Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 752 - 759)



  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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