Examination of Witnesses (Questions 683
- 699)
WEDNESDAY 15 SEPTEMBER 2004
REV DR
JOHN I. FLEMING,
RT REV
DR MICHAEL
NAZIR-ALI,
MRS JOSEPHINE
QUINTAVALLE AND
DR HELEN
WATT
Q683 Chairman: Can I say how delighted
I am that you have been able to come, Helen particularly standing
in because Peter Smith is caught on a train. Thank you very much
for coming, and I am sure you will be able to participate fully
as he would in this discussion. Given your opposition to assisted
reproductive techniques requiring the creation of embryos, are
there any circumstances in which you think the creation and I
guess destruction of human embryos can be justified? You have
strong objections to that. Are there any circumstances in which
those strong objections might melt somewhat?
Rev Dr Fleming: Speaking for myself,
there are approaches to dealing with problems of human infertility
which do not involve the destruction of human embryos, and any
such technologies, whether macro technology or microsurgical techniques,
with the removal of an egg from the ovary and placing it in a
fallopian tube and intercourse taking place, would not represent
an in-principle difficulty.
Q684 Chairman: What is the event
that raises the objection? Is it the combination of two different
DNAs? What is the basic parameter on which you decide it?
Rev Dr Fleming: In principle,
there are two main objections. One is the separation of procreation
from the act of natural sexual intercourse, whereby a human-being
knows and understands that they are the fruit of their parents'
conjugal love, and their identity and so on is secure. Secondly—and
this is where SPUC would put the strongest emphasis for the moment—reproductive
technology, as we have it—in vitro fertilisation and other
related procedures—is very inefficient and highly wasteful
of human life. It goes to the third question then: what are the
implications of children born of the technology? We now know that
there are significant increased risks that obtain with a child
born of the procedure. The literature indicates that.
Q685 Chairman: Are there any circumstances
that might arise that would melt your objection, and you would
say that the social conditions or something merit allowing this
to happen?
Rev Dr Fleming: I would be looking
at techniques other than in vitro fertilisation to address the
question. I have no objection to addressing the question of human
infertility. My sister and her husband were infertile. The question
is at issue is: how do I do it; what are the techniques that would
be acceptable and what would not be acceptable? It is not a blanket
rejection of dealing with the problem of infertility.
Q686 Chairman: I am sure we will
come to the specific new technology that might open up that argument
for you, because as you will realise the world moves on in terms
of science and medicine. Does anyone want to add anything to that?
Rt Rev Dr Nazir-Ali: You will
have had the Church of England submission. To add to what Father
Fleming has just said, from the Anglican point of view, the question
is not so much an act of sexual intercourse but a relationship,
in this case marriage. IVF therefore could be permissible if people
want to have children and they cannot have them naturally. To
what extent it should be permissible is the question. Should it
be permissible only when there is no destruction of supernumerary
embryos for example? That is now possible to do, and indeed is
encouraged because there are all sorts of dangers in hyper-stimulation
of women to obtain a number of eggs. If it is possible to have
IVF to promote the having of children within a loving relationship,
then it is that which we would regard as prior rather than simply
an act of making love at one time or another.
Mrs Quintavalle: I want to establish,
because I am in very illustrious and holy company here, that CORE
is not a religious group. It is a pro-life group, not a religious
group. We uphold the right to life of the embryo in absolute.
Our solution in terms of IVF would be not to create surplus embryos,
and that is where we start from. Infertility treatment is possible
if it is done without creating a surplus.
Q687 Bob Spink: Can you tell us what
CORE would say about the recent designer baby ruling?
Mrs Quintavalle: We are very concerned
in that respect because, as you may have read from the submission
from CORE, our concern is not so much about the decisions that
are being made but about how these decisions are being made. We
are prepared to discuss the decisions themselves and the effects
that are involved, but our major concern is about the lack of
accountability and transparency that the HFEA has demonstrated—and
they have demonstrated that yet again in the recent decision.
Q688 Chairman: We will return to
so-called designer babies later on. I remember, and you will remember,
the strong reaction against IVF, and now it has almost become
part and parcel of the British way of life in the Health Service.
