Proposition 51K2567

Projet de loi relatif à la procréation médicalement assistée et à la destination des embryons surnuméraires et des gamètes.

General information ¶

Submitted by

The Senate

Submission date

Nov. 23, 2005

Official page

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Status

Adopted

Requirement

Simple

Subjects

test tube fertilisation bio-ethics artificial insemination embryo and foetus

Voting ¶

Voted to adopt

Vooruit Ecolo PS | SP Open Vld

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Discussion ¶

March 15, 2007 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, although in a less favorable condition after a heavy burst, yesterday night, I am still able to present this report now, though with great difficulties. It was a serious updoffer, Mr. Wathelet. It was a heavy updoffer.

Is this a medical statement, doctor?

For me, this is a painful medical determination. I see a lot of people present who like and enjoy it and that I give them.

I will try to briefly summarize, both for Mr Chevalier and for myself, what the work has been on this bill. During the discussions, there were interventions from Mr. Monfils, from Mrs. Detiège, whom I no longer see here, from Mr. Bultinck, Mr. Verhaegen, Mrs. Burgeon, Mrs. Salvi, who is present, Mrs. Tilmans, Mrs. Lejeune and Mr. Mayeur. In addition to myself and some other members. Their comments are evidently reflected in the written report.

Medical-guided reproduction – or in short: MBV – is a set of new techniques for guided reproduction, such as artificial fertilization, in vitro fertilization, and many others. However, the use of these techniques is not regulated in our Belgian law, except as regards the care programmes for reproductive medicine.

In general terms, the draft sets out the objectives of the MBV techniques, the conditions for their use, the procedure, what should be done with the excess gametes or embryos, and the penalties applicable in case of non-compliance.

Following the hearings and their discussion in the Bioethics Working Group, several comments have been made in the Senate. This demonstrated, among other things, the positive trend of finally creating a legal framework for such an important ethical issue. The framework remains sufficiently large and flexible to take into account future developments that will surely come in the light of medical progress.

Other positive points include the removal of the maximum age for men, and donation of gametes remains possible in certain cases.

Not insignificant was the question of the reporter, present here, after the general discussion, to Professor Yvon Englert, to give an explanation on the current bill. Professor Englert clarified the bill by giving a scientific approach to the yet not always obvious jargon used in the bill and managed to situate the bill in a yet magistral way, and above all also to answer many questions that emerged from the amendments.

The previous bill was then discussed by the Social Affairs Committee on 20 April and 4 May 2005. During its meeting of 13 July 2005, the Committee on Social Affairs dedicated a new discussion to medical-guided reproduction, this time on the basis of an adapted text which took into account several observations made during the hearing of 4 May 2005 and which already contain the contours of the legislative proposal to be submitted later. At that meeting, the committee agreed to take this bill as the starting point for further discussion of the problem of medical-guided reproduction.

Indeed, on 23 November the bill concerning the MBV and the destination of the overwhelming embryos and the gamets was submitted by the senators Mrs Defraigne, Mr Vankrunkelsven, Mrs De Roeck, Mr Mahoux and Mrs Durant.

Following the adoption of the amended version of this proposal, the previous proposals were withdrawn, respectively, and declared invalid.

The current draft law. We believe that the practice of medical-guided reproduction should be defined with respect for the essential differences that characterize every human being. While the procedures for medical-guided reproduction should ⁇ become more uniform and thus more transparent, it is likely that access criteria will be introduced that will not be interpreted in the same way for everyone. The proposal gives some room to the doctor or the consulted fertility centre, as the joint decision to switch to medical-guided reproduction is ultimately based on the necessary relationship of trust that must exist between the consulted doctor and the person or persons concerned. This confidence is an essential element that is guaranteed, on the one hand, thanks to the control carried out at the centres by the local ethical committees and, on the other hand, thanks to the free choice that the patient has in choosing the doctor with whom he wants to go through the process of medical-guided reproduction.

This freedom of choice has two consequences. On the one hand, the freedom of choice of the physician and thus also of the fertilization centre, which presupposes greater transparency in terms of the practices and the uniformity of the procedures, on the other hand, the fact that the freedom to proceed to medical-guided reproduction presupposes a choice as regards the destination of the above-numbered embryos. In addition, we also wanted to contain in a text the basic procedures relating to gametes, gonads, gonade particles and pre-implantation diagnostics.

In addition, a regulation is also being sought for the prenatal implantation technique. The PID is the one in which the genetic characteristics of embryos are analyzed in vitro so that only healthy embryos are placed in the womb and is therefore intended to optimize the results of in vitro fertilization.

Eugenic practices should be prohibited in this regard. Therefore, a number of rules are imposed.

Finally, I would like to explain a few positive points from this draft. For further explanation, of course, I refer to the written report, which is all-telling.

Finally, a legislative framework will be created, within which the techniques will remain reserved for recognised centres. This is about a legislative framework that goes beyond simply defining medical-guided reproduction. It also concerns the fate of the gametes, the covering of the donor data, the over-number embryos, even the PID, an explicit arrangement for post-mortem implantation, and so on.

Furthermore, there is no age requirement for men, but for women, as they could carry a health risk. There is no distinction between couples. Both heterosexual and heterosexual couples can be eligible. You can freely choose a doctor. A certain referral obligation is introduced if one does not wish to respond to the request for medical supervised reproduction.

No amendments were adopted during the discussion of this draft, despite the fierce efforts of Ms. Salvi, who sometimes attempted to defend her ideas in an emotional way. It was not immediately taken into account. However, I believe that the text sent to us by the Senate gave answers – and, as far as Professor Englert is concerned, many answers – to the questions she has asked. You were very active, Mrs. Salvi.

The present text has therefore gone a long way. A legal arrangement, as it now presents itself, was necessary given the rapid evolution of the domain. Until now, this has not been regulated by legislation, but by practice.

The reporter, we thank you.

I will try to organize the passage of the speakers registered in the general debate.

In arbitrary order are registered M. Mayeur, Mr. Bultinck, M. Monfils, Mr Verhaegen, Mrs Salvi and Mr Chevalier.

I alterneer de talen in stel voor de heer Verhaegen als eerste te laten spreken, then Mr. Mayeur, dan of Mr. Bultinck, then Mrs. Salvi in of Mr. Chevalier. Mr. Monfils, do you want to finish by deploying the entire range of your talented experience?

( ... ) : ( ... )

I understand . I would do the same.

Mr. Speaker, colleagues, CD&V has always been in favor of a legal framework related to medical-guided reproduction with a view to a greater quality and better accessibility of all possible fertility treatments. In this sense, the medical world has taken a high flight in recent years.

We work with young couples with fertility problems. The number of people with fertility problems is increasing. I recently read that in Flanders it would already be about one in eight pairs. This does not necessarily mean that those people are infertile, but that it takes longer than normal to get pregnant. Increasing fertility problems are often a result of delaying the first pregnancy to now an average age of 28 years and this due to longer study time, higher work pressure, heavy investment burden often also for the family home. Young families are coming to children later and later. We therefore advocate a warm policy that supports and encourages young families.

MBV is at this time for many couples the only hope to see their child wish realized. They often have a whole period of disappointment and sadness behind their backs and it is therefore a positive thing that the medical world is now able to realize that child desire of people with different fertility techniques. This bill contains, how could it otherwise, a number of positive elements: the explicit information obligation, the psychological guidance of the parent-in-law, a better control of the centres for MBV, the ethical filter with a ban on eugenics, on free choice of sex and on the commercialization of embryos and gamets. All of this is seen positively in our group.

Nevertheless, we ask, colleagues, much more attention to prevention and alternatives to these yet rather expensive and intrusive treatments such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). We support the decision to reimburse the laboratory costs of IVF since mid-2003. That is a good measure, Mr. Minister. Today, however, the latter is put low. There will therefore be the risk that these treatments will be taken much faster, while good medical practice must first identify the causes of infertility and possibly treat them. It could best be an infection or an obstruction. This is best done by specialists in the field of both female and male infertility. Only then can artificial insemination or IVF be considered.

