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FIRST MEETINGFriday, January 18,
2002
Session 6: Human Cloning 3: Policy Issues and
Research Cloning Discussion of
Cloning Working Paper
#4
CHAIRMAN
KASS: All right. We come
to the last of the cloning sessions, and the last session before the
public comment session, and this is a session devoted to policy
considerations. Again, the working paper has been prepared not
because it represents any even tentative view of this Council, but
to stimulate discussion.
There are lots of policy options
for any of the matters that might come to our attention, and it
would be very nice if one could have a de novo discussion of it. But
once one embarked on the discussion of cloning, we discover that we
do not start de novo, but we start in a world in which the policy
discussion has been framed for us by legislative options. And it
would be irresponsible of us to pretend that that was not the case,
and therefore, in this case, even if this might be the unique case,
we come at the policy questions in the light of the question of
legislation. I think Frank Fukuyama said yesterday, and I agree with
him, legislative bans are if ever useful, going to be rarely useful
in these complicated areas. So, this might be an exception, but here
we are.
I would like to divide this session into two parts
as the working paper has divided it. First, to look at the major
legislative alternatives, and then, an initial discussion of
research or therapeutic cloning, some scientific, moral, and policy
questions. On neither of these topics, and we can say this with
certainty in advance, are we going to get very far today. This is
meant really to-- This whole meeting on cloning has been meant to
sort of lay the table, and to get the parts of the discussion
opened. Lots more work is going to have to be done on all of this.
The relation between these two parts I would like to put my
own personal spin on, although others can dissent from it. The moral
and practical questions connected with research cloning are partly
connected to the question of reproductive cloning, primarily because
they come up in the context of legislative bans that have been
proposed. That is an unavoidable fact of life. But the moral
questions connected to cloning embryos for research are not that
different from the moral questions of creating embryos for research
by IVF or some other means. In other words, the ethical issues of
the questions about therapeutic cloning are not that different from
the scientific and medical issues, and ethical issues, connected
with all embryo research. And it is somewhat uncomfortable, I think,
to have to be thinking about the reproductive cloning question, and
large questions of embryo research at the same time, but there is a
confluence of the two subjects.
So, we will not shortchange
that subject at all, but I regard the major activity of this body to
have been to take up the really novel thing, which is this new
proposal, new mode of human baby-making. But we would be
irresponsible to pretend that this other matter is not central to
the debate, and we will, therefore, try to do it as responsibly as
we can, though I hope that we do not have to at great length take up
all aspects of embryo research, but people on the Council might
think otherwise, and it may turn out to be not feasible to do so.
But you will see that the question of research cloning comes up in
the context of the policy considerations, rather than as a separate
matter.
Now, pertinent to this discussion, and I will start
the policy discussion in a moment, I repeat, the National Academy of
Sciences report is out, and so is the report from California, and I
will see to it that we all have these materials within the week. And
I think we will want to have people come to speak with us about
that, and to indicate, I think, their view of how the discussions of
the research cloning fit into the overall discussion that we are
having here. So, it may be that this preliminary place of putting it
in the context of policy may have to be amended, but the reason it
is there I think I have articulated.
All right. Part I, the
legislative options, and the staff has laid out, in fact, the three
options: no ban, a partial ban on reproductive only, and a ban on
all cloning.
Mindful of the kinds of arguments that Stephen
Carter made about intruding government regulation, and especially
legislative bans, we have taken up and made, I think, a series of
good points in favor of a position which said there should be no
legislative action whatsoever, summarized on page 2 and 3. But as
Charles has pointed out, everybody in the House of Representatives
was for some kind of ban or other, and therefore, it seems that at
least if we want to think in the context in which we find ourselves,
the real legislative alternatives are the ban on clonal reproduction
only which would prohibit the attempt to initiate a pregnancy, or a
ban on cloning in toto beginning with the creation of the embryonic
clones.
I do not think it is necessary to summarize the
arguments here. I mean, you may like some of them, or not like them,
but I think people have tried fairly, at least in this case, to
state the positions that have been heard on various sides, and I
would simply like to open the discussion with, I guess, one further
comment.
As I see it, the gist of the arguments are one:
whether if you are seriously interested in stopping reproductive
cloning, an attempt to do just that would be sufficiently effective.
There is the effectiveness argument. There is on the other side an
argument which says the ban on all human cloning is too costly in
terms of what it would cost us in scientific and medical research.
And the third point would be the moral argument having to do with
the question of creating embryos solely for research, and with the
added peculiarity in the law in which it would become a federal
offense not to destroy them. That would be the novel wrinkle of the
law which explicitly sanctioned the creation of embryos for
research, and then made it a crime to implant them. I think those
are the three major pieces of the discussion, but other of you may
have other points, and I think the floor should just be open, and
let it go where it will.
Elizabeth, please.
DR.
BLACKBURN: I am going to confront
right away the idea that you said perhaps in the last sentence or
two. You said cloning for medical research. I think that misses an
essential point. What is the point of the research? It is not for
the self-indulgence of people who just like to, you know, putter
around lab benches. It is truly to relieve human suffering. That
really is the end goal of this, and I think we should not leave that
out of sight.
And I am actually concerned when I read the
working paper. I am concerned that I felt a bias in the writing.
There was the quotes "therapeutic" cloning. But there was never
quotes around other words. You know, I just want to raise that,
because I know you will say that, of course, these are only
beginning working papers, and I am glad to hear that. But I just
wanted to say since you did say today is about laying the table.
CHAIRMAN
KASS: Please.
DR.
BLACKBURN: The table was laid with
some silverware that, you know, I am a bit concerned about, and that
was the way this was written. So, I do want to hear when we talk
about medical research, I think we should not uncouple it from its
inextricable goal which is to try to relieve human suffering.
CHAIRMAN
KASS: Point not only well
taken, but I think if it is in any way not made explicit here, it
should be understood.
I think to explain the quotes, by the
way, the language has been much convoluted, and much argued afore,
and we have put-- We did not know what right name to call this, and
we put reproductive cloning in quotes, and we put research cloning
in quotes, and I think the glossary there has been an attempt to try
to indicate that there is a difficulty about the right language. The
therapeutic intent is perfectly laid out in the discussion of the
research cloning in that section, but I take your point completely.
DR.
BLACKBURN: Words carry freight with
them, and research means something, I think, which does not always
imply what I think in this context is very important to keep in
mind, what is the research's goal. That was all I wanted to do.
CHAIRMAN
KASS: I mean, it has been
very puzzling, Elizabeth, that at the very beginning of these
debates in Congress, the proponents of therapeutic cloning, we will
call it, were very eager to have the word "therapeutic" cloning
used. But now many of those people have retracted from that term
because they like the presence of the term "cloning" less than they
like the benefit that is gained from calling it "therapeutic". And
we need, I think, to sort this out amongst ourselves. But let me not
belabor it. I take your point completely.
Where were we?
Jim, Robbie--
DR.
WILSON: I need help from
the scientists here, because I am uninitiated with respect to what
we now choose for the moment to call therapeutic cloning. On page 3
it says a ban on clonal reproduction only would begin with a ban on
an attempt to start a pregnancy by banning the transfer to a woman's
uterus of a cloned human embryo. And it suggests that therapeutic
cloning, or whichever you wish to call it, can be done entirely in a
petri dish. That is to say that a woman's uterus is nowhere
necessary. It also leaves the question open-- And is that true? I
want to make sure I understand the facts. Secondly, how long does
the fertilized egg have to grow before it can produce cells useful
in therapy? Or do we know the answer to the question?
