11 July 2016
A symposium titled 'The Ethics of Human Artificial Gametes' was recently held at the International Association of Bioethics 13th World Congress of Bioethics in Edinburgh on 16 June 2016. The symposium consisted of four speakers: Dr John B Appleby (Chair) (King's College London), Dr Daniela Cutas (Umeå University), Dr César Palacios-González (King's College London) and Professor Dr Heidi Mertes (Ghent University). The aim of the symposium was to discuss the ethics of human artificial gametes (also known as synthetic gametes or in vitro derived gametes), following on from recent scientific advances and ongoing public debate in this area of research (1,2).
The event began with Dr Appleby explaining the science involved in creating artificial gametes and the ethical need for artificial gametes to be made available for human use via a clinical trial, if and when this becomes possible. Next, Dr Cutas spoke about the potential use of artificial gametes for solo reproduction, which was followed by a presentation given by Dr Palacios-González on artificial gametes in the context of the new natural law and the same-sex marriage debate. Finally, Professor Mertes explored the question of whether or not there is a place for non-patient-specific stem-cell derived gametes in assisted reproduction. A number of interrelated themes from the debate surrounding artificial gametes emerged during the symposium.
One of the themes that cut across each of the presentations was the significance of genetic relatedness. A central reason why prospective parents may want to use artificial gametes is because they could be used to create a child with a parent-child genetic link that would otherwise not exist if adoption or donor gametes were used. However, a question was raised about whether or not fulfilling the preferences of intending parents to have genetically related children was worth the considerable time and money it will take to develop artificial gametes from 'bench to bedside'. Another point of discussion was about whether or not the development and potential human use of artificial gametes will serve to further reinforce the (already prominent) social significance of genetic relatedness in families and what the consequences of this might be.
Another topic from the symposium was the potential role that artificial gametes might play in addressing concerns about the supply and demand of gametes for fertility treatment and research. For example, Professor Mertes discussed how the potential scientific development of safe and reliable methods for creating artificial gametes (e.g. non-patient-specific stem-cell derived gametes) could one day allow clinics to alleviate shortages of gamete supplies for fertility treatment, because clinics would be able to cultivate new gametes in response to demand. One possible consequence of this would be that the need for new donors (of both sexes) would be drastically reduced.
Research ethics was also a main topic of debate surrounding artificial gametes. Dr Appleby explained how, historically, assisted reproductive technologies have not been consistently introduced into clinical use via clinical trials. A number of reasons were provided as to why artificial gametes should be introduced via a clinical trial, including the importance of gathering detailed information about health outcomes of the first generation of offspring created this way. It was argued that this information was potentially important for the offspring being studied, the parents of those offspring, future prospective parents (wishing to use artificial gametes), researchers, regulators and society as a whole. Some questioned whether there was an ethical duty to introduce artificial gametes into clinical use via a clinical trial. Others considered what would happen if clinical trials revealed negative findings about artificial gametes and whether or not this could damage the progress of science in the field of assisted reproduction.
Questions and discussion also emerged about the possible risks associated with the future use of artificial gametes. For example, Dr Cutas discussed whether or not artificial gametes were likely to present a heightened risk of inherited genetic mutations in offspring and whether or not there were possible health risks associated with solo-reproduction (when both sperm and egg come from the same individual). In addition, Professor Mertes discussed the issue of whether or not the use of artificial gametes might cause possible psychological problems for the resulting offspring. Some audience members questioned whether artificial gametes should ever be developed or permitted for human use because safe alternatives methods of creating families already exist in the form of conception with gametes or embryos, or adoption.
The presentation by Dr Palacios-González discussed how the development of artificial gametes would impact the same-sex marriage debate. He began by introducing the theoretical possibility that eggs could be derived from men and sperm from women (for more information see 1 and 2) and that same-sex couples could therefore have genetically related children just as heterosexual couples do. For those 'traditional marriage' positions where reproduction is a central feature of marriage, it seems that the advent of artificial gametes presents an insurmountable challenge. Some questioned if such use of artificial gametes entailed the heteronormativisation of same-sex couples and if this would therefore only serve to reinforce current heteronormative social structures. Others questioned the need to engage with those opposed to same-sex marriage, on the grounds that they have already been philosophically defeated.
An overarching theme from the symposium was about whether or not artificial gametes will bring an end to infertility and to what lengths people affected by (either medical or social) infertility should seek to have children. For instance, Dr Cutas discussed the possibility that the development of artificial gametes might alter norms and cultures of reproduction and society's perception of gender. Will solo-reproduction become a new form of single motherhood? Members of the audience also questioned whether or not the development of artificial gametes will create unnecessary social pressure on 'infertile' parents to attempt to have children at all costs and what the implications of this pressure might be.
The questions, themes and issues that emerged from the presentations and audience discussion are of significance for the broader debate surrounding the ethics, policy and regulation of artificial gametes. Importantly, this symposium reveals that there are a substantial number of complex issues surrounding the ongoing development and future use of artificial gametes, and these issues require further analysis and debate.
The symposium was organised and supported by a Wellcome Trust funded research programme titled 'The Donation and Transfer of Human Reproductive Materials' (www.reproductivedonation.com).