The Life Technologies and Public Policy

Hannah Gay is a history professor at Simon Fraser University.

David J. Roy, Director of the Centre for Bioethics of the Clinical Research Institute of Montreal and Maurice A.M. de Wachter, Director of the Institute for Bioethics, Maastricht, The Netherlands have conducted a study that they see as preparatory for policy design in the areas of human reproduction technology, prenatal diagnosis, human genetic engineering and genetic therapy. The authors present a reliable introduction to these new technologies and are especially good on human reproduction technology and prenatal diagnosis. Roy, who writes about the former, discusses the present status of technologies such as artificial insemination, in vitro fertilisation (IVF), embryo transfer, cryobanking of sperm, ova and embryos, sex selection, artificial placentas, and the more distant possibilities of human cloning. Collectively they provide general solutions to sterility and many revolutionary social implications.

To what extent should the state be involved in matters of reproduction? Should the state legislate

controls over surrogate motherhood? What is the legal status of the human embryo? What is the status of an embryo whose parents have died? And of the child who might develop from such an embryo?

De Wachter, who writes about prenatal diagnosis, raises a particular version of a more general problem, namely how the medical profession should act when the gap between diagnostic and curative techniques is large. The prenatal diagnosis of hereditary disorders is improving by leaps and bounds and the demand for such services is growing likewise.

Should screening, now ordinarily limited to mothers over 35, extend to a lower age group? Should it be compulsory, do we have obligations to society to prevent the birth of children requiring expensive care? Or, if treatment procedures improve, will we have an obligation to the unborn child? Knowing what we know now about the effect of smoking or transmissible diseases such as AIDS, it is hardly too soon to raise the issue of the rights of unborn children.

A discussion of the costs and benefits of genetic screening is also included and the fact noted that in Canada today, these services are very unevenly distributed and are largely made use of by upper income families.

Roy discusses genetic engineering and genetic therapy; he gives a brief history of the technologies and of the public debates surrounding them.

The authors argue that these complex issues cannot be seriously faced without accurate, up to date, easily accessible and continuous information. They suggest something along the lines of a Scientific Communication Institute to serve the public, an institution with a mandate to examine, from the public stance, advances in specialised branches of knowledge. Further, they wish to see greater public participation in science research policy and in decisions regarding research applications. They also wish to see examined the growing problems associated with corporate academic links. Will economic incentives lead to new forms of conflict of interest?

This is a useful and timely book, and one accessible to the general reader. It contains prefatory material in both English and French. However, if any future edition is planned, itshould include a glossary, especially of acronyms. If half way through the book, for example, the reader forgets what AFP stands for, it will be a nuisance to have to search for the first citation to be reminded of alpha-fetoprotein!