"This transcript has not been edited or
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SECOND MEETINGFriday, February 14,
2002
Session 6: Human
Cloning 8: Ethical Issues in
"Therapeutic/Research" Cloning
CHAIRMAN KASS:
Good morning. I hope people are refreshed. We worked ourselves or I
worked you pretty hard yesterday afternoon, and we have a couple of
sessions this morning to continue our exploration of human cloning.
A brief backward looked, I promised something of that, as a
prelude for what we will do next on the subject that we discussed
yesterday.
We had a very rich discussion and in response to the staff
Working Paper suggestion that we might take the low but solid road
of liberalism. There was an outpouring of suggestion that that would
be a mistake, especially when we do not have to, and that we should,
in fact, take the high and richer road but in turned out in the
second session that this high road is a hard road to travel.
And I think that a number of good things were said but they need
to be developed. I mean, there were people who talked the language
of dignity. There were people who worried about manufacture. There
were people who wanted to emphasize some corruption of the relation
of the generations. There were people who saw in this a certain
problem of the attitude towards children not confined to
technological manipulation but to be found in other practices of the
society.
And with the additional exhortation that we not simply present
these things in negative terms as what is wrong with this but try to
articulate, as I said from the start, those goods that we think are
vital to defend so that we can more easily -- in fact, it might be
that the objections make clearer to us what it is that we find vital
to defend but I do think that we are in the position of going away
from yesterday's meeting and trying to draft something. I do not
mean -- we will draft something collectively but in order to do that
at the staff level we would very much like some written materials
from the various people who have spoken in the name of this or that
good that we care about.
I do not think we need additional arguments on the moral
implications of the unsafe character of the procedure. That, I
think, has been done. The Academy has done it and the moral argument
we can make powerfully. What we need help on are these other matters
with about which people were so enthusiastic.
If you could get us some comments or if you cannot develop these
thoughts in your name but can articulate what it is you would like
to see someone else develop, that also would be helpful. So, two,
three, four, five pages within a couple of weeks on one of those
topics.
And, by the way, although the people from the sciences are not
generally used to discussing those sorts of things, it seems to me
that -- at least I would like to invite you also to contribute on
that because we are here not primarily as experts but as fellow
thoughtful human beings trying to find the right course here.
And as some people are trying to learn from the scientists the
language of discourse and the way to talk about those things, it
seems to me all of us would do well to have a crack at trying to
formulate the ethical norms and the objections and the goods that we
think might be at stake in the cloning for baby making.
I think I am going to try to speak that way. Maybe this vulgarism
will catch on and we can get used to it and maybe even use it.
We come to probably the hardest part of our discussion on the
ethical issues related to human cloning for biomedical research. We
barely started this discussion last time, though a concern about
this has intruded itself at various stages in the previous meetings.
There are difficulties about doing this. There is -- we could
enter into the discussion of the ethics of cloning for biomedical
research as it has, in fact, appeared in the public discourse.
Namely as a complication en route to trying to do something
legislatively about human cloning for baby making. Or we could take
it up in its more natural setting, which is to say as one subspecies
of the question of the ethics of experimentation on nascent human
life, the stem cell discussion, which we have bracketed as a general
matter for down the road until we get more evidence as to what is
going on with the research.
And to deal with the whole question of the ethics of embryo
research through the lens of cloning seems -- well, it is in a way
peculiar. On the other hand, I do not think we can do the proper job
on the discussion of the ethics of cloning for biomedical research
without taking up almost all of the same questions that are there
and the last time I tried to finesse this difficulty it seemed to me
wrong in retrospect that we should not be driven by the way the
legislative debate has framed this question but we should be driven
really by the internal logic of what is before us here, and so here
we are and we will tackle it.
The second thing to say is that for many people this discussion
is somehow tied up with ethical questions of abortion and many
people who enter into this discussion either are or are accused of
being or are suspected of being people who are fighting that battle
on other grounds. I would like to suggest that -- there will be
carry over, I am sure, but I would like to suggest that this is in
an important respect distinct.
For one thing, the extracorporeal embryo does not exist in
conflict with the interests of a woman who is carrying such an
embryo. These embryos would be, at least in the case we are
discussing, especially created -- especially, excuse me, synthesized
for their usefulness in research and in the debate in the Congress
and, in fact, in documents that are circulating all kinds of
prochoice people have nonetheless come out in opposition to the
research on the embryos.
So I would like -- whatever your stakes are in the abortion
discussion, I would at least like to invite you to try to think
about this thing in its own terms and not as the tail that is on the
abortion dog. Forgive me.
Third, and in relation to that, and this is -- this is perhaps
naivete of a classroom teacher. There is nobody in this room who has
a thought about this question in one way or another, and lots of
people are in here probably with positions which, if not dug in, are
annealed.
Nevertheless, it seems to me that if we really constitute ourself
as a group that is searching for understanding and the best moral
grounds, I would at least like to have the discussion under the --
maybe it is a pretense but certainly under the hope that the
conversation could be had in a way in which minds might be changed,
that we might actually learn something from discussing this
together, and I mean that on all sides of the discussion.
You can see that there is a certain nervousness about actually
getting to the subject but now --
(Laughter.)
CHAIRMAN KASS: -- but I
think this is important because I think this is really quite
important and I want to say one last thing.
The warm up points really to this matter: It is clear from the
discussions that we have had already that there are going to be
probably unbridgeable differences with respect to an outcome on the
morality. I am not talking about the law now but just on the
morality of the research on cloned human embryos or on embryos
generally.
And looking ahead to what it is we might produce, one possibility
would be, in fact, that that division should be uppermost in what
the result looks like and I have no idea what the count is and much
depends, in fact, on whether the conversation moves anybody
anywhere.
My, again, I think, perhaps naive, ambition is something to
produce something different. As a person who has, I think, sat on
more than one side of these questions and knows that there are
powerful goods being defended on all sides, I would at least like to
aspire to a piece of writing at the end that every person in this
body could own. By which I mean that we would produce the statements
of the various positions with as great clarity and as great strength
as we can. Maybe say that -- and the various positions would have to
acknowledge or at least encounter and think about the goods that are
being defended by what they regard as the weaker side.
And that we will have made a contribution to whoever it is that
has to make these decisions if we make perfectly clear what at the
price of what and, conversely, what at the price of what if one
chooses another way. That would be a rather novel thing for
political bodies here to do where usually you are trying to either
find consensus or beat down the opposition to such a point where
they have to yield and, if they do not like it, write minority
reports.
I would much rather -- I think we could make a really fine
contribution, of course if the discussion warrants it, if we can get
very clear and strong presentations in which, say, the right to life
people have to say something about what it is owed to people with
serious suffering and the people -- the scientists who want to go
ahead with the research have to say something about what it is that
might be owed to embryos or what it means, what it might mean, in
fact, to embark upon research on nascent human life, and then in the
end we can say some of us agree more with this and some of us agree
more with that.
But I would like to postpone the question of the votes and I do
not want to discuss it at least in this session under the heavy
burden of the ban, which I think unduly influenced, if I may say,
Irv Weissman's presentation of the question. That hangs over the
discussion. I understand that people are nervous but it seems to me
our task is in the first instance not to worry about the legislative
options here in this session but to try to think through the ethical
questions of this research -- of human cloning for biomedical
research.
I think I should pause to see if there are serious dissents or
criticisms of that suggestion of the spirit of the discussion. It is
always revisable if it turns out that it does not work but this is a
way, I think, of trying to produce something not heuristic in the
first instance but something that is dialectical and which we can
actually explore together notwithstanding where we might start out
in such a conversation.
Robbie, are you -- is that a hand on the way to --
PROF. GEORGE: No, but,
since you asked, I think it is a very good idea. The idea of working
toward a document in which all of us can affirm that the arguments
being presented at thorough, articulate, authentic representations
of the competing points of view held by reasonable people seems to
be not only the best we can do but also to be a genuine contribution
to the debate, which is so often marred on all sides by straw man
presentations of what competing points of view are. So I think it
would be a genuine contribution.
CHAIRMAN KASS: Other
comments?
(No response.)
CHAIRMAN KASS: All
right. We heard yesterday from Irv Weissman, and he gave us only the
barest bones of it, certain arguments as to what the biomedical
research with cloned embryos might have to offer us and I think if
we were listening carefully there were arguments as to why
biomedical research using cloned embryos would offer certain
possibilities that are not available from biomedical research just
on the spare embryos from in vitro clinics. In particular,
the ability to produce embryos with specific disease
characteristics, taking them from patients who have those diseases.
For the record, there was a brief discussion, and we might want
to get some additional scientific remarks on this last time, but
part of the discussion finally of ethical choices depend upon
existing alternatives and there was mention of this very exciting
but still yet unpublished work out of the University of Minnesota
about these not absolutely totipotent but multipotent cells
derivable from individuals and they could be from individuals with
diseases but the scientific discussion we bracket for a moment.
As Irv Weissman himself indicated, the Academy regards the larger
ethical questions, societal questions, still to be had and we want
to begin by taking as given, not open up the question at the moment,
the scientific promise that we were given yesterday. Whether that
promise is going to be realized as an empirical question, one would
not know unless one did it so that is before us.
And I would suggest the following: That we try to discuss
sequentially in this session, and I am not going to be able to say
this in language that everybody is going to like but make the
necessary adjustments, on the one side what is it that we owe to the
embryo or the nascent stages of human life. What is it that we owe
to those who suffer horribly for whom such research holds out great
promise of cure?
And then keeping in mind that there are considerations that do
not turn on benefits to this individual or that, remarks made by
Michael Sandel and others, maybe the question is what do we owe to
ourselves or what does it mean for a community to embark on a road
in which what is nascent human life, whatever it is worth, and
whatever its standing, comes to be treated as a resource for
perfectly good reasons?
I mean, I think those are three aspects of this discussion that
are worth engaging and I mean that without prejudice. I mean, to
raise the question is not to answer it. I mean, some people think to
raise it is already to prejudge it but I think it is an important
matter.
Let's start with the hard one, which is the question of we are --
we would be producing in cloning for biomedical research -- Michael,
with all -- with your permission, I am going to call it an
"embryo-like being that can develop at least to the blastocyst stage
extracorporeally" and is to be the object of exploration and study.
And the question is how to regard it and what do we owe it?
Our predecessor bodies, whether it be the NBAC or the most recent
report out of the California Commission, speak about the human
embryo or these early stages -- the early developmental stages of
human life as being deserving of respect or special respect or in
some cases even profound respect. And we have had memos from Rebecca
Dresser and from Gil on this subject, which I hope you have looked
at. Neither of these bodies regard those entities as full human
persons or members -- the same respect that is owed to babies and
thereafter but they also do not regard them as humanly nothing.
And both Rebecca's note and Gil Meilaender's note invite us to
ponder what does that -- what in the world does that actually mean
in practice? I mean, to say that something is deserving of respect
but it does not in any way restrain anything that you do to it seems
to make the notion of respect vacuous.
So the question is, and this is hard to talk about but
abstracting from the question of whether it is a person -- let's not
fight that one out -- first, if we begin with the precedence that we
have been given that nascent human life from its beginning is
entitled to some kind of respect, what in the world does that mean
with respect to what we can and cannot do with this?
And let me just add one last thing. I want to lay the table and
then step back and listen.
This might -- several people have already indicated that to put
the question even in the way in which I have put it is to suggest an
all or none matter. Whereas, what we have in embryonic development
is something which is a slippery slope, if you will. There is a
continuum and part of the reason that slippery slope arguments are
especially suited to this discussion is because there is, in fact,
in embryological development a continuum and, in fact, it is
possible very easily for -- if there are no natural boundaries in
that continuum, the arguments that are made for dealing with a very
early stage might, in fact, be arguments that cover what can be done
with later stages. So we have got that particular matter to deal
with and the general question.
The last thing, I have handed out a piece of paper that was in an
earlier draft of one of the staff documents, which at least lays out
before you a partial topology of the various positions that have
been taken with respect to human embryos. And it does indicate at
least a variety of possible ways to regard them under this heading
of special respect or not.
But the floor is open. What would it actually mean? What does
this notion, respect, special respect, profound respect mean
practically when we start to think about the cloning for biomedical
research?
Michael, please?
PROF. GAZZANIGA: Just to
get the cells going here, the physicians here should speak more to
this than I should but everybody who has taught a human neuroanatomy
lab receives a lecture from the pathologist in charge about the
respect they have to show the dead material. And after the
dissections are made, there is a tremendous effort to continue that
respect in how the tissue is disposed.
So I think throughout the whole life span our culture has evolved
a set of rules that treat all human tissue with respect, whether it
is alive or dead, and so the concept of dignity applied has quite a
broad use and is commonly used in every medical school and every
teaching institution I have ever been in.
So I think that helps us think about how those terms are used in
the reports you referred to as well.
CHAIRMAN KASS: Yes, but
let me draw you out a little bit. It seems to me that you are in a
way assimilating embryonic stages of a developing life with human
tissue and --
PROF. GAZZANIGA: I am
just speaking to the concept of respect of matters human --
CHAIRMAN KASS: Good.
PROF. GAZZANIGA: -- with
respect to the body. And that is extended throughout the biomedical
profession even after death and that -- I think that concept should
be clear to all members that there is -- you start with a high level
of respect for all matters medical.
CHAIRMAN KASS: Rebecca,
please?
PROF. DRESSER: I am
sorry to complicate things but I do think we have to also consider
the role of the women who would have to provide oocytes in this
discussion. And, I mean, you mentioned some of the earlier
government commissions but there was also this Embryo Research Panel
in '94 and they did want to create a procedure by which some
synthesis of embryos might be permitted for very deserving grounds.
However, they also said that no woman should undergo the oocyte
retrieval procedure purely for research and they did not discuss,
you know, payment and so forth.
So, I know, this is outside your framework but for me it is an
important moral component of this so-called synthesis of cloned
embryos purely for research. So I want to keep that in the picture,
too.
CHAIRMAN KASS: Well,
let's add it to the list of the questions.
DR. KRAUTHAMMER: Excuse
me.
CHAIRMAN KASS: Let's not
--
DR. KRAUTHAMMER: Can I
just interject? Would that not be covered by the principle of
informed consent?
PROF. DRESSER: Well, no.
They were making a decision that as a -- and they were only talking
about federally funded research but they were making a decision that
it is inappropriate to -- it was involved in the sort of
co-modification and it would be kind of paying women to produce
embryos for research and we want to avoid that, and asking women to
undergo these kinds of risks. We should only -- they viewed the
appropriate sources of the oocytes as women undergoing infertility
treatment who would go through the procedure anyway or they also
discussed donations, cadaver donations, either from the woman or
from the woman's next of kin. Because there is just a view that we
do not want to expose women to more risk purely for this purpose.
Now that is, you know, something we can discuss but that is a
factor.
PROF. MEILAENDER: Leon,
could I just make a quick comment?
CHAIRMAN KASS: Please.
