Man's Intrusion on Nature

Submission to The Government Inquiry into Human Fertilization and Embryology

THE NATIONAL COUNCIL
OF THE SOCIETY FOR THE PROTECTION
OF UNBORN CHILDREN

A feature of recent years has been the recognition by scientists and society of the great harm done by man's unthinking intrusion on nature. One example has been that of the indiscriminate use of insecticides; almost from the outset a few conservationists (originally regarded as cranks, only too often) persistently warned that some forms of widely used insecticides would result in destruction of the soil and decimation of wildlife. However, it was not until society was almost facing disaster that some action was taken. Gradually our awareness of the vital necessity for conservation has grown and today we recognise that man must modify his behaviour in many respects. Thus, we see legislation to preserve forests and particular species of animals, impositions by political agreement on fishing quotas and various legal measures to prevent pollution.

Other examples readily come to mind. For instance, it is now generally recognised by the medical community that their own therapeutic endeavours are frequently hazardous to the patients whom they seek to help. Indeed, there is a whole group of potential conditions classified as iatrogenic i.e. having their origin in the medical treatment given to patients. A typical history of some new products originally hailed as "wonder drugs" has been that of (a) initial wide usage; (b) retrospective realisation of unforeseen harmful consequences; and (c) consequent withdrawal or very limited usage (e.g. Opren, Corticosteroids).

As was the case originally with many "wonder drugs" society does not appear to have awakened to the possible dangers intrinsic to some forms of human breeding -- perhaps because the purveyors come under the aegis of "healer" and appear to the public offering immediate benefits to particular patients, accompanied by skilful propaganda on the apparent certainty of future benefits to mankind through the application of the results of experimentation on human embryos.

It is, therefore, essential to examine the possible factors causing the whole sphere opened by IVF to obtain such eager support from some members of the medical profession and the scientific world.

Infertility

Treatment and Possible Prevention

Problems of infertility have until now always formed one of the least popular (if not the least popular) branch of gynaecology. For instance, when the abortion law first came into operation it was a common practice in some hospitals for those doctors who refused to carry out abortions to undertake the responsibility for the infertility clinics of their colleagues in order to compensate for their refusal to take part in distasteful work.

Although artificial insemination has been practised for a considerable number of years it has never aroused the same excitement among scientists and doctors (apart from more recently in private medicine where it has formed a lucrative sideline in some abortion clinics).
Other developments relating to infertility have created little interest in the medical profession and one is, therefore, led to the conclusion that perhaps the great interest in IVF is not so much (as doctors claim) that it can relieve the suffering of infertile couples. It is the whole spectrum opened by this method of fertilization in relation to the use of the human embryo as ant object of research.

Infertility can be loosely defined as the inability to beget children. It is difficult to define infertility more precisely as it is, to a certain extent, encompassed by a time factor. For example, most GPs refer patients for investigation only after approximately eighteen months of involuntary infertility. There then follows a usually protracted period of investigation that often reveals no abnormality.
In addition, there is a natural waning in fertility with age, particularly in women.

I

Infertility in Men

1. Complete azosopermia in men is untreatable.

2. Men with borderline sperm counts can be helped by counselling. to educate them and their wives to recognise ovulation and to concentrate sexual activity at this time. While in the past much has been written to discredit natural techniques of family planning owing to claims that it was impossible to identify accurately the time of ovulation, this is shown to be untrue by IVF: in order to harvest eggs by laparoscopy it is essential to be able to identify accurately the time of ovulation. According to Dr J.J. Billings (a pioneer in natural techniques of family planning), in those cases where there is ogliospermia the ovulation method can achieve pregnancy in 80-90 per cent of cases. (PLEASE NOTE: SPUC is a non-sectarian organisation and includes members who believe in contraceptive techniques of birth control as well as those who do not.)

Infertility in Women

l . In cases where ovulation is not occurring. it can be stimulated by use of drugs such as Clomiphene Citrate.

2. Genetic disorders such as Turner's Syndrome amid its variants in which e.g. the uterus is very small or absent are untreatable.

3. Tubal obstruction following. previous therapeutic sterilization can sometimes be reversed. Blockage can also be caused by appendicitis; IUCD (some doctors now refuse to insert IUCD unless a woman already has children); endometriosis; and pelvic inflammatory diseases following induced abortion. Most common of all is blockage due to veneral disease.

