A Calgary fertility clinic has been crucified in the media over the past week after a Calgary woman made public the clinic’s policy restricting patients from using gametes that do not match the patient’s ethnic background. One physician was quoted saying the clinic does not make “rainbow families”.
The rationale for the policy was that children should have a cultural connection to their donors so that they have the ability to connect with their ethnic roots. A comparison was made to the provincial adoption regime which has a goal to place children with families from the same cultural background. The policy was reportedly withdrawn last year.
What is the concern with the policy?
The law is the minimal ethical standard – an act can be ethically repugnant but technically legal. Below summarizes some of the major criticisms raised with the policy:
- The policy implies a preference for racially homogenous parents
- The policy is discriminatory
- The policy is unethical
- The clinic is the only fertility clinic in Calgary, so patients who are refused must travel great distances to obtain treatment elsewhere
- There are already so few donors available that this policy restricts the pool to an even smaller number, making it hard to find a donor and resulting in too many half-siblings in one place
- The policy is offensive to mixed-raced individuals
- There is no evidentiary basis that using gamete donors of different backgrounds will lead to disadvantages for the child
- It does not reflect Canadian values
What is the situation in Ontario?
It does not appear that any fertility clinic in Ontario has a similar policy. If such a policy did exist in Ontario, it would likely not be upheld if challenged by a patient on the basis of discrimination.
The Ontario Human Rights Code states that:
Every person has a right to equal treatment with respect to services, goods and facilities, without discrimination because of race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability.
The College of Physicians and Surgeons of Ontario has a policy on physicians and the Human Rights Code that states the following with respect to how physicians ought to manage moral or religious beliefs:
If physicians have moral or religious beliefs which affect or may affect the provision of medical services, the College advises physicians to proceed cautiously with an understanding of the implications related to human rights…. Physicians should, however, be aware that the Ontario Human Rights Commission or Tribunal may consider decisions to restrict medical services offered, to accept individuals as patients or to end physician-patient relationships that are based on physicians’ moral or religious beliefs to be contrary to the Code.
What can we learn from this story?
It is likely this misguided policy was created many years ago with the good intention of protecting unborn children, and it was simply not repealed once social norms reached the point that it was no longer acceptable practice. Clinics must often self-regulate when it comes to challenging ethical dilemmas as there is a lack of ethical guidelines to assist fertility clinics. Due to the fast-paced technological developments, ever-changing laws, and Canada’s collective movement toward greater acceptance of diversity (in all its rainbow colours), clinics should schedule regular policy reviews to ensure their practices are keeping up to date with the legal, social and ethical environments in which they operate. In addition, clinics should ensure they have a proper complaints process in place.
This story also raises the recurring issue of whether physicians should even be able to refuse to provide treatment that is outside of their moral comfort zone (a question that comes up regularly in debates about euthanasia, abortion and birth control). Prior to refusing treatment on moral grounds, fertility professionals should pause and consult with their colleagues, supervisors, legal and ethical advisers to ensure they have a proper risk management strategy in place and that the patient is provided with a proper referral.
And, finally, individuals who intend to use donated sperm, egg or embryos may wish to inquire with fertility clinics about their policies and practices prior to moving forward with treatment.
through a difficult time?