PROF. MEILAENDER: I
think, in a sense, Rebecca's concern fits under your third category
or could be said to fit in the sense that one might ask do we want
to be the sort of society that simply, you know, permits women as
long as they consent to do this or that takes seriously a certain
other kind of concern so that would be -- I mean, that would be one
way of retaining your basic outline but not losing your concern.
CHAIRMAN KASS: By the
way, on this subject, and I do not want to be dictatorial, I would
actually like to hear from everybody on this question. Not just the
lawyers for the embryos but I would like everyone to really have to
grapple with the question. What is it that we think we owe? Granted
that there is a long tradition in the medical community that even
the mortal remains and even the tissues dissected from mortal
remains are not humanly nothing but there is a special question
really that is our province, which is these early stages of human
life, and what is that and what do we owe it? Even if we choose to
experiment on it, I mean, I think that is -- or else this notion of
special respect just disappears.
Rebecca, do you have a -- do you want to start?
PROF. DRESSER: Well, I
am reluctant to -- I certainly would not want to support a view that
we should synthesize human embryos as just another research tool
analogous to say an animal model, although I have some problems with
some of the things we do with animals, too. So I would not want to
support a view that this is kind of a piece of property or a
research tool.
I do -- I am attracted to this special respect concept. I
certainly think where I start with that is that the only situation
in which we ought to synthesize embryos purely for research would be
there is some sort of compelling need to help the patients because,
of course, you know, I do give moral weight to the patients.
So, if anything, I would require a very high standard of
justification in terms of scientific merit and no reasonable
alternatives. Some concept of necessity that has some substance to
it, not just I think it is necessary, therefore let's go ahead.
CHAIRMAN KASS: Comments?
Alfonso?
DR. GÓMEZ-LOBO: I would
like to start with some reflections on the word "embryo," not to
look into its entomology but to think about the concept for which it
stands and from yesterday's discussions, particularly from what
Robbie urged in the discussion with Irv, it became even more clear
to me that embryo is what is usually called a "phase sortal" in
philosophy. Now that looks complicated but it works like this: We
may ask what sort of thing something is and we respond with a term
and we say that is a sortal but there are proper sortals, that is
the sort of thing that something is throughout its existence, and
then sortals are words that tell us the sort of things something is
throughout a stage of its existence.
Now it seems to me that embryo is surely of the latter sort. I am
looking at the definition of embryo in the National Bioethics
Advisory Committee report and it reads as follows: This is in
Appendix 2. "Embryo: The developing organism from the time of
fertilization until significant differentiation has occurred when
the organism becomes known as a fetus." So it is a stage of
something that we have to characterize in a different manner.
Now, that should be the next step to think about but in the
meantime I cannot but infer from the two figures that Irv Weissman
presented yesterday that there was something missing in the oral
presentation. Namely that there is at the phase in which both forms
of cloning start there is something that is the same, and that was
clearly granted.
Now, under this definition of embryo, it seems to me clearly the
case that a human embryo is generated, is produced, we can use
different verbs, and it is allowed to grow until a certain stage,
and then -- only then when it reaches the stage of the blastocyst
ways part. You can either implant it or retrieve the stem cells.
So from this scientific information it seems to me clear that
there is there a stage in an organism that we have to further
characterize.
Now, as I think about these matters and the -- I have read more
about genes and DNA, et cetera, than I had ever read, in the last
few days -- it seems to me relatively clear that what guides this
development are the genes.
Now this has to be refined, of course, and I am not a scientist.
I am not competent to do it. But it seems to me that the outcome
might possibly be the following: That genetic determinism probably
has to be rejected. From what I have read there is so much
contributed by the environment in the broad sense, by nutrition,
culture, education, et cetera, that it is simply foolish to think
that we can clone someone. You know, Michael Jordan and get exactly
the same Michael Jordan. That is not going to happen. I have heard a
lot of arguments in that regard, right? Michael Jordan may end up
being a chess player, you know. There are other factors.
However, it seems to me, and I am very interested in what the
scientists say about this, that genetic determinism is one thing but
genetic developmental programming is something different. Namely the
fact that the genes determine that a certain embryo is going to
develop a brain or a certain kind of a brain, you know, human brain
instead of a sheep brain, that the organs that are going to start
developing very young, et cetera, are going to be different
depending on the genetic structure of that being.
Now, the conclusion that I draw from this is that a human embryo
is simply the early stages of a developing organism that will, if
everything goes well and there is implantation, will become an adult
human being. Now, if that is the case, then my reasoning goes like
this: Do I have any reason to deny the identity of the adult with a
teenager some years back, with the infant, with the unborn child,
and I just do not see how I could deny that. How I could argue no,
there is a break in the identity here.
Scientists tell me -- and again I need confirmation of this --
that I -- each one of us has the same DNA that he or she had right
from the beginning. Now, those would be, in my opinion, underlying
facts that I would like to hear about whether they are correctly
expressed or not. Upon which, it seems to me, as a further step, the
moral judgment would have to be based.
Thank you.
CHAIRMAN KASS: To this,
Janet?
DR. ROWLEY: Oh, no, I
want to just point out that in the diagram to which you refer that,
in fact, it is right at the stage where you obtain an egg that you
remove the nucleus for somatic nuclear transfer. You remove the
nucleus that is in the egg and you replace it with the nucleus of --
in some of Irv's descriptions you would replace it with the nucleus
from an individual who has the particular disease you are trying to
study and then that single cell develops in tissue culture until it
reaches the blastocyst stage, which is when you then separate the
stem cells, which would have had -- which are derived from that egg
with a different nucleus than it had in the ovary.
CHAIRMAN KASS: On the
general point that Alfonso makes, can we simply stipulate that there
was not a moral point made exactly but there was a -- if I heard him
rightly -- that there was a certain argument of biological
continuity. If you start at the beginning you sort of say that could
give rise to this. If you look at it backwards, all grown-ups came
from that by not necessarily -- well, by continuous process and at
least the -- both the humanoid aspects, as well as the individuated
aspects are in a continuum. That does not settle the moral question
but, I think, Alfonso is simply trying to give us the general
morally relevant biological account or at least part of it. It may
not exhaust what is morally relevant.
Dan?
DR. FOSTER: I personally
think there would be no disagreement with the formulation that
Alfonso sort of eloquently made. It has been made over and over
again that there is potential life which has the capacity to
self-direct to a full-blown human being. I do not think that is a
question for me as a non-philosopher.
The fundamental question is not whether the zygote or the cloned
egg has the capacity to develop into a human being and, therefore,
is deserving of profound respect if you wish to use that or even to
have certain very strong protective rights, the question for me is
-- and I have mentioned this before -- is this zygote or this clone
equivalent to life as we know it in a human being?
Now, if one goes back to ancient literature, it is sort of
interesting to me that in the early biblical story of creation, the
issue is also posed with a different conclusion that some others
have had. You will remember that in that story -- and I am just --
it is a magical, mystical story and I am not talking about this in
terms of a particular faith, Judaeo-Christian faith, but just the
story.
And in the first chapter of "Genesis" we are simply told that
humans are made in the image of God but in the second chapter, which
leads into the sort of luminous story of the Edenic paradise, the
story is different. And it says, and I will paraphrase, it says,
"And God made humans..." actually said "man" generic but "And God
made humans from the dust of the ground and into his nostrils
breathed the breath of life and man became a living being."
Now, as the words are written, whoever wrote these words,
anciently -- people of faith might say under revelation -- but said
that there was a creature who had nostrils and was developed but was
not a living being until the creator of all that is breathed into
that life something of essence and it became a living being.
Now, that does not mean anything in a scientific standpoint but
it does pose the serious question to me as to the equivalence of two
cells or one cell to life itself. I mean, whoever wrote that,
perceived of it as a time of ensoulment. I mean, the -- you know,
the last report, the National Bioethical Advisory Committee report
used that term in one of the papers.
I would not particularly use it but I just want to say that it
seems to me that it is a great mystery, and everybody who writes on
both sides seems to say that they know and I am not sure. I think we
know that the program is there but I do not know that we know that
this is -- I jotted down something that Richard Feinman said one
time in this little book "The Meaning of it All."
He says that we ought to view life as part of a universal mystery
of greatest depth and we ought to delight in the futility of trying
to understand what this atom (sic) in the universe -- he is speaking
of humans, what this atom in the universe is, this thing, atoms with
curiosity that looks at itself and wonders why it wonders.
In other words, I guess what I am trying to say is that I am
uneasy and do not know whether a zygote or a cloned cell is actually
life or pre-life destined under the right circumstances to come --
and I do not know the answer to that. In regard to what Leon said, I
think that this sense of mystery ought to be -- that ought to be
part of the environment of our deliberations rather than the
assumption that somebody here or all of us here actually know.
It is sort of interesting. One other biblical statement. There
was a great teacher called -- I guess all of you know -- called Paul
the Apostle. He makes a famous statement, too, in his letter to the
Corinthians. He says, "If anyone says, 'I know,' he does not know."
You see it is a very interesting concept.
So I simply wanted to say where I am in terms of looking at all
these matters and I hope that was not offense to anybody and I just
wanted to sort of share what goes on inside me when I think about
it.
CHAIRMAN KASS: Dan, can
I draw you out on this because it seems to me there might be
implications from recognizing one's ignorance and standing before
this as a mystery that one can ponder but not know. How would that
translate into what it is that you might owe this thing whose actual
nature of being were if you do not know? In other words, you are
talking about a certain general attitude but the question is how
does this actually -- would this translate in practice if someone
says, "Well, what actually does this mean with respect to whether I
can use a seven day old embryo, a three month old fetus?"
I am not trying to put you on the spot. That is not the point.
DR. FOSTER: Yes, you
are, Leon.
CHAIRMAN KASS: No,
seriously.
DR. FOSTER: Yes.
CHAIRMAN KASS: I mean, I
think that --
DR. FOSTER: Okay. Well,
let me try to give you just one example. I certainly do not need to
dominate this. My wife tells me that when I am talking to her I talk
too much and I really do not want to do that.
CHAIRMAN KASS: I will
not let you.
(Laughter.)
DR. FOSTER: The question
is it seems to me that many people here have as the highest human
good life as it begins as a zygote or an embryo or whatever, that is
the highest good and that it dominates all other goods. Now, the way
I would think about this is in a different way. I would say that
there are relative goods, as you have pointed out, and that it might
be that this life is not the highest good.
Let me give you an example. Our country and our society --
Alfonso and philosophers, do not hold me -- I am a scientist, I
mean, I do not talk about this very much but we, as a country, even
in the light of the terrorist things have always said that there was
a higher good than life itself and that higher good is the
willingness to give one's life on behalf of the society or for
others.
For example, in every war, essentially all the wars, we draft 19
and 20 year old young people. They do not give informed consent.
They go into battle. They go to Iwo Jima and it is a slaughter.
Society has already invested in them familial love, education. They
are potentially Einsteins or potentially other -- Mozarts or
whatever. And then when they die on our behalf, when they die on our
behalf, we lift them up as heroes and heroines, and we say that the
sacrifice of life is higher than the preservation of the life. One
who flees and is a coward in the face of death preserves life but it
is not the same thing as one who gives one's life.
Now, one way that I am trying to think about this because, as it
would be evident from comments that I have made, I am one of those
odd scientists who is able to have a religious faith and so I think
about these things in a lot of different -- I realize I am an oddity
about that. But maybe the highest respect that one could give
societally to a clone or a zygote is to allow those few cells to be
used for the greater good of conquering human disease and suffering
that is not just in the United States but everywhere else.
So that might be one way in which I would think about this. It
would be moving from the concept, as I hear and I have read Robbie's
views and so forth, that this organism, this -- which I am perfectly
willing to use the term "embryo" and perfectly willing to accept
that if we stop this development, if it is going to be implanted and
so forth, we stop a human being -- that one might argue that there
is a greater good that might come under here.
Now, if later on I will come back to say how this -- what I think
this might be -- how this might be, if one decided to do it how one
might regulate it and so forth, I mean no disrespect in any sense to
somebody who in their heart believes fervently that this, in
essence, is equivalent to which is said -- equivalent to ending a
life not in terms of a murder or something but in -- so that would
be a way which I would try to develop this myself.
CHAIRMAN KASS: Charles,
I have, and Bill and Michael and Jim Wilson.
DR. KRAUTHAMMER: I would
like to take off from that and to suggest perhaps a framework for
trying to answer your question, Leon, about does this organism
deserve respect and why, and what does it mean.
I would say there are probably two reasons why you might argue
that it deserves respect. All of us were once blastocysts and the
question is does a blastocyst deserve respect and why? One reason
would be -- I would call one mysterious and the other prudential.
The mysterious would relate to what Daniel has talked about, that
because there is something unique and special about this particular
collection of cells, namely that it can become us, there is
something -- it ought to put us in some kind of awe and some kind of
position of granting it moral status and, therefore, practical or
moral status and, therefore, treatment different from an ordinary
collection of cells.
The other argument would be, well, there is nothing particular
about the blastocyst in and of itself that commands respect. It is
on the head of a pin. It has potential but it is not -- it is -- in
and of itself it does not command respect.
However, were we to try to manipulate it, to play with it, to
strip mine it, to use it, to manufacture it, it will predispose us
to treating this kind of thing in a way so that we may break down
the barriers towards treating a fetus that way, ultimately a child
or a human that way. In other words, it is more an argument about us
and the weakness of human nature and the temptations, particularly
the temptations of technology than it is a statement about the
nature of the cells itself.
In other words, I could believe that there is nothing special
about a blastocyst but I do believe there is something special about
an infant. There is something special about an eight month old fetus
and I would not countenance the killing and experimenting on an
eight month old fetus. So at what point looking back -- at some
point -- I mean, all of us would agree a child at birth is a person
who deserves ultimate respect. It is on a continuum with that
blastocyst. At some point each of us would say, "Here is where I
draw the line." I am sure that would be unanimous.
So the question is are you predisposing crossing that line by
allowing, in principle, the assault on the blastocyst at that stage?
So I would posit that as two ways of approaching it. Personally I
believe in the second way even though I stand in awe of the
organism. There is nothing about the 100 cell, the collection, which
would in and of itself -- if I knew that we could stop right there,
I might be disposed to saying given the goods that could come of
using this, I might be disposed to saying it is okay to do.
However -- and I mentioned this last time -- I was raised in the
Jewish tradition, which has this notion of the fence. The fence
around the law that when you make a prohibition you think of what
related activities, which are not prohibited, bring you right up to
the edge and predispose you, you prohibit those other activities as
well because, knowing human nature, the crossing of the line becomes
so easy.
So I would say that the alternatives here in approaching this
issue of respect and restraint is that (a) there is something
intrinsic. We might call it the mystery of it and which would
dictate treating this differently. Or, secondly, what I would call a
piratical approach, which would be there is nothing intrinsic here
but, knowing who we are, let's stop before we go on to a place where
we would all agree it will be immoral to act.
CHAIRMAN KASS: Response
directly to Charles? I have a queue but this looks like it might be
an occasion where a very clear set of distinctions has been put
before us and we might make progress if we actually stayed with it
rather than just going in order.
