A One-Act Drama:The Early Human Embryo:'Scientific' Myths and
Scientific Facts
Implications for Ethics and Public Policy, Medicine and Human Dignity
"International Bioethics Conference, 'Conceiving the Embryo'"
Centre Culturel, Woluwe-St. Pierre, Brussels, Belgium
Sunday, October 20, 2002 (9:30 A.M.)
Revised 23 October, 2002
Copyright October 14, 2002
Reproduced with permission
Dianne N. Irving, M.A., Ph.D.
*"When I use a word," Humpty Dumpty said in
rather a scornful tone, "it means just what I choose it to mean -- neither
more nor less."
"The question is", said Alice, "whether you CAN make words mean so many
different things."
"The question is," said Humpty Dumpty, "which is to be master --that's all."
Through the Looking-Glass, by Lewis Carroll
[Charles Dodgson]
[Emphases are used throughout this text only to aid those unfamiliar with
certain terms and issues.]
SCENE: A dark meeting room somewhere in Brussels.
CHARACTERS:
Chairman
Lobbyists
Dr. "Science"
Dr. Gyno
Dr. Human Embryology
Prof. Philos
Master Bioethics
Crippled Conscience
Well-Formed Conscience
Others
Jaded Judge
Perplexed Parliamentarians
Narrator.
PLOT: The selected committee members are meeting to debate and
reach an ethical consensus on proposed legislation concerning human cloning
and human embryonic stem cell research. The language of the legislation has
been written by those in attendance.
The Chairman enters the dark meeting room and calls the meeting to order.
All members, except Well-Formed Conscience, who is knocking politely on the
other side of the heavy locked doors, are present.
Mr. Chairman: The purpose of this meeting is to listen to all
relevant opinions concerning this critically important piece of
legislation on human cloning and human embryonic stem cell research that we
Parliamentarians have already decided to propose. Each lobbyist present will
be given a full 2 minutes to present his or her suggestions for the language
to be used in the legislation before we finally vote. Since the issues
involved in this legislation are very technical, I would like Master
Bioethics to proceed first, and to explain to the rest of us the medical
facts we all need to understand accurately in order to be well-informed on
these subjects. After all, the starting point for considering these
technical issues is the bioethics.
Dr. Gyno: I object, Mr. Chairman. Physicians, especially ObGyn's,
are the medical experts in these issues. We should proceed
first.
Dr. "Science": Objection, Mr. Chairman. Physicians have medical
degrees, not Ph.D. degrees. The correct starting point for considering human
cloning and human embryonic stem cell research is the empirical science
of mouse molecular biology and frog genetics.[1]
Mr. Chairman: Of course, Dr. "Science". Proceed.
Dr. "Science": Everyone would agree that we scientists already
have absolute freedom of scientific inquiry; but it would be helpful if such
authority were to be fully sanctioned by national legislation, and declared
ethical. We only want to derive stem cells from some relatively worthless
human "pre-embryos". These "pre-embryos" can be easily obtained using
donated "surplus" IVF-embryos, or by creating our own by means of either
sexual reproduction (e.g., IVF) or a-sexual reproduction (e.g.,
cloning) in the lab. Objections to this research are simply based on nothing
more than the subjective opinions of scientifically illiterate
religious zealots using debatable "scientific facts" who want to force their
own morality on the rest of us. They actually claim that these cells are
persons immediately at fertilization or cloning. Imagine that! Every
scientist knows that "personhood" cannot begin until at least 14-days
after fertilization.[2]
Right, Master Bioethics? At most, these collections of cells possess only a
"reduced moral status". So there are no serious ethical problems with our
proposals.
Crippled Conscience: That's right!
Prof. Philos: Not so fast, Dr. "Science". Medicine and science are
extremely worthy endeavors, and have accomplished countless good for us all.
And we both agree that the scientific facts are the starting point
for these public policy decisions. But they must be the correct
scientific facts. And, may I remind you, that they are also the starting
point for the correct formation of conscience, and for the moral
decision making process?[3]
Thus isn't it even more urgent for us to make certain that all of us in this
room begin our deliberations with the most accurate and relevant
science available? Remember that remarkably wise caution: "A small error in
the beginning leads to a multitude of errors in the end."[4]
If we begin with erroneous science, then all of our decisions will be
erroneous in the end -- and that could lead to great harm and injury!
Crippled Conscience: What is he talking about, Dr. Gyno?
