‘My only dogma is science and biology’ | Stephen Spiteri

Yesterday, Health Minister Chris Fearne quipped that ‘The PN has a history of agreeing with reforms after they happen.” He has a point, hasn’t he? Initially, the PN was against IVF; then it accepted IVF, but objected to embryo freezing (among other issues). Now, the PN agrees with embryo-freezing, but opposes ‘PGT’: a genetic screening method, which could ensure that hereditary conditions are not transmitted to children.  Why is this one issue – IVF – still so evidently problematic, for the PN? 

Let’s start with this. IVF is certainly not a ‘problem’: either for the Nationalist Party, or for myself. On the contrary, as a doctor I am delighted to see children who were born through IVF; and even more so, the children of children who were born through IVF. Because today, those children are growing up, and having families of their own. 

Besides: as a doctor I CANNOT be against IVF. It is a mechanism that assists patients who have fertility problems; and I will definitely not go against any form of medical assistance that can help my patients. 

But I feel I have to correct you, slightly: it was actually the Nationalist Party, in 2012, that recognized the need to come up with a legislative regulatory framework for IVF. Bear in mind that this service already existed in the private sector…  without any form of regulation at all; and without us even knowing what sort of abuse may, or may not, have been happening.

Now: as you well know, IVF raises a fundamental principle. Not a ‘moral’ principle: we’re not here to discuss ‘moral’ issues; or ‘church’ issues; or ‘religion’. We’re here to discuss facts. And facts bring with them a certain responsibility. God forbid we were to behave without responsibility, in life:  because we would be living in the ‘Wild West’. 

We all agree, then, that the sector needs to be regulated. And it was the Nationalist Party that first introduced IVF regulations, with the Embryo Protection Act in 2012…

Hang on, wait. For all the years that the PN had opposed IVF on moral grounds… we WERE ‘living in the Wild West’. Effectively, IVF had to wait until 2012 – i.e., until the Nationalist Party’s moral qualms had finally subsided – for a long-overdue, much-needed regulatory framework…

No, what I’m saying is… what I said in my parliamentary speech, basically. I began by pointing out that first regulatory framework for IVF was introduced, by the Nationalist government, in 2012; and since then, both our society, and the laws that govern it, have evolved a lot. Naturally, then, we had no choice but to eventually amend the [IVF] law. But just because the 2012 law wasn’t perfect, it doesn’t mean that the principles it was based on – which remain valid to this day - can simply be discarded...

Nor does it mean that the Nationalist Party has to consistently find something to oppose, merely for its own sake. Take PGT, for instance. How is the PN’s current opposition to that, any different from its earlier objections to embryo freezing? And given that your earlier position has changed, between 2018 and today: should we expect this one to change, too?

Let me be clear: the Nationalist Party was not against embryo-freezing, ‘merely for its own sake’. As a party, we recognize that we need to look at what is happening in other countries, and try to adopt the best possible scientific approach. 

But I think that our biggest concern, at the time, was the stockpiling of frozen embryos. And in fact, today we know that there are almost 400 frozen embryos, held in storage in Malta…

Having said this, though: I can’t deny that using frozen embryos will give you a much higher success rate… aside from also reducing the stress on women, who would otherwise have to go through another cycle (with all the risk of oocyte hyper-stimulation, and so on.)  

Which brings me to the situation today. Now, we are facing another set of amendments – because the IVF sector is constantly evolving; and there are always new developments to catch up with – and we, as a party, agree with ALL the other amendments [apart from genetic testing] that are being discussed. For example, to raise the maximum age for women to undergo IVF to 45; and for embryo transplants, to 48. These are all important issues, and we agree with all of them.  

There was only one difficulty we found, with these amendments… and we found it in Amendment 8 of the main article: where it mentions PGT. That is where we found a difficulty.

You’re saying it yourself, though: ‘Seek, and ye shall find.’ Isn’t that what the PN is doing, in this instance (and in its earlier opposition to embryo freezing, too)? ‘Looking for things to morally object to?”

[Laughing] No, come on, it was just a manner of speaking! What I mean is that: we will not object to things, just for the sake of it. We will only object to them, if they conflict with the principle that ‘human life begins at conception’. That is our point of departure; and it has always been our point of departure. And from that perspective… we do find difficulties with PGT, yes. 

Let’s talk about these difficulties, then. In Parliament, you described PGT as “invasive, selective and destructive”. And yet, IVF as a whole is by definition ‘invasive’ – indeed, you can use the same word to describe any medical intervention – and it is also ‘selective’, in the sense that embryos are ‘selected’ in the process. So if PGT is objectionable on those grounds… why not object to IVF, in its totality (as your party used to, in the past)?

Yes, very good! I agree with you entirely that IVF is a ‘manipulation’… it has to be, in fact… but that’s not where the problem lies. It’s not a problem that medical science ‘manipulates’; it’s a question of HOW medical science manipulates: whether we do it in a way that respects the fundamental principle of human life, or not.

Let me put it another way. As a doctor, I see many positive things about these amendments – as I already explained, also in Parliament – but my concern is that [through PGT] we would be manipulating at the embryo stage, in a way that could lead to two possible consequences.

