Worcester, Mass., my hometown, has once again become the center of bioethical debate. The Worcester Foundation for Experimental Biology gave us the oral contraceptive that helped spawn the sexual revolution; now Advanced Cell Technology (ACT), under the leadership of its chief executive, Michael West, has continued the tradition. On Nov. 23 of last year, ACT, a private research corporation, announced that it had cloned 24 cows that are healthya critical announcement because of concerns about the long-term health status of cloned animals.
Then on Nov. 25, ACT made two even more dramatic announcements: first, that it had activated 22 human eggs through a chemical process, thus generating a parthenogenic organism; second, that it used 19 eggs to generate cloned human embryos. The purpose of both procedures is to obtain stem cells that will be used for therapeutic purposes in the individual from whom the nucleus or genetic information came. Either one of these announcements by itself would constitute major news, but both coming together, particularly after the news of the cloned cows, constitutes a scientific and ethical blockbuster of the first order.
My general concern over the past decades has been to apply the traditional wisdom of the Scholastic philosophers of the Middle Ages, who argued that there should be some congruence among the disciplines of science, philosophy and theology. Our knowledge of biology has clearly corrected many of their formulations, but their instincts about the coherence of knowledge remains correct. Thus I have attempted to combine the biological knowledge that the early human embryo is not individualized until about two weeks or so into its developmental process with philosophical insights about individualization derived from the Scholastic philosopher and theologian John Duns Scotus (1265-1308). Then I argue that until the process of restriction is completedthat is to say, the commitment of the various cells of the early embryo to becoming particular body partsthe blastocyst is not an individual. The cells of this early embryo are totipotent (able to become any cell in the body); and if divided, either through twinning or embryo division, each part can become a whole organism. The organism can be divided so that each part can become a whole.
Because individuality is a necessary but not sufficient element of personhood, the early embryo is not a person. This organism is living, has the human genome and clearly shares in what we understand the human species to be. But the lack of individuality is a critical lack of one of the many elements that go into personhood.
One moral conclusion of relevance to these latest developments is that this position is open to the extraction of embryonic stem cells from this organism for use in research. Even though that process destroys the embryo, this is not murder, because there is no individual moral agent who can be the subject of this act. The act is a premoral disvalue that can be justified in principle by the offsetting moral value of health and cure of disease.
This is not an advocacy argument for such research; it is rather an argument that such research can in principle be justified. This is not, of course, the position of the U.S. Catholic bishops or of most in the pro-life community. I am not attempting in this article to prove my case; I have made that argument elsewhere. The purpose of this article is to show that even someone like myself, who argues that the early embryo is not a person, can still have serious reservations about human cloning.
So now we have two new procedures to think about: parthenogenesis and human cloning. Mammalian cloning burst onto the screen in 1997 with the birth of Dolly, the cloned sheep. The immediate fear from the Dolly success, of course, was that this technology would eventually be applied to humans. Almost all the scientists involved with cloning technologies said that they were not interested in human cloning, nor would they participate in it. Initially human cloning referred to reproductive cloningthat is, cloning to allow an infertile couple to have a child.
Now we are hearing of what is called therapeutic cloning, the cloning of a human genetic embryonic twin in order that stem cells may be extracted from this embryo to generate cells to treat a disease afflicting the donor of the nucleus. The difference in the two procedures is that, unlike reproductive cloning, an embryo cloned for so-called therapeutic purposes will not develop beyond the blastocyst stage, but will be destroyed in the process of removing its stem cells.
If in principle I have argued that such an organism is not individualized and is not a person, can I then consistently argue that therapeutic cloning should be prohibited? In principle, no, because I do not think research to establish cloning either for reproductive or medical purposes violates the rights of a human person. In practice, yes, because of all the problems currently associated with therapeutic cloning.
I begin with some general comments. First, a word about nomenclature. I would prefer medical cloning to the term therapeutic cloning. The process of cloning is not in itself therapeutic and it is certainly not therapeutic for the clone, because its stem cells will be extracted and that process will destroy it. The cloning is not done to benefit the clone but to benefit the donor.