Dr. Human Embryology: Quite right, Prof. Philos. Dr. "Science",
you do fail to make several important distinctions. First, the question of
when a human being begins to exist is strictly a scientific
question, and should be professionally required to be answered by scientists
-- but only by us scientists who are academically credentialed human
embryologists.[5]
After all, we are the scientific experts who provide you
scientists with the correct, accurate, and most current scientific facts
concerning the beginning, growth and development of the early human embryo
-- the subjects of this legislation on cloning and stem cell research that
we are here to write. And our objective scientific facts are hardly
"debatable", or based on subjective religious opinions.
In fact, human embryologist are professionally required to use those
scientific facts which have been sanctioned by the international Nomina
Embryologica Committee, along with the Carnegie Stages of Early Human
Embological Development.[6]
This international committee consists of over 20 of the best and brightest
human embryologists from around the world. They meet about every 3-5 years
to examine and to evaluate the latest research studies in human embryology.
They then determine which scientific facts about the beginning and early
development of these human beings are accurate and reliable, and
which are not (and thus rejected). Their scientific conclusions are also
published in the international Nomina Anatomica.
Second, the question of when a human person begins to exist is not
a scientific question at all, but rather left to philosophers and the
like.
Third, there is no such thing as a "pre-embryo". The term is a complete
myth. There is, rather, an already existing, new living human
embryo, a human being that begins to exist immediately at
fertilization or cloning. Indeed, the terms "pre-embryo" and
"individualization" have been formally rejected by the Nomina
Embryologica Committee as scientifically inaccurate and misleading. I
just happen to have an example of their scientific rationale with me right
here:
"The term
'pre-embryo' is not
used here for the following reasons: (1) it is ill-defined because it is
said to end with the appearance of the primitive streak or to include
neurulation; (2) it is inaccurate because purely embryonic cells can already
be distinguished after a few days, as can also the embryonic (not
pre-embryonic!) disc; (3) it is unjustified because the accepted meaning of
the word embryo includes all of the first 8 weeks; (4) it is equivocal
because it may convey the erroneous idea that a new human organism is formed
at only some considerable time after fertilization; and (5) it was
introduced in 1986 'largely for public policy reasons' (Biggers)." ... Just
as postnatal age begins at birth,
prenatal age begins at
fertilization." [O'Rahilly and Muller 2001, p. 88] ... "Undesirable
terms in Human Embryology":
"Pre-embryo"; ill-defined
and inaccurate; use "embryo".7
[O'Rahilly and Muller 2001, p. 12]
Crippled Conscience: I don't think I want to hear any of this. Dr.
Gyno, can't you do something?
Narrator: A fierce verbal scuffle immediately breaks out among
several of the committee members, with Master Bioethics finally gaining
unfettered speaking recognition. Well-Formed Conscience continues knocking
politely on the other side of the heavy locked doors.
Master Bioethics (in a scornful tone): Mr. Chairman, please. This
scientist is absurdly wrong! As everyone knows, the "pre-embryo" has been
the international scientific standard used for decades now in all sorts of
private and public documents, guidelines, regulations, laws, etc. At
fertilization or cloning there just simply is no embryo, no
organism, no "developmentally single human being", no person,
no pregnancy. The embryo doesn't begin until the formation of the
inner cell mass in the blastocyst -- about 5-7 days after
fertilization. Pregnancy doesn't begin until the implantation of the zygote
-- or fertilized egg. And besides, almost two-thirds of the products of
normal fertilization are lost as "wastage" before they even implant. How
could they possibly be human beings already? Everybody here agrees on these
"scientific" facts. Right, Judge?
Jaded Judge: Well, eh ......... . That's right. Until 14-days
there is only a -- what did you call it -- a "possible human being", or a
"potential human being" -- yes, a "pre-embryo". At least that is how I was
advised by my expert bioethicists. Those other people just couldn't make up
their minds about it. Of course ............ if there is a human
being present immediately at fertilization or cloning, then we would have to
go back and review that legal decision, as we so stated.
Crippled Conscience: Please! Those little "pre-embryo" things are
just blobs of the mother's tissues, bunches of cells -- sort of like blood
clots! Dr. Gyno assured us of these scientific facts. And he should know. He
is part owner of a very famous IVF clinic, and does a lot of IVF research
himself.[8]
With such expert scientific information I gladly signed my "informed
consent" forms and donated my tissues to his distinguished research team
just yesterday! I am so grateful for all the good to society my tissues can
do to help advance science and to cure all such devastating diseases.
