ITALY : Physicians Ban Controversial Biogenetics

Alarmed by freewheeling artificial insemination and the growth of unregulated fertility clinics, Italian doctors have waded into a legal vacuum that has made biogenetic ethics a national controversy.

A 62-year-old woman had a child last year after a donor’s eggs were fertilized by her husband’s sperm and implanted in her uterus. Rosanna Della Corte enjoys being a “granny mom.” Now, at 63, she wants another baby.

Fertility specialists recently celebrated the birth of baby Elizabetta, carried to term by her father’s sister from her mother’s egg two years after her mother’s death in a traffic accident.

Specialists have injected one woman with the frozen sperm of her dead husband, and they have engineered “designer babies” from sperm donors screened for their looks, intelligence or social status.

One Naples doctor is accused of substituting unknown sperm for that of a child’s putative father. The baby has a congenital illness that it could not have received through her parents.

Enough, says the national medical association that represents Italy’s 330,000 doctors.

A new code of ethics for doctors that went into effect this month forbids such practices. Framed as part of “an urgent appeal” to Parliament for controlling legislation, the code prohibits doctors from engaging in biogenetic practices that have drawn widespread criticism inside and outside Italy.

“When patients come to Italy from abroad for procedures that are forbidden in other nations, then clearly it is past time to act,” said Dr. Benito Meledandri, secretary of the National Council of the Federation of Doctors.

About 100 fertility specialists will be principally affected by the association restrictions, Meledandri said in an interview. Doctors who violate the code risk suspension or expulsion from the professional guild, which would effectively bar them from practicing medicine.

“Infertility is a malady, and doctors should try to cure it,” he said. “We are not against scientific progress, but neither should we permit what should not be ethically allowable.”

In predominantly Roman Catholic Italy, it is not only doctors who are concerned. “We have reached the point of producing human beings as if they were boxes,” snapped 81-year-old Cardinal Ersilo Tonini.

With support from Italy’s health minister, the medical association instructs doctors to accept only stable, heterosexual couples for artificial insemination. That would mean no sibling for Sara, born last year to a lesbian couple.

The code forbids artificial insemination for post-menopausal women and after the death of a partner. It forbids doctors from engendering all forms of surrogate motherhood.

“There should be no selection of sperm based on the social, economic or professional standing of the donor,” the manifesto asserts. It bans “all artificial procreation in any way based on racial prejudice.” It also rejects all kinds of commercial, industrial or advertising exploitation of embryos.

A commission of doctors based the new rules on existing laws in other European countries. The Italian Parliament, where gestation of laws is typically measured more in years than in months, may finally enact long-pending legislation later this spring.

Reaction to the new rules has been generally positive in the medical community and in society at large, the association says.

But the rules go too far for some--and not far enough for others.

“I will disobey. I will disobey in the name of the women and the children,” Rome gynecologist Severino Antinori said. A leading fertility specialist, he gave Della Corte her baby at 62.

Antinori calls the code “anachronistic, illiberal and anti-democratic.” He also rejects the ban against artificial insemination for single women, a view shared by Arcigay, Italy’s most vocal alliance of homosexuals. Arcigay calls the doctors’ code “dangerous and illegitimate” and urges members to challenge it in court.

On the other side of the street, the Roman Catholic Church looks with disfavor on the code because it does not order doctors to cease all artificial insemination.

Echoing Pope John Paul II’s “moral condemnation” of medical intervention on embryos, Italian priests are telling congregations that artificial insemination of any sort is immoral, forbidden, sinful.

In a country that is home to both the Vatican and the world’s lowest birthrate, the doctors’ ban may curb excesses. The church’s total veto, though, may exert no more respect among would-be parents than its prohibition of artificial birth control among the general population.

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A Bioethics Debate

Italy’s national association of doctors says its new code of ethics attempts to fill a bioethical vacuum in the country. Critics challenge the code’s constitutionality. The new rules forbid artificial insemination of:

* Single women

* Post-menopausal women

* Lesbians

In additional, the rules prohibit:

* All forms of surrogate motherhood, in which a fertilized egg is implanted in another woman.

* Artificial insemination using sperm from a partner who has died.

* Any selection of sperm based on the social, professional or economic standing of the donor.