|The Family Man – Dr Patrick Stowe|
(Warning: contains plot spoilers!) The Family Man is a three part BBC 1 drama centred on the successful (fictional) ‘Wishart Fertility Clinic’. The patriarch of the clinic is Dr Patrick Stowe (Trevor Eve) whom is driven by pursuit of better ways to help distressed couples have a child. The drama follows four couples facing a spectrum of fertility problems. In an attempt to fulfil their dreams, they turn to Dr Stowe to help find the answers. At times this tests the legal parameters of fertility treatment in the United Kingdom, and as such raises a whole raft of bioethical issues.
Gary (Katy Cavanagh) and Tina (Lee Ross) – Egg Sharing
|Gary and Tina during the IUI procedure|
Tina has a daughter from a previous relationship, but she and husband Gary turn to the clinic to help them start a family of their own. Unable to achieve pregnancy despite tests showing that her eggs and Gary’s sperm are normal, they initially opt for IUI or Intrauterine Insemination, a procedure that artificially inserts the sperm into the uterus via a catheter to aid fertilisation. This is a relatively cheap option to help couples with fertility problems, and it soon becomes apparent that Gary and Tina have chosen it primarily because of money constraints (Part 1 00:05:42 – 00:06:37).
Unfortunately the procedure was unsuccessful, and again they find themselves back at the clinic discussing egg sharing (Part 1 00:10:28 – 00:12:51):
Dr Stowe: “You can’t afford IVF and you can’t wait to face your turn on the NHS. Well this could solve both those problems”
Tina: “Egg sharing?”
Dr Stowe: “I have to be honest with you, I used to have a problem with it. Women who couldn’t afford having IVF getting free treatment by sharing their eggs with other women who could. The idea that the women was giving away half her eggs wasn’t truly giving her consent.”
Dr Stowe: “But I had to concede that women in this situation would be going through egg collection anyway if they could afford IVF, so it’s already a risk they are willing to take.”
Gary: “Well we’ll take it”
Tina:”Look why don’t we think about it”
Gary:”Well what is there to think about. He is offering us free treatment.”
Dr Stowe: “The other reason I changed my mind is, it helps two women at the same time, and gives women, women like you another choice. Let me give you a better outcome next time, complete success.”
|Gary and Tina discussing their options with Dr Stowe|
When discussing this option Tina is reluctant at first “What if she gets pregnant with my eggs but I don’t?” However Gary’s frustration and determination to have a child of his own soon persuades Tina to rethink and they decide to go ahead (00:15:32 – 00:16:02 and 00:18:16 – 00:20:18). Despite their best efforts, however, the IVF again proves unsuccessful and Tina is left wondering how the other woman is getting on (Part 1 00:49:17 – 00:50:53).
Tina confronts Dr Stowe to ask him if the other woman has got pregnant (Listen to BBC Radio 4 ‘Womans Hour’ – The ethics of egg sharing). Bound by patient confidentiality not to divulge this information he declines to answer, but does say that her eggs work perfectly fine. This discussion (Part 2 00:02:34 – 00:04:10) also reveals that Tina was adopted as a child, and as a consequence she must be removed from the egg sharing programme on ethical grounds. Tina is left to tell Gary for the first time that she was adopted and that, as a result, she can no longer egg share. Gary is unable to cope with the situation and the relationship dissolves . Luckily this is only short lived; Tina meets her biological mother and is later reconcilled with Gary.
The story of Tina and Gary raises several ethical issues including;
- Limited availability of IVF on the NHS. Is this ethical? Is it right that couples are forced to seek private healthcare?
- Is there full and proper ‘informed consent’ made by the donor (Tina) when egg sharing? Is it affected by the extreme emotional pressure to try and have a child? Does the women’s autonomy remain or is it diluted by the limited available choices she has?
- Ideally egg donation would be a truly altruistic act, a decision made without inducement or coercion; however in reality patients with reduced access to finances are not entirely free from external intrusion.
- The patient must consider ‘donor anonymity’. In 18 years they may be faced with a child they have not parented but are genetically related to. How could this affect their own children and their relationship with her partner?
- Egg sharing does provide a partial tonic to alleviate ‘egg shortages’ for infertile women. It is also an arrangement that helps benefit more than one women from the available eggs.
