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(generated from captions) This Program is Captioned Live. # Theme music I'm Waleed Aly. Hi there and welcome to Big Ideas, designer babies and the future. On the show today, synthetic life, choose the sex of our babies? What's wrong with being able to intelligent embryo What about selecting the most the greatest sporting ability, or the one with one without asthma,

or one that might live to 100? to creating synthetic life, And as scientists get closer could mean for our world? do we really understand what all this As part of its Alumni Speaker series, put together a panel, Monash University ethicists, one Catholic, one not. featuring an IVF doctor and two thrown during this feisty encounter, To make sure no illegal punches were yours truly was on hand to referee. the topic for tonight, I was just thinking about that it can go in. and there's so many strands people, actually, throughout history My first thought was that plenty of the master race. have attempted to create that by trying to eliminate people Usually they've done of realising that goal. that they thought got in the way the means to do something similar? But what if technology gives us questions that are at play? Does that change the ethical that we should pursue, Does it mean that it's something through technological means, given that we can do it really is best left untouched, or is it something that with something that we're perhaps meddling that we don't understand? I suppose, of social engineering, Is this a form of - and extreme form, or are there public benefits and pursuing. that we should be thinking about sorts of decisions? Who would make these about the perfect children Would parents make descisions into the world? that they are going to bring right to make that choice? If so, what's the basis of their a consumerist descision? Is it, essentially, about the cars that we buy, We get to make choices why not the children that we have? questions at play as well, Or are there broader social in giving people that choice? is there a social benefit Kids can't choose their parents, to choose their kids? why should parents be able dimensions to this area. Then of course there are the health Is it OK to do things of foetuses, for instance, that would result in the termination in medical research, if it results in advances in health research? What about creating people? Having children for the same reason. set of questions Does that raise a different or is it essentially the same thing? do you have to be for the the other? If you're for one, And the same with being against them. I can't answer. These are all questions that I'm not going to. So, you're lucky of people who can, Instead we have a group in very different ways, and answer them but all in very enlightening ways. just so you're aware, So, the way I'm going to run this, I'm going to go - it's 20-to, now, probably about a quarter past seven, so I'm going to go 'til

on how much fun we're having, maybe a bit longer, depending we'll open the floor for questions. and then after that and I'll say it again later - I'll say this now when we open the floor for questions, for questions. we're opening the floor Not speeches. electoral platforms, Not for people outlining for questions. none of that, we're opening the floor by asking the first question I'm going to start 'cause that's what I get to do

to you if that's OK. and Julian, I'm going to direct it talk about of proactive beneficence. Take us through this concept that you nugget of language, Congratulations on a great but what does it mean? language that it's very immemorable Well, it's such a great nugget of procreative beneficence. becuase it's actually Right. an obligation in procreation It's the idea that we have that we can have. to bring about the best children has no mind to equality, The basis of it is that nature no mind to health, of the children that it produces, no mind to happiness in terms the embryos and foetuses. There are huge disparities that children are born with, in terms of the diseases how healthy they are, or talents but also in terms of their gifts to control their impulses, or even their basic abilities enough at school, to be able to attend and concentrate able to participate in society. to be able to learn enough to be and modern science So, what modern genetics that Gab Kovacs is doing and the sort of stuff enables us to do now, is to create a range of embryos of those embryos and to test the biology and gain some information to develop certain diseases. about how likely they are information But very soon it will give us personalty, characteristics, about the kinds of dispositions, gifts, talents and so on. abilites, disabilities, use that knowledge And the idea is that we should that we could have to select from a range of children the children who are going to have the healthiest lives, or predicted to have with advantages and those that start off life rather than disdavantages. unfairness of the natural lottery. So, if you like, it's to correct the people be permitted to use genetics So the idea is not only should and our knowledge of biology that they have, to choose the kinds of children they should, they actually should, they can use this technology in so far as

to themselves or society, without significant cost who are healthy use it to try to have children

of the best life. but also have the best chance in what you've just said, though, There's a lot embedded to what you're saying - I'm just listening 'advantages'. phrases like 'the best life', those decisions? On what basis do we make I, for instance,

that I have eyesight. happen to be quite fond of the fact may feel differently about that, Someone who has never had eyesight social experience. they have a different So, on what - I mean they may not feel differently, but they may. The point is that these are decisions that, although we often mask the fact, have subjectivity to them. So, to what extent is it really appropriate for us to be imposing our subjectivity on this range of things and calling it an 'objective good'? Well, of course people have disagreements about what a good life is and we all have different ideas for our own life

