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Mr. Watson: I am afraid that I cannot give the hon. Gentleman that information right now, but I will write to him about it in more detail. On his point about capacity building, I do not recognise his description of the mission as being in some way tougher than we thought it would be; we knew it would be dangerous at the start, but we knew that we had to capacity-build the security forces of the Afghan Government, as I have already said. Perhaps the request coming from theatre to which I alluded in my statement suggests to the hon. Gentleman that we are addressing that point.
Dr. Roberta Blackman-Woods (City of Durham) (Lab): I am grateful for the assurances that my hon. Friend has given this afternoon that the mission is part of the support that is necessary to build the capacity of the new Afghan state and the new Parliament and—crucially for us in the Chamber—to support the parliamentarians as they seek to build democratic institutions throughout the whole of Afghanistan. Is it not important that the Minister’s Department should do everything that it can to argue that, despite the difficulties and the terrible loss of life that we are experiencing, we must stay to see through reconstruction and a viable Afghan state? Is it not important that all Members of the House support that position?
Mr. Watson: Yes, is the short answer to my hon. Friend, but let me give two quick answers. First, she is right that our presence has allowed the first democratically elected Afghan Government for many decades to be put in place, and secondly, our goal now is to make sure that their authority can be enhanced and improved.
Adam Price (Carmarthen, East and Dinefwr) (PC): There are increasing reports of large-scale civilian casualties resulting from US air strikes in southern Afghanistan. What discussions has the Minister had with his US counterpart, as whatever the short-term military advantage that flows from taking out Taliban fighters embedded in civilian areas, the resultant loss of civilian life has potentially a corrosive effect on local sympathy and support, and could make the already difficult task of the British forces on the ground nigh-on impossible?
Mr. Watson: We talk to our American colleagues regularly about these issues, but the Taliban and the drug traffickers are killing people—innocent civilians—every day in Afghanistan, as a result of their terrorist aims, and until we can give the Afghan Government the capacity to deal with that, we have to be there.
Mr. Edward Garnier (Harborough) (Con): My hon. Friend the Member for Mid-Norfolk (Mr. Simpson) mentioned the numbers of Foreign Office and other civilian Government staff working in Afghanistan. I understand that they will only travel outside their offices in armoured Warrior vehicles. Given the absence of adequate air cover at the moment, should not those Warrior vehicles be reserved for the Army on the ground, so that they can get the full benefit of them?
Mr. Watson: The way in which such people travel varies in different parts of Afghanistan, but our advice from the Chiefs of Staff is that our capacity is appropriate for current circumstances.
Mr. Andrew Robathan (Blaby) (Con): Several hon. Members have spoken about the mission. Soldiers understand that it is absolutely essential that one has a clarity of mission, which all energies are devoted to fulfilling, yet the Minister has spoken about narcotics, the economy, the Government and all sorts of things. What exactly, succinctly and clearly, is the mission that our soldiers are pursuing, and to which their energies should be devoted?
Mr. Watson: This seems to be round 2 of the defence debate the other week and I know that the hon. Gentleman does not give his support to our Chiefs of Staff, but they tell us that our mission objectives are clear and that they will be met.
Several hon. Members rose—
Mr. Speaker: Order. May I tell the hon. Member for West Bromwich, West (Mr. Bailey) that he should stand up to try to catch my eye from the start of the statement, to give me an indication of who wants to speak?
Sir Nicholas Winterton (Macclesfield) (Con): Will the Minister admit that the lives of everyone in our armed services—men or women—in Afghanistan and Helmand province are very valuable indeed? Will he therefore perhaps go a little further in indicating that all the equipment that is required by our armed forces to ensure that their lives are put in as safe a situation as possible will be provided? In the light of the additional opposition to our personnel in Helmand province—this is along the lines of the question asked by my right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith)—is it not right that the original mission should be reviewed?
Mr. Watson: The hon. Gentleman always stands up for our services, and I commend him for that. When the Chiefs of Staff put a request to Ministers, we always take them seriously. If we get any request in these circumstances, his point will be well made and we will take it on board.
Several hon. Members rose—
Mr. Speaker: Order.