Second, perfecting the technology of scientific or medical cloning is implicitly to perfect the technology and increase the likelihood of its being used in fertility clinics. When all other methods have failed, there will now be one other method left to trycloning. And since these clinics are loosely regulated and are essentially private, there may be fewer restrictions on attempts to reproduce through cloning.
Third, no federal money can be used to try to clone a human being, and the U.S. House of Representatives has passed a bill prohibiting such cloning. But are these restrictions only on reproductive cloning, or do they include scientific or medical cloning? Is cloning simply cloning, or is the distinction between the two applications validand can legislation reflect this distinction?
These problems, however, are only the tip of the iceberg. The real challenge here is drawing up ethical standards for human cloning, given the presupposition that the early embryo is a not a person. In short, is it ethical to clone a blastocyst for medical purposes?
Let me first propose a few possible analogies to help set up the ethical problems. One analogy to this predicament might be the practice of using in vitro fertilization in combination with pre-implantation genetic diagnosis in order to produce a child who will be a guaranteed blood donor for a sibling suffering from a fatal disease. Blood can be taken from the umbilical cord and used for the therapy, so the procedure is risk-free.
I have argued that this is producing a child explicitly as a means to an end and should not be done. What I find morally problematic is the generating of a child for a particular purposein fact, custom-designing a child to ensure that he or she will be a match for the purpose of donation. The difference between this process and medical cloning is that the blastocyst is, from my perspective, not a person, nor was it ever intended to be.
Another analogy might be the following traditional cloning scenario: I need a new kidney, so I generate a clone, and when the kidney is of sufficient size, I take it. In addition to the fact that I might be dead before the clone can be gestated and the kidney matures to the proper stage, I would have to take the organ from a person. A strong assumption of this position seems to be that since it is a clone, I could do with it as I want. But this ignores the fact that the grown clone is a person and has rights, one of which would be bodily integrity. Again, and by contrast, in the medical cloning scenario, the cells are not taken from an individual, much less from a person.
A third analogy might be the case in which I give my blood to be used for transfusions during surgery performed on me. The difference here is that none of the components of the blood taken for donation are the equivalent of the blastocyst. Additionally, blood is a renewable product of the body, and some blood loss is insignificant. Yet this case does show that we can use some of our own body parts to benefit ourselves. One might think of one’s genetic information as a body part, but the problem here is that this body part needs to be combined with an enucleated donor egg and then stimulated to become more than genetic information. Thus these three analogies lack a critical component that might make them useful in this analysis.
What seems to be of moral significance is the explicit generation of the essence of human nature (though not, by my definition, a person) to cure the donor of the nucleus, the source of the genetic information. Within my philosophical perspective, as I have indicated, what we would be generating at this point would be a human nature. We would not yet have a person, though we would indeed have the biological substrate that is a necessary but not sufficient ground for a person. I do not think that abandoning my philosophical perspective is warranted, but I am morally uncomfortable with these developments. We are proceeding very rapidly into uncharted waters, and caution and public scrutiny are warranted.
Let me offer several sets of arguments herefirst, on the question of the moral standing of the embryo. I developed my position about the early embryo as an attempt to integrate modern embryology and ethics. I did not do it to justify a particular research protocol. Second, I see no reason to revise my ethical understanding of the embryo in the light of new scientific discoveries. The position stands or falls on its merits, not on its potential applications. Third, the fact that my understanding of the moral status of the embryo could be used to justify research protocols including obtaining stem cells from frozen, donated embryos and medical cloning does not in itself constitute a mandate to conduct such research. That is a separate issue and needs much more ethical evaluation.
A second set of arguments has to do with the research itself. In that research, many embryos were cloned, but they all died, and they died before stem cells could be produced. The eggs chemically stimulated to divide all died before a single cell division. Can such experiments be called successful, or at least successful enough for publication? While this is mainly a question for the scientific experts to determineseveral have said the research was not successfulthe results do show that cloning is at best a very inexact science and that there are many problems and unknown elements involved in it. Even if the goal of this research is the production not of a human being but of stem cells, much caution is needed as the experiments are developed, particularly since cells from such embryos will be implanted in humans. The conclusion here may be simply that we are really at too early a stage of the research to draw any meaningful ethical inferences.
