HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Tuesday, June 5, 2001

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[English]

The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Ladies and gentlemen, I'll call this meeting to order.

It's my pleasure, on your behalf, to welcome Dr. Patricia Baird as our single witness today. Dr. Baird was chair of the Royal Commission on Reproductive and Genetic Technologies, which reported a few years ago, and now is professor and chair of the department of medical genetics at the University of British Columbia.

Dr. Baird, we're ready to hear you when you're ready to begin.

Dr. Patricia Baird (Chair of the Royal Commission on Reproductive and Genetic Technologies (1989-1993); Professor and Chair of the Department of Medical Genetics, University of British Columbia): Thank you. I'm very pleased you invited me to be here. It's a great pleasure to be here.

What I want to cover is going to take about 40 to 45 minutes, and your clerk said this was all right, so I'm going to do that.

First, let me say that I'm very pleased Mr. Rock has brought forward this draft legislation. We've been discussing and consulting widely on these topics in Canada for over a decade, and I think the overriding need now is to put in place a system to deal with reproductive technology. It can be fine-tuned over time.

In the time you've allotted me I'd like to do two things. First, I'd like to briefly go over the work of the royal commission, which reported seven years ago, and its findings, because I think it's important to remember that Canadians have been consulted and have had input on these issues since the late eighties. It's a long time. Second, I'm going to then address the current proposed legislation and make some comments and ask some questions. And I'll leave my speaking notes for you so you don't need to hurry to take down anything.

First, the royal commission. Its mandate was very far-reaching. In essence, we were asked to look at a range of technologies and practices, which I've listed up there, that relate in some way to reproduction, and then recommend how, in Canada, we would deal with them in the public interest—and that last phrase is important.

I think it's very clear, and as you do your work you'll become very apprised of the fact, that we're in the middle of an ongoing knowledge revolution with regard to genetics and reproductive biology. Increasingly, we can use techniques to alter, to control, or to monitor human reproduction, and we can permit things that certainly couldn't be done by sexual intercourse. A child can come from parents who died in the past, from a pregnancy of his grandmother, or from the pregnancy of a woman who's not even related to him genetically.

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How we apply this knowledge has many ethical and social issues. We can't set back the clock; we have to respond to these new capacities, because they're not going to go away. How we do respond I think is going to reveal what our priorities are and what kind of a society we want to live in. Whether or not we personally use the technologies, all of us have a stake in the kind of society we live in—that it not be one where people or their reproductive capacities are treated as commodities. So how reproductive technologies are handled must take into consideration the values of Canadians.

When we did our survey research at the commission, we found that having children and a healthy family were the most important aspect of their lives for most Canadians. This means that for most people infertility is not a trivial matter. It's not simply a one-time event, but it has effects throughout people's lives. We also found that Canadians think that if there are safe and effective ways to help people wanting to have a family, they should be available. But at the same time, they want government to ensure that there are limits and that beneficial and not exploitive or harmful use of technology is made.

So what did we do? How did we start off our task? We started by consulting very widely, and I've put some of the things there. We had public hearings across the country, of course—that's what all royal commissions do. We had hundreds of written submitted briefs. But we also had toll-free telephone lines so that people who found it hard to get out to that kind of venue were able to have input, and over 6,000 people called.

And because all those ways are self-selected, we felt that we needed to have surveys of randomly selected Canadians, and we did that with over 15,000 individuals. We had round tables and several other avenues for people to have input.

By the time we were finished, over 40,000 people had had input to us, and some of those individuals, for example those who represented religious groups or labour unions, actually gave us input on behalf of thousands of other people. So by the time we were finished we had more input than any royal commission to that date.

At the same time as this was going on, we had a research and evaluation program, and this found out what was actually occurring across the country. In the clinics we gathered data, and also from patients. We also examined the issues extensively with projects and analyses in many disciplines, including social sciences, ethics, and law, as well as medicine, and over 300 researchers at some 50 institutions participated.

Through these two streams of work, the research and the consultations, the commission was able to provide for the very first time in Canada a picture of infertility and new reproductive technology use and substantive social, ethical, and legal analysis of the implications of using or of not using technologies.

The commission made its decisions in the light of both the research findings and the input that was broadly based from the public using explicit ethical principles to guide the choices we made. The broad ethical orientation we took was something called an “ethic of care”, and that's a stance that gives priority to the mutual care and connectedness between people and their communities. And then within that orientation there were eight guiding principles.

I sent you a copy of an article that briefly summarizes our work, but if you want more information, our two-volume final report and the 15 volumes of research studies are available. The report sets out the science and the social and ethical issues in a clear and comprehensive way, I believe. It's written for the general reader deliberately, and we outlined our reasons for coming to the recommendations we came to. Obviously you can't do all the research volumes, but I think you'd find going over some of it useful to you.

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For example, even the chapter that explains human reproduction is not as simple as the birds and the bees, or the chapter on the ethical framework we use for decision-making. So I hope the clerk will make a copy available to you.

I think it would be a quite useful context for me to briefly go over a few things we have found. First is the prevalence of infertility. As context for setting public policy in this area, it's obviously important to know how common is infertility. We were surprised to find that information wasn't available. The data had not been collected in Canada. The commission's research found that 8.5% of couples who had been cohabiting for a year without contracepting, in which the woman was between 18 and 44, hadn't been able to have a pregnancy. If you waited till two years, it was a smaller number—about one in five became pregnant during that year—so that at two years, 7% of couples had not been able to do so.

Another immediately obvious and ethically indicated thing to do is prevention, if it's possible. The commission found that the risk factors that can lead to infertility are complex, they're interrelated, and both people bring them. Nevertheless, the three most important risk factors that we found for infertility, in the sense that they're both causative and there are strategies we could have to prevent them, are sexually transmitted diseases, smoking, and delaying childbearing.

We examined adoption, because of course it's always suggested as an alternative for infertile couples. The data showed that it's a disappearing option in our country and it's no longer a realistic alternative for many. That's important information, I think because it shows the need for other methods to assist people to have a family.

Donor insemination is an option when there's no fertile male partner. The commission found that in Canada it's the next most common way to have assistance to have a child after fertility drugs. The child has another biological father than the male in that couple, and that's the reason people often may prefer not to have it. But it's a safe, inexpensive, and effective way to have a child, provided standards are followed. As we gathered data across the country, we found they simply weren't. Because of poor record keeping, it wasn't possible to say precisely, but donor insemination probably led to the birth of somewhat under 1% of all children in Canada in the early nineties.

Voluntary guidelines were developed by dedicated infertility specialists in 1988. We were looking at these issues in the early nineties, and they certainly weren't followed in over half of the clinics and even less so in offices. We found there was great variation in what in fact, if any, medical and social information on the donor was collected and in how long it was kept. That means there's no assurance on the limits of numbers of offspring from one particular donor in a community or that individuals who are half-siblings may not mate.