and there's lots of areas you can't make clear decisions about what's better, but there are some areas where you can. Some of you might have heard my favourite example, but there's one aspect of people which all of you will have because you're here sitting and listening to a fairly longish debate, but you have an element of self control and impulse control. And there was a famous experiment where a guy called Walter Mischel put four-year-old children in front of a marshmallow and told them not to eat the marshmallow, and, when he came back some of them had eaten it and some of them hadn't. Some of them had delayed gratification and controlled their impulses. Now, when he followed those children up 10 years later those children who were able to control their impulses, delay their gratification, had more friends, more motivation to succeed and much better academic performance. And when you follow these people through life they have much higher - enter a much higher socio-economic level and they don't end up in prison. If you have poor impulse control you're highly likely to end up at the bottom of the socio-economic scale and in prison. Now, impulse control is not something that determines what we do in life, it's something that's useful no matter what you want to do. If you want to be a basketballer or a priest or a footballer or a doctor, being able to apply yourself long enough to achieve what you want to achieve is a basic, a basic talent, a basic advantage. And there are some things like that that are beneficial no matter what sort of life you want to lead. Now, I would take issue with you that blindness and deafness aren't actually disabilites, even if people claim that they are. Are you accusing them of false consciousness if they happen to disagree with you? Well, I mean, think about the range of impediments that you face in the way that world is today, OK? If you are deaf, you can't hear alarms you can't hear music, you can't hear various stimuli and engage in the world in a certain way. Now, if you are deaf, what's the advantage of being deaf? Well, you can sign and you can be a part of a deaf community, but, of course, if you're hearing, you can learn to sign and also be a part of a deaf community, you can communicate, you can be - so it's like speaking two languages. So there isn't a good reason to claim, 'Well, you know, if my child goes deaf, I don't have to correct it because it's just a disagreement about the value of deafness.' If you had a child, and the child developed an infection that was going to render the child deaf and you refused to give the child antibiotics I think you should be taken to court and the court would authorise the treatment, because we don't, as a society, have complete relatavism about what's a good life. That's how we design our education systems, that's how we design our social programs and that's how we try to bring up our children. Can I come in on this? Yeah, sure. I'm a little surprised, I thought tonight - because I'd be talking about reproductive discrimination and some of the issues there, I thought that tonight, you know, I would be defending a more restricted position against a more liberal position. I'm surprised because what Julian has outlined - the idea of an obligation to produce the best children, sounds to me as though this is Big Brother imposing on our community an obligation not to have children with disabilities. It seems to me that what's happened here

is a kind of reversal of what I expected, in that, I'm gonna try and defend liberty. Um, the freedom of people to form their families and to form their families with disabilites,

to defend a community that has people with disabilities, to defend the status of people who have disabilities. I think you're running two issues together. I didn't say they shouldn't be free and in fact I defended peoples freedom - The obligation to produce the best children. Sorry, there's a difference between what people should do - You should give up smoking. Should you be compelled to give up smoking?

No, you should be free to smoke if you want. There are two separate issues - what the goals of a morality should be, and I'm happy to stand up and say I think we should have children who have the best prospects of the best life. You should be free to have any sort of children you want. I mean, you should be free to deliberately select a deaf child if you're a deaf couple and you want to have a deaf child. But you want to say they've got an obligation not to have children with disabilities.

No, I'm saying that's what they should do. Obligation here means this is what - it's like saying you've got an obligation to look after your health and give up smoking. Now, I think we can have this kind of discourse without imposing on people restrictions of their freedom. In fact, I'm the one that's defended procreative liberty or procreative freedom, the freedom to - Or more than that - beneficence. So, what I'm arguing here is that you should have some account of the good to guide those decisions but at the end of the day we live in a liberal society and people should be free to decide how many children they have, when they have children and what kind of children they have. When you put up the word 'obligation', in a society, obligation and the language of obligation doesn't come without weight. It doesn't come without saying, 'I think you're doing the wrong thing, if you have a child with disabilities.' Well, look, how far your obligations go and how we should discuss people's obligations and what they should do are different issues. I mean, I personally don't think you should be criticising other people's lives. Somebody might make the wrong decision about how they bring up their children, that doesn't mean we have to criticise them. These things are seperable, they don't necessarily fall together. Oh, but come on, Julian you're making an ethical argument about what people should do and what they shouldn't do. That implies a judgement about what other people are doing. You can't escape that.

We make these kinds of judgements every day, when we say someone shouldn't have another child because they can't provide enough for their existing children. We make these decisions, how we impose those decisions is a seperate question. I've been in print as defending peoples procreative liberty and I sincerely believe that we should respect the rights of people not to use these selection techniques to have children without disabilities. And we should also respect that in the sense that we don't undermine their ability to do it in indirect ways, so you know, you can have, in this case, your cake and eat it too. You can have freedom but also have a discussion about what people should or shouldn't be doing. But you make the argument that given the choice, the better choice is too use these tools that are available? Look, if you've got two embryos here,

and on the basis of your tests, you know this one - on everything you can tell - is going to have a normal life and you know that this one is going to have profound deafness, blindness and intellectual ability, I'm sorry I just have to say, that you've got a reason to choose this one and a reason not to choose that one, you should choose this one. Now, if somebody says well, I want that one because I feel we haven't done enough to promote peoples disabilities in the world,

well, so be it. I want to bring Dr Kovacs in on this in a moment, but just one final question - Is there a danger of setting up a false choice here, that the comparison between someone who lives, for example, with deafness or without it. Whereas for the person concerned, the choice is really living with deafness or not at all? And so isn't that a very different question that we're answering at that point? I think this is a complicated thing for people to get their minds around. When you're talking about reproduction, you're talking about two individuals, one of whom will exist and one of them won't. So, you'll either have a child who will be born hearing, or you'll have a child who will be born deaf. But you can't make the deaf child hearing, and likewise you can't make the hearing child deaf. You're faced with this choice, so the question is which is it better to bring into the world?