While the incidence of tubal obstruction is tragically on the increase, it can be seen that in most cases it is due to avoidable factors.

Tubal Microsurgery
According to Professor John Leeton tubal microsurgery may be helpful in 30-40 per cent of cases overall. In cases of reversal of sterilization procedures, the success rate is much higher.

Low Tubal Ovum Transfer

This technique was originally developed in the USA at the National Institute of Child Health and Human Development by Dr D.D. Hochgen and Dr O. Kneitman (See also Submission from Professor Jerome Lejeune). It involves harvesting an ovum by laparoscopy (as for IVF); however, with this technique the egg is immediately transferred to the womb where it is fertilized in the normal way. It can be used to overcome precisely the same abnormalities as IVF and ET.

Results in animals have been successful -- although it shares with IVF the hazard of ectopic pregnancy. However, it has many potential benefits. It retains in vivo conditions, which has both biological and ethical advantages.

There are a number of points which must be made in conclusion:

1. There are a large number of couples in whom, after investigation of infertility, no cause can be found. Fortunately these couples exhibit a spontaneous cure rate of approximately 40 per cent.

2. If IVF and ET expand without restriction to include these couples (particularly if superovulation continues to be used in IVF) then their apparent success rate in obtaining pregnancy will improve. But this will be spurious. 3. The apparent drawback of the long, drawn-out orthodox approach to infertility could, in fact, be a latent advantage since during that time many couples succeed in obtaining. pregnancy and a child. 4. However, it could be an irresistible temptation to some doctors (particularly in the private sector) to short cut this procedure. Using IVF amid ET, a flexible technique can be moulded (using donor ova or surrogate mothers and eventually cloning) to suit partienilan couples in order to satisfy the desire for children without attempting to cure the disorder of infertility. Some cosmetic clinics (attacked by the BMA), as well as other developments in medicine, show that some doctors (albeit a minority) may be motivated by mercenary considerations rather than by the best interests of patients.

Recommendations

(Ia) The Government should finance and encourage far more research into other techniques to overcome infertility (e.g. low tubal ovum transfer).
(Ib) Without prejudice to our recommendation for a Moratorium (see Section II and Recommendation IIa), IVF should only be permitted -- if at all -- where it has first been established that all other methods of overcoming infertility have been thoroughly tried. Documentation from doctors approved by the Secretary of State should be required to prove this. In the private sector couples could be rushed into IVF for a fee, whereas other cheaper and better techniques would succeed just as well.
(Ic) Sterility ought to be a lesser problem today than formerly owing to modern knowledge of reproductive biology and advanced surgery. Yet, we have a "sterility crisis" to some extent due to present-day sexual behaviour undermining the benefits of scientific advances. The Government should launch a health education programme on the causes of infertility, stressing the preventable aspects. Infertility (particularly when caused by avoidable factors) is a human tragedy to be faced by individuals for whom IVF and all other techniques may prove to be of no help. It displays a frightening lack of sensitivity and real concern that in the plethora of material promoting IVF as a technique to overcome the unhappiness of childless couples, almost no mention has been made of the urgent need for proper education on the possible consequences of sexually transmitted diseases, artificial termination of pregnancy, IUCD, and other factors.

II

Medical Dangers of In Vitro Fertilization

One of the more worrying aspects of IVF and ET is the manner in which publicity material has over-emphasized the apparent successes which in reality are very low. Little has been published on the failures, prior to the birth of the first test-tube baby, Louise Brown.(1)

There are a number of problems associated with the work of IVF.

1. Destruction of human embryos is inherent in the procedure as presently practised. Published material on the Melbourn IVF programme showed a high loss;

if 1 embryo is transferred, implantation is achieved in 12 per cent of eases.
if 2 embryos are transferred, implantation is achieved in 28 per cent of eases.
if 3 embryos are transferred, implantation is achieved in 40 per cent of cases.

Failure is accepted after only three attempts. Thus to offer an infertile woman a 40 per cent chance of achieving implantation (and remember implantation is not synonymous with the birth of a normal child), the loss of up to eight sibling embryos has to be an acceptable prospect.

