Life Liberty & the Defense of Dignity

The Challenge for Bioethics

Leon Kass

• Publisher: Encounter Books
• Year: 2002
• ISBN:
  9781594033902
• Topic: Medizin
• Subtopic: Ethik in der Medizin

At the onset of Life, Liberty and the Defense of Dignity, Leon Kass gives us a status report on where we stand today: "Human nature itself lies on the operating table, ready for alteration, for eugenic and psychic 'enhancement, ' for wholesale redesign. In leading laboratories, academic and industrial, new creators are confidently amassing their powers and quietly honing their skills. For anyone who cares about preserving our humanity, the time has come for paying attention." Trained as a medical doctor and biochemist, Dr. Kass has become one of our most provocative thinkers on bioethical issues. In Life, Liberty and the Defense of Dignity, he has written a book that grapples with the moral meaning of the new biomedical technologies now threatening to take us back to the future envisioned by Aldous Huxley in Brave New World. In a series of mediations on cloning, embryo research, the sale of organs, and the assault on mortality itself, Kass questions the wisdom of trying to break down the natural boundaries given us and to remake the human body into an instrument of our will. He also attempts to chart a course by which we might avoid the dehumanization of biotechnical "recreationism" without rejecting modern science or rejecting its genuine contributions to human welfare. Leon Kass writes profoundly about the limits of science and the limits of life, about what makes us human and gives us human dignity. Life, Liberty and the Defense of Dignity.

Ethical Challenges from Biotechnology

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Life and Lineage:
Genetics and the
Beginning of Life

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CHAPTER THREE

The Meaning of Life—in the Laboratory

People will not look forward to posterity who never look backward to their ancestors.

—Edmund Burke

What’s a nice embryo like you doing in a place like this?

—Traditional

The readers of Aldous Huxley’s novel, like the inhabitants of the society it depicts, enter into the Brave New World through “a squat gray building . . . the Central London Hatchery and Conditioning Centre,” beginning, in fact, in the Fertilizing Room. There, three hundred fertilizers sit bent over their instruments, inspecting eggs, immersing them “in warm bouillon containing free-swimming spermatozoa,” and incubating the successfully fertilized eggs until they are ripe for bottling (or Bokanovskification). Here, most emphatically, life begins with fertilization—in the laboratory. Life in the laboratory is the gateway to the Brave New World.

We stand today fully on the threshold of that gateway. How far and how fast we should continue to travel through this entrance is not a matter of chance or necessity but rather a matter of human decision—our human decision. Indeed, it seems to be reserved to the people of this country and this century, by our conduct and example, to decide also this important question.

Should we allow or encourage the initiation and growth of human life in the laboratory? This question, in one form or another, has been an issue for public policy since the mid-1970s, even before the birth of the first test-tube baby in the summer of 1978. Back in 1975, after prolonged deliberations, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research issued its report and recommendations for research on the human fetus. The Secretary of Health, Education and Welfare (HEW) then published regulations regarding research, development and related activities involving fetuses, pregnant women and in vitro fertilization. These provided that no federal monies should be used for in vitro fertilization of human eggs until a special Ethics Advisory Board reviewed the ethical issues and offered advice about whether government should support any such proposed research. Perhaps for the first time in the modern era of biomedical research, public deliberation and debate about ethical matters led to an effective moratorium on federal support for experimentation.