CHAIRMAN
KASS: We know the answer
to that. They grow to the blastocyst stage, at least with respect to
the stem cell kind of research that people want to do. It grows to
the blastocyst stage, a couple of hundred cells, age about four to
five days.
DR.
WILSON: It would be nice
to have these things recorded here, because those of us--
(Simultaneous discussion.)
DR. HURLBUT: I
am sorry. I am not quite sure what the question is.
DR.
BLACKBURN: Oh, I was hoping Bill
could say something addressing the issue--
(Simultaneous
discussion.)
DR.
WILSON: --how long a
fertilized egg has to grow before it becomes useful for therapeutic
or regenerative purposes.
DR. HURLBUT:
Just what Leon said, the blastocyst stage. They take the inner cell
mass, which is the part that will become the embryo, and that forms
around four to five days. It is usually put into the woman's womb
five to six days, and implants approximately six days in humans.
Much later, by the way, in cattle, which is why some of the studies
done with cattle do not parallel with the stage in humans.
DR.
WILSON: But it is
transferred into a woman's womb, uterus?
DR. HURLBUT: It
does not need to be.
DR. WILSON: Does not need to be. But it could be under some
circumstances.
DR.
BLACKBURN: But it is not.
DR.
WILSON: Thank you.
DR.
ROWLEY:: I think it is important
just to clarify that, in fact, if you are talking about using this
for medical purposes, you would not put it in the womb, because you
would never be sure you could get it back out, or what had happened
to it in the meantime. So, in fact, you would never do that.
DR.
WILSON: Thank you.
CHAIRMAN
KASS: Robbie, I guess.
Yes?
PROF.
GEORGE: Elizabeth and I share the
same underlying concern, but we draw different conclusions from it,
and therefore, read the documents differently. Both of us, I think,
are concerned that language not be used, or definitions not be
manipulated in order to win a debate, so that I see the quotation
marks around words that I would prefer not to use, because I think
they prejudice the debate against what I think to be the truth of
the matter, and I am reassured. Elizabeth sees the quotation marks,
and she is the opposite of reassured, because she sees the quotation
marks as themselves indicating a prejudice against a term which she
thinks is appropriate.
So, we are a little bit, I think, at
loggerheads about what follows, how the staff should be instructed
to write, precisely in order to achieve the goal that you, Leon, and
Elizabeth and I have in common, and I am sure everybody would share
it, of making sure that you get a fair representation of competing
points of view without the definitions or language prejudicing it.
CHAIRMAN
KASS: We will work at it,
and we will do the best we can, and if we do not do it right, you
will tell us.
I am going to exhort the group to take up the
question on the agenda, which are the legislative options. Charles,
is that you?
DR.
KRAUTHAMMER: Well, let me just
engage the issue directly. I think there are two main arguments for
the full ban on cloning which would include both reproductive and
research or therapeutic. The first is, and I think it is outlined in
the paper, it is hard to imagine that if you allowed this to happen,
if you allowed it, what would become an industry of cloned embryo
creation, that you would not result within a fairly short period of
time, I would guess, in implantation. It would be, of course,
banned, but it is hard to imagine that with hundreds, thousands, of
embryos floating around, with all that interest, that you would not
have one implanted in a woman which would present us with that
extraordinary dilemma that under law that embryo, that fetus, would
have to be destroyed, which of course, none of us would want to
contemplate.
So, I think the path from therapeutic to
reproductive is clear, and I think it is inevitable. There is a
principle in Jewish jurisprudence called the fence. Siag(?) is the
word. You make a fence around the Torah. You protect yourself from
sinning by expanding the bounds of what constitutes a sin. For
example, you are not allowed to engage in commerce on the Sabbath,
but the rabbis expand that so that you cannot handle or touch money,
knowing that if you handle or touch it, you will inevitably find
yourself in a position where you may end up engaging in commerce.
So, you expand the boundaries of what is impermissible as a way to
protect yourself against committing the core sin.
The core
sin here, which I think all of us would agree on, is that
reproductive cloning is wrong, ought not happen. And I would argue
that the way to build a fence around it is to not permit the
creation of an industry of embryos. That is argument number one.
The second is not an argument about the contingency, or how
it might expand, but an argument about what happens when you allow
the creation of cloned human embryos for their destruction. And here
I would like to, if I could take a second, to talk about the history
of the argument about stem cells. In the original debate about stem
cells which led to the President's speech, you found a fairly wide
consensus that we ought to allow this research because of the
benefits that would happen, and that we might permit the use of the
discarded embryos from IVF clinics because they were doomed to be
destroyed anyway. However, and the argument I think here was fairly
consensual, we would not want to countenance the creation of embryos
to be destroyed and essentially mined for the purposes of creating
stem cells. And we were assured by the advocates of stem cell
research that we would only be using discarded embryos. It was a
sort of morally reasonable argument: if the embryos are going to be
destroyed anyway, let's use them. I think a lot of us who supported
the stem cell research proposals agreed with that, but were afraid
we might actually be on a slippery slope.
Well, here we are
on the slippery slope. If we countenance the creation of cloned
human embryos for the sole purpose of their exploitation and
destruction, we are entering a whole new era of the commodification
of the human embryo, of its exploitation, and its use as a commodity
and as a thing. And I think that is extremely dangerous. It does not
require that one believe that life begins at creation. I think as
Michael Sandel said yesterday, it is not an on and off proposition.
Personhood either is or is not at the moment of zygote creation, or
in this case with the beginning of the cloning process. You do not
have to believe that the original cell is imbued with a soul or with
personhood to believe that its exploitation and destruction starts
us on a very dangerous and destructive path of exploitation of our
own species.
So, I think those are the two arguments, and I
think that that might be a basis for the start of a discussion of
the ban.
CHAIRMAN
KASS: That is very useful,
I think, as a way of starting the discussion. Someone want to
respond directly to Charles?
DR. WILSON: I have a question.
CHAIRMAN
KASS: Okay, sure.
DR.
WILSON: Charles, or other
people here with scientific knowledge that I do not have. Are
discarded cells, fertilized cells, embryos, that are the result of
in vitro fertilization, sufficient in number and quantity to support
all present and likely future forms of research?
DR.
KRAUTHAMMER: The answer, I think,
is yes. I think that is undisputed.
CHAIRMAN
KASS: Janet, or--
DR.
KRAUTHAMMER: It is a huge number. I
mean, we do not know how large it is, but a fraction of that would
support present research for perhaps half a decade or more.
DR.
WILSON: Do others have
other views?
CHAIRMAN
KASS: We have a couple
of-- Janet, or Elizabeth, or Bill? Janet, would you want to comment?
DR.
ROWLEY:: Well, I cannot speak with
any certainty about the number that we have. As you may be aware, at
the time of the President's proclamation, if you will, in August, it
became apparent that there were potentially 60 embryonic cell lines.
