In their commentary article 'Recruiting egg donors after the removal of anonymity', (BioNews 299, 14/3/05), Alan Thornhill and Ian Craft of the London Fertility Centre lament the fact that the Department of Health (after wide consultation) abolished donor anonymity before addressing the issue of allowable expenses. Their memories are short I fear. When I was a member of the Human Fertilisation and Embryology Authority (HFEA) in the mid 1990s I chaired a working group, which produced a thorough report on the issues of payment and expenses. The HFEA did this precisely because we were aware of the building pressure to remove anonymity, and wanted to initiate the debate about types of donors and the culture of donation through the related issues of payment and expenses.
The HFEA attempted to initiate this debate well in advance of the (then distantly threatening) issue of anonymity removal, so that clinics were well prepared and had plenty of time to anticipate the changes. Unfortunately, when our report was published several of the clinics, as well as the British Fertility Society, complained loudly about our proposals and, Canute-like, effectively refused to consider them seriously. In consequence, and after agonising debate amongst its members about priorities, the HFEA backed down and did not press the issue. Now the chickens are coming home to roost and we get wailing and gnashing of teeth because anonymity has gone and the preparatory work to ensure services continue has not been done by clinics.
I respect the many dedicated clinicians and health workers providing excellent services to many couples. However, why did clinicians resist previous attempts by the HFEA to help them prepare? And why then, when it was clear that anonymity removal could no longer be resisted, didn't they initiate moves to re-open the question of expenses and payments rather than moaning that the Department of Health and/or the HFEA hadn't done so?
It is easy for clinics to forget that the HFEA grew out of excellent and forward-looking groundwork done in the 1980s by clinicians and scientists through the Royal College of Obstetricians and Gynaecologists and the Medical Research Council. The HFEA has been there to help clinics, not to hinder them, and whilst no organisation is immune from problems, since its inception, it has worked hard to promote best practice, to look ahead, and to ensure wide participation and input into its deliberations.
Many, maybe most, clinics and their staffs realise this and appreciate it. How can we best recapture that forward-looking approach from all clinics (especially the more vocal ones) before the whole edifice of support and protection for clinics and their patients is put at risk? I would hope that active and constructive engagement can resume, and clinics can take their share of responsibility for the current state of affairs rather than shuffling it off entirely to others.