Examination of Witnesses (Questions 760
- 779)
WEDNESDAY 13 OCTOBER 2004
PROFESSOR ROBIN
GILL, PROFESSOR
JULIAN SAVULESCU
AND PROFESSOR
ALASTAIR CAMPBELL
Q760 Dr Harris: What evidence is
there from, for example, unregulated jurisdictions that there
has been any particular harm to children who may have been born
which would justify us saying we need to regulate to prevent those
harms? Alastair opposes "saviour siblings". In the case
of the "saviour siblings" there is no clear evidence
of harm to the child that is going to be born as the "saviour"
and clear evidence of amelioration of harm to the child that is
helped. On that basis do we not have, if you are adding up welfares
of children, both existing ones who I would say probably have
a stronger claim to it and putative ones, a moral imperative to
provide this technology to reduce harm and save life rather than,
as you have indicated in paragraph 4 of your evidence, actually
stopping that activity?
Professor Gill: It seems to me
you are reversing normal medical ethics at this point. Normal
medical ethics says we do not have medical interventions on individuals
unless there is some benefit to them and that is the normal position.
Elective ventilation without prior consent was deemed to be unethical
and illegal on precisely that ground. This is a very rare situation
in which medical ethics struggles to find a justification for
a medical intervention on one individual without that individual's
consent and without any benefit to them. I think there is an argument
which can say, as the BMA has tried to say, that there might be
some benefit to that "saviour sibling" in that they
will not have grieving parents. It is quite a narrow point. I
would differ slightly from Alastair in the sense that I do think
there are grounds for being compassionate in this area, but I
want very strict conditions for this. There really must not be
any other therapeutic path possible and there must be only minimal
discomfort to the "saviour sibling" from anything that
is transacted and that sibling really must be valued and cherished
and loved as a person in their own right so that you are not using
a person instrumentally for the benefit of somebody else. Having
made all those conditions, I think on compassionate grounds I
am certainly sympathetic to the idea of "saviour siblings".
Q761 Dr Harris: What about the disasters
that have happened in unregulated jurisdictions?
Professor Gill: In the case of
novel technologies very often one is trying to anticipate what
these might be and this has been some of the problems with PGD
for example, and the on-going debate about the effect of IVF full
stop. Ethicists were rather cautious in the first place about
this. It probably went ahead at a time when there was still probably
ethical disagreement about whether it should go ahead. I think
we have learnt to value the benefits of IVF, although I gather
that there is still some alarm in some quarters about the effect
of IVF on the future health of the children. I have not examined
that evidence carefully myself. I did examine the initial evidence,
such as it was, suggesting that there might be abnormalities as
a result of IVF, but we never know. Science makes these jumps
and it sometimes makes these jumps by doing things on animals
and then on human beings. I think it is right that we should be
cautious, but it is always difficult to cite evidence of things
which have not actually happened yet.
Professor Campbell: I have been
clinically involved in this in the sense that I have been asked
to advise in a situation where a child was born, the other child
was five years old and they were the right match for bone marrow
to a sibling. I know that you have already got a problem there
because you are going to do an intervention on a child who cannot
possibly give consent, you are going to stick a needle into a
bone and pull out bone marrow and so on. They will thank you later
perhaps, but at the moment what you are doing is not for their
benefit except in an obscure way. The "saviour sibling"
scenario is one of double jeopardy in that not only are you going
to be doing that to this child once born, if that is what you
do, but in fact the whole reason for conceiving that child is
for the sake of someone else. I do not believe our society should
go down that path of creating children in order to serve the ends
of others.
Q762 Chairman: The Scottish Council
on Human Bioethics has told us that the process of human development
is a continuous one in which any demarcation would be arbitrary.
I want you ethicists to be straight with me, please. Is there
an ethical solution to the status of an embryo? How do you make
that judgment as an ethicist? Do you leave it to the medics or
do you both do it together 50:50, 60:40 or whatever? I have asked
that question for years and never got a straight answer from anybody.
There are people who have given me straight answers but I do not
believe them.
Professor Savulescu: It is true
that development is gradual, but there are significant landmarks
along that journey and at 20 weeks the foetus becomes conscious.
