FAMILY DIVISION
Strand, London, WC2A 2LL |
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B e f o r e :
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ELIZABETH WARREN |
Claimant |
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- and - |
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CARE FERTILITY (NORTHAMPTON) LIMITED HUMAN FERTILISATION AND EMBRYOLOGY AUTHORITY |
Interested Parties |
____________________
Miss Jane Collier Counsel for the Interested Party
Hearing dates: 31 January 2014
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Crown Copyright ©
Summary of Judgment
Mrs Warren seeks a Declaration that it is lawful for the sperm of her husband Warren Brewer who died on 7 February 2012 to be stored beyond 18 April 2015 and for a period of up to 55 years until 18 April 2060 so that it can be used by her for the purposes of conceiving a child or children.
I have granted that Declaration.
Sadly Mr Brewer was diagnosed with a brain tumour in about April 2005. After operative treatment he required radiotherapy. A well-known likely consequence of such treatment would be to render him infertile.
He wished to keep open his option open to become a father of his own child. Thus he was referred to the Clinic for collection and storage of sperm before he received radiotherapy. This was undertaken in April 2005.
Mrs Warren met Mr Brewer in 2004. Over the years the relationship developed and deepened, they became engaged to be married in October 2010 and were married in December 2011 in the Hospice shortly before his death.
They had spoken of marriage, a life long commitment, and the prospect of having children. It was their mutual wish to become parents. In 2008 Mr Brewer formally named Mrs Warren as "his partner" to enable her to use his sperm after death, and for him to be named on the birth certificate of any child created with his sperm. He subsequently told Mrs Warren that he had done this, and as he wanted to enable her to have his children if she wished. Thereafter it was an accepted matter as between them.
I have heard Mrs Warren in evidence and read statements from his parents and consultant oncologist who make it clear what he wished and intended.
I am satisfied that after 2008 Mr Brewer never changed his mind and wanted Mrs Warren to have the opportunity to have his child, or children, after his death.
The Human Embryo and Fertilisation Act 1990 as amended provides for a deceased's sperm to be used by "his named partner" to create an embryo. The initial maximum storage period was established as 10 years. The 2009 Regulations enable the extension of that period, subject to certain requirements under Regulation 4 or 7.
Notwithstanding his wishes and intentions and various written consents Mr Brewer did not provide written consent as required by the Regulations, nor did he provide the requisite medical certificate. This was through no fault of his own. The clinic upon which the obligation fell failed to give him relevant information as to the requirements of the Regulations and failed to obtain the requisite long-term consent from him or the appropriate medical opinion.
I am satisfied had he known what was required he would have done that which was necessary. As it was he was not given the information, not advised and thus he did not fulfil the requirement of the Regulations. However, when asked he signed every consent form sent to him, particularly the consent forms for storage, but they were limited in time by the clinic and associated with their own requirements for payment of fees.
I have been critical of the clinic in that respect. After The Human Embryo and Fertilisation Authority learnt of this case it issued further guidance on 31 May 2012 to storage centres. The Authority recognised the clinic and other storage centres, being anxious to secure their fees for storage for a limited period had not or may not have obtained a longer term consent from the sperm provider. The Authority was anxious that the circumstances of this case should not arise in the future.
The Human Rights Act 1998 has come to the aid of Mrs Warren. Specifically Section 3 and Article 8.
Section 3(1) : "So far as it is possible to do so primary and subordinate legislation must be read and given effect in a way which is compatible with the Convention (Human Rights) rights.
Article 8: "Everyone has a right to respect for his private and family life. The state shall not interfere with the exercise of this right except such as in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic wellbeing of the country, for the prevention of disorder of crime, for the protection of health or morals or for the protection of the rights and freedoms of others".
I have held that Mrs Warren has a right under Article 8 in that she has the right to decide to become a parent by her deceased husband, for which he had made provision and which would accord with his wishes and intentions.
I have considered the exceptions set out in Article 8. None of them apply to this case. In my view the state should not interfere with Mrs Warren's right under Article 8, and following English case law (Ghaidon v- Godin-Mendoza 2004 2AC 557). I have interpreted the statutory legislation with "a broad approach concentrating in a purposive way on the importance of the fundamental right involved" per Lord Steyn.