This is usually justified on the grounds that there is a spontaneous foetal loss rate of 50 per cent and more in the population in general. This is not only a spurious argument (by the same token it would be permissible to justify the unnecessary risk of killing any human on the grounds that everybody will die, anyway) but is factually incorrect.

b. The commonly quoted figure of 50 per cent natural wastage rate is derived from the work of Hertig and Rock.3 They studied 34 human ova that were obtained from the uteruses of 211 hysterectomy patients. On the basis that four of the eight fertilized ova that they found were abnormal, the figure of 50 per cent natural wastage was derived. This is a patently unreasonable extrapolation. c. A further more recent work4 suggested foetal loss after conception is approximately 43 per cent and of these 77 per cent are lost in the embryo stage (i.e. approximately 33 per cent embryonic wastage as natural phenomenon). Although this last study is biologically and statistically more satisfactory than the other, it is nonetheless considered questionable as the sample studied was not homogeneous. It makes the basically unsound assumption that all embryonic loss is due to some intrinsic defect in the embryo whereas in fact there are at least two possible causes other than those presumed in the paper:

ii. Artificial contraception may alter the developing ova (e.g. Lejeune5 in 1978 produced results suggesting that oral contraceptives might have this effect). He found that the proportion of children born with Down's Syndrome was significantly higher to women who previously had used the contraceptive pill (29.3 per cent) as opposed to mothers in the control group (20.2 per cent).

The only statistically verifiable information relating to foetal wastage is the generally accepted rate of spontaneous abortion of 15-20 per cent of known pregnancies. Indeed, in a private letter to Dr John Billings, Professor Carl Wood (Professor of gynaecology at Monash University, Melbourne; and who is, incidentally, a protagonist of IVF) admitted that 15-20 per cent natural loss was a more realistic figure.

There are no completed studies that are biologically or statistically valid that confirm the often stated view that natural embryo wastage is substantially greater than this figure. Thus there is no factual basis for the claim that there is a naturally occurring wastage rate that is in any way comparable to the wastage intrinsic to the technique of IVF.

2. Risk of Foetal Abnormality: Since the Abortion Act came into operation there has been a growing antipathy towards the handicapped baby:

everything. possible is done to "detect" the disabled baby in the womb with the aim of aborting those discovered to be abnormal. This attitude has more recently extended to the newborn handicapped baby6 and some doctors have advocated what is described as withdrawal of treatment (i.e. simply not feeding) in cases of Down's Syndrome and spina bifida.

Yet, with IVF the risk of producing abnormal human beings is unknown and unknowable -- unless it is now ethically permissible to proceed in ignorance and assess the results in retrospect. Until recent years this has always been regarded by the medical profession as indefensible. In addition to the immediately detectable foetal abnormality there is simply no knowledge of the long-term consequences of in vitro fertilization.

For example, superovulation (the use of drugs such as Clomiphene Citrate to encourage ovulation explosions) may also encourage the maturation of ova that nut tine would not encourage because of some intrinsic deficiency.

Similarly the spermatozoa that fertilize the ova in IVF may be intrinsically deficient in some unknown way, but in the normal course of events following natural intercourse the sperm would have been "filtered" and would never have reached the ovum.

These problems are well stated by Henry Nadler.7 On the comparable problems arising from risks involved with amniocentesis, he wrote that while this technique detects gross abnormalities "there is no way with present studies, our own included, of establishing ten or fifteen years from now if these children (the children saved from genetic abortion by a normal result from amniocentesis) lose five or ten IQ points" as a result of the original test. "The risks of "induced congenital malformations are difficult to determine and the subtle change in terms of loss of intelligence is almost impossible to evaluate".

Remember Nadler is only writing. of amniocentesis. What chance have we then of anticipating the long-term effects of in vitro fertilization? A number of scientists who support the principle of IVF agree that we will need to wait many years (until the adulthood of many hundreds of IVF children has been reached) before we can say with any degree of certainty what effect this form of human production may have on individuals. Even with regard to easily diagnosed abnormalities, estimates of up to about 3,000 births8 are given as the number before we can say if there is any increased risk of handicapping in the newborn.

Indeed, it may be several generations before we can justifiably declare IVF to be "safe". Prescribing Stilboestrol to women appeared to have no adverse effects on them. However, it was an unusually higher number of their daughters who developed cancer of the vagina.

3. Increased Risk of Ovarian Cysts: The use of drugs such as Clomiphene Citrate or Human Chorionic Gonadatrophin to produce multiple ovulation may result in the formation of ovarian cysts -- thus introducing a further cause of infertility ... which IVF is supposed to "cure".

