France’s bioethics reform reaches the Senate floor on Tuesday, three months after lower-house lawmakers passed the controversial legislation. The bill, which has been considerably amended by senators in committee, could yet change, with the lesbian couples and single women poised to gain legal access to medically assisted reproduction potentially seeing social security coverage for the procedure withdrawn.
Opponents of the reform staged a fresh demonstration against the polemic measures on Sunday in Paris, with tens of thousands of protesters taking to the streets. The main point of contention is the bill’s flagship measure – the extension of legal access to medically assisted procreation to lesbian couples and single women, a measure Emmanuel Macron mooted publicly during his 2017 presidential bid.
The lower-house National Assembly debated the bill at length before passing it on first reading in October and sending it to the Senate for review.
But before progressing to the Senate floor on Tuesday, the draft lower-house lawmakers adopted in the fall withstood 136 amendments’ worth of revisions in committee. What remains of the initial reform and what does Macron’s bioethics plan look like today?
Medically assisted reproduction not covered in certain cases
Despite opponents’ vocal opposition, the bill’s emblematic elements endure.
While amendments submitted demanding that access to medically assisted reproduction “sans père”, without a father, not be granted after all were rejected, a number of tweaks the senators did okay considerably reshape the bill’s headline Article 1.
But while extending assisted reproduction to women regardless of their sexual orientation or marital status remains, it may no longer be systematically covered by social security.
Conservative senator Muriel Jourda, who represents Les Républicains in the upper house, has proposed that medically assisted reproduction be covered for heterosexual couples only when specific medical criteria are met, such as diagnosed infertility or in order to prevent transmission of a serious illness to the child. As such, lesbian couples and single women would be obliged to foot the full bill for treatment.
In distinguishing between assisting reproduction in order to overcome infertility from providing assistance to meet a desire for children outside a heterosexual couple, the amendment contradicts France’s health minister, Agnès Buzyn, who expressed her support for total coverage for medically assisted procreation, regardless of the circumstances.
On Twitter, one senator, Laurence Rossignol, said that the Socialist group she sits with in the chamber voted against “this punitive and unjust right-wing amendment”. Rossingnol, a former Socialist minister for Family, Childhood and Women’s Rights, said the group plans to submit a new amendment in session in a bid to re-establish full coverage.
Embryos stored for longer
Measures concerning the cultivation and storage of reproductive tissue (gametes) and embryos were also subject to changes in committee.
The bill initially set the maximum period for cultivating an embryo at 14 days, up from the current seven. That increase was extended via amendment in committee to 21 days. The period allowed for embryo storage, meanwhile, is to be prolonged from five to ten years.
Several left-leaning senators submitted, and saw passed, an amendment in committee that would open the task of storing embryos – which had been the exclusive domain of public institutions – to for-profit private facilities. According to the senators behind the amendment, demand is such that public facilities no longer have the capacity to meet every request, which has led to lengthy delays. Moreover, authorising medically assisted reproduction for more women will mean further congestion in an already saturated system. Senators argued that allowing private sector provision of medically assisted reproduction services will also “diminish, [or] end the deregistration of women over 40 on waiting lists and prevent patients, on the basis of financial and age criteria, from turning to private centres abroad.”
A partial lifting of donors’ anonymity
Despite fervent conservative opposition, there were no changes to initial text on the establishment of parentage for children born to lesbian couples by medically assisted means. As agreed in mid-September, the couples will need to officially recognise the child as their own with a notary before birth. At that point, the woman who will not have carried the child will be legally recognised as one of the child’s two parents, on an equal footing with her partner, the biological mother.
Provisions that partially lift the anonymity of sperm, egg and embryo donors – whose contributions, incidentally, are unremunerated in France — have also been subject to intense debate.
The rules in place for maintaining the anonymity of reproductive tissue donors, and those regulating access for people born as the result of a donation to information on their genetic origins, stirred yet more debate in committee. Until now, every donor has had to provide consent for the possible transmission of “non-identifying data” (physical appearance, background or age) as well as for the release of a donor’s identity to a child born as a result of the donation.
An amendment to that provision proposes allowing donors to choose whether they reveal their identity. But donors will be asked before the donation to accept providing irrevocable access to non-identifying data, available upon request to individuals born as a result of the donation after they turn 18.
“This mechanism preserves in a more balanced way the interests of the person born from a donation of gametes (access to origins), those of the donor (the donor’s right to a private life for themselves and their relations) and the general interest (to not discourage gametes donors),” the accepted amendment argued.
Children born from donations would now also benefit from the ability, espoused by the senators, to request access to the donor’s identity at a later date. The National Council for Access to Personal Origins (Cnaop) could at that point make contact with donors to ask for their agreement in sharing their identity.
‘Saviour babies’ reinstated, preimplantation diagnosis broadened
The concept of “saviour babies” has been a key point of friction throughout the bioethics debate. Controversially, it means authorising the conception of a child free of the genetic illness afflicting his or her sibling via embryo selection; the “saviour” child – known in French as a “bébé-médicament” or medicine-baby – whose immune system is compatible with that of the afflicted sibling, can then go on to help cure the afflicted child with stem cell-rich umbilical blood. A previous French bioethics law in 2004 had permitted the technique on an experimental basis, but in October the National Assembly voted to put an end to the practice. In committee this month, the Senate proposed that it be reintroduced into the current bill.
Meanwhile, the preimplantation diagnosis – analysing embryos in vitro before they are implanted – that is part of the embryo selection process could also be broadened in the pending reform and authorised “in the search for chromosomal anomalies not compatible with embryonic development”.
Today, preimplantation diagnosis is authorised only in cases where one parent, or another direct ascendant, carries a genetic illness “of a particular seriousness recognised as incurable”. According to the amendment proposed by the conservative Les Républicains senator Corinne Imbert, the technique could now be allowed for verifying the state of embryos before they are transferred into the uterus when the woman has already suffered repeated miscarriages or implantation failures “in order to avoid several painful failures”.
The legal framework for the procedure was, however, maintained and the committee issued a reminder: Any research on an embryo must be subject to prior authorisation by France’s biomedicine agency.
As for the subject of surrogacy, which is illegal in France and a perennial hot-button issue among demonstrators, there are no changes in sight. The opposition, which holds the majority in the Senate, continues to block any movement to allow it. Indeed, Les Républicains senate leader Bruno Retailleau had an amendment voted in committee aimed at “providing full and entire scope to the prohibition of surrogacy in France”.
Senators are set to debate the bioethics bill through February 4, after which the reform will shuttle back to the lower house for a second reading.
This article has been translated from the original in French.