A retreat from reason? The Catholic church and scientific progress.

THE 19TH CENTURY WAS DOMINATED BY THE discoveries of chemistry from dyes to dynamite; the 20th century by physics, from computer chips to nuclear weapons; and the 21st century looks as if it will be dominated by biological discoveries from the repair of failing organs to bioterrorism. The current age of explosive scientific progress throws up new and challenging ethical problems on an almost daily basis.

The key discoveries in the greatest immediate need of an ethical framework relate to cloning, stem cell research and the manipulation of very early pregnancy. They require respectful dialogue to resolve seemingly intractable differences in outlook--especially between different moral traditions.

As an obstetrician working to help people manage their fertility, I have had to confront the scientific, policy and practical issues related to early pregnancy, safe abortion and setting up large-scale family planning programs in resource poor countries. From my standpoint, the hierarchy of the Catholic church has had more to say about these issues than any other recognizable grouping. And, while Catholic teaching has valid, important and creative contributions to make to reproductive ethics, the essence of resolving differences--negotiation and give and take--appears to be absent from the positions that the pope and his bishops currently take. But it was not always so.

NATURAL LAW

The essence of natural law is to confront new facts, criticize emerging theories and keep the ethical tension wound up. There is a compelling theological tradition that transcendental and empirical thinkers actually start at the same place. The late Fr. Bernard Haring, whose teachings were praised by Pope John XXIII and which helped open the door to Vatican II, illuminated the nexus between biology and theology when he wrote, "the moment of ensoulment, or the moment of `conception' in the fullest sense as the beginning of the human person, does not belong to the data of revelation." (1)

It is an insight that goes back to St. Alphonsus Liguori, (2) who taught that in cases of doubt the fact must be proved and may not be presumed. Even St. Augustine, from his often harsh and weakly nuanced Vantage point, agreed, "The great question about the soul [in relation to the embryo] is not hastily decided by unargued and rash judgments." (3) Daniel Callahan, the Catholic ethicist, gave a 20th century gloss to this ancient tradition when he wrote, "To say, for instance, that God forbids the taking of `innocent' life while conceding--as I think we must--that it is left up to a man to define what an innocent life is, is to fail to see that the only possible meaning this rule can have is the meaning human beings choose to give it.... To place the solution to these problems in the hands of God is to misjudge God's role and misuse human reason and freedom." (4)

The tragedy of the present situation is that Vatican politics, not theological thinking, prevent a much-needed input that would be welcomed by Catholics and non-Catholics alike. As a consequence, human reason and freedom, indeed, are being misused.

LOUISE BROWN

At Cambridge, I worked on studies that involved very early embryos, including observations on stem cells. At the time, my friend Bob Edwards in the next building was pioneering work on in vitro fertilization (IVF). Usually, IVF is used to merely bypass a pathological block in the mother's Fallopian tubes. In the case of Louise Brown, that first IVF baby, her parents benefited and Louise is now a healthy, mature young woman. Pope John Paul I, who sadly died a few months later, welcomed Louise's birth with the words, "I send the most heartfelt congratulations to the English baby girl whose conception was produced artificially." (5)

Indeed, rigorous ethical scrutiny is constantly needed in the case of the other applications of IVF, such as using donor eggs or sperm or implanting the embryo into a surrogate mother. But since Pope John Paul I, the Vatican has foreclosed useful dialogue in this area. In Instructions on Respect for Human Life in Its Origin and on the Dignity of Procreation, the Congregation for the Doctrine of the Faith calls loving parents who seek IVF victims of a "dynamic violence and domination." (6)

HUMAN CLONING

As a one-time laboratory scientist, I would know in some detail how to set about cloning another person. I do not think such a process is just around the corner, but I can find it useful to play the thought experiment: Would we clone another human being?

The Vatican regards cloning as wicked, dangerous, frightening, Boys from Brazil stuff, with the potential to fill the world with Adolf Hitlers. But it is superficial and unhelpful to arbitrarily claim that cloning is intrinsically wrong. It is surely more useful to apply a different sort of test to ethical questions related to such things as cloning and in vitro fertilization (IVF): not "Is it wrong?" but "Who would it benefit?" Would the application of this technology make anyone's life less painful, more fulfilling, longer or happier?

IVF clearly passes the test of benefiting others. Cloning is not so clear-cut an issue. It is difficult to see why a woman would suffer the burdens and dangers of pregnancy, except for money or if she were coerced. There would be possible dangers. Possibly some wealthy, egocentric man might want to see himself cloned and sooner or later, somewhere or other, somebody is going to get a lot of attention by artificially cloning another human being--as the Raelians did at the end of 2002 in an as-yet unproven case. I think it would be an unwise thing to do, but even in a world that adds 1 million more births than deaths every 110 hours, the number of people with the motivation and wealth to clone themselves will be infinitesimal and hardly a threat to humankind. Anyhow, there are already millions of clones alive--we have all met identical twins.

