"This transcript has not been edited or corrected, but rather appears as received from the commercial transcribing service. Accordingly, the President's Council on Bioethics makes no representation as to its accuracy."
FOURTH MEETING
Thursday, June 20, 2002
Session 3: Human Cloning 12:
Public Policy Options
CHAIRMAN KASS: I think we're all here. We're expecting Charles Krauthammer
who is traveling and I hope he hasn't been unduly delayed, but he said
he'd try to be here for this afternoon's session.
We're in the middle and I don't think I'll even hazard a summary and just
allow us to continue where we were. And people who I had on the list previously
included Robby George, Bill Hurlbut, Mike and Paul -- Bill Hurlbut, Mike
Gazzaniga and Paul. Have I omitted somebody who -- okay.
Robby, would you like to start?
DR. GEORGE: I want to respect Frank's desire not to get into the big
debate, at least not here, but I did want to at least offer a clarification
from my point of view about what the debate is about because I think that
the examples that Frank raised when he was talking about the political
and civil rights of children and the question of the status of human corpses,
I do want to clarify what I think the debate is about that we've been
carrying on, at least to some extent in submissions that many of us have
made to the Council.
I think it's about the question of what confers upon the human being at
whatever stage of development, a status that is sometimes referred to
as inviolability and whether one and the same substantial entity can be
morally inviolable at some stages of development, but not morally inviolable
at other stages of development.
So as I see it, we've got a dialectic going on, at least between those
of us who think that the embryo deserves full moral respect than those
of us who think that the embryo deserves intermediate status or I think
what we've been referring to as special moral respect.
And the argument has been going back and forth and I do hope that it will
continue to go back and forth because I think it's kind of hanging in
mid air. Those who have argued for the special respect view have presented
some arguments including the question of an argument based on the possibility
of monozygotic twinning prior to 13 or 14 days of embryonic development.
The question of the high rate of natural pregnancy loss, our emotional
responses to miscarriages as distinguished from the loss of children at
later stages of development and so forth and I think that those of us
on the other side have proposed responses and counter arguments to those
various points and I hope that this debate will continue because I think
that it's an important one.
Of course, there's also the point that Michael Gazzaniga has pressed about
the importance of brain development and there's been a response from me
and from others to that as well and I think Michael has now responded
to our response, so perhaps on that one the ball is in my court and others
who have my point of view. I actually have something drafted to submit
on that. Perhaps others do as well. But I do think that this debate should
continue and that we shouldn't simply say well, look, we're not ever going
to convince each other on something like this. Perhaps we won't convince
each other, but I think we can better inform each other and who knows,
but that minds yet could be changed one way or the other.
That was my first point. The second point I would like to frame as a question
to the scientists on the Council, I have heard that there's at least speculation
that it might be possible to avoid the basic question that vexes us, at
least some of us on research cloning of the moral status of the embryo.
By the deliberate create of entities possessing a human genome, but lacking
other features such that people who believe that the -- as I do -- that
the human embryo, strictly speaking, is morally inviolable, would not
consider the entity to be -- that has been produced to be a human being
or an embryo strictly speaking, but that nevertheless, the entity could
develop in such a way as to make the extraction of stem cells possible.
And I wonder if scientists on the Council just happen to know the factual
answer to the question whether that is within the realm of possibility.
The third point is completely unrelated to the other two. And that is
the question with respect to what we've been calling reproductive cloning
and anticipating as a moratorium or ban on reproductive cloning. What
is it that we would be proposing to ban when we propose to ban reproductive
cloning? Would the crime or offense be the creation by somatic cell nuclear
transfer of an embryo with the purpose of implanting the embryo? Or would
the crime or offense be the implantation of an embryo that was created
by or brought into being by somatic cell nuclear transfer? It seems to
me that quite a lot from an ethical viewpoint might depend on which of
those is what, in fact, is being proposed. So it's something that I hope
will at least clarify and if we have different views on what it is that
ought to be banned, perhaps those could be gotten out onto the table.
PROF. SANDEL: I'd just ask, Robby, a quick question. Which of those do
you think would be ethically less objectionable?
DR. GEORGE: The ban or moratorium on creating, on synthesizing or creating,
bringing into being an embryo by somatic cell nuclear transfer with the
purpose of implanting.
CHAIRMAN KASS: I have to tell you, just as a legislative matter, I shouldn't
be telling you, you should be telling me, that if one wants to prescribe
a certain activity one wants to prescribe it precisely so people will
know what it is that is wrong and approving intent is difficult and to
make the crime to create the embryo with the purpose of implanting it
would lead to the following situation. Person 1 produces the embryo with
the purpose of using it for research, gives it to Person B who then implants
it and neither of them does anything wrong. Anybody who wanted to prevent
this activity would never write the statute the way you would find it
morally -- easy to support. That's the difficulty.
DR. GEORGE: Well, I do think it would be difficult to draft a statute
and any statute that you drafted would have loopholes and there would
be cases where people would actually get around the law. I do think you
could probably draft it in such a way as to impede the development of
a commercial human reproductive cloning industry.
CHAIRMAN KASS: Point taken.
DR. GEORGE: I wonder if anybody knows the answer to the question?
CHAIRMAN KASS: Did someone respond to the first question about, if I understand
the question, is it possible to produce -- precisely because they're not
embryos, they might be -- they would not be inviolate and therefore, but
they might be perfectly good for all the research that one would like
to do.
DR. GEORGE: The closest thing I can think of to it in nature would be
a hydatidiform mole, but a hydatidiform mole that or like entity that
would be sufficiently differentiated to make possible the extraction of
stem cells.
Does anybody know anything about that?
DR. BLACKBURN: I think there might be an issue in which the DNA would
be the same, but what's called the imprinting of the DNA which can lead
to these abnormal outcomes like the hydatidiform mole, that would be different,
so that would have some commonalities with the normal embryo that had
been normally imprinted, but it wouldn't be the same.
I honestly don't know what you're referring to, but perhaps that's what
you're meaning.
DR. GEORGE: That is it. If I understood you correctly, I think that
is what I'm asking.
DR. BLACKBURN: So the imprinting that is happening is probably, as we've
seen in various written documents, much of the source of the problem with
getting cloning, for reproductive purposes to work in animals, that it
doesn't happen very well, even with somatic cell nuclear transfer of a
diploid cell into say a human egg, well, this hasn't been done, but into
a mouse egg.
So I'm not sure whether you had that in mind or Bill had proposed something.
I didn't know whether that was what you had in mind as well.
DR. GEORGE: Well, maybe Bill could say.
DR. HURLBUT: Well, on the end of my comments for my moral position, I
added what I call a speculative proposal. I apologize for the length of
it and maybe some of you didn't get that far. But it was what it took
for me to think about the issues.
And I formulated that with some conversations with scientists, Paul Berg
sparked some of my ideas and Irv Weissman, and others, and talking with
developmental biologists, and then thinking about the theological issues,
theological objections and some of the traditional medical and legal objections,
it struck me that if the objection hinges on the potential of the embryo,
that actually what we're going on about here in our disputes about the
status of the embryo is pretty much the meaning of potential, whether
potential is in a sense actual or sort of theoretical.
Well, if you could render the potential not there in a certain sense,
then you couldn't say that there was in any sense personhood present or
human inviolability, even if you don't say personhood. So it struck me
that if you could do some simple gene transformation, alteration of the
cytoplasm or maybe even alteration of the culture medium, that maybe there
would be a way to say we've created what Paul's been on to, an artifact.
And I have to say I sympathize with it to a degree to what Paul says because
it feels like a lab procedure to me. But what troubles me with Paul's
point of view is that you could implant that entity and it would become,
I'm convinced, a person. Paul, whether you think fully human or not, I
don't know, but I'm inclined to give it that.
So what if we could render it sort of disarm -- I hate to even use the
word embryo, but disarm it and take it to the most extreme. If you could
do a nuclear transfer that was missing a chromosome or something like
that that wasn't necessary for the production of anything -- or put it
another way, it was essential for the production of an embryo, but wasn't
essential for the production of say a kidney, well then you could do this
lab procedure without having the moral problem present. You think, Robby?
DR. GEORGE: This is precisely what I'm asking. And what I'm interested
in right now is not the ethical issue, but simply the factual -- the question
of whether such an entity could be brought into being. And by that, I
mean is there some lab that could do it tomorrow? Is this the kind of
thing that if people put their minds to it, could be accomplished in the
foreseeable future.
DR. HURLBUT: Well, I've had numerous conversations with scientists about
this and it sounds to me like this could be done. Not only that, but scientists
told me yesterday that you could first render the gene inoperable and
then reverse it when you had the stem cell isolated. I know it sounds
like a technicality, but so what? There are important principles here.
