“[T]he fact is, society seems already to have accepted, or allowed itself to be persuaded by men in white coats, that making children in labs, flushing unwanted ones down the sink, and experimenting on embryos as if they were just more cell cultures, is all ethically A-OK. It’s not A-OK for myself and many other people, but it would be hypocritical or arbitrary for those who have accepted everything thus far to start twitching the curtains over so-called ‘three parent’ babies”—David Oderberg, Professor of Philosophy at the University of Reading
Two weeks ago, UK independent regulator the Human Fertilisation and Embryology Authority (HFEA), approved “the use of mitochondrial donation in certain, specific cases,” allowing fertility clinics to apply for licenses to provide two forms of Mitochondrial Replacement Therapy (MRT). This will be welcome news to women who are aware that, owing to their genetic makeup, any child they conceive could likely suffer from life-threatening mitochondrial diseases. Regulations permitting these treatments—which use in vitro fertilisation, but, as well as involving an egg and sperm from the child’s two biological parents, incorporate part of a second woman’s egg to prevent the child inheriting its mother’s mitochondrial DNA—were passed by parliament last year. The HFEA ruling means that the first children conceived this way could be born in 2017.
The press has dubbed these future children “three-parent babies”—whether this term is apt is just one of the complex questions arising from the news. To help me address those questions, I asked Oderberg, an ethics specialist, for his thoughts. While Oderberg doesn’t think that “mitochondrial transfer represents any kind of watershed moment or breaking of an ultimate taboo, in the way some ethicists—and the media—seem to think,” this is predicated on the view that it’s an unsurprising development, considering the choices our society has already made.
The birth of Louise Brown, in 1978, marked the beginning of the IVF age. Around 2 per cent of babies now born in the UK are conceived through the procedure, mostly to parents who otherwise have little chance of reproducing. In April, a boy conceived as a result of MRT was born in Mexico; he has, owing to the second woman’s involvement, been widely referred to as “the first three-parent baby.” However, the now-outlawed use, in America, of different techniques led to 17 children being born in the 90s who also had direct genetic input from three people.
We all rejoice in the birth of healthy children, and few of us would disagree that scientific advancement should have a strong focus on healthcare. Nonetheless, some consternation has arisen over MRT’s legalisation. Rather than dismissing that response as unthinking or cold, we should assess its conflation of several important issues.
Firstly, concerns have arisen about the technique itself. The most pressing of these seem to be that, although the Mexican baby is reportedly healthy, apparently one per cent of his mitochondrial DNA does come from his mother. If the treatment’s aim is to prevent a child from having any of that specific DNA, this seems problematic.
The HFEA claims to have considered fully such risks: the “independent expert scientific panel” that the regulator convened “published its fourth review into the safety and efficacy of mitochondrial donation” before last week’s ruling. This report states that the “carryover of mtDNA is reassuringly low—below 2 per cent,” although they “could not rule out the risk of levels of carried-over mtDNA increasing during subsequent development.” It concludes that the treatments “are now at an acceptable stage for cautious clinical use.” Moreover, as Oderberg explains, while mitochondrial transfer (MT) does involve germline transfer (meaning it will affect future generations), its “purpose is to eliminate mitochondrial disease, which means future generations will, at least in theory, not suffer that disease.” He also points out that “we know now about the increased risk of various problems, such as birth defects, in IVF children. Presumably the same will be the case for MT children.”
If we dispel worries about the treatment, we still face questions related to its provision. There’s little time here to debate the purpose or funding of the NHS, but IVF is regularly cited as an example of the service’s overreach. Not only does IVF’s expense often end in “postcode lottery” accusations, but if one wanted to reduce the NHS’s overall cost there’s a strong argument that a place to start could be in paring back non-medically necessary treatments. That’s not to suggest its focus should be solely curative: many preventative and life-prolonging treatments are easily justifiable in cost terms. But the objective of IVF is not to cure or treat—it is to fulfil someone’s wish to have a child.
Similarly, this new treatment will not cure mitochondrial disease sufferers. Rather, it aims to prevent as-yet-non-existent people from being affected by such diseases. Wanting one’s own biological child is highly understandable, but whether the NHS should intervene to make that possible is not simple. If it should, then how to provide that opportunity fairly to all is as yet unanswered. When we consider MRT in such clinical and utilitarian economic terms, the fact that it will benefit so few people is particularly unhelpful. There are many expensive projects and treatments that would be advantageous to many more—not least research into why the UK retains one of the highest infant mortality rates in the west.
Finally—or, in an ideal world, first—are questions about whether these types of procedure are a “good thing” in a deeper sense. These questions are ethical, and include asking whether it is right to create a child using DNA from three people, or to intervene in its genetic makeup. Typically, we don’t discuss these problems in the abstract sufficiently—rather, we tend to focus on people’s wishes and feelings.
Most of the reasons given in favour of such treatments hinge upon one widely-held, yet hard to justify belief: that a person has some kind of inalienable “right” to have a child, biologically. Remember, we’re considering here whether someone should be enabled to conceive a healthy child, when they recognise that if they were to try naturally, there would be high risks of their child being unhealthy. This means that only those who know of these risks in advance can benefit from this treatment—and already have other options, including adoption. Any pregnancy could end in the birth of an unhealthy child, and, while modern screening methods help people to be more aware of when this will be the case, they do not take away the difficult question of what to do if it is.
However, arguments around the usual provision of IVF are much simplified by it only ever involving the DNA of two people. It seems sensationalist to refer to MRT children as “three-parent babies,” but it also seems hard to deny that this is accurate. Sure, as New Scientist clarifies, “almost all of the [child’s] DNA will come from his mother and father […] because most of our genes—around 20,000 in total—are found in the cell’s nucleus; just 37 are found in the mitochondria.” But when we’re considering this in terms of fundamental principles, then it wouldn’t matter if there were only one gene that the child inherited from the third person. Some might argue that this third-person involvement is little different from, say, organ donation, but that would be to miss that we’re discussing the creation of a person, rather than an amendment to someone who already exists.
And, ok, the term “parent” may be controversial. After all, as Oderberg points out “we already have three-parent children in the UK: they’re the children of surrogacy arrangements. In fact, in UK law the surrogate mother is still treated as the legal mother unless she ‘signs away’ her rights. […] So if anyone is going to get hot under the collar about MT children, they should already have done so over surrogacy; otherwise, they are being pretty arbitrary about when they start getting worked up.” That said, this doesn’t detract from the fact that with MRT, we’re talking about biological contribution from three people—something that must pose new questions on top of all those regarding identity and legal parentage, which already arise when establishing who should be deemed a child’s “parent” when more than two people have claims aside from the biological.
We must also take account of the way in which MRT children have effectively been “designed.” In this case, such design seems a happy use of technology, yet it nonetheless brings up further slippery-slope questions about the intervention we see as acceptable in determining the children we have. So, although it seems uncharitable to criticise a treatment that has been developed with the intention of eliminating disease, the strength of slippery-slope arguments is that they highlight the risk of future (often unintended) consequences of things that, in themselves, seem acceptable. Therefore, while I agree with Oderberg that it seems “hypocritical or arbitrary for those who have accepted everything thus far to start twitching the curtains over so-called ‘three parent’ babies,” he doesn’t mean that we should stop trying to convince people to consider things properly: there doesn’t have to be a never-ending slippery slope.
It is, of course, to be celebrated that medical advances continue to improve the chances, across the world, of children being born healthy. But it seems more appropriate to see having a child as a privilege rather than a right. And the health of that child, and the implications for the health and ethical safety of future generations, should come before a person’s desire to procreate, no matter how harsh that may seem.
