Sir

You reported that the World Health Organization (WHO) has published draft guidelines on bioethics (Nature 398, 175&179; 1999). I would like to draw attention to an earlier effort completed by WHO in spring 1998 — “Proposed International Guidelines on Ethical Issues in Medical Genetics and Genetic Services”. As co-rapporteur of these guidelines, I consider them some of the most comprehensive on ethical issues in clinical genetics, while they also address several research issues. The more recent general guidelines on bioethics reiterate some of their provisions.

WHO began its efforts on ethics and genetics in 1995, and a final document was drafted by 16 WHO experts in 1997. The experts were divided on the issue of human cloning and refrained from making hasty conclusions, preferring to issue a compromise “statement of fact” that cloning “has been rejected by many international bodies” and “is not in accord with currently accepted international standards”. Most of those present at the meeting considered cloning to be peripheral to the practice of medical genetics and of minor importance when compared to critical issues of access to services, fairness and education.

Since the proposed guidelines pertained mainly to services, rather than to research ethics, embryo research and germline gene therapy were not discussed. In general, the group opposed rushing to legislate for these ethical issues.

The proposed genetics guidelines were presented at the World Health Assembly in May 1998 and will be presented again in 1999. I would recommend readers to peruse them, and to comment or suggest revisions (http://www.who.int/ncd/hgn/hgnethic.htm ).