One, that we will end up with an excess of frozen embryos that are genetically defective… so to argue that ‘they will all be adopted’ is, to me, utter nonsense. Let’s face it: people wouldn’t even buy a tin of beans from a supermarket, if they think it’s of inferior quality… just imagine how much they would ‘adopt a defective embryo’…

Secondly, it is important to see where all this might lead to, in the end. Because if we are going to start ‘selecting’ at that stage… we will be opening Pandora’s Box. We will then start ‘selecting’, on other criteria…

I can understand the general concern, but how does any of this address the medical needs of those people who suffer from those nine hereditary diseases? And who are worried about passing those defective genes onto their children? What sort of solution is the Nationalist Party actually offering those people?

That is precisely what I was coming to. We – and here I’m speaking both as a PN representative, but also as myself: Stpehen Spiteri – are certainly not opposed to helping those people, and offering them solutions. I would be the last person to try and deny them the chance to have children, without the worry of transmitting those conditions…

Sorry to have to insist, but… isn’t that precisely what you’re doing, right now? 

No! Because PGT is not the only way in which those people can be helped. If you look at those nine conditions: all but one of them, can be diagnosed by ‘Polar Body Testing’ [PBT]: another method that tests the oocyte (i.e., the egg) and not the embryo.

The only exception is Huntington’s Disease, where [for reasons which are too complex to be reproduced here] PBT can only be used to diagnose the maternal side of the equation: in other words, you can only diagnose half those cases.

So what we are saying, basically, is that – bearing in mind that we live in a country where the law recognises the value of a human life, from the moment of conception: and we even have an ‘Embryo Protection Act’, and an ‘Embryo Protection Authority’, for that very reason – we do need a more rigid regulatory framework, that respects the value of human life. And we do have to be careful to find the right balance, between respecting the rights of prospective parents, and also the human life we are ‘creating’, so to speak, in a laboratory…

Because it’s no joke. We are, at the end of the day, creating human lives…

That a human embryo can be defined as ‘human life’, is one thing. But with all due respect, you are talking about ‘frozen embryos’ as if they were ‘frozen babies’. As a doctor, do you not see a distinction between those two things?

What I’m talking about is ‘frozen human life’…

You do acknowledge, then, that there is a difference?

Yes, of course: but you can’t have one without the other, can you? What is an embryo going to develop into, if not a baby?

That’s like saying: ‘What is an acorn going to grow into, if not an oak tree?’ (It doesn’t mean that ‘acorns’ and ‘oak trees’ are the same thing, does it?) But let’s put the philosophical part to one side, for now. You seem to be deliberately using highly emotive language, to appeal to the (non-scientific) viewpoint of people who REALLY can’t distinguish between a newly-conceived embryo, and a new-born baby. Aren’t you just exploiting those people’s emotions, for political purposes?

Definitely not! I will stand by my position that I believe that human life begins from conception. That is my point of departure; and my arguments are all based on that premise. Now: if we do not depart from the same point – and fair enough, I can understand that others will see things differently – then yes, the arguments would be very different. If I myself do not depart from that point … I would be telling people to ‘abort’. I would tell people to ‘discard any embryos that are genetically defective’; I would tell them, ‘Choose which embryo you want. Do you want a girl, or a boy? Design your own embryo…” 

I’m giving you extreme cases, naturally; but that’s where the argument would lead…

Fair enough; but what are you actually telling people today? Because the way I see it: you’re telling the radical pro-lifers exactly what they want to hear… but then, you’re turning to people who suffer from serious hereditary diseases, and saying: ‘Science can help you; but it goes against my own personal conscience… so, sorry! You just have to lump it!”

No, no… come on, it’s not like that at all! We’re giving them hope. We’re giving them treatment; we’re giving them a diagnosis; because, as I said before, we can use other technologies that do not involve the human embryo. Like Polar Body Testing: which could be a means of eliminating the dangers of experimenting on the human embryo, while still successfully diagnosing almost all the listed conditions… except half of the cases of Huntington’s Disease.

This raises another issue, though. Discrimination. Doctors For Choice (and now also the Commission for Persons with Disability) have argued that it is discriminatory to exclude a category of patients – in this case, sufferers of those nine conditions – on the basis of a genetic disorder. How do you respond to that?

It’s a very good question. And also, a very difficult one to answer. It is, I admit, a very sensitive issue. But let me put it this way: why do we have to introduce genetic testing on embryos – with all its possible side effects: on the embryo, on human life, etc - to perhaps reduce the genetic transmission of those nine conditions… when we have another method, that will NOT have all those side-effects; and will also cater for a very high percentage of those cases anyway?

This reminds me of when Prime Minister Gonzi insisted on ‘oocyte freezing’, instead of ‘embryo freezing’. The PN always seems to be looking for obscure alternatives, which somehow magically resolve all their own conscience problems. What if I put it to you that is actually your party’s conscience problems, that are causing the problem to begin with?

You can call it conscience, if you like; but my only dogma is science, and biology. It is science that tells me that the embryo is the beginning of a human life. And that is why I think we should respect a human life, from that stage. 

Besides: even though we do find difficulties with that one aspect of the amendments… it doesn’t mean we’re trying to stop anyone from having access to IVF. We still believe that this discussion can lead to a law that is acceptable to all parties. 

At the risk of repeating what I said in parliament: as Opposition, we are prepared to continue discussing the amendments at committee level, and to reach a consensus in the best interest of both the embryo, and those undergoing the IVF process. 

Ultimately, we are here to to legislate in the best of interest of our Maltese society.