NEW MEMBER
The following Member took and subscribed the Oath:
Robert Neill Esq., for Bromley and Chislehurst
ESTIMATES DAY
estimates 2006-07
Department of Health
[Relevant documents: Fifth report from the Science and Technology Committee, Session 2004-05, HC7, on Human reproductive Technologies and the Law and the Government’s response thereto, Cm 6641; Eighth Special Report from the Science and Technology Committee, Session 2004-05, HC 491, on the Inquiry into Human Reproductive Technologies and the Law; the Department of Health departmental report 2005, Cm 6524.]
This Estimate is to be considered in so far as it relates to a grant-in-aid to the Human Fertilisation and Embryology Authority (Resolution of 27 June).
Motion made, and Question proposed,
That, for the year ending with 31st March 2007, for expenditure by the Department of Health—
(1) further resources, not exceeding £37,417,520,000, be authorised for use as set out in HC 1035,
(2) a further sum, not exceeding £38,276,451,000, be granted to Her Majesty out of the Consolidated Fund to meet the costs as so set out, and
(3) limits as so set out be set on appropriations in aid.— [Liz Blackman.]
4.9 pm
Mr. Phil Willis (Harrogate and Knaresborough) (LD): I welcome the opportunity to debate this important and topical issue on the Floor of the House. I once again pay tribute to the former Chairman of the Science and Technology Committee, the hon. Member for Norwich, North (Dr. Gibson), and members of the previous Committee on producing an extremely thorough and thoughtful report shortly before the 2005 general election.
Few areas of medical and social policy command greater interest or promote greater controversy than research and clinical practice in the area of human reproductive technologies. Producing the report was in itself a considerable challenge. It is no secret that at least half the membership of the Committee disagreed with the report. Well, some people disagreed with it, and it was a real challenge to agree on a final report to bring before the House. That reflects the divisions not only in the Committee but in society on these issues. There would have been something strange about an all-party Committee that did not have significant disagreements on this subject.
In spite of the difficulties in arriving at a consensus, the Committee was right to tackle the question. It is surely the job of Parliament to lead debate and not to shy away from key issues of public concern, however divisive they may prove to be. I would argue that this is a good example of the Select Committee system in operation: not simply scrutinising but helping to influence policy.
The
Committee’s inquiry began in late 2003. They began because the
Committee had serious concerns about the Human Fertilisation and
Embryology Authority. The Government said that they would keep the HFEA
under review. The Science and Technology Committee thought that that was
not good enough. The Chairman said that the HFEA should be reconnected
with the 1990 legislation. That was one of the reasons behind the
inquiry. A year later, in 2004, the Department of Health announced its
own review of the Human Fertilisation and Embryology Act 1990. The
Department sensibly waited for the Committee to produce its report
before issuing a consultation alongside its response in August
2005.
The results of the consultation were published in March of this year, and further announcements are promised for the summer. The Government should be commended for the way in which they have responded to the Committee’s work. However, after a lengthy period of consultation—it is well over a year now—I think that the time has come for the Government to come forward with firm proposals, and, I hope, to produce a Bill in draft form.
A Bill is required anyhow to facilitate the creation of the new regulatory authority for tissue and embryos—RATE—from the Human Fertilisation and Embryology Authority and the Human Tissue Authority, which the Government have pledged to do by 2008. I commend to the Minister a draft Bill which would give the House an opportunity to debate and scrutinise some of the recommendations that will emerge from the Government’s consultation. I hope that today’s debate, and the Minister’s appearance before the Science and Technology Committee next week, will stimulate some decision making on the role of the new authority and related issues.
Before tackling some of the more controversial aspects of the Committee’s report, I shall outline the boundaries of the debate. I shall do so by stressing areas of agreement on the fundamental issues, which are unlikely to change. Both the Government and the Committee agreed with the gradualist approach to the status of the embryo adopted by the original Warnock Committee. I acknowledge that there are those who may disagree with this approach. However, I do not think that there is any realistic chance of it being dropped now for the purpose of legislation—so I think that we must start with the premise of the gradualist approach.
I think that there is general agreement that assisted reproduction is a legitimate area of interest for the state. It is only the extent of that interest that is in question. That in vitro fertilisation is now a common clinical procedure is not in question. The Government agree that legislation should take account of consequent changes in public perception, and that is what the debate is all about. The question is: how far are we prepared to accept assisted reproduction being regulated like other medical procedures, and what additional safeguards are required to protect the human embryo and the future child?
