Ethical issues in reproductive biotechnology

There has been an intensive debate on the exact moment a human being comes into existence and the moral status of the embryo. This debate emerged primarily from the ongoing discussions on proposed legislation relating to reproductive biotechnology.

From the scientific point of view there is a precisely timed sequence of events with distinct developmental stages including sperm penetration, syngamy (fusion of the male and female pronuclei), formation of an embryoblast (the group of cells that form the embryo proper), formation of the primitive streak that directs the organisation of cells to form the rudiments of the different body parts, and formation of the embryo in which the external shape and organs rudiments become defined.

Various interpretations have been given as to the beginning of life, of embryo formation and of the human being. These have been used as evidence to justify or to disapprove of embryo experimentation, preservation, cloning and stem cell research.

It is very difficult if not impossible to define when life begins. In fact human life is a continuum. The formation of a zygote is seen as an obvious starting point where an individual is formed with a unique genetic individuality that distinguish it from all other individuals, except for the occasional monozygotic twin.

However the source of the genetic uniqueness lies in the germ cells which are responsible for generating the almost infinite genetic diversity. And the germ cells are put apart from all other cells at a very early stage in embryogenesis. Is the formation of the zygote an actual or just a convenient starting point? The diverse views of when life begins are just perceptions and interpretations of the same facts.

Scientifically, the embryonic stages referred to above are all scientifically correct but what is perceived to be a human being and when this comes into existence are philosophical arguments that cannot be proved scientifically. We cannot base the ethical issues solely on what we might perceive to be the beginning of life or of a human being.

Ethics is a code of behaviour that is based on values and on what is morally correct and good, and in this case what constitutes respect or disrespect of human life and its sanctity. The code of ethics we are trying to establish is one that regulates our behaviour with respect to reproductive technology.

An important consideration in this discussion is to recognise the fact that assisted conception, embryo storage and stem cell research are already being performed. What we need to decide on is where we, the Maltese people, wish to draw the line of what we are prepared to accept as ethically correct and morally valid. Our decisions will lead to an accepted practice of behaviour, which should be based on practical, legal, social, moral and religious issues.

Past history has shown that the chain of developments in reproductive biotechnology including sperm cryo-preservation, artificial insemination, in vitro fertilization, and a whole range of methods of assisted conception technologies that were quite revolutionary at the time when they originated, all met with considerable initial opposition based on ethical problems, religious beliefs and social implications.

Now, most of these technologies are widely accepted, while there is also widespread agreement that some forms of assisted reproduction such as that for elderly mothers and surrogate motherhood should not be permitted.

Although some people might still harbour some religious doubts regarding assisted conception, it is doubtful whether anyone would advise an infertile couple to remain childless and not avail themselves of the available technologies!

In fact, most couples who have to resort to assisted conception see this as God's blessed gift in his works of creation.

The latest developments of cloning, stem cells and embryo research are now facing the initial ethical issues that need to be resolved.

The current debates concerning embryo freezing, cloning and stem cell research all centre around one main issue, the destruction of the human embryo, and the implications arising from the universal commandment "Thou shalt not kill!" However, this is not an absolute commandment.

It is now accepted that individuals who are certified brain dead and require extraordinary measures to keep their bodies alive can have their life support stopped. The early embryo produced in the laboratory by assisted fertilisation has a very similar status. It has not developed any brain, not even its rudiments, and requires extraordinary measures to keep it alive.

By a similar argument, just as it is justified to take organs for transplantation when it is decided to stop artificial life support from a brain dead individual, it would also be justified to take stem cells from cryo-preserved embryos. This is not to say that embryos should be generated at will, but that under certain defined circumstances cryo-preservation of embryos and obtaining stem cells from them may be ethically permissible.

I am well aware that there are several counter arguments to disagree with this perception of an embryo generated outside its normal environment. The ethics of a particular procedure is not to be decided upon by a group of individuals with the same viewpoint but should be based, as much as possible, on finding the common ground based on a consensus of what is ethically permissible. If we start from the premise that any procedure involving a human zygote or embryo is intrinsically wrong and lacks respect from human life, we preclude further ethical discussions.

I think that the question to be debated is not so much the time when a human life begins or when a human being comes into existence, but whether it is ethical to adopt the proposed procedures on zygotes and early embryos, intended ultimately to ease suffering and promote a better quality of life.

I also wish to present another view point, and to consider the time, which we presume is not very far away, when treatment of some severe diseases with stem cells becomes a reality. What would we decide then? Would we then continue to debate whether it is ethical to provide or accept treatment for such diseases using stem cells on the basis that they were derived from an embryo that was "killed"?

If we condemn embryonic stem cell research now, should we feel morally entitled to reap the fruit of that research later? Will we have the same courage to refuse treatment by stem cells to our patients, our children or ourselves? Or might we review the way we perceive the meaning of life until we ourselves are actually threatened by premature death?

It is true that the end does not justify the means. However, we do need to face the present and future realities and ensure that we are giving a fair interpretation of what constitutes respect for human life. We are in a crucial stage where our political representatives will formulate the wording of the laws regulating reproductive technology.

These laws will define the ethically permissible norms of behaviour, with the aim of safeguarding our respect of human life and at the same time being open to new-ly emerging technologies and concepts.