French Bioethics: Main Revisions Adopted by the Senate during First Reading

The vote for the first reading of the Bioethics law was held in the French Senate on February 4, 2020, passing by 10 votes (153 votes for, 143 against). Although we appreciate the attempts made to amend the draft law, it has not fundamentally changed.

The Senators have made one contradictory vote after another. In the end, this text is still unacceptable because of the serious injustices it inflicts on future generations by yielding to individualism and scientific technology. Ethics is supposed to protect human rights, life and human dignity but never before has a text on bioethics been so far removed from ethics. Nevertheless, all these new revisions could still be reformed during the second reading at the National Assembly, which is most likely to be held in April, although the exact date has not yet been confirmed.

Authorizing “ART without a father”, but health care reimbursement denied

The controversial subject of a number of discussions, Article 1, dealing with medically assisted procreation (the so-called “ART”) with a donor for female couples or a woman on her own, without a male partner, was finally adopted after considerable modifications. Some revisions previously recommended by the special committee were reintegrated, such as the criterion of medical infertility for heterosexual couples and the subsequent reimbursement for the procedures. On the other hand, the senators denied health care reimbursement of ART with a donor for single women or lesbian couples. The words asserting that “no one has the right to a child”, justifiably specified in the preamble to this same article, lose their forcefulness, when “ART without father” is made possible.

In view of these reforms for expanding ART, the senators have argued in vain to include a conscience clause for doctors and health care personnel who do not wish to be professionally involved in these procedures, regardless of the context. In addition, the national research infertility program, which was introduced by the deputies to study the causes and prevention of infertility, was abolished by the special committee under the pretext that it is not a legislative matter. Why not address the major health issue of infertility in its entirety, instead of focusing only on artificial procreation techniques, which are physically and psychologically burdensome for both women and couples? All the more surprising knowing that less than half of the couples resorting to ART have no child.

Nonetheless, the senators discussed the clause for double gamete donation and banned this practice. They also adopted an amendment to specify that only non-profit centers could be allowed to receive, store and freeze embryos. Previously, this stipulation had been deleted by the Senatorial special committee, which would have opened the door to the procreation market.

Gamete auto-preservation rejected

Article 2 for oocyte auto-preservation for women in the absence of any pathology, for procreation at a later date, by in vitro fertilization, was rejected.

The dilemma of lifting the anonymity for gamete donations

Another key measure hotly debated by the Senate was that of lifting the anonymity for gamete donations. The initial draft, approved by the National Assembly during the first reading, stipulated that the donor had to reveal his identity if the child requested it when he is 18. The Senators have amended this article to allow the donor the prerogative of whether or not to disclose his identity upon the child’s request. As a result of this significant modification, the so-called lifting of anonymity will not have much impact. This hypocritical situation is a ticking time bomb and extremely detrimental to the child.

Two maternal filiations denied

In the original text regarding ART requested by female couples, the rules to establish parentage purported to recognize both “women” as parents. The Senators rewrote this article and the establishment of either two maternal or two paternal filiations for the same child is no longer allowed.  The woman who gives birth will automatically be considered as the child’s mother, while a distinction will be made for the other woman, who must file for adoption of the child. Unmarried couples who live together or who have signed a civil solidarity agreement (“PACS”) are now allowed to adopt, with less complicated adoption procedures for the second partner.

Surrogacy – Civil Registry Transcriptions Prohibited

The issue of surrogacy, which had been discussed by the special committee, was raised again.

For children born abroad from surrogacy, the ban to transcribe the foreign birth certificates onto the French civil registry has indeed been maintained (after having been adopted by the committee). Nonetheless, the rapporteur, Muriel Jourda, filed an amendment to authorize the transcription of adoption rulings, without any reference to this unfair practice. For the record, in a recent case law, the Court of Cassation allowed the transcription in France for these birth certificates established abroad, despite the fact that surrogacy is a fraud against French law.

Articles 5, 6 and 7, relating respectively to transplants, donating hematopoietic stem cells and the consent requirement for persons under protective supervision, were all adopted.

Precautionary Principle for Bioethics Rejected

At the very beginning of the discussions, an amendment to include a precautionary approach in the law was rejected. The answer by the Keeper of the Seals, Nicole Belloubet is instructive: “the precautionary approach is both a system of assessing and implementing proportional and provisional measures in the event of serious and irreversible damage. However in bioethics I think we could endlessly question what constitutes a serious and irreversible attack; this would be difficult.”  This is exactly why this bill raises voices of concern and why our opposition is justified.