A third set of concerns has to do with public policy issues. First, should we continue to practice high-tech rescue medicine, or should we begin thinking about allocating money to other preventative health care needs? Should our model of medicine continue to be what it has been for several decades, or should we begin to rethink that model in terms of prevention? Second, how do we set priorities for research? We obviously cannot fund all possible research proposals. The current method of allocating resources according to which proposal has the best spokesperson or lobbying group is no longer viable. Third, also in terms of public policy, will ACT, by going so far so fast, generate so much negative publicity that restrictive legislation will be enacted that will halt all research? This would not be helpful for the biotech community in general, but it might occur. In fact, the ACT research has already drawn negative comments from President Bush and members of Congress. Fourth, those two announcements last November may create unrealistic expectations on the part of the ill. Those announcements, scientifically interesting as they may have been, report only a few experiments and are only early steps in a very lengthy process of developing a therapy. A cure for diabetes or Parkinson’s disease is not around the corner.
I conclude that although my positionthat the early embryo is not a personwould in principle permit research for medical cloning, such research is premature at this time for the reasons suggested above. This is an area of research that is going off in a very particular direction and includes many presuppositions about health and health policy, just as embryonic stem cell therapy does. Also, the method itself is not yet perfected. While the moral standing of the blastocyst is surely an important consideration in the ethical evaluation of this research, it is by no means the only criterion to be applied in the ethical analysis of this research.
The issue is further complicated by the question of parthenogenesisconception without fertilization. We have known since Dolly that mammalian life can begin without fertilization. That is mind-bending enough. But now we have the case of a human egg that has been chemically stimulated into dividing: no cloning, no new genetic information from the donor nucleusjust an egg that begins to divide. Depending on what happens within this egg, we may have some new questions about human origins to consider. What do we call this organism? Since the egg has but 23 chromosomes, and it takes 46 to make a human being, what do we have here? Could such an organism develop beyond more than a few cell divisions?
This process of parthenogenic cell division really stretches the categories, if it does not in fact break them down entirely. If this organism has only 23 chromosomes and can therefore be said not to present the case of a human genome, then its use would not create a problem associated with the moral category of personhood. This may be a safer way to go morally and is in fact why that research initiative was undertaken. But without the presence of a Y chromosome, will therapies based on cells from a partheongenically generated organism be applicable to males, or will such research be useful for women only? Given that most research has been predicated upon male physiology, many might argue that turnabout is only fair play! But the critical issue here is how to think of such an organism, if in fact it has 23 chromosomes but is dividing and developing. This demands much more thought and research.
Research using human embryonic material is proceeding faster than anyone would have predicted even two years ago. It is proceeding so fast, in fact, that we do not have time to comprehend the implications. And it is proceeding so fast that the expectations it generates might in fact prevent a careful analysis of those implications. This in itself is an argument for some sort of public oversight of all research involving human genetic material.
ACT, as noted above, is a private corporation, whose research, including the recruitment of women willing to sell their eggs, is subsidized by private funds. Thus it is independent of all public scrutiny. But I do not think we can any longer afford in this area the luxury of such a legislative divide between public and private funding. Granted that secrecy is important for competitive reasons, and granted that many of these companies, including ACT, have their own ethics committees, nonetheless modest oversight of such research will not end it.
The oldest question in bioethics is: should we do everything that we can do? This may be an instance where we are moving too fast and are unable to comprehend the implications of the research. And that may suggest extreme caution or even a moratorium similar to the one on the technology of recombinant DNA until its safety could be established. This research is being done in the name of health and curing disease, and who could be against that?
But we do know that research comes at a price, and we may be approaching a situation in which we can estimate the price of everythingincluding human healthbut ignore the values that may be compromised to pay that price.
