Ethical Concerns of Artificial Insemination by Donor in Japan

Introduction

Artificial Insemination by Donor (AID) has been widely used around the world by couples who want to have children but cannot due to male factor issues such as physical infertility or psychological conditions. The purpose of this Assisted Reproductive Technology (ART) is for women to achieve fertilisation and pregnancy by using a donor's sperm, typically when Artificial Insemination by her partner is not available. In Japan, it has been more than 60 years since the first procedure was undertaken at Keio University Hospital in 1948 (Senba 2003). In contemporary Japan, hundreds of children are reportedly born through AID every year (Nara 2005). As the news and, notably, the success stories of AID are reported in the media, increasing numbers of infertile couples perceive it as a viable and beneficial option for having children.

It follows that AID has been discussed from the viewpoint of couples who undertake the procedure; however, "little attention has been given to the perspectives of the children thereby produced" (O'Donovan 1989: 96). Donors, couples and the family seem to be the primary focus in public and specialist discussions of the ethics of AID. One of the reasons for this may be that there is very little information on AID children. In particular, "we know very little about what AID children feel" (O'Donovan 1989: 108).

At the time of publication, there is no law designed to regulate such reproductive technology in Japan. The most robust reference for practitioners is the guideline offered by the Japan Society of Obstetrics and Gynaecology (JSOG 1997). Since it is legally invalid, whether or not to provide the procedure is left completely up to individual doctors, hospitals and clinics although the guideline strongly urges considerable care in carrying out the procedure.

These provisions clearly do not suffice. Further discussions of AID are indispensable because they raise ethical concerns over children's right to know about their biological roots, require government regulation, and also raises questions from the bioethical perspective of autonomy. By addressing these three concerns, this article seeks to promote the discussion of AID. It also considers how AID-related issues present bioethics with specific opportunities for extension.

AID Children's Right to Know about Their Biological Roots

AID has paved the way to parenthood for couples or individuals with limited choices in conception, offering a breakthrough technology for the fulfilment of significant life goals. However, it needs to be recognised that AID may also lead to serious problems for individuals conceived.

First, these individuals' sense of security in their own identity and in the relationship with the parents stand to be seriously disrupted. Parents tend not to reveal their children's conception by AID to them (Sakai 2007). When these individuals are subsequently informed of the truth, the news can raise questions about their identity, to the very core of their being. As one person born through AID explains, "The secrecy of AID leads to further destruction between the child and parents. The important thing is the trust relationship between them and hence it will be benefit for parents to tell the child the truth as early as possible" (Senba 2006: 152).

Second, the secrecy adds to the above affective, social and psychological concerns by introducing questions about physical vulnerability, specifically in relation to diseases potentially inherited through AID. Since AID-born individuals cannot access the information of the sperm donor, they feel anxiety about the donor's medical history. As Sakai points out, the need for information of the donor parent's medical history, in addition to their ethnic roots, are main reasons why AID children look for their donors (Sakai 2004). However, the wish to know of the person is also a factor. In one study, Senba and colleagues interviewed five people conceived through AID about their experience as Donor Conception offspring and what kind of information of donors they wanted. According to the study, "AID offspring seek to learn not only identifying information about the donor such as name, age, address, academic background, job history and medical history, but also about the donor's personality by meeting him...