You only have this choice if people have their children on IVF programs. Which at the moment is something like one per cent - Three per cent. Three per cent is it. Three per cent of babies. Umm. So it's small proportion. What you're talking about, this kind of choice is only available to those people who are on IVF programs -

Gab Kovacs is itching to get in here. our feedback on the ground. I was just going to say, let's get you think we can actually achieve, I really am impressed by how much and what can actually do. what you think we can I don't believe any where near be able to isolate and I don't think we'll ever those perfect children. infertile people have children. I mean, IVF was developed to help who had blocked tubes. In fact it was developed for women

back in the 1970's. That's what we started doing to other sorts of subfertility, Since then, of course,it's expanded unexplained subfertility like male-factor, with those couples. and we do reason well we can't improve the pregnancy rate But even then we try really hard, to do better with those couples. all the time, value added to IVF, PGD spun off as sort of where Alan Trounson had this idea off the embryo and do certain tests. that would take some cells about what PGD does. But let's be clear

it's not roadworthy on the embryo. First of all, and say it's a normal embryo, We can't take a cell off the embryo which people would like us to do. let alone it's a talented one,

and the good athletic ability. You know, the blue eyes thats's a pipedream, We'll never be able to do that, it's not going to happen. something like Cystic Fibrosis And if we do go to PGD to look for which we try to eliminate or some other single gene disease, it's a difficult, complex process. from two carriers, cost and the complexity of IVF It significantly increases both the people going through IVF and less than five percent of thee actually take part in PGD.

about it is, And of course the other thing and you put that embryo back, even if you do make the diagnosis it's going to take, there's no guarantee it's about a one in three chance. to do is refocus what technology So, I think the first thing we have and what it might be able to achieve will be able to do now in the future. we'll have the ability And I don't think and use it for eugenics. to choose the perfect children create a different ethical debate. Does that, in your mind then, that we have to grapple with? Does it change the ethical questions to essential principles, Or is it, once you boil it down just a matter of degree? really the same thing, Look, it's really difficult. because we've got an ethical debate where you have to police you have to go through and be approved,

So, we already do ethical screening of who may or may not be parents by IVF, not that we do it for natural parents. Um, and then, of course, if we're going to do any other genetic screening in Victoria, we have to justify it to the... ..to the patient review committee, and people who decide whether it's a reasonable thing to screen for or not. So, therefore, I think, what we're talking about is a pipe dream, because they'll never approve any of those things, we'll never be doing them, and I think we're talking about, sort of, fantasy land. But I guess what I'm asking, then, is does that mean the argument, for example, that Julian's putting, where people should be making these decisions to try to, bring into the world a child that has the greatest advantages. Does that argument lose it's force, because, for example, the knowledge on which it's based is not as solid as we might think? Well, we don't have to think about IVF, we know that children born to people who've got certain things like they're overweight, they smoke, have marijuana, have a disadvantage, and we know that mothers dying in pregnancy might affect the children, we've got the Barker Hypothesis, about what happens to you at birth and in utero, and if the child's going to affect you, and do people in the community take any notice? No, they don't. They all smoke, they drink, they're overweight, and people in the community do not make the best efforts to produce the best and healthiest children they can. But if I'm overweight, and I want to lose weight, that takes a lot of effort, not the same as ticking a box on a form that says, 'Choose this child or that child.' And so, it's a different sort of circumstance. But after you've ticked the form, you've got to go through the IVF process... Can I just - ..which takes a lot of effort. I mean, look, we may as well go home if there's no debate to be had, according to your argument, and, you know, so be it. Um, but I frankly find this - I mean, I know what you're saying now is focused on the present

and I know you have a business in IVF and are reassuring people that everything's fine, but even if there's just one test, or a series of tests - and you've got to remember that in ten years time you'll be able to analyse, presumably, the whole genome of an embryo. Now, you may not be able to pick somebody who's gonna have a perfect life, but you'll get information about various characteristics, besides the disease propensity. Now, I frankly can't believe you, that you won't be able to test for eye colour. You could test for the ace gene, that enables you to be an elite mountain climber. I mean, there are genes that are already identified that dispose to certain characteristics in people. Now, I really can't believe that we won't be able to make any decisions

that aren't just about disease in ten years time. But if we can't, debate's over! We may as well go home. One of the things that we are debating right now, is the question of gender - people choosing gender, which we've got the capacity to do. It's, as I understand it, relatively easy and relatively confident that you can do it. Um, that raises issues for us of what - I'll reuse the phrase 'reproductive discrimination', that is, decisions that are made on grounds that we think, generally, we think they shouldn't be made. And here, I'm on the moral side of things, it's interesting to - I'm quite happy to talk about moral obligations, I know that Julian's uncomfortable about it, but I do think there are issues to be raised, about decisions people make that are discriminatory. And a decision to have a boy or a girl, and to use the technology for that purpose, does seem to me, to raise concerns for the whole community, not just for that individual couple and to their child. You've said that you're worried about people undertaking IVF for what you call 'frivolous reasons.' I've not used that word but, you know. Well, do you... ..do you therefore suggest that there are reasons that would be perfectly acceptable? Or is that enough for you to say that the whole idea isn't - Look, I understand the motivations of people who use IVF in order to have children.