Other points on which the Government agree with the Committee are that there is a need for greater clarity in the policy-making functions of HFEA, and that legislation covering abortion should be removed from the Human Fertilisation and Embryology Act. I will return to that point later. The Government also agree with the Committee that there is a need for some rationalisation of existing bodies. These areas of broad agreement provide a solid foundation for debate on other matters of principle, such as the extent and nature of Government intervention in reproductive health.
There are, of course, areas of disagreement. That is not surprising. The Committee made 104 recommendations. It is interesting that the Government rejected very few of them outright. Indeed, rather than do so, the Government chose instead to consult more widely to gauge professional and public opinion. Not surprisingly, there was disagreement over the Government’s use of the precautionary principle. I am rather pleased that my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) is not here to make a speech. He is delayed and has sent his apologies to the House. We have just spent a considerable amount of time discussing the precautionary principle in a new inquiry, and we have not come to any sensible conclusion. The hon. Member for Braintree (Mr. Newmark) nods from a sedentary position. The Committee’s recommendation to include the Human Genetics Commission in the new regulatory body was a rationalisation too far for the Government, but I am sure that the hon. Member for Norwich, North would like to take up that issue later, because it was a fundamental proposal in the Committee’s report.
My hon. Friend the Member for Oxford, West and Abingdon is in Committee at the moment and there was a vote at 4 o’clock, which is why he is delayed. I know that he has given his apologies to Members—in case there was some concern over his health.
The Government disagreed with the Committee’s argument that there was a mismatch between the protection afforded by legislation to an embryo created in vitro before implantation and one at a later stage of development. The Committee was pointing out that allowing the greater use of pre-implantation genetic diagnosis, or PGD, may mean that the demand for abortions falls—particularly in the case of abortion on the grounds of foetal sex, which is technically illegal but difficult to police. Perhaps the greatest area of disagreement was over the future role of Parliament in regulation. I will return to that a little later.
Andrew Selous (South-West Bedfordshire) (Con): Does the hon. Gentleman agree that Parliament should not do anything to deny any child the possibility at birth of growing up with both a mother and a father?
Mr. Willis: The Committee made it absolutely clear that it is important for children to be brought up in a loving environment. A significant number of children are brought up in incredibly abusive and unhappy environments. I would not wish to speculate on a child being brought up in a single household, but I agree with the hon. Gentleman in that, where possible, my personal view is that I would like there to be two parents—a male and female—within the household bringing a child up. That does not preclude other methods of rearing, which are perfectly satisfactory and which have proved to be helpful in terms of developing good human beings as far as society is concerned. I will return to that issue later.
On many of the
key issues, the Government agreed to consult further. The results of
that exercise were published in March 2006 as a summary of the views
expressed, with no accompanying explanation of lessons drawn. I am
looking forward to hearing from the Minister how helpful the exercise
was, although if my interpretation of the volume of the published
responses—there were 535—is correct, it would be fair
to say that a variety of views were expressed. It was very difficult to
draw firm conclusions, but perhaps the Minister will add her comments
later.
Judging from the views expressed in Committee, I suggest that the extent of disagreement was never in doubt. However, disagreement should not be an excuse for inaction. Sooner or later the Government must take a view and convince Parliament and the public of the merits of their proposals. There were issues of concern to members of the Committee, and I am sure that right hon. and hon. Members will highlight their own, so I will not attempt to raise anything other than what I consider to be one or two crucial areas, for which Government proposals must be forthcoming.
First is the issue of sex selection for social reasons, which is highly contentious. I am sure that hon. Members on both sides of the House will have different views about it. The Committee could find no adequate justification for prohibiting the use of sex selection for family balancing, but sensibly called for further work to establish the demographic input of such a policy. The HFEA has also consulted on the issue and advised against it. The Government invited views but announced no plans to change their position.
I confess that the Government might be right on this occasion, and that such a policy might well give rise to unforeseen difficulties, so I would want to see convincing evidence of the potential impact before being convinced of the need for change. I suspect that the demand for sex selection is actually quite low—much lower than many hon. Members believe. We should not forget that it currently requires people to go through incredibly difficult and costly treatments to get a child. However, we have to plan for a time when there is a pill that destroys male sperm or ensures that a male embryo could not implant, so the Government need to be clear about how they would prevent sex selection, and they cannot dodge the issue in any draft Bill, or when they bring their conclusions from the consultation before the House.
