Abstract
Is there any ethical justification for limiting the reproductive autonomy and not make assisted reproductive technologies available to certain prospective parents? We present and discuss the results of an interdisciplinary clinical ethics study concerning access to assisted reproductive technologies (ART) in situations which are considered as ethically problematic in France (overage or sick parents, surrogate motherhood). The study focused on the arguments that people in these situations put forward when requesting access to ART. It shows that requester’s arguments are based on sound ethical values, and that their legitimacy is at least as strong as that of those used by doctors to question access to ART. Results reveal that the three implicit normative arguments that founded the law in 1994, which are still in force after the bioethics law revision in July 2011—the welfare of the child, the illegitimacy of a “right to a child,” and the defense of the so called “social order”—are challenged on several grounds by requesters as reasons for limiting their reproductive autonomy. Although these results are limited to exceptional situations, they are of special interest insofar as they give voice to the requesters’ own ethical concerns in the ongoing political debate over access to ART.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Art L.2141-1, French Public Health Code.
Art L.2141-10, French Public Health Code.
For the purposes of this paper, the two terms are considered to be equivalent.
A provision that the law would be reviewed every 5 years was written into the first 1994 law, and carried over into the 2004 law, based on the principle that the law would have to be updated to reflect rapid scientific and technological progress in the field.
Kelly (1999) “Action research has two basic characteristics: to be "simultaneous" and "integrated": action and research proceed together and are integrated insofar as the collected data can enhance the comprehension of the people involved in the decision-making process itself.”
See the limit for reimbursement by public funding, fixed March 11, 2005 by the Union nationale des caisses d’assurance maladie, Livre II Classification commune des actes médicaux, § 09.02, JO du 30 mars 2005: the woman must be under 43 years. For what concerns the male age, the limit for the Centre d’études et de conservation des oeufs et du sperme (CECOS) of the Cochin hospital, who sent to us the major part of people that were included in our study, is 60 years. It must be noted that the limit recommended by the French Fédération Nationale des CECOS actually is of 55 years (http://www.cecos.org).
See, most recently: Cass. Civ. 1ère, April 6, 2011 (3 rulings), Revue Dalloz 2011, p. 1522; commentary by L. Brunet et D. Berthiau. C. Neirinck has published another commentary on the decision (comm. no 14. Droit de la famille. May 2011). For an overall analysis of French law in the area, see Brunet (2010).
For example, remarkably enough, one of the chief architects of the 2011 update to French bioethics legislation, the author of several important reports to Parliament, is a physician/MP, Jean Leonetti. He also exerted significant influence on the reception, in France, of the concept of "medical autonomy" when the French law on end-of-life care, commonly referred to as the "Leonetti Law", was up for vote.
See the dissenting opinion of four judges published following the ruling on S.H. v. Austria, § 13. See also on this point Hervieu (2011).
References
Actes du Colloque. 1985. Génétique, procréation et droit. Arles: Actes Sud.
Brunet, L. 2010. La Gestation pour autrui: entre le marteau (de la loi) et l’enclume (des pratiques). Revue Lamy Droit Civil, pp. 75–83.
Cobb, R.W., and C.D. Elder. 1983. Participation in American politics: The dynamic of agenda building. Baltimore: John Hopkins University Press.
Charmaz, K. 2006. Constructing grounded theory. London: Sage Publications.
Engeli, I. 2010. Les politiques de la reproduction. Les politiques d’avortement et de procréation médicalement assistée en France et en Suisse. Paris: L’Harmattan.
Fournier, V., and M. Gaille. 2007. Approche par les principes, approche par les cas : sur le terrain, une complémentarité nécessaire et féconde. Ethique et santé 4: 126–130.
Fournier, V., E. Rari, R. Forde, G. Neitzke, R. Pegoraro, and A.J. Newson. 2009. Clinical ethics consultation in Europe: A comparative and ethical review of the role of patients. Clinical Ethics 4(3): 131–138.
Fournier, V. 2010. Le Bazar bioéthique. Quand les histoires de vie bouleversent la morale publique. Paris: Robert Laffont.
Glaser, B.G., and A. Strauss. 1967. The discovery of grounded theory. London: Sage Publications.
Herring, J. 2010. Medical law and ethics, 345. Oxford: Oxford University Press.
Hervieu, N. 2011. Recul de la Grande Chambre de la Cour européenne des droits de l’homme sur les techniques de procréation médicalement assistée (PMA). Lettre Actualités Droits-Libertés du CREDOF. November 6th.
Kelly, A. 1999. Action research: What is it and what it can do? In Qualitative research, vol. 4, ed. A. Bryman, and R.G. Burgess, 201–219. London: Sage Publications.
Mehl, D. 1999. Naître? La controverse bioéthique. Montrouge: Bayard Editions.
Mehl, D. 2008. Enfants du don. Procréation médicalement assistée: parents et enfants témoignent. Paris: Robert Laffont.
Mehl, D. 2011. Les lois de l’enfantement. Procréation et politique en France (1982–2011). Paris: SciencesPo. Les Presses de Sciences Po.
Merchant, J. 2003. Féminismes américains et reproductive rights/droits de la procréation. Le Mouvement Social 203: 55–87.
Montpetit, E. 2005. The politics of biotechnology in North America and Europe. Lanham: Lexington Books.
Pennings, G. 2002. Reproductive tourism as moral pluralism in motion. Journal of Medical Ethics 28: 337–341.
Pidgeon, N. 1999. Grounded theory: Theoretical background. In Handbook of qualitative research methods, ed. John T.E. Richardson, 75–85. Oxford: Blackwell.
Pulman, B. 2010. Mille et une façons de faire des enfants. Paris: Calmann-Lévy.
Purdy, L. 2006. Women’s reproductive autonomy: Medicalisation and beyond. Journal of Medical Ethics 32: 287–291.
Rari, E., and V. Fournier. 2009. Strengths and limitations of considering patients as ethics “actors” equal to doctors: Reflections on the patients’ position in a French clinical ethics consultation setting. Clinical Ethics 4(3): 152–155.
Robertson, J.A. 1994. Children of choice: Freedom and the new reproductive technologies. Princeton: Princeton University Press.
Salter, B. 2007. The global politics of human embryonic stem cell science. Global Governance 13: 277–298.
Acknowledgments
We would like to thank the French Agency for bioethics that provided a grant to support our research, as well as the ART medical teams, patients’ associations and all the couples we met for their trust and cooperation in the course of the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fournier, V., Berthiau, D., d’Haussy, J. et al. Access to assisted reproductive technologies in France: the emergence of the patients’ voice. Med Health Care and Philos 16, 55–68 (2013). https://doi.org/10.1007/s11019-012-9402-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11019-012-9402-z