Robert
Key: I strongly endorse the comments of the hon. Member
for Bolton, South-East. I served on the Select Committee to which he
referred in the last Parliament. The inquiry into human reproductive
technologies and the law visited both Sweden and Italy and met their
national bioethics committees. In Italy I was quickly aware that the
committee was not what it seemed—seemed to me, anyhow. I think
that I recall, for example, that there was only one woman on the
committee, which reflected the political reality of Italian democracy,
but convinced me that it was not a satisfactory way of proceeding in
this country. I also recall that when the Joint Committee scrutinised
the Bill last summer and produced our report, the Government listened.
The Government took us seriously. They gave the Bill a new title and
binned a huge chunk of their proposals. That surely shows the virtue of
such a Committee. I commend the Government for listening to
Parliament. Both
Houses of Parliament are, de facto, the national bioethics committee of
this country. We should be jealous of that. It would not be possible to
create another body, independent of Parliament, that would have
anything like the authority that we have, with the authority of
democratically elected Members, representing
every constituency in the country, together with the authority of the
men and women in another place, who have come there via a variety of
routes, which may evolve in the future. However, we have a de facto
national bioethics commission in Parliament itself. We now need to find
how to establish a new Joint Committee, which would be a Standing
Committee, like the Joint Committee on Human Rights or some such body,
which would sit for the duration of a Parliament and would be made up
of members nominated, as they are for existing Joint Committees, by the
Leaders of both
Houses. At
the other end of the spectrum, I endorse what the hon. Member for
Bolton, South-East said about local medical ethics committees. I do not
think that members of the public generally realise that in every
hospital or clinical research establishment there is a local ethics
committee which considers all the factors as they are legislated for
and played out in their local communities and establishments. They are
extraordinarily influential bodies, and they are localised to a degree
that makes them credible to our constituents at a local
level.
That is the
approach that we ought to take in future. We should not rely on the
setting up of a joint Committee for the pre-legislative scrutiny of a
particular bit of legislation; we should have a permanent Standing
Committee of both Houses to deal with such bioethical issues, which
will only get more complicated and arise more frequently. It will not
be another 18 years before more legislation. Mark my words,
Mr. Hood: we will be back within 10, maybe five years,
because something else will have happened. Medical technology and
science will have moved forward so fast that once again Parliament will
have to catch up. The voice of Parliament should set the ethical and
moral framework and the regulatory authority should decide on
individual cases within it. That is the way we should be going, and
that is why I strongly support the new
clause. Dr.
Ian Gibson (Norwich, North) (Lab): I, too, support the new
clause. I do not think that there will be any problem with the Nuffield
Council on Bioethics, which has done lots of work that I shall explain
in a minute. It is quite independent, is financed independently and
does fine
work. In
the Joint Committee, while we were discussing the Bill, high-octane
meetings were held with people from the Lords and the
Commons—everyone who had some ethical view about
everything—and it was good to have the opportunity to talk about
things. There was nothing more tendentious than the need for a father.
That evoked some heavy stuff, and there was a lot of disagreement on
both sides, but it was important to have that debate. We have never had
such a debate properly in Select Committees and so on, because there
just ain’t time. We need a place to discuss those
issues. I
could say lots about bioethics. It is the fastest growing profession in
the medical world at the moment. People are suddenly realising more and
more that biology and the biological sciences are developing new
technologies and ideas that will have to be considered in terms of
society—not just this society but other societies, such as in
the developing world and so on. I think that such a Committee would
have a lot to say. Some of the things that it would look at include
genetic screening and age discrimination. When do we start and stop
breast screening? Do doctors behave differently depending on the age of
the patient in front of them? I think that I know, but I will not say it
here. A lot of discrimination goes on. There are also ethical and legal
issues involving human tissue that we have discussed here, such as
animal-to-human transplants or xeno-transplantation—the odd bit
of pig appears in people’s aortas during some
treatments—mental disorders and so
on. The
Chairman: Order. As we are getting to the end of the
Committee, I ask the hon. Gentleman to stay in order when addressing
the
Committee.
Dr.
Gibson: Then, of course, there are stem cells and so on,
and pharmacogenetics—it is almost a continual process—and
the DNA database. There has never been a more important arena. More and
more information is being brought to our notice. We need a place where
people can contemplate and think about those issues and build them into
hard science and medicine. I am glad to support the idea of a joint
bioethics Committee in this
place.
Dr.
Pugh: I warmed to the proposal when it was mentioned on
Second Reading, but since then, scepticism has grown on me. I accept
that the remit should be wider than defined in the new clause and that
the HFEA, the Nuffield Council or whoever do not actually do the jobs
envisaged by those who tabled the new clause. Most ethical committees,
as I understand them, are basically endowed with a set of principles
that they apply with respect to a certain group of professionals. What
I think that we are asking for, implicitly, is a bioethics commission,
parliamentary or otherwise, to formulate a set of principles to take us
out of the moral mire that we are in.