We also find it good that the commercialization of embryos and gamets is avoided by this bill. It is not a commodity for which contracts can be concluded. The production of embryos should therefore be limited to what is medically necessary.

The post-mortem techniques are also not a good idea. Consciously conceiving children who will never know a parent, they are actually half orphans, is a wrong signal for us. Adults immediately set up a situation that is not the best for education. Having a child is preferably not an individual project and ⁇ not a remedy to process a mourning process. For this reason, the well-being of children lies far behind our hearts.

We have been working on animal welfare in our committee for weeks. There was another hearing this week. I think now is the time to pay more attention to child welfare. On my critical question what men with an embryo created do if their wife suddenly dies, for example in an accident, the minister has admitted that this opens the way to caregiving motherhood, to prenatal adoption. In fact, the Pandora’s box is opened. Also, not all the legal implications of this construction in relation to inheritance, descent, naming, and so on have been sufficiently studied.

The design also aims to uphold the full anonymity of donors of semen or egg cells. We want to introduce the double possibility: on the one hand, donors who wish to remain anonymous at all times and, on the other hand, donors whose personal identification data may be provided at the request of the growing child. Every child has, as far as possible, the right to know his own roots, his own descent. This is also stated in the Convention on the Rights of the Child. However, we want to address this, to the extent possible, by means of a central registration where the child can request the identity of the biological father from the age of 16 through the legal parents. We have seen that anonymity is being released more and more in other countries. We have cited the example of the Netherlands and Sweden.

I therefore found it surprising that our amendment was rejected in the committee, given that the text comes directly from the government agreement of July 2003. “Parliament will also be asked to distinguish between sperm donors between those who want to remain absolutely unknown and those who have no objection to later eventually be identified at the request of those concerned.”

Since one then moved to the mood quite quickly – it was almost an impulsive mood – because of the late hour, I now give the majority the chance to come back to it. I want to serve the majority here today and therefore make a new offer by bringing this amendment back to the plenary session.

It is good that there is a legal regulation for medical-guided reproduction, but it must ⁇ remain framed in the existing family law, in the international agreements and within the bio-ethical standards.

In this bio-ethical dossier, Belgium threatens to become isolated. Our in fine request to be able to discuss an annual report of the fertility centers in Parliament was not accepted, just like all our other amendments.

Therefore, we fear that the execution will fade and fade in the long run, as is often the case in other bio-ethical files. The law is broken out and of good intentions comes little into the house. We must avoid this at all costs and therefore we submit this amendment again.

Mr. Speaker, Mr. Minister, dear colleagues, I would like to thank the rapporteur who, with some nuances, well described the work of the committee. It is true that the bill on medically assisted reproduction and the destination of overnumbered embryos and gametes has triggered a relative ethical debate, where the most surprising considerations have sometimes been formulated.

This type of project imposes some rationality in the advanced arguments. Thus, it is true that most practitioners were not requests for a law in the matter and the local bioethics committees also work very well, to the general satisfaction.

I said in committee that I didn’t want to support a project that was below field practice and fortunately, the project that is presented to us respects the experience carried out in the field for many years. It also brings a recognition to these 25 or 30 years of practice in medical assisted reproduction centers. From this point of view, it can be said that the law is useful.

The bill provides both a clear framework, which marks the practices related to procreation in respect of the essential differences existing between each human being and the choices of each. It leaves all latitude to practitioners and fertility centers demanding confidence between the treating doctor and the patient with regard to over-number embryos and post-mortem insemination. It provides a legal basis for egg donation.

Each year, approximately 12,000 in vitro fertilizations are performed in the 11 medical assisted reproduction centers. More than 2,000 babies are born every year. What is the legal framework for these practices so far? Two royal orders, one concerning the standards of the PMA centers and the other concerning the reimbursement by the INAMI. Therefore satisfactory functioning based on two essential principles: medical freedom and the right of the patient.

The freedom to initiate medically assisted reproduction implies that a choice is made as to the destination of the overnumbered embryos. In addition to the purely procedural regulation and embryonic management, the text specifically examines a number of fundamental issues relating to reproduction, such as the maximum age permitted for medical assisted reproduction limited to 45 years, the anonymised or non-anonymous donation of gametes, the explanation of the rules of filiation in case of donation, the prohibition of marketing of gametes and embryos, eugenics and the choice of sex for non-medical reasons, the rules applicable to research, post-mortem insemination and the practices of pre-implant diagnostic for the design of an embryo with specific characteristics, as well as the necessary clarifications for better legal security and a better framework for these complex procedures.

I would also like to address other aspects that have caused criticism and comments in committees, and even in the press.

Even yesterday, the Catholic episcopate was upset because the bill would not sufficiently take into account the true interest of the child, arguing that the law does not regard the embryo “as an end in itself”, but as “a means designed to satisfy the desire for a child” and deploring that the child “made” by science is a biological orphan.

These arguments should, in my opinion, be handled with caution and a little restraint.

The Medical Assisted Reproduction Act synthesizes ⁇ thirty years of practice and more than a century for artificial insemination. Ethical debates have been numerous in the context of a society moving at the level of values, but also of the structure of families.

If the contestation of the choices that are about to be made by the legislator is obviously legitimate for each social group including the episcopate, it must first be emphasized that the idyllic image of the traditional family that one would like to offer us is as far away from the experience of child psychotherapists as the diabolized image that transpires in all other divorced, recomposed, homosexual or from donations of anonymous gametes which are now probably more numerous in Belgium than the classical family to which we refer.

The criticism also concerns the authorization of access for homosexual couples and the anonymity of gamet donors.

The artificial insemination of homosexual couples has been practiced in Belgium since the 1980s. The studies of child development all go in the same direction, that of being perfectly reassuring. This access to parentality is a social fact that the legislator has recognized (homosexual marriage law, homosexual adoption law) and reflects a concern for non-discrimination and protection of individuals in their dignity and rights, but also and above all of the legal security of children raised in these families rather than on a value judgment.

It would be unthinkable today to go back and reject these women in reproach, which would be the immediate consequence of a ban. In some countries, until the 1970s, judicial authorities even took their children from these mothers for the defense of good morals. Per ⁇ the judges thought, at the time, that it was in the best interests of the children. For our part, we think that time has passed.

I would like to quote the intervention of the philosopher, François Dagognet, recently questioned by a journalist of the magazine "Le Point". François Dagognet explains that "homoparentality" raises only one problem of importance that is rarely addressed. Should the foundations of social morality and law be based on the strict biological, that is, the law of blood, or on personal responsibility, the "conscious"?

But the whole culture in France and elsewhere consists of listening to the blood and not taking into account what man has decided. Furthermore, in this area, we cannot give ourselves to the half measure. The union of two persons of the same sex is more and more accepted, one cannot refuse adoption to this couple, and I add that one cannot refuse medical assisted reproduction to this couple. The agreement with the first results in the agreement with the second and this results in the agreement with the third. It is then claimed that the child will suffer from this situation but it would rather be feared what will come from other children who smile at what they hold for abnormal while everywhere, we engage in the praise of the difference. And this is what must be supported: we are no longer strictly in the blood bonds but in the choice of responsible individuals, able as much as others to assume the fact of raising children.

Another criticism concerns the guarantee of the anonymity of donors, which would contradict the International Convention on the Rights of the Child, with the right of children to know their origins and with their psychological well-being. The project symmetrically protects families and donors from unjustified interference by establishing clearly that under no circumstances can parent relationships be established between the child and the donor. Perfectly permitted in the text, donation without anonymity is however very difficult to accomplish without the other clarification taking place. Indeed, what legal uncertainty for the donor if it could one day be imposed a paternity, a maternity, but also what uncertainty for the receiving family if one day the donor could come to claim a paternity, rights on the child due to the genetic origin.

