Wednesday, September 12, 2018

Victorian ART review


The Victorian Government is undertaking a review of assisted reproductive treatment law in Victoria.  The review is being conducted by Michael Gordon AM, a lawyer who is a former chair of the Victorian Assisted Reproductive Treatment Authority and Patient Review Panel.
Mr Gordon has said:
            “It is now a decade on since the last significant review of assisted reproductive treatment regulation in Victoria, and it is timely to reflect on the significant changes that have occurred since then, including:
·         changes to the number, ownership and management of assisted reproductive treatment clinics from the clinician-owned and led clinics originally established in Victoria;

·         great advances in treatments and technology for IVF and related procedures;

·         changes to social values and opinions, including changes to legislative rights and responsibilities;

·         changes to the Marriage Act for same-sex marriage and other changes dealing with gender and sexuality.”
Mr Gordon also says:
            “Assisted reproductive treatment offers many benefits, and it is important that it is not inappropriately limited by people’s ability to pay or by where they live, nor affected by inadequate knowledge or information, or by discrimination according to gender, sexuality, identity, race or other attributes.”
The review has identified a number of legal rights of access.  For example, section 47 of the Assisted Reproductive Treatment Act allows for the posthumous use of gametes or embryos where “the treatment procedure is carried out on the deceased person’s partner or in the case of a deceased woman by the woman’s male partner commissioning a surrogacy arrangement”.
The review comments:
            “This appears to restrict the posthumous use of gametes by people in same-sex relationships and by single women who may require a surrogate because they are unable to carry a baby themselves.  It may be timely to consider where there is an appropriate rational for such a restriction.”
The review notes that a single cycle of IVF treatment can cost well in excess of $8,000.  “Costs can quickly add up where multiple cycles of treatment are required.”
Furthermore:
            “Demand for donated gametes and embryos continues to rise, without a corresponding increase in the supply of donors.  This has resulted in shortages of donor gametes and increasing pressure on clinics to source donor sperm, eggs and embryos.  These shortages may be even more acute for people from diverse ethnic groups, who seek to source gametes/embryos from donors with a shared ethnic background.”
It was noted the small but increasing number of surrogacy arrangements and that the restrictions about finding donors and surrogates:
            “…designed to protect people from exploitation, may have the effect of leading people to make arrangements outside the regulatory framework and therefore without support.  It is understood that unmoderated online forums and discussion groups connecting potential donors and surrogates with intended parents have become common over recent years.  There is significant but undocumented use of these forums that may bypass the legislative restrictions on advertising.”

Compensation for donors and surrogates

The review states:
            “It has been suggested that there may be some lack of clarity about what constitutes reasonable expenses for donations.  This lack of clarity has resulted in different interpretations and different levels of compensation paid by different clinics within Victoria.  This could act as a disincentive to those who may otherwise be interested in participating on an altruistic basis or result in donors ‘shopping around’ between clinics to receive the highest level of compensation.
As to surrogates:
            “Victoria has among the most restrictive rules in Australia in relation to reimbursement of surrogates.  Unlike New South Wales, Queensland and Tasmania, for example, the Victorian regime does not allow for any additional insurance expenses incurred by a surrogate to be met by the intended parent, nor is there provision for lost income as a result of leave taken during pregnancy.”
Concern is raised about Victorians undertaking overseas surrogacy:
            “There can be complex legal issues associated with overseas surrogacy, depending on the nature of the agreements entered into and the laws of the country in which the surrogacy arrangement occurs…many countries where Australians may pursue surrogacy arrangements have little regulatory oversight or protection for surrogates or intending parents.  Reportedly, there is a rising trend towards multinational commercial surrogacy operations, with major players responding to tightening restrictions in one country by moving to another less regulated country.”
Furthermore:
            “There are risks for the child to be born.  Unethical surrogacy arrangements do not put the rights and interests of children to be born first.  Non-existent or inconsistent record keeping means that children born of surrogacy arrangements using donated gametes are unlikely to have access to information about their genetic history.
            For the surrogate, a lack of regulation can increase the risk of exploitation.  Health risks associated with pregnancy can be exacerbated through pressure to agree to risky procedures such as multiple embryo transfers or deliveries toned to meet the schedule of the intended parent.
            Finally, poorly regulated countries may also expose intending parents to risk of exploitation.  People may pay high sums of money and, if promised services are not delivered, there may be little opportunity for recompense.”

LGBTI people

The review states:
            “The language of the Act reflects the social attitudes and understanding of diversity that existed at the time it was drafted.  Over the last decade, attitudes and recognition of the rights and needs of LGBTI people have evolved dramatically, and LGBTI people are increasingly making use of assisted reproductive treatment services.  Seen through today’s lens some of the provisions of the Act appear outdated at best and at worst discriminatory…It has also been noted that the Act’s guiding principles state that “persons seeking to undergo treatment procedures must not be discriminated against on the basis of their sexual orientation, marital status, race or religion”.  It is time to consider if this is sufficiently inclusive or whether it should, for example, also extend to discrimination on the basis of gender identity and/or intersex status.”

Submissions to the review can be sent to art.review@dhhs.vic.gov.au.  Submissions close on Friday, 21 September 2018.