4. Increased Risk of Ectopic Pregnancy: It is possible that where tubes are damaged without complete obstruction there is an increased risk of ectopic pregnancy. Dr Steptoe's first IVF pregnancy was ectopic.

So little is known about the long-term effects of IVF that the primary principle of medical ethics, Primum Non Nocere -- First Do No Harm -- is totally incompatible with the technique as matters now stand. Indeed, because of the fact that IVF and ET have been improperly researched from both the medical and sociological points of view, Dr Michael Thomas (former Chairman of the BMA Ethical Committee) urged that there should be a moratorium.

The Medical Research Council withdrew support from Edwards and Steptoe because they maintained that the technique had been insufficiently researched and that far more work should be done on animals. No extensive work of this nature has been conducted yet the MRC have now given the "green light" for the work to continue with their own researchers.9 The only difference appears to be that Edwards & Steptoe obtained backing from a private enterprise (the Ford Foundation) and won headlines throughout the world when they succeeded with the actual technique of fertilization and transplant: the original objection to their work (hack of research into the results) has not been removed.

Recommendations
(IIa) The Society for the Protection of Unborn Children calls for a moratorium on all programmes involving the fertilization of human beings "in vitro" until the general public has had time to be properly informed on all facts and implications of such programmes, and has had time to express its willingness or otherwise to allow such programmes to proceed.

III
Ethical Considerations of IVF and ET
One cannot consider human rights (as, for example, the right to different forms of treatment for infertile couples) without considering what those rights entail and whether or not they infringe upon the rights of others.

This of necessity brings us to the point as to whether the human embryo can properly be regarded as a human person entitled to human rights. Indeed, IVF compels us to face up to the question: "at what stage does a human life begin, with all the rights accruing. to it as a human person?"

The World Medical Association still adheres to the Declaration of Geneva which states: "1 will maintain the utmost respect for human life from the time of conception; even under threat I will not use my medical knowledge contrary to the laws of humanity ".

Throughout history man has always recognized conception (fertilization) as the point at which human life begins. "Human being" is a scientific term used to describe a living being. who is human and this the human embryo is from the moment of conception.

Put another way, a human being, or a human person, is a distinctive individual member of the mammalian species, Homo Sapiens, with biological structures and functions similar to animals, but with additional non-biologically defined higher functions such as inquiring, understanding. and deciding. The claim that the embryo at conception cannot inquire, understand, read or write is no justification for denying. it all human rights; precisely the same argument could be used to deny human rights to an eight week foetus, to newborn babies, to some handicapped people, to some geriatrics, and indeed, to all men and women if they become comatose or when they sleep.

"Because it is customary to refer to an adult as a person does not establish that a child is not a person. Merely because it is not customary to refer to a foetus as a person does not establish that a foetus lacks that status".10

The claim that to give the embryo the status of a human life means that we have to give the separate ovum and sperm also the status of human life is scientifically untrue and philosophically dishonest.

Conception is the first moment in the life of a human being when it can be said both scientifically and philosophically that there is now a distinct entity with all the necessary genetic attributes for being able to learn to read and write among any other endowments humans may have. The fact that a newborn baby only has the potential for such gifts in no way diminishes that child's humanity: the same thing applies to the human in the womb. Equally the fact that handicap may frustrate the development of such gifts makes a human child no less human any more than an ordinary person who through injury or sickness is deprived of speech or loses his/her memory becomes a non-person.

To claim that the ovum and sperm are human life can be likened to saying that arms and legs are human life. They most certainly are part of human life but they are not distinct entities and no matter how they grow they can never be anything other than arms and legs. In the same way no matter how the ovum develops of its own it can never be anything other than an ovum, unless it is fertilized. The embryo on the other hand simply has to grow and develop in the same way as a newborn baby or any other member of the human species.
A distinct individual of this sort commences when a single cell of human origin and with a human genotype gains the power to organize its own growth, multiplication and differentiation in a way which ordinarily leads to a human adult requiring nothing other than nutrition and a favourable environment..

A claim frequently made by those seeking to deny any moral status to the human embryo is that the Christian churches did not outlaw abortion until the nineteenth century. This is totally incorrect. From the time of the ancient Hebrews those of the Jewish tradition have always condemned abortion. The Didache, the earliest known Christian document (other than the Gospels) states specifically: "Thou shalt not kill the foetus in its mother's womb"..

