FAMILY DIVISION
Strand, London, WC2A 2LL |
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B e f o r e :
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AB |
Applicant |
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- and - |
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CD -and- The Z Fertility Clinic |
Respondent |
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Miss Marisa Allman (instructed by Simpson Millar LLP) for the Respondent [CD]
Miss Ashley Thain (instructed by Mills & Reeve LLP) for the Intervener [Z Fertility Clinic]
Hearing dates: 7, 8, 9 May 2013
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Crown Copyright ©
Mr. Justice Cobb :
Introduction and summary:
i) the law relating to contact & residence (section 10(4)(a) Children Act 1989);ii) child maintenance (schedule 1, para.4 and 10 Children Act 1989 as amended by schedule 6 HFEA 2008);
iii) inheritance (section 48(5) HFEA 2008);
iv) "bring(ing) and defend(ing) proceedings about the child" (Baroness Hale in Re G [2006] UKHL 43 [2006] 2 FLR 629 @ §32);
and importantly:
v) "mak(ing) the child a member of that person's family" (Re G ibid.)
i) Whether the 'consent' forms purporting to vest 'parental' status in AB were completed and submitted to the licensed clinic in accordance with the requirements of the HFEA 2008, and supporting guidance. This gives rise to questions of:(a) The timing of completion, and submission to the 'person responsible' at the licensed clinic overseeing the assisted reproduction, of the relevant forms;(b) Whether the consent to parental status evidenced by those forms was truly 'informed' consent.ii) Whether at the time the treatment was given to AB and CD, the fertility clinic had complied with its licence requirements under the HFEA 1990. In particular:
(a) Had the clinic provided sufficient information to both parties to enable them to make informed decisions about parentage issues?(b) Had the clinic provided the parties with an opportunity to receive proper counselling about the step proposed?If not(c) Does the non-compliance with the licence requirements vitiate the consent of the parties?iii) Generally, I have been asked to consider what significance should be attached to the intention of the parties on the question of grant of parentage, if the legal, procedural and regulatory principles have not been strictly observed.
iv) If I determine that the requirements for establishing 'parentage' were not complied with in the instant case, whether I should reject the application for a declaration as to (non-)parentage, on public policy grounds (i.e. on the basis that the court should be slow to deprive AB of the status of 'parent' and potentially other 'parents' in her situation who have failed to acquire the relevant status by reason of what has been described as a 'technical' non-compliance with the statutory requirements).
"the relationship which develops through the child demanding and the parent providing for the child's needs, initially at the most basic level of feeding, nurturing, comforting and loving, and later at the more sophisticated level of guiding, socialising, educating and protecting."
Essential background facts
"Hi. We are a gay female couple and have lived together for the past 10 years. We are both aged 33. We are hoping to start a family and would like to (sic.) some information on how to start the process please. We look forward to hearing from you. Best wishes [A] and [C]".
"I am not married to [CD] but I acknowledge that she and I are being treated together and that I intend to have parental rights for any resulting child."
"(NOTE: the centre is not required to obtain a partner's acknowledgement in order to make the treatment lawful but it is advisable in the interests of the (sic.) establishing the legal parenthood of the child.)" (emphasis in the original)
Intentions of the parties as to AB's status as legal parent
The legal framework
i) The HFEA 2008 is to be construed "and applied in a way that creates as much certainty as possible" (Lord Hope discussing the HFEA 1990 in Re R (IVF: Paternity of child) [2005] UKHL 33 [2005] 2 FLR 843[2005] 2 FLR 843 at §17) ("Re R");ii) Overall, the "twin pillars" supporting Parliamentary regulation of this difficult field are intended to be: (a) the requirement for informed consent, capable of being withdrawn at any point prior to the transfer of the embryos to the woman receiving treatment; and (b) the focus on child welfare required by section 13(5) (see Evans v Amicus Healthcare Ltd and others [2004] EWCA (Civ) 727 [2004] 3 All ER 1025);
iii) In circumstances where life is being created, as where in my judgment consequent legal relationships are created, there is a need for mutual, bilateral, understanding and agreement: per Thorpe & Sedley LJJ in Evans (above) at §69:
