PETITION BY SB AGAINST THE UNIVERSITY OF ABERDEEN AND OTHERS [2020] ScotCS CSIH_62 (25 September 2020)


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Scottish Court of Session Decisions


You are here: BAILII >> Databases >> Scottish Court of Session Decisions >> PETITION BY SB AGAINST THE UNIVERSITY OF ABERDEEN AND OTHERS [2020] ScotCS CSIH_62 (25 September 2020)
URL: http://www.bailii.org/scot/cases/ScotCS/2020/2020_CSIH_62.html
Cite as: 2020 SLT 1124, [2020] CSIH 62, 2020 GWD 31-400, [2020] ScotCS CSIH_62

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SECOND DIVISION, INNER HOUSE, COURT OF SESSION
Lord Justice Clerk
Lord Glennie
Lord Woolman
[2020] CSIH 62
P273/20
OPINION OF THE COURT
delivered by LADY DORRIAN, the LORD JUSTICE CLERK
in the Petition
by
SB
Petitioner:
against
(1) THE UNIVERSITY OF ABERDEEN, (2) NHS GRAMPIAN, (3) THE HUMAN
FERTILISATION AND EMBRYOLOGY AUTHORITY, (4) THE LORD ADVOCATE, AND
(5) THE ADVOCATE GENERAL FOR SCOTLAND
________________________
Respondents
Petitioner: M Ross QC; Morton Fraser LLP
Respondents: C O’Neill (sol adv); Brodies LLP
25 September 2020
Introduction
[1]       The petitioner wishes to undergo IVF (in vitro fertilisation) treatment using the
sperm stored for her late husband at a fertility clinic at the commencement of a serious
illness. The day before his death, by which point he was unconscious, it was discovered that
the forms he had previously completed provided consent only to the use of his sperm in IUI
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2
(intra uterine insemination) and other similar treatments, but not IVF which involves the
creation and storage of embryos. The petitioner, following expert advice, wishes to pursue
IVF as being the most likely method of success; and for this purpose she seeks to have the
period for storage of the deceased’s gametes extended beyond the normal statutory period
of ten years. The deceased’s will contained a clause relating to the storage and use of his
sperm. The question for the court is whether in the absence of the customary consent forms
the will, either alone or in combination with the forms which the deceased had signed,
constitutes consent for the use of his sperm for IVF, as required in terms of schedule 3 of the
Human Fertilisation and Embryology Act 1990?
The statutory provisions
[2]       A detailed statutory framework, principally contained in the 1990 Act and
regulations made thereunder, regulates human fertilisation and embryology. Specific
provision is made in relation to consent in the use of such material in schedule 3. A
distinction is made between consent which involves the creation of an embryo and that
which does not. Paragraph 6 provides in particular that a person’s cells or gametes cannot
be used for the creation of any embryo in vitro unless there is effective consent by that
person, and in terms of paragraph 6(4) the consent must be in addition to that provided for
the purposes of paragraph 5.
Schedule 3
[3]       The relevant provisions of schedule 3, for current purposes are as follows:
Paragraph 1(1):
“A consent under this Schedule, and any notice under paragraph 4 varying or
withdrawing a consent under this Schedule, must be in writing and, subject to sub -
paragraph (2), must be signed by the person giving it.”
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3
Paragraph 2(1):
“A consent to the use of any embryo must specify one or more of the following
purposes
(a) use in providing treatment services to the person giving consent, or that person
and another specified person together,
(b) use in providing treatment services to persons not including the person giving
consent,
[…]”
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 implicat ions of taking the
proposed steps, and (b) he must be provided with such relevant information as is
proper.”
Paragraph 5:
“(1) A person's gametes must not be used for the purpose of treatment services [
... ] 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.
(2) A person's gametes must not be received for use for those purposes unless
there is an effective consent by that person to their being so used.
