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Právna úprava asistovanej reprodukcie v Spojených štátoch


 | 27.6.2011 | komentárov: 287

V januári roku 2009 viedla správa o osmerčatách ktoré sa narodili Nadyi Suleman, prezývanej „Octomom“ (matka osmerčiat) k ostrej diskusii o úlohe asistovanej reprodukcie (ART). Použitie ART sa v USA exponenciálne zvyšuje, čo je odrazom vysokého dopytu po tejto metóde a minimálnej právnej regulácie. V roku 2006 CDC zaznamenalo 43.343 živo narodených detí pomocou asistovanej reprodukcie, čo je viac ako dvojnásobok počtu z roku 1996. Otázkou však ostáva, ako asistovanú reprodukciu čo najlepšie regulovať zákonom.

Obrazok ART zahŕňa liečbu plodnosti, pričom narába s vajíčkami a spermiami, a najčastejšie sa realizuje pomocou oplodnenia v skúmavke (in-vitro fertilizácia – IVF). Pri metóde IVF sú vajíčka a spermie spojené mimo maternice za účelom vytvorenia embryí, ktoré sú neskôr do maternice implantované. Osmerčatá Nadyi Suleman boli splodené prostredníctvom IVF, tak ako aj ich šesť starších súrodencov. Nadyin lekár, Dr. Michael Kamrava jej do maternice implantoval 6 embryí, čo je oveľa viac ako odporúča Americká komora reprodukovanej medicíny (American Society for Reproductive Medicine – ASRM). Výskumy CDC ukázali, že IVF je riskantnejšie ako normálne tehotenstvo, a to hlavne z dôvodu vyššieho počtu viacnásobných pôrodov, ktoré zvyšujú riziko komplikácií ako napríklad predčasný pôrod alebo pre-eclampsia.

Po narodení osmerčiat USA čelilo medzinárodnej kritike z dôvodu nedostatočnej regulácie vykonávania ART. Profesijné štandardy, ktoré sú právne nevynútiteľné, sú vytvorené súkromnými spoločnosťami ako napríklad ASRM alebo Spoločnosť pre technológie asistovanej reprodukcie ( Society for Assisted Reproductive Technology – SART), ktorá je samozvaným vládnym pozorovateľom. Avšak štandardy stanovené týmito subjektmi sú často ľahko zneužiteľné. Napríklad, ratingové dáta kliniky asistovanej reprodukcie sa môžu ľahko ovplyvniť prostredníctvom implantovania viacerých embryí, ktoré zvyšujú riziko viacnásobných pôrodov, prípadne odmietaním neperspektívnych prípadov.

Na druhej strane, podporovatelia slobodného trhového prístupu k reprodukčných technológiám sa obávajú zaťažujúceho zásahu vlády do hlboko intímnej skúsenosti, akou je- rodičovstvo. Oblasť realizácie ART sa vyvinula z potreby riešenia neplodnosti v dôsledku ochorení, ako je napríklad endometrióza alebo poškodenie vajíčkovodu, prípadne nízka kvalita mužského semena. Podľa prieskumu CDC, ktorý sa zaoberal  rozvojom rodín, približne 12 percent ženskej populácie v reprodukčnom veku je považovaných za neplodné. Využívanie ART procedúr sa rozšírilo na homosexuálne páry a ženy, ktoré chcú deti, nechcú si však vyskúšať, aké je to byť tehotná.

Dorothy Greenfeld, profesorka pôrodníctva, gynekológie a reprodukčnej medicíny na Yale School of Medicine dodáva: „Právo zaostáva za technologickým pokrokom. Nezáväzné pokyny (guidelines) sú vydávané omnoho rýchlejšie, takže ľudia sa na ne musia spoliehať.“ Rýchly a neustály rozvoj v oblasti medicíny znemožňuje vytvorenie komplexnej právnej úpravy. Iné krajiny, ako napríklad Spojené kráľovstvo (UK) sa vydali smerom vytvorenia vládnych úradov zaoberajúcich sa asistovanou reprodukciou, ktoré stanovujú štandardy.

V roku 2005 bola vo Veľkej Británii ukončená možnosť anonymného darovania spermií s odkazom na práva dieťaťa v súvislosti s vývojom ART. Takýto zákon spôsobil krátkodobý nedostatok darovaných spermií a opätovnú kritiku vlády pre nadmernú reguláciu v tejto oblasti. Avšak práva detí narodených prostredníctvom ART sa zväčšujú a stávajú sa transparentnejšími z dôvodu takzvaných „grassroots“ hnutí, ktoré sa snažia o identifikáciu darcu vajíčka, spermií a tehotných matiek, hovorí Greenfeld.

