SCIENCE AT THE SHINE DOME canberra 4 - 6 may 2005

Symposium: Recent advances in stem cell science and therapies

Friday, 6 May 2005

Professor Julian Savulescu
Uehiro Chair in Practical Ethics, University of Oxford, UK

Julian Savulescu is Uehiro Chair in Practical Ethics at the University of Oxford. He is Director of the Oxford Uehiro Centre for Practical Ethics. The Centre is devoted to research, education and stimulating open public discussion around the ethical issues which arise in everyday life and which are related to the changes in society, particularly related to technological advancement. He is also Head of the Melbourne-Oxford Stem Cell Collaboration, devoted to examining the ethical implications of cloning and embryonic stem cell research. Previously, he was Director of the Ethics of Genetics Unit at the Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne. He was also Director of the Bioethics Program at the Centre for the Study of Health and Society at the University of Melbourne and the Chair of the Department of Human Services, Victoria, Ethics Committee. He has published over 100 articles in journals such as the British Medical Journal, Lancet, Australasian Journal of Philosophy, Bioethics, Journal of Medical Ethics, and the American Journal of Bioethics.

Ethical issues raised by stem cell research

Thank you for the opportunity to address you. I am a great supporter of science, as many of you will know.

I will just start off with my own idiosyncratic view of the ethics of stem cell research and cloning research. (Some of you will have heard this before.) Imagine that a laboratory, BioAce Laboratories, in 2010 discovers a drug that will save the lives of people who are suffering from a disease that kills about 100,000 people a year. BioAce Laboratory has this drug approved, but it decides not to release it, for whatever reason – perhaps there are fights amongst the members of the group about who gets what from the returns, or perhaps there are legitimate moral disagreements. The laboratory doesn’t release the drug for one year, and 100,000 people die as a result of the drug not being available.

Many people would say that not only is this morally wrong but it is morally outrageous. The laboratory would have to have a very good reason indeed not to make available a lifesaving drug that would stop 100,000 people dying per year.

Now imagine that, instead of it being 2010, BioAce Laboratories is about to engage in a line of research in 2005 that will, if it progresses as expected, derive a treatment in 2010. But because of ethics committees or laboratory fights, or for whatever other reason, they don’t get started until 2006 and so the drug is again not developed until 2011. Again 100,000 people die.

It may well be that the legislation that we have in Australia, if it does retard important basic research into cloning and stem cell science, is actually resulting in the death of people in the future, perhaps large numbers of people. It may be that we actually have lethal legislation. I think it is a failure of our moral imagination, to discard the lives of these people in the future. If we lined up 100,000 people today and said, ‘These are the people who will die if we don’t do this research,’ people might well be more motivated.

I think the great ethical issue is what a staggering failure of moral imagination we have in our society today, when it comes to this kind of research. I think the real moral issue is that it is wrong to retard this research and we should be devoting more energy to it. But of course that is not the usual perspective, so I will leave that.

Most of the hurdles to Australian scientists, and scientists in many places of the world, engaging in more research have to do with either the moral status of the embryo or the fear of reproductive cloning. I want to focus on a couple of pieces of research that I have been doing with both of these areas.

In the middle I will give you quite a provocative position – Bob Williamson asked me to be provocative so that he looks moderate! – but I will start off with quite what I think is a moderate position on creating embryos for research.

The major ethical hurdle to creating new embryos for research has to do with the moral status of the embryo. There are basically three positions you can take on this. One is to say that the embryo has a full moral status – it has a right to life and a moral status that is the same as yours and mine. And of course some people hold the view. Predominantly the Catholic Church holds that view, but many other religions hold the view that the embryo is just like you and me. That view is wildly inconsistent with vast numbers of social practices.

It means that abortion is not just wrong; it is the killing of an innocent person like you or me. A hundred thousand abortions per year is like a holocaust. It implies that the IUD, the commonest form of contraception around the world, is not just wrong but involves murder of an innocent person, as does the morning-after pill. And when the Victorian government requires that frozen embryos be destroyed after five or ten years, by law, it is requiring legally required murder.

In this area, if we take this view, if we impose this view on science, we are actually discriminating against scientists, because we are imposing a moral view that nowhere else in society has that kind of restrictive effect.

At the other end of the spectrum is the view that the embryo has no moral status. I have heard of a scientist who begins his lecture in Princeton about the moral status of embryos with a large glass of water on the desk. He picks up the glass of water and says, ‘This glass of water contains 1000 embryos,’ and proceeds to drink it. He, obviously, believes that the embryo has no moral status – as do I.