Dr. Human Embryology: With all due respect, Your Honor and
Crippled Conscience, it has been known, and universally agreed for well
over a hundred years now, that a new unique living human being begins to
fully exist immediately at fertilization. Indeed, this has been known
since 1880's, with the publication of Wilhelm His' three-volume treatise on
Human Embryology.[9]
Every human embryologist knows this. But then, no one on your Court, Your
Honor, accepted our professional expert position on this question. Only
amicus briefs from bioethicists, mouse molecular biologists and frog
embryologists were considered relevant.
However, let me take the opportunity now to set the record straight.
Fertilization is indeed the beginning of: the embryo, the
embryonic period, the human organism, the genetically and
developmentally individual human being, and normal pregnancy.
"Wastage" usually occurs because the embryo is abnormal, or the uterus is
not properly prepared. If it is a normal embryo, it's unfortunate
death does not negate it's real but short existence as a living human being.
And there is no such thing as a "fertilized egg", especially one that would
implant in the uterus. Nor is there such a thing as an "ovum". Further,
the whole blastocyst is the embryo, not just the cells from the inner
cell mass. I can prove these scientific facts with just these few
direct quotations from several of our best and brightest human
embryologists, some of whom have served on the Nomina Embryologica
Committee for decades:[10]
"Although life is a continuous process,
fertilization... is
a critical landmark because, under ordinary circumstances,
a new, genetically
distinct human organism is formed when the chromosomes of the male
and female pronuclei blend
in the oocyte... [The] coalescence of homologous chromosomes results in
a one-cell embryo.
...The zygote is
... a unicellular embryo
and is a highly
specialized cell. ... [I]t is now accepted that
the word embryo,
as currently used in human embryology, means
'an unborn human in the
first 8 weeks' from fertilization'. Embryonic life begins with the
formation of a new embryonic genome (slightly
prior to its
activation)." [O'Rahilly and Muller, 2001, p. 87]
"Human
pregnancy begins with the fusion of an egg and a sperm, ... Finally,
the fertilized egg, now properly called
an embryo, must
make its way into the
uterus ....". [Carlson 1999, p. 2]
"In this text, we begin our description of the
developing human with the formation and differentiation of the male and
female sex cells or gametes, which will unite at
fertilization to initiate the embryonic development of
a new individual.
... Fertilization takes
place in the oviduct [not the uterus]...
Embryonic development is
considered to begin at this point. ... These
pronuclei fuse with each
other to produce the single, diploid, 2N nucleus of the fertilized
zygote. This moment of
zygote formation may be taken as the beginning or zero time point of
embryonic development." [Larson 1997, pp. 1, 17]
"A
zygote is the beginning of a new human being (i.e., an embryo); [Z]ygote:
This highly specialized,
totipotent cell marks the beginning of each of us as
a unique individual....
Although fertilization may occur in other parts of the tube,
it does not occur in the
uterus. ... [T]he zygote, a unicellular embryo... " [Moore and
Persaud 1998, pp. 2, 34]
"This process, which occurs about 4 days after
fertilization, is called cavitation, and the fluid-filled space is known as
the blastocoele. At this stage,
the embryo as a whole is
known as a blastocyst. (p. 38) ...
At the blastocyst stage,
the embryo consists of two types of cells: an outer superficial layer
(the trophoblast) that surrounds a small inner group of cells called the
inner cell mass. The appearance of these two cell types reflects major
organizational changes that have occurred within the embryo and
represents the
specialization of the blastomeres into two distinct cell lineages.
Cells of the inner cell
mass give rise to the body of the embryo itself
plus a number of
extraembryonic structures." (Carlson 1999, pp. 39-40)
"'Primordium'" [e.g.,
"embryo proper"]:
This term refers to the beginning
or first discernible
indication for the earliest stage of development of an organ or
structure." (Moore and Persaud 1998, p. 3)
"Thus the germ layers should not be considered in
rigid isolation one from another, and many interdependences, particularly
what are termed epithelio-mesenchymal interactions, are important in
development. (p. 10); ... The
developmental adnexa,
commonly but inaccurately referred to as the
"fetal membranes",
include the trophoblast,
amnion, chorion, umbilical vesicle (yolk sac), allantoic diverticulum,
placenta and umbilical cord. These temporary structures are
interposed between the embryo/fetus and the maternal tissues. ... The
adnexa are
programmed to mature fast, to age more rapidly, and to die sooner than the
embryonic/fetal body.