The proposed provision recalls that donors are not parents because they make a solidary gesture towards persons who have – they – a child project that this gift allows them to realize, making them the parents of the child they bring into the world. It is therefore almost by absurdity that one can demonstrate that the reference to the International Convention on the Rights of the Child is inappropriate to oppose anonymous donation. Article 7 paragraph 1 of the Convention states: “The child shall be registered as soon as he is born and has, from this date, the right to a name, the right to acquire a nationality and, to the extent possible, the right to know his parents and to be raised by them.”

Unless the gamete donor is considered a parent – then, according to the Convention, it would be up to him to raise the child – it is obvious that this provision is aimed at gamete recipients, just as each of us does when we bring a child into the world by natural means. Pregnancy and childbirth make a mother and her partner a father, which is not the case with gamet donation. The right to access to origins is a notion, it is true, increasingly valued. For some, access to the donor’s identity without there being yet a filiation link should be part of it.

However, this statement is far from being supported and shared by all. Moreover, countries such as Sweden that have banned anonymity are sometimes faced with negative consequences or perverse effects: the catastrophic decrease in donors, who fear to be considered parents, and the departure of patients to neighboring countries to avoid their families being registered as being made up of gamet donation.

It is remarkable that not only is this trend towards a social desire for non-anonymous donation taken into account in the project, but that this project is also interested in opening up to more freedom for future parents who are, in the end, the most competent and most apt to make choices that they think are good for their children - beyond abstract polemics and as long as they find candidate donors ready to fit into a non-anonymous program.

Thus, it is the evolution of culture and society that will tell which solution, of anonymity or of the known gift, holds, not the truth, but the best suitability to time and techniques of assisted procreation.

I will conclude, Mr. Speaker, Mr. Minister, Dear colleagues, by reminding that in our democratic and pluralist society, no one can be compelled to engage in a procedure that does not correspond to its ethical principles; but that the one who engages in it must be free to choose, protected in his choices, be made aware of his rights, and that he may see them fully respected.

Mr. Speaker, Mr. Minister, colleagues, I think that the legislative initiative, which originally comes from the Senate, which is here ahead is a very important workpiece. I would like to say very clearly from our group that we are fully aware that we have come to a pluralist society and that we, as a non-confessional party, have no problem with it. Nevertheless, the debate on this draft is and remains a very sensitive ethical debate for us.

Mr. Minister, you will remember that from the very beginning of the discussion we have said very clearly that for us this is about respect for human life. Respect for human life also has to do with the very delicacy of procreation within human life. That is something else than just a discussion about just some material matters, about animal welfare or God knows what items. For us, this is a debate – let us make it clear – that is framed within the broad discussion of values and norms that is now a little backward.

Mr. Minister, I say very honestly – you have heard me do so also in the committee – that I am one of those who from the beginning of their parliamentary career dared to question also your predecessor, Minister Frank Vandenbroucke, on this problem with very concrete oral questions on this topic. I am one of those who dared very clearly question the reimbursement of abortion treatments at a time when the full reimbursement relating to medical-guided reproduction had not even been realized. In that sense, we say very clearly that we are happy with an improvement in the rules relating to the refund through the RIZIV on medical-guided reproduction. We have always supported this evolution.

However, we have applied to this a number of nuances that we think are justified. I think we should also conduct the debate initiated, for example, by the World Health Organization. That stated very clearly that we must examine whether it would not be good for couples who have a legitimate desire for children and should resort to medical-guided reproduction to first consider whether it would not be more convenient and practical, for example, to first use some techniques of artificial insemination before going to a physical and psychically very heavy treatment of in vitro fertilization for those couples. This could indeed be a legitimate consideration for the stakeholders.

Mr. Minister, in this sense I return to a question to which the answer remains to me still somewhat unclear because there has been no concrete answer. We have also very clearly questioned you in the recent past about the possible refund of KI. You said very clearly in your answer that you are willing to take this opportunity into consideration as a minister.

Mr. Minister, I would like to make another attempt to get an answer to my question to what extent you would like to consider the opportunity or not.

Mr. the reporter, there was a period in which the reporter was sitting next to the minister on the first bank. From that point on, he defended the report and gave answers based on the committee’s own events. Per ⁇ we should return to the aforementioned use.

I have neither more nor less the pretence to do so. I sat behind the minister. I also do not intend to resume the debate, as it was held in the committee.

Mr Bultinck, however, I would like to return to the debate held in the committee.

It was the purpose for which Professor Englert was asked to frame the bill. So it hurts me now to hear that, despite the report and the expert explanation given by Professor Englert, principles and scientific terms such as artificial insemination and in vitro fertilization are still being confused.

I will step into your reasoning.

You still state that “you should first do that ...”. Can you imagine that every couple should go through that? The discussion on this was held. Every couple offering in vitro fertilization has already gone through hell.

Artificial insemination is a term derived from animal medicine. Artificial magic insemination takes place in a certain way, but each involved couple has already passed that stage. I refer to the report, in particular to Mr. Englert’s presentation. You return to concepts, analyses and principles that do not exist and that do not apply. You want to question again whether this is possible. You wonder if there are no other solutions.

I can confirm what was stated in the report and was stated by Professor Englert. For any couple that goes to in vitro fertilization – that is to say to other than the classical methods, because ultimately artificial insemination is a classical method, Mr. Bultinck – has in the meantime gone through a year to one and a half years of hell.

The purpose of the bill and the matters you are talking about do not really have to do with each other.

Mr. Germeaux, with all respect, we are making an unnecessary attempt here to misunderstand each other. What do I mean with this?

You have never heard me say on behalf of my group that we want to put a brake on medical-guided reproduction and on techniques such as IVF. Let us understand each other well. We think, and we are not just of that opinion, that we should have the courage to say what the World Health Organization says. Given the psychically and physically very heavy IVF procedure, it is good that we point out to couples who are struggling with this type of problems first on a number of other possibilities, such as artificial insemination.

Let us understand each other very well. I dare to say the following honestly and dare to consider it as one of my personal merits of my parliamentary career. We have always defended this type of technology. We have always said on behalf of our group that we have infinite respect for people who need to resort to the techniques of medical-guided reproduction.

It would therefore be completely inappropriate here to give the impression that we should misunderstand each other here unnecessarily. However, we must rightly say that it is right to take the consideration that is also made by the World Health Organization. We need to correctly inform people about a number of other possibilities that go slightly less far than the classic IVF procedure.

Mr. Minister, therefore, if possible, I would like to receive an answer today on the question of how the dossier is in relation to the refund of KI and whether you have already seriously considered the opportunity you presented in a response.

Mr. Minister, colleagues, if we make the actual conclusion and above all the scientific conclusion, then we all come to the same conclusion, namely that, this was also very recently confirmed by fertility specialist Paul Devroey, that some people, some people have fertility problems.

On the one hand, this has to do with the actual finding that the first pregnancy, among other reasons due to career planning, but also for a number of other reasons, is delayed slightly longer than was previously usual. It is not up to us to speak about it. This is a social evolution. This is the result of a social evolution. However, we must make a scientific and factual conclusion here.

On the other hand, there is also the next factor that we cannot underestimate. Recently, through a specialist, there was some better news for male fertility. It is about the influence of environmental factors. In recent years, according to scientific research, it has been slightly improved in this area. This is good news for us men. However, some of these problems were due to a decrease in male fertility, which requires the use of this type of techniques.

Let it be very clear – I want to say this again very explicitly to the attention of colleague Germeaux – that also the Flemish Interest as a group clearly realizes that to satisfy that child desire for a number of couples the last possibility is indeed the technique of medical-guided reproduction. Colleague Germeaux, on behalf of my party, I also say very clearly that we have infinite respect for it and there have always been those who have held a plea for better repayment. It is good that there would be no uncertainty about this today.

