John Windell looks at the religious, moral and scientific principles that have governed research into embryos and asks if a rule that has stood for 30 years is set to change.
In May 2016, the findings from a research project into embryo growth, led by Professor Magdalena Zernicka-Goetz from the Department of Physiology, Development and Neuroscience at the University of Cambridge, were published in Nature. The paper caused little stir outside the scientific community. Few other people even noticed it – nowhere near as many, for example, as the announcement a few months earlier that physicists had detected gravitational waves.
Described with widescreen drama as “ripples in the fabric of spacetime” and with walk-on parts for Albert Einstein and colliding black holes, gravitational waves made the front pages and evening news slots. By comparison, the embryo research appeared a touch prosaic. No black holes, no special effects, no cultural icon. Just a petri dish or two.
That changed in December when 225,000 readers of Science Magazine voted the embryo research the “People’s Choice Breakthrough of the Year 2016”, knocking the discovery of gravitational waves into second place. What did they see that so few others could? Possibly they found it easier to relate to the more earthbound discovery, and maybe they more readily realised the immediate potential the embryo research held for medicine. After all, Zernicka-Goetz and her team had managed to create the conditions that meant they could keep embryos alive in a laboratory for up to 13 days after fertilisation. Perhaps those who voted grasped the ethical reverberations that the research would set off.
Test tube babies
In the popular imagination, the great awakening moment for embryo research was the birth of Louise Brown in 1978 in Oldham General Hospital. Louise (pictured above) was the first human “test tube baby”, though she was actually conceived in a petri dish – a product of the pioneering in vitro fertilisation (IVF) work of Sir Robert Edwards and Patrick Steptoe. The world applauded, but also woke up to the serious moral considerations that emerged from IVF and the developing science of embryology.
A few concerns were practical and relatively simple to address. For instance, were IVF laboratories doing enough to ensure that embryos did not get mixed up, eliminating any chance of an embryo from one mother accidentally ending up in the womb of another mother?
Other concerns had a more ethical dimension and were not so easily resolved. For some people, particularly religious communities, the idea that a human egg could be fertilised in a laboratory and the resulting embryo would exist for a time outside the mother’s body was profoundly disturbing, with its hints of scientists playing God. And what happened to the unwanted embryos? Many eggs from a mother would be fertilised in order to improve the chances of a successful conception and implantation.
But since only one embryo would ultimately be chosen, what would happen to those that didn’t make the final cut? Who would decide and on what basis? What about creating “designer babies”? Would scientists or parents be entitled to tweak the genetic make-up of an embryo in order to weed out “undesirable” characteristics, such as an inherited condition or hair colour? Could they add more “attractive” traits to produce a taller, stronger, smarter human? The possibilities could be troubling, to say the least.
The biggest question, though, was the one that stood at the heart of all IVF and embryology work. At what point does an embryo become human? Is it the precise moment that a sperm from the father successfully fertilises the egg, sparking the rapid cell division that will produce a child? Or is it later – when the heart begins beating after about three weeks? Or later still – around the end of the first trimester, when the human form becomes unmistakable?
IVF TREATMENT IN THE UK
- 1992: Just over 14,000 women had IVF treatment
- 2007: Around 36,000
- 2014: Almost 55,000
- 122,043 babies were born following IVF treatment that started between 1992 and 2006
- In 1991, the IVF birth rate was 14%.
- In 2012, it was 25% In 2012, 2.2% of all babies born in the UK were conceived through IVF treatment
Ethical questions
Faced with rapid leaps into previously unexplored territory, the government in 1982 set up the Committee of Enquiry into Human Fertilisation and Embryology. This would look into the science and the moral implications of IVF and embryology, and suggest principles to govern any future work.
In a break from convention, and to acknowledge the serious ethical questions posed, the civil servants assembling the committee looked for a chair outside the traditional disciplines of science and medicine. They settled on the moral philosopher Mary Warnock, who had previously steered the Committee of Enquiry into the Education of Handicapped Children and Young People during the mid 1970s, which drove the reforms of the 1981 Education Act. She could take this large and challenging task while remaining sensitive to social anxieties. Warnock had no illusions, though. “The task you set the inquiry was not an easy one,” she wrote. “The issues raised reflect fundamental moral, and often religious, questions which have taxed philosophers and others down the ages.”
