10 March 2008
'From IVF to Immortality: Controversy in the Era of Reproductive Technology', by Ruth Deech and Anna Smajdor (Oxford University Press, November 2007), is a lively, accessible account of modern reproductive technology and the complex issues surrounding it. Punctuated with case histories used to illustrate and explain each passage, the book explores the science, history, legislation, ethics and future of assisted reproductive technology (ART) and its associated fields of medicine and scientific research. Ultimately, it is a clear explanation of the status quo of ART in the UK today under the control of the Human Fertilisation and Embryology Authority (HFEA).
The focus throughout the book is on the origins and development of the HFEA's regulatory framework, and the roles played by the public, the media, politicians, lawyers, scientists and clinicians in creating this framework. This theme is discussed within the context of recent advances that have prompted passionate responses from all sectors of society, including the capacity of IVF to enable selection of sex, or 'designer babies', in particular 'saviour siblings', or to allow post-menopausal women, single people or same-sex partners to have babies. Through detailed examination of the decisions made by the HFEA, the authors approach several important philosophical questions of the modern age, such as the notion of fertility as a human right and the effect that ART has had on the concept of family.
Although Deech and Smajdor carefully debate the many varied emotions, perspectives and opinions that each topic they discuss inevitably elicits, they come down undeniably in favour of the HFEA. They describe, with sympathy, the diverse moral climate in the UK within which the HFEA must operate, suggesting that 'it is perhaps inevitable that in the face of such a broad moral spectrum, decisions made by HFEA will be viewed as unethical by at least some people (p32)'. To a degree, the text is an intellectual defence (or, at least, a measured justification) of the HFEA, particularly with regards to some of the more controversial 'landmark' cases discussed. However, as such it provides an engaging and knowledgeable insight into the moral, ethical and legal reasoning behind each decision ruled by the body.
In discussion of a case where the HFEA ruled against permitting a couple to select an embryo during IVF that would be a tissue match, and therefore a 'saviour sibling', for their son (who was suffering from a rare, crippling form of anaemia), the authors seem at pains to portray the humanity of the HFEA. They emphasise that 'what is certain is that the HFEA agonised over these deliberations and there was nothing arbitrary in its decision...the judgement was made in good faith' (p72). The rationale behind the decision is explained in detail and, intriguingly, has since been over-turned with respect to future cases. This change of tack is at least in part a result of the pressure put on the HFEA by the heavy criticism of the media. Here the authors express exasperation at the power held by an excitable and fickle press, describing it as 'part of the perennial problem for the regulator' (p74). In this particular case, only a few months earlier the press had damned the HFEA for allowing selection of a saviour embryo and so 'it seems inevitable that for any decision a vocal cohort of dissenters will emerge...and] this means that media attention and public perceptions are nearly always polarized in such a way which makes dialogue fraught' (p74).
Another interesting case where the HFEA's decision was widely condemned by the press has an entire chapter dedicated to it. The authors use the story of Diane Blood, who innocently but illegally had sperm retrieved from her dying husband, to argue that the 'HFEA is obliged to consider its regulatory decisions from a broad perspective, encompassing considerations beyond the needs and desires of specific individuals' (p101). Mrs Blood was denied the right to use her husband's sperm as it had been obtained unlawfully without his consent. This caused uproar in the media, who were predictably eager to 'champion a widow in distress' (p124). It is an undeniably compelling tale, but the authors eloquently and persuasively argue that a 'relaxation of the rules in order to accommodate a particularly appealing case creates a precedent which undermines the law' (p115). Permitting the un-consented retrieval of gametes, which are in this day and age 'marketable commodities' (p123), could pave the way for a wealth of highly undesirable indiscretions. Mrs Blood was eventually allowed to take her husband's sperm abroad for fertility treatment, highlighting another difficulty faced by the HFEA - the disparity between nations in the regulation of ART.
The HFEA has been criticised for not permitting treatments available in other countries and the authors frequently use examples of practices abroad to create a context for the HFEA's decisions. However, they argue that 'national convictions that a practice is wrong must prevail' (p65). They express pride that 'the HFE Act in the UK is the expression of a democratic process which has concluded that fertility treatments require a system of licensing and regulation' (p147-148)...'At first Britain was alone in the world in establishing such a system' (p2). The implementation of this system is examined in depth, providing an insight into the realities of undertaking public consultations, the problems faced when aligning UK law with European law, and the difficulties keeping the law abreast with the times - 'the law is a blunt instrument in the context of fast-moving research and volatile public opinions' (p74).
Perhaps the most compelling praise for the regulator is the emphasis on what its existence does allow, rather than what it does not. The authors assert that recent legislation distinguishing therapeutic cloning from reproductive cloning, permitting the former but not the latter, is 'one of HFEA's greatest achievements, for from this period the UK has led the world in both advancing and monitoring stem cell research' (p28). Discussion of this field of research is given less mileage than ART, but it is approached in the same clear, even manner, avoiding, and even warning against, over-hyping the realms of possibility that stem cells may hold. Indeed, in general, their approach to the future is less fantastical than the title 'To Immortality' may suggest, though they touch on the creation of 'artificial wombs' and 'artificial gametes' and the possibility of babies 'with two mothers'. But the real interest of the book is as a book about today, about reproductive choice and regulation in the age of technology. It is a successful analysis of the many issues beyond the science of ART, including, amongst many others, what it means to be in a family, the complexities involved in defining disability, the new age of feminism, and the interpretation of human rights.
Overall, it is an informative and thought-provoking read, appropriate for a wide rage of interested parties with diverse areas of expertise. Highly recommended for anyone in the field of fertility treatment or stem cell research, whether clinicians, scientists, counsellors or workers in other capacities. Equally, those practising or studying medical law, policy makers and journalists may find this book useful and insightful, along with any member of the public interested in ART or bioethics.
Buy From IVF to Immortality: Controversy in the Era of Reproductive Technology from Amazon UK.