Mr. Speaker, I want to say the following. I was just pleasantly surprised when I heard the CD&V group and I am now pleasantly surprised when I hear the comments of the Flemish Belang group.

We are thirty years later. If there is or was no legal framework, it is mainly related to the mentality – I look at Mr. Mayeur – of thirty years ago. This was out of the wicked. I do not call the episcopate at hand here, but in certain universities in vitro fertilization was prohibited by religion. I am speaking in 1982. It started in a risky way.

I am delighted to hear today that twenty-five years later you jump on the train and see the Enlightenment, the truth. If the episcopate had the power, there would have been no in vitro fertilization in Belgium. I am pleased to hear that you and the previous speaker are jumping on that train and joining you.

Colleague Germeaux, I am surprised that you are surprised about us. I am a representative of a non-confessional party. With us, such a debate can be held without any problem.

I will say more. The Minister can confirm that I also said this in the committee. I say, on behalf of my group, that we are in favour of a legal framework as it presents today, but with some important nuances. In that scheme, however, a number of important details must be drastically updated.

We are in favor of a clear legal framework. The draft, as transmitted by the Senate, provides for better and stricter rules than the current regulation for the Centers for Medical Accompanied Reproduction, which was defined in a number of royal decrees.

This is positive. Our voting behavior will also show that we consider this as a positive element.

Colleague Germeaux, this does not mean that the Flemish Interest would suddenly have discovered the Enlightenment. We recognize that we live in a pluralist society. This is not a problem for us. I can guarantee you that within our party people of all kinds of philosophical disposition can very well cooperate with each other.

An important point in the present draft concerns the debate we held in the committee on the freedom and policy options of fertility centers with regard to the accessibility of the entire dossier. We take note of the fact that the whole problem is settled with a conscience clause.

We must have the courage to weigh the freedom of personal initiative against the control of government.

On this point, Mr. Germeaux, we differ fundamentally. I am fully aware of the risk of making such statements in such files in these politically correct times. We have said very clearly that as far as we are concerned, MBV is indeed a scheme that we see in the context of medical assistance. We want to see this strictly limited to heterosexual relationships. We differ in opinions, which is very clear.

On the other hand, I also say very clearly that we are satisfied with the age limit as now established in Article 4 of the present draft. We have recently seen a number of examples in Europe where a number of grandmothers have given birth to children. It seems to me good that in the present draft clear age restrictions were included that are scientifically relevant, though it was only because each of us who know the dossier a little, knows that above the age of 40 years can be scientifically demonstrated that there can be very clearly additional problems in a pregnancy. We also strongly support that age limit in the present draft.

On another element in the debate, Mr. Minister, we can go over very easily because that part of the debate has indeed been clarified in the committee. It is the debate we have held about whether or not the anonymity of the donors. This was an important debate in the draft. I think that the committee’s work has made it very clear that under a number of very strict conditions the anonymity for gamet donation can indeed be lifted. However, that anonymity shall be ⁇ ined at all times for embryonic donation. This important debate has been cleared in the committee.

One element in which we put very large questions and which we have a lot of criticism, Mr. Minister, is the whole item of post mortem implantation of embryos and post mortem insemination. We stated very clearly at that time that this could happen as the introduction of a kind of discrimination between fertile and infertile persons. It is a very strange fact that it ultimately makes reproduction after death possible under a number of conditions. I think we, as a group, rightly raise a lot of questions. For those with somewhat less correct intentions, this can open a number of backdoors. In that sense, we are not really enthusiastic – I express myself very cautiously – about that post mortem implantation. Our group raises very serious questions here.

We feel strengthened in this criticism by the legal argument. I would therefore refer to Article 27 of the draft, which contains the provisions relating to the right of descent. In that article it is very clear, I quote: "... at some point, the rules of descent play in the benefit of the future parent." This is, however, an article that is very vague and can give rise to all sorts of problems related to the right of descent. This is not the best legislative work we have created here from the committee.

We would rather have seen it differently. I think my colleagues in the Justice Committee will also say that the Public Health Committee has not legally done the best work here.

Mr. Minister, it is positive that this draft includes a complete ban on the commercialization of embryos and gamets. I think it is very good that our group also fully affirms that this is one of the very positive elements in the draft presented today.

I would like to address another important part, namely the problem of the agreement that must be concluded between the parties concerned in the event that there is a surplus of embryos. I think this issue needs to be clearly and well resolved. This is also the case in the present draft. It cannot be intended that over-sized embryos must, by definition, absolutely fall into scientific research.

I have a second, very concrete question, Mr. Minister. Whether we like it or not, this design is very clearly linked to the law of 11 May 2003 on the scientific research on embryos in vitro. Even in the recent past, this was not quite clear. There have been a number of problems with the composition of the Federal Audit and Evaluation Committee. Are these problems at the moment of the job? Is that important control element, which was approved here in the previous legislature, actually dealt with right now? It would be good if you could give us some clarity on this today.

I would also like to mention the element of the Convention on Human Rights and Biomedicine. I return to the first verbal question in my parliamentary career in this House, Mr. Speaker. This always gives a special feeling for a member of parliament. On 19 October 1999, I questioned the then minister about the signing of the Convention on Human Rights and Biomedicine.

Mr. Minister, you have known the position of our group for a very long time. We have always regretted that Belgium did not want to sign this Convention. It would be good if today, following this discussion, you would still want to give the argument for it. I hope in all silence, but I fear that we should not make ourselves too many illusions at the end of this legislature, that there is still a change in the attitude of the Belgian government in this file.

Mr. Speaker, if you allow me, I would also like to use this discussion to briefly explain our amendments.

That is no problem. Do you do.

You know that our group has submitted two fundamental, principled amendments. You know that we have different opinions on this. I think this will remain the same today. The first principled amendment we have submitted is a clarification that we intend to make in Article 4.

For our group, the techniques of medical-guided reproduction belong indeed to the medical care to be able to help those with an express desire for children, under the strict condition – in which we differ in opinion, colleague Germeaux – that it must be stable, heterosexual couples. For us, MBV should clearly not become an alternative method of reproduction, but should help solve the human problem of infertility or sterility in people with an explicit desire for children.

The second very important amendment, which we have again submitted to the plenary session, concerns the problem of pre-implantation diagnostics. In the title of the relevant chapter, we would much rather reflect that pre-implantation diagnostics is in principle, as a general rule, prohibited, while it is only permitted in very exceptional circumstances. This is ultimately included in the draft. I think it is good that we clarify the title in the form of an amendment, even if it was only to give concrete shape to our vision on the subject.

In conclusion, Mr. Minister, colleagues, I say very clearly that our group will soon abstain from voting, as in the committee, because we support the general principles and very clearly recognize that the draft is an improvement compared to the current arrangement, but its effect in the draft as it comes from the Senate, for us, however, could still be updated on a number of points.

With abstinence there is not much fertility, Mr. Bultinck.

It is probably an artificial infertility.

Mr. Speaker, I have waited until colleague Bultinck was pronounced to respond to what colleague Germeaux said.

Colleague Germeaux, you place us in the past. If respect for the fate of the born or unborn child is a return to the past, I would like to step into that remote time machine.

Our vision is based – I have also tried to demonstrate this – on compassion and respect for couples in a crisis situation, who have done everything possible and want to do to fulfill their child wish. I am glad that medical science comes to help. I was also happy that there was a legal framework.

What disturbs me is the exhibition of colleague Mayeur, who looks at everything from the point of view of the adult. He sees the child almost as an instrument to fulfill the wishes of adults. This allows children to take a difficult start, while it doesn’t really have to. This is not necessary, because there are other possibilities.

Mr. Speaker, Mr. Minister, dear colleagues, in the framework of this debate, and from the beginning in the Senate, the CDH has shown itself in favour of the adoption of legislation that encompasses medical assisted reproduction (PMA). Indeed, these practices have already existed on the ground for more than 20 years – not a century, as Mr. said. Major just recently – and we think it’s important to be able to give them a legal framework today.