A second area of contention between the Committee and the Government surrounds the welfare of the child provision in the Human Fertilisation and Embryology Act 1990. The Committee argued that the requirement for those providing fertility treatment to have regard for the welfare of the child, including the need for a father, was unjustified. It held that the provision was not only discriminatory towards the infertile and some sections of society, but that it was
“impossible to implement and...of questionable practical value in protecting the interests of children born as a result of assisted reproduction.”
Quite apart from the difficulty of interpreting what the welfare of the child means in practice, I cannot see a case for the state interfering in the reproductive decisions of parents because they happen to be infertile, when it makes no such attempt in respect of anyone else. For example, there is no welfare of the child provision for other fertility treatment such as vasectomy reversal. So, if the Government are committed to maintaining a welfare of the child provision, I hope that they are prepared to spell out exactly how it should be applied in practice. I look forward to hearing the Government’s latest thinking on what is, admittedly, a very difficult issue.
A third area is the allowable use of pre-implantation genetic diagnosis—PGD—and this needs serious clarification. At present, it is the responsibility of the HFEA, but paragraph 251 of the Committee’s report describes the authority’s policies and licensing decisions on pre-implantation tissue typing as “highly unsatisfactory”. Lord Winston, I suspect, used more graphic language. Certainly, no evidence was produced by the HFEA to support its claim that PGD would be used for “trivial” purposes, and the fact that the Government have agreed that it would be preferable if the parameters for PGD were more clearly set out in law is a tacit admission that the Committee was right.
For many, PGD provides a welcome opportunity for parents to reduce or eliminate the risks of passing on hereditary conditions and diseases such as Duchenne muscular dystrophy, Huntington’s and cystic fibrosis. The Committee argued in line with the gradualist approach that if an embryo is to be destroyed because it may carry a serious disease, it is better to do so when it is just a few days old than at 24 weeks. However, I fully accept that those who believe that all abortion is illegal and wrong would not subscribe to that view.
The crucial point to emphasise is that new technologies are developing quickly and, as a consequence, the HFEA is being required to take decisions with an ethnical dimension and with serious consequences. For example, the HFEA recently ruled that PGD could be extended to testing for certain types of cancer, and only last month we heard about a new technique developed at Guy’s and St. Thomas’ hospital in London that may enable thousands of diseases to be screened for as existing tests are improved significantly. The key change is that whereas the original PGD screening was for known diseases or hereditary conditions, the new screening is for possible development of conditions later in life, and that requires a substantially different approach from the present one.
Geraldine Smith (Morecambe and Lunesdale) (Lab): If we are not careful, could not such screening become the ultimate form of discrimination against people with disabilities—denying them the chance to be born?
Mr. Willis: I have enormous sympathy with that point. I spent much of my professional life working with children who had sensory impairment and physical disabilities. All of them were precious to their parents, despite the fact that many had huge problems in managing their condition. However, I suspect that many of those parents, if they had had the opportunity to screen out some of those difficulties, would have done so. The question that the Committee rightly asked, and that the Government have to answer, is: should parents in that situation have the choice? We hope that the Government will adopt a fair position on that question.
Geraldine
Smith: Is the hon. Gentleman not concerned? Once we start
down that slippery slope, where does it all end? I am sure that parents
would much rather have a very intelligent child. Many would hate to
have a child who grows up to be a politician. They might want a child
with blue eyes. That is getting into the realm of
eugenics—producing the perfect child
that the parent wants. I do not want a world that has no one with any
sort of disability, because such people have all been screened out and
denied the chance to live.
Mr. Willis: Few hon. Members would disagree with the hon. Lady. I would go further and say that what we have seen in parts of the United States, where deformities, in particular deafness, have been screened in because the parents want their child to mirror their own condition, is absolutely horrendous.
Science is getting to the point where we have an amazing number of techniques and can do amazing things, but at that point we have to stop and to ask, “Is this what we want?” The Committee was right to ask some of the questions and it was right to say to the Government that we simply cannot let such matters drift on. The Government are there to make some of those decisions. The Committee’s recommendation about a bioethics committee is relevant. The hon. Lady is correct: not everyone is comfortable with the new possibilities or with the fact that it is the HFEA, which has only limited input from professional ethicists, that is taking those decisions. That worries me. In my view that is the job of Parliament—but I know that many people would disagree.
