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PMA, anonymity of sperm donation, research on stem cells ... What will change the bioethics bill in France and what are the fracture lines?
Debates on the bill of bioethics must begin Tuesday, September 24 at the National Assembly and they promise to be animated. Among the 32 articles, very complex, some developments are far from unanimous.
► The PMA for all women
What's Changing : Medically assisted procreation (ART) was previously reserved for heterosexual couples suffering from infertility. Article 1 of the bioethics bill removes this medical criterion. Lesbians and single women could now use it. And as for heterosexuals, the PMA would be supported by the Health Insurance. It should be noted that the bill does not provide for a specific conscience clause for doctors, as is the case for abortion.
Why it is sensitive : Opponents of the PMA for all, ranks Republicans (LR) in the Assembly at the Manif for all, a collective that includes twenty associations, denounce a " PMA without a father " and judge that this extension will take place in defiance of " the interest of the child ". Moreover, they insist on a " domino effect " according to them ineluctable towards the legalization of the surrogacy (GPA) , as defended the elected LR in committee. In other words, the possibility of using surrogate mothers.
→ Read also: The French predominantly in favor of PMA, GPA and euthanasia
► Allow access to origins
What's Changing : For the moment, children born in donor-assisted LDCs who want to know who is the author of this donation face the principle of anonymity of sperm donation . Article 3 provides that these children, at age 18, will be able to " access non-identifying information [age, physical characteristics, ed] about the third party donor and the identity of the latter ". Although this remains to be clarified, this provision marks a break: henceforth, men must imperatively have consented, at the time of donation, to their identity being revealed if the child, once major, makes the request. The anonymity remains however preserved at the time of the donation: one will not be able to choose one's donor and vice versa. And for donations made before the change of law, the commission that will process applications for people born donation can also receive the agreement after the fact donors who wish.
Why it's sensitive : For years, some children born of donations claim to know the identity of their biological "parent". In the early days of PMA, some families had made the choice to ignore the use of artificial insemination with donors. A secret that could have deleterious effects and created trauma. Hence this desire to end anonymity with this new law. In this regard, some associations do not fail to recall that it is rarely the couples of women who make the choice to maintain the "secret" around the conception of a child ... With this end of anonymity, some fear a shortage of donations, at least in the beginning. Health Minister Agnès Buzyn explained that the law would be implemented in three phases to avoid this risk. In addition, awareness campaigns will be launched.
► A recognition of filiation aligned with heterosexual couples
Which changes : In committee, the deputies finally adopted the proposal of the Minister of Justice Nicole Belloubet. Lesbian couples, married or not, will have to make an "early recognition" of the child before a notary before launching their LDC project. One way to recognize the woman who did not wear the child as one of two parents. If in theory, unmarried heterosexual couples can make such an advance recognition process, in reality they do not need it, because the man is automatically considered as the father under the presumption of paternity, even if he is not the "biological father". In addition, no mention of the design by PMA will be made on the birth certificate, as for heterosexual couples, contrary to what was originally planned. Initially, the text also provided that female couples should sign an "advance joint declaration" In front of a notary.
Why it's sensitive : " early joint declaration "had sparked an outcry from LGBT associations who found the provision discriminatory in that it created differential treatment for children born to same-sex couples. SOS Homophobie therefore welcomed this new proposal which " protects and secures without discrimination or distinction between children or families ". In the past, the woman who did not carry the child had to start adoption procedures at the birth of the baby. For its part, the president of the Manif for all Ludovine de la Rochere, denounces " a demolition of filiation, which becomes entirely fictitious with a complete erasure of the father ".
What is not in the bill
- GPA
Even if opponents of the PMA think that it will sooner or later lead to the authorization of surrogacy (GPA), this issue does not appear in the bill bioethics. It is " contrary to our ethical principles ," assured Agnes Buzyn. A position confirmed by Nicole Belloubet: " We are always absolutely bent on the questions of non-commercialization of the human body ". On the other hand, the government wants to allow the recognition of children born abroad by GPA to clarify " the rule of law ".
- Post-mortem PMA
Can one use the frozen sperm of her deceased husband to conceive a child by PMA? Health Minister Agnès Buzyn was opposed, arguing the " risks for the construction of the child, " but the issue was debated in groups in the Assembly. MEPs finally narrowly rejected amendments to this effect.
► Freeze eggs without a medical reason
What's changing : Today, the conservation of gametes (oocytes and spermatozoa) is highly regulated. Roughly, it is only possible for medical reasons, for example when a treatment against cancer may impair fertility. This bill removes the medical condition. One way, justifies the text, to take into account the fact that " the average age of the first pregnancy went from 24 years in 1974 to 28.5 years in 2015 ".
Why this is sensitive : But be careful, warns the legislative project, it is not " to encourage women to resort to a precautionary conservation of their oocytes ": " The self-preservation of eggs will never be the cause of decline in the age of first birth. Strict conditions will therefore be set in terms of age: self-preservation would be allowed between 32 and 37 for women, 32 and 45 for men. In committee, and against the advice of the government, the deputies allowed " authorized " private health establishments to keep gametes for an LDC.
► Genetic tests : information that can be useful
What's changing : Except for medical reasons, genetic tests are and will remain banned in France. And even then, they are very well supervised. They must be used for a purpose defined in advance, for example to search for a particular disease. So if during the test, the geneticist doctor discovers something else, he can not inform the patient. With the new law, and subject to his consent, he will now be able to inform the person of " incidental genetic discoveries that are medically useful ".
Why it is sensitive: The preconception tests (made by a couple to know if the two people who compose it are likely to be carriers of a genetic disease) remain proscribed. For the Minister of Health, there is a " risk of sliding towards eugenics ".
► Use embryonic stem cells for research
What's Changing : Embryonic stem cells (the "mothers" of all cells) are able to repair or replace all body tissues. Since 2013, France has authorized research on embryos and stem cells derived from a human embryo. But all this is strictly regulated. The law wants to soften a little this straitjacket and " remove unfounded constraints ." How? 'Or' What ? Considering that research on embryonic stem cells raises fewer ethical questions than those on the embryo, the text proposes to differentiate the legal status of these two types of research to facilitate that on embryonic stem cells.
After the Assembly, the text is expected in the Senate in January. But the two chambers may need several round trips to agree on a common version. The Minister of Health, Agnes Buzyn, hopes for a final adoption " before the summer ".