Advances in reproductive technology have undoubtedly brought benefits to many infertile couples by alleviating the grief and misery of childlessness. Inevitably, however, technological advances create problems of their own. These problemes are heightened when the technology involves dealing with the very origins of human life, a subject on which most people have very strong views. Two areas which are extremely controversial are human embryo experimentation and surrogacy.

Human embryo research has been advocated to further the improvement of assisted conception, the diagnosis and prevention of genetic disease and the development of better methods of contraception. Such research may be divided into therapeutic (in which the aim is not to destroy the embryo but to improve it and increase its chances of survival) and destructive ( in which the procedures by their nature cause damage to the embryo so that it is unfit for implantation or less likely to survive if implanted). In practice, differentiation between the two may be difficult.

If we assume that embryo experimentation is desirable, is it morally and ethically justifiable? On this issue, there are a number of considerations. Is the embryo a human individual or a person? Does it have any rights? What duties do we have towards it? is it permissible to override those duties in the interests of the advancement of medical treatment and the benefit of the community as a whole? if it is accepted that research is permissible, then a number of other considerations follow. Should there be any control on it? if so, who should control it? what sort of experiments should be permitted? Should consent be obtained in a general sense or should it be sought for specific experiments? These issues are complex and not easily resolved. The most important question (but not the only one) to be clarified is the actual status of the human embryo.

In addressing the question of the status of the embryo, there can be no doubt that it is human in the sense that it is derived from human gametes and that it is alive. It is also special, because it has the capacity to develop into a human being.

Because of its human nature, is the embryo therefore entitled? On this issue there are essentially two positions. One is that the embryo is entitled to be treated with the respect we would accord an adult human being, because of its potential to develop into a rational being worthy of respect, and this development is a continuum. The other position is that, it does not have human caracteristics, it is therefore not entitled to special consideration; this entitlement comes later, when the brain and nervous system have developed. Resolution of these positions is, extremely difficult because of their philosophical nature, but the majority took the view that a prudential position would be to regard the embryo as if it were a human subject for the purposes of biomedical ethics, while at the same time making no statement on its legal status.

The most immediately relevant area of experimentation is that involving genetics. This could cover a range of procedures from embryo typing to possible gene therapy. Technically, it's possible to remove one or two cells from the embryo at the 6-8 cell stage (embryo biopsy), such a procedure can allow the elimination of sex-linked recessive diseases in the offspring. This procedure can be extended to detecting a defective gene and not implanting those embryos carrying the gene. Such genetic sorting raises the possibility of creating the illusion of the "perfect baby", which itself raises further issues. It has implications for how we treat the disabled in society, not to mention how the disabled see themselves; who decides what caracteristics are desirable; and the psychological and sociological implications of such screening for the couple involved.

An important question araises, should there be any limitations on the stage of development of the embryo beyond which the research would not be permissible? where there are regulations, either existing or proposed, the usual time is 14 days. The creation of embryos specifically for research has been ruled out by most research workers, but the distinction between "research" embryos and those for "treatment" is not clear-cut as may first appear and is complicated by the difficulty in assessing which embryos are normal and which are not reasonably implantable.

Surrogacy involves the bearing or gestating of a child by a woman for another woman or couple. Usually this is achieved by a fertile woman (the surrogate) being inseminated with the semen of the commissioning husband. However, other combinations are at least technically possible, using either of the commossioning "parents" gametes, up to the extreme case in which both donor ova and donor sperm are used. Surrogacy raises a number of medical and social issues which affect all the parties involved. It has been advocated on the basis of an individual's freedom of action, but this takes no account of the implications for the child that result from such an arrangement.

It has been customary to divide surrogacy into"altruistic" (in which the surrogate mother carries the pregnancy for no financial reward) and "commercial" (in which there is a financial payment to the woman "for services rendered"). In the United States in 1984 the most common fee was US$ 10.000 plus expenses, with a total cost of US$ 30.000 to US$ 50.000.

As with embryo research, the fundamental issues are not disputed between the protagonists for each side. Some of these are: exploitation of women, especially the poor; fragmentation and downgrading of motherhood; possible psychological effects on the child from knowing this his social mother was not his gestating mother nor (possibly) his biological mother. There is also the potential for confusion with respect to family relationships. Another concern is that it will lessen the importance of the family as fundamental unit of the society.

The Ethics Committee of the American Fertility Society also highlighted a number of risks and took the view that surrogacy was a "clinical experiment" and did not recommend its wide use.

However, the most important question we should ask is whether it is in the best interests of the child-to-be, to be subjected to a "clinical experiment", and whether we are justified in making that decision on his or her behalf.

Abdelali Haoudi

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