"The need, as perceived by Parliament, is for bilateral consent to implantation, not simply to the taking and storage of genetic material, and that need cannot be met if one half of the consent is no longer effective. To dilute this requirement in the interests of proportionality, in order to meet Ms Evans's otherwise intractable biological handicap, by making the withdrawal of the man's consent relevant but inconclusive, would create new and even more intractable difficulties of arbitrariness and inconsistency. The sympathy and concern which anyone must feel for Ms Evans is not enough to render the legislative scheme of Sch 3 disproportionate".iv) When obtaining bilateral consent for treatment, (as again in my judgment for the creation of legal relationships), proper information needs to be provided to both parties making the commitment. It is just as important that information is given to, and consent obtained from, the person who is not directly receiving the treatment – i.e. in the position of AB in a lesbian relationship – as the person being treated:
"If an unmarried man is to become the legal father of a child of which he is not the biological father, that is a momentous matter for both father and child, and one which must be brought home to the prospective father as clearly as possible": Re R @ §35v) It is essential that the courts pay proper respect to the scheme laid down by Parliament, and supported by the Human Fertilisation and Embryology Authority, for the regulation of assisted reproduction. As Hale LJ (as she then was) said in Centre for Reproductive Medicine v U [2002] EWCA Civ 565 at §24
"The whole scheme of the 1990 Act lays great emphasis upon consent. The new scientific techniques which have developed since the birth of the first IVF baby in 1978 open up the possibility of creating human life in ways and circumstances quite different from anything experienced before then. These possibilities bring with them huge practical and ethical difficulties. These have to be balanced against the strength and depth of the feelings of people who desperately long for the children which only these techniques can give them, as well as the natural desire of clinicians and scientists to use their skills to fulfil those wishes. Parliament has devised a legislative scheme and a statutory authority for regulating assisted reproduction in a way which tries to strike a fair balance between the various interests and concerns. Centres, the HFEA and the courts have to respect that scheme, however great their sympathy for the plight of particular individuals caught up in it."vi) The very significant legal relationship of parenthood should not be based on a fiction (Re R §42), and reliable safeguards need to be in place to ensure that this relationship is created in an appropriate way: Re R §26.
vii) Whereas "[t]he perspective of the clients is…to be treated as part of the relevant evidence" (Re R @ §19 and §43) when the court is considering a question of fact which imports a subjective element (such as whether the parties were being "treated together" for the purposes of section 28(3) of the HFEA 1990), the 'perspective' or intention of the clients cannot otherwise trump the strict letter of the legislation.
"If no man is treated by virtue of section 35 as the father of the child and no woman is treated by virtue of section 42 as a parent of the child but –
...a) the embryo or the sperm and eggs were placed in W, or W was artificially inseminated, in the course of treatment services provided in the United Kingdom by a person to whom a licence applies,
...b) at the time when the embryo or the sperm and eggs were placed in W, or W was artificially inseminated, the agreed female parenthood conditions (as set out in section 44) were met in relation to another woman, in relation to treatment provided to W under that licence, and
...c) the other woman remained alive at that time,
then, subject to section 45(2) to (4), the other woman is to be treated as a parent of the child."
"(1) The agreed female parenthood conditions referred to in (1) section 43(b) are met in relation to another woman ("P") in relation to treatment provided to W under a licence if, but only if, –
...a) P has given the person responsible a notice stating that P consents to P being treated as a parent of any child resulting from treatment provided to W under the licence,
(b) W has given the person responsible a notice stating that W agrees to P being so treated,
...c) neither W nor P has, since giving notice under paragraph (a) or (b), given the person responsible notice of the withdrawal of P's or W's consent to P being so treated,
...d) W has not, since the giving of the notice under paragraph (b), given the person responsible –
(i) a further notice under that paragraph stating that W consents to a woman other than P being treated as a parent of any resulting child, or
(ii) a notice under section 37(1)(b) stating that W consents to a man being treated as the father of any resulting child, and
...e) W and P are not within prohibited degrees of relationship in relation to each other.
