Examination of Witnesses (Questions 752
- 759)
WEDNESDAY 13 OCTOBER 2004
PROFESSOR ROBIN
GILL, PROFESSOR
JULIAN SAVULESCU
AND PROFESSOR
ALASTAIR CAMPBELL
Chairman: Thank you very much for coming,
Professor Campbell, Professor Gill and Professor Savulescu. I
notice that John Harris is not here, he is ill and we shall miss
him, but I am sure he will watch. Thank you for coming to help
with us our inquiry. It is quite a torturous one with lots of
serious questions being asked and legislation always being in
our minds. The first questioner is Evan Harris.
Q752 Dr Harris: I want to ask about
the precautionary principle and the way we regulate things and
whether we should have a system whereby we allow people to exercise
and access help to exercise reproductive choice and freedom unless
something is specifically disallowed or whether we should only
allow that artificial help for things that are allowed. I would
be happy for you to argue amongst yourselves publicly as it were
if there is a difference of opinion. John Harris said, "One
of the presumptions of liberal democracies is that the freedom
of citizens should not be interfered with unless good and sufficient
justification can be produced for so doing. The presumption is
that citizens should be free to make their own choices in the
light of their own values whether or not these choices and values
are acceptable to the majority. Only serious danger either to
other citizens or to society is sufficient to rebut this presumption
. . . If anything less than this high standard is accepted then
liberty is dead." Discuss in this context, please.
Professor Campbell: I think that
is John Stuart Mill as much as it is John Harris.
Q753 Chairman: Maybe he cribbed it
from Mill!
Professor Campbell: It is a familiar
argument in terms of the demonstrable harm principle being the
only way in which we should prevent individual liberty. I take
a different view from that, which is why I thought I might start.
I think the first thing to notice is that what is not mentioned
in any of that is the point that we are not talking here about
consenting adults, we are talking potentially about children and
so what we have to ask is, in terms of our duties in relation
to the vulnerable in our society, how cautious or how experimental
we can be. The word precautionary principle has become a bit of
a catch word now, it is just thrown into a debate. What many of
us are concerned about is that in this area, where there is vulnerability,
simply leaving it to individuals to make up their open minds is
not doing what we ought to be doing in terms of our duties to
the children who may be born.
Q754 Dr Harris: Can you explain why
you think that does not apply to compulsory parenting classes
or checks on how parents are bringing up children who are much
more vulnerable than a potential child in terms of they are there
and they are vulnerable and the vulnerability may be greater?
Professor Campbell: There is an
even better one, of course, which is putting contraceptive in
the water supply and then having a government department that
issues a licence for parenting.
Q755 Chairman: Whose idea was that?
Was that Stuart Mill too?
Professor Campbell: We can go
to another extreme in the sense that we can go to a point where
we really are interfering in the liberties of individuals and
judging by appearance and I have never supported that. I think
we are always in a balance between the allowing of liberty and
the protection of the vulnerable. In the area of reproductive
medicine, as I have said in my paper which I submitted to the
Committee, there are some particular vulnerabilities and there
are also some duties that accompany the fact that we are providing
a medical service and these are different from what we might see
in relation to other parents who worry us and so I think we are
justified.
Professor Savulescu: Could I just
agree with Alastair and say that we clearly need to consider the
vulnerable and I think John Harris would agree with that. I think
the point that John is making with the precautionary principle,
which I have heard him discuss in relation to the shift to preimplantation
genetic diagnosis, is that simply citing the possibility of some
harm in the future is not a sufficient ground for interfering
in liberty. So simply citing that we need to be cautionary because
there is a risk is not a sufficient ground. I think here John
and I part company, although I agree with the general presumption
in favour of liberty. John, for example, has supported preimplantation
genetic diagnosis for sex selection because he says the risk is
so small of genetic diagnosis to the embryo that we should not
interfere with liberty. I believe that we should consider the
vulnerable and consider the children by balancing the risks and
benefits. He is right that the precautionary principle is wrong,
but what we have to do is simply evaluate the risks and the benefits.
So in the case of sex selection the benefits to the embryo or
the future child of preimplantation genetic diagnosis are going
to be pretty small, therefore we would not tolerate even small
risks. It is a question of balancing the risks and benefits to
the future child and making a responsible estimate of those that
I think is critical in evaluating whether we perform procedures
particularly in the area of reproduction.
