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The earliest intervention is normally desirable; that is the basis for much of the Governments policy toward children and families. My noble friend Lady Warnock told us at Second Reading, as we have heard, that clinicians currently pay little attention to the requirement that consideration of a childs need for a father is given during the assessment for IVF treatment. While counselling is offered, take-up of that is low and can be in the region of 15 per cent. How might support for these families be strengthened at this early stage? I would be interested in the literature of which the noble Baroness, Lady Hollis, spoke, to see how helpful that is.
Members of the Committee may have seen the excellent documentary about the impact of postnatal depression on the normal development of an infant which was broadcast last Wednesday on Channel 4. Help Me Love My Baby showed a child psychotherapist from the Anna Freud Centre working with a young mother. The mother's depression was unexpected. Six months after the birth, the baby Isabel was unable to meet her mother's gaze or take comfort from her mother when distressed. We later learned various things about the maternal grandmother, who was an alcoholic who abandoned her daughter at the age of 12. Isabels mother risked repeating the cycle in which she grew upthe cycle of rejection from one generation to another. The presence of another parent with uncomplicated, normal parental feelings towards Isabel would have been an important protective factor.
A discussion with a paediatrician or psychologist might help parents to build strategies to minimise risks to their infants if, for example, they are a lone parent going into this process. A lone parent might be advised about the value of having a co-parent or surrogate from the very beginning, about the need to contact a health visitor as soon as she felt in danger of being troubled by isolation or about the importance of having a godfather or similar figure from the very beginning. We talk about engaging men in the lives of adolescents and the importance of male mentors, but
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As I said, this is a probing amendment. I would be grateful to learn from the Minister what additional support is offered to families in these exceptional circumstances to help them think about the challenges that their children may face. I beg to move.
Earl Howe: Until the noble Earl moved his amendment, I thought that my own Amendments Nos. 58 and 59 might be thought rather provocative. But I am comforted that he has joined me in a similar sentiment and I hope to convince the Minister that being provocative was not my intention.
Clause 14(3) extends the requirements under the 1990 Act in relation to the provision of counselling by fertility clinics. Whereas the 1990 Act requires all women receiving IVF treatment along with their male partners to be offered relevant counselling information, the Bill extends that to apply to same-sex couples. In addition, where a couple gives notice that they want the intended mother's partner to be treated as the parent of a child who is conceived by donor sperm, the treatment cannot be given to the intended mother until suitable counselling has been offered to both partners.
We should be in no doubt how important counselling is in this context. The noble Baroness, Lady Hollis, spoke earlier about the need for prospective parents to internalise the practice and principles that are central to the welfare of children, and I fully agree. It is not unreasonable to propose that prospective parents should be required to receive certain information in that vein, but my concern chiefly centres on three types of case. The first case is where a woman and her male partner apply to receive donated gametes or embryos, the second is where two women make such an application, and the third is where an application is made by a single woman. All three cases have one feature in commonthe child who is eventually born will not be the genetic offspring of at least one of the parents.
In recent years, the donation of sperm or ova may have become commonplacewe may take it for grantedbut we should never let ourselves forget that to bring a child into the world in circumstances where one or more of his genetic parents is kept deliberately secret and anonymous is to saddle that child with a grave psychological handicap from the moment when later in life he becomes aware of his origins. Parents of children conceived by donation need to be made aware of the vital importance of being absolutely honest with those children about the circumstances of their conception, the way in which the breaking of this news is best done and the most propitious timing for doing so. They need to be aware that, for many children, the trauma and hurt of this knowledge never leaves them. Some children spend the rest of their lives recovering from the blow to their sense of identity and agonising over the injustice of their circumstances compared with those of children who grew up with their true parents.
If the news is conveyed ineptly or too late, children feel deceived and can end up being alienated from their parents. I have read a number of personal accounts by donor-conceived children who found out late or the wrong way about their true origins, and they make harrowing reading. Parents should not suppose for one second that their troubles are over the moment that the woman successfully conceives. They should be made to realise that the responsibility towards the child's future well-being is in one important sense even greater than it is for ordinary parents. By gratifying their own wish to bring up a child, which I do not mean to imply is an ignoble wish, they are storing up at the very least bewilderment and hurt for that child in future years. Counselling matters.
If it is agreed that the imparting of this type of information and knowledge is important, if not essential, the question we need to ask is whether it is enough for the law to say merely that women or couples should be offered counselling. In my opinion, they should be made to receive at least a bare minimum of counselling as part of the deal that they have with the clinic, as a matter of course. I suspect that the Minister will tell me that it is not possible to force people to receive counselling, but I disagree. I hope very much that she will undertake to think about the proposal that I have made.
