15 May 2017
ByAppeared in BioNews 900
For some years now, counsellors and psychologists have been spreading the message that it's in the best interest of children to know if they are donor conceived. However, my recent literature review has shown that there is in fact very little empirical evidence to support this position (Pennings, 2017).
The review looked at three lines of evidence: information on children who were not told, a comparison between children who were or were not told, and information on children who had been told at varying ages.
The first line of information, mainly based on research from the first part of this century, showed that children who do not know about their donor conception function normally and do not show signs of psychological problems.
The second line of information, based on the five studies that compared children who had been told with those who had not, found no significant differences in child well-being (Ilioi et al, 2016).
The final line made a distinction on the time of telling: those who were informed early compared to those informed late. The general conclusion from the studies on offspring who were told in their preschool years is that they are fine. In contrast, studies on some persons who were told late state they developed severe psychological problems. The evidence on late disclosure should be interpreted with caution, however, since these studies are all based on biased samples; most respondents are recruited from donor offspring support groups and/or are self-selected (Turner & Coyle, 2000). Moreover, the few studies that specifically compared children who had been told early with those who had been told late could find no, or only small differences. So the frequently stated claim that it is better to tell early is not corroborated by empirical evidence.
The argument by counsellors can be summarised as follows: neutral or positive consequences when told early, and possible psychological harm when told late. The balance then tips towards early disclosure. However, this conclusion is not correct for at least two reasons. First, non-disclosure is not included in the comparison but may still be the most preferable option. The idea that early disclosure is completely unproblematic is also not true. In one study, 37 percent of the offspring who were told during childhood felt confused and 27 percent were shocked (Jadva et al, 2009). That was a lower percentage than in those who were informed later but clearly worse than in those who are not told at all. Second, given the biased samples in the group told in adulthood, we actually have no clue about the percentage of offspring who are told late and do not have an issue with it.
It is a pity that researchers are missing the opportunity of looking more closely at some of the general theoretical rules underlying much of their attitude. One such rule is that secrets are bad for family functioning and for the child. The fact that the studies performed in the donor conception context have not found evidence of such harm has not made anyone question this assumption. A search for explanations of these discrepancies might actually improve the theory and move the field forward.
A question that presents itself after this review is how did counsellors and psychologists come to hold these beliefs? An indication can be found in the fact that a number of them present recommendations that deviate from their own findings. Some authors of the studies explicitly state that no differences were found, and yet conclude that it is better for children to be told. It seems rather obvious that such a conclusion cannot follow from that finding alone. One possible explanation is that the conclusion is not based on scientific evidence but on implicit moral premises such as ‘children should be told the truth’ or ‘children have a right to know their genetic origin’. There is nothing wrong with holding these beliefs as such, but they should not be packaged as scientific facts about the psychological well-being of offspring.
When these beliefs are expressed and pushed upon people during counselling, this is an outright violation of the non-directiveness rule that stipulates that the moral values and views of the patients (parents and would-be parents) must be respected. It seems that evidence-based counselling is either no longer an ideal or that we still have a long way to go.