For these reasons I have made the Declaration.
The Human Fertilisation and Embryology Authority, while resisting Mrs Warren's application, have expressed its sympathy for her. May I also add my great sympathy for her. She fell in love with a man, cared for him and loved him. He wanted her to have the opportunity to have his children if she wanted. She has suffered an enormous loss. I know she is supported by her parents-in-law. I wish her and Mr Brewer's parents well, and ultimately whatever her decision may be I wish her and the family much happiness after such a difficult and sad time.
For the full Judgment refer to Bailii
MRS JUSTICE HOGG :
The Factual Background
"had thought about it and was happy with the idea of his children never meeting him, and he was happy that if having his children was something I wanted"
"Normally the law allows you to store your sperm for 10 years. In certain circumstances the storage period can be extended. Your health care practitioner will be able to explain whether you can do this, and for how long you may be able to store your sperm."
"I consent to the storage of my sperm (please tick and complete one of the following options):
i) for 10 years;
ii) for a period other than 10 years please state the storage period of years."
It was here that the clinic inserted 4 or 6 and it was this option he ticked.
About this form.
Who should fill in this form?
Fill in this form if you have eggs or sperm in storage and wish to extend your current storage period.
You can consent to the storage of your eggs or sperm for up to 55 years. If you wish to store your eggs or sperm for more than 10 years either yourself, your partner, or someone to whom your eggs or sperm have been allocated to must meet medical criteria.
A medical practitioner must certify that the medical criteria are met when the storage period extends beyond the initial 10 years and subsequently every 10 years for the duration of storage. The medical practitioner's statement(s) should be attached to this form.
How do I know if I am eligible?
For eggs or sperm to be stored for longer than 10 years:
the eggs or sperm provider or
the person to whom the eggs or sperm have been allocated to must have or be likely to develop premature infertility.
Why do I have to fill in this form?
Under the Human Fertilisation and Embryology Act 1990 (as amended) you need to give your consent in writing if you want your eggs or sperm to be stored.
You can make changes to or withdraw your consent to storage at any time. If you would like to change or withdraw your consent you should ask your clinic for new forms.
Before filling in this form your clinic should make sure you receive all the relevant information you need about extending the storage period of your eggs or sperm. You should also have been given an opportunity to receive counselling about this.
For how long do you consent to your eggs or sperm being stored?
You can consent to the storage of your eggs or sperm for up to 55 years. Your eggs or sperm may only be stored for more than 10 years if you or someone to whom your eggs or sperm have been allocated (including your partner) is prematurely infertile or is likely to become prematurely infertile. A medical practitioner must certify in writing that the medical criteria have been met. Where the criteria have been met the storage period will be extended from the date the criteria are met. The storage period can then be extended by further 10 year periods if it is shown at any time within each extended storage period that the criteria continues to be met. There is a maximum period of 55 years. The medical practitioner's statement(s) should be attached.
I declare that
- before I completed this form I was given information about the different options set out in this form, and I was given an opportunity to receive counselling
- the implications of giving my consent, and the consequences of withdrawing this consent have been fully explained to me, and
- I understand that I can make changes to or withdraw my consent to storage at any time until the eggs or sperm (or embryos created from them) have been used or allowed to perish.
I declare that the information I have given on this form is correct and completed.
I understand that information on this form may be processed and shared for and in connection with the conduct of licensable activities under the Human Fertilisation and Embryology Act 1990 (as amended) in accordance with the provisions of that Act.
Who should fill in this form?
Fill in this form if you are a man, and your partner is receiving treatment using embryos created in vitro with your sperm.
Why do I have to fill in this form?
Under the Human Fertilisation and Embryology Act 1990 (as amended) you need to give your consent in writing if you want your sperm or embryos created in vitro with your sperm to be used or stored. You will need to decide what will happen if you die or lose the ability to decide for yourself (become mentally incapacitated).
You can make changes to or withdraw your consent at any point until the time of embryo transfer or the use of embryos in research in training. If you would like to change or withdraw your consent you should ask your clinic for new forms.
Before you fill in this form your clinic should make sure that you receive all the relevant information you need about your and your partner's treatment. You should also have been offered counselling about the implications of having treatment.
For how long do you consent to the embryo (created in vitro with your sperm) being stored?