And I see this as a way to go forward with the science even better than
what's proposed in a sense because we know from -- I don't think so much
hydatidiform moles. We know from teratomas that you can get whole portions
of a body like teeth, fingernails, hair wrapped into an ovarian tumor.
So we know that you don't have to have the whole embryo present to generate
partial parts.
So what I'm interested in is parts apart from wholes and partial generative
potential. And Janet and I were talking about this over lunch and based
on a preliminary conversation seemed like Janet -- I think there were
some possibilities. What do you think, Janet?
DR. ROWLEY: I haven't had any time really to think about how one would
do this practically. It's certainly in the laboratory, there are ways
of putting genes under the control of say tetracycline and in the presence
of tetracycline, the gene is operative and when you withdraw it, the gene
becomes inoperative or vice versa. There are a number of different strategies
called that lead to conditional expression, but how you could get such
a system to work reliable such that you could put such a genetically altered
nucleus into a somatic cell nuclear transplant into an oocyte and expect
the oocyte to grow under those circumstances to give you a multicellular
embryo, I'm totally ignorant of whether such a strategy could work or
alternatively when you do just removing genes through homologous recombination
and just alter a single gene which can be done in the laboratory and obviously
mice are developed and live with such altered genes. But how applicable
that is to the human situation, I'm totally ignorant of.
DR. HURLBUT: Well, let me give you a suggestion. Suppose you rendered
a gene essential for angiogenesis. This is the production of blood vessels.
Suppose you rendered that gene inoperable. Clearly, you'd never get an
embryo, but you don't need that gene because for stem cell, simple stem
cell transplants, they don't need to generate their own blood supply,
so you could theoretically deactivate a gene essential for embryological
formation that was not essential for the uses you wanted to make of the
cells or tissues, and claim a good moral position and also good science
at the same time.
What do you think, Elizabeth? Is this maybe a break to the impasse?
DR. GAZZANIGA:: I think this is nutty.
(Laughter.)
DR. GAZZANIGA:: That's a technical word.
CHAIRMAN KASS: Next argument.
DR. GAZZANIGA:: The notion of doing a gene knockout that will selectively
hit -- let's go for your pet topic, the soul, so therefore this thing
that -- this blastocyst doesn't have it and the notion of doing away with
the embryo by not giving it the genes for the blood supply -- well, it's
just another form of doing the deed. So I just think this whole -- this
does sound Frankensteinian to me and it gets into all kinds of convoluted
reasoning that doesn't make much sense.
DR. HURLBUT: It's not at all --
DR. GAZZANIGA:: On the positive note though, on the positive note and going
back to Mary and the dilemma this morning or suggestion, I guess it was.
A lawyer never has a dilemma, they just have suggestions. I looked up
what moratorium means because I thought we were sliding around with the
definition and the definition is a legally authorized period of delay
on the performance of a legal obligation. So I assume that's correct.
That would mean that if one signed on to a moratorium, it would men that
they would be open, I assume, once certain issues were cleared up to go
ahead with the intent of the act for which there is a moratorium, for
which a moratorium has been placed on it. Is that going too far?
PROF. GLENDON: That's one definition.
DR. GAZZANIGA:: Definition 2 is a suspension of activity. Is that what
you mean by it? So it's another -- you mean there's truly an equivalence
between ban and moratorium.
PROF. GLENDON: A temporary ban.
DR. GAZZANIGA:: But temporary then means you're ready to go to action once
all the issues have been cleared up.
CHAIRMAN KASS: Let me clarify. Since the term comes from headquarters.
It wasn't taken from the dictionary. It was meant to indicate a ban for
a limited period of time which unless the ban were reinstituted would
automatically lapse, whereas a ban which doesn't have a fixed limit on
it requires someone to make an argument to lift the ban. That's the difference.
DR. KRAUTHAMMER: And the word already has a historical use. It isn't as
if it came out of a dictionary yesterday. We have had a moratorium on
nuclear testing. Everybody understands what that means, the temporary
ban which if and when it expires, is reversed.
CHAIRMAN KASS: Let me say this is not the place, I think, to argue out
the possibility or impossibility of these modified beings that may or
may not be whatever they are and that it would make them suitable or not
suitable for experimentation. The possibility has been noted. It is at
this point speculative.
DR. GEORGE: I think, Leon, that it is relevant. I'll tell you why I
think it's relevant.
CHAIRMAN KASS: How would it be relevant to deciding in the next week,
month, three months, six months, one way or the other on what is before
us?
DR. GEORGE: I think it could affect someone's judgment as to whether
they think a moratorium is appropriate.
CHAIRMAN KASS: I see. In other words, if he told you scientists are working
on this and they will find you something --
DR. GEORGE: That within two years you could, it's realistic, that there
could be an unobjectionable entity from which we could extract stem cells
and even the people like myself who believe in the inviolability of the
human being at the embryonic stage as well as all other stages wouldn't
have a problem with this. That might lead some people who might otherwise
be for going forward right now with it to the thought that well, gee,
our fellow citizens do have some grounds for their moral objection. I
don't happen to share it, but if there's a way to avoid putting them in
the position of -- that they would be in.
CHAIRMAN KASS: I understand. Thank you.
DR. FOSTER: The one thing that I would say and I agree, we need to move
on is that within the realm absent some miracle from the deity to speculate
that within two years that you would get something like this working,
all these chromosomes act in all different ways. I mean one of the problems
of the genome is that you can't take some isolated thing out and expect
to get the VEGF which is the key angiogenic early has many other effects
in the embryo than it does in forming blood vessels. Everybody knows that.
And as a consequence, to say well, I'm going to knock out -- that's vascular
endothelial growth factor, you know. VEGF is just one of the angiogenic.
It does many other things. It controls other genes and so forth so the
idea to me, I'm not a developmental biologist, but I certainly would be
skeptical that many scientists think this is -- I mean I'll check this
out myself, I don't know, because we have very good, but I think to put
an early time limit on that would be very unrealistic. It would -- and
then even if it's a good idea, I'm not sure that it's going to apply in
the short run, Robby. I just don't know, but I'd be very interested to
know what Paul -- I'd be interested to know what Paul Berg said about
this or others. I just don't think that's possible.
DR. HURLBUT: Let me clarify it. I didn't mean to say that Paul Berg is
endorsing this, but I've talked with him about it. I've talked with Irv
Weissman. I've talked with other developmental biologists. I agree with
what you say, largely the genes operate in important ways that are much
more complicated than one gene, one trait. I'm not arguing that. But we
do know from teratomas that it's possible to produce parts apart from
the integrated whole.
I think what I'm trying to do here in suggesting this is I don't think
inappropriate or nutty. Frankly --
DR. FOSTER: By the way, I did not say nutty. That was Mike. So turn --
(Laughter.)
DR. HURLBUT: Well, let me just say this. Frankly, I wouldn't be very satisfied,
personally, if after the effort we've all put into this and the importance
of the issue are taken account of, that this Council comes out with just
a more articulate restatement of what the public already knows are the
central issues. I personally think if we could define the boundaries of
the moral problem more clearly and at least make some, clear some territory
for if you could do this, you would have the consensus, I think that would
be a real contribution and I don't think what I'm suggesting is unrealistic
and neither did certain developmental biologists I talked with. And I
think it's important that we work for moral consensus in our society as
we go forward. This is a much more hotly debated and deeply felt issue
than is sometimes acknowledged within the scientific community. And I
think it's our moral responsibility to see and listen rather than just
spend 30 seconds on a subject. If somebody comes up with a proposal, I
think we need to explore whether it's a reasonable way to proceed and
not just label it nutty.
DR. BLACKBURN: Could I add something? I see a parallel which may be
a constructive one. In the debate on recombinant DNA, I think -- Bill,
correct me if this is correct analogy, but the proposal that was made
and was enacted earlier was to have strains of bacteria which were unable
to survive outside the laboratory. So I think that is an analogous situation
to what Bill is saying.
Now the difficulty that we've been alluding to, Robby, is this internet
work sort of behavior of genes. I'm just thinking of a gene that one of
my colleagues found to do with the immune system. It was key. He thought
it was absolutely only involved in the immune system, but it turned out
to be involved in the development of the nose and all sorts of other things
as well.
So I see the idea, I think, and am I understanding that you're saying
that you think that something that would allow a certain portion of the
development of the embryo, that you'd know it could never become a full
person, would be an acceptable proposal? Am I correct?
DR. GEORGE: I would put it in different language, I think, Elizabeth.
But I think you understand where I'm going. In other words --
DR. BLACKBURN: If it could never live to be a baby.