The desire to have a child is an enormous desire, and it's a way in which people fulfil their lives by being parents and so on. So, I understand that motivation. What I'm talking about, I guess, is using that technology, developed for that purpose, for a discriminatory purpose, to decide what sort of children there should be, which is not what it was designed for. And it's a reason, I think, that the community needs to look at and decide whether the technology should be used for those reasons. The community has looked at it, and the legislation here in this state and the national guidelines, both prohibit using reproductive technology for the purposes of choosing gender. They do allow the technology to be used to choose against major disibilities, and that's the purpose of the Patient Review Committee, is to look at - the Patient Review Panel, sorry - to look at those issues. But, um, there is an argument in the community about whether that's discriminatory, and I take the view that it is - I think it is reproductive discrimination to eliminate embryos because you think that they have disabilities, that is, they have characteristics you would prefer they didn't have. It's a really interesting example that you raised, Julian, I wouldn't mind coming back to you on it. Because of your opening remarks about choosing children that have advantages, for instance, over those that have disadvantages. Does that change where advantage is socially constructed, gender being a good example? Plenty of places in the world where it's highly advantageous to be male as opposed to being a female. So, does your ethical logic lead you to a conclusion

that it's perfectly acceptable to selectively bring men, or males into the world, without necessarily thinking about what that might mean for society in the long run, when there are no women left? Well, another example is often given to me in the US, where there's discrimination against African Americans, whether you should prefer to have lighter-skinned children, rather than darker-skinned children, so they don't suffer so much disadvantage. Um, so you have to - what's the best way of correcting injustice in society? Well, the best way is to deal with the attitudes and the institutions that cause that injustice. It isn't about interfering in reproduction, it isn't about engineering. Of course, you might think that it's a good way to make a statement, to have a certain kind of child to try to promote respect for people of a disadvantaged or discriminated class, but I don't think that, even in this case, it's a reason to prevent people from making choices. If they make choices in those cases to have a white child, or make a choice to have a male in a sexist society, that's the symptom of the disease, it's not the disease. The disease is the background set of institutions,

attitudes and norms and so on, that require changing, not, you know, whether we interfere in their reproduction or not. Sure, but should we be facilitating the symptom, I guess? Well, again, here you have to ask how far are you facilitating the disease itself by allowing people to make these choices? And, I mean, if you look at India - Why do people select to have a male in India? Well, one reason is that only males can, er... ..have religious obligations to the dead, and bring, you know, the dead parent into some kind of heaven.

You also have to pay an enourmous dowry if you have a girl, so it's very expensive to have a girl, um,

and part of it's an economic reason. That's why people choose to have - Partly it's a religious reason and partly it's an economic reason. That's why they have a strong preassure, to have, um... ..male babies rather than female babies. Now, I think those are sort of crazy institutions, and we should change those. But, you know, given that they're there, I don't see why we should interfere in people's choices. Let's shift it back away from cultures that favour one gender over another, and just look at gender- discrimination in reproduction in our society where we don't have those obvious - at least I don't think we have those obvious differences, although I guess you could say that we do still, to some extent, that men still earn more than women on average, and those sorts of things, so there is still some discrimination left - But generally you wouldn't say, that there was a huge advantage either way, in being male or female. But, it's still an issue, when a couple chooses to use this technology, and on that occasion, makes a discriminatory choice to say, 'Right now, we would prefer to have a girl rather than a boy.' It's offered in terms of family balancing, the idea, 'if we've got two boys already that we want a girl, or vice versa.' And, you know, rather than continuing to have children trying to get that girl or get that boy, we could do it by, go on the IVF programme and have PGD. It still seems to me that there's an issue for the community there, um, beyond - In India and China we know the familiy, the balancing, has worked out very badly, and we know in some provinces of China, there are 138 boys born to every girl born, and that sort of thing. But, we wouldn't expect that here. So it's not that the economic argument you're putting, or those sorts of arguments, it's really this individual choice. And I still think that there is a problem with a couple intervening in such a way as to destroy those embryos of the unchosen gender and favouring those of the other, and transferring those, using the technology in that way... So would you - ..does say something that is unfortunate. Would you also, um, dissagree with sperm sorting? Can I finish what I'm saying? The issue here is that you're making parenthood contidional.

