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We could have a philosophical debate about what God intended and how much of medical science is playing God and going against what nature
intended. Treatment for erectile dysfunction also interferes with what God intended but we do not hear many men arguing against access to such treatment.
The hon. Member for Windsor (Adam Afriyie) made a good point about the Governments evidence for the removal of donor anonymity. He may know that one of the problems with that is that families who use donors choose not to tell the child because they do not want that to be discovered. That means that fewer children have access to such knowledge. There was no good evidence of harm in the current circumstances or of any benefit from following the suggested path. However, there was good evidence of the threat to gamete supply, which has been affected by donor anonymity. I feel strongly about the use of the precautionary principle, which my hon. Friend the Member for Harrogate and Knaresborough mentioned.
When there is clear evidence of benefit or likely potential benefit, the rule should be that there should be good evidence of serious harm before closing down research options. As the hon. Member for Salisbury said, there is a moral imperative to do good. We should try to maximise the benefits of the treatment. There is a moral imperative to treat infertile women and couples, to conduct research using stem cells to cure disease, and to develop new technologies.
Dr. Harris: There is a question about what constitutes the moral rights of the unborn child and where they come in. We had the debate about the 14-day limit and that on the limit on viability. We are considering those matters. There is a balance to be struck.
The report is not a slippery slope. If there is a slope, it goes upwards. I do not speak for my colleagues, but allowing people to take advantage of the technologies and helping people when there is no evidence of harm constitutes an upward moral slope. In any event, we are not considering a slope but a step. That hard-earned legislative step is considered every 16 years at least. That is why we have confidence in proposing that we go down the path that the report suggests.
Harriet Harman, the Solicitor General, said: This has always been a matter of individual conscience. If something is a free vote it cannot be in a general election campaign... We can debate it later.
The Government rightly acknowledge that they do not have a mandate for the status quo for ever and that they should give Parliament the opportunity, through a review and a debate, either to keep the status quo or to change the law. We must have that opportunity.
Mr. Andrew Lansley (South Cambridgeshire) (Con): I congratulate all those who contributed to the excellent debate. I hope that it greatly improves the understanding of those who have listened to it and those who read it of a range of issues that willI hopecome before the House and that require, as the hon. Member for Norwich, North (Dr. Gibson) said, a great deal of debate,
I thank the hon. Member for Norwich, North and the Committee for the excellent report. I do not have to agree with all of it to realise that it is an important piece of work. As the hon. Member for Harrogate and Knaresborough (Mr. Willis) said, it shows the work of Select Committees at their best. It does not simply hold the Government to account, which is important, but tries to enhance Parliaments role in the discussion and shaping of policy. That is especially apt in circumstances in which the House has responsibility not only to review the law but to make decisions in future about the shape of legislation on the subjecton a free vote.
The hon. Member for Oxford, West and Abingdon (Dr. Harris) mentioned the two important words free vote. Before I venture into the subject of the report, I emphasise that point. Hon. Members who were present during the passage of the Human Fertilisation and Embryology Act 1990 will recall that, two years before the measure was introduced, the Conservative Government said that such issues would be considered on a free vote. So they were. It is one of the Committees recommendations that the Government should make it clear that the passage of any legislation on this matter will be conducted on a free vote basis. That would certainly be true for the Conservatives, among whom there are different views that it is legitimate for any hon. Member to express.
The hon. Member for Harrogate and Knaresborough did a marvellous job of encapsulating many recommendations in a number of key themes. I prepared a set of notes for this debate containing all the issues that I thought we should discuss, but I have discarded them because, in the course of the debate, each of those issues has been raised. That is the mark of an excellent debate that has covered all the necessary ground extremely well. Some might think that it has covered more ground than was desirable, but I believe that we have done the subject real justice.
The hon. Gentleman touched on a matter of considerable importance, namely the procedure involved in taking this subject forward. I also want to emphasise that point before the Minister responds to the debate. On the strength of the consultations that have been carried out, I believe that we have reached a point at which the Government could come forward with proposals. Bearing in mind what happened during the passage of the Human Tissue Act 2004, I believe that the Committee is right to call for pre-legislative scrutiny of any proposed legislation. I hope that the Government will therefore publish a draft Bill for that purpose. I also hope that the Minister will confirm that that process will be conducted on a free vote basis. These are obviously matters for the House as a whole, rather than solely for Front Benchers.
The need for a Select Committee on bioethics merits further discussion. We have discussed a range of issues this afternoon, and there are others, such as surrogacy, that have not been mentioned. The need for discussion on other matters, including the use of gene therapies and genetic research, demonstrates the desirability of having a body of continuing expertise to be developed in the House, on which we could all rely. The Science and Technology Committee has done a marvellous job in producing this report, but we cannot ask it to be responsible for continuously updating Parliaments views on these issues.
We say that we have had no legislation on these issues since 1990, but we have returned to them from time to time. I recall that, when we debated stem cell research four or five years ago, many Members felt as though they were suddenly being asked to consider the matter without having had the opportunity to do so before. The same applies to the issue of abortion, which, as the hon. Member for Oxford, West and Abingdon said, does not get debated if we are not considering legislation on the matter. A Select Committee would offer greater opportunities to debate all these issues.