Generally,
ethics is a tricky business. I have spent a lot of my life studying it
from the philosophical point of view. There is no agreement about what
it is or how ethical disputes should be resolved, even where consensus
has arisen. For example, in the Warnock report, Baroness Warnock states
clearly that she applied utilitarian principles to resolve the moral
dilemmas. But if we are not utilitarians, we would simply not buy into
that in the first place. There is nothing blindingly obvious with the
moral consensus that we have at present, but there might be a pious
hope that we can have a bioethics group and, through that, a consensus
or solution from a group of moral experts who will just tell us what
framework we need to work
within. The
existence of moral experts has been a matter of debate since the time
of Plato and it is still yet to be
resolved.
Dr.
Gibson: He is not here at the
moment. 2.30
pm
Dr.
Pugh: No, he is not, nor is anyone who we can be assured
knows what is good and what is right. A group of moral experts does not
get Members of Parliament off any moral hoof of thinking ethically
ourselves. If we think of the committee as a mechanism for reflecting
ethical opinion, encouraging ethical debate or ensuring that decisions
are made in an ethnically informed way as opposed to
pragmatically—I take on board the comment made by the hon.
Member for Norwich, North about scientists not being pure—we
would have a modest committee that could do a useful job.
However, our
difficulty, which no committee can resolve in connection with the
legislation, is that we are not working within a clear, ethical
framework. There is no clear ethical thread binding all the various
moral decisions that are made in the context of the Bill. That is not
only my view. I read the evidence presented to committees on draft
legislation and the remarks of Professor Haldane and others, and that
is exactly what they picked up. There is a series of ad hoc commissions
and things that we believe are right on balance, and a series of
case-by-case arguments, but if we went for the position that we wanted
in respect of the Mental Health Bill and said, “Here is a piece
of legislation but, before we get into the detail, let us put in the
Bill the moral principles that will guide us”, and explained why
we made various decisions in the clauses, we would be in serious
difficulty. We would be incapable of taking such action, and many
people who reported on the draft legislation said precisely
that. A
bioethics committee that is prepared to fill a modest role might have a
place in the mix. However, what we shall not achieve—and perhaps
what hon. Members are hoping for—is a cast of modern Solomons.
We might reach the position when people know why they are making such
decisions, as a result of which ethical rationale would be laid out
with greater clarity, but we would not achieve wholesale agreement on
what is right unless—this is the fear of some people—we
rig the committee in such a way that it would be guaranteed
consensus. In
the past, many of the debates on ethnical committees have been about
whether they are set up fairly or whether the balance is such that the
democratic verdict goes in one direction rather than another. I do not
know how that can be resolved. A great deal of hard work has to be
done. On the assumption that we have something that adds grist to the
mill—that adds something to the general picture and informs the
decisions of Parliament—there would be nothing wrong with it,
but it will not take us out of our current bind of making hard, moral
decisions for all time on particular
issues.
Dr.
Harris: I declare an interest as a member of the British
Medical Association medical ethics committee. The hon. Member for
Salisbury mentioned local ethics committees. He is right; they are well
developed in research ethics. I was a member of one of those committees
for many years. They are moving on apace in respect of clinical ethics
in
hospitals. I
was on the same visit to Sweden and Italy to which the hon. Gentleman
referred, and the system was not ideal. I support the thrust of the new
clause, but I want to put it in the context of the Select
Committee’s recommendation on human reproductive technologies
and the law in 2005. The hon. Member for Bolton, South-East read out a
recommendation. We argued that the HFEA’s policy-making aspects
and the Human Genetics Commission could be combined usefully in one
commission that would advise a standing parliamentary
committee.
The problem
with the HFEA’s current policy-making role, as some people see
it, is at least twofold. First, because primary and secondary
legislation can cover only a certain number of things, the HFEA is
called
upon currently and will be called upon under the Bill to develop policy
in areas where there is not regulation and where it has discretion. The
HFEA does its best to do that; I am not arguing that it has not done a
good job, but because it does not have any of the
“antis”, arguably there is not the same degree of debate
in its policy-making committee, as opposed to its consultations, that
we have here in Parliament. The second
problem is that, as a result of that lack of debate and the fact that
the HFEA makes policy in sensitive areas, it is liable to be criticised
by politicians. That is the nature of things; politicians criticise
those whom we have set up and given the power to make decisions for us.
Perhaps that is unfair, given that we have voted for a measure that
gives the HFEA discretion to make policy. There was one occasion when
the Science and Technology Committee criticised the HFEA for making a
decision about pre-implantation genetic diagnosis. The Committee was
provoked into doing that partly by the combative performance of the
former chair of the HFEA, now Baroness Deech, my constituent. She is a
woman whom I greatly respect, but she was quite combative and there was
a critical report, which I thought was unfair because the HFEA was only
doing what it had been asked to do in the 1990 Act—to make
policy.