We also support several of the principles contained in the project. First, the prohibition of any act of commercialization of gamet donations or embryos; the prohibition of any donation, any research or any pre-implantable genetic diagnosis of eugenic or sex-oriented character; the maintenance of the freedom granted to fertilization centres to invoke a clause of conscience in respect of requests addressed to them. This is commonly called the right of appreciation. Thus, tomorrow, the medical team requested will be able to best meet the expectations of applicants for reproductive aid, depending on their means and their specialization.

Nevertheless, Mr. Minister – you know this because I have said enough in the committee – the text that is proposed to us poses a fundamental problem: that of post mortem fertilization. Therefore, we will abstain from the whole text.

In fact, the project provides for the possibility of post mortem implantation of surnumeral embryos and post mortem insemination of surnumeral gametes. For us, death puts a definitive end to any will of conception since the couple no longer exists. The possibility of recourse to post mortem thus gives the conscious authorization to give birth to an orphan. According to the experts hearing in the Senate – and they were very clear about this – post mortem fertilization weighs on the child a weight far too heavy to carry: that of being all his life the one who allowed the mother to mourn her deceased spouse. It is therefore extremely dangerous to put such pressure on the child, a kind of restorative waiting.

Furthermore, as I have already pointed out in the committee, the text also raises a series of questions, always related to the interest and identity of the unborn child.

First, the question of the anonymity of the embryo donation has not been the subject of any serious reflection or discussion in the commission. Article 7 of the Convention on the Rights of the Child and the European Convention on Human Rights attach importance to the possibility for a person to know his personal origin, including his biological or genetic origin. By donating embryos or gametes, the donor or donor transmits more than just biological material. Without questioning the importance of the socio-educational bond that is created and developed after birth, the biological origin of a person is an integral part of his or her identity. Being able to answer the question “Who am I from?” is important.

The question of the identity of the unborn child also arises in the case, left open by the project, in which a single woman uses PMA. What references will the child born of a single person have? And what about single men? Since, technically, I would dare to say, it is not yet possible for them to carry their child – you cannot contradict me – the question of carrying mothers remains open.

Without questioning the happiness of single-parent families, we at least ask ourselves the question of whether, in the best interests of the child, the law should not exclude the possibility of resorting initially to procreation outside a couple project.

Finally, the project authorizes pre-implantable genetic diagnosis (PDI) in the therapeutic interest of a child already born, without however setting framework conditions. It is on these framework conditions that we wanted to delay.

This concept also seems a little weak. How can we more accurately ensure, for example, that IPR is not instrumentalized for medical purposes in a context of relative fragility of certain couples? We find it more appropriate to include in a specific law, containing a complete definition of IPR, the conditions of its application and, possibly, the more stringent additional conditions of application provided in the case of application of IPR, in the therapeutic interest of a child already born.

For all these reasons, Mr. Minister, the CDH will abstain from this text.

Colleagues, when the House Speaker made the list of speakers, he told me that I would be in turn before the experience – Mr. Monfils – and after the charm – Mrs. Salvi.

I said it privately.

I am always open to the comments of a wise man such as the House Speaker, but I must honestly admit that I occasionally got it ⁇ cold when I heard a number of statements here today. Particularly in the introduction to the draft, the Minister made it very clear that the practice of medical-guided reproduction should be defined in all serenity, beyond emotion and urgency, with respect for the essential differences that characterize each human being.

I would like to thank the expert and reporter of the committee. Sometimes it is good and necessary to have a doctor nearby. Together with Dr. Germeaux and other colleagues with a solid scientific basis, we have been able to do this in the committee in all serenity. At the same time, we must note that there are still a number of interpretations and philosophies that are primarily aimed at limiting the freedom of man, to go against the possibility offered by such law, to exploit individual freedom of choice regardless of their own moral or philosophical conviction.

This law sets a clear framework and clear restrictions on the commercialization and trade of gametes, donors and embryos. At the same time, people are given opportunities to shape life as one wishes to shape it, thanks to this law. The question is whether we give people this power and let them choose this perspective, or whether we condemn them to lasting childlessness.

During the discussions and interpellations, I found that some members of the committee show some sort of moral cramp. It could not be expressed better than by Mr. Verhaegen who said, "We live with." I get it cold. If someone says to me from this philosophical conviction, “I live with you,” I get tremendous fear. Then I know that this usually actually ends up in something very passive with shoulder blows, but that one eventually makes a split between people who do not need anything to naturally have children and others who are restricted by nature.

Mr. Germeaux and other colleagues have charted the benefits of this law in particular. I would like to talk again about the various additions and possible amendments that we have received from the opposition. A first point is that one attempted to introduce the notion of "stable relationship".

The question is, of course, whether a stable relationship is necessary to engage in medical supervised reproduction. What is a stable relationship? Is it measurable in time? Is it quantifiable? Is a relationship only stabilized after two years? Are you ready to start thinking about a child’s wish? I know people who don’t need much time to establish that they want to continue with each other in life. I also note that there are people who have known each other for two years and who are more connected to each other by shared debts than by affection. I wonder what they do in those two years. I read today in The Morning about a study in France that shows that 15% of men and women with a fixed relationship, which is likely that stable relationship, says not having had sex with their partner in the last three months. I do not think this is the best way to get children naturally.

It is also suggested that the choice for medical-guided reproduction is a free choice, a comfort. Instead of trying to have children first, one would immediately opt for in vitro fertilization because that is much easier. It does not work that way. The choice to choose in vitro fertilization or other therapy is, of course, a reasoned choice. This is a choice in which a couple or a single woman takes advantage of the opportunity to realize a desired reproduction.

It has already been said tonight. Ms. De Meyer also spoke about this during the discussion in the committee. No one does this for their pleasure. No one takes time credit to go to the hospital every week and get examined there by gynecologists, biologists and other specialists. Choosing medical-guided reproduction is a huge step. That is not paradise, that is hell, as Mr. Germeaux says. Sometimes one is tormented for years by the question of whether or not something is possible.

I found it somewhat perfidious that one attempted to introduce, through an amendment, the idea that, once one is registered for the medical-guided reproduction, one must wait another twelve months to be confirmed again what the causes of the possible infertility are. In the previous period, one learns perfectly how it is. For whom should everything be transferred again? I would rather propose a strategy of discouragement. People in a so-called stable relationship want to destabilize and discourage to continue with what they had decided.

Equally strange is the proposition that a child wish must always involve two people, and that a child wish cannot be fulfilled with a single woman. At first, this seems plausible, as it is still the most common practice.

That is a statement that is, of course, equally hard and unreasonable because it means that it is disrespectful for those who are single or for those who become and that they are excluded from the right to children. If one wishes to consistently apply this reasoning, which is unacceptable to me, in all ethical records, then this actually means – think carefully about it – that this would imply that he who today would accept the image of the ideal family absolutely as the only norm, de facto would have to apply this reasoning also in the case of abortion legislation. You have all been against it for the sake of the child’s interest. Now one speaks of the “on-importance” of the single mother and then one must also be consistent. As a single mother, a woman should under no circumstances have a child.

I find it a bit unfortunate that the former colleague had to reaffirm it absolutely. This creates in me the impression that there is a certain consequence in the arguments of some colleagues. However, the more I hear it, the more frightening it becomes. I quote her again: “Death definitively puts an end to any marital desire to conceive a child since the couple no longer exists.” We heard them in the committee. It was included in the report and it is repeated today. With death, the partner is completely removed, despite the expressed wish before death to choose for a child. I have already said that one does not voluntarily choose an in vitro. This is a justified choice. In fact, they would have preferred it differently. I also note that I have not encountered any man with a child desire who dies for his pleasure before the child is born. I can’t imagine a single partner who says to his wife, “Don’t love me tonight, let’s postpone it until I’m dead and then you can do your favor with that little one, but I’m a donor. I think the partner in any case wants to experience both pregnancy and birth and want to see his child grow up. However, this is not granted to everyone.