What are your feelings about that?
Rev Dr Fleming: From SPUC's point
of view, we would say that clearly what you have said is correct.
The question then is: ought there to be, in a review of the practices
involved, any tightening up? Ought there to be regulations which
take account of what we now know, which would go some way to meeting
some of the objections?
Q689 Chairman: Do you think the same
level of regulation is required now, or do you think it should
be loosened or tightened?
Rev Dr Fleming: I think it should
be tightened.
Rt Rev Dr Nazir-Ali: There is
the prior question about regulation, is there not, which I think
Josephine was raising by implication. Having been a member of
the HFEA and chair of one of its committees, it is a very difficult
task. However, the more I think about it—and I quite often
disagree with decisions of the HFEA—if you did not have
something like a regulatory body that the HFEA is, things would
be much more difficult to decide, and in the end something would
have to be invented.
Mrs Quintavalle: I reiterate the
point I am trying to make. I am in favour of regulation. I certainly
think it is necessary. But between regulation and ethical decision-making
a very big barrier should be drawn. I am very concerned at the
moment about the proposed amalgamation of the HFEA with the Human
Tissue Authority. I just cannot imagine what kind of bureaucracy
is going to come out of that and what chance we will then have
of getting any of our concerns represented.
Q690 Chairman: Helen, can I invite
you to say anything on any of the subjects we have raised so far?
Dr Watt: Yes. I begin by saying
that Father Fleming talked about the in-principle objection to
IVF. I would see this objection as the non-sexual production of
embryos, which is very close to production of any sort of sub-human
entity. There is a lot of evidence that when embryos get produced
as if they were products, they get treated like products. We see
lots of wastage of life—IVF quality control—the embryo
treated very much as a commodity under the control of the parents.
On the subject of regulation, I am a bit uncomfortable with the
term. I certainly would like to see the worst aspects of IVF prohibited—things
like the wastage of embryos and surrogacy, donation—particularly
anonymous donation—and that kind of thing—embryo experiments.
It would be a matter of prohibiting what I see as the very worst
excesses of IVF.
Q691 Chairman: What would you substitute
for regulation?
Dr Watt: I would prohibit particular
practices such as embryo experimentation, surrogacy, production
of excess embryos—just targeting the worst abuses of IVF,
as I have said.
Q692 Dr Turner: Dr Watt, since you
are representing the Archbishop, I can ask you some questions
about the Archbishop's stated views. He has submitted evidence
that increasingly children are seen as a set of consumer choices.
What evidence do you or your Archbishop have to suggest that children
born from this form of reproduction are any less loved than children
who were conceived naturally?
Dr Watt: I suppose first of all
I would want to ask: "Why look just at born children?"
There is an enormous amount of evidence that children conceived
from IVF get treated as products, and there is lots of quality
control, lots of discard, experimentation. We have now got embryos
being discarded not just because they are spare or not just because
they have some genetic problem, but because they are not good
tissue matches for a sibling. There is lots of evidence before
the child is born that it is being treated as a product. Admittedly,
as the child gets older, bonding happens and you would hope that
the parents would come round and see the child more or less as
a child whose rights they should be respecting, but this is not
a good way to start your life. It is not a good thing for a child
to be born knowing that it has got so many siblings that did not
make it because there were too many of them or because there was
some problem with them. I suppose I would say that it is a very
important thing, conceiving a child, and it has to be done in
a way that encourages the parents to see the child as something
to be welcomed unconditionally.
Q693 Dr Turner: By implication, you
are saying that as far as these children are concerned it would
have been better if they had not been born at all.
Dr Watt: Well, I certainly would
welcome their lives, but I think you can welcome the life of any
child without saying that the way that child was conceived was
respectful of the child's dignity. Children can be conceived by
adultery or rape. Obviously, these children have valuable lives
that we have to respect, but some ways of conceiving children
do not respect their dignity. I think you have to separate the
value of a child's life from whether the child's conception respected
that value.