It is humbling to remember that strawberry plants and ants clone themselves every day. Nevertheless, the ability to clone another mammal reminds us of the awesome complexity of biology. Every cell in all plants and animals contains all the genetic information to make an identical copy of the adult. Dolly the sheep was made by removing the nucleus from a sheep egg and replacing it with a nucleus from a cell taken from an adult sheep. The genetic information in the adult cell then drove the development of a clone of that adult. Technically cloning a mammal is difficult, many clones fail. And Dolly died prematurely for reasons that still need to be understood.

STEM CELL TECHNOLOGY

Stem cell technology is very different from cloning and clearly passes the test of benefiting others. In the first few days after fertilization, the dividing egg sets aside cells that will form the placenta and multi- (or pluripotent) cells that will form the embryo. These stem cells can be grown in tissue culture and will mature into a variety of tissues. In the short term, the potential of stem cells has probably been oversold, but in the longer term it is considerable. An article in Science has suggested that 128 million Americans have diseases that might benefit from stem cell research in the coming decades. (7) In Sweden, some people with Parkinson's disease have had their symptoms alleviated for long periods after cells were implanted from aborted embryos. (8) Stem cells cultured outside the body have been induced to produce small amounts of insulin, and eventually they may provide a genuine cure for diabetes--a disease affecting 16 million Americans.

Ultimately, stem cell research to benefit humans will have to be done with human stem cells. In vitro fertilization is a costly process and it is common to fertilize several eggs at the same time, all of which may not be replaced in the woman's uterus. The contemporary debate revolves around the ethics of using such early human embryos as a source of stem cells.

If, as theologians and ethicists of stature argue, it is up to "human reason and freedom" to decide the ethical status of the early embryo, then where do we go next? Embryological development is a process of continuous change. There are no unambiguous milestones, when we can say, "now the embryo has the status of a human being." We face a similar challenge, although perhaps less emotionally charged, related to life after birth. A law about when an individual can vote, or can be compelled to risk their life defending their country, is necessarily arbitrary. We can be certain it should not be as young as age two, or as late as age 65, but whether it is 18 or 21 or 25 is a matter of judgment. Similarly, we can distinguish between four-day-old blastocysts and a seven-month-old fetus, but exactly when we ascribe the status of a human being in that continuum is a matter for human judgment.

That judgment can be informed by--but not necessarily determined by--scientific observations. In both biology and ethics it is useful to treasure exceptions. Not all naturally fertilized eggs give rise to embryos. Some become molar pregnancies when only the afterbirth is present. Not all naturally arising embryo-like structures are the result of sexual intercourse, as in the case of teratomas--a type of tumor. A large percentage of fertilized ova are discarded from the woman's uterus before she even recognizes she has been pregnant. In the most closely studied series, only 42% of fertilized eggs survive to the 12th day of pregnancy. Some of the naturally discarded fertilized eggs are defective, and would otherwise have given rise to tragically abnormal children; but the majority of these are perfectly normal embryos. This study was done by Dr. John Rock of Boston, who also helped develop the oral contraceptive pill. He was devout Catholic who went to Mass every morning before he went to work.

Experts and consultants at the Vatican cannot reach consensus on whether it is permissible to remove an embryo when the fertilized egg implants in the Fallopian tube or abdominal cavity of a woman. While refusing to recognize any permissibility for a direct abortion, differences of opinion still exist when an abortion, though not directly intended, occurs. The Vatican has chosen so far not to issue any statement directly opposing surgical procedures designed to save the life of a pregnant woman facing a life-threatening ectopic pregnancy, when medical intervention has the secondary effect of prematurely ending the pregnancy. It follows that ultimately everybody (including the Congregation of the Doctrine of the Faith) agree that in certain circumstances the life of the embryo may be terminated, showing that conservative and liberal interpretations of early embryonic life are divided by statistics, not by moral absolutes.

VATICAN INTRANSIGENCE 

A framework of scientific evidence can help in the judgments we are forced to make as scientific horizons expand, but sincere people are still likely to differ in their conclusions in such complex and difficult areas. The only sure thing is that everyone is likely to benefit from articulating their reasons and submitting them to debate. It is at precisely this point, where judgments need to be refined and cross-checked in as many ways as possible, that the Vatican chokes off its own voice.

The assertions of Pope Paul in Humanae Vitae (1968)--and the numerous comments of Pope John Paul II on more recent advances in reproductive science--are so deeply rooted in an obscurantist medieval tradition and so systematically exclude the expanding observations of science, that creative and needed dialogue is simply impossible. This deep and persistent hostility to women is clearly not a reflection of the Christian tradition, but is a crude expression of a male desire to control female reproduction and secure incontestable proof of paternity. The current pope and the cardinals he has appointed behave more like male elephant seals, fighting and goring those they see as rivals, than as loving shepherds of a flock seeking ethical guidance.

