Journal of medical ethics, 1995; 21: 350-355

Human gene therapy and slippery slopeargumentsTony McGleenan Faculty ofLaw, Queen's University of Belfast

AbstractAny suggestion of altering the genetic makeup ofhuman beings through gene therapy is quite likely toprovoke a response involving some reference to a'slippery slope'. In this article the author examines thetopography of two different types of slippery slopeargument, the logical slippery slope and the rhetoricalslippery slope argument. The logicalform of theargument suggests that ifwe permit somatic cell genetherapy then we are committed to accepting germ linegene therapy in the future because there is no logicallysustainable distinction between them. The rhetoricalform posits that allowing somatic cell therapy now willbe taking the first step on a slippery slope which willultimately lead to the type ofgenocide perpetrated bythe Nazis. The author tests the validity of these lines ofargument against the facts ofhuman gene therapy andconcludes that because of their dependence onprobabilities that cannot be empirically proven theyshould be largely disregarded in the much moreimportant debate on moral line-drawing in genetherapy.

We can identify a number of reasons why discussionsof gene therapy are particularly prone to the use ofslippery slope rhetoric. Firstly, the technology cur-rently offers one practical technique, somatic cellgene therapy, while scientists are on the threshold ofdeveloping others, such as germ line gene therapy,enhancement gene therapy and cosmetic genetherapy (1). The fact that these developments are onthe horizon exposes the possibility that by acceptingor allowing somatic cell gene therapy we may have topermit the other forms of gene therapy. A secondfactor explaining the prevalence of slippery slopearguments in the gene therapy debate is undoubtedlythe historical link between eugenics and genetics.Perceptions of eugenics are still prevalent in societyand are redolent with significance as Laberge andKnoppers have noted:

Key wordsLegislation; ethics; jurisprudence; germ line gene therapy;somatic cell gene therapy.

'Within these "imaginaires populaires" of this newdiscipline are found the legacy of Mary Shelley'sFrankenstein and George Orwell's 1984. The Naziexperiment and the scientific and technologicaladvances of the last decade have fuelled this publicperception. The practice of genetic medicine findsitself therefore in an emotionally charged atmos-phere' (2).

Thirdly, slippery slope arguments can carry greaterforce where the discussion centres on a topic which,because of its complexity and the use of genetictechnology, is one of those categories of medicinewhich is perceived as being in some way potentiallymalevolent.

What is a slippery slope argument?The basic structure of a slippery slope argument isfairly straightforward: 'If we allow somatic cell genetherapy now then germ line gene therapy mayfollow and since germ line gene therapy is morallyunacceptable we should not begin by allowingsomatic cell gene therapy'. The basic structure of theslippery slope argument has been outlined byFrederick Schauer:

'... regardless of the term employed, the phenome-non referred to is the same. The single argumenta-tive claim ... is that a particular act, seeminglyinnocent when taken in isolation, may yet lead to afuture host of similar but increasingly perniciousevents' (3).

There are a number of characteristic components ofa slippery slope argument whose presence shouldalert us to the type of argument being pursued aswell as shedding some light on the nature of theargument itself. The first characteristic is describedby Schauer as 'the implicit concession'. This is thepoint usually made at the outset of the argument thatthe instant case under consideration is itself quiteinnocuous. Analysis of the implications of genetherapy regularly start from the premise that somaticcell gene therapy is acceptable. LeRoy Walters has

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identified 20 policy statements by eminent bodieswhich 'accept the moral legitimacy of somatic cellgene therapy for the cure of ... disease' (4).The second characteristic of a slippery slope

argument is that the two cases in question, theinstant case and the undesirable danger case, can beseparated from one another by some type of linguis-tic boundary. Somatic cell gene therapy can be lin-guistically distinguished from germ line gene therapysimply by describing how somatic cell therapyinvolves the treatment of one single individual,whereas the goal of germ line gene therapy is thepermanent alteration of the germ line in order toprevent certain characteristics of disorders recurringin future generations.A difficulty which nurtures these types of argu-

ments is that of linguistic imprecision. Our capacity toexpress ourselves is finite. In order to attempt to drawa distinction between something as complex assomatic cell gene therapy and germ line gene therapy,the descriptions will necessarily be complex and tech-nical, requiring both a degree of prior knowledge andinterpretative skill. This difficulty can be exacerbatedby the use of sloppy or vague language, which issometimes deliberate. In law, it is not unusual forcontroversial legislation to be peppered with vagueexpressions which devolve the resolution of poten-tially divisive issues onto the judiciary and the courts.

