Ken Daniels

Secrecy and openness in donor insemination.

This article explores the issues surrounding the notions of secrecy and openness in donor insemination (DI). Secrecy in DI is first placed in historical context, with an outline of some of the main reasons that secrecy has been advocated. The concept of openness is then introduced, and some of the arguments for a more open approach to DI are presented. On this basis, the responses of various governments to calls for more openness are outlined, and the social policy implications of these are discussed. It is concluded that more openness in DI would be advantageous to all of those involved. Couples, professionals, and policymakers are therefore urged to reexamine their views about the need for maintaining secrecy in the area.

Telling donor insemination offspring about their conception: The nature of couples' decision-making

The issue of openness and secrecy in the use of donor gametes is the subject of considerable disagreement and debate, not only for social scientists and health professionals, but also for the recipients of donor gametes. This paper has its origins in a study of 58 couples who had a child/children as a result of donor insemination (DI) at the Dunedin Infertility Clinic. Respondents completed questionnaires and took part in an interview during which they were asked whether they intended to tell their offspring about their DI conception. The nature of agreement/disagreement between partners on this issue, the dynamics operating between couples that may affect decision-making, and the views of couples in a time-frame perspective are the focus of this paper. Transcripts from some of the interviews are presented to illustrate the points made and commentary and discussion is provided.

Artificial insemination using donor semen and the issue of secrecy: The views of donors and recipient couples

The issue of secrecy and artificial insemination using donor semen has psychosocial, moral and legal implications. These implications are explored within the context of New Zealand AID practice, and particularly, recent legislation aimed at clarifying the status of the child. The results of two studies, one covering 37 donors involved in six AID programmes and the other covering 55 couples who had been accepted into one of the same six programmes, insomuch as they relate to issues of secrecy, are reported. Recipient couples and donors, while thinking that secrecy is important, have told other people-a not dissimilar situation to what occurred in the adoption field 25 years ago. Forty-one per cent of recipient couples and donors do not believe children should be told of their origins. A high 46% of couples had not yet decided if they would tell their child. Donors are almost equally divided over the childs right to non-identifying information about them. Donors are more likely than recipient couples to believe that the child who knows s/he has been conceived via AID will want information about them. Only 11% of donors and 5% of couples believe a child would want to know the identity of the donor, although for three quarters of both groups the issue is far from clear. Donors were not as opposed to the possibility of tracing occurring as some doctors suggest. Response to questions concerning the legal position suggests there is considerable confusion amongst both groups. The overwhelming majority of couples were intending to place the husbands name on the birth certificate, regarding him as the father.(ABSTRACT TRUNCATED AT 250 WORDS)

Semen donors in Germany: A study exploring motivations and attitudes

BACKGROUND Germany is one of the countries where donor insemination (DI) is shrouded in secrecy and where, until recently, donors were assured of anonymity, and clinics were able to destroy documents after 10 years. For many years, preparation seminars for recipients have been conducted. Almost all participants of these seminars intend to disclose the nature of conception to their child, thus representing the beginning of a culture change. This study sought the views of donors regarding their willingness to be identified and therefore meet these expectations. METHODS AND RESULTS Thirteen of 15 clinics in Germany agreed to participate and of 153 anonymous questionnaires sent, 41% (n = 63, from eight clinics) were returned. Thirty-seven per cent of donors suggested that parents should disclose the nature of the conception to their child, 34% uncertain and 29% opposed. Forty-three percentage were willing to meet offspring, 22% uncertain and 35% opposed. CONCLUSIONS One-third of the donors supported parental disclosure and just under half of the donors are willing to be identifiable, despite a climate and history of secrecy. This study indicates that there are donors who are agreeable to be part of the move away from secrecy, and this will have implications for professionals involved in providing DI services in Germany.

Factors associated with parents’ decisions to tell their adult offspring about the offspring's donor conception

BACKGROUND Tensions and anxieties surround secrecy within families in the context of gamete donation and family building. This paper presents the views of parents who had kept their use of donor insemination a secret from their offspring. A sub-set of these parents said that they wished to tell their now-adult offspring, and discussed the questions and issues this secrecy raised to them. METHODS In-depth interviews were undertaken with heterosexual parents (of 44 families) who had given birth to children conceived via donor insemination between 1983 and 1987. These interviews comprised a follow-up study, with the first interviews being undertaken when the children were aged up to seven. In this paper, qualitative data relating to a sub-set of 12 parents (from seven families) who now wished to tell their offspring are presented. RESULTS The parents describe the pressures that the secret-keeping had created for them as well as the impact of those pressures. They report on the reasons they now want to share the family building history and the associated fears and anxieties about doing so. The parents all say that they wish they had told their offspring much earlier. In five of the seven families, parents describe how the offspring had raised questions concerning a perceived genetic disconnection between them and their parents. CONCLUSIONS Keeping the use of donor insemination a secret from offspring created considerable pressure for these parents. Despite the secrecy, offspring can become aware of the genetic disconnection.