Inherent in the suggest ion that the human embryo is not a person and is not entitled to have human rights is the concept that we are not human in our own right: to become humans we have to "qualify" by some arbitrary test . This means that the endowment of human rights becomes a matter of opinion and while some may regard 14 days as a good arbitrary line, others may consider 12 weeks; and yet others may consider that at birth it is essential to ensure that a child is normal before granting. it the right to life, the most fundamental of all human rights.

While it is not the intention of this Society to raise the ethics of abortion, the fact remains that one only has to consider the history of the Abortion Act 1967 to recognize the erosion of the rights of the foetus which have taken place during the past fifteen years with the National Abortion Campaign leading a body of opinion in a campaign to repeal the Infant Life Preservation Act of 1929 and legalize abortion up to birth (a suggestion which was regarded as unthinkable sixteen years ago).

It is a fact that specialists dealing in animals do not refer to the mousification of a mouse or the horsification of a horse! Embryonic animals are always given the status of their own species : a mouse, a horse It is only when man seeks to exploit others that he diminishes their value Those who opposed Wilberforce denied the full humanity of the slaves. Shaftesbury fought the ethos which suggested that the working classes in Britain w ere not as human as their more fortunate brethren; and Hitler denied the full humanity of the Jews.

Only by ignoring the biological facts and substituting an arbitrary starting point for "personhood" can the human embryo be denied the moral status and rights of a human person.

The Moral Status of a Person within Society
We are driven further to ask what are the fundamental rights and duties of human persons? The only tenable philosophy is that all men have an equal right to life, liberty and other goods essential to the common ends of humanity. (Any philosophy which would maintain that some men have a greater natural right to life -- and its inseparable concomitants -- than others is quite arbitrary.)

The acceptance of the rights of one implies a duty on the part of others to respect that right. Duties imply a moral code, identifying good and evil, right and wrong. This code must be objective, consistent and universally applicable. Such a code is defined by John Rawls11 who states that the central principle be that "each person is to have liberty equal to the most extensive liberty compatible with a similar liberty in others".

A basic code such as this would certainly encompass the night to life of all persons on an equal basis . Thus " my right to life is no greater than yours" . Quality of life cannot enter into such a judgment, since the removal of life itself inevitably removes all other rights.

There cannot be a genuine conflict of fundamental rights between two persons, although of course there are many apparent conflicts which civil law must help to resolve. People are often mistaken in claiming that what would be to their apparent benefit is also their right.

IVF as presently practised relies on the sacrifice of sibling embryos for success. In addition, too, the risks to the baby manufactured by in vitro fertilization are unknown and unknowable (except in retrospect) so that in effect these risks are taken for the benefit of another person, the mother. According to a code as outlined above, such activities would have to be considered immoral. Furthermore, such a code would not permit experimentation on embryos, as recommended in the Medical Research Council guidelines,12 particularly as these specify the ultimate destruction of the embryo as a pre-condition.

However, there is another moral code that permeates the language of many doctors and biologists involved with IVF. This is the philosophy variously known as Utilitarianism or Consequentialism. The essential nature of this code is that persons only have a moral status insofar as there is a "balance of good consequences" (enjoyed by the parents in a case of in vitro fertilization), or by "benefits" to society, in the case of experimentation on extra human embryos. In other words the worth or status of the embryo is nothing more than a reflection of its use (or worth) to parents or society.

Such a code is subjective rather than objective in its principle and is vulnerable to corruption.

For example, when the abortion law was first introduced in Britain, it was hotly denied that it would ever lead to euthanasia of the newborn handicapped. However, in 1976 the suggestion was first made in newspaper columns that withdrawal of treatment from newborn handicapped babies (i.e. by overdosing with drugs and deliberately underfeeding them until they died) was acceptable particularly in view of the fact that had the condition been diagnosed before birth such babies could have been aborted.13 The criteria for such treatment related to the attitude of the parents. (It should be noted that the DHSS produced data on the cost effectiveness of aborting the handicapped which could apply equally to withdrawal of treatment for newborn babies [see 13].)

Gradually this ethos gained credibility in the media and a number of paediatricians stated publicly that they we're adopting. such "techniques" in their units.

