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Michael Asciak MP is one of the driving forces behind a proposed law for the protection the human embryo, expected to curtail the current reaches of the non-regulated medical practices in IVF treatment.
In his home-office right off the Fleur de Lys aqueduct, Dr Michael Axiak, a doctor and Nationalist MP, speaks of natural law and its inherent norms with the ease of any self-respecting Catholic conservative. The chairman of the Bioethics Consultative Committee, Axiak literally quotes from papal encyclicals and theologians like Aquinas, his desk heaving underneath scores of documents outlining embryonic scientific research and the European laws on the human embryo. Malta is set to get its own law, and the regulations are expected to be restrictive, expected to regulate the number of embryos implanted, exclusion of IVF by a third donor, exclude IVF to overage women, exclude surrogacy and the freezing of human embryos.
Axiak’s wall, decked with icons of the Christ from various European countries, attest to his faith. An Opus Dei supernumerary, his copy of the Da Vinci Code is stacked away on one of his bookshelves. He hasn’t watched the film yet, and by the looks on his face as he describes his views on the book, he won’t even be seeing the film any sooner either. “Opus Dei is an organisation of the Catholic Church. It’s my personal spiritual method. I mean, aren’t you a Roman Catholic yourself?” he asks me, as I stammer into an awkward silence. “There’s a lot of hype about the organisation. It basically focuses its charisma on work, whichever profession it is…”
Axiak is impeccably conservative on social issues such as stem-cell research, and the point of departure on the complex debate on embryonic stem-cell research starts on the debatable view of where human life starts.
In a world suffused with disease and gloom, stem-cell research offers hope for providing humans with a repair kit that can be used for the replacement of vital organs and the curing of diseases, impairments and conditions.
But there is also a widespread controversy over stem-cell research, due to the way these are created and used. Most adult cells in the body have a particular purpose which cannot be changed. A liver cell for example, cannot be transformed to suddenly take on the role of a heart cell. Stem cells are different. They are still at an early stage of development, and can turn into many different types of cell, and scientists claim stem-cell therapy can cure diseases such as Parkinson’s, Alzheimer’s disease, heart disease, stroke, arthritis, diabetes, burns and spinal cord damage. Stem cells may also provide a useful way to test the effects of experimental drugs.
But the most useful stem cells come from the tissue of embryos, because they are pluripotent – that is, they have the ability to become virtually any type of cell within the body. Stem cells are also found within adult organs, but it far easier to grow embryonic stem cells in laboratories, because it is harder to grow sufficient amounts of adult stem cells, and this is what makes the former so important to research: large numbers of cells are needed for stem cell replacement therapies.
Controversy however exists over lab-created embryos used for their stem cells, because opponents like Asciak argue that all embryos constitute human life.
“There’s no problem with adult stem cells, or cord blood, which are also pluripotent and be coaxed into becoming new organs. However, embryonic stem cells have to be acquired by the destruction of the embryos, usually after the fifth day of development. Additionally, these stem cells are also totipotent at this stage, which means every embryonic stem cell has the potential of developing into a human being, if extracted and put into a womb.
“So here we are dealing with two issues: the provenance of embryonic stem cells, and their use as totipotent cells.”
Asciak is not entirely against the use of stem cells, claiming a 24-hour window of opportunity after the sperm penetrates the female ovum, can make it possible for experimentation and the harvesting of stem cells.
“Today, conception and fertilisation are synonymous for the Church. There are Catholics who believe individual human life happens on the fourteenth day, when implantation occurs. It’s not a widely held opinion. The most widely held view is ‘conception’, but that also represents a problem, because there is disagreement over where it starts exactly.”
Conception is indeed no simple, straightforward process. It is a series of 14 stages of fertilisation happening over a period of 17 to 24 hours after the sperm first enters the female ovum, to later fuse together to form a single set of chromosomes. For Asciak, the crux is pointing out which of these stages can come closest to the crucial stage of conception.
“Here there is a difference of opinion, since the Church just mentions ‘conception’, so the issue is left up to the scientific community to decide. The official position is stage 13, where syngamy, the fusion of the sperm and the ovum, occurs.”
At this point, Asciak says the pre-syngamy point, before the embryo comes into being, allows scientists a 24-hour period for the extraction of stem cells. He is without doubt that this is the particular stage when human life comes into being. In the drafting of a new law protecting the human embryo, defining this important stage is crucial. Many Catholics still point to “conception” as the starting point of life. President Eddie Fenech Adami, who will be signing the law into force once approved, has already stated his discomfort at putting his name to the law if such a definition falls short of anything but conception.
“That is his personal position,” Asciak says. “I think we should have a law which achieves consensus, the same which the Church chooses. I think we should use the word ‘fertilisation’. The authority on when human life starts is the scientific community, so if there is doubt on where human life starts, we should not bring doubt into the law. There is serious doubt over saying that ‘penetration’ of the sperm into the ovum is the starting point of life. Official scientific opinions say it is at the point of fusion – syngamy – between the two gametes, 24 hours later, that life is constituted. That is why we should use the world ‘fertilisation’.”
