They be Guidelines!

Oh, I assure you, I was deadly serious when I said that we were given forms to take to our GP. Forms on which it is open to them to opine on our fitness to be parents.

Some of you may recall this discussion, in which I asked for your views on a public consultation being held by the Human Fertilisation and Embryology Authority (HFEA). However, having read over that post, I am not sure I explained myself very well as to the dealio in the United Kingdom. So, let's review.

The Law

If you were to run run run to your British statute book, flip merrily through the pages to the Human Fertilisation and Embryology Act, and scroll down until section 13(5), what you would find is this little gem:

“A woman shall not be provided with treatment services unless account has been taken of the welfare of any child who may be born as a result of the treatment (including the need of that child for a father), and of any other child who may be affected by the birth.”

I won't get into how we ended up with such a provision- though the short answer appears to be because MSPs were worried about single or lesbian women getting treatment. If you are interested in the full background of how we were saddled with such a law, there is a very full, cogent and worthwhile dissection of the issue and its history here.

Right, so what does the section mean? It means that by law, anyone in the UK seeking fertility treatment cannot be provided with that treatment until the provider has considered what is commonly referred to as the "Welfare of the Child" principle. It makes no difference that the "child" to be born from treatment is but a mere hypothetical at that stage. A twinkle in the lab technician's eye, as it were.

The observant among you will note that the section does not say anything about how one goes about making such an assessment, and indeed, the Act itself is silent on that point. Obviously, given a very stringent interpretation, it would be open to clinics to make prospective patients jump through all sorts of hoops. And what's more, theoretically, clinics could simply deny treatment to anybody they didn't like the look of.

The Code of Practice

However, in order to receive and retain a license for fertility treatment, clinics must comply with the HFEA Code of Practice. Now, as Captain Barbossa would say, the Code is more like...guidelines. These guidelines are issued to all clinics, to set out some parameters as to how they should go about meeting the legal requirements of the welfare principle, and the kinds of factors which should be "taken into account" in assessing prospective patients. And it was those guidelines which were recently up for review, and on which HFEA carried out their consultation.

I responded to that consultation, and my main view was insert wet ppppphhhhttttbbb sound. Though, to be fair, one of the possibilities is that in response to the consultation, the guidelines might be loosened up somewhat.

In the meantime, every fertility clinic can choose to comply with the Code as they see fit. And it would seem there is some room to move around to how the assessment takes place. So what you get can really vary. For example, despite my disgruntlement about other aspects of the Ass Con clinic, they did manage to dispatch the "taking into account" rigamarole with relative lack of fuss and bother. We had to fill out a questionnaire and talk to Dr Percent about a few general things like our living situation. But that was about it, and it was handled in a very low key, non-intrusive way.

The Declaration by General Practitioner

The OC on the other hand, have obviously opted for the other end of the Code spectrum. Before we can commence treatment, both E. and I have to have our respective GP's sign off on the rather grandiosely titled "Declaration by General Practitioner". What this requires in a nutshell is for the GP to declare that they have discussed fertility treatment with [me]/[E.], and considered "the interests of any children born as a result of treatment". The GP also has to tick a box that says :

A: "I know of no reason why treatment should not proceed, or relevant facts that should be brought to the clinics attention;

B: There are issues which should be taken into account;

C: I am/am not (delete as appropriate) willing to supply information that I consider to be relevant upon request.

Sign/date/practice stamp. Love and kisses, Doc.

Oh, and we also have to fill out another questionnaire, in which we are asked stuff like, "have you ever been convicted of a criminal conviction", or even been investigated for a criminal offence. The latter part leaves no option to do a Danny Ocean- you know, "Well, ma'am, as you say, I was never charged."

E.'s GP has already signed the form, ticking A (with a little grumbling about what a crock of shit it was) and I am hoping that my GP will have no difficulty in simply doing the same.

How do you like them apples?