(3) This paragraph does not apply to the use of a person's gametes for the
purposes of that person, or that person and another together, receiving treatment
services.”
Paragraph 6:
“(1) A person’s gametes or human cells must not be used to bring about the
creation of any embryo in vitro unless there is an effective consent by that person to
any embryo, the creation of which may be brought about with the use of those
gametes or human cells, being used for one or more of the purposes mentioned in
paragraph 2(1)(a), (b) and (c) above.
(2) An embryo the creation of which was brought about in vitro must not be
received by any person unless there is an effective consent by each relevant person in
relation to the embryo to the use for one or more of the purposes mentioned in
paragraph 2(1)(a), (b), (ba) and (c) above of the embryo.
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4
(3) An embryo the creation of which was brought about in vitro must not be
used for any purpose unless there is an effective consent by each relevant person in
relation to the embryo to the use for the purpose of the embryo and the embryo is
used in accordance with those consents.
(4) Any consent required by this paragraph is in addition to any consent that
may be required by paragraph 5 above.
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.
(2) An embryo the creation of which was brought about in vitro must not be kept
in storage unless there is an effective consent, by each relevant person in relation to
the embryo, to the storage of the embryo and the embryo is stored in accordance
with those consents
Background
[4]       The petitioner is the widow of the late JB, who died in 2019. At the onset of his
illness, JB’s doctor advised him that he should store his sperm in order to allow him to have
children later should his fertility be affected by the course of treatment upon which he was
about to embark. At that time (about 10 years ago) JB did not have a partner, and had not
met the petitioner. Accepting this advice JB attended a local fertility centre where he
provided the relevant samples. He was given various consent forms to complete. The forms
he should have been given to complete were a “GS” form, consenting to the storage of his
sperm, and a “CD” form, consenting to disclosure of identifying information. These were
the appropriate forms to be completed by men without partners but requiring long-term
storage. JB was given and did complete and sign both such forms. He was also presented
with additional forms, designed for men with a partner: an “MGI” form, for consent to the
use of his sperm in artificial insemination, and an “MT” form, for consent to treatment and
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storage, which would have included consent to IVF. The former was completed and signed,
the latter partially completed but not signed. Although the date on the MGI form is a day
before that on the GS and CD forms, it seems likely, from an affidavit of a con sultant at the
relevant clinic, that the forms were completed by JB on the date of his visit and that a
member of staff had earlier inserted the date in the MT form in preparation for that visit. It
is suggested in the affidavit that during the visit a member of staff realised, before its
completion, that the MT form was not appropriate to JB’s circumstances, hence it was left
uncompleted. The forms completed by JB did not include consent for IVF, which would
only have been included in the MT form.
[5]       In succeeding years, the centre asked JB to confirm his wishes regarding the sperm
stored, and on each occasion he replied that the centre should continue to hold the semen in
store.
[6]       In due course JB met and married the petitioner. He suffered a recurrence of serious
illness. During his final illness JB and the petitioner commenced fertility treatment to enable
them to have a family. They consulted their GP who referred them to a co nsultant. The
consultant, now retired, states in her Affidavit that both were fully committed to proceeding
with the treatment, and wished to use the stored sperm. They were frank about JB’s limited
life expectancy. The consultant does not recall whether any specific treatments were
discussed, but referred them back to the clinic to use the stored sperm for treatment “as the
specialist clinic saw fit”. She asked that they be seen urgently, given the state of JB’s health,
and wrote to the clinic subsequently asking for their treatment to be expedited.
[7]       Meanwhile, it seems that the clinic did not apprehend the gravity of the situation and
by the time an appointment was offered, JB was receiving palliative care. At this stage it
became apparent that the only forms hitherto completed by JB were those appropriate to a
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man without a partner and that further consents were required, appropriate to someone
with a partner and to the use of IVF. By this stage JB was unconscious and unable to sign
any forms.
