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Head to head: The need for a father?
IVF insemination
Should everyone have access to IVF?
Earlier this week, UK ministers gave their clearest indication yet that IVF clinics will not be able to refuse to treat single women and lesbians.

Here, two commentators present their views on what is important when deciding what is in the best interests of a child conceived through IVF.

Daniel Sokol, medical ethicist at Imperial College, London

Discrimination is a dirty word, but the question should not be avoided: when is discrimination in IVF treatment justified?

Few would allow convicted paedophiles to get IVF treatment, however discriminatory this may be.

Although there is scant scientific evidence to support it, it is highly probable that paedophiles make rotten parents.

Should we also discriminate against infertile heroin-addicts and alcoholics?

Unless we adopt a sky-high threshold when considering the welfare of the future child, it seems right to eradicate the 'need for a father' clause
Daniel Sokol

What about a terminally ill single woman whose greatest wish is to have a child in her last years of life?

The simple answer is that discrimination is justified if the resulting child is likely to have an unacceptably low quality of life (the 'welfare of the child' consideration).

And therein lie the disagreements: what constitutes an unacceptably low quality of life?

The answer to that question is not objective, but value-laden.

It will vary from person to person, culture to culture.

A bearable life?

In some parts of the developing world, where fathers are the sole bread winners and cultural norms require a father to head the family unit, a fatherless child will be at a greater disadvantage than an equivalent child elsewhere.

In this country, one could argue that a fatherless child has a perfectly acceptable quality of life, and likewise for children of older mothers.

The decision to grant IVF treatment based on child welfare considerations will depend on the chosen threshold of 'child welfare'.

If the threshold is low, then we should provide IVF to problem gamblers, alcoholics, and other types whose children would probably have a bearable quality of life.

If the threshold is higher, then a 'bearable' life is simply not good enough and thus drug users, chronic gamblers and alcoholics are off the list.

'Quality' of life

But how can this be proved? How can we predict how a particular child will fare in life?

Does showing a child who, despite his cocaine-snorting, terminally ill, physically abusive, and alcoholic mother, went on to gain a PhD at Oxford University and became a high-flying lawyer, sufficient justification to allow such women to have IVF?

No research study will tell the IVF doctor how that particular child will turn out or how competently specific individuals will bring up their offspring.

Scientific research simply give doctors broad indications of outcomes, usually based on small samples.

In other words, the decision will inevitably require doctors to exercise judgement in balancing probabilities and, as a result, will contain an element of risk.

Do children born to single women or lesbians have an acceptable quality of life?

I have not doubt that they do, although I would not be surprised if, other things being equal, a child born to a single woman experiences more hardships than a child with two parents - at least that is what common sense dictates.

Yet, unless we adopt a sky-high threshold when considering the welfare of the future child, it seems right to eradicate the 'need for a father' clause.

Josephine Quintavalle, founder of Comment on Reproductive Ethics

Let me declare immediately that I am a great fan of fatherhood, and consider it a complex role which goes way beyond the biological act of a male providing sperm to fertilise the human egg.

Society in general, whilst reluctant to reduce the role of the male simply to the act of fertilisation, tends to get distracted with the economics of naughty dads and the Child Support Agency, rather than address anything more meaningful.

With Fathers' Rights Groups never more than a frustrated powder-throw away, I feel we would do well to encourage a much deeper discussion.

the child itself might later also feel discriminated against if created deliberately without one or other of the traditional parents
Josephine Quintavalle

The current debate, however, is not about the role of fathers per se, but about how they are referred to in the Human Fertilisation & Embryology Act, and whether their inclusion in Para.13. (5) represents an unacceptable gesture of discrimination.

For this reason I think we should keep our focus very clearly on the Act itself and also consider briefly what actually happens when it comes to the provision of IVF treatment for single women.

The first point to make is that the Act does not state that a child absolutely must have a father, it simply recommends that account must be taken of its need for one.

Once 'account' (a legal weasel if ever there was one) is taken, this recommendation can then be easily ignored, as has regularly happened since 1990.

Little evidence of discrimination

Which is my second point. There has been no shortage of IVF licences provided to single women since the Act came in to play, although inevitably the vast majority of treatments are provided to women with male partners. Evidence of discrimination in this field is not convincing.

In April 1998 Ruth Deech, at the head of the Human Fertilisation & Embryology Authority, wrote to CORE, that as "the actual presence of a father is not required, it may be that this requirement can be satisfied through the woman's network of family or friends".

She also stated that the Act does not exclude any category of woman from receiving licensed treatments.

Playing the gender discrimination card in the field of human reproduction is immensely difficult because at the very least three people are involved, all with the ability to feel offended.

If we take 'father' out of the Act, should we also revisit the child's need for a 'mother' as well.

You would be surprised how many times mothers and fathers are mentioned in the Act.

And the child itself might later also feel discriminated against if created deliberately without one or other of the traditional parents.

I am in favour of keeping the law as it is in this regard. Poor old dads.

The wording in the Act is nothing more than a token gesture towards their importance in the reproductive triangle. It is silly political correctness to suggest otherwise.

How fertility laws might change
16 Aug 05 |  Health
Lesbian couple want 'rare IVF'
19 Apr 05 |  Health

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