Nevertheless they are genetically a part of the individual and are composed
of the same germ layers." (O'Rahilly and Muller 1994, p. 51).
"The appearance of the blastocyst demonstrates the
differentiation into (1) trophoblast (or trophectoderm), the peripherally
situated cells and (under the influence of E-cadherin) in first epithelium
formed, and (2) embryonic cells proper. The latter, at first few in number,
form the inner cell mass
(ICM). The trophoblast at the future site of attachment is
sometimes termed polar, the remainder being called mural.
The cells of the ICM
(inner cell mass) are considered to be totipotent initially."
(O'Rahilly and Muller 2001, p. 39)
"A high percentage of abortuses (30-80%, depending on
the study) are
structurally abnormal, and it is maintained that all abortuses under
4 postovulatory weeks have abnormally formed embryonic tissue. Thus,
spontaneous abortion greatly reduces the number of malformed fetuses born."
[O'Rahilly and Muller 2001, pp. 92-93]
"Early spontaneous abortions occur for a variety of
reasons, one being the
presence of chromosomal abnormalities in the zygote. The early loss
of embryos, once called pregnancy wastage, appears to represent
a disposal of abnormal
conceptuses that could not have developed normally, i.e., there is a
natural screening of embryos." [Moore and Persaud 1998, p.p. 42 - 43]
"Egg"; best confined to the hen and to cuisine; use "oocyte".
"Ovum"; does not exist
in human; use "oocyte", "ootid", "embryo". [O'Rahilly and Muller
2001, p. 12]
Narrator: At this point everyone in the dark meeting room starts
shouting all at once; Well-Formed Conscience begins banging fiercely on the
outside of the heavy locked doors. Eventually the Chairman regains control.
Mr. Chairman: Order! Let's have order in this meeting! Dr. Human
Embryology, perhaps you can explain to us in a bit more detail exactly what
happens before, during and immediately after fertilization that can help to
further illuminate your disagreement with Dr. "Science"?
Dr. Human Embryology: With pleasure, Mr. Chairman.[11]
There are two basic categories of cells in the human organism: somatic
("body") cells, and germ line ("sex") cells.[12]
During very early human embryonic development, primitive germ line cells are
initially totipotent,[13]
and they are diploid, i.e., they each have "46" chromosomes" (and
thus they too can be cloned). So before fertilization can take place, the
number of chromosomes in each germ line cell must be cut in half through the
process known as gametogenesis -- which can ultimately take decades to
accomplish. The final effect of gametogenesis is the production of haploid
"sex gametes", the sperm and the oocyte, which have only "23" chromosomes in
each cell. Once gametogenesis has taken place, then fertilization is at
least scientifically possible. During the process of fertilization, the
sperm and the oocyte fuse, and each ceases to exist as such. Rather, a new
single-cell human being is produced.
This is a sexual method of human reproduction, but there are also
a-sexual methods of human reproduction that are involved in our debates
here this evening, and need to be distinguished.
Sexual reproduction (e.g., in fertilization) and a-sexual
reproduction (e.g., in cloning) involve several different, even opposite,
biological processes. I like to use the analogy of the "zipper".
Think of the process of sexual reproduction roughly as predominantly
a sort of "zipping up", and that of a-sexual reproduction as
predominantly a sort of "zipping down".
For example, in sexual reproduction, this new single-cell human
being contains all of the genetic information it will ever need. No
genetic information is lost or gained during growth and development; this
information is only turned on or turned off, depending on what products are
needed. This process is called "methylation", and the more
specialized or differentiated a cell becomes the more methylation of the DNA
has taken place.[14]
The products formed by means of the genetic information in each cell then
cascade[15]
down throughout the life of the organism. This is "zipping up".
Scientifically, empirically, we know that immediately at fertilization
species-specific human proteins and enzymes are produced, and
species-specific human tissues and organs will be formed.[16]
We also know empirically that carrot, corn, frog, or monkey proteins,
enzymes, tissues, or organs, are not produced.