The reasoning that was held here is that the child should be at the center. However, you need to apply this once again to some things out of reality. I want to give you an example. A man dies, a woman is undergoing a medical supervised reproduction procedure. And then you have to explain to that lady that this can no longer be because her husband is dead, making the couple no longer exist. Per ⁇ the couple still exists for that woman. They may have agreed to apply this procedure in certain circumstances, even if it was only because the wish was expressed that that man would thus continue to survive for a while in the next family in which he is no longer actively involved. If the child is still central and the individual happiness of that child is charged, then I try to imagine a number of situations.

Ever thought of the happiness of that child as the mother can later explain that the father died but that it was the only wish of the father that the child would be born? It may—that is my feeling—be happier because it knows that it was born from parents who absolutely chose it. I even think there is more happiness than in the case of a child who is born from a non-existent relationship or from a relationship in which the man has established that the woman was pregnant and it has been cut off. Those children are likely to be more unhappy and have more difficulty fighting up against the idea that they are the result of a relationship that has broken down too quickly or the fruit of a relationship in which the father with the northern sun has disappeared. If we repeat this reasoning for pregnant women whose partner died during natural pregnancy, then we automatically return to the abortion file.

Ladies and gentlemen, as a non-scientist I am of course limited in the committee but Dr. Germeaux has provided the necessary explanation and assistance. This was also done by other people who were scientifically trained. I think we have had a very good symbiosis in the committee of people with a philosophical background, people also with a clear political stance and people with a scientific background. In the end, we have come to a law that provides a very good framework and that provides sufficient freedom of choice, regardless of moral conviction. It also introduces a number of practices that could possibly arise and that will now be banned. In any case, it is meritorious that it removes a number of discriminations and inequalities. Ultimately, it is the choice that one has natural happiness on his side or not and that there are wishes parents who are less fortunate or less fortunate to walk through life. I think it is the task or mission of politics to give everyone equal opportunities and to give everyone equal freedom of choice. Because it sometimes biologically fails or works differently, one is not superior to the other. Hence this law helps this kind of superiority happily out of the world.

Mr. Monfils, I will not repeat the compliments you have been given.

Do we need to legislate in this case? This is a question that we should all ask ourselves whenever a situation, a problem, or even a different fact, alerts parliamentarians. In many cases, sometimes from the topics, texts are instantly proposed – more often to prohibit, by the way, than to authorize. This is the law of gender, and we know well that sorting is on the agenda of parliamentary committees.

However, here it is not a matter of any area. We are in personal ethics, i.e. the analysis of what is most intimate in the human being: sexual relations and fertility, the hopes of certain couples contradicted by nature or even the motives of certain parents who want to give life.

In all the ethical issues that the Parliament has dealt with over two legislatures, I have always asked myself two questions. I do not know if I have experience, but I still have memory.

Memory is a way of having experience.

First question: Is there a requirement for regulation, and why?

Second question: does the human person face risks that regulation could exclude?

In the field of euthanasia, the demand emanated from people themselves, as well as from some doctors who could not determine the limits of their intervention. The risk of abuse of power existed, we remember - everyone, and not only doctors, could estimate themselves, in the absence of regulation, able to judge the moment of death and how to give death.

For cloning, the researchers themselves asked us to place tags between which they could work as they heard it. It was, of course, necessary to protect people from the risks of abuse that science could put on them.

With regard to gay marriage and adoption by gay couples, the demand was obviously strong, and – for a number of colleagues and for myself – it was infinitely better to authorize adoption than to resort to the perfectly hypocritical mounting that allowed the Civil Code.

In all these ethical cases, there were answers to questions raised about the usefulness of legislation. But here, about medically assisted reproduction, who demands regulation?

The quality of the centres was controlled on the basis of a royal decree. However, this has not changed, as the law devotes half an article to the subject. No claims came from the medical body. The Patient Rights Act already provided many provisions on information, consent to interventions, etc. So, to justify the text, some mentioned Europe and a possible future general regulation.

To attend Europe at the Council of Europe as a delegate, and to have known it when I was a European parliamentary, I can tell you how the entry of European institutions into the ethical field is extremely low.

In general, decisions are accompanied by the freedom of States to accept or not accept the voted provisions – I refer, for example, to the Convention on Biomedicine – when European attempts such as the Council of Europe to provide for a text valid for all countries on euthanasia are not doomed to fail. It was a regrettable failure!

In short, no serious European taxation, a well-stabilized situation where the doctor-patient relationship was predominant, no risk on the horizon.

We could have lived without law.

Nevertheless, since it is there and I do not intend to make parliamentary terrorism, it is worth analyzing its provisions, its positive and negative points.

On the positive side, this project has the merit of confirming what was already known and what was already supported, i.e. the non-discrimination between homosexual and heterosexual couples, as well as the possibility for a single person to use the PMA. The text also ⁇ ins the anonymity of the gamet donor.

Professor Englert, in an article published in "La Libre Belgique" in mid-February, rightly defended these provisions; he showed how they were in no way contrary to the best interests of the child. I will not demonstrate all this here, but I am content to remind those who would be interested in the question, if they had not read the note of Prof. Englert, to get into it: it is very enlightening, especially with regard to the child.

Unfortunately, this bill did not stop there. He has taken advantage of it, and I do not hesitate to say it, to diminish the freedom of those who resort to medical assisted reproduction.

By what way? Simply by sacralizing the medical technique which no longer becomes a mere palliative to the inadequacy of nature, but which, because it is used, generates rules that are important to respect.

Making love to create a child requires neither rule nor justification. But making a child by technique, then, the servants of the new technological religion shake their eyebrows and want to set a series of conditions! It will not be possible to inseminate beyond this age, psychological support is mandatory, couples are obliged to fix by convention the fate of the embryos in the event of the death of the husband, as if, at 25 or 30 years, when one suffers from a fertility problem, in a PMA sequence, one thought of the death of the other.

More deeply, and that’s what shocks me, one blames the woman a second time. Already in difficulty because it is often on her that the causes of infertility are rejected, wrongly or rightly, she is forced to enter an administrative system where she signs conventions, commitments, where she must undergo, during the whole process, the intervention of a person outside her partner, in this case a psychiatrist or a psychologist, and all this simply to do, through medical progress, what she cannot succeed with the union of flesh.

Instead of minimizing the use of technique, the couple is presented with an organizational system where the functionary aspect takes the step on the simple and deep relationship that is between the patient and the doctor.

You will say I exaggerate, but no. Let us read the law. An agreement must be concluded between the centre and the author(s) of the parental project. It provides for the assignment of overnumerous embryos even in the event of divorce, insoluble differences of opinion between authors, permanent incapacity or death.

It can also provide for the possibility of post mortem implantation. The preservation period for overnumbered embryos may be extended by a separate request from the author(s), i.e. a new note or a new convention. Finally, in Article 32, the recipient must submit a request for implantation of overnumbered embryos by registered letter addressed to the fertilization centre concerned. And, of course, the same is true for gamets.

I would suggest that every person applying for a PMA should use the services of a notary for administrative formalities and, of course, the doctor should attach the collaboration of a lawyer because, if there is a breach of the law, he is punished with imprisonment from one to five years and a fine of 1,000 to 10,000 euros. This is much more expensive than road safety violations!

And all this, without forgetting that the text provides in case of violation of the law that the doctor or the scientist could be deprived of exercising his activity for a period of five years!

The interesting question to be asked is the following: if the authors of the petition reject and reject all this administrative fatras, what will happen? If they say, “Make me have a child by medical technique, since I can’t have it otherwise, and give me peace with your conventions, your psychological aid that are so many elements of social control and intervention in the intimacy of the couple!” And well, the servants of the new technological religion will not be able to accept your request and they will refuse to undertake the PMA. Otherwise, they will be illegitimate in relation to the law.