Michael, did you want to say --
PROF. SANDEL: Well, I
had some comments that I will reserve for my place in the queue but
just to take up the distinction that Charles raised. We have heard
from Irv and the scientific account of the goods to be had. We have
had a lot of discussion along the lines of Charles -- what Charles
calls his "prudential consideration" which is really a moral
prudential consideration. Where do we stop if we do this? Won't we
dispose ourselves to harvesting organs from fetuses and babies and
so on?
What we have not heard in any of these discussions any arguments
of the intrinsic kind that Charles very helpfully distinguished, and
I think that we should give an opportunity to those who hold the
intrinsic view that quite apart from the worry about what next, what
about harvesting organs from fetuses, from those who think on moral
grounds and/or religious grounds, which should be entirely
appropriate here to voice and to examine and discuss, that the five
to seven day blastocyst, that taking the life of the seven day
blastocyst is intrinsically morally wrong.
CHAIRMAN KASS: Someone
want to speak to that? Bill, are you still on this?
PROF. MAY: No.
CHAIRMAN KASS: You want
to go back to Charles.
PROF. MAY: Responding to
Charles.
CHAIRMAN KASS: Paul to
Charles and someone else to Charles. We now then also owe to Michael
what he has invited but, please, Bill.
PROF. MAY: Well, you may
recall that I -- a month ago is a long time ago, though -- referred
to the comment of E.B. White about every morning I am torn between
the twin desire to reform the world and enjoy the world and it makes
it hard to plan the day. And I mentioned that the twin impulses of
savoring and saving, and I wrote a short paragraph and I pointed out
in science there are two sides to science, beholding and molding. I
mean, research and research directed toward therapy. And it seems to
me that respect bears on both sides of what I talked about.
We talked at the beginning mainly about the question of what does
respect have to do with regard to our behavior and that it should be
an important cause and indispensable en route to achieving that end
and so forth.
It seems to me if you talk about the beholding side, it seems to
me one is talking about awe, which is a term that has been used now
several times. That seems proper and right to use. When one thinks
about the molding side of things, one wants to explore appropriate
restraints, caution and so forth, and one can begin to talk about
criteria important in making good on that caution.
Now, Michael earlier mentioned that while medicine always
preaches this, and I think that is right, but it reminded me that
there is a problem for all professionals with regard to the
profaning, I think, of the problems faced by priests and ministers,
relating to that which is the ultimate object generating awe and
wonder but you traffic in it regularly and so there is a process of
profaning precisely because you constantly deal with, constantly
handle the thing and so the relationship, shyness of approach, and
restraint in behavior tends to get worn away by this constant
trafficking.
I think that happens for physicians, "I have got a myocardial
infarct in 407." And the fact that this is a human being tends to
fade before the urgency and the speed and the rapidity with which
one has to perform and handle things.
I can remember in the early days of my marriage sometimes I felt
I was talking all the time in school, I came home to discover my
wife complained that I did not talk. I said, "Well, I have worn out
words," you know, and that was a terrible self-defense in the
relationship but teachers as well. I mean, here you should use those
words respectfully and carefully with respect for the subject about
which you are talking and the rest but one profanes in the course of
relating. So awe is constantly at risk for those who traffic in
things that -- if not ultimately wholly, derivatively command our
awe and beholding and our caution and restraint in molding.
CHAIRMAN KASS: If I
could -- it seems to me this is -- this seems to me a very important
point to stress in this conversation. It ties in with the
discussions of desensitization that we have worried about with
respect to clonal reproduction.
And I did not -- I practiced -- I trained in medicine and did a
little medical research for a number of years, and in some ways did
not have the kind of awe and reverence for the materials until much
later when as a teacher of biology at St. John's College I looked
down a microscope and I saw a single cell divide. It was a sea
urchin egg. And while I am watching, this one cell becomes two
cells.
And I have to say it is one of the most powerful experiences of
my life. That did not somehow constrain me from continuing to do
other things but I knew that I was in the presence of something.
There was a power at work here that was really just astonishing. And
that gives way to manipulation and one loses it even as one tries to
retain it.
And it does seem to me that whatever -- whether one thinks that
the embryo is a person, fully one of us or not, there is something
here that calls for this kind of response if we allow ourselves to
notice it and I think that to somehow trample that is to do damage
to ourselves, never mind to the thing at issue.
So this is an aspect of this discussion that I hope we could
develop. It does not finally, I want to say, settle the moral
question of what to do here or whether the research should be done
but it does seem to me part of what it means to stand properly
beholding the material before us, however one finally decides the
question of personhood. I am sorry to have -- just Bill's comment
just moved me very much.
Let me go back to the queue. I have a long list of people. I have
Bill Hurlbut. I have Jim, then Michael, Paul, Alfonso and Gil.
And, Mary Ann, did I miss you, too? Sorry.
DR. HURLBUT: I want to
speak to the -- in continuity with what you just said but also to
the intrinsic dignity of the embryo. I always every year in my
classes bring the assisted reproductive technologies lab director
and clinical director to speak to my students and one day one of the
students said to the lab guy, "What does it feel like to be handling
these cells and how do you think of your role in this whole process
of infertility?" And he said, "Well, I do not think of myself as an
embryo pediatrician." Which was kind of a shocking statement because
it seemed to imply that having dealt with this tissue so long and
having it so unlike what it will become that it did not seem like a
patient in any sense but it seemed like something to be used
instrumentally for the sake of the desires of the parents who were
the real patients.
And what this brings to my mind is the difficulty either
intrinsically or through over familiarity with trying to reach into
the -- what is before you in the case of an early embryo and try to
make some connection of its deepest human significance.
Yesterday I mentioned when Irv was here that I had a long
conversation with Ian Wilmont, who is -- as you probably all know --
the man who cloned Dolly and I mentioned that we were talking about,
well, when does human life have an intrinsic dignity. And he said,
"I do not know when exactly it is but it is like midnight and noon.
Dawn is somewhere between them. And the way we can handle this is
just be so safe that we go to maybe 15 minutes after midnight and
then we know we are not violating its dignity."
But what strikes me as the problem there is, as I said yesterday,
that is imposing a metaphor over what is emerging. It is implying
that there is something -- that its intrinsic dignity is accrued or
cumulative or has to do with its organization. And yet if you take
it a little bit differently and consider that it has a kind of form
to it that is not just a static form but a being in process like a
narrative that has its quiet early beginnings, maybe you think of a
symphony where the first notes are very quiet, almost indistinct,
and then finally you realize in retrospect what those notes were.
You look back at an embryo and it is an amazing thing to think
of. Think about the one cell that starts a human being. Every one of
us was once a one cell and when you look at it backwards you see
more clearly what it is. It strikes me that with Ian Wilmont's
metaphor one might just turn it around on him. And I am not saying I
understand this. I am struggling deeply in my own mind about this
issue, too, but it strikes me that maybe the darkness is not because
there is no intrinsic -- whatever you would want to call that --
personal being unfolding presence of personhood, maybe the darkness
is not because it is not there but because our type of mind is made
for the practical realities of existence.
There is no question in my mind but that there is a sense in
which evolution or God through evolution has shaped us for what we
need to be able to do in life, not for every kind of understanding.
We never needed to worry too much about what the embryo was in human
history. It was not something we needed to have an instinctive
knowledge of. It just happened. We did not even actually have to
know what sexual intercourse was for. There is at least one culture
in which they did not associate sexual intercourse with reproduction
but somehow the job got done.
And here I would suggest that maybe the darkness that Ian Wilmont
-- and here I am just exploring this idea -- is not so much an
ontological reality but perceptual reality, an aesthetic reality.
Every year I ask my students to give some sense of what the depth
of the tragedy is at death at every stage from fertilization to 100
years old and they draw a curve for me. And it is amazing, that
curve barely ramps off of the baseline until maybe six months of
gestation and then it rises up, peaks around three years, dips a
little for adolescence --
(Laughter.)
DR. HURLBUT: -- then it
goes soaring back up at fertility and then slowly descends down to
death. It spikes a little just before death because people become
interesting again if they get very old.
(Laughter.)
DR. HURLBUT: But it
always strikes me that it is an aesthetic judgment. It is what we
are made to value. We value young children because I think nature
has made to value those beautiful big eyes and those chubby little
cheeks because we need to protect them. We value people in their
fertile years because we need to be attracted to them. They are the
most valuable commodity, if you will, or being in any species but
that does not mean that there is not some intrinsic dignity here and
it seems to me there is another way where we could put this dignity
in.
We have always, it seems in some form or another, defended this
usually with the notion of something called the soul, which one
might say is the something more of matter. We can -- I do not want
to go on any longer because I do not want to talk about what a soul
is but I think it is an interesting thing for us to enter.
I would just like to at this point introduce this notion that
maybe our problem is an aesthetic sense, not so much -- in other
words, we are confusing our intuitive aesthetics with clear thinking
about ontology. Does that make sense?
CHAIRMAN KASS: Mm-hum.
Jim Wilson?
DR. WILSON: I would like
to raise an issue that stems from Leon's remarks and Dan's remarks
based on my inadequate understanding of the science and then ask two
questions from the scientists present have I got the facts even
approximately correct and then from everyone present what, if
anything, do these facts mean. I am not sure I am confident I know
the answer to the first question and I am not sure I even have a
good guess about the second question.
The issue is viewing life prospectively versus retrospectively.
If you view it retrospectively it is obvious. Everybody in this
room, everyone in the world comes from a fertilized egg. There are
no exceptions. If you view it prospectively from the point of view
of fertilization, however achieved, by sexual congress, by in
vitro fertilization or by cloning, it is a very different
matter.
I asked the staff to see if they could find any estimates on how
likely it is that a pregnancy -- a fertilized egg will proceed to
implantation and then to become a fetus, and they provided me with
some estimates. One estimate was that 50 percent of all pregnancies
are not viable and that occurs before the first missed menstrual
period. Now, of course, I raised the question how do they know this
if there was not a missed menstrual period.
Second, from the New England Journal of Medicine of
November 8th last year, maximal fecundity is approximately 30
percent and of the pregnancies that are lost, 75 percent represent
failure of implantation and, therefore, are not clinically
recognized as pregnancies. And then at another point, the incidence
of pregnancy loss after implantation is high, estimated at 25 to 40
percent, and though some of these losses may involve genetic
abnormalities there is often no known cause.
So prospectively we see here something that I am not sure I can
describe accurately. I was tempted to call it a lottery but that is
not true because it suggests it is mechanistic and purely random
when, in fact, there are probably important causes here that we do
not understand but prospectively the fertilized egg has a small
chance of becoming a fetus and, therefore, it seems to me that may
influence how we evaluate pregnancies in their early stages up to
the point perhaps of implantation, which occurs shortly after the
blastocyst is formed, in those circumstances where it occurs at all.
This is not to say that a blastocyst or even a fertilized egg
deserves no respect but it is to say that we are giving respect to
something that has somehow managed to survive a bitter struggle for
survival and this may color, I think, how we view it as opposed to
how we view a fetus.
DR. HURLBUT: Why should
that color it?
DR. WILSON: Pardon? I
cannot hear you, Bill.
DR. HURLBUT: Why should
that color it? I am just not clear.
DR. WILSON: I asked the
question should it color it. This is the question I am asking. Does
it make a difference that retrospectively we all came from
fertilized eggs but prospectively the chances of a fertilized egg
even becoming a fetus, much less a child, are very, very small.
DR. HURLBUT: Well, for
example, death at one year old would not change the intrinsic value
of a one year old, would it?
DR. WILSON: No, it
certainly would not.
DR. HURLBUT: I mean,
like in poor countries where a lot of people die at birth or soon
after.
DR. WILSON: Quite right.
DR. HURLBUT: Okay.
DR. WILSON: No.
CHAIRMAN KASS: And one
does not know prospectively which one of those is destined not to
implant, right?
DR. WILSON: That is
right.
CHAIRMAN KASS: So,
forgive me, but how does this help?
DR. WILSON: I am not
saying it helps. I am just calling --
CHAIRMAN KASS: You are
asking the question.
DR. WILSON: Earlier
people said that prospectively and retrospectively --
CHAIRMAN KASS: Was the
same.
DR. WILSON: -- we all
deserve the same degree of respect. I am raising the question of
whether prospectively respect is owed in the same degree as it is
retrospectively.
CHAIRMAN KASS: Does
someone want to join that? Alfonso?
DR. GÓMEZ-LOBO: I would
view it as follows: I would say that indicates that there is a great
deal of uncertainty about particular cases. In other words, there is
no doubt that we are not clear about a particular instance, say a
blastocyst, will make it or not but I doubt whether that carries
over to uncertainty about the general class of the action in which
we are -- we would be engaged if we take a blastocyst apart. Because
there it would seem clear that if this very important clause that I
see biologists always using, "if all goes well" -- in other words,
if that is added, "if all goes well", we would be destroying an
organism at a certain phase of its life.
DR. WILSON: We would be
destroying an organism at a certain phase of its life when it has
approximately a one in four chance of becoming something other than
that simple organism. Does that make a difference? I am raising the
question. I am not trying to answer it.
PROF. GEORGE: Jim, I did
not hear what you said in that last comment.
DR. WILSON: I said, I am
raising the question of whether an organism, let's say the
blastocyst, that has -- pick a ratio -- one in four chance of
becoming implanted and surviving implantation to become a fetus,
does protecting that organism deserve as much respect as protecting
the fetus?
DR. GÓMEZ-LOBO: It seems
to me that Bill answered that question already. In other words,
infant -- high infant mortality in a country does not justify
infanticide.
DR. WILSON: But that is
because a recognizable human being is in existence and the question
is does an entity containing 60 to 200 cells constitute the same
thing as a child that has died of starvation of malnutrition or
whatever?
DR. GÓMEZ-LOBO: Well, if
all goes well, that is if it is constituted properly, and of course
in the particular case we may not know, the reply would be, yes, it
should be worthy of the same respect.
CHAIRMAN KASS: I have
Michael Sandel, Paul, Alfonso for a different point, Gil, Mary Ann,
Rebecca, and we are five minutes to 10:00. Let me make the following
proposal: Let's go a little past 10:00 to get at least some of these
people in the queue into the discussion. The agenda called for
moving to the policy questions but with your indulgence I would like
to continue this discussion. We also have the other part of this
matter to take up, which is to say what is owed to the people who
are suffering severely. I mean, the embryo is only part of the
discussion of the goods that we have here to be thinking about.
So rather than do two conversations badly, I want to propose that
we actually proceed with this one and try to some progress if that
is -- if that is all right. Let's see how far we can get.
Michael Sandel?
PROF. SANDEL: One
striking thing to me about the discussion is that everybody here
seems to agree that the embryo is not a mere thing and the only
differences of expression so far really have to do with different
answers to Leon's question. Given that it is not a mere thing, how
best to describe the obligations we have with respect to it.
