TUESDAY 26 JUNE 2007
PROFESSOR RAANAN GILLON, PROFESSOR SØREN HOLM AND PROFESSOR JOHN HALDANE
Chairman: We come to our second panel this afternoon. Again, gentlemen, I do apologise to you for being late on this afternoon, but I think you will appreciate that the Committee is trying to grapple with a number of very, very complex issues and it is important that we try to give justice to them. Our second evidence session, for the record, is Professor Raanan Gillon, who is Emeritus Professor of Medical Ethics, Imperial College London, Professor SØren Holm of Cardiff Law School, and Professor John Haldane, Professor of Philosophy and Director for the Centre for Ethics, Philosophy and Public Affairs in the University of St. Andrews. So we have England, Scotland and Wales before us, so if we cannot achieve something this afternoon then we will have miserably failed.
Robert Key: And Denmark actually, Chairman!
Q805 Chairman: And Denmark, yes. If I could start by saying that we have heard a lot about the place of ethics within the decisions and place within the Bill, and could I start by asking you, Professor Gillon, whether in fact a National Bioethics Committee would help resolve these issues both now and in the future?
Professor Gillon: I think it is a good idea myself but there are plenty of arguments against it and the country so far has been, as Ian Kennedy has indicated, very reluctant to have one; so it has a sort of de facto one in the Nuffield Council on Bioethics. But it seems to me to be quite useful, provided that the Committee represented a very broad range of ethical perspectives because within some universal norms there is enormous ability to come to different conclusions when those norms conflict.
Q806 Chairman: When you look at the Bill as it stands do you feel that it is underpinned by a strong ethical framework, or is it a very legalistic framework, which is updating the 1990 Act?
Professor Gillon: Definitely the second. I do not think there is a strong ethical framework within the Bill and I think that is a pity, and in trying to reflect on how one might insert an ethical framework I personally am committed to a very simple ethical framework that I will bore the others with, and they the so-called four principles that I think could be widely acceptable in terms of respect for people's autonomy, beneficence, helping others, not harming others, and justice, and it seems to me that that ethical framework is quite a useful one trans-nationally. I know that there is a lot of opposition to that these days too, different turf wars going on in ethics, but there is an UNESCO universal declaration on bioethics and human rights and it seems to me that one way forward it might be quite useful to look at that and if you prove it—and it seems to be quite difficult to disprove it, myself—to build that in, as it were, as an ethical underpinning to the way forward. But it does exclude one crucial issue, and that is the moral status of the embryo, which really runs through the ethical problems of all these discussions. It talks about human life and like all these international declarations it does not say what is meant by human life, allows the possibility of abortion while respecting human life, and I think that is the fundamental ethical problem that is not addressed in that declaration or indeed elsewhere.
Q807 Chairman: Professor Haldane, those two basic questions: do you think that we actually needs an Ethics Commission to be able to advise on this, and do you feel that there is a strong ethical framework underpinning the Bill?
Professor Haldane: Beginning with the second of those, no, I think it is clear that this draft legislation has a history and that history is one of a high degree of uncertainty under conditions of enormous change and so on, and people are trying, as best they can, to fabricate legislation that will deal with the whole array of issues, but not within the framework of a systematic understanding of what the basic ethical principles and values might be that should aggregate all of that. That fact alone, it seems to me, would argue the case for having statutory provision for a National Bioethics Committee whose remit would be much larger than the embryological and tissue questions that are before us. Relevant to that, if I may say, I spent the first part of last week in Moscow and the second part in Rome and the first of those visits was to the Russian Academy of Sciences and the second was speaking to a congress of European professors. In the second of those there were parliamentarians present and others with relevant interest. There is within Europe a very high degree of surprise that this type of legislation is being proceeded with in circumstances in which there is no National Bioethics Committee. For example, I have spoken with members of the Italian Bioethics Committee in Rome and with others elsewhere and legislators are also surprised at the absence of this in Britai—At least one minister of a Central European country, now a member of the EU, was remarking on how surprising it was that legislators felt themselves confident, to be dealing with these very large and difficult questions. So it seems to me the case for a Bioethics Committee is really pretty much overwhelming and has been for quite some while. Professor Gillon referred to there not being support for it in the country, or opposition perhaps in the country, but as far as I am aware the only significant opposition is from the Department of Health, and this goes back at least 25 years. It was in the early 1980s when the idea of a Bioehics Committee was first proposed. The Medical Research Council supported it, the British Medical Association are all for it, and, as, was mentioned, the Nuffield Council was a response to the recognition that government was not going to do anything about it. It was blocked within the Department of Health. The most recent call for a National Bioethics Committee, with which I was in fact associated in drafting a proposal it, which was taken to the Prime Minister who responded by saying he would be interested to see this. But when it went to the Department of Health, again, the response was no thank you.