That judgment may seem unreasonably harsh, but comes from real life experiences. In the 1980s I had the privilege to be the only non-Catholic in a meeting of six leading Catholic theologians, five Catholic gynecologists and myself at a retreat in Maryland. The meeting was put together by the late Father Francis Xavier Murphy, the Patristic historian and distinguished theologian who died in 2002. I found common ground could arise between thoughtful people coming from seemingly different starting points. However, the success of the meeting depended on everybody agreeing that it would never be published. Had it been otherwise, the theologians involved would either have held back expressing their most sincere thoughts or have risked disciplinary action and possibly excommunication. It was a small meeting well over two decades ago, but what could be sadder than Vatican politics forcing a discussion of fundamental ethical questions to be held in secret? Human reason flourishes in an environment of freedom and transparency in the honest exchange of ideas. Later, I attended a larger meeting organized by Dr. Guiseppe Benagiano in Italy on The Meaning of Sexual Intercourse. The last paper was by Archbishop Carlo Caffarra, director of the John Paul II Institute for Studies on Marriage and Family. He had not attended the creative discussions that had taken place earlier, but he gave one of the cleverest speeches I ever heard. For half an hour he strung together nouns, verbs and adjectives in such a way as to ensure that at no point did he confront a single one of the challenging topics discussed at the meeting but still sounded extremely erudite.

More recently, my wife was deeply involved in four days of closed-door negotiations in Bangkok, in the once-a-decade UN Asia and Pacific Population Conference, where the Bush administration initiated wasteful diplomatic discussions. The US contrived to enter this regional meeting as the owner of Guam, and then, using Vatican language to promote "natural" family planning and other limitations on reproductive health services, tried to discredit and weaken the 1994 International Conference on Population and Development consensus on reproductive health and family planning. John Klink, who has represented the Vatican at UN conferences, advised the US delegation in this horrendous hijacking of a meeting that would otherwise have been productive. In the end, the US was voted down by every Asian and Pacific nation, but only after political grandstanding, rather than ethically based thinking, had wasted everyone's time and energy. It was the polar opposite of the role the Catholic church should be playing.

UNDERMINING WISE JUDGMENT

Whether we are dealing with cerebrate diplomats who deliberately obfuscate key issues or with anti-science Luddites, the outcome is the same--wise judgment is undermined. For example, influenced by the Vatican line, President George W. Bush came up with the silly ruling that stem cells already obtained could be used for research, but new lines could not be taken from human embryos. All the Bush decision does is to prevent National Institutes of Health, the most influential funder of medical research, from playing a responsible role in an important new area of research. The lack of intellectual integrity that this type of thinking displays ends up opening the door to new abuses against science and health. More recently, the Bush administration has been removing evidence-based data on the role of condoms in slowing HIV/AIDS from the Centers for Disease Control website (see page 23).

As a non-Catholic, I value my friendships and my ability to exchange ideas with friends who are Catholic theologians and lay people, who I believe represent the true tradition of the Catholic church. The ethical problems that scientific research throws up are not going to go away. There are no absolutes in biology, and few absolute rules other than a vast overproduction of gametes (in animals, eggs and sperm) and a good many errors during reproduction. Sincere and informed people are going to continue to end up recommending different policies, and in a pluralistic society contradictory practices are going to exist side by side.

In the case of the controversy over abortion and stem cell research, it is important to recall that philosophically the US Supreme Court had to confront the same basic conundrum that engaged Augustine, Liguori and Haring. The majority in Roe v. Wade wrote,

We need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary at this point in the development of man's knowledge, is not in a position to speculate as to the answer. (9)

The debate is not, as it is so often framed, about women's rights, nor embryonic rights, but about that fundamental underpinning of US life--religious toleration. We must accept that others have beliefs that are not our own, and respect them for their differences, and not force our own beliefs upon them. The Vatican, too, needs to learn how to do this.

If society is to move forward, then individuals making hard decisions about their own lives, or those of us who work to help them make those decisions, have an obligation to submit our ideas to inspection by others, with the understanding that one may always be wrong. It is sad that the Vatican has cut itself off from this essential dialogue, which might be more enriching with the involvement of some truly catholic minds from the Vatican.

NOTES

(1) Bernard Haring, "A Theological Evaluation," in John T. Noonan, The Morality of Abortion, Legal and Historical Perspectives, Harvard University Press, 1970, p129.

(2) St. Alphonsus Liguori, Theologia Morali, 1753.

(3) Corpus Scriptorum Ecclesiasticorum Latinorum, Vienna 1866-.

(4) Daniel Callahan, Abortion: Law, Choice and Morality, Macmillan, 1970. (Emphasis in the original.)

(5) Jonathan Kwitny, Man of the Century; The Life and Times of Pope John Paul II, Henry Holt and Company, 1997. Quoted in Garry Wills, Papal Sin, Doubleday, 2000, P97.

(6) Congregation of the Doctrine of the Faith, Instructions on Respect for Human Life in Its Origin and on the Dignity of Procreation (Donum Vitae), 1987. Quoted in Wills, 2000, p224.

(7) Daniel Perry, "Patients' voices; the powerful sound in the stem cell debate," Science, Vol. 287: p1423.

(8) Marcia Barinaga, "Fetal neuron grafts pave way for stem cell therapies," Science, Vol. 287, pp1421-1422. The Swedish scientist is Anders Bjorklund.

(9) United States Supreme Court, Roe v. Wade, 410 US 113, January 22, 1973.

PROFESSOR MALCOLM POTTS is the Bixby Professor of Maternal & Child Health in the School of Public Health at the University of California in Berkeley.