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I do not think a national bioethics committee should be seen as something which would hinder research or treatment. Nor should it be seen as an either/or. Can we not still have Select Committees? Can we not still have HFEA ethics and law committees? Can we still not have Nuffield committees? Of course we can. By adding the word “national”, however, would we not assist the ethical thinking that everyone in our country should do so that the treatments and the research which our remarkable scientists and medics are undertaking now and will undertake in the future will be seen as being for the common good and for the well-being of individuals and society? If ethical thinking is sidelined, or treated only by those who have an interest in these things, or treated as a matter simply of pragmatism, then trust in research and treatment will decrease and scepticism will set in, which will be to the detriment of science and our society.
In no sense is the creation of a national human bioethics committee outsourcing ethics. I have learnt a huge amount about ethics by being a Member of this House, and this must and will continue here. This is a question not of either/or, but of both/and, and if we do not set up such a commission, we will have missed a great opportunity.
Lord Walton of Detchant: My Lords, I listened with great care to the outstanding opening speech of the noble Baroness, Lady Williams. It was extremely persuasive because I have enormous sympathy with the objectives which she so clearly enunciated in making the case for a national bioethics commission. Like many other noble Lords, however, I have serious reservations about the potential efficacy of such a body. In the course of my professional life, I have been much involved in ethical discussions in a whole series of different fora: as president of the British Medical Association; and subsequently as a member of the standards and ethics committee of the General Medical Council and later as its president.
It is important to recognise not only that we have bodies such as the Human Genetics Commission, the Nuffield Council on Bioethics and the Genetic Interest Group, but that the professional medical bodies themselves play a major role. The British Medical Association regularly publishes and recently updated a substantial booklet entitled Medical Ethics Today. The General Medical Council continually gives advice to the medical profession about ethical issues that have emerged as a result of recent developments not only in medicine but in medical science. The Royal Society, too, has a role in ethical discussions with scientists in the broader sense. The more recently established Academy of Medical Sciences regularly produces significant reports on ethical issues as they affect various situations in medicine.
In 1992-93, I had the privilege of chairing the ad hoc Select Committee on Medical Ethics, which was established in this House. That body was set up simply to examine in detail two important issues. The first was the sanctity of life and whether it was appropriate to change the law on euthanasia and assisted suicide. The issue arose after a number of cases such as that of Tony Bland, the young man who had been crushed in the Hillsborough stadium disaster, and another case in which a doctor had been accused of murder because
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The field of medical ethics is enormous. A human bioethics commission simply could not function with six to eight members, even if you trebled that number to cover the representation that would be demanded not only by ethicists and philosophers but by people of various faiths and of different persuasions in science, medicine and the law. It would be an enormous body if it were to fulfil its task fully and properly. The problems that would emerge would make it almost impossible to deal with the short-term issues to which my noble and right reverend friend Lord Harries of Pentregarth referred, because inevitably in matters of complexity in the medical and scientific-ethical field, it takes many weeks and months to be able to assess the evidence and come up with recommendations.
Although I have all possible sympathy with the proposal, this House has the opportunity to create ad hoc Select Committees to consider crucial ethical issues, and an ad hoc Select Committee, rather than a human bioethics commission, is likely to be the right forum.
Lord Alton of Liverpool: My Lords, when the noble Lord, Lord Brennan, first brought this proposal before the House, I was particularly attracted to it. Indeed, I moved the amendment in his absence in Committee and as a result looked in some detail at some of the situations that applied in other jurisdictions. I could see that its applicability here could have quite a lot of merit, but I also see some of the defects. I was therefore very pleased when I saw that the noble Baroness, Lady Williams, had tabled the amendment again for our consideration today.
We have had a very good debate this afternoon, but some of the arguments that have been introduced should be examined more closely. My noble friend Lord Walton of Detchant referred to the importance of our Select Committee system. I agree. The Select Committee that considered the Assisted Dying for the Terminally Ill Bill and was chaired by the noble and learned Lord, Lord Mackay, and the committee that considered medical ethics in the 1990s and was chaired by the noble Lord, Lord Walton, are very good examples of how this House can continue to inform public debate outside Parliament. Noble Lords will be aware, however, that it is not always easy to establish Select Committees and ad hoc committees.
