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Michael Cook Editor BioEdge

I suspect that people who use the expression “I’m feeling conflicted” are mostly American, so I avoid it. However, when discussing slippery slopes, synonyms like doubtful, faltering, irresolute, undecided, or wobbly don’t do the job. I am conflicted.

The slippery slope is derided as a logical fallacy, which it would be if it describes necessary consequences. But it seems to describe a reality if we take into account lawyers’ searching for loopholes or bioethicists searching to push back the frontiers of repugnance.

One example of this in this week’s newsletter is Switzerland’s famous assisted suicide law. Apparently this was first proposed almost a hundred years ago to help a few victims of unrequited love and wounded honour. It was only in the 80s that the cobwebbed loophole was discovered by right-to-die groups. Since then hundreds have died. Isn’t that a slippery slope?

Perhaps a century is too gradual to be called a slope. I spotted a swifter version in a startling article in the Journal of Medical Ethics about why it might be good for children to have not two, not three, but four or many more genetic parents. Quite a lot of the reasoning by British bioethicist John Harris evokes the slippery slope for me. Here’s an example:

“If we find it morally unproblematic that people who cannot achieve natural reproduction rely on assisted reproduction to have genetically related kin then we find no reason why this should not hold also for non-couple partnerships for whom simultaneous genetic kinship is currently prevented.”

Let’s put this in Plain English. If, back in 1978, when Lesley and John Brown wanted their own genetically-related baby, we invented IVF, then now when Tom, Dick, Harry, and Sarah want their own genetically-related baby, we should invent “multiplex parenting”.

I admit that logic has never been one of my strong points (I’m a journalist, right?), but the “if… then” construction looks curiously like a slippery slope to me. Does anyone else think so?

Analysis of legal assisted suicide in Switzerland

by Michael Cook | 8 Mar 2014 |

tags: assisted suicide, slippery slope, Switzerland

An extensive survey of assisted suicide in Switzerland between 2003 and 2008 has found that the most vulnerable people are women, people who live alone or people who are divorced. People who ask for assisted suicide tend to be wealthier and better educated.

The results have been published in the International Journal of Epidemiology. The authors, from the University of Bern, conclude that disadvantaged sectors of the Swiss population are not more vulnerable to assisted suicide, because relatively fewer low-income people take advantage of it. Their principal recommendation is that the government should require better statistics.

However, other interesting findings also emerge.

* Fewer people with a religious affiliation, especially to the Catholic Church, seek assisted suicide. “The association with religion may reflect greater social integration among the religious as well as social norms and dogma,” they say.

* The existence of right-to-die associations might possibly be increasing demand for suicide. Although one-third of doctors said that they had been confronted with a request for suicide, only 6% of then actually participated without the involvement of a right-to-die association.

* The right-to-die associations are not following the law, but the authorities do not seem to be reacting. “In a substantial minority of death certificates (16%), no underlying cause of death was recorded, despite the fact that only those who suffer from an incurable illness, intolerable suffering or a severe disability are eligible for assistance by the associations.”

* The authors believe that their data may disprove the danger of a “slippery slope” because lower socio-economic groups are less vulnerable than the wealthier and better educated. However, if the time frame encompasses the 1918 law on assisted suicide, the “slippery slope” seems more plausible.

Nowadays, Swiss assisted suicide is “marketed” as a remedy for an unendurable disability and an alternative to the pain of terminal illness. However, that is not why the legislators of 1918 proposed it and the legislators of 1937 approved it. They removed penalties for assisting a suicide if the motivation were altruistic. But, surprisingly for our generation, health was not a consideration. Legalised assisted suicide was for people suffering the pain of wounded honour or disappointed love.

But in 1982 two non-profit associations, one for French speakers, Exit Suisse Romande, and one for German speakers, Exit Deutsche Schweiz, were formed to help their members die. These were followed by EX International in 1996, which helps foreigners, and Dignitas in 1998, which helps both Swiss and foreigners. What began as a policy in the spirit of The Sorrows of Young Werther ended up as industrial death.

Stop fretting about 3-parent embryos and get ready for “multiplex parenting”
by Michael Cook | 8 Mar 2014 |
tags: artificial gametes, artificial reproduction, IVF, multiplex parenting

The controversy over three-parent embryos could soon be old hat. Writing in one of the world’s leading journals, one of Britain’s best-known bioethicists has outlined a strategy for creating children with four or more genetic parents. He calls it “multiplex parenting”.
John Harris, of the University of Manchester, and two colleagues, César Palacios-González and Giuseppe Testa contend in the Journal of Medical Ethics (free online) that this is one of many exciting consequences of using stem cells to create synthetic eggs and sperm. (Or as they prefer to call them, in vitro generated gametes (IVG).)

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After the discovery of induced pluripotent stem cells in 2007, theoretically any cell in the body can be created from something as simple as a skin cell. Mice have already been born from sperm and eggs created from stem cells. Harris and his colleagues believe that the day is not far off when scientists will be able to do the same with humans. In their paper, they spin an ethical justification for this and outline some possible uses.

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First, is it ethical? Of course it is, so long as experiments on mice show that it is safe. After all, they write, this is already a much higher ethical bar than the one used for the first IVF babies. “If impractically high precautionary thresholds were decisive we would not have vaccines, nor IVF, nor any other advance. Nothing is entirely safe.” Besides, any children brought into the world are better off than if they never existed.

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Second, there are many potential uses. The first four are familiar from the world of IVF: men who cannot produce viable sperm; women with premature menopause; people who have lost gonads or their fertility due to cancer treatment; and people who have been involuntarily sterilised (rare, but they do exist).

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Many clients for such a service would be gay and lesbian couples who could have children who are genetically related to them both. “There is nothing morally wrong with same-sex competent caring people using IVG for satisfying their legitimate interests in becoming genetic parents of their children,” they say.

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Another would be “single individuals, who may wish to reproduce without partner and without resorting to gamete donation”. This would be the most intense form of incest – an individual effectively mating with himself – so its safety is not guaranteed. But if it were safe, it might be permissible.
Finally, “multiplex parenting”, an option which Harris and his colleagues tackle with great enthusiasm. This is “a radical expansion of reproductive autonomy that allowed more than two persons to engage simultaneously in genetic parenting”.

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“IVG could permit instead a much more substantive sharing of genetic kinship, through what is in essence a generational shortcut. Imagine that four people in a relationship want to parent a child while being all genetically related to her. IVG would enable the following scenario: first, two embryos would be generated from either couple through IVF with either naturally or in vitro generated gametes. hESC lines would be then established from both embryos and differentiated into IVG to be used in a second round of IVF. The resulting embryo would be genetically related to all four prospective parents, who would technically be the child’s genetic grandparents.”

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But it could be far more than four parents. An Australian bioethicist has discussed how children with even more progenitors could be created as a form of in vitro eugenics. By creating gametes from embryonic stem cells, it would be possible to create 20 or 30 generations of Petri dish humans in as little as ten years. So four parents might be a conservative estimate. “The in vitro compression of generational time appears thus like the most transforming feature of IVG derivation,” they write.

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An ethical defence of this scenario is tall order. But Harris et al are up to it. In the first place, arguments drawn from what is “natural” are obviously irrelevant as there is no such thing as “natural” ways of acting. Hence, what can be wrong with opening up genetic kinship to a wider range of people than one father and one mother?

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If there are some drawbacks, the child can hardly complain. It exists, and existence is better than non-existence. In any case, even today, parenting involves many different individuals from different generations. The use of IVGs merely gives this reality a genetic component. “Prospective parents will be able to choose among a hitherto unimaginable variety of potential children,” they write.