Bioethics in Europe: the facts and figures

1. SURROGATE PARENTHOOD

Surrogate motherhood is the practice of bearing a child for the express purpose of handing it over to a third party to raise. This might involve the egg or sperm of one of the intended parents, sperm donation, or be the genetic offspring of the surrogate mother. Laws across Europe are varied, with a general ban on commercial surrogacy. Some states facilitate surrogacy where no financial arrangement is involved, a so-called “altruistic-surrogacy”.

- The European Parliament officially condemns surrogate parenthood as exploitative of vulnerable women.

- Surrogacy arrangements are illegal in Finland, France, Iceland, Italy, Switzerland and Bulgaria.

- Commercial surrogacy is illegal in Hungary, Portugal, and the UK.

- Spain allows citizens to cross national boundaries for surrogacy arrangements.

- Non-commercial altruistic surrogacy is permitted in Belgium, Ireland, and Denmark.

- Some surrogacy is permitted in Greece, subject to strict conditions being met.

- Sweden subsumes surrogacy under adoption law.

- Because surrogacy is difficult in Europe, many Europeans seeking these arrangements sometimes travel to places such as India, Thailand, Ukraine, Russia and certain American states. Regulations in each of these places vary widely. India, for example, allows surrogacy, but it is illegal to facilitate surrogate parenthood for homosexual couples. In Thailand, the surrogate/birth mother has legal rights over the newborn, whereas in India she does not.[1]

2. GENDER TRANSFORMATION

Across Europe, there are widely different legal responses to people who wish to identify themselves as other than their birth gender. Gender transformation is amongst the most highly charged debates across Europe today. Some of the key facts in Europe include:

- Gender change is legally possible in Austria, Germany, Hungary, Poland, Switzerland, Iceland, Latvia, Lithuania, Sweden, Italy, Portugal, Spain, Netherlands, and the UK.

- Transsexual activists campaign against some of the restrictions placed upon legal gender change which include compulsory sterilisation (in Slovakia, Finland, Greece, Luxembourg, Bulgaria, France and Turkey); sterilisation plus surgery (in Czech Republic), surgery (in Romania), and surgery and hormone therapy (in Belgium).

- Only Cyprus denies people the ability to change their name.

- Bulgaria, Cyprus, Czech Republic, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Poland, and Slovakia insist on compulsory divorce for persons changing their gender identity.

- Laws protecting transsexuals from “hate crimes” have been passed in Belgium, Bulgaria, France, Greece, Hungary, Iceland, Malta, Portugal, Spain and the UK.

- Laws protecting transsexuals from “hate speech” have been passed in Belgium, France, Greece, Hungary, Iceland, Malta, Portugal, Spain and the UK.

- Laws aimed at preventing discrimination against transsexual people (in such matters as employment, purchasing goods and services) have been passed in Austria, Belgium, Bulgaria, Croatia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Spain, Sweden and the UK.

- The number of people identifying as transgender is unknown and estimates vary enormously. Historically, the numbers were thought to be around 1:30,000 males, and 1:100,00 females seeking gender reassignment. Transgender activists today claim far higher numbers, anything up to 1:250 in some cases. [2]

3. THE NEW EUGENICS

The completion of the mapping of the human genome in 2003 opened a new chapter in genetic research, loaded with both new possibilities and threats. The European response to this has been to spawn a multi-million-dollar genetics industry alongside a fearsomely complex regularity and advisory framework. The fight to combat genetic disease comes into conflict with the serious threat of the development of “designer humans”, which genetic editing might facilitate. Inevitably in Europe, such debates take place against the backdrop of abhorrent Nazi racial theories and policies.[3]

- Studies stress that the regulation system in Europe is not only vast and complex, but that it is unable to handle the scientific challenges it faces. “The pace of scientific advancement is moving faster than the legislation” write medical-legal experts Joanna Hook and Grant Strachan.[4]

- Bio-IT World describes European regulation as, “a series of vague regulations and moving targets”, which are often “unenforceable”. “Sometimes legal language is even unclear about which kinds of research it aims to regulate.”[5]

- Regulation comes from devolved parliaments like Scotland’s, nation-states, the EU, and an array of advisory and regulatory quangos such as the UK’s Human Fertilisation and Embryology Authority. Where states are signatories, they also refer to the extensive directives of the Council of Europe.

