The Influence of Mary Warnock

D. Joy Riley, M.D., M.A.

Philosopher and public intellectual Helen Mary Warnock died on 20 March 2019, at age 94 years. (See here and here.)

Baroness Warnock’s imprint marks not only public policy in the United Kingdom, but also the public policies of much of the western world, particularly in the arenas of assisted reproductive technologies and embryo research. She famously chaired the Committee of Inquiry into Human Fertilisation and Embryology, 1982-84.

The Warnock Committee (as it came to be called) was formed to advise Parliament regarding, inter alia, in vitro fertilization (IVF) after the 1978 birth announcement of Louise Joy Brown, the world’s first “test-tube baby.” The committee chose to assign 14 days as the limitation for embryo research. That is, embryos could be used for research for up to 14 days post-fertilisation—not including freezer time for those that were cryopreserved.

Mary Warnock contributed the idea that a specific number of days, as opposed to a particular stage of the embryo, be used as a limit for legal purposes. She admitted that 14 was an arbitrary number, and explained the rationale to The Observer’s Robin McKie in December 2016:

“Before 14 days, it is absolutely certain – beyond any doubt whatsoever – that there are no beginnings of a spinal cord in an embryo,” says Warnock. “That means that whatever is done to the embryo during that period it cannot be feeling anything. And yes, it was a pragmatic decision. Everyone can count up to 14, after all.

“After this stage, however, development of the embryo becomes very rapid and it develops quickly towards becoming a foetus with a spinal cord and a central nervous system. So that is why we came up with that limit.” (https://www.theguardian.com/science/2016/dec/04/embryo-research–leap-forward-step-too-far)

Parliament embraced the Warnock Committee’s recommendations including the use of embryos for research, and codified these into law, primarily The Human Fertilisation and Embryology Act of 1990. The idea of a time-limited rule for embryo research spread. By 2016, ten other nations besides the U.K. had enshrined in law a 14-day limit: Australia, Canada, Denmark, Iceland, Netherlands, New Zealand, Slovenia, South Korea, Spain, and Sweden. Uniquely, Switzerland restricts embryo research to seven days. Five nations maintain the “guideline” of 14-days: India, Japan, Mainland China, Singapore, and the United States. (https://www.nature.com/news/embryology-policy-revisit-the-14-day-rule-1.19838)

Mary Warnock’s influence impacted more than IVF and embryo research. Before she chaired the Committee that bears her name, Warnock served in a variety of posts. She was a member of the Independent Broadcasting Authority; then came a stint on the Royal Commission on Environmental Pollution; she chaired the Committee of Enquiry into Special Educational Needs; and she also presided over “a Home Office committee on the use of animals in laboratories” (Mary Warnock, A Memoir – People & Places (London: Duckbacks, 2002), 31-2).

Warnock did not back away from controversy. In 2008, she wrote “A Duty to Die?” for a Norwegian publication. She explained her views further in The Telegraph:

“I wrote it really suggesting that there’s nothing wrong with feeling you ought to do so for the sake of others as well as yourself.”

She went on: “If you’ve an advance directive, appointing someone else to act on your behalf, if you become incapacitated, then I think there is a hope that your advocate may say that you would not wish to live in this condition so please try to help her die.

“I think that’s the way the future will go, putting it rather brutally, you’d be licensing people to put others down.”

(https://www.telegraph.co.uk/news/uknews/2983652/Baroness-Warnock-Dementia-sufferers-may-have-a-duty-to-die.html)

Mary Warnock was indeed a public intellectual. She applied her nimble mind to a wide variety of topics. Although her pen has stilled, her widespread influence continues. Her strongly-argued utilitarian positions of embryo usage and death advocacy necessitate able rebuttals for the defense of the most vulnerable among us.

The expansion of euthanasia in the Netherlands

Dr. Steve Phillips

Ever since advocates for euthanasia began making arguments that euthanasia was morally permissible and should be legal, their arguments have begun by picturing a person who is near death from a disease that is causing severe pain. Then they argue that out of respect for the autonomy of and compassion for that person we should conclude that it is permissible for her or him to request and receive euthanasia as a means of ending suffering. Those who take the opposing position frequently counter with arguments about the value of human life in the midst of suffering, the importance of never saying that a human life is not worth living, and an understanding that compassion means coming alongside a person to help them live the life that they have the best that they can rather than destroying that life.

In addition to those arguments related to ethical principles, some raise concerns about what will happen if we make the decision that euthanasia is permissible and should be legal. One of those concerns is that euthanasia will spread to a much wider range of situations if it is accepted in an initially limited way. When we examine the arguments favoring the permissibility of euthanasia, the argument from respect for autonomy is actually arguing for euthanasia in any situation in which a person would choose to request it. The argument from compassion actually argues for euthanasia even in situations in which the person is not able to request it. Can euthanasia remain limited or will acceptance lead to much broader use?

Frequently people look to the Netherlands because of its long history with euthanasia to answer that question. A recent detailed report on the Netherlands’ experience with euthanasia by Christopher de Bellaigue in The Guardian adds some insight to this question. He looks at how the situations addressed by euthanasia in the Netherlands have expanded. He focuses on cases in which the person is not in the process of dying and cases in which an advance decision results in euthanasia of a person who is not requesting it at the time it is done. These have been areas of concern that have caused some who supported euthanasia in the past in the Netherlands to have second thoughts.

Bellaigue reports that the indications for euthanasia have expanded to include those with psychiatric illness who have no life-threatening condition and the elderly who are not dying but have become tired of living. He shares the story of a physician who once performed euthanasia but has stopped because patients were expecting him to provide euthanasia in situations in which he saw no need for it. They simply wanted him to do it because they requested it. He also reports on the problems that have arisen when a person with progressive dementia makes an advance directive requesting euthanasia when a certain level of intellectual and functional decline has occurred. The problem is that many times when the conditions stipulated to trigger the use of euthanasia occur the person who has requested it in the past no longer has a desire for euthanasia and may actively resist it, but no longer has the capacity to refuse it.

The experience in the Netherlands makes it clear that moral and legal acceptance of limited euthanasia leads to expansion of the indications for euthanasia beyond those who are terminally ill and beyond voluntary to at least nonvoluntary euthanasia.