[8]       An affidavit from the petitioner (whose veracity was not challenged) provides more
detail of the meeting with the GP and referral to the consultant. Her recollection of the
meeting with the GP makes it clear that IVF was discussed. Furthermore, the consultant
indicated that she would recommend IVF treatment rather than IUI as it was more likely to
be successful in the circumstances. The petitioner and JB understood that there is an
increased risk of twins with IVF, and considered that this would be a happy outcome. She
has no doubt that IVF was a form of treatment in the contemplation of the deceased.
[9]       During JB’s last illness, and as his condition deteriorated, he discussed with his
father what he wanted to do with his estate, and specifically in respect of his stored sperm.
In consequence he had his solicitor insert a clause into his will, in the following terms:
Human Fertilisation and Embryology
I direct my executors to ensure that my donation of sperm will be, for as long as
possible, and for as long as she may wish, available to [SB].”
[10]       The appointment which had been offered to the petitioner and JB was postponed to
enable the clinic to take legal advice, it having been discovered that no additional forms
relevant to a man with a partner had been completed by the deceased and that the original
forms did not cover IVF. The medical advice to the petitioner was that her only real
prospect of having a child was by IVF but that in the absence of the relevant consent this
could not be provided.
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7
[11]       JB’s treating consultant clinical oncologist has provided an opinion stating that JB
was likely to have experienced premature infertility or significant alteration of the gonadal
function as a result of the treatment provided to him.
[12]       SB petitions this court asking it to exercise its powers under the nobile officium and
grant certain orders to allow her to use her late husband’s stored sperm for IVF treatment.
Although the matter for decision by the court at this stage is restricted t o the question of the
effect of the clause in the deceased’s will, the petition contains averments tending to suggest
that the distinction made in the legislation between IVF and other forms of treatment is “of
no materiality” and is artificial, with the suggestion that this should not prevent treatment
by IVF even where the relevant consent has not been provided. Following discussion
between parties, and with the approval of this court, a restricted hearing was fixed to
consider the single question of whether the will executed by JB (alone or in combination
with other material) was sufficient to constitute his consent to the posthumous use of his
gametes in IVF treatment.
[13]       Answers have been lodged by the Human Fertilisation and Embryology Authority
(“HFEA”), NHS Grampian and the Advocate General for Scotland on behalf of the Secretary
of State for Health and Social Care ("SSHSC). NHS Grampian has no opposition to the
grant of the petition. The SSHSC's interest in the petition is restricted to what is necessary to
defend the legislative scheme and to assist the court with its interpretation and application.
On the hypothesis that the court were satisfied that the will, alone or with completed forms,
constituted effective consent in terms of the legislation to any embryo, the creation of which
may be brought about with the use of his gametes, being stored and used in providing
treatment services to the petitioner, the granting of appropriate orders was not opposed.
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Otherwise opposition was maintained on the basis that the result would subvert the
statutory scheme.
