Thinking ethically about genetic inheritance: liberal rights, communitarianism and the right to privacy for parents of donor insemination children

The issue of genetic inheritance, and particularly the contradictory rights of donors, recipients and donor offspring as to the disclosure of donor identities, is ethically complicated. Donors, donor offspring and parents of donor offspring may appeal to individual rights for confidentiality or disclosure within legal systems based on liberal rights discourse. This paper explores the ethical issues of non-disclosure of genetic inheritance by contrasting two principle models used to articulate the problem--liberal and communitarian ethical models. It argues that whilst the latter provides a more constructive avenue to providing an ethics for donation than the competing and contradictory positions represented in a liberal rights approach, it raises issues of ethical judgement and authority that remain problematic. This ethical discussion is supported by a field study, funded by the Wellcome Trust, exploring the perceptions and experiences of recipients of donor sperm and their partners towards donor anonymity. The field study provides the empirical basis of an argument for making ethical judgements on the grounds of the community good rather than individual rights, that nevertheless recognises that both are inherently problematic.

The (ir)relevance of genetics: engendering parallel worlds of procreation and reproduction

Informing offspring of the nature of their conception when conceived via donated gametes such as donor sperm, is increasingly considered by professionals and policy makers to be desirable for many reasons. The aim of this research is to explore and understand processes within families that either facilitate or hinder the telling of children about their conception. This exploration includes analysing the complexity of sociocultural processes surrounding parents' attempts to make sense of, and construct meanings of 'family'. We analyse the stories of a group of New Zealand parents, representing 41 families, who have formed their families with the assistance of donor insemination. The analysis takes its point of departure from current sociological and anthropological debates in the field of kinship, or family studies. We argue that parents generate a parallel construct whereby genetic inheritance is seen to be simultaneously irrelevant (to the constitution of the family), and yet at the same time relevant (in highly bounded domains, for example related to medically specified conditions). We analyse the ambiguities of interpreting this construct as one reflecting a separation of procreation from the process of reproduction, and reflect on the implications for information-sharing.

Topic avoidance and family functioning in families conceived with donor insemination

BACKGROUND

While a move away from non-disclosure and secrecy toward more openness is demonstrated in the changing practices of donor insemination worldwide, scholars and practitioners continue to debate the effects of disclosure versus secrecy. This study examines if an association exists between adult donor offspring's perceptions of their parents' use of topic avoidance to maintain secrecy, and their perceptions of their family's functioning.

METHODS

Using a cross-sectional design, a convenience sample of 69 young adult donor offspring completed a demographic questionnaire, a topic avoidance scale relative to each of their rearing parents, and the Beavers Self Report Family Instrument.

RESULTS

There was a moderate significant inverse correlation between family functioning and topic avoidance in general, as well as for donor insemination-related topics, for both mothers (r = -0.55, r = -0.40, respectively, P <or= 0.01) and fathers (r = -0.53, r = -0.50, respectively, P <or= 0.01), even after controlling for demographic variables. Disclosure by both parents jointly was associated with higher family functioning than disclosure under other circumstances.

CONCLUSIONS

While this study is limited by the convenience sampling, the correlational design and measuring offspring's subjective perceptions, findings suggest that the information about donor conception should not be held secret from offspring and that the parents should disclose jointly.

Families working it out: adolescents' views on communicating about donor-assisted conception

BACKGROUND

Prompted by legislation in Victoria, Australia, permitting gamete donors to seek identifying details of people conceived from their gametes, this research investigated the views of adolescents from the general population on how parents can best talk to their donor-conceived adolescent children about their conception.

METHODS

Qualitative interviews (six group discussions, n = two to six per group, and one individual interview) lasting c. 50 min with 25 secondary school students.

RESULTS

Naïve adolescents had views largely consistent with those of donor-conceived adults, for example, urging parental honesty, adaptation to individual children, and family cohesion. They identified the social father as the parent while acknowledging the significance of genetic connection to the donor. A minority asserted a preference for non-disclosure; all said that, if disclosed, it should be by parents.

CONCLUSIONS

This small study contributes to increasing understanding of communication within families about donor-assisted conception.

