On June 18, 2014, a year after the liberalisation of embryo research, the INSERM Ethics Committee made public a "note1" in which one of its working groups regrets that "very little embryo research [is conducted] in France". If it seems surprising that an ethics committee pushes to accelerate practices that it is supposed to regulate, it is even more so when perceiving that it advocates an extension of liberalisation to the major issue of studies on embryos and even the implantation of experimental embryos (pregnancy). Explanations.
We are no longer in the debate that led to the liberalisation in summer 2013 of research that destroys embryos for stem cell use. The INSERM Ethics Committee announces the purpose of the note from the outset: it is not an issue of stem cells, but "embryo research" as such. The committee should speak of studies and not research on the embryon2 (is erasing the distinction harmless?). What is it exactly? From a fundamental point of view, it is the study the normal and pathological development of the embryo before implantation and with an applicative goal to study the embryo itself and the conditions of its development: "to fight against infertility" and "the transmission of diseases", "particularly in the context of medically assisted procreation". For MAR, this is the challenge.
Thus, the paper is guided by a single, non-discussed idea: more "research" (indeed studies) on the embryo is needed in France. This need does not come from a scientific or clinical urgency, but a principle. At no point in the development of the note is a draft rationale found justifying this position, nor a picture of what these studies that we want to permit could serve themselves, except on one point that appears later.
The basis of the note, its main and legal subject, is given on page 9 under "a more efficient organisation of research": "If lifting the ban on the research principle (following the law of August 6, 2013) is justified from a scientific and medical point of view, and acceptable from an ethical point of view, it is not a sufficient measure to allow the promotion of research in the interest of the embryo". This statement of intent has, in fact, two contradictory aspects: firstly, the INSERM working group wants to eliminate restrictions that still limits researchers’ access to embryos discarded by clinics; secondly, it must take into account the legal realities, which want embryo research to benefit from such studies (directly or indirectly), and is thus incompatible with the first term where the embryo is destroyed.
This contradiction is only apparent because it is used to justify that the "embryo transfer has been part of the research", and we guess that this is the main reason for the note, which it proposes in practice. This reason was already announced on page 8 in a sentence which seemed cryptic, but becomes meaningful posteriori: "This research could be done on embryos no longer responding to a parental project, but also partly on embryos that may be transferred into the uterus for purposes of gestation. In the latter case, the research would benefit future parents, but also "benefit" the embryo itself insofar as it would have a better potential for development. Finally, the knowledge gained could benefit other embryos and would result in reducing the number of embryos created to better respond to the parental project of those who use MAR". What does this mean? This means the transfer from destructive embryo research to embryo research itself, not only non-destructive but actually targeting the embryo or other embryos in the same situation, with the study as far as possible in pregnancy, for its survival.
This work would present scientific interests a priori: sampling blastomeres, as in the case of pre-implantation diagnosis and already authorised by law, metabolic, genetic and epigenetic studies on growth factors, and ultimately gene therapy interventions on the embryo currently not permitted by law. In this latter case, corrections could be made, for example, of a genetic "family" defect or even a trisomy.
However fundamental and worrying questions remain unanswered:
• Could these studies not be conducted on animal embryos?
• To the extent that these studies can actually lead to beneficial interventions for embryos, in what timescale is this possible? In the meantime, how many embryos will be used as guinea pigs?
• The interest being shown to improve MAR, ostensibly to limit the number of embryos created unnecessarily, studies on embryos have real meaning when the embryo is then transferred intrauterine and its development is studied during pregnancy. What about information for parents? Parents using IVF due to subfertility would have difficulty accepting that we manipulate their child at an embryonic stage, with the risks of anomalies and loss of embryos that entail.
• Even if the parents accept such manipulations, they are not the "owners" of their child.
• Even more problematic, the note brings pregnancy into the experimental field: the authors of the note seem to support "experimental" uterine implantation of embryos deemed non-implantable. This entails the acceptance, for the sake of research, of the intrauterine development of a child whose viability or phenotypic normality appears immediately compromised.
It is always surprising - and yet so common - to see an ethics committee positioned at the utilitarian and materialistic forefront (read the paragraph on the "rightful place" of the embryo on page 7).
In this case, while part of French research renders the absolute liberalisation of all forms of work on the embryo a leitmotif, it is difficult to read this note without witnessing an increasingly disconcerting situation.
2. In French law, since the first bioethics law in 1994, a distinction is made between studies and research on the embryo, the first not infringing the latter, unlike the second, which leads to its destruction.