[14]       The HFEA, established under section 5 of the 1990 Act, has functions accorded to it
under section 8 of the Act. One is to provide, to such extent as it considers appropriate,
advice and information to those providing or receiving relevant treatment. It accepts that
completion of the relevant form or forms is not the only means by which effective consent
for the purposes of Schedule 3 to the 1990 Act may be given . In a case raising issues of
whether effective consent has been given there may be material sufficiently clear and
uncontroversial for it to express a positive view on compliance which clinics and individuals
may rely on. However, in cases of ambiguity the HFEA is not in a position to adjudicate on
the matter, that being an issue for the court. In the present case the HFEA:
(a) recognises that IVF treatment appears to have been in the contemplation of the
deceased;
(b) considers that effective consent was given by Mr B for his gametes to remain in
storage after his death (fulfilling the requirement for consent in Schedule 3,
paragraphs 2(2)(b) and 8(1)). That view was reached by reference to the terms of
the GS form read with the MGI form and, in particular, because the latter
contained consent to the use of his gametes in his partner's treatment (without
the creation of embryos in vitro) in the event of his death ;
(c) considers that effective consent was given by the deceased for his gametes to be
used in the treatment of the petitioner (fulfilling the requirement for consent in
Schedule 3, paragraph 5). That view was reached by reference to the terms of
the MGI form together with Mr B's will;
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9
(d) accepts that it is appropriate to distinguish between information and
opportunities for counselling offered at the outset of JB’s illness, when his sole
purpose in storing samples was preservation of fertility, and that offered when
he and the petitioner subsequently sought treatment;
(e) accepts that there is no inconsistency between the affidavit of the consultant to
whom the GP referred JB and the petitioner, who had no recall of a discussion of
specific forms of treatment, and that of the petitioner who did have such a recall,
which the authority had no basis for challenging; but
(f) has been unable to conclude that JB gave effective consent for the purposes of
paragraph 6 of Schedule 3 to the 1990 Act, for the following reasons:
(i) the MT form was only partially completed and not signed;
(ii) the MGI form gives consent to the use of gametes in IUI or similar
treatment but without the creation of embryos in vitro; and
(iii) the will does not make any reference to the creation of embryos or more
specifically to the purpose for which the gametes may be used.
[15]       However, should the court find that the requirements of paragraph 6 of Schedule 3
have been met, the Authority considers that there would be no impediment to IVF treatment
for the petitioner using her late husband's gametes.
[16]       The main interest of the Authority, as with the Advocate General, was to defend the
integrity of the legislative provisions and to contest any argument that , if the will did not
provide effective consent, it might be possible for certain statutory provisions to be waived.
[17]       NHS Grampian was not represented at the hearing since it did not oppose the
petition. With the court’s permission the Advocate General for Scotland was excused from
appearing at the hearing.
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10
[18]       Submissions were made on behalf of the petitioner and the HFEA. We do not
require to rehearse them, as their essential terms will be apparent otherwise in this opinion.
Analysis and decision
Competency
[19]       It might appear that the issues could have been addressed in an action for declarator.
That is true only to the extent that the agreement of parties limited the issues to be
addressed at this first hearing. However, should the court find against the petitioner there
remain other and more complex issues relating to the materiality of the statutory distinction
between IVF and other forms of treatment. Senior counsel for the petitioner submitted that
this would require examination of the whole legislative scheme and whether it afforded a
remedy for this unforeseen situation or whether there was a gap requiring the exercise of the
courts powers under the nobile officium. In the whole circumstances we are persuaded that
the petition is competent.
The requirements of effective consent
[20]       We proceed on the basis that the requirements of an effective consent to use of the
deceased’s gametes for IVF treatment are that:
(a) It must be in writing;
(b) It must be signed by the deceased;
(c) It must specify the purpose of use, and be clear that it encompasses consent to the
creation of any embryo in vitro;
(d) The individual must have been given a suitable opportunity to receive proper
counselling about the implications of taking the proposed steps, and have been
provided with such relevant information as is proper; and of the consequences in
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respect of the possibility of variation or withdrawal of consent as specified in
schedule 4, paragraph 4; and
(e) It must not have been withdrawn.
In our view, the terms of the deceased’s will constitute sufficient consent to meet these
requirements. It is in writing, it is signed and it has not been withdrawn. The remaining
two conditions for effective consent relate to the opportunity for counselling and whether
the terms of the clause are sufficiently clear to provide consent for the specific form of
treatment that is involved in IVF.