DR. GEORGE: No, not that it could live to be -- in other words, it would
not be -- it would lack the epigenetic primordia for self-directed growth
to the next more mature stage on the continuum of life. That would --
in the way, for example, that a teratoma would, despite possessing a human
genome. Right?
DR. BLACKBURN: I think the concern would be to sort of make that a condition
because as Dan says that mightn't be easy to put into practice.
DR. GEORGE: This is really my question.
DR. BLACKBURN: At least if it were one of the proposals out there to
-- I think it's something to consider, but I think at this stage it wouldn't
be realistic to say oh, we could do this now, so therefore let's make
this the way to do it.
DR. GEORGE: Oh no, I understand that. I'm not asking whether it can
be done now. Although I think -- if we knew the answer to the question,
is it reasonable to suspect or to hope that this could be done in the
next few years. I think that if the answer to that question were yes,
it could factor significantly into the thinking of some people about what
policy they think we ought to adopt now even if they don't share my view
about the inviolability of the embryo.
DR. BLACKBURN: I think people could try, attempt to do it, but I think
there would be absolutely no guarantee that it would --
DR. GEORGE: No guarantee. I understand that.
DR. BLACKBURN: Right.
DR. GEORGE: How would be obtain better information about that, about
that possibility? I mean is it out there and we just don't happen -- the
people here just don't happen to do that kind of work or is this just
something nobody has ever thought of?
DR. BLACKBURN: I think it would a type of the work that I had alluded
to in the morning session where one would be doing somatic cell nuclear
transfer type of development of stem cells. And then using the kind of
approaches you are talking about and saying ah, can we now modify that
process. I think it would be very hard not to do the kind of research
that would involve somatic cell nuclear transfer and getting to say stem
cells out of it, to get the answers out. But once one had the answer out,
then one could say, okay, well, there is a way that now would be doable
perhaps. But I don't know -- I can't think of how you could find that
out, actually without being in control of the beginning material for the
experiment. Could you do it with excess IVF embryos, for example? I can
see that might be tougher.
I haven't thought about it enough either to be honest.
PROF. SANDEL: Could I just ask Robby a quick question. On the first part
of his comments, not on this issue.
DR. GEORGE: I want to say -- go ahead that's fine. Go ahead, Michael.
PROF. SANDEL: Going back to the moral status --
DR. GEORGE: The moral status, yes.
PROF. SANDEL: Would you say given your view of the moral status of the
embryo that cloning for stem cell research is morally worse than reproductive
cloning, where after all, no person is killed?
DR. GEORGE: Oh yeah, I thought I had made that clear. If I hadn't --
yeah, I'm sorry.
Just a final note on that since Michael raised this question of the soul,
I hope jocularly. It has circulated, I mean sometimes it seems to be an
assumption that those of us who are -- who believe in the moral inviolability
of the embryo believe that on the basis of putatively revealed propositions,
religious propositions or theological propositions about the presence
of a soul, I don't think that that's the case, as a matter of fact. And
as far as I can tell, I think Daniel alone has raised the question of
the soul or presence of the soul as relevant to a determination of the
moral status of the embryo. I certainly have not in any of my -- we've
now had four meetings. Any of my interventions, I don't think any of the
submissions that have been made have raised that issue, so I don't think
that we've got here a debate about revealed truth.
CHAIRMAN KASS: Could I intervene here? We've got about another hour to
go on this topic. There are people in the queue. I don't want to demonstrate
disrespect to the suggestion that's been offered. I understand both why
it matters to Bill, Bill Hurlbut, that if there is, in fact, a way to
use our science to get around what is for many people a profound moral
objection to doing this, that would be very nice to think about and to
do, right? That's a creative thought which hasn't generally appeared.
I also see its relevance for someone like Robby who by and large wouldn't
be in favor of anything other than calling for a ban. I'm simply assuming.
He might go along with something more temporary. One of the things that
might lead him at least to think about it is if he thought the intervening
time might actually provide him with an alternative, might provide us
all with an alternative, now not available.
I think if I could say that that's -- and if there's great uncertainty
with varying degrees of skepticism around the table, but without a lot
of evidence at the moment, and if people would like to gather further
evidence on this matter and maybe Bill would like to provide it, I think
we should have it, but there's no way in the world I think that we here
can do much more on this than we've done and I think we should, if it's
all right, I would like to move back to the options themselves that are
here and not the various possible reasons that might ultimately be one
way or the other.
Bill, you're next in the queue, so you can just rebut the Chair's admonition
that we try, I think to come back. There's still people who want to have
their first say on what they think we should do. But the floor is yours
and if I've done you an injustice, please correct it.
DR. HURLBUT: A fortuitous sequence.
CHAIRMAN KASS: It's just there.
DR. HURLBUT: Actually, I'd like to first ask Janet a question and maybe
Elizabeth too. How important is it that we come up with a solution that
opens up the possibilities for federally-funded research? Obviously, we
could do nothing and the private research would continue, but how important
is it for federally-funded research to be opened?
DR. ROWLEY: Well, I think it's extremely important for federal funding
to be available to scientists on some of the issues we have said are important
to get answers on which we cannot at the present time obtain answers because
of the lack of funding and I point out that this has been a ban for a
number of years. I know Clinton reaffirmed that there could be no research
using embryos and embryonic stem cells.
There is now, of course, with President Bush's allowing the use of cell
lines, I understand that the first serious of grants has actually been
reviewed and funded, I believe from NIH in that particular, using that
particular source of cells, but I think that many of the questions that
we would like to know the answers to, to come to a much more informed
judgment ourself are presently prohibited, so we just have to wait for
scientists in other countries where they do have the opportunity to do
this research to provide us with the information.
DR. HURLBUT: Can I ask Elizabeth the same question? How important is it
that we able to do things like nuclear transplantation at the university
level, not at just the currently accepted private level?
DR. BLACKBURN: Well, some of my points this morning were addressed to
why I think that kind of research is very important. As to the setting
of it, I think that if one grants that the research is important to be
done, then the university setting which is an open setting, where there
is review, where there is critical input, much better information made
the quality of the sciences generally going to be much better, will use
the resources that the country has in terms of its brain power to do it
right.
So my view, that's the way research really does get done right in that
kind of environment because I think while there are talented people in
industry, they're not guided by the same sets of imperatives, necessarily,
and one also doesn't have access to it and the information about what
the quality control has been in the same way as the more open sort of
scientific community which is exemplified by universities. In my view,
it's very important.
DR. HURLBUT: So I want to make the point that this is what I've heard
from all the scientists I've spoken with that we need to open up the broadest
possible, morally acceptable science at the level of basic research because
without that, first of all, as William May said earlier, that it's hostage
to proprietary interests and secrecy if it's in the private sphere only.
Is that what you were implying, right?
That's unfortunate, plus there's kinds of research that can be done at
the university level that won't be done in the private level. And the
science can go forward more rapidly if it's broadly published, so this
is why I think it's very important that we not -- that we define our moral
boundaries carefully, that we see if we can find a way scientifically
to work within those moral boundaries. I'm not very political and I don't
want to pretend I know what's going to happen, but I think I'm awake enough
to know that even if our counsel were to unanimously vote in favor of
all kinds of cloning, that that's not going to happen because our President
has plainly said that he will not favor that. So it would take, at least
I guess two-thirds of the Congress to override that. And that doesn't
seem imminent.
So it seems to me very worthwhile for us to try to define what the moral
boundaries are and seek, at least to tell scientists what they might work
toward. I just feel like that's the direction to go and if it takes a
little bit of speculative proposal, so be it. At least it clarifies to
us what our moral positions really are.
CHAIRMAN KASS: Mike Gazzaniga. You were on the list before lunch, maybe
you ate too well. Okay. Paul McHugh.
DR. MCHUGH: Yes. When I came after having read the draft of Chapter 7,
the moratorium idea seemed perhaps right. There are a number of reasons
I thought that. One of them was Mary Ann's point. It would continue the
conversation and perhaps win people over even to my idea that this is
a better way of looking at these clonotes and that the clonote and the
zygote were distinction with a big difference. But even more so, a period
of time we've already talked ourselves and we're still making progress
in the conversation and so more time perhaps would do as well.
I also felt that a moratorium might also show some respect from each of
our points of view to the other points of view about not only of our members
here, but of the feelings of people in the country, feelings that derive
from their points of view, some of the feelings that derive from their
religious points of view, that that might be able to be done during a
moratorium. And it would be a clear gesture of ours to the sense that
we are pluralistic society and that there are voices that we want to respect
and that thirdly, that there would be more opportunity for research that
would go, particularly in animal research that would do a number of things
for us. Particularly, I thought it would reduce the hype around this and
get us knowing more about what we had and what we could accomplish and
it would, for example, also bring up more issues in relationship to the
adult stem cells.