That is not embryos, but lines that had been derived from embryonic
stem cells. The concern at that point was that most of them had not
been well characterized, so we did not know, for instance, were they
chromosomally normal, or were they aneuploid, and this is a critical
issue if you are trying to do research. We did not know many of the
other characteristics, and the concern is that as studies proceed,
there may well be need for even some known genetic variants with
defined mutations that would allow you then to do further studies on
the response of these mutant cells to various therapies which would
inform you as to how better to treat patients, so that I think that
the comment I made yesterday, which is we are asked to make
judgments about matters that we do not have the basic knowledge
required to make any informed decision. This is the problem that we
face.
DR.
KRAUTHAMMER: But Janet, Jim was
asking not whether existing stem cell lines were enough to support
research.
DR.
ROWLEY:: Or are there enough
embryos. I do not know. How many embryos are there?
DR.
KRAUTHAMMER: He was asking whether
discarded embryos would be enough to support current research.
DR.
ROWLEY:: Exactly. Do you know how
many? I have no idea how many there are that are available for use.
Some of these are covered by various forms of consents of the donors
which may preclude their use. I do not know that figure.
CHAIRMAN
KASS: Bill, on the facts?
DR.
HURLBUT: The figure estimated is
there are a million embryos in frozen storage now. But the fact is
that you can only derive stem cell lines from those which have been
already developed to the blastocyst stage. That is generally
thought. That is a lot smaller number. Who knows? Maybe a hundred
thousand. Those have only been done in the last two years. And the
fact is that even when you try to do this, deriving stem cell lines
is very difficult to do.
Look, there are many good,
scientific reasons to do therapeutic cloning. Let's not fake
ourselves out about that. The argument is whether it is morally good
to do. That is another question. But I do not think we should
preempt the question by saying, oh, we have got enough, we can go--
Well, maybe that is a practical matter, but it is not a very good
scientific approach.
DR. : But are not 100,000 enough?
DR. HURLBUT: The
problem is--
DR.
KRAUTHAMMER: How many do you need?
DR.
HURLBUT: You could do a lot of
science with specifically produced types of cell lines. For example,
one of the big efforts now in advanced cell technology is to clone
specific individuals so that you could do studies with those cells
back into the same individual for immune reasons. That might not be
necessary, but it is at least-- If you are going to talk science
without moral constraints, you would probably be scientifically more
open to not restraining anything. But we restrain all sorts of
things in science, so let's not preempt that either.
CHAIRMAN
KASS: We have to try to be
clear about a number of distinctions that are operating in this
area. One is the distinction between the extracted stem cell lines
for which there is now federal funding. Then there is the question
about the number, usefulness, availability of other spare embryos
from which lines can be, are being, developed in the private sector
and can be used there.
But we have here to consider the
question about the cloned human embryos, and the special benefits
from doing research possibly on embryos created by somatic cell
nuclear transplantation or cloning. And there are arguments that
have been advanced that suggest that no matter how many spare embryo
lines there are, there are added benefits from doing the research on
these kinds of embryos. And that is why the arguments for
therapeutic cloning, or research cloning, are independent, are in
addition to the arguments for stem cell research, and we are going
to have to try to-- These are related questions, but in our context
of talking about cloning, we should think especially about the
question of (I cannot help but use the quotation marks, Elizabeth. I
will try to fix it.) therapeutic research cloning.
Someone
was going to-- It was a request for information. I would like
someone now to respond, if they are ready to. Charles, at least, has
staked out a position and made two kinds of arguments as to why he
thinks that a complete ban would be the more desirable.
DR.
WILSON: Could I begin by
asking them a question now that I know one more fact than I knew ten
minutes ago?
CHAIRMAN
KASS: Please.
DR.
WILSON: Charles, you said,
if my notes are correct, that we should not countenance creating
cells that would die.
CHAIRMAN
KASS: Creating embryos, he
said.
DR.
WILSON: Pardon?
CHAIRMAN
KASS: Creating embryos,
embryos.
DR.
WILSON: Well, how does
that differ from creating through in vitro fertilization embryos
that will die?
DR.
KRAUTHAMMER: There are two
distinctions. The first is that in IVF, you are not creating them
with the specific intent to kill them. You create a number, you find
the ones that work, and you do not use the others. It is in a sense
a side effect. It is as if you had IVF where you never implant a
single embryo. The analogy to cloning is IVF where you implant the
(Inaudible.) and you destroy them all. I think that is morally
different from what happens.
DR. WILSON: How is it morally different?
DR. KRAUTHAMMER:
Because your intent is to create a life, and as a result, you have a
side effect in which some end up being discarded, and I think that
is different from creating all of these embryos with the express
intent of simply destroying and exploiting all of them.
CHAIRMAN
KASS: I have Stephen,
Michael, and Gil. And Paul.
PROF. CARTER:
Just a small point, partly in response to what Charles said. I think
that what Janet and Bill have said needs to be taken seriously for
the following reason. On the question we discussed in the previous
session about the morality of the practice, it is not clear to me
that a civil judgment whether it is right or wrong to do the cloning
is going to turn in an important way on the question of the
availability of alternatives. However, when it comes to the
legislative process, if one of the arguments in favor of allowing
what some have called, (let's put it that way, Robbie), what some
have called therapeutic reproductive--therapeutic or regenerative
cloning, if one of the arguments in favor of that is the necessity
for scientific research, then from the point of view of whether
there should be a ban or not, it matters a great deal whether the
necessity in fact is present. Because if it is present, then the
argument may count in the legislative process. If it is not present,
then there is the concern about is there some other ultimate goal.
However, having said that, I just want to emphasize that one
of the problems that I think we will not be able to avoid in this
debate, and any debate about a scientific process, is that the
future is very, very hard to predict, and benefits and costs both of
basic research can be very, very hard to predict, and there have
been many times, historically, obviously, when we got surprising
benefits from research that was problematic on other grounds.
The only reason I mention that is that I think, again, we
should be very careful when we speak of the issue of a ban, or of
building a fence, to make sure that we really know to the best of
our ability what it is that we are fencing in, and what it is we are
fencing out.
CHAIRMAN
KASS: Michael Sandel.
PROF.
SANDEL: Charles invokes the
doctrine of the double effect to reply to Jim, and the difference he
sees between using embryos created by IVF is that those were created
with the aim of reproduction. Tell me if I have this right, Charles.
They were created with the aim of reproducing, and the discarded
ones are leftovers. And it is morally more permissible to use those,
you say, than the others because in the other case, the embryo is
being created for the sake of the research which will kill it. That
is the moral difference.
But the doctrine of the double
effect, which is just this idea that if you are aiming at a worthy
aim, it is possible to justify a morally troubling side benefit.
That doctrine of double effect could be employed to save the thing
that you are against because the people who create embryos, whether
through cloning, or through IVF, for the sake-- You could imagine
people creating embryos through IVF who wanted to contribute to
scientific or therapeutic research, and they would invoke the same
doctrine of double effect, not implausibly, to say our aim is not to
create an embryo or a life for the sake of destroying it. That is
not the telos. Our aim is to create an embryo that will give rise to
stem cells that will cure some disease, and we recognize it is very
likely, maybe even certain, that an unfortunate side effect which we
regret is that it will die.
