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As president of the Spinal Injuries Association, I can say that it can be very helpful for people who break their necks and backs, many of them young men who may lose their sexual powers and become impotent, to have their sperm taken while it is still fresh and stored so that it can be used when needed. For people
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The loopholes relating to extended storage include the fact that no age is given for the normal limit for childbearing, and therefore there is no line against which to measure "prematurity". A full 10-year extension can be granted on the basis of the person being certified as prematurely infertile on any day within the existing 10-year storage period, and the medical practitioner does not have to certify that they will be prematurely fertile for the whole of the subsequent 10-year period. Only one of the persons whose gametes are used to make an embryo needs to be classified as prematurely infertile or likely to become so. The other person whose gametes made the embryo may be well beyond childbearing age but would still benefit from the extension granted to the partner. For example, a man could potentially be granted a 10-year extension in his sixties or seventies; his wife may be of a similar age but they could still potentially have a child, via surrogacy if necessary. A single medical practitioner simply has to give a written opinion that the person is prematurely infertile or likely to become so on the day they are examined; a full 10-year extension would then be given, subject to the 55-year maximum. The individual medical practitioner determines not only whether the person is infertile, but also prematurity. There are genuine differences of opinion in relation to normal childbearing age, particularly in regard to men.
Treatment would then, in theory, be subject to the "welfare of the child" provision. However, considering that the regulations were drafted to allow young women to give birth to their half-sister or half-brother, where the grandmother would be the real mother, the welfare of the child provision seems rather meaningless. It is unlikely that it would be a sufficient safeguard in the case of elderly people being able to have children.
As this is an ethical matter, it is a pity that no right reverend Prelate will be speaking tonight. I hope, in the interests of future children, that these regulations can be improved and made more acceptable for everyone concerned.
8 pm
Lord Patten: My Lords, I speak as someone who is no scientist, nor a philosopher, nor a jurist, but as a Member of your Lordships' House who senses that we may be looking at an issue that has not been subject to proper parliamentary scrutiny in another place-and, were it not for my noble friend's excellent Motion, would have had no proper scrutiny in your Lordship's House, let alone any full discussion by the general public. It is easy to sneer them away, particularly in the scientific community, but the general public have perfectly proper ethical concerns.
Mine are twofold. First, I instinctively distrust the thought of scrambling the generations-indeed, to use shocking language, I dislike it intensely. However, these points have been very well made by my noble friend Lord Howe from the Front Bench and, if I may say respectfully-to use the argot of the trade-by the noble and learned Baroness, Lady Butler-Sloss, and,
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The scrambling of the generations is a purely utilitarian approach to the problems of humanity. That is my first reason for disliking these regulations. My second, to which I shall speak a little more, is that they also have an equally utilitarian, nay almost casual, disregard for the later welfare of those who have been born in this way. There is absolutely no concern expressed-not by the department, the Government or anyone else from officialdom-for the welfare of these children, once they find out that the person they thought was their mother was also their half-sister, and that the person they have happily been calling Granny, they should actually have been calling Mummy. I do not think that has struck home at all, but it is true.
There is, perhaps, an intention by the Government to prevent children born in this way, by regulation, learning about their background and from whence they have sprung. I am sure that the Minister will, with her characteristic openness, wish to say "Yes" or "No" to the Government's intentions about transparency, and whether they intend to move to prevent a child from knowing that they came as someone who has been born through scrambling of the generations.
Also, the Minister cannot deny that the Government are making absolutely no provision to deal with the seemingly certain emotional distress for children, if they find out that they have been born in that way. I have tried to think about their psychological confusion. If I had suddenly found that out as a teenager, I would have fallen prey to it, just like that, and to the identity crises on stilts that would surely follow-born, as they were, as the result of what seems to be a developing, full-on Eugenics Society policy from the Government.
I have two points with which to conclude, in the interests of time. The Government seem to have given no thought whatever to what to do after creating an open door to the manufacture of genetic backgrounds. Those may indeed be within, first, hitherto legally prohibited degrees of relationship and, secondly, there is the possibility of unhealthy relationships developing within the family. I do not criticise the Minister, as I shall get straight answers to these points, but that is what these regulations do. I really would suggest, with respect to the Minister, that the Government should take these regulations away, think again, allow a proper public debate and bring them back to the House in a more seemly fashion.