In 1979 the British Medical Association published new guidelines on medical ethics in which they stated: "The doctor's leadership does not detract from the necessity for a clear understanding. as to who is finally responsible for decisions about whether the child should be treated or not. Adult patients can make their own decisions but for an infant the parents must ultimately decide . . . The doctor must attend primarily to the needs and rights of the individual infant . . . but must have concern for the family as a whole".14 The latter was used to justify the refusal of doctors to operate on Down's baby, Alexandra, a refusal over-ruled by Appeals Court Judges who ordered that the child be given the same treatment as ordinary babies.

The public outcry (mainly from handicapped people) following a further case in which Dr Leonard Arthur was acquitted of the charge of attempted murder of Down's baby, John Pearson, led to the BMA Conference decision in July 1982 which called for a change in the BMA Ethical Guidelines to ensure that newborn handicapped babies were treated with the same respect as normal children. Speaking after the decision, Dr Michael Thomas (then Chairman of the BMA Ethical Committee) stated: "We must say to the public "you cannot leave us without moral guidance on this: you cannot turn your back on this issue and leave us with the responsibility . . . " the medical profession is not the guardian of public morals".15

The fact that the BMA could make such a radical change in their code of ethics because of public opinion highlights the dangers of arbitrary decisions on when humans qualify for "personhood".

Were the public to call for euthanasia for the handicapped and the elderly would the BMA again change the ethical guidelines?

According to newspaper reports the BMA evidence to the Committee of Enquiry into In Vitro fertilization declares that experimentation on the human embryo should be allowed up to the fourteenth day. It would be interesting to know on what grounds the fourteenth day was selected as the time beyond which the embryo qualifies for some protection. What guarantee is there that if public pressure ordain it, the BMA and other medical bodies will not opt for twenty-one days or beyond?

An article in the influential journal, Nature (October 7, 1982) states:

"The extent to which knowledge of what happens -- and what goes wrong -- in the early stages of natural embryonic growth can be extrapolated from observations of other than human mammals is strictly limited. Sooner rather than later, it will have to be confirmed with human embryos. And one of the next big prizes in biology, an understanding of the process of differentiation, at this stage sought by observations of laboratory animals, will in due course probably require confirmation in human embryos grown beyond the gastrulation stage (two to two and-a-half weeks). When that time comes, the potential benefits in medicine are also likely to seem overwhelming" . (our emphasis)

Later in the same article it is stated:

"The danger that (the Warnock Committee) will be stampeded ... into a flat prohibition of work with human embryos is probably remote. But it is to be hoped that the committee will fight shy of arbitrary distinctions between the permissible and the impermissible. People with sensible questions to ask should be allowed to ask them. Just now, there are not many. Later there will be a host".

Already the pressures are growing. Under the impetus of Nazi atrocities and a world war the Nuremberg Code of 1947 and later the Declaration of Helsinki of 1964 (as amended in Tokyo in 1975) revealed a sounder instinct for human rights than is evident in Britain at present. These state, inter alia:

i. "Biomedical research involving human subjects cannot legitimately be carried out unless the importance of the objective is in proportion to the inherent risk to the subject.

ii. "Concern for the interests of the subject must always prevail over the interest of science or society.

iii. "No experiments should be conducted where there is a prior reason to believe that death or disabling injury will occur".

It is obvious that these standards have been ignored in IVF procedures and the excuse that ultimately IVF and "observations" on the embryo could benefit mankind is ethically unsound.

"No man is allowed to put his mother in the stove because he desires to know how long an adult woman will survive the temperature of 500°F no matter how important or interesting that particular addition to the store of human knowledge may be". (The Doctor's Dilemma by George Bernard Shaw)

Recommendation
(IIIa) All experimentation on human zygotes, embryos and foetuses should be banned unless for the specific benefit of the particular babies themselves.

(IIIb) According to Counsel's opinion -- submitted herewith as part of the SPUC evidence -- the IVF embryo, prior to transplant to the womb, has no legal status. A law should be passed giving. legal protection to the test tube baby from zygote stage onwards.

IV
Embryo Freezing
The ethical considerations of embryo freezing are covered in the submissions of both Professor Jerome Lejeune and Professor Paul Ramsey . We consider it questionable, to say the least, that the MRC should encourage experiments of this nature before the Committee has reported and, indeed, before Parliament has had the opportunity to consider the issues.