Now, you might say it is so
likely that it is a certainty. Where is the room for the double
effect? But that is true of the IVF case, too. So, as long as there
are multiple embryos produced in IVF for the sake of reproduction,
the double effect is not any-- There is no more space, there is no
more moral space, for double effect doctrine to get going in that
case than in the other case. So, I do not think the double effect
doctrine can save the one, and condemn the other.
DR.
KRAUTHAMMER: Well, I do not want to
monopolize this, but if I can--
CHAIRMAN
KASS: Briefly.
DR.
KRAUTHAMMER: Well, I think, first
of all, in cloning, the effect is 100 percent. There is no-- It is
not a side effect; it is the effect. The only way to get the stem
cell is to kill the cell.
PROF. SANDEL:
But what gives the doctrine of the double effect its moral weight,
is that it puts the weight on the intention, not on the effect, and
that is the only reason it works in your other case, is not it?
Because is not there a certainty that with IVF you do not just
produce one embryo that you know will lead to a child? Is not there
a certainty there that you are going to have to produce some that
will be discarded?
DR.
KRAUTHAMMER: I am not sure it is a
certainty. It is certainly a high probability. But the point I think
that is important here is that what you engage in is a kind of
desensitization to the process of destruction, and I think it seems
to me that it is far more, desensitization is far more certain, is
far more powerfully affected when you are creating for the sole
purpose of destroying, exploiting, to help someone else. In other
words, it is purely nothing but an instrument. It is nothing but
something to be dismantled and strip mined, as opposed to IVF, which
I must say, if we were having an argument here 20 years ago about
IVF, I would probably raise these same concerns. It is a settled
practice.
PROF.
SANDEL: But why do not your same
moral concerns condemn IVF for the same reason? There is no space
for the double effect to get going, the doctrine of double effect.
CHAIRMAN
KASS: Very briefly. There
are two things, it seems to me. Charles is trying to make, whether
successfully or not, some kind of a distinction, and if that
distinction cannot be made, it cuts in two directions. Either what
he has accepted before--
PROF. SANDEL: I
agree very much, yes.
CHAIRMAN
KASS: The two gentlemen at
the end of the table are masters of the argument of double effect,
and if I give them half a chance, we are going to get a long lecture
on it, and I do not want it.
(Laughter.)
PROF.
MEILAENDER: (Inaudible. No
microphone.)
CHAIRMAN
KASS: I know that.
(Laughter.)
But I saw Robbie's hand go up, and I
knew what was coming, right?
PROF. GEORGE:
Fair point, Mr. Chairman.
CHAIRMAN
KASS: We should provide
some written material on this, because it is an important aspect of
the moral argumentation, and there is no reason why it should be the
private prerogative of some of us. Let's get the writings out on
this.
But Gil was on the list from before. Paul, Rebecca,
Janet, and Mary Ann. Is your light on for--?
DR. KRAUTHAMMER:
No, I do not want to monopolize it. I would carry it on. I do not
know if you want to go on with it.
CHAIRMAN
KASS: Well, look, I think
on the general point, Charles at least has raised the question
about-- And he did not even-- He, in a way, raised the question,
what happens when you allow the creation of embryos for use and
destruction. The question is whether that should cover just these,
or those, but that is a piece of this discussion. And he has, in a
way, framed it.
Some people will find this a persuasive
concern. Others will say we can find the right boundary at the
appearance of neurological cells, or something like that, where we
can live with this. But I think the question has been posed, and
this kind of discussion, while complicated, does not seem to me to
undermine the importance of the question that has been raised.
DR.
KRAUTHAMMER: I mean, all it
implies--
CHAIRMAN
KASS: So, I mean, if--
DR.
KRAUTHAMMER: It implies that people
who oppose reproductive cloning, research in cloning, ought to be
campaigning against IVF. I do not think that follows.
CHAIRMAN
KASS: Okay.
DR.
KRAUTHAMMER: You can simply argue
it is a settled practice, and we ought not complicate our moral
lives by going on in the same direction if you want, or we can argue
about distinctions between the two processes. But either way, I do
not think it affects the argument.
CHAIRMAN
KASS: Let's go forward, if
we could. Gil, Paul, Rebecca, Janet, Mary Ann.
PROF.
MEILAENDER: Before we ever got involved in double effect, I
already was on your list because I wanted to say something about and
in support of, but from a little different angle, Charles' second
argument, which I do not think, at least in terms of what I want to
say about it, requires talking about double effect language at all.
Indeed, I am not even sure that double effect language is good
language to clarify what is going on there.
What I wanted to
note is this. We have had considerable agreement, by no means
unanimity, but considerable agreement among lots of people who do
not agree just generally on these questions, that the use of spare
embryos for research could be looked upon more favorably than the
deliberate creation of embryos for research followed by destruction.
I know there are complicated arguments about it. One does not have
to be persuaded by it. But I just note that we have actually had a
good bit of agreement on that point. A lot of people who do not
agree on general things have agreed on that. And the point has
involved not a complicated argument about double effect, but the
notion that these spare embryos are at some point going to be
discarded anyway. The question is simply whether they should die
through being discarded, or whether they should die by being made
the object of research. I mean, we have had considerable agreement
about that. I am not saying it is persuasive, but we have had it.
What I want to notice, and it comes to Charles' second
argument, is that there be a kind of peculiar thing about the
position B in these policy options that would say are you for
banning clonal reproduction but permitting whatever we call the
other thing, research or therapeutic cloning, or whatever, in that
in a sense, under the guise of doing something restrictive, under
the guise of saying, well, now we are going to ban clonal
reproduction, one would actually be giving greater approval to the
deliberate creation of embryos for the purpose of research followed
by destruction, something that, in fact, there has been a good deal
of hesitance about, and a good bit of squeamishness about. It would
be a very peculiar result that what you would be adopting is a
position that on the face of it looked as if, you know, we were
doing something restrictive, but that would in fact, in terms of the
kind of a rough consensus of opinion that has been going on, would
turn out to loosen the restrictions. I take it that in a way, that
is what Charles' second point was about. I think that would be a
peculiar thing. Or at least if one did it, one should realize what
one was doing. I hope that is clear.
CHAIRMAN
KASS: In scribbling, I
lost my page. Paul.
DR. MCHUGH: Thank you.
I am going to lead the discussion just slightly in another
direction, only to pick up on what I said yesterday. I have not made
my mind up at all about what should be legislation in this arena,
but I do think that the crucial thing to keep in mind for all of us
is that the burden of proof for changing what we do, and how we
should act, has to be on those that propose that we move in that
direction, and legislation might or might not maintain that burden
of proof. If we do that, I think we will gain the support of the
American people for the animal research that is going on right now
in stem cell research, and we encourage that, and we want to wait
for what directions for human stem cell research those animal
results command.
Now, yesterday I said that it was very
important that we have people come and talk to us about just what is
happening in the therapeutic stem cell arena. And one of the
problems that is present in our discourse now is the presumption
that stem cell therapies work simply like transplant cells, that you
replace the cells that are lost by the stem cells that you grow.
Now, the animal research is quite clear that that is not
always, in fact, not often the way a therapeutic phenomenon occurs.
Right now, excellent research, excellent animal research is going on
at Johns Hopkins by John Gearhart and others on animals that have a
form of amyotrophic lateral sclerosis, the death of cells in the
spinal cord, anterior Hans cells, and they are demonstrating in mice
that stem cells will alleviate the symptoms of those mice. However,
they now know that those stem cells do so not as transplanted
anterior Hans cells, but because they become biological pumps
producing important trophic factors that support the failing cells
of the host, rather than replacing the failing cells with healthy
neurons.