You're making the entry of a child into life, conditional upon, whether the child belongs to the gender that the parents want or not. And the view I take, is that there shouldn't be any conditions on whether a child is to be born or not. There shouldn't be a, kind of, sifting out of which children may be allowed to survive, and which not. That all children, the whole nature of parenthood - If you think about what happens in parenthood, all of the things that can go wrong, all of the things that can turn a perfect infant into a difficult two year old, and an even more difficult adolescent, and all of those sorts of problems that can develop. Parenthood needs to be an accepting sort of thing from the beginning. We need to be able to say that as parents we will accept our children no matter what, and that's been the character of parenthood, that there's a unilateral gift that you make as a parent to accept that child and rear that child and care for that child no matter what. But the whole process of putting them through a technology to choose a child, greatly undermines what it means to be a parent and what parental love actually means. It's no longer unconditional. But where is the evidence for that claim? I might jump here to Professor Gab Kovacs, because I think you have a lot to say on this issue. Well, I have. First of all, I'm in the difficult situation, I've seen several couples who wanted to come on for gender selection. I don't believe I've seen anyone who's come along saying we're going to have our first child, and we want that first child to be a boy or girl. So, in our community the problem is basically family balancing. And I was going to ask Nicholas how would he feel - I understand he doesn't like the embryos being discarded - but if we said to couples, 'OK, you can come along, you can have IVF and PGD, you only want a female child, that's fine,

but are you prepared to donate all the other male embryos to some other couples, who have to use them, who can't get pregnant so that those embryos aren't wasted? Would that remove one of your oppositions to gender selection, Nicholas? Well, my objection is to having all those embryos in the laboratory in the first place, and putting them in to that situation where their life is just subject to choice in that way. I mean, that's one way you could look at it, but gender selection is here and it's very real. But again, let's get our feet back on the ground. Because, obviously, I'm debating with philosophers who talk about ideas. I'm a simple gynecologist who has problems to solve every day and has to be fairly non-judgemental, because often I sit in my consulting room and I'll see a woman who wants a termination, and I'll see someone else who's got a fertility problem, someone else who wants to be sterilised.

So its really difficult not to be judgemental, but I have to try and divorce myself and look at the problem of that particular couple. So, when the couples come along, to do PGD, you have to be dedicated, because rather than getting pregnant at home, you have to go through the whole gamut of IVF, all the things that are involved. The people who now are doing it are going off-shore. They have to be prepared to go to Thailand or America, spend a whole lot of money, and, again, there's no guarantee it's going to work. So these people are pretty desperate. Now, we've always said - or people who've been controlling reproductive technology have said -

it should be in the best interests of the child. Now, can I put it to you that maybe it's in the best interests of the child to be a boy if that couple really wants a boy

or to be a girl if that couple really wants a girl.

Because if they have a child naturally, and it turns out to be the opposite sex, then that child may not have as good a loving, accepting family,

unconditional love.

Yeah, I'm interested in that argument that you make,

because it's one that I've heard before. Is there evidence to show that that's the way that parents actually behave once the child is actually born? I mean, you may have hope for a child of a particular sex, but when they're there, do you really see a difference

in the attitude of parents? I don't know, I don't think there would be any evidence, Waleed, but I don't think anyone's really looked into those sorts of studies. It'd be interesting, but I don't know. I'd like to respond. Sure. That question that you raise of the couple treating the child badly - I guess, I mean I don't know that there's any evidence for it, but if that was the case, that would highlight the point that I'm making, that parenthood ought not be like that, parenthood ought not be conditional. I agree with you, we shouldn't let anyone be parents.

But no, if you think about the issue of gender. If a couple are choosing a child because they want a child of a particular gender,

what are they saying about gender that makes it so important, what's the stereotype of gender that's being used there that says that this is so vitally important to have a child of this gender rather than the other gender, that they're going to go through this kind of process in order to achieve it. I mean, the very fact that they want to go through all of that process

to achieve it, says something to me that indicates their attitude to parenthood

isn't completely accepting. But I mean, there's the woman who says, 'I've had three boys, I really love my boys and I wouldn't be without them, but I'd really dearly love to have a girl who I can dress in pretty dresses and put pink ribbons in her hair - ' And the girl may not want to do all those things, that's what I'm saying,

if there's a stereotype that you've got of what a girl should be, then I pity that girl having to conform to those ideas of what a girl should be. I guess - Can I just say something? Yeah sure. There's a parallel debate where we do have some experience, and this is creating so-called saviour siblings. Using these technologies to create a child who can give some blood

upon being born, to save the life of an existing sibling who has no stem cell donor. Now, Nick and other people objected to this with the exact same claim that parents won't unconditionally love these children, that this is the wrong kind of attitude, you should only have children on the basis on unconditional love for that child's sake.

There's absolutely no evidence to support Nick's claims that these people treat these children adversely

when they've been born as saviour siblings. I'm sorry, but there's just so few of them, that've got no evidence. There's no evidence to support any of your claims about the way people treat children. So, you're trying to deny them access to make choices, to infringe their freedom to go and visit Gab and get treatment that they want, or intervention that they want, on the basis of just pure speculation about the quality of their parenting and the way they'll treat their children. And I think that that is fundamentally against the principals of a liberal society - of intervening in freedom without any evidence of harming anyone. Well, the issue here is the interests of children, and the kinds of - There's no evidence that the children in these circumstances are harmed in any way. But the burden of proof, when it comes to new technologies, is in the other direction. No, sorry, the burden of proof -

The burden of proof of a technology like this is to prove its safety. No, the burden of proof should not be - That's the way we operate on all of the new technologies except this one.

