Yesterday, the UK’s fertility regulator approved a new technique of mitochondrial transfer, which allows babies to be made from two women and one man in order to prevent children being born with serious genetic diseases. Dr Iain Brassington considers some of the potential legal, ethical and practical implications of the decision.    

• There is a specific legal exemption to allow for techniques designed to avoid ‘serious mitochondrial disease’
• We ought be cautious with new technology which might have ramifications down the generations
• Making future people healthier is not, in itself, a bad thing
• Mitochondrial transfer could have repercussions for social pressures and women’s reproductive autonomy

As widely expected by people who follow these things, yesterday the Human Fertilisation and Embryology Authority (HFEA)  approved the creation of what the media have for some time been calling “three-parent babies”.  Mitochondrial transfer is a technology that allows woman who carries mitochondrial illnesses to have children that are genetically related to her without the risk of that illness being passed on, in effect by transplanting the nuclear material from one of her eggs into an enucleated donor cell, and then having that re-nucleated cell implanted.  (There is a couple of ways in which the procedure might be performed, but the difference isn’t all that important for present purposes.)

The move today follows a legislative process the genesis of which can be traced back to the Human Fertilisation and Embryology Act of 1990, which would have ruled out the technique.  The current law dates from 2008 and stipulates that a genetically modified embryo, or an embryo created from genetically modified gametes, may not be implanted in a woman – but, vitally, a specific exemption is created when it comes to techniques designed to avoid “serious mitochondrial disease”.  Public consultations on licencing mitochondria transfer began in 2012, and Parliament debated the matter in 2014 and 15.  Legislators deserve credit for having foreseen the possibility of mitochondrial transfer and begun to prepare the ground for it in good time; even so, the legal situation in the UK is only just up to speed, with reports having come from Mexico earlier this year that the first baby had been born as a result of mitochondrial transfer.  (An analysis of that case by Manchester doctoral graduate César Palacios González can be found here.)

What are the main ethical and regulatory considerations?

The most important one is that the technique does still have to be licenced by the Human Fertilisation and Embryology Authority, and it will consider applications on a case-by-case basis.  There will be no free-for-all.  The HFEA itself admits that it is only willing to permit “cautious” use of the technology.  Granted that the technology is new, this seems to me to be a wise approach; we do not know exactly what its consequences will be on humans, and so treating carefully is likely to prove virtuous.

But caution can be over-done.  While we ought to take care with any new technology – and perhaps ought to take more care when that technology might have ramifications down the generations – we should also keep things in perspective.  Granted that there will be risks associated with making use of mitochondrial transfer, we should keep in mind that there is a risk associated with not using it: to wit, a risk that a child will be born vulnerable to a range of serious and potentially fatal medical conditions.  Thus the decision that needs to be taken is not one that requires choosing between a procedure that we can allow for the sake of the argument to be risky and an otherwise perfectly healthy child.

On that basis, we need to know more about the risks we are taking.  But on this front, we have done a great deal of research on nonhuman animals, and there is no reason to believe that the procedure is risky (or, certainly, that what risks it brings are worse than not using it).  Thus the onus is on the sceptic to show that the risk is unacceptably large, rather than on the HFEA to show that it is not.

A slippery slope to designer children

A slightly more speculative concern is that this technology represents the first step on a slippery slope to designer children.  If we’re willing to manipulate an embryo to ensure it has “desirable” genes in one way, doesn’t that indicate that we’d do the same in other ways as well?  Altering the nuclear genome to insert desirable characteristics is, thanks to technologies like CRISPR, the sort of thing we might consider next.  Would we want that?

Well, we might not.  Then again, we might: making future people healthier is not, in itself, obviously a bad thing.  Either way, though, that would be a further debate; the law as it stands would not allow such manipulation of future children, and a change in that law is not going to happen any time soon.  For the time being, it’s sufficient to note that mitochondrial transfer has the support of lawmakers, but also the support of people whose lives are affected by mitochondrial illness.

Reproductive autonomy and the construction of motherhood

There is a couple of final considerations, though, that are probably worth taking seriously.  First, the availability of mitochondrial transfer may plausibly make it the default option; and this may generate a subtle social pressure on women who carry the faulty genes to make use of it, thereby creating an additional moral and medical burden for them.  “But why would you not?” is a question that can morph into an expectation that a woman ought to use whatever technology is available, and to criticism of her for getting pregnant naturally and not aborting; and this might erode her reproductive autonomy.  Whether that erosion is justified by the gains to the child-to-be is not at all obvious.  On this front, we perhaps should be a little careful – though, of course, this tells us more about the cultural expectations surrounding reproductive technologies than it does about the permissibility of using them.

Second, I wonder whether there’s a subtext here about what it is to be a mother.  Women who would otherwise pass on mitochondrial illness and who would prefer not to could make use of donor eggs – this would require IVF, but so would mitochondrial transfer.  Much of the argument in this debate has been framed in terms of allowing women to have a genetically-related child.  Is this so important, though?  What is the relationship between genetic relatedness and motherhood?  If one can be a mother in the full sense without a genetic relationship, or with the genetic relationship that we have with random strangers – which is already very close! – then is this kind of technology all that important after all?

Headline concerns about risk and designer babies can be swiftly answered; more subtle concerns about pressures on women, and what it is to be a mother in the first place, are rather more demanding.  But, while we’re considering them, we should celebrate the chances we now have to avoid debilitating illness by swapping a few mitochondria.