The CMA Code of Ethics and the donation of fresh embryos for stem cell research

The promises of human embryonic stem cell (hESC) research and the needs of Canadian scientists to acquire fresh human embryos with which to participate in this important field of inquiry may result in the unintended compromise of the professional obligations of Canadian physicians.1 The strong preference for fresh as opposed to cryopreserved embryos follows the work of South Korean scientists who have derived multiple stem lines using fresh human embryos,2,3 with an efficacy rate much higher than rates reported in studies involving cryopreserved embryos. Canadian scientist Andras Nagy confirmed recently that he indeed used fresh embryos provided by a Canadian physician for his successful stem cell derivation.4 However, since the advent of embryo cryopreservation in the late 1980s,5 physicians have generally not offered their patients the choice to donate fresh embryos to research, since this choice could decrease their patients' chances of pregnancy or increase their risk of harm because of the additional cycles of menotropin drugs and oocyte retrieval surgery that may be required if the current treatment cycle does not result in a child).6 Canada's Assisted Human Reproduction (AHR) Act7 and the Canadian Institutes of Health Research (CIHR) Human Pluripotent Stem Cell Research Guidelines8 allow physicians to approach patients with the option of donating cryopreserved embryos no longer required for reproductive purposes. Although these documents prohibit the creation of embryos specifically for research purposes,7,8 donation of fresh embryos created for reproductive purposes to research is not considered, nor is this possibility addressed in any Canadian professional practice guideline. A legislative and professional policy grey zone thus exists, which may lead to confusion about the professional obligations of physicians approaching their patients to donate fresh embryos. Physicians may be in a conflict of interest when approaching patients to donate fresh embryos because of subtle imperatives to aid hESC research. These imperatives may be collegial, academic, institutional, financial or altruistic (to help Canadians with conditions that may in future be ameliorated by hESC research). Potential academic and financial conflicts of interest in hESC research are recognized in the AHR Act7 and CIHR's stem cell research guidelines,6 which prohibit physicians who offer the choice of cryopreserved embryo donation from being part of an hESC research team or includ