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Fertility Therapy
An influential panel of the New York State Health Department is urging sweeping changes in the
regulation of new fertility technologies, including more steps to reduce the incidence of multiple
births.
In a report being issued today, the panel said doctors providing infertility treatments must think
more about the babies born as a result and avoid treatments that are more likely to produce socalled high-order multiple births -- pregnancies of three, four or more babies who are far more
prone to devastating problems like retardation and blindness.
Doctors should talk with patients in advance about the possible need to abort one or more
fetuses in a high-order multiple pregnancy, the panel said. If an abortion is not an option for the
patient, it added, doctor and patient should consider other treatments, even if the chances of
pregnancy are reduced.
The panel, the New York State Task Force on Life and the Law, said that many women are
inadequately informed about the risks of fertility treatments and that couples are often not told
enough about the costs of such therapies and their generally low chances of success.
The therapies include drugs to induce the ovaries to produce eggs, the transfer of embryos
fertilized in the laboratory directly into the womb and artificial insemination. With such
techniques, a child can be born with three biological parents -- a man who provides sperm, a
woman who provides an egg and a woman who carries and delivers the child.
The panel rejected calls for legislation mandating health insurance to cover such therapies
because it found ''no persuasive reason for giving'' them special legal priority, given that the
United States does not pay for everyone's health care.
Independent experts who have followed the drafting of the report praised it, particularly its
emphasis on the well-being of children born through the new techniques. They predicted it would
be a model for regulation around the country.
The 24-member panel, made up of doctors, lawyers, ethicists, members of the clergy and
others, has had unusual influence since its creation in 1985. Its recommendations are not binding,
even in New York, but earlier recommendations have become part of state laws and United
States Supreme Court decisions on defining death, withholding and withdrawing life support,
organ transplantation and other issues of medical ethics.
Dr. Barbara A. DeBuono, the New York State Health Commissioner, said in an interview she
would immediately take steps toward implementing the recommendations, starting with
reviewing processes used to inform patients of all risks of the reproductive technologies.
''The technology is advancing faster than government officials, religious leaders and medical
ethicists can keep up with,'' Dr. DeBuono said, ''and therefore many of the thorny ethical issues
are being played out in the courts.''
The panel said its main focus was to recommend ''laws that promote clarity about parental
rights and responsibilities that protect the stability of the parent-child relationship.''
Among the recommendations that the panel made in addressing an array of issues were:
*Establishing the woman who gives birth as the child's legal mother, even if it was conceived
from an egg donated by another woman.
*Requiring doctors to tell women if procedures are experimental.
*Not making embryos from donor sperm and eggs without the explicit permission of the
individuals who intend the embryos for their own use.
*Conducting research to determine the odds of consanguinity.
The panel said physicians offering fertility treatment are not ethically obliged to treat everyone
who seeks help. But it said doctors who use psychological screening of potential patients should
recognize that such testing is often prone to mistake and abuse and should insure that similar
standards for such screening are applied to all patients.
Dr. DeBuono said that if a dispute arose between a birth mother and the woman who donated
the egg from which the child was conceived, ''the burden would be on the genetic mother to
prove in courts why an exception should be made.''
''Teknologi ini maju lebih cepat dari pejabat pemerintah, pemimpin agama dan ahli etika medis
dapat mengikuti,''kata Dr DeBuono,''karena itu banyak masalah etis yang pelik yang sedang
diputar di pengadilan.''
Panel mengatakan fokus utamanya adalah untuk merekomendasikan undang-undang''yang
mempromosikan hak kejelasan tentang orang tua dan tanggung jawab yang melindungi stabilitas
hubungan orangtua-anak.''
Diantara rekomendasi bahwa panel dibuat dalam menangani masalah array adalah:
* Membentuk wanita yang melahirkan sebagai ibu hukum anak, bahkan jika itu dikandung dari
sebuah telur yang disumbangkan oleh perempuan lain.
* Membutuhkan dokter untuk memberitahu wanita jika prosedur eksperimental.
* Tidak membuat embrio dari donor sperma dan telur tanpa izin eksplisit dari individu-individu
yang berniat embrio untuk mereka gunakan sendiri.
* Melakukan penelitian untuk menentukan kemungkinan kerabat.
Panel kata dokter menawarkan pengobatan kesuburan tidak etis wajib untuk memperlakukan
setiap orang yang mencari bantuan. Tapi kata dokter yang menggunakan skrining psikologis
pasien potensial harus mengakui bahwa pengujian tersebut sering rentan terhadap kesalahan dan
penyalahgunaan dan harus memastikan bahwa standar yang sama untuk skrining tersebut
diterapkan pada semua pasien.
Dr DeBuono mengatakan bahwa jika perselisihan timbul antara ibu melahirkan dan wanita
yang menyumbangkan sel telur dari mana anak itu dikandung,''beban akan berada di ibu genetik
untuk membuktikan di pengadilan mengapa pengecualian harus dibuat. " '
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