Winston – “Ethics are not written in stone”

Lord Robert Winston

Professor Robert Winston has spent much of his career working in gynaecological and reproductive medicine. His research has contributed to improvements in the areas of endocrinology and IVF, including the invention of genetic diagnosis techniques that have enabled families with gene defects to have children free from fatal illnesses. A Labour Party representative in the House of Lords since 1995, Professor Winston was voted ‘Peer of the Year’ in 2008 for his work on the Human Fertilisation and Embryology Bill. He is also a presenter and writer of award-winning popular science television programmes, including the BBC’s The Human Body and Child of Our Time. He talks to Global about a wide range of issues relating to medical ethics from the sale of organs to the use of embryonic stem cells to the value of patents and the compatibility of religion and science.

 

Global: Stem cells arguably promise the most radical medical advance since the discovery of penicillin, providing the possibility of cures for severe physical trauma, as well as the degenerative genetic diseases, like multiple sclerosis and Parkinson’s. However, there is a controversy that surrounds the use of embryonic stem cells in research, as it involves the destruction of human embryos. To what extent do you agree that the potential for good that embryonic stem cells represents outweighs the destruction of potential human life?
Professor Winston: Well, I think there are a whole lot of misconceptions in your question. I don’t believe there is a controversy around them, except on the margins. I think the evidence in this country [the UK] is that the vast majority of people feel that the ethical imperative is inevitably to try and heal people who are sick. And I think the controversy that you cite is partly due to the actions of a minority in this country, who are a religious minority, and it’s fuelled by journalists. To some extent, the press has a responsibility here.

It would be interesting for you to consider how many journalists you know, who are not science journalists, that have a science qualification. If you said to me, “I’ve not read Hamlet, or seen Hamlet, and I don’t know when it was written,” I would say, quite reasonably, “Well, you are a philistine. You are uneducated.” But if you said, “I’ve no idea what a randomised controlled trial is, or what a proton is, or what a structure of an atom is. Or for that matter, whether or not stem cells might be made into tissues,” you would not be regarded as a philistine, but actually quite normal. That’s because there are too few people who are science literate in our society. And I think science illiteracy is as bad as not being able to read and write.

And the other misconception in your statement is that embryonic stem cells are likely to be used for human treatments. They’re probably not. I think the work on embryonic stem cells is important, but I think it’s rather exaggerated by a large number of people. It’s been exaggerated, because it’s a reaction to the religious right. If the religious right say, “There is no such thing as evolution,” people like Richard Dawkins get up and say that “Science is the truth, and religion is the root of all evil.” Unfortunately, what ends up is a very polarised perspective of something which is much more nuanced.

I think there has to be a clear understanding that science is not the truth. It’s a version of the truth.

In October, the European Court of Justice banned the patenting of embryonic stem cell research. What impact will this decision have on stem cell research in the EU?
I’m not sure [the judgement] is very important. Does it matter? Probably not very much. Can it be enforced? Probably more difficult, because other countries won’t adhere to that anyway. America won’t.

Also, there’s a confusion between patenting and invention. They are different. You can’t patent a gene because it occurs naturally, and the European Court was absolutely right to argue that. What you might be able to patent is the way that you’ve detected the gene, because you’re using a technology there, which you’ve invented. And in the same way with stem cells – you may not be able to patent the stem cells, but I don’t see how you can prevent someone from patenting the technology which enables you to use those stem cells. I think that would be a colossally difficult thing to enforce.

Patents aren’t bad. In 1990, Alan Handyside and I invented the screening of embryos for genetic diseases. At the time we both agreed that we probably shouldn’t patent something which might be humanly useful. It was a massive mistake. We should have patented it. We wouldn’t have made a profit, but we would have prevented people using it to exploit women who don’t need the treatment, because we would have licensed it. So patenting offers a method of control, as well.

Do you think there is a place for religious faith in science?
Yes, of course. Why shouldn’t there be? Are the two mutually incompatible? No, of course they’re not.

But there are people who say that scientists can’t be religious. Well, they’re wrong. There are vast numbers of scientists who hold a religious view, or who go to church, or who, in extremis, pray – and sometimes when not in extremis. I don’t think they’re incompatible. They’re different views of the world.

Do you think that it is possible to have a set of guiding ethical principles? If so, what would they be?
The idea that ethics are written in stone is not true. The classic example of that is the finding by [Nicolaas] Hartsoeker, who in 1694 showed, under a microscope, that a sperm had a little man inside the head. Therefore, people thought that to destroy the seed was like killing a person. If you think about it, the ethics were impeccable, but it’s wrong because the science is wrong. So our ethics have to depend on our best knowledge, and our knowledge changes.

