Guido Pennings, professor of ethics and bioethics at the University of Ghent, Belgium, told the 21st annual conference of the European Society of Human Reproduction and Embryology today (Monday 20 June) that thousands of people travelled between European countries each year, seeking to take advantage of fertility laws that were more liberal in countries other than their own or because treatment was cheaper.
But he said that rather than seeking harmonisation of laws on reproductive medicine across Europe to prevent such tourism, we should accept the existing diversity and recognise that it enables people of different ethical and religious views to live peacefully together.
Prof Pennings said: "The number of movements is increasing because people are more used to travelling, are much better informed about policies in other countries and clinics by means of the internet, and because some clinics facilitate access by foreign patients by offering packages including visas, hotels and interpreters.
"The main causes of reproductive tourism are that a type of treatment is forbidden by law for moral reasons, certain categories of patients are not eligible for assisted reproduction, and the waiting lists are too long."
People seeking fertility treatment were travelling between most European countries now. "There is a general move to former East European centres because of the lower financial costs and towards Spain for oocyte donation (they have more donors because compensation of donors is allowed). In reality there is movement from almost every country to other countries and vice versa."
Prof Pennings said Italy was an example of a country where people were voting with their feet following the new law that banned embryo and gamete donation and the freezing of embryos and that allowed only three eggs to be fertilised, all of which had to be implanted in the woman in one go, regardless of their quality or the age of the woman.
"The main criticism is that the law clearly expresses the beliefs of only one section of society i.e. Catholics. No attempt was made to take into account other views. It should surprise no one that non-Catholic Italians feel frustrated, ignored, angry and unfairly treated. Patients and practitioners will vote with their feet and this process has started already, with hundreds of non-sterile couples at high genetic risk of a particular condition going abroad for treatment.
"Reproductive tourism illustrates the conflict between ethics and politics. Although the majority has the political right to express its moral views in the law, a number of important ethical values such as autonomy, tolerance and respect for other people's opinion urge the majority to take the minorities' position into account.
"There are three possible solutions: internal moral pluralism, where there are no strict prohibitions on fertility procedures; coerced conformity, where the majority attempt to force dissenting minorities to abide by the majority's laws – a situation that can lead to a head-on clash and jeopardises social peace; and international harmonisation.
"Although the call for harmonisation has an initial appeal, it may be a siren song leading to more restrictive legislation on reproductive technology if the European Convention on Human Rights and Biomedicine is any indication. It is much easier to move from permission to prohibition when controversial issues are considered, than vice versa.
"Moreover, there is no unified European culture and no consensus on substantive human values. This implies that European decisions would have the same problems as national restrictive laws but on an even higher level. The main reason for leaving these decisions to national states is that reproductive matters should be decided by the people concerned. Switching to the European level will most likely lead to political apathy, which I consider as very dangerous.
"The solution I prefer is that individual countries adopt a liberal legislation that does not exclude too many people from infertility treatment. The main argument is that legislation should try not to express the moral convictions of only one group in society. A liberal law also shows tolerance and respect for other people's opinion.
"Reproductive tourism is usually presented as a problem, but I believe that it is a safety valve that allows some degree of personal freedom for dissenting individual citizens on the one hand and democratic decision making on the other hand. As such, it contributes to a peaceful coexistence of different ethical and religious views in Europe. Contrary to some existing views, it may increase justice by giving people, who cannot pay for the treatment at home, the ability to look for cheaper treatment elsewhere."