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

T he 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 un-intended 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 cryo-preserved 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 cryo-preservation 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) Act 7 and the Canadian Institutes of Health Research (CIHR) Human Pluripotent Stem Cell Research Guidelines 8 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. In many countries, such as Great Britain 9 and the United States (except in federally funded laboratories), 10 the creation of human embryos specifically for research purposes is permitted; thus, a source of fresh embryos exists for stem cell scientists in those countries. In Canada, however, fresh embryos must come from patients engaged in in-vitro fertilization (IVF). The CMA Code of Ethics instructs physicians to " consider first the well-being of the patient " and " take all reasonable steps to prevent harm to patients " as fundamental responsibilities. 1 These directions imply that physicians participating in IVF are obligated to maximize their patients' chance of achieving pregnancy and minimize their patients' risk of …