Lord Winston: My Lords, I listened with great care to the speech by the noble Earl, Lord Howe. He made quite a complicated speech and I may miss some of the points that he made, for which I apologise. He raises a few issues which it seems rather surprising that he has not raised beforehand. First, however, I was sorry to hear that the noble Lord, Lord Alton, is unwell. We have been adversaries over this issue for a long time, but we are certainly not enemies, and I hope that he is better very quickly.
My first point is that nothing in this particular aspect of the legislation changes the possibility of
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The issue of transgenerational embryos is a tricky one, and I understand and recognise the concern of a number of people who have spoken against such transfers. The problem is that we do not really have evidence-although the noble and learned Baroness, Lady Butler-Sloss, made an impassioned speech on this-that this is necessarily harmful to the welfare of the child, providing that there is no secrecy and that it is done with openness, as it has been in a number of parts of the world. For example, I believe that it was first done in South Africa some 10 or 15 years ago. There is an issue, then, about always keeping this kind of thing under surveillance, but again, that is quite possible without the storage of embryos or sperm. That can always happen, and the storage aspects are irrelevant to this, for they simply mean that you could do that for a longer time afterwards.
The actual problem that we have to contemplate is one that we tried to deal with in discussing the Bill as it went though Parliament; that is, the issue of secrecy. Now, there is something of a misapprehension here about premature fertility. Your Lordships have, perhaps, forgotten that it is possible to be prematurely infertile at the age of six months. It is not just a question of Turner syndrome-although, to the noble Baroness, Lady Knight, I must say God forbid we should not have compassion for the rare cases that, like that syndrome, affect a few children, for they are as deserving of our compassion as anyone else. I accept that it is quite a rare event, but there are many other instances where a child will be made infertile, particularly by deliberate medical treatment.
Increasingly, cancers are treated by heavy radiation or toxic drugs that destroy their gametes, and if those gametes can be stored at the age of two or three-an ideal time biologically, as it turns out-then that is what the 55-year limit protects. You might say that 55 years is a long time, but if you actually think about it logically it is not. Certainly, men of 55 are capable of having another child, and generally still consider that they might wish to.
We are now living at a time that is very different from even 20 years ago. A paper was published in the Lancet two weeks ago by Dr Christensen from Denmark. His paper is a beautiful piece of serious mathematics, which I do not think anybody doubts. It shows that, of the children born in the last decade, more than half will have a life expectancy of greater than 100. Our society is changing and people will work for much longer; it is inevitable. People will have quite different
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What this has done is simply to take a compassionate look at all possible opportunities, with wisdom to the future. It is clearly not going to be a common occurrence. British statistics tell us that very few women over the age of 50-or even 45-request treatment for infertility. There are a few. They are generally, of course, women who are taken very carefully through the process. I am surprised that your Lordships are concerned about the fact this should be a matter for just one doctor's opinion. That, to my mind, does not make sense. As far as I am aware, in legislation, the only times that we require two practitioners are, first, if we are committing somebody after 30 days because they are mentally unfit; and, secondly, for an abortion under the Abortion Act 1967. Medical treatments are not performed with multiple doctors taking decisions. I can say for certain that it is quite possible for five or six doctors who see a patient to misdiagnose premature infertility. I have seen it happen. Mistakes can always be made. Indeed, I have foolishly made that mistake from results after other doctors have made that comment, and then a patient has got pregnant.
I listened carefully to what the noble and learned Baroness, Lady Butler-Sloss, said; she said that this was unnatural. I do not wish to take issue with her because she is one of the wisest Members in the Chamber. However, I have to say that the whole procedure of in vitro fertilisation is unnatural. Taking an antibiotic is unnatural. Medical treatment is not natural. What we try to do with medical treatment is often a compromise; it is an attempt to find something that preserves and maintains the sanctity of life in whatever way we feel is appropriate. The noble Baroness also mentioned-and I fear I have to disagree with her-that there has been no animal research on embryo freezing. There has been, over a long period. Dr David Whittingham, who first froze embryos in the mouse over 30 years ago, regularly took tranches of embryos from that store every five years to examine the changes in them and then transfer them to the mouse uterus. Over 30 years he never found any change in their fertility.
