THE way embryo research and fertility treatment are regulated in the UK is to undergo a radical overhaul. The government announced this week that with reproductive technologies moving rapidly, it is time to make sure that laws keep pace.
Such a move will doubtless seem strange in the US and other countries where reproductive technologies are only lightly regulated. But the tight rein on which these technologies are kept in the UK has led the government鈥檚 watchdog, the Human Fertilisation and Embryology Authority, to become increasingly embroiled in arguments over such issues as whether to allow babies to be created to cure sick siblings. Even the HFEA鈥檚 existence is now up for grabs.
It is the moral challenges these technologies present that make them so controversial. Even as the government announced its review, the HFEA was starting to canvass opinion on whether it should allow embryos to be screened for genetic mutations that cause breast cancer. Answering this apparently innocuous question may force a fundamental switch in how the public regards embryos.
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The technique that makes such screening possible, pre-implantation genetic diagnosis (PGD), is an adjunct to IVF. Embryos created in the clinic are screened genetically, and only those free of certain harmful mutations (or with genes that would benefit a sibling) are implanted into the woman. In the UK, PGD is used only to identify DNA sequences that cause lethal disorders, including cystic fibrosis and Huntington鈥檚 disease, and serious lifelong disorders such as Fragile X.
Screening embryos for mutations in genes such as BRCA1 and BRCA2, which can cause breast cancer, would break new ground in two respects. First, breast cancer is treatable, and survival rates are growing by the year. More importantly, only about 80 per cent of women with these mutations will ever develop the disease. This means that many embryos rejected by PGD could have developed into people able to live full lives free of the disease.
Reactions to the HFEA鈥檚 consultation from pro-life campaigners was predictable. For those who accord embryos the moral status of people, any procedure that leads to embryos being discarded is anathema. Yet many people with different views also feel uneasy when 鈥渉ealthy鈥� embryos are discarded for no purpose.
At the root of this unease is the uncertain status of embryos. While some religious groups see an embryo as a human life, looked at in a cold, rational light they are no more than tiny balls of cells. They can, of course, become a human under the right circumstances, but so can eggs and sperm, and with the advent of cloning so too can skin cells. These cells cannot all merit human status.
The lack of clarity over how embryos should be regarded is reflected in how they are dealt with. In most countries surplus embryos created during IVF are simply discarded. In other words, by accepting IVF society has implicitly decided that embryos are disposable.
Accept this and the decision whether or not to screen embryos for inherited breast cancers becomes a lot easier. If unwanted embryos can be discarded, the test becomes no different from any other preventive measure. Ask prospective parents if they would rather have a child with a predisposition to breast cancer or one without and they would all choose the latter. PGD has the potential to allow couples to make this choice 鈥� and indeed is already doing so in some countries.
鈥淢any embryos rejected by PGD could have developed into people able to live full lives free of breast cancer鈥�
The argument of some pro-life groups that this would be the height of immorality won鈥檛 wash. There is no incipient moral decline here, simply the acceptance that embryos are bundles of a few cells. Society needs to look further than the moral status of embryos when deciding whether, for example, couples may choose their children鈥檚 gender or hair colour.
One group with a major stake in the outcome of this debate is made up of those men and women who have seen mothers and sisters sicken and die of inherited breast cancer, and have no desire to see their daughters go through the same ordeal. It is hard to see what right society has to stop them making use of this technology if they wish to. Women have abortions for all manner of reasons, after all.
This is a compelling argument. But squaring it with the many other dilemmas thrown up by fertility treatment and embryo research to form a cogent ethical framework will be no simple task.
