APPENDIX 60
Memorandum from Professor Alastair V Campbell,
Centre for Ethics in Medicine
I wish to make quite a brief submission to the
Committee, drawing attention to what seems to me quite crucial
ethical concerns in any proposed revisions of the Act.
1. The UK is in a very fortunate position
in having such an Act, and in having, as a consequence, the Human
Fertilisation and Embryology Authority. I have been fully involved
in debates in the EU on ethical issues in reproductive medicine,
and in particular (as a member of the CMO's Expert Advisory Group
on Stem Cell Research) I have been engaged in international debates
about uses of embryonic stem cells and cell nuclear replacement
("therapeutic cloning"). In this highly contentious
area, the existence of a regulatory authority is crucial in maintaining
a balance between extreme views on both sides. It would be a serious
loss to the quality of debate and decision making in the UK if
there were no such body.
2. In my opinion, the area of Assisted Human
Reproduction (AHR) has to be treated separately from general considerations
about reproduction and parenthood. I do not subscribe to the views
of some bioethicists that, in the interests of justice, we should
not interfere in the choices of those seeking AHR in any way.
I base my opinion on the following points:
(a) There are medical risk factors associated
with the techniques of AHR (for both mother and offspring), which
require careful oversight and regulation.
(b) In all medically assisted AHR (not DIY
instances) issues of professional responsibility arise. In these
cases reproduction ceases to be a purely private matter between
partners and is appropriately a concern of the state, as well
as of the profession. Special duties arise in relation to protection
of the vulnerable (both mothers and children).
(c) In those cases of AHR in which a third
party is involved (gamete and embryo donation), questions about
the welfare of the child are especially relevant. The existence
of other biological parents creates greater vulnerability for
the child, and may also result in "family secrets",
which when revealed later can cause much distress. For this reason,
an analogy with adoption, though not perfect, certainly holds
some relevance (especially as regards identification of donors).
In light of the above, I believe strongly that
it is not unjust to treat people seeking AHR differently from
those who conceive naturally. The issue is not whether there should
be regulation, but whether the regulation is applied in a justified
way and with the right criteria.
3. A philosophical argument often used to
counter the "welfare of the child" justification for
regulating AHR is as follows: Except in exceptional cases of truly
tragic existence, being alive (even if that life carries some
deficits) is always preferable to not being alive at all. Advocates
of this position use this argument to oppose most, if not all,
regulation of AHR, such as selection of potential parents. This
argument is mistaken and it should be rejected, when considering
appropriate regulation. As I have argued before, when the state
and the professions are involved in parenting decisions (as they
are in AHR and adoption), there is an obligation to avoid harm
wherever possible. By preventing a pregnancy through regulation,
no child is harmed (unless we believe in pre-existing souls!).
Refusing to select parents could result in complicity in clear
harms to children, eg AHR for known child abusers. The only ethical
issue is what criteria should be employed. Here again, the analogy
with adoption is useful. I accept that the area of predictable
harm to children is an uncertain one empirically, but this does
not mean that we can abrogate responsibility to try to avoid it.
4. In addition to defending the welfare
principle, I have argued elsewhere that we should view children
as gifts, not as products. On this basis, I argue against conceptions
(and pregnancies using PND (pre-natal diagnosis) or PGD (pre-implantation
genetic diagnosis), when these are based on social reasons (gender,
height, intelligence, physical appearance, etc). These are all
examples of treating the child, not as a person in her own right,
but as a product, designed by parental wishes. For the same reason,
I am opposed to the creation of children as sources of therapy
for others ("saviour siblings"). While it is accepted
that parents will often use natural means to try to produce the
child of their dreams, I do not believe that the state and the
medical profession should be collusive in this consumerist approach
to children.
5. Finally, I wish to draw the Committee's
attention to the continuing danger of commercialisation in AHR.
I believe that we should oppose all sale of gametes and embryos
(in line with the opposition to sale of other human tissue in
the Human Tissue Bill currently before the Lords). I draw particular
attention to the commercialisation of surrogacy and the continued
lack of proper regulation in this field. It is now six years since
the Brazier Report produced its recommendations for a new Surrogacy
Act. I was a member of that group, with Professor Brazier and
Professor Susan Golombok. The main concern that we raised was
the fiction of "expenses" in current arrangements, and
the total lack of protection for all parties, including the offspring.
I hope that the Committee will include surrogacy in its considerations.
I am aware that this paper makes its points
somewhat briefly and without lengthy argument. I have sent copies
of two of my publications which develop more fully some of the
points I have made.
October 2004
References
Brazier, M, Campbell, A, Golombok, S. (1998)
Surrogacy: Report of the Review Team Cm4068.
Campbell, AV (2000) Surrogacy, Rights and Duties:
A Partial Commentary. Health Care Analysis 8:35-40.
Campbell, AV (2002) Reproductive Medicine: the
ethical issues in the twenty-first century. Human Fertility,
5 Supplement, S33-S36.
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