Natalie (Claire Skinner) and Matthew (Dominic Rowan) – Egg donation
|Natalie and Matthew visiting the fertility clinic|
Natalie and Matthew have had several unsuccessful cycles of IVF at the Wishart Fertility Clinic. In a final effort to have children they look to Natalie’s sister to donate an egg. Despite this apparently perfect solution, her sister unexpectedly gets pregnant and is unable to help (Part 1 00:07:32 – 00:08:10, 00:24:30 – 00:24:52 and 00:27:37 – 00:28:54).
With limited choices the couple look for an alternative egg donor. Mathew has some initial concerns that the physical characteristics do not completely match those of Natalie’s (Part 1 00:33:35 – 00:34:36). Despite this, in their desperation they decide to go with one particular egg donor (Tina).
Natalie is afraid that this is their last opportunity to have a child, and pressures Dr Stowe to implant three embryos instead of two, to maximise their chances (Part 1 00:36:20 – 00:37:50). This goes against fertility regulations designed to safeguard against multiple pregnancies, which place great strain on both the mother and the foetuses; there is a high possibility of premature births; developmental and future health complications for the children. Despite attempts to persuade Natalie and Mathew otherwise, Dr Stowe presents the case to the clinic’s ethics committee to seek their approval (Part 1 00:39:17 – 00:43:15), leaving Mary, the counsellor at the clinic, concerned that Dr Stowe has forgotten his duty of “clinical detachment, resisting the emotional concerns of the patient”. The case is approved and sure enough all three embryos begin to develop in the womb (00:51:41 – 00:53:06).
Early into the pregnancy, Natalie and Mathew are faced with a terrible predicament. They are advised by the doctors at the hospital to consider selective reduction, terminating one of the pregnancies because the foetus is not developing very well (Part 2 00:07:10 – 00:09:41 and 00:13:50 – 00:14:55). Natalie adamantly refuses to follow their advice, since terminating one of the foetuses risks inducing a miscarriage of the remaining two, and thus she opts to continue the pregnancy with all three.
|Natalie and Matthew with their triplets in the neonatal department|
Almost inevitably, the children are born very premature (28 weeks) with initial health complications (Part 2 00:22:28 – 00:25:31). The news is difficult for everyone, especially for Mathew becoming increasingly distant from Natalie and extremely angry with Dr Stowe whom he blames for the situation (Part 2 00:34:16 – 00:37:08). Eventually, with a lot of effort from the hospital staff, Natalie and Mathew are able to return home with all three children (Part 2 00:53:28 – 00:54:08). But Matthew’s anguish continues, as he attempts to deal with his fear that the children will grow up with a series of health difficulties (Part 3 00:30:28 – 00:32:26 and 00:36:00 – 00:38:15). This stretches their relationship and tests their ability to cope as a couple and as a family, but with much persistence they begin to manage the situation better and remain happy with their new family.
The story of Natalie and Matthew raises some interesting ethical questions;
- Is it good clinical judgement by Dr Stowe to bow to the emotional pressure of Natalie and seek to implant three embryos rather than two?
- When implanting the embryos, whose welfare is more important the mother or the potential child/children?
- Does the potential benefit for Natalie to mother her own child outweigh the potential harm a multiple pregnancy would have on the children?
- Who should be considered when making a decision about terminating one of the foetuses to help the remaining two? The mother? The father? The children? The doctors?
Gillian (Michelle Collins), Steve (Peter McDonald) and donor Kelly (Daniella Denby Ashe) – Paying for egg donation
|Gillian and Steve shopping in the middle of night|
Gillian and Steve’s story begins in the Henri Gradinaru Clinic, Bucharest, where, in their desperation to find a suitable egg donor they visit a ‘questionable’ fertility clinic. Gillian immediately becomes fearful of the quality and safety of the donor and returns home empty handed (Part 1 00:03:55 – 00:05:27). Gillian has delayed starting a family due to her demanding career running her own business, and now finds she is unable to have a child using her own eggs. In her early forties, her turmoil about being childless has intensified to a level that she chooses to do her food shopping in the dead of the night to avoid seeing mothers with their buggies. This pushes the couple to advertise privately for a donor in the UK (Part 1 00:28:54 – 00:30:57).
|Kelly – egg donor|
Kelly, a university student with a sizeable debt, sees egg donation as a means to generate income (Part 100.28:54 – 00:30:57). Gillian contacts Kelly to arrange to meet and both discuss their predicaments. Kelly agrees to donate her eggs, but only for a price and they agree on £5000 (Part 1 00:31:49 – 00:33:12 and 00:34:42 – 00:36:29). Knowing that it is illegal to pay egg donors in the UK, they agree to lie when they visit the Wishart Fertility Clinic, implying Kelly has known Gillian for a long time (Part 1 00:44:15 – 00:49:33). Before the procedure, Kelly confides in Steve that she is worried that she won’t produce enough eggs for Gillian, and that they acknowledge the scenario is a little bizarre (Part 1 00:52:46 – 00:53:56).
