Morality of shopping for babies at the clinical casbah

Mary Warnock is the Lytton Strachey of the reproduction revolution - the fascinated participant-observer puncturing idols - and Making Babies is a remarkable and revealing book. Warnock chaired the 1982 inquiry into the existing and emergent social, ethical and legal consequences of human fertilisation and embryology. The existentialist traces of some of her professional philosophical writings are evident in this essentially compassionate account of whether people may be said to have a right to have children or, indeed, the right to choose the type of children they want. These, she argues, are necessarily public claims, demands for justice, and are not a matter of individual conscience.

Warnock examines whether infertility treatment is for the mortgaged middle classes or whether there is a wider right to access treatment for any individual or couple. She deplores the tendency to conflate rights conferred by law with general human or moral rights, a tendency exacerbated, she claims, by the Human Rights Act. This, she argues, adds a "borrowed authority" to claims of rights without a specific grounding in law.

There was much in the 1982 Warnock report that could be read as "the right way to have children", and there are many echoes of that here too. But Warnock has come to table a fairly liberal agenda of reproductive opportunities (same-sex parenting and aspects of reproductive cloning being the stand-outs), and she has changed her own position significantly. On posthumous births, such as the case of Diane Blood, on access to identifying information for those born following treatment services ("all such deception is an evil"), and on aspects of surrogacy, Warnock counsels a different approach 20 years down the tube, embryologically speaking.

There are fascinating and occasionally extraordinary insights into the workings of the Warnock committee's moral games in scenario-building, with mythical characters serving as surrogates for the dilemmas. And we learn that there was a good deal of spot-on philosophy: the paramount interests of the child-to-be-born was not, she states, estimated nor seriously examined in committee, but "the principle sounded good and we adopted it".

Four women dominate the book: philosophers Elisabeth Anscombe and Phillipa Foot, who rescued moral philosophy from analytical domination; embryologist Ann Maclaren, whose role as midwife in the development and parturition of assisted conception in the UK is constantly referred to; and Warnock herself.

When Warnock replies to the apparently scientific question of logical positivism, "when does human life begin?", with the words "what sounded like a scientific question was in fact a moral question in disguise", Foot's imprint is discernible. In Warnock's now (in)famous reformulation, the question becomes "at what stage does an embryo become morally significant?"

This reflective essay does not read as an essentially optimistic account of human relations with modern scientific medicine. There is something of the approach of the late Hans Jonas in these pages, the call for the discovery and retention of a heuristics of fear, or certainly of wonderment.

As Warnock rightly argues, examining assisted conception entails a much broader colloquy that goes to the very nature of the modern doctor-patient relationship. Anxiety about the "new morality" is embodied in the prospect of patients being no more than shoppers at the clinical casbah - their talons replacing trust, their wild optimism fed by Wildean cynicism. This is a vision that Warnock finds intolerable but plausible.

Making Babies is an important contribution to the wider public understanding and critical appreciation of science and its applications. Yet Warnock's eloquence is occasionally shrouded in ellipsis. And although this is a short book, she would have been better served by an editorial team tidying the irritating factual inaccuracies and errors.

Derek Morgan is professor of health care law and jurisprudence, Cardiff Law School.