But most people don’t have the same view as the scientists and me. They believe that the embryo has some intermediate moral status, a special moral status but not the full moral status of a person. That is the view I want to look at today, because I think that is the view that most people in Australia hold. I want to show to you that if you hold that view, you should creating new embryos, either through cloning or through IVF, for research purposes.

I want to begin with a recent argument by John Harris, a philosopher from Manchester – a friend and colleague who is probably one of the top three bioethicists in the world. He is a member of EuroStem and works a lot in relation to the ethics of cloning stem cells. Harris has been making this argument recently, and his target is just these people who hold this ‘moderate’ position of embryonic moral status.

He wants to specifically target people who accept natural reproduction but reject embryo research. He wants to ask: what can we learn from our attitudes and the reality of natural reproduction for the moral status of the embryo and the permissibility of creating embryos for research?

He bases his argument on the observation that, he claims, four in five embryos perish naturally during reproduction. It doesn’t matter whether it is three in five, one in two, four in five, let’s just take his number. There is no doubt that large numbers of embryos perish naturally during reproduction.

He has argued that if it is morally permissible to engage in reproduction, either natural or artificial – let’s focus on natural, because it is obviously the most acceptable – despite the knowledge that a large number of embryos (he claims four in five) will fail to implant and quickly die, then it is morally permissible to produce embryos for other purposes which include killing them, to harvest stem cells that may be used to save people’s lives, and to use spare embryos. The third one is a much weaker claim than the second.

And he wants to argue that we should use the fact that we are prepared to engage in natural reproduction, and prepared to, foreseeably, engage in a practice that will result in four embryos dying for every one that goes on to produce a baby, to say that the embryo doesn’t have full moral status.

Imagine that a couple has a genetic condition for which there is no treatment and no diagnostic test, and they will have to produce four abnormal babies before they can produce a normal one, on average. So this couple will produce four newborn babies that will live a very short period of time, lead short, truncated lives and then die. But then the couple will be able to produce a fifth that will have a normal life.

Many people who believe that the embryo has a full moral status and a right to life would believe that it is wrong for a couple to produce babies, knowing that four in five will die very soon after birth. Many people would believe that it would be wrong to engage in natural reproduction in that circumstance.

So the argument here is that the moral status of the embryo can’t be the same as that of a baby, because not only do we think it is permissible to produce four embryos for every fifth that will survive; even if the figures were thousands of embryos for each live-born baby we would think it is permissible to engage in natural reproduction. So even if natural reproduction was highly inefficient, such that 1000 embryos died during the process, it would still not change our attitude to natural reproduction. But it would if we were producing thousands of live-born babies that lived only weeks.

So the argument goes: the embryo has either no moral status or some intermediate, lesser moral status than a newborn baby or an adult individual.

There is a problem, I think, in Harris’s argument, but we can learn something very important about what is permissible in embryo research, based on our attitudes to natural reproduction. But first of all the problem.

Natural reproduction is clearly different from embryo research in a number of ways. First of all, natural reproduction doesn’t involve killing; embryo research does involve killing. I can’t go into it, but there are ways of arguing to show that that difference is not relevant.

The relevant difference, rather, is that natural reproduction is in the embryo’s interests. It is getting the best chance it can of a future life. And it doesn’t use embryos as a means of treating other people’s conditions. [inaudible]…terms it doesn’t instrumentalise or use the embryo; it doesn’t treat it as a mere means.

The objection to embryo research, however, that even people who don’t hold that the embryo has a full moral status can [inaudible] and kills that embryo for the benefit of other people, and that’s where the moral problem with creating embryos only to be destroyed is. That’s the difference between using embryos that would otherwise be destroyed – spare embryos – and creating new embryos.

I think that Harris’s view actually assumes that the embryo has no moral status. But what I want to put to you here is that I think many people believe that the embryo has a kind of intermediate special moral status by virtue of being a potential human being. I don’t personally hold this view, but I think that many people believe that what is special about a one-cell embryo is that it could become a human being. That’s why it deserves some kind of special respect.

The embryo has a special value, I want to claim, when it is an actualisable potential human being.

The argument that I think is correct, from our attitude to natural reproduction, is that if it is morally permissible to engage in natural reproduction despite the knowledge that a large number of embryos will fail to implant and quickly die – so, have this intermediate moral status – then it is morally permissible to produce embryos for other than reproductive purposes, which include killing them for research purposes, when to produce them for reproductive purposes is not a viable alternative.

