Monday, 4 October 2010

Nobel Prize for Medicine 2010

Today has seen the announcement that the 2010 Nobel Prize for Medicine has been awarded to Dr Robert Edwards, in recognition of his work in developing IVF techniques for the treatment of human infertility. This prompts a number of reflections that arise from the implications of this award in terms of the ethics and culture of the practice of medicine.

Firstly, one might take the point of view that this award can be seen as a recognition of the scientific work undertaken by Dr Edwards and his colleagues, and that it prescinds from any ethical judgement in favour of or against that work. This point of view would hold that one can separate a recognition of the scientific work from its ethical evaluation. I think there is some validity in this point of view, but only in so far as one might wish to respect the autonomy of the scientific enterprise with respect to the religious sphere, and therefore might wish to refrain from imposing onto the "secular" (in the best sense of that term) scientific world the ethical point of view of one particular religion. On the other hand, though, if by taking this point of view we mean that scientific activity is intrinsically neutral from a moral point of view, and that the evaluation of scientific activity has no ethical component; then I would not consider it valid. Perhaps the most famous discussion of this idea of moral neutrality in science - and rejection of it - is that of C P Snow.

The second thought follows from this first. IVF treatment is subject to different ethical evaluations, as is recognised at least implicitly, if not explicitly, in one sentence of the announcement of the award to Dr Edwards. It might, therefore, have been possible for the Nobel Committee, in making the award, to remain itself neutral with regard to the different ethical evaluations of IVF treatment and therefore of Dr Edwards work. This would not be to suggest that Dr Edwards' work has no ethical "content"; but it would be a reciprocal stance to that of not wishing to impose onto the scientific world the ethical point of view of one particular religion, a reciprocal stance that refrains from imposing onto the wider world of politics, ethics, religion and human culture a single ethical stance from within the scientific community.

I do believe that this kind of respect by science for a kind-of-autonomy of the wider culture represented a real possibility for the Nobel Committee. A careful reading of the press release of the announcement, and a careful listen to the video of the presentation of the award (it is in English!), will reveal no explicit ethical endorsement of IVF. One can, however, read in to the announcement an implicit ethical endorsement, and this arises from three aspects of the announcement. The first is the unqualified description of Dr Edwards contribution as being a "milestone in the development of modern medicine"; the second is the recognition in the announcement that IVF is now an "established therapy throughout the world"; and the third is the way in which the announcement refers to the "joy" that IVF has brought to couples who would otherwise have been childless. The following comment, from the BBC news report carries this implicit ethical endorsement further:
Professor Basil Tarlatzis, past-president of the International Federation of Fertility Societies, said: "This is a well deserved honour.

"IVF has opened new avenues of hope for millions of couples throughout the world.

"Edwards and Steptoe were real pioneers, and the award of the Nobel Prize honours not just their work, but the whole field of reproductive science...
One might do well to notice the implicit nature of the ethical endorsement of IVF expressed in this award; and to notice that it is implicit and not explicit. One could make a case that the award of the Nobel Prize does not, in itself, represent an ethical endorsement of IVF but, more than anything else, is a recognition of a widespread use of IVF in medicine. Whilst that implies an ethical endorsement, that is all that it does; and one can challenge the implication without denying the legitimacy of the Prize.

The Nobel Prize announcement does suggest a very positive view of the experience of IVF treatment by couples who undergo that treatment. Others will have better experience than I have to comment on the experience of repeat IVF cycles, which may constitute a less positive experience.

I think it was about the year 1972 that a French physician committed himself to working in defence of pre-born children, particularly those suffering from trisomy. This followed a television programme in his country that first suggested that those diagnosed within the womb as suffering from a disability might be aborted. That eminent physician's daughter relates how Professor Jerome Lejeune had already spoken at the United Nations in defence of the life of the unborn child. And the evening that he had done that, writing to his wife, he noted:
This afternoon I lost my Nobel Prize
Professor Lejeune discovered the particular genetic abnormality that gives rise to Down's Syndrome. It was the first ever identification of a connection between one particular genetic fault and the illness or disability that it caused. It is the discovery that lies at the beginning of the search for genetic treatments for illnesses, a search that is now expressed in different forms of stem cell research, some that Professor Lejeune would not have considered ethically just and others that he would have supported.

I wonder if, when that research comes to its fruition, and medical treatment undergoes the revolutionary change to genetically based treatments; I wonder if at that point the work of Professor Lejeune will be considered worthy of a Nobel Prize, in the same way that Dr Edwards has been awarded his prize as the results of his work have become an everyday experience in the medical world? Nobel Prizes are not awarded posthumously, so no prize could actually be awarded; but it would be nice to think that Professor Lejeune's contribution to the field were recognised in some way. It would represent a genuine "secularity" of the world of science in respect to a particular ethic of science itself.

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