The recent announcement that scientists have successfully created ‘embryo models’ (sometimes called ‘synthetic’ human embryos) using single living stem cells has caused two debates to be re-joined. One is general about the proper ethical limits to scientific research and how these should be enforced; the second is particular about the proper ethical limits to embryo research and, specifically, the continuing warrant – if any – for the 14-day rule.
This week’s Moral Maze programme, ‘Should science ever be stopped?’, addressed the first question. Some of the discussion was helpful, for instance in exploring whether science is driven by a simple imperative to discern what is true or possible and thus whether all the problems lie downstream in the applications of science. Other parts of the discussion were less illuminating. The question of whether religion and science are incompatible, for example, took on something of the pantomime form of an exchange of assertion and denial: ‘they are’, ‘oh no they’re not’, ‘oh yes they really are’.
On the big picture questions, there are surely some areas of consensus. I think we can all agree that science should be regulated, but that over-regulation is unhelpful. We can all agree that new scientific developments must be placed in context and without over-promising on the benefits for research or for patients. We can agree that we need always to ensure that the public is properly informed about what the new science is and what it portends. We can further agree about the value of proper consultation with an informed public before any significant changes to the law or policy are put in place. We can also probably agree that, in the current climate, such informed, open, and constructive public dialogue may not be politicians' highest priority.
We can agree to disagree over how regulation is managed and by whom. We can agree that we disagree about some fundamental moral issues, and about how best to manage them.
It is when we go beyond these broader areas of agreement that interesting disagreements emerge. This is well illustrated by the second debate provoked by the creation of stem cell-derived embryo models. Again, there are some points of consensus. Synthetic embryos are not embryos, certainly not as the law defines them. As it currently stands, such embryos will not and could not be successfully implanted and lead to pregnancies. Research using such embryos could potentially be of enormous benefit in understanding the ‘black box’ stage of embryological development, thereby reducing the risks of failed pregnancies and increasing better health outcomes for babies.
However, the announcement of the new development generated some unhelpful hyperbole and misleading generalisations. As with any news coverage relating to human reproduction, some commentators will raise concerns about ‘playing God’ and how we can now pass on the gift of human life. Or will speculate about the end of sexual reproduction. But one could argue that we have been ‘playing God’ with medicine by prolonging life and eliminating various causes of death for years. And we have surely grown accustomed to the fact that nearly fifty years on from the birth of Louise Brown, we can help people to have healthy babies using reproductive technologies. As for the death of sexual reproduction claim, one is prompted to paraphrase Mark Twain’s famous rejoinder to his own premature obituary and suggest that the death in question is ‘greatly exaggerated’.
Another assertion made in media reports is that the creation of synthetic embryos is another case of ‘science outrunning ethics’. What might this mean? One thought is that what is scientifically possible lies beyond the scope of regulation. The Guardian report, for instance, says that, ‘The development highlights how rapidly the science in this field has outpaced the law’. But even this is ambiguous. It might mean that the law as it stands cannot regulate what is now possible, because, for instance, synthetic embryos are not embryos as defined in the UK law. Or it might mean that regulation has simply been rendered unable to allow what it clearly should permit. The latter of course needs arguing for.
As for the first, it is hardly news that the law and regulatory measures can be increasingly unfit for purpose as time goes by. Legislators cannot predict what may in the future need to be regulated. Attempts at generally worded statutes or codes of practice are notoriously clumsy measures for anticipating later changes. Indeed, the Human Fertilisation and Embryology Authority has been conducting an exercise, involving public consultation, to determine what parts of the relevant Act need amending to accommodate relevant changes in scientific research and clinical practice. I am a member of the Advisory Group assisting the HFEA in this exercise.
The other meaning of ‘science outrunning ethics’ is not about regulation but ethics. However, if the claim is that what is now scientifically possible cannot be morally evaluated then that is palpably false. The same concepts and moral claims that animated Mary Warnock’s Report on artificial fertilisation and embryo research are still relevant. Essentially, these concern what moral status should be accorded to clumps of cells that might develop into human lives, and what follows from according such status. Warnock said the human embryo has a ‘special’ status, and that this was ‘a matter of fundamental principle which should be enshrined in legislation’. But she would probably have agreed that saying this – even if not the ‘fudge’ some critics allege – did not definitively settle the question of what that meant in practical terms. She certainly conceded later that it makes little moral sense to permit sluicing away something you have called ‘special’.
In effect, Warnock was trying to negotiate moral disagreement within her Committee, and beyond in wider society. She was seeking to make recommendations that both had some moral justification and could be acceptable to as many as possible. This means that her defence of the 14-day rule was not in my view, as argued in a recent blog, ‘a pragmatic compromise’. I think it was, as I argued in a Nuffield Council workshop on that rule, a careful balancing of different considerations, some pragmatic, some scientific and some moral.
These ethical questions are as relevant to the current discussion as they were 40 years ago to Warnock’s understanding of what the proper regulation of the entirely new science of reproductive technology should be. I note the Guardian’s editorial conclusion: ‘Perhaps it’s time for a new panel to convene and find an ethical consensus’. Consensus may not be possible. Judging by some of the participants’ comments on the Moral Maze, it may never be. But if a panel to consider the ethics of this – and any new science that impacts on human health – is the order of the day, the Nuffield Council stands ready, willing, and able.
Hi Dave. Interesting blog post! I wonder how you (a moral philosopher) would deal with the issue of potentiality? If a future embryo model shares the potential to permit a live birth of a healthy child (unclear this will ever happen) with a bona fide embryo (in appropriate circumstances), it would presumably be called an embryo by many, on that basis alone (and they would presumably argue that it should be regulated as such). But does that mean the stem cell(s) from which it was derived – and which therefore in a sense shared that future ‘potential’ (in the appropriate circumstances...) – should have the same moral status? If not, why not?
What if an embryo model has 90% of the required potential (defined by a comparative analysis of its cellular transcriptome, epigenome etc) – do we regulate it proportionately? Does that even make sense? Or should we only attribute moral status (and regulate as such) if the model could (in the right circumstances) yield a live birth i.e. be used for human reproduction? But what of all those bona fide human embryos that cannot be used for reproduction because of their (sub-optimal) biology - they are still embryos, right?
Sorry - too much text! Well done for starting a discussion.
Many thanks Dave. A very helpful blog.
Robin (former Council member)