Now, if stem cells are capable of doing this good
because they produce trophic factors, that is, chemicals, we can see
a future after all, in which with certain diseases anyway, these
trophic factors can be supplied without the need of having them
delivered by cells with all of cellular problems, and all of the
things that cells bring besides their generation of trophic factors.
I believe that we are often proposing our future on a lack
of adequate scientific studies, and the hypotheses those scientific
studies command. So that, I think, is tremendously important for us
to understand, that stem cells are probably going to do many other
things than we think they are doing, and that some of those things
will or will not require-- After all, we do not need the mold any
more to produce penicillin, and that is a great thing, and we may
not need the stem cells to produce some of the therapeutic
advantages that we have.
As I say, I have not made my mind
up about issues of legislative banning and the like, simply because
I want to learn more from the conversation. But anything that will
continue to enhance our capacity to think into the future will come,
in my opinion, from extended animal research, and the results that
they show.
CHAIRMAN
KASS: Thank you. Rebecca,
then Janet.
PROF.
DRESSER: I will just mention
another moral distinction that has been invoked to differentiate
leaving IVF embryos in the freezer, believing that it is certainly
likely that at some point they will deteriorate and quote "die"
versus destroying them, either just taking them out of the freezer,
actively destroying them, or destroying them in research, is act
versus omission, or active/passive. Now, whether that is a
significant distinction or not is another question, but that is
another set of concepts that have been used.
I would like to
mention a fourth legislative option which is-- I am not an expert on
this, but I have read enough to know that some people really
question whether the FDA has jurisdiction to regulate human
reproductive cloning, because there is debate over whether it is a
biologic, this thing, or whatever it is that we are talking about is
a biologic. So, another basic concern that I have is that Congress
should clearly indicate that they want the FDA to regulate this, and
treat it just as they do drugs and devices.
CHAIRMAN
KASS: Treat what, Rebecca?
PROF.
DRESSER: Well, reproductive. That
is, if there is an effort to implant a cloned embryo and create a
child, I want that to be regulated in the private sector as well as
the public sector, just as the development of a drug or another
biologic is, so that if you are going to implant this embryo into a
pregnant woman, I would like to see the HHS regs on research
involving pregnant women and fetuses apply to that study.
Certainly now, the FDA requires proposals to test drugs in
human beings to be reviewed by an IRB, and to meet the human
subjects regulations. At some point, this future child should be
considered a human subject, and so, these questions about is it safe
enough, is there enough basis to try this in a human, would apply.
Any private company that tries to clone an embryo and bring it to
term who did not go through the FDA would then face fines and other
things that already exist.
CHAIRMAN
KASS: They have never
regulated IVF, have they?
PROF. DRESSER:
No. I also think that is something they might. But the FDA is now
saying that they have jurisdiction, and they, in fact, sent a letter
to one of these people who said that--
CHAIRMAN
KASS: I think that has
been-- It is now in dispute what they are saying. I mean, I think
there was some talk that they claimed jurisdiction that appeared in
the testimony. In the last week, I have heard the controversy. We
could look into this.
PROF.
DRESSER: But in any event, it is a
question of Congressional intent, so Congress could make it clear
that they want this to happen, and that would be another option.
And that also, I think, would not run into questions in
terms of constitutionality and federal jurisdiction questions that I
think really-- I do not know if it would be appropriate to have a
commission paper to look at questions about whether a federal
legislative ban would pass a--you know, the Supreme Court would
approve it, because we have potentially the quote "reproductive
rights" here, individual rights. We also have, some people say, the
right to conduct scientific research, certainly in the private
sector is protected by the First Amendment. And also, you know,
medicine in general is considered a matter for state regulation, so
what is the federal government doing coming in and imposing this on
the states?
Those are all questions I would have as a
lawyer, and I am not an expert on that, so I would want those to be
considered.
My problem with the term "therapeutic cloning"
is that I want us to present this in a way that the public gets an
accurate impression of the uncertainties here. I do think it is
important to say there are potential medical benefits, and that
could be a justification for research cloning, but it is very
uncertain at this point whether these things will pan out. It is not
therapeutic at this point to anyone. It is very much in the early
research stage. It is not clear that we are going to need
genetically identical stem cells if this does go forward. So, you
know, which way that cuts on our ultimate position is another
question, but I do want to get some-- I think this has been oversold
to the public in terms of how close we are to a cure, and how close
this is to actual therapy, and I want to make clear the state of the
science.
And finally, another moral consideration that we
need to bring in here is that research cloning requires oocytes, and
so, where are these oocytes going to come from? We know that there
already is demand for oocytes to help people have children. This
would create another need for these oocytes. We have been struggling
with this issue about should there be payment; if so, how much? And
so, this would take us further into that debate as well, and those
things need to be addressed.
CHAIRMAN
KASS: Good. Thank you.
Look, I am going to just recognize Janet and Mary Ann on this topic,
and then, I think we should spend some time explicitly on the
therapeutic cloning research, on the research cloning question.
Janet, please.
DR.
ROWLEY:: Well, I certainly support
Paul and Mary Ann in their call for more research in these areas
because it is true these are very early days. And the question of
how important this may be medically is totally unresolved which is,
I think, a reason for us to urge caution, that we do not prevent
American scientists from trying to help to resolve these issues,
because scientists in other countries already have approval from
their governments to move and study these questions.
Now,
maybe you say that is fine, let the Brits do this, and when they
find the answers, we will come hat in hand to try to get the
results. But I think as a scientist, I would feel very unhappy if,
in fact, my colleagues were not also given the opportunity to
participate in this. So, that, I think, urges us to be very cautious
in whatever stand that we take.
I welcome the chairman's
suggestion that we help with the text of the working paper. I agree
with Elizabeth. I found many of the terms pejorative and judgmental,
and I think it is inappropriate for a paper which is in theory to
inform us neutrally about the facts, that much of the text contains
what I would consider very serious scientific flaws.
I do
urge us, and the chairman has already said that we will invite
others to come and help with our general education because I do have
a copy of the National Academy draft report, not the final report,
and their recommendations in the report itself states what we have
already been emphasizing, that this is just at the very beginning of
a very complicated process of understanding the use, or the lack of
use, or those situations in which it will be useful, and those
situations in which it will not be useful. And so, the Academy has
recommended that stem cell research be continued and supported, and
publicly funded, supported, and human stem cell research, so that we
are able to answer some of these uncertainties.
And Paul had
his example where the cells themselves were not needed. It was clear
they were providing chemicals. Another paper that came out in the
Proceedings of the National Academy this month on Parkinson's
disease using a rat model and murine stem cells, showed that it was
the murine stem cells that actually provided the chemicals
themselves directly from the murine cells that helped to treat the
animals, so that certainly in some circumstances, the cells
themselves are going to be needed.
CHAIRMAN
KASS: Thank you very much.
Mary Ann.
