2. Scientific issues
2.1 Adult stem cells
2.2 Embryonic stem cells
2.3 Cloning for birth
2.4 Cloning for transplantation
3. Status of the human
embryo
3.1 What is a human moral subject?
3.2 When does the human individual begin? 3.2a Fertilisation
3.2b The embryo and its placenta
3.2c Identical twinning 3.3 Do all human beings have full moral
status? 3.3a Human rights
3.3b Human embryos
4. Respecting the
embryo
4.1 Rights of the embryo
4.2 Research on 'spare' IVF embryos
4.3 IVF for research
4.4 Cloning for research
4.5 Conscience and complicity
4.6 Cloning for birth
5. Public policy 5.1 General principles
5.2 Benefits and alternatives
5.3 Unacceptable consequences
5.4 Recommendations
6. Responses to
questions
Summary
S.1 There are scientific aspects of cloning and stem cell research which
need to be clarified before ethical questions are posed. In particular,
it seems that research on adult stem cells is comparably advanced to and
perhaps more promising than research on embryonic stem cells. Further, the
results of attempting to clone non-human animals cast serious doubt on the
safety of cloning for transplantation, as well as cloning for birth (see
sections 1.1.1-2.4.1).
S.2 Human beings are animals (of a special sort) who begin to exist when
the individual organism begins to exist. The universal terminus a quo
in developmental biology is fertilisation. The development of the placenta
and other foetal organs does not undermine the significance of fertilization
as the normal beginning of the human organism, and neither does the phenomenon
of identical twinning, if this is correctly understood (see sections 3.1.1-3.2c.6).
S.3 The basis of the concept of human rights is that there is a minimum
respect which is due to all human beings simply in virtue of their being
human. This represents the rejection of the possibility of a natural human
underclass (consisting of slaves, the disabled, women, children, or those
of `lesser' races). The humanity of embryonic human beings entitles them
also to a minimum human respect, despite the evident differences between
human embryos and older human beings (see sections 3.3a.1-3.3b.7).
S.4 The human rights of the embryo include the right not to be attacked,
used or commercialized, and the right to a certain care from the genetic
parents. It is irresponsible to allow one's genetic material to be used
to create an embryo who has no chance of implantation. IVF for research
and cloning for research are wrong for similar reasons, whereas cloning
for birth is wrong for other reasons (see sections 4.1.1-4.6.7).
S.5 The Helsinki Declaration on Medical Research Involving Human Subjects
condemns research which is without the consent of the subject, harmful to
the subject or which subordinates the interests of the subject to the interests
of science and society. In cases of genuine doubt concerning the humanity
of the subject one should err on the side of caution. A significant body
of scholarly opinion to the effect that embryos are human beings constitutes
a reasonable doubt concerning their supposed subhuman status. Human embryos
should therefore be protected by law (5.1.1-7).
S.6 Human cloning for research and a major expansion of research on IVF
embryos are being permitted in the face of international condemnation when
it is far from evident that there is an urgent necessity to justify such
dramatic moves. Such practices are likely to lead to cloning for birth,
to further erosion of public confidence in the ethics of scientific research,
and to an invidious promotion of treatments which many patients will regard
as unconscionable. Cloning should be prevented before the regulations come
into effect (5.2.1-5.4.1).
1. Introduction
1.1 Stem cells
1.1.1 Stem cells are versatile cells in the
body which are able both to reproduce themselves and to produce more specialized
cells. As such, they are of great potential value in repairing and regenerating
damaged cells and tissue. Many conditions are currently or potentially treatable
with the use of stem cells, including Alzheimer's, Parkinson's, heart disease,
stroke and diabetes.
1.1.2 Stem cells can be obtained from various sources. They can be obtained
from the early human embryo, from the older human embryo or foetus, from
the newborn baby (e.g. from the umbilical cord), from the older child and
from the adult. As the individual develops, it is thought that stem cells
become more committed to a particular destination in the body; however,
some degree of flexibility appears to be retained. (We will be looking in
the next section (2.1) at the clinical potential of adult versus embryonic
cells.)
1.2 Embryonic stem cells
1.2.1 Embryonic stem cells can be obtained from
the human embryo or foetus during or after an abortion, or after a miscarriage.
They can also be obtained from the early human embryo after in vitro fertilisation
(IVF) or similar procedures. The IVF embryo may be `spare', i.e. surplus
to the infertile couple's requirements. Alternatively, the embryo may be
specifically created for experimental use.
1.3 Cloning
1.3.1 Embryos may very soon be created for experimental
use by means of cloning. In this procedure, the nucleus of an unfertilised
ovum is replaced by the nucleus of a body cell from an existing human being.
The ovum is then stimulated to create an embryo. As the nucleus contains
almost all of the cell's genetic material, the embryo created is the clone
or twin of the human being from whom the nucleus was taken, and could be
used as a source of stem cells for research and eventual transplantation.
1.3.2 Cloning for research is sometimes described as therapeutic as opposed
to reproductive cloning. In `reproductive' cloning, the clone is transferred
to the body of a woman and allowed to go to term. It should be noted that
the cloning procedure itself is identical for `reproductive' and `therapeutic'
cloning: the only difference lies in the purpose for which the clone would
be created.
1.3.3 The terms
`reproductive' and `therapeutic' in this context are misleading.1 `Therapeutic' cloning is not
therapeutic for the clone, who will die in the course of its cells being
taken when it is 5-7 days old. Such cloning is, moreover, reproductive,
since it involves the creation of an embryo, although this embryo will not
survive to the point of being born. Supporters of cloning have conceded
that the clone embryo is a human organism: an early human life.
1.3.4 In this Submission, we will be referring not to `therapeutic' and
`reproductive' cloning, but to cloning for birth, and cloning for research/transplantation.
2. Scientific
issues
2.1 Adult stem cells
2.1.1 Until recently, it was thought that stem cells could rarely be found
in adult tissue. However, this view has been conclusively disproved. The
last twelve months have seen an explosion of information on adult stem cells
(the term is often used to include stem cells from, for example, newborn
babies). Adult stem cells have, in fact, been given to patients for decades
in the course of bone marrow transplants, and new trials on patients using
adult stem cells have had positive results.
2.1.2 It is clearly
best if the cells used in transplantation can be taken from the patient
him- or herself, to avoid rejection by the body. While embryonic cells have
been proposed as a means of avoiding rejection problems, even early embryonic
cells have surface molecules which can cause an immune response.2 Supporters and opponents of
embryonic stem cell research are in agreement that the ultimate goal should
be to use the patient's own cells.
2.1.3 There are
various ways in which adult cells can be used. They can be taken from the
patient, or a donor, and used without being modified, as in the case of
bone marrow transplants for patients with cancer. Alternatively, stem cells
from the patient can be subjected to gene therapy before being re-introduced,
as in the case of children who were treated recently for Severe Combined
Immune Deficiency.3
2.1.4 Stem cells can
be induced to carry out a new role in the body, as when a patient with heart
disease was given stem cells from muscle in his leg, which then formed a
different kind of muscle in his heart.4 It is known that adult bone marrow cells are particularly
versatile, and can produce bone, cartilage, tendon, muscle, fat, liver and
neural cells. Neural stem cells can also form other cell types, such as
blood and muscle cells.