A few years later, the whole matter once again became the subject of intense policy debate when an Ethics Advisory Board was established to consider whether the United States government should finance research on human life in the laboratory. The question had been placed on the policy table by a research proposal submitted to the National Institute of Child Health and Human Development by Dr. Pierre Soupart of Vanderbilt University. Dr. Soupart requested $465,000 for a study to define in part the genetic risk involved in obtaining early human embryos by tissue culture methods. He proposed to fertilize about 450 human ova, obtained from donors undergoing gynecological surgery (that is, not from women whom the research could be expected to help), with donor sperm, to observe their development for five to six days, and to examine them microscopically for chromosomal and other abnormalities before discarding them. In addition, he planned to study whether such laboratory-grown embryos could be frozen and stored without introducing abnormalities, for it was thought that temporary cold storage of human embryos might improve the success rate in the subsequent embryo transfer procedure used to produce a child. Though Dr. Soupart did not then propose to perform embryo transfers for women seeking to become pregnant, his research was intended to serve that goal: he hoped to reassure us that baby-making with the help of in vitro fertilization was safe, and he sought to perfect the techniques of laboratory growth of human embryos introduced by Drs. Robert Edwards and Patrick Steptoe in England.

Dr. Soupart’s application was approved for funding by the National Institutes of Health (NIH) in October 1977, but because of the administrative regulations, it could not be funded without review by an Ethics Advisory Board. The HEW secretary at the time, Joseph Califano, convened such a board and charged it not only with a decision on the Soupart proposal, but with an inquiry into all the scientific, ethical and legal issues involved, urging it “to provide recommendations on broad principles to guide the Department in future decision-making.” After six months of public hearings all over the United States and another six months of private deliberation, the board issued its report in 1979, recommending that research funding be permitted for some in vitro experimentation—including the sort proposed by Dr. Soupart. But until very recently, no secretary of health and human services has been willing to act on that recommendation. In fact, Dr. Soupart died in 1981 without having received a clear answer from the government.

There the matter stood until 1994. In the previous year, Congress and President Clinton had for the first time given NIH the authority to support research on human embryos. In response, NIH established the Human Embryo Research Panel to assess the moral and ethical issues raised by this research and to develop recommendations and guidelines for the agency’s review. In September 1994 the panel released its report, recommending that some areas of human embryo research be acceptable for federal funding, including research on embryos created expressly for the purposes of research, under certain limited conditions. Two months later, the Advisory Committee to the Director of NIH unanimously accepted the panel’s report. However, President Clinton directed NIH not to allocate resources to “support the creation of human embryos for research purposes,” though his directive said nothing about research involving so-called “spare” embryos remaining from clinical in vitro fertilization procedures performed to help infertile couples become parents. While NIH was in the process of developing guidelines to support research using those “spare” embryos, Congress stopped the enterprise dead in its tracks by enacting an amendment to the omnibus appropriations bills that prohibited NIH from using federal funds for any and all research on human embryos. Similar congressional prohibitions have been enacted in every year since then. Meanwhile, private-sector research using human embryos was heating up, yielding some remarkable discoveries that would soon reignite the controversy about federal funding for human embryo research.

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In November 1998, Dr. James Thomson of the University of Wisconsin and Dr. John Gearhart of Johns Hopkins University announced the isolation of human embryonic stem cells, so-called pluripotent cells extracted from human embryos that are capable of being turned into any of the tissues of the body. As a result of this capacity, these cells are widely believed to hold great promise for regenerative medicine—the replacement of damaged tissues responsible for many horrible genetic or chronic diseases or disabilities. With this discovery, privately funded research on human embryos went into high gear, and federally funded researchers looked for ways to circumvent the legislative prohibition. By a clever interpretation of the law that went against its spirit but not its letter, NIH attorneys ruled that the prohibiting law actually permitted federal funding of research on the embryonic stem cell lines, provided that the researchers were not themselves responsible for the acts of embryo destruction needed to produce them. After a study by the National Bioethics Advisory Commission supported such research, and after the NIH developed guidelines for it, President Clinton authorized such funding in 2000.