Baroness Hollis of Heigham: I am sympathetic to a lot of what the noble Earl, Lord Howe, said and I can see how what he suggested could be more easily deliverable within an NHS set of treatments, where those services tend to be an extension of the primary care trust in terms of its relationship with social services and so forth. However, how would he ensure that counselling was delivered in the 90 per cent or so of cycles that are handled through private clinics? Would it be rather like cosmetic surgeries where a doctor's receptionist does a 10-minute chat and says, You can have a tummy tuck but not a facelift, or vice versa? How would he ensure that it was delivered? I can see how it might work within an NHS framework, where treatment is not paid for by the recipient at the point of use, so to speak, and therefore could be suggested as an implied contract, but how would it work in the private sector?
Earl Howe: In the same way that the Healthcare Commission enforces minimum standards in private hospitals, it is perfectly feasible to envisage that the HFEA would enforce minimum standards in private clinics.
Lord Warner: I support the two amendments of the noble Earl, Lord Howe. I disagree with my noble friend Lady Hollis on this issue. This is a regulated industry and, as such, certain requirements can be made. That is the nature of regulation. It is perfectly possible to put an obligation on a clinic, whether private or NHS, to ensure that counselling is carried out. I do not think that the noble Earl has been at all outrageous or overdemanding.
The Minister may not like what I am about to say but, if I were standing at the Dispatch Box, I would take the noble Earls amendments away for further consideration. They are good amendments and absolutely in line with the concern expressed around the Committee during most of the afternoon about people getting into situations, the full implications of which they may not fully understand. It is a shame that my noble friend Lord Winston is not here, as these amendments would help doctors. They could shelter to some extent behind what Parliament has said and what the regulator requires of them, and that would make it easier for them to have these conversations with the women sitting across the table from them. Therefore, I fully support the noble Earls amendments.
Lord Alton of Liverpool: I support the comments made by the noble Lord, Lord Warner. He is right. I am not trying to put words in the mouth of the noble Baroness who is about to reply, but I hope that she will take very much to heart what he said about giving the noble Earls amendments a fair wind. Whether this is in the private or public sector is not the issue; the issue is whether we should seek to provide proper counselling arrangements. There may be problems but they are not insurmountable, as the noble Baroness implied. There are many examples in the law of where we do it elsewhere across the public and private sectors. As the noble Lord just said, this provision would help rather than hinder doctors.
Lord Northbourne: I support these three amendments. It would be wholly irresponsible not to do everything we could to ensure that prospective parents in the difficult situation of having an IVF child were fully aware of the problems and, as far as possible, were armed to deal with them.
Baroness O'Cathain: I, too, support these absolutely appropriate amendments. There should not be two worlds in IVF of the National Health Service and the clinics, with the latter able to get away with what they want. The counselling and consultation carried out in the National Health Service should definitely be mirrored in private clinics.
Baroness Finlay of Llandaff: I support the amendments of the noble Earl, Lord Howe. I should point out that counselling is a very broad word. It does not necessarily mean that you have to have a prolonged encounter, but it is about helping people to recognise their own thinking and to move on. I also think that the measure may help healthcare professionals who are struggling to make an assessment, because those people who are motivated to do the best for the child will want to know how to inform him or her about these very difficult and sensitive issues. Oddly enough, if the prospective parent does not want to know about it, they tend to screen themselves out because they are declaring that they do not want to learn about what might be in the best interests of the child. There is no obligation for them to follow whatever constructive advice they are given, but simply being prepared to listen to it can be an important way of assessing whether they are prepared to look at the issues ahead of them.
Baroness Barker: We risk a serious outbreak of unanimity and I do not feel very comfortable with that. I wish to make a couple of important points. First, perhaps the most valuable experience that any potential parent can have is to speak to actual parents. While I understand and support what the noble Earl, Lord Listowel, is trying to do, his amendment is slightly overprescriptive. There is nothing like learning from people who have been through exactly the same experiences; that is, the experiences of other parents who have had donor-conceived children, and those of donor-conceived adults.
Baroness Barker: I thank the noble Earl for that support. I seize this opportunity to flag up organisations such as UK DonorLink and the Donor Conception Network. The conversations that I have had with them reveal that they are extremely anxious that their work should be supported. On later amendments we may disagree about such issues as when and how children have the right to be told about their origins, but supporting such voluntary agencies is an important factor. This measure may provide a way to do it.
Secondly, private clinics have come in for some castigation. Usually I am generally in favour of that but in this case it is not fair because some of the best practice around these sorts of issues is found in private clinics. We ought to raise standards across the piece, whether it be in the NHS or in private clinics.
There is a very important factor behind all this, which goes back to the definition of a parent. If this measure applied across the board to all applicants equally, it would be a measure for good. If it does not, and if we have tight definitions of who parents are, that same process becomes a means of screening out people who could be good parents. Therefore, although I am extraordinarily sympathetic to what both noble Earls are trying to do, this is a matter to which I should like to return once we have established some fundamental issues, such as who are allowed to be potential parents under the Bill.