2.1.5 Finally,
there are ways of treating stem cells while they are still in the body of
the subject. In animal studies, positive results have been obtained by adding
the proper growth signal to the injured brains of rats, so that their own
stem cells could proliferate.5
2.1.6 Treatments of human
patients using adult cells are already yielding results. Successful treatments
have been carried out on children with cartilage defects,6 patients with corneal scarring,7 and patients with lupus,8 systemic sclerosis9 and rheumatoid arthritis.10 A number of cancers have been
successfully treated using adult cells, including metastatic retinoblastoma,
which has a poor prognosis with conventional treatments.11
2.2 Embryonic stem cells
2.2.1 How
do these achievements using adult cells compare with those made using embryonic
cells? It should be noted that cells from early embryos have not so far
been used on patients, and appear too unspecialised to control, unless modified
in some way.12 We are
some years away from any treatment using early embryonic cells.
2.2.2 Where stem
cells from foetuses have been transplanted into patients along with other
tissue the results have not been altogether positive. Even foetal cells
can be difficult to control, and it is feared that embryonic stem cell transplants
could give rise to cancer. In one case, a man with Parkinson's died after
a transplant of foetal cells; it was later found that these cells had given
rise to bone, skin and hair in the patient's brain.13
2.2.3 A recent
clinical trial did find some improvement in younger Parkinson's patients
(those aged 60 or less). However, in 15% of those treated the patient developed
permanent uncontrollable movements such as writhing, head-jerking and constant
chewing.14 One patient
now has to be tube-fed, so severe are his symptoms.
2.2.4 In animal
experiments, there have been some favourable results using embryonic cells.
However, there are technical problems involved in keeping human embryonic
stem cells alive, and in making them differentiate along the right lines.
A trial in which cells from human embryos were transplanted into rats found
that these cells did not readily differentiate into brain cells. Instead,
they stayed together in a disorganized cluster, and nearby cells began to
die.15
2.2.5 While it
is too early to say whether embryonic or adult stem cells will ultimately
prove more effective, there is more current evidence of usefulness in the
case of adult cells. Statements to the contrary may owe more to external
pressures - political or commercial - than to the scientific data. To quote
the journal Science in December 2000, `the human embryonic stem cells and
fetal germ cells that made headlines in November 1998 because they can, in
theory, develop into any cell type have so far produced relatively modest
results. Only a few papers and meeting reports have emerged from the handful of
labs that work with human pluripotent cells.'16
2.3 Cloning for birth
2.3.1 Cloning for birth has been carried out in various species of mammal,
including sheep, cows, mice, pigs and goats. However, it is very difficult
to produce a healthy animal by cloning. Problems arise at every point: in
producing embryos by cell nuclear replacement, in bringing these embryos
to term, and in obtaining healthy live-born offspring. There is a high rate
of miscarriage of clones, throughout the period of gestation, and a high
rate of neonatal death. Major fluid retention in the gestating mother has
also been observed.
2.3.2 Abnormalities in clones include developmental delays, heart and lung
defects, malfunctioning immune systems, and excessive size. Genetic errors
in the clone can cause unpredictable problems at any stage. Some mouse clones,
after growing to the equivalent age in humans of thirty, suddenly become
obese.
2.3.3 Despite these problems, there are those who wish to carry out cloning
for birth in human beings. Fertility specialists Panos Zavos and Severino
Antinori plan to clone for birth within the next two years. Zavos claims
it will be possible to identify abnormalities at the embryo stage, so that
abnormal embryos can be discarded. However, experts in animal cloning have
suggested that this cannot be done, since there is no test for determining
whether genes in the embryo have been properly reprogrammed.
2.4 Cloning for transplantation
2.4.1 The
high rate of serious abnormality in animal clones gives us reason to fear
the effect on patients of transplanting into them genetically abnormal cells
from an embryonic clone. In general, embryonic cells are unstable and difficult
to control because of their pluripotency. Cells from a cloned embryo, prone
to genetic abnormality, raise still more difficulties. In any case, the
great expense involved in cloning, and the need for a large number of human
eggs, would be major impediments to its clinical use.17
3. Status of the human
embryo
3.1 What is a human moral subject?
3.1.1 Morality and law are concerned with the respect that is due to human
beings as moral subjects. People are not reducible to the sum of their physical
parts or their biological drives. Mature and competent human beings can
make decisions for themselves, for which they are held responsible both
morally and legally. Furthermore, all human beings are members of
the human community, whether or not they have come to full maturity, and
all share a common humanity.
3.1.2 No human
being is to be thought of as a mere physical object or a mere
animal, for all possess a common dignity or significance that is not shared
with any other animal.18
However, it is also important to stress that human beings are animals
- of a particular sort. We should not think that the real person is a ghostly
spirit inside the head (the mind or consciousness) or a demon who has taken
possession of a body - as though the living human body were one thing and
the person were something else. This would degrade the human significance
of the body and undermine the conviviality and bodily communication that
help to constitute the human world.
3.1.3 The Greeks
defined a human being as a `rational animal' and this seems to capture something
of the essence of a human being, as long as we are careful not to define
`rational' in too narrow a fashion. Similarly the philosopher Boethius defined
a subject (persona)19
as an individual being which has a rational nature: persona est rationalis
naturae individua substantia.20
These definitions have the great virtue of simultaneously acknowledging
the unity and the transcendence of the human individual.21 The human being is not two things
joined together (a thinking thing and a physical thing) but one whole being.
3.1.4 It may seem that in the modern Western world, there is little danger
of `dualistic' ideas posing a real threat. However, there seems to be something
in the Western way of life and in modern culture that encourages, on the
one hand, a view of political and technological freedom as unlimited by
any rules concerned with human nature and, on the other, a view of the body
as purely mechanical and empty of any intrinsic human significance.
3.1.5 The human
moral subject is the human being, who is, essentially, a very special animal.
We should not be afraid to admit that we are animals, members of the species
homo sapiens, and that our lives are the lives of these living
human bodies.22 Human
individuals are biological individuals. The question nevertheless
arises: when and how does this human individual come to be? And does he
or she possess full human moral status from the very beginning?
3.2 When does the human individual begin?
3.2a Fertilisation
3.2a.1 In species which reproduce sexually, a new
organism comes to be with the successful fusion of the gametes. This is a rule
that applies not only to human beings but reflects the very nature of sexual
reproduction. The offspring are genetically distinct from the parents, so that
the moment of generation of the new individual is clearly defined.
`Fertilisation is the process whereby the two sex cells (gametes) fuse together
to create a new individual with genetic potential derived from both parents.'23
3.2a.2 If the distinction between gametes and embryo
is clearly defined, so too is the continuity between the single-cell zygote and
the multicellular adult organism. `In nearly all cases the development of a
multicellular organism begins with a single cell - the fertilised egg, or
zygote.'24 While there are identifiable stages in the process
of division, pattern formation and differentiation, the process itself is
gradual and continuous. If one asks when and how development begins, the
biological answer is clear: `development begins with the fertilised egg, which
is a single cell, giving rise to a number of smaller cells.'25
3.2a.3 Progress
within the science of developmental biology has done nothing to displace
this most fundamental of starting points. The basic biological outlines
of human development are not controversial: fertilisation initiates a cascade
of developmental events and is the universal terminus a quo for considering
embryonic development. The fertilised ovum, termed a zygote (the
single-cell phase) or a conceptus (the general term for the product
of conception), is also termed an embryo from fertilisation until
the end of the second month when it is designated a foetus. Thus, from a
biological perspective, the product of fertilisation is a new organism, an
embryo in the process of development. `After these gametes combine, a new
organism begins to develop.'26
3.2b The embryo and its placenta
3.2b.1 Biologists generally consider the new individual organism to begin
with fertilisation. Fertilisation is a process that takes time -
in human beings it takes about 24 hours from the first contact between the
ovum and spermatozoon to the union of the chromosomes (`syngamy') and the
first cell division - yet there is a point within this process when the
most significant phase has been accomplished (when the process is essentially
complete). From this point a new biological organism exists. However, some
people have suggested that the embryo does not begin to exist when
fertilisation is complete. They point out that most of the cells of the
conceptus (95% at the 64 cell stage) go to make the placenta and amniotic
sac, and claim that, until the embryo `proper' is clearly differentiated
from these other structures, the human individual does not yet exist.
