A Third Axis Of Potential Harms

[I’m continuing a discussion of potential harms that ought to be considered in determining how/when/whether to use third-party gametes for assisted reproduction.  This consideration starts a few posts ago and there are very lively comments if you want to get into that.]

I started this thread by thinking about the harm suffered by (some of) those who identify as donor-conceived and identified four potential harms.  I’ve given those names for ease of reference:   harms of concealment, medical harm, identity harm and loss of a parent.   Then I considered the harm of unwanted childlessness.     If you’ll look at that last post you’ll see that I laid this out as “the other side of the equation” but that is, I am afraid, descriptively inaccurate.  It presumes that there are two sides.

But if you consider that the topic is the use of third-party gametes, then surely there must be three sides to consider, right?   I think there are and so this post is about the potential harms that might warrant concern as you think about the providers of third-party gametes–those often called sperm donors and egg donors.   (There’s a long story behind the terminology–the bottom line is that I prefer to call them “providers.”)

Now I’ve been reading and thinking a lot about this subtopic quite a bit recently so there’s lots to say.  But for the moment I think I’ll start simply and keep it short.

For women who provide eggs for ART there are some clearly recognized medical risks.   That’s one set of harms (or perhaps more accurately, potential harms) to be considered.   I’m going to call these medical harms.   There are no analogous medical harms to consider for male gamete providers, which is something that might be worth noticing.

Beyond that, perhaps there is some sort of potential harm down the road that might be relevant for all gamete providers–something I’m going to call a regret harm.   What I mean here is that it is possible that those who provide gametes for third-party reproduction will come to regret their actions.   This is a tricky thing to figure in and likely a controversial one.  I’ll include it for the moment on the theory that it is better to lay everything out and then decide which things warrant what kind of weight.

There is certainly more to say about both these things, but for the moment I’ll just set them out and call it a start.

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30 responses to “A Third Axis Of Potential Harms

  1. You forgot that they are jeopardizing their own health and the health of other family members preventing them from knowing and being knowing to their children. They will lack their child’s health information for themselves and their other family members. Medical information is way more than a 2 way street its a non-stop, 24 hour-a-day, 7 days a week, 365 days a year information superhighway from birth to postmortem where the info about the child is every bit as important to the parent and parents relatives, as the parents and parent’s relatives is to the child. Its not something a person can write down and be done with as a one time only gig, nor is it something that can adequately be handled by genetic analysis and a 52 page report identifying what diseases they’ll probably get. Its not something we can trust ill relatives to update us on if we are not actually in their lives on a daily basis. Its incredibly foolish and selfish and shortsighted for a person to abandon their offspring they jeopardize their health and the health of their current and future relatives.

    • I’m not sure about this one. If I do not have any offspring, would anyone say that I am jeopardizing my health by not getting the information I might get by tracking the health of a child I might have? I don’t think so. So a person who provides gametes and does not get information about the health of the child is no worse off than a person who didn’t have any offspring at all.

      It may be an opportunity forgone–in other words, if you have a child and you do track health history, maybe there is a benefit. I say “maybe” because I’m not sure I’m persuaded about this. But I don’t see it as a an added risk.

      • Well here is where you stop making sense. We are not concerned about people that have no offspring right? They are not part of this discussion. People that do have offspring are biological parents and the health of their offspring is as critical a tip off to their own health issues as their health is a tip of to their offspring. They mirror one another and, like in my case a health problem with blood clots led them to test my parents which identified my father as the source of the trait and now I know my daughter has it and now my cousins know that they have it and because of this my father’s doctor had to modify his medicine and because of this my cousin was able to have a successful pregnancy because they treated her as high risk and gave her blood thinners and my daughter will also have that same chance at not having 13 (give or take a couple it was pretty traumatic) and a kid that lives not quite a full day.

        So if you have offspring keeping yourself and your family in the dark about your offspring’s health is every bit as much a problem as keeping your offspring in the dark about you. If you raised your offspring rather than giving them up and lets say you had a few kids, then you’d take them to the same pediatrician so that all the information about all of them would be at the doctors finger tips and if one of them turned out to have some disorder you’d have your other kids checked, maybe yourself and maybe your sister and her kids checked too.

  2. Julie – you need to diagram it all out with entities and bullet point harms beneath each entity, with sub-bullets after each harm.