Becoming a mother by non-anonymous egg donation: secrecy and the relationship between egg recipient, egg donor and egg donation child

The object of the study was to investigate secrecy in non-anonymous egg donation, to explore some characteristics of this kind of egg donation arrangement and the relationship of the recipient with her non-genetic child. Forty-four egg recipients and 62 IVF patients with a child conceived through egg donation and/or IVF were recruited. A semi-structured questionnaire was sent to all the participants. Chi-square and T-tests were used to examine the differences between the groups. There were no significant differences on the following aspects. The same high proportion of egg donation mothers (77%) and IVF mothers (87%) had the intention of telling their child about the conception but most women thought disclosure at a later time preferable. Two thirds of the recipients and IVF mothers said the way of conception had no influence on the relationship with their child. The two groups differed however in their argumentation about secrecy and named different feelings. Egg donation mothers expressed more denial and showed more defensive reactions, anxieties and uncertainty. It is suggested that recognition of a certain difference between a natural conception and egg donation could be helpful in early disclosure and could help to diminish anxieties in egg donation mothers.

Strategies for disclosure: how parents approach telling their children that they were conceived with donor gametes

OBJECTIVE

To describe how parents envision, plan, and enact disclosing to their children that they were conceived with donor gametes.

DESIGN

In-depth ethnographic interviews.

SETTING

Participants were recruited from 11 medical infertility practices and 1 sperm bank in Northern California.

PATIENT(S)

A total of 141 married couples who had conceived a child using donor gametes (62 with donor sperm and 79 with donor oocytes).

INTERVENTION(S)

Husbands and wives were interviewed together and separately.

MAIN OUTCOME MEASURE(S)

Thematic analysis of interview transcripts.

RESULT(S)

Disclosing parents predominantly subscribed to one of two disclosure strategies: the conviction that early disclosure is of paramount importance so that the child "always knows," or the belief that later disclosure is preferable after family routines have been established and the child has the maturity to understand biologic concepts and has developed a sense of discretion. No parent regretted disclosing, and many expressed relief.

CONCLUSION(S)

Parents choosing early disclosure were more at ease with the disclosure process, whereas parents choosing later disclosure reported greater uncertainty about how and when to disclose. Parents wished for more peer and/or professional support and guidance to assist them with disclosure, not only initially but continuing long after their children were born.

Constructing families and kinship through donor insemination

This paper presents some central findings of an exploratory qualitative study of New Zealand families with children conceived by donor insemination (DI). Drawing on social anthropological and sociological theorising about kinship and contemporary Western families, the paper explores the ways in which parents and their kin actively construct parent-child relationships and kin connections through the notions of biological and social ties, nature and nurture. The paper discusses three major themes emerging from the data: the social construction of the 'natural facts' of procreation, physical resemblance, and the construction of families through choice, not biology. Whilst the primacy of biological or genetic connection is a powerful cultural theme, particularly evident in the ambiguities and uncertainties for social fathers and their kin, these families also deconstruct this notion. Drawing simultaneously on the power of social and biological connection, using biology as a metaphor for social relations, or by privileging social ties and the formation of families through choice, over time these families strategically establish themselves as the sole parents and kin of their children conceived by DI.

Non-genetic and non-gestational parenthood: consequences for parent-child relationships and the psychological well-being of mothers, fathers and children at age 3

BACKGROUND

Findings are presented of the third phase of a longitudinal study of children conceived by assisted reproduction procedures involving surrogacy and/or donor conception.

METHODS

At the time of the child's third birthday, 34 surrogacy families, 41 donor insemination families and 41 oocyte donation families were compared with 67 natural conception families on standardized interview and questionnaire measures of the psychological well-being of the parents, mother-child relationships and the psychological well-being of the child.

RESULTS

The differences found between family types reflected higher levels of warmth and interaction between mothers and their 3-year-old children in assisted reproduction families than in families with a naturally conceived child. A higher proportion of surrogacy parents than donor conception parents had told their children about the nature of their birth.

CONCLUSIONS

It appears that the absence of a genetic and/or gestational link between parents and their child does not have a negative impact on parent-child relationships or the psychological well-being of mothers, fathers or children at age 3.

Helping parents to tell their children about the use of donor insemination (DI) and determining their opinions about open-identity sperm donors

OBJECTIVE

To look at the level of compliance with Swedish law whether or not parents intend to tell their child about donor insemination. We also wanted to look at the parents' attitudes towards open-identity sperm donors and at relationships within the family.

METHOD

All parents who were treated and gave birth to a child through donor insemination from 1997 to 2003 were included in the study. Sixteen of 20 couples (80%) were willing to take part in an interview, where the men and women were interviewed separately. The children of these couples had an average age of 2.9 years.