PROF. GLENDON: I think Charles
introduced a very important word into our discussion when he brought
up the idea of desensitization as a way of talking about the broader
social effects of actions and decisions we might take now. Sometimes
when people are trying to make that argument they use the expression
"slippery slope", which actually is not helpful here because if you
are on a slippery slope, you know it. You feel the breeze going by,
and the problems that we are dealing with here usually involve
changes that are so gradual and imperceptible that you do not know
what has happened until you end up desensitized, and we have a
history of racism, and a history of eugenic practices in other
contexts that show us how easy it is to become desensitized.
So, for that reason, I wanted to raise a question about the
relationship of desensitization to settled practices because,
Charles, you said, if I understood you correctly, that 20 years ago
you would have raised similar concerns about IVF, but now it has
become a well settled practice. And the question would be whether
that having become a well settled practice has already desensitized
us to a certain extent to misuse of our own species.
And
here, I will just raise a research question for us later on. One of
the reasons why I would like to look into what other countries are
doing on this is that we have been told that Germany has been
extremely hesitant about going down this path. My own research
suggests that countries that were under German occupation are very
hesitant. Well, there is a reason for that, and the reason has to do
with a lot of factors peculiar to the civil law systems, but also
with history, and the idea that maybe we should be thinking about
heightening sensitivity as well as the potential harm of
desensitization.
CHAIRMAN
KASS: Thank you. Do you
want to respond immediately to this?
DR. KRAUTHAMMER:
No, I will wait.
CHAIRMAN
KASS: Michael, go ahead.
These will be the last two comments before I turn the discussion.
PROF. SANDEL: Well, I agree entirely with
what Mary Ann has said, and by challenging the dis-analogy, the
moral dis-analogy, Charles was offering I was leaving open the
question of which direction one pursues it in. I think we should
first see whether the analogy is morally sustainable, and then if it
is not, we may have to examine settled practices. Or we may have to
reconsider the unsettled practice. So, I think that is a further
step, but we have to get clear on whether the moral analogy works or
not, because it does raise yet another possibility that we have not
discussed.
So, just to replay the bidding quickly, the
question arises, is therapeutic cloning morally different from
medical research carried out on embryos created for that purpose
through IVF. And I think most people would agree, no. Here we are
talking about embryos created for that purpose, not for reproductive
purposes.
But then the question is, is therapeutic cloning
different from research on extra embryos created for reproductive
purposes, and that is where this question about whether there is a
morally persuasive distinction arises. My argument there was that
they are morally on a par. They are morally on a par because both
aim at worthy ends, reproduction in the one case, relief of
suffering in the other, and in both cases there is a certain but
undesirable side effect, namely the death of embryos. It is an
undesirable side effect for anyone who regards an embryo as other
than a thing. Quite apart from whatever else one considers the
embryo to be, it is undesirable.
So, one issue is whether
you can create a dis-analogy there. But a further question is, are
these two ends-- Do we take for granted that these two worthy ends
are equally worthy? We take for granted as settled practice, as Mary
Ann was saying, that the worthy end of human reproduction justifies
IVF. That is the settled practice Charles was describing. But if the
dis-analogy cannot be made out, if Charles's dis-analogy does not
hold, then we have to compare, or we might find ourselves comparing
the relative worth of those ends, and we may find, or an argument
could be made, that depending on just what the medical promise is,
and the scientists have to tell us about that, it might be that a
more worthy end to aim at is to create through IVF embryos to have
some great breakthrough through dread diseases. I do not know.
Depending on whether that is plausible, whether that could happen,
that might be more morally important than creating embryos through
IVF for the sake of creating a baby. There are other ways of having
a child, adoption for example. Maybe the morally stronger case is
actually the creation of embryos through IVF to relieve human
suffering, if the science actually tells us plausibly that that
great good really would be achieved, in which case we would have to
weigh that.
But all of this is consistent with Leon's point
that to break down that analogy does not answer the question, well
then, in which way do you go.
CHAIRMAN
KASS: Charles, last word
on this, and then we are going to move.
DR. KRAUTHAMMER:
I do not want to turn this into a seminar on this issue, although I
would be happy to have one with Michael anywhere, anytime, but not
here.
Let me just make one point. The distinction that
Michael is overlooking is that in cloning, it is 100 percent
destruction. In IVF, it is not. And that makes it important because
in cloning, the cell is created only as a means. In IVF, you are
creating a series of embryos hoping that they will become a child.
You are creating all of them in a sense to be an end, but you do not
know which one. Some will make it, and some do not. And that, I
think, is a fundamental distinction. It is not as if you are
creating a single embryo in IVF and the others are helper embryos
who will die and be discarded. All of them are candidates. One will
make it, others will not. And in fact, the ones who will not will
end up in the freezer, and they can be implanted. So, it is not as
if it is a means to an end necessarily. That is the only possible
outcome in cloning, and that is why I think turning it into purely a
means, purely an instrument of our will to another end, I think is
the fundamental moral distinction. And as Mary Ann indicated, it
starts a real process of desensitization, and it could end up quite
badly if we do not stop it at the beginning.
CHAIRMAN
KASS: Please, Elizabeth.
DR. BLACKBURN: It is just a factual
interjection, not to argue against or for what you are saying. But
in fact, there is a process of twinning, whereby an embryo is taken
to a four cell stage, and this naturally happens in identical twins,
can happen, and now there are two embryos. I am just going to raise
the question: What if one is for a purpose that somebody finds
different and appropriately moral, and one is for, you know, using
for therapeutic cloning? Because, so Charles, I am just saying, it
is actually not 100 percent inevitable that the embryo would be
destroyed, because it could have an identical twin produced, you
know, at a two cell-- Is that right? Two cell stage, or four cell?
DR.
HURLBUT: Actually, you can get
twinning all the way from the two cell stage up to the primitive
streak and beyond, which is conjoined twins.
DR.
BLACKBURN: Just a fact. I am not trying to argue for or
against.
CHAIRMAN
KASS: Let me-- We have
really run over on this, though it has not altogether been run over
because I would observe that with very few exceptions the group as a
whole has been somewhat more leery than in previous sessions of
grasping the nub of the question, of the legislative alternatives
for discussion. There are lots of good reasons for that. It may be
that one has not thought through the moral argumentation
sufficiently, or that people are leery of legislation. Many people
are much more interested in the moral arguments, and let somebody
else worry about the policy questions.
But I remind you that
we do have a charge here, not only to think abstractly and
philosophically, but to try to be helpful to the people whose burden
it is to make these decisions, whether we would have put them in
that position or not. And we do find ourselves in the middle of this
kind of debate. And it is too early, I think, for us to come down on
this, but I think we would be irresponsible if we did not air it out
in here as to which of the legislative, including a fourth possible
alternative, makes the most sense to the people here.
In
some way, the sticking point in this discussion has really to do
with the importance of what one would be giving up if one enacted
the strict ban that Charles has argued for. He has made two parts of
the argument, and I think has been willing, he did not say so, but I
think he is willing in fact to say, look, I grant that there might
be various kinds of scientific and therapeutic benefits that come
from allowing the cloning of embryos for research, but given what he
cares about in this legislation, he is willing to pay that price for
this kind of good, and that is open to discussion.
