This week, Leiden hospital in the Netherlands revealed the latest chapter in an ever-expanding corpus of scandal surrounding the historical operation of fertility clinics.
The paternity of at least 21 children conceived through the clinic has been traced to a single doctor, Dr Jos Beek (d. 2019), who worked there between 1973 and 1998. Dr Beek inseminated his patients in the clinic using his own sperm while telling these women it came from anonymous donors. The issue was first flagged when Fiom, an organisation that helps people to trace their biological parents, found DNA matches between multiple children of mothers who had been patients of Dr Beek. Further investigation established a match between these individuals and one of Dr Beek’s own children.
The hospital has now established an independent investigation, which is appealing for mothers treated in Leiden hospital’s fertility clinic during this twenty-five year period to come forward. The investigators are due to report in the middle of the year but their efforts have been hampered by the destruction of internal documents. In addition to the 21 individuals Dr Beek is known to have fathered, there may be “dozens more” yet to find.
It is now known that at least two other doctors from the Netherlands – Dr Jan Karbaat and Dr Jan Wildschut (d. 2009) – cheated in the evolutionary stakes by fathering multiple children (at least 49, in the case of Karbaat and at least 17 in the case of Wildschut) through their unsuspecting patients. The Donor Child Foundation, a voluntary group that assists donor-conceived children, avers knowledge of two further Dutch doctors implicated in similar “doctor conception”. Dr Donald Cline, in Indiana, fathered more than 50 children; Dr Norman Barwin in Ottawa, Canada, at least 11; Dr Cecil Jacobson, perhaps as many as 75.
The case of Jacobson involves multiple types of fraud: he injected his patients with the hormone hCG (a hormone normally released in pregnancy) which produced false positive results to fertility tests. These allowed Jacobson to claim his fertility treatment had been successful and to invoice his patients accordingly. The pretence could be maintained through the early stages of pregnancy while Jacobson identified a “foetus” in granular ultrasound images, pointing to shapes later found by a court to have been nothing more than nearby organs or faecal matter. At some point, these women who had never in fact been pregnant, would be told by Jacobson that their babies had died.
Others of Jacobson’s patients were successful in becoming pregnant using sperm ostensibly sourced from anonymous, screened donors, whose identity was known only to Jacobson. The courts later heard that no such donor program had ever been established; Jacobson supplied the sperm himself. According to his legal testimony, this only happened sometimes, when donors failed to appear in the window of time that was optimal for the women to fall pregnant. In one case, Jacobson’s own sperm was used in place of his patient’s husband’s sperm; an error Jacobson could only account for by proposing contamination in the lab.
“Jelmer”, now in his late 30s and one of Dr Jan Wildschut’s progeny, has laid out some of the profound philosophical questions likely to arise for children fathered through “doctor donation”:
“How big is the group to whom we’re related? Should we think of the others like us as half-brothers or half-sisters? How will this affect our ability or willingness to have relationships? Should we tell other people? How will it affect how others see us?”
Because unscrupulous fertility doctors had the opportunity to father more children than the average sperm donor, the issues raised for their progeny might differ quantitatively from those of other donor conceived children. If these crimes of fertility fraud have a clear victim, however, it must be the women unknowingly inseminated by their own doctors.
True, choosing an unknown sperm donor to father your child must come with its own peculiar set of issues to be resolved by any prospective mother who enters a fertility clinic. But the complexity of those issues is significantly compounded when the donor is someone known to her and enjoys the secret advantage of knowing he is the father of her child, while she is kept in ignorance of this fact. Doctors have fiduciary obligations to their clients and exploiting the power differential in this way clearly represents a serious ethical breach.
The suspicion that, at least part of the gratification for the male doctor in these cases derives from his power over the women under his care, adds a further and more personal dimension to the abuse. If creating a child together is one of the most extreme indicia of intimacy between a man and a woman, there is something intuitively creepy about the possibility that doctors might create such intimate and enduring connections while keeping the woman concerned in ignorance of this.
Reporting on the subject of doctor donation normally blithely assumes that problems of this sort have been wholly resolved through regulations that, since 2004 in the Netherlands, have required fertility clinics to collect and store donor’s personal information in order to give effect to the rights of donor conceived children to access information about their biological parents:
“Exactly how what was then cutting-edge treatment was delivered and regulated was in the hands of the treating physicians themselves – and thus wide open to abuse by rogue doctors, with little or no external supervision, especially compared to the protocols and audits required today.”
Undoubtedly, the new obligations on fertility clinics to collect and retain better data must act as a significant deterrent. Perhaps guiding documents such as the Australian Government’s Ethical Guidelines on the use of assisted reproductive technology in clinical practice and research will ensure that fertility clinics conduct their business accordingly. Given that stories continue to emerge about how poorly regulated the fertility industry is, both in Australia and the United States for example, questions need to be asked about whether enough is being done to regulate the industry and ensure such ethical breaches that are now being uncovered are not able to happen again.
On the other hand, detection of these crimes is often the subject of generational delay, occurring only when the donor-conceived children reach adulthood and sometimes, as in the case of Fiona Darroch, only when they then have children themselves. Given that technology moves ahead of the regulation – and there is a further time lag between the detection of a problem and the implementation of regulations to remedy that problem – we have no reason for complacency.
Arguably the speed of technological development makes it impossible to anticipate the multiple ways in which new technologies might be misused or what profound implications this may have for the families affected into the future. The fertility business opens new possibilities for the abuse of trust in matters that have peculiarly intimate and personal significance. How do we begin to think of genetic relationships when these are detached from the social relationships that would normally be associated with belonging to the same family?
It might take a whole generation for the deleterious aspects of ART technological change to be recognised and a further period of time before policy is developed to correct for those problems. In the meantime, it’s the women and children who are most affected when ethical abuses occur, given the intimate nature of the service they are receiving.
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