Linguistic imprecision is, however, only part ofthe equation. Descriptions, whether they be of germline gene therapy or the thirty-miles-per-hour speedlimit must be interpreted. However, the messagereceived is not always identical to the message sent,particularly if there has been a lapse in time. This isparticularly true of legal interpretation, as JudgeCardozo noted:

'The half truths of one generation tend at times toperpetuate themselves in the law as the whole truthsof another, when constant repetition brings it aboutthat qualifications, taken once for granted are dis-regarded or forgotten' (5).

A final defining feature of a slippery slope argumentis the increased risk of a calamitous conclusionbrought about by permitting the instant case. It is akey feature of the slippery slope argument that thedegree of risk will always be dramatically increasedby permitting the first prima facie innocuous event.This is what makes the slope slippery, otherwise itwould just be a normally treacherous incline.Having set out the parameters of the argument, theremainder of this discussion will focus on two par-ticular versions of the slippery slope argument: thelogical version and the rhetorical version.

The logical slippery slopeThe logical form of the argument states that once weallow somatic cell gene therapy we are logically

committed to accepting germ line gene therapy. Vander Burgh has argued that there are two differentforms of the logical version of the argument (6). Thefirst version would be based around the idea thatsince there is no relevant conceptual differencebetween somatic and germ line gene therapy therecan be no reason to draw a line between them. Thisis because the arguments offered in favour ofpermit-ting somatic cell gene therapy can also be used infavour of permitting germ line gene therapy. Indeed,much of the current debate on whether germ linegene therapy should be allowed is based on exactlythese lines. Those who think that germ line genetherapy should be permitted argue that somatic cellgene therapy has been sanctioned because it offerstremendous therapeutic potential for seriously illpeople and therefore any risks can be overlooked. Itis argued that germ line gene therapy offers exactlythe same benefits but has additional attractionsbecause somatic cell gene therapy will have to berepeated and the disorder may well be passed ontochildren. The attraction of germ line gene therapy isthat it need only be done once and can eradicate thedisease from future generations. Therefore, theargument runs, it is logical that germ line genetherapy will be allowed if somatic cell gene therapy isallowed and since germ line gene therapy is undesir-able we should never permit the first step. Thisargument only has real force if we determine thatgerm line gene therapy is morally wrong. If wedecide that there is no logical distinction to be madebetween somatic and germ line gene therapy andthat germ line gene therapy is not morally troublingthen it becomes much more difficult to justifydrawing a line between them. It could be pointed outthat what is being discussed here is not really aslippery slope at all, since there is a clear endpointand only one step between it and the instant case.Perhaps it is more of a 'treacherous crevasse'argument.

GradualismThe second form of the 'logical' slippery slopeargument, is based on gradualism and can besummed up thus: 'Although there may be a clear con-ceptual difference between somatic cell gene therapyand germ line gene therapy, there is no such differ-ence between somatic cell and cosmetic gene therapy,nor is there such a difference between cosmetic genetherapy and enhancement gene therapy and thereforewe will ultimately accept that there is no real differ-ence between this and germ line gene therapy'.

This argument basically claims that despite thefact that there may be a clear conceptual distinctionbetween these two forms of genetic manipulation wewill always end up accepting germ line gene therapyif we accept somatic cell therapy. This form of theargument can be persuasive where there are realproblems finding clear non-arbitrary cut-off points.

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352 Human gene therapy and slippery slope arguments

These 'logical' slippery slope arguments have con-siderable force when we are discussing the moralityof certain courses of action. However, when wecome to consider law it becomes apparent thatcertain clear distinctions can be made. Law is an all-embracing term and the validity or strength ofslippery slope arguments depends on whether we arereferring to statutory laws or precedent (7). Withunambiguous legislation logical slippery slope argu-ments may have little or no force. This is often illus-trated by examples about speed limits. Althoughthere is no practical or morally significant differencebetween thirty miles per hour and thirty-one milesper hour this does not mean that the speed limit will,or should, become thirty-one miles per hour. It is thepower of law in such contexts to impose with moralforce the type of arbitrary cut-off points which lackcogency in moral argument. A logical slippery slopeargument can therefore be seen to have relativelylittle force in the context of legislation.