Then, a newly elected President Bush announced early in 2001 that he would review the matter before permitting implementation of the NIH plan. During the following six months of deliberation, President Bush consulted widely with persons holding every imaginable viewpoint on the subject, as he sought to find a solution to his moral dilemma: how to allow federally funded scientists an opportunity to find out whether embryonic stem cells could indeed deliver on their therapeutic promise, while at the same time upholding his strong belief that nascent life should not be destroyed in the process. In August 2001, he announced his solution. The federal government would agree to fund embryonic stem cell research only on already existing stem cell lines, but there would be no cooperation in, and no abetting of, any further destruction of human embryos. That is where things stand as this book goes to press, though it is almost certain that we have not heard the end of the matter. The existing stem cell lines might age and wither; newly derived cell lines may show more promise than the existing ones; and other important uses for human embryos in research and treatment will no doubt be discovered. It is almost as certain as death and taxes that we shall experience enormous pressures to grow more and more life in the laboratory. It is thus extremely important that we think about the meaning of doing so and assess the moral arguments for and against.

The Meaning of the Question

How should one think about such ethical matters, here and in general? There are many possible ways, and it is not altogether clear which way is best. For some people, ethical issues are immediately matters of right and wrong, of purity and sin, of good and evil. For others, the critical terms are benefits and harms, promises and risks, gains and costs. Some will focus on so-called rights of individuals or groups (for example, a right to life or childbirth); still others will emphasize supposed goods for society and its members, such as the advancement of knowledge and the prevention and cure of disease. My own orientation here is somewhat different. I wish to suggest that before deciding what to do, one should try to understand the implications of doing or not doing. The first task, it seems to me, is not to ask “moral or immoral?” or “right or wrong?” but to try to understand fully the meaning and significance of the proposed actions.

This concern with significance leads me to take a broad view of the matter. For we are concerned here not only with some limited research project of the sort proposed by Dr. Soupart, and the narrow issues of safety and informed consent it immediately raises; we are concerned also with a whole range of implications, including many that are tied to foreseeable consequences of this research and its predictable extensions—and touching even our common conception of our own humanity. As most of us are at least tacitly aware, more is at stake than in ordinary biomedical research or in experimenting with human subjects at risk of bodily harm. At stake is the idea of the humanness of our human life and the meaning of our embodiment, our sexual being, and our relation to ancestors and descendants. In thinking about necessarily particular and immediate decisions, we must be mindful of the larger picture and must avoid the great danger of trivializing the matter for the sake of rendering it manageable.

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The Status of Extracorporeal Life

The meaning of “life in the laboratory” turns in part on the nature and meaning of the human embryo, isolated in the laboratory and separate from the confines of a woman’s body. What is the status of a fertilized human egg (that is, a human zygote) and the embryo that develops from it? How are we to regard its being? How are we to regard it morally (that is, how are we to behave toward it)? These are, alas, all too familiar questions. At least analogous, if not identical, questions are central to the abortion controversy and are also crucial in considering whether and what sort of experimentation is properly conducted on living but aborted fetuses. Would that it were possible to say that the matter is simple and obvious, and that it has been resolved to everyone’s satisfaction!

But the controversy about the morality of abortion continues to rage and divide our nation. Moreover, many who favor or at least do not oppose abortion do so despite the fact that they regard the pre-viable fetus as a living human organism, even if less worthy of protection than a woman’s desire not to give it birth. Almost everyone senses the importance of this matter for the decision about laboratory culture of and experimentation with human embryos. Thus, we are obliged to take up the question of the status of the embryo in our search for the outlines of some common ground on which many of us can stand. To the best of my knowledge, the discussion that follows is not informed by any particular sectarian or religious teaching, though it may perhaps reveal that I am a person not devoid of reverence and the capacity for awe and wonder, said by some to be the core of the religious sentiment.