The IVF procedure is a success and Gillian becomes pregnant, but the story takes two dramatic twists. Initially, Steve have an affair with Kelly, which Gillian eventually discovers. Kelly’s mother also reveals that she has a half-sister Tina, put up for adoption because the mother was 16 at the time(Part 3 00:11.22 – 00:14:00). This all becomes too much for Kelly and she self-harms, cutting her stomach with a kitchen knife (Part 3 00:15:45 – 00:18:30). Gillian fears that Kelly’s actions are not just a one off, but may be symptomatic of an underlying, inheritable condition (Part 3 00:19:55 – 00:23:19 and 00:27:36 – 00:29:11). Kelly extinguishes these concerns and returns to her family, leaving Gillian and Steve to repair their marriage following the birth of their own baby.
The story of Gillian, Steve and Kelly raises several issues;
- Financial incentives offered to women to donate their eggs may influence their ability to give full ‘informed consent’. If there was no financial incentive would the women donate her eggs purely as an altruistic act? Are these women who need the money in a vulnerable state?
- Are the health risks associated with egg donation always explained in a precise and clear manner? Do the women truly understand these risks?
- In the UK, paying for egg donation is illegal, this helps remove some of the issues expressed above, but also to help protect not only the donor, but the recipient, the future child and the IVF clinic. At no point did Gillian ask for Kelly’s past medical history, presuming that she was fit and healthy. It is unknown what the consequences could have been for Kelly, Gillian and the baby if she was not.
- Paying egg donors may help reduce ‘egg shortage’ and help other women overcome their fertility problems
Jane (Sara Powell) and Paul Jessop (Lennie James) – PGS & Sex selection
|Jane and Paul speaking with Dr Stowe|
Jane and Paul’s only son has been killed in a road traffic accident outside their home. Despite having three daughters both are distraught at the loss, particularly Paul who left the garden gate open and feels responsible (Part 1 00:09:07 – 00:10:22). Wanting to ensure their next child is a boy, the couple look to Dr Stowe to guarantee the gender of their intended baby.
In as aspect of the programme that will later become relevant to Jane and Paul’s story, the clinic is looking to offer a new treatment Pre-implantation Genetic Screening (PGS) (Part 1 00:12:41 – 00:15:21). Dr Stowe suggests they use PGS to screen embryos for aneuploidy (that is, abnormal chromosome number, as seen in Down’s syndrome where someone has three copies of chromosome 21 rather than two. This differs from Pre-implantation Genetic Diagnosis (PGD) which likely involves testing for genetic disease associated with a specific gene, for example Cystic Fibrosis and Huntington’s disease).
These sections (Part 1 00:12:41 – 00:15:21 and 00:24:55 – 00:25:22) provides an excellent description of PGS and some of the ethical issues which surrounds the procedure, including:
- The moral status of the Embryo
- Discarding of unwanted embryos
- Advantages of PGS compared to both amniocentesis or chorionic villus sampling (CVS). (PGS; diagnosis of embryo made before implantation, discarding of embryos vs. Amniocentesis & CVS diagnosis of foetus at 12-13 weeks of pregnancy leading to possible abortion).
Ever since the loss of their son, Paul and Jane have wished to have another boy. Having heard of cases abroad (Part 1 00:26:05 – 00:27:37, 00:43:08 – 00:44:09), of fertility doctors using PGS to select the gender of the embryo, the couple visit Dr Stowe (Part 1 00:53:40 – 00:55:30).
Paul: “You are doing PGS?”
Dr Stowe: “Screening for aneuploidy, not for the sex of the embryo.”
Paul: “Yeah, but you could, couldn’t you?”
Dr Stowe: “Sex selection in this country is illegal. I can’t abuse the science.”
Paul: “How terrible would it be for you to help me and Jane have another baby boy?”
Jane: “You have the technology to make us happy, you can do it.”
Dr Stowe: “You can do all sorts of things but sometimes we have to choose not to. For the welfare of the child for a start.”