I think Bill May's distinction between beholding and molding was
a very good way of getting at two competing impulses behind which
lie two sets of human goods that bear on the way we regard the world
and creation and life. And that distinction, the one that Bill has
offered, corresponds very closely to the way Judaism views nature
and human relation to nature because on the one hand -- and this is
the beholding idea -- the sanctity of life is grounded in the idea
that life is a gift, a gift of a creator so that is the beholding
and that is the element of awe.
Corresponding to the molding idea in Judaism is an obligation to
heal. The idea that nature is not -- was not complete or perfect at
creation and, therefore, man is a partner with God in creation. And
the covenantal idea is the most vivid expression of the partnership
of man with God in creation and with that goes an obligation of
mastery and dominion with respect to nature. This is brought out
even in rituals, these two dimensions.
In the ritual for the first born child, the redeeming of the
first born, the (Hebrew). I had to sort of symbolically buy back
from God my first born son as part of the bris but it is also
a part of the bris that there is a circumcision and the circumcision
expresses both the covenantal idea and the idea that nature is not
complete.
PROF. MAY: It certainly
is molding.
(Laughter.)
PROF. SANDEL: Well,
there you have it.
(Laughter.)
PROF. SANDEL: And then
when we get to these questions then about how to regard nature and
how human beings should -- what role, there is a tension between the
commandment of mastery and dominion or molding and at what point
does that come into tension with the idea of life as a gift or the
beholding idea, the idea of awe. I think those two moral impulses
run through these debates about cloning and about biomedical
research, cloning in particular.
So that still leaves unanswered the question, well, then what
respect is due, what respect is due the seven day old blastocyst?
And I think that at least the beginning of an answer is because it
is not a thing it is not open to use. It is not open to any use but
only certain uses. Only uses for worthy ends but that is not
demanding enough.
I would say only those worthy ends that have something to do --
and here I think this fits with Dan's -- what I found very moving
account -- only worthy ends that have something to do with healing
or preserving life or curing disease. That would be one more
stringent answer. Not just worthy ends but ends having to do with
appreciating and saving life.
To that you might arguably add "and also the ends of human
reproduction itself, which would allow for the sacrifice of embryos
involved in IVF. Though, I, myself, am inclined to -- here I am
unsettled. I do not know the answer but it seems to me that the more
stringent restriction, only those ends that have to do with healing,
curing disease, healing and in saving life are consistent with the
respect owed the seven day blastocyst. That stringent definition
would call into question the moral permissibility of sacrificing
early embryos that is involved in IVF and we do not have to resolve
that question here but I think it is depending on how broadly or
narrowly you construe the character of the ends necessary to justify
using the blastocyst you might or might not include the sacrifice
involved in IVF but I think that the stronger case, morally stronger
case, is in curing disease than in providing a means of reproduction
for infertile couples. That seems to me the morally weightier.
And I recognize that there is even to the stringent account of
proper or appropriate use, there is one possible -- possibly
powerful objection, which is if the seven day blastocyst is a human
life with the same moral status as a baby then even that use would
be wrong and there are those who hold that view and I would be
interested in hearing an account of that view and an articulation of
that view because if it is persuasive then even the stringent use
would be morally objectionable, which is why earlier I tried to
suggest that I think those who hold that view should have an
opportunity to articulate it.
CHAIRMAN KASS: Paul?
DR. MCHUGH: Wow! I do
not know that I have anything to really add to what Michael said but
I want to put it in another set of terms. The same things in another
set of terms and that is to go back and to go with Michael on the
idea that we are involved in a conflict of goods here and I want to
express the goods the way a doctor of a special sort has looked at
these goods because I think the conflict is between my sympathies
and my pieties. And with these situations both my sympathy and my
piety weigh in and I look for information to help me and guidance
from the group.
And, by the way, I do not think it is any different than the rest
of America. I think that is exactly what this conflict is about. It
is a conflict about sympathy and piety. Sympathy for the sick and
the necessity for more information and treatment for the sick. And
piety for human life, its giftedness, thankfulness for it, and its
manifest joys. Again, I think Bill is saying the same thing.
By the way, such a conflict of sympathy and piety is not unique
to this arena. After all, it is at the root of the environmentalist
conflict and it spoke to Harry Truman when he decided that two
cities in Japan were enough and he stopped further atomic bombing
and it may well have had something to say in the debate about the
super but it plays out for me in a very special way and I thought I
would just go over a little biographical sketch about this because
it tells this story.
You know, at Hopkins, for 25 years I have overseen the
development of a major neuropsychiatric research center. We are
primary in Huntington's disease and secondary in Parkinson's disease
and Alzheimer's disease at Hopkins. We know these patients.
These Huntington's patients, in particular, and their families
very, very intimately and have cause to join with them in all of
their struggles for life and the like. Investing ourselves in basic
research and in the clinical service for them. It is not just our
center. It is not just a research center. It is a service center and
we do prediagnostic testing, brain imaging and the like. And let me
tell you, you have to be with somebody who has done a prediagnostic
test who is healthy and you have to tell them that, yes, they carry
the gene and this is going to -- and we do not have a treatment for
them, and so we know a lot more about it now. It's genetic etiology,
the trinucleotide repeat on chromosome 4, and I have wonderful
colleagues now at Hopkins intended to understand this condition.
And, you know, I am probably telling you things that you know
perfectly well but Huntington's disease is a disease that you get at
conception but it does not show up until you are 35 or 40. That
means there is a delay of 40 years before the gene plays itself out.
Now, naturally enough, what we want to do is to make the gene not
play -- well, we could replace the gene, do better that way, but if
we could figure a way in which we could make the gene take 90 years
to play itself out or 110 years to play itself out, in a sense we
would have cured that condition. And to some extent, our discussions
yesterday were that.
So much for the sympathy but do not underestimate it. You are
with these patients day after day. You work with them. You work with
their thoughts about their children. You are looking for help. What
about piety?
The extrapyramidal disorders that we are talking about here,
Huntington's disease, Parkinson's disease and the like are
characterized by insidious and aggressive tissue loss in the brain
and pluripotential cells may well replace this.
Over 25 years ago, both in my department and others, animal
investigators demonstrated that fetal neural transplants to brains
could replace neural cells deep in the brain and for some humans in
other countries, after all this has been done, fetal tissue, not
embryonic tissue, not stem cells but fetal brain tissue has been
transplanted into the brains. And let me just tell you that I have
seen some remarkable results with this. Remarkable results. I have
seen them myself. The Parkinsonian patients got better. Not all of
them. There have been also catastrophes in that way but they have
gotten better.
But the use of human abortions as sources of this tissue is
repellant. Not simply because it is wet work but because of the
misalignment of power and the subversion of human -- one human to
another. A kind of desecration.
And if you experience that, like I did in our department, then
the idea that maybe a particular kind of stem cells represented an
opportunity to move from this desecration to something else, the --
I believe, by the way, that same impulse to kind of piety for work
did lead to President Bush's Solomonic decision to let cell lines
that would -- could be used.
Now Irv Weissman yesterday passed rather quickly over that
limitation. It is because he emphasized the limitations he saw in
that research and that treatment lines permit. But there is much to
be said for demanding that the scientists prove with a sample what
they could do with -- before we give them a whole population and
that -- I thought that was what President Bush was out to ask them
and this is identical to asking an oil rigger or a miner to show in
a small place what he could extract without giving them the forest
primeval.
We know that some stem cells work by secreting trophic factors
though and that is one of the new discoveries. There are other stem
cells that replace neurons and so there is no mystery that with each
disease it is going to be different but this whole idea that these
cells are going to give us a chance to work to help patients for
whom we have sympathy and we need to know whether the new technique,
the new method will permit us to do so without infringing on our
piety.
We learned a lot yesterday from Irv Weissman. You know, he is a
gifted scientist and he told us he was a wonderful entrepreneur and,
you know, he missed his calling as a salesman because it was amazing
to me that he took us up to the mountain top, pointed out the
future, but never described a single animal experiment in nuclear
transfer that revealed the cellular mechanisms illumining an animal
disease as he promised we were going to find out something about Lou
Gehrig's disease.
Now, our moralist made a point that he was making moral
decisions. I was impressed that he little bit finessed the
scientific issue and I really -- do not get me wrong, I think there
probably is an experiment out there where one of the Jackson Lab
mice have been really cured by a stem cell and the like.
Now, this just brings me to my point. What is my point besides
the fact that this is sympathy and piety? I cannot walk away from
this nuclear transfer method for producing stem cells without grave,
grave reasons for it. And Michael Gazzaniga and I yesterday argued
for the idea that this method is a distinct method and we go back to
using the word "embryo" for these cases, this method, yet it is
different from -- the cloned cell is different from a zygote for
which we have this piety and it has a linkage that looks more like
tissue culture in some way than it does exactly like a zygote.
And I am very anxious that as we see our way forward here, we
remember that the progress in science may permit us to do the curing
that Michael mentions as one of the themes of our effort as human
beings but at the same time does not make us kind of committed to
dealing with life as though it were insubstantial or just matter in
motion. So that is really where I am.
I have not gotten -- I have not made my mind up yet on this
matter. I am just seeing in these conflicts of goods that we should
look at the method itself and decide whether that technology does
not permit us to see that we are in a new arena where good things
could come and our pieties and our deep concern for human life is
preserved.
DR. HURLBUT: What makes
that more like tissue culture?
DR. MCHUGH: Well, very
simply that you take a cell from someone, the somatic cell, you put
it in a medium, okay, and it -- like in a tissue culture, it just
follows along. It just grows. Now we want to name stages of which it
grows but it is not like the union of two gametes. It is -- well, it
is not exactly tissue culture but it is like it.
What is tissue culture? You go in and you take a piece of -- take
a cell. You put it in a culture and it grows. This time you take a
nucleus, you put it into a particular envelope and it grows and it
gets to a particular point. I am saying that is a different thing
than taking either IVF embryo or the abortions that used to be --
that have been used for Parkinsonism. That is a different species
and I am struggling --
DR. KRAUTHAMMER: Could I
make a point?
DR. MCHUGH: -- to
express it, I know, but I would like to say that something is new
here and that the scientists have brought us this and we should be
at least ready to embrace it before you send me back to Baltimore to
tell those people with Huntington's disease, well, back to the
drawing boards, we are going to have to do something else yet.
CHAIRMAN KASS: A quick
comment and then we are going to take a break.
DR. KRAUTHAMMER: I would
like to think that the cloned embryo is just an intermediary, sort
of a transitory step between a somatic cell that you start with and
the stem cell that you want for your patients but unfortunately for
about seven days it is there. I mean, we would like to escape that
and perhaps we are going to get a technology which will allow us to
go from a somatic cell dedifferentiated just to the point of
producing a stem cell and then we are not going to have any of these
discussions because we are not going to have a clone.
But, unfortunately, what we have now is this week during which we
have an entity which I do not understand how there is any way to say
anything other than it is identical to an embryo produced by sexual
-- by say IVF or sexual union in the sense that it has all of the
potentials we would assume to be -- to become a human life.
DR. MCHUGH: I would like
to agree with you, Charles, but it is just not true. The fact is
that a zygote formed between two gametes is a different thing than a
cloned cell from a somatic cell from somebody else. It is just
different. It is different in its origins and it is different in
what it has.
DR. KRAUTHAMMER: It is
different in origins but not in its destiny, and that is the point.
DR. MCHUGH: Excuse me.
DR. KRAUTHAMMER: It is
different in its origins but not in its destiny.
DR. MCHUGH: Oh, yes,
that is true. That is exactly right.
DR. KRAUTHAMMER: And
that is what troubles us.
DR. MCHUGH: Well, that
was --
DR. KRAUTHAMMER: It is
the root of our problem.
DR. MCHUGH: That may
trouble -- it is a very legitimate thing to be troubled with but all
I am trying to say is you should also notice that it is different
and that there may be something to honor here or to appreciate here
because it is different.
CHAIRMAN KASS: This has
to -- the argument will continue. Sort it out between yourselves.
Fifteen minutes, 10:30.
(Whereupon, at 10:12 a.m., a break was taken.)
CHAIRMAN KASS: Unless I
hear strong objection, I would like to follow my intuition and
continue the discussion we were having. It is an important
discussion that should not be truncated just because the agenda
called for us to do something else. Paul McHugh only barely got us
started on what has to be said on the side of sympathy, which leads
into that other aspect of this as to what it is, in fact, we owe the
patients and their families with severe suffering.
Yes, let me not take up time by intervening in the hope of
clarifying something. I will try to do that if necessary as we go
along. There are still people waiting to speak. Alfonso, Gil, Mary
Ann and Rebecca is what I have and others may want to come in.
Michael Gazzaniga.
DR. GÓMEZ-LOBO: Okay. A
quick comment on what Dan said. As a matter of fact, I find myself
in agreement with your approach but on the other hand my tendency is
to be in awe of the results of contemporary science. I am just
amazed at the kind of knowledge we have today. For instance, what
Paul just said that there is a gene that is obtained at
fertilization and expresses itself -- what is it? -- 35 years later.
That I find an astonishing discovery and I am really very impressed
but that is to me an indication of the identity through time if
there ever was any way of arguing for it.
I mean, it really -- it has to be the same person. If it is the
first cousin then it is not going to work, right? It is the same
person. So I would insist that there is this deep intuition that we
have to consider, namely that the genes do not determine everything
we are but do provide something like a programmed command and
control for our development. Proof of it is that there is an illness
that can be traced back to a gene, although it appears 35 years
later.
Now I have still not really gone into the moral arena and this
may be my first gingerly step into it and I want to address the
point that Dan mentioned about the good. Now it seems to me that
life -- I mean, there is no way I would accept the idea that life is
the highest good.
Surely, if you have -- if you are alive and have other goods, you
have something to strive for. You have the good life and that
probably could be called the highest good. Life is one good among
many goods. However, life has a very special position it seems to
me. Life is actually the good that sustains our enjoyment of all the
other goods. If I am alive, I can enjoy friendship and such things.
If I die, well, that is it. I cannot enjoy those other goods.
And I think that this is recognized by the moral tradition which
you rightly illustrated. We highly praise those who give up their
lives for others and there are many ways in which that could happen
and that is why it sounds to me quite rational to praise those who
do that.
On the other hand, it is interesting that we consider the worse
crime the intentional taking of innocent life of someone else and we
also consider the death penalty that is the deliberate taking of the
criminal's life to be the worse punishment. So both of those
reflections indicate, it seems to me, that life is a grounding good.
Life is a very important good that grounds all of the other ones.
And I think that there is a connection between that and the question
of respect.
Now the last position I would like to make is this: Sometimes in
these discussions there is a lot of reference to potential life.
Now, it seems to me that there is a sense in which there is actual
life there from what the scientists tell me. And really I admire
greatly everything I have learned these days. From what the
scientist tell us, right from the beginning in the case of the
zygote there is this nutrition, growth, excretion, reproduction
there and those are the basic signs of life.
Now, what is potential, it seems to me, in the development
probably of any animal are the higher functions. When Dolly was
generated or cloned, clearly there was life there. Now the faculty
of perception, for instance, was not there. It was potential. But
again from what scientists tell me, the genetic programming was
there so although this was a clone this was very close to what the
-- what Molly, the sheep next door, was about because she also had
these 46 chromosomes and was going to develop in that direction.