RESULTS

Three of the 16 couples had told their child about donor insemination and 9 couples intended to tell the child when he/she was older. Thus 12 couples (75%) had disclosed or planned to inform their child in the future. Fourteen of 16 couples had told others about the donor insemination. The majority (21 of 31 individuals) had a positive attitude towards open-identity for sperm donors and 16 of 31 would have chosen an open-identity sperm donor if they had had the choice between that and an anonymous donor. All the parents felt they had an equal relationship with their child.

CONCLUSION

Couples who conceived a child through donor insemination are open about the donor insemination, both to other people in their surroundings and in their intention to tell the child. These families seem to be functioning well with relaxed attitudes towards the donor insemination process.

From a social issue to policy: Social work's advocacy for the rights of donor conceived people to genetic origins information in the United Kingdom

This paper outlines a 22 year campaign to introduce openness into the arena of donor conception in the UK. It identifies key aspects of the development of an advocacy based approach to such work and argues that social work values and principles can prove key to identifying structural inequalities which are not necessarily based in socio-economic disadvantage. Donor conceived people may find themselves in families which enjoy material privilege but whose exposure to a legislative framework and dominant professional cultures within the treatment centres encourages secrecy around genetic origins. Social workers' experience of adoption and family work leads them to recognise the danger of such secrets within families. Turning such social issues into policy changes requires vision, strategic long term advocacy and partnership with those directly affected.

Is blood really thicker than water? Assisted reproduction and its impact on our thinking about family

The traditional notion that a family is built around and based on blood or genetic ties is challenged when assisted human reproduction utilizing donor gametes is used. A focus on the family--in contrast to the individual--requires from medicine an extension of thinking in which a model that incorporates treating infertility and building a family becomes the norm. Such a model will require that attention is given to the psychological and social needs of the would-be parents, thus enabling them to approach their family building with confidence. This confidence is expected to carry through to their sharing with their offspring the nature of their family building and thus avoid the stigma that leads to secrecy. Research relating to dimensions of family building when donor insemination has been used is reviewed. The impact of professional attitudes, along with the policies adopted by governments concerning access to genetic information for offspring, significantly influences the families built with assistance of donor gametes or embryos. The evolution of professional thinking in this area is reviewed, along with the increasing involvement of governments.

The national lesbian family study: 4. Interviews with the 10-year-old children

This 4th report from a longitudinal study of U.S. lesbian families presents data from 78 families in which the children were conceived by donor insemination. Results indicate that the prevalence of physical and sexual abuse in these children was lower than national norms. In social and psychological development, the children were comparable to children raised in heterosexual families. Children of unknown donors were indistinguishable from those with known donors in psychological adjustment. In total, 57% of the children were completely out to their peers, and 43% had experienced homophobia. The children demonstrated a sophisticated understanding of diversity and tolerance.

Solo mothers and their donor insemination infants: follow-up at age 2 years

BACKGROUND

Findings are presented of the second phase of a longitudinal study of solo-mother families created through donor insemination (DI).

METHODS

At the time of the child's second birthday, 21 solo DI mother families were compared with 46 married DI families on standardized interview and questionnaire measures of the psychological well being of the mothers, mother-child relationships and the psychological development of the child.

RESULTS

The solo DI mothers showed greater pleasure in their child and lower levels of anger accompanied by a perception of their child as less 'clingy'. Fewer emotional and behavioural difficulties were shown by children of solo than married DI mothers.

CONCLUSIONS

The findings from this first cohort of solo DI families to be studied lend further weight to the view that these women represent a distinct subgroup of single parents, who, out of a strong desire for a child, have made the active choice to go it alone. Moreover, this route to parenthood does not necessarily seem to have an adverse effect on mothers' parenting ability or the psychological adjustment of the child.

Families created by gamete donation: follow-up at age 2

BACKGROUND

Findings are presented of the second phase of a longitudinal study of families created through gamete donation.

METHODS

At the time of the child's second birthday, 46 donor insemination families and 48 egg donation families were compared with 68 natural conception families on standardized interview and questionnaire measures of the psychological well being of the parents, parent-child relationships and the psychological development of the child.

RESULTS

The gamete donation mothers showed a trend towards greater pleasure in their child accompanied by a perception of their child as more vulnerable, with egg donation mothers tending towards greater pleasure and donor insemination mothers tending towards greater concern. The fathers did not differ on any of the variables under study.

CONCLUSIONS

The findings from this recent cohort add further weight to the growing body of research showing that the absence of a genetic link between a parent and a child does not necessarily jeopardize the development of a positive relationship between them.