IVF was the least commonly used strategy to overcome infertility. In 1991, about 400 children were born in Canada after its use. The annual number has probably doubled or slightly over-doubled since. We found that the data to allow proper evaluation of the success rate were not collected at all clinics, that at some centres, when we interviewed the women rather than the clinic, we found that incomplete and misleading information was given to women, considering it's a procedure that is expensive. It involves health risks both to women and to offspring.

We found that some clinics actually take couples who have a relatively short duration of trying; it wouldn't be uncommon for them to have a baby without any treatment.

We found that there was a real need for evidence to be used to guide practice. The health care system has to pick up the costs that are generated by private clinics—the multiple births, for example—but it can't control the practices of clinics that make such outcomes more likely.

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Normally about 1% of pregnancies are twins. If you have IVF, somewhere around one quarter to 30% are multiple pregnancies. That's a way of undercounting, because it's not pregnancies that matter, it's individuals, and because there may be two or three individuals born, the important figure to remember is that about four out of ten individuals born after IVF come from a multiple pregnancy. That's important because of some of the complications and problems.

Preconception arrangements: Of wide concern both in the medical and in the wider community is that it's possible to use donor insemination and IVF in a growing and widening variety of circumstances—for example, to allow a woman to embark on and carry a pregnancy in order to hand the resulting infant over to a commissioning couple who pay her.

The commission found at the time that the going rate was about $15,000 to the woman and about $15,000 to $20,000 to the broker. The most common arrangement was for the woman to have insemination with a commissioning man's sperm, although embryo transfer after IVF using both of the commissioning couple's gametes was done on occasion.

When we looked into this and reviewed the evidence we were somewhat disturbed, because we found that commissioning couples have higher incomes and they're more highly educated than the women who undertake the pregnancies. The brokers represent the interests of the commissioning couples because that's who pays them. Those facts make it pretty unlikely that the parties are negotiating as equals. The arrangements have the potential to exploit women who are in financial need and they leave some women open to coercion.

We did surveys that found that very few women in the general population in Canada would be willing to do it under any circumstances. I think that's because pregnancy and birth is a very personal and meaningful human experience. So a woman who does it for money can't really win. If she denies her emotional responses and views it as a commercial transaction, at some level she's dehumanized. If she doesn't and she becomes attached to the baby, it results in grief and loss. Her capacity to have a child is reduced to a marketable service that someone purchases. We judged that commercial surrogacy was contrary to human dignity.

We also found that the gestational mother's family is affected by her participation. If she has other children, they see mummy's tummy getting big and then the baby is sent away and they may be afraid that they too could be relinquished.

If a child is born with congenital anomalies, which happens—it's part of the human condition several percent of the time—if the commissioning couple won't accept that baby then the gestational mother and her partner, if she has one, are faced with raising a child who requires substantial emotional and financial resources they didn't plan to have.

It's hard to escape the fundamental reality that commercial preconception arrangements view a child as a product that can be bought on the market, and I believe a caring society has an obligation to ensure that individual actions, even those that benefit some, don't generate greater harms to other individuals and to groups.

I think there are benefits to a few individuals from commercial preconception arrangements, but they're far outweighed by the harms to others and to society that are likely to result. Commercial surrogacy by insemination is not illegal in Canada, and I hear increasingly that there are private clinics making surrogacy arrangements by IVF.

The commission recognized that private arrangements with no medical and no legal intermediaries involved can't be stopped, but even in that situation the interests of children need protection by putting in place some relevant legislation.

Embryo research: Some knowledge about reproduction is needed in the treatment of infertility, and it can only be gained by research observing fertilization and early development under different conditions. So some research is essential to ensure the safety and the quality of medical treatment in the field. There are also potential benefits from research on stem cells that are derived from early embryos, but at the same time it's really essential to ensure that embryos are treated with respect because of their connections to the human community. Boundaries and regulation with regard to embryo research are needed, and rules and control of embryos that are ex utero are also needed. And we don't have those in Canada.

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Pre-implementation diagnosis—that's not prenatal, it's before someone becomes pregnant. And it's an example of the need to use genetics carefully. Provided—and it's a big provided—you do in vitro fertilization, you have the early embryo in hand, as it were, so it's accessible for genetic testing before it implants. You can take a cell from the cluster of cells that makes it up and you can use genetic probes to look at particular genes, or you can look at the chromosomes to see if there are any unusual findings. Then only those embryos that don't have a genotype identified as undesirable can be transferred to the woman's uterus.

The number of instances when it's appropriate to offer pre-implantation diagnosis is extremely small. It's relevant only for people who are at a high risk of an identified particular monogenic or chromosomal genetic disease, but who don't want to have less risky, less costly, more accurate prenatal genetic testing. In spite of this, private clinics that provide this technology can be expected to market and promote it. The more services they provide, the more successful they are.

In 1997 a Toronto private fertility clinic offered, for a fee of about $8,000 a cycle, to screen embryos for the risk of genetic disease before implantation. And it offered pre-implantation diagnosis to the public for 27 so-called genetic diseases. Some of these had no close correspondence between having a particular gene and the disease. One of them was breast cancer.

The clinician involved said this was the beginning of the end of genetic disease. He obviously didn't know much about genetics. And he added that the roster of diseases the clinic would identify was going to grow dramatically over time.

This kind of promotion and hyperbole markets the technology as quality control for parents, and it's likely to lead to inappropriate overuse. We're at a stage when identification of genotypes that are only associated with a risk of disease is becoming more common. And the public may not understand that having a gene doesn't necessarily lead to having its perhaps related disease. So letting such pre-implantation diagnostic testing develop just ad hoc is not a recipe for ensuring that it will be used in a way that is beneficial.

Most people would like to have healthy children, and marketing of this technology could play into that goal in an exploitive and a very misleading way. If it's going to bring health benefits, pre-implantation testing should only be offered in clinics with clear protocols, demonstrated benefit, demonstrable expertise, and resources for counselling and for follow-up.

Sex selection: There are three approaches to selecting sex simply because you prefer a boy rather than a girl or vice versa. They are sex-selective abortion after you've done prenatal diagnosis; sex-selective embryo transfer after you've done pre-implantation testing; and sex-selective insemination after you've treated sperm. Each of those methods raises different ethical and social issues. The commission regarded sex selection for preference as contrary to its guiding principles and to generally held values on sexual equality. We don't have any policy or mechanisms in place.

Altering human genes: Gene therapy at the somatic or body cell level involves inserting a normal gene into the body cells of an individual to correct a genetic disease. Use of this approach may, in children or in adults, be appropriate if there is no other treatment for severely affected individuals that works. If you are going to propose it in the prenatal context, it poses risks for the woman who's carrying the baby, as well as the baby. And this means, as well as the usual ethical reviews, another level of scrutiny would be desirable.

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Genetic alteration that alters the germ line, the gametes, of an embryo or person so that it's inherited, or another kind of genetic alteration, non-therapeutic genetic alteration, which is to improve or to enhance a healthy individual, are quite different matters. These carry great social and medical risks without any clear benefit to a given individual, so regulation is needed to improve accountability and put boundaries in place.