Sharing information with adults conceived as a result of donor insemination.

A growing number of jurisdictions have introduced legislation to give children the right to information about, and identity of, ‘their’ gamete donor. This has been accompanied by a reduction in the social stigma associated with infertility and building families with the assistance of donated gametes. This changing culture has meant that an increasing number of parents are seeking assistance regarding how to share their family history, including the donor insemination conception story. The literature suggests that the sharing of information is best undertaken when the children are young. There is virtually no literature available for parents who wish to share their family history with adult offspring, or for those professionals whose guidance they may seek. This paper addresses this emerging area of practice. It is suggested that there are three main areas that will be of assistance with any attempt to understand the individual and family dynamics involved: identity and self-image, stigma and power. Strategies and suggestions emerging from each of these areas of knowledge are outlined. This paper aims to generate discussion and to encourage others to share their clinical experiences in this area.

The controversy regarding privacy versus disclosure among patients using donor gametes in assisted reproductive technology.

8. Human Fertilisation and Embryology Act 1990, London, HMSO 9. Human Fertilisation and Embryology Code of Practice, revised Dec 1995. London, HFEA (Paxton House, 30 Artillary Lane) 10. Glover J: The Glover Report on Reproductive Technologies to the European Commission, Fourth Estate Ltd. Fertil Steril 1989 11. Snowden R, Snowden E: The Gift of a Child, 2nd rev ed. Exeter, University of Exeter Press, 1993 12. Shenfield F: Filiation in assisted reproduction: Potential conflicts and legal implications. Hum Reprod 1994;7: 1348-1354 13. Golombock S, Cook R, Bish A, Murray C: Families created by the new reproductive technologies: Quality of parenting and social and emotional development of the children. Child Dev 1995;66:285-298 14. Klock SC, Jacob MC, Maier D: A prospective study of donor insemination recipients: Secrecy, privacy, and disclosure. Fertil Steril 1994;62:477-484 15. Well E, Cornet D, Sibony C, Mendelbaum J, Salat-Baroux J: Psychological aspects in anonymous and non-anonymous oocyte donation. Hum Reprod 1994;7:1344-1347

Openness of information in the use of donor gametes: Developments in New Zealand

Abstract A committee appointed by the New Zealand Government to inquire into developments in assisted human reproduction recommended in their 1994 report that all offspring born following the donation of embryos or gametes should have access to identifying donor information. This paper presents the Committees conclusions, along with a description of current attitudes and practices in New Zealand. Sweden and New Zealand have, until recently, been the only two countries in the world that have adopted the ‘openness’ approach. Some brief comparisons are made between the approaches followed in these two countries.

Semen providers and their three families

Background: In 1985 the Swedish government introduced legislation that required all semen providers to furnish identifying information on themselves which would then be made available to their biological/provider offspring when they are deemed to have ‘sufficient maturity’. The purpose of the legislation was to protect the childs rights and needs. The aim of this paper is to examine the degree to which semen providers have considered the implications of their decision to donate upon their three families; their birth family, the family they form with their partner, and the recipient family. Methods: Thirty semen providers from two Swedish clinics were sent self-completion questionnaires collecting both quantitative and qualitative information. The initial response rate was 100%. Questions requested demographic information; the degree to which semen providers had consulted with or advised their partners, family, existing offspring and acquaintances about their semen donation; views and attitudes of semen providers towards donor offspring, anonymity, information sharing, payments to semen providers, community acceptance of DI and semen providers, experience of donation, recruitment/screening procedures. Results: Almost all respondents had told their partners that they were providing semen, however, a much smaller proportion had told their birth families. Almost two thirds of semen providers were positive or very positive about the prospect of meeting their offspring at some time in the future, with older men expressing more enthusiasm. Conclusions: The findings suggest that semen providers have only partially considered and addressed the full implications of having semen provider offspring. The age of semen providers could be influential in determining some attitudes and views.

Is blood really thicker than water? Assisted reproduction and its impact on our thinking about family

The traditional notion that a family is built around and based on blood or genetic ties is challenged when assisted human reproduction utilizing donor gametes is used. A focus on the family – in contrast to the individual – requires from medicine an extension of thinking in which a model that incorporates treating infertility and building a family becomes the norm. Such a model will require that attention is given to the psychological and social needs of the would-be parents, thus enabling them to approach their family building with confidence. This confidence is expected to carry through to their sharing with their offspring the nature of their family building and thus avoid the stigma that leads to secrecy. Research relating to dimensions of family building when donor insemination has been used is reviewed. The impact of professional attitudes, along with the policies adopted by governments concerning access to genetic information for offspring, significantly influences the families built with assistance of donor gametes or embryos. The evolution of professional thinking in this area is reviewed, along with the increasing involvement of governments.