Adolescents with open-identity sperm donors: reports from 12–17 year olds

BACKGROUND

Donor insemination programs can include 'open-identity' sperm donors, who are willing to release their identities to adult offspring. We report findings from adolescent offspring who have open-identity donors.

METHODS

Using mail-back questionnaires, youths from 29 households (41.4% headed by lesbian couples, 37.9% by single women, 20.7% by heterosexual couples) reported their experience growing up knowing how they were conceived and their interest in the donor's identity.

RESULTS

Most youths (75.9%) reported always knowing, and were somewhat to very comfortable with their conception origins. All but one felt knowing had a neutral to positive impact on their relationship with their birth mother and, separately, co-parent. The youths' top question about the donor was, 'What's he like?' and >80% felt at least moderately likely to request his identity and pursue contact. Finally, of those who might contact the donor, 82.8% would do so to learn more about him, with many believing it would help them learn more about themselves. No youth reported wanting money and few (6.9%) wanted a father/child relationship. We also discuss differences found among youths from different household types.

CONCLUSIONS

The majority of the youths felt comfortable with their origins and planned to obtain their donor's identity, although not necessarily at age 18.

Parenting infants conceived by gamete donation

In recent years, concerns have been raised regarding the potentially negative consequences of gamete donation for parent-child relationships. Findings are presented of a study of families with an infant conceived by gamete donation. Fifty donor insemination families and 51 egg donation families were compared with 80 natural conception families on standardized interview and questionnaire measures of the psychological well-being of the parents, the quality of parent-child relationships, and infant temperament. The differences that were identified indicated more positive parent-child relationships among the gamete donation than the natural conception parents, accompanied by greater emotional involvement with the child. Comparisons were also carried out between the donor insemination and the egg donation parents on their experiences of gamete donation. In contrast to the findings of earlier investigations, the donor insemination and egg donation parents appeared to be more open toward disclosing the donor conception to the child. It was concluded that infants conceived by egg or sperm donation did not appear to be at risk for parenting difficulties.

Donor insemination: the secret experiment

This paper gives an overview of the research that has been done into people created by donor insemination (DI) (note 1), shows how the secretive way DI is carried out makes objective knowledge of their situation impossible to obtain and describes how doctors support this secrecy. It argues that DI is a social experiment whose potential justifications are implicit theories that have either been falsified or are unfalsifiable, and that consequently DI is conducted unscientifically and unethically. In conclusion, it questions the integrity of the industry and the institutions that support it, and considers where we should go from here.

Why adoption is not an option in India: the visibility of infertility, the secrecy of donor insemination, and other cultural complexities

Child adoption in the face of reproduction gone awry continues to remain an under researched aspect of contemporary Indian reality. This paper seeks to unpack some of the critical cultural issues underscoring the deep-seated reluctance towards adoption. Drawing on a larger multi-sited research project examining the experience of infertility and assisted conception in India, the paper sheds light on the state of current adoption practices in India. Thus, when faced with infertility, couples in this research emerged as favouring secret gamete donation as a means of bypassing infertility rather than the option of adoption. Invoking the concept of systematic misrecognition, the paper situates the modalities of salvaging infertility, either through medically assisted conception or adoption, as structuring infertile people's quest for children. The paper relates the perceived stigma associated with infertility treatment and adoption with the inclusion of a "third party" that fractures the culturally conceptualized boundaries of family as inextricably tied to the conjugal bond. It is therefore argued that secrecy is born out of a need to obfuscate a "public and visible" violation of a culturally priced ideal that views an intimate connection between the "married body" and the progeny. Adoption continues to remain an undesirable option because the links between an adopted child and the social parent become a public, vocal, and visible admission of infertility that cannot be subsumed, like donated gamete conception, under a conspiracy of silence.

A group-work approach in family building by donor insemination: empowering the marginalized

Family building with donor insemination (DI) is often perceived as stigmatizing and the secrecy surrounding the practice contributes to this perception. In recent years, patient organizations in several countries have started to challenge this stigma and marginalization. This paper reports on a professional group-work approach for couples in Germany using DI. Participants of four seminars with a total of 74 participants and a return rate of 89% were asked to report on their expectations of and experiences during the seminars. Participants were asked to comment on their views and perspectives regarding DI practice. The results indicate a need for more information on DI and for the opportunity to meet other couples in the same situation. Participants also argued for normalization and social acceptance for families built by DI. The group-work approach described in this paper contributes significantly towards fulfilling the needs of couples involved in DI.