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Assisted reproduction in Italy.

In Italy, artificial reproduction is not regulated by law. The Italian legislative statutes on reproductive technologies are limited to an old letter circulated by the Ministry of Health, which in March 1985 licensed public health facilities to perform only simple cases of IVF (those involving married couples and using the husband's sperm, leaving no surplus of embryos). Private centers remain in a legal void, unfettered by either law or morality. Owing to large differences of opinion concerning the nature of the family and of reproductive liberty, all of the bills introduced to address these matters have failed to pass. However, the discussion among bioethicists has grown increasingly vigorous, with new books and articles on the issues of procreative rights and on the status of the human embryo appearing constantly. Some cases given wide play by the media have also recently drawn the general public's attention to the consequences of a total legal void, in which all kinds of practices are defacto sanctioned.

The National Committee for Bio ethics (CNB) has been considering reproductive technologies since 1991, but only issued its recommendations on 17 June 1994. Due to the large variety of ethical theories and opinions held by the members, the committee's recommendations were not unanimous, although the members found common ground on several points.

The CNB unanimously recommended that practices of artificial reproduction inspired by racial prejudices be banned; that the practice of using gametes or embryos for artificial reproduction without the interested parties' consent be prohibited; that any commercial or industrial exploitation of gametes, embryos, or fetal tissues be banned, along with any form of compensation, brokerage, or advertisement; that embryo splitting, cloning, and ectogenesis with the object of procreation be forbidden; that the production of hybrids or chimeras and interspecific implantations be legally prohibited; that producing embryos solely for scientific purposes be forbidden.

However, these unanimous recommendations do not follow from a common understanding of the nature of the human embryo. In fact, some members believed that the human embryo should be treated as a person from the moment of conception, while others believe that the embryo cannot be a person, at least until the fourteenth day of its development. Moreover, some members from the first group believe that the personal dignity of the human embryo mandates that all practices of artificial reproduction be forbidden, while others in the same group are willing to accept homologous forms of in vitro fertilization, provided that all the embryos produced are transferred to the woman's womb and that no embryo is subjected to nontherapeutic experimentation. Opinion in the second group is also divided, as some members are willing to accept these limitations on IVF practices while others believe that a national commission should determine criteria to regulate specific cases of bio-medical experimentation on human embryos.

The same differences can be found with regard to access to the practices of artificial reproduction. In fact, while there is general agreement that it is best for a baby to be conceived and raised by a heterosexual couple in a deep and loving relationship, not all members draw similar normative conclusions. Most members believe that access to artificial reproduction should be denied to women who are postmenopausal, to homosexual couples, and to single women or widows. Others, however, while allowing that these limitations are the most important and pressing, would prefer to ban all donation or sale of gametes. A third group suggests a moratorium on postmenopausal pregnancies until more is known about their psychosocial consequences, and favors creating a commission to evaluate the requests made by single women.

As for contract pregnancy, all members agree that it should be considered generally inadvisable. However, while some members deem it absolutely immoral, others believe that it can be undertaken out of human altruism. There is universal agreement that contracts of this kind should not be legally enforced.

The CNB also agreed that not all its ethical recommendations should necessarily have legal enforcement and that, in any case, the law should guarantee to children born by artificial reproduction the same rights as all other children and citizens.

Finally, the CNB unanimously recommended that all centers practicing artificial reproduction should develop a consistent policy aimed at people seeking aid in procreation and at the general public, of publishing their rates of success and the inherent risks for each technique. The CNB also asked that a national official register of the centers be compiled and that every new protocol for artificial procreation be subjected to approval by an independent ethics committee.

Guidelines like these, introducing so many distinctions on various topics, might be seen as of little or no help in devising a consistent bill on the matter. However, it must be noted that the CNB was not entrusted with the preparation of the bill itself, but rather with giving ethical advice. Its task was thus to illuminate the areas in which consensus is more easily achieved, and to point out the topics that cannot be settled by rational discussion alone and need parliamentary assessment and voting.

The National Committee has identified the most difficult problems, suggesting different possibilities for resolving them and the reasons upholding each. The Parliament is now in a better position to devise a consistent policy on the matter, if not one that will please everyone. A Parliament with a prevailing sense of perplexity concerning new technologies of artificial reproduction will prudently set prohibitions where the members of CNB were not unanimous; a more liberally oriented Parliament will optimistically interpret the absence of unanimity as a license to sanction the practices not explicitly banned. - Paolo Cattorini, Director, Medical Humanities Department, S. Raffaele Hospital, Milan; Professor of Bioethics, Medical Faculty of Varese; and member, National Committee for Bioethics.

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Title Annotation:recommendations of the National Committee for Bioethics
Author:Cattorini, Paolo
Publication:The Hastings Center Report
Date:Nov 1, 1994
Previous Article:A new bioethics commission.
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