If you want to ask when does life begin in a morally significant
way, one way of answering that question is to ask when does life
end in a morally significant way. As a society we now accept brain
death as the criterion for death and in fact we allow the withdrawal
of life prolonging medical treatment from people who are permanently
unconscious. Tony Bland is the most famous example. Indeed, we
allow the withdrawal of medical treatment from people with severe
brain damage. So if our life ends when our conscious life ends
in a morally significant sense, our life begins in a morally significant
sense when our conscious life begins and that is at around 18
to 20 weeks. That explains why we tolerate early abortion, because
most abortions are before 12 to 14 weeks before the foetus has
any chance of being conscious. That explains our social practices
and it also is consistent with our attitude to the end of life.
That is the simplest answer.
Q763 Chairman: Robin and Alastair,
would you agree with that?
Professor Gill: No, I would not.
Q764 Chairman: Oh, dear! Carry on,
please.
Professor Gill: I have always
worried about that argument from philosophers because it seems
to me it ultimately privileges philosophers themselves. Since
the argument is that consciousness and thinking is the most important
thing about a human being and we know that philosophers are the
best people at thinking and so ultimately the philosophers are
at the top of this tree and at the bottom of the tree are the
people who cannot think and in the middle are one or two people
as well and maybe parrots and things and higher apes more at this
end and so on—
Professor Savulescu: This is not
about thinking, it is just about experiencing simple pleasure
and pain. There will not be any thinking.
Q765 Chairman: I know we are not
going to get consensus from you, but please argue through me.
Professor Gill: We have to take
into consideration not just how that person values themselves
or what they think or what they feel but what other people feel
about them. It makes me extremely uncomfortable if we only value
a person for what goes on inside their head. I think we are also
people in the sense that we interact with other people and we
are loved by other people. I think there is still room for progress
on this. I am sure you do not read Church Times on a regular
basis.
Q766 Mr Key: Yes, I do!
Professor Gill: John Habgood,
the articulator of the gradualist position, this week produced
a very startling article and I would certainly recommend that
to you. It puts very well a case which I think can be shared by
humanists and religious people alike about how we understand the
individual as somebody relating to others but with increasing
respect as life develops.
Q767 Bob Spink: Is not the pragmatic
point here that the foetus or even the embryo is a potential human
being that will become a real human being, that will have needs
and rights and that deserves protection during that very vulnerable
stage before it can shout for itself and that it must look to
society as a whole, ie to the law makers, to give it that protection
and should not that protection be paramount?
Professor Campbell: I think the
potentiality argument has some difficulties in terms of you can
look at all sorts of potentials. For example, every sperm has
the potential to unite with an egg, so the potentiality argument
does not really solve our problem. It is straightforward enough.
Q768 Bob Spink: It is not just a
potentiality argument because that embryo will become a human
being unless something intervenes to prevent that.
Professor Campbell: There are
technical questions here in relation to the very early development
of embryos. I believe that what has been called gradualism is
really the only way to go in terms of getting some kind of consensus
in our society and that is to say, we would be appalled if someone
said human embryos have no risk whatsoever, you can make them
into ornaments, earrings, you can do what you like with them,
you can cook them up for supper. That is appalling on the one
side. On the other side, for the vast majority of people to say
that this collection of cells at that point is the same as a living
child simply is an over-statement. Gradualism—and it is
a gradient, we are not talking about open and closed—is
saying that as we see this increasing development the moral questions
become increasingly serious in relation to what we may or may
not do in relation to it and I think that has to be the basis
for our regulation. Even though people's personal views and religious
views will differ from that, in terms of a basis for regulation
I believe that gradualism is the one.
Q769 Chairman: And it is a consensus
opinion?
Professor Campbell: Yes.
Professor Savulescu: Gradualism
has to be squared with other practices around early human life,
such as the termination of pregnancies, the use of the morning
after pill. So whatever you include in terms of reproduction research
has to be consistent with our gradual suppression in other areas.
The second point is that it does not give us any answer as to
how we should treat a four week embryo, how much respect, in what
way, it does not provide any action.
Q770 Mr McWalter: When Professor
Savulescu said about the centrality of consciousness you disagreed,
but I thought you disagreed by saying that that does not do everything
for us because we still want to treat. Let us take the example
of the dead body. We want to treat a dead body with respect. There
is a way of treating a dead body which is consistent with that
body having been the body of a person. Equally, a conception of
respect clearly applies earlier for the reasons that Professor
Campbell has just given. I think you need a respect principle
which may well have, as it were, gradual tones but also a demarcation
point at which you say this is a recognisable human life, but
that is not the only thing that it is entitled to respect.