In a-sexual reproduction, such as cloning,[17]
many of these processes operate in reverse. One begins with a specialized or
differentiated cell, in which some or even most of the DNA in that cell has
been "silenced", and then the methylation bars on that DNA are incrementally
removed -- eventually resulting in, e.g., a new, single-cell zygote, an
organism, an embryo, a human being.[18]
This is "zipping down", and roughly what happened with the production of
Dolly the sheep.
Narrator: There is utter silence in the dark meeting room. Even
Well-Formed Conscience stops banging on the outside of the heavy locked
doors to try to listen. But rapidly Dr. "Science" regains his usual scornful
composure.
Dr. "Science": This is all very interesting, Dr. Human Embryology,
but there is still one major scientific problem that you have not
confronted: i.e., the empirical fact that these little "pre-embryos" can
form twins until 14-days, and that two of them can fuse to
become one human being. That proves that these "pre-embryos"
can't possibly be "developmentally individual" yet!
Dr. Human Embryology: Not a problem, if you understand the basic
embryology. The quickest way to explain what is going on in both of your
examples is to understand the biological process called "regulation".
Regulation is operative in both "zipping up" and "zipping down". In "zipping
up", as in sexual reproduction (fertilization), regulation concerns various
processes of differentiation; but it also becomes involved when an injury
has occurred to the organism. Here, regulation is the ability of an embryo
or an organ primordium to "heal" a normal structure if parts have been
removed or added.[19]
In "zipping down", as in a-sexual reproduction such as twinning, regulation
could possibly revert separated totipotent embryonic cells back to
new living human embryos, i.e., new living human beings. Indeed, this
is what happens with human twinning in vivo.[20]
I know, Dr. "Science" -- you want to know when each twin is to be
considered as an "individual", right? Well, please consider twinning from
the standpoint of regulation. A normal human embryo is produced sexually
via fertilization (in vivo or in vitro). Scientifically we
know that this embryo produced at fertilization has already been
determined scientifically to be an individual -- both "genetically"
and "developmentally". He or she is a new human being. The embryo grows
developmentally in total continuity with itself, and is composed initially
of totipotent cells. If cells of the embryo are damaged, the embryo could
die, or regulation could set in to "heal" the embryo and restore it
to wholeness. On the other hand, if these totipotent cells are actually
separated from the whole embryo, then these separated cells
too could just die, or regulation could possibly set in and revert
these totipotent cells to new human embryos. So the first twin
is the original human embryo produced sexually and begins to exist as an
individual at fertilization. The second twin is the new human embryo
produced a-sexually and begins to exist as an individual when
regulation is completed. Thus there is not only a "genetic" continuum
involved between twins, but also a "developmental" continuum, from
fertilization on. Finally, twinning can take place after the
arbitrary 14-day marker event.[21]
And so there is no "pre-embryo" -- other than in someone's mind, as a
sort of "thought experiment".
Now please consider the fusion of two early human embryos to form a
single chimera from the standpoint of regulation.[22]
If two human embryos fuse together to make one organism, that organism is
not a human being. It would have 92 chromosomes -- whatever kind of
animal that makes it! Both original embryos have died. If this chimeric
organism undergoes regulation, ejects all excess chromosomes, and reduces
the number and proper mixture (male and female) of chromosomes to "46", then
it could theoretically result in the formation of a new human embryo. But
that embryo would not be the same individual as either of the original
embryos that fused. However, assuming that this process would even be
possible in humans, there would still be both a "genetic" and a
"developmental" continuum in this new human chimera from fertilization on.
Most of the "scientific" data used by the proponents of the "pre-embryo"
and its various "substitutes" (of which there are many!) is elementarily
erroneous science; they selectively use bits and pieces of "data"
on which is superimposed very specific ideologies; they leave out, or
don't themselves understand, any of the more sophisticated understanding of
the biological processes involved; and the term has been formally rejected
by the appropriate international scientific experts in the field. There
is no such thing as a "pre-embryo -- or any of its various "substitutes".
Crippled Conscience (slightly upset): Does this mean, Dr. Gyno,
that my "morning-after" pills might sometimes be abortifacient?[23]
Dr. Gyno: Nonsense, my dear Crippled Conscience. Even if there is
no such thing as a "pre-embryo", at least we do know for certain that the
early human embryo is not a human being until it gradually evolves into
one during gestation -- sort of like a tiny "human-being-on-the-way",
right Master Bioethics? That's what the famous "biogenetic law" so states.