3.2b.2 These critics are right in saying that the distinction between the
placenta and the embryo `proper' is not present immediately after conception.
The placenta takes time to develop. However, they are mistaken in thinking
that this distinction is a distinction between the embryo and something
else. The placenta belongs to the embryo; it is an organ of the embryo by
which it takes nourishment from its mother. If the amniotic sac and the
placenta are understood as parts or organs of the embryo, then the appearance
of these structures will be no more or less significant than the genesis
of other embryonic structures. A new identifiable human individual already
exists from the beginning, before these specialised structures start to
appear.
3.2c Identical twinning
3.2c.1 A second phenomenon is more difficult to comprehend. Whereas most
embryos develop into a single adult organism, a small number (0.3%) undergo
division at an early stage so as to produce identical (or `monozygotic')
twins. The process of identical twinning is often thought to demonstrate
conclusively that the early conceptus is not an individual. If a biological
object is to be described as an individual organism it requires a certain
level of integration, such that it is not just a collection of cells held
together mechanically but a single integrated unit. Some claim that the
phenomenon of identical twins shows that the early conceptus is not a unitary
organism but only a loose collection of cells yet to develop into an organism
or organisms.
3.2c.2 A survey of textbooks of developmental biology
shows that the embryo is more than an aggregate held together by mechanical
forces. `From the outset, the cells of the embryo are not only bound together
mechanically, they are also coupled by gap junctions.'27
Nor do biologists regard the phenomenon of twinning as something to be explained
as the breaking up of a loose aggregate. They regard twinning as evidence
of a power possessed by the embryo to redirect cells that normally
would have contributed to only a portion of the embryo, a power they term
regulation.28 This
is a power of the embryo as a whole, rather than of individual cells.
`Since early vertebrate embryos show considerable capacity for regulation and
many of the cells are not determined, this implies that cell-cell communication
must determine cell fate.'29
3.2c.3 Identical twinning
is an exceptional event proving the rule that, in general (in 99.7% of cases),
only one foetus develops from each zygote. Where identical twinning does
occur, the twinning event (whatever this is) triggers the formation of one
or more discrete organized wholes, each in the process of development.30 Each newly generated twin
then continues as a well-formed individual. It does not form just half a
foetus, nor does it grow wildly as a teratoma. Both in singletons and in
identical twins, early human embryology shows a strong commitment to the
development of distinct organized individuals.
3.2c.4 Biologically speaking, the early embryo is a well-integrated whole
which, even in the rare cases when it splits, does so in such a way that
one or more well-integrated individuals are formed. However, it might be
argued, do not even these rare exceptions undermine a principle that is
supposed to be absolute? If the conceptus could split, or could be
made to split, does this not show that it is not yet a genuine individual,
even in those cases where it goes on to become an individual?
3.2c.5 This argument relies on the principle that whatever is an individual
cannot give rise to other individuals. This principle may once have
seemed plausible; however, it is undermined by the very possibility of human
cloning. In many living things, including some vertebrates, reproduction
can occur asexually: by a parent-cell splitting to give two daughter-cells;
or by a new organism budding off from a continuing parent. The suggestion
that adult human beings might one day be cloned assumes that human beings
can be reproduced asexually - without this compromising the individuality
of the human being who generated the clone.
3.2c.6 There is ample evidence for strong integration in the early embryo,
both in the case of singletons and in the case of identical twins. From
the perspective of biology it is clear that there is one individual which
endures from the single cell stage until the death of the multicellular
organism - except in the case of identical twins, who are natural clones
produced early in development by asexual reproduction. Furthermore, as soon
as these twins come to be, they also endure as individual organisms
until their own deaths. The normal habit of biologists is to count
embryos: to test them, select them and transfer them. In all these actions
it is assumed to be unproblematic that even early embryos are a discrete
number of individual living organisms such that they can readily be counted.
3.3 Do all human beings have full moral status?
3.3a Human rights
3.3a.1 Human subjects are to be respected by others and protected by society.
Though every concrete human society seeks to limit those who can be accounted
full members or citizens, there is a certain minimum protection that is
generally thought due to every human being, whether a full citizen
or not. The classification of some categories of people - especially foreigners,
criminals, slaves, the mentally ill, women, children, and the disabled -
as less than human was explicit in many ancient and even in some modern
societies. It was in reaction to the horrors of Nazism that the United Nations
sought to frame a list of basic `human rights' possessed by all people irrespective
of their situation, simply on the basis that they are human beings. `Human
rights' language assumes the existence, or at least the possibility, of
a universal community to which all human beings belong. Human rights are
those things which are owed to a human being simply in virtue of being human.
3.3a.2 The moral insight basic to the very idea of human rights is that
the human moral community naturally extends to all human beings, so that
the exclusion of some category of human beings as subhuman is arbitrary
and unjust. Human beings are revealed to be moral subjects by their thoughts
and their mature free decisions, but those who are too immature or incapacitated
to exercise these capacities are not to be discriminated against on the
basis of what they cannot do. Human dignity resides in what human beings
are rather than what they can or cannot do at any particular
moment. All forms of society favour the full-grown and the strong and the
bright, but these favoured few should not consider themselves more worthy
of protection than the weakest or least able.
3.3a.3 Consider the protection due to a newborn infant. Not only the parents,
but the great majority of people, recognize the child as more worthy of
protection than the adult because more vulnerable. Physical abuse of small
children rightly provokes a sense of horror or outrage, and few things are
more shocking than the death of a child. The old and the sick are less immediately
attractive than little children, but again, the sight of an old person who
has been violently assaulted is viewed as monstrous precisely because the
victim was so vulnerable.
3.3a.4 The newborn infant, the mentally disabled adolescent and the Alzheimer's
patient are no less human, and no less worthy of the protection of society,
than the healthy worker or the brilliant student. They are all, equally,
members of human society, which is, or ought to be, for the benefit of all.
The human being who is mentally impaired or who has lost the use of his
or her faculties is in a deprived state, but is not thereby subhuman. The
newborn infant cannot speak or understand any more than a dog or cat, but
he or she is already human, and it is this humanity that is the basis for
his or her developmental potential. The baby is human, someone's son or
daughter, with a human future in store. The significance simply of being
human is immediately recognized by men and women of good will and is the
basis of efforts in civilized societies to protect children and to secure
better treatment for the mentally impaired. Human infants have an
interest in health, in a stable family and in a future, even before they
can take an interest in these things.
3.3b Human embryos
3.3b.1 Many people who would strongly oppose discrimination on the basis
of age or mental capacity, and who would defend the rights of children born
with a disability, do not see the protection of five- or six-day-old human
embryos in the same light. Whereas it is obvious to them that disabled children
are human beings deserving protection, the same is not obvious in the case
of human embryos. This may be for several reasons. Some do not consider
human embryos to be human individuals. Others consider the allegedly high
level of natural wastage of embryos points to their lack of worth. Finally
there are many who simply cannot believe that the embryo is a human being
because it appears to be just a ball of cells.
3.3b.2 Essential to the proper understanding
of the human embryo is that it is not just human life, but a human individual;
that is to say, an integrated human organism. This has been argued at length
in the previous section and, when contentious moral questions are not foremost
in people's minds, there seems to be no problem in regarding human embryos
as discrete biological individuals. The fact that one embryo occasionally
produces two does not undermine the empirical observation that it was genuinely
one before and genuinely gives rise to two after.
