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In Vitro Pregnancies

Volume 21: debated on Tuesday 30 March 1982

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Motion made, and Question proposed, That this House do now adjourn.— [Mr. Gummer.]

11.35 pm

Early last month I asked the Prime Minister whether, in view of the development of in vitro pregnancies, she would appoint an interdepartmental interdisciplinary advisory committee, not less than half the membership of which would be women, to report on the social, medical, legal and ethical issues involved. It is a request that I repeat tonight. This, of course, is not simply a second request. In fact, I originally demanded it three and a half years ago, on 26 July 1978—on the morning after the birth of the Oldham baby—in a Statutory Instruments Committee debate that I initiated on the genetic manipulation regulations.

As the record shows, I received a dusty answer from the Department, which at that time was under the control of the right hon. Member for Crosby (Mrs. Williams). Now, suffering the political amnesia which so frequently afflicts members of the Gang of Four, the right hon. Lady attempts to blot out her responsibility for the nation's total lack of preparedness to meet the challenges that test tube baby techniques bring, and, with a rare display of insouciance, she now belatedly calls for a Royal Commission.

In fact, the right hon. Lady's neglect in the past is a major contributory factor to our present confusions where, once again, technology is leaping ahead without the implications for the future of our society being properly understood or thought through by this legislature, entrusted with the task of making the major policy decisions for the nation.

I hope that the Minister's response to my plea will not compound the right hon. Lady's blunder, and I hope that he will not attempt to hide behind the fragmentary and necessarily limited approach of the many diverse bodies now pondering the issues, when so clearly there is a need for this House to be provided with the conclusions of a comprehensive Government-initiated review upon which Parliament can make its decisions.

Let me make it abundantly clear that in initiating this first debate—the first that has ever been held on this issue, such are the priorities in Parliament—I am in no way seeking to follow the deplorable example of the BMA spokesman who recently called for a moratorium on the splendid work being done by Professor Craft of the Royal Free hospital and by Mr. Edwards, Mr. Steptoe and others who have given so much hope to infertile couples yearning for the blessing of parenthood.

Indeed, the dangers of the Government listening on this issue to individuals or bodies, however high their reputation, without attempting to bring the disciplines and varying bodies together, is only too chasteningly illustrated not only by the ill-informed pontificating of the BMA spokesman but even more seriously by the frustrated conservatism of the Medical Research Council, whose bad advice led to no Government funds whatever being given to research for in vitro fertilisation.

Steptoe and Edwards achieved the breakthrough despite—not because of—the Medical Research Council. But by that breakthrough the opportunity, if the Government wish to fund appropriately the NHS, has already arrived for thousands of infertile couples to become families. Unhappily, the number of infertile parents appears to be increasing. Child, the valuable and only registered charity for promoting and raising funds for infertility research, claims that infertility problems are becoming far more widespread; that three years ago infertility affected one in 10 couples; and that now it affects one in six. It claims that some of the reasons for this increase are the result of infections of the fallopian tubes caused, it affirms, by the increased number of abortions, the use of the coil and the widespread use of the pill over a long period.

Certainly, if this reputable charity, which has Professor Craft as one of its trustees, is correct, it appears to be indisputable that infertility problems affect millions, not thousands, of couples in the land.

How lacking in impartiality responses can be to the yearning for children—and how sinister, therefore, a fragmentary approach to dealing with the innovatory techniques now available can be—is illustrated when one contrasts the profound desires of members of Child to have more hospital facilities available to achieve parenthood with the attitudes struck in the recently published report of the working party of the Free Church Federal Council and the British Council of Churches. None could dispute that much of that report is most constructive, but its hesitant, if not churlish, approach to the allocation of more resources being devoted to those wishing to find families that embrace their own children, reveals, given different needs, prejudices and philosophies, how wide the gap can be between groups considering the challenge of in vitro fertilisation.

I concur with those demanding increased NHS facilities. Why should the only hope of many infertile couples in Wales rest on their capacity to afford to come to and remain in London for considerable periods, where there may be a slim chance for them to gain the treatment so sparsely available outside the metropolitan teaching hospitals?

However, the widely different emphases in approach cannot only be shown by listening to the members of Child, eager for parenthood, and then reading this report of the Churches. The Prime Minister responded to my request for a comprehensive Government interdepartmental committee by saying that the Minister was currently awaiting advice from the General Medical Council, the BMA, the Medical Research Council and the Royal College of Obstetricians and Gynaecologists.

Let me bluntly tell the Minister that that procrastinating reply is not good enough, not only because the past record in this matter raises grave doubts about the soundness of advice on this issue from bodies such as the Medical Research Council—because it obtusely appears to be not activating advice from the Royal College of Psychiatrists and the Institute of Psychoanalysis, which may be able to provide guidance from child psychiatrists and child analysts, since the issues that arise affect the destiny of children as well as parents—but fundamentally because it is bizarre to affect that Government and legislator can shrug off their responsibilities by implicitly saying that these developments—benign in many respects, but dangerous in many others—can be left to the doctors.

