There is political consensus that, over the past few years, our country experienced a dramatic revolution in LGBT rights.

The introduction of civil unions and same-sex marriage, the granting of adoption rights to gay and lesbian couples, the prohibition of conversion therapy, the enactment of a straightforward procedure to change one’s gender identity and the replacement of gender-specific references in Maltese law with gender-neutral terminology have suddenly propelled Malta from the back row to the forefront of LGBT rights, even compared to the rest of the EU.

It is, therefore, not surprising that the government has now announced the imminent publication of a Bill removing one of the last legal barriers discriminating against LGBT couples: the prohibition of access to IVF treatment for lesbian couples.

The family-building options available in the medical setting for same-sex couples include artificial insemination and in vitro fertilisation (IVF) for lesbian couples and gestational surrogacy (a surrogate either undergoes artificial insemination or IVF with sperm from one or both members of the couple or from a sperm donor) or traditional surrogacy (a surrogate carries a pregnancy and delivers a child that is created from the egg and the sperm of the intended parents and/or donor egg and/or donor sperm and/or donated embryos in any combination) for gay couples.

In Malta, the Embryo Protection Act introduced in 2012 prohibits same-sex couples from access to medically-assisted procreation. There’s also an outright legal ban on surrogacy and on the use of donated eggs and sperm.

The latest medical developments and guidelines issued by reputable international bodies more than justify the government’s decision to make IVF treatment accessible to lesbian couples.

Indeed, there is also justification for the government to remove the ban on surrogacy and the use of donated eggs, as retaining the ban (while introducing IVF treatment to lesbian couples and allowing them to use donated sperm) would otherwise mean that gay (male) couples would be the only ones to be denied access to medically assisted procreation services.

This would not make sense, given that the practices that raise specific ethical issues in the field of fertility treatment, such as the preservation of embryos, sex selection and surrogacy, have got more to do with issues that challenge humanity’s core values rather than issues that distinguish between heterosexual and homosexual reproductive rights.

In the United Kingdom, the National Institute for Health and Clinical Excellence has updated its guidelines for the treatment of people with fertility problems and has, for the first time, recommended broadening the criteria for the provision of IVF to women in same-sex relationships who have not conceived after 12 cycles of donor or partner unstimulated intrauterine insemination.

For infertile couples, access to IVF treatment is the only option to conceive a much-wanted child

In a Dutch study (Hunfeld, 2004) which interviewed the directors of 13 licensed IVF centres in the Netherlands, the authors concluded that arguments against accessibility to IVF treatment for same-sex couples mainly concerned a perceived psychological instability and the quality of life of the future child and were rooted in the harm principle rather than scientific rationale.

In the US, the ethics committee of the American Society for Reproductive Medicine declared that since the overall results of research suggest that the development and well-being of children with LGBT parents do not differ markedly from that of children with heterosexual parents, there is no justification for restricting access to assisted reproductive technologies on the basis of sexual orientation.

This was echoed by the American College of Obstetricians and Gynecologists, which held that: ‘‘Allowing physicians to discriminate on the basis of sexual orientation would constitute a deeper insult, namely reinforcing the scientifically unfounded idea that fitness to parent is based on sexual orientation and, thus, reinforcing the oppressed status of same-sex couples”.

In Australia, ethical guidelines issued by the National Health and Medical Research Council stipulate that, in determining an individual or couple’s eligibility to access assisted reproductive technology services (such as IVF), there must be no unlawful or unreasonable discrimination, for example, on the basis of sexual orientation.

Notwithstanding this broad scientific consensus, it is undeniable that the provision of IVF and other assisted reproductive services to same-sex couples raises controversial issues of a political, cultural, religious and ethical nature.

A significant minority regard the latest government announcement to be a direct contradiction of their religious faith or a clear interference with the laws of nature.

Yet, while such differing views should be respected and debated, it is imperative to keep in mind that, for socially infertile couples, access to IVF treatment is the only option to conceive a much-wanted child.

Consequently, in the absence of medical reasons against the availability of such an option, denying same-sex couples access to IVF treatment would neither be just nor respectful of human dignity and the natural human rights of all people.

Claire Axiak is a psychiatrist and psychotherapist.

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