Thank you.
CHAIRMAN KASS: Okay.
Gil, Mary Ann, Rebecca, Michael Gazzaniga, Charles, and I do not
want to preempt what you are going to say but I am going to make an
exhortation to professors that there are some questions that were
sort of started on the question of what it was we actually -- what
this special respect means. Michael Sandel has invited people who
want to say something about that to please speak up who think that
it has intrinsic meaning. I will pray that some of those in the
queue will actually speak to that but, as you wish, Gil, Mary Ann,
et cetera.
PROF. MEILAENDER: No, I
do want to speak to that, in fact.
CHAIRMAN KASS: I am not
disappointed.
(Laughter.)
PROF. MEILAENDER: I am
sorry to be quite so predictable.
(Laughter.)
PROF. MEILAENDER: If you
go way back to when we started down this road, Alfonso and Dan, who
spoke very early actually from quite different angles of vision,
agreed, I think, that when we talk about this cloned embryo we are
talking about one of us in the very earliest and least developed
forms but nevertheless one of us. And so if that is what we are
doing and we ask what do we owe to one of us in that stage of
development, what would it mean to show respect. It seems to me that
when I try to sort it out it would mean that we would want to show
ourselves people who were not willing to use others simply for our
own purposes, even for very good purposes, even for indisputably
good purposes.
And, in particular, we would want to show ourselves as people who
were not willing to use the weakest ones among us, who cannot, as it
happens, sacrifice themselves. We can sacrifice them but they cannot
give their lives meaning by sacrificing those lives. So that it
smacks a little too much of the strong using the weak and that is
hard for me to understand that as being encompassed by the language
of respect, much less profound respect or anything like that.
And it is even a little harder to understand it in the context of
the particular circumstances that we are discussing when not only
would we be showing ourselves willing to use the weakest among us
for our purposes but to use them in a circumstance where it can be
only using where we are, in fact, I think probably committed to
seeing to it that they could not have any continued development and
that that is sort of part of the package. That is use only and there
is -- without remainder.
And at least as I try to sort it out for such beings who are the
weakest and who cannot sacrifice themselves, I have a hard time
encompassing that within the language of respect. I mean, I can
understand doing it and I can understand powerful motives for doing
it but I would not try to call it moral respect.
CHAIRMAN KASS: For the
sake of clarification so that we know on something of the underlying
premise of the discussion where you talk about one of us because I
am sure that people will be interested in this, one of us in the
category of this list of five that we have here, embryos are the
more equivalent of both a later stage fetus and all living beings.
One of us in that sense? And there are people in this room --
PROF. MEILAENDER: Yes,
the earliest form of nascent human life.
CHAIRMAN KASS: Is one of
us in a full sense is what you want to say. That is the premise of
the rest of the discussion.
PROF. MEILAENDER: Right.
Yes, which I thought was actually -- that, subject to correction,
was where we started quite a long time ago.
DR. MCHUGH: Can I just
say that -- come back to my point? The real question -- no one
denies what you are saying, Bill. I do not think anyone denies that
the use of the strong over the weak and the destruction is
repellant. What I am concerned about is why we begin by assuming
that somatic nuclear transplant produces one of us. That is what
Charles and I are discussing and you might be able to persuade me.
Leon says it is a difference but a difference that does not
matter ultimately but it is a difference. And we are talking today,
not like we talked yesterday, about the creation of a human being,
which we have prohibited and said we will not do and for all the
reasons this is something different and it is new to be able to do
the somatic. And the question is why do the same things apply to it
as to a zygote?
PROF. MEILAENDER: Leon,
may I have just a sentence?
CHAIRMAN KASS: Yes,
please.
PROF. MEILAENDER: And I
do not wish more than a sentence. I have already said this to Paul
and it is not going to persuade him but --
DR. MCHUGH: You might.
You might. We are here to be persuaded. We are not here with fixed
opinions.
PROF. MEILAENDER: If you
want to call that cloned embryo a different species then were it to
be gestated and given birth to, it would not be a homo sapiens. The
question of its rights and dignity would be entirely an open
question at that point. I do not think that that is the position you
really want to defend.
DR. KRAUTHAMMER: And
yesterday when Irv spoke of it as an embryo, did you object, Paul?
DR. MCHUGH: Yes, I
objected. I object to the use of the word "embryo" on these -- at
the beginning of these things if you are not going to call it a
special embryo. And, you know, it really does come back to this idea
of where we are in our science.
CHAIRMAN KASS: Look, it
seems to me that the move that Paul is making in this discussion is
to say, yes, we might owe special respect to the embryo but that is
not the question in this discussion because the cloning for
biomedical research does not involve embryos or, if I might extend
your remarks, things that are embryo enough like -- things like unto
embryos sufficient to even warrant the question of respect coming up
in the first place. You have defined the problem out of existence,
right? I mean, you really have.
DR. KRAUTHAMMER: And you
also contradict the conclusions of the National Academy of Science
report. I mean, I am not arguing on my own authority. I am saying he
gave us a report of the finest scientists in the world on this
subject. I do not think any of us question the biological and
medical expertise behind that report and he had no question either
in his presentation or in the report that this was an embryo.
DR. MCHUGH: I have said
my piece on that and --
CHAIRMAN KASS: Let's go
ahead. Mary Ann?
PROF. GLENDON: I know
you wanted to hear from all of us on your first question but I have
to say that I find it very difficult to separate the first question
from the third question and it seems to me in listening to the
comments of others that many of the comments addressed to the first
question really are more properly related to the third. So let me --
CHAIRMAN KASS: Would you
remind us so that everybody knows the first question?
PROF. GLENDON: Yes. I am
thinking of the reasons that Charles gave as prudential reasons.
CHAIRMAN KASS: Right.
DR. GLENDON: I think that that kind of
argumentation has less to do with the respect that we owe to human
life in its earliest stages of development than it does to your
third question, which is -- you might say the connection is this:
The emphasis should be on the "we". Who is the "we" and how do we
envision ourselves or how are we constituting ourselves as a "we"
with the decisions that we are going to make about the respect that
we owe to these two very important poles that Paul described as
sympathy and piety.
So, I guess, it is a good idea that I waited until the end
because I think my comment is really a suggestion that we restore
the connections among your three questions and that we think about
what I think a lot of our fellow Americans are thinking about.
What kind of society are we bringing into being? What kind of
people do we want to be and how will these decisions that we are
making now constitute us in the future?
CHAIRMAN KASS: Let me
say hurrah for the insistence that we do that and ask you to turn
the mic on and put your toe in the water on the very -- speak to the
very question you have just articulated with respect to what we are
talking about.
PROF. GLENDON: Well, we
have not yet talked about the second question but maybe let me take
this occasion since I am not going to be able to stay for the public
comment to say -- I mean, the question of what we owe to those who
hope for cures. At our last meeting in the public session someone
made the comment that there is no representative of patients on this
Council and I think it is very important to state publicly and for
the record that all of us are patients, potential patients, friends
and relatives of patients, many of us treat patients, and so I would
like most emphatically to say that representation of patients does
not require the presence of a paid lobbyist on the Council but it
does require the presence of people who are interested in and
sympathetic to patients.
CHAIRMAN KASS: As we are
friends, let me bully you a little longer.
(Laughter.)
CHAIRMAN KASS: You have
tied together, you have now made comments about the importance of
all three of these things and that we owe something there. Let's
disaggregate them slightly and I am not going to spend the rest of
this morning simply on the side of the -- shall I say "embryo" in
quotation marks.
We really want to turn to the other side of this but Gil has
posed a challenge in saying that he finds it very hard to encompass
under the notion of respect for human life in its earliest stages
that that life should be regarded simply as useful for even, if I
understand them, the very best of human purposes.
You might be able to justify doing it. This is not my gloss on
Gil's but you can justify it in the name of respecting it if that is
an acceptable loss and everybody that has spoken -- everybody prior
to us that has spoken about these matters has said, as Michael
Sandel said earlier, everybody agrees that the earliest stages of
human life are not things. Either because of what they are now or
because of what they will become or some combination thereof.
And the question -- that seems to imply treating them differently
or regarding them differently and treating them differently from not
just things but from other cells of the body, and I guess the
question is do we have an answer? Shall we abandon the language of
"respect" or does it have -- I mean, Rebecca and Michael have said
respect which produces restraint save in the presence of certain
necessary compelling, otherwise not available benefits to certain
high human goods like healing disease. Okay. There is a certain
formulation here but there is a presumption of respect which sets
restraints on violation.
Gil says that is not right, that to use even for those goods is
disrespectful even if worthy and even if finely morally defensible
but you cannot somehow claim it -- correct me because I do not want
to --
PROF. MEILAENDER: No, I
just want to add that it is a heavy burden to demonstrate that there
is no other way to achieve the good in this particular case.
CHAIRMAN KASS: That is
correct. Correct.
And I not only wanted to hear from everybody but I wanted to hear
from everybody on this particular question that has been joined and
if you would just add.
PROF. GLENDON: Well, we
agreed -- we started out with the terminology on the sheet we were
handed this morning that these nascent examples of human life are
not nothing and then we moved, as Michael suggested, to a somewhat
more positive assertion. They are not only not nothing but they are
not things. That is an important move and we may be in one of those
situations where, although we would all agree, they are not things,
that does not settle a lot of important issues.
So the question then might become one about burdens of
persuasion, about what follows from the fact that they are not
things. You could have many people who would say, "Well, I
understand they are not things," but also I write up in "A" here
they should be used for research anyway with proper respect. We will
handle them carefully but we will do whatever we want.
So this is what brings me into your question number three. How
are we as a society going to handle all these issues without really
treating these -- I do not know what word to use. Treating nascent
human life as a thing to be mined, to be exploited, to be put at the
disposition of the wealthy.
I think I mentioned last month that in the civil law systems of
Continental Europe there is a deep principle in the structure of
these systems that the human body shall not be in commerce and they
have in various ways made exceptions to that principle. They passed
statutes to permit sale of blood for blood transfusions but it is
interesting that they have to pass a statute to permit it.
So I think maybe this is a useful way to think about it. The
"thing-ification" of whatever it is we are talking about and the
commercial and other implications that that may have. That is about
all I can say at the moment.
CHAIRMAN KASS: Thanks
very much, Mary Ann. By the way, on this last point, I hope people
have noticed that the AMA is -- the morning paper -- again
reconsidering lifting the statutory -- trying to have statutory
language that would permit a certain financial incentive for organ
donation. There was a statute, I think, in the mid '80s that simply
prohibited all commerce in organs. The bill might be introduced, in
fact, as early as today. That is under consideration. That might
come our way. We might choose to take this up.
I have Rebecca, Michael Gazzaniga and Charles and Bill Hurlbut
and then Robbie.
PROF. DRESSER: A few
different points. I do think that Paul's comments, and to some
extent Jim Wilson's comments, really take us back to what Michael
Gazzaniga said at the beginning of our meeting yesterday, which is
are these embryos. And I know you are tired of hearing this but I
guess I really do have a question that -- well, we know Dolly
existed but we do not know whether it is possible for this different
-- very different entity to become a person, to become a baby. And
so it is either in terms of what Jim was talking about, the odds of
this entity becoming a person. They are either -- there is a much
lower chance at least at this point of this entity becoming a person
than there is for an IVF embryo or a created for research regular
embryo, and it might not be possible. You know, it might not be
possible in the human species for it to become a baby.
So I think we should at least acknowledge that and say whether we
think that makes a difference in terms of what this entity is owed.
Whether it is a quantitative or a qualitative difference. Are they
more like parthenodes? I mean, in that same experiment by Michael
West. Didn't they get that parthenodes to go farther than cloned
entities?
CHAIRMAN KASS: Exactly.
PROF. DRESSER: So are
these more like parthenodes? Now how would we regard a parthenode?
So I do think we need to discuss that issue.
Going back to what Dan was saying about respect and awe for life,
I do think we have to talk about the need to draw a line. I mean,
for example, we would not say that we would think it appropriate to
draft people for important medical research, you know, in the way
that you were talking about the military. I think most everyone
would have problems with that. So the question is to -- when is it
appropriate to use a particular entity for important research
without consent, you know?
And on the other hand I do think we want to think about respect
and awe for life of the patients. I mean, the patients have lots of
things that these -- that nascent human life does not have. They
have relationships. They have projects. They have pain and suffering
and loss and all these things, and so I think that is important.
So that gets us to the question of what is the nature of any
responsibility we might have to try to help them? How far does that
go? Does that take us to a point where we give up some of these
social considerations that trouble me? Again, I would say that one
of the primary things that troubles me is this idea that we already
have this oocyte provider situation in the fertility area where
women have procedures done and hormones given that are not
risk-free. They are not extremely risky but there is a risk there
and they are paid for it.
I do not see how we could develop much of a supply of these
entities without money changing hands. I do not think there will be
that many women volunteering. So to take -- to get into that whole
area really troubles me and we have to count that, too.
CHAIRMAN KASS: Michael
Gazzaniga?
PROF. GAZZANIGA: So
let's see here. Go back to your wonder of the cell dividing back at
St. John's College, which is -- we all remember that moment. It is
not so exhilarating when it is a tumor cell. In fact, you grow to
hate it and you are sitting there trying to figure out how can I
stop this thing from killing somebody, and so that is what we are
talking about here.
So let's go back to the --
CHAIRMAN KASS: Well --
PROF. GAZZANIGA: Let me
make my point.
CHAIRMAN KASS: Sure.
PROF. GAZZANIGA: Let's
go back to the woman who is undergoing in vitro fertilization
and she is having her eggs harvested. She can harvest -- they can
harvest six to 20 eggs in that procedure. And she says in informed
consent, "By the way, I want to give a couple of those eggs to
science," and signs off on that and the rest of the eggs are used
for her procedure so she has given two eggs to the scientists.
The scientists then take them and put them mixed with a somatic
cell and put it in a culture and it grows up to the blastocyst
stage. They harvest the stem cells, the blastocyst is destroyed.
That is what we are talking about.
Now the concern, the moral concern here, as I understand it, is
that that blastocyst by assertion of some people's religious belief
is a person and if you believe that there is just no scientific
statement or data that can change that belief.
But for those who do not believe that, they can consider, well,
what is this blastocyst? And the argument generally is, well, it is
potentially a human being and so you have the potentiality argument,
which is a hot argument in philosophy and it is argued both ways.
But an analogy helps me think about it, which is you go into a Home
Depot -- it is not a perfect analogy but it is good enough for this
time of day -- you go in a Home Depot there are the elements for 30
homes and they have the potential of 30 homes in that Home Depot.
The Home Depot burns down. The headline is not Community Burns Down
Houses; A Home Depot Burns Down. That is the stage those goods were
at.
So the notion that this blastocyst is something else or can be
something else, it is a truism. Of course, it can be. That is the
whole point but are you concerned about it -- I am talking to the
people here who have not made up their mind. Are you that concerned
about it as a clump of 200 cells or not? And a lot of people are
not.