It is abundantly clear that social, ethical and legal issues arise. If the issue were simply that of harvesting an ovum from a woman, fertilising it in the laboratory with sperm taken from the husband, and implanting the resulting embryo back in the woman's womb, there might be a case for resting the issue upon doctor's advice. However, that is not the challenge facing us, and the Prime Minister should know it.

Let us consider some of the present and potential problems that can arise. First, let none doubt that as the law now stands, a coach and four could be driven through our adoption laws, carefully designed as they are to ensure the long-term welfare of children by surveillance of adoption agencies and rigorous inquiries into the suitability of would-be adopters, and by giving the right to adopted children to have a secure identity by knowing their natural parents. Now, however, an embryo created in vitro, perhaps by strangers to one another, could be sold by an embryo bank and inserted into a woman, who would give birth to a child who would not know who he or she was, from whence he or she sprang, and never perhaps able to gain a confident identity. There is no existing law that makes such practices illegal, and there is no technical reason why that could not happen now.

However, it is not only our adoption laws that could be subverted. Our laws of legitimacy and inheritance could be thrown into confusion, unable to cope with the new phenomenon of someone else's natural child being given birth to by a stranger. Incest laws could be bypassed. The tragedy of Oedipus, the man marrying his mother, looms into view as the ability to freeze embryos develops and the anonymity of donors of ova is maintained. International sperm banks claiming to offer high quality, high intelligence sperm, are—if some reports are to be believed—already in existence. Certainly, no law exists in this country which insists that there should be adequate medical and psychological screening of AID donors, recipient mothers and social fathers, before any attempt at AID commences.

The Church's recent report tells of a new practice beginning to emerge, especially in the United States. A fertile woman, frequently a mother who enjoys the experience of pregnancy but not of parenting, is impregnated with the semen of a man married to an infertile wife. By prior arrangements and for an agreed fee, she hands over the child to the couple after the birth. Currently, no attempt has been made to resolve the ethical and legal problems raised by that practice.

In a recent court decision here in Britain, where a surrogate mother changed her mind and determined to keep the child, the judge described the contract involved as "pernicious". Pernicious it may be, but it certainly is not illegal. If surrogate motherhood is already a possibility, the successful development of in vitro fertilisation now opens the door to womb leasing. Working wives, wanting a child but not wishing to interrupt their working lives for a pregnancy, could engage a woman to lease out her womb to bring to term a foetus which she had no part in producing. There would be no illegality in such a practice.

How long will it be before the lessons in animal husbandry can be applied to human embryos? Cloning could become a reality, not a piece of science fiction. Side by side with the laudable efforts to manipulate the embryo outside the womb so as to master inherited diseases could come a move into a grey area where the temptation to produce a child without blemish would not be resisted and could lead to genetic engineering and the attempted breeding of a new man.

All those awesome issues are matters of which Governments should be seized. Each day new bodies, all non-governmental, all operating separately, each with a legitimate vested interest, are being set up. Today, in The Times, we learnt of a new working party of four set up by the Council for Science and Society under the chairmanship of a professor of moral and social theology to study the issues.

Last week I learnt that the Leverhulme Trust had granted £40,000 to the Society for the Study of Medical Ethics to study the ethics of clinical research. The British Medical Association, the General Medical Council, the Royal College of Obstetricians and Gynaecologists, the Medical Research Council, are all variously at work. The Law Commission will shortly be bringing out its report on the law of legitimatcy and will be compelled to deal with the way AID, and, doubtless, in vitro fertilisation, impinges upon its recommendations.

There is so much activity, but the Government so far remain supine, taking no steps to create the forum into which all those well-intentioned reports—some concluded, some nearly finished, some about to start—could be placed so that an informed consensus can be created and so that the House could take informed decisions that would help the infertile, whilst protecting our society from becoming a victim of its own hubris.

Tonight I hope that we shall learn from the Minister that the Government's mind is not closed to taking the initiative for which I am pleading. That initiative Is dangerously overdue.

11.48 pm

The Under-Secretary of State for Health and Social Security
(Mr. Geoffrey Finsberg)

The House will be grateful to the hon. Member for Pontypool (Mr. Abse) for initiating this debate. The subject certainly raises far-reaching issues.

It may be convenient for the House if I start by setting out some of the technical background. I will leave the words about the right hon. Member for Crosby (Mrs. Williams) on the record, as stated by the hon. Gentleman.

