Nurturing the Embryo Research Debate

Human Embryo Research—Yes or No? The CIBA Foundation.Published by Tavistock Publications in association with Methuen, New York, 1987. 232 pp. $39.95 HB. $14.95 PB. The sanctity of human life has been the intellectual province of philosophers and theologians since time immemorial. Rapid strides in medical technology have placed the medical scientists and the specialist physician at the center of controversy, as lawmakers and ethicists scramble to keep up with current events. July 1978 marked the birth of the first child conceived as a result of in vitro fertilization. Since that time advances in reproductive endocrinology and infertility have remained at the center of public interest and have captivated the imagination of scientists and clinicians throughout the world. Human Embryo Research—Yes or No? attempts to focus on the medical, scientific, moral and legal implications of experimental research on early human embryos. It is the product of a November 1985 CIBA Foundation meeting—involving scientists, moral philosophers, doctors, lawyers and theologians—designed to elucidate the issues for non-scientists and explain how this research might benefit mankind. The moral issues generated by human embryo research are discussed in terms of legal, religious and ethical implications. The distinguished group of contributors includes Robert G. Edwards, who, along with Patrick Steptoe, was responsible for the first "test-tube baby" in 1978. All of the contributors are British, which is not surprising since the idea for the CIBA Foundation meeting arose out of the public debate over pending U.K. legislation on human embryo research. The original purpose behind the fertilization of human oocytes in vitro was to overcome the blocked' fallopian tubes of an infertile female. Current techniques involve the use of superovulatory agents, which result in the production of multiple follicles and multiple eggs. This improves the efficiency of the process, since many eggs can be fertilized in vitro, with the creation of several human embryos. However, during any given cycle, only three or four embryos are returned to the mother's womb. This creates an explicit moral problem: What should be done with the surplus embryos? Should they be donated to other infertile recipients? Should they be the subject of scientific experimentation? On a more fundamental level, do these embryos represent any element of what we designate as a human being? This volume addresses these questions and, appropriately, does not provide any specific solution. Rather, it provides the modes of thought to address the issues in a lucid manner. Introductory chapters deal with the morphologic definition of an embryo, the stages of embryogenesis and the medical aspects of infertility and human in vitro fertilization. Several chapters are devoted to the areas in which medical knowledge would be advanced by the use of pre-implantation human embryos. These areas include the diagnosis and treatment of both male and female infertility, the diagnosis of genetic disease prior to the fetal stage of development, the recognition of the causes and means of preventing congenital malformations, and the development of improved methods of contraception. The final chapters deal with the sociology of public opinion and the religious and moral implications of embryo research. Human Embryo Research—Yes or No? suffers from a problem common to textbooks derived from scientific meetings—the underlying theme is insufficiently developed. Some of the material is disorganized and perhaps irrelevant. Each chapter concludes with a general discussion that is often repetitious. Of greater significance is the fact that some of the most important issues of the day are omitted. These include the use of donor embryos, surrogate mothers, the cloning and bartering of human genetic material, and the discussion of numerous other ways in which this new science can be exploited. Since this is a very exacting science, it is unclear why most of the ethical discussion is in abstract terms. Although the role of developmental genetics is underscored, risk of germ-cell gene therapy, the potential of manipulating genetic information through several generations, is inadequately covered. Part of the debate centers around the ethical distinction between using surplus embryos for research versus creating new embryos for experimental purposes. These two 'situations may be morally equivalent, but they will always be legally and socially dissimilar because of the consequences to society of allowing the creation of experimental human embryos. The moral debate centers around the issue of when the cluster of cells we call a human embryo assumes human rights and entitlements. The medical value of human embryo research does not, in and of itself, make this activity ethically acceptable. In other words, the end does not justify the means. Rules may be required to allay the fears of society, while allowing such research to proceed in a prudent manner. Perhaps, in this balanced approach, the quest for a fundamental understanding of human life and experience will succeed. Brody is a reproductive endocrinologist and clinical instructor in gynecology and obstetrics at Stanford University Medical Center, Stanford, CA 94305.

Nurturing the Embryo Research Debate

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