CHAIRMAN KASS: May I
take this one on?
PROF. GAZZANIGA: Sure.
May I consult my lawyer?
(Laughter.)
CHAIRMAN KASS: Yes.
Look, as far as I know, this opinion that you will hear has no
theological foundation. It has got nothing to do with religion. My
religion is Jewish and they are very liberal with respect to these
matters. My opinions about this matter are formed as a biologist and
as a reflecting biologist and has something to do with certain
philosophical notions which are not foreign to biology but upon
which biology richly understood, I think, rests.
I would not say that an early human embryo -- let's leave the
clones out for the moment because there is dispute about whether
they belong in this discussion at all. Ordinary zygote or blastocyst
formed sexually, whether in vivo or in vitro, that is
I think the right way to say that, to talk about it, is to say that
it is a human organism at that stage of development. It is not a
potential human organism at that stage of development. It is a human
organism at that stage of development. That is all it could be at
that stage of development. It has potentiality for other powers and
one of the funny things about potentiality is that it both is and is
not what it is. I mean, to be potential is to be -- to have a
potentiality is to have something real which is not yet. A long
discussion, not for now.
So there is something there that is of worth because of what it
is now and even more because of what it might become. That does not
mean to me that you cannot touch it but it means to me you should
not somehow define it into something else in order to enable you
easily to touch it. It is not a religious argument. It is simply --
and the unfolding -- the division of a zygote to two, and then four,
and then eight, and so on is very different from the division of
wild cancer cells because this is guided by an imminent unfolding
plan to produce a whole. The thing divides as a whole, forms as a
whole, grows as a whole. It even has polarity at a very early age,
which tumor cells -- as masses of clumps of cells do not.
That is very different from the way in which you could say the
boards in the Home Depot are potential houses but only if some
outside force would come along and put them together. Whereas, the
potentiality to become a full organism in this case is imminent to
the thing that is unfolding.
PROF. GAZZANIGA: Well,
do we really want to do this?
CHAIRMAN KASS: Well, I
think it partly helps to determine what it is we are talking about
here because if you are right, the conversation really in some ways
is over.
PROF. GAZZANIGA: Well, I
am not disagreeing that the blastocyst is a human in a stage of
development. That is a truism. Can anybody argue with that? That is
just the way it is. The question is what kind of agency you want to
assign that blastocyst at that point in development and my argument
is not much.
PROF. GEORGE: Agency?
PROF. GAZZANIGA: Sure.
PROF. GEORGE: What do
you mean by "agency"?
PROF. GAZZANIGA: Well,
what do you mean by it?
PROF. GEORGE: The act of
capacity to act on the basis of one's will and choice.
PROF. GAZZANIGA: Right.
So you have a clump of 200 cells and it is not there.
CHAIRMAN KASS: Organism
comprising 200 cells.
PROF. GAZZANIGA:
Whatever.
CHAIRMAN KASS: It is an
organism. It is growing.
PROF. GAZZANIGA: The
point being that if that tachistoscopic shot of that stage brings
upon a great number of people all these problems that I know you
feel and I know you feel; fine. It does not bring that problem to a
lot of other people and that is all I am pointing out and what I
happen to believe.
CHAIRMAN KASS: I think I
will subside on this. I mean, this really should be continued,
Michael.
DR. KRAUTHAMMER: Let me
pick up on it if I may and to go back and sort of look at the shape
of the debate if I may. It seems that to me that what we are talking
about here is research cloning and there are three possible
objections.
The first would be sort of the one that Michael is rejecting. The
idea of the intrinsic worth. The mystery, the awe, the respect owed
of this organism. The blastocyst would impel us to do -- treat it in
a way different from other tissue, the intrinsic value.
The second would be for those of us, because I -- whereas I share
the --
PROF. SANDEL: Could I
just ask, Charles, the first one, the way you characterized it is
relatively uncontroversial. The issue is not whether there is an
intrinsic worth that commands respect. The issue in the strong claim
is the equal moral status view.
DR. KRAUTHAMMER: I think
Michael would reject that there is intrinsic worth that commands
respect.
PROF. SANDEL: Maybe
Michael would but the -- maybe Michael would but we do not --
DR. KRAUTHAMMER: I was
following up no it as a way to say that even if you have that lack
of objection there are two other issues at stake here.
PROF. SANDEL: But even
before we get to the two other issues there is the equal moral
status view that is carrying a great deal of weight for some people
and yet no one has offered any articulation of it.
DR. KRAUTHAMMER: I was
endorsing Michael's position, which is that there is a view, a very
widespread view, perhaps not here, but certainly in the country that
a blastocyst is not owed any particular respect, that it is simply a
clump of cells. Do I misunderstand your position?
PROF. GAZZANIGA: With
all the caveats that we respect those clump of cells but it is not
respect in the sense that --
DR. KRAUTHAMMER: Right,
and that is a very widespread position. I would say it might even be
a majority position in the country and it reflects the fact that the
majority of Americans would support stem cell research which
involves tearing up a blastocyst. So it may not be a widespread
position here but it certainly is in the country.
Number one, intrinsic respect for this organism. But even if you
reject that, as I think Michael does and a lot of people do, and I
think I would as well, there is the question of the slippery slope.
Prudential arguments, yes, a blastocyst we could tear up and use but
it will predispose us to tearing up and using a fetus ultimately
transgressing on their lives.
But there is a third issue and that is should we as a society be
engaged in the creation of blastocysts solely for the purpose of
tearing them up? And that I think is a separate issue because -- and
it involves the example you brought up of donating IVF embryos. It
would also be involved in the issue of cloning. Even if you thought
that a blastocyst in and of itself is not something that needs
protection, do we as a society want to begin a new industry, the
commercial creation of human embryos, for the sole purpose of their
destruction?
I think that is a third element in this discussion that has to be
introduced because of what that -- how that would affect society and
how it affects our views of life and how it might coarsen us and
predispose us in the future to the kinds of violations of embryos,
fetuses, ultimately humans that might occur. So I wanted to put that
on the table as a third possible argument against research cloning
solely on the grounds that it introduces the idea of creating human
embryos for the sole purpose of their use and destruction.
CHAIRMAN KASS: A small
footnote, Charles, to the beginning first point that you made and I
think it was very helpful in illuminating Michael's remark. We have
so far been speaking about nascent human life homogeneously,
although some people want to make distinctions about various stages.
The Brits in their own regulations treat 14 days, the time of the
primitive streak, as a boundary.
When we do this right, it seems to me, we have to -- at least
people who holds Charles' view at least tacitly are saying that
there might be boundaries later on where "intrinsic worth" somehow
has some greater standing and if not for the cloning discussion when
we get around to the stem cell and embryo question, I suspect, that
age of embryo might be one of the factors that enters into the
discussion at least for those people who do not regard the embryo as
one of us fully in the full moral sense from the very start. So we
are not doing that right now but I just want to flag that
consideration because I think we will have to take it up.
DR. FOSTER: Leon, could
I just make one quick response to Charles?
CHAIRMAN KASS: Please.
DR. FOSTER: Implicit in
Irv Weissman's statement yesterday was a historical reference to the
Recombinant DNA Advisory Committee and the safety that was involved
by the scientists there, which when Marty Klein deviated from that,
he was -- I mean, he simply lost his whole career because of that.
Implicit, as I heard him speak, is that one recommendation might be,
if it was considered that research could be carried out, that there
would be appointed an equivalent of the RAC committee, which was one
-- in my view, in recombinant DNA -- was one of the glories of what
the NIH and others have done.
And then that committee would draw the lines, I think, maybe
along the lines that we might recommend -- I mean, there clearly
would have to be an external body of scientists and others,
ethicists and so forth, which would say this much is acceptable and
beyond this is not acceptable, and that is the way that it -- and it
worked very well so that the RAC is essentially functionally out of
business now.
So I simply wanted to say that it would not be -- I do not think
that you would be freely available commercially or otherwise to move
beyond that if and when there was a possibility.
CHAIRMAN KASS: Janet, on
this point?
DR. ROWLEY: I just want
to follow-up on that and say this was a voluntary committee. Well,
the committee was not necessarily voluntary but it was the
scientists themselves said that in order for us to go forward we
want this kind of regulation. It was not Congress that said we will
legislate that you are regulated. It was the scientists themselves
who recognized many of the issues and they, through NIH, had this
committee formed. And there is, therefore, precedence.
Implicit in some of the discussions are that it is the wild
scientist who is going to just destroy us all and I think it is very
important to come back to this as an example that scientists are
responsible and that they do understand in certain circumstances,
particularly the development of a new critical area that review and
restraints are perfectly appropriate.
CHAIRMAN KASS: Thank
you. I have Bill -- Robbie, Bill and Gil, and then I want to shift
to the other neglected part of this discussion.
Robbie?
PROF. GEORGE: Leon, I
want to -- Michael, I want to take you up on your invitation to
argue for the equality and dignity or worth, moral status of all
human beings, irrespective of age or size or stage of development or
condition of dependency or any other contingent factor. And my
proposition is that we should reject the view that worth or dignity
is contingent on those factors in the same way that we reject the
view that dignity is contingent on other contingent factors such as
race or sex or ethnicity or any other factor that we were all agreed
should not enter into a consideration.
And I want to suggest that what is really at stake in this issue
is not the question when does a human being acquire intrinsic worth
or dignity but rather whether human beings have intrinsic as opposed
to some other category, some other descriptive word, worth and
dignity.
I think that if we reject the idea that even the youngest and
tiniest human beings have intrinsic worth and dignity, rather
their's is acquired by the activation of capacities which are merely
radical at the stage at which we are talking, we will, in effect, be
giving up the proposition that any of us at any stage of development
or size or age have intrinsic worth, that our work depends instead
upon contingent factors which exist in people as actuations of
capacities in matters of degree such as strength, intelligence,
wisdom, beauty and so forth and which some people have in very low
degree if at all.
Irv Weissman said two very important things, I thought,
yesterday. One was that the blastocyst stage of human existence is
just that. It is a stage. There is not this entity that is a
blastocyst that might be on a list of entities with human being
along with rabbit and palm tree and garden post.
No, the blastocyst is a human being at a certain stage of
development such that the proposition that at that stage the
blastocyst, the human being, lacks worth and dignity. The rejection
of that is to say that at that stage what that human being is, is a
human nonperson. A human being who lacks the intrinsic worth and
dignity that some other human beings because of some factors, some
stage of development, age, size, et cetera, have.
Michael suggested -- Michael S. suggested -- Michael Sandel
suggested that the possibility that between the category of person
and mere thing there could be a third category. I realize Michael
did not assert it. Here merely suggested it and I agree that we
should consider whether there is such a possibility and I want to
say now why, having considered it myself, I reject it, although I am
certainly open to counter argument.
I think that it is impossible to find room -- if we eliminate the
words "thing and person" just for purposes of -- heuristic purposes
at the moment -- find room between something being a subject of
respect or rights or what have you and something being an object
that can be used for the purposes of others. And here I am simply
trying to reenforce, I think, something that Gil said earlier.
Now it is certainly true that some objects have such importance
or value, and in an analogous but merely analogous sense we might
say intrinsic value, that we would not want to sacrifice them
lightly. For example, great art. The Mona Lisa we would not want to
sacrifice or dispose of lightly but we do not consider the painting,
the Mona Lisa, to be a person. It is a painting of a person
obviously but we do not consider the painting to be a person.
Something of extraordinary value could never be lightly sacrificed.
If it were to be sacrificed it could only legitimately be
sacrificed to a very high cost like the saving of life. Let's say
that someone had the painting, was trying to escape from the Nazis,
running out the door with his family, the Nazis were coming at him,
he threw the painting at them in order to make the escape. We would
consider that justified in a way that we would not considered
justified the Nazis destroying the Mona Lisa because it was
allegedly the work of an inferior race or whatever their reasons
are. But, of course, the Mona Lisa is nevertheless an object and not
a subject. It is property. There are circumstances under which it
could be disposed of. It can be owned. Others can exercise power
over it and use it for their ends.
If we conclude that human beings at some stages of their
existence, whether it is the very young, tiny, dependent, or the
very old, frail, dependent, or the very severely retarded and,
therefore, dependent, if we conclude that in any of those cases we
are justified in -- for high reasons like the reasons we might
sacrifice the Mona Lisa -- using them, harvesting their parts, then
we will be treating them as objects rather than subjects, whether we
use the word "thing" with respect to them or not and even if we
think that the word "thing" does not do justice to the rare and high
importance that we attach to them. Again, whether it is the Mona
Lisa or a very severely retarded child who happens to have two good
kidneys or whether it is an early embryo.
What is it then that we have in common that is the core of our
dignity on the account I am offering if it is not age and size and
stage of development, if it is not strength and wisdom, and
intelligence and ability and beauty. All these things are obviously
unequal. What is it in terms of which we are equal?
My own judgment of why we are equal and what gives that -- gives
us a fundamental equality and moral dignity and worth justifying
requiring us to treat each other as subjects of rights and justice
rather than as objects is our common possession of a rational
nature. What do I mean by that?
I mean, the radical, at least, capacities for the exercise of
some rational faculty, life, love, laughter, the capacity to be
loved and to be cared for as a person by others who can reasonably
understand us as one of us, as part of the human family and part of
the family, and that capacity, those radical capacities, that nature
is not contingent on any other factor like age, size, stage of
development, race, sex, but rather exists just in case, just in the
event that, just when there exists a being possessing in the human
case the epigenetic primordium for self-directed maturation through
-- self-directedly through the stages of human existence from the
embryonic, through the fetal, the infant, the adolescence and so
forth such that looking retrospectively as Irv Weissman told us
yesterday, we can identify the Leon Kass now before us directing our
deliberations as the same Leon Kass who earlier in his life was a
precocious adolescent and a mischievous infant, and a fetus and
embryo and so forth.
Let me then address Daniel's point about whether we treat life
implausibly as the highest good when we say that the lives of all
human beings at every stage of development must be protected and
respected. I want to say I think with Bill Hurlbut and possibly Gil
as well that we do not do that. And to explain that, let me step
back to say why I deliberately frame the position I am defending as
a defense of the equal rights and dignity of the human being rather
than the question of whether the early human being deserves equal
moral weight.
The reason for that is that the language of equal moral weight
invites, although Michael of all people I know because of my respect
and admiration and knowledge of his philosophical work does not
subscribe to this view, nevertheless it invites in general
discussions the idea that the proper way to evaluate, to make moral
decisions is one where we weigh pre-moral goods against each other
according to a consequentialist utilitarian calculus to decide which
one weighs more.
Now that is a respected position in philosophy. My colleague,
Peter Singer, holds it and many other people hold it. I would be
very happy -- I am lecturing too much the way it is but I would be
very happy to give a critique of that as would Alfonso and others, I
think.
I am going to assume, though, that we do not want -- that
probably none of us here want to end up making decisions of life and
death of this moral magnitude on the basis of a utilitarian
calculation because the consequences of that are things that I think
we would not want to live with.
