Father Kevin FitzGerald, S.J. is a geneticist clearly inspired by the complex beauty of his vocation."Early on in development, you have very rapid cellular growth," FitzGerald says, leaning forward eagerly in his office chair, his impromptu lecture punctuated with handwaving air diagrams of major points."The cells are dividing a lot. The embryo is expanding rapidly, and cells take on the specific tasks that they're going to have: kidney cells, liver cells, lung cells.
"Cancer is sort of like development gone awry.... The regulation that goes on in causing that cell to do a specific task is partially lost, and the cell reverts back to an earlier stage when it's just growing rapidly. The problem now is there is no control of its growth."
FitzGerald's discourse is interrupted by a phone call from his lab. On the other side of this building at the Loyola Medical Center in Maywood, Illinois, a few of FitzGerald's students are hard at it, decoding the biological messages unveiled by strips of human DNA. FitzGerald and his team are on the trail of MLL, the Mixed Lineage Leukemia gene, a particularly troublesome member of the human gene pool. When MLL is "translocated" on a chromosome--that is, somehow let loose from its normal position and relocated some place where it shouldn't be found on a chromosome--it triggers the beginning of deadly forms of leukemia.
FitzGerald's work will, at the minimum, lead to better diagnostic techniques for the cancers MLL causes, but he hopes it will one day lead to treatment of the cancer itself--perhaps even therapy that includes a preemptive strike on MLL, a fix at the genetic level in the cells themselves.
The work in FitzGerald's lab and in thousands like it across the country represent a new frontier in biomedical research, a frontier not beyond, but within, humankind. If FitzGerald's efforts to devise a therapy for a particularly cruel cancer can be seen as one end of the spectrum of that research, at the other end are projects that could lead to the creation of human clones suitable for organ harvesting or genetic ego gratification or the capacity to perfect offspring according to a genetic palette of mental and physical capabilities.
On a February day in 1953--a day that may come to resemble the first moon landing or a wayward Columbus' first steps on a Caribbean beach in terms of its impact on human history--Englishman Francis Crick and American James Watson worked out the twisted staircase design of deoxyribonucleic acid: DNA. They believed then that they had unraveled the secret of life, but in truth the two researchers had only begun a process of discovery that has led to a converging group of biotechnological projects that will likely pose the most profound moral challenges of the next century.
For example, the $15 billion Human Genome Project (HGP), an epic, multi-year effort to identify the 100,000 genes in the human body, is cracking the code that is the very stuff of humanity and in so doing, raising new hopes and expectations for the treatment of some of our most debilitating illnesses at the same time it raises profound challenges to what "natural" reproduction might look like in the future.
The moral and even political implications of the new biotechnologies can get a little mind-boggling. For instance, genetically re-engineering "designer babies" according to "desirable" traits will likely be a costly procedure--particularly if it is legally prohibited--perhaps only affordable for the most wealthy and most powerful among us. It is foreseeable that some will pursue such technology despite its cost or legality, intent on providing all possible advantages--genetic or otherwise--to offspring. Will future generations of "naturals" then be lorded over by a genetically enhanced master class?
Part of David Byers' job at the National Conference of Catholic Bishops' Science and Human Values Committee is to respond to such difficult questions. Byers emphasizes that the church is not somehow the enemy of science in responding to the moral issues raised by biomedical research. In fact, he argues, the church has been in the forefront of health care "ever since Jesus began curing people."
But it's clear that some of the church's other, perhaps most basic interests--to protect human dignity and promote human solidarity--are being threatened by some research. In the era of petri-dished, microsurgery miracles, the church's concept of human dignity and its protection of human life must arguably be extended to life before conception--not only to the "pre-embryonic" and quasi-embryonic matter that scientists use as raw material for research but also to couples discouraged from having children because their genetic profiles are considered "poor risks."
"The scientific community is geared to get results, the bishops to raise questions," says Byers. "We're not holding up a red light to the medical community; what we're doing is holding up a yellow light and asking the scientific community, `Are you worried about the moral implications of what you're doing?'"