Dr. Human Embryology: Unfortunately, Dr. Gyno, there is no such
thing as a "human-being-on-the-way" either; the "biogenetics law" too has
long been rejected by scientists. Quoting from O'Rahilly and Muller:
"Recapitulation, the So-Called Biogenetic Law. The theory that
successive stages of individual development (ontogeny) correspond with
("recapitulate") successive adult ancestors in the line of
evolutionary descent(phylogeny) became popular in the
nineteenth century as the so-called biogenetic law.
This theory of
recapitulation, however, has had a "regrettable influence on the progress of
embryology" (G. de Beer). ... According to the "laws" of von
Baer, general characters (e.g., brain, notochord) appear in development
earlier than special characters (e.g., limbs, hair). Furthermore, during its
development an animal departs more and more from the form of other animals.
Indeed, the early stages in the development of an animal are not like the
adult stages of other forms but resemble only the early stages of those
animals. The pharyngeal clefts of vertebrate embryos, for example, are
neither gills nor slits. Although a fish elaborates this region into gill
slits, in reptiles, birds, and mammals it is converted into such structures
as the tonsils and the thymus." [O'Rahilly and Muller 2001, p. 16].
Crippled Conscience: I am totally confused now. How can one thing
go by so many different names? And I just don't see why it matters
how one scientifically defines a human being, or when it begins to exist.
What difference does it make, ethically? Bioethics has already
assured us that these are "pre-embryos" and not persons, and that it is
ethical to use and destroy these little blobs or cells for "the greater
good".[24]
What's ethical is ethical. That's what we're really here to vote on tonight!
Master Bioethics: Precisely, Crippled Conscience. And that should
be quick and easy to do. Forget all these scientific facts.[25]
After all, we bioethicists have already decided for you what is
ethical. Our ethical principles, you know, are ethics -- they are
brand new, and perfectly fitted for promoting the rapid progress being made
in all of these "converging nano/bio/info/cogno technologies" these days[26]
-- for that matter, in all areas of human endeavor -- globally![27]
The possibilities are endless! This ethical theory was all sorted out by us
back in 1978 at a quiet meeting in Belmont, when we wrote our Belmont
Report as appointed members of the National Commission.[28]
With that famous Report of ours, "bioethics" was formally "born".[29]
The U. S. Congress actually mandated that we identify what is ethical in
their 1974 National Research Act.[30]
So we did just that! Of course, we incorporated all of this sophisticated
and enlightened "pre-embryo" science in subsequent documents, regulations,
laws and guidelines over the years.[31]
And our ethical theory is neutral -- perfect for public policy
decision making in any pluralistic, multicultural, democratic society! Don't
worry your little conscience about any of this.
Prof. Philos: Excuse me, Master Bioethics, but your nouvelle
theory of ethics is not "ethics-per-se", nor is it in any way
"neutral" for use in public policy. There are dozens of different kinds of
ethical theories throughout all of human history; and there is certainly no
such thing as a "neutral ethics".[32]
Even your bioethics Founders and textbooks clearly state this.[33]
It would seem that you are imposing your non-neutral normative ethics
on the rest of us!
Jaded Judge: Perhaps the Master can tell us more about this new
bioethics theory. It sounds rather invigoratingly new, and we all
could surely use a change! What ethical principles do you use to
determine what is ethical, Master Bioethics?
Master Bioethics: Well, Your Honor, we decided that there would be
three ethical principles -- we just combined bits and pieces of those
ethical theories used by Kant and Mill, mixed them around a bit, and came up
with "autonomy", "justice" and "beneficence" -- otherwise known as
"principlism" or the Georgetown mantra". These three ethical principles are
very democratic. They are prima facie -- no one principle can
outweigh either of the others![34]
Prof. Philos: But if each of these ethical principles are prima
facie, Master Bioethics, then what happens when one of these principles
comes into conflict with either of the other two principles? For
example, how to we consistently respect the "autonomous" demands for
medical treatment of a patient, while at the same time respect the medical
expertise of the physician who needs to "do good" for his or her patient (or
at least "do no harm"), and the "just" cost of the patient's medical
treatment to society -- all at the same time? It is impossible. Isn't that
why many of your own Founders have recently admitted that after 25 years of
application these bioethics principles simply don't work in the real
world?[35]
Master Bioethics: Well, we keep trying.
