrogacy is a partial solution for female infertility, AID is the analogous partial genetic solution for male infertility. The solution in each case involves the contribution of gametes by a donor--either by the uterine mother in the normal case of surrogacy, or by the sperm donor in the case of AID. One reason, among others, we took issue with surrogacy was the commercial aspect of the transaction--both in the "sale" of the ovum involved and the "rental" of the womb. This same problem is involved in the current practice of AID. A woman is inseminated with the sperm "donated"--for a fee--by an anonymous donor, most likely an impecunious medical student.

While the purchasing of sperm for AID may not appear to involve the commercialization of the baby-product as strongly as does the purchase of surrogate services--because the baby itself does not "exchange hands," the implication is nevertheless present. And just as in surrogacy the uterine mother conceives and bears a child from financial motivations, so also in AID the genetic father who sells his sperm to the "bank" makes the paternal contribution to conception of children from the same motivation. To say that the selling of sperm does not implicate the male in this motivation as much as the surrogate female is merely to assume the old stereotype of the father as mere provider of gametes, rather than co-nurturer of children.

Paid surrogacy and sperm selling both drive yet one more wedge between reproduction and the love of children for their own sake. Our society has driven these too far apart already, as the staggering numbers of unwanted pregnancies and battered children attest. This aspect of AID may be avoided if sperm donation is not permitted by law to be a financial transaction. Certainly the argument our society has adopted with respect to blood and organ donation should apply with equal force to gamete donation. Society must avoid the emergence of a market in human tissue.

AID raises other issues that we believe the Commission needs to address. There is a danger that children born of AID procedures do not become aware of their "partial adoptive" status, and hence that they may be genetically related to persons other than their "adoptive" extended family. Thus they may quite unknowingly marry their half-sibling, for example. The more the sperm banks from which donor sperm is taken rely on a few donors, the more significant this problem. We recommend that regulations prohibit the use of sperm from the same donor to produce more than a very limited number of AID pregnancies. Since AID children are partially adopted, they should have the same rights concerning their genetic heritage as our society recognizes in the case of other adoptive children. Adequate long-term record keeping of donors is essential. We are deeply troubled about the secrecy and anonymity surrounding AID. Disclosure to children that they are AID produced is essential, and they must have access to the genet ic records of the donor.

There is also a danger of the formation of eugenically defined sperm banks, which allow couples to obtain sperm from donors with socially highly desirable traits such as intelligence, athletic prowess, attractive physical features, etc. This has already occurred in the United States and elsewhere. We strongly urge that such sperm banks be strictly prohibited by law in Canada. Genotype selection, if allowed at all, should be subject to the most serious restrictions. Clearly, a couple should not be allowed to select the sex of the child.

RECOMMENDATIONS RE AID

1. We recommend that sperm donated for the purposes of AID not be sold by the donors, but be donated in the same way as blood and other human tissue must be voluntarily donated in our society.

2. We recommend that the number of sperm donations from the same donor be limited to a small number of inseminations to prevent the spread of the same genotype into significant numbers in the population.

3. We recommend that the children of AID be recognized legally as adoptive children, and that they be given the same rights regarding knowledge of their genetic heritage as other adoptive children.

4. We recommend the legal prohibition of sperm banks based upon eugenic assumptions of any kind.

We are aware of tremendous pressures in the medical and scientific research communities to use the living human foetus as a subject for experimentation. We understand that there are many strong scientific reasons for preferring foetal experimentation over experimentation with animals, because it allows the researcher to experiment directly with live human tissue, providing a far more reliable basis for transferring the results from the experimental stage to clinical application in children and adults. Foetal "tissue" is used in much cancer and immunological research. Foetal research is also an important aspect of the development of prenatal medicine, including the treatment of genetic and other prenatal diseases, and the development of premature birth technologies, including artificial womb environments to increase the viability of premature babies. The human foetus also is seen as a potential resource for the "cultivation" of organs and other tissue for transplantation into post-natal persons.