It does
seem to me that we need some clarification, however, some explicit
discussion, and we can just barely open it up today, to really talk
about this matter of the non-reproductive cloning, with apologies to
Robbie. And here in the last part of this paper, and all we can
really do is at least barely get it discussed, in this section of
the working paper beginning on page 8, we make it perfectly clear
that we are aware of the fact that this is somehow central to the
current legislative debate. And it turns out to be of interest, I
think, for this body well beyond what we might have to contribute to
that debate. Because as the discussion has already proceeded, it is
clear that this is a test case, maybe a good test case, for thinking
about how faced with the uncertainties both of the scientific
promise on the one hand, and with the moral hazard on the other,
prudent decisions should be made.
There are some people who
would argue that the burden of ignorance on the promise means you
should do nothing. Some people would argue that the burden of
ignorance--that the moral hazard being sufficiently great, you
should do this and revisit. There are moratoriums, there are bans
that are doing nothing. A lot depends really, since we are going to
be necessarily deliberating in the presence of considerable
ignorance, both about the scientific promise and the medical payoff,
as well as about how many of these moral worries really are moral
worries. That is the way in which policy decisions and political
deliberations take place, not in the way in which people of science
like to do business. But that is where it is. So, I think it is
worth our while as an example, to sort of think this one through,
and to begin to talk on the side of the research therapeutic
cloning.
There is a section in here which describes the
idea. I think it is at least the idea which has been most highly
touted. There are other avenues of research to be done with cloned
embryos that have not been given as much promise, but the major one
has been the individualized, hence presumably rejection-proof cells
for re-transplant and regenerative medicine. The idea of that is
here, the idea behind it, and how do the advocates of research say
this will work. And then we have a series of scientific, conceptual,
and practical questions. Will this in fact work? Is it necessary, or
are there alternative ways to get around this problem? Discussions
of terminology, a mention of other kinds of perhaps even more
beneficial research from research cloning than this particular one
that has been touted. And then, a series of moral, prudential, and
social considerations.
And finally, concluding with
something that Paul and Mary Ann have mentioned in the past, that in
some ways, what is at issue in this policy question is a burden of
proof question, and ordinarily in these matters, we place the burden
of proof on the opponents of going forward with anything, whether it
be technological innovation, or scientific discovery. Some people
are arguing here that precisely because a cloning ban would shift
the burden of proof to those who show why it would be necessary to
have it, that that is a good thing, given what the stakes are.
Others will insist, look, that this is a perilous threat to
scientific and technological progress dealing with freedom, and the
law might not hit the target, and various other reasons.
It
seems to me worth our while to look at the particular subject of
therapeutic cloning now, at least to get us started on it, and
perhaps Janet, or Michael, you would like to start off on-- Tell us
something about, in brief, why you think it is-- Let me place the
burden on you. Why is this work necessary, since if as Rebecca
suggested, there might be some things that are desirable but not
necessary? Could you help get us started in thinking about that?
DR.
ROWLEY:: Well, I would, because I
think the way you phrased it, you then put the burden of proof on
people who are in favor of proposing a ban, which is, I think,
correct. I think the burden of proof is why when we now allow this
to go forward, you think it should be stopped. So, the burden of
proof is on those who want to stop it, I believe. But that is not
the question you asked me.
I think that it is impossible to
tell you now what the benefits of therapeutic or regenerative
medicine might be. But that, in my view, is all the more reason to
allow it to move forward in a thoughtful manner because the
potential, if this potential is realized, will be extraordinarily
important in many of the degenerative diseases which will face
Americans in the future, as well as some of the other diseases that
face young people as well. And I was very heartened with Michael's
discussion that you have two moral goods competing with one another,
or two moral considerations competing with one another, and that in
fact, one moral consideration that this could be of benefit to a
large number of people may outweigh the moral harm of destroying an
embryo, if in turn that is how it ultimately comes to pass. And I
think, and it is very clear in the Academy report, we are just at
the very beginning of something that is potentially very important.
And I would like also now to just refresh people's memories about
other medical breakthroughs, and I will use my own personal
experiences, because it is currently relevant. Studying chromosome
abnormalities in leukemia cells, I discovered a translocation. This
translocation in the genes at the translocation breakpoint were then
identified, and the effect of the translocation on the function of
these genes was identified. This led to the search, the informed
search, for an inhibitor of the abnormal function of the gene
involved in the translocation, and this is now a very important
treatment for chronic myelogenous leukemia. Namely, the drug is SDI
571, or Gleevek(?). Finding the translocation was 1972. The drug is
used in 1998. So, you are talking about almost 30 years from a
discovery to treatment.
We cannot be impatient in this. And
there are a lot of failures, and it took many people in a number of
countries to really bring this to fruition, and we have to keep that
perspective very clearly in mind as we are talking about this. And
again, one of the terms I was concerned about in the report talks
about the imminent use. Nobody is talking about imminent use of
these stem cells for regenerative medicine in patients as the
present time.
CHAIRMAN
KASS: Michael, did you
want to follow?
DR.
KRAUTHAMMER: Could I make--? Sorry,
just one sentence on that. A lot of people in Washington who have
been advocating on one side of this issue have argued often and
repeatedly about imminent use. They say those of us who are against
this research, or who want to ban it, are preventing a cure for
Grandma or Grandpa or whoever, and the strong implication if not
explicit statement is that this is around the corner, and we will be
harming people today who could be helped tomorrow. And that, I
think, is unfortunate. I think it is misleading.
DR.
ROWLEY:: Well, I do not disagree
with that, and I think that helping to educate people as to the
actual facts will be useful as well.
CHAIRMAN
KASS: Thank you. Michael
Gazzaniga, please.
DR.
GAZZANIGA: I think what Janet is
reflecting on reminds me of what Charles Townes, the Nobel laureate
in physics, said. He said, "The wonderful thing about a new idea is
you do not know about it yet." And so, we, those who are laboratory
scientists, are constantly surprised and overjoyed at what might be
learned.
I want to go back to my earlier comment this
morning, because I think one of the duties is to set the stage as to
whether the ethical, moral problem is as deep as we have been led to
believe. And I want to again just reiterate for us to think about
and discuss this model of the transplant. Because we have societally
in place now this major, almost bizarre but routine, daily happening
that during the course of one year in the United States, there are
8000 heart transplants carried out on people who are declared
brain-dead. The heart is assigned to either a bank, or a family can
assign it to a particular person. It is harvested by a surgeon in an
otherwise live person. They take the heart out, and carry out the
transplant. And this goes on routinely, and with great support by
the American people.
Now, in the blastocysts, we have to
come back to the fact that we are talking about a 200 cell organism
that is basically the next-of-kin are the two parents. And the
next-of-kin could be asked, we are going to have to destroy this, or
we can destroy it, or you could make it available for stem cell
research. It is your call. There is no brain, so there is no issue
there. Do you want to do it? And they say yes or no. And if they say
yes, then I think one also confusion that may be on some people's
mind here, we are not talking about cloning the embryo. We are
talking about cloning the stem cells from the embryo. That is what
is being cloned for potential medical use.
CHAIRMAN
KASS: After the embryo is
created by nuclear transplant.
DR. GAZZANIGA:
That is different. But I would suggest that for the near future,
that the hundreds of thousands of IVF frozen embryos are going to be
the source of the biomedical community's interest. So, I think that
is just not a relevant point.
