Nobody's Child, Everybody's Children:

Informed Decision-Making in Reproductive Technology: What is the Role of Counselling?

Counselling prior to fertility treatment is now required under the provisions of the Assisted Human Reproduction Act (2004), in recognition that modern fertility procedures often involve a range of complex decisions and implications that should be explored before proceeding. Counselling is therefore expected to help facilitate an informed consent on the part of all participants. To some extent, this signals a change in how services are delivered, given that counselling has not always been readily available or encouraged by clinics providing fertility treatment. However, policy-makers reviewed the opinions of many stakeholders and determined that the medical domain alone cannot sufficiently address all the ethical and psychosocial ramifications of treatment. The impact and risks of such treatment raise particular issues for the women who undergo them, and for the children and families created by them. The first principle of the new bill is that ‘the health and well-being of children……must be given priority’, and therefore considering the interests of the potential child is one aspect of informed consent that can be addressed through the counselling process.

Specifics about counselling services will be contained in the form of regulations and are expected to address a range of details, such as who should provide the counselling, what issues should be covered during counselling sessions, and whether counselling services for those using donated gametes differ from those using their own gametes? Although only counselling prior to treatment is mandated by the Act, this presentation also highlights the role of professionals in addressing ongoing concerns of families and individuals who use reproductive assistance.

n summary, what implications do these aspects of Canada’s legislation have for ensuring an informed consent to treatment, and how might they ultimately benefit the resulting children and families?