If you want to introduce a new drug into the community, if you want to introduce a new kind of farming, if you want to do a different kind of mining, you've got to show that the harm isn't there. You've got to do the assessments. I'm sorry, the technology is physically safe enough, we know that. What you're speculating is... No, no, no, actually, we don't. ..that there'll be people who will be unfit parents. If you look at the most recent results for Victoria for PGD,

that is, the results published for the year 2009 - 2010, there was a recorded 80% miscarriage rate following PGD compared to a 22% in ordinary IVF. Well, this is just a tiny sample. Gab Kovaks, what's the - No, it's a small sample, it's 164 patients. ..how safe is PGD and IVF? You're the expert.

Well, it depends on what you mean by safe. I mean, IVF, five million babies now born worldwide, I don't think there's any major abnormalities that would happen that we haven't unearthed. Louise Brown, the world's first - We're talking about PGD though. We're talking about PGD. Well, PGD, again, there is a very good surveillance going on through the European Society of Human Reproduction that recorded all the cases, and I don't, unfortunately, I'm too old and senile now

to remember figures off the top of my head, but certainly, they produce data each year and it is published, and not a significant increase in any abnormality, as such. Can I - I can't tell you the miscarriage rate off the top of my head, I just haven't got that. But it's still relatively new, there still aren't that many people, it's a complex technology. But certainly for gender selection, it's readily available

and if it wasn't for the fact that it was illegal, probably some people would choose it, not many people,

but there would be some people that would choose it. Can I bring the discussion back to the ethical questions?

A lot of what's been said here has been about a parents' right to choose. For instance, Nicholas, if I may paraphrase you, essentially arguing that this is not the way that we should be thinking of children, of parenthood. Julian, I want to ask you, then - the ethical argument that you make, what's the philosophical basis for it?

Is it about the rights of the parents as individuals? Or are you making a 'social good' argument? Because we haven't really touched on the 'social good' aspects of the discussion so far. Well, there are two distinct arguments. One is about whether people should be free to access these technologies, and that is just a basic principal of freedom within a liberal society -

That you should be free unless you're harming other people. And the mere speculation that you might harm someone is not a reason to infringe people's freedom. So it's a fundamental principal of a liberal society. Nick might have his own views, or other people might have their views on how people should found their families, how many children they should have,

whether they should use contraception or not, but those views should not be imposed to restrict freedom. So that's one basic political, philosophical tenet. The second tenet about selecting children is simply a rational principal. If you've got two embroyos and you've got information about those, you should use that information to select the best one, that's how you make rational choices.

So when you're having children, you're making a choice about - when you have a range of embryos, which of those you should bring into existence. Yeah, I understand that, but I guess what I'm asking is what are the parameters, what is the basis of that choice? When I say, 'This is the better embryo,' am I thinking, or would you require us to think socially, or... Disability's a bad thing, apparently. I think disability IS a bad thing. ..or are you thinking for that person? So, let me give the example of - let's assume that this embryo will be more intelligent that this one. Do I choose the more intelligent embryo because I decide it's better for that child? Or do I say, 'Well, society needs stupid people in order to function, and therefore, I'll do my bit for society in making that - ' What are our horizons? Are they social, or are they individual? Basically, a principal of reproductive decision making

is that there is an obligation to focus on the child's welfare, as Gab Kovacs said.

Now, the parameters of that should be - if those choices significantly harm others in society. So if you're making choices that impose direct costs on other people, that would be a reason for intervening. The opposite of that, if making certain choices benefits society, well, that's a reason. If having children that are going to be more productive benefits the economy, that's a reason. But should it be imposed on people? No, we should keep the focus of reproductive ethics on the child. So, I think the only real way of intervening with parents should me when they're harming somebody,

and unfortunately, that's not the focus of this debate.

It's about certain views about the way parenting should be

or about how society should be constructed. And I think that's very dangerous.

Wouldn't it be consistent with your view, to say that when a couple is faced with this choice of embryos, some that are more able than others in different ways, wouldn't you say then, on your view, that it would be harming those children to choose the ones that had the lesser ability. Well, you're not harming them, because that's their only choice of coming into existence,

but you're making a choice between different individuals here. I mean, it's also important also - when people say, 'Well, you know, disability's bad.' We all have disabilities now, we all find we have impediments to our lives going as well as they could go. So this idea that disabilities

are just things like deafness and blindness is a very mistaken and outdated concept of disability.

We all have things, different personality traits make it much more difficult in life. We're all disabled. But we already do this, or large proportions of the community already do this by the first trimester screening. Now, there are some people who wouldn't want to go ahead and do anything about it, and they don't have it, and no one forced them to have it, but the majority of people who are pregnant want to have first trimester screening to look for chromosomal abnormalities, and neural tube defects and things, and they have the choice,

and then they have the choice of choosing that pregnancy or not choosing that pregnancy once I've made a diagnosis. For the people who are not interested, we don't force those people to have this test done, and don't force them to then terminate the pregnancy. And so that's kind of what's happening a practical way today, and what Julian's talking - If I can follow that up,

there's a culture there, I think, that's worth talking about. I've been doing a fair bit of work, lately, in the this area to see what is happening with couples

who have the first trimester screening. We know that about 90% of those couples in this society, if they have a serious abnormality, will abort the child. But we also know, from figures from the UK and the US where there's a slightly different set of circumstances, where they are offered what's called perinatal palliative care, or perinatal hospice care, and we know that that 90% reduces down to 60%, that is, 40% choose the perninatal hospice care, in other words, they choose to continue their pregnancy through to the child being born with a serious abnormality. And it says something, I think - the difference in the figures of 90% to 60% - says something about our own Australian culture

and what we don't provide.

