Survey informs debate on future bioethics bill

On 7th February 2007, the "Agence de la biomédecine" published the results of the first nationwide survey on the French public’s views about bioethics. The public was questioned about artificial reproduction, research on the embryo and human genetics. The aim was to get “a picture of the opinion on subjects covered by the Law on Bioethics.” The Law on Bioethics (as modified by the law of 2004) is due to be reviewed by the French Parliament in 2009.

About the "Agence de la biomédecine" and the Survey

The "Agence de la biomédecine" is a pubic body created by the 2004 Law on Bioethics. It oversees four areas of medical science: “organ procurement, procreation, human embryology and genetics”. Its main goal is to “ensure respect for safety and quality, anticipation, ethics and transparency”.

The survey , carried out by InfraForces, took the form of a phone questionnaire submitted, between 19th December and 29th January 2007, to a nationally representative sample of 1086 French adults aged 18+.

The results

1. The use of assisted reproductive technology (ART)…

1.1 Seen as the main solution to fertility problems
The use of ART is widely accepted: 78% of respondents rate it as the foremost solution to fertility problems, ahead of adoption (32%) or giving up on having a child (26%). More than 69% state that “all the possibilities offered by science to have a baby must be explored.” However, the responses reveal concerns about these techniques as almost one third say they incur a risk for the mother and the child.

1.2 But a solution that should not be opened to everyone
As Jean-Yves Nau points out, the Bioethics Act of 1994 only allows access to ART for couples “consisting of a man and a woman in age to procreate”. The survey asks questions about such access according to criteria of:

Sexual orientation
55% of people think that only heterosexual couples should benefit from ART and only 29% would support female same-sex couples using ART.

Relationship status
46% of respondents say they support “the possibility for a widow to have a baby using frozen sperm from her husband”.
38% agree that a single woman should be able to use ART to have a baby.

Age
An overwhelming majority thinks age is a valid criterion to limit access to ART: 91% strongly disapprove of its use on women over 50 and 72% do not support its use on men over 50. Only 46% support its use on women over 40.

2. Surrogacy
55% of respondents think that the "fact for a woman in good health to give the use of her body to a couple in order to bear and give birth to their child" is acceptable and 53% think that this practice should be legalised.
Interestingly the survey shows that 44% of people think, wrongly, that surrogacy is already legal in France.

3. Sperm and egg donation: people are attached to the principles of anonymous and free donations but the survey notes a slight shift on the issue.

Anonymous
79% of persons declare that they are very attached to the principle of anonymity for sperm and egg donation and think that it protects the donors and their family. However, and paradoxically, half think that the child must be able to know his origin.
54% disapprove of the fact that parents could select specific characteristics in the donor such as skin colour, height, academic qualifications while 29% are open to this possibility.

Free
79% of respondents say they are attached to the principle of free donations and clearly oppose any possibility of trade in gametes and embryos.
However, 55% say they support a payement for the expenses incurred for the donation of ovocytes and around a third (32%) would accept compensation for female volunteers.

4. The embryo: people lack clarity on the definition of this term, but they seem to support medical research on the embryo

Human Embryo

People are not too sure what an embryo is: half say that embryo is synonymous with foetus and 47% say that the embryo is a “blob of cells”. In any case, the embryo is seen as the beginning of life (87%).
80% of respondents think research on embryos and human genetics is “a source of hope for the future and progress for patients and their family”. Only 19% think “it is a step too far”. Finally, 65% say they support donation of embryos for research.

5. The Prenatal diagnosis and the Preimplantation genetic diagnosis are both widely endorsed
95% of the persons surveyed think that prenatal diagnosis is a good thing.
They think that if a genetic disease is detected, it is the couple who must decide what to do (89%).The advice of the doctor in this situation is important for half of respondents.
75% of the French reject the fact that the law or an ethics committee could intervene in the decision.
Regarding the preimplantation genetic diagnosis, 48% of people think that “it is a very good thing” and 36% that “it constitutes an important progress for medicine”. Only 16% say that “it is a step too far”.
However, a majority of persons rejects the possibility for parents to have a child to cure another one (47% were against and 18% unsure).

6. Cloning: an unclear and massively rejected notion
The survey reveals some vagueness about what the term “cloning” refers to: 40% say it is the “possibility to replicate identical human beings” and the same proportion that it is “a means to obtain cells for medical treatment”.
91% of people say that cloning “is a step too far”.

7. Minimal room given to religious institutions in the debate
The survey notes that 80% of respondents think that religious institutions must not take part in the bioethics debate and a large majority of believers agree (68% amongst practising believers).

8. Trusting scientists for the regulation of medical research
45% of people think that research is sufficiently regulated in France and 23% that it is insufficiently so.
To ensure a sufficient level of regulation they trust first and foremost the scientists (72%), then the Agence de la biomédecine (69%), the State (47%) and ethics committees (42%).

Conclusion
The "Agence de la biomédecine" concludes that the French have not yet made their minds on bioethics. The survey shows that criteria of social class, gender, age and level of education do not have an impact on the views of the respondents.
According to the Agency this lack of decisiveness can be explained by “a lack of reflexion, a lack of information, the complexity of the subject, or because these are intimate and personal questions for which a society-wide response does not yet seem to make sense”.

- fig1: Human sperm frozen at - 105°Celsius as seen with a cryomicroscope, image by Dr. M. Jondet (1985).