And man became God
The artificial creation of human embryos has led to pressing new dilemmas. Peter Popham asks whether scientific innovation has outstripped our social and moral codes
Thursday 15 August 1996
"Bokanovsky's Process," repeated the Director.
But one of the students was fool enough to ask where the advantage lay.
"My good boy!" The Director wheeled sharply round on him. "Can't you see?" He raised a hand; his expression was solemn. "Bokanovsky's Process is one of the major instruments of social stability!"
Sixty-five years ago, in Brave New World, Aldous Huxley described a scene that has haunted the century: a ward of human babies in sterile tanks, gently swelling towards their perfect, painless births. In his vision of the future, humanity had mastered the science of genetics, and applied it to perpetuate a society of mindless conformity and leisure.
This week, Huxley's premonition came closer to realisation than ever before: a team of Japanese and British scientists announced that they were experimenting with a hi-tech tank in which a foetus would be able to grow to full term without ever knowing a human womb.
It was only the latest of numerous news stories that have made evident that the future of science fiction speculation is the future no longer: it is already with us. Yet late 20th century reality differs from the visions of dystopians like Huxley in that these sinister possibilities are brought about not through the agency of an omnipotent state, but through the attempts of doctors and scientists, tenuously controlled by government, to add to the sum of human happiness, or reduce the sum of human misery.
Three weeks ago came the news that some 3,000 unclaimed frozen embryos were, in conformity with the law, to be destroyed, having reached the statutory age limit of five years. The outcry provoked by this slaughter of the innocents was barely stilled before the news emerged that a woman pregnant with twins had been granted what is called a "selective termination" to abort one of them, after claiming that she would be unable to cope with both.
Again, mass moral panic ensued. The anti-abortion campaign had not had such a shot in the arm for years, and its efforts to induce the mother- to-be to bear both twins were only cut short when it emerged that the abortion had already been performed.
Finally there was the tragi-comic case of Mandy Allwood, pregnant with octuplets after disregarding her doctor's advice to remain chaste while undergoing fertility treatment, who with her errant partner Paul Hudson has since been strapped to the roller-coaster of tabloid celebrity. The outcome of her pregnancy remains to be seen.
The subtext of all these stories is that the moral ramifications of the creation, preservation and termination of human life are intensely complex and hard to resolve. We have put in place laws and statutory authorities which we sincerely trust will ensure that what happens in the nation's surgeries and clinics is morally and medically satisfactory; but human frailty and the imperatives of scientific development continually explode the comfortable assurance that we have got it roughly right.
In the ensuing confusion, it is the pro-life campaigners, with their dogmatic certainties, who have made hay: the widespread anguish about the incineration of unwanted embryos or the abortion of a twin merely confirms them in their fundamental faith that we are reaping the moral disaster that Sixties permissiveness sowed.
But it is those who acknowledge the pain of pregnant women appalled by the prospect of becoming mothers, and of infertile couples appalled by the prospect of childlessness, and who believe that if medical science can help them it should be allowed to, who have the moral dilemma - or, rather, multiple dilemmas.
Human agency creates human responsibility. Left to itself, nature is full of failures and mistakes and waste. Miscarriages, the wastage of embryos that fail to take in the womb, handicaps, sterility: all of these are the work of nature to which the blissfully simple response of the pro-lifers is endurance and resignation. But when, 18 years ago, Dr Ralph Steptoe engineered the first test tube baby, Louise Brown, he accepted on behalf of his profession God's creative prerogative - but was unable to claim God's immunity from blame. Man has now established his own thriving corner of creation, but it's a corner with its own highly peculiar set of questions and problems, too.
Many of them have surfaced in lay people's minds for the first time in the past few weeks. Here are some of the most pressing:
Why must embryos die?
Embryos die all the time: naturally, during a woman's menstrual cycle, and in the embryologist's laboratory because there is no certainty that a given embryo implanted in the womb will result in pregnancy, and if it doesn't the doctor wants another attempt at it. To enable him to do that means creating numerous embryos, which, if not used, must then be disposed of.
Awareness that their own embryos are dying in the laboratory, while they themselves have yet to conceive, is one of the many traumas experienced by couples undergoing IVF treatment. In order to avoid that trauma many couples opt to have their embryos frozen, giving them the opportunity of trying for one or more further pregnancy in the years ahead. But it is only a way of postponing the problem. Sooner or later they must decide to give them away to another, embryo-less couple, donate them to research or have them destroyed. Given that each embryo contains human life (but not, it can be argued, "personhood"), none of the options is easy.