Judge-made case law, or precedent, is rather morevulnerable to slippery slope claims than legislation.Firstly, the whole process of adjudication in manyways involves and resembles critical moral reasoningand so slippery slope arguments can have more force(8). Secondly, the nature of the rules of precedentare such that they impel many judges to decide caseswithin a narrowly circumscribed framework dictatedby previous decisions. Thus there is much less scopefor them to legislate and set clear and arbitrarylimits. Similarly judges may feel constrained fromsetting such limits because to do so would be a'naked usurpation of the function of the legislature'(9). There are constitutional reasons why judges areless likely to impose clear limits and case law is there-fore more likely to be influenced by logical slipperyslope arguments.

This feature is exacerbated by the nature of adju-dication in a precedent-based legal system. Cases aredecided in a step by step manner, and while there areno sudden variations in the law, incremental changedoes come about through the development ofexisting precedents. Thus the second type of logicalslippery slope argument may have some force inrelation to judge-made law. The problem is compli-cated by the fact that it is difficult to make reason-able and enforceable distinctions in judge-made law.In legislation such distinctions can be made andenforced on what appear to be flimsy and illogicalgrounds (10). Another reason why law seems vulner-able to slippery slope arguments is because of itshistorical nature. Both in the development of thecommon law and in the drafting of legislation, theretends to be an awareness of what has gone before aswell as a desire to provide for the future (11).

Rhetorical slippery slopesThe rhetorical slippery slope arguments are pre-sented as the other half of a dichotomous family

of arguments. However, the taxonomy does not fitperfectly and the increasing use of the term'psychological' to describe this particular variety ofargument may have as much to do with a desire forverbal tidiness as it does with philosophical integrity.

This form of the slippery slope argument tends tobe most commonly used in popular discourse. Thusit is not uncommon, in discussions on topics such aseuthanasia or abortion, to hear claims that if weallow the legalisation of mercy killing of individualsin terminal and intractable pain we will be taking thefirst step towards the type of genocide perpetrated bythe Nazis. The exact process which could lead fromallowing defences of mercy killing to Nazi-stylegenocide is rarely explicitly sketched out, but theargument undoubtedly had great rhetorical force.The case of euthanasia in the Netherlands has

been suggested as an example of such a slipperyslope in action (12). Since the early 1970s thepractice of euthanasia has become an establishedpart of Dutch medical practice. Euthanasia was notlegalised as such but a practice had grown upwhereby doctors who performed so-called 'mercykillings' were unlikely to be prosecuted under theDutch criminal law. In January 1994, after twodecades of turning something of a blind eye to thepractice of euthanasia (13) the Dutch legislatureintroduced legislation which without legalisingeuthanasia, brought certain constraints into play. Adoctor is now obliged to report his actions to thestate prosecutor in each case of 'mercy killing' sothat an investigation can be carried out to determineif charges should be brought against the doctorunder the criminal law. The Dutch euthanasiaexperience seems to illustrate the point that althoughthere may often be a low friction gradient involved inissues like this, it is just as possible that law andmorality may stop the downwards slide at a clearlydefined point, or may even initiate a movement backup the slope by concretising in legislative form theway in which the practice is sanctioned.The practice of euthanasia in the Netherlands has

evolved from an ad hoc situation whereby doctorscarried out life-shortening treatments followingmedical society guidelines (14) to one where thepractice of euthanasia is explicitly prohibited by lawexcept in cases where the doctor is adjudged by thestate to have carried out a 'mercy killing' withinstatutory guidelines. As well as illustrating that it ispossible to slip both up and down slopes, the Dutchexperience demonstrates the importance of attentionto detail in the language used to present a slipperyslope argument. Typically, the formulation runsalong such lines as: 'If we allow A then we willinevitably have a situation where B is also allowed'.This argument belies the subtleties of law-makingand the scope of the variations which are available tolegislators. The Dutch legislators never 'allowed'euthanasia in the free and unrestricted sense whichcritics now suggest, rather the practice grew up

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because in that particular society a consensusdeveloped around the idea that it was morally appro-priate to hasten death in certain circumstances. Thiswas never officially sanctioned by the legislature.The absolute prohibition on killing remained anunshakeable principle of the criminal law.