V
Cloning and "Organ Farming"
The possibility of artificially creating "identical twins" for the purposes of farming tissues etc is given full consideration in both the papers submitted by Professor Lejeune and Professor Ramsey.

Recommendations
(IVa) Embryo freezing totally undermines all respect for the rights of the human embryo and should be outlawed.

(Va) Cloning and "organ farming" would encourage the attitude of "quality control" with regard to human reproduction and should be totally banned.

Does a Women have a Right to have a Baby?
The most basic human right is the right to life itself. Other rights --the right to work, the right to a home -- may be regarded as more dear to some people. But, the right to life is fundamental, the condition of all other rights. Therefore, it must be protected above all other rights.

In vitro fertilization introduces a number of considerations. Another person, the baby, is created in jeopardy, in circumstances of unquantifiable risk to itself, for the benefit of a second party -- the mother. In addition, IVF involves the creation of several sibling embryos that are inevitably destroyed or regarded as experimental subjects and then destroyed.

A humane and caring society will recognize the very real distress of infertile couples and seek to satisfy their yearning for children. However, no absolute right to have children pertains to women, and some means of obtaining. children have to be viewed with the utmost caution, while others are immoral and should be rejected.

The basic commitment of a married couple is a love-commitment that is unconditional: it is not conditional on the physical or mental perfection of the partners or their children and not conditional on the capacity of the wife to become a mother. The "pregnancy at all costs" (if we plan it) ethos certainly undermines the dignity of those men and women who are infertile through one reason on another and, therefore, poses a threat to the stability of some marriages.

Moreover, IVF does not "cure" infertility: it is a technique which by-passes the problem of blocked tubes. Whereas artificial insemination was originally regarded as a "cure" in cases of sub-fertile sperm etc it has since been found that trauma caused by feelings of inadequacy may remain and can sometimes be exacerbated by the technique.

In addition, when considering rights, society may sometimes have to balance carefully to ensure that allocation of resources does not jeopardise the rights of others. For example, if medical resources have to be mobilised in order to fulfil a wish (rather than to overcome or prevent disease or illness) other considerations may have to be entertained. If diversion of medical facilities for purposes of overcoming infertility puts at risk the life of another person because of limited medical resources, the woman's claim to obtain a child by using such resources is at least imperilled. While a caring society most certainly should not balance claims in this way, but should seek to satisfy both needs by expanding medical facilities, the fact remains that the economic difficulties of today have caused serious curtailment of life-saving work in a number of fields of medicine.

VII
The Use of Surrogate Mothers and Donor Ova
Ethical, legal and social problems involved with the use of surrogate mothers and donor ova are covered in the submissions presented by Professor Lejeune and Professor Ramsey.

From the medical point of view the donation of ova involves a surgical operation, laparoscopy, known to be associated with some morbidity (chiefly pain) and a small mortality. It is unethical to submit a woman to a surgical procedure which is not to her benefit (other than in cases of a life-saving procedure such as kidney donor).

Such arrangements usually include a financial reward for the donor. and it is reasonable to suspect that the donor's consent would be better described as lubricated rather than "informed". In cases of poverty or hardship, it would be more a matter of coercion rather than a "voluntary" act. It is morally unacceptable that poor people should be allowed to give up their rights as persons for a fee.

There is also the complex issue of human relationships to which little thought appears to have been given: very little is known about the type attitudes and jealousies which could develop in the
inter-family relationship and of which the child could become the victim.

Surrogate motherhood is open to similar moral and legal objections as the use of donor ova. In the United States surrogate motherhood has become the centre of lucrative business with women receiving. fees of about £6000 for carrying. a baby to term . In the abortion controversy it is frequently claimed that to suggest a woman might carry a child to term with the aim of having it adopted relegates women to the status of "breeding" machines. Whatever one's views on abortion, such an attitude is certainly inherent in surrogate motherhood. Wealthier women could afford to hire wombs, whereas the poor would be reduced to the role of womb letting. It undermines the dignity of women and reduces children to items which can be bartered. It is also beset with legal problems to which Professor Ramsey refers in his testimony.