Professor Gill: I agree. I think
the respect principle comes in part from respecting that individual
and respecting that individual who other people have loved, that
is important.
Q771 Paul Farrelly: One of the problems
in considering these hotly debated topics in a Committee like
this is that you can talk to libertarians and you can talk to
the extreme pro lifers and nothing you say will actually change
anything in their minds. In this instance, in these hotly contested
areas, the definition of something very much depends on the purpose
to which you are going to put the definition. What prospect do
you think there is for getting a consensus because this is the
only way forward given your libertarian position?
Professor Savulescu: As I have
argued from the moral perspective, the morally significant line
is around 18 to 20 weeks. From a public policy perspective, you
clearly do not want to introduce a law that permits destructive
research on 18 week foetuses. Just as there may be no difference
before birth and after birth in terms of the capacities of the
human infant, we draw a morally significant line for social purposes
at birth. I think it is for you to decide what line at the moment
will be publicly acceptable. Maybe it will be three or four weeks
into development for the purposes of research, but that is a question
I cannot answer, that is where it is necessary to bring other
people on board, I am simply providing the moral framework for
that, and it is a question of what people will accept at this
point in time.
Q772 Chairman: Are there now new
moral grounds to change the 1990 Act and to prohibit embryo research
in your opinion?
Professor Savulescu: Yes, I think
the 1990 Act should be liberalised to allow more experimentation
and also wider use of assisted reproduction for non-traditional
uses.
Q773 Chairman: You mean by chimeras
and things?
Professor Savulescu: I certainly
do not see any moral objection to creating human/non-human chimeras
if those are destroyed early in development for valid scientific
research.
Professor Gill: No, I would not
change it. I am conscious that it represents a sort of truce.
Anybody who does ethics widely in Europe will know that we are
already regarded as dangerously liberal in this country in this
respect. I personally support it. I am on the Stem Cell Bank Steering
Committee. I know that a number of religious people are deeply
opposed to what we do at present but I am not. I think for the
moment we have gone far enough.
Professor Campbell: The Act got
it about right. The 14 day limit is now being adopted elsewhere.
I think we should leave it just where it is.
Q774 Mr Key: This time yesterday
I was involved in a debate on telephone boxes and we were advised
that there was one MP who was conceived in a telephone box. Unfortunately
we were not able to discover who. Perhaps he or she will own up!
Given that people are currently travelling to Spain for eggs and
to Denmark for sperm and given that 1% of all babies born in the
UK are from IVF and that 50% of all babies are conceived by accident
anyway, and given that the most successful IVF treatment is in
Finland, which is totally deregulated, what would be the impact
of deregulation in the United Kingdom or self-regulation by professionals?
In other words, the HFEA would be scrapped.
Professor Savulescu: We know that
in Sydney, Australia there is no regulation. The practices are
essentially the same as Melbourne where they have some of the
most restrictive laws in the world and the first Infertility Treatment
Act 1984. The only difference is there are a handful cases for
sex selection using PGD for family balancing reasons where over
50% of the children born are female. There hardly seems to be
any social disruption in Sydney compared to Melbourne.
Professor Campbell: I disagree
with Julian's conclusion. I am interested in where you got the
statistics, particularly the one about 50% being by accident.
Q775 Mr Key: Previous evidence.
Professor Campbell: I am very
much an advocate of, and indeed involved in, the supervision of
doctoral work and post-doctoral work on the whole question of
harmonisation within Europe. It is a very tricky one in this area.
I think that if the UK just threw in the towel and said we should
just deregulate we would not actually be doing the right thing
in relation to our place within the negotiations that we must
continue to have with our partners in Europe about what would
be a sensible regime in relation to assisted reproduction. We
should hold on to regulation. That does not mean it is a "blunder
bus" or that it is absolutely cast in stone but it does mean
that we should hold on to that in order to negotiate and to achieve
something that will never prevent the "tourism" you
mentioned but, nevertheless, will seek some kind of European consensus.
Q776 Mr Key: Are you talking about
white Anglo-Saxons here as opposed to anybody else in the world,
that we should stick together?
Professor Campbell: Not at all.