You can consent to the storage of your embryos for up to 55 years. Your embryos may only be stored for more than 10 years if you or someone to whom your embryos have been allocated to (including your partner) is prematurely infertile or is likely to become prematurely infertile. A medical practitioner must certify that the medical criteria has been met.
Where the criteria have been met the storage period will be extended by 10 years from the date the criteria are met. The storage period will be extended by further 10 year periods if it is shown at any time within each extended storage period that the criteria continues to be met. There is a maximum storage period of 55 years. The medical practitioner's statement(s) should be attached to this form.
"The law is clear gametes and embryos should only be stored when there is effective consent. The HFEA has no powers to authorise extended storage when the consent provisions laid out in the 1990 Act have not been complied with."
"HFEA Directions specify that consent must be provided on a designated form to ensure that consent is properly taken and understood. The HFEA form provides an opportunity for a gamete provider to document their consent in relation to possible scenarios, including posthumous parenthood. In the absence of information a gamete provider's consent may not be clear which could impact on the future use of the gametes:"
"In our experience these situations are more likely to arise where patients are routinely asked to restrict their storage to a period of only two or three years. We know that centres ask patients to do this either to encourage them to maintain regular contact to avoid gametes and embryos being stored longer than the patient need them to be or, on occasion, to ensure that payment for ongoing storage is required. If your centre asks patients to restrict their storage to a period less than the maximum permitted by the law there is a higher risk that in the event of a patient dying the gametes or embryos cannot continue to be stored causing significant distress. We strongly encourage you to consider the impact of this practice particularly in circumstances where individuals have life-threatening illness."
"for their foresight in obtaining sperm banking prior to Mr Brewer's oncology treatment. The risk of male sub and infertility caused by craniospinal radiotherapy and cytotoxic chemotherapy is widely understood. Almost certainly the exit dose from the interior border of a craniospinal field would be associated with some form of azospermia. The concern is that surviving sperm could well be affected by low dose (mutrogenic) effects of radiotherapy, i.e even as low as 1.2 Gy cumulative dose. In addition whole brain radiotherapy is associated with endocrine dysfunction".
"When I first met Warren (in 2010) I was aware of his intention to start a family and I strongly encouraged them not to try to conceive during the treatment with Etoposide because of the effect on total spermatogenesis; there is a very real risk of mutogenesis. We hoped that Warren's condition would have improved to such an extent that he would have been able to use his sperm for IVF treatment."
"I know that it was the prospective risk of both Warren and Beth together that his sperm should be preserved and that every attempt should be made for Beth to conceive after Warren's death, using his sperm. I am strongly and unequivocally in support of this "
Conclusions
1. Mrs Warren and Mr Brewer having met and developed a strong relationship were a devoted couple, and wanted to be life long companions and have and raise their own children;2. Mr Brewer was made aware that if he were to receive radiotherapy there was a likelihood of him becoming infertile;
3. Mr Brewer, even before the relationship developed sufficiently to declare Mrs Warren his 'named partner', wanted to preserve his sperm to enable him to become a father in due course. With that in mind sperm was stored in April 2005;
4. By 2008 the relationship had developed and deepened and there were discussions between the couple that in the event of his death Mr Brewer wanted Mrs Warren to have the opportunity to have his child, or children, if she so wished. There was no time limit to this in his mind;
5. Over time this wish was conveyed to his parents and to Dr Spooner;
6. From the documentation provided by CARE there is no evidence to indicate Mr Brewer was given any information as to the law and regulatory requirements in respect of the length of time sperm could be stored either in April 2005 or following 1 October 2009 upon the 2009 Regulations coming into force;
7. The letters from CARE refers to "a further 2 years", and largely relate to provision of payment of their fees. The letters sent to Mr Brewer do not clarify his rights or options as required by the Code of Practice, and referred to in the HFEA LGS forms;
8. I accept Mrs Warren's evidence that on such forms as she saw which had been sent to Mr Brewer by the clinic the number of years had been inserted by the clinic prior to Mr Brewer signing the forms;
9. CARE failed to provide relevant information to Mr Brewer as to the options available to him and the necessary requirements of him, and failed to give him any option other than to consent for a specified number of years less than 10 years.
