Examination of Witnesses (Questions 940
- 959)
WEDNESDAY 10 NOVEMBER 2004
MS MARILYN
CRAWSHAW, MS
DEBORAH CULLEN,
PROFESSOR ERIC
BLYTH, DR
JIM MONACH
AND MS
SHEILA PIKE
Q940 Dr Harris: Do counsellors counsel
for free?
Ms Pike: No, they do not.
Q941 Dr Harris: So I think it is
realistic, not cynical, but, again, we may have to—
Ms Pike: Disagree on that.
Q942 Dr Harris: Yes, indeed.
Ms Pike: Perhaps the term "mandatory
counselling" is not the best way to describe it. I do not
believe that you can impose counselling on anybody but I do believe
that you can offer a realistic opportunity to people. At the moment
the opportunity that is provided varies from centre to centre
and I think it is important that people have an opportunity to
attend an initial counselling consultation in order that—
Q943 Dr Harris: How is that different,
though? Because the current section 13, paragraph 6, I am told
in this briefing, says that, "A woman shall not be provided
with any treatment services . . . unless the woman being treated
and, where she is be ing treated together with a man, the man
have been given a suitable opportunity to receive proper counselling
about the implications of taking the proposed steps . . . "
That is what you just said, they should have the opportunity.
Ms Pike: No. It is how you define
that suitable opportunity. A suitable opportunity might just be
a consultant mentioning, "You could go along to counselling,
and here is your next clinical appointment." Or perhaps they
are given written information about the counsellor. It is very
much the way the counselling is described and delivered within
each individual unit that will impact on the take-up rate of counselling.
I do believe that, because there is still a stigma attached to
counselling, there is a fear perhaps that people assume—and
I think I have said this before—that they will be seen as
not coping if they attend the counsellor. I believe that if that
is made a routine procedure, just as routine as an initial clinical
consultation, that they attend the counsellor and they are able
to find out for themselves what is involved in counselling, it
demystifies counselling, it allows them to identify any future
counselling needs. To be sure, if they feel that counselling is
not for them, there is no requirement for them to go any further
with it.
Q944 Dr Harris: You said earlier
that you accepted, Dr Monach, that the evidence base that the
efficacy of counselling in these circumstances was not strong.
Dr Monach: In these. The evidence
for the efficacy and effectiveness of counselling in a range of
other circumstances is strong.
Q945 Dr Harris: But in these circumstances.
Dr Monach: Yes. I am being pedantic.
Q946 Dr Harris: It could be argued
that it is reasonable for government, before we impose a mandatory
requirement in these days of regulatory burdens and all this,
to ask for there to be evidence.
Dr Monach: Yes.
Q947 Dr Harris: You said there was
not evidence because of these damn research councils—and
as a committee obviously we hear this all the time—but is
it not incumbent on the counselling industry to provide strong
evidence, and, if necessary, if it is so critical, to fund it
themselves. That is what people do.
Dr Monach: Yes. I do not entirely
disagree with what you say. I think it is very important that
counsellors themselves develop a better research base than there
is at the moment and it is partly because of timing: 14 years
still makes infertility counselling quite a young profession and
a lot of the emphasis needs to come from them. But, could I just
come back to the other point, because I think you made an excellent
point when you read out what the act says about a suitable opportunity.
In a sense, our argument is not so much with the act, it is more
with the code of practice within the HFEA, because I too do not
see any reason why one should not interpret the meaning of what
you read out as being precisely what we are arguing for and what
Sheila described. It is because the code of practice does not
interpret in that way, and clinics are quite happy to say, "Well,
a suitable opportunity just means that we have a notice on the
wall." From where we stand, a suitable opportunity would
be exactly what you describe and we have argued for.
Q948 Dr Iddon: What percentage of
people undergoing the new technologies seek, or are advised and
therefore seek, counselling? Is it very tiny?
Dr Monach: It varies enormously,
as Sheila said. We do not have any formal figures, but, wearing
another hat, I am an inspector for the HFEA, and going around
you look at the figures that are being generated and it can go
from anything like 2 and 3% right up to 40%, and it entirely depends
on the attitude and the practices of the clinic. If those in the
clinic are keen, they are motivated, they understand what the
counsellor offers, they are enthusiastic and they do not just
stick a notice on the wall, then a lot of people will take up
the opportunity. It is back to the point we were making earlier
really, that unfortunately the perception is still that counselling
is a demonstration of weakness and not a strength.
Q949 Dr Harris: If I may come back
to this evidence point.
Dr Monach: Evidence about . .
.?
Q950 Dr Harris: Evidence about the
efficacy of counselling, mandatory or otherwise. Given that the
HFEA, on issues around egg giving, say, "Where is the evidence
that this provides better results in their evidence base?"
it would not be unreasonable of us, surely, to recommend that
we do not go down this "more counselling" path and say,
"Come back in ten years when you have the evidence that it
is useful" because it is a burden.
