Bioethics council reaches consensus on assisted reproduction

The President's Council on Bioethics has released a consensus report on reproductive technology that calls for federally funded research, more self-regulation and a ban on "outlying experimental practices."

"Reproduction and Responsibility: The Regulation of New Biotechnologies" is the council's fifth report. Council member William Hurlbut, MD, said it was intended to serve as the foundation for future legislation. "We were trying to make a document that had some forward progress," said Dr. Hurlbut, a consulting professor in human biology at Stanford University.

Dr. Hurlbut said controversy in the early days of assisted reproduction led to an environment with little oversight and follow-up research, and now the field's "self-evident and compelling uniqueness" requires that these deficiencies be corrected.

"Clearly, if medicine should be careful anywhere, it should be careful when it is engaging in a voluntary intervention at the very origins of life," he said. "Here the therapy is more than the treatment of an individual disorder. The medical interest is, by intention, the creation of a new life."

In part, because of the well-known conservative philosophy of the council's chair, Leon Kass, MD, PhD, medical societies representing assisted-reproduction physicians were concerned that the report would call for more restrictions on the use and scope of assisted-reproduction technology.

There was relief when the report was issued, and it appeared that the council had incorporated many opinions relayed to them by groups such as the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology.

"We may not have a complete consensus on every conclusion presented; however, the council was very willing to listen to our comments and concerns," said ASRM President and York, Pa., reproductive endocrinologist Marian Damewood, MD, in a joint ASRM-SART press release.

Dr. Hurlbut downplayed any contentiousness that might have existed before the report was released.

"We did benefit from their input and did follow some of their suggestions," he said. "But we would have refined the document in the direction of their lobbying efforts anyway. We both share the same goals."

Personal statements included

Although the report emphasized consensus, its appendix included personal statements by council members in which disagreements were aired. Council member Janet Rowley, MD, a University of Chicago professor of medicine, molecular genetics and cell biology, said wider insurance coverage for assisted-reproduction treatment could lead to a beneficial layer of industry self-regulation.

Dr. Rowley said the report's defining of reproductive cloning as "any attempts to conceive a child by any means other than the union of egg and sperm" might be its most significant element. "There are a number of us who believe the issues should be uncoupled, and that may provide Congress with a way out of the present impasse," she said.

A ban on cloning has stalled in the U.S. Senate because the bill includes prohibitions on both reproductive and therapeutic or research cloning.

The council report calls for a ban on cloning babies. But in calling for a prohibition on experiments only with embryos older than 10 to 14 days, it falls short of demands by conservatives to outlaw human embryonic stem cell research altogether.

The sponsor of the Senate's anti-cloning bill, Sam Brownback (R, Kan.), issued a statement expressing disappointment that the report did "not reflect the biological reality of the one-celled human embryo as a person."

Dr. Hurlbut said there remains disagreement on the council about whether embryonic stem cell research should be conducted, but said all agree that experiments should be prohibited on embryos older than 10 to 14 days (with the exact age left up to Congress to decide). He added that the council's position should not be misinterpreted as an endorsement of embryonic stem cell research.