Lastly, on use of fetal tissue, the commission found that the evidence shows there's a real possibility that the use of fetal tissue transplant could result in considerable alleviation of human suffering in some devastating disorders. If you were to prohibit pursuit of such research, I think it would be uncaring and unethical. But at the same time, because elective abortion is the only practical source of such tissues, we recommended controls to ensure that use of tissue in research doesn't encourage abortion and doesn't exploit women. We recommended, for example, that the decision to permit tissue use be taken after the decision to end the pregnancy, that no directed donation be possible, for example to a family member, and that no payment or benefit be given to the woman.

I've raced through a lot of that, but in summary I think you can see that reproductive technologies aren't a monolith. Some technology uses are beneficial and they should be supported, some uses require outright prohibition, and some should be within particular limits. I think the situation with regard to new reproductive technologies needs badly to be addressed. The issues aren't going to go away. The field is growing. You read headlines every few weeks and months about some new technique, and potential uses and misuses are widening.

So what did we conclude? The commission recommended that the Canadian government, as guardian of the public interest, must do two things: it must put boundaries around the use of new reproductive technologies and it must put in place a system to manage them within those boundaries, and not just for now, but, importantly, in a flexible, ongoing way. And we recommended legislation to prohibit several aspects of new reproductive technologies: certain kinds of embryo research, reproductive cloning, for example, making hybrids, or transferring human embryos to other species. We recommended prohibiting using eggs from female fetuses for implantation. We recommended prohibition of selling human eggs, sperm, embryos, fetuses or fetal tissue, and we recommended prohibition of paying for, or acting as, an intermediary for surrogacy arrangements.

The great majority of Canadians want those boundaries, we heard, and our ethical analysis suggested to us that these should never be done. This is not something that is going to change over time. The ethical reasons, the why not, will be there in decades to come.

Second, we strongly recommended that the Canadian government establish a national regulatory body with licensing being mandatory for the provision of new reproductive technologies to people. We really should not continue with the present harmful and inequitable patchwork of standards and uses that the commission demonstrated, with clinics and practices that range from exemplary to harmful. There was a very strong consensus that a regulatory body was needed. Almost everybody we talked to believed that. And a national approach is needed because technologies have implications that aren't containable within one province. For example, if you allow commercial surrogacy in one province, it conveys a view that the practice is acceptable and you can't contain that view within one province's boundary. If you allow 65-year-olds to have IVF in one province but not in another, it would encourage reproductive tourism. The examples are many.

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We recommended that a national regulatory body be set up to license and regulate provision of services to people and that it be at arm's length from government. We heard that many times. We recommended that women normally make up at least half of the membership, that it include people who had a broad range of experiences and perspectives, and that the members do not have to be reproductive medicine experts.

The members of the regulatory body can get expert input just the way you have. The individuals on it should not feel they're representing particular constituencies or stakeholders to whom they're accountable. I think that's a recipe for stalemate. They should be people drawn from wide and diverse experiences and backgrounds who wear a citizen's hat in making judgments. I believe they are there, just as parliamentarians are, to make judgments in the public interest, not for special interests.

We heard a very strong message from across the country that the regulatory body should be arm's length from Health Canada to ensure openness and transparency. We recommended that it should report annually to Canadians through Parliament on what's occurring across the country in uses of reproductive technology, and that licence hearings should be public.

The commission recommended that it be compulsory to have a licence from this regulatory body in order to provide services to people. The licence would be conditional on complying with certain very clearly specified conditions. I think the ultimate cost to Canadians of not putting such a system in place will be far greater than the relatively modest expenditures in setting this up.

I think an advantage of the regulatory body is that a minimum can be embodied in legislation. Although the law would require a licence to provide services to people, the policies and the rules to be complied with to continue to hold that licence could be shaped in a fashion that responds to change without having to change the law. I think that's very important in a field where knowledge is changing rapidly, and where it takes, as we know, many years to change legislation.

I think in essence you can see there's an awful lot of similarity between what the commission recommended and the current proposed legislation.

That was a very brief tour of the royal commission. To come to my second big topic, the current proposed legislation, I think it's much more important to get a regulatory system established than delay and delay over particular specifics. Currently many of the people using these technologies are doing so without benefit of fully disclosed information on the risks and benefits, without good data collection or record keeping. So without reliable information on the outcomes of treatment, the important thing is that licensing will be mandatory.

I think it will be quite possible to make changes when we have this overall system in place so that in this fast-moving field you'll be able to respond in a timely way. My strong preference would be to keep specific legislative prohibitions to a minimum necessary, and address the need for control in the conditions of licence.

I think there's another reasons to do that too, and it's that the language of the prohibition legislation could inadverently prohibit something it didn't mean to, or it could leave out something that then becomes possible. I think the proposed legislation you have in front of you is much better and more balanced than Bill C-47 was, because it addresses not just prohibitions but the other side of the coin, ensuring access to safe and beneficial technology use.

I think Canadians using these technologies to build their families need to be confident that the technologies are being provided in a regulated environment with standards of service provision, information disclosure, and record keeping that are being met.

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This legislation opens for the first time the option to have identified sperm donors. Individuals who are born after donor insemination have the same wish as you or I and most people to know something about their biological progenitors. I'd make a comparison to where attitudes about adoption were 50 years ago. It was felt then that adoption had to be kept secret, and it was somehow seen as shameful. Adopting is now viewed as socially valuable, and children learn they were adopted as they grow up. Perhaps we can make some progress toward a situation where altruistic sperm donors are comfortable with providing identifying information. I think the psychological needs of people who are not just infants, they become grown-ups, and who have complicated feelings about this do need to be strongly weighed.

We heard, as I'm sure you will hear, from some professionals that they were self-regulated, and so no oversight body was needed. I would agree, professional self-regulation is necessary, but it's not sufficient. Many of the decisions that relate to how we use reproductive technologies are ethical and social policy decisions, and medical specialists are not best equipped to make those decisions on behalf of society. I believe we should build on the valuable work professional societies have done on standard setting, training and accreditation, technical guidelines, but a body is needed to set policy and act as a focus for societal input on how we'll use the technologies in Canada. We heard a great many times from Canadians that simply having professional self-regulation was not appropriate.

With regard to the draft legislation wording itself, there are six provisions that I have questions on, and I'll go through those in turn. The first one is where the definition of genome reads, “the totality of the nuclear deoxyribonucleic acid sequence of a particular cell”. It seems to me this would omit from regulation cytoplasmic or mitochondrial transfer, and you'll probably have heard—it's certainly in the newspapers—that recently U.S. scientists announced the birth of children created by transferring cytoplasm and little organelles in that cytoplasm called mitochondria, which have genes, from the egg of one woman into the egg of another. The children, therefore, have nuclear genes from two parents, as usual, but they also have extra genes from a third person, the mitochondrial genes, and these could be transmitted in turn to their children.