It is perfectly true, as the noble Baroness, Lady Knight, said, that I am concerned about the freezing of eggs. Indeed, I am quite concerned about the freezing of embryos. However, the evidence from my laboratory is nothing to do with long-term storage. Once in liquid nitrogen, the molecules hardly move at all. The changes are, on any scientific basis, bound to be very slight. There may be the most remote risk from background radiation, but Dr Whittingham's experiments did not show any such risk, which is something he tried to elicit. No, the problem with embryo freezing and the reason why I am concerned, particularly about egg freezing, is that the process that we use may cause epigenetic changes immediately in that gamete. That is something that we will have to explore and we need to continue to take under surveillance. This is something,
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8.15 pm
Furthermore, I am puzzled about introducing the issue of switching embryos. The noble Baroness mentioned the noble Baroness, Lady Deech. The switching of embryos can, of course, occur at any time, but I do not think that there is any evidence that the safeguards for long-term storage in proper laboratories, which are regulated by Human Fertilisation and Embryology Authority, are likely to be at any greater risk at any time simply because storage is long-term and staff have changed. Staff change in many in vitro fertilisation units at yearly intervals.
I have to take issue with the noble Lord, Lord Patten. The scientific community cares passionately about ethics. Indeed, if you look at the literature on the ethics of in vitro fertilisation, you will find that the majority of papers which take account of ethical issues have been published by practitioners in the field, often, but not always, after consultation with ethicists.
Finally, even if we decide that longer-term storage is not possible, there is no doubt that there are a number of women who are requesting storage for longer than 10 years at the moment. I get e-mails-very pathetic ones-from women whom I no longer treat, but who have run out of time and whose circumstances would still be appropriate for having a child. Nobody here would doubt that. In cases of donor treatment, they sometimes want to have the same donor as a parent. That is not unreasonable; I know a number of patients who have wanted that. There is a risk that we might destroy that. Our biggest problem, and the concern that we should be addressing, is that when we start to have very punitive legislation, we have seen that, in practice, these patients go overseas. Once they do so, the very problem to which the noble Lord, Lord Patten, referred-the question of secrecy-is much more likely. In fact, if you prevent this practice, you will increase secrecy of parentage-exactly what you do not want to see. I beg noble Lords to think about that if they decide to press a Division on this Motion, which I hope they will not do. Also, the other problem that we are very concerned about is that we know that when women and families go overseas, they are exploited and not cared for as well as they would be under the regulations which Parliament has so wisely enacted in this country.
Baroness Butler-Sloss: My Lords, I wonder whether, under the rules of debate, I might be permitted to make sure that the point I was making was clearly understood. I am looking at the rules of debate and I think I am allowed to do that. Very briefly, I was not criticising the storage or the limit. It was the 55 years of storage that I was concerned about. Having read what the noble Lord, Lord Winston, had said, there has, as far as I know, been no work done beyond 30 years. That was the point that I was making; I think I may have been misunderstood.
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Lord Bates: My Lords, very briefly, I am aware of the time, but there are assurances from the usual channels that we are not limited to an 8.30 pm finish for this debate. I will be very quick indeed. I made some remarks, when these matters were considered previously, about the welfare of the child provision, particularly the importance of considering fathers in that respect. I seek some assurances from the Minister in respect of government policy on the importance of fatherhood in consideration of these matters.
The right honourable Hilary Armstrong, when she was Minister for social exclusion, gave what many of us considered to be an absolutely outstanding speech on 29 June 2006, in which she outlined government policy. She said:
"But government can't do it all, and throughout my career I have seen the critical importance of good parenting. And fathers are as crucial a part of this as mothers. It is an obvious, but profoundly important statement that fathers have a key role to play in caring, loving, guiding and protecting their children. Research from the National Child Development Study has demonstrated that quality involvement-fathers who read for their child, take interest in their education-is closely linked with the absence of behavioural difficulties, greater academic motivation, and greater psychological resilience. The list of positive outcomes goes on and on. In short, fathers matter. And this is why fathers-indeed all parents and caregivers-must be considered as part of the vanguard in our drive against persistent social exclusion".