At the heart, perhaps, of the moral resistance the church proposes in the face of some biomedical projects is the scientists' insistence that much of their research be conducted on human embryos while much of the-fruit of their research will lead to manipulation of human embryos. Not only does the church object to the clinical creation of embryos explicitly for research, it objects to the use of embryos "in excess of clinical need," spare parts for genetic research gathered from among the abandoned embryos freeze-stored in the nation's fertility clinics. In the case of stem-cell research, the church further objects to the harvesting of fetal tissue from aborted fetuses.
No flood ends from evil means
Some of the basic questions the church asks, says Byers, in evaluating the moral acceptability of a specific research or procedures include: Is the research aimed at therapeutic ends, and do you have to destroy an existing being to get the benefit of the research?
Most of the current efforts surrounding stem-cell research fail the latter question. In November 1998, after two decades of research, scientists successfully isolated and cultured human stem cells. Stem cells--or "undifferentiated" cells--may be considered the building-block cells of the human organism. They develop into the 210 different kinds of tissue in the human body. Medical researchers believe these cells will allow them to incubate tissue that can be used to treat people suffering from Parkinson's, Alzheimer's, heart disease, diabetes, and other cell-degenerative afflictions.
"There is a great eagerness to proceed with this research," says Byers. "The first biotech company to find a cure for a disease using this technique is going to make a fortune."
Scientists harvest stem cells from embryos acquired at fertility clinics and tissue recovered from fetal cadavers from abortion clinics. Some ethicists are concerned that researchers may also use in vitro fertilization (IVF) techniques to create their "in-house" embryos.
Though Byers appears sympathetic to scientists' eagerness to find some form of treatment for some of the worst diseases humankind currently faces, he argues that stem-cell research using embryos and fetal matter clearly cannot pass the church's moral litmus test. In 1987's Donum Vitae, the church reiterated its defense of human life from the "first moment of its existence," arguing that an embryo "demands the unconditional respect that is morally due to [human beings in their] bodily and spiritual totality."
Thus the destruction of embryos during research or during harvesting of stem cells--for treatment of even those most terribly afflicted by disease--cannot be ethically acceptable. "You can't achieve good ends by evil means," Byers says simply.
Loyola's FitzGerald has a less metaphysical criticism of current trends in stem-cell research. According to FitzGerald, there is reason to believe that therapeutically usable stem cells may also be acquired from adult tissue by returning differentiated cells to an undifferentiated state. The issue then, he charges, can be reduced to a simple problem of resource allocation.
The question becomes: Is society willing to pay more in time and money to develop stem-cell therapies that dodge the moral hazard of the destruction of human embryos or the harvesting of tissue from fetal cadavers?
Cloning around with creation
Scotland's Dolly has been called the most remarkable mammal ever produced.
Dolly is an identical genetic copy of another adult sheep (since Dolly, researchers have successfully cloned other sheep, mice, and cows). She has no father. She is a clone, the petri-dish concoction of a group of veterinary researchers who transferred the nucleus of a mammary cell from Dolly's "mother" into an enucleated sheep egg, that is, an unfertilized egg from which the natural nucleus had been microsurgically removed, then nurtured, implanted, and finally birthed the results.
The initial public response to the prospect of human cloning raised by the "success" of Dolly suggested an almost innate repugnance to cloning. But there are signs that this technology may follow the cultural pattern established by in vitro fertilization (IVF)--which similarly had initially been decried as bizarre and unnatural by most people.
The church's teaching on artificial techniques of human procreation is distilled in Donum Vitae and couldn't be more direct. After a discussion of IVF's inherent moral hazards, the procedure is unequivocally denounced; therefore, it follows that human cloning, being wholly dependent on IVF techniques, is by extension prohibited.
But some Catholic ethicists question the church's position on IVF, a process now widely accepted with more than 300,000 births worldwide. Is it possible that cloning may ultimately prove comparably acceptable? Wouldn't the general public, for example, have sympathy for parents desperate for a bone-marrow donor for a dying child? Or as a short cut for those who cannot have a baby by any other means?
If these and other scenarios prove persuasive, the church may need to formulate a more forceful response to cloning than Donum Vitae musters.
Human spare parts
Father Richard McCormick, S.J., is a moral ethicist and retired professor of Christian ethics from the University of Notre Dame in Indiana. He does not believe the church can rely on documents such as Donum Vitae to respond to recent biomedical innovations such as cloning.