Dr Monach: I can say to you quite
conclusively that there are lots and lots of studies now that
say that the increase in depression and anxiety amongst childless
couples is very significant, is more significant than most other
long-term medical conditions. You can say, on the one hand, that
is clearly demonstrated, and on the other hand you can say that
counselling is now very well established as effective as a first-line
intervention for people with anxiety and depression. Those two
are quite indisputable in the literature now and therefore I think
it is quite possible to put those two together, even though not
much work has been done on the infertility-driven depression and
the counselling.
Q951 Dr Harris: I am not against
counselling, I am just saying that, in other areas of mental health,
unless they fall under the act they do not have mandatory treatment.
I am surprised that you are arguing that in this particular area
of—
Dr Monach: Sorry, your question
was about the literature.
Q952 Dr Harris: — mild to moderate
mental health problems (that is, depression based on infertility—given
that you accept the stigma, which, if you force people to go down
something that stigmatises, for better or worse might be a barrier
for treatment) there should be mandatory treatment.
Dr Monach: No.
Ms Pike: No. I think you are pathologizing
now. We are not talking about mandatory treatment at all. I think
people should be required to attend an initial consultation, an
initial counselling consultation.
Q953 Dr Harris: All right. I am going
to move on to the issue of donor anonymity and ask again what
the evidence was and what studies you are aware were done by the
HFEA that showed that this would be in the interests or the welfare
of the child produced by donated gametes.
Professor Blyth: We need to recognise
that the decision about anonymity has been made by government
already, so to some extent we are talking after the horse has
bolted, so to speak. Given that proviso, there is certainly increasing
evidence, based on a number of small-scale studies—and I
guess I am likely to fall into the same difficulties as colleagues
have earlier in relation to convincing you that there is sufficient
empirical evidence. The whole problem about getting empirical
evidence in relation to anonymity is that, because the practice
has been characterised by secrecy and anonymity, that has presented
a very major barrier in undertaking any research anyway. With
that proviso, the information that we do have is from a number
of studies in this country, and in the United States, which indicate
that people who have learned about their origins, from a variety
of ways, sometimes in adulthood, sometimes by accident, sometimes
as a result of family disagreement, have actually experienced
extreme psychological discomfort because that information had
been withheld from them previously.
Q954 Dr Harris: That is the point.
Because it seems to me, from my understanding of the evidence,
that there is at least a series of cases, which one might describe
as anecdotal, of people who feel they have been damaged by the
secrecy—by the fact that they have not been told—as
well as—but mainly that—not being able then to identify,
somewhere out there, their fathers, say, in the case of donated
male gametes. There is some evidence I have also seen that ending
donor anonymity makes it more likely that parents will not tell
the child of the fact of their gamete-donated origins. That is
therefore more secrecy and runs the risk of the secrecy being
discovered. Would it not be logical, on that basis, to force parents
who are using regulated gamete donation, where there is no longer
anonymity, to tell the children of the fact at the appropriate
age so that they can then trace their parents?
Professor Blyth: I am sorry, I
got a bit lost in terms of the actual question. One of the points
you said was that you were aware of some evidence that said that
parents were less likely to tell their children. I would be interested
to know what that is because I have certainly not seen that.
Q955 Dr Harris: If people who have
been asked, "Why do you not tell the child?" say, "Well,
we don't want them to go off and look for the other parent,"
that is understandable.
Professor Blyth: But the evidence
that is available is very much the other way. The evidence that
is available is that parents are reluctant to tell their children
because of the very little information they have about donors,
both in terms of non-identifying information that they have been
given themselves and particularly if they do not know the identity
of the donor. That comes through time and time again, that one
of the reasons why parents do not want to tell is because they
are opening a can of worms, because they will not be able to answer
the follow-up questions these children will have—which will
be information about the donor and information about the identity.
Anticipating the next session, there is a very recent piece of
research, of which Professor Golombok is a co-author,[3]
which shows quite clearly that parents who have told their children
report far fewer difficulties in terms of their relationship with
their children and their children's development than parents who
have actually not told their children. So we have the evidence—
Q956 Dr Harris: I understand what
you are saying. I would be interested to see the evidence, so
feel free to send it in. Should we not now, because of all these
benefits of this openness, just tell the children? You do not
have to get the parents to do it; you just tell the parents that
the register will contact the children and tell them at the age
of 16 or 18. Win, win, win.
Professor Blyth: No, I have not
said that at all. I think that is a gross interference in terms
of parents' responsibilities towards their children.
Q957 Dr Harris: But children have
rights.
Professor Blyth: Parents ought
to be strongly advised that the evidence suggests that it is better
if children are told. You will have heard this from organisations
like DC Network.
Q958 Dr Harris: I am not arguing
with you, I am just asking why you do not take the next natural
step.
Professor Blyth: It is not a natural
step.
Q959 Dr Harris: Which is to tell
them and then give them mandatory facts.
Professor Blyth: With all due
respect, that is not a natural step for the state then to disregard
parental wishes and say, "Well, we are going to find some
way of telling these children anyway."
3 Note by the witness: Lycett, E, Daniels,
K, Curson, R, and Golombok, S, (2004). "Offspring created
as a result of donor insemination: a study of family relationships,
child adjustment and disclosure", Fertility and Sterility,
821, 179-179 Back
|