Er, yeah. How do I feel about this? Huh. Not great. But you know, when one is looking down the barrel of a shotgun, one's options for complaining about the person with the finger on the trigger begin to seem a little...limited. We need the treatment, so we need to get the form stamped. That's the reality. And I can only hope that in time, with other aggrieved voices added to the chorus, that things can change.

Until then...? Well, I've known for some time now that infertility is a dish served with lashings of injustice and unfairness, with a side of helping of bitterness. This part of it is, for me, simply one more sour garnish. It won't kill me- but I suspect I may never get the bad taste out of my mouth, ever again.

Comments

[Manuela]

THIS... leaves me absolutely speechless with rage. I am quite literally... at a loss for words...

[Mellie]

Wow. I'm constantly amazed at what gets passed into law, apparently not just in the U.S. but everywhere. Is there the equivalent of the religious right in the UK? I only hope that more and more docs will take the approach used by E's GP and the law will eventually be amended. But enough about that. Think happy thoughts about a retrieval in August. Progress is good!

[MM]

Wow. That is so fucking ridiculous and wrong.

[meggiec2]

I'm pissed off on your behalf. Fertiles don't have to pass a test, as if you aren't dealing with enough crap already. Besides you wouldn't be about to do ivf if you weren't committed.

[estel]

Arggghhh!!!! I'm kind of glad to see its a complete crock of shit, but it doesn't make it any better.

But I have a complaint to make - inspired your UK gov, our gov thinks they need to be doing something too. So I spent last month writing and sending in my submission to the relevent committee in response to their modest proprosal that we get
a) a criminal background check
b) a clearance from the social workers
c) a mental/physical health clearance
d) and even if in the clear for all that, could still get refused for any reason anyone happened to think would make us "unsuitable parents".

Mellie - as far as I can tell here its just a bunch of bureaucrats and medical ethicists who are into a little empire building. More jobs for medical ethicists seems to be the main reason - they get to be on all of the comittees they want to set up to oversee us all. And of course they get to say pious things about the rights of children. No doubt we get to pay for (and wait for) the dubious honour of official approval of our would be parenting abilities if this absurdity ever becomes law.

estel

[LEB]

This makes me so angry - HFEA should be abolished they serve neither the interest of the patients, nor clinics, nor law makers.

I always vowed I'd never have treatment in this country (Spain for me thanks) while I would be required to sign the Welfare papers - well as with many nevers that's gone by the wayside & a couple of weeks ago I signed the fucking things & oh how it hurt. I know personally of 3 couples who've been refused treatment for either failing to co-operate with the assessment process or due to negative comments from their GPs.

My GP has never seen me - not once, I have no interest in involving him in our fertility problems (I have SIF so I wouldn't get anything 'free' on the NHS); he's seen my husband once for a 'flu vaccination - & he's the one who gets to decide if we'd be fit parents. I actually don't have the words to describe how angry it makes me.

As far as I'm concerned it is a disability right's issue - the infertile are disabled & on the basis of that disability alone we are denied medical treatment on a par with the able-bodied fertile.

Trouble is we want babies & if we need ART to get them we have to sign the fucking form. Bastards.

[LEB]

estel - I absolutely agree with you about the medical ethicists, they're on huge power trips. Medical ethics was the only course I failed at med school (I had slightly more libertarian views than are permitted in such a staunchly hierarchical & paternalist environment). I argued against the welfare principle (oh the irony now) when I was 20 years old & had no idea it would apply to me one day - and they failed me for it (bastards - I'm not bitter, honestly ;)).

[ManhattanAnne]

Yeah, and you forgot to add a heaping pinch of bigotry. Lucky thing you and E are financially-comfortable native English speakers...

[PJ]

Uh, could they make it any more difficult.

What a crock Mare. I realize you have to go through with it but there's no rule saying you have to be happy about the bureaucratic bullshit.

I'm glad you are able to go forward with IVF though, regardless of the hoops you are made to jump through.

[P.]

Wow, and WOW! I am speechless. I hope your GP is a great as E's and you can keep the ball rolling.