Now Professor Singer is willing to live with them, such as the
permission of infanticide and so forth but let me just lay that
aside.
But it relates to what Daniel says for this reason: When we
conscript the soldiers and send them into battle and even into
certain death, we do not do that on the basis of a calculation that
their lives are less worthy of respect and concern than others. They
are going to be victims of decisions that we make but we are not
treating them as simply body parts that are expendable because of
their inferior status by comparison with us.
I think the way to see that very clearly is to notice that even
people who strongly accept the morality of conscription would recoil
in horror at the proposal. To heal diseases, to save lives by
conscripting, let's say the same people, those same 18 year olds, in
order to harvest their body parts, despite the fact that every
single one of those conscripts possessing two kidneys, two lungs, a
heart, a liver, a pancreas, represents -- could represent the
possibility of saving 18, 22, 25 lives.
That difference in reaction, I think, signals the fact that we do
not want to treat these issues as issues of a calculus of moral
weight as between those human beings who weigh more on the scale
than those who do not but rather want to address them by way of a
principle that says we can never intentionally choose -- at least in
the case of an innocent human being -- to destroy his life and
harvest his body parts for the sake of helping other people. That
the killing involved, even though certain -- the death involved even
though certain in the case of the conscript soldier does not all
into that category of us deliberately willing the death of another
either as an end or as a means to another end but rather accept it
as a side effect, which if miraculously does not come about we are
very happy about indeed.
I wanted to address some other points. I think I have spoken far
more than I should have. Certainly I would want to address Michael's
-- I forget whether it was Home Depot or Lowe's. The Home Depot
example. But let me just sort of invite Michael and others into
conversation on the basis of what I have said so far.
CHAIRMAN KASS: Could we
have just a few brief responses? We owe the other part of this
discussion at least some serious time. A brief response, Michael,
because he was answering your question.
PROF. SANDEL: Well, a
quick comment and then a question. The comment is, yes,
utilitarianism is something that should be opposed but the question
is whether the way to oppose the widespread utilitarian tendencies
in our moral culture is to insist on a dualism between persons on
the one hand and mere things on the other or subjects and objects.
I think it is a mistake, because it will fail, to combat
utilitarian assumptions that have a powerful grip by imposing and
insisting on that dualism. The reason is illustrated by exactly the
Mona Lisa example, Robbie, that you raised because the Mona Lisa is
neither a person nor a mere thing open to any use. It is neither a
subject nor a mere object fit for utilitarian treatment, nor should
it be treated as property in the sense of ordinary property. We
would not imagine -- wouldn't we have objections if the Mona Lisa
were bought by an eccentric billionaire who wanted to use it as a
doormat for people to wipe their feet on when they came into his
house. We would regard this as a failure of respect. It would be
natural to speak of this as a failure of respect for this great work
of art even though to use the language of respect does not require
that we say that the Mona Lisa is a person.
Well, what this suggests is that it is a mistake to claim that
respect is all or nothing, on or off. Instead it suggests that we
should understand respect, that to respect something is to treat it
in ways that are fitting or appropriate to its nature.
Now to come to our case then, then we have to answer the question
what is the nature of the embryo? And Robbie has addressed this
question and I understand, and I think I see the force of his
answer, but this brings me to my question. Is it a consequence of
your view, would you say, that extracting stem cells from the seven
day blastocyst is as morally objectionable as harvesting organs from
a baby?
PROF. GEORGE: I believe
that in principle it is. That the fundamental -- by "in principle" I
am signalling the idea that the fundamental wrong is the same.
Having said that, there are probably additional factors, additional
wrongs in the case of the baby, additional social consequences in
the case of the baby that would make it, one might say, even worse
but having in mind that by even worse we mean in addition to, not
more wrong in terms of the fundamental wrong.
Leon, very quickly to respond to Michael's first point about the
Mona Lisa and the utilitarian calculus? Thirty seconds. Fifteen.
I think, Michael, I disagree. I think rather the -- your use of
the utilitarian calculus actually proves my point that utilitarian
does not necessarily believe that anything subject to the calculus
can be used for any purpose. It is a matter of relative weighing.
What matters is that the Mona Lisa could be used given a
sufficiently weighty consideration in a way that was destructive.
CHAIRMAN KASS: Eighteen.
Very good.
(Laughter.)
CHAIRMAN KASS: I have
two here and I am going to ask them to be brief because the time is
going. Bill Hurlbut and Gil, and then we are going to move subjects.
DR. HURLBUT: I will
pass.
CHAIRMAN KASS: You are
going to pass. Gil, did you want --
PROF. MEILAENDER: Just a
word. In fact, it leads in a certain sense to where you want to go.
CHAIRMAN KASS: Please.
PROF. MEILAENDER: I just
want to note in terms of what you, yourself, Leon, outlined at the
start as the -- what you saw as the most desirable product somewhere
down the road that we might come up with.
CHAIRMAN KASS: Right.
PROF. MEILAENDER: That
is to say some kind of document, argument in which we were all able
to agree that weighty and powerful arguments had been put forward
for differing positions about which we had differing views, and I am
coming back to Michael Gazzaniga's point here. I am not sure we are
on the road to that at this point because, for instance, I was able
to say with respect to those goods that we might seek by the
research that they were indisputable goods. It seems to me we are
going to have to be able to get equal language about the other good
that is involved and the respect for that embryonic life or we are
not on the way to the kind of document you had in mind.
CHAIRMAN KASS: Thank
you. I was going to make the transition, Gil. You anticipated me. To
step out of a conversation to talk about it is always a risky thing
to do but let me stock of what we have done here at least as I hear
it.
It is a lot harder, Gil, I think. It is very easy, I think, to
see the worth of gaining knowledge that could be humanly beneficial
in saving life. It is relatively uncomplicated. The argument is how
likely is it, how much good, et cetera, but we all understand those
principles and we want to talk about it in a moment.
Part of the difficulty here is there is some dispute about what
it is that we are talking about such that we should respect it from
someone who thinks it is like parts in Home Depot. I exaggerate
slightly. I mean, it was an analogy to help -- it was an analogy to
help make a point, not an assertion of the standing to someone who
thinks that it is fully one of us, to someone who thinks it is
something in between, and yet I would like to think -- and some who
think that, yes, this is appropriate but not the things created by
nuclear transfer.
I would like to think that somehow hovering over this discussion
is at least a recognition that that for which people have spoken up,
either more eloquently or less, is not humanly nothing and that we
should not simply be driven by the conclusion of policy that we
want, namely that we want the research to go forward or we do not
want the research to go forward, to color how that discussion goes.
That is what I mean by suggesting that we should try to own the
argument. The difficulty is we have not yet got it to the point
where enough of us can say, yes, that seems to speak for -- I
understand -- we can understand it, we cannot yet acknowledge it.
I think the task on this side of the discussion, and most people
-- many people have weighed in more or less on topic. Some have not.
The scientists have -- I mean, Dan spoke, I think, really --
actually, Janet, I think maybe you are the only one who has not
spoken on the question of the embryo proper, and I do not want to
put you on the spot now but it does seem to me all of us, all of us
should be thinking about this question.
If the embryos are not things or the substitute for it that we --
where shall we come out and how can we articulate the goods that are
being spoken for here, both with respect to the things under
discussion but also to the issues raised by Charles and Mary Ann.
What does it mean for us to somehow regard nascent human life
without agreeing exactly on its status as a natural resource to be
used?
We might decide that we want to do it, that there are great goods
here, but there is an issue raised about this that does not have to
do with anything that is done to the embryo but has to do with us.
Let me bracket that. I would love to have -- this was the first
real good conversation on that and it seems to me anybody who is
moved to put pen to paper -- in fact, that is the wrong way to put
it. Please, some further thoughts and comments on this.
Please?
DR. HURLBUT: I just want
to say that I tried to bring this out with Irv yesterday. I think we
have to -- as well as acknowledging the -- what you might call the
positive attitudes toward the embryo, we have to acknowledge that
there should be some way once we articulate the positives to
subtract them such that we could then instrumentally use what we
had.
In other words, once we get to the point where there is just
partial generative potential or truly parts apart from wholes, then
we need to clear the space for future research because -- not by
compromise but by principle so that -- because the future of this
research is truly fantastic and when Paul says that we should not
regard this creation as an embryo, I take that seriously. In part, I
am just uncomfortable with what might happen if we develop
ectogenesis and we could keep it going but there would be a point at
which when it was rendered or created less fully capable that we
should be able to do such research.
I think it is very important that we allow the research to go
forward. There is a sense in which the initiation, the early moments
of life are ambiguous and I think we should acknowledge that and not
try and walk around it. There is this question of individuation
which we have not addressed.
I personally do not sympathize too much with it because I think
it is -- if you -- like one of my students said, the comment here is
if it is not yet an individual because it twin, is it sort of like
they are just stirring the dough but you cannot call them cookies
yet? Or another comment is if you have one worm and you cut it in
two, does it mean that the one you had before was not one?
I mean, these are funny analogies but the point is we have to
face the question of whether there is this phase in early human
development and whether -- that it is not fully individual and then
we need to find a way to define for all -- opening all future
research what we mean by the minimum standards. So in that sense, I
think, Paul and Mike's comments have some route we ought to pursue.
CHAIRMAN KASS: Thank you
very much. Mike, are you moved to --
PROF. GAZZANIGA: I move
to just ask you a question.
CHAIRMAN KASS: Please.
PROF. GAZZANIGA: When
you hire a lawyer, the lawyer's job is to present the client two,
three, five options and for the client to decide what to do.
CHAIRMAN KASS: Right.
PROF. GAZZANIGA: Isn't
that our function with respect to the President?
CHAIRMAN KASS: On this
matter where we, I am sure, in the end are going to place the
weight, the moral weight in different places, I think that is a
wonderful public service. But when I said I thought I would like us
to own the whole document -- in other words, I would like us to be
able to say, 'Here, Mr. President, is a brief...' Actually to put it
better, "Here is a Supreme Court opinion that holds in favor of this
result in which there has actually been deliberation with the other
side and which we have taken into account what they have to say. And
here, Mr. President, is a different Supreme Court opinion that holds
to a different result but has taken into account the other opinions.
A small footnote, n of us think more this way, q of us think more
that way, but you should know that you have got the best
presentation of the issues and what is at stake here, and all of us
agree to that.'
I mean, that is, it seems to me, an aspiration. If we could pull
it off, it would be remarkable even for the Supreme Court, if I may.
(Laughter.)
CHAIRMAN KASS: Let me
turn -- I want to turn to -- we have the following change: We have
had requests for the public session, which we had originally
scheduled for 12:00. There are only two people who have asked to
speak. With apologies to people who are counting on beginning that
at 12:00, I would like to use some of that public session time.
I know people have to leave promptly at noon and if you have to
leave, by all means, go, but I would like to begin and go into some
of the time allotted for the public session to make sure that the
people who speak with such eloquence on behalf of nascent life have
to answer the question what is it that we are going to say to the
sympathy side as well as to the piety side of this discussion.
And I want to get him back to the table because he is going to
have a turn. Gil, would you mind if I imposed on you since you have
made -- I mean, you have made a very strong argument that would seem
to imply that, though, great good can come from the use of embryos
to derive cells or other means of cure, that this is a -- not just a
balancing judgment but there is a transgression here that at least
in terms of respect you could not countenance. What are you going to
say to Paul McHugh's patients if the moral argument you are
upholding prevails?
PROF. MEILAENDER: Just
so we are clear on what I said before, the last thing you said is
important that I could not figure out how to work it out under the
language of respect.
CHAIRMAN KASS: Right.
PROF. MEILAENDER: If you
want a bald faced argument that does not use the language then, you
know, we would have to think about that.
Well, what I would say is something like this, recognizing that
if you really -- if I am actually talking to his patients -- I mean,
the first thing to say is the language is going to limp and that I
am not going to say anything -- be able to say anything that is kind
of humanly adequate to such a person's condition.
But I would say that what we owe you is not necessarily relief of
suffering and not necessarily a cure because we cannot be obligated
to give you what we do not that we can provide but we owe you hope.
We hope sort of a firm commitment that we will do everything within
our moral power, everything that we think we can morally do to try
to find ways to, if not cure, at least relieve your condition.
There may be -- we may arrive at a moment when we think that here
is something that could conceivably be done or tried but that we
ought not do and what I would say to them then is that the reason I
would not do it is because I would not want to do something that
helps to create a world in which neither you nor I would want to
live.
Something like that would be what I would say.
CHAIRMAN KASS: Do you
want to respond, Paul?
DR. MCHUGH: Yes. I think
that the patients to some extent would say, "Gee, I have got a
wonderful doctor here in Gil. Paul McHugh has trained him pretty
well but here is my concern: I am a 35 year old woman and I have got
this Parkinsonism and you could take my ova and put it into my --
put my somatic cell in there and develop it. It all belongs to me.
It does not belong to somebody else. We are not taking from anybody
to give me these cells back in the form that will sustain me from my
Parkinsonism and why wouldn't you want to do it. I agree with you
that to take embryonic cells and use them for the purposes of others
is a transgression but on this occasion -- and it gets worse, the
transgression gets worse as the cells develop further and further
but we are really taking my cells and allowing them to grow and
giving them back to me."
What is the matter with that, Dr. Meilaender?
PROF. MEILAENDER: Well,
it would be difficult with that patient at that time to have
precisely the kind of conversation I might want to have about some
aspects of that, namely about whether we really want to think about
"my", these things as mine in quite the way that you described them
and what that might suggest for other things that we could do with
them.
I mean, there would actually be some important points there. It
would be difficult just existential to engage in that conversation
with the patient at that point but it seems to me that if we are
thinking about it, stepping back and reflecting on it, we need to
pay some attention to that and we would not want to be quite so
casual about that language.
DR. MCHUGH: All the
nuclei belong to me. All the --
PROF. MEILAENDER: It is
exactly that language that is bothering me. This notion that your
body is something that belongs to you. That is exactly what we would
want to talk about. If they belong to you, you know, we are not
going to let you sell them necessarily for instance. You know, there
are a lot of complications there. Now, as I said, we are not
necessarily going to have this conversation with the patient but the
language would have to be refined considerably it seems to me before
I would be prepared to acquiesce in it.
CHAIRMAN KASS: Bill May
and then Michael. Bill, are you going to respond to this?
PROF. MAY: May.
CHAIRMAN KASS: Let
Michael respond quickly to it.
PROF. SANDEL: I just
wanted to respond directly to this, which I think Dr. Meilaender
with the patient has been overly timid. Why isn't your answer to the
patient to say, 'Well, what you propose is just as bad as if you
proposed having a baby with a consenting sperm donor or with your
husband, just as bad as if you proposed having a baby and taking
organs or something from that baby to cure you? Now maybe you have
not reflected on that fact but I could persuade you that on
reflection it would be like having a baby and using that to cure
you.'
PROF. MEILAENDER: May I?
PROF. SANDEL: Why isn't
that the answer?