[21]       As to the first of these, it is clear that the deceased was, at the time of his first visit to
the clinic at the start of his illness, provided with suitable and appropriate opportunities for
counselling in respect of the steps which he was then undertaking. What is “a suitable
opportunity to receive proper counselling”, or provision of “such relevant information as is
properis, as is accepted by the HFEA, situation specific. The context in which the deceased
and the petitioner consulted their GP and were referred to the consultant and thus to the
fertility clinic, was one in which they were investigating the possibility of having a child in
the face of JB’s impending death. It seems clear to us, taking together the affidavits of the
consultant and the petitioner, that the terms of paragraph 3 of schedule 6 were adequately
met before the deceased signed his will about two months after being seen by the GP and
consultant. In addition, during their consultation with the consultant, the couple completed
and signed a fertility clinic “Welfare of the Child” consent form. Under the heading “we
have considered the following issues”, they ticked a box stating “Our possible need for and
the availability of independent counselling. The form was signed by both of them. The
referral letter from the consultant to the clinic stated “The couple seem to have considered
the difficult road ahead”. The Authority accepts that treatment by IVF appears to have been
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in the contemplation of JB, and the affidavit of SB makes this clear. We consider therefore
that there was a discussion, albeit limited, about IVF which was in the circumstances
sufficient to meet the statutory requirements.
[22]       The remaining issue relates to the construction of the clause in the will. It is
axiomatic that we should start by examining the plain meaning of the words in the context
in which they occur. We regard the following features as important. First, it is a
testamentary document in which JB was not only making disposition of his estate but, by
this clause, expressing his wish for the future use of his stored gametes. Second, he and his
wife had sought and been referred for treatment to en able them to have a child. Third,
although it is expressed as a direction to his executors, in reality it is an expression of his
wishes. For present purposes, we are not concerned with whether the clause could be given
testamentary effect. The only question is whether it can be construed as granting the
necessary consent. In our view there is no doubt that it can. It is the sort of provision that
would only sensibly be made by a man contemplating his death in the near future, and
seeking to make his wishes clear. The heading refers not merely to fertility but to
“embryology”. The clause itself is expressed unconditionally and in the widest terms. It
specifies that the material be availableto SB, in other words available for her unqualified
use, thus covering the prospect of her treatment, given the known context, and meeting the
terms of paragraphs 6(2) and 2(1)(b) of the schedule. All these factors point unerringly
toward JB having given consent to IVF treatment. Consent to use of the gametes for the
purpose of IVF must impliedly include consent for the storage of any embryos thereby
created, thus meeting also the terms of paragraph 8 of the schedule.
[23]       Where it is desired to store gametes for a period in excess of ten years for the
provision of treatment services there must be written consent of the donor and a medical
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opinion to the effect that that person was, or may have been likely to become, prematurely
infertile (Human Fertilisation and Embryology (Statutory Storage Period for Embryos and
Gametes) Regulations 2009, regulation 4(3)(a) and 4(3)(b); and In re Warren [2015] Fam 1).
The clause in the deceased’s will, specifying that the material be available to the petitioner
for “as long as possible”, together with the opinion of the treating oncologist as to the
deceased’s state of fertility, clearly meet these requirements.
[24]       In the circumstances we are therefore minded to grant the orders sought. The precise
wording was the subject of some discussion, it being accepted that the original wording of
the orders sought in the petition was not appropriate. Following discussion between both
sides of the bar, a form of wording was suggested which we readily adopt. We will
therefore find and declare that the late JB:
(i) gave effective consent to the storage of his gametes for the purposes of
paragraphs 2(2)(b) and 8(1) of Schedule 3 to the Human Fertilisation and
Embryology Act 1990;
(ii) gave effective consent to the use of his gametes to bring about the creation of
an embryo or embryos in vitro, and to any such embryo or embryos being used for
the provision of treatment services to SB, for the purposes of paragraphs 2(1)(b) and
6(1) to 6(3) of Schedule 3 to the Human Fertilisation and Embryology Act 1990; and
(iii) gave effective consent to the storage of any embryo or embryos, the creation
of which may be brought about with the use of his gametes, for the purposes of
paragraph 8(2) of Schedule 3 to the Human Fertilisation and Embryology Act 1990,
and that such storage is subject to the statutory storage period of ten years, in terms
of section 14(4) of the Human Fertilisation and Embryology Act 1990.



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