    I like the way you are trying to break it down.

    I agree with Marilyn on the gamete providers family. It is seen in the adoption world quite often, not only the medical side but the feelings side of grandparents, siblings, etc.

    I also think perhaps you are starting to agree the anonymous route is fraught with harms.

    • Some sort of diagram is a good idea. I’m working on a larger/longer piece–something I hope will someday be a book–and perhaps an illustration of some sort is really what is called for. Not sure if I can pull that off here, but I’ll think about it.

      I just responded to Marilynn but reading your comment makes me realize I perhaps only really responded to part of her point (the part about health information gained by having an offspring.) There is this other potential harm–the one you allude to–that members of your family (parents, siblings) will have feelings about what you do. While that is something people might want to think about, I’m not sure what to do with it. I guess I’m thinking that the idea that your choices may not make your relatives happy is something we all live with all the time. Is this situation sufficiently different?

  3. No adopted ones I think its a strategic approach to document the harms because well watch

    We know already that Julie always responds to harm statements by saying something like “that may be how this person feels about it but it certainly is not how all people feel about it”. If the the harm statement happens to be an emotional harm then she will add to that response something akin to “and the harm here is debatable, its open for discussion, more research is needed…”

    So she’ll lay it out and I’m anticipating it will go like this
    Of all all the people on the planet who could be classified as donor conceived a percentage of them has voiced concern that they have experienced one or all of these four harms and only one of those harms is concrete enough to say that yes probablyu all donor conceived people are open to the possibility of harm that is of the provable sort. The remainder of this percentage of donor conceived people are voicing concerns about the way they reacted to a situation and while they perceive that as harm there certainly is no proof that they are actually harmed in any way.

    Take that in contrast to the harm of unwanted childness that was experienced by 100% of the people who chose to aleviate that harm by using ART. Those of them who successfully produced children were able to aleviate the harm of childlessness and a fraction of the children perceive that they have suffered some emotional harm from ART and that harm is still really open for debate.

    So really here we have this group that was harmed by childlessness not all are harmed and they aleviated that harm with ART and that is a good thing and some small percentage have a perceived harm. Let’s look at what we can do to mitigate the perception of harm by that small minority of people what can be done to address that problem without altering or “doing violence to” ART which has eleviated the harm of unwanted childlessness for so many. There is no real proof of any harm save for the potential harm should there be a medical need for an exchange of information so lets find a solution to fix that and then carry on – shall we?

    —————–
    Except that that is tactical bull shit intended to get adopted people and people that identify as DC into a docile and compliant pablam sucking brain dead inarticulate state – their rights are being trampled upon by this process they do not need to make it work they do not need to accommodate it in any way shape or form. Nobody with offspring should have the legal room to hide from them to abandon them without doing it in court in front of God and everyonne on paper. There would be no donors with 150 kids you can be sure of that. And there would be no identity release at 18 it would be full board identification take care of your kid or follow the same process as everyone else. Donor conception would come to a grinding halt without having to outlaw it. People would just not really do it if they had to give their resulting offspring up for adoption because they’d have to deal with the reality of what they are actually doing which is relinquishing their children to absolute freaking strangers. For God sake they’re doing it for money. They are doing it for money no less, Let them face that. Let them face their children and say that they donated them to a needy couple. Let them have some integrity and responsibility.

    No. There is no need to lay out all these harms and try to solve them mitigate the damage. Lets find a win win? No. No it is not ok to treat people unfairly just because there is no proof that they suffer from that unfair treatment that is a very vial kind of pre war german take on things I don’t think we should be ok with. I am particularly disturbed with any one who wants equal rights to marriage that cannot see the clear cut violation of equal rights for children here. The right to expect the same thing other children have a right to from their biological parents, support and their f-ing names or the law to hunt them down and call it abandonment. Nothing less is fair nothing less will do.

    • I’m not going to engage in a discussion of where I’ll come out here, but I will defend my method. I’m not trying to lull people into passivity or become docile.