Not that the church would have much trouble coming up with a moral case against cloning, according to McCormick. Reminded of the various rationales that have been floated by ethicists in support of the process, McCormick responds flatly: "I can't think of a single case for cloning another human being that would be acceptable."
The problem with cloning, says McCormick, indeed with any biomedical procedure that relies on created or existing life, is that it puts one form of human life at the service of another human life's desires, ambitions, or physical needs.
"The case of someone losing a daughter and then bringing someone into the world as a replacement instrumentalizes the clone, and that to me is objectionable. You can't just do what you want with a human being.... You're not treating the human person as a person but as an object to be manufactured for your purposes, reducing them to nonperson status, and that is always wrong."
But the implications of cloning technology extend beyond its potential usefulness in human reproduction. Some researchers hope to use the technique to create human tissue for transplants.
Loyola's FitzGerald describes the procedure: "We'll take your nucleus, put it into an enucleated human egg, or even a cow egg if you can live with that, and we'll start to grow this entity, this thing, and it will look a lot like an embryo. If we implanted it, it would act pretty much like an embryo....
But instead, we'll never implant it; we'll keep it in a petri dish, and we'll use our growth factors and we'll tweak it along, so it starts to develop fetal brain cells, fetal nerve cells, and we'll take those cells and we'll culture them and cultivate them and then we'll take them [to treat your disease] because they' re your cells and we'll put them into your brain.
"Can anyone argue against that? It might look like an embryo and quack like an embryo, but it's in a petri dish and it's never going to be implanted, so it would die anyway.... It will never be born; it will never be a human being that way, but it will have your specific cells to treat your fatal, terrible, debilitating illness. Why can't we [use this procedure]?"
FitzGerald says the answer depends on where society draws the line of definition on humanity. "Presently we can't use an adult for spare parts and we can't use prisoners on death row for spare parts and we can't do research on an infant"--all dearly members of the human family requiring at least the minimum of human respect and dignity. The church has drawn its line to include the embryos that would provide the raw material and target of human cloning research. Will the rest of civil society follow suit?
A fellow scientist has asked FitzGerald if he doesn't believe the current confrontation between the church and genetic researchers will eventually seem like "Galileo all over again."
"Well, my worry is that when this is all over we're going to look at this stuff and say, `This is slavery all over again.' That is, using one segment of the human spectrum and saying, `No, this segment isn't quite like the rest of us, therefore we can use this segment for the benefit of the rest of us.'
"It's a temptation; it's a human tendency. We're always looking for ways to say, `How can I make you different so that I can take advantage of you?'"
Looking for the perfect child
If cloning is the future's ultimate expression of selfishness and narcissism, an obsessive search for the perfect child may represent contemporary life's closest equivalent. Right now, would-be parents of the perfect child have to rely on genetic screening, prenatal testing, and preschool French to achieve their goals, but a recent biomedical breakthrough opens a Pandora's box of possibilities.
A Canadian biotechnology firm has engineered lab mice to carry an extra artificial chromosome that these mice have successfully passed on to their offspring. The Canadians' success means that human "germline" gene therapy--insinuating changes into the human genome that will be inherited by future generations--is becoming a practical possibility.
While few people would likely feel the technique were ill-used if it were employed to cut cystic fibrosis out of a family's genetic line, Notre Dame law professor and ethicist M. Cathleen Kaveny warns that any use of germline technology begins a series of slippery-slope ethical dilemmas.
The problem lies in distinguishing between therapeutic and a genetically cosmetic use of the technology--the difference, that is, between altering chromosomes to remove a genetically transmitted disease like CF and altering them to improve vision, increase height, even change hair or eye color. Unlike cloning, which can only recreate from a single genetic template germline therapy's potential for genetic manipulation is limited only by human imagination and desire, while its impact potentially cuts across generations of humanity.
It's because of the profound threat it poses to natural human genetic reproduction that Kaveny wonders if all experimentation in human germline therapy should be prohibited. She's not confident it can be deployed wisely and still somehow be restrained from the market of human reproductive desires. "Is the treatment designed to fix a disease or designed to enhance something? How do you decide what is an appropriate target [of germline technology]? It's easy to shift over [from therapeutic needs] to designer babies."
Some genetic ethicists offer a moral shrug of indifference to that shift. Most parents already do all they can to enhance the social performance of their offspring with the best health care, nutrition, and education their money can buy. Why should parents be prevented from providing their kids with a genetic head start?