Responding to the many concerns and viewpoints on the issues, the make-up of the committee extended beyond scientists, physicians and even a philosopher to include health and legal experts, a social worker and a theologian. Despite this inclusivity, Warnock acknowledged the many differences in opinion between the members – the main area of contention being research on human embryos.
Special status
The Report of the Committee of Inquiry into Human Fertilisation and Embryology, otherwise known as The Warnock Report, was published in 1984. Having examined the science of IVF and embryology, it weighed up the attending ethical anxieties and recommended a way forward. On the emotive subject of embryo research, it argued that the strong moral objection came down the simple fact that embryos are human and should share the same status as a child or an adult. The logic followed that, “since an embryo used as a research subject would have no prospect of fulfilling its potential for life, such research should not be permitted”.
Conversely, the scientific opinion was that a human embryo couldn’t be considered a potential person. “It is simply a collection of cells which, unless it implants in a human uterine environment, has no potential for development,” said the report. “There is no reason, therefore, to accord these cells any protected status. If useful results can be obtained from research on embryos, then such research should be permitted.”
The report said, despite the potential benefits of research, human embryos should have some degree of respect and protection. “A majority of us therefore agreed that research on human embryos should continue,” wrote Warnock. “Nevertheless, because of the special status that we accord to the human embryo, such research must be subject to stringent controls and monitoring.”
The controls would take two forms. The first would be a new statutory licensing authority to regulate and monitor embryology and IVF (the Human Fertilisation and Embryology Authority, established in 1990), and second would be a stringent statutory framework: “We recommend that research conducted on human in vitro embryos and the handling of such embryos should be permitted only under licence… that any unauthorised use of an in vitro embryo would in itself constitute a criminal offence.”
That was clear enough, but the big question remained: at what point does an embryo become human? Warnock and her colleagues settled on the “primitive streak”. This refers to the moment during the rapid early development of an embryo when it starts to exhibit features that are recognisably human. The neural groove begins to form, then the neural folds, and the first signs of a spinal cord emerge, in turn signalling the development of the central nervous system and the brain. This begins on around the 15th day after fertilisation. The report concluded that it marked “the beginning of the individual development of the embryo”.
To establish a rule that everybody could work to, the report recommended that “no live human embryo derived from in vitro fertilisation… may be kept alive, if not transferred to a woman, beyond 14 days after fertilisation, nor may it be used as a research subject beyond 14 days after fertilisation.”
The limit
The 14-day limit for research has proven remarkably robust in the 30 years since, even in the face of developments such as stem cell research and gene editing. But the main reason it has remained unchallenged is because nobody has been able to keep to an embryo alive outside the womb for more than around five to seven days. Until now.
This is why the Zernicka-Goetz research caused a stir. In extending the potential realms of embryo research, it also reignites the whole ethical debate. “When we reached the 13th day, we stopped the experiment because we were so near the legal limit,” Zernicka-Goetz says. “We could have gone to the limit, but I don’t know how much longer the embryo would have survived.”
From a scientific point of view, the breakthrough is important because an embryo makes huge developmental leaps from day seven to day 14 and onwards, but so little is understood about what happens and why. The feeling is that if embryos could be studied up to the limit and possibly beyond, it would bring enormous benefits – from understanding more about miscarriages, to improving the success rate for IVF implantations.
But while some are excited by the extra doors that the Zernicka-Goetz research could open, others are worried that moral and religious concerns will refocus their efforts to shut the existing door.
From an ethical point of view, the research could be the slippery slope that The Warnock Report warned about: “Once a foot is set on the ‘slippery slope’ of deliberate creation of embryos, no end can be set to the dangers.”
Even today Warnock remains convinced that the 14-day limit is the right one. “It has nothing to do with science, and everything to do with politics,” she said at the Progress Educational Trust annual conference on embryo ethics held London in December. “IVF and stem cell research would never have been permitted if ideas had come from scientists alone.” For her, the fixed 14-day limit is the best guarantee that research can continue as it has done since the Human Fertilisation and Human Embryology Act 1990, and she is urging researchers to make more use of that full limit – which Zernicka-Goetz looks to have made a far more feasible prospect.