[reprogirl]

Without in any way meaning to sound inadequately sympathetic about how pissed off this kind of intrusion and judgment must make you feel, I have to admit I think this is fascinating. As I understand it, this kind of requirement would be very, very hard to do in the US, even in states that would love to do it to keep all those lezzies from making babies, because the right to procreate has all kinds of constitutional clout. But if you adopt - it's open season. They come to your house, they make you write essays, they interview your dog, they sniff your underwear, and they charge you a big fat wad of cash (no insurance for this) to do it. I took a family law class with a professor who is very outspokenly pro adoption and questions the legal privileges that biological parenting gets, and she argues that it makes no sense to have this imbalance, for the incentives to be tilted so far against adoption. She polled everyone in the class to see if we thought there should be any restrictions on access to reproductive technology (we pretty much all voted no, including me) and if we thought some of the barriers to adoption, like home studies, should be eased up, and again we pretty much all voted no, including me. But she may have a point that those two positions are not 100% logically consistent. I think about it a lot these days. I would love to adopt a baby. Why am I not? Because (1) I can't afford it and (2) I wouldn't pass a home study because I live in a tiny poky room in a shared apartment and spend my entire life at the office. But no one asks about that before they stick the sperm catheter up me. I'm glad they don't. But it does make you think.

Anyway, I am sure no one will question for a moment what wonderful parents you and your guy will be, and although this is a pain in the ass it will turn out fine. Wishing you lots of luck.

[Anna H.]

Fucking assholes.

xxoo

[Thalia]

I'm with you. Not to mention the fact that our clinic has made us wait 2 months for the appointment just to get this bloody form signed.

[Lala]

I can't believe someone took my "crock of shit" comment already! Damn you smart women!

[bj]

boy, oh boy. You know, we in the US think that we're stuck in the dark ages, but because of weirdness in the politics here, fertility treatments are largely unregulated, so I think things are really a lot stranger in some parts of europe (see, for example, italy).

But, what does this mean in practice? Are lesbian couples unable to get treatment in the UK? And what constitutes treatment? I'm out here on the left coast, and here, it seems like there's no real problem with lesbians finding treatment (and I know a number with children).

And, how about you? As I remember, you're not married to E? Does that affect your treatment options at all?

bj

PS: regarding the difference between home studies for adoption & "home studies" for infertility treatment -- the key to me seems to be the existence of a child. With adoption, we really do have to think about the interests of the child, a person, who exists, and who cannot make their own decisions.

[Soper]

Bah, I say. Bah!

[JennaM]

Holy shit.
You know I am shocked and yet not at all surprised.
All the worst things about infertility seem not to be the physical pains and indignities, which is so sad. When we need most to address medical and physical problems and complications, we keep getting interrupted by political agendas, social stigmas, emotional burdens, legal bureaucracies, and myriad other entanglements that drain all of our best energy. Energy we should devote to the (relevant!) corporeal realities. This society. You get heads--all you need is a good chardonnay and a f--- or two; you get tails--clear your calendar for the next six years and forget that you have anything else going on in that head or life of yours. The mainstream always need martyrs and scapegoats to make up for its sloppy convictions and hypocritical behavior patterns.
Sigh.
If fertiles only knew what it really means to "want a family..."

[InSpring]

That is just absolutely absurd. Is there an appeal process if your GP denies you the right to procreate? Or does one only have a right to procreate unARTfully?

[sarah]

I had to sign all of those forms and to be honest when you get them they are a shock, then you go to an evening meeting where they go over everything in the "pack" they sent you (a waste of fucking time as all us infertiles know so much we could run an IVF clinic. Then they make you wait again....tick tock tick tock..To top it all when my treatment failed the bitch nurse on the end of the phone said I'd let them down!

I feel so much better for that rant!

[patricia]

I'm so tired of this bullshit. It's the power of the ignorant majority and it makes me feel sick to my stomach.

[Sarah/Badlands]

Unbelievable! You'd think this was 1672 or something.

Still ... I second reprogirl. You deserve all the luck in the world.