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04/02/2010

Arizona non grata

It's a beautiful Friday afternoon here, one of the first to feel like spring, which can mean only one thing: Somebody's fucking with someone else's reproductive rights.

Two bills are currently before the Arizona legislature.  Each of them has enormous implications for infertility treatment in that state.  Please take a minute to read and seethe before you dig out your flip flops and fret about the state of your toenails.

Background

The current Arizona initiative is the work of CAP, the Center for Arizona Policy.  CAP, the conservative group recognized as Arizona's most influential lobby, has crusaded in the past against gambling, pornography, and abortion rights, and counts among its successes a state ban on same-sex marriage and acquisition of funding for abstinence education.  Their current agenda includes giving adoption preference to married couples, extending the waiting period for divorce, and restricting embryonic-stem-cell research.  Oh, and a charming little duo they like to call SB 1306 / HB 2651 and SB 1307/ HB 2652.

These bills, if signed into law, will discourage egg donation for use in IVF; prohibit compensation for egg donation for research; and severely limit the options available to patients with unused embryos.

Here's a quick breakdown of why these bills are problematic.  (Chime in, knowledgeable friends, if I'm missing anything.)

Discouraging donation through legislating informed consent

SB 1306 / HB 2651 "is designed," according to RESOLVE, "to discourage doctors from providing donor egg treatment…" and really, we could stop right there, because that's a complete sentence in itself, and an accurate one at that.  That's exactly what this bill is intended to do.

But the alert continues: "…by imposing a raft of new informed consent requirements coupled with harsh penalties — loss of medical license — if a doctor does not follow the new rules to the letter." 

But wait, you say, what's the problem with that?  Don't clinics already require informed consent?

Indeed they do if they're run anywhere within hollering distance of widely accepted ethical standards, and certainly if they're affiliated with the ASRM, which requires this as a minimum:

[E]ach prospective patient/couple must be provided with all relevant information necessary to make an informed decision regarding the proposed treatment and must be given the opportunity to ask questions in order to gain a better understanding.  It is also important that couples are provided with full information concerning risks, benefits, and alternative procedures available to circumvent their specific infertility problem, including procedures that are not performed by the treating center, as well as non-medical options such as adoption and no treatment.

I don't know a single ART patient anywhere who hasn't had to sign multiple pages of multiple documents attesting to their informed consent.  Clinics already do this.  Legislation is unnecessary.  So why bother?  To control the message and limit the application of ART.

The problems with this aspect of the proposed law are twofold — well, possibly severalmorefold, but these are the issues that immediately concern me:

  1. The only other medical procedure that has a legislated informed consent process in place?  Abortion.  Not only is there obvious potential for abuse with such a law, but the parallel being drawn between ART and abortion is chilling, as it is intended to be.  If informed consent is legally mandated, so can the content of that consent be, and if you don't see why that's scary, let me know.  I'll work up a puppet show or something.
  2. Notably, the bill calls for such a consent to include notice that an egg donor "cannot be completely informed of all potential risks or effects because all potential risks or effects and the magnitude of those risks or effects are not known."  This is as true as it is for any mainstream medical treatment.  That is to say that it is true, but that we've established, by this time, a reasonable understanding of those risks, their likelihood and their severity.  This is the "scary additional language" RESOLVE mentions, which insinuates that ovarian stimulation and egg retrieval, practices that have been undertaken and closely studied for almost three decades now, are a shadowy mad scientist affair.

Acquisition of eggs for research

SB 1306 / HB 2651 also prohibits physicians and researchers from paying for eggs to be used in research, i.e., "for any purpose other than treatment of human infertility."  Aside from the fact that other types of human tissue are collected for research purposes in exchange for compensation — plasma and sperm, for example — this dramatically hampers the efforts of Arizona researchers to develop new therapies for infertility.  (The original draft of the bill called for outlawing compensation to egg donors, period; cooler heads prevailed, but it's a useful fact to keep in mind when considering the mindset behind the initiative.)

Prohibition on research and destruction of human embryos

SB 1307 / HB 2652 comes from another angle and deals with the treatment of human embryos.  According to the bill as written,

"A person shall not intentionally or knowingly engage in any activity for nontherapeutic research that causes or results in the injury, death or destruction of an in vitro human embryo."

...where "nontherapeutic research" is defined as "research that is not intended to preserve the life or health of the particular human embryo subject," i.e., anything but transfer into a human uterus.

In other words, if you have embryos left over after your own infertility treament, in Arizona you may not donate them for research, and you may not have them destroyed.  Your physician would do well to note this, on pain of felony prosecution.

Reaction

The bills came as a surprise to area fertility specialists, who weren't given sufficient opportunity to speak in hearings about the bill.  Very little public debate has occurred; Senator Linda Gray, who served as a primary sponsor of both bills, declined to read in committee the letter signed by eight reproductive endocrinologists opposing the measures.

This is the same Linda Gray who told the Phoenix New Times that she didn't read the bills before signing on.  (Good one, Linda.)  If she had, maybe she'd have known better...

Gray insisted that she never intended to upset fertility specialists or their patients. Three decades ago, she says, she herself was a member of RESOLVE, the chief support/advocacy group for women dealing with infertility. Her only grandchild is the happy result of in vitro fertilization..."I know the pain these families go through," she says.

...but then again, maybe not, as she still stands by the bills, despite the restrictions they place on exactly the people she claims to identify with.  To paraphrase, "I got mine, Jack."

CAP claims that it is "committed to protecting and defending the family by influencing policy, communicating truth, and empowering families to promote timeless values."  But what exactly is pro-family about restricting the opportunity to become one?  How can you empower a family if you stand in the way of creating one?

Even if you're not infertile, this issue matters.  These bills are not a personhood initiative, but they're about as close as you can get without being emblazoned with big red letters saying FULL VOTING RIGHTS FOR ZYGOTES (AS LONG AS THEY VOTE CONSERVATIVE).  Don't give that crucial inch.  Please speak up against these bills.

What you can do

If you live in Arizona or care about someone who does, please contact your legislator and make your opinion known.  You can send a letter through RESOLVE, or you can contact your representative directly.  E-mail, call, and fax.  Let them know you're serious: use up all their toner.

What I'm hearing is that representatives are soothing callers by telling them that the bills have been fixed.  They haven't.  If you can, please make some angry noise.

I don't speak for RESOLVE, but they sure do a good job of letting me know of new and exciting opportunities get good and super-cranky.

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