3.3b.3 The number of ova which are successfully
fertilized but without the embryo implanting is subject to much dispute
with many conflicting estimates. It seems that there are abnormal fertilisations
giving rise to products which are so disordered as to lack all human developmental
potential and which should not be regarded as embryos or as human individuals
but as pseudo-embryos. On the other hand, it would be fair to say that,
even among those conceptuses showing serious chromosomal abnormalities,
many of these would be children suffering from severe disability, rather
than pseudo-embryos.
3.3b.4 Even if the normal level of wastage before
implantation were `only' 10-15% this would still amount to tens of thousands
of embryos each year in Britain alone. Is this a cogent argument against
attributing human status to the early embryo? High mortality may sometimes
have the social effect of cheapening human life, but this is not a moral
argument for taking this attitude oneself. In human beings, as in most animals,
it is the young who are most vulnerable, and throughout history high rates
of infant mortality have been the norm. This is still the case in many parts
of the world. High rates of infant mortality probably contributed to the
culture of the ancient world in which infanticide was regularly practised,
but it did not justify the practice. Nature is sometimes cruel, but `the
survival of the fittest' is no guide to justice in society, and the prevalence
of high mortality is no guide to the moral status of the human embryo.
3.3b.5 It seems likely that neither the phenomenon
of identical twins nor the rate of spontaneous embryo loss would have been
given much weight if the individual in question had only looked more
like a child. Newborn babies cannot exercise the human powers of speech
and reason, but the potential they have is clearly rooted in their existing
humanity. The mentally impaired, the sick and the old may be disabled and
even disfigured, but they have human faces and human flesh and blood. The
early embryo looks very different and does not easily evoke the concern
or compassion evoked by a child or a comatose adult. Society recognises
the human status of those with unrealized or frustrated human potential,
but in every case this is based on an acknowledgment of the visible
humanity of the person. It is precisely this which is in question in the
case of the early embryo.
3.3b.6 Appearance is important, and immediate human sympathy or compassion
is an important weapon in overcoming cultural prejudice against certain
categories of human being. However, it is the task of moral reasoning to
criticize our immediate emotional reactions and expand our moral horizons.
The early embryo, whether produced by fertilisation, by natural cloning
(identical twinning) or by artificial cloning (cell nuclear replacement),
is a biological individual, a developing human being in the earliest stage
of life who, if allowed to develop, could enjoy a human future. Killing
a human embryo is unjust for the same reason that killing an unwanted newborn
child is unjust: because an innocent human being is deliberately destroyed
and robbed of a future.
3.3b.7 Throughout history some human beings who were undeniably human, but
who were different from others because of sex, race, age or disability,
have been accorded a graded `respect' without `equality'. In each case the
rhetoric of difference was invoked in defence of injustice. The basis of
this injustice was the very existence of the category of a human being
who is not a member of human society, a subhuman or untermensch, a category
which was firmly rejected by the UN declaration of human rights. Human embryos
are human individuals who, given time and opportunity, will grow into older
human beings. They are no less human than any other human being but only
younger and less aware, more vulnerable and less able to arouse our compassion.
4. Respecting the embryo
4.1 Rights of the embryo
4.1.1 We have seen that there are solid grounds for acknowledging the embryo
as a human moral subject: an individual who has human interests and, therefore,
basic human rights. What, then, are the basic rights of human beings as
they apply to the embryo? We should distinguish, first of all, between the
positive rights and the negative rights of human beings.
4.1.2 Human beings have positive rights, that is, rights that other
people make certain choices which concern them: to provide them with medical
treatment, for example, or some other portion of the communal resources.
While these rights are very important, it is clear that they do not apply
in all situations where help might be needed. It is easy to imagine situations
where there are more patients than a doctor can treat, and no patient has
more right to treatment than any other. It would therefore be wrong to say
that each patient has an absolute right to be treated; the doctor must simply
distribute resources as best he or she can.
4.1.3 In contrast, the rights that human beings have absolutely are
certain negative rights: rights that other people not deliberately
harm them. For example, people have the right not to be intentionally killed
(at least if they are innocent of violence or serious injustice). In the
same way, people have the right not to have their bodies harmfully invaded;
for example, not to have their organs harvested while they are alive.
4.1.4 As the embryo is a human moral subject, it too has the negative rights
of an innocent human being. It has the right not to be deliberately killed,
and not to have its body deliberately invaded in ways which do it lethal
harm. The process of harvesting its cells, in the course of which the embryo
dies, is no more permissible than extracting organs from a newborn child
who dies as a result.
4.1.5 The embryo also has certain positive rights to shelter and nourishment
from its mother. A pregnant mother has an extra reason to take care of her
own health, for the sake of her unborn baby. She should also take reasonable
steps to provide for the child's growth and development, by eating appropriately,
for example.
4.1.6 Given that
a mother has certain responsibilities to her child, it is clearly wrong
for a mother (or father) to permit embryos to be conceived in vitro who
will not have a chance of being born. Parents who have had children by IVF
normally consider the embryo to be a child or potential child.31 It is clearly irresponsible
to accept the status of parenthood in this way and at the same time neglect
the `spare' embryos who have been conceived.
4.2 Research on 'spare' IVF embryos
4.2.1 In a typical course of IVF treatment, some embryos will be conceived
who will be surplus to a couple's requirements. In the case of these embryos,
who would otherwise be discarded, it may be thought that they are `going
to die anyway', and should therefore serve some purpose, rather than be
wasted altogether. We should note that this approach would not be accepted
in the case of other human beings who are threatened with imminent destruction.
In the case of prisoners on death row, or patients who are dying but not
yet dead, we can see how disrespectful - and how dangerous - it would be
to use them as live organ `donors'.
4.2.2 In any case, we need to ask why IVF embryos are created in such lavish
numbers. Leaving aside other questionable aspects of the IVF process, it
is surely unethical practice deliberately to produce greater numbers of
embryos than will be transferred to the mother.
4.2.3 Potential parents seeking fertility treatment are in a vulnerable
position and it is difficult for them to object to the use of their embryonic
offspring for research into infertility. The dangers inherent in using patients
for medical research into their own condition are well documented. The Helsinki
declaration on research on human subjects, as emended at Edinburgh in 2000,
states that `[s]pecial attention is required for those for whom the research
is combined with care' (para. 8). The 1989 Hong Kong version was even clearer:
`The subjects should be volunteers - either healthy persons or patients
for whom the experimental design is not related to the patient's illness.'
[III.2 Helsinki 1964 as revised 1975, 1983 and 1989] Even if destructive
embryo research were acceptable in principle, analogous considerations would
mitigate against using any embryos supplied by patients undergoing a course
of fertility treatment. The situation of need or dependence tends to undermine
freedom of consent.
4.3 IVF for research
4.3.1 One step beyond experimentation on surplus IVF embryos is the deliberate
creation of IVF embryos for experimental use. Here there is no pretence
that any embryo produced will be given a chance of survival. It is not a
case of bringing some good out of the supposed accident of too many IVF
embryos; it is creation for destruction.
4.3.2 Conceiving IVF embryos for research compounds the disrespect shown
towards them. The industrial or commercial exploitation of embryos is a
further violation of their rights. It involves treating embryos as livestock
to be farmed, managed, traded and slaughtered. The degradation of the IVF
embryo conceived for research lies not simply in its early destruction but
in the whole context within which the embryo lives out its brief existence.