The central ethical principle of all human ethics is very clear – the sanctity of human life. And pretty well everything stems from that. It will become more and more interesting in the future. [For example,] if we believe that consciousness is an important definition of our humanity – which it may well be – then what happens when we develop robots that have consciousness? The continuum of philosophical thinking should give us pause before making didactic judgements about ethics.

In August, a senior research fellow at the University of Dundee said that people should be allowed to sell their kidneys for £28,000. However, there are critics who fear that payments of this nature would create a market for organs. What is your position on substantial fees being paid to organ donors?
Well, I think that there is probably no reason why they should not be paid, providing you can be absolutely sure that people who are giving the organs are doing so without risk to themselves, and without coercion. I think it’s much more difficult to justify the donation of a kidney, for example, than it is for an egg. You have lots of eggs [but] only two kidneys, and there is an inherent risk in removing a kidney. On the other hand, we don’t see it as an ethical dilemma for a brother to donate a kidney to a sister. And yet, the brother is putting himself at risk.

One has to be very careful about making hard and fast rules because there will be different circumstances for different individuals.

Essentially four principles are involved. First, in any medical procedure, whether you are the recipient or the donor, there is a need for practitioners to respect the autonomy of the individual in front of them. The second issue is: Are you likely to do harm? Third: Are you likely to do good? And lastly: Is this a fair solution?

We probably should be doing much more to look at alternatives to transplantation, because no amount of donation of eggs, kidneys or hearts is going to really solve the ultimate problem.

Sometimes medical progress seems to be a double-edge sword – some therapies have unintended medical consequences and there are costs and outcomes that society isn’t prepared for. Is progress necessarily always something to strive for? Are there some areas that medical science really shouldn’t be exploring?
That’s what my book [Bad Ideas] is about. It says that all scientific advances have a downside, starting with the flintstone hand axe, two million years ago. Actually, once we’d invented that we changed our evolution. Without the hand axe, we wouldn’t have antibiotics. We wouldn’t have the motorcar. We wouldn’t have global warming. And we wouldn’t have an epidemic of obesity.

I would argue that pretty well every human invention ends up not being used for the purpose for which it was actually designed – we find some other better use for it. Secondly, most human inventions are not made with any particular purpose in mind, anyway. [In Bad Ideas] I say, “Nearly all technological advances have threatening or negative aspects, which are usually not fully recognised or predicted, at the time of the invention.” I also say, “Many human discoveries have a beneficial application, which are not envisaged when the discoveries are made.” And that, “The announcement of any new discovery is almost invariably exaggerated, in its value.”

We need to recognise that no government, however democratic, can ever be trusted to use science wisely, because it follows, from those sorts of principles, that it won’t be. And that we need to be as literate in science as we can be, because ultimately if we are really to use science wisely, we have to be able to control the technology to benefit from it maximally. That applies to medicine, but it [also] applies to physics and chemistry, and engineering.

From MRI scanners to robotic surgery, technology seems to be playing an increasing role in Western medicine. Do you think that this reliance on technology is a good thing? Are there any drawbacks?
Well, of course, there are always drawbacks in the reliance on technology. Probably one of the biggest problems in medicine is not the reliance on technology, but the apparent need for more and more controlled governance and bureaucracy, which follows. Which ends up with doctors not talking to their patients, and nurses not listening to their patients, and people not caring for their patients, but treating them in a formulaic way. We are becoming more and more alienated as patients, and more and more alienated as doctors and nurses. Technology encourages that, because [we are] able to avoid intercourse with the patients and more and more diagnostic work is not done at the bedside, but in the laboratory.

What do you think will be the greatest medical breakthrough in the next ten years?
Why people think scientists can predict the future any better than anyone else is completely irrational. Why would I know that? Of course, there will be trends. But the overall? Well, it may be something out of the blue.

If you’re going to ask me what I would like to see developed, I can tell you that. One of the greatest needs, worldwide, is more progress in our battle against infection. Whilst we think of global warming as being the big threat, actually the thing that is much more likely to wipe the human race out is global infection – we haven’t really invented a new antibiotic for two or three decades. So new approaches, particularly to viral infections that threaten humanity.

Interviewed by Elissa Jobson
Professor Winston’s latest book, Bad Ideas: An Arresting History of Our Inventions, is published by Bantam Press.

About the author:

Professor of Science and Society and Emeritus Professor of Fertility Studies at Imperial College, London

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