The hon. Member for Morecambe and Lunesdale (Geraldine Smith) made a powerful case for the need for a debate on abortion. Taking a very different tack, the hon. Member for Islington, South and Finsbury (Emily Thornberry) argued her case on the issue. I want to echo what the hon. Member for Oxford, West and Abingdon said on the issue. We cannot decide here and now whether there is sufficient evidence to justify the view that 24 weeks is too late a pointbased on the viability of a foetusfor abortions to take place except in the most exceptional circumstances. The Committee makes a perfectly reasonable case for that subject to be examined. Although such an examination would not necessarily lead to the introduction of legislation, there are proposals about access to early terminations of pregnancyinvolving a nurse carrying out the procedure, for examplethat might require legislative reform.
My personal view is that it would probably be unwise for that issue to be wrapped up in the reform of the Human Fertilisation and Embryology Act 1990. I would not want hon. Members to have to take a view on the desirability or otherwise of a whole piece of legislation on the ground of their strongly held views on abortion, when the bulk of the legislation ought to be able to proceed without having to deal with that issue. In that respect, it would be helpful if Ministers would make it clear that those issues will be considered separately, and that, if a Committee of the House were to propose options for the reform of the law on abortion, the Government will do as a previous Government did and make parliamentary time available for the House to conclude any such discussions.
My hon. Friend the Member for Congleton (Ann Winterton) took us into the question of the welfare of the child, on which the Committee made a number of recommendations. The way in which the Committee did that was rather curious, because it suggested that the welfare of the child, as currently expressed in the legislation, should be abandoned, but then went on to say that it should still be considered if there were a risk
of significant harm to a child, and that there should be a threshold in such circumstances. I cannot see how a legislative framework that requires third parties to intervene to bring a child into the world cannot consider the welfare of the child.
if the welfare of the child provision is to be retained in any revised legislation it should be based on the principle that the state has a role in determining who can have fertility based on their personal history and circumstances.
We also stated, in relation to medical treatment, that doctors are required to have regard to these issues without an extra layer of regulation. We do not need a specific provision that allows clinics to discriminate, because having regard to the welfare of the child is already embedded in good clinical practice.
Mr. Lansley: I understand that, but unless there is wholesale deregulation of assisted reproductive technologies, those who carry out fertility treatments must take responsibility within a specific regulatory framework. It would send the wrong message if we were to abandon a particular aspect of that framework. If we were to go down a much more deregulatory path, however, the situation might be different.
My hon. Friends the Members for Congleton and for Broxbourne (Mr. Walker) expressed a view that is shared by many people about the best circumstances in which to bring a child into the world. I do not think that we have any doubts about what they said; I hope that we do not. However, when we ask whom we should prevent from having the opportunity to provide a loving home to a child, that is a different question. The argument was put to the Committee that the Human Fertilisation and Embryology Act 1990 was out of kilter with the Adoption and Children Act 2002, but it is not. Under the Adoption and Children Act, social services considering a child for adoption have to consider the childs welfare very carefully, and to decide whether it will be cared for and given a loving home. That is a perfectly reasonable test. The issue is not whether the welfare of the child should be considered in any proposed legislation but whether we should preclude providing artificial reproductive technologies to lesbian or gay couples.
Mr. Walker: Does my hon. Friend agree that the hon. Member for Oxford, West and Abingdon (Dr. Harris) was getting slightly confused when he talked about male erectile dysfunction? This is a serious point. If a man is treated for erectile dysfunction to improve his sex life, that is one thing, and I hope that, if two lesbians were having problems in their sex life, they would receive the necessary treatment. However, we are not talking about erectile dysfunction and sex lives here. We are talking about having children. I think that the hon. Member for Oxford, West and Abingdon was confusing the two issues.
I am grateful to my hon. Friend. We are, of course, talking about children, and about the circumstances in which couples, and in some cases
single people, have access to help to become a parent. From my point of view, a gay couple who go through the process of surrogacy are capable, and in some circumstances entirely capable, of providing a long-term loving home for a child. If a lesbian couple or a single woman wish to have fertility treatmentrather than, for example, donor inseminationthat is a perfectly acceptable way of proceeding. PersonallyI emphasise that I speak entirely personallyI would prefer that, legislatively, we enabled children to be brought into the world to parents who want to give them a loving home, using the welfare of the child as a continuing measure, rather than trying to restrict that. Too few children are being brought into loving homes, and too many are being brought into unhappy homes where they are not loved and not looked after.
The hon. Member for Norwich, North, who should take pride in ownership, with his Committee, of this report, said that he would rather take penalties in the last minute than go through this again. We would all prefer that, as he might succeed. He touched on the whole question of the HFEAs role. I confess that I do not understand why the Committee concluded that the HFEAs tasks of policy interpretation and of inspection and maintenance of standards are necessarily incompatible or subject to a conflict of interest. I think that its understanding of the role that fertility clinics play and of developments in technologyand its interface with clinical practitionersare an essential part of informing policy. I accept his point that by dint of working with 1990 legislation the HFEA must increasingly make policy decisions that were not anticipated in 1990 and which legislators at the time would have expected to be brought back to Parliament for consideration. That is one of the reasons why we must have legislation, which I hope might establish a slightly more flexible structure that allowed Parliament to take more of the policy decisions, a decade or two hence, rather than leaving such matters entirely to the HFEA.