      I think understanding the types of harms is important because it helps us understand the results of the choices, maybe helps us assess options for remedies. So for example (and I know I’m repeating myself here) the concealment harm is something that can be avoided even if you still have anonymous providers. You can recognize this harm and seek to minimize it in a variety of ways. But some of them will still leave you with other harms. Is that okay? It depends. And it might be that having donor information available to a child when the child reaches a specified age addresses some of the other harms–but it won’t address the loss of a parent harm. This means if I advocate for that sort of donor information release I’m not solving the whole problem and I need to acknowledge that. At the same time, I think it is important to realize that there are other interests besides those of the donor-conceived and we need to think about them, too. Maybe we have to make trade-offs in the end, but it’s better to recognize them than pretend they don’t exist. Specific attention to harms makes all of this possible.

      And I don’t intend to simply dismiss emotional/psychological harms out of hand. (I hope I have not done so in the past.) It is true that individual reactions vary and that might be important. It’s useful to know what sorts of reactions are common and what sorts are rare. And when claims are ade about what is common, I think we do need to ask about the validity of those claims. At the very least, I think it’s worth acknowledging that there is stuff we just don’t know. The experiences articulated by the more organized donor-conceived are important, I think, and need to be considered. I’m just not sure how representative they are. I’m not saying that because I’m about to discard them from consideration, but just to paint a fuller picture.

  4. I think, when discussing harm done to people from commercial activities, it is important to remember that the burden of proof for the safety of the product or procedure rests on the company, not on the public. Third party reproduction is a commercial activity carried out for profit. It is so called ‘treatment’ and in some countries (like Canada) sperm used for ART is classified as a drug. This use of medical language, is an ill-disguised attempt to sidestep the issue of reproductive responsibility.

    The question is, why with third party reproduction, the burden of proof for the safety of the ‘treatment’ has been reversed. It is the clients not the ‘fertility’ industry which have to prove that the procedure is safe.

    I think the reason is that the outcome of the ‘treatment’, the donor children, are considered more like objects than autonomous people with their own rights. I read an interview with a donor conceived boy and his mother. When she was disappointed with his academic performance she always told him how much she had paid for the sperm. He retaliated by deliberately failing his exams though he found them easy, simply because he resented being regarded as ‘ordered to specifications’.

    I believe that commodification of reproduction leads to ‘objectification’ of people, not only of the donor conceived but also of the donors and in the end of the ‘customers’ themselves.

    • I think your comment raises some good questions about the context in which ART operates. ART, particularly in the US, may indeed be driven by large commercial concerns. At the very least all the major gamete providers are probably commerical concerns (and all but one I can think of are for profit.) But they are tangled up with medical care. Now you might say that physicians involved in ART are also commercial actors and perhaps some (many?) are. But some (many?) are acting as medical professionals seeking to help their patients to better lives. And some ART is actually quite non-commercial–the home insemination with sperm from a friend?

      As a general matter, I’m not sure you are right in your initial statement about where the burden lies, although I sort of wish you were. I think I can sell something pretty freely unless/until someone shows it causes harm. At least that seems to be how things work in the US. I know there are different rules when you are talking about some sorts of medical treatments, but I’m not actually sure how that all works. Look at all the (to my mind, ridiculous) supplements sold all over the place. But this all may be beside the point.

      • “And some ART is actually quite non-commercial–the home insemination with sperm from a friend? ” not only is it non commercial, it isn’t even ART since it does’t involve any technology, and in fact a number of states such as california I think exclude it from sperm donor status.

        • Actually anything other than conception by intercourse is generally considered ART, even if the “T” is nothing more than a turkey baster. California and Washington (as well as a few other states) draw the line in this way–so that home insemination is on the ART side. It’s not so clear in a lot of other states.

          • I thought california law stated it had to be handled at some point by a licenced health professional? My memory must have mixed up with another state.
            Actually when searching for sperm donor statutes, the states that didn’t mention the licensed professional thing, didn’t define sperm donor at all. Kind of odd and makes the law very ambiguous. but maybe i was looking in the wrong place- you would know better than me.

            • The older Uniform Parentage Act (UPA) made the involvement of a doctor critical. If sperm was provided to a doctor, then the donor was not a father. No doctor and the donor was a father.

              Some states still have this scheme but the UPA was rewritten in 2000 and 2002 and addressed what came to be known as “the turkey baster problem”–by which they meant home insemination without any doctors present. The new UPA says no intercourse then not a father, end of story. About nine states (CA and WA among them, and I think TX, too) have this as their law. So you’re basically right, but the law changed out from under you–at least in some places. This is part of what makes it all so very confusing.

