From time to time cases arise in ART that appear to cry out for regulation. (You can read about some of them elsewhere on this blog, though I fear I have not been entirely consistent in using the appropriate tag.) I’m not sure there’s really much of a debate about the need for some sort of regulation but, as is so often the case, the devil is in the details. Who will regulate? How will they regulate? What interests will be protected? Who will have a seat at the table?
There are several stories that cropped up (or at least came to my attention) recently that raise the regulation issue. In the not-so-distant past there’s the number of offspring problem. And this more recent story discussed the incidence of multiple births in IVF. (Fairly obviously, transferring more than one embryo increases the risks of twins, triplets, etc. There are many doctors who as a matter of practice will not transfer more than one embryo, but of course, plenty of others still do.) And this story about the prospect of ever more extensive pre-implantation genetic testing and the spectre of designer babies could also encourage regulation in that direction.
As I said, I don’t think the idea that some regulation of ART is needed is a particularly controversial one. The root problems posed are similar to those posed with regard to other medical care. Some for-profit medical providers (no matter what field of medicine we are talking about) will place their financial interest ahead of the patient’s interests. That might mean ordering unnecessary medical procedures or it might mean transferring multiple embryos. Either behavior is problematic. Someone has to set standards of care and perhaps has to actually enforce them. (Of course, there is some enforcement of ART standards already–the doctor in the notorious octomom case lost his license.)
But what exactly should regulations say? While it might typically be fine to only transfer one embryo, there are surely cases where prudent medical judgment would point towards transferring two. And while some efforts at designing a baby may be deeply disturbing, using PGD to select a fetus with a high likelihood of successful transfer and development seems eminently practical. And what should I make of proposed standards in Canada that would deny fertility treatment to obese women?
Then there’s the related question–who should make/enforce these regulations? One possibility is obviously some government-centered entity. I suppose that is rather like the UK model with the HFEA. (I believe the HFEA is still slated for abolition as a part of the conservative government’s budget cuts.) But thinking practically, enhanced government regulation isn’t terribly popular just now. And it’s clear that some government regulation can be frankly political–essentialy a thinly veiled effort to accomplish some other end. It’s just not a process that inspires competence.
Of course, one alternative is some form of self-regulation, which I think is what the ASRM tries to do. But commenters here have been clear about the reasons to mistrust self-regulation. While it isn’t doomed to failure, there is certainly a whiff of the fox guarding the henhouse.
I’m afraid I cannot close here with some terrific proposal for some grand plan. I think the most useful thing I can try to do here is to shift the discussion a little. I don’t think many people will argue against all regulation in general. What we need to talk about are those details.