The question goes to the heart of the vocation of parenthood, says Kaveny. When parents have such a profound role in the creation of a child, she worries that an expectation has been created that ultimately denies the personal integrity of the child--the child's equal dignity and liberty.
Perhaps the greatest parental virtue, says Kaveny, is learning to accept the personhood of the individual children, learning to accept each child for who she is, learning to nurture that child and her unique talents and abilities to her fullest potential. "What is [genetic tinkering] going to do to the parent-child relationship? Are parents going to see their children as equals in dignity with a vocation given to them by God, not by their parents?"
Our DNA-driven future
Worrisome to ethicists--both those who support much of the current biomedical research and those who seek to restrain it--is how much of the ethical infrastructure that will guide society's response to the onrushing discoveries of the reproductive sciences is now primarily being constructed by infertile couples eager for children, HMOs determining which procedures they will pay for, and for-profit medical research and treatment facilities competing to be the first to cash in on particularly "promising" research.
The problem of the market leading the morality is particularly evident in the United States, which, unlike many European nations, maintains weaker legal barriers--where they exist at all--to research on cloning or research on human embryos. Current restrictions against using U.S. government resources for controversial programs such as stem-cell research do nothing to prevent privately financed research where some of the ethical worst-case scenarios in terms of embryo experimentation and destruction may be taking place.
"Industrial" application of such technologies is years away, so U.S. society is not yet confronted by the problem of regulating the use of these new biotechnologies. But it could do a better job in at least regulating the current experimentation, Kaveny says.
Discussion of social policy around reproduction has been difficult because it necessarily intrudes upon what could be viewed as the most private aspect of any couple's relationship, their sexual expression. But Kaveny believes a more forceful government regulatory role at this technological juncture is badly wanted. She argues that government intervention does not represent an attempt to regulate sexual intimacy but only the exercise of a well-precedented authority to regulate industry.
The "ghost" in the discussions of the new reproductive technologies, Kaveny says, is abortion and the "negative reproductive" rights created by unrestricted abortion policies. Those negative privileges may make it difficult in the future to restrain the beginning of "positive reproductive rights" to tinker in an equally unrestrained manner with human procreation.
If upcoming technologies, Kaveny suggests, allow parents to learn enough about their fetus, his susceptibility to disease, his sexual orientation, his intelligence, to then opt for an abortion, how can it be argued that parents can't step in "positively" to manipulate those genes so that they produce an offspring they're willing to want?
When reproductive choice and privacy have primacy over all other concerns, it is difficult to even engage in a cultural discussion of the new reproductive technologies, much less hammer out meaningful public policy. "The big problem in the U.S. is that we don't recognize that reproduction is not just a private matter," she says. "It is not just about a parent's actualization. You have to think of the well-being of the child"--and the broader cultural implications new reproductive technologies create.
"I do think you have to consider the symbolic nature of actions," Kaveny says. She argues that in the same way no-fault divorce has engendered a series of cultural cues that ultimately weakened the common meaning of marriage in American life, new procreative technologies may provide cues that could lead to the cultural redefinition of family and the parent-child relationship. "This is a common-good question."
"There is time to think [these issues] through," says the NCCB's Byers, noting that "practical" exploitation of much of today's biomedical research is years away if it is possible at all. "Research on human stem cells could turn out to be a dead end, and human cloning may be impossible."
And FitzGerald reminds us that this is a moral struggle not unique to our times. "It's the oldest temptation," he says. "This is something that humanity has always struggled with.... We want to be God; we want to determine our fate."
The specter of nuclear annihilation haunted humanity during the worst days of the Cold War when it became clear that our special genius for tinkering with nature might prove our final undoing. Though nuclear dangers certainly remain, it appears that, for the time being, humankind has dodged the atomic bullet.
Unwilling to take a metaphysical breather, however, we seem poised to risk a different sort of extinction with an altogether different technology. Once again our genius for tinkering with nature is to blame. This time we are not tinkering with the stuff of matter, but the stuff of ourselves.
See our Web site at www.uscatholic.org for more information on genetic engineering.
RELATED ARTICLE: THE PROMISE, PERILS, AND PRINCIPLES OF BIOTECHNOLOGY
* Could lead to new treatments for a battery of degenerative diseases such as Alzheimer's or Parkinson's disease.
