Meet Raj and Shahana Hashmi. Their gorgeous three-year-old son, Zain, has a serious blood disorder. He needs a cell transplant, and if they do not find a suitable donor he could die. On 22 February, the Human Fertilisation and Embryology Authority (HFEA) gave the Hashmis permission to try to create that donor. Shahana is to have IVF treatment. Any embryos that result will be subjected to genetic diagnosis. The hope is that the couple will find an embryo that could become the child with the bone marrow that will save Zain’s life.
The odds are not in their favour. The success rate for a single course of IVF treatment is less than one in three. The likelihood of Shahana Hashmi creating a genetically suitable embryo is one in 16. So she and her husband must have a hard time understanding why so many people think they’re playing God. If only, they must be thinking. All they want is to take this one-in-about-50 chance to keep their son alive.
How strange it must be for them to open the paper and read that they are symbols of moral decay. No one is quite ready to condemn them outright. No one who wants to avoid a writ, anyway. No, almost everyone is sure that the Hashmis will love any second child just as much as they love their first. Some have gone on the record to say we can count on this even if something goes amiss and their second born turns out not to be Zain’s saviour. But what about the six other couples who have already announced they will be following in the Hashmis’ footsteps? What about all the faceless others who are bound to follow them? What if the rules get looser still and this sort of thing becomes standard practice? When we work ourselves up into a moralistic froth about reproductive technology, what exactly are we talking about?
The short answer is that we are talking about too many things at once, and in a very muddled way. The dirge gets played out on the lowest keys on the piano. Many of the fears it evokes are, however, worthy of attention. There is, for example, the entirely legitimate fear of the new – or of the social havoc that can result when new technology makes false claims, or gives people more power than they know how to use, or changes the rules by which we procreate. There is religious fear – about hubris, damnation, sacrilege and playing God. There is the fear of eugenics trying to “get in through the back door”. There is the free-floating fear of the wrong people being in control. We are afraid of doctors taking control of our bodies to create a master race, of parents buying into the fantasy of perfection, of babies being turned into consumer products. And what if something goes wrong? What if, instead of creating the perfect baby, the scientists accidentally create a monster?
One of the most interesting things about the debate on reproductive medicine is its heavy reliance on the language of fairy tales. There are spectres, monsters and bogeymen, wishes and dreams and magic cures. Babies are not just babies, but potent symbols of our cultural future – what we want to pass on, what we stand to lose if the story goes the wrong way. When people talk about designer babies, they’re not just talking about the manipulation of genes. They are talking about the next generation and who gets to shape it.
If they sometimes forget that they are talking in symbols and fall too easily into magical thinking, if their ideas about “suitable candidates for treatment” are arch-conservative, and even racist, it is also true that they are asking important questions. A society is not a society unless it can reproduce itself. The social regulation of fertility, the system of controls and supports that decides who gets to have children, and who does not, is what makes a society what it is. Every time a society changes its system, everyone and everything in that society feels the effects. The faster the change, the bigger the disruption.
In the past generation, we have seen one of the most dramatic changes ever. The regulation of fertility is less and less a private matter: increasingly, it is decided in the public domain. When fertility goes public, the game changes utterly.
Let me give a very obvious example – I cannot live as a free woman, in control of my body, in charge of my choices, unless I live in a society which supports that freedom with affordable, accessible contraception. I depend on the state to make sure that the services I use are regulated and staffed with real doctors. I need to have the right to complain if I find the service poor. I need to know that I can campaign for changes in legislation as and when they seem necessary. I need to bear in mind that other parties are free to do the same, which is why my right to birth control is something I should never take for granted.
As with birth control, so with birth. I need to bear in mind that my right to have a child at all is also subject to political control. If I live in a democratic society, I can fight my corner. If I happen to be in China in the time of the one-child policy, I cannot. If I live in any of the countries that condone the use of sex selection technologies to favour boys and weed out girls, my ability to protest against that policy will depend on the political system within which I am operating.
Wherever I am, whatever aspect of reproductive medicine I am talking about, the questions are the same. Who decides? And what ideological agenda are those people serving? Thus, Nazi eugenics was evil because it served Nazi ideals. It was dangerous because it was backed up by a fascist state.
If reproductive medicine is properly regulated and democratically debated, if the use of new technology is overseen by a regulatory agency with a clear ethical framework, it does not lead inexorably to the same place. Our own HFEA is far from perfect, but you have only to look at the chaotic, under-regulated United States to see how lucky we are. In Britain, at least, we have rules and principles. We can harness change, make sure it is not open to abuse, or slow it down so that we have time to think about it.
The HFEA’s slow but steady move to a stance in favour of “eugenics for sound medical reasons” is a case in point. Most experts in the field predict that public attitudes will follow suit. But that is only a tiny part of the picture. The larger, cultural implications of reproductive technology will continue to trouble. Every new technique will challenge power relations within families and kinship networks, and therefore the way we bring up children. Wherever the family loses power over an individual’s right to become a parent, the advantage goes not just to the individual but to the medical profession, big business and the state. Is this what we want? If we do not, we are going to have to fight it out politically. But first, we need a more rational debate.