Q756 Mr Key: Who is this "we"
you keep referring to? Is the "we" the medical profession,
the public, the parents, the potential child or the Human Fertilisation
and Embryology Authority?
Professor Savulescu: It is the
Human Fertilisation and Embryology Authority in deciding whether
to licence the particular use of reproductive technology. That
is where the current power lies in terms of reproductive technology.
John is arguing that that power should shift more to couples unless
there is evidence of harm. The responsibility of the authorities
in licensing terms should be one of assessing whether the risks
and benefits are balanced or not balanced and not in simply interfering
on the basis of the disapproval of a group of people in society.
Professor Gill: I think both Alastair
and Julian have missed one point which is in Alastair's original
paper, which is to make a distinction between actions which are
out there in society at large and actions that the medical profession
are being asked to undertake and which involve medical interventions.
I agree largely with the point that Julian has made, but there
is a difference between, on the one hand, trying to please couples
who want children—and, like everyone, I am a libertarian
in that respect—and requiring the medical profession to
intervene and not to be respecting their own autonomy and not
to be respecting that they are being asked to do something for
other people. It seems to me at that point there is a distinction
we can make and should make if we have a proper regard to the
medical profession.
Q757 Dr Harris: Would you be happy
for there to be 100 children born to child abusers as long as
they are conceived naturally? You are not going to intervene with
that. Why do the children born into child abusive families naturally
deserve less care from us as regulators, if we are regulators,
than the one for the people who need assistance?
Professor Gill: Happy is the wrong
word to describe the first situation. Would I like to live in
the sort of society where we go around policing individuals who
want to have children by natural means? My answer to that, as
your answer would be, is no, I certainly would not, I would regard
this as a gross infringement of liberty, but there is a cost to
this. Two wrongs do not make a right in this situation. The second
situation where you are being asked to use medical personnel,
it does seem to me irresponsible if they do not use their judgment
in terms of risk and so forth. The reason for wanting to protect
the first situation has very little to do with the second situation.
Professor Savulescu: I think we
would all agree that doctors should make their own conscientious
decisions about the case in front of them and if they were unwilling
to offer assisted reproduction they should not be compelled to.
The question is who is going to make that decision? Are doctors,
in consultation with their patients, going to make a decision
about whether they believe in this situation the benefits outweigh
the risks or are we going to use a "blunder bus" of
a law which says there should be no use of artificial reproduction
in this circumstance? For me it is clearly better to place the
decision in the hands of the doctor, as you say, with the patient
in front of them rather than trying to regulate this in a fine
grade way through laws that simply are not tight enough and with
the complexity and sensitivity of individual procreation.
Q758 Geraldine Smith: I think the
vast majority of British people do want to see some sort of regulation
and they do not want to just leave it to individual couples and
their doctors. We have mentioned John Harris, it is a shame he
is not here, but he does hold quite extreme views in some respects.
I understand that he does not think infanticide is always wrong.
We have got to know where people are coming from. Most people
want to see some regulation in place. I do not think they want
to see a free-for-all where it is just down to couples to decide
and they do not consider the welfare of the child and there are
children born to paedophiles, but I do accept what you say about
who should play God in deciding which children are born and which
children are not.
Professor Savulescu: I think there
is a place for a leadership role here. It is true that, for example,
the majority of people probably disapprove of sex selection but,
likewise, the majority of people probably approve of capital punishment
and that is not a reason per se to introduce capital punishment.
I think we need to lead rather than to follow public opinion.
That is not to say there should not be any regulation. Clearly,
the more risky and new procedures should be regulated in a way
that inspires confidence.
Q759 Geraldine Smith: Why should
you lead public opinion? Surely it is your job to inform public
opinion. Why should not the churches lead public opinion? What
gives you the right to lead rather than someone else?
Professor Savulescu: The point
is that procreation is a private affair between, in this case,
the doctor and the patient, not between the public through an
indirect route, through the HFEA influencing what should be a
private decision. Just as the public should not interfere in my
decisions about sexuality, how I run my life, likewise they should
not be involved in my decisions around procreation unless there
is a clear risk either to the public interest in terms of serious
harm or in terms of the child being adversely affected.
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