The mass destruction of embryos in July was due to fact that an arbitrary five-year limit has been put on the storage of embryos which are unclaimed, and that limit was reached. None of the embryos - the product of some 900 couples - had been claimed.
Does freezing damage embryos?
The jury is out. A recent French report suggested some cell damage; in an experiment with mice born from frozen embryos, the mice did fine until mouse old age, when they reportedly deteriorated fast. But another report from Belgium persuaded at least one British fertility clinic that freezing embryos was without risks, and they duly began doing it.
Aside from the question of damage, the freezing option raises the thorny problem of the psychological effect of their origins on children who might, if the British guidelines were to change, be born long after their parents' deaths.
In what sense was the recent abortion of a twin a watershed?
So-called "selective termination" or "selective reduction" of foetuses in the womb has been carried out before, but only when multiple embryos implanted during IVF treatment have all taken, and the termination of one or more foetuses is necessary to ensure the wellbeing of the other(s). The case reported two weeks ago was the first time in Britain that a twin had been aborted for social reasons - because the mother felt that she would be unable to cope A similar case was reported Tuesday, the pregnant woman voicing her fear that her partner would leave her if she went ahead with having twins.
The public's misgivings about the destruction of half a pair of twins for the mother's convenience, misgivings heartily stoked by the pro-life movement, has helped to re-open a more general debate about abortion. The original Act legalising abortion in 1967 was designed to eliminate backstreet abortions: it was explicitly not meant to sanction auction on demand. Yet today, it is argued, the liberality of doctors means that an abortion on demand system is what we have: only 2 per cent of the 184,000 abortions carried out in Britain annually for medical reasons.
What are the other reasons that abortion is back in the news?
Last month the Conservative MP Elizabeth Peacock asked a question in the House of Commons about the occurrence here of a method of termination know as "partial birth abortion", which involves withdrawing the foetus until only the head remains inside, then piercing the skull and sucking the brains out until the head collapses. This gruesome-sounding procedure is common in America, but her question failed to elicit any information about its use here. Of course the details of all abortion procedures make grim reading, but concern about this practice, which Mrs Peacock shares with more than 50 other MPs, has also helped to re-ignite the abortion debate.
Why did Mandy Allwood conceive octuplets?
Because she disregarded her doctor's advice. In the month that she conceived, she was taking a fertility drug and he had evidence that it was proving more effective than intended. Accordingly he instructed her to refrain from sex. But she didn't.
Who decides who gets fertility treatment?
IVF treatment, the last resort for infertile couples who have tried everything else, is said to be increasingly hard to obtain on the National Health Service: patients are required to wait two years or more. As a result, more and more of those desperate for children are undergoing treatment privately, at a cost of pounds 700-pounds 2,500 per cycle. Success is far from guaranteed: birth rates vary from 0 to 20 per cent, giving a national average of 14 per cent.
But other, less drastic forms of fertility treatment, such as the drug prescribed to Mandy Allwood, are far more widely available. It is the doctor's duty to consider the health of his patients, not their social or financial circumstances: there is no machinery for policing who may or may not be entitled to such treatments.
What has genetic testing got to do with all this?
Medicine's ability to diagnose diseases prenatally is advancing by leaps and bounds: already genetic testing can identify foetuses suffering from conditions such as cystic fibrosis or muscular dystrophy. In the near future many other ailments will be tracked down in the womb. But the only treatment available for such ailments is abortion. As parents are encouraged to adopt an increasingly consumerist attitude to their babies - demanding only perfection, as if they were buying an item in a department store - the idea of the sanctity of life becomes ever hazier.
All the moral dilemmas thrown up by the developments in embryology and connected fields stem from the urge to gratify the desires of women and couples - to have babies, not to have babies, to have more babies, and so on. The embryology revolution is one that liberal society has inspired and smiled on.
The Warnock Commission, which reported in 1984, led to the setting up of the Human Fertilisation and Embryology Authority of 1990, designed to regulate these issues. The fact that we are in a moral firestorm suggests that its remit has been outstripped by science. The challenge now for those who endorse liberal society's achievements in reducing suffering and increasing the sum of happiness is to find legislative solutions for these new dilemmas.
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