Is there a slippery slope in gene therapy?The argument usually begins with the premise 'byallowing somatic cell gene therapy ...' or 'ifwe allowsomatic cell gene therapy ...'. It is important toconsider this first clause of the slippery slope claim.Firstly, what is meant by the word 'we'? This raisesthe question as to who could possibly have thepower to sanction the beginning of such a process.Commonly in this type of argument the 'we' isintended to be society, the electorate, the generalpublic, or some other community body. Yet inreality such groups rarely have the power or theinclination to get involved in determinations of thepermissibility or acceptability of practices such asgene therapy. Although rhetorically, the 'we' seemsto refer to society, in reality, at least in the UKcontext the 'we' is more likely to refer to a selectcommittee or quango (15). Secondly, the questionarises as to what is meant by 'allowed'. As far aslegislation is concerned, the structure of legislationis such, particularly in a country with no writtenconstitution, that the idea of something being'allowed' is somewhat alien. Our law rarelyaddresses the question of allowing practices, ratherit more commonly tends to concern itself withestablishing exceptions to blanket prohibitions.Even laws which are considered by many to beliberal, such as the Abortion Act 1967, do not infact allow abortion but rather provide a defence to acriminal charge (16). The same principle applies toalmost everything that is sanctioned by the legisla-ture. Parliament did not allow homosexual activityfor men aged 18 and over, rather it modified theexisting criminal law which made buggery anoffence if it took place with someone under 21 yearsold. This is in keeping with our constitutionalsystem of residual rights. It is somewhat inaccurateto talk about allowing certain types of activity,because most legislation regulates by drawing upexceptions to general prohibitions.What then is the situation in relation to gene

therapy? Again the question does not arise here ofallowing certain types of gene therapy. In the UnitedKingdom the issue has been referred to a committeeof experts, the Clothier committee, which hasmade certain recommendations which will nowbe implemented by the GTAC (Gene TherapyAdvisory Committee). The Clothier Committeedetermined that a clear line could be drawn betweengerm line gene therapy and somatic cell gene therapy.It did not, however, simply decide to 'allow' somaticcell gene therapy, rather the report in fact states:

'The development and introduction of safe andeffective means of gene modification for this purposeis a proper goal for medical science. We thereforerecommend that the necessary research continue'(17).

So the issue is clearly not one of simply allowingsomatic cell gene therapy, but rather of regulating it.The Clothier Committee has decided that researchinto gene therapy should be allowed to continue.This decision has been supported by the setting upof the GTAC to supervise and determine what typesof gene therapy research are to be permitted. Thiscommittee's terms of reference include:

'To consider and advise on the acceptability ofproposals for gene therapy research on humansubjects, on ethical grounds, taking account of thescientific merits of the proposals and the potentialbenefits and risks' (18).

The Gene Therapy Advisory Committee is a per-manent regulatory body adjudicating researchproposals for gene therapy. It is apparent that we area very long way indeed from a scenario wherescientists are given a free hand to carry out somaticcell gene therapy on patients. Indeed, by July 1994 atotal of eight gene therapy research protocols hadreceived outline approval from the GTAC and threemore are pending. In circumstances where theslippery slope argument is used and where it hasconsiderable rhetorical force, very often the firstpremise of the argument ('if we allow A then') isoverly simplistic and flawed and a thorough exami-nation of what is being sanctioned will indicate thatthere is little danger of slithering down a slipperyslope.

Gene therapy and the logical slipperyslopeThere are two different forms of the logical slipperyslope argument. The first logical form of the slipperyslope argument might claim that 'if the GeneTherapy Advisory Committee prohibits somatic cellgene therapy except in carefully controlled researchprojects we will be taking the first step that may leadto germ line gene therapy because there is no logicaldistinction to be made between the two'. It isapparent from this formulation that the argument isalready being weakened by the checks and balancesput in place by such a system of regulation.What then of the claim that research in somatic

cell gene therapy will inevitably lead to germ linemodification because there is no conceptual dif-ference between the two? In fact there would appearto be a clear conceptual, as well as linguistic, dif-ference between somatic cell gene therapy and germline gene therapy. Somatic cell therapy involvesmanipulation of the DNA in the ordinary cells of the

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354 Human gene therapy and slippery slope arguments

body which are then replaced by mechanical meanssuch as injection or the use of an inhaler. If therecombinant DNA aspect of the procedure was notinvolved then there would be no difference betweensomatic cell gene therapy and the type of autologousbone marrow transplant which seems to have passedthe test of acceptability.Germ line gene therapy on the other hand is con-

ceptually different. Whereas ex vivo and in vivosomatic gene therapy involve treatment of normalbody cells, germ line gene therapy involves manipu-lation of the DNA ofreproductive cells, the objectivebeing that such modification will benefit not just thepatient but also the children of that patient. Themajor conceptual difference between the two tech-niques is the intergenerational potential of germ linegene therapy. This clear distinction made the task ofthe Clothier Committee much easier. Science andnature rarely provide us with such clear non-arbitrary points at which to draw a bright line.Clothier wrote:

'The purpose of gene modification of sperm or ovaor cells which produce them would be to preventthe transmission of defective genes to subsequentgenerations. Gene modification at an early stage ofembryonic development, before differentiation ofthe germ line, might be a way of correcting genedefects in both the germ line and somatic cells.However, we share the view therefore that there is atpresent insufficient knowledge to evaluate the risksto future generations .... We recommend, therefore,that gene modification of the germ line should notyet be attempted' (19).