It may be that other clinics have fallen into the same trap, and the mischief which the HFEA sought to avoid in its Guidance of 31 May 2012;
10. As a consequence Mr Brewer was not provided with an explanation and information as to his rights and options, or regulatory requirements when he came to sign the various consent forms, particularly those post 1 October 2009;
11. I am satisfied from the written evidence produced on behalf of Mrs Warren and her own oral evidence that had he have known fully of his options and the requirements Mr Brewer would have consented to his sperm being stored for a period in excess of 10 years, up to a maximum of 55 years, and would have obtained the necessary medical opinion required under the 2009 Regulations. I am satisfied it was his wish that Mrs Warren should have the opportunity to have the use of his sperm after his death in order to have his child or children if she so wanted, and he would have done everything required of him to achieve this.
The Legal Framework
"to provide advice and information for persons to whom licences apply, or who are receiving treatment services or providing gametes as embryos for use, and 8(1)(cb) to promote compliance with:"
(i) requirements imposed by or under this Act, and
(ii) the code of practice under Section 25 of this Act, and
(d) to perform such other functions as may be specified in regulations.
"A woman shall not be provided with treatment services unless account has been taken of the welfare of any child which may be born as a result of the treatment, including the need of that child for supportive parenting, and of any other child who may be affected by the birth."
(a) such shorter period, or
(b) in such circumstances as may be specified in the regulations such longer period.
(1) Giving guidance about the proper conduct of activities carried on in pursuance of a licence under the Act and the proper discharge of the functions of the person responsible and other persons to whom the licence applies.
(2) The guidance given by the code shall include guidance for those providing treatment services about the account to be taken of the welfare of children who may be born as a result of treatment services;
(2A) The code shall also give guidance about:
(a) the giving of a suitable opportunity to receive proper counselling, and
(b) the provision of such relevant information as is proper.
(6) A failure on the part of any person to observe any provision of the code shall not of itself render the person liable to any proceedings, but
(a) The Authority shall in considering whether there has been any failure to comply with any condition of a licence and conditions requiring anything to be "proper" or suitable take account of any relevant provision of the code, and
(b) The Authority may where it has power to do so whether or not to vary or revoke a licence takes into account any observations of a failure to observe the provisions of the code.
(5A) If
(a) a child has been carried by a woman is the result of the placing in her of an embryo or of sperm and eggs or her artificial insemination,
(b) the creation of the embryo carried by her was brought about by using the sperm of a man after his death, or the creation of the embryo was brought about using the sperm of a man before his death but the embryo was placed in the woman after his death,
(c) the woman was a party to a marriage with the man immediately before his death,
(d) the man consented in writing (and did not withdraw his consent)
(i) to the use of his sperm after his death which brought about the creation of the embryo carried by the woman or to the placing in the woman after his death of the embryo which was brought about by using his sperm before death, and
(ii) to being treated for the purpose in subsection (5l) as the father of any resulting child;
(e) the woman has elected in writing not later than the end of the period of 42 days from the day the child was born for the man to be treated for the purpose mentioned in (5l) as the father of the child, and
(f) no one else it to be treated as the father of the child by virtue of subsection (2) or (3) then the man shall be treated for the purpose mentioned in subsection (5l) as the father of the child.
(5B) to ..(5H) not applicable.
Subsection (5I) provides the purpose referred to in subsection 5A . is the purpose of enabling the man's particulars to be entered in the particulars of the child's father in a register of live-births or still-births kept under the Births and Deaths Registration Act 1953, or Section 45 of the Act makes provision for the Secretary of State to make regulations under the Act.
A consent to the storage of any gametes, any embryo or any human admixed embryo must:
(a) specify the maximum period of storage (if less than the statutory storage period);
(b) except in a case falling within paragraph (c) state what is to be done with the gametes, embryo or human admixed embryo if the person who gave the consent dies or is unable because the person lacks capacity to do so to vary the terms of the consent or to withdraw it, and
(c) not applicable, and may (in any case) specify conditions subject to which the gametes, embryo or human admixed embryo may remain in storage.
(2A) A consent to the use of a person's human cells to bring about the creation in vitro of an embryo or human admixed embryo is to be taken unless otherwise stated to include consent to the use of the cells after the persons death.