When I told you that this law infringes on individual freedom!

But there’s even better – or worse – that’s obviously the way pre-implantation diagnosis (DPI) has been settled. It is clear that eugenic or gender-selection-focused IPP should be prohibited. This is not a novelty. The Senate has once again joyfully copied previous texts. In fact, all this is prohibited since the law of 11 May 2003 on research on embryos in vitro. Of course, in order to do well, we have added this article to the project that we are dealing with. This makes another article without the slightest utility.

But Article 68 which, in its own case, exceptionally authorizes the pre-implantatory diagnosis in the therapeutic interest of the child already born of the author or of the authors of the parental project prescribes: "It belongs to the fertilization center consulted to estimate that the parental project does not have as the sole objective the realization of this therapeutic interest. This estimate must be confirmed by the consulted Human Genetics Centre, whose opinion shall be attached to the file."

Translations: the author or authors of a parental project have a child affected by an infection for which no compatible donor is found; the parent or parents consider having another baby hoping for compatibility to save the first child. If they are unlucky to say this when applying for IPR, that request will not be accepted.

This clearly means that in a case of terrible distress, the knowledge of the genetic situation of the embryo is refused. This recognizes the victory of a retrograde conservative tendency, which compels to endure the consequences of the chance of birth and which does not admit that human beings are masters of their destiny, free and enlightened.

How can the fact of having only a therapeutic interest as a sole objective be regarded as humanly degrading for the unborn child? There are no known cases where the compatibility between brothers and the subsequent healing have more united parents and children than the many families called without problem.

The phrase "baby medicine" conceals the will of some to not admit that the man and woman have anything to say about their filiation. Moreover, if one refuses knowledge for the benefit of ⁇ ining the blind chance – this is what this text advocates – it is possible that disillusion is at the end of the way if compatibility cannot succeed. "The child medicine," as they say, then risks being stigmatized or even rejected because it could not meet the couple's expectations for their first child.

In the debate we are dealing with, I would like to refer to someone we all know very well, Ms. Rosita Winkler, research master at FNRS, specialist in cancer molecular biology and member of the Bioethics Advisory Board.

To a question about the fact that one generally procreates because one has the desire to love and raise a child, Ms. Winkler replied: "From time to time, one has wanted to have children for all sorts of reasons: to perpetuate the name, the family, to leave his property or to take care of the elderly when social security did not exist. A beautiful concept was invented: having a child through a kind of immense altruism, but it does not quite correspond to reality. And then, what are we talking about? Parents who had a very sick child and who wanted to have another child simply wishing that he could help his eldest. I believe that we have always done everything we can to try to improve the fate of a sick child, since we know that we can take blood from the umbilical cord. But before, we were allowed to do nature. We were conceiving a child and if we were lucky, that child could help heal his brother or sister.” And Mrs. Winkler concluded: “That’s why I’m not scandalized. And I think that if I had been in the same case and had the same opportunity, I would ⁇ have chosen it. It also seems to me that this child who would have helped his eldest survive would have been even more precious in my eyes.”

To the specific question "Should we legislate on babies-drugs?" the interested person said: "How do you want? Will a gendarme be placed in every section of gynecology, an instructional judge who will question future parents about their motivations? This question should be left to parents and their doctors."I totally agree with this opinion. Moreover, my colleagues, the control provided by the law seems precise but it is in fact perfectly hypocritical. It is sufficient that the authors of the parental project, well informed, evoke another element than the sole therapeutic interest (for example: "I would like to have a child to succeed me when I will no longer be a parliamentary") for the center to carry out the preimplantatory diagnosis. Once again, well-educated couples or individual authors, aware of the content of the law, will avoid the trap into which will inevitably fall people less accustomed to legislative texts, less well advised, less aware of all these issues.

Finally, on the occasion of the examination of this text, we have seen emerging the old demons that were agitated at the time of abortion, and even in the debates on cloning, on the nature of the embryo, the attempt to reduce the autonomy of the human person, the social control, the obligation to assume the sometimes dramatic consequences of birth. We could have made the economy of this debate that we thought closed. Instead, this text presents here and there traces of a donor-donor between the supporters of knowledge, of autonomy, and those of a carefully contained freedom. The solution found for pre-implantable diagnosis is an example of this. The entire surrounding system – not to say “sinking” – the or the PMA requests is another.

By the way, have we not heard colleagues say in the committee that taking everything, having a child at 30 or 35 years old, it was not serious, it was irresponsibility. These are the risks: defining a standard based on I don’t know what state of society is and stigmatizing all those who do not comply with it.

In conclusion, Mr. Speaker, dear colleagues, Mr. Minister, I would have expected better from a text concerning simply the legitimate desire for children of women who, by fault of nature, cannot procreate. These women do not need carcass, social control, administrative paperwork. On the other hand, they need a doctor who listens to them and with whom they can dialogue, they just need a technical act that, once successful, will allow them to have a child in their arms. For the reasons I have stated, I will not vote in favour of this bill.

Mr. Speaker, I would like to comment on Mr. Monfils. I have full respect for his position on the infringement of individual freedom.

Mr. Monfils, I can follow you in that. In the case of medical accompanying pregnancy, third parties are involved. Those three are doctors. You find that this should not be arranged, but that it should be an appointment between the doctor and the patient. In that I can follow you. However, precisely to avoid other examples to this day – I am talking about Mr Antinori – we thought that a legal framework was needed. You can say that all of this is not necessary on the ground. But you also know, if you are honest, that reality far exceeds fiction. I think that is why this bill is in place.

I do not legislate for a particular case.

Hearing about Dr. Antinori every time begins to upset me! I don’t know a lot of people in distress who want to have a child and who rush to mr. and Antinori. I also don’t know a lot of 65-year-olds who want to have a baby by calling Mr. and Antinori.

In all human behaviors, there are extremes. I repeat that I do not legislate for the extreme. I legislate or try to legislate for the majority of the population.

You have drawn from a series of elements, which virtually never occur, the consequences aimed at unacceptably entangling the PMA into a series of arrangements too precise.

In this case, you have your opinion. I have another. You know that in our group, the freedom of vote is strict.

You will not make me change my mind. For years I have been examining the ends and ends of the ethical problems that Parliament is striving to solve.

Today we are facing an important text. Dear colleagues, this text is not banal and it actually comes in time, even though in vitro fertilization has now earned its letters of nobility after more than 25 years of happy practice in hospitals, which has already been recalled in this tribune.

On July 25, 1979, Louise Brown was born at Oldham Hospital in England. That little girl weighing 2,600 kg was the first baby in the world to be born in vitro. The method used, which was then revolutionary, can now be considered as one of the first medical applications of cell therapy. The method consists in provoking a fertilization between an egg and a sperm in a beneficial cultivation medium. The embryo that grows from the conception is then, in the hope of normal development, placed back in the womb of the mother.

The birth of the experimental tube baby was the beginning of reproductive medicine, which has since continued to provoke heated discussions between the advocates and opponents of the simultaneously fascinating and inevitable progress of science.

The position of Belgium in this regard is quite exceptional. Our country can boast in this area of an impeccable reputation which is also increasingly improved by our globally recognised expertise.

The now-developed techniques of medical-guided reproduction will now be widely applied by the approved laboratories connected to a reproductive medicine care program and to a centre for human heredity, as referred to in the Royal Decree of 15 February 1999.

Nevertheless, beyond this finding, doctors, health professionals, philosophers or patients have confronted, and still sometimes continue to do so, on the question of the need for a law concerning medical assisted procréation. Those who succeeded this tribune, even though they are not ⁇ sharp in their opinions, all raised this problem. However, experts agree that the procedural standards that regulate the medical practice of medically assisted reproduction offer sufficient quality guarantees for the approximately 15,000 trials undertaken annually in Belgium. At first glance, the centers self-manage without difficulty and thus allow each year, in respect of our philosophical differences, more than 3,000 children to be born in our country through these methods.