The techniques of in vitro fertilisation and of implantation of a fertilised ovum in the womb have a surprisingly long history. Implantation of a fertilised egg in an animal was achieved as long ago as 1890, at the University of Cambridge—though in that case the fertilisation had occurred by natural means. The next step—fertilisation outside the womb—was first achieved successfully in France in 1954. The extension of these techniques to humans was pioneered by Dr. Robert Edwards—a physiologist at Cambridge—working with Mr. Patrick Steptoe, a surgeon at the Oldham and district general hospital.

By 1970, those researchers had been successful in producing a fertilised human egg. The next stage—implantation back in the womb—is very much more difficult, and it was 1977 before that was achieved with total success. The first baby conceived outside the mother's body was born in Oldham in June of the next year 1978.

The intention behind those experiments was to help women who were unable to conceive because their fallopian tubes were absent or blocked by disease. It is not, of course, a cure for all types of infertility;, and even in those cases where it is the appropriate treatment the success rate is still not very high—at best one in five transferred embryos survives. To date, there have been at least eight successful deliveries in this country, and I understand that the programme at the clinic now run by Mr. Steptoe and Dr. Edwards has resulted in over 100 pregnancies. Only one other group in this country has used the techniques successfully, though there have been nearly 20 births in Australia and a few in other countries.

In these cases, in vitro fertilisation has been used simply as a substitute for normal conception. The egg has been implanted back in the woman who produced it originally, after fertilisation by sperm from her husband. The techniques could equally well be used to implant the fertilised egg in the womb of another woman. That has been achieved in veterinary practice but has not so far been tried with humans. This could be of help to women who cannot themselves carry a pregnancy to term, but who could donate an egg, fertilised by their husbands, to be carried by a "surrogate" mother. Conversely, women carriers of hereditary diseases could become pregnant with a donated egg fertilised by their husband's semen—a kind of mirror image of artificial insemination by donor. The problems that that raises are immediately apparent. A child born in that way would have two identifiable mothers—the genetic mother who provided the egg, and the biological mother who carried the child and gave birth. Clearly there are questions about the relative rights of those two vis-a-vis the child, and I shall return to these later.

There are two other possible developments in this field that have given rise to even greater concern. The first—which has already happened—is the freezing of the embryo after fertilisation, but before implantation. Freezing the embryo allows the time of implantation to be varied so as to give the maximum chance of success. Once again there are obvious problems—to which I will return—about the status of an embryo kept in a frozen state of suspended animation in this way.

The second development—which has even more of an air of science fiction about it—is tile possibility of cloning. This term describes the technique of producing a number of genetically identical embryos. In theory, starting with a single cell, it is possible to produce a number of animals—or humans—that are genetically identical in all respects. I must stress that in the case of humans this is very much a theoretical possibility. Cloning of humans has not yet occurred, nor is it likely to be technically possible for some years. Of course, that does not mean that we should not start thinking about the problems it might cause at this stage. The potential consequences if cloning were possible are enormous, and there is already much literature on the subject.

Speaking personally, I must say that I find it very hard to grasp all the implications of a procedure such as this, and I must stress again that the possibility of this sort of technique still lies a fair way in the future. Beyond that, there are even more extraordinary theoretical possibilities of so-called genetic engineering—actual manipulation of genetic material to eliminate the hereditary defect.

As with so many scientific and technological developments, these possibilities can be of real help to humanity and be of great assistance to couples suffering from the effects of infertility or of a hereditary illness. Equally well, they have their darker side. Once the possibility of manipulation of the act of conception exists, a whole area of possible scientific inquiry opens up—and in this area there are many paths down which some of us, at least, would be most unhappy to see scientists wander. It is this thought perhaps which lies at the back of much of the obvious disquiet in the public at large about the directions in which research is going—and even more about the directions in which it might go.

I have spent some time on the purely technical background because I think it is very important that discussion of this subject should be set firmly in a context of what is occurring and what is not.

To avoid wasteful speculation, the Government felt that the place to begin a consideration of these issues was with the medical profession, which is in the position to comment against a background of detailed knowledge, and which is equally well in a position to provide the background that the rest of us will need. This is not to say that the profession should have the last word, but I think that it is right that it should have the first. For this reason, as the Prime Minister told the hon. Gentleman, officials of my Department wrote to the various medical bodies asking for their views on the issues.

The British Medical Association, the Royal College of Obstetricians and Gynaecologists and the Medical Research Council have indicated that they will let us have their views as soon as possible, though in view of the complexity of the issues involved this may take some while. However, the General Medical Council has written to my Department within the past few days to say that it would not wish to express views on these issues unless it was clear that the medical profession in general considered that it would be useful for the council to give advice. It feels also that the issues arising have not yet been made sufficiently explicit for it to be possible at present for them to give advice.