Prof. Philos: What I am most curious to know, Master Bioethics, is
precisely how you are defining "autonomy", "justice" and
"beneficence" in your Belmont Report? You know how fussy we
philosophers are about "definitions"! In my reading of The Belmont Report,
those terms have rather "strange" definitions -- and therefore, of course,
could lead to "strange" ethical conclusions.
Master Bioethics: There is nothing strange about them. We all
agreed that "autonomy" should be defined as "absolute choice by human beings
who are actively exercising their rationality". Why most bioethicists so
define "autonomy" -- e.g., Peter Singer, the founder and first president of
the International Bioethics Institute himself!
Prof. Philos: But wouldn't that mean that non-autonomous
human beings who are not capable of actively exercising their
rationality -- e.g., even adult human beings who are mentally ill, the
mentally retarded, the emotionally ill and depressed, alcoholics and drug
addicts, the physically disabled, the comatose, etc. -- are not persons?[36]
This, again, creates two subclasses of humanity -- one composed of human
beings, and the other composed of human persons -- and we've
already been there before! And how can you theoretically defend the
mixing and blending together of the ethical theories of two totally opposite
philosophers?[37]
Wouldn't that be self-contradictory? That doesn't seem very "rational" to
me.
Master Bioethics: Indeed, you are correct, Prof. Philos. I can see
you like to "push the logic"! Not to ignore your questions, but to continue,
"justice" is defined as "fairness" -- as in John Rawls' Theory of Justice.
Of course, "fairness" is then defined as "the fair distribution of the risks
and benefits of participation in purely experimental research for the
greater good of society" -- which participation is, as we stated in our
Belmont Report, a strong moral obligation and duty for every citizen in
society. And "beneficence" is defined, of course, mostly in terms of that
"greater good" -- you know, the "common good".
Prof. Philos: Those are unique definitions, for sure. But tell me,
Master Bioethics, by what process did you eleven selected committee members
arrive at such enlightening definitions of what is "ethical"?
Master Bioethics: By consensus, of course -- just as with our
"scientific definitions". We want to be strictly democratic. Our "bioethics"
and "science" is now used exclusively by literally thousands of bioethics
experts around the world.
Perplexed Parliamentarian: I am curious, Master Bioethics. Just
what makes one an "expert" in bioethics?
Prof. Philos: I can answer that question, Mr. Parliamentarian.
Only a handful of "professional" bioethics experts have academic degrees in
the discipline, and even for those few who do, there is no uniform or
standardized curriculum. Most professors of bioethics don't know the
historical or the philosophical roots of the subject matter they teach; the
courses vary from institution to institution; there are no local, state, or
national boards of examination; and there are no real professional
standards. There is not even a professional code of ethics for
bioethicists.[38]
Jaded Judge: Master Bioethics, I am worried now. It puts me in
mind of an old legal colleague of mine who was a legal consultant for the
National Commission. He remarked to me one day that he was fearful for the
future: "What one fears", he said, "is that the [National] Commission may
become the mechanism whereby the speculations of the ethicists become the
law of the land. It is already far too easy for abstract notions of right
and wrong to emerge as deontological rules which begin their public life as
'guidelines' but culminate in the force of law."[39]
Perplexed Parliamentarian: The more I think about bioethics,
Master Bioethics, the more perplexed I get. I seem to recall too that even
many of your Founders lately have expressed deep concern about this
bioethics theory -- one of them even went so far as to refer to it as an
"ailing patient" whose "diagnosis is serious, if not terminal".[40]
Well, aside from these minor problems, what are some of the ethical
conclusions that bioethicists come to concerning today's urgent bioethics
issues?
Master Bioethics: Yes, well ...... we have made great progress
over these last 35 years. For example, by deducing from our ethical
principles we would conclude that the following are "ethical": designer
babies; prenatal diagnosis with the intent to abort defective babies; human
embryo and human fetal research; abortion; human cloning; the formation of
human chimeras (cross-breeding and "back-breeding" with other human and
animal species); human embryonic stem cell research; "brain birth; purely
experimental high risk research with the mentally ill; euthanasia;
physician-assisted suicide; living wills documenting consent to just about
anything; and, withholding and withdrawing food and hydration as
extraordinary means.[41]
We are quite certain about these ethical conclusions.
Prof. Philos: In contrast, I would suggest a very different
ethics, one that has withstood the test of centuries, and is grounded in our
empirical experience of human nature, our common natural and supernatural
goals, and which goods we all hold in common (a different
definition of "the common good") by virtue of that common human nature.