4.3.3 With the recent expansion of the legal grounds on which embryo research
may be performed, IVF for research seems likely to become much more common
in the future. As research expands it is inevitable that there will be calls
to extend the period of embryonic development within which it is permitted,
particularly if cells from early embryos prove difficult to manage. If research
is permitted on human embryos, how long before it is seriously suggested
that research should be extended to human foetuses?
4.4 Cloning for research
4.4.1 Cloning for the purpose of research is an area of special concern.
As with IVF for the purpose of research, it is intended not to allow the
embryo to live longer than the experiment dictates. Already in the case
of IVF - even IVF to treat infertile couples - the embryo risks being treated
as a product or commodity, since the procedure itself involves a process
of manufacture. In the case of cloning, the method of production would be
further dehumanized. The clone embryo would have no genetic parents, and
would be created like a product to precise specifications. Having no parents
in the normal sense, the clone would have no natural human protectors, and
would be still more vulnerable than the IVF embryo today.
4.4.2 Cloning for research is the same procedure as cloning for birth, and
already involves the decision to produce a human clone, although the clone
will then be destroyed. The technical expertise developed in cloning for
research will certainly assist those who want to clone for birth. Thus,
if cloning for birth is regarded as objectionable (see below [4.6]), cloning
for research must also be so regarded.
4.5 Conscience and complicity
4.5.1 If the expansion of destructive research on IVF embryos and the initiation
of cloning for research is allowed to go ahead, this will generate further
moral problems concerning the issue of complicity in these activities. It
is morally wrong not only to destroy human beings, but also to commission
or authorize their destruction. Cloning and stem cell research create serious
problems of conscience for doctors, patients, researchers and those asked
to donate material to produce embryos for research. For example, a patient
who supplies a cell for the purpose of creating a clone would be intending
the destruction of the clone for the sake of harvesting its cells.
4.5.2 Complicity problems are not limited to cases where one intends
the wrongdoing of others. Even those who do not intend an act of injustice
can act wrongly themselves by giving the impression they condone it, if
what they do is closely linked to such an act. Thus a patient might be acting
wrongly if he or she accepted a stem cell treatment - even one which did
not itself destroy embryos - if that treatment had been developed by means
of the destruction of embryos.
4.5.3 If the only treatment developed for a serious medical condition
is one that involves, or has involved, the creation and destruction of embryos,
this will condemn conscientious physicians and patients to endure a cruel
trial. Unless they act against their conscience - and do what they consider
inhuman and barbaric - patients will suffer without hope of treatment and
doctors will be unable to offer any alternative. This situation would be
intolerable.
4.5.4 Consider alternative avenues of research where one might lead to successful
treatment which would be universally welcomed, while the other, even if
it led to successful treatment, would create problems of conscience for
thousands of patients and physicians. If the research possibilities are
as yet uncertain, then it is particularly unfair to pursue research that,
if successful, will be unconscionable to a significant proportion of the
population. This is especially so in an age of integrated national healthcare
provision. It is invidious to alienate so many people from the healthcare
system.
4.5.5 Foetal tissue
can be obtained from foetuses who have miscarried spontaneously, with the
permission of the parents. In the case of taking tissue from aborted foetuses,
it is often claimed that the act of abortion can be separated from subsequent
research on tissue from the foetus, in such a way as to make this research
morally acceptable. This claim is somewhat disingenuous: the mere presence
of an intermediary between the abortionist and the researcher does not mean
there is not a close link between their activities.32 In any event, with regard to stem cell research on
early embryos, it is not possible to dissociate the embryo destruction from
the research, since the embryo would be destroyed by the very scientist
who does the experiment.
4.5.6 Abortion may be linked to stem cell research, not only as a way of
obtaining cells directly, but also as a means of supplying ova for the creation
of clone or IVF embryos. Adult women are currently reluctant to allow their
ova to be used to create embryos for research. It has been suggested that
ova from a young aborted female could be appropriated - thus treating her
body and fertility as a mere means to an end. Not only would the embryo
created from the foetal ovum be treated as if it were an object, but the
embryo would be the offspring of a foetus who was herself treated in this
way.
4.6 Cloning for birth
4.6.1 Though cloning for birth does not involve the intention to destroy
all the offspring created (and, in this respect, is better than cloning
for research), it would nonetheless be seriously wrong for a host of other
reasons.
4.6.2 The first objection to cloning for birth is the physical harm it would
cause in cloned human beings. The experience of attempting to clone other
mammals shows that the great majority of human clones would have genetically
related disabilities. Some nuclear replacement would not result in a true
human embryo, but in an entity with no developmental potential. If embryos
were created, most would have severe abnormalities, some of which would
only become apparent late in pregnancy. Screening for genetic abnormality
would `eliminate' a proportion of such abnormalities, but only at the cost
of eliminating the unborn child itself. Of the babies born alive, many would
suffer from disabilities inflicted on them irresponsibly because of the
means used to produce them.
4.6.3 Nor is it only the child who would be abused in such experimental
reproduction. Those women who chose to gestate a cloned child would risk
the trauma of a very high rate of miscarriage, the trauma of being offered
abortion when severe abnormalities were detected in utero, and the health
risks of a difficult and atypical pregnancy. Whatever the motives of women
who chose to take part, it would be irresponsible of the scientists to impose
such risks on any human subject.
4.6.4 Even if cloning for birth was carried out in a large enough number
of cases for the risks to be substantially reduced, this could only happen
at the cost of many dead foetuses, many disabled infants and many pregnant
women who had suffered excessively en route to making cloning safe.
4.6.5 Added to
these serious but extrinsic reasons for objecting to cloning for birth is
the intrinsic objection that it is demeaning to the cloned child. The reaction
of unease or revulsion which is generated by the idea of creating multiple
genetically identical copies of an existing person is not something which
should be dismissed as irrational.33
Our natural reactions can sometimes be a guide to important human values.
In the case of human procreation there seems to be a symbolic as well as
a practical value to the novelty generated by sexual reproduction. Family
resemblance leaves symbolic room for novelty and individuality.
4.6.6 Human beings
are not, of course, reducible to their genes,34 and a cloned child would be as distinct from his or
her genetic original as identical twins are distinct from one another. Nevertheless,
deliberately producing people to resemble an existing person would make
them seem like replacements, and this would undermine their quest
for individuality and make them appear, to themselves and to society, as
(replaceable) `copies' rather than as (irreplaceable) originals. Identical
twins are not deliberately produced to resemble each other, nor is there
an age-gap between them. In contrast, a cloned child would always be a copy,35 deliberately produced so as
to fulfill the potential already demonstrated by another.
4.6.7 The cloned
child would be produced without genetic parents, as a copy of some existing
person, perhaps someone who had recently died (a replacement child), or
perhaps someone still alive (a `designer baby'). Even if the clone survived
to live a healthy life, he or she would live in the shadow of the person
cloned, under pressure to be like the person he or she was made to resemble.
This compromises the interest of children in establishing a separate identity
for themselves; it subjects the child's freedom unreasonably to the parents'
desires. Irrespective of the psychological harm to the child which might
or might not follow, cloning is intrinsically a form of excessive parental
control, since the child is created as a copy of someone chosen by the parents.3
5. Public policy
5.1 General principles
5.1.1 The implications of the embryo's status as a human moral subject do
not stop with the duties of those individuals who are personally involved
in the creation of an embryo. There is a wider question of how society should
respond to issues surrounding research on human embryos. It is instructive
to consider how society responds to the moral rights of children and the
mentally impaired. The most basic of these rights, such as the right to
life (that is, the right not to be deliberately attacked or lethally neglected)
are seen as enforceable by law, while other rights are, at least, promoted
as a matter of public policy.