But in the conversation today and this morning, I began to wonder whether
a moratorium was really the right thing because a moratorium, I think
has to have a particular meaning. You have to -- really, it's not just
the inchoate feelings that I have about what might happen during this
time, and what I might wish, but it has to have some meaning and for a
reason not only to have it, but to give it a particular time. And it was
when I thought about the time that was going to be given to what has sounded
now more and more like a ban, I begin to worry about time because time
is of the essence in this, if like me, you have to talk to patient populations
about the possibility or the probability or the may be possibility of
their treatment.
Remember, if this work goes forward and the science goes forward with
it in any time, there's still going to be lots of other times that are
required because we're talking about therapeutics and you're going to
have to get into the FDA business and the Phase I, Phase II, Phase III
and we know that there are years and years that are going to come. Even
if we have a terrific discovery tomorrow, there's going to be years and
years of trials before it will be available and for the patients that
we're talking about time is of the essence.
And so as I thought then about the moratorium and I listened to Rebecca
and to Frank and to others, it seemed to me that perhaps we were talking
against what I feel and hope for patients and for this possibility and
that maybe the idea of working, considering a de facto moratorium as we
work out the regulations would, in fact, accomplish all the things that
I had wanted for a moratorium. It would, by giving a further arena of
debate as we were talking about licensing and things of that sort, allow
people, well, allow people to listen to me more about what we were feeling;
think about what Bill has proposed. By the way, I think this idea is a
very good idea. The coincidence of it, showing that this idea is just
around the corner was that the day before I received Bill's e-mail and
old friend had raised exactly the same question to me, but I didn't have
Paul Berg to go to, but when I got your kind of reinforcement, I thought
yeah, well, that's what our talking is supposed to do. It's supposed to
bring these things up for us to consider. And since we heard this morning
that it takes four, five, six years from even the beginning of some gesture
in this to get a regulatory body up and running, that would accomplish
pretty much what the moratorium would be trying to do, it seemed to me.
So that given the fact that time is of the essence, that there are very
important things both at stake in the moral issues, but also at stake
in the clinical issues, I'm moving towards issue 3 and feel that it would
accomplish all the things that I had wanted to accomplish when I came.
CHAIRMAN KASS: Alfonso and then someone else.
DR. KRAUTHAMMER: Excuse me, could I ask a question just on the meaning
of 3 of Paul? You then would say ban present regulation with the understanding
that there would be a moratorium imposed until the regulations are issued
or would you be permissive in the interim? Prohibitive in the interim,
rather than permissive?
DR. MCHUGH: Yes. Because it would be licensing that would be at issue
in the regulations, I would be prohibitive during that time.
DR. KRAUTHAMMER: Is that how we are to understand Option 3? Because as
I read it, I would have assumed the ban plus regulation means that research
cloning would be permitted and then regulated at a later date. I just
want to understand what you mean by that.
CHAIRMAN KASS: Certainly, I think that since no one in the current debate
has been proposing that we set up a body like the Human Fertilization
and Embryology Authority, the more liberal of the bans being proposed
in the Senate on reproductive only, at least to this point have barely
gestured in the direction of regulation. The original bill, even the modified
bill talks about certain rules at the NIH that govern experimentation
on human subjects and that means everybody but the embryo. I gather that
there's some proposal now that there might be an amendment saying nothing
past 14 days, but no one over there is thinking about setting up a regulatory
agency that would then have to take these things under consideration prior
to the existence of which nothing would happen.
So I read Proposal 3 as not being -- the people who tried to collapse
Proposal 3 and Proposal 6, I think did so erroneously. Proposal 3 would
be some new legislation now that's set forth a few conditions, but that
didn't really establish the kind of regulatory system that the British
have. It's perfectly possible for that to be modified by saying look,
I don't want to join a moratorium for any reason other than my interest
in regulation and therefore we beef up Proposal 3 to include precisely
that this research is prohibited, unless and until a regulatory body was
in place and that addressed the questions of commercialization that addressed
the question of duration, of licensing, of all of those things that one
saw that seemed to be common practices in the British and Canadian system.
That's a possible recommendation that we could make, but as it appears
here, we could dress it up that way if that is the way people would certainly
like to go.
Janet?
DR. ROWLEY: Yes, I'm surprised at your statement because certainly the
National Academy report recommended that there be a regulatory body that
would be established and I guess I had assumed that in the Feinstein bill,
there was something about regulation, but I don't remember the details.
CHAIRMAN KASS: I don't think that's accurate. There's some reference to
guidelines that are operative.
Rebecca, do you know, do you recall
off-hand?
PROF. DRESSER: I think you're right, although I would like to see it again,
but that's my recollection.
I didn't interpret 3 the way you were interpreting. I interpreted it in
the more restrictive way, so I don't know if Frank had that same interpretation.
CHAIRMAN KASS: Well --
PROF. SANDEL: I also want to address this because it seems to me that
this Council can define Option 3 --
CHAIRMAN KASS: Absolutely.
PROF. SANDEL: However it wants to. Moreover, we already can easily imagine
language that would provide exactly the understanding about licensing
and noncommodification that Rebecca and Frank and Paul and Charles have
raised just now. The language wouldn't be hard to draft. We could say
that it would have -- a regulation would have to include (1) establish
a number of days, whether it's 14 days or other; (2) license and conduct
prior review of all research involving cloned embryos or for that matter
all human embryos; (3) register and track each individual cloned human
embryo; (4) establish a list of what may and may not be done with cloned
human embryos once they're created and so on; (5) oversee corporate, academic
and industrial cloning for biomedical research; (6) monitor and regulate
or for that matter the buying and selling of cloned embryos and human
oocytes; (7) establish guidelines -- we would have to work very hard to
develop language of that kind.
CHAIRMAN KASS: To be sure. In fact --
PROF. SANDEL: Mr. Chairman, I didn't want to refer to any documents because
I know we don't do that --
(Laughter)
-- so I simply offered seven descriptions of the regulatory regime that
this Council could perfectly well adopt.
CHAIRMAN KASS: Correct.
PROF. SANDEL: And the licensing one, in particular, is the one that triggers
what Rebecca called and Frank the de facto moratorium because if we say
that it should be permitted only under conditions of regulation where
one of the regulations, perhaps the second item in the list we would devise,
says license and conduct and according to that position, the Council would
be saying there shall be no research done on cloned or human embryos for
that matter, except in such time they're duly licensed by a proper authority.
DR. MCHUGH: The time -- excuse me, please. I just meant the time would
be being spent in an appropriate, discussive way with a goal in mind and
in a fashion that just a flat out moratorium would not. There would be
work. There would be debate. There would be change, but there would be
progress.
CHAIRMAN KASS: Let me make a small comment. I'm on the list for my own
comment in a moment, but I would just simply remark on the oddity of developing
this massive proposal for regulation on cloned embryos alone and --
PROF. SANDEL: Why would be restricted to that? Why couldn't we say for
all embryos?
CHAIRMAN KASS: But here is how we started on a project that was really
primarily interested in the question of cloning to produce children. It
turned out that we ran into the embryo problem as a complication of trying
to figure out what to do about that. In my view, the proper context for
the discussion of the ethics and the policy about cloned embryos belongs
in the embryo research question, not somehow as a little tiny piece of
the cloning question, although there are people here who disagree with
me because cloning is cloning. But now it would turn out that one in a
way envies these other countries where they have at least, in the case
of the Brits, they put everything around the embryo so it's the fertilization
and embryological authority. The Canadians talk about reproduction and
have put the context somewhat differently, but they at least have larger
contexts in which they can plug this question. We would be trying to invent
the whole thing, attached to a question of public policy connected to
cloning. I'm not saying it's wrong. I'm not saying we shouldn't, but it
would seem that this is part of a piece for a longer term matter, rather
than something that -- well, certainly as I speak I can hear the counter
arguments.
PROF. SANDEL: In that case, you can offer it, Mr. Chairman.
CHAIRMAN KASS: Let me see. There are people who want to jump in the queue,
but Alfonso is waiting and then I am after him. Are there small things
to what's just been said because we should have it?
Gil, on the list; Rebecca; Frank. Alfonso.