To avoid that
problem, one could have the best aspects of the HFEA’s
policy-making function combined with the Human Genetics Commission. It
is hard to see a distinction between those two, and indeed, the Human
Genetics Commission provided evidence and a view on hybrid embryos
during the HFEA’s consultation. The best elements of those could
be combined into a committee or commission that gives advice—a
Standing Committee of Parliament. Such a Committee would have the
advantages of being in Parliament. It would also, because of the way in
which such things work, be able to capture all the strands of opinion,
so that those, for example, who were not supportive of embryo research
would not be excluded from policy development, which the HFEA has to
deal with.
For those
reasons, the Science and Technology Committee of 2005 was right in its
report to say that the policy-making functions could be taken away from
the HFEA, which could then concentrate on regulation and inspection,
but that that was worth doing only in the context of a parliamentary
Standing Committee. For the reasons that have been given in the debate
already, there are huge advantages in creating such a
Committee.
What would be
the powers of such a Committee? Another Select Committee making
recommendations mainly to the Government, which the Government felt
they had a mandate to accept or reject as they saw fit would not be
ideal. That is why a model like the Joint Committee on Human Rights is
a good one. In its reports, the Joint Committee on Human Rights does
not simply make recommendations to Government and other organisations
as other Select Committees do; it gives specific advice to Parliament
on human rights issues. In that sense, it goes beyond the normal role
of a Select Committee and both Houses can choose to accept or reject
its
advice. The
second merit of the Joint Committee on Human Rights is that it was set
up by statute. I do not know what advice the hon. Member for Bolton,
South-East received, but it may not be possible within the scope of the
Bill to give a Committee statutory functions. The
Joint Committee on Human Rights does have statutory functions in respect
of declarations of incompatibility by the European Court. The fact that
it is statutory gives it authority; the fact that it is joint gives it
authority, and the fact that it is a Standing Committee gives it
authority, as well as the confidence and the staff to produce useful
reports. We saw in the debates in this House yesterday and the day
before that the Joint Committee on Human Rights has now gone further.
Where a majority agree with a recommendation, members of the Committee
are tabling amendments not in the name of the Committee but which
reflect the recommendations of the Committee. The primary function of
that Committee, other than its statutory one, is legislative scrutiny
from a human rights perspective. There are
significant merits in the idea of a parliamentary ethics committee. It
would enable Parliament to visit these issues on a more structured
basis and far more regularly than we otherwise do. I do not share the
confidence of the hon. Member for Salisbury that we will be back in
five years with another Bill. I think that he is right that science
will progress quickly in the next five years—perhaps even in the
field of IV-derived gametes, but I will not open that up again. Science
will move on, but I suspect that we will not be able to come back in
the next five years, or even 10 years. However, a parliamentary
Standing Committee with authority—even without statutory
powers—would put pressure on the Government of the day to enable
a free vote to take place, even if it had to make majority decisions. I
think that my hon. Friend the Member for Southport was right to say
that there would never be unanimity, which would probably be unhealthy,
on some of these fundamental issues. They are generally free vote
issues so it is difficult for parties to seek a mandate at a general
election and say, “This is what we are going to do”,
because the matter would be subject to a free vote—rightly, in
my opinion—which requires that the Government do something. It
is quite difficult to do that, for reasons of the parliamentary
timetable, the pressure of legislation and that such measures contain
yuck factors, which Governments run a mile from. It is to the
Minister’s credit that she has not run as fast as some Ministers
might have, from taking on the issues. I am sure that she enjoyed the
prospect of dealing with the
Bill. I
do not think that we are in a moral mire. If we are, I think that we
are climbing out of it with measures such as the new clause. There is a
clear basis for establishing such a Standing Committee. Its remit
should be wider than simply embryology. I accept the point made by the
hon. Member for Norwich, North that it might have been difficult to
raise the issue within the scope of the Bill if the Committee proposed
in the amendment had not been restricted to embryology. If this is a
probing amendment, I hope that the Minister is listening and will come
back with a proposal that has the support of a number of Select
Committees. I echo the view of the hon. Member for Salisbury that not
only did the Joint Committee that considered the Bill do good work, as
did the Science and Technology Committee on the hybrids issue, but that
it was good that the Government listened and changed their position.
They were not accused of a U-turn, but were applauded for
listening—I repeat that. I pay tribute to all the members of the
Joint Committee, especially the Chairman, my hon. Friend the Member for
Harrogate and Knaresborough (Mr. Willis), for his
work.
Although I
understand that the new clause is probing, I would like to associate
myself strongly with the thinking behind it. I hope that we see
something like the Committee that the hon. Gentleman proposes, to give
Parliament the ability to debate emerging ethical issues
transparently—so that the public can see us debating
it—and with some effect
.
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