There is a paragraph 3(1)(b) that says it's prohibited to knowingly “alter the genome of the cell of a human being or in vitro embryo such that the alteration is capable of being transmitted to its descendants”. But because genome is described earlier as simply nuclear genome, as the current wording of the legislation is, it would be permissible to alter mitochondrial genes that could be inherited.

Whatever policy position is taken on this, it seems to me it shouldn't be taken preemptively by individual clinics or individual doctors. The pros and cons need to be assessed by the regulatory body, and policy that encompasses mitochondrial as well as nuclear genes needs to be put in place.

So that was my first point. I've only got six and I'll try to go quickly.

Still under definitions, human reproductive material is defined as “sperm, ovum, other human cell, human gene or in vitro embryo...”. I'm not clear, because I haven't had sufficient time available to me to really think through this yet, if there'll be any unintended implications of that wording for tissue cloning research or for infertility treatment. “Other human cell” seems to define all living human tissue as human reproductive material, and later on, subclause 8(1) says only people licensed by the regulatory body can “treat any human reproductive material for the purpose of...facilitating human reproduction”.

Under those definitions, it seems to me, if you had a physician doing tubal surgery, he'd be affected, because he's facilitating human reproduction and he's treating human reproductive material, under the current definition. So you might want to look at that.

My third point relates to another definition under clause 2, which says

“Surrogate mother” means a female person who carries an embryo or foetus derived from the genes of a donor with the intention of surrendering the child at birth...

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There needs to be an addition in there of the words “or donors”, creating “a donor or donors”. The current wording would not address IVF embryo transfer surrogacy, because in that instance the genes of the fetus are from more than one donor. The person concerned wouldn't be defined as a surrogate mother in the current wording and would fall outside legislation in subclause 4(1), which prohibits paying a surrogate mother.

Fourth, I want to draw your attention to clause 10, which is about the reimbursement of expenses. As I read it, paragraph 10(b) means that licensed facilities will be able to pay expenses to egg or sperm donors. What are legitimate expenses for egg donors? Does it include taking a month off work to recover from hormonal treatment and egg retrieval? The commission didn't think it was justified for women to take health risks to donate eggs for somebody else. We thought women who were having gynecologic surgery or having infertility treatment, so already undergoing the health risks, should be able to donate eggs, if they wished, but there would be no expenses payable to them. If substantial so-called expenses are paid out by licensed facilities, it's easy to envisage exploitation.

Women who are in financial need could be induced to donate, and as an aside, I think we should be very careful to use language accurately, because it really helps in clarity of thinking. Certain Ontario clinics now pay $5,000 to what they call egg donors. That's not an accurate term. If this amount is handed over, they're egg sellers, and it does help clear thinking to call things by their proper name.

The next provision of the legislation, paragraph 10(c), means that doctors may be paid to perform donor insemination or IVF used to bring about surrogacy, and the following paragraph 10(d) allows licensed facilities to pay expenses to surrogate mothers. What are expenses? If a woman takes several months off work, buys maternity clothes, has to travel for tests and doctor check-ups, takes vitamin supplements, etc., so-called surrogate expenses could be many thousands of dollars. Those expenses could induce people who are in financial need to undertake a pregnancy in order to hand over the baby.

Although an earlier provision, subclause 4(2), prohibits advertising or acting as an intermediary to arrange surrogacy, I think paragraph 10(c) means that doctors performing donor insemination or IVF embryo transfer for surrogacy may be paid to do so in a licensed facility. This seems to me being an intermediary. The commission recommended that surrogacy not be encouraged at all, and allowing medical assistance that's paid to bring about surrogacy would show societal acceptance of the practice.

Counselling too, with regard to surrogacy, is permissible in licensed facilities, but for the reasons I talked about earlier, the commission recommended that commercial surrogacy be prohibited, just as this current legislation does. But in contrast to what you have before you, we found that so-called altruistic surrogacy has many problems. These include coercion or family pressures to participate—we found several instances of that—confusion on the part of the child as they grow up and perhaps know who the donor was, and putting a healthy woman at medical risk for the benefit of somebody else. Even if no money at all changes hands, a child is still conceived in order to be handed over to somebody else, and it commodifies children. If generous so-called expenses for surrogate mothers are permitted, I think it's problematic, and in effect, it's commercial surrogacy.

The commission recognized that private donor insemination without intermediaries may occur, and to protect the child in such instances, we recommended that family law be amended to specify that pre-conception arrangements are not enforceable, that the woman giving birth is the legal mother, that there be a minimum waiting period before she relinquishes her maternal rights, and that in any dispute the child's best interests should prevail. But a difference is that we also recommended that any facility that knowingly provided donor insemination or IVF to facilitate a surrogate arrangement should lose its licence. This is an issue that maybe the committee would like to think about further.

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I have two more very brief points. One is with regard to subclause 20(2) concerning destruction of health information. I'm not a lawyer, but I don't understand the reasons and the implication of the provision that a donor, a treated person, or an offspring should be able to have destroyed health reporting information, but perhaps you'll understand it better than I.

My last point is with regard to subclause 21(2), which says a health information registry on donors, patients, and offspring will be kept. It doesn't say for how long, and I think it would be a good idea to specify. When we gathered data from across the country, we found great variation, as I said, in how long information was kept. That's important, because individuals may be adults by the time they need relevant medical or other information on the donor, so it should be kept for many years. In Britain they keep it 70 years. We recommended 100.

I'd like to close by thanking you for the chance to talk with you. I'm probably as aware as anybody of the real difficulties and of the task that's ahead of you—it cerainly isn't easy. I think all innovation is not by definition progress. It's not Luddite to recognize that exploitation, social injustice, and dehumanization can result from some uses of genetic and reproductive technology. I think in making policy we need to be aware not just of the physical dangers, but of the dangers to how we relate to each other.

I want to emphasize again that the main thrust of my input is that I am supportive of the bulk of this legislation, as the real need is to have a regulatory system in place for reproductive technologies. We've been debating, discussing, and consulting on these issues for over a decade in Canada, and while we go on doing so, there are several thousand Canadians each year who are using these technologies. The government has a duty to make sure their health and safety is protected, and I think it's most important to put a regulatory body in place as soon as we can, then we can fine tune it as we need to.

I think it's a great responsibility you have to manage the way through the choices that are facing us, and I wish you insight and success as you do your work on behalf of all of us.

Thank you.

The Chair: Thank you, Dr. Baird, for that very thorough review of your activities, and particularly your review of the proposed legislation.

We'll move now to the speakers list. I would like to remind my colleagues that also on the agenda we have a review of a potential report to Parliament on the screening process for the donation of blood. It's fairly short, but it might be controversial, so we have to leave some time. So I'm going to be a little stricter about the time today.

The speakers list so far is Mr. Merrifield, Mr. Bonin, Madame Picard, and Ms. Sgro. I'm going to try to keep you to five minutes each—that means five minutes including question and answer.