(2) A notice under subsection (1)(a), (b) or (c) must be in writing and must be signed by the person giving it."
i) Direction 2009/1 given under the HFEA 1990 (as amended) (signed on 20 February 2009 by the Chair of the Compliance Committee of the Human Fertilisation and Embryology Authority) ("Direction 2009/1"),ii) HFEA Consent Form Guidance (version 1: published in 2009) ('HFEA Consent Form Guidance');
iii) Letter from Professor Lisa Jardine CBE, Chair of the Human Fertilisation and Embryology Authority 'CH(09)01' headed 'Early introduction of legal parenthood provisions' (23 February 2009) ("CH(09)01");
iv) 'Legal Parenthood Guidance Note' published by the Human Fertilisation and Embryology Authority (February 2009), setting out the new 'Mandatory Requirements' ('Legal Parenthood Guidance Note')
v) 'Commencement Arrangements Guidance', issued by the Human Fertilisation and Embryology Authority in February 2009 ('Commencement Arrangements Guidance')
vi) Code of Practice (7th edition, 3rd revision: [2007] in force at the time, though subsequently revised) ('Code of Practice');
i) Direction 2009/1 provided that any consent of a person whose consent is required under section 44(1) must be recorded in the appropriate forms known as WP and PP;ii) The 'Commencement Arrangements Guidance', and the accompanying letter ('CH(09)01') contained the following clear message:
"[2] From 6 April 2009 partners of women to whom they are not married or with whom they are not in a civil partnership will only be recognised as the legal parent of any child born from treatment with donor sperm or embryos if written consent has been given before gamete or embryo transfer takes place." (emphasis in bold in the original).In the accompanying letter, it was clear that the 'written consent' had to be given on the forms WP and PP.iii) It was further provided in the 'Commencement Arrangements Guidance', explicitly that:
"[8] …The female partner of the woman receiving treatment must have consented (prior to embryo or gamete transfer) to being the second parent of any child born as a result of treatment in order to be legally recognised as such. The woman receiving treatment must also have consented to her being recognised as the second parent. If the consents are not in place before gamete or embryo transfer, the partner of the woman receiving treatment will not be legally recognised as the second parent of any child born as a result of the treatment" (emphasis by underlining added).iv) The publicity material generated by the Human Fertilisation and Embryology Authority ("Are you ready?" – see §30 above) contained the clear directive:
"From 6 April 2009, make sure consents to parenthood are in place before treatment with donor sperm or embryos – otherwise any child born will not have a second legal parent." (emphasis added)v) The HFEA Consent Form Guidance required licensed centres to obtain "written informed consent" (my emphasis) and to that end, directed that the person giving consent needed to be given:
- "Enough information to enable them to understand the nature, purpose and implications of his or her treatment or donation;
- A suitable opportunity to receive proper counselling about the implications of the steps which he or she are considering taking, and
- Information about the procedure for varying or withdrawing any consent given..."
vi) General Guidance in the Code of Practice indicates that for consent to be valid, it must be:
(a) Given voluntarily (without pressure or undue influence being exerted to accept treatment); and(b) …(c) Given only upon receipt of sufficient information to enable the person giving consent to understand the nature, purpose and implications of the treatment."vii) The Legal Parenthood Guidance Note contained 'General Procedures' for obtaining consent including a direction that the centre should ensure that any person giving consent declares that:
- "They were given enough information to understand the nature, purpose and implications of giving this consent;
- They were given a suitable opportunity to receive proper counselling about the implications of receiving treatment…
- The information they have given in writing is correct and complete."
viii) There was a specific 'Protocol for taking Patient Consent' published by The Z Fertility Clinic for its own use, which contains the following provisions:
(a) "It is a general legal and ethical principle that valid consent must be obtained before starting treatment…"(b) "It is our duty as medical professionals to ensure that the patient has been provided with the relevant information relating to the procedure they are to consent to, that they have been given sufficient time to digest this information and that they have had the opportunity to have their questions answered."(c) "If the patient is not offered as much information as they reasonably need to make their decision, and in a form they can understand, their consent may not be valid."(d) "Consent should always be taken before the day of treatment, in order to allow the patient time to consider the implications of giving such consent."
i) Section 12 of the HFEA 1990 sets out the general licence conditions, including the duty upon the clinic to maintain proper records;ii) Section 13 of the HFEA 1990 sets out the further conditions of every licensed activity under paragraph 1 of Schedule 2 of the Act;
iii) It is a condition of the licence that a clinic shall not treat a woman unless account has been taken of the welfare of any child who may be born as a result of the treatment (Section 13(5) of the HFEA 1990);
iv) It is a condition of the licence that a clinic shall not provide treatment with donated gametes unless the patient, and any man or woman who is to be treated together with her, have been given a suitable opportunity to receive proper counselling about the implications of her being provided with treatment services of that kind, and have been provided with such relevant information as is proper (Section 13(6) of the HFEA 1990);
v) It is a further condition of the licence that a clinic shall not provide treatment services to a woman after she has given the 'person responsible' the WP form (i.e. notice under section 44) unless (before or after the event) she and the intended second parent (who has given the 'person responsible' the PP form) have been given a suitable opportunity to receive proper counselling about the implications of the woman being provided with treatment services after the submission of those forms (intending to create the legal relationship of parent for P) "and have been provided with such relevant information as is proper" Section 13(6A) of the HFEA 1990, and Part 2 of Schedule 3ZA (ibid.)