* Current research focuses entirely on developing therapy based on experimentation on and "raw material' harvested from embryos and tissue recovered from aborted fetuses.
* Raises ghoulish specter of a market place for abortion "material."
* "You can't achieve good ends from evil means."
* Human embryos are human life and deserve the respect accorded other human life.
* Abortion is morally wrong and taints whatever good is achieved from research using fetal tissue recovered after abortions.
* Could provide organ replacement for the terminally ill and new possibilities for infertile couples or couples seeking to "recover" a deceased child.
* Cloning research conducted on human embryos; "mistakes" would be discarded.
* Embryos would be created solely for the purpose of creating, incubating, and harvesting human tissue.
* Social attitudes of "naturals" toward the "cloned" may lead to the creation of a new, vulnerable underclass.
* Cloning is a fundamental violation of human dignity. It "instrumentalizes" the cloned human life, puts the cloned life at the service of the ambitions, desires, or needs of another human life.
* Offers the possibility of the ultimate genetic fix to a number of inherited diseases like Cystic Fibrosis.
* Mistakes during embryonic microsurgery or when treatment produces unexpected results mean therapy leads to the discarding of multiple human embryos.
* The same procedures could be employed in broader, "cosmetic" tinkering with the human genome, perhaps leading to genetic "designer babies," even, some theorize, to the creation of a completely different species of superhumans.
* Could irrevocably alter the common cultural understanding of family and the parent-child relationship.
* Parents aren't the owners or ultimate creators of children, nor the dictators of their children's lives; they're the stewards of their children's God-given gifts and vocations.
RELATED ARTICLE: SEARCH-AND-DESTROY MISSIONS
The preselection technology that will advance the future's construction of the perfect child already exists. Pre-fertilization genetic screening and prenatal testing have instituted a de facto "quality control" filter into the process of human reproduction, says Jeannie Hannemann, a family life minister and one of the founders of the Elizabeth Ministry, an international mentoring service for women during pregnancy.
In the past, Hannemann had to counsel only a small number of pregnant couples in her parish who were confronted with crisis pregnancies. Now "basically every pregnancy has become a crisis pregnancy."
In an effort to ward off malpractice suits or avoid the costs associated with the care of problem pregnancies, congenital illnesses, or special-needs children, obstetricians and HMOs are standardizing prenatal testing and genetic screening procedures previously reserved for couples with histories of problem pregnancies or congenital birth defects, she explains.
Hannemann is no fan of prenatal testing, arguing that these procedures endanger fetuses, produce untrustworthy diagnostic results, and needlessly drive couples to panic and anxiety. But more important, according to Hannemann, prenatal screening procedures are often not conducted to cure a disease but to alert parents of a potential "special needs" infant
What typically begins then is a process of cajoling and pressuring that terminates in an abortion, she says. "Science has gotten very far advanced on prenatal testing, but science has not gotten very far on being able to correct any conditions in the womb.
"We're not against prenatal testing if it's leading toward a treatment to correct a condition. But that's not where the society has moved. Now it's on these `search-and-destroy' missions for any child that has any kind of disability so that they can be aborted."
Hannemann sees a culture shift taking place moving away from supporting families with special-needs children toward resenting such families for creating a "burden" on society. She has read pamphlets on "abortions for love," seen "wrongful life" lawsuits against physicians who delivered special-needs children, and heard of HMOs refusing treatment to special-needs children, arguing their mental or physical problem represented a "preexisting condition" because their parents elected not to abort them after prenatal screening indicated a problem.
Already eight out of 10 fetuses diagnosed with Down's syndrome are aborted, and unseemly pressure toward abortion is being applied to parents when their offspring are determined to carry any number of mild to severe congenital problems. What may be evolving is a process of social eugenics driven not by some Hitlerian racial fantasy but by a cultural disinclination to respond to special-needs children and by government to keep down the social costs of such children.
"The bottom line for Catholics is how much do we need to know before a baby is born? Why are you going to have these tests and risk your child when so little can be done?
KEVIN CLARKE is managing editor of online product at Claretian Publications in Chicago.
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|Title Annotation:||ethics of reproductive biotechnology|
|Date:||Jan 1, 2000|
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