5.1.2 Moral principles regulating medical or other research on human subjects
were laid down at Helsinki in 1964 and subsequently revised at Tokyo (1975),
Venice (1983), Hong Kong (1989), Somerset West, SA (1996) and Edinburgh
(2000). Three paragraphs are pertinent to the use of human embryos for research:
3, 5 and 8.
5.1.3 The Declaration of Geneva of the World Medical Association binds
the physician with the words, "The health of my patient will be my
first consideration," and the International Code of Medical Ethics
declares that, "A physician shall act only in the patient's interest
when providing medical care which might have the effect of weakening the
physical and mental condition of the patient." (para. 3)
5.1.4 In medical research on human subjects, considerations related to
the well-being of the human subject should take precedence over the interests
of science and society. (para.5)
5.1.5 Medical research is subject to ethical standards that promote respect
for all human beings and protect their health and rights. Some research
populations are vulnerable and need special protection. The particular needs
of the economically and medically disadvantaged must be recognized. Special
attention is also required for those who cannot give or refuse consent for
themselves, for those who may be subject to giving consent under duress,
for those who will not benefit personally from the research and for those
for whom the research is combined with care. (para. 8)
5.1.6 Several points may be noticed. First, in the 1964 declaration (and
until 1989) these paragraphs, or their analogues, occurred in a section
entitled `Non-Therapeutic Biomedical Research Involving Human Subjects'.
As mentioned above (1.3.3) research for medical reasons but not for the
benefit of the subject of the experiment is properly described as non-therapeutic.
Research on a human subject without the subject's consent, where the research
would cause serious harm to the subject, where the benefits to science and
society take precedence over the life and well being of the subject, are
forbidden on every count. If research on human embryos is correctly described
as `research on human subjects', then it stands in square contradiction
to the principles laid down with so much care at Helsinki and elsewhere.
5.1.7 The right of vulnerable individuals not to be attacked always outweighs
the long-term benefit to others of medical research. However, what are we
to do in cases of doubt, where it is not clear whether the research is harmful,
or where it is not even clear that there is a human being who will be harmed?
Take the case in which it is not clear whether a patient is dead and where
a research team wishes to use his organs. If the patient is dead then removing
his organs will not harm him as there is no human individual present. However,
if the patient is alive then removing his organs will kill him. In such
cases the death of the patient must be established beyond reasonable
doubt before it is legitimate to act. 5.1.8 In the case
of human embryos, there is no social consensus as to their human or moral
status. Many people, not all of whom have interests in the research community,
do not believe that the early embryo is a human individual with an interest
in being born, and in not being harmed. The matter is fiercely debated in
respectable academic journals of philosophy, theology and social policy.
The argument presented in this paper is a contribution to that debate, giving
public reasons why the human embryo should be acknowledged as a human moral
subject. However, even if there are other reasonable people who disagree
on this matter, this does not nullify the existence of a large body of respectable
and well-reasoned opinion holding that the human individual begins at the
single cell stage. This body of academic opinion37 constitutes at the very least, a reasonable doubt
within the community as a whole concerning the status of the embryo. If
the case is unproven then the only ethical course is not to risk killing
the innocent, even for the sake of benefit to others.
5.1.9 There is no reason why society should tolerate destructive research
on human embryos, any more than similar research on older children. It is
important not to set a precedent of lethal research on human subjects, however
worthy the motive. Even if society as a whole is not sure if the embryo
is a human individual, as a society we should at least admit that this is
a strong possibility, and so exclude research on what may well be human
beings.
5.2 Benefits and alternatives
5.2.1 If there is a serious moral doubt, which continues to exist within
the national and international community, then morally questionable research
should not be permitted. However, Parliament and popular opinion has clearly
been influenced by the argument that this research is morally necessary
because it offers the only hope of finding a cure to serious diseases such
as Parkinson's, Alzheimer's and multiple sclerosis. Yet the haste with which
this decision was made gave little time to weigh the scientific evidence
in what has been an unusually fast moving field. Far from supporting the
necessity of embryonic stem cell research, the evidence from current research
suggests that there are great difficulties with embryonic stem cell therapy,
comparable in magnitude, if not greater, than those associated with adult
stem cell therapy.
5.2.2 It is not the case that embryonic stem cell research offers a real
chance in the near future of revolutionary therapy for the diseases mentioned.
Nor is it the case that there are no alternative and promising avenues of
research. The pluripotency of early embryonic cells, which is the reason
they are thought attractive, is at the same time the greatest obstacle to
their use. The flexibility of these cells makes them unpredictable in the
kinds of cells they produce, in a way which could endanger the patient if
they were ever used in transplants.
5.2.3 Clinical
promise in this area is currently being shown by adult stem cell research.
Use of adult stem cells poses no ethical problem in principle and, if the
patient's own cells are used, avoids the problem of rejection. Such treatment,
which is already underway, is morally acceptable to the vast majority of
patients. To the extent that it is thought necessary, embryonic stem cell
research can be carried on in morally acceptable ways, on cells taken from
animal embryos or, with the permission of the parents, from foetuses who
have spontaneously miscarried.38
5.2.4 Researchers have a vested interest in
stressing the prospects of their own research, but in the case of embryonic
stem cell research there is reason to doubt these prospects and the necessity
of adopting this particular approach. All things being equal, no scientist
wishes to be restricted in which methods may be employed, but social responsibility
sometimes makes legal limits right and important. We would suggest that
the public has been much misled as to the prospects of embryonic stem cell
research in relation to the (scarcely mentioned) prospects of adult stem
cell research.
5.2.5 As there are
ethical alternatives which offer similar or better immediate and/or long
term prospects, the government should give serious reconsideration to the
moral doubts which have been expressed and the public unease surrounding
the use of embryos for research, and especially the licensing of human cloning
for research purposes. Stem cell research on clone and other embryos has
been made legal without necessity at the very time when adult stem cell
research is making most progress.39
5.3 Unacceptable consequences
5.3.1 The statutory instrument which permitted cloning for research purposes
was greeted with dismay by the rest of Europe. The prohibition of cloning
recommended by the European Parliament covers cloning for research as well
as cloning for birth. Indeed, if cloning for research is permitted it seems
difficult to imagine how cloning for birth could be resisted.
5.3.2 It was only one week after the passing of the statutory instrument
by the House of Lords that Severino Antinori hosted a conference in Rome
to announce his intention to bring a clone baby to term. As so often, it
seems that the technical challenge represented by an unprecedented step
(in this case, cloning a human being) is incentive enough to impel any scientific
project. The legitimacy of this form of research is a matter of global and
not merely national concern, for research forbidden in one country will
move to another. It is imperative that the Select Committee inform itself
on the grave misgivings expressed in other scientifically developed nations
in Europe, America and Australasia, so as to reach a common mind on what
are matters of global ethical importance.
5.3.3 Not only would the acceptance of cloning for research make cloning
for birth inevitable, in the judgment of many, but it would also make inevitable
a further extension of research on human embryos beyond 14 days. There are
places where logically and politically a line can be drawn, and cloning
is one of few such lines. A ban on cloning is supported by a great mass
of people internationally and could provide a bulwark against further erosion
of ethical standards within medical research. If society is not able to
resist the attraction of this research, when the benefits are uncertain
and international opinion is against it, it is hard to imagine what, in
the future, it would be able to resist.
5.3.4 If stem-cell research on human embryos and cloning for research go
ahead, this will seriously compromise many physicians and patients if and
when treatments based on this research become available. In contrast, if
research funds are diverted to develop treatments that all can accept, patients
and doctors will not be placed in this invidious situation.