Recommendations
(VIIa) Surrogate motherhood and donor ova should be banned and IVF should be permitted (if at all) only to married couples, with the embryo being transplanted only to the natural mother (without prejudice to IIa),
(VIIb) Without prejudice to VIIa, all financial inducements for surrogacy and donor ova should be banned.
(VIIIa) Far more research should be conducted into child problems in relation
to family breakdown, single-parent families, homosexual "family" units.
(VIIIb) At present a number of organisations carry sperm banks, over which there should be stringent control. What cheek, if any, is made with regard to possible accidental incest? Strict records should be kept of sperm donors (and without prejudice to VIIa, strict records should be kept regarding donor ova). The principles underlying the laws on incest should be re-asserted.

VIII

Homosexual "Family" Units
In the past fifteen years the break up of the traditional family unit has escalated in Britain and with it we are witnessing an increasing number of child tragedies. Whereas it is not the aim of the writers of this paper to comment on the lifestyles of homosexuals one does have to consider the best ways in which society can encourage a happy and healthy environment in which children may grow up.

Multiple Cell-Lines
Compound Animals or "Chimera"
As described in the submission from Professor Lejeune, mice have already been bred with three different colours of fur -- the results of genetic manipulations, mixing three cell-lines. This is certainly a scientific possibility so far as human progeny are concerned.

Interspecies Fertilization
"Human Hybrids"
The ova of hamsters have already been fertilized with human sperm, the aim of which, it is claimed, is for purposes of "providing information on the penetration capacity and chromosome complement of sperm from subfertile males".

The Medical Research Council has approved this work although it states that the fertilized ovum should not be allowed to develop beyond the early cleavage stage.

At this stage, however, scientists do not know how to maintain such an embryo beyond cleavage stage and one only has to consider the change in attitudes of doctors and scientists since the abortion law came into operation to realise how swiftly any sense of ethos can crumble once the capacity to do something has been achieved.

In evidence to the US Congress Ethics Advisory Board in Washington, Professor Roger Short of Edinburgh (who heads the MRC Research Team on in vitro fertilization) referred to interest in the possibility of the fertilization of human eggs with sperm from gorillas, chimpanzees and orangutans (R.V.
Short, Human Fertilization and Embryo Transfer, 1978, p.6-7; a paper
prepared for presentation to the US Ethics Advisory Board). In it he said that this achievement would soon be within the reach of scientists and declared that while " . . . it would be abhorrent to many . . . only fear of public reaction" had so far restrained scientists from attempting such experiments.

Recommendations
(IXa) Genetic manipulation, mixing cell-lines in human embryos should be
banned.
(Xa) Interspecies fertilization should be totally banned for any reasons whatsoever.

International Implications
One of the greatest dangers about the present situation is the fact that whereas some scientists have a clear vision of the manner in which IVF cant be used to manipulate both animal and human life, policy makers appear to regard such possibilities on a par with science fiction.

There are many scientists who can be quoted on the manner in which human reproduction could develop. For example, Clement M. Arkott (Professor of biology at Yale) told BBC listeners that he was "confident" that "we can shortly preside over our own evolution and make new kinds of people".

Controls, to be effective, must be established on an international basis. Indeed, with due respect to the Warnock Committee of Inquiry, a Commission should be established -- free of any departmental controls
and which would include representatives of all sections of the community to investigate all aspects of IVF work.
The ultimate aim should be to call for an international moratorium through the United Nations until a fuller knowledge of the whole ethos amid techniques has been achieved.

Investigations should go ahead on an international basis into IVF and genetic engineering of animal life as well as human life.

International legal codes need to be established as can be recognised by the fact that in 1980 the US Supreme Court ruled that scientists could patent new life forms which they create in the laboratory (1980: cite 447 US Report p.303). However, whereas such may be the legal ruling in the US, the situation would undoubtedly be different elsewhere.

In the same way, while Britain may outlaw interspecies fertilization, genetic manipulation in humans and many other such techniques, other countries could adopt a reverse policy and encourage work of this nature.

Recommendations
(XIa) A Royal Commission should be established without delay to
investigate the whole field of IVF and genetic manipulation covering humans and animals.
(XIb) The Commission should prepare recommendations to be put before the European Parliament and the United Nations with the aim of establishing an international code.

(XIc) Britain should introduce a moratorium, giving a lead to other countries throughout the world with the aim of encouraging. others to suspend all such vvork to allow for full research to be conducted (on an international level) into the social, medical, ethical, scientific, and legal aspects of IVF and ET.