It would come to quite different ethical conclusions. I am referring
to philosophical natural law ethics. In fact, that ethics would conclude
that all of those actions are unethical, because they would
lead to serious harm to people, and impede them from ever reaching their
common goals as human beings. You see, different scientific
definitions of "a human being" and when a human being begins to exist lead
necessarily to different philosophical "anthropologies". Different
anthropologies lead necessarily to different philosophical "ethics"
-- and therefore to different ethical conclusions.[42]
Mr. Chairman: Well, this is all much too deep for me. We have a
practical job to complete here tonight -- to decide on the
legislative language to be used in these proposed bills on human cloning
and human embryonic stem cell research. I want some solid suggestions now.
Dr. "Science": I would suggest that we make this bill a "ban" on
all human cloning using the somatic cell nuclear transfer (SCNT) technique.
That technique, as you know, would produce a human clone with the exact
genetic information as is in the donor cell.
Dr. Human Embryology: Objection, Mr. Chairman. A human being
cloned using the SCNT cloning technique would not be an "exact
genetic copy of the donor cell". The mitochondrial DNA of the donor cell is
not transferred, and the mitochondrial DNA of the recipient cell is
retained in the product. If you so scientifically mis-define the SCNT
human cloning technique itself, then the bill will not apply to the
real SCNT technique at all -- isn't that correct, Your Honor?
Jaded Judge: As a matter of fact, that is the case. The bill would
only apply to those activities that are specifically articulated
in the language of the bill.
Dr. Human Embryology: And what about all of the other
cloning techniques that can and could be used to clone human beings? Why
aren't they specifically articulated in the bill, Dr. "Science"?
Master Bioethics: There are no other cloning techniques. What are
you talking about?
Dr. Human Embryology: Come now, there are quite a number of other
kinds of cloning techniques. For example, there are cloning techniques such
as: germ line cell nuclear transfer;[43]
"twinning" (blastomere separation and blastocyst splitting)[44]
-- which is the most genetically exact kind of cloning technique;[45]
the formation of chimeras (now by using pronuclei, or back-breeding to new
human embryos); and many other kinds of "de-methylation" experimental
techniques. As the Jaded Judge explained, if these cloning techniques
are not included in the language of the bill, then they too will not
be banned. In fact, a bill with such erroneous science and linguistic
loopholes would effectively ban no human cloning at
all.[46]
Perplexed Parliamentarian: But let's be practical, Dr. Human
Embryology. First we need to get some bill passed, and then later we
can come back and refine it. What difference does it make, as long as we can
at least limit the evil bill proposed by some of the other
Parliamentarians?
Jaded Judge: It makes a big difference, Perplexed Parliamentarian.
Once this erroneous science gets passed into law, it is simply reduced to
stare decisis -- legal precedent.[47]
The Courts would then only have a legal duty to apply this erroneous
science to any and all further related legislation. These scientific flaws
may never be revisited for correction.
Prof. Philos: And I wonder, Perplexed Parliamentarian, can any
and all "means" be used to reduce or limit the evil in some other bill,
or only morally licit means? Does knowingly using this false science
and these linguistic loopholes in this bill constitute morally licit
means or not? This bill would legally guarantee that any and all
human cloning techniques would be legally protected. These "means" would
ensure that untold numbers of innocent living human beings would be able to
be cloned and used in destructive experimental research. How can that be
"ethically" or "legally" acceptable?
Mr. Chairman: Well, I think we have debated these issues long
enough. It is time to roll up our sleeves now and actually write this bill
so that it can be submitted to the full Parliament tomorrow. Let's unlock
the doors, take a short break, and come back here to go to work in exactly 5
minutes.
Narrator: The weary and bedraggled committee members slowly begin
to collect their piles of papers, stuff them in their briefcases, and singly
file out of the dark meeting room into the corridor, the various points of
their heated discussions weighing heavily on them. The silence is deadening.
Five minutes later, the Chairman wanders back through the doors, relocks
them, and shuffles over to the head of the long committee table. He looks up
to discover that the meeting room is quite empty! Everyone else has simply
disappeared, except for Well-Formed Conscience, who is now patiently sitting
across the table. The Chairman's eyes begin to get a little twinkle in them.
Mr. Chairman: "Well, it's about time you got here, Well-Formed
Conscience! It's late -- let's get to work!"