[Translation]

Mr. Yvon Charbonneau (Anjou—Rivière-des-Prairies, Lib.): I would like to talk about our schedule, Madam Chair. With Mr. Ménard's permission or co-operation, we could agree to delay our study of this matter to the next meeting, on Thursday, because we wasted some time in the beginning of this meeting because of the vote. Mr. Ménard is in the same situation as we are.

In order to do justice to the issue we studied together, and in order to take advantage of Ms. Baird's presence here today, a person with exceptional experience, could we agree to postpone the study of this matter until our next meeting, on Thursday?

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): If we delay the study of this matter until Thursday, we will not be able to make our report public by the end of this session, because this is probably the last week the House will be sitting. We could publish our report in September.

There is no urgency, but I would like a guarantee from the government side that we will table the report in September. This is not urgent. We can agree on this, but I do want the report tabled, because we did meet with certain witnesses.

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I think that we should take the time to have a discussion with Ms. Baird, given her expertise. In this case, it would be preferable to talk about this again in September, because discussing it on Thursday will not get us anywhere. You will not be able to table the report on Friday.

[English]

The Chair: Thank you, Mr. Charbonneau.

Mr. Ménard, I would like to caution you that we have one witness today, and on Thursday we have six representing the faith groups. So that's going to be quite a long presentation, and I would think some complicated questions will come from it. Of course, we didn't predict the vote today. but I did predict we might go a little over time, so lunch is being provided. So we could do at least one round with Dr. Baird, break for lunch, and then look at this report. It's only one page. I wanted also to caution Mr. Ménard that the committee has not yet decided whether it wants to make a report or whether it just wants to write a letter to the minister, etc. I said we would try to have a report, and there is a draft for us to look at, but that doesn't mean the committee has to do it. So the committee needs to look at this. I thought when we broke for lunch, people could read what is proposed, and then we could discuss it after that.

Mr. Charbonneau, I'm worried that Thursday's going to be very long anyway. So maybe we should just get cracking. I would ask my colleagues to be as succinct as possible. Dr. Baird is leaving a summary of her remarks with us, so all her major points will be in your files anyway.

Mr. Merrifield.

Mr. Rob Merrifield (Yellowhead, Canadian Alliance): Five minutes can go very quickly, so I want to thank you for coming. You obviously have a great wealth of experience in this area, and I certainly appreciate that being shared with us this morning.

I'm a little concerned with regard to your saying that embryos need to be treated with the utmost amount of respect. I guess some of the difficulties we're going to be dealing with concern the question of how much respect. Cloning and the use of embryo research in the area of cloning you suggested should not be tinkered with. We've seen other witnesses come forward saying, as you've said, be careful of the prohibitions. The status of the embryo is something we really need to wrestle with. Have your views changed a little on that? That's one question.

The other one I'd like to get in before my five minutes is up—and I hope you can answer both of them—is on the regulatory body. You're suggesting that this group of individuals not have special interests, and yet 50% of them, you're suggesting, will be female, which also would be a special interest. So I see some flawed logic in the view there. Could you respond on that question as well?

Dr. Patricia Baird: I'll have to keep it brief, so we can get a few questions, but the moral status of the embryo is something theologians and philosophers have wrestled with for hundreds of years. We wrestled as a commission, and so do all of the committees or inquiries that go into it. Clearly, in Canada there's a range of views on the moral status of the embryo. I think your task and our task was to find a way through that was principled and humane, that recognized that there was this very large range of views. Our commission, along with most other inquiries that have actually examined this issue, believes that respect is due to the embryo because of its connections to the human community, but that it's permissible to use it in certain circumstances during the first week or two weeks of development, and that's what we recommended.

I think you could also say that half of the regulatory body we recommended was male, and perhaps males have special interests too. Our society is composed of half males and half females. Most of the technologies are actually used on the body of females, and it seemed to us really appropriate that we make sure the female perspective was therefore represented on the committee.

I really think it is a mistake to have people who are representing particular interest constituencies on the regulatory body. I think people need to feel very strongly that they're dealing with very complex issues and there are dilemmas they have to find their way through as to what is in the public interest in a diverse society.

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Mr. Rob Merrifield: I would just like to follow up on this special interest. You're suggesting that since 50% of the population is female, it is not therefore special interest. Is that your logic on that?

Dr. Patricia Baird: No. I'm saying there are male perspectives and there are female perspectives. I think if you have half and half, you get both of them represented pretty well.

Mr. Rob Merrifield: Yes, we could try.

I think there are other special interests. It's just interesting to me that you flagged that one in this perspective. The logic is interesting on that.

I think the regulatory body is something we should be going down. You're saying arm's length from government. How arm's length is it, then? Is a quasi-judicial body preferable to one that reports under Health Canada?

Dr. Patricia Baird: I think we heard very strongly that Canadians wanted to have an arm's-length body that was outside Health Canada. It needs to be accountable to the people of Canada, through Parliament, and probably the most sensible way of doing that is through the Minister of Health. Because parliamentarians are accountable to the people of Canada, and if the body is accountable to them, there will be ultimately some accountability. I think having it completely free-standing means that it's not really accountable to Canadians.

You're going to have to look at a number of models. One of them that has worked reasonably well is in Great Britain. But you should be aware that we received a very strong message time and time again that Canadians wanted a free-standing body—not totally free-standing, obviously reportable through the minister—that they could feel was acting in the public interest.

The Chair: Thank you, Dr. Baird.

Thank you, Mr. Merrifield.

Mr. Bonin.

Mr. Ray Bonin (Nickel Belt, Lib.): Thank you, Madam Chair.

First I'd like to congratulate our chair, our researchers, and our clerk for the quality of witnesses you have been inviting.

I'm really impressed by your skills in teaching your specialization.

I expressed my appreciation to the minister for presenting a draft bill, because I'm finding out that a majority of us have problems with the morality and the ethics of this. We're not alone. Since it's a draft, it allows us to participate and contribute.

I too have a question on the regulatory body. It may be unfair; if so, share with us what you can, because you did hear from religious groups. When we say that the regulatory body should not belong to an interested body or body of interested individuals, does this mean that Canadians with strong religious views and convictions should be screened and prevented from sitting?

I understand how difficult this question is, probably for you too. But you've heard witnesses. Can you help us out with this?

Dr. Patricia Baird: No. I think that faith communities have given a great deal of thought over the centuries to some of these issues. We have a lot to learn from that kind of an analysis and thinking. So it would be quite appropriate that there are some people on the body who are from different faith communities. But what is important is that they don't see themselves as being there to represent solely that faith community and that they're accountable back to the constituency. They need to be there, I believe, to bring those perspectives to the table so that everyone wearing a parliamentarian's hat, as it were—a public interest hat—can then come to consensus on what makes most sense about policy.

I think we have a lot to learn from the faith communities' analysis.

Mr. Ray Bonin: The difficulty for some of us is there are people who believe that politicians should leave their morals at the door. I've heard that so many times. I don't leave my morals at the door. Does that mean that I couldn't...? It's difficult, because I don't represent the Catholic Church; I represent myself.

