PROFESSOR SHEILA MCLEAN holds the International Bar Association Chair of Law and Ethics in Medicine at Glasgow University. Her new book, Modern Dilemmas: Choosing Children has been described as “written by an expert for experts”. It addresses from a jurisprudential angle some of the emerging questions in what is described as the field of repro-genetics. Professor McLean is particularly good at presenting case histories and describing decisions of the HFEA (Human Fertilisation and Embryology Authority) showing how they have furthered or hindered what she describes as reproductive liberty. Her book is far from dispassionate however in presenting her argument that “facilitating free reproductive choice is a goal to be respected, not derided” – indeed it is to be “prioritised”.
As the book advances, this purpose sweeps all arguments for restraint aside. In dealing with pre-implantation genetic diagnosis and the statement of an adversary to her position who considers that “to choose the sex of one’s children is a trivial choice”, she sternly retorts: “It should be remembered that …the most important value is the right to reproductive freedom.”
Later still, when considering “discarding” embryos that happen to carry a defective gene, she argues “embryos at this stage (of possible implantation) may be worthy of some respect but that is over-ridden by the value attributed to reproductive liberty”.
Professor McLean considers that “the state’s involvement with reproductive choice may be benign or negative, but it is always an intrusion into people’s private lives”, an intrusion she considers justifiable only where “failing to interfere would cause harm”. She claims her approach owes much to the work of John Stuart Mill “whose libertarian approach to the relationship between the state and the individual has underpinned the philosophy of many western democracies”.
I would perhaps take a more benign view of the role of the state, considering it the responsibility of government, on behalf of society, to ensure by statute the common good.
However I find myself in the ironic position of thinking that the HFEA has gone far and beyond its democratic remit in allowing certain procedures inimical to the integrity of the human embryo, while Professor McLean clearly thinks it hasn’t gone far enough: “The interest of the state in the reproductive practices of its citizens becomes legitimate only where it enhances rather than reduces that liberty,” she states.
I would be content with that statement if instead of liberty we were to substitute “the good of children” – the ‘bonum prolis’ – in the sense of children as the good of both the family and of society.
This is where I and others diverge from Professor McLean, for while she may consider children a benefit to society they appear in her book not so much as a good in themselves but as goods to be selected, disposed of, genetically enhanced and sex-determined as decided by those who hold reproductive freedom as the “ultimate value”.
She is even prepared to see them as instrumental goods, defending their in-vitro and implantation-stage selection as “saviour siblings”; in other words as what she would consider legitimate means to a (worthy) end. In this she boldly flies in the face of received
and defensible wisdom.
In speaking of assisted reproduction, Professor McLean states: “Once it is available, decisions about gaining access to it must be based on non-discriminatory criteria, both in terms of the choice whether to reproduce and also what kind of children to have.”
Logically therefore she argues in favour of cloning, sex selection, ‘perfect’ babies and the proudly dubbed “saviour siblings”. It would seem that nothing should be hindered except, perhaps, in certain places the preference of parents for male offspring! Unless, and she makes this clear, evidence of harm can be presented. However the nature of the harm is not categorised nor fully explained – a serious omission when what is at stake is the nature of society itself. Think for example of the possible ill-effects of a woman bearing a male child which is the clone of her husband…
Wisdom must hold its tongue apparently, until the empirical evidence can be adduced.
Even the slippery slope argument is somewhat summarily dismissed though Professor McLean admits that “the extent to which the argument is flawed is for philosophers to explain fully”.
Yet it is surely no more than common sense to recognise that once a principle is permitted to have an exception made to its application, more and more exceptions are sought and justified. And, so, for example, the unqualified protection from experimentation of the conceptus after fertilisation – once arbitrarily set at a fortnight – is now in peril of being extended further.
Or to give another example: once it is permitted to screen an embryo for a genetic disorder, an imperfection such as a cleft palate is considered by some as sufficient grounds for selective abortion.
Perhaps it is not surprising that Professor McLean is commended by Baroness Warnock for not giving the slippery slope argument “the weight it was given in the cautious early days”. Anyone who has followed the Baroness’s subsequent career will recognise that she herself is a casualty of that slippery slope.
Generally speaking all opposing views are give short shrift by the author. “Dissenters from the repro-genetic phenomenon” – those who “dissent from the amazing potential that science and medicine offer” – are variously described as “timid”, “fearful”, “negative”, “hidebound”, and “religious”. This is in contrast to colleagues with more “enlightened” views of, for example cloning for birth, who are hailed as “brave”, “nuanced”, “thoughtful”, “concerned”, and “compassionate”.
Such a missionary approach to the questions considered in the book led one director of a bioethical research establishment to whom I showed the book to describe it as “an astonishingly badly written book”. She described it as “full of sweeping rhetoric and assertions which, though unsupported are unblushingly repeated”. I think that may be a rather harsh criticism and it is only fair to say that the doyenne of repro-genetics, Baroness Warnock considers that Professor McLean as always, writes “forcefully and with wonderful clarity”.
For myself, given the prestige of her Chair, I wish that Professor McLean had been less partisan in her approach and less driven by her dedication to reproductive liberty, a little more appreciative of the arguments of her adversaries and of the necessary role of what she calls “the state” and what I would prefer to call “human society” in defending not only the liberties of individuals but the common good. This latter is not a vague concept but a concrete reality – a complex of relationships and a conversation of values and beliefs formed over centuries by common values and prudential insights and supported by laws. There are many who are as concerned at the interference of science as they are at the state in the bringing to birth of a new generation.
There are however flashes of light here and there in this book: for example the author comments with rare perception, that “creating clones to be destroyed (as would be the case with therapeutic cloning) is probably more objectionable than creating clones to be born, all else being equal”. Elsewhere she observes that “the way in which we treat human embryos is one indicator of the extent to which we call ourselves a civilised society”. In her final chapter she notes that human embryos are alive and are “worthy of some respect”, and should not be worn as ear-rings.
Professor McLean quotes D Steinbock with apparent agreement: “Embryos are not merely things, they are alive and under certain conditions, have the potential to become people with interests – indeed to become people, like you and me.” When Steinbock adds that “their potential to become persons does not give them the moral status or the rights of actual persons” I reflect that in our expanding culture of human rights we are still to address the rights of the unborn.
As I was preparing this review I dreamt that Professor McLean had espoused the cause of the unborn, bringing to it something of the vigour she displayed in defending reproductive freedom in her passionate book. But then I awoke, sadly, to the reality of her position in the ranks of the libertarians – but surely there is still room for dialogue.
MODERN DILEMMAS: CHOOSING CHILDREN
by Sheila McLean
Capercaillie Books, £12.99
pp224 ISBN 095512462X