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I had the recent experience of putting a proposal before the Liaison Committee. The noble Lord, Lord Steel of Aikwood, who is in his place, and the noble Baroness, Lady Finlay, supported that proposal, which I thought was an eminently reasonable proposal to look at a seriously controversial question. However, that committee could not be established because of all the competition from other issues. We sometimes have to accept the practicalities and accept that the sheer pressure of business, not only on bioethical issues but on the many issues that come across people’s desks, means that it will not always be possible to set up ad hoc committees to consider incredibly important questions. Moreover, Bills do not often come before your Lordships’ House on these issues. We last looked at human fertilisation and embryology in 1990. I might say in parenthesis that I am glad that a joint scrutiny committee examined the Bill before it came here and came out against such issues as sex selection, which the noble Baroness, Lady Williams, identified as one of the fragile questions that we may well return to in due course and which is not included in the Bill. Will another 18 years pass before there is another Bill?
As we have heard again and again throughout the debate, the science is extraordinarily fast moving. The noble Lord, Lord Walton, will be aware of an issue that I raised last week when I quoted Professor Yamanaka from a recent New Scientist article in which he looked not at cloning but at the way in which reproductive cells—gametes—could be produced from one person and a new human literally created. The scientific questions to which that possibility gives rise are not the only ones that we want to consider. Professor Yamanaka himself identified the possibility as dangerous and said that there was no regulatory framework to consider it or deal with it. Surely we would want to ponder the social implications for the family, for the individuals concerned, and for the new entities that will be brought into the world—what position they would have and what condition they would be in. We know that this is not science fiction. As the noble and learned Lord will recall, in 1990, during debates in another place in which I took part, the possibility was raised that the way may be open to developments such as human reproductive cloning. The then Secretary of State said that it was not an admissible issue because that was unlikely ever to happen. Yet within 10 years science had changed the rules and terms of the debate, and in 2001 we introduced a full ban on reproductive cloning.
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The noble Baroness, Lady Williams, said that we have always to command wider confidence. I agree entirely. However good the debates may be in your Lordships’ House, however good our Select Committees may be, there is a need to command wider public confidence. Our existing structures are themselves not enough. It was suggested earlier that the Human Fertilisation and Embryology Authority has a difficult role because it is both a regulator and is also at times called upon to take ethical decisions. Alan Doran, the acting chief executive, said as recently as last November at a BioCentre symposium:
“We do not claim to be a national bioethics commission. We are not a body whose primary function is to resolve ethical issues. I do not think the HFEA was set up as an ethics commission”.
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The noble Baroness, Lady Kennedy, said that we all need to be our own ethicists. I agree. However, we need to inform ourselves about these very complex questions and we need a sense of where the issues are proceeding. The public on the whole look to us and to the bodies that we establish to give them some kind of lead and to set out the terms of the debate. That was one of the very good things achieved by the committee chaired by the noble and learned Lord on the issue of assisted dying. It did not seek to come to a conclusion. It clearly was divided on the substantive issues but it set out the arguments on both sides and it allowed not only your Lordships’ House but also the public outside to reach a conclusion.
We have been told that the Nuffield Council could perhaps fill this gap, but it only meets four times a year and, as we heard, is accountable only to its founders. Sometimes we have to uncouple commercial interests from ethical issues. Many of the papers produced by Nuffield are some of the most interesting I have ever read. Nevertheless, its word is not the only one to be had on this issue; it is not definitive. That is why the noble Baroness, Lady O’Neill of Bengarve, was right to say that this should not be the end of the argument. It has been an incredibly valuable discussion today. When the noble Baroness, Lady Williams, comes to reply, I know that she will sum up the debate and suggest a way to proceed. Many colleagues in another place are looking at this question very seriously. I hope they will be able to build on some of the very sensible and eminently productive suggestions that have been made in this debate.