PROF. MEILAENDER: Well,
at one level that is an answer and it is a very good answer. All I
was saying was that there are moments when speaking the abstract
truth is not necessarily heard as the truth and he had set me up to
talk to a patient. I mean, it is like -- and there are many other
situations in which you do not walk into the hospital room and say,
'Well, I guess you are dying.' So that, yes, that is -- that is an
issue that one would want to take up but really much better --
PROF. SANDEL: If you
were speaking the truth to the patient that is what you would say,
isn't it?
PROF. MEILAENDER: No,
not necessarily because you want the truth to be heard as truth and
it cannot always be received. That is my point. Ideally we would
live in a world in which all of his patients or my patients would
already have had the kind of conversations that would have prepared
them to think about these things in that way and all I was saying is
that if they have not, you know, there are moments when you can take
up some questions and moments when you cannot but I do not deny that
that is intellectual an appropriate issue to raise.
DR. MCHUGH: And I
disagree. Of course, I disagree. I do not think that they are the
same thing. It is not like having a baby and it is not like having a
zygote but I have said that so many times that you are bored with
it.
CHAIRMAN KASS: Bill May,
please.
PROF. MAY: I think some
of the awkwardness Gil would face in front of the patient, timing
and all the rest, remind me that respect means recognizing that we
can make no totally untroubled decision on the issue that we
currently face. I do not see how we can achieve purity. One side is
it is not a person, therefore, we are home free in using it for
purposes of research grants directed to noble ends. On the other
side it is nascent life, sharing a common rational nature of equal
status, therefore we are forbidden to use and home free of
responsibility for having to cope with the answer for a patient in
such urgent need.
It seems to me we occupy a place in between where a clean drip
dry purity is not available to us and we will come down somewhere
here but respect means acknowledging both sides of the trouble in
the decision.
CHAIRMAN KASS: Thank you
very much.
Let me make a small modification of the way the question was
posed. I did not really mean to make the situation, the existential
clinical situation of what do you actually say to that patient but
it seems to me what do we say to the legions of patients who stand
to benefit and who are suffering greatly so that we do not somehow
make the discussion immediately more complicated by the needs for
tact and delicacy when one is actually in the face of suffering?
I see Michael Gazzaniga, Charles, Robbie.
PROF. GAZZANIGA: Well,
just to make the practical point. You might say that a patient buys
stock in British Airlines -- because this is going to go forward and
other nations are already decided on this issue. So what you are
doing is you are setting up in America, should this option be
foreclosed, two classes of medicine. It will be the rich who can go
travel and be healed and there will be those who cannot afford it.
CHAIRMAN KASS: We are
not yet talking about the ban, Michael. We are talking about the --
PROF. GAZZANIGA: No, I
understand, but what are you going to say to the patient? One of the
problems --
CHAIRMAN KASS: Oh, I
see.
PROF. GAZZANIGA: I mean,
that horrific sort of conversation --
CHAIRMAN KASS: I am
sorry. I misunderstood.
PROF. GAZZANIGA: --
would not be fun to deliver.
CHAIRMAN KASS: Charles,
Robbie?
DR. KRAUTHAMMER: Janet?
DR. ROWLEY: This is a
discussion in my view remote from the real issues and so when we get
to the -- what I consider some of the more scientific issues, I will
comment.
CHAIRMAN KASS: Could you
help? What -- could you just say what you think the real is, Janet,
so we know what the difficulty is?
DR. ROWLEY: (Not at
microphone.)
CHAIRMAN KASS: Can I put
you on the list? Charles and Robbie and then Janet.
DR. KRAUTHAMMER: You
asked the question what do we say to the patient?
CHAIRMAN KASS: Or owe to
the patient?
DR. KRAUTHAMMER: Or owe
to the patient. Well, as it happens, I am one of those patients.
Mary Ann has talked about all of us being patients or having
relatives. I have a very obvious connection with this issue and I am
one of those in whose name people have spoken and said this research
has to be permitted so that I can walk or people like me can walk.
Spinal cord injuries are always on the list so I am acutely aware of
this issue but I am not only a patient.
I am also a father and what I would say to myself, and I have
said to myself about this issue, and I think we ought to say to
other people who suffer from similar problems and disabilities, is
that we have children and we want to raise them in a world that we
want to bequeath to them a world, a moral universe, in which we
think they ought to live and that we may be jeopardizing the moral
quality of that universe, the humanity of that universe by
cavalierly breaking moral rules that we have observed for
generations in order that people like me can walk.
So I think there is a serious moral issue here and I think the
assumption that all that people who suffer from disabilities want is
a cure at all costs is a misreading of their own humanity.
CHAIRMAN KASS: Robbie?
PROF. GEORGE: Well, I am
reluctant even to follow something that powerful with language that
is a little more technical but on the question of what to say to
patient or patient advocacy groups or to potential beneficiaries of
research in this area, I think that we should say and honestly say
that we have -- I can speak for a community that I am not part of,
the medical community -- will do as our community always has done
everything it can do in line with the ethical norms that have shaped
the practice of medicine since Hippocrates.
But we cannot transgress them and it would be a transgression to
bring into being a new human being to be treated as an entity for
harvesting of body parts for the benefit of others. That is
something that we cannot do.
To Michael's point about this train already having left the
station and the possibility of likelihood, certainty that we will be
generating, if there is a ban, and I realize we are not talking
about a ban now but the point has been raised, two classes of
medicine, rich and poor, I would simply point out that this is not
unique to this issue. If there will be ethical norms of medical
practice there will always be the possibility that different nations
will relax the norms perhaps very substantially in some areas, and
regrettably, but making possible the same possibility that we would
have in this case here. We could explore various examples of it
historically and then various possibilities even for the future
outside of this area but I would simply respond that it is not a
unique problem by any means but what is at stake is what we want to
be here and whether we will be true, in my judgment, to the basic
principle of fundamental human equality that is enshrined in our
founding documents and makes us the nation we are.
CHAIRMAN KASS: Let me
lean on you with the help of Charles earlier. Charles says whatever
the philosophers amongst us might say, the moral intuition of the
nation is that a blastocyst is not one of us in the full sense. That
is just a fact. And this quite apart from abortion or anything like
that. And, therefore, that this language of creating beings for
their body parts seems somewhat a lurid way of putting -- taking
this, we do not quite know what it is, relatively undifferentiated,
you should excuse me, clump of cells -- and let's even add to the
argument that -- and this is still untested, it is part of the
complication. There is promise. There is not certainty but let's
take the promise seriously. Real help for people with Parkinson's
disease from this line of research and not from other lines of
research.
I mean, there is a lot of hype about the embryonic stem cells.
There is a lot of putting down of the adult stem cells. It is too
early to know but let's put the case forward in its strongest terms
and face it.
Does one want to say the intuition of the general public is the
well-being and suffering of a million people with serious
neurological disease should go unanswered if the real remedy is to
be found here?
PROF. GEORGE: First, let
me say that a question that we have to address independently would
be the status of any research material brought into being, whether
it be a parthenode or otherwise, that would at least arguably not be
a human being, although it possesses a human genome because it
lacked the primordium for self directed maturation.
CHAIRMAN KASS: Okay.
PROF. GEORGE: So I am
not quite sure about the basis of the argument that Paul has been
pushing here about the status of the clone.
CHAIRMAN KASS: Right.
PROF. GEORGE: But if
Paul is wrong about that, it might be that by other procedures, such
beings could be brought into existence, and as I say that would be
an independent question.
Specifically on your question, and having in mind the need for
sensitivity in drawing analogies, including historical analogies,
and also having in mind that the American public is not of a single
view about this, that view being a muddle, the muddle is there are
all sorts of different views along the spectrum about it so
different people are in different places just as the Council is
different places.
Having said all that, we are not without historical examples of
people even in general, populations in general, failing to
understand other members of the human family, other human beings as
not part of the community that really counts or that counts up to
the -- you know, counts just like the rest of us.
In 1857, famously, five Supreme Court justices validated public
opinion. Treating Dred Scott and the slaves he represented not as
strictly speaking its or things -- even the Constitution said
persons held in a bond in certain jurisdictions counted as
three-fifths for purposes of the census -- but not also in any real
sense as full persons. The dissent said, I think, what is to be said
here -- one of the dissenting justices putting it in religious terms
that perhaps not all of us around the table would be comfortable
with, certainly Steve Carter would think there is nothing out of
line in this, but putting it in the religious terms that were in
that day public discourse that "You see before you..." he said to
the majority "...a slave, a mere chattel but he is not that. He is a
man amenable to the laws of God and man, bearing the impress of his
maker and bound for an existence that is eternal."
I do not think I would want to make the argument in those
theological terms and I have pointed out in public writings that the
question of ensoulment is actually beside the point here all
together and it is not a question of the immortality of the fetus or
embryo or anything else. Simply a question of their membership in
the human family.
I think that what the dissenting justices said in the face of a
public opinion that honestly just could not see the Black man,
woman, child as truly one of us, not quite an animal but not truly
one of us, is the right thing that has got to be said whenever
anybody says that there are some human beings that are not yet or no
longer persons, that there are some human nonpersons.
CHAIRMAN KASS: Janet,
could I draw you out on what question of import that we are either
ducking, skirting, not paying attention to because we need to hear
that?
DR. ROWLEY: Well, I am
not sure this late in the day whether we want to get into some of
these issues. I think that for me it is an issue of competing goods
and Michael Sander talked about this the last time, and I pointed
out that I thought that it was a very important issue. And I am not
prepared to say what status the single cell ovum fertilized egg has
and what status the blastocyst has in the context that others have
spoken about. I am certainly -- it is quite clear that this is or
has the potential for developing into a human if it is not otherwise
altered.
But, for me, the possibility that it could be altered in ways
that have the potential of leading to greater understanding of the
consequences of genetic change are extremely important and that from
that understanding of the consequences of genetic change, we could
great hundreds and thousands of patients. I think that that is a
competing good that we run the risk of losing site of.
I think this is a diverse society with many different points of
view and we are running a serious risk of really trodding down those
points of view by the position that we hold of being able to
articulate our own views at the risk of ignoring the views of others
who would look at this from a very moral standpoint but from their
own different moral perspective.
And I would like to come back to a more practical point of view.
I think Rebecca's concerns are very valid. It is absolutely clear
that eggs for such a purpose of research with the hope of leading to
therapy are going to be very scarce and I think the idea that some
investigator is going to take 100 or 1,000 of these and do all sorts
of possible experiments on them without a great deal of thought and
one would hope experience from doing some of the experiments on
animal -- using animal eggs, that these experimenters would be very
mindful of the importance of being extremely thoughtful in what is
done and very thoughtful about the potential goods, the goals that
can come from such experiments.
This is not something I think that people are going to enter into
lightly and the very scarcity of the eggs will put a great deal of
pressure on everyone to try to find alternatives that would be more
widely available. And whether this is possible, we do not know.
Whether it would be possible for some circumstances and not for
others, we have no idea. But again my plea is not to close the door
right now because of our ignorance.
CHAIRMAN KASS: Janet, if
I might say, I take your comment to be not on a different subject
but precisely on the subject that we are exploring.
DR. ROWLEY: But it is
from a totally different perspective and that is a perspective some
people have expressed but not others.
CHAIRMAN KASS: No,
indeed. I mean, I think my original goal was -- I mean, the vexed
question here seems to be the balance between what this human
material is on which the research is done and what is owed to it and
to us in dealing with it and on the other side, and I think maybe
this part was left out of the discussion so far when we have put it
in terms of what do we owe patients who are suffering.
And certainly Irv Weissman's presentation was not just about the
text of the report but the peroration and even went so far as to say
it would be on our heads if we recommended any curtailment of this
in terms of the suffering of various people.
So the case for that was made and is strong and the competing
goods here are -- I guess the one thing that was left out of the way
in which we have been talking about is one cannot somehow be helpful
to patients immediately without doing the fundamental scientific
research about which -- in fact, which was the main emphasis of Irv
Weissman's presentation.
I hope everybody noticed that the move away from the much hyped
therapeutic cloning, each person, his or her own little individual
embryo was a very minor part of what Irv Weissman's presentation was
and he stressed instead the need for different models of embryos
with different diseases, and the fundamental research and
development very different from the way this thing has been played
in the media, played in the public. And I think Janet is certainly
right to remind us that there is the proximate goal of greater
understanding in the service of the ultimate goal of the relief of
suffering and the cure of disease.
But I thought that the conversation from the start had as one of
the competing goods already articulated and well defended is this
kind of benefit. It has hardly been forgotten and I have been trying
to lean on -- that is what I meant by starting with Robbie on this
particular point. Here is a man who has been articulately defending
the other side. I want to hear what he has to say to this competing
good. How to adjudicate among the competing goods? That, I think, is
a secondary question. The first thing is to get clarified what they
are and what their weight is.
Also, I think your comment to Rebecca, I think, leads me to ask
whether Rebecca wants to come back because we have really -- you
early on wanted to add something to this list, which is to this
point, until Janet returned to it, neglected. Janet says, "Look, not
to worry so much."
PROF. DRESSER: I think
that gets to the part of the discussion we have not had which are
the policy recommendations. One option is a ban. One option is it
should not be allowed unless it is reviewed by -- I mean, the RAC
has come up as one example -- some sort of committee that would look
at the significance, the likelihood of the goal, the lack of
alternative procedures. That sort of thing. And, I mean, that might
be a way to handle the oocyte donor issue.
I guess, at this point, I just want to make sure that that is in
the mix because in some ways to me it bears on category 3, that is
the social implications, but it also in some ways bears on category
1 in that this is an essential ingredient to this entity that we are
talking about and will require the participation of a woman and I do
not want that to get left out of the picture.
Another thing just to get to what you were talking about at the
very end is in terms of benefit what this offers. I feel strongly
that we do want to try to get across a picture of the benefit. At
this point it is not a therapy for people. It is a possibility. As
you pointed out, Leon, probably for Irv Weissman, the main reason to
do this is to have models to study disease, not to create stem cell
therapies.
There is a huge amount of basic research that needs to be done so
this misimpression that here we are possibly standing in the way of
something that could cure patients today is really wrong and I want
to make sure that we state accurately where the science is, and the
contingencies, the probabilities, the time factor, the degree of
research that is probably necessary before any therapies are
available are important to put into that second category of what do
we owe the afflicted or what are the possible benefits.
CHAIRMAN KASS: Let me
make an executive decision here at the table. We are gradually
losing our quorum and here is where I think -- this discussion
reveals that, among other things, not only is it preliminary and a
lot more work needs to be done but as one suspected, one cannot
treat the question of the ethics of cloning for biomedical research
isolated from a whole range of other things.
One cannot really treat it separately from the question of stem
cell research generally, which will be part of our charge. And I am,
frankly, somewhat mystified as to how well we can do this as part of
the current project or how much it has to overlap with things that
will be left for us when we take up the embryonic stem cell question
all by itself.
Once again, I mean, staff will try to begin to articulate the
arguments of the goods which will be placed in competition. If you
have got a favorite good in the race, let's hear from you. Let's
hear also how you would really think to address what you owe to the
people on the other side of this question because this is not an all
or none matter.
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