So the first logical form of the slippery slopeargument does not seem to apply. What then of thesecond form of the argument? This argument wouldbe primarily based on gradualism, the idea thatalthough there may be a coherent distinction to bemade between germ line gene therapy and somaticcell gene therapy there are many intermediatecategories where such a distinction cannot so readilybe made. This argument is largely inapplicable in thecurrent context. In fact there is no intermediatecategory between somatic cell and germ line genetherapy. Currently somatic cell intervention isfeasible, but only just. Germ line gene therapy inhuman beings is still some years away.

Both the logical forms of the slippery slope argu-ments are based around arguments about whether ornot a clear distinction can be drawn between the twocategories of gene therapy. I have argued that such aclear conceptual difference can be drawn. Thisseriously weakens the first form of the argumentalthough it does not particularly affect the secondform of the argument. The last vestiges of force inboth lie in the proposition that it would be morallyunacceptable to allow germ line gene therapy (20).In conclusion, both logical forms of the argument

begin with a simplistic vision of the regulatorymechanisms already in place to scrutinise geneticmanipulations. They are further weakened by thefact that gene therapy is a rare incidence of scientificenterprise which lends itself spectacularly well to thedrawing of bright non-arbitrary lines. Finallythey both present an unchallenged but extremelychallengeable assumption that the acceptance ofgerm line gene therapy would be morally abhorrent.

Gene therapy and rhetorical slipperyslopesThe cogency of rhetorical slippery slope argumentsin relation to gene therapy owes much to past linksbetween genetics and the eugenics movement.Modem genetics need not necessarily have anythingto do with eugenics although the motives of indi-vidual scientists and research teams are difficult topolice. A rhetorical slippery slope argument mighttake the following form: 'If the Gene TherapyAdvisory Committee prohibits somatic cell genetherapy except where there is a clearly defined andapproved research project then we will have takenthe first step on a slippery slope towards the type ofgenocide perpetrated by the Nazis'.

Such an argument derives its power from itsappeal to facts and probabilities which it would bepointless to try empirically to prove. It is impossibleto determine whether a liberal attitude towardssomatic cell gene therapy will ultimately result in areturn to Nazi atrocities, but those who propose thisviewpoint are not particularly concerned about that.The strength of their position is determined by thefact that it is enough simply to raise the possibilitythat a liberal attitude to human gene therapy couldlead ultimately to Nazi-style atrocities.

There is one further reason why the rhetoricalslippery slope argument has little application inrelation to gene therapy. I have argued above thatthe rhetorical argument does have some merit in alegal context. However, the crucial distinction wasthat the rhetorical slippery slope argument only hasforce in relation to precedent and not in relation tolegislation. Gene therapy, although not subject tostatutory regulation as yet, is unlikely to be an issuewhich will come before the courts. Its regulation isoverseen by the Gene Therapy Advisory Committeewhich, although an adjudicatory body in somesenses, is not a precedent-bound hierarchical systemand thus cannot be susceptible to the same type ofrhetorical slippery slopes as the court system.

ConclusionSlippery slope arguments present only one facet ofthe debate on the acceptability of the various types ofgene therapy, but their rhetorical force can obscurethe arguments' obvious philosophical flaws. Detailedanalysis of the weakness of slippery slope claims

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should help to displace such claims from theirprominent position in ethical debates and allowattention to be focused on the demanding andimportant aspects of moral line-drawing in the newgenetic technologies.

Tony McGleenan, is Lecturer in Jurisprudence, Schoolof Law, Queen's University ofBelfast.

References and notes(1) The first patent application for a germ line gene

therapy technique was made to the European PatentOffice earlier this year. See: Coghlan A. 'Outragegreets patient on designer sperm'. New scientist 1994Apr 9 and, anonymous. Patents for eugenics [editor-ial]. Nature 1994; 368: 572.

(2) Laberge C M, Knoppers B M. Rationale for an inte-grated approach to genetic epidemiology. Bioethics1992; 6:317.

(3) Schauer F. Slippery slopes. Harvard law review 1985;99: 361-383.

