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