PROF. GÓMEZ-LOBO: Okay, just a minor reminder here that we're already talking
about regulation, but we're talking about experimentation on human beings
without consent and with destruction. Now I know that immediately raises
the problem, but I want to raise the problem of the moral status of the
embryo. I don't think, and Frank you'll forgive me, that it's enough to
say we will not come to an agreement. I don't know. You may produce arguments
that are so clear that I may be convinced. I'm open to that. But I think
that moral skepticism is a very serious matter. Let me just give you an
example. There was a woman in Spain in the 16th Century where there was
skepticism, I mean it wasn't clear of the status of Native Americans,
whether they were human beings or not. And that cost thousands of lives
until you had someone who decided not to be skeptical, Bartoleme Las Casas
and that's very important in this case. I just cannot sit back and say
look, we don't know or we can't agree. I think if anybody in this republic
has to make the effort to hash it out it has to be this one.
Now I want to make an objection of that with what Bill Hurlbut was saying
because I think -- I see something very admirable in that and I'm not
going to go back to your adjective, Mike, because it's really a bona fide
effort to do this, to say look, for us the science is tremendously important.
We have a tremendous trust in what is being done and although some people
say it's a hype, it's an exaggeration, I'm personally willing to bet that
it's very, very important and that a lot of good is going to come from
it. But there is this matter of making it compatible with a very deep-rooted
principle of our civilization is that you just don't kill innocent human
beings for the benefit of the rest of us.
Now how can we make that compatible? Well, any exploration of that along
the lines of saying well, if there's an organism that we have reason to
think is not human, then that would be a solution. Then we would not have
a problem. Then that would be wonderful. Whether it's feasible, whether
it's an allusion, I don't know, but in a way it's a goal. It's an end.
It's a way of preserving a very basic right and of course, I could go
back and discuss with Frank the question of evolving rights and why I
think it's an incoherent notion. I think much of it and I'm just suggesting
it now, has to do with the kinds of rights and the kinds of goods we consider.
Sure, your voting rights come with age, but there are other more basic
rights such as the right to physical integrity that we have to respect
even in a small child. So I think that there's an allusion there that
because certain perhaps secondary rights have to do with our age, that
that would entail at some basic rights or rights of noninterference with
basic goods would be affected.
Now that's exactly the kind of discussion I would love to have.
PROF. SANDEL: Could I just ask Alfonso if that leads him, that those considerations
lead you to favor a ban or a moratorium?
PROF. GÓMEZ-LOBO: I'm really flexible because the -- as Mary Ann Glendon
said, a ban is just a moratorium of a different sort. If a moratorium
means that this is not going to be done, either destruction of early human
embryos and there's going to be a chance in the country to rethink it
and to have discussions, for instance, like the one I would like to have,
surely that would be a favorable situation.
PROF. SANDEL: Just a quick follow-up, Alfonso. If you regard embryonic
stem cell research as morally tantamount to infanticide, yanking organs
out of an infant for good ends, would you also favor a moratorium rather
than a ban on infanticide for that purpose?
PROF. GÓMEZ-LOBO: Well, I don't think anyone thinks -- is proposing, infanticide
at the moment, but there are people proposing stem cell research with
destruction of the blastocysts.
CHAIRMAN KASS: Why don't you go first and I'll go next?
PROF. MEILAENDER: Yes, because what I had to say really does follow up
on this in some ways. A lot of the discussion has really centered on the
question of whether 3 and 6 are distinct policy options or whether in
a sense, they roughly collapse and I would like to keep them separate
and it seems to me that there's a good reason for that. Unless I just
misunderstand what's been going on.
As I understand 3, even on the restrictive McHugh, Sandel, Fukuyama interpretation,
what it means is is that the moratorium, the moratorium means that we
intend to go forward with research cloning, but we need time to figure
out the circumstances under which and the limits on which, on the basis
of which we will go forward.
If that's what it means then that's saying that some of us really don't
need to enter into that conversation any longer. The crucial question
has been answered and it's over. We're not thinking about extending the
conversation or trying to prolong it in order to reach better understanding
or more consensus.
If what the moratorium means is we don't know whether at the end of this
time we'll say yes or no to this, and during the time of the moratorium
some of us will come up with model legislation for what regulation could
look like and thereby stimulate discussion. Some of us will keep working
on animal studies. Some of us will try to persuade people that it's a
bad idea to do it, but everybody is in the conversation, so that the two
different understandings of what a moratorium means are quite different
in that respect. To collapse 6 into 3 is to say that really we've made
what at least some people regard as a fundamental decision and they don't
have anything to contribute to the conversation any longer. To leave 6
as an independent option means that everybody continues to be a contributor
to the argument, or so it seems to me anyway.
CHAIRMAN KASS: That certainly and I'm glad you went first, because that
certainly is part of why I think that Option 6 is the preferable option
for us at this time.
My own thinking goes something like this, it's partly informed by principle.
It's partly informed by the fact that there is this deep disagreement,
and it is modestly informed by my concern that once again we will not
be able to do anything at all on the thing I care most about, namely a
ban on cloning for reproduction because of the continued division over
this other matter which divides us.
Let me see if I can put together certain things which I would stipulate
as, if I say they're facts, I'm only going to raise the flag and someone
will shoot them down, but let me call them assumptions, close enough to
the facts. First of all, Council is unanimous in opposing cloning to produce
children as far as I know. I don't have any dissenters from that. Maybe
some are for it only temporarily, maybe they wouldn't want a moratorium
on it. Maybe some would want a ban, but that's number one.
Number two, the Council has been of many minds on the question of cloning
for biomedical research and don't simply divide neatly into those who
approve it and those who disapprove it, not only because of whether we
approve with enthusiasm or approve with concern, but there are even some
people who might approve the research, but who might not be willing to
approve it just yet either because of the absence of a regulatory scheme
or because they think there might be at the moment lack of sufficient
evidence to sustain the claims for the unique value of cloning for biomedical
research or because they are concerned to ride roughshod over the powerfully
held opinions of colleagues in the absence of sufficient evidence. So
there are a variety of positions out there. And of the people who declare
themselves in opposition, some will do so because they will always be
in opposition unless Bill Hurlbut's proposal or something like it could
be met and others are opposed to -- would be in favor of a ban or oppose
it because even if they don't hold the embryo to be inviolate, they worry
about, and this I think is Charles' position, they worry about us starting
down the course of treating nascent human life as a natural resource for
the benefit of others with what some people call the "slippery slope" but what Bill Hurlbut has called establishing a principle that our subsequent
practice will merely catch up with once it turns out that going further
is even better for Paul McHugh's patients.
And then there are finally some people and I include myself among them,
who are worried about permitting cloning for biomedical research because
they're concerned also that once the embryos are available there, it will
be much more difficult to in the absence of regulation to certainly police
what's done with them and there's a slightly greater risk how much is
an empirical question, but I don't want to find out that this will lead
to cloning to produce children.
That, I think, is an accurate assessment of where the Council has been.
I would note another thing that figures into my consideration is the great
uncertainty about the research, not just with cloned embryos and clones,
but even with stem cells all together, embryonic adult, we just don't
know. Everybody has said that and it's agreed.
And there's no question, I think all of us have seen the promising benefits
of this research though it's still too early to tell.
These uncertainties cut sort of in two directions. I mean on the one hand,
Paul McHugh has said several times they ought to temper something of the
immodest claims that the miracles are just around the corner and they
place a very high -- they should place a certain kind of higher demand
on the cautious accumulation of evidence and yet they should also temper
people with their equally immodest assertions that we can know in advance
that there will be a morally nonproblematic way of doing what needs to
be done. I mean the uncertainty question, it seems to me, goes in both
directions and doesn't settle anything but it should make us very, very
modest, I think, about what it is we do.
Next point I think which is very important and doesn't show up in the
question of federal funding. Legal proposals to ban cloning for producing
children which then tacitly and then in some cases even explicitly would
allow cloning for biomedical research would be different from simply allowing
it without legislation at all for this reason. You would have the official
legislative endorsement of crossing this boundary, of creating embryos
solely for research. To this point, we don't have this. It's not illegal,
the private sector can do it. We have federal funding of the stem lines,
but we do not have -- we have no official government policy which says
it is all right to cross this boundary and we would do so explicitly and
officially, approve crossing this boundary, a boundary that the previous
federal advisory body, including the NBAC, said should not be crossed
at least not with official government sanction. See, that's an important
political step. Whatever you think about -- wherever you come out, that's
a statement of our whole community.
Last point, I think that's also a fact. You may not value the fact very
much, but it is a fact. And the other fact that's important to me is having
watched now in 1998 and again in the present time, seeing the Congress
struggle to try to enact a ban on cloning to produce children and with
what looks like very likely a failure once again, a failure that nearly
everybody supports and we might be overtaken by events, a failure that
is the result of the fact that we have a standoff between and I say this
without meaning to disparage, the zealous proponents of biomedical research
and the zealous opponents of any research that destroys cloned or any
other kind of human embryos. And zeal, I mean to be a praiseworthy term.