vi) One of the key standards of the Code of Practice (S.7.5.3) obligates the licensed clinic to establish documented procedures for individuals considering or giving consent to treatment to ensure that:
(a) "reasonable steps are taken to verify the identity of any other person whose consent is required to be obtained,(b) Appropriate verbal and written information is provided in conjunction with obtaining consent and its provision is recorded."vii) The documentary procedures in (vi) above apply to the important separate 'standard' of the same Code (S.7.6.2) obligating the clinic
"to ensure that people seeking treatment … are given a suitable opportunity to participate in counselling about the implications of the proposed [treatment] before they consent to treatment."viii) Guidance offered in the same Code (G.5.4.5) provides that
"the centre should provide information to people seeking treatment with donated gametes or embryos about legal parentage and the collection and provision of information, specifically:(a) Who will be the child's legal parent(s) under the HFEA Act 1990…"In the 8th edition this has been sensibly expanded in Chapter 6 (dedicated to 'Legal Parenthood') to include the following (§6.1):"The centre should provide information to people seeking treatment about legal parenthood … The centre should explain that there is a difference in law between the legal status of 'father' or 'parent' and having 'parental responsibility' for a child. In any case in which people seeking treatment have doubts or concerns about legal parenthood or parental responsibility for a child born as a result of treatment services, the centre should advise them to seek their own legal advice."ix) That was supplemented by an obligation on the clinic to "record each offer of counselling and the person's decision to accept or reject such offers in the patient notes" (Guidance G.7.4.1)
x) The 'Legal Parenthood Guidance Note' provides, as guidance to the interpretation of Sections 43 and 44:
"Where a woman who is not married or in a civil partnership … is to be treated together with a female partner using donor sperm … the centre must advise those seeking treatment that the female partner can be the parent of any resulting child if the conditions outlined in paragraphs 43 and 44, Part 2, HFEA 2008 are met including that:(a) the female partner consents to being a legal parent of any child born as a result of her partner's treatment; and(b) the patient gives consent to her partner being a legal parent of any child born of her treatment; and …….(f) these consents are in writing and signed".xi) In interpreting Section 13(6A), the Legal Parenthood Guidance Note provides the following 'Mandatory Requirement':
"The law states that a woman who has consented to her partner being the legal parent of any child born as a result of her treatment can only be treated when she and her partner have:
- had a suitable opportunity to receive proper counselling about the implications of treatment in these circumstances, and
- been given proper information."
xii) The 'Commencement Arrangements Guidance' made clear that:
"[11] Clinics should note that from 6 April 2009 they will need to comply with licence conditions set out in section 14(3) of the 2008 Act, which amends section 13(6) and adds section 13(6A)-13(6E) to the 1990 Act. Schedule 4 to the 2008 Act, which introduces a new Schedule 3ZA to the 1990 Act, will also be brought into force on 6 April 2009 to set out the additional counselling requirements and to ensure that they also apply to the female second parent…."xiii) And later in the same 'Commencement Arrangements Guidance', and in my judgment crucially:
"[13] Where couples
- began treatment before 6 April 2009;
- are to undergo gamete or embryo transfer on or after this date; and
- were already provided with the relevant information and offered counselling before this date in line with the 1990 Act before it was amended by the 2008 Act
centres must repeat the offer (sic.) counselling and ensure they have provided information in line with these new requirements".xiv) Implications counselling for those receiving donated gametes is mandatory at the Z Fertility Clinic, and no treatment would be provided for those who chose not to attend; this is "because the consequences of receiving donated gametes … are immense for … recipients and for any children so conceived" (according to the counsellor at the Z Fertility Clinic): "It is critical that those seeking treatment with donated gametes such as [AB] and [CD] have thought through all the implications of treatment, both for their own sake and for that of any children they may have as a result."