Q808 Chairman: Professor Holm.
Professor Holm: I think the answer to your first question on the ethical framework depends on what you think of when you think of an ethical framework because in this Bill and previous ones they do not explain what ethical considerations you have to put in place. But in another sense, of course, there is an ethical framework, there is a possible implied view of the moral status of the embryo, and at least the legislation means that there are certainly views of the embryo that this legislation and the previous one does not reflect. So in that sense it has an ethical framework but does not have a framework for how you should think about the ethical issues that are going to arise in the future. With regard to a National Bioethics Committee, having been a member of the Danish one and now being a member of the Nuffield Council, on ethics I am probably biased in believing that these kinds of things are good things. But I think it has to be a committee which has reasonably broad scope and it should not be introduced because there is a perceived problem with reproductive medicine or the Human Fertilisation and Embryology Authority; it should be introduced because there is a real need for having some more public discussion about ethically contentious and difficult issues.
Q809 Chairman: But basically you agreed that it would be probably a sound principle?
Professor Holm: Yes.
Chairman: I just slightly challenge you on the 1990 Act not being underpinned by an ethical framework because could I suggest that Baroness Warnock provided that ethical framework, which has perhaps stood us in good stead for some 17 years, but I will leave that in the air.
Q810 Baroness Deech: Could I press you on the difference between ethics and religion? Professor Haldane, my experience of Italy was that first of all everything was permitted because they had not got around to regulating anything, and when they did regulate it has gone purely along the catholic line. There would be no question in Italy of, for example, insemination for two lesbians or surrogacy or freezing embryos—virtually everything that we allow is banned because it is catholic, and that has been my experience in Austria and Germany to some extent. And there is also a distinct lack of the female voice. So are you sure that you are talking about ethics or are you talking about the religious patterns in Europe as opposed to this country, which in my experience is much more secular?
Professor Haldane: As far as I am aware there are ten—at least the last time I counted—bioethics committees in Europe established by statute or by government ministers. They are quite diverse in their structure, their composition, their remit and so on. One that I have looked at in the past is the German one, which is made up of two elements, part of which is parliamentary and part of which is the standard committee that draws in experts from outside. My concerns here, responding to the initial question of the Chairman, are on the general need of a bioethetics committee. What culture that reflects, how that is composed, and so on would lie within the power of the parliamentarians to decide in drafting the legislation for such a committee, and no doubt that would reflect to some degree the nature of British culture. But this is quite a formal point about the need of a bioethetics committee, to be constructed in ways that Parliament sees fit.
Q811 Bishop of St Albans: All three of you referred to the moral status of the human embryo; do you think that moral status changes, as it were, at point zero 14 days 22 weeks and nine months, or is the moral status exactly the same from beginning to end?
Professor Gillon: Neither of those. I think it develops. My own view of the moral status of the embryo is that it gradually develops from relatively little moral status in itself other than its potential to become something rather wonderful, to at some stage of its development—probably, in my view, after it is born—to being the wonderful thing that we all are. But of course that is a particular perspective and I do not imagine for a minute that everyone would agree with that approach to the moral status of the embryo. I should say that it is, however, implicit in our law—in our law—that the embryo and the foetus do not have the full moral status that we accord each other, otherwise we would not have abortion and we would not have destruction of embryos.
Q812 Bishop of St Albans: Professor Holm?
Professor Holm: I am probably a gradualist like Professor Gillon, but my personal view is that embryos have significant moral status; they do not have the same moral status as you and I have, but they have, merely by the fact of being members of the human species with developmental potential, significant moral status. There are things that can harm a late foetus that cannot harm an embryo; late foetuses, in my view, have more moral status and at some point before birth they essentially get the same moral status as we have. That would be my view.
