Select Committee on Science and Technology Minutes of Evidence


Examination of Witnesses (Questions 804 - 819)

WEDNESDAY 27 OCTOBER 2004

DR MICHAEL WILKS AND DR VIVIENNE NATHANSON

  Q804  Dr Turner: My apologies to Dr Nathanson and Dr Wilks, our first witnesses, for starting late; we will try and get on as quickly as we possibly can. Welcome to this latest session in our long-running saga of an inquiry into human reproductive technologies. As members of the BMA's Medical Ethics Committee and Professional Activities Director we want to hear your angle on human reproductive technologies. Your evidence mentions five ethical principles implicit in the 1990 HFE Act. Do you think clinicians would be helped if these were explicitly stated?

  Dr Nathanson: Yes, we believe that these principles are very helpful and that if explicitly stated they would actually help the debate about how the rules, the law itself, needs to be interpreted, because very often when individuals are looking at specific, individual cases—and the nature of human fertilisation is that it is about individual cases as well as being about the global body of regulation—then it does help people to interpret and to look at those and to say, "When I am making judgments about whether this person fits within what the law allows or not then the overarching principles help to frame the way in which that consideration is done".

  Dr Wilks: Yes, I agree with that entirely. Obviously the point is that we are here looking at a possible review of an Act that is relatively young, and it is amazing to think how far technology has moved on beyond the initial purposes of the HFEA. So general principles are very important and have to encapsulate possible changes that are completely unknown over probably a relatively short period of time, and I think things like the special status of the embryo and the welfare of the child and access to treatment being based on individual treatment are three very important principles that we think would apply to a great deal of potential future therapeutic and reproductive technologies and treatments.

  Q805  Dr Turner: Technology has moved on very considerably in the last 15 years since the Act was first drawn up as a Bill. During that time other issues have arisen, and if you were setting out a list of basic ethical principles now would you wish to add to that five?

  Dr Nathanson: I think not. I think we would actually say that those five principles encompass the things that it is easy to state as principles. Whether there would be other specific clauses is a different matter but as a set of general principles we think those encompass the background upon which both the legislation and, indeed, the considerations under the legislation are framed.

  Q806  Dr Turner: How would you wish to deal with the issue of reproductive freedom?

  Dr Harris: It seems like a good principle.

  Dr Nathanson: When we are thinking about reproductive freedom we need to consider what we mean by that. Are we saying that individuals have the right to reproduce if they do not need help, and whether because they need medical help we are looking at things differently? We would look at reproductive freedom and say that the state, in general, does not and should not interfere with the decisions people make. However, there is a difference when you are looking at assisted reproductive technology because in these circumstances you are looking at the use of medical and scientific expertise, and the question then is: is it legitimate to interfere with people's freedom or—to put it another way—can people require that this technology be made available to them? We believe that the key issue here is that you are asking doctors and scientists to help create a potential child, but to think about that in terms of looking at each individual case separately and to have a firm focus on the welfare of the child, so we would not want to make a general, very broad prohibition with one or two exceptions—such as reproductive cloning. The point about looking at the welfare of the child and to make decisions when you are talking about the potential for very serious harm to the child rather than only giving people reproductive freedom if they fit some kind of idealised family which we do not think to be appropriate.

  Q807  Dr Turner: How would you frame that in an Act?

  Dr Nathanson: I think it is about the principles which talk about the need to take account of the welfare of the child and to talk about that in terms of not making these global assumptions that there is an idealised family and that only people that fit within that idealised family concept should be allowed access to the technology. That is one of the key issues.

  Q808  Bob Spink: I am going to look at the embryo and research on the embryo, if I may, please. Many people in the public are deeply concerned about the fate and status of embryos, and therefore society, one could say, is deeply concerned about that. Do you think Parliament should reflect that?

  Dr Nathanson: We believe that the current provisions in the legislation on embryo research are appropriate and right. One of the problems with some of the concerns that are expressed is that there is a mixture of both misunderstanding and, also, a concern about what could happen in the future. So I think the key issue here is to have reassurance that the fact is that the law is unlikely to be changed to allow more to be done, to allow research to continue until a much later date. Indeed that medical science continues despite—or indeed perhaps because of—all the developments, makes the 14-day limit that was set entirely appropriate. I think one of the concerns that people have expressed relates to people's perception that perhaps we did not understand enough about embryonic development at the time the law was set. I think we did and the limit was set well below the time at which there was the possibility of pain and so on, which is one of the public's concerns.

  Q809  Bob Spink: We are talking now about very early embryos. Do you think, therefore, there is in principle a difference in status between a one-day old embryo and a 14-day old or 28-day old embryo?

  Dr Nathanson: I think the embryo always has a special status; it is not the same as any other tissue. However, the key factors that were taken into account accepting that special status at the time at which research was allowed seemed to be based upon two things: one was that the research could not be carried out on any other form of tissue to get the medical gains and benefits that were essential and, secondly, that the stage of embryonic development was before the stage at which there was any possibility of pain or of sentience. I think those were both important reassurances for the public.

  Q810  Bob Spink: Do you see any value in redefining the term "embryo", say, to embrace stem cells?

  Dr Wilks: I am not sure necessarily that we would. It is not a thing that we have specifically considered. I think in terms of the place of the embryo, we have in our evidence suggested that the overarching statements on the face of the Bill reflect a special status of the embryo. That then begs the question, what is that special status and how do you define it? Unless you believe deeply—and some people do believe deeply—that life begins at that moment of conception then I think we are forced into some consideration of a sort of graduated series of rights which we have to reflect as duties to that embryo. It is also unsatisfactory[1], I think, that the law gives no legal right to a foetus, but we believe a moral duty is owed to that embryo/foetus. So I think the idea of graduated rights may, to some people, seem a convenience but I think it is a reality in terms of framing legislation. I think, when it comes to stem cells, there are problems in that although we are very interested in the work that may be useful in future stem cell treatment using adult stem cells, nevertheless we are absolutely convinced that the need exists to continue with work on embryonic stem cells. However, that technology is going to vary so much that to frame a right according to an embryonic right, I think, would be very complicated and would probably rapidly become out of date.

