Annas G J
Department of Socio-Medical Sciences and Community Medicine, Boston University School of Medicine, USA.
Child Welfare. 1981 Mar;60(3):161-74.
Current AID practices are based primarily on consideration of protecting the interests of practitioners and donors rather than recipients and children. The most likely reason for this is found in exaggerated fears of legal pitfalls. It is suggested that policy in this area should be dictated by maximizing the best interests of the resulting children. The evidence from the Curie-Cohen survey is that current practices are dangerous to children and must be modified. Specifically, consideration should be given to the following: 1. Removing AID from the practice of medicine and placing it in the hands of genetic counselors or other nonmedical personnel (alternatively, a routine genetic consultation could be added for each couple who request AID); 2. Development of uniform standards for donor selection, including national screening criteria; 3. A requirement that practitioners of AID keep permanent records on all donors that they can match with recipients; I would prefer this to become common practice in the profession, but legislation requiring filing with a governmental agency may be necessary; 4. As a corollary, mixing of sperm would be an unacceptable practice; and the number of pregnancies per donor would be limited; 5. Establishment of national standards regarding AID by professional organizations with input from the public; 6. Research on the psychological development of children who have been conceived by AID and their families. Dr. S.J. Behrman concludes his editorial on the Curie-Cohen survey by questioning the "uneven and evasive" attitude of the law in regard to AID, and recommending immediate legislative action: The time has come--in fact, is long overdue--when legislatures must set standards for artificial insemination by donors, declare the legitimacy of the children, and protect the liability of all directly involved with this procedure. A better public policy on this question is clearly needed. I have suggested that agreement with the need for "a better public policy" is not synonymous with immediate legislation. The problem with AID is that there are many unresolved problems with AID, and few of them are legal. There is no social or professional agreement on indications, selection of donors, screening of donors, mixing of donor sperm, or keeping records on sperm donations. Where there is agreement, such as in requiring the signature of the donor's wife on a "consent" form, the reasons for such agreement are unclear. It is time to stop thinking about uniform legislation and start thinking about the development of professional standards. Obsessive concern with self-protection must give way to concern for the child.
当前的人工授精做法主要是基于保护从业者和捐赠者的利益，而非受助者和孩子的利益。最可能的原因是对法律陷阱的过度恐惧。有人认为，这一领域的政策应以最大化由此产生的孩子的最佳利益为导向。居里 - 科恩调查的证据表明，当前的做法对孩子是危险的，必须加以修改。具体而言，应考虑以下几点：1. 将人工授精从医疗实践中分离出来，交由遗传咨询师或其他非医疗人员负责（或者，可为每对要求人工授精的夫妇增加一次常规遗传咨询）；2. 制定统一的供体选择标准，包括全国性的筛查标准；3. 要求人工授精从业者对所有能与受助者匹配的供体保留永久记录；我希望这能成为该行业的惯例，但可能需要立法要求向政府机构备案；4. 相应地，精子混合是不可接受的做法；每个供体的受孕次数应受到限制；5. 专业组织在公众参与下制定关于人工授精的国家标准；6. 对通过人工授精受孕的孩子及其家庭的心理发展进行研究。S.J. 贝尔曼博士在其关于居里 - 科恩调查的社论结尾，质疑了法律在人工授精方面“参差不齐且含糊不清”的态度，并建议立即采取立法行动：立法机构必须为供体人工授精设定标准、宣布孩子的合法性并保护所有直接参与该程序者的责任的时候已经到来——事实上，早就该来了。显然需要在这个问题上制定更好的公共政策。我曾提出，认同需要“更好的公共政策”并不等同于立即立法。人工授精的问题在于，人工授精存在许多未解决的问题，而且其中很少是法律问题。在适应症、供体选择、供体筛查、供体精子混合或精子捐赠记录保存等方面，没有社会或专业上的共识。在有共识的地方，比如要求供体的妻子在“同意”表格上签字，达成这种共识的原因也不明确。是时候停止思考统一立法，开始思考专业标准的制定了。对自我保护的过度关注必须让位于对孩子的关注。