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To be fair to the body and the legislation, I can make it known what my hang-ups are, but I think I should be permitted to be a member of this regulatory body—I don't say I should be a majority of the body—to assure ourselves that the other views are presented.

Dr. Patricia Baird: Just as we're a diverse society with many different perspectives, we really need to have that body be pretty diverse too.

Mr. Ray Bonin: Thank you very much. I appreciate that.

The Chair: Thank you, Mr. Bonin.

Madame Picard.

[Translation]

Ms. Pauline Picard (Drummond, BQ): Good afternoon, Ms. Baird. I am very pleased to see you again. What you have to say is always interesting, even though this is fourth time we have studied this subject. Thank you for appearing before us today.

I am sure you are of the view that research is progressing faster than the regulations. You mentioned that earlier. At the time of your first consultation, when you tabled the Baird report, the committee had discussed human cloning. At that time, there was no talk about cloning for therapeutic purposes.

I myself tabled a bill to prohibit human cloning. At the time, you said you were not in favour of it, because of the way in which it was drafted. You thought that this would slow down research, that it could prevent research developments. I imagine that at that time, you were thinking about cloning for therapeutic purposes. Are you in favour of cloning for therapeutic purposes?

You mentioned earlier that the draft bill we have before us is better than Bill C-47. How is it better?

[English]

Dr. Patricia Baird: From my understanding of this bill, it prohibits reproductive cloning. I strongly agree this should be prohibited. It permits research on stem cells that are derived from early embryos—embryos that are in excess of the treatment needs of couples and that exist currently. It seems to me that's a very reasonable position, because it permits the research to be done that may in fact be of great value to society and to people who have devastating illnesses.

So it seems to me this bill manages to prohibit some unethical procedures, such as reproductive cloning, but at the same time does so in a controlled and accountable way. My understanding is that any facility doing cloning on stem cells from embryo will have to be licensed and their progenitors will have to get permission and a whole range of other caveats. It seems to me that is a reasonable compromise.

[Translation]

Ms. Pauline Picard: You answered my first question, but what are the problems with the draft legislation, in your view? You said that it was better than Bill C-47, which the government withdrew and which died on the Order Paper.

You said that it is better. You provided a great deal of information, but I did not understand the main point. You do have some reservations about the current draft bill. What are they? Does the bill not go far enough?

I am very interested in the issue of infertility and its causes. I think assisted reproduction is used very readily. Of course, it is very interesting for science to find new materials and new techniques, but I do not think we are focussing enough on the causes of infertility in women. In your opinion, does this draft bill reflect an interest in doing research on the causes of infertility, as was the case in the report of the Baird Commission?

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[English]

Dr. Patricia Baird: Obviously one of the things you want to do is prevent infertility, if possible. We recommended that there would be an overall reproductive health approach that would in fact try to meet that goal. I understand Health Canada is actually developing or trying to develop an approach to reproductive health per se. Maybe you could ask people within Health Canada what their approach is on that. But it's very true and it's essential that as a country we do what we can to prevent infertility.

Nevertheless, I think it's really important that we move forward and get a regulatory body and some legislation in place. I think we can fine-tune. For example, if a clinic has to have a licence, one of the conditions of licence can be they don't take people for treatment unless, for example, they are of a certain age and have been trying for a certain length of time. The clinics that will take people after five or six months of trying in their early thirties.... You wouldn't get that quick off the mark to treat approach if you were to put the conditions of licence for a clinic in an appropriate fashion.

We would also make sure that the information that's disclosed to potential patients is accurate in terms of giving them the risks, so that they know about multiple pregnancy, the downside of low birth weight as a complication, and the fact that most people who have IVF do not have a baby. Even after several cyles of treatment, 80% to 85% of them don't.

I think we could address some of those issues through the conditions of licensing.

The Chair: Thank you.

Ms. Sgro.

Ms. Judy Sgro (York West, Lib.): Thank you very much, Dr. Baird.

As we sit here every week and listen to these deputations from such great people as yourself, I'm glad that you're a Canadian and so grateful you're in the position to do the work you've done.

It's an issue that continues to make me really uncomfortable. I wish I had a wand in one second to make it go away. Then the other second I know we have to move forward and deal with this issue. But there are so many issues involved in this, from an ethical and moral avenue, that I find it tremendously difficult.

How widespread currently are the uses? Or are you in a position to be able to give me that information? Are there a lot of clinics out there doing this without some of the controls you're recommending? How widespread is this in Canada?

Dr. Patricia Baird: Well, I can give you some ballpark figures. There haven't been scientific surveys since ours, so I'm projecting and updating.

I would think approximately 4,400 women are having a cycle started, a year of IVF treatment, or something like that. Probably somewhere around 800 or 900—I haven't seen the statistics, so this is just off the top of my head—have babies from IVF. Donor insemination would be probably 2,000 or 3,000. We don't have statistics on it because some of that is being done in private offices as well as in clinics.

What you're talking about is probably several thousand Canadians a year coming to facilities and being affected. There are probably, I would say, fewer than two dozen clinical facilities that do these advanced techniques, so it's not a huge problem. But it's an important one, because the health effects are pretty significant if you don't have appropriate standards and disclosure. People's expectations are different, if they don't have accurate information.

Does that give you some ballpark?

Ms. Judy Sgro: What kinds of licensing and controls are there currently under these various laboratories or agencies that are doing this?

Dr. Patricia Baird: Not a great deal.

There have been efforts by some people within the medical profession—Canadian Fertility and Endrology Society, for example—in setting guidelines and setting standards. It's voluntary. This means the people who are in the private clinic and who don't want to be accountable and who are really doing it as a business may not want to participate and don't participate.

Ms. Judy Sgro: Numbers could be much higher.

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Dr. Patricia Baird: Not at infertility clinics, because obviously they have to advertise to get patients so one knows where they are. I think there are about 22 of them right now. But as I said, I haven't looked at it within this last year.

Ms. Judy Sgro: Has anyone tracked the success rate at the end of the day? This has been going on for quite a few years now. I would expect that there are—

Dr. Patricia Baird: You see, one of the problems is how you define success rate. There are so many definitions that different clinics use, and women are told the success rate is such and such.

What's the success rate? Well, if you define the success rate as cycle of treatments started and live-born baby to take home, it's probably somewhere in the area after IVF of 15% to 20%. If you do something called ICSI, intracytoplasmic sperm injection, it's probably slightly higher than that. But still, the great majority of people who have this advanced treatment do not have a baby.

That means that if a couple are fully informed—they know the costs, the risks, the health risks, the complications to the infants—if they wish to go ahead, then it's better than having a very, very low chance of having a baby. Some couples are in that position.

Ms. Judy Sgro: Madam Chair, just a question to you. In our list of deputants who will be coming and speaking to us on this issue, are we planning to invite some of the couples who have utilized these various procedures?

The Chair: Yes.

Ms. Judy Sgro: Thank you.