The new treatments bring their own ethical dilemmas. The value or rights of an embryo have to be weighed against the potential benefits of avoiding certain conditions; equally, the impact of such activity on existing people with such conditions must be taken into account. Although there are arguments over what diseases and conditions are serious enough to warrant screening, there is a more fundamental argument about who should make those decisions. The Committee argued that Parliament should set the ethical parameters for the use of PGD and other such procedures, and that regulators should then be responsible for ensuring the highest possible clinical standards.
I fundamentally agree with that position. Parliament, rather than unelected regulators, should have responsibility for establishing the ethical framework for the use of PGD and other procedures and for endorsing guidelines as necessary. The Committee proposes a new parliamentary Standing Committee on bioethics that would make recommendations on the need for legislative changes and scrutinise any secondary legislation in the field. Such a system has been adopted throughout Europe and I commend the principle to the Minister for serious consideration.
Of course, such an approach to bioethics would necessitate changes to the existing regulatory framework, which is a fourth area of contention between the Committee and the Government. The Committee recommended a three-pronged approach on a new regulatory framework to give greater clarity to existing legislation and thus allow medical professionals to get on with their jobs without the bureaucratic burden of frequent applications to the regulators.
The
Committee’s call for a new human genetics, fertility and human
tissue commission to replace the HFEA, the Human Tissue Authority and
the Human Genetics Commission appears to have been rejected in favour
of a model that combines the HFEA with the HTA. That body will retain
the HFEA’s licensing
responsibility, although that is a matter about which the Committee was
critical. I hope that the House will debate the two sides of that
argument today.
My final point is about abortion time limits. Paragraph 308 of the Committee’s report recommended that a Joint Committee of both Houses should be established
“to consider the scientific, medical and social changes in relation to abortion that have taken place since 1967, with a view to presenting options for new legislation.”
It is more than 15 years since the legislation was last reviewed by Parliament. We now know a lot more about the foetus and have gained more evidence about the factors underpinning the 24-week limit. There is growing pressure from those on both sides of the abortion debate to look again at developments since 1990 to determine whether a change to the existing legislation is warranted.
Early-day motion 2379 was tabled by the hon. Member for Morecambe and Lunesdale (Geraldine Smith) in support of that, and it had been signed by59 Members at the last count. Its signatories have all viewpoints; indeed, I signed it myself. The head of the Catholic Church, Cardinal Cormac Murphy-O’Connor, has recently called for the time limit to be reviewed. All that shows that there is a feeling in the House and the country that we should at least review the scientific evidence and put it before the House, rather than simply pretending that things are as they were in 1990—or, indeed, 1967.
Geraldine Smith: Does the hon. Gentleman agree that the matter goes much wider than just the Catholic Church? There is a feeling among people in the country and MPs that a debate should take place. The Government should be leading the debate and putting legislation before us.
Mr. Willis: I agree that the matter goes much further than the Catholic Church. I am not a practising Catholic and do not come from that particular lobby, although I have a strong Christian background. However, this is not about religion. When I become Chairman of the Science and Technology Committee, one of the first things that we did was to ask the House of Lords to fulfil the recommendation of the former Committee by setting up a Joint Committee to review the science and determine where we were on that.
Dr. Brian Iddon (Bolton, South-East) (Lab): Does the hon. Gentleman think that there is any new science—and science alone—that would require the issue to be brought back to the House?
Mr.
Willis: With the greatest respect to the hon. Gentleman, I
do not know the answer to that. Does the fact that we now have better
imaging of the foetus at24 weeks represent a substantial
change from the situation 10 or 20 years ago? Of course, people
such as Lord Winston claim that the foetus is exactly the same at 24
weeks as it was 20, 30, or 40 years ago. However, medical technology,
and our ability to maintain life at 24 weeks, have changed. The purpose
of having an inquiry was to examine such matters and to try to ensure
that we put on the table the question of where
the science and technology were, and how we could tackle the key ethical
questions so that Parliament could debate and discuss that and the
Government could take action, if necessary. That is what Parliament
should be
doing.
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