Some, however, fear that the megalomaniac veletages of some will lead to disappearances, such as those that have been met recently in the US, Italy or Romania, to name only the most recent ones. The authors of what is originally a parliamentary initiative, since this text was deposited in the Senate and signed by Ms. Christine Defraigne, Jacinta De Roeck, Isabelle Durant and MM. Philippe Mahoux and Patrik Vankrunkelsven, considered it appropriate to label practices related to medically assisted reproduction with respect for the essential differences existing in our society.

This text, the result of a long work of reflection, hearings, multiple working sessions to which I have provided the active support of my cabinet, illustrates well what the Senate can accomplish in the evolution of our bicameral system. Becoming a bill following its adoption in the Senate, it now comes before you after a new interesting debate in the Health Committee.

For me, this text comes at its time because the experience accumulated by our practitioners has been refined and precised in accordance with the technical developments that have come to enrich the practice, to result today in something sufficiently finite and stable to be flooded into force of law by the legislator without risk of being immediately obsolete by new technical developments.

The general meaning of the text presented to you is procedural. This is a deliberate will because if it is indeed appropriate to make the procedures of medical assisted reproduction more uniform and therefore more transparent, without, however, putting the conditions of access that could not be interpreted identically by all, it was time to find a normative space.

The proposal therefore leaves a wide range of manoeuvre to the doctor or fertilization center consulted, being understood that the shared decision to proceed to medical assisted reproduction will eventually generate the necessary confidence.

This confidence must exist between the doctor consulted and the person or persons concerned.

This trust is also a fundamental element guaranteed, on the one hand, by the structure of the information and control of the procedures provided in the current bill and, on the other hand, by the freedom of the patient, who has the possibility to choose the doctor and the center with which he will start the PMA process.

The text of the project is not limited to formalizing what has been validated on the ground. It also provides a legal basis for a few major points where practice does not necessarily rely on sufficient bases.

I will cite these points.

1 of 1. The freedom to initiate a PMA which presupposes that a choice is made from the beginning as to the destination of the overnumerous embryos. It has become clear today that more attention must be paid to defining, with applicants, the ultimate destiny of frozen over-number embryos if the child’s project fades along the way, mostly because the treatment has been a success and the family is complete.

The future of these embryos can pose problems in some centers if this destination has not been planned. The text therefore obliges the centers and applicants to take the time of this reflection and to formalize it before starting a treatment, even if, on the way, the instructions left to the center are changed if the applicants consider it necessary, the consent documents are always revisable.

The duration of the retention was in principle limited to five years, which is a reasonable compromise for, on the one hand, to give the applicant sufficient time to return, eventually, to complement the family after the birth of a first child and, on the other hand, to avoid excessively prolonging the retention time, so it is also true that the longer this duration will be, the more there is the risk of one day to see a disagreement or dispute between the members of the applicant couple.

2 of 2. The bill proposes the legislator to position itself on socially difficult and delicate subjects, namely the determination of the age limit for embryo replacement which is set at 47 years to avoid the considered undesirable development of excessively late maternities and send a strong message that the current trend to lower the maternity age is undesirable in terms of public health. In fact, both the risks of sterility and complications of pregnancy increase regularly with age.

3 of 3. The establishment of a framework limiting the practice of insemination and the replacement of embryos in post mortem, a practice which should be strictly limited in time, but which must also be preceded by a waiting period allowing the process of mourning for the missing loved one to take place.

In fact, we were ⁇ that this period would allow most requests to turn off on their own, the legislator considering it more desirable – even if he has not gone to the ban – to encourage these women to rebuild their lives rather than persevere in a project that has lost its foundations.

The third element I wanted to highlight is that which consists of giving a legal basis to the practice of “the child medicine” – an expression that I find somewhat lapidary. By recognising the right of parents of a child with an incurable disease to use this technique to try to conceive an immunologically compatible child to serve as a spinal cord donor in order to save his sick brother or sister, and by allowing specialized teams to practice pre-implantable genetic diagnosis in this very special and rare context, the legislator provided a legal basis for these practices. Nevertheless, in return, he insisted on the duty for the teams to ensure that the conceived child would always find a place for himself in his family as well as his brother(s) and sister(s).

The bill therefore allows to clarify very important points in the field of medically assisted reproduction with gamet donation, where we have found discrepancies between what is practiced and what is desirable, on the one hand, and the current legal framework, on the other.

It also provides a clear legal framework for the rules of filiation concerning children born from gamet donations, specifying that the donor cannot claim or be imposed on a filiation, by clearly investing the applicants in their status of parents. However, this framework was designed without creating exceptions to the general rules of filiation. This provision was in breach of our right. Therefore, not voting this text is like missing this opportunity. It is important that we can frame the practice of the anonymous donation of gametes.

Society is evolving. We are witnessing more and more positions, in some environments at least, to encourage this gift. Without taking a position in the ideological debate based on evidence, it seems to me prudent that the legislator clarifies the roles and protects both the donor and future parents or the child, in the event that after an anonymous donation a paternity contest would come to be made known.

The fourth major point that I wanted to emphasize concerns the legal basis given to the King to organize the exchange of information between the centers, in order to limit the number of different families that can have children with gametes from the same donor or donor. This measure is very important for the future safety of children born, as it is necessary to avoid consanguinities ignored in future generations.

The fifth and fifteenth point is that which relates to the legal basis relating to the donation of ovocytes, which is a technique practiced for a long time, both at home and abroad, but which "stricto sensu" is not illegal today: it is a cell donation by surgery on a woman who does not need it for herself and who makes a gesture of solidarity with another woman, she is sterile, who cannot provide ovocyte for herself.

The only existing legal framework is that of the law of 13 June 1986 on organ harvesting and transplantation and regulating organ and tissue donation. This law explicitly excludes reproductive cells from its scope.

So this gap has been filled, which significantly improves the protection of ovocyte donors and doctors who practice these techniques, and which paves the way for a discussion on a suitable refund system. It is indeed not normal that these rare situations, indeed, in view of the general activity of medical assisted reproduction, but how important for those in need, are not covered by the social security, in the same title and at the same level as the other techniques currently reimbursed. This also allows me to answer a question asked by a speaker recently about these other techniques.

I recall that I have given the Medical Technical Commission a task to make proposals for me on the reimbursement of artificial insemination; I am waiting for them and they have been promised to me before the end of the legislature.

The sixth and foremost point concerns the determination of a legal framework for the practice of pre-implantable genetic diagnostics, closely linking it to the Centre of Genetics, which in our country has the expertise and genetic advice indispensable for the management of patients and the authorization to practice these laboratory techniques necessary to carry out the genetic tests themselves.

The extensive debate in the Senate has helped to refine the text and avoid inconsistencies, but the primary meaning of the text has not changed: on the one hand, defining a broad and tolerant framework for patients by fixing some essential and clear tags for practitioners who are happy to complement existing texts and, on the other hand, defining procedural rules aimed at transparency and proper information of persons seeking reproductive assistance.

The text therefore fills gaps, little apparent but important, as you have seen, in our law. It improves the safety of these techniques for the greatest benefit of these children who will thus be able to come into the world, their parents later and, finally, health professionals who practice these techniques of medically assisted reproduction.

As you can see, it is a very comprehensive bill that is presented to you today, as illustrated by the text itself, structured in 8 titles and 75 articles, which reflects the ambition of the text and the complexity in the matter.

I would also like to quote you Flaubert that I find to be an author who, in this case, has a relevance in the words that I give you to know. He said, “The future torments us, the past holds us back, and this is often why the present escapes us.”

I think it is necessary, at some point, to demonstrate boldness and, if it is true that a certain number of techniques have emerged in our society, it is good that the legislator gives them a framework for them to express themselves in their full freedom, guaranteeing to the individual and to the society its letters of nobility.