I want to put it to you that what is special about a human embryo is its potential to create a human life. Now, there are various ways in which it may lose that potential. Some are biological; you may have a genetic disorder. But some are social: that a couple has completed its family. Most of us accept today that there is some moral imperative to reproduce but it is not absolute. Some religions, of course, dispute that. They say you must produce as many children as it is physically possible for you to produce.

But most of us don’t believe that there is an absolute imperative to reproduce. We think that there is a strong imperative in cases of underpopulation, so where a human society is about to become extinct, contraception or masturbation may be wrong because there is a very strong imperative in that situation to reproduce. But it is much weaker when there is overpopulation. Many people would believe that where a society is threatened, such as in China, then restriction of reproduction is morally legitimate.

We have in our society a freedom to choose our family size. Most people have around two children. And for that reason we allow people to employ abortion, to decide which children they have and when they have children, to destroy embryos when their family is complete, because those embryos are no longer necessary socially for reproduction. And we allow them to sterilise themselves when their family is complete.

We think that some forms of embryo research would be permissible: on embryos which, after IVF, look abnormal, so are ‘unfit’ in a social sense to be implanted; or on spare embryos, embryos that would otherwise be destroyed because they won’t be implanted, and so have not only no actual potential but no actualisable potential, given that couple’s social desires.

So according embryos special moral status in virtue of their potentiality is consistent with creating embryos for research when people’s reproductive needs are met. It would be permissible for thousands or millions of early embryos to die if this was necessary to produce one live baby by natural reproduction, but if our reproductive needs have been met, surely it is also permissible for some embryos to die for the values of health, wellbeing and longevity.

If you accept research on spare embryos, you accept a principle that it is legitimate to destroy a human embryo when reproduction is no longer necessary. There is no gap between that and the move to creating embryos for research.

So that is the moderate position. I think that, realistically, if we accept the destruction of embryos in IVF, abortion, the IUD, and research on spare embryos, there really is no moral reason not to move to creating embryos for research, once our reproductive needs have been met.

The other major objection is that, if we allow research into cloning, we will end up with reproductive cloning. There is a slippery slope from, at one end, research into cloning for very, very beneficial purposes, to cloning of human beings.

There are two ways to respond to slippery-slope arguments. One is to show either that the bottom of the slope is not bad at all; the other is to show that there is no slope but a set of steps. I want to focus on the issue that there is no slope but a set of steps, and I want to distinguish between research and application. But first of all, the ‘provocative’ bit that Bob Williamson has asked me to give you: I want to argue that reproductive cloning is permissible.

I was asked recently to write a piece for The Times. I just want to read you a short piece here for why I think all these fears about reproductive cloning are overblown. I start off by giving some arguments for why we might want to engage in reproductive cloning, but then I look at the arguments against it.

A clone of me would be somebody 175 cm tall, 42 years of age, with the same memories and mental states, and the same physical appearance. Nuclear transfer is never going to do that, alone.

This is one of these fashions today, of plucking ‘rights’ out of thin air.

This is a very popular argument in bioethics.

So what I want to argue is that really what is wrong with our attitude to reproductive cloning is that we hold either some irrational belief about genetic determinism or some discriminatory belief about people’s lives.

One last point: I think it is very important to draw a distinction between research and application. We have heard a lot of arguments for the importance of doing basic research.

We have been able to clone people for many years through embryo splitting, but we could easily freeze one of those embryos and implant at a later date. That would cause clones of different ages to be born – the great fear people have about nuclear transfer. That hasn’t happened, despite our having absolute technological ability to do it. What this shows is that simply having the scientific power and doing the scientific research doesn’t necessarily lead to adverse social consequences. We need to regulate the way in which we use science, but to limit science and basic scientific research on the basis of fears of some kind of social abuse is entirely the wrong way to do it.

Either laws will be effective, in which case they can be applied to preventing the application, or the misapplication, of various forms of scientific knowledge, or they will be ineffective, in which case there is no point in prohibiting or preventing very valuable scientific research.

So I am very supportive of giving much greater freedom to scientists, and focusing our attention, if we really do fear reproductive cloning or some other adverse social consequence, on introducing legislation to prevent its application rather than to prevent basis scientific research.

If scientists want to develop a pig heart valve, we don’t think that people’s disapproval of introducing animal material into humans is a reason not to conduct the research. It may be a reason, once we have done the research and we understand what those valves will do, for not making them clinically available if there is some risk of infection, and it may be a reason to allow people to opt out, personally, of accepting a pig heart valve. But it is not a reason to prevent the research. We have a very strong moral imperative to do more basic research and to focus our legislation on preventing abuse of the application of that research but not inhibiting the research.