I emphasise again that we recognise that these are not issues purely for the medical profession. In fact, the chairman of the BMA ethical committee has made just this point himself. The problems involved are very far-reaching and go way beyond purely medical issues. Correspondingly, they must be looked at in a wider arena. Before I turn to what that arena might be, it might be helpful if I elaborated on some of the problems that we see arising.

First, there are what might be called social problems. Perhaps I could start with the problem of the allocation of resources. This is perhaps not the immediate problem that one thinks of in this context, though from a Minister's chair it is sometimes easy to think that this is the most important of all problems. None the less, I think there are very real issues that arise whenever a new—and expensive—development in medicine becomes available

I have already referred to the possibility of children with two mothers—a genetic mother and a biological mother. This raises legal questions, to which I will come in a moment, but it also raises social questions. These problems are not completely new, of course. Analogues already exist in the case of adoption or fostering, or in the case of artificial insemination. What we are dealing with here is not something different in kind. It is, I think, something different in degree. There can be no doubt that there must be a very strong relationship between parents and their genetic offspring—to use an older, and less clinical term,
"flesh of my flesh,
Bone of my bones".
Equally well, there can be few relationships as close as that between a woman and a child that she has carried in her womb and to whom she has given birth. Any possible conflict between these two rights obviously poses extraordinarily difficult problems and ones of a quite new type.

The legal issues, are more technical but they are no less important for that reason. First, there are the immediate questions of the legal rights of the two mothers vis-a-vis their offspring. Here again, there are guidelines in the existing law arising from adoption, but precisely because our common law is rooted in the needs of society a new problem for society must be a new problem for the law. The questions are manifold. If one woman agrees to act as surrogate mother for another, should this be a legally enforceable contract? What happens to the offspring if the surrogate mother changes her mind? What happens to the law of inheritance? What about hereditary titles?

Another group of problems are those arising out of actions for negligence. In recent years, there have been a number of cases of negligence raising novel questions—whether there is a right to sue for damage done in the womb, whether one can claim damages for the fact of being born. The possibility of genetic counselling has raised the possibility of actions for negligence by the child or by its parents when a deformed child is born following counselling. Again, we would not be breaking completely new ground, but I think that there are a number of new permutations and possibilities.

If the whole purpose of in vitro fertilisation is to avoid a particular genetic defect and this is not avoided, is there an action for negligence? What are the responsibilities of technicians dealing with embryos outside the human body, or of those looking after a freezer containing embryos? I do not suggest that existing law does not have answers to these questions. Once the questions are asked in a completely new context, however, we must consider whether answers provided by existing law are always the best.

That brings me to what are perhaps the most difficult questions of all—questions which lie closest to the boundary between law and ethics. I refer, of course, to the responsibilities of a doctor toward an embryo fertilised in vitro. Is there a duty to care for it and to keep it alive? Can it be used for research purposes? If so, up to what point of maturation?

It is clear that these issues involve basic moral questions. Some will no doubt find an answer to these questions more easily than others. I am sure that most people would find difficulty on the cloning of human eggs.

This has the beneficial aim of a child free of genetic defects but may also have more sinister implications. Today is not the time to attempt to answer these questions, but it is clear that finding an answer generally acceptable to the public at large will not be easy.

We appreciate the force of the arguments put forward by the hon. Gentleman for an independent inquiry into these questions. However, we must think carefully about the best form for such an inquiry. As I hope I have made clear, the questions raised are far-reaching and cover a wide variety of subjects. I recognise that these are not matters solely for the medical profession. The inquiry must involve experts from a number of fields. Even more importantly, it must involve those who are not experts. It may well be that an interdepartmental committee might be the best approach, but we wish to consider other possibilities. Both membership and terms of reference need to be right. Moreover, we must consider precisely what role the Government should play in the inquiry.

We are studying these points urgently, and this debate will be helpful to us in these considerations. We are sympathetic to the arguments put forward by the hon. Gentleman. However, at this stage, we would not wish to give a firm commitment to any precise form of inquiry, or to the possible membership.

The hon. Gentleman made a detailed speech and clearly we shall wish to study it. In response, I have equally tried to give him a considered view of the problems which the Government envisage could arise from this issue. Although people have talked about this issue for years, it is still novel. It has thrown up a wide variety of different ideas, concepts and problems that those who drew up our laws could not have envisaged.

I hope that the hon. Gentleman will feel, at the end of this important but brief debate, that he has not been brushed aside, and that the Government understand clearly the problems he has put. Merely rushing to set up a committee, without giving consideration to the problems it might meet and without considering properly what terms of reference were needed so that the answers that emerged were practical and sensible, would not be the right way of proceeding.

I hope that I have convinced the hon. Gentleman that we view this matter seriously and will come to a view on it as soon as possible.

Question put and agreed to.

Adjourned accordingly at three minutes past Twelve o' clock.