APPENDIX 59
Memorandum from Professor Len Doyal, University
of London
I am Len Doyal, Professor of Medical Ethics
at Queen Mary, University of London. I have published widely on
moral philosophy in general and ethics and law applied to medicine
in particular.
On a variety of issues, I have been a consultant
to the General Medical Council, the Department of Health, the
Royal Colleges of Surgery and Medicine and the Medical Research
Council. I am a member of the ethics committee of the British
Medical Association (BMA).
1. I would argue that procreative freedom
should be maximised in relation to reproductive technologies and
that with one exception, legal constraints on reproductive choice
should generally be abolished. This includes current constraints
on termination of pregnancy, at least up to 24 weeks. The exception
is the use of reproductive technology to produce rather than to
prevent children who are physically harmed in relation to their
future potential for successful participation in any form of social
life they may wish to choose, including choices that their parents
may not anticipate.
2. Thus, for example, I think that the deliberate
use of IVF to produce children who are deaf or blind (or both!)
should not be allowed and that licensed clinics should be prohibited
from facilitating it or anything like it. For the same reason,
although no other, I would also oppose cloning for reproductive
purposes until its safety is ensured. The corollary of this is
that clinics employing reproductive technology should be allowed
to do anything necessary medically to comply with the wishes of
parents to facilitate the birth of children without physical harm,
even when their birth is intended to help other children or adults
to avoid such harm. The latter case of course assumes that children
born will not be physically harmed as a result of the help that
they give others. There is no good evidence to suggest that such
children would be otherwise harmed in such circumstances.
3. This is not to suggest that children
born through reproductive technology might not face other forms
of foreseeable non-physical harm. For example, children born in
a socio-economic background of poverty and poor education may
also be seriously disabled in their capacity for social participation.
However, this will be no more or less than children who are born
without reproductive technology into the same social environments.
Equally, human history is replete with narratives of adults who
have totally overcome the socio-economic constraints of their
childhoods. So long as the regulation of "normal" birth
is rightly prohibited on the grounds of human rights and civil
liberty, the same should apply to the use of reproductive technology
to constrain parental choice—unless the aim of the intervention
is to produce a child who will be physically harmed.
4. I recognise that parents who, say, wish
a deaf child with the help of IVF and other technology, might
argue that they can now try to have one without such technology.
This is true but in my view when serious physical harm is foreseeable
with certainty and it can be avoided, it should be. I equally
recognise that it may be argued that since children who are not
expected to be physically harmed may overcome socio-economic disadvantage,
such potential children should not be aborted. This statement
is not the place to debate the ethics of abortion. What is relevant
is to underline the fundamental importance of the human right
of women to choose what happens to themselves in the course of
their pregnancies, always remembering that they will probably
remain the best judges of the quality of lives of future children
they choose to terminate.
5. Three consequences follow:
(i) The HFEA (or something like it) should
continue to have two functions: a) to protect the safety of the
use of reproductive technologies by clinics and b) to ensure that
this use is not abused by the deliberate creation of children
who are harmed in terms of their future capacity for successful
social participation and choice of type of such participation.
(ii) The HFEA (or something like it) should
have no further control over the reproductive choices of parents.
They should be regarded as the best judges of when it is best
to have children, and to the degree that it is safe, what kind
of children they should have through the use of reproductive technology.
For example, if they wish to choose the sex of their child then
this should be as acceptable as their choosing that their child
not inherit a genetic disease. It is the parents who must be judged
to have the final decision about so-called positive as well as
negative physical attributes, both on the grounds of civil liberty
and because they will have a better understanding of the psycho-social
environment in which their child will evolve into an adult and
the potential harm to which this environment might lead.
(iii) If the first two consequences are correct,
it follows that any use of reproductive technology should be allowed
that has the goal of adding value—increasing and not decreasing
potential for successful social participation—to the lives
of future children or future adults. Further research into such
uses is essential and should only be regulated to the degree that
other medical research is already successfully regulated. I realize
that such a view presupposes that it is morally acceptable to
sacrifice human embryos with the goal of furthering the physical
health of already existing or potentially existing children and
adults. It would be inappropriate to defend this belief here,
although it should be noted that with some exceptions (eg reproductive
cloning) it appears to be acceptable to the general public.
6. To conclude, therefore, I have argued
that the use of reproductive technology should be broadly deregulated
in ways that optimise the civil liberties of parents, particularly
women. The same goes for research into and employing reproductive
technology, provided that it, like other medical research, is
regulated by the application of the principles of the Helsinki
Declaration. To the degree that continued regulation is justified,
it is to ensure the quality and safety of the delivery of reproductive
technology and that this technology is not deliberately used to
create children who are physically harmed in ways that will foreclose
future types of social participation that they may choose.
October 2005
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