Test tube politics | Michael Farrugia

Seven years since the so-called ‘Clyde Puli report’ recommended a regulatory framework for ‘in vitro fertilization’ (IVF) – on offer at private hospitals for decades, though still technically unregulated at law – all efforts to pass the proposed legislation appear to have stalled.

Apart from the original report in 2005, during this legislature the Social Affairs Committee discussed the issue again in considerable detail: culminating in the appointment of yet another, ad-hoc committee, this time to discuss any issues left unresolved by all the previous debates.

Dr Michael Farrugia is the Opposition’s representative on both the SAC and the ad-hoc committee, and as such has been involved in all these discussions. So my first question practically asks itself: what’s taking you all so long to draw up the legislation?

Though he avoids using the word himself, it seems the main stumbling block remains the same as it was in the case of divorce: the ‘conscience’ of individual MPs.

“When we first started talking about regulating IVF, there were many who expressed opinions against from a moral point of view,” the family doctor from Naxxar begins.  “The 2005 Clyde Puli report did make a number of recommendations, but these were passed without the participation of the opposition members because we first wanted to consult the rest of our parliamentary group. This report left three basic questions unanswered. One, who was to be eligible to the treatment? Two, should the freezing of embryos be allowed? And three, what about donation of gametes by third parties?”

All three questions were immediately inundated by a tsunami of ethical objections. From the outset, numerous voices (for instance, former Children’s Commissioner Sonya Camilleri) were heard clamouring for IVF to be restricted to married couples only. Even louder objections were raised to embryo freezing – to the extent that a lobby group called ‘Professionals Against Embryo Freezing’ was set up specifically to dissuade parliament from regulating the practice at law. Elsewhere, the Church generally objectsto gamete donation (among other things related to IVF_, on grounds that it “compromises the marital bond and family integrity”.

All these objections, and more beside, have been raised consistently throughout the various committee stages in Parliament. And yet, Farrugia himself openly questions their consistency: pointing out that even among exponents of the Catholic Church there were contradictory opinions.

“I am not convinced that the Church’s position is in fact so categorical against IVF. Consider what Rev. Prof. Peter Serracino Inglott told the parliamentary committee. He said it was an ‘injustice’ for the service not to be provided by the State…”  

But as tends to be the case with clerical opinions, you will always find one which says the clean opposite. I point towards the testimony of Rev. Prof. Emmanuel Agius – dean of the Faculty of Theology, and a lecturer in bioethics at the University of Malta– who told the same committee that “man’s primary intention in IVF was to kill the embryos that remained unutilised, and this could never be acceptable…”

Farrugia nods. “It’s true that there is a tangible gap between Serracino Inglott’s opinion and that of Agius. But this is true even of the global Church’s position regarding IVF.”

He describes an analogous difference between the various pronouncements of Pope Benedict and Cardinal Martini: the ‘liberal’ retired Cardinal who, in 2006, had shocked the Catholic world by striking out in a considerable different direction with regard to life issues such as IVF, abortion and euthanasia.

“So these differences in opinion are not limited to Malta. Even internationally, the Church is divided on the issue.”

Leaving aside the Church’s position – we are, after all dealing with Parliament here – and I ask Dr Farrugia what happened to the original three questions raised by the Clyde Puli report in 2005. Considering that no law has been drafted since that time, these must surely remain unanswered to this day…

Farrugia shakes his head. “Not exactly, no. It had been decided to set up an ad-hoc committee, comprising two government MPs – Dr Jean Pierre Farrugia and Dr Frans Agius for the government, and myself representing the Opposition – specifically to address these issues. And we answered them in a report we tabled in September 2010.”

This second report had whipped up even more furore due to its conditional acceptance of embryo freezing – albeit on the proviso that any excess embryos may be adopted – as well as for limiting eligibility to ‘couples in stable relationships’.

But apart from opposition from pro-life lobby groups and religious organizations – not to mention a few individual MPs – these recommendations also hit an immediate snag.

 “I was the one to raise the issue that Maltese law offered no legal definition of ‘stable relationship’,” Farrugia continues; adding that the committee found itself turning to the (conservative) Italian law, recommended by one of the govenment MPs, as a basis on which to formulate a local equivalent. 

Farrugia explained that in the absence of a divorce and cohabitation law, the committee had recommended that “any couple, whether married or cohabiting, who remain childless after trying for about two years, and after undergoing all medical investigations are found as good candidates for IVF, should be allowed to undergo the process of IVF” 

But the recommendation to look at the Italian Law alone as a basis for discussion set off alarm bells, as the same legislation has been criticised for banning gamete donation and surrogate mothers altogether, and also for restricting assisted fertilisation to stable heterosexual couples.

I am about to ask whether the local proposed legislation, limited to ‘stable couples’ – as well as the apparent omission of gamete donation - would cut off all access to homosexuals…. but Farrugia’s next comment renders the entire line of questioning redundant.

“In any case, we shall have to redefine all these proposals in the light of recent developments. The last time the SAC met, the landscape had changed completely. With divorce legislation now certain to be introduced, our definition of ‘stable couple’ will have to change. Also, if government decides to move forward with its plans to recognize cohabiting couples , then this will change the whole scenario…”

Even without these considerations, the proposals of the ad hoc committee were in any case discarded by government.