“Recreational” genetic testing and preconception screening refused

The Senate also voted to delete articles 10bis and 10ter, which had been adopted by the Special Committee. Article 10bis, initiated by the senator and rapporteur Olivier Henno (“Union Centriste Group”) would have allowed “recreational” genetic testing.  He had also tabled an amendment (article 10ter) to allow couples to have recourse to preconception screening “on an experimental basis“, meaning that both members of a couple could have their genetic characteristics analyzed, without any prior medical reason, to determine if they are “compatible” or whether there is a potential risk of transmitting a known genetic disease to their future children. Currently, preconception screening is very rarely practiced, only in cases where the family in question has a previous history of transmitting a genetic disease. The Health Minister, Agnès Buzyn, declared in support of deleting this article:  “This would eventually pressure everyone into feeling required to have this kind of test performed […] It portrays the image of a society where DNA controls everything, where man controls his descendants, the delusion of having future generations unscathed. “

Creation of Transgenic and Chimeric Embryos Denied

Although less mentioned in the media, research on human embryos remains an important issue in this bill.

Article 17, which proposed creating chimeric and transgenic embryos, was finally rejected by the senators. Thus, combining human embryonic cells or induced pluripotent stem cells (IPS) with animal embryos is allowed. Alliance VITA has been a whistle-blower to denounce these chimeras, especially since the general population was largely uninformed, partially due to the ambiguous and changing vocabulary used by its promoters. The bill does intend to allow research on artificial gametes, but a Senatorial amendment specified that artificial gametes (created from reprogrammed human cells, called IPS) cannot be fertilized to create an embryo.

Time period extended to 21 days for cultivating embryos for research

On the other hand, all the requests for regulating or restricting research on embryonic stem cells or human embryos were rejected. The Senate has proposed extending the research period on human embryos to 21 days, which is a very advanced stage of development, in particular for the nervous system. The deputies had voted for a maximum of 14 days. The current law specifies a limit of 7 days, a major symbolic date, since under natural conditions this is when the embryo is implanted in the maternal uterus.

Refusal to Extend Pre-implantation Genetic Diagnosis (PGD)

The PGD-HLA refers to performing pre-implantation genetic diagnosis (PGD) with tissue typing for human leukocyte antigen (HLA) to screen for compatibility. Also known as “savior babies” or “savior siblings”, it had been deleted by the National Assembly then reintroduced by the special committee. It was finally confirmed by the senators, who denied the requests to outlaw this ethically controversial procedure, which has not been practiced since 2014. PGD-HLA consists in a double selection process for embryos created by IVF. First the embryo must be free from the disease affecting a family member, and secondly it must be genetically compatible, in order to graft the stem cells obtained from the newborn “savior baby’s” umbilical cord to his sick elder. In previous bioethics legislation, this procedure was approved with the stated objective of accumulating a stock of cord blood cells, to avoid this.

The Senate did however vote to delete article 19ter, introduced by the special committee, which proposed pre-implantation diagnosis to screen embryos from IVF for aneuploidies (PGD-A), meaning an abnormal number of chromosomes, and thus including trisomy.  Already with PDG alone, less than 200 children are born annually with aneuploidies. The PGD-A technique would most likely bring further eugenic practices by screening embryos for non-hereditary and therefore unpredictable criteria.

Revised consciousness clause for doctors in the event of abortions for medical reasons

The Senatorial special committee deleted the specific conscience clause for healthcare personnel regarding abortion for medical reasons because it is already covered by the public health code for terminating pregnancy. Article L2212-8 states: “No midwife, nurse, medical assistant, or whomsoever, is required to contribute to terminating pregnancy for medical reasons.”). For doctors, however, the committee decided to maintain the measure in the governmental text, in alignment with the conscience clause on other abortions, which requires them to refer the patient to another practitioner. “A doctor is never required to carry out an abortion for medical reasons, but he must immediately inform the patient of his refusal and promptly refer the patient to other practitioners likely to perform this act.”  The senators also voted to abolish parental authorization for minors and to delete the proposed 7-day reflection period established by the initial bill.

Deleting the one-week reflection period prior to having an abortion for medical reasons, in addition to giving up the parental consent for minors, leads to further trivializing an act which has serious human and psychological consequences, to the detriment of alternatives such as welcoming and caring for sick or disabled newborns and their families.

 

 

Share This