It is our understanding that there are in Canada no regulations or guidelines with respect to the use of aborted foetuses for research, experimentation and tissue transplants. We find this state of affairs completely unacceptable. We do not believe that experimentation on the human foetus should be allowed to go forward in Canada until the status and rights of the foetus are clearly established in law, and there are precise regulations governing its use for experimentation.

The issue of foetal experimentation is closely related, of course, to that of the legality of abortion in a society, since there is a direct correlation between the numbers of abortion performed in a society and the numbers of live foetuses available for experimental use. It is sometimes argued that if society has already decided that the abortion of the human foetus is legally acceptable, then should there should be no legal bar to using the already "rejected" foetus for experimental purposes. We emphatically reject this reasoning. It is invalid on several counts.

First of all, however the government of Canada ultimately sets the conditions under which abortions may legally be performed, the reasons for permitting them would not, even for most people who support them, imply the denial of all rights of the foetus, but only that the rights of the mother may in some circumstances override them. Whatever the law of abortion may be in a civilized society, it is morally imperative that the sanctity and dignity of the human foetus be affirmed and protected.

Secondly, the fact that a foetus has been aborted, does not give other people the right to do anything they wish to it. Only the most sadistic among us could believe, for example that it would be acceptable to subject a foetus to experiments which kept it alive for extensive periods during which it was subjected to significant pain or emotional stress.

In establishing criteria for what might be acceptable, we believe, then, that the fact that the foetus has been or will be aborted is completely irrelevant to the question of the respect to which it is entitled for any further purposes. It should be accorded the same status as that of a foetus carried to term. In practical terms that means the foetus is entitled to the same protections with respect to experimentation that are accorded to children and other non-consenting persons. These generally exclude any non-therapeutic experimental procedures that are significantly invasive or that inflict any suffering or stress. At a minimum, any experimental procedure involving the maintenance of a live foetus beyond the stage of where there is clear brain or other neural activity present should be strictly prohibited. Since experimentation upon an aborted foetus which will be subsequently discarded can hardly be therapeutic for the foetus itself, this is a highly restrictive rule, especially in light of the many ut ilitarian benefits foreclosed by such a rule. But we believe that any more liberal rule involves a reckless disregard for the sanctity of human life. Any use of the foetus for the "harvesting" of tissue or organs for transplantation should be prohibited for the same reasons.

RECOMMENDATIONS RE FOETAL RESEARCH

1. A foetus aborted for any reason whatever should not be considered by that fact to have lost any of its rights to be treated with dignity and respect.

2. We recommend the adoption of regulations prohibiting non-therapeutic research on the human foetus which is significantly invasive or inflicts upon it any suffering or pain.

3. We recommend the strict prohibition of the use of human foetuses for the "cultivation" and "harvesting" of any tissue or organs for transplantation.

Again, there is potential for much human good to be achieved by the development of genetic technologies. Genetic research is making it possible to reduce the incidence of, or even to cure, certain genetically transferred diseases, including, potentially, many forms of cancer. We affirm the aspirations of the scientific and medical communities in their commitment to reduce pain and suffering caused by genetic disease. Nevertheless, there is also potential for much evil in the form of eugenic programs that attempt to shape the genetic definition of the human species in accord with various genetic ideals. We recognize that the line of demarcation often is not clear between so-called "negative eugenics", which attempt to eliminate or reduce genetic defects and diseases, and "positive eugenics", which seek the improvement of the species in accord with some ideal or model human type.

But, while the line is not perfectly clear, we believe that it is a distinction that must be maintained. There are genetic proposals that clearly move beyond the line, and we believe that they must be avoided. These include any form of genetic manipulation, whether it involve technologically sophisticated means such as gene splicing, genetic screening, and the like, or less sophisticated programs of selective breeding, sperm or egg banking, which has as its objective the general "improvement" of normal human levels of intelligence, strength, physical beauty, etc., or which reflects preferences of race, gender, or other genetically related characteristics on the basis of which humans beings may be discriminated against or disvalued as persons.