And what we're seeing is accounts of women who are saying - who made the choice after the screening not to have an abortion, when they had the child with a serious abnormality, and they talk about the enormous pressures that are applied to them and how difficult it is for them to continue on with those pregnancies in this society. Because the medical approach to them is to sort of say, 'Well, you've brought this on yourself. This is your problem, you must've known you were going to have to deal with this.'

And in this community, we don't have the supports, we don't have the perinatal hospice services, or the perinatal care services for people in these circumstances. Now, the point I'm making is that if we move a little bit further down the track, so that we have developed PGD in the way that Julian says we will and Gab says we won't, but if we have developed it down the track like that,

will those people also be under those same pressures that women are under right now not to continue their pregnancies?

I'm going to do something very risky, perhaps foolish given we've only got ten minutes left - I want to raise the question of the destruction of embryos in the process of scientific research, and Nicholas, I want to come to you on this, because I understand that your position is against it, but on the basis that if you believe that this is a human life then there is no difference between destroying that life for scientific research purposes or destroying the life of anyone here, for the same purposes. Is that a misrepresentation of your argument? Yeah, there are obvious differences between destroying an embryo that nobody's yet got to know, and destroying people that we've formed friendships with and the rest of it, so there are a whole lot of psychological differences, obviously. But when you're talking about the nature of this being, and it was interesting that Julian, a minute ago, was saying these embryos already exist, so you know, in terms of discriminating against them by destroying the ones with disabilities, but that's the view I'd take - I'm surprised he took it. So my view is that once an embryo comes into being,

there's a new unique human being there, I'm not saying it's a human being that has feelings or a human being that has yet a functioning brain, but it is a member of the human race, it is a member of our species, it is a member of the human family, and so to destroy it is to destroy a member of the human family. What if the destruction of it, though, saves another member of the human family? Given that you've accepted now there is a difference between that life and the lives of people here? I'm not saying there's any difference in terms of intrinsic value, I'm saying there are differences, obviously, in terms of the humanity that's involved. So, you're saying there's no basis on which to privilege one kind of life over another? If you say why don't we use embryos to produce cures and treatments and so on, why don't we use people who have dementia

or why don't we use people who are conscious and so on? And the reason is they're members of the human family. We don't treat unresponsive people in that sort of a way. Could it also be because they have a social meaning attached to them

that is different to that which is attached to an embryo,

as you've said. Well, there's a difference in that they've got past relationships and there are people around who still care for them and so, yes, there are differences in a social sense but it doesn't change the nature of who they are as persons, they're still living members of the human family,

just as the embryo is a living member of the human family. Julian, does it matter whether or not we catagorise them as human beings at that point? Well, they're clearly human beings in the sense that they're members of the species but I think none of us - well, not none of us, but very few people in today's society accept Nick's view because they use contraception that destroys early embryos, they use the IUD, they have abortions, they use IVF, all of these practices result in predictable loss of embryos. In fact, I think there's 100,000 abortions in Australia each year. We have laws requiring the destruction of embryos and we don't have laws requiring the killing of innocent human beings

and that just shows that the embryo, if it is a human being, is a different kind of human being and it doesn't have the moral status of a person. It's not just that it doesn't have friends,

it doesn't have the moral status of - Well, it shows that that's the way we approach it. It doesn't necessarily show

that it's not something that could be rethought though, does it? Well, of course you could rethink it but you have to have a philosophical basis for it

and what is the reason that you think that it should be? Well, it's just that it happens to have the same number of chromosomes as us?

It happens to belongs to the same species? But why is that something that's intrinsically morally significant? You have to, I think, point to some feature that grounds a special kind of respect and at that point,

it's a group of cells that grow in a certain kind of way but there's no element of consciousness, there's no ability to interact with other human beings, or have anything but the most rudimentary biological existence. You can't tell the difference between a pig embryo and a human embryo - Oh come on. When Gabs is in the laboratory with a human embryo in front of him, he knows he's not dealing with a pig embryo. He knows he's dealing with an embryo that has the chance to develop as that child, that much wanted child, he knows that within that little embryo is the complete capacity, all the information required to develop rationality, and all the things we value - Sorry, in every one of your skin cells has a complete code -

No. No, there isn't, because there isn't the capacity for embryogenesis.

I mean, the point you have to realise that obviously we're discussing when life begins - I'll come back to that in a moment - but we're talking about at best it's a potential foetus. The majority of embryos we produce in the very best blastocyst which have grown to five days, look good under microscope, only one in three will implant. So we can't call them human beings - at best they're potential embryos who might then go on to become a foetus and, you know, a human being. So, I think they're a long way away from a human. Can I just say one thing? I think we're running out of time. And it's really uncanny because it's 30 years ago, in April 1981,

I'd made my television debut on The Peter Couchman Show and there was Peter Singer sitting in your chair and Carl Wood asked me to go on at the last minute because he was busy.