In a bid to protect the human embryo, the government is expected to ensure a greater protection of human life, and that creates ethical challenges for medical professionals and couples making use of in vitro fertilisation.
IVF, strongly opposed by the Catholic Church, involves removing ova from the woman’s ovaries and letting sperm fertilise them under lab-controlled conditions. The fertilised egg is then transferred back to the woman’s uterus, with the intent of impregnating the woman.
However, the chance of a successful pregnancy is approximately 20-30% for each IVF cycle. Doctors therefore try to boost the chances of pregnancy by placing multiple embryos during embryo transfer. This naturally carries the chance of multiple births. Doctors tend to limit the implantation of the creation of embryos to two or three, but if there are even more embryos at their disposition, they are left with the option of freezing them so that they may be used later if the woman fails to get pregnant, or even discarded. IVF being an expensive treatment, costing thousands, it pays to have surplus embryos frozen.
Asciak claims embryos should not be frozen, because it is unethical on the embryo since it can be damaged in the process or after thawing. If the patient doesn’t use the embryos again, they end up just being left in a frozen stage. With thousands of frozen embryos around Europe, I ask if it wouldn’t be more ethical to have these embryos given to other women seeking IVF treatment? Being such an expensive process, why limit the creation of embryos for women who may not get pregnant upon their first attempt at IVF?
“Foreign countries end up with thousands of embryos. I have no problem with those embryos being used for IVF. Even the Church accepts this position. It’s the lesser evil.”
Instead, Asciak says that at the stage where cells are not yet developed into embryos by syngamy, these can be frozen. “If we use the timeframe before an embryo is created at syngamy, we can freeze the pre-embryonic cells to be used for fertilisation if a woman’s first attempt at IVF fails. It’s a way out of having to freeze embryos or at having to go through hyperstimulation” (stimulation of the ovaries with fertility drugs to encourage the growth of several eggs).
At this point, Asciak seems to be rather distant from traditional points of view on genetic testing. He says that possibilities exist for tests to identify any possible diseases in developing embryos. “When a sperm actually enters the ovum, a discharge of extra chromosomes, well above the 46-chromosome complement, occurs. We can check this extra set of chromosomes to test for certain severe diseases, such as Parkinson’s, Huntington’s disease, and muscular dystrophy, to see if the genes of these diseases are present in the ovum. We could stop the process to prevent the development of the egg, since it isn’t an embryo at this stage, so it would not be tantamount to preventing life at this stage.”
Malta’s high infertility rate and low birth rate – down in Gozo by 50 per cent over 15 years and in Malta down by 33 per cent – shows that many families need advanced technology to be able to have children. Infertility is something that can break relationships.
Asciak’s opinion is that no more than three embryos should be implanted in a woman, without the creation of excess embryos which would be later on frozen. The problem is that women will have to go through the process once again if it fails, costing anything like Lm3,000. So why create this limitation?
“Statistically, implantation of one or two embryos has just as much chance as more. The British authority on fertilisation suggests not more than one embryo for under-40s, and not more than two for over-40s. Before implantation, there is a biopsy on the embryo itself and if there are any diseases in the embryo, it is not implanted and instead discarded. This would not be possible in Malta.”
So how does he reconcile opposing the freezing of embryos when considering that the current surplus stock should not be left to waste and indeed used. “That is adoption, even the Church allows it. Freezing of embryos should not be allowed. If there are left over embryos, they should be allowed to be used, but we shouldn’t freeze anymore embryos.”
And how does he see IVF policy taking shape? “Although I would like to see the position of family strengthened by insisting that only married heterosexual couples should have access to IVF, I think at law this won’t be possible and it will be also afforded to stable, unmarried heterosexual couples. Single couples, no.
“I am personally of the opinion it should be offered as part of public healthcare. It wouldn’t be fair to bar this treatment to people who cannot afford this treatment. It is also already part of the national service, partly. People who carry out IVF in Malta only carry out the implantation of the sperm into the egg. The rest of the treatment is carried out in the public hospital.
“However, I wouldn’t offer it free of charge then to unmarried couples, because the government would be destroying the institute of marriage. We have to conserve the family.”
Frozen embryos, leftovers from the IVF process, can also be used to cure diseases through embryonic stem-cell research. Naturally, it means destroying these embryos by extracting the stem cells.
“We cannot do something bad to create something good, and that’s a basic principle of moral philosophy. The lesser evil would be used in, for example, a situation where there is a law that allows abortion up to the 24th week, and a Catholic politician has to vote upon a law which allows abortion up to the 12th week. Voting for the latter would be justified because it is a lesser evil. In the case of direct killing of an embryo to treat someone else, would be doing something bad to do something good. That is a basic moral precept. The only way to go around it is if it is a non-intended, indirect killing.”
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