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Department of Health

As a society, we are increasingly uncomfortable with the existence of received wisdom and moral certainties. It is probably also true to say that we are becoming uncomfortable even with the principles of secular morality—be it utilitarian or libertarian. Such secular morality is increasingly branded as an extension of ““public interest””, so that it need not appear to be morality at all. The Warnock report proposed that the putative regulatory body for biotechnology should not be"““exclusively, or even primarily, a medical or scientific body. It is concerned essentially with broader matters and the protection of the public interest.””" It is perhaps fitting that a body that exists to deal with, among other things, the ethical dilemmas posed by genetic hybrids and chimeras, should be similarly heterogeneous. But it is true that scientific evidence and more traditional moral yardsticks must continue to complement one another. The ascendancy of science untrammelled by other concerns leads us into dark places. The Committee’s investigation of eugenics and pre-implantation genetic diagnosis, for example, touched on the potential disaster of social objectives triumphing over ethical objections. Perhaps that is the danger implicit in conflating ethical, clinical and political judgments, which is why I believe that the Human Fertilisation and Embryology Authority might no longer be fit for purpose. There must now be a solid case for reconsidering its remit—and, consequently, its composition—from the ground up. The intention to merge the HFEA and the Human Tissue Authority into a new regulatory authority provides an important opportunity to address the fundamental concerns about the biotechnology regulatory regime that the Committee expressed. The fact that the new authority will no longer be called the regulatory authority for fertility and tissue does not mean that it cannot become a ““RAFT”” in troubled ethical waters. The HFEA’s most important failings are not those related to the practical problems that, to some extent, afflict all Government organisations. It is no surprise that the Committee’s recommendation 66 highlights critical failings in the agency’s data management policies. Nor is it a surprise, for example, that the Government’s response lays the blame on the goose that has so often failed to lay a golden egg: IT infrastructure. I was, however, more struck by the Committee’s findings on the HFEA’s inadequate expertise. I want to focus my remarks on recommendation 47, and particularly the following statement:"““We believe that ultimate authority on issues of public concern should lie outside of the scientific and medical communities.””" That is a sound principle, although many would argue that the scientific and medical communities do not harbour nefarious intentions of the kind that would make them incapable of self-regulation by their various professional bodies. But even if the status quo of lay dominance over day-to-day decisions is to be preserved, it is indefensible for the HFEA to lack a sound basis of scientific expertise; that must be corrected in any new body. My concern is that insufficient parliamentary time is given to these complex ethical decisions, which are based on a rapidly evolving scientific evidence base. The introduction to the Committee’s report notes the statement, made during an earlier inquiry, that, after 12 years of the Human Fertilisation and Embryology Act 1990, it was necessary to"““reconnect the Act with modern science.””" It also reiterated earlier criticism of the complacency of certain members of the HFEA, and the Department of Health’s ““limp response”” regarding a policy of constant review. If the HFEA is not keeping abreast of a rapidly advancing field because it has insufficient expertise or organisational capacity, it is clearly necessary to do one of two things. The first option is to return regulation to the relevant professional bodies. The Royal College of Obstetricians and Gynaecologists stated in evidence that"““the body regulating this area should have sufficient expertise in its make up to tackle some of the difficult clinical, scientific and ethical issues presented to it””." Does that description not include the professional bodies themselves? We should at least be asking whether regulation can safely be left in the hands of the royal colleges or the British Medical Association, safe in the knowledge that they are deemed capable of engaging with other complex areas of medical ethics. After all, the Committee made a number of recommendations concerning professional bodies’ increased involvement in the management of clinical and laboratory standards. It is only a small step from that position to professional bodies’ wholesale involvement in the development and review of an appropriate regulatory regime. It is only the Warnock principle of lay primacy over these ethical questions that holds us back. Alternatively, we must establish a regime of regular statutory review by Parliament. It is time to turn our backs on a generation of ad hoc, laissez-faire intervention by Parliament, which relies on the initiative of Back Benchers to ensure that the law is kept in touch with science. That is particularly apposite in the case of the law relating to abortion. I am not an expert on accepted parliamentary practice concerning Back-Bench initiation of legislation, but it seems in this instance to be a convenient caveat to justify the Government’s inertia. I do not want to go too far off piste and into the dangerous territory of advocating a review of the time limit applicable to abortion, about which we have heard much already. The decision whether to allow abortion up to 24 weeks, 20 weeks or even 18 weeks should be based on the available scientific evidence and should, if anything, err on the side of caution when it comes to the protection of a potentially viable foetus—in other words, a potential life. But, above all, I do not believe that the Government should absolve themselves, or Parliament, from the responsibility of regularly engaging in the ethical debate on the regulation of human reproductive technology. I believe that Parliament, not the HFEA, is the only crucible in which these questions can be discussed fully, because we are uniquely placed to respond to the scientific evidence, as well as to ethical problems and public opinion. The HFEA is quite wrong to view its role as insulating Parliament from difficult ethical choices. I am heartened by the strength of support of witnesses called by the Committee for Parliament’s increased participation in difficult ethical situations. The Committee’s recommendations about parliamentary involvement are very welcome, particularly on the need for Parliament to be able to revisit contentious issues. But more than that, I am pleased that the Committee recognises the benefit of the increased public confidence that stems from greater parliamentary involvement in difficult ethical questions. It is, after all, easy to lobby a Member of Parliament on a free vote—and much less plausible that anyone should lobby the HFEA. The HFEA is an unhappy compromise between scientific, evidence-based decision making and the Warnock principle governing the primacy of lay ethical opinion. If that primacy is still required, its proper forum is Parliament—a point that the hon. Member for Bolton, South-East (Dr. Iddon) alluded to earlier. The Government must now take steps to see that Parliament is entrusted with the regular review of the legislation governing biotechnology. Only Parliament has the resources to co-ordinate and balance the available scientific evidence, the ethical concerns, and the vagaries and inconsistencies of public opinion that are vital to this area of law. More importantly, only Parliament has the moral authority to ensure that the law keeps pace with scientific advances, without exceeding ethical boundaries or failing to meet public expectation.