Why the critics got it wrong over 'designer babies'
"FRANKENSTEIN", "libertarian" and "radical": all words used to describe the report on reproductive technologies issued on Thursday by the House of Commons select committee on science and technology. The report certainly is radical, but in a positive not a negative sense, and provides a thorough and principled analysis of the uses of assisted reproductive technologies; a fact that has sometimes been disguised by the coverage in the media.
The select committee was concerned to establish at the beginning, and with complete transparency, the principles and values which informed its discussion. First, it identified a range of ways in which the human embryo could be viewed - as a person, as a mere collection of cells or as something worthy of respect but not fully human. In selecting the last of these as the basis for its deliberations - the so-called gradualist approach, meaning that, as the embryo develops, it becomes increasingly worthy of respect - the committee not only agreed with the views of the Warnock Committee, whose report formed the basis of current UK law, but also with what is probably the view of many, if not most, people in this country.
Second, the committee was convinced, by evidence and by its own observations, that assisted reproduction, which has been in use for more than 20 years, can now be categorised as essentially routine medical practice. The implications of this are that - although it was sensible in the past to regulate assisted reproduction closely in case evidence of harm arose - it was no longer necessary to do so.
This area of medicine is unusually closely regulated, to the frustration both of patients and of doctors. It is wrong, therefore, to suggest - as some antagonists to the report have done - that the committee sought to endorse whatever scientists want to do without evidence. On the contrary, the so-called precautionary approach was recognised by the committee, which found, on the evidence, that its use was no longer appropriate. There is not merely an absence of evidence of harm to children born as a result of the use of such technology; there is positive evidence to suggest there is no harm.
The logic of the committee’s position, then, was as follows: reproduction is generally regarded as a private matter. The state has the right to intervene only when there is evidence of harm. The evidence obtained over the past decades points to an absence of harm. Therefore, there is no justification for interfering with such reproductive choices. Thus, the committee was able to embrace the concept of reproductive liberty: something which is regarded as a positive good. The logical result of this is that decisions about the use of assisted reproduction are a matter between doctor and patient.
Inevitably, this includes choices about pre-implantation diagnostics for a variety of reasons. It is already widely accepted that selecting embryos which will not suffer from a specific clinical condition is appropriate. The committee’s conclusion that it may, in some circumstances, also be acceptable to select for other characteristics, such as sex, logically flows from this and is already endorsed by other bodies, including the ethics committee of the American Society for Reproductive Medicine.
However, the select committee was also concerned that, where needed, regulation should remain in place. A number of people who gave evidence, in writing or orally, had expressed concerns about the way in which the regulatory body - the Human Fertilisation and Embryology Authority - went about its business, and it was incumbent on the committee to take these views into account.
Despite what has been reported, far from recommending deregulation of the uses of embryos and what can be done in clinics, the report recommended a strengthened regime, based on deploying appropriate expertise in the licensing, policing and monitoring of clinics and the services they provide. Quality scientific scrutiny coupled with additional ethical oversight from parliament and a new regulatory body is more, rather than less, likely to ensure a robust regulatory regime.
One more thing needs to be said. The select committee did not recommend the creation of human/animal embryos. However, it did have an obligation to look to the future, as well as the past. There may be sound scientific and ethical reasons in the future for using animal hybrids for research purposes rather than human ones; the committee addressed this possibility and recommended that it be kept under review. So, too, the ban on reproductive cloning, which was rushed through parliament in record time, allowing little opportunity for a rational, reasoned debate. It can surely not be wrong or misguided to argue that reasoned debate on the big issues of our time is important.
There are, of course, some for whom this report is a step too far, but we will never know just how many feel that way until it has been read and digested - not misrepresented. For some, assisted reproduction itself is a step too far; for others, the desire of parents to have a child of a particular sex, or to create a child with the aim of both giving it life and saving the life of an existing child, is the stuff of nightmares. However, commitment to the principle of reproductive freedom and to the value of existing as well as potential life surely leads to the conclusion that - in the absence of evidence of abuse or harm - we must at least consider whether or not these are legitimate uses of technology.
In tackling these difficult and complex issues head on, and with complete transparency, the select committee has done the debate in this area a great service. That some members of the committee could not approve the final report merely serves to demonstrate the sensitivities and complexities involved.
Sheila McLean is professor of medical ethics at Glasgow University and was a specialist adviser to the House of Commons select committee on science and technology. Read her in our expanded Medical Matters pages every Monday.
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