So, if you get people thinking
in terms of the transplant model, if you educate people that this
blastocyst really is brainless, would thinking change? You know,
there is a saying in Washington, what did you know and when did you
know it. We are sort of all locked in by our culture, and I am
wondering if Aquinas knew-- We could change the phrase and say, what
did not he know when he said it. And if these people who did a lot
of our moral thinking early in our human history knew what we now
know today, I wonder what they would think. And I think that it is
our duty to at least put those facts out on the table, and let this
group and the larger American community try to sort it out.
CHAIRMAN
KASS: Does not it affect
your analogy that in the case of soon-to-be-pronounced brain-dead
prospective donor of an organ, that that being has no future,
whereas this blastocyst is not yet brain-dead? Sorry, not yet
brained, but on the way. Does that bother the analogy?
DR.
GAZZANIGA: It does not bother me.
But--
(Laughter.)
CHAIRMAN
KASS: Should it?
DR.
GAZZANIGA: You remind me of my
mother. The notion of potential energy, of course, is there, the
potential of what could happen. But I just think that is just
something you are comfortable with or you are not comfortable with,
and that just does not bother me.
CHAIRMAN
KASS: Stephen, Bill, and
then we will break soon so we can have proper time for the public
comment. Stephen?
PROF.
CARTER: Thank you. First of all, I
suppose that since this is the mode today, I also need to say a word
about some of the terminology in the debate, especially in the last
few minutes. I am very troubled by the term "burden of proof" I
should say. I think that it suggests a kind of legalism that is not
appropriate in these discussions. We might, perhaps, say "burden of
persuasion" which also is just a legalism, but less so.
Here
is why I think it is a better term. At this point in our
deliberations, we are talking about policy. We are talking about how
to respond to items that are on the legislative horizon, that are
imminent in some sense. And legislation has a momentum of its own,
often driven by where legislators believe the public is at a
particular moment. So, the burden of persuasion is a practical
burden, not an ethical burden, and as a practical matter, it rests
on those who are trying to push things differently than the way they
seem to be going. So, if we think that there is a roller coaster
toward a ban, then the burden of persuasion politically rests on
those opposing the ban. And that is one point I wanted to make about
that.
But let me say a word about this distinction. Let us
call it a distinction between cloning that is and is not meant to
lead to human live birth. How is that? Let's call it that. It
strikes me that one's view of the distinction between what is meant
to lead to live birth, and cloning that is not depends deeply on the
reason that one is troubled by cloning that is meant to lead to live
birth.
We said a few minutes ago, well, reproductive cloning
as it has been called, everybody seems to be against it. I am not
sure that is true, but people seem to be against that. It strikes me
that suppose one is against that because of a sense that we are
somehow tampering with natural forces in a way that we should not.
That concern would not necessarily carry over into cloning that was
not intended to lead to live birth. In fact, one could easily draw a
distinction, and say that the tampering with natural forces is more
serious if you intend to produce a human being. So, there the
distinction is clear.
On the other hand, you can imagine
someone whose view is that from a very early stage, and possibly
from the moment when the sperm enters the egg, that you have if not
a human life, certainly something other than a thing to be used as
an object with certain societal responsibilities to protection
attaching to it, and if that is the case, then it strikes me that
the case for banning so-called therapeutic or research cloning is
stronger than the case for banning reproductive cloning. Because at
least in the reproductive cloning case, you tend to create a live
birth. In the other case, you intend to create the embryo, harvest
the cells, and destroy the embryo. So, it matters a great deal what
one's ground is for this supposed consensus on the reproductive
cloning ban to decide how one feels about the so-called therapeutic,
the ban that I said is the research that is not intended to lead to
a live birth.
CHAIRMAN
KASS: Bill, you want to
wind this up for us?
DR.
HURLBUT: I have a little problem
with what you said, and I feel the weight of it. But when Dr. Rowley
was speaking about this potential research, I just felt more than
affirmation, because I mean, she probably knows more than I do about
science and trained as a physician. But my instinct, and my sense is
that this is going to be more than just a possibility; that we have
discovered a new continent of possible therapeutic use. We have
stepped on to Plymouth Rock, and to say that there is nothing out
there, no resources, is probably underestimating. My own feeling is
that stem cell research might turn out to be the greatest
therapeutic tool in the history of medicine. I think we have to be
extremely, extremely careful not to preclude any positive
possibilities here.
But the problem is that it is unlike any
time or any question in medical history. We are dealing with the
most powerful, fundamental question of all. We are dealing with the
sanctity of life. And I do not use that term lightly. I think that
if you start by saying, okay, it has no moral status until it has
brain waves, then you might ask what kind of brain waves. At two
months, it apparently has some early neuronal firings. Okay, other
people say it is only six months that it has actual human-like brain
waves. Other people said a few years ago, in the history of
medicine, that infants do not have consciousness. We do not need to
give them anesthetic when we do operations. You remember that. So,
then the question comes, well, when? And what kind of brain? And
what kind of mind? Is the mentally retarded person a human being? Is
it nothing? If it is nothing, and I must admit it is a rather odd
society where we can on one side of the medical center do abortions
up until 24 weeks, and actually beyond, and on the other side,
cannot do medical research on a little clump of cells. I mean, that
seems like a strange discontinuity. Of course, there are other
issues involved, other interests and so forth.
But we have
got to get it together as a society. We have got to figure out what
developing life actually is. What is the status of it? Is it
nothing? In which case, why do we oppose the idea of going beyond
the 14 day stage that they are talking so-- You know, oh, it is an
individual then, and so forth. Actually, ask the logical question.
If we allow abortion in this society the way we do, which we do, and
I am not arguing against that at this point, and maybe we should
never have argued against it. I am not interested in laws; I am
interested in ideals anyway. Sorry, I guess I do not belong on the
committee.
But here is the question. If we allow this, and
we say that the status of the embryo is an open matter, then why
should not we not only create embryos in order to take the cells,
what some people call harvesting them for their spare parts, but why
should not we actually implant those embryos into the womb until it
has what you would define as the human mind? Why should not that--?
I mean, suppose somebody said, as it was made years ago, a desire
for somebody to have their father's sperm impregnate them so that
they could grow a tissue-compatible kidney donor for their father
who was dying of kidney failure? We all know that horrible story.
Well, what is the reason why not, actually? Why could not we implant
it? Why 14 days? Why 30 days? Why ever?
The question is a
profound question. I am not trying to preempt the discussion at all
in saying this, just to put the weight on what is actually at stake
here. What is potency? I would not use the word "potential", by the
way. I would use the word "potency". When you have the joining of
sperm and egg, you have the initiation of the most complex chemical
reaction in the known universe. What weight do we place on that?
Just one final point. I am worried about it, and I am not
pretending I have the answers. But it seems to me that we should
take weight of this argument, that if it is April 15th, and we are
in Central Park, and the sign says "Do Not Pick the Flowers", and we
go to the flower bed, and there is a bud coming up but it has not
yet formed a tulip, we might ask ourselves, does the sign that says
"Do Not Pick the Flowers" preempt us from picking the bud?
CHAIRMAN
KASS: I am not even going
to follow.
DR.
HURLBUT: What?
CHAIRMAN
KASS: I will not presume
to follow. Let's take 10 minutes, and we will have the public
session. I will look back on this session at the beginning of the
next.
(Whereupon a brief recess was taken.)
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