Q694 Dr Turner: Does this not come
down to theological views about the actual process of conception
itself, rather than any other issues?
Dr Watt: I do not think those
views are just theological views. There is very powerful symbolism
in natural conception of the best kind because you are welcoming
a child into your relationship. You are receiving a child as a
gift, in the same way as there is powerful symbolism of production
that you see with IVF. Certainly in the case of the treatment
of embryos, you see them treated very much as a product that has
been produced.
Q695 Dr Turner: Again, the Archbishop's
evidence suggests that the HFE Act is influenced by mistaken scientific
and philosophical views on the nature of the embryo. How do you
see the status of the embryo? Is it a moral absolute, or is it
a matter of personal judgment? If it is a moral absolute, then
whose moral absolute is this?
Dr Watt: I would see this as a
human rights issue, so the issue is, who has rights; whose rights
should we be respecting? This is not something we can just agree
to differ on; it is a matter of the rights of all human-beings.
You cannot make distinctions and say that certain human-beings
have no rights at all. The second point is scientific views. People
talked at the time of embryos being undifferentiated groups of
cells and so on, and the more we know about the embryo the clearer
it is that that is not true; there is polarity, a front and a
back, if you like, of the embryo from the very beginning. There
is evidence on that and there is evidence on the very rapid activation
of genes from both the father and from the mother. The twinning
arguments that got used to say the embryo could not be an individual
because a twin could come from the embryo—we should know
from cloning if from nothing else, that an individual can give
rise to a new individual in a non-sexual way and still be an individual
itself.
Q696 Bob Spink: Can I clarify this
point? Is it your view that the moral absolute should be determined
by the HFEA in a non-transparent way, without accountability to
the public or that it should be determined by Parliament on behalf
of the public in a way that is accountable?
Dr Watt: Very much by Parliament.
The HFEA is the worst possible organisation to be looking at things
like public policy, because it is staffed by people who already
agree with things like embryo research and so on. As you say,
it is a quango and I think it is very important that Parliament
is the body that decides.
Q697 Paul Farrelly: Dr Watt, I do
not want to monopolise you, but you spoke about the dignity in
terms of process of conception and the concept of dignity of the
child. In my experience, people who undergo IVF love each other
so much that they desperately wanted to consummate that love by
having a child, and that child was born with all that love behind
it. How undignified does that make the child?
Dr Watt: It is not the child who
is undignified, but if you talk to IVF couples themselves, a lot
of them find the process very stressful, very humiliating. The
man has to provide a sample and is given pornography to help him
do that. If you talk to IVF couples themselves, many of them are
doing this reluctantly out of desperation and this is not the
ideal way of conceiving a child at all. It is very interesting
actually because there has been some research on parents of born
IVF children which found that almost all of them saw the embryo
either as a child or a potential child from the very beginning;
so their embryos is in cold storage they see either as children
or potential children—at least these IVF parents who already
had born children. There are lots of guilt feelings in couples.
Many couples do not contact the clinics on what to do about their
excess embryos. They do not like to ring up and say, "discard
them". Those who can bring themselves to tell the clinics
that that is what they often want a funeral service. IVF couples
themselves are not happy with the IVF scene.
Mrs Quintavalle: In relation to
Dr Turner's and Paul Farrelly's comments, we have to be careful
not to be rose-coloured about IVF. I look at things usually in
my organisation from the perspective of the welfare of the child.
We need first of all a lot more research, in-depth objective research
from the child's perspective, which will always be difficult because
of the amount of secrecy that is involved in IVF. The other issue
that you have to take on board is that fortunately while there
are not a huge number of cases, there are cases where IVF children
have been taken into care, and this is often one of the consequences
of IVF, which is an increased risk of multiple births. It is something
that the more serious IVF specialists are trying to face full
on. IVF does equal a very increased risk of multiple births, and
that is not something all families are able to cope with, or welcome.
We even have to look at the health of the children who are born
as a consequence.