Any program of genetic improvement raises the question of whose ideal of humanity will prevail in the new definition. It also raises the question of how those individuals who do not meet the standards of the genetic ideal come to be valued (or, more importantly, disvalued) by the rest of society. The fundamental values of human dignity and equal worth are too much at risk in these projects. Techniques which involve distortions of the very conception of human nature itself, such as splicing of human and non-human genes, or of personal identity, such as the cloning of human individuals constitute an equal threat to these values.

Even in the realm of so-called "negative eugenics" there are issues that need to be addressed. The practice of screening for genetic diseases in adults and in the unborn with a view to preventing the conception and or birth of genetically defective children can sometimes be race or gender biased in its consequences if not its intent. It can also involve discrimination against healthy unborn children in cases where genetic screening is used for purposes of selective abortion of those foetuses "at risk" of genetic disease. This kind of "genetic roulette" raises for us serious moral questions.

RECOMMENDATIONS RE GENETIC MANIPULATION

1. We recommend that techniques involving the reshaping of human genes in any way be limited to the very narrow sphere of prevention and cure of specifically identifiable genetic diseases associated with human suffering and misery, and not extended in any way to positive eugenic programs of species improvement

2. The cloning of human individuals for experimental or any other purpose, and the splicing of human with non-human or synthetic genes should be absolutely prohibited by law.

3. We further recommend that a system of public monitoring of genetic research and therapy be instituted, reflecting a range of ethical opinion in the society beyond that of the scientific medical community. This might be done via the appointment of ethics review committees in universities, hospitals and both public and privately funded research centres.

Current restraints for both amniocentesis and chorionic villi sampling should not be weakened. Clinics should have uniform policies that both of these procedures be used only for diagnosing the most serious genetic problems and definitely not for sex selection purposes. Also, regulations must insure that these procedures are used only with the full, informed consent of the mother.

Our Western culture takes much technology for granted. No one would deny that our lives have been made more comfortable by technology. Yet it is sometimes necessary to pose some larger questions. Is technological know-how and availability always intrinsically valuable? Technology is in some ways self-generating. Technologies often are used simply because they are available, without a clear understanding in the society of whether this use in fact serves essential or acceptable social ends.

A good illustration of this is the use of ultra sound and foetal monitoring in prenatal care. When this technology was first introduced it was used only in high-risk pregnancies. Now both procedures have become virtually routine. This widespread use has contributed to furthering the disease model for pregnancy. This medicalization of a natural healthy female process in turn increases the expense of prenatal care.

This raises important issues of resource allocation. Does technology, in this instance, ultra sound and foetal monitoring, prevent a more equitable delivery of health care services? Can routine expenditures on such procedures in urban centres be justified when some native communities, for instance, lack basic health care?

RECOMMENDATIONS RE GENETIC SCREENING

1. We recommend the establishment of uniform and restrained criteria for the use of ultra sound and foetal monitoring. Neither of these procedures should be routine and when they are used informed consent must also be sought.

2. We believe that prenatal screening techniques should be permitted only for diagnosing the most serious genetic problems and certainly not for the determination of sex or other genetic characteristics.

We wish to underscore the need for regulation in the area of New Reproductive Technologies. We are witnessing a trend towards less regulation in Canadian society. In many sectors of our society there are growing pressures for less intervention and regulation by the state. It is our hope that this orientation does not govern the approach society takes with respect to NRT. We believe that the state has an important regulatory role to play. The issues surrounding NRT are profoundly ethical and it cannot be assumed that the scientific and medical communities have the ability to be self-regulating. A laissez faire approach cannot be in the public interest when some aspects of NRT carry the potential of significantly lowering social respect for human life and the equal worth and dignity of persons, and even of altering what it means to be human.

Again we affirm the work of the Royal Commission on Reproductive Technologies. It is our hope that the conclusions of the Royal Commission be well publicized and that its work serve as the basis for effective government legislation with respect to NRT.