In passing, as the hon. Member for Oxford, West and Abingdon spoke well of HFEA members, let me say that I have been impressed by their work in my dealings with them. I know that the Committee has had criticisms of them, not least in the past. I am grateful for the work that Dame Suzi Leather has done as chairman. She is now moving on, and although I do not necessarily agree with every one of her statements, I think that she has helped tremendously and tackled some difficult issues extremely well in a public context.
My hon. Friends the Members for Salisbury (Robert Key) and for Braintree (Mr. Newmark) touched on the contest between scientific capability and the framework in which it should be exercised. I am not sure that I could ever help my hon. Friend the Member for Salisbury with his question about what heaven might consist of, and I doubt that he was asking my advice on the subject. However, his comments about not stopping science are terribly important, and pre-implementation genetic diagnosis is a good example. We are clear that there are circumstances in which we would not want PGD to be used. For example, would we expect it to be used to try to eliminate a small increased risk of a certain disease later in life? No, I do not think so. In that area, however, the legislation will introduce not broad prohibitions, but a range of criteria, which will have to be determined over time and as science
develops. That is one of the compelling reasons for having an interface between lay and scientific views. As the Committee made clear, however, that interface should not just take place in the HFEA but in a dialogue between the HFEA, the scientific and medical community and Parliament. It is important for that to dialogue to continue.
To echo a point that was implied by my hon. Friend the Member for Braintrees comments, science may continue to change, but science does not drive ethics. As we have in part set out to do, we must make clear not just the ethical framework but the ethical standards that apply to this area of technology. Reproductive cloning is a good example. I cavil slightly at the argument that reproductive cloning technology might have changed in 20 years time, which of course it mighthuman reproductive cloning might even have been achieved in other parts of the world. However, I cannot for the life of me see why this countrys legislative framework should do anything other than say clearly that we are against it and that it will not happen here. I do not subscribe to the view that because science changes, our law must change. On some matters, we must be quite clear. The legislation will contain both broad prohibitions and sets of criteria in certain areas, and we must be clear about the distinction between the two.
The hon. Member for Brighton, Kemptown (Dr. Turner) referred to clearer legislation on sex selection criteria, which is a good example. We must make clear where those boundaries are to be set. The Committee was right that, for instance, the criteria for the use of human-animal chimera, PGD and pre-implantation tissue typing must be set out to a greater degree in the new legislation.
My hon. Friend the Member for Windsor (Adam Afriyie) made an important point about donor anonymity. In Committee, we made precisely that point, and voted against the regulations on those grounds. I am disappointed that the Minister brought forward legislation and whipped it through without a free vote. The Committee noted that, and subsequently discovered that the legislation was drafted on the basis of poor evidence. As a consequence, those providing fertility treatments are suffering.
The hon. Member for Bolton, South-East (Dr. Iddon) made an important comment, which I echo, about the availability of fertility treatments. I declare a sort of interest, although not a personal one. While Louise Brown may have been born in Oldham, the scientific work was undertaken at Bourn Hall clinic in my constituency, and I am vice-chair of the all-party infertility group. Two years ago, the Prime Minister said that the NICE guidelines, especially on the availability of three cycles of IVF, should be achieved, and that the Government would make clear further progress on that. More than two years later, that has not happened. As a consequence, there are still serious inequalities in the availability of treatment. With regard to my constituents, from last September to this spring, my primary care trust stopped making fertility treatments available. It has now started to make them available, but it has limited the number of contracts to 200, which means that fewer couples are gaining access to fertility treatment than are coming on to the waiting list. Some PCTs are setting perverse criteria, such as
not making fertility treatment available until women are 36 years old, whereas the NICE guidelines were designed to optimise the cost-effectiveness of fertility treatments provided through the national health service.
The hon. Member for Bolton, South-East took an admirably utilitarian view of fertility treatments, and said that they contributed to the countrys economy as a whole, which is no doubt true. From my point of view, I just meet couples who want to provide a loving home to children and who, in my view, should be given the opportunity of having their physical impairment remedied by the NHS, as it remedies many other diseases. Infertility is a disease, and it has a big impact on peoples lives. Bringing loved children into a loving home would have an enormously positive impact on those lives, and would do a great deal for society.
Mr. Lansley: My hon. Friend says, from a sedentary position, that it is a condition. Something that causes people considerable distress is a disease, and it can be a consequence of what is clearly a disease. For example, one of the reasons we are fighting chlamydia is that in later life it will lead to an increased incidence of infertility. Members may say that infertility is a subsequent condition arising from a particular disease, but that is splitting hairs, and I do not want to split hairs in this context. We are dealing with couples who want to provide a loving home, and I think that one of our responsibilities as a society is to increase the number of such opportunities..
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