Baroness Royall of Blaisdon: As my noble friend Lord Darzi explained, the Bill sets out that any woman shall not be provided with treatment services unless she, and any man or woman being treated with her, has been given a suitable opportunity to receive proper counselling about the implications of any treatment service being received. This provision is currently under the 1990 Act, but the Bill now includes reference to two women being treated together.
Further to this, the Bill sets out that any woman shall not be provided with treatment services unless she, and an intended second parent, have been given a suitable opportunity to receive proper counselling at every stage of the woman and the intended second parent signing up to a parenthood agreement.
On Amendments Nos. 58 and 59, tabled by the noble Earl, Lord Howe, the Government recognise that it is highly desirable for any person undergoing fertility treatment to receive counselling, to give them an opportunity to consider all the implications and consequences of receiving such treatment. Indeed, counselling matters. It is important that when two people are signing up to a parenthood agreement they are both fully aware of what this means at all stages of the process. Both parties should have an opportunity to consider the implications of this serious, lifelong commitment.
However, people should be willing to receive counselling for it to be effective. I fear that if counselling were mandatory, resources would be devoted to it, but for some patients it would have no effect because they would not wish to engage with it. Indeed, if it were to be mandatory, it might well produce the opposite effect to that intended, and people might resist it. There are many related problems. For example, what would you do if a woman refused counselling? Would you turn her away?
Baroness O'Cathain: Has the Minister really taken on board the comments of the noble Baroness, Lady Finlay, who made a very salient point? On the basis of what she said, you should not worry about women saying, I dont want to have anything to do with that.
Baroness Royall of Blaisdon: I was going on to address that and other issues. I did, indeed, take on board the point made by the noble Baroness, Lady Finlay. If somebody refused counselling, she might rule herself out. However, we need to devote attention to that consideration.
The noble Earl raised the issue of the need for parents to be open about the true conception of the children and for information to be provided in a sensitive way. Clearly that must be dealt with in counselling, although there are organisations such as the Donor Conception Network which work with potential parents of donor-conceived children to help and encourage them to tell their children about their origins, and to tell them the best means of going about this. Things are being done. However, the arguments that have been made this evening about the need for counselling have been extremely persuasive, so I am happy to take this back. I give no guarantee that we can make changes but I am certainly happy to look at it because I think it is an extremely important issue. I take on board the point made by the noble Baroness, Lady Barker, about the need for all parents, irrespective of their sex, to receive counselling. We should also look at that carefully.
Amendment No. 57ZA would require patients to receive information and advice on child development, and to have participated in a discussion with a specialist social worker, paediatrician, psychologist or other person before receiving treatment. The amendment would introduce an additional stage for fertility patients. It would seem unfair to require people who, through no fault of their own, need medical assistance to get
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The existing requirements of providing information and offering counselling already provide an opportunity for people to discuss issues that are relevant to them. This amendment imposes a significant extra requirement which we do not consider necessary. If there were genuine concerns about the well-being of any child born through IVF, particularly that the child is likely to come into harm, the HFEA guidance on the welfare of the child says that treatment should be refused. People undergoing assisted conception treatment are fully committed to wanting children. They have often been trying to conceive for many years and any resulting child will be treasured and loved. We do not think that people who undertake treatment require more information or advice on parenting than those people who conceive naturally. The Bill already takes into account the welfare of the child to be born through treatment, and requires that people seeking treatment be given the opportunity to receive counselling. Possibly we will make that stronger, though not mandatory.
Earlier this evening we had a discussion about the literature available to prospective parents. As the noble and learned Lord, Lord Mackay, pointed out, this literature is provided by the HFEA. I am sure that the Government will be very willing to enter into discussions with the HFEA to see whether the information provided is entirely adequate, and if not, how it could be improved.
Earl Howe: Before the noble Earl decides what to do with his amendment, let me say that I am extremely grateful to all noble Lords who have spoken in support of mine. I genuinely feel that, as the noble Lord, Lord Warner, suggested, they could be of real help to doctors. In the light of the comments of the noble Baroness, Lady Royall, I am willing to listen to arguments about the practicability of insisting on a measure of mandatory counselling. I am also very willing to look at ways of refining what we mean by counselling in this context. But it is extremely helpful of her to say that she is willing to take my amendments away. I look forward to further discussions with her. Let me just say to the noble Baroness, Lady Barker, that I would not wish to discriminate between different sorts of parents, other than in the obvious respect that a child born from IVF involving the gametes of both his parents is in a different position from a donor-conceived child. The advice given to each category of parent therefore has to reflect that fact.
The Earl of Listowel: I thank the noble Earl, Lord Howe, for saying that he was grateful for this amendment in terms of perhaps making it not so controversial to
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I was grateful also to the Minister for her reply. I was particularly pleased to hear almost a consensus for once this afternoon on how important it was for families to be well informed before they embarked on this process, and I was gratified to feel that she felt these arguments to be persuasive enough for her to see what constructive response the Government would make at the next stage. I beg leave to withdraw the amendment.
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