“Having asked us to come up with recommendations, the government went on to simply ignore these same recommendations… even though two out of three of the committee that came up with them are themselves government MPs.”

First to fly out of the window was the proposed restriction to ‘couples in stable relationships’. Instead, the Prime Minister has now declared his intention to restrict IVF only to married couples, as the moral objectors have all along demanded.

Apart from nullifying the reason for the ad-hoc committee in the first place, Farrugia also envisages specific problems caused by this restriction… especially in the light of introduction of divorce.

“There is a grey area concerning the four-year limit for divorce: which was specified in the referendum question, and will therefore have to be included in the divorce law. But if IVF is to be limited to married couples, and separated couples have to wait four years for a divorce so they can remarry… well, four years is a long time for a prospective mother to wait. It can make the difference between being able to and not being able to have children… which, in this context, means all the difference in the world.”

At this point I ask him his own opinion of the ethical concerns raised by objectors. So far he has spoken from an almost entirely pragmatic point of view. But does he make of the ethical dimension to the debate? How valid does he himself consider these arguments himself?

“As a medical doctor and a parliamentarian tasked with drawing up a report into IVF, what interests me are not only the rights of the foetus, but also the rights and health of the mother, and those of the baby to be born. The questions we have to ask concern the morbidity and mortality of all three: mother, foetus and eventual baby…”

This, he goes on, inevitably impacts the way parliament legislates. Farrugia argues that, because health considerations vary from case to case – and above all, because the technology involved in IVF is undergoing constant innovation and development – it does not make sense to draw up rigid and inflexible laws.

“Legislation to regulate IVF is important, but we must be conscious of the constantly changing scenario. This is why I proposed setting up a regulatory body, to be able to adjust the law according to developments in medical technology. Otherwise, Parliament would have to keep changing the law with each new technological breakthrough…”

Furthermore, he advises against writing restrictive measures into the law (for instance, limiting the number of implanted ova to only one); but instead, to draw up protocols to govern these and other areas, which the same regulatory body can, if necessary, tailor to individual exigencies.

Meanwhile, on the subject of ethical considerations, Prime Minister Gonzi recently announced that ‘technological advances’ have helped ‘settle’ problems of conscience for MPs. He was referring specifically to oocyte vitrification: a method which does not require the freezing of embryos, but rather the freezing of unfertilized ova (eggs), and as such sidesteps the issue of embryo storage. But is this really an answer to all the conscientious objections to IVF?

Farrugia half smiles as he answers. “It’s surprising to hear oocyte vitrification referred to as something ‘new’ or ‘recent’, when in fact the technology has been available for years. Not only that, but the equipment for both oocyte vitrification and embryo freezing are already installed at Mater Dei hospital! It’s all there, under lock and key, just waiting for this legislation so that it can be used. But as for the process itself: it is interesting, yes, but only up to a point.”

Farrugia points that while the technology has indeed improved recently – and will probably improve further in years to come – it would be unwise to invest only in one technology at the expense of all others

Echoing other professionals who spoke to MaltaToday last week, Dr Farrugia confirms that the procedural costs involved in oocyte vitrification are ‘significantly higher’ than other methods: “not so much because of the equipment – which in any case is already there – but because the process itself involves much higher costs.”

The real issue, however, concerns the rate of success, which – despite the recent improvements – remains lower than with other methods.

“Offer oocyte vitrification by all means, but it would be a mistake to restrict the service only to this one technology alone. It is not enough on its own. The way the law is currently being proposed would detract from the overall rate of success.”

Farrugia argues that issues of personal conscience – being personal - should not be imposed on society at large. “Just as people are free to consult whichever doctor they choose, they are also free to take advice on ethical issues from a religious or spiritual angle. If someone is adamant on oocytevitrificationfor religious reasons, then that’s entirely up to them. But it doesn’t mean that others have to be bound by the same considerations…”

Having spoken so much about the ethical dilemmas surrounding this single issue, it seems only natural to bring up the dilemma facing government since the divorce referendum. Having opposed divorce on ideological grounds, the Nationalist Party now finds itself in the uncomfortable position of having to ratify a law it officially disagrees with… somehow, without compromising its principles in the process. Farrugia shrugs.

“Dr Gonzi recently told Gaddafi to ‘listen to his people’. And then what? He himself doesn’t listen to his own people, when they vote in a referendum that he himself first proposed…”

And considering the conservative resistance he himself has encountered while trying to regulate, Farrugia is similarly scathing about the PN’s claims to ‘want to attract liberals’.

“If you talk about liberalism, you need to have liberal thinking from the top downwards. It is not enough to say, ‘I have liberals in my party, and I’m happy about that’… and then keep taking decisions along purely confessional lines. IVF is itself a good example. You can’t claim to have a ‘liberal wing’ in the party, and then simply ignore all its recommendations because you disagree with them. Otherwise, the words become meaningless.”

Dr Farrugia is however skeptical that the PN is really as ‘divided’ as it now appears.

“If you ask me, the only thing that unites the PN is Labour,” he points out flatly. “On all other things the party is torn apart by internal conflicts. But just mention the Labour Party, and suddenly they all join forces again.”