      • “I think I can sell something pretty freely unless/until someone shows it causes harm. ”

        And there it is. You will outline potential harms and demonstrate that no one can prove harm because each individual will have their own unique response to having been produced by methods classified under the ART umbrella.

        Your begging the question so that it sounds like your taking an objective look at concerns raised by people who identify as donor conceived when really its a set up to demonstrate that there is no reason to stop people from selling their genetic material or selling the genetic material of others.

        Your taking the pro-active position of someone concerned about the harm done to children produced this way. Your suggesting that we identify the potential harms to see if maybe gametes should not be sold. Then, you’ll arrive at the conclusion that it is not possible to prove that people will suffer harm if produced this way and therefore there is no reason to discontinue the sale of gametes. You’ll offer some helpful and productive measures for managing issues that might be perceived as causing harm by some people produced in this manner as a gesture of concern for their well being. That would be things like advising people to be honest about having used gametes and also making medical information available.

        You don’t have to engage in a discussion about where you’ll come out because that is easy enough to anticipate. I did not go to school but I figure this blog is some sort of laboratory where arguments are tested so you can generate an array of reactions similar to what you might get out there in the real world and then work on making your answers to those reactions really solid. Or abandon ship and try a different argument for achieving the same thing. I’m telling you I would still totally buy your book.

        • I don’t object to the selling of ones unneeded body tissue (Sperm that is). Its the redefinition of paternity that I oppose. You want to sell?? sell away. just don’t think that makes you any less a father. I’d say the same thing to the recipient- you want to buy? buy away. just don’t think the money you paid means anything to the kids identity. Or course, then, the trade would go down to near nonextistent.
          So I guess what I’m saying is taht I oppo se the government alloweing for a special class of laws that affect only acertain group of people, just to promote this type of business.
          I could imagine that the population replacement rate could drop so low that the government would be justified in promoting the creation of new people any which way , and even then, a lot of people would have a problems with that goal.
          but we aint there yet

          • I think it’s important not to lose sight of the core issue here–which is what you’ve flagged. What makes person a legal parent? If you think that genetic connection is what does it, then it seems to me it is hard to countenance the sale of sperm. It’s the functional equivilant of selling parental rights, which is the functional equivilant of selling a child. And we’ll all agree (I think) that you cannot sell children.

            This means that if you allow the sale of sperm you generally have to say that genetic connection is not what makes you a parent. (This is my view, for anyone who doesn’t already know that). It might be possible to say that it is okay to sell your sperm but you are still a legal parent of any child produced with the sperm, but that’s impractical. No one wants to buy sperm if it comes with a parent attached. What I mean is that the reason people buy sperm is to use it to have children that they (the people buying) will raise. They don’t want to raise a child with the man providing the sperm. If they did, they probably wouldn’t have to buy his sperm.

            • Actually, I feel there is a third view between “genetic connection makes a person a parent” and “genetic connection does not make a person a parent. ” I believe that the genetic connection makes a person a parent UNLESS they specifically sign away their rights. So I believe that, for example, a man who did not consent for his child to be given up for adoption, or a man who had sperm at the clinic to be given to his wife that was mistakingly given to someone else, are parents and should be legally recognized as parents, because they did not sign away the rights to be parents to their biological children. However, I believe that a willing sperm donor, or a person who freely signs a consent for their child to be given up for adoption, are not parents, because they have signed that right away, and should no longer be legally recognized as parents.

              Does that make sense? Basically, I believe that the biological parent should always be the legal parent UNLESS they have signed that right away.

              • There’s a couple of ways I might try to characterize what you are suggesting, but I don’t know if either captures what you are saying. Do tell me if I get it wrong–I’m not trying to assign any view to you. In any event, you are certainly right that there are more than two approachs.

                You might say that the genetic connection is the first determinant (or the default determinant) of legal parenthood. What that would mean is that you start with an assumption that the genetically connected person is a parent. But then you might allow something to displace that presumption–like the fact that the person was a sperm provider who didn’t intend to become a parent. I think that this view basically means you have two parallel sets of rules–one set of rules for ordinary conception and a different set of rules for ART with third-party gametes. In fact, this is not far from where the law is now in a lot of places, though you get complications from presumptions about marriage. (Let’s just agree to ignore those for now.)

