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Medicínsky turizmus v preprodukčnej medicíne


 | 4.3.2014 | komentárov: 291

Reprodukčnou turistikou je čoraz rozšírenejšie cestovanie do iných krajín za účelom liečby neplodnosti formou náhradného materstva. Môže to byť považované za určitú formu zdravotnej turistiky. Hlavnými dôvodmi reprodukčnej turistiky sú nevyhovujúca právna úprava v domovskej krajine neplodného páru alebo nižšia cena zákroku. K turistike prispievajú aj iné zákony niektorých štátov napr. páry z Činy cestujú do iných krajín, aby sa vyhli politike jedného dieťaťa.

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Náhradné materstvo je metóda asistovanej reprodukcie. Slovo náhradné pochádza z latinského slova surrogatus (substitučný).  Termín náhradné materstvo sa používa, ak žena vynosí dieťa a po pôrode ho odovzdá inej žene, ktorá sa postará o jeho výchovu. Náhradné materstvo je čoraz populárnejšie, pretože v prípadoch, keď pár nemôže mať z rôznych príčin dieťa, môže isť o najefektívnejšiu cestu k vytúženému  dieťaťu, keďže adopcia dieťaťa je zdĺhavým procesom.

Pri náhradnom materstve je možné použiť dve metódy:

IVF / In Vitro fertilizácia – je to častejšia metóda náhradného materstva, kedy dochádza k mimotelovému oplodneniu vajíčka. Pri tomto postupe, náhradná matka vynosí embryo genetického páru. Vajíčko manželky je oplodnené in vitro spermiami manžela a embryo sa prenesie do náhradnej maternice po dobu deviatich mesiacov. Dieťa nie je genetický (biologicky) príbuzné s náhradnou matkou.

Tradičné náhradné materstvo – je to metóda, kedy vajíčko náhradnej matky je umelo oplodnené spermiami mužského partnera, kde sú genetickými rodičmi mužský partner a náhradná matka, ktorá dieťa vynosila. Ide o výrazne lacnejšiu metódu ako je metóda IVF. Na druhej strane aj spornejšiu, nakoľko dieťa je geneticky (biologicky) príbuzné s náhradnou matkou.

Náhradné materstvo je fenomén, ktorý sa postupne šíri do celého sveta.  Páry v Saudskej Arábii, ktoré nie sú schopné mať deti, zamestnávajú náhradné matky v Ázii či Európe, aj keď náhradné materstvo je podľa islamského práva (Islamic Jurisprudence Council) neprípustné. Nemožno odhadnúť počet párov, ktoré takto zamestnali náhradné matky, ale mnoho lekárov v krajine dáva prednosť liberálnejšiemu výkladu zákona.

Dr. Samir Abbas, člen saudskej spoločnosti gynekológie a pôrodníctva sa pre bioedge vyjadril: „Takýto jav by nemal byť v spoločnosti tabu, pretože mechanizmus prijímania výživy pre plod cez pupočnú šnúru náhradnej matky je podobný konaniu ženy, ktorá dojčí dieťa inej osoby, a takéto konanie je podľa islamského práva prípustné“.

Náhradné materstvo je u nás ilegálne, za matku dieťaťa sa podľa zákona považuje žena, ktorá dieťa porodila. Rovnako je to vo Francúzsku, v Poľsku, Rakúsku, Nemecku, Španielsku, vo Švajčiarsku, v Chorvátsku či Austrálii. Sú však aj štáty, ktoré náhradné materstvo povoľujú. Okrem Indie medzi ne patria Rusko, Ukrajina, niektoré štáty USA či Veľká Británia, kde fungujú sprostredkovateľské agentúry. Vo všetkých týchto štátoch však služby v záujme narodeného dieťaťa poskytujú manželom.

Reprodukčné destinácie:

Rusko

Liberálna právna úprava je pre turistov atraktívna, a tak mnohé páry hľadajú pomoc v tejto krajine. In vitro fertilizácia aj tradičné náhradne materstvo sú v Rusku úplne legálne a sú dostupné prakticky pre všetkých dospelých, ktorí sú ochotní stať sa rodičmi. Cudzinci majú v tejto oblasti rovnaké práva ako ruskí občania. Do troch dní po pôrode rodičia dostávajú ruský rodný list, avšak so svojím menami, pričom nezáleží na genetickom vzťahu k dieťaťu. Súd v Moskve dňa 4. augusta 2010 rozhodol v prospech muža, ktorý požiadal o náhradné materstvo (pomocou darcovských vajíčok), tak že v rodnom liste dieťaťa môže byť zapísaný ako jediný rodič a náhradná matka na rodnom liste uvedená  nie je. Šlo o prvý prípad, kedy sa ruský občan rozhodol brániť svoje právo stať sa otcom prostredníctvom súdneho konania.