There are moral goods here that are being passionately defended. That,
I take it, is our situation.
How to solve the situation, assuming you want to get passed this impasse
at the very end which is very important to me. Let's get an agreement
on what it is there is an agreement on which is a ban on cloning that
would produce children. Let us recognize, let us get us a little extra
insurance in the absence of regulation by not allowing the cloned embryos
to be produced period. And let's have time for the following important
public reasons. Several of them have been said. One is the question to
get a little extra research so that the scientific case could be made
more compelling so that it isn't just the promise, but we've got models
with cloned embryos in animals where you've actually produced some kind
of therapeutic value. Or let's show that -- we can spell it out. I don't
want to spin out the scientific possibilities.
There would be time and there would be an incentive to develop the regulatory
mechanisms if one of the reasons for the moratorium was explicitly to
say to those people, you want to do it? Go out there and devise the --
go out and devise those regulations that would be able to persuade people
that you could lift this moratorium without really running grave risks
of any of the harms that people want.
We haven't had really, there's been an interesting debate. We don't normally
have these things and unless you think it's just deplorable that the country
should try to decide about these things -- I don't mean we here, I think
we've done pretty well, but it's been interesting to see the nation struggle
over this little tiny question, but to wrestle with things that really
are about terribly important things, but it hasn't been conducted all
together on the highest level. You don't somehow really try to win the
moral argument, either by having the Bishop threaten the candidate in
Missouri or rolling out Christopher Reeve and Michael J. Fox in the Senate
and have that serve in place really of a deliberation about where the
boundaries should be. It seems to me that with -- that the argument can
continue and if you got the reproductive cloning issue off the table,
that ban stays in place. Then the argument would have to be thought out
where it really is. You couldn't somehow use people's disgust over cloning
to produce children to try to try to smuggle through the back door a ban
on some embryo research. And you couldn't -- and you would have to take
up the embryo research question two part, and then try to figure out what's
the right way in this country to regulate embryo research across the board
and not sort of fight it all out over this little tiny matter.
It also seems to me and here I make this appeal to the scientists. You
might think I'm wrong, there are cowboys out there and there are disasters
that are in the making and it seems to me that a moratorium that was undertaken
not just as a stop gap measure, but as an invitation to the scientific
and technological community come forward, join the process, help the community
design those kinds of boundaries and standards that we all would be willing
to live by, it seems to me the scientific community could only gain an
increased trust and support of the nation as a whole.
If I really thought, I mean, if I really thought that we really were turning
down the manna from heaven tomorrow or the next couple of years in cloned
stem cell, cloned embryo research, I might have more hesitancy, Paul,
but I really have the feeling that at the moment, I mean it's uncomfortable
to say that any kind of scientific research would be banned and it makes
me uncomfortable notwithstanding what you might suspect of me. It makes
me uncomfortable and I don't like the jail time. I mean I would never
-- but it seems to me to ride roughshod over this moral boundary on a
mere promise of the absence of the evidence when so many of our fellow
citizens would be offended by this, I think it calls for a delay affirmatively,
not as some kind of fall back measure. We simply -- we don't have a consensus
on this and the question is how can we move toward getting -- we may never
get a consensus, but we can at least have this argument prolonged on a
higher level, perhaps even stimulated by something of the way in which
we would contribute to that discussion.
I don't think that's a mere compromise. I think that's to somehow dignify
what this debate is about and to try to let it go forward without undue
sacrifice and in fact, really inviting the scientific community to come
forward and say look, you're right, you've raised certain kinds of moral
hazards for us. We respect that. We'll help design ways in which those
things can be respected without crippling our research.
Now -- sorry for -- I think it was semi-coherent. I've been worrying this
for months. There was a line -- was I last? I guess I'm last, so Michael
Sandel and Michael Gazzaniga.
Excuse me, oh, there was Rebecca. I'm sorry. So eager was I to speak I
didn't write her name down. I'm sorry. Please.
PROF. DRESSER: Well, I'm not sure I want to follow that, but it was very
rich. Just a couple, a few comments. I agree with you, certainly on the
uncertainty, I agree with you. And I agree with you that this is really
a broader issue in terms of embryo research in general and it would be
certainly intellectually more appropriate to tackle the whole question.
So I know I've heard some discussion. I don't know whether this Council
is going to take on that topic in the near future, but it sounds as though
we might. So one way to address that would be to say something, if we
were -- if the people who wanted to endorse some version of 3 were to
say the regulatory principles and procedures appropriate to such a regulatory
system applicable to biomedical research cloning would also be relevant
to the general question of the use in embryo research and so -- of embryos
in research, generally, and so really in order to move forward with 3,
we have to think through what the process and procedures, in general,
ought to be and then we could start working on our thoughts about that.
Another point, I guess another reason why I have more difficulty seeing
differences between 3 and 6 is because for me, at least, a regulatory
system does not have to be very permissive, that is, I could imagine a
regulatory system that would have a process and principles in place that
were extremely demanding and would demand an exceptionally compelling
showing of necessity before something would be allowed to go forward and
a showing that would have to be accepted by people not only from the scientific
community, but from a broader group of people. So I could see -- and this,
I guess, leads me to my last point which is in some ways I think you're
talking about the work that could go on during a moratorium is very similar
to what some of us would think about the work that could go on during
a process of thinking about what a regulatory system would look like which
would involve scientists talking with other people in the community to
figure out what kinds of principles would work, what kinds of a showing
would be acceptable, a lot of these details that we've been struggling
with a little bit today. So in some ways it just sounds as though your
thoughts about a moratorium would also include some of this process going
on informally that some of us are thinking about well, if we took 3, then
there would be some process of proposal, notice and comment, public discussion,
probably revised proposal, you know, on-going in a more official way.
So whether it would be informal or formal, might be more the difference.
CHAIRMAN KASS: Good. Thank you. I have the two Michaels and Mary Ann.
Charles, we haven't heard from at all. Let's just go in order. Mike Gazzaniga
and then Michael Sandel and then --
DR. GAZZANIGA: We're all sort of just weighing in here. The rationale
that I would follow would be pretty much what Liz said this morning and
maybe to add a little flavor to it to go to your Option 2 and not that
I would do that, but that by during the establishment of the regulations
not to have any police around which would be a way of social engineering
to get the regulators to work fast and get their job done, in other words,
I don't know -- I just wouldn't know how one would recommend, with regulation,
and then put various specific moratoriums out on activity.
But I do want to just say one last thing. And remind the Council why I
think the scientists here are so clear about this and the reason is that
we know and everyone knows if they think about it, the most and I've said
this before, the most conservative group of people in this room are scientists
-- maybe not the scientists, but science. It moves slowly. It checks.
It double checks. It's out in the open. It will be the thing that moves
this question along and you have to start because it's slow in its activities
and in how it actually establishes truth. So I think you can have policy
discussions, philosophical discussions, ethical discussions for 10 years
on this, why not? They're tough questions, but if you don't let the science
go forward it will be in a factual vacuum.
CHAIRMAN KASS: Michael Sandel, Mary Ann and Charles, and Frank.
PROF. SANDEL: Well, Leon, you asked whether your statement was coherent.
I would say more than coherent, it was an eloquent statement of the case
for the moratorium/ban which however one wants to describe it, it's been
articulated here today. Some of the defenders of the moratorium define
it as more or less interchangeable with the ban that Mary Ann and Gil
and Alfonso and Leon, you made a strong case for at least some version
of a moratorium which in this discussion today has essentially become
merged with the ban and I think it's a powerful statement and set of considerations.
I would just like to address two of them. One is that you feel it would
have the moratorium/ban would take the reproductive cloning issue on which
there's wide agreement off the table and so it wouldn't muddle the other
discussion. But that seems to me true of all of the proposals we're considering.
All of the proposals, policy proposals would ban the reproductive cloning
and therefore take it off the table. And so that's not uniquely true of
the moratorium/ban.
The second thing I'd like to address is a point that you raised, Leon,
and that Mary Ann and Gil and Alfonso raised, the idea that a moratorium
would allow the moral argument to continue. I think it's very important
that the moral argument continue and that the moral/policy argument continue.
I think it's a mistake to assume that any of these proposals would prevent
that argument from continuing. I think the reason we are tempted to think
that a policy decision of one kind or another would somehow prevent public
discourse in wrestling with these moral questions including the moral
status of the embryo which I think should be preserved as a live argument
and debate in public discourse, regardless of what policies are recommended
or enacted. The reason I think that we -- people fear rightly the danger
of kind of shoving off the public agenda that question or related questions
is what happened with the abortion debate, but there's a big difference.