I begin by noting that the circumstances of laboratory-grown blastocysts (that is, three-to-six-day-old embryos, containing from 100 to 200 cells) and embryos are not identical with those of the analogous cases of living fetuses facing abortion or living aborted fetuses used in research. First, the fetuses whose fates are at issue in abortion are unwanted, usually the result of “accidental” conception. The lab-grown embryos are wanted and deliberately created, despite certain knowledge that many of them will be destroyed or discarded. Moreover, the fate of these embryos is not in conflict with the wishes, interests or alleged rights of the pregnant women. Second, though the federal guidelines governing fetal research permit studies conducted on the not-at-all viable aborted fetus, such research merely takes advantage of available “products” of abortions not themselves undertaken for the sake of the research. No one has proposed and no one would sanction the deliberate production of live fetuses to be aborted for the sake of research—even very beneficial research.^e In contrast, we are here considering the deliberate production of embryos for the express purpose of experimentation.

The cases may also differ in other ways. Given the present state of the art, the largest embryo under discussion is the blastocyst, a spherical, relatively undifferentiated mass of cells, barely visible to the naked eye. In appearance, it does not look human; indeed, only the most careful scrutiny by the most experienced scientist might distinguish it from similar blastocysts of other mammals. If the human zygote and blastocyst are more like the animal zygote and blastocyst than like the twelve-week-old human fetus (which already has a humanoid appearance, differentiated organs and electrical activity of the brain), then there will be a much-diminished ethical dilemma regarding their deliberate creation and experimental use. Needless to say, there are articulate and passionate defenders of all points of view. Let us try, however, to consider the matter afresh.

First of all, the zygote and early embryonic stages are clearly alive. They metabolize, respire and respond to changes in the environment; they grow and divide. Second, though not yet organized into distinctive parts or organs, the blastocyst is an organic whole, self-developing, genetically unique and distinct from the egg and sperm whose union marked the beginning of its career as a discrete, unfolding being. While the egg and sperm are alive as cells, something new and alive in a different sense comes into being with fertilization. The truth of this is unaffected by the fact that fertilization takes time and is not an instantaneous event. For after fertilization is complete, there exists a new individual, with its unique genetic identity, fully potent for the self-initiated development into a mature human being, if circumstances are cooperative. Though there is some sense in which the lives of egg and sperm are continuous with the life of the new organism (or, in human terms, that the parents live on in the child-to-be), in the decisive sense there is a discontinuity, a new beginning, with fertilization. After fertilization, there is continuity of subsequent development, even if the locus of the new living being alters with implantation (or birth). Any honest biologist must be impressed by these facts, and must be inclined, at least on first glance, to the view that a human life begins at fertilization.^f Even Dr. Robert Edwards had apparently stumbled over this truth, perhaps inadvertently, in his remark about Louise Brown, his first successful test-tube baby: “The last time I saw her, she was just eight cells in a test-tube. She was beautiful then, and she’s still beautiful now!”

Granting that a human life begins at fertilization and develops via a continuous process thereafter, surely—one might say—the blastocyst itself can hardly be considered a human being. I myself would agree that a blastocyst is not, in a full sense, a human being—or what the current fashion calls, rather arbitrarily and without clear definition, a person. It does not look like a human being nor can it do very much of what human beings do. Yet, at the same time, I must acknowledge that the human blastocyst is (1) human in origin and (2) potentially a mature human being, if all goes well. This, too, is beyond dispute; indeed, it is precisely because of its peculiarly human potentialities that people propose to study it rather than the embryos of other mammals. The human blastocyst, even the human blastocyst in vitro, is not humanly nothing; it possesses a power to become what everyone will agree is a human being. One could even go further: the in vitro blastocyst is exactly what a human being is at that stage of human development. Only its extracorporeal location is different.

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Because of the embryo’s special location, it may be objected that the blastocyst in vitro has today no such power, because there is presently no in vitro way to bring the blastocyst to that much later fetal stage in which it might survive on its own. There are no published reports of the culture of human embryos past the blastocyst stage (though this has been reported for mice). The in vitro blastocyst, like the twelve-week-old aborted fetus, is in this sense not viable (in other words, it is at a stage of maturation before the stage of possible independent existence). But if, among the not-viable embryos, we distinguish between the pre-viable and the not-at-all viable—on the basis that the former, ...