5.4 Recommendation
5.4.1 It is not too late to reconsider this matter. Although the findings
of the Select Committee have no weight in law, and the statutory instrument
has already been passed, if the Committee were to argue strongly against
permitting cloning for research, in particular, it would be difficult for
the government to ignore its findings. The legislation might yet prove a
dead letter, with the HFEA unwilling to give licenses, or further legislation
might be introduced to prevent all human cloning. A moratorium on using
clone or IVF embryos in stem cell research would help adult stem cell research
attract more of the available research funds so as further to prove its
case as scientifically as well as ethically superior. Research on clone
or other embryos contravenes basic principles of justice and seriously threatens
international ethical standards in research. This is an opportunity to prevent
a step being taken that need not and should not be taken. It is a question
of having the prudence to know when a line must be drawn, and the courage
to draw it.
6. Responses
to questions
6.0.1 The Select Committee has set out certain questions to which we here
respond. However, we are not thereby endorsing these as the most pertinent
questions which could be asked, and our answers cannot be taken as a summary
of this Submission (a summary is provided before the Introduction, S.1 7).
6.1 Do the additional purposes in the 2001 Regulations raise issues
of principle different from the purposes specified in the 1990 Act?
6.1.1 Yes, destroying human embryos in stem-cell research leads to new questions
of conscience (4.5.1-5; 5.3.4); furthermore, the interpretation of these
regulations as allowing cloning for research raises the question of the
ethical legitimacy of cloning (4.4.1-2; 4.6.1-6), and also the question
of whether and how to promote alternative avenues of research (5.2.1-5).
However, the most important issue of principle is one already compromised
in the 1990 Act and which urgently needs to be reviewed; i.e. the legitimacy
of producing and using human embryos for destructive research (4.1.1-4.3.3).
6.2 There is a range of different views world-wide on the acceptability
of research on embryonic stem cells. What considerations underlie these
differences? Do changes in the law here have implications for practice overseas
and vice versa?
6.2.1 Those who accept embryonic stem-cell research either see no ethical
objection to what seems to be a beneficial technical advance or else they
have accepted the overriding necessity of this form of research.
6.2.2 Those who object do so for many different reasons. What they have
in common is that they are unconvinced by claims of the imminence of the
prospective benefits and/or by claims of the necessity of research using
these means (2.1.1-2.2.5). Many also hold that there are ethical objections
in principle to this kind of research (4.1.1-5.1.9; 5.3.1-4).
6.3 Have increased globalisation and other international commercial developments,
in relation, for example, to e-commerce and patenting, changed the context
of the debate in the UK? Would issues relating to research on embryos benefit
from more attention at international level?
6.3.1 Yes scientific research and development is now an international
endeavour and effective regulation and maintenance of ethical standards
requires international co-operation. If one country allows unethical research
then it will quickly attract those wishing to avoid restrictions placed
on research in their own countries. Such international research tourism
is already apparent with some fertility treatments, and cloning would surely
follow this pattern. As international co-operation is essential, it is important
to pay close attention to the concerns of international partners when framing
domestic legislation in this area (5.3.1-2).
6.4 What are the potential medical benefits of stem cell research? What
is the most likely time-scale for realising them? What are the potential
risks?
6.4.1 There are great potential benefits from stem-cell research for
a range of diseases. Some patients are already benefiting from (adult) stem
cell research; however, for other conditions it will take many years before
we see results at the clinical level.
6.5 There are differing views on the extent to which potential treatments
could be developed from non-embryonic stem cells, such as adult and umbilical
cord stem cells. What are the advantages and disadvantages of working with
these alternative sources of stem cells?
6.5.1 Treatments using adult and umbilical cord stem cells are already
being carried out for some conditions (2.1.1-2.2.5). It is clearly best
if the patient's own cells can be used to avoid rejection problems. Cloning
has been mooted as a way to avoid these problems; however, the high rate
of genetic abnormality found in animal clones casts doubt over the safety
of cloning for transplantation (2.4.1).
6.5.2 Another advantage of adult stem cell research is that human ova (already
a scarce resource in fertility treatment) are not required to generate adult
stem cells.
6.5.3 Adult stem cells are also more stable and less inclined to produce
cancer or disorganized growths (2.2.1-4; 2.4.1).
6.6 What are the commercial interests involved in research in this area?
Does increased commercial involvement create additional ethical difficulties?
6.6.1 Biotechnology companies have invested heavily in cloning and embryonic
stem cell patents. Commercial interests endanger the clarity of the ethical
discussion as commercial benefits may distort the fair presentation of the
medical benefits.
6.7 Human reproductive cloning (the transfer of an embryo created by
cell nuclear replacement into a woman's uterus) is unlawful in the UK, and
the Government has announced its intention of reinforcing this ban by specific
primary legislation. Is there likely to be any pressure to resist such a
ban? What are the principal ethical (and scientific) arguments against human
reproductive cloning?
6.7.1 If it has proven politically difficult to block research on cloned
embryos, even though this is unnecessary and unethical, it may also prove
difficult to block requests that some clones be allowed to come to term
to fulfill the desire of an infertile couple for a child.
6.7.2 Cloning for birth is objectionable: first, as it would involve the
creation of hundreds of damaged embryos, most of whom would miscarry; second,
as it would impose significant risks on the gestating mother; and third,
as the clone would be produced asexually and according to a predetermined
genetic plan. Cloning would deprive the child of natural parentage and genetic
novelty and subject him or her unfairly to the desires of the commissioning
parents (4.6.1-7).
6.7.3 All cloning, including `therapeutic cloning', is reproductive in the
sense that it generates a new embryonic individual (1.3.2-4). In any primary
legislation, human reproductive cloning should be defined as `cloning for
the purpose of implantation'. It is the initial generation of the clone
embryo which should be prohibited, not the implanting of a clone embryo
who already exists.
6.8 Does the extension of embryonic stem cell research, and, in particular,
the technique of cell nuclear replacement therapy (therapeutic cloning)
- designed to grow tissue for therapeutic purposes - increase the likelihood
of human reproductive cloning in the future?
6.8.1 Yes it is clear to everyone that cloning for research facilitates
cloning for birth both technically and politically (4.4.2).
6.8.2 It should, however, be made clear that generating clones who will
then be destroyed in the course of `harvesting' their cells is itself seriously
wrong irrespective of the fact that it might lead to cloning for birth.
Indeed, in its treatment of the clone embryo, `therapeutic cloning' is a
greater injustice than `reproductive cloning' (3.3b.6-7).
6.9 Has the regulatory framework established by the 1990 Act operated
effectively? Is it likely to remain adequate for the foreseeable future?
Have any gaps appeared in the regime as a result of developments since 1990?
6.9.1 The 1990 Act presumed the legitimacy of creating embryos in the
course of fertility treatment who would not be implanted, and even of creating
embryos purely for the sake of destructive research. As these procedures
are both unethical, the regulatory framework could never have `operated
effectively' in any ethical sense.
6.9.2 The intention of the statutory instrument seems to presuppose the
existence of a significant gap, in that the 1990 Act forbade one technique
of human cloning but did not envisage cloning by the `Dolly' technique.
It is remarkable that this gap should be thought a sufficient basis for
the regulation of such an ethically contentious issue as the creation and
use of cloned human embryos.
6.10 Do additional guidelines need to be developed to assist the Human
Fertilisation and Embryology Authority in issuing licences in accordance
with the new Regulations? If so, what should the guidelines contain?