Lord Elton: My Lords, the noble Baroness, Lady Kennedy, rightly reminded us that we are all responsible for our own ethics. It is only when we find it difficult to come to a conclusion that we want some superior authority. Many of your Lordships will remember as clearly as I do that one used to be able to look for that guidance from either the churches or the Royal Society. It is only as the churches and to some extent the Royal Society have lost their authority that we have started to look elsewhere. When you are in doubt as to what to do about an important thing, it is always comfortable to be told by somebody who knows more about it than you do what you should do. All of us in this House are accustomed to receiving that service from our Chief Whips and Front Benches, which leads me to mention very briefly the conversation almost between my noble friend Lord Patten and the noble Baroness, Lady Hollis, about the use of the three-line Whip. It is worth pointing out that the function of a three-line Whip is not to get people to vote against their conscience. It is to get people who have no particular persuasion in an argument to vote with their party and thus increase the numbers in favour of an argument in which they have taken no part.
My real purpose in standing up to detain your Lordships is simply to say that this is such an important issue and so closely touches Parliament that both Houses ought to be involved in any final structure that is set up. We ought to hear the opinion of the other place on this. It is pre-eminently a subject on which your Lordships should put up an idea, the other place should elaborate on it, and then, if it seems fit to both
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Lord Krebs: My Lords, I found much to agree with in the introductory remarks of the noble Baroness, Lady Williams. However, like many others who have spoken, I reach a different conclusion. I do not wish to repeat the very compelling arguments that have been made for the fact that existing bodies to a great degree cover the waterfront. I simply want to expand very briefly on one additional point which has been touched on by both the noble Baroness, Lady Williams, and my noble friend Lord Alton. I refer to the question of public trust and confidence. I speak as someone who had the privilege last year of chairing a working party of the Nuffield Council on Bioethics to produce one of its reports. What struck me when the report was launched last November—a report on the ethics of public health—was the high degree of public confidence as expressed, for example, by the reaction of the media to the work of the Nuffield Council on Bioethics. It is worth reflecting on where public trust and confidence, so essential to any pronouncements in the complex field of human bioethics, come from. There are a number of different strands to public trust and confidence.
First, the Nuffield Council is seen as an independent body. It is not funded by the Government primarily, although it receives some funding from the Medical Research Council. The fact that it is independent of the Government makes it a more trusted body. I speak again from personal experience, having chaired the Food Standards Agency—a government body where it is much harder to persuade the public that one is genuinely independent. Independence is important and I could add parenthetically that the funders—the Nuffield Foundation and the Wellcome Trust—exert absolutely zero pressure on those publishing or producing the reports in terms of the conclusions.
A further strand of the public trust is gained through the Nuffield Council’s working parties. My working party met roughly 10 times a year over two years and those meetings very often engaged a wide range of views. We chose particularly to meet those who had opposing views; for example, on the issue of fluoridation. There were also very wide consultations. The trust comes in part from transparency, openness and inclusiveness.
Why do I mention this? I do so partly to reiterate the point that the waterfront, as has been said, is very well covered by a number of bodies, including the Nuffield Council, but also to make the point that, were a new national bioethics commission to be created as suggested in the amendment, it would have to work very hard over a very long time to earn public trust and confidence. It is not at all clear to me that it would succeed to the extent that existing bodies have succeeded in earning that public trust. That is one of a number of reasons why I feel that the amendment should not be supported.
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Baroness Royall of Blaisdon: My Lords, this has been truly an excellent debate. The amendments address an issue in which noble Lords have expressed a very keen interest, both this evening and in Committee. The wide range of sincerely held views was apparent then and remains so. It is clear that the proposal for a national bioethics commission should be considered alongside the alternative possibility of a parliamentary standing committee on bioethics. It remains the Government’s view that establishing a national human bioethics commission would involve a number of very significant practical difficulties and risks.
The practical difficulties include determining the membership of, and interests represented on, such a wide-ranging commission. There is a likelihood that there would be ongoing and disruptive disputes about representation that would undermine its role and authority. Some of that was made clear in the discussion that we had in Committee. I hear what the noble Baroness, Lady Williams, said about membership, but there must also be a danger that pressure for the commission to accommodate a range of various interests and points of view would lead to it being unwieldy; for example, in the consultation arrangements that it would have to have in place.