- Genetic testing was initially provided by doctors in a regulated environment. Modern technology facilitates direct to consumer (DTC) marketing of such services, which function across national boundaries but are not controlled centrally by the EU.

- A detailed report in the journal Nature described the differences in approaches taken by European nations. It concludes that central EU regulation is required to create a coherent, enforceable, regulatory system from the present tangle.[6]

- New gene editing techniques enabled Chinese scientists to change the genes of a fertilised embryo for the first time.

- This development led to the British Government licensing The Francis Crick Institute to practice CRISPR-Cas9 gene editing. This involves identifying and changing some specific genes in a fertilised embryo. The UK is extremely rare in not banning research on fertilised embryos. This “opens the door to an era of high-tech consumer eugenics” warned 150 scientists and academics in protest.[7]

4. EUTHANASIA AND ASSISTED SUICIDE

Human intervention to end life, either by licensing doctors to practice euthanasia, or by legalising assisted suicide is an issue brought before several of the parliaments of European democracies. As Europe becomes increasingly secular, previous assumptions about the “sanctity of life” are being challenged as individuals assert that they have the right to choose their time and manner of death. Opponents of euthanasia stress that in practice, once it is allowed, the numbers involved inevitably escalate as the intrinsic value of the old, the weak, the infirm, the sick, or even the depressed, is systematically undermined.

- Netherlands (2002), Belgium (2002), and Luxembourg (2008) are the only states in the world that have legislated to specifically allow euthanasia.

- The Dutch euthanasia rates have grown steadily from 1923 deaths in 2006 to 4829 in 2013.

- France and Ireland do not allow either euthanasia or assisted suicide, but neither insists that doctors intervene to prolong life either. Likewise, in Sweden it is legal to remove life support.

- In Germany and Switzerland, euthanasia is illegal, but some forms of assisted suicide are tolerated within defined limits.

- Switzerland saw a 700 per cent increase in assisted suicides between 1998 and 2009, of which 1298 were deaths at the Dignitas Clinic.

- Belgium now sees over 1400 people a year die through legal euthanasia.

- Denmark and Finland neither legalise nor criminalise euthanasia, which is practiced covertly.

- In the UK, euthanasia is illegal, but prosecution is unlikely. Both the British and Scottish parliaments have rejected calls to legalise the procedure.

- There is concern that the principle of informed consent written into most euthanasia and assisted suicide laws is routinely flouted. It is reported that there were 500 deaths without proper consent in the Netherlands, 208 in the Flemish region of Belgium, and 248 nurse-administered deaths in Belgium in this category.

- Recent research shows that depression (rather than intolerable pain, for example) was a major reason people requested death.

- Under the Groningen Protocol, the Netherlands has extended euthanasia to children and infants where they deem that the cost of caring for them outweighs their worth.[8]

5. ABORTION

The vast majority of European states both allow the termination of pregnancy, and facilitate the killing of human foetuses. There are, however, some important differences in the laws and behaviours across the continent.

- Ireland only permits abortion where continuing the pregnancy would threaten the life of the mother.

- Andorra does not allow abortion, and it remains technically illegal in Malta.

- Croatia and Portugal do not allow abortion after 10 weeks gestation.

- Greece, Cyprus, Czech Republic, Estonia, Latvia, Lithuania, Slovakia, Hungary, Poland and Denmark set abortion limits at 12 weeks  gestation (many of these allow longer in some specified cases).

-  Italy allows abortion up to 90 days gestation.

- Luxembourg, Belgium, Spain, Austria, Germany and France permit abortion up to 14 weeks gestation.

- The UK allows abortion up to 24 weeks gestation.

- Cyprus does not prevent abortions until 28 weeks.

- The Netherlands places no restrictions upon abortion.[9]Just as abortion laws vary, so abortion rates are different across the continent.

- In Southern Europe: the rate is 18 abortions per 1000 women.[10]

- In Northern Europe: the rate is 17 abortions per 1000 women.[11]

- In Western Europe: the rate is 12 abortions per 1000 women.[12]

- In Eastern Europe: the rate is 43 abortions per 1000 women.[13]

- It is estimated that 30 per cent of pregnancies in Europe end in abortion.