                But you could also say something subtly different. You could say that a genetic connection always determines parenthood but that parenthood can be waived–given away or abandoned–by specified acts. This might end up in the same place–a sperm provider would not be the recognized legal parent of a child conceived by ART. But there a couple of differences that might matter. First, you’d have a uniform rule for all cases–genetics equal parentage. Uniform rules can be nice because when you have them (instead of two sets of rules, as above) you don’t have to figure out which set of rules will apply. Second, you will have created some rule about how parenthood can be waived or given away or something like that. Right now it isn’t that easy to step away from parenthood. So you’d either have to insert some fairly rigorous process for terminating parental rights in the sperm gathering phase of the operation or you could lower the standard and make it easier to terminate rights. If you did the latter then you’d have to decide when that easier method could be used–all the time or just in ART?

                It’s also possible you could make some sort of hybrid test of intent plus genetics. If you have genetics and no clear lack of intent, then you are a parent. If you have genetics and clear lack of intent, then you are not. This rule may take you places you don’t want to go outside of ART–a man who has sex and says quite clearly “no kids for me” might not be a parent if you had this rule, I think.

                All of these are possibly consistent with at least some of what you suggest and I’m sure there are other possibilities as well.

                • I’m kind of on the same page. I would say that the genetics is the default parent with some clearly delineated exceptions. I don’t know how to delinieate those exceptions but it should be clear that the exception is not meant to overrule the rule. Thus if a sperm donor was classifed as an exception, it couldn’t be used as a precedent for other circumstances that didn’t quite match the criteria, such as the one-night-stand guy or the so called donor-uncle etc.

                  • I think you might mean that whatever exceptions there are would have to be clearly defined and sharply delineated, lest they swallow the rule. If we all agreed that you did fall within the clearly defined exception, though, it would override the rule right–because otherwise the exception wouldn’t have any meaning? (I’m not trying to assign this point of view to you, just to be clear on what you mean.)

                    I think the hard project with this approach is that process of delineation. (Again–not to say you cannot take this view–I’m just thinking about it.) And even if you have good clear lines drawn, there will inevitably be cases that fall very close to the lines and those tend to be hard cases. This is always the way with law–any time you draw a line you know that there will be cases that are close to it.

                  • yes you understood me correctly

                  • but since the genetic would be the default rule unless clear exception criteria were met, in cases that were borderline, the genetic parent case would be much stronger. I would also like the langauge “exception ” or “exclusion” to be used explicitly.

              • I agree with you 99.9 % except I don’t think that private donor contracts should be enforced because they are not approved by the the court first. There is no homestudy or confirmation that no meny changed hands no confirmation that nobody was cooerced and worst of all the people raising the child usually don’t have any real proof the biological parent intended to donate their gametes. There is no original birth record that serves as a health record to even fight for.

          • 2nd what ki said

        • Please don’t take what I say out of context. I don’t think it’s fair to do that.

          My comment about ‘I can sell what I want unless I cause harm” was in response to a specific comment someone else made. I didn’t actually even tie it to ART–it’s a general observation about how our US regulatory system is structured. As such, I stand by it. (This is not the same as saying that I like it this way–maybe it would be better if you couldn’t sell something until you could prove it wasn’t harmful.) I did not mean to sweep away all the discussions of harm elsewhere in this dussion–I didn’t say a thing about ART harms in this context. You’re too quick to put the pieces together, I think.

          By the way, if you’re sure about where I’ll come out I’d love to know what you think.

          • OK, I’ll put the sentence that I quoted of yours back into the context I took it out of and we can start again:
            ————————————————————————————–

            “I think your comment raises some good questions about the context in which ART operates. ART, particularly in the US, may indeed be driven by large commercial concerns. At the very least all the major gamete providers are probably commerical concerns (and all but one I can think of are for profit.) But they are tangled up with medical care. Now you might say that physicians involved in ART are also commercial actors and perhaps some (many?) are. But some (many?) are acting as medical professionals seeking to help their patients to better lives. And some ART is actually quite non-commercial–the home insemination with sperm from a friend?