  Dr Nathanson: The other part of that question, I think, is whether putting that within this legislation with the revised authority regulating it flows into the same areas of research. For people doing stem cell research it is very often somewhat very different and the question is how is it best to regulate it? I think that we certainly need regulation of stem cell research to get public confidence that it is appropriately controlled, but we have not considered whether it would be appropriate under this legislation. It needs to be clear to everyone how it is regulated and appropriately limited.

  Q811  Bob Spink: You have suggested in your evidence to us that the definition of an embryo should be extended to include cell nuclear replacement embryos. Should we try to define an embryo by its capabilities rather than by the process by which it was formed?

  Dr Nathanson: That is a very tempting suggestion. The question, really, is whether it is possible to find a simple definition that would capture not only all current scientific possibilities but the ones that people speculate might happen within the next 10-15 years, because one assumes that you do not want to change the legislation on a very regular basis. I think that if it were possible to find a definition of embryo that does not actually have to define the scientific or non-scientific method of its creation that would be useful because it might capture all those things that we cannot yet currently specifically pin down as scientific possibilities, but if one cannot find an acceptable phrase for that then we would still commend putting in the concept of cell nuclear replacement because it is so important.

  Q812  Bob Spink: Could I ask you three very quick questions? How should the status of human-animal hybrids or chimeras be resolved?

  Dr Nathanson: I am sorry—in terms of regulation?

  Q813  Bob Spink: Yes.

  Dr Nathanson: That is not something we have considered. It could be under the Human Fertilisation and Embryology Authority but that would be unusual or odd because, again, they are unlikely to be being created in the same types of facilities that are doing work on assisted reproductive technology. So the question is whether this is the best body to be regulating that, or whether we need, along with stem cells, perhaps, a group looking at stem cells which would fit more naturally into that, because it is about the creation of cells, human tissue, not with the intention of producing reproductive ends but for other scientific experimental ends. I would see those two fitting closer together than it does with assisted reproductive technology.

  Q814  Bob Spink: Are there any special or different ethical issues surrounding the creation of human embryos by parthenogenesis?

  Dr Nathanson: I do not think there are any extra special issues.

  Dr Wilks: No.

  Q815  Bob Spink: Finally, then, does the creation of artificial gametes raise any new ethical issues?

  Dr Nathanson: Again, I do not think it raises any new issues that are not considered under the general tenor.

  Bob Spink: Thank you very much.

  Q816  Dr Turner: In your evidence you say that despite the fact that IVF is now a standard medical procedure the current level of regulation should remain in place. Yet your colleagues in the British Fertility Society would argue that that level of constant regulation is unnecessary and that spot regulation to look for trouble spots would be adequate. Do you have a view on this? Why are you more cautious?

  Dr Wilks: I think caution is a good principle when we have uncertainty about the way the technology will take us, both at a research level and at treatment level. Although I think it would be unwise to be too obsessive about the issue of safety at a stage when, of course, clinical trials need to be done to establish the safety of the technology when it becomes a treatment, I think the idea of a kind of spot safety check would actually, probably, be an inadequate level of control.

  Dr Nathanson: The other thing is that we would have concerns about whether there would be sufficient public trust in that, and we have to recognise that there remain people who are cautious about the whole concept of assisted reproductive technology. I think the fact that there is a strong regulatory framework helps to encourage public support for people who would otherwise, perhaps, sit on the fence.

  Q817  Dr Harris: On that basis, if there was a loss of public trust in the medical profession generally, would the BMA argue that professional self-regulation was no longer sufficient and there ought to be external majority lay regulation? In other words, is the principle that you need to maintain public trust and, therefore, have regulation something that you think is extendable to other areas of medical practice or medical practice generally? If not, why do you say it is necessary in this area specifically?

  Dr Nathanson: I think you have to look at every single area separately. We say it in this area for two reasons: one is because we are looking at the human embryo, its special status and people's emotional and other connections with that concept. Secondly, if you like, part of the bargain that was made with society, from the Warnock report onwards through the passage of the legislation, was that this technology would be legislated for and controlled and regulated in a particular way. Moving away from that at a time when there remains some public disquiet would cause us some concern. Having said that, we also recognise that, of course, we are not looking at this on behalf of clinics which are inspected, regulated, visited and so on, so we are not commenting in that sense upon whether that is a tremendous burden on them; we are commenting purely from the point of view of the view we have of the public confidence this helps to support.

  Q818  Dr Turner: IVF is relatively straightforward, yet it is totally regulated, whereas there are other more complex procedures which are outside regulation designed to have the same effect. Do you see any moral or ethical difference?

  Dr Wilks: What sort of procedures are you thinking of?

  Q819  Dr Turner: You know better than me.

  Dr Wilks: I see, within the technology.

  Dr Nathanson: I think that we see advantages in having, in general, the majority of these technologies covered within the legislation, but there is always that fine balance of how much those technologies are innovative, potentially risky, and so on, that you need to balance before including more things into the legislation. We would not want the regulatory system to be so complex and so costly that its effect became to deny access to increasingly safe and common procedures to people who need these procedures. So it is a fine balance.


1   Note by the witness: Dr Michael Wilks has subsequently stated that he should have used the word "strange" rather than "unsatisfactory". Back


 
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