The abortion debate -- the Supreme Court decision did contribute, it seems
to me, to taking off, out of public deliberation the question about abortion
and the moral status of the embryo, precisely because it took that decision
out of the legislative arena, out of the democratic arena, but nothing
-- we are not a Supreme Court and if there is a decision taken, a recommendation
by this Council, enacted into law by the Congress or by some state legislature,
the debate is still open in a democratic society as all such debates are
open and should be open. So we're not facing a question here of a Supreme
Court ruling that's going to say no, there can be no more democratic deliberation
about this question, forget about it except for journal articles and philosophy
journals. This will still be and should be the subject of continuing discussion
including on the most fundamental of the moral questions that we've discussed
here.
I think the question we should ask ourselves is not are we by one policy
recommendation or another going to suddenly prevent public debate on this
question. I think we should ask ourselves how can we frame the alternatives
that have developed over this 6-month period in a way that not only will
permit, but will give focus and structure and maybe inspiration to continued
public debate about these ethical issues.
I think that we sell ourselves short, if we think that offering two major
policy options, some favoring one, others the second, whether it's called
the moratorium or a ban, developing the reasons as we've developed the
ethical arguments and the various sides, that in itself, would be not
only a contribution, but it would be a way of giving focus and inspiration
and animation to a continued public debate on this question. We're not
the Supreme Court.. We're not foreclosing. Whatever of these we choose
or whatever pair of them, we recommend, we're not going to be foreclosing
public debate on these moral questions and shouldn't. The question is
how can we give it structure and focus and I think listening to the comments
this morning and today, we're basically there. We basically, I think,
have thrashed it out to their two clear positions and people have developed
-- have defended the two positions broadly speaking, whether you want
to call the second a moratorium or a ban, that can be up to the final
drafting, but I think that we've really identified the major alternatives,
both ethically and in terms of policy and I don't think we should underestimate
the public service that that constitutes.
CHAIRMAN KASS: I have Mary Ann, Charles and Frank, in that order. Please.
PROF. GLENDON: As I recall, the reason that we took up cloning was not
because --
CHAIRMAN KASS: I wish somebody could remember.
PROF. GLENDON: Not because there was any logic to it, but rather that
because there was pending legislation and we were asked or thought it
was a good idea to address ourselves to that problem because it was so
current.
But especially listening to the discussions this morning of how other
commissions and other countries have approached these issues, and listening
to the discussion this afternoon, it seems to me that maybe where we are
is that we're ready to make a policy recommendation on cloning for reproductive
purposes, but the second matter, cloning for research purposes really,
logically belongs within the general question of embryonic research which
other countries and other commissions have taken up systematically. So
I guess what -- thinking out loud and maybe this is zany, but it seems
to me that maybe what this Commission ought to do is unlink the policy
recommendation about reproductive cloning from the more complex issue
of embryonic research of which cloning for medical research purposes is
a sub-issue and take that up systematically.
CHAIRMAN KASS: Can I just -- boy, would I love to do that, but I don't
think one can make -- I don't think -- well, I mean you could say look,
we make a recommendation that we would like to see cloning for producing
children banned and the world will not because even the National Academy
of Sciences thinks that. So -- but then you sit down and try to give effect
to that and you can't do it without trampling on this other tirade. If
we could do it, fine. Part of the reason I think -- part of the reason
for wanting to have some time where you don't explicitly give permission
for that to go ahead, not just that it doesn't go ahead, but that you've
sort of explicitly sanctioned it by law, that's one of the advantages,
it seems to me, for the moratorium, so that the next time the question
comes up, the no baby making part is there and this could then be dealt
with in the context where I think it properly -- I absolutely am sympathetic,
but if we're asked to make a recommendation that actually could have --
could be implemented, we're in the soup. That's the real -- Robby, George
and I, 18 months ago because we started in different places, had an agreement
that we would sit down and try to draft legislation that was like Item
2, absolutely silent on the other question. Write a legislation that would
just ban cloning for baby making and didn't say a peep, one way or the
other, didn't imply anything about the other. I mean better people --
in fact, I even asked Michael Sandel if he had had a shot at it, because
I thought he thought it was a preferable -- I don't know if you tried.
It's very hard.
I'm sorry, I've abused the privilege of the chair. I wish we could do
that. I don't think we can make a responsible policy recommendation and
simply say this other thing isn't here. It's attached to this like a barnacle.
PROF. GLENDON: Can I?
CHAIRMAN KASS: Please.
PROF. GLENDON: I wasn't suggesting that we say the other thing isn't there,
but that this Committee should take the time to systematically --
CHAIRMAN KASS: I see. Forgive me.
PROF. GLENDON: -- View the second issue within its proper context of embryonic
research.
CHAIRMAN KASS: I see and therefore not have a full policy recommendation.
PROF. GLENDON: And make a policy recommendation later.
DR. KRAUTHAMMER: But Mary Ann --
CHAIRMAN KASS: You have the floor, actually, Charles.
DR. KRAUTHAMMER: Yes. If we were designing a seminar on the question of
embryo research we may not have chosen in advance that cloning be the
entry point, but in fact, it has been the entry point just by historical
accident, if you like and I think that, in fact, if you look at all of
the documents that have been produced in all of our discussion, we have
done a pretty thorough investigation of the issue of embryo research,
even though it focused on the cloning aspect.
I think it would be a pity to throw away everything that we've done which
is quite extensive, I think, quite remarkable. I've looked at the documents
that were produced. I think there are major contributions to the national
debate and I think we ought to -- given that we have spent all this time
and gone deep into the issue, both the science and the ethics of it, I
think it would be a mistake not to go to the next logical step which is
to issue a recommendation on the basis of what we've said. I'm sorry,
I missed the discussion this morning, I was out of town and I -- perhaps
I'm stepping back here, but I just want to step what my position is on
the question and that is, as you know, I oppose research cloning really
on two bases: (a) I think it crosses a new moral frontier which is the
creation of a nascent human life for its exploitation and use by others;
and secondly, because I distrust and this is just based on experience
and observation of what happens in Washington when with the regulation
I distrust our ability to establish a new line, a line that will hold.
But these are both credentialed judgments and they are subject to review,
given new facts and new history that we will be creating in the future.
So I would come out at position 5 where I would prefer a ban on both,
but I could live with 6 which would be a ban, plus a moratorium. I see
the difference. You probably have had this discussion. I'm sorry that
I'm late. I'm probably repeating it, but in a democratic society obviously
all bans are temporarily. They can all be reconsidered, so that the difference
between a ban and a moratorium is simply that when we do inevitably reconsider
this issue, a ban means the burden of proof is on those who want to undo
it and a moratorium means that the burden of proof will be on those who
want to institute a ban. And as a proponent of the ban, I'd be quite willing,
happy, to restate, refight the fight in the future, if necessary. So I
would be for 6.
CHAIRMAN KASS: Frank.
PROF. FUKUYAMA: Well, just one last comment on why I prefer 3. Gil was
saying that 3 made the decision in principle in favor of embryo cloning
and therefore in a way it foreclosed that discussion. I understand that
point, but I think that you need to consider the question of whether 6
may not actually lead to the same result faster because it's one thing
if you assume -- okay, we have a two to three-year moratorium. Either
people are convinced by Alfonso and Robby about the moral status questions
which I think there's close to zero probability of, or adult stem cells
or some other approach seems very promising and the embryonic stem cells
seem less promising which may also happen, but there's also the possibility
that after that period of time the embryonic stem cell research from animal
studies or from other countries will seem so promising that in fact, once
the moratorium expires you will go right into unregulated embryonic cloning.
I mean that that pressure -- the moratorium period will be used to build
pressure for that. And at that point, you're going to have the cloning
and you won't have a regulatory structure in place. And so that seems
to me a risk that you have to consider if you go for number 6.
Now on Leon's point that it seems a little strange to want to create this
huge new regulatory structure just to deal with the cloning issue, I actually
regard that as an opportunity because I actually think that there are
many issues out there much more important than cloning that will need
a regulatory structure: pre-implantation, genetic diagnosis, you know,
germ line, when we get to it, creation of hybrids, I mean, all the things,
issues that these other agencies deal with that we ought to be as a Council
thinking about where we don't have rules, where we don't have an institution
capable of dealing with that and so I welcome the fact that this gives
us a good excuse to actually set this kind of institution up or think
seriously about what such an institution would look like.