Under paragraph 3:
(1) Before a person gives consent under this Schedule:
(a) he must be given a suitable opportunity to receive proper counselling about the implications of taking the proposed steps, and
(b) he must be provided with such relevant information as is proper.
(2) Before a person gives consent under this Schedule he must be informed of the effect of paragraph 4.
Paragraph 4
(1) the terms of any consent under this Schedule may from time to time be varied and the consent may be withdrawn by notice given to the person keeping the gametes, human cells, embryo or human admixed embryo to which the consent is relevant.
Paragraph 5:
(1) A person's gametes must not be used for the purposes of treatment service unless there is an effective consent by that person to their being so used and they are used in accordance with the terms of the consent.
Paragraph 8:
(1) A person's gametes must not be kept in storage unless there is an effective consent by that person to their storage and they are stored in accordance with the consent.
(1) For the purpose of this regulation "relevant period" means ten years from the date that:
(a) the gamete in question was first placed in storage; or
(b) if later, the most recent previous written opinion was given under sub-paragraph (3)(b).
(2) In the circumstances specified in paragraph 3 the maximum storage period for a gamete shall subject to paragraph 4 be the period beginning with the date on which the gamete was first placed into storage and ending ten years after the date of the most recent written opinion given under subparagraph (3)(b).
(3) The circumstances referred to in paragraph (2) are that:
(a) the person who provided the gamete in question has consented in writing to the gamete being stored for a period in excess of ten years for the provision of treatment services, and
(b) on any day within the relevant period a registered medical practitioner has given a written opinion that the person who provided the gamete or where they are not that person, the person to be treated is prematurely infertile or is likely to become prematurely infertile.
(4) Where the maximum storage period calculated in accordance with paragraph (2) would be greater than fifty five years, the maximum storage period for the purpose of that paragraph shall be fifty five years.
(2) Where paragraph 1 applies the maximum storage period for any gamete shall be
(a) subject to paragraph 5, where the circumstances in paragraph (3) are met the period beginning with the date on which the gamete was first placed in storage and ending ten years after the date of the most recent written opinion given under sub-paragraph (3)(b) or
(b) ten years where those circumstances are not met.
(3) The circumstances referred to in sub-paragraph (2)(a) are that
(a) the person who provided the gamete in question has consented in writing, whether before or after coming into force of these Regulations, to the gamete being stored for a period in excess of ten years for the provision of treatment services; and
(b) on any day within the relevant period but after the coming into force of these Regulations, a registered medical practitioner has given a written opinion that the gamete provider is prematurely infertile or is likely to become prematurely infertile.
(4) For the purposes of paragraph (3)(b) the relevant period means ten years from the date that
(a) the gamete in question was first placed in storage; or
(b) if later the most recent previous written opinion was given under sub-paragraph (3)(b).
(5) Where the maximum storage period calculated in accordance with the sub-paragraph (2)(a) would be greater than fifty five years, the maximum storage period for the purpose of that paragraph shall be fifty five years.
Summary
1. As long ago as 1990 Parliament accepted that gametes and embryos could legally and properly be collected and stored to be used at a later date to create a child.
2. That such activities needed to be prescribed and regulated by statute and regulations. Safeguards and prohibitions were required to ensure that proper arrangements were in place and managed and such have been in place under the Act and relevant Regulations.
3. Since 1990 the Act and Regulations have been amended, and in particular S.28 was amended by the H F & E (Deceased Fathers) Act 2003. By those amendments it was specifically envisaged, and provided for, that the sperm of a man collected before his death could be used to create an embryo, and that any child born of that creation could be recognised and registered as the child of the deceased. The importance of the amendment is that Parliament accepted that medical science had progressed, and thought fit to enable with safeguards to make it lawful to create an embryo using the sperm of a deceased man.
4. There are basic issues about which the parties before me agree:
(i) gametes cannot be stored without consent of the provider;
(ii) consent for storage of gametes must be given in writing and signed by the gamete provider. There is no prescribed form;
(iii) there is a statutory storage period (ten years) but a gamete provider must specify the maximum period of storage if less than 10 years;
(iv) the consent must also include what is to happen to the gametes in the event of his death, or mental incapacity, whether they should perish at the end of the stated period or remain in storage;
(v) the 2009 Regulations provided circumstances in which gametes could be stored beyond 10 years from first storage with a maximum of fifty five years.