The noble Baroness, Lady O’Neill, spoke of the problems relating to remit. There must be concern about a commission with such a wide remit having the right balance of expertise and knowledge to be able to deal effectively with ethical issues on specialist subjects.
The Government considered whether to establish a single commission with a remit covering the entirety of bioethics issues as part of the Department of Health’s review of arm’s-length bodies. As my noble friend Lord Warner informed us, this was rejected, after careful consideration, on the basis that the present distributed model of advisory bodies with more specific briefs remained the best option, as it enables specific bioethical issues to be addressed by dedicated groups. Noble Lords have mentioned the Nuffield Council on Bioethics, the Human Genetics Commission, the BMA Medical Ethics Committee and the National Screening Committee. They have the appropriate expertise and sufficient time to devote to complex issues within their field. Parliamentary Select Committees also play an important role in the current system. My noble friend Lord Turnberg referred to the House of Lords Select Committee chaired by the noble and right reverend Lord, Lord Harries, which looked at stem cell research, and the Select Committee chaired by the noble and learned Lord, Lord Mackay, that looked at the Assisted Dying for the Terminally Ill Bill. The noble Lord, Lord Walton, spoke of the ad hoc committee that he chaired on medical ethics.
The current system means that there is a collective responsibility for bioethical debate, which ensures that ethical discussion is embedded in decisions across all committees. This distributed system of bioethical advice works well. It remains our view that a national human bioethics commission would not bring sufficient benefits in comparison. Indeed, it could lead to ethical issues being marginalised and ignored by committees that are responsible for guidance or policy on any number
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The noble Baroness is also absolutely right about the huge value of debate on bioethical issues in this Chamber, to us as individuals, to Parliament as a whole and to informing the laws that we make. The Government have made clear their view that there is value in the consideration of bioethical issues in Parliament. We said as much in our response to the committee of both Houses that scrutinised the draft version of this Bill, which recommended the establishment of a parliamentary standing committee on bioethics. That would be the most appropriate forum for an accountable and democratic discussion about bioethics, a discussion that would have the necessary influence, as has been mentioned by several noble Lords. We remain of that view, but the decision as to whether to establish a joint bioethics committee of both Houses is for Parliament itself to consider, taking into account in particular the likely composition of such a committee, its remit, and the way in which its relationship with other parliamentary Select and Joint Committees and current ethical bodies would work.
The noble Baroness and the right reverend Prelate made a very persuasive case—but I am rather persuaded by my noble friend Lord Turnberg, the noble Lord, Lord Walton, and others. The Government see merit in a parliamentary standing committee on bioethics but do not see a national human bioethics commission as the way ahead. Like my noble friend Lady Kennedy, I believe that we should all be ethicists. We have our duty as parliamentarians. I therefore invite the noble Baroness to withdraw her amendment.
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Baroness Williams of Crosby: My Lords, I am grateful for a very interesting debate, which in some ways achieves at least one of my objectives—to bring home to this House and another place, as the noble Lord, Lord Elton, rightly suggested, the extraordinary importance of having a mechanism whereby we can follow the advances of science, the issues that are thrown up and the challenges that exist and at the same time try to deal with the issue of retaining public confidence.
Many noble Lords pointed out the difficulties that arise from, for example, the membership of a human bioethics commission. In that respect, the noble Baroness, Lady O’Neill of Engrave was extremely eloquent. On the problems of trying to involve the public more widely, the noble Baroness, Lady Kennedy, used effectively the argument from the Human Genetics Commission, which she headed and which did so much work in getting across to a wider public the concerns that exist. I also know that if there is no mechanism in place, including a mechanism for establishing a parliamentary Joint Committee or committee of this House, what happens under the pressure of work and time is that those things that are not already in the picture and
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There has to be a mechanism—perhaps a parliamentary committee of the kind mentioned by the Minister—that would provide us with the reasons for having regular debates brought to the attention to the House, and beyond it to the attention of the country, on the extraordinary speed of scientific advance. There is no such mechanism at present. There are excellent bodies, which produce very good reports, but they do not oblige the Government to consider the steps that they will take in the light of advances being made. That is the whole point about the fact that the Nuffield Council, and so on, are not in any sense statutory bodies.
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