Rev Dr Fleming: I certainly agree
with Mr Farrelly that often times in the general the generation
of a child by IVF is accompanied by strong parental love and desire
to express that love in the having of a child. But I think what
Dr Watt is driving at, and what I want to drive at, is that the
love of the parents is not at issue. What is at issue is the technique,
which Dr Watt is really saying is the technique and all those
techniques that surround it which are at variance with the dignity
of the child, and not least because of the question of the eugenic
sorting out of who will be acceptable and who will not be acceptable.
Secondly, there is a universal agreement that all members of the
human family have a human dignity, and arising from that is an
inviolable and inalienable right to life. Quite clearly, the human
embryo is a member of the human family; so when you ask who is
absolute, the fact of the matter is that we have all signed on
to that, and it would seem to me that when we begin to bracket
out groups of human-beings as not worthy of moral consideration,
then the trouble begins because then it becomes just a matter
of arbitrary choice. Who would you leave out; who would I leave
out; and who would somebody else leave out? I have worked for
six years on the South Australian Council on Reproductive Technology,
very much like your HFEA here. One of the things that the clinicians
pointed out to us on the question of embryos was that having got
to the point where they have sexed the embryos, precisely to avoid
the possibility perhaps of some kind of sex-linked disability
or something like that, and they have a set of healthy embryos
of both sexes, they say, "why should the doctor decide whether
this couple will have a male or a female; why could the couple
themselves decide that on the basis of their existing family or
their personal preferences?" When we talk about selection,
it does come in at a number of different levels and increasingly
so, as the technology improves and we are able to give better
markers for identity of particular embryos.
Rt Rev Dr Nazir-Ali: Chair, a
number of issues are cropping up, and I am sure you are making
a list of them, but just to repeat, IVF within a loving relationship
is one thing—and there are issues even around that to do
with the unnecessary destruction of embryos—and we would
distinguish between that and, say, IVF by donor. They are quite
different things. On the question of respect for the embryo, this
is part of the whole process which led to the legislation that
brought the 1990 Act into existence. The reason that there is
legislation at all, and a body like the HFEA, is precisely because
the embryo is regarded worthy of respect. You may say that the
philosophical background to this respect is incremental. This
is why there is a 14-day limit for instance to research on the
embryo because it is thought that a person emerges gradually.
Whatever else we may disagree about, I hope all of us would agree
with the law as it is, that the embryo deserves respect. The question
is why that is so. Some people would say it is because the embryo
from its earliest stages is a person; some would say it has the
potential to be a person; some might say we do not know when there
is a person; and there is a proper agnostic position to be had
as well. The question of respect is not at issue here. The other
main issue that has been around already in our discussion is that
of instrumentality. This is a question that arises not only for
embryos but also for human persons, at whatever stage of development;
that they must always be used as ends in themselves, and never
merely as a means to an end. There are questions whether certain
kinds of assisted reproduction procedure can lead to children
being used as a means to an end rather than an end in themselves.
Q698 Dr Harris: Dr Watt, in reply
to Dr Turner's first question you said that it is not a good start
for a child to know that many of that child's brothers and sisters
did not make it. What is your evidence for the fact that a child
born of IVF is damaged by this knowledge or this phenomenon?
Dr Watt: The evidence is anecdotal
at the moment but there is a book in French called The Embryo
on the Couch, looking at psycho-social aspects of IVF, and
particularly at something called the survivor syndrome, which
is found in other contexts, the feeling that "I survived
and many of the people in my group did not". That can lead
both to survivor guilt but also to survivor omnipotence, the idea
that "I am a magic child because I made it through and the
other embryos did not".
Q699 Dr Harris: I was wondering if
there is any published evidence that this is a problem for the
children themselves, and indeed whether in relation to those children
who survived when their potential siblings were miscarriages there
is any evidence that they are damaged by the fact that many of
their siblings at a later stage did not make it through? Is there
any published evidence, because we would like to read it, rather
than hearing about potential books?
Dr Watt: Twins who have lost a
twin—there have been cases of twins where a twin has died
during gestation or been stillborn or whatever—feeling the
loss of that twin they had never known as a born child. There
is evidence coming through on—
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