Let us not get into Europe and why we are in Europe. The fact
of the matter is that in Europe there are plenty of non-white,
non-Anglo-Saxons and what I am concerned about is really the documents
that come from Europe which are relevant to us, treaties of various
kinds, agreements, some of which we have signed, some of which
we have not. We cannot close our eyes to these. This is part of
a political reality. We should try to ensure the UK is responsible
in relation to that in the final decision about how we regulate.
Professor Savulescu: I do not
understand why you necessarily want to harmonize with Europe.
You want to do what is right and what is right is to allow individual
couples to make their decisions unless there is a serious risk.
The job of regulatory authorities in this area should be in evaluating
serious risks and that is the right thing. You should do the right
thing.
Q777 Paul Farrelly: We have just
been talking about "tourism" by individual couples.
I would like to address the question with respect to professionals,
doctors and people who are regulated and licensed by the HFEA
as well as the medical authorities. To what extent should our
laws here be extra jurisdictional, ie individuals should be punished
or unlicensed for having encouraged or sponsored or funded activity
overseas for which licences would not be granted?
Professor Campbell: I have not
thought about that one. It does come up in other areas like trying
to create a market in organs. This should be explored without
it being too strong, too severe, but that is as far as I can go
on that.
Professor Savulescu: I think it
is a very interesting question. It is like child pornography.
We believe child pornography is wrong so we pursue people no matter
where they perform it. If this is really wrong, we should be pursuing
them and punishing them wherever they do it, but we do not actually
believe it is wrong, that is why we do not do it.
Professor Gill: You used the words
"assisting people" to do this, aiding and abetting in
other words. It does seem to me that there is something important
there because, after all, we have actually started ignoring that—I
think wrongly—in terms of people aiding and abetting people
to commit suicide for example and going abroad to do that. A number
of newspapers have done that and they have not been prosecuted
as a result of that. I cannot think why they have not been. I
do not think we can actually stop people from doing things when
they are abroad, but should we actually be aiding and abetting
people in this country to do that? That seems to me very questionable.
Indeed that seems to me to be what is at the heart of the latest
stories about late term abortions. There is an aiding and abetting
involved in assisting somebody to do something which is not legal
in this country and the assisting is being done in this country.
It seems to me that is clearly wrong.
Q778 Geraldine Smith: Julian, your
views frighten me because I think we need some regulation. It
has been alleged, you can tell me if it is true, that you would
justify aborting children with teeth defects. That frightens me
because I was born with a hole in my heart. You may well think
that a free-for-all is okay but a great deal of people disagree
with you and their views have to be fed into the process, the
Church's views, philosophers, theologians, all sorts of people,
not just people with extreme views such as yourself.
Professor Savulescu: I agree with
you that we need public education. Whether our laws should follow
those opinions as they are now is another question. I have teeth
defects from tetracycline staining. I fully support people's right
to have a termination of pregnancy for teeth defects, for heart
defects, for skeletal defects, for any defects or no defects at
all. Ninety-five per cent of terminations are for normal pregnancies.
I simply fail to understand how one can say that foetuses are
a morally significant being and so we should not abort on the
basis of a tooth defect and yet we allow tens of thousands of
abortions for no abnormality whatsoever. We allow those because
we think that couples or women are best placed to decide when
to have a child or in what circumstances to have a child. If this
couple believes that they cannot give a child with a tooth detect
the best life, why is that any different to a couple saying we
cannot bring a third child into the world at the moment because
we have not got the resources to do it?
Q779 Geraldine Smith: You have also
spoken at a conference of the Royal Society recently on why we
are morally obliged to genetically enhance our children. Can you
explain what you mean by that? Clearly that frightens me.
Professor Savulescu: Most people
accept that we should treat disease and prevent disease. Why is
disease bad? It is not just intrinsically bad. Cancer is bad because
it shortens your life, it shops you interacting with your family,
it stops you achieving your goals, it prevents you living a good
life. There are many other genetics states that will determine
how our lives go. For example, impulse control is highly correlated
with socio-economic success. Your ability to control your impulses
and your anger is going to have a significant impact on how well
your life works. People are familiar with uncontrollable rage.
That can land you in prison. If we think that disease is important
because it makes our lives go worse, why do we think that these
other aspects of how our life goes are not important? If we can
improve those, why should we treat them any differently to disease?
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