Friday, October 10, 2008

The Draft ART Bill, 2008

The MOHFW has published a draft ART (Assisted Reproductive Technology) bill on its website (here and here). The bill seeks to regulate the practice of surrogacy. On the whole, it is well written and avoids some of the pitfalls of the ICMR guidelines on the same question.

The bill empowers a National Advisory Board to act as the regulatory body laying down policies and regulations. It also seeks to set up State Advisory Boards that are, in addition to advising state governments, charged with monitoring the implementation of the provisions of the Act particularly with respect to the functioning of the ART clinics, semen banks and research organizations. Several newspapers have already published some of the details of this bill (a summary of some of its key provisions may be found in this article in Tehelka). Below are some of the other salient features.

ART clinics are to become the central hub of all surrogacy-related activity. They are tasked with obtaining all relevant information, informing all the parties involved of their rights and obligations, maintaining accurate records of all the transactions every step of the way. Requirements of confidentiality and other procedural obligations of all the institutions are also specified. The bill lays down conditions (such as age, usage, etc.) that potential gamete donors and surrogate mothers must meet.

Three ‘kinds’ of parents are involved in surrogacy: intending parents who seek the child, genetic parents who provide the genetic material for procreation and the surrogate mother who carries the fertilized womb until delivery. An individual can and often does wear more than one hat. For example, a man wanting to have his own child also provides the sperm to conceive the baby thus being both the intending as well as the genetic father. Likewise, a woman can not only provide the ovum but also carry the conceptus thus acting as both the genetic and surrogate mother. Several other combinations are also possible which is where controversy often arises. The bill draws clear lines to avoid these problems.

While not using the word ‘intending’ anywhere, its implications are nevertheless clear. Firstly, it categorically states that donors, at the time of donation, and surrogate mothers, after delivery, shall relinquish all parental rights (s.33(3), 34(4)). Secondly, it bars the surrogate mother from also being an oocyte donor – in other words, traditional surrogacy (s.33(13)). In its most common form, this method involves the surrogate woman undergoing artificial insemination with donor sperm and was the primary method of impregnation before the onset of more recent techniques such as in vitro fertilization (IVF). The important difference here is that unlike in gestational surrogacy where the surrogate mother only carries the child, here she is also the genetic mother. This was evidently a potential source of legal complications and would have required the government to come up with a more detailed framework of the parties’ rights in such cases. A ban no doubt precludes the problem but it comes at the cost of the law being more restrictive than it is perhaps necessary to be. Finally, the wording of the provision (s.33(13)) has a potential loophole . It only mentions ‘oocyte’ and not ‘ooplasm’ (the content of the oocyte barring the outer membrane and nucleus), a distinction that has become important ever since ooplasm transfers started to be carried out. Thus, an individual can now end up having two genetic mothers; if the surrogate mother also ends up donating the ooplasm that is introduced into the recipient’s oocyte, that would in effect amount, at least in part, to traditional surrogacy through the backdoor and all the issues associated with it.

Foreign couples/NRIs would be required to appoint a local guardian to be legally entrusted with the surrogate mother’s welfare until the baby is handed over to them after delivery. They are also required to establish to the clinic through documentation their ability to take the child back with them (s.34(19)). This is probably in response to the recent Manji incident where a surrogate baby conceived by a Japanese couple was stuck in India following emigration issues of the baby and the father (thanks to Mr.Venkatesan for bringing it to attention). In the controversy that followed, several infirmities in the arrangement came to light including the absence of a legal contract between the parties, a fact that many saw as a worrying reminder of the potential for exploitation of native surrogates.

The bill allows individuals and unmarried couples to avail of this route to have children. There is also a provision (s.20(10)) that conception by surrogacy shall not be considered by any clinic if it would normally be possible to carry a baby to term. The disparate impact is obvious: a woman desiring a child would thus have to show that she is not capable of bearing one; a single man of course is free to conceive as and when he pleases. There is a broader ethical question here: is it wrong to have ‘designer babies’, a phenomenon this provision is ostensibly meant to prevent? If two people consensually seek to conceive a child with the woman, for whatever reason, not wanting to go through the trouble of carrying it unto delivery, what is the state’s interest in preventing it given that it has no problem permitting surrogacy regardless of the family arrangement of the concerned individuals?

There is also a restriction on ART clinics from providing any information ‘about surrogate mothers or potential surrogate mothers to any person’ (s.34(14)). Parties seeking a surrogate mother thus have to either advertise (permitted under s.34(7)) or approach middlemen. It may not be unwise for ART clinics to stay clear of matchmaking but for those looking for a surrogate, it would be of benefit to have a reliable source of information regarding potential candidates. If he/she/they are investing so heavily in it, it is only fair to them to be able to select someone from a list by reviewing their attributes and ‘past performance’. Also, the strict confidentiality requirements of s.34(12) and s.34(14) would render it difficult for a private entity outside the purview of this law to fulfill this role given their inability to access information even for verification purposes. Introducing a caveat on the lines of s.33(2) (that applies to donors) allowing for the release of personal information at the discretion of the surrogate might allow for such a prospect in the future.

Clarification: In the comments section, I made a point that gay couples would have to adopt a child post-birth as there is no provision in the act for a gay couple to have a child. In doing so, I gave the example of heterosexual couples who adopt children when one of the genetic parents happens to be an external donor. I said ‘My understanding is that this bill does not seek to change that arrangement…” I wish to clarify that while this arrangement will continue to hold for gay couples, the situation will change for heterosexual couples (both married and unmarried) should this bill pass to become law. Under s.32(2), informed consent is mandatory for both partners (in case of a married or unmarried couple); s. s.35(1) and 35(2) would automatically render the child the legitimate child of both parties.
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