Furthermore, page 5 of the Engaging Fathers document produced by the Department for Children, Schools and Families states under the heading, "Key research findings":
"What are the gains for children of engaging fathers? Positive father involvement in their children's learning is associated with better educational, social and emotional outcomes for children, including: better examination results, better school attendance and behaviour, less criminality, higher quality of later relationships, better mental health".
Those are government statements of government policy in relation to this.
The welfare of the child provision in the measure that we are discussing does not require clinics to consider the presence or existence of fathers or their active involvement in the welfare of their children. I seek assurances from the Minister that government policy in regard to the importance of fathers still obtains. If that is the case, does she consider that a further strengthening of the welfare element of these regulations is required in order to make that policy as explicit as other members of the Government have made it in the past?
Baroness Barker: My Lords, I thank the noble Earl, Lord Howe, for his Motion, which has precipitated this debate. These matters are so important that it is vital that this House debates them extensively. Therefore, I welcome this evening's debate.
When I looked at these regulations for the first time a couple of weeks ago my initial reaction was that they raised a whole raft of new, very important ethical issues. Having studied them in detail and listened to tonight's debate, I am now not convinced that that is the case. I say that because when noble Lords started to debate the Bill that became the 2008 Act, we had a considerable number of debates about omissions from that Bill. That Bill amended the 1990 Act. The 2008 Act was criticised for not containing a sufficient basis
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I make that point because I listened to the speeches of the noble Lords, Lord Patten and Lord Bates, with great care. Both of them raised important issues but those were extensively debated in this House during the passage of the 2008 Act. We discussed openness about donation and came to the conclusion, after considerable discussion, that that should be encouraged but that it is a decision best made by families. We debated the need for a father extensively and reached a conclusion with which the noble Lord, Lord Bates, disagrees, but none the less represented the view of this House and another place.
This matter has become more important for reasons which have absolutely nothing to do with reproductive medicine but concern developments in other areas of science. For example, survival rates from childhood leukaemia are now considerably higher than they have ever been previously. The noble Lord, Lord Winston, talked about our ageing society. I have a further statistic, which I hope is as engaging as the one he mentioned. It is now reckoned that every day the average life expectancy of an individual increases by 15 minutes, so people are living longer and a considerable number of them will live very long lives. A life span that we now consider represents old age may, in the not too distant future, be viewed as representing middle age. That is the context in which we should consider these regulations.
I understand that when the regulations came before the Merits Committee, noble Lords asked whether records of donated gametes, embryos and donors were not more likely to be lost if the current 10-year period were extended to 55 years, as proposed. I note that the review period remains 10 years. That important fact may have been overlooked. Because of the ending of donor anonymity and the new provision for the creation of human admixed embryos for research, never for implantation in a woman, that was introduced in the 2008 Act, clinics, the HFEA and others are required to have much higher standards of record-keeping than has ever been the case previously. Individual practitioners and clinics face severe penalties if they fail in that regard.
The noble Earl, Lord Howe, referred to intergenerational donation. Noble Lords will have seen the briefing from the Turner Syndrome Society and will have read about some of the cases. We are not talking about people who are being selfish as regards wishing that their children might have a family in due course. Many of those people are taking a very considered and thoughtful approach to the matter. The society cited the example of the lady who did not wish her daughter to be forced to contemplate becoming pregnant at the age of 18 or 19; she wanted her to be able to do that at a later stage, as other young women do when they enter settled relationships. I understand entirely
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As regards removing the upper age limit, I understand entirely the concern that children could be born to old mothers. However, I believe that that issue was first discussed shortly after the birth of Louise Brown, who was born in Boundary Park Hospital, Oldham, and has been discussed ever since then. That is why I think there is no absolute cut-off limit. The matter should be kept under review and is one to which Parliament should return from time to time. We should not forget that the decision to allow somebody to have fertility treatment is always an individual clinical decision, which always includes an assessment of the welfare of the child who will be born as a result. I agree with the noble Earl, Lord Howe, that there is a case for there to be more guidance but I do not believe that these regulations in themselves introduce sufficiently new and substantial ethical issues that they should not be passed by this House.
8.30 pm
Baroness Thornton: My Lords, I am grateful to the noble Earl and other noble Lords for their informed and valuable contributions. I hope I can provide assurance that these regulations put in place the necessary safeguards and that we are taking on board many of the complex issues that have been raised.
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