India
India je najznámejšou destináciou, ktorú navštevujú páry za účelom náhradného materstva. Prichádzajú tu tisíce ľudí ročne, ktorí sa rozhodnú pre náhradné materstvo, teda mať deti prostredníctvom procesu in vitro fertilizácie (IVF) alebo prenosu embryí. India je jednou z mála krajín, kde je náhradné materstvo legálne, náklady sú nízke a zákony flexibilné. Cudzí štátni príslušníci prihádzali do Indie na základe turistických víz, avšak došlo k sprísneniu zákonov a od novembra minulého roka páry vyhľadávajúce náhradné materstvo si musia zabezpečiť lekárske víza. Taktiež je potrebné dodržať určité sprísnené podmienky. Okrem lekárskych víz medzi základné podmienky patrí, že muž a žena musia byť manželmi a manželstvo musí trvať minimálne dva roky. Okrem toho, krajina, ktorej sú manželia štátnymi občanmi, musí uznávať náhradné materstvo a manželia musia prijať záväzok, že sa po narodení dieťaťa budú oňho starať. Oplodnenie by malo byt vykonané na niektorej z registrovaných kliník asistovanej reprodukcie.

Indiu navštevuje veľa párov z USA, Austrálie, Spojeného kráľovstva a iných európskych krajín. Presné počty amerických občanov prichádzajúcich do Indie, alebo občanov iných štátov za účelom náhradného materstva sú ťažko zistiteľné, ale sú zlomkom tých, ktorí hľadajú náhradné materstvo v rámci USA.

USA
V Číne je náhradné materstvo nelegálne, takže páry cestujú do USA prostredníctvom  amerických agentúr pre náhradné materstvo. Náklady na dieťa sa pohybujú od 120.000 dolárov až do 140.000 dolárov. Avšak, ak sa dieťa narodí na americkej pôde, v takomto prípade má Ústavou zaručené americké štátne občianstvo. Takto môžu využívať americký systém, teda rodičia majú nárok na materskú dovolenku, pričom americký systém poskytne dieťaťu s americkým štátnym občianstvom aj vzdelanie.
Páry zo Spojeného kráľovstva, ale aj iných oblastí prichádzajú do Spojených štátov kvôli možnosti výberu pohlavia svojho budúceho „potomka“ protredníctvom tzv. predimplantačnej genetickej diagnostiky (preimplantation genetic diagnosis). V Spojenom kráľovstve je toto vyšetrenie pre účel výberu pohlavia zakázané, okrem prípadov, ak je využivané na zisťovanie genetických ochorení, zatiaľ čo zákony USA sú v tejto oblasti oveľa liberálnejšie.

Jennifer Garcia z Kalifornie z Agentúry pre náhradné materstvo uviedla, že v súčasnosti prevažný počet klientov, požadujúcich náhradne materstvo, pochádza z Číny a spolu tvoria asi 55% všetkých žiadateľov.

V Spojených štátoch síce je náhradné materstvo legálne, avšak mnoho párov cestuje do lacnejších oblastí., náhradné materstvo môže stať  120.000 dolárov až 140.000 dolárov, zatiaľ čo v Indii sa suma pohybuje od 20.000 dolárov do 60.000 dolárov, v závislosti od typu služby a kliniky.

Záver:
Náhradné materstvo vytvára množstvo rizík.

1) Motivácia ženy byť náhradnou matkou

Vzhľadom na to, že náhradné matky napr. v Indii sú platené v priemere 7.500 dolárov, znamená to pre mnohé ženy cestu z chudoby. Diksha, 31 ročná Indka, matka troch vlastných detí, o ktoré sa stará, vynosila dve deti pre klientov. Jej manžel zarába mesačne 40 dolárov. Diksha za prvé náhradné materstvo dostala 7.260 dolárov a pre trust.org sa vyjadrila: „Vynosenie dieťaťa inému páru dramatický zmenilo náš život. Túžiaci ľudia po dieťati dostali šancu byť rodičmi a na druhej strane zaplati sumu, ktorá nám zmenila životy k lepšiemu.“ Diksha využila peniaze na kúpu nového domu a zabezpečila lepšiu budúcnosť svojej rodine. Je však na mieste položiť si otázku: Vynosila by táto žena dieťa inému páru aj v prípade, ak by nebola vo finančnej núdzi?

Náhradné matky pochádzajú z najchudobnejších domácností, a hoci sa registrujú a náhradné materstvo podstupujú dobrovoľne, častokrát to robia preto, že nemajú inú možnosť. Dr. Ranjan Kumari, ženský obhajca práv sa pre CBS News vyjadril: „zraniteľnosť chudoby je využívaná v celom tomto systéme."

2) Ďalším rizikom je zhoršenie zdravotného stavu náhradnej matky, i keď náhradné matky sú vyberané na základe prísnych klinických testov. Avšak, náhradne matky môžu potratiť alebo sa u nich môžu rozvinúť zdravotné problémy počas/po tehotenstve. Kliniky nie vždy poskytujú nadväznú zdravotnú starostlivosť, ak sa vyskytnú nečakané zdravotné problémy, hlavne v menej vyspelých krajinách.


Zdroj:
www.bioedge.org/index.php/bioethics/bioethics_article/10805
articles.timesofindia.indiatimes.com/2013-10-30/india/43526104_1_surrogacy-tourist-visa-medical-visa
www.newrepublic.com/article/115873/fertility-tourism-seeking-surrogacy-india-thailand-mexico
www.medicaltourismco.com/assisted-reproduction-fertility/low-cost-surrogacy-india.php
www.trust.org/item/20131004162151-r5i0w/

Foto: freedigitalphotos.net

Spracovala: Katarína TOMKOVÁ



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