Were the 'Consent to Legal Parent' forms properly completed & submitted?
i) CD had been provided with the link in a message (a copy of which I have seen) from her correspondent on the Fertility Forum blog, and she said that in "just three clicks" she had found the forms on the internet. She had printed it double-sided (as per the forms available in the clinic) as this was her practice at work.ii) It was not necessarily in CD's interests to explain the provenance of the forms in this way (given that she had sought to play down the parties' joint wish for AB to acquire legal parental status);
iii) It is inherently unlikely that the experienced specialist fertility nurse would have given the couple the forms on 4 May after one insemination procedure. This would have been to ignore the requirement for the forms to be completed before treatment. Further, the requirements were clear for the forms to be offered, and the counselling/information provided, on a day before the treatment not on the treatment day itself. The specialist nurse would surely have realised the confusion to the legal status that this would produce.
i) I accept CD's evidence that she probably did not collect any leaflets from the clinic on the visits in April 2009; she told me that she had picked up a number of leaflets on their first visit (July 2008), but none since; she told me that she said that she had not actually even seen the posters in the clinic, indeed what had been more eye-catching "was the collage of photos of the new born babies (born as a result of treatment at the clinic), especially the photos of twins";ii) CD only visited the clinic on three occasions between 29 January 2009 and 4 May, once for a prescription and twice for a scan. She said that she was not offered any information on those visits; she did not go through reception but went straight to the treatment rooms; I accept that;
iii) It is unrealistic to expect patients to have digested entirely the information from posters and leaflets in the clinic: as CD said with considerable understatement "I don't sit and read them, particularly when I have other things on my mind";
iv) AB had not been to the clinic between 29 January and 4 May 2009; there was therefore no opportunity for her to have received further information from the clinic prior to the first day of the third cycle of treatment;
v) AB was vague as to whether she had seen a leaflet reflecting the change in the law; importantly, she was specifically asked to look at the "Are you ready?" leaflet (prepared to inform patients about the change in the law) and did not recognise it;
vi) AB said that while the clinic staff had been good at answering their questions about the medical procedures (catheterisation etc), no one had taken time out with them to discuss the issues around legal parentage. Given the "momentous" issue at stake, it could not be said on the evidence that the significance of the proposed agreement had been "brought home" to AB "as clearly as possible", or indeed at all (see Re R and §48(4) above).
Clinic's compliance with licensed conditions
i) At §56(vi) to (ix) the relevant 'standards' expected of the clinics, and the guidance which it is expected that the clinics will follow in fulfilling its licensed conditions.ii) At §56(x), (xi), (xii) and (xiii) the specific guidance issued by the Human Fertilisation and Embryology Authority in relation to the taking of consents for legal parenthood.
"The 1990 and 2008 Acts require clinics to provide appropriate information, offer counselling and record consent to parenthood".
"I would not have felt able to take on board counselling and information on the same day as an insemination procedure. It is a highly stressful procedure … I would not have been in a proper emotional state to take on board information and implications counselling"
"If the circumstances which were taken into account when the couple were together change dramatically, it would better serve the purposes of the Act if the matter had to be reconsidered and fresh counselling offered before a further attempt at implantation is offered. That can only be beneficial to the children born as a result".
i) The clinic had not provided sufficient information to both parties to enable them to make informed decisions about parentage issues at the time of the treatment;ii) The clinic did not provide the parties with an opportunity to receive proper counselling about the step proposed prior to treatment.
iii) Inadequate records have been kept of the treatment and the delivery of the WP / PP forms.
Public policy
"Centres, the HFEA and the courts have to respect that scheme, however great their sympathy for the plight of particular individuals caught up in it."
Conclusion: summary
i) The parent consent forms (WP and PP) were neither signed nor submitted to the Z Fertility Clinic prior to treatment on 4 May 2009. They were probably obtained by CD from the internet; I accept CD's evidence that she filled in part of the form on the morning of 5 May 2009 and the balance after the second procedure on 5 May 2009; only then did she hand the forms to the nurse at the clinic.ii) To be effective to bestow parental status on AB, the forms would have had to be submitted before the treatment.
iii) If I were wrong about that (and I am conscious that I am trying to divine a forensic 'fact' from an imperfect set of recollections), I nonetheless am satisfied that the consent forms were completed and submitted in breach of the clinic's licence obligations in that
(a) there was no offer of counselling to the parties on this issue;(b) the 'consent' on the forms was not 'informed consent' as defined/discussed in the Guidance (set out above).
i) the issue of leave to make the contact application,and
ii) substantive orders where appropriate
can be considered without any further delay.
Post-script