            As a general matter, I’m not sure you are right in your initial statement about where the burden lies, although I sort of wish you were. I think I can sell something pretty freely unless/until someone shows it causes harm. At least that seems to be how things work in the US. “

            ————————————————————————————–
            So first you aknowledge that physicians who vend sperm and eggs do it to help patients but are clearly also doing it for profit. The very next thing you say is:

            I think I can sell something pretty freely unless/until someone shows it causes harm. At least that seems to be how things work in the US. “

            So I read that as you telling the person who made the comment (and I’m paraphrasing in my not so eloquent way’Julie goes’:) “Look, is it such a bad thing for physicians to make a profit off of selling gametes? Obviously the doctors think they are helping patients by doing it and patients think they are being helped by physicians that sell gametes. Based on that it appears that gamete selling answers a need and solves a problem for patients. Unless someone can come up with some hard evidence that causes harm, I see no reason to stop the sale of eggs or sperm.”

            And there it is again. Only better this time. Thank you. I did not realize how totally perfect the entire thing was in context because your entire harm exercise is outlined in those very two paragraphs. There are doctors solving problems for their patients with the sale of gametes and this is America where you can sell anything you want unless it causes harm. Hell even if it does cause harm you can still sell stuff here in America, look at guns and cigarettes. You don’t see anyone shutting down the tobacco industry and like it or not someone’s always going to want to exercise their right to shoot a coke can off a fence. So unless someone comes along with some concrete harm that can’t be handled via damage control efforts – its status quo all the way.

            Am I wrong? Your interested in allowing the practice of gamete sale to continue are you not? You were just looking for a way to make those in favor of maintaining the status quo look sensitive and responsive to the needs of people that you’d define as having been conceived via ART. And that is not such a bad thing, to want to appear like the decision to leave things as they are was not arrived out without careful consideration for the well being of people conceived this way.

            In an earlier post of yours “Still thinking about the donor conceived, what causes harm” You question the perceived harms experienced by some donor conceived individuals. You think that public perception about donor conception heavily influences their feelings about themselves and that in time as donor conception becomes more common (if status quo is maintained) that we will see fewer of them having negative feelings about it themselves. I think the comparisons you drew were to like being gay or wearing glasses its one of those things you can become comfortable with as time passes.

            Where do I think you will come out with the harm excercise? Well people pay thousands of dollars a semester to sit and listen to you talk hoping they will learn some of what you know. People read your scholarly papers and take them seriously. I think that you would end up writing a paper that does not change the law. Which is what you want, but it seems like it would be not nearly as rewarding as having taken the time to write something that was the impetus for a major change in the law in the areas you care about like recognition of lesbian partners as second parents. I understand you need gamete donation to continue in some form in order to achieve that goal but you do have the wheels of commerce on your side for that. Anyway I think your paper will help nothing change in the world of gamete donation. Which is what you want. That is what I predict.

            • Ah–I see now.

              I’m going to short-circuit this discussion a bit–perhaps I was unclear. That original sentence of mine you quoted was meant to specifcally respond to Nelly’s comment where she said:

              I think, when discussing harm done to people from commercial activities, it is important to remember that the burden of proof for the safety of the product or procedure rests on the company, not on the public.

              I was disagreeing with that statement. (I put that after the stuff about ART that you quote here because I had started with more specific points and moved to more general points.) But really, all I meant to say at that moment is what I will now repeat–I am sorry to say that her description of where the burden lies isn’t an accurate one. Would that it were. I do not mean this generalization to forecast where I’m going in this specific discussion.

              Even if I’m not sure exactly what I’d propose, I can be fairly confident I will suggest changes to the law. As it stands the law is a total mess–inconsistent, incoherent and difficult for all involved. I am strongly inclined towards coherence and consistency, but I cannot quite figure out where that ends up. And it doesn’t pre-ordain specific answers to the harm question. It is certainly true that I don’t agree with you on the importance of the genetic link, but that doesn’t mean I think it is completely without meaning. What I’d really like to do is find a more nuanced solution–something that isn’t so black/white, on/off. That’s why being careful about descriptions and categories of harm and the like matter.

  5. The drug analogy is an interesting one. What percentage of users must report severe adverse effects before a drug is removed from the market?

  6. (although I wouldn’t classify it as a drug myself, so wouldn’t base any practices on the answer).

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