Dr. Patricia Baird: We interviewed over 500 couples at the commission who had used various.... It might save you some work to look at our sub-report on the testimony from those people.

Ms. Judy Sgro: Thank you.

The Chair: Thank you, Ms. Sgro.

Mr. Ménard.

[Translation]

Mr. Réal Ménard: I would like to ask you three brief questions. Have things changed so much since the tabling of your report that we can no longer put forward a bill banning human cloning?

I understand that things are evolving quickly and that there are new technologies available. As legislators, could we not have passed a bill on human cloning quickly, and later studied the other issues, the five other recommendations contained in your report? Are things moving so quickly that what the Baird Commission recommended is preventing us from taking action regarding human cloning?

There is one aspect of your presentation that is not clear. The Commission does not take the same stand as that which appears in the draft bill. Do you still hold the same position? Do you or do you not agree with the use and creation of embryos for research purposes only? The Baird Commission seemed to say that this was possible, but the draft bill completely prohibits it.

Finally, I did not understand your recommendations about surrogate mothers very well. What are your warnings, and what changes would you like to see to the draft legislation? Could you remind us of them?

I understood that you had six areas of concern, but I missed one regarding surrogate mothers.

[English]

Dr. Patricia Baird: I think you asked three different questions. I'm not sure if I have the gist of them completely.

The first question was with regard to whether research has moved on a lot since the commission. It has continued to move. One of the things that has become possible since we reported is cloning—reproductive cloning. We saw it on the horizon. It wasn't possible when we recommended, but we did recommend it shouldn't be done. So that was one thing.

With regard to embryo research, I think—

[Translation]

Mr. Réal Ménard: Could we not have passed a bill now? Have things changed so much as far as the scientific aspect goes? Could we not have taken action now to ban human cloning as an initial step and deal with your other questions later? Would it be preferable to start by having all the answers to the questions you asked?

I think we could have legislated on human cloning now.

[English]

Dr. Patricia Baird: I don't think it's a good idea to have a bill that is a one-off, that addresses the issues in this field one at a time. It's essential to prohibit reproductive cloning, but I think that needs to be done in the context of management of reproductive technologies as a whole. That's one thing this year, but what will it be next year, and the year after?

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We need an overall integrated approach, a framework, so you can add on things as the science evolves. I don't think it would be smart to just simply do a one-off and prohibit cloning. It certainly should be prohibited, and without too much delay, but it should be part of a whole approach.

Creating embryos for research is a difficult issue. I can certainly support the bill as it stands, because there are opportunities to do research on thousands of frozen zygotes that exist in freezers across the country.

If you were going to, for example, try to improve the fertility treatment rate—instead of being eight and a half out of ten that don't go home with a baby—what kind of fluid do you keep the sperm in, and what kind of fluid do you keep the egg in, so you get maximum fertilization rates? The only way you can address and improve that is to keep them in different fluids, and then analyse your fertilization rate.

It's a difficult issue, because to provide medical treatment in a field, you really need to have some appropriate research backing it up to improve it. But I can certainly support the current position in this bill, because I think we have thousands of in vitro frozen embryos we could use to develop some stem cell research that would be beneficial.

There was a third one.

[Translation]

Mr. Réal Ménard: What do you think about the issue of surrogate mothers?

[English]

Dr. Patricia Baird: You were not clear why I thought surrogacy was not a good idea?

[Translation]

Mr. Réal Ménard: You seem to be saying that the surrogate mother definition contained in the bill was a problem. What changes should be made in your view?

[English]

Dr. Patricia Baird: What amendments would I make to the current bill, with regard to surrogacy? I would amend it to make it a condition of licence that clinics not do IVF or DI in support of surrogacy, that they don't knowingly make surrogate mothers.

You will still have some instances of surrogacy, because it's fairly easy to do personally, with a turkey baster, as it were. But to show societal approval that it's okay to deliberately conceive a child not to have and rear and love, but to hand over to someone else—that's the difference I would make.

The Chair: Mr. Charbonneau.

[Translation]

Mr. Yvon Charbonneau: Thank you, Madam Chair.

Thank you very much for your testimony, Ms. Baird. I would like to give you my own summary of your overall message and then check whether or not I understood you correctly. You say that, generally speaking, there must be some bans on certain things, that much is clear. However, we must be careful, because some prohibitions could have some unexpected consequences.

You then said that rather than trying to refine indefinitely the list of banned activities and regulated activities, it would be preferable to work on establishing a balanced, enlightened regulatory body that would really have the power to monitor the issue as it evolves. That is what I understood you to say. Would you care to comment?

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[English]

Dr. Patricia Baird: I think you've put it extremely well. That's my main message. We need to get on with it, and put a system in place that's going to protect the health and safety of Canadians who use these technologies. That's my big message. We've been talking about it long enough.

[Translation]

Mr. Yvon Charbonneau: You are therefore suggesting that we do our best to establish a list of prohibited and regulated activities. Moreover, because of your considerable experience and all you have observed over all the years you have spent studying this matter, you suggest that we should establish a body supported by the research community that represents the range of views in our society, to give it a great deal of latitude, while requiring it to report in one way or another.

I would now like to ask you a question. Do you think that this body could report directly to the House of Commons or to the Minister of Health? Have you thought about that? What would be preferable in the case of this regulatory body?

[English]

Dr. Patricia Baird: We recommended that the body be accountable to Parliament, that it report annually to Parliament with a report on what's going on at clinics, what is happening, and what new issues are coming up in reproductive technology.

I think such a body would be able to not only regulate and monitor, but act as a sort of societal focus for people's concerns and discussion. For example, they could put out white papers on something new that was coming up, solicit input, and then start setting policy.

The regulatory body certainly doesn't start from a tabula rasa. We gave a very detailed blueprint in our report, as to what needed to be done by the regulatory body, with details on what is suggested about policy and regulation.

[Translation]

Mr. Yvon Charbonneau: Thank you.

[English]

The Chair: Mr. Lunney.

Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance): Thank you, Madam Chair.

There are three areas I'd like to touch base on very quickly, and give you an opportunity to respond. The first is in regard to pre-implantation genetic testings.

Dr. Baird, as an expert in the field of medical genetics, I believe I heard you say that there's certainly been some misleading hyperbole with regard to being able to test genes and cure certain diseases by finding them in very early stages. In fact, I believe I heard you say that having the gene does not mean someone is going to have a particular disease or develop that disease. If you'd like to expand on that, we'd appreciate hearing your comments.

Second, there have been some very exciting advances in research using stem cells from adult sources—bone marrow, adipose tissue with lyposuction, and so on, and for newborns from cord cells and so on. There is the possibility of being able to isolate adult cells, grow in vitro tissue, and implant that into a person who has an organ need, avoiding the genetic incompatibility of fetal tissue, which requires anti-rejection drugs for the recipient, if they receive tissue from another source. I would be interested in your comments on that.