Professor Haldane: It depends what you mean by moral status, I am afraid, and I am going to draw a distinction. What we need to consider here is whether we are talking about the intrinsic moral status that a human being might have at any stage of its development or throughout its full life, and the question of acquired status. If we take human beings in the phase before birth and then at later stages, then in virtue of the relationships in which people stand to one another, and the associated duties and obligations and so on, then we say that additional values supervene, as it were. But if the question is whether or not there is any intrinsic value possessed by human beings with respect to which we would wrong them, if, for example, we destroyed them, then my view is that all human beings have an intrinsic value and that this intrinsic value attaches from the point at which you have an individual human being.
Q813 Bishop of St Albans: Which is when?
Professor Haldane: I am happy to answer that one as well. The issue that has sometimes been focused on arises from monozygotic twinning, and the question of whether if at a certain stage you have one individual and then you have fission, so you then have two individuals. All I think that what existed previously was a human being. This raises a question about is the issue of the identity of the individual through its development. I take the view that what you have prior to fission is also a human individual. So wherever you have the human individuals, that are prior to the state of monozygotic twinning, in my view you have something deserving of the intrinsic regard accorded to a human being.
Q814 Chris Mole: To what extent do you believe the notion of sentience has in your definitions?
Professor Holm: I think that sentience matters simply because there are specific kinds of Harms that are linked to sentience. Unless you can feel pain I cannot cause you pain in the procedures I do on you; I do not have to consider whether they cause you pain or not. But sentience obviously matters for late abortions; if we think that the foetus can feel pain then we have the same obligation not to cause pain, as we would have towards other sentient creatures, so sentience matters. But I do not think sentience is the most important factor in whether something has moral status or not.
Chris Mole: Can we see if there is agreement on that?
Q815 Baroness Hollis of Heigham: My late husband was a philosopher, and that is certainly not a view shared, I think, by very many philosophers, that sentience is not intrinsic to the issue of humanness of embryos.
Professor Gillon: I think there is disagreement about that.
Q816 Baroness Hollis of Heigham: I think very much so.
Professor Gillon: But it does seem to me that whatever your view about the intrinsic moral importance of the embryo, the fact of its sentience will be at least an additional morally relevant factor.
Professor Haldane: I am not absolutely sure that I have altogether understood the force of the question, but I would put it this way. Human beings exhibit a whole set of characteristics, in virtue of which they are vulnerable to certain harms and in virtue of which certain goods are also available to them. Sentience is one such bundle of characteristics. If you are a sentient being then you are vulnerable to certain harms, obviously privations with regard to those powers and so on, but it also opens up to you the possibilities of certain kinds of values, satisfactions, realisations of those powers, and so on. It is part of what it is to be a human being that among the powers that one comes to exhibit and exercise is sentience and that is extremely important, but it is not the only thing.
Chairman: We have to make progress now so we will move to the section on RATE.
Q817 Dr Naysmith: The Bill that is before us really goes much wider than just different times of development of embryonic tissue and it includes all sorts of other kinds of tissues as well if the RATE goes ahead as proposed. Do you think that there is a distinction between the ethical principles that should underpin regulation of assisted reproduction and the use of other kinds of human tissue for clinical reasons?
Professor Gillon: It seems to me that the answer should be yes because although I do not personally think that it is of enormous moral relevance what you do to early human embryos myself I recognise that it is very important for people who hold the view that John Haldane, for example, would hold, and that is that it is in the same moral camp, as it were, that we are, and that killing it, for example, would be unjustified.
Dr Naysmith: I take it that would be your position?
Professor Gillon: Correct. Many people do have that position. Given that fact it seems very important to keep the regulation of embryos and what you do to them in a different camp from the regulation of what you do to other human cells.
Q818 Dr Naysmith: Should the use of other kinds of human tissue be regulated at all?
Professor Gillon: I suppose again that the problem arises from people's perceptions about the use of tissues that I think stem from the way they were treated—people were not told about tissues being kept and so on—which produced an enormous emotional backlash, and I think because of that, yes, you do need to have some form of regulation. A great shame in my view.
Professor Holm: To the first question asked, I think that at the fundamental level the principles might be the same but there are so many specific technical, contextual and public perception issues that differ that that overshadows the fundamental ethical principles. So I think you need different regulations in the different areas. Yes, obviously human tissues, at least the way in which you obtain them from the people you obtain them from, has to be regulated for all the reasons that became evident in Bristol, Alder Hey and in the many other instances of problematic use of human tissues.