And that was just after the weekend they first spoke about freezing embryos on the ABC, on The Science Show. So, all of a sudden, people thought IVF might be dangerous and, you know, we had this sort of general discussion, 'When does life begin?' and here we are, 30 years later on, we still haven't worked out when life begins. But we still agree to disagree on a lot of things. That's a good point because... (Applause) ..it's a question I was going to ask and I suppose, in a way, it's a yes/no question, although I suspect that's not the answer I'll get here. (Laughter) Is there a way to determine when a human being comes into existence that is not ultimately a religious or some other metaphysical question? Well, it's very easy, the Jewish people have worked it out. Life, for a Jewish mother, begins when a son enters medical school. Right. (Laughter) I think you have to ask yourself what really matters in life and, you know, we've invented this criteria in brain death. We've decided that when people's brains cease to function that they're now technically dead. In fact, we withdraw life-sustaining treatment

from people who are not brain dead but permanently unconscious, that is, we say that their life, in an important sense, stopped when they stopped being conscious. Well, if you think that what's important is consciousness, then you've got to look at the point where consciousness begins which isn't until about 20 weeks into gestation. And that's just bare consciousness. But you accept this is more or less an arbitrary distinction or is there something absolute and real that we can point to? We have to, in all of these cases, ask what's our fundemental value.

What's the common currency that we can share? All of us can share the common currency of consciousness. When you come to other claims about value, you're starting to look at what minorities value. So, it seems to me that the most uncontroversial view is something to do with consciousness. Final words? Just on the brain death thing - is not about consciousness,

brain death is about the loss of integration of the body. We haven't defined it in terms of consciousness - at least not yet. They have in the UK but they haven't here. But in terms of this issue, of course I have to say that it is a matter of metaphysics, it is a matter of the way in which we regard human beings, but then the position that I take is that every human being is important no matter their disability, no matter what stage of life they're at. And that the stage of life that an embryo is at or the stage of life that an unconscious person is at, a person in an unresponsive state is at, is still part of this existence, part of this life. And so all human beings are important, all human beings are worthy of our respect and worthy of our love. Well, in the words of another great moderator, I'm going to draw a line under that discussion and open it up to the audience, who I can no longer see. Julian, you're - when you were talking, you seemed to focus a lot on genes and so-called 'best genes'. I was just wondering, I'd like to throw this question open to the whole panel. Are human beings no more than their genes?

Are we simply bags of DNA? I sort of gave a quick answer to that before.

I think that the evidence isn't in about how much of our nature is determined by our society,

our upbringing, our treatment, our maternal environment, and how much of it is strongly influenced by our biology and the data that we know so far is both of them have important influences. Your biology can set a ceiling on certain talents or abilities and so on and then you can way below that with certain kinds of environmental treatments. So, I think we're going to be a mixture of our environment, our biology and our choices. So, my arguments really only pertained to that bit that's to do with our biology and that's not going to determine, as Nick and other people, and everyone - it's obvious - that you can still have a fantastic life with a disability

and you can still have a terrible life even if all the genetic tests for disease show that you're free of disease you can still get cancer at the age of five. So, I think you have to have a balanced picture. Our question here is, how much should we use our knowledge of biology to influence our reproductive decision making? I think we should use as much of it as we can gather. We should use information. We should try to make more informed decisions and the opposing view is we shouldn't gain that information and we shouldn't use it in our reproductive decision making. I think there much is more to your question than Julian has indicated because what you're saying is that we are no more than our genes or are we more than our genes? I mean, the issue here is, how do we respect people no matter what their genes are? Julian Savalescu, Gab Kovacs and Nicholas Tonti Filipini

thrashing out the ethical minefield around designer babies at Federation Square in Melbourne, for Monash University. That's it for today's Big Ideas, but don't forget you always have the right to choose with us a veritable feast of choice from our online collection of other lively debates, panels and talks. Point your browser in the direction of the address on your screen. I'm Waleed Aly, see you again. (Closed Captions by CSI) ..

THEME MUSIC Java - one of Indonesia's 14,000 islands. Our treasure is the largest ancient monument in the Southern Hemisphere, a giant pyramid-shaped Buddhist temple called a 'stupa'. Borobudur, the greatest Buddhist stupa in the world, was built in the 8th Century. It's been likened to a blueprint for reaching Nirvana. There are nine levels. Each level is a route which pilgrims take to learn things necessary to achieve enlightenment. Beautiful carvings define the different levels on the route to enlightenment. This is Princess Maya, the Buddha's mother, sleeping. The next levels above tell the story of Sudhana, the pilgrim on his quest for truth. Presiding over this, one of the many images of Buddha. BIRDSONG From the top, an amazing landscape can be seen - little changed in 1200 years. EXOTIC CHIME MUSIC PLAYS BIRDSONG Enlightenment is getting closer,

and this is signified by a landscape of 72 bell-shaped mini stupas sitting on top of the giant stupa. Each bell-shaped stupa contains an image of the Buddha. Very few people would have achieved this level. Only a handful of Buddhist pilgrims now make the spiritual journey here. Indonesia is mainly a Muslim country today, and the great stupa is usually thronged with tourists. But Borobudur's path to enlightenment still brings serenity for those prepared to seek it. Closed Captions by CSI ..

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