Problematika invitrofertilizácie je oveľa komplikovanejšia taktiež z dôvodu predimplantačnej genetickej diagnostiky (pre-implantation genetic diagnosis –PGD), ktorá umožňuje ľuďom vybrať pohlavie, určiť vrodené vady alebo poruchy, prípadne tkanivové zhody pre oplodnené embryo. Odporcovia tejto technológie tvrdia, že sa ňou umožneňuje eugenika a vytvárajú podmienky pre diskrimináciu. PGD podľa najhorších predpokladov môže viesť k diskriminácii, sociálnej selekcii a „vytváranie“ detí pre bohatých rodičov schopným platiť za PGD vyšetrenia a IVF liečbu. Reguláciu PGD v značnej miere zaviedli krajiny ako Francúzsko alebo Veľká Británia. Avšak britská vláda bola v tejto súvislosti v roku 2008 kritizovaná z dôvodu diskriminácie postihnutých, a to v prípade hluchého páru, ktorý chcel mať hluché dieťa. Ich žiadosť bola podľa platných zákonov zamietnutá, pretože PGD vyšetrenie IVF embryí núti potenciálnych rodičov vybrať si dieťa, ktoré nie je hluché.

Mnoho odporcov potratov je súčasne aj proti PGD a IVF, a to z dôvodu ničenia nepoužitých embryí. Oporu majú aj v oficiálnom stanovisku rímskokatolíckej cirkvi, ktorá je všeobecne proti ART a zastáva názor, že takáto metóda plodenia detí porušuje prirodzený proces počatia a rodičovstva.

Napriek mnohým odporcom ART sa táto činnosť stala miliónovým biznisom. Politická ekonómka pôsobiaca na Harvard Business School a autorka knihy The Baby Business, Debora Spar, nazýva ART  komplexom priemyslu plodnosti. Rizikom v tomto prípade je podľa nej považovanie detí za výrobky a považovanie žien za inkubátory. Podľa ASRM, jeden cyklus IVF v priemere stojí viac ako 12.000 dolárov. Okrem toho, je IVF procedúrou, ktorá je zvyčajne spojená s ďalšími nákladmi napríklad na poskytnutie vajíčok alebo spermií a inými zmluvami. Vysoké náklady robia ART systémom, ktorý spôsobuje sociálne nerovnosti  a stáva sa luxusom.

Obchody s náhradným materstvom, ktoré sú Indii legálne od roku 2002, tu ročne predstavujú zisk asi 500 miliónov dolárov. Tieto sumy, ktoré sú platené nemajetným ženám, sa stávajú lacným spôsobom pre páry zo Západu, ako sa dostať k dieťaťu, pričom zneužívajú práva indických žien.

Aj keď v USA existuje istá právna regulácia v oblasti náhradného materstva na úrovni štátov, dodnes nebol prijatý jednotný federálny zákon. Americký kongres pôrodníkov a gynekológov (American Congress of Obstetricians and Gynecologists – ACOG) uvádza, že dojednania o náhradnom materstve vedú často strany z  nerovných mocenských, vzdelanostných a ekonomických pomerov. Navyše, tieto nerovnosti sú prekážkou v spravodlivom prístupe. Poistné krytie procedúr ART sa líši podľa krajiny, pričom sa zaoberá otázkami nutnosti jej výkonu a aj právami splodiť a vychovať dieťa.

Technológie asistovanej reprodukcie sa vyvinuli z dobre myslených vedeckých pohnútok zlepšiť vyhliadky neplodných a umožniť každému realizáciu biologicky zakorenenej túžby rozmnožovať sa. Avšak nedostatok regulácie má tendenciu viesť k lekárskej nezodpovednosti, a dokonca k ohrozeniu zdravia matiek, ako je to v prípade osmerčiat pani Suleman. V súčasnosti je Dr. Kamrava vylúčený z ASRM pre opakované páchanie trestných činov a v rovnako je vyšetrovaný Kalifornskou lekárskou komisiou (California Medical Board) za viacnásobné pochybenie spočívajúce v hrubej nedbanlivosti. Hoci príprava detailných právnych noriem môže byť ponechaná na lekárskych expertov, nedostatok právnej úpravy a jej vynutiteľnosti v USA ponecháva príliš mnoho žien, detí a rodín v ohrození.

Connie Cho je poslucháčkou druhého ročníka politológie na Silliman College.

Autor: Connie Cho

Zdrojový text: CHO, C.: Regulating Assisted Reproductive Technology, Yale Journal of Medicine & Law, 2010, http://www.yalemedlaw.com/2010/10/regulating-assisted-reproductive-technology/

Preklad: Tomáš Szalontay

Editoval: Zuzana Zoláková

Obrázok: inmagine.com


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