(vi) gametes may only be used for treatment purposes but only if the provider gives consent, in which case he may identify a particular person to receive the treatment.
(vii) before a person gives consent he must be given the opportunity to receive proper counselling, and be provided with such relevant information as is proper. That is set out in the statute, and provision made for guidance on this subject to licence holders in the Code of Practice.
Discussion
The Human Rights Act 1998
Section 3 of the HRA provides:
(1) So far as it is possible to do so primary legislation and subordinate legislation must be read and given effect in a way which is compatible with the Convention rights.
1. Everyone has the right to respect for his private and family life;
2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic wellbeing of the country, for the prevention of disorder of crime, for the protection of health or morals or for the protection of the rights and freedom of others.
"Section 3 is a key section in the Human Rights Act 1998. It is one of the primary means by which Convention rights are brought into the law of this country. Parliament has decreed that all legislation existing and future shall be interpreted in a particular way. All legislation must be read and given effect to in a way which is compatible with the Convention rights "so far as it is possible to do so". This is the intention of Parliament, expressed in Section 3, and the courts must give effect to this intention."
at paragraph 30:
" .. in the ordinary course the interpretation of legislation involves seeking the intention reasonably to be attributed to Parliament in using the language in question. Section 3 may require the court to depart from this legislative intention that is, depart from the intention of the Parliament which enacted the legislation. The question of difficulty is how far, and in what circumstances. Section 3 requires a court to depart from the intention of the enacting Parliament. The answer to this question depends upon the intention reasonably to be attributed to Parliament in enacting Section 5."
paragraph 32:
" Section 3 enables language to be interpreted restrictively or expansively. But Section 3 goes further than this. It is also apt to require a court to read in words which change the meaning of the enacted legislation so as to make it convention compliant. In other words the intention of Parliament in enacting Section 3 was that to an extent bounded only by what is "possible" a court can modify the meaning and hence the effect of primary and secondary legislation."
"The second factor may be an excessive concentration on linguistic features of the particular statute. Nowhere in our legal system is a literalistic approach more inappropriate than when considering whether a breach of a Convention right may be removed by interpretation under Section 3. Section 3 requires a broad approach concentrating, amongst other things in a purposive way on the importance of the fundamental right involved."
at paragraph 46:
" . it was envisaged that the duty of the Court would be to strive to find (if possible) a meaning which would best accord with Convention rights. This is the remedial scheme which Parliament adopted."
"It is not disputed between the parties that Article 8 is applicable and that the case concerns the applicant's right to respect for her private life. The Grand Chamber agrees with the Chamber that "private life" which is a broad term encompassing, inter alia, aspects of an individual's physical and social identity including the right to personal autonomy, personal development and to establish and develop relationships with other human beings and the outside world, incorporates the right to respect for both the decisions to become and not to become a parent."
paragraph 72:
"It must be noted however that the applicant does not complain that she is in any way prevented from becoming a mother in a social, legal or even physical sense since there is no rule of domestic law or practice to stop her from adopting a child or even giving birth to a child originally created in vitro from donated gametes. The applicant's complaint is more precisely that the consent provisions of the 1990 Act prevent her from using the embryos she and J created together, thus given her particular circumstances from ever having a child to whom she is genetically related. The Grand Chamber considers that this more limited issue, concerning the right to respect for the decision to become a parent in the genetic sense also falls within the scope of Article 8.
73. The dilemma central to the present case is that it involves a conflict between the Article 8 rights of two private individuals if the applicant is permitted to use the embryos J will be forced to become a father whereas if his withdrawal of consent is upheld the applicant will be denied the opportunity of becoming a genetic parent .
74. In addition the Grand Chamber, like the Chamber, accepts the Governments submission that the case does not invoke simply a conflict between individuals; the legislation in question also served a number of wider public interests in upholding the principle of the primacy of consent and promoting legal clarity and certainty."
At paragraph 90:
"The Grand Chamber does not consider that the applicants right to respect for the decision to become a parent in the genetic sense should be accorded greater weight than J's right to respect of his decision not to have a genetically-related child with her."
Discussion