Assisted Reproduction and Selective Reduction of Pregnancy

Abstract

The question of multiple pregnancies came into public debate when septuplets were born to a mother in Liverpool and none survived. The question arises as to whether it is ethical and legally appropriate to carry out a selective reduction of pregnancy, i.e., to destroy 1 or more fetuses in order to give the remaining fetus or fetuses a better chance at survival. In terms of the law, the fetuses are not live being, with the benefit of full legal protection. While it is too immature to be viable, any fetus may be legally aborted as long as the terms of the 1967 Abortion Act are met. Each year in the UK some 170,000 abortions are performed, and it appears that the selective killing of some immature and nonviable fetuses in the womb could come within the terms of the 1967 Abortion Act. The Voluntary Licensing Authority announced in May 1987 its intention to impose restrictions on in-vitro fertilization (IVF) on the number of implants/cycle, with a view toward curbing the frequency of multiple pregnancies and to reduce the need for selective reduction of pregnancy. The new guidelines now provide that "if the IVF procedure is used no more than 3 pre-embryos should be transferred in any cycle, unless there are exceptional clinical reasons when up to 4 pre-embryos may be replaced per cycle. If the GIFT (gamete intrafallopian transfer) procedure is used no more than 3 or exceptionally 4 eggs should be introduced to the fallopian tubes." There is no maximum regarding the dose of a drug used in the treatment of infertility, although such a drug may give rise to multiple pregnancies. According to the guidelines, each center should have access to an ethical committee, and no procedure should be undertaken without the knowledge and consent of the ethical committee. Professor Ian Craft, supported by his team at the private Humana Hospital in Wellington, voiced his unwillingness to abide by the new guidelines. He maintains that only the doctor and the patient or the couple should decide the number of implants. Craft thinks that the new guidelines will unfairly deprive some women of the chance of pregnancy. The Humana Hospital's ethical committee has since agreed to abide by the 1987 guidelines, but Craft hopes to influence the Voluntary Licensing Authority to revert to a more flexible approach. Selective reduction has been carried out for at least the past 5 years in several hospitals in the UK, but apparently and surprisingly not under the 1967 Abortion Act. Doctors undertaking selective reduction claim that there is no abortion or miscarriage and that no termination of pregnancy is intended or occurs. If selective abortion would have satisfied the requirements of the 1967 Act, the breaches of the law are, strictly speaking, technical. The question of whether selective reduction of pregnancy comes within section 58 of the 1861 Offenses Against the Person Act has not been tested in the courts.