Finally, in the interest of time, I'll just throw the third one out as well. In your royal commission report, you mention prohibitions. The things you mentioned there were the transfer of human embryos to animals, and animal embryos to humans, and the creation of human-animal hybrids, or chimera. I wonder if you would comment on that, because in the current legislation there is provision for the creation of so-called chimera for research purposes.

Dr. Patricia Baird: I missed that then.

On pre-implantation diagnosis and genetic disease, there are some genetic diseases called monogenic or Mendelian diseases where if you have the gene, there is a fairly close correspondence with having the condition. For example, if you have the gene for achondroplasia, you have achondroplasia. But as we're learning more through the human genome project, we're now able to identify particular genotypes that are only associated with an increased risk of having a particular clinical disease.

So I think pre-implantation diagnosis should only be used for those diseases where we know there's a very close correspondence between having the particular gene or chromosome anomaly and a disease outcome. We shouldn't start using it for these so-called susceptibility genes, etc.

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Also, if you approach that way of diagnosis, the woman has to take the risks of in vitro fertilization and the hormonal treatment, etc., and her chance of having a pregnancy isn't good, etc. So most people will choose to have prenatal rather than pre-implantation diagnosis.

With regard to sources of stem cells, there's a lot of work going on in the field, and it obviously would be ideal if we could direct adult stem cells to provide tissue. It's a lot more difficult than it seems. The people who know the field still seem to feel that there are advantages to stem cells from embryonic sources that you simply don't have in adult cells. We need to keep an eye on it and watch. We certainly should be supporting research on adult stem cells as well. It would be preferable if that turns out. But rather than neglect some of the really exciting opportunities to cure some devastating diseases, I think we should be permitting some embryonic stem cell research.

On creating chimera, when I read the legislation, I didn't interpret it as permitting the creation of chimera. What clause was it? I don't remember—

Mr. James Lunney: It's on page 10.

Dr. Patricia Baird: Yes. I'm not sure what they mean by chimera. For example, there are some techniques for diagnosing sperm defects that involve having to inject sperm into a hamster egg. Now, whether that kind of thing is what they're thinking of.... I missed that. So I'm sorry, but I can't comment on that. But I don't think we should be making animal-human hybrids.

Now, if by “chimera” here they mean joining human early embryonic tissue that has some abnormalities, say, with other early embryonic tissue that doesn't, then I think that would be impermissible. It should be. You might have found another clause that needs to be looked at closely.

The Chair: Perhaps, Dr. Baird, you could examine this, talk to some of your colleagues, and write to us on that topic. Could you?

Dr. Patricia Baird: Sure, I'd be glad to.

The Chair: Thanks very much.

Dr. Castonguay.

[Translation]

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.): Thank you, Madam Chair.

[English]

The Chair: After Dr. Castonguay we'll stop for lunch.

[Translation]

Mr. Jeannot Castonguay: We spoke about the pre-implantation diagnosis. I see a great deal of potential there. In your comments, you talk about undesirable genotypes and healthy children. Has this been raised? What is a healthy child? What is an undesirable genotype? Are we heading toward a situation in which we want purity in breeding? Have we reached that point at the moment? I would like to hear what you have to say about this.

I too would like to talk about infertility. I share Ms. Picard's concerns. Are we not taking the easy way out, by using embryos and believing that this will solve all problems? If we do that, we forget the importance of finding the causes of infertility and trying to solve this problem. I would like to hear your comments on these two matters.

[English]

Dr. Patricia Baird: With regard to what is an undesirable child, the motivation of many people who wish to have prenatal diagnosis is to avoid suffering.

There are some conditions that are lethal in early childhood, that cause devastating conditions—multiple seizures all day long, never being able to know other people or be able to be fed, etc. From the survey research we did, we certainly found that if there are the opportunities for people at high risk of having this kind of condition occur in their offspring, people think there should be diagnostic tests available and those at high risk should have the opportunity to avoid having such offspring.

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You need to put that into a larger context. As a society we ought to be appreciating diversity. Just because a person has a handicap doesn't mean this person should not be included as a complete, respected, and full member of our society. But there are some conditions that cause early death and real suffering. We found most Canadians felt that if this was the case, then as a society we should provide the opportunity to avoid those.

Not everyone would take it. We need to make sure that the conditions are in place so people can have the opportunity. If they don't want to, they're going to be supported by society.

Did that more or less cover it?

Mr. Jeannot Castonguay: Yes.

[Translation]

Let us talk about infertility. Of course, it is easy to take an embryo and implant it. Initially, this technique was used in cases where the tubes were blocked. The thinking was that while it was not possible to correct the blocked tubes, there was another way of creating a child and implanting it in the uterus, where it would develop normally. Now, we've gone much further in developments in our society. Are we forgetting that it might be a good idea as well to continue our research on the causes of infertility? What is being done at the moment in this area? Do you have anything you could share with us on this?

[English]

Dr. Patricia Baird: No, I think your point that we need to prevent infertility where we can is a very important one, and a very large section of our report deals with it.

As I mentioned earlier, some of the things are prevention of infectious disease—pelvic inflammatory disease particularly—smoking, and delaying child-bearing. We laid out the kinds of policies that would need to be in place to try to decrease those causes.

Correcting blocked tubes rather than offering IVF if the tubes are blocked is a difficult thing. Tubular surgery has been done, and research has been done on it for many years, and it doesn't work well, unfortunately. If it did, it would be perhaps a preferable way to go. But it seems that pelvic inflammatory disease damages the inner lining of the tube.

It's a very exquisite, beautiful sort of process, where the little fine cilia on the tube move the egg along, and the sperm is motile within a particular biochemical environment. When you've had pelvic inflammatory disease, this lining is altered and not able to offer this exquisite help to the fertilization process. So simply re-establishing a channel by surgically reaming it out doesn't work.

[Translation]

Mr. Jeannot Castonguay: I understand, but at the moment, is Health Canada trying to get information and encourage research on the causes of infertility? Is it trying to give people information? Is anything being done along these lines at the moment? I'm trying to clarify my question.

[English]

Dr. Patricia Baird: It might be very useful to ask Health Canada to make a presentation on what they're doing on that. Yes, I think it's needed.

[Translation]

Mr. Jeannot Castonguay: Fine. Thank you.

[English]

The Chair: Thank you very much, Dr. Baird.

We've completed one round of questions. There is lunch waiting in an anteroom, and I suggest that people who had second questions might want to take this little break period to talk to Dr. Baird and have their questions answered.

I would like to say, Dr. Baird, that we're starting this, and we're not sure what we might be struggling with next November, but we would like to reserve the possibility of having you back to guide us further, if this would be agreeable to you.

Dr. Patricia Baird: I'd be delighted to come.

I really feel for you, because I bet you're feeling the way I felt, and it's a big responsibility. Finding your way through is not easy.

The Chair: Yes. Well, thank you on behalf of all Canadians for the work you've done in the past and for being available to assist us with this particular project. Thank you.

We'll take a break now, ladies and gentlemen, and come back, please.

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The Chair: Due to loss of quorum, this meeting is now adjourned.