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Nobel Committee Brushes Ethics Aside

By Michael Cook

What did the Swedes have in mind when they awarded the 2010 Nobel Prize in Medicine to the inventor of the test-tube baby?

The Nobel Prize for Medicine is given for a “discovery” that has “conferred the greatest benefit on mankind”. IVF, though, is more a clinical application than a theoretical advance. So when the 2010 prize was given to British biologist Robert G. Edwards, the father of French IVF, Jacques Testart, expressed his disdain for the Nobel committee’s choice in the journal Quotidien du Médecin: “That deserves a Nobel? I thought that the prize was meant for discoveries, not for inventions.”

While the birth of nearly four million IVF babies to infertile couples worldwide since the arrival of Louise Brown in 1978 seems to be an indisputable good, what tipped the balance in Edwards’ favour was his particular “vision”, not just of infertility but of science. For decades, Edwards fought to wrest control of reproductive mores from the “establishment”.

In “a visionary key paper” published in Nature in 1971 he insisted that it was up to scientists to set ethical standards, not politicians or religious figures. “When scientists clearly foresee potential conflicts with existing rules of society arising from their work, paradoxically both human progress and scientific freedom may hang on their activism generally regarded as social or political,” he wrote.

Edwards was a harbinger of the scientific activism that has marked the climate change debate, writing that scientists “may have to stir up public opinion, even lobby for laws before legislatures, in the hope that the attitudes of society as evidenced in its laws will mature at a rate not too far behind the transition of scientific discovery into technological achievement.”

Bizarrely Prof Christer Höög, a Nobel official from the Karolinska Institute, told the media that the ethical controversies over IVF had all been resolved. This is a bit like claiming that the ethics of nuclear weapons have been resolved.

Yet Edwards always saw IVF as a deeply ethical issue. In 2003 he told London’s Times: “It was a fantastic achievement, but it was about more than infertility. It was also about issues like stem cells and the ethics of human conception. I wanted to find out exactly who was in charge, whether it was God himself or whether it was scientists in the laboratory.” And what he discovered was that “it was us”.

The Catholic Church is widely seen as the main critic of IVF. It argues that each human embryo, from the moment of conception, is a human person who has a right to be treated with dignity and to be born into a family with a mother and a father. It points out that hundreds of thousands, if not millions, of embryos have been destroyed in the course of IVF treatment.

Although this goes to the heart of the controversy, few people outside the Church feel compelled by this stark logic. A churchman defending the right to life of a human being who is no bigger than a full stop is much less persuasive than Edwards cuddling a baby at his IVF clinic.

But this is not the only ethical problem. In 2004 the US President’s Council on Bioethics outlined a number of issues that still vex IVF: the well-being of the participants in assisted reproduction, the possibility of human enhancement, and the disposition of spare human embryos left over from treating patients.

Every week brings news of new ethical conundrums, ranging from OctoMom, the fertile California woman who had IVF octuplets plus six other IVF children, to using the wrong sperm in clinics, to villages in India where the main industry is surrogate motherhood for rich Westerners.

None of this is really surprising. IVF was born in an ethical desert. Edwards carried out IVF on 1200 women before any studies were reported on primates. ICSI, a technique for injecting a single sperm into an egg, was only tried on animals years after it was declared an ordinary clinical procedure by the IVF profession.

There has also been an appalling dearth of long-term health studies of IVF children. The Nobel committee dismissed studies showing that the risk of birth defects is twice as great in IVF-conceived children.

IVF may actually depress birth rates instead of increasing them. Many women balance the cost of having a child against extra income. They defer having children, with IVF as their safety net. By leaving it too late, they then find themselves unable to conceive. IVF acts as a flickering beacon of hope, allowing women to invest so heavily in their careers that they are unprepared for the fading of their fertility.

IVF has helped to engineer massive social change as well. The creation of thousands of genetic orphans who are cut off from their sperm donor fathers, a rise in single mothers and gay parenting, and the growth of surrogacy as an industry in the developing world are all a result of the ready availability of IVF.

The day of designer babies has not yet arrived, but it is coming, and Edwards was a cheerleader. Long before the birth of Louise Brown he foresaw that his work would eventually lead to embryonic stem cell research, sex selection and genetic engineering. His 1999 remarks backing eugenics are widely quoted: “Soon it will be a sin for parents to have a child that carries the heavy burden of genetic disease. We are entering a world where we have to consider the quality of our children.” He was actually in favour of human reproductive cloning, provided that the procedure was safe.

By garlanding the man who made cloning and eugenics possible and overlooking IVF’s countless moral complications, the Nobel committee has canonised Edwards’ radical view that scientists are the ultimate arbiters of ethics.

Michael Cook is editor of BioEdge, a bioethics newsletter.