(4) Walters L. Human gene therapy: ethics and publicpolicy. Human gene therapy 1991; 2: 115. See also TheClothier Report. Report of the Committee on the Ethicsof Gene Therapy. London: HMSO, 1992: CM 1788.

(5) Allegheny College v National Chautauqua County Bank,246 NY 369, 373, 159 NE (1927).

(6) Van der Burgh W. The slippery slope argument. Thejournal of clinical ethics 1992; 3: 256-268.

(7) The slippery slope argument is particularly popular inEnglish case law. A LEXIS search of the phrases'slippery slope' and 'thin end of the wedge' producedone hundred cases where these were used in thejudgment. For some reason the majority of these cases(53) involved planning disputes; whilst only oneinvolved an actual slippery slope; Home v RAC MotorSports Association Ltd (unreported) (motor sportaccident).

(8) This is particularly true in medico-legal adjudication.In such litigation slippery slope arguments oftenexplicitly appear, although usually only to be dis-counted by the judges. See Airedale NHS Trust vBland [1993] 1 All ER 821: 'I wish to add that I wasunable to accept his suggestion that recent decisionsshow that the law is proceeding down a "slipperyslope" in the sense that the courts are becoming moreand more ready to allow doctors to take steps whichwill result in the ending of life.'

(9) Magor and St Mellons Rural District Council v NewportCorporation [1952] AC 189: 'It appear to me to be anaked usurpation of the legislative function under thethin disguise of interpretation and it is the less justifi-able when it is guesswork with what material thelegislature would, had it discerned the gap, filled it in.'

(10) For an illustration of a legislative distinction whichmany regard as indefensible, see the arguments inrelation to the lowering of the homosexual age ofconsent to 16. Parliament decided on 21 February

1994 to preserve inequality in the age of consentamongst homosexuals by lowering it to 18, whereasthe heterosexual age of consent remains 16.

(11) See reference (3): 383 where Schauer argues that 'theprevalence of slippery slope arguments in law mayreflect a societal understanding that proceedingthrough law rather than in some other fashioninvolves being bound in some important way to thepast, and responsible in some equally important wayto the future'.

(12) Keown J. The law and practice of euthanasia in theNetherlands. The law quarterly review 1992; 108:51-78. Keown notes at 77: 'The significance of theDutch euthanasia experience for law, medicine andsocial policy in other countries is considerable, notleast in respect of the support it lends to the "slipperyslope" argument.' See also Gomez C F. Regulatingdeath: euthanasia and the case of the Netherlands. NewYork: Macmillan, 1991; Nadeau R. Euthanasia:charting the legal trends in Canada, the United States andthe Netherlands. Toronto: Human Life ResearchInstitute, 1990.

(13) Van der Maas P J. Euthanasia and other medicaldecisions concerning the end of life. Lancet 1991;338: 669-674. A 1991 study estimated that Dutchdoctors perform euthanasia at the request of thepatient around 2,300 times per year, that they alsoend the lives of 1,000 patients who are unable to makea request, and that they assist in around 400 suicides.In 35 per cent of cases death was caused by high dosesof painkillers or by decisions not to treat. One pointeight per cent of deaths were caused by the activeadministration of a lethal injection. Sixty-two per centof GPs were found to have practised euthanasia at therequest of a patient. See Remmelink Commission.Report of the Commission ofInquiry into Medical Practicewith Regard to Euthanasia, the Hague, 1991.

(14) Royal Dutch Medical Association: central committee.Vision on euthanasia, 1986.

(15) As far as gene therapy is concerned the issue wasdetermined initially by the Clothier committee ongene therapy which reported in 1992. Cm 1788.Report of the Committee on the Ethics of Gene Therapy.Since November 1993 this area has been regulated bythe Gene Therapy Advisory Committee (GTAC) apermanent body with sixteen members, chaired byProfessor Dame June Lloyd.

(16) Sections 58 and 59 of the Offences Against thePerson Act 1861 make it an offence unlawfully toprocure a miscarriage. What the 1967 Abortion Act,as amended by the 1990 Human Fertilisation andEmbrvology Act, does, is to provide a defence to adoctor who procures a miscarriage where he complieswith one of four sets of conditions.

(17) See reference (4): The Clothier report at 8.4.(18) Department of Health press release, 1993 Nov 15.(19) See reference (4): The Clothier report at 5.1.(20) Zimmerman B K. Human germ line gene therapy: the

case for its development and use. 3rournal of medicineand philosophy 1991; 16: 593.

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