Jane: “The welfare of the child, he wouldn’t be more loved” (She laughs)
Dr Stowe: “All I’ve ever wanted to do is to help couples, make them happy, but I can’t be God.”
|Pro-life protesters campaigning outside the fertility clinic|
Despite Dr Stowe’s initial reluctance to even contemplate using PGS for sex selection, Paul visits him again to explain how traumatic their lives have been since their loss (Part 2 00:15:00 – 00:17:58). Dr Stowe is unable to ignore Paul and Jane’s pleas and discusses the matter with his embryologist, the clinical staff at the clinic, and the ethics committee (Part 2 00:25:14 – 00:28:36 and 00:41:20 – 00:44:07). In spite of the group’s major reservations, Dr Stowe decides he wants to help the couple. But to do this, he needs to force the issue, by raising support from the public and applying to the Human Fertilisation and Embryology Authority (HFEA) who regulates fertility clinics in the UK (Part 2 00:29:20 – 00:30:47, 00:38:40 – 00:40:35 and 00:41:11 – 00:42:38). Paul, Jane and Dr Stowe embark on a series of media interviews to raise awareness of their story. However as a consequence, pro-life protests against the clinic intensify. The Jessop’s family home is targeted and the fertility clinic is bombed (Part 2 00:48:14 – 00:50:30, 00:55:30 – end and Part 3 Start – 00:04:00).
The application to the HFEA is refused (Part 3 00:14:00 – 00:15:30) which, Dr Stowe feels, leaves no other option but to do the procedure without their approval. Mary the counsellor at the clinic is unable to stand by and allow this to happen, and so she reports Dr Stowe to the HFEA, triggering an investigation (Part 3 00:23:19 – 00:27:36 and 00:32:26 – 00:36:00).
Before the HFEA were able to close down the clinic to begin their enquiry, Dr Stowe carried out the procedure. In an unfortunate twist, the embryos which Dr Stowe had implanted had an abnormality and Jane miscarries the foetus (Part 3 00:41:00 – 00:43:00). This news drives Paul to even greater lengths in an attempt to have a new son, and visits the same fertility clinic where Michelle and Steve started their story. The same ‘questionable’ fertility doctor suggests to him, that without his wife’s eggs, the only available option is ‘reproductive cloning‘. He explains that if he had some DNA of his son he could use a donor egg and surrogate womb to reproduce an exact copy of his son, which in reality is presently impossible. Paul and Jane’s story reaches its lowest ebb as Paul attempts to dig up his son in order to obtain some of his DNA. He eventually comes to his senses and stops, realising that in his desperation for another son he had harmed his family almost beyond repair (Part 3 00:44:00 – 00:49:30). The HFEA exonerates Dr Stowe as they found no evidence of sex selection in their investigation, and the clinic is reopened.
Paul and Jane’s story raises many ethical issues in addition to those mentioned above;
- Sex selection will mean that embryos of the ‘wrong’ gender (in this case all female embryos) will be discarded. Is this act proportional to ensure that the family has a boy?
- In support of using PGS for sex selection, the issue of ‘Family balancing‘ is raised (Part 2 00:25:14 – 00:28:36). Some may argue that PGS should be allowed to permit the baby’s gender to be chosen.
- It is important to consider the welfare of the new child. How will they feel about being conceived in this way? What if the new born is completely different to the sibling who has died? How will the parents cope with this?
- The parents must consider the welfare of their other children. As seen in this drama, the three daughters are often neglected by their parents.
- And finally; both the story of Paul and Jane, and Gillian and Steve raise the issue of ‘fertility tourism‘. An issue which raises much concern, because these actions may jeopardise the safely of the person seeking treatment and those who provide donor eggs for the visiting foreigner.
This is an interesting drama which exposes many ethical topics. Dr Stowe is a highly motivated doctor, who believes in maximising the parents ‘procreative autonomy’, to give them the best chance and choice available with current reproductive technologies. But such ambition should never excuse a doctor neglecting his/her responsibility to consider the consequences of their acts, not just for the parents or the chid but also for society as a whole. Because of the length of this three part drama (3 episodes of 60 minute), it would be most advisable to focus on each of the stories individually, by either watching the clips or just using them as individual case studies to discuss one set of particular ethical issues.
The Family Man was first broadcast on 23rd March 2006 (Part 1 – 60min) TRILT Identifier 00584B76, 30th March 2006 (Part 2 – 60min) TRILT Identifier 00587D15 and 6th April 2006 (Part 3 – 60min) TRILT Identifier 005887D8). It is also available at Amazon.