6.10.1 If fundamental ethical principles have already been compromised
in the framing of the Regulations themselves, it is difficult to see what
could be the ethical basis of any further guidelines. Additional specification
could perform only a cosmetic or a rhetorical function, not the function
of specifying in greater detail valid ethical principles.
Notes
1 Finnis,
J. (2000) `Some fundamental evils in generating human embryos by cloning'
in Mazzoni, C.M. (2000) Etica della Ricerca Biologica Florence: Leo
S. Olschki. back to text 2 Cells from a clone embryo
would, of course, be more compatible with those of the patient. back to text 3 Cavazzana-Calvo, M. et
al. (2000) `Gene therapy of human severe combined immunodeficiency (SCID)-X1
disease', Science 288, 669-672, April 28. back
to text 4 Associated Press (2000) `Approach
may renew worn hearts', Nov 12. See also Wang, J.S. et al. (2000)
`Marrow stromal cells for cellular cardiomyoplasty: Feasibility and potential
clinical advantages', J Thorac Cardiovasc Surg 120, 999-1006, Nov;
Scorsin, M. et al. (2000) `Comparison of the effects of fetal cardiomyocyte
and skeletal myoblast transplantation on post-infarction left ventricular
function', J Thorac Cardiovasc Surg 119, 1169-1175, 6. back to text 5 Tuszynski, M.H. (2000) `Intraparenchymal
NGF infusions rescue degenerating cholinergic neurons', Cell Transplant
9, 629-636, SeptOct. back to text 6 Horwitz, E.M. et al.
(1999) `Transplantability and therapeutic effects of bone marrow-derived
mesenchymal cells in children with ontogenesis imperfecta', Nat.Med.
5, 309-313, March. back to text 7 Schwab, I.R. et al.
(2000) `Successful transplantation of bioengineered tissue replacements
in patients with ocular surface disease', Cornea 19, 421-426, July. back to text 8 Traynor, A.E. et al.
(2000) `Treatment of severe systemic lupus erythematosus with high-dose
chemotherapy and haemopoietic stem-cell transplantation: a phase 1 study',
Lancet 356, 701-707, August 26. back
to text 9 Martini, A. et al.
(1999) `Marked and sustained improvement 2 years after autologous stem cell
transplant in a girl with system sclerosis', Rheumatology 38l, 773,
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(1999) `Hematopoietic stem cell transplantation of multiple sclerosis, rheumatoid
arthritis, and systemic lupus erythematosus', Cancer Treat. Res.
101, 157-184. back to text 11 Dunkel, I.J. et al.
(2000) `Successful treatment of metastatic retinoblastoma', Cancer
89, 2117-2121, Nov 15. back to text 12 In the case of cells from
older embryos or foetuses, scientists are experimenting with `embryoid body-derived'
cells created from embryonic cells, which seem easier to control (Shamblott,
M.J. et al. (2001) `Human embryonic germ cell derivatives express
a broad range of developmentally distinct markers and proliferate extensively
in vitro', Proc Natl Acad Sci USA 98, 113-118, Jan 2). back to text 13 Folkerth, R.D., Durso, R.
(1996) `Survival and proliferation of non-neural tissues, with obstruction
of cerebral ventricles, in a Parkinsonian patient treated with fetal allografts',
Neurology 46, 1219-25. back to text 14 Weber, W., Butcher, J. (2001)
`Doubts over cell therapy for Parkinson's disease', Lancet 357, 859,
March 17. back to text 15 Vogel G. (2000) `Stem Cells:
New Excitement, Persistent Questions', Science 290, 1674, 1 December. back to text 16 Ibid. back
to text 17 Aldous, P. (2001) `Can they rebuild us?' Nature 410, 622-623 April 5. back
to text 18 However, it is not necessary
for this argument to question whether, and if so to what degree, these personal
characteristics might be shared by another species. The presence of one
or even several `fellow travellers' does nothing to undermine the intrinsic
worth or dignity of specifically human life, and it is this that
is at issue here. back to text 19 We are using the term `subject'
rather than `person' because there are now so many conflicting meanings
of `person' that the word often confuses rather than clarifies discussion. back to text 20 De duabus naturis,
c.3; cf. Thomas Aquinas Summa Theologia Ia Q. 29 art. 1. back to text 21 Not only classical philosophers
but also many great philosophers of the twentieth century have attempted
to hold together the unity and the transcendence of human beings, and so
avoid the twin errors of `reductionism' and `dualism'. Examples are Whitehead,
Wittgenstein (both early and late), Heidegger, Husserl and many modern followers
of Aristotle and Thomas Aquinas. back to text 22 Flew, A. (1978) The Rational
Animal Oxford: Clarendon Press; Midgely, M. (1979) Beast and Man
London: Methuen; Braine, D. (1992) The Human Person: Animal and Spirit
Notre Dame, Indiana: UNDP; Olson, E. (1997) The Human Animal Oxford:
OUP. back to text 23 Gilbert, S. (1997) 5th ed.
Developmental Biology, New York: Sinauer Assoc, p. 121. back to text 24 Gilbert (1997) p. 3. back to text 25 Wolpert, L. (1991) The
Triumph of the Embryo Oxford: OUP, p. 11. back
to text 26 Walbot, V., Holder, N. (1987)
Developmental Biology New York: Random House, p. 26. back to text 27 Alberts, B. et al.
(1989) Molecular Biology of the Cell 2nd ed. New York: Garland Publishing,
p. 881. back to text 28 Gilbert (1997) p. 186. back to text 29 Wolpert, L. (1998) Principles
of Development Oxford: OUP, p. 80. back
to text 30 Very occasionally, the process
of separation of the twins is incomplete, leading to conjoined twins. However
even in this case one can generally recognise two individuals (hence the
term `conjoined twins'). The process which gives rise to conjoined
twins seems to be a distinct process with a different cause from that which
gives rise to the formation of a disorganised teratoma. back to text 31 McWhinnie, A. (1996) `Outcome for Families Created by
Assisted Conception Programmes' Journal of Assisted
Reproduction and Genetics 13 (4), p. 363. back
to text 32 Even if the abortion in
question were supposed to be of `such moral complexity' as not to be `inevitably
so heinous' (Polkinghorne, J. et al. (1989) Review of the Guidance
on the Research Use of Fetuses and Fetal Material London: HMSO, para.
2.7) it cannot be appropriate that the agents of a child's death should give
consent to the use of his or her body. Involvement in killing, even without
subjective culpability, disqualifies one from acting as an executor, cf. Keown,
J. (1993) `The Polkinghorne Report on Fetal Research: Nice Recommendations,
Shame About the Reasoning' Journal of Medical Ethics 19 (2) 114-120. back to text 33 Cf. Elshtain, J.B. `To Clone
or Not To Clone?' and Tracy, D. `Human Cloning and the Public Realm: A Defense
of Intuitions of the Good' in Nussbaum, M.C., Sunstein, C.R. (1998) Clones
and Clones: Facts and Fantasies about Human Cloning New York: W.W. Norton
& Co.; Kass, L. `The Wisdom of Repugnance' in Pence G.E. (1998) Flesh
of My Flesh: The Ethics of Cloning Humans Lanham, MD: Rowman & Littlefield;
Midgley, M. (2000) `Biotechnology and Monstrosity: Why We Should Pay Attention
to the "Yuk Factor"' Hastings Center Report 30 (5) 715. back to text 34 Cf. Gould, S.J. `Dolly's
Fashion and Louis's Passion' in Pence (1998); Lewontin, R.C. (1993) The
Doctrine of DNA: Biology as Ideology London: Penguin Books; Appleyard,
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to text