Charles, a couple of years ago wrote this article where he said about
stem cells that people ought to be more worried about where the stem cells
are going, rather than where they came from and I think that's absolutely
right. I mean it's where they're going that creates, for me, all of the
really frightening possibilities. And for that, you are going to need
a broad-based regulatory institution that will not hold back therapeutic
technologies, but will put some kind of long-term societal control on
ethically questionable things that go way beyond this particular embryo
cloning thing. So I would say the issue is not just embryo research, it's
embryo in general and new biotechnologies, in general. Because I think,
for example, if you looked under this rock of the American IVF industry,
you'll find exactly the same sort of things that Patricia Baird found
when the Canadians looked under their IVF industry, that there's a lot
of stuff that is going on that doesn't get a lot of attention, but really
probably needs further regulation. So all of those are issues that are
tangential to cloning, but I think we need to address, so that's why I
think that number 6 is actually a good excuse to get us into this.
CHAIRMAN KASS: You meant 3, right?
PROF. FUKUYAMA: I'm sorry, 3 is a good excuse to get us into this.
CHAIRMAN KASS: The only thing I would say and -- yes, please. Are you
going to respond? The only thing I would say is that the general sort
of political economic climate in this country is not Canada and that is
to say, the ease of doing something like what they've done there given
our absence of bureaucracy and the laissez-faire attitude in the industry
is -- means that one shouldn't be too sanguine about how easy it -- we
can sit here and recommend whatever regulatory agency you'd like, but
if you think that -- if you saw how unhappy the industry that had basically
not much interest in cloning for biomedical research was about this, wait
until you see what happens when you sort of threaten the whole activity
in which they're engaged because to do this thing right, you're not just
interested in dealing with the area of federal funding. I mean if you
really want regulation, you want it across the board, and let's not be
naive about how -- it's very easy to kill legislation in this town. It's
very hard to pass it and especially something which goes against the grain
of the leading zealots for doing these things.
PROF. SANDEL: Was that also zealot in the complimentary sense?
CHAIRMAN KASS: Yes, yes. Dan, I'm sorry.
DR. FOSTER: I think I would just like to say that I will support position
3 and having heard your very eloquent presentation including at lunch
when we talked privately, the key issue for me has to do with the inviolability
of the embryo. If you believe that, then you have to say no cloning at
all. You simply have to say that. This is the same thing as destroying
or sacrificing a human. You have to say that. I don't hold that view.
I don't even know what the evidence is for that view. I mean this is in
that broad space between -- that Russell talked about, this no man's land.
People can say what they think it is, and one follows the logic of the
reasoning and see whether it's valid or not. So that's out.
I think that -- I once gave a speech where there was an argument and I
ended with a confession of faith, not a religious faith, but you might
claim that I'm making a religious faith. I said I thought it was an argument
about whether science should exist in medical education and so forth that
I thought that in the end science would win and that is because you cannot
squelch truth ultimately.
I have a high confidence in what has already been said in the practicality
of the scientific communities, sometimes even in the biotechnology community.
And that is I do think that they're cautious and things that don't work
quickly get dropped. In the first place, they can't get published and
secondly, they don't work. Even with such a hopeful thing in the treatment
of cancer as the angiostatin, you know, the stuff as Bill was talking
about to stop the growth of blood vessels to stop -- stuff to cure cancer,
I think it was $35 million to the rights of that that a biotech company
paid. They dropped it like a hot cake because it didn't work. Even a biotech
company dropped it like a hot cake.
I don't think that the new evidence that we need to make a decision after
a moratorium of three years or six years or 10 years can be forthcoming
without the kind of comparative investigation that several of us spoke
about this morning. Scientists do not wish to look at things in isolation.
They look to the whole truth. They would like to look to the whole truth,
whether stem cells, adult stem cells are better or cloned stem cells and
so forth. And to put a moratorium on this simply begs the question of
the information that one wishes to make. We have all the information we
need to make a moral decision. I mean because the arguments have been
made ad nauseam. If I've heard one time that we were once an embryo, I
must have heard it even in the course of this conversation multiple times.
The argument is almost always the same. The same people, different people
speak, but it's the same message. So I think that we ought to just have
-- we ought to just vote for what we think.
I said in a very short public statement in an e-mail that if I was convinced
that this was an inviolable thing, I would be with Gil or whoever. I wouldn't
do it, no matter what the promise was. But I happen not to think that's
true and therefore for not only individual patients, but for humanity
itself and so forth, I think we ought to let the facts that science gives
us tell us what to do.
Now do I think this ought to be regulated? Yes, I do. And how long it
takes to do that, I don't know. And maybe we'll just say that the American
scientists will wait for the English scientists to do this, but in one
sense, I don't want this to sound wrong, but in one sense I have confidence
in the -- maybe because the society in which we live more confidence in
the caution of the scientific investigation with American scientists who
are influenced by all the moral issues that we've talked about here, about
making these judgments as well. That was almost never talked -- but I
did want to say the reasons why I think we ought to go ahead and we ought
to do it in terms of what we think the embryo is and what we think the
risks, is this a line? Leon thinks this is a bright line that we're making
life and then killing life. Do we believe that? Then I don't even know
why you want to do a moratorium. If you believe that, then you ought to
just have a permanent ban and try to defend yourself.
But it is my confession of faith that finally you cannot stop what biological
or other truth is and we have to simply see if these things work and I
would like it much better if we could work on it and get the answers and
if it doesn't work, let's get on to Bill's view or something else along
those lines.
DR. KRAUTHAMMER: Dan, if I could just make one point. For some of us,
the reason that we oppose this is not because we see a bright line between
life and nonlife and creation and believe it's the destruction of a person.
And our concerns are rather different. They're about the possibilities
of what this research could lead to. So I just want to clarify that it's
not -- this is not a debate, if you like, a recapitulation of the abortion
debate. For some of us, it's a debate about what might eventuate, rather
than say origins of the cell.
DR. FOSTER: Well, thanks for that clarification. I know that you feel
that way. You've told me that previously.
I think that the issue that we worry about would be the one that it would
make it much easier to make human beings for rogue scientists or other
scientists to do that and that's a -- there are evil people around and
there are things like that will happen. I somehow think at least in the
developed countries, maybe that doesn't -- that that would be -- I mean
there's such a universal -- some people have used the term here revulsion
against that, a revulsion which I hold, I might add, that it would not
-- that that would be easier to police and to prevent than -- you know,
than maybe what you think it would be. I don't know.
DR. KRAUTHAMMER: What I worry about is not what the rogue scientists will
do, it's what the good scientists, the good society will allow itself
to do.
CHAIRMAN KASS: Robby George, we're going to wind up very soon. If there
are any people who want to add something before a break, Robby, a comment?
DR. GEORGE: Yes. Dan, I appreciate the frustration of hearing the same
argument from the same people, time and time again, and particularly,
the point that the being that is now you or me was at the earliest stage
of his existence an embryo. And we have heard it time and time again.
But I don't think I've heard the counter argument to that. The point of
the assertion is the claim that we have our inviolability and our dignity
by virtue of the kind of entity we are, rather than by virtue of some
acquired characteristic that may or may not come with fuller development
and which different people have in different degree. I think it's therefore
incumbent on people who take the position that the embryo is not inviolable,
is not fully one of us to say what it is then or to say in virtue of what
it is that those human beings who have inviolability and dignity, who
have achieved whatever it is you need to achieve to have inviolability
and dignity have. That -- Michael Gazzaniga, I think, has put something
on the table with brain development and there has been an exchange about
that and if that's the general position, then at least we know what the
argument is, but I don't think it's enough simply to say I don't accept
the claim that the embryo is inviolable. I think if you're going to reject
that claim, given that reasons have been advanced for the claim, it is
incumbent to say in virtue of what then, if it's not the kind of entity
we are that gives us our inviolability, in virtue of what it is that we
have our inviolability. Because if people on my side of this debate knew
that, what it was, then either we'd be persuaded by it or we could give
our reasons for why that -- as far as we can see, doesn't work.
DR. FOSTER: Sure and I know we have to quit and I respect the argument.
I would say that I would put myself in a position that I'm agnostic because
I don't know how to answer that question and you tease me a little bit
about bringing in the issue of the soul. I was just repeating an old story
from the Bible and saying at least the person who wrote it, that the soul
came in later. That's all I meant. I didn't mean that I -- I wasn't trying
to introduce a revelation in here. I carefully said that I didn't know
who wrote this and that it was old, but it was very interesting that it
was into the intact human that God breathed life and that the human became
a living soul and it's just a story from Genesis. That's all I meant by
that.
So the reason that I don't -- it doesn't make sense to me and I really
followed at some point I wrote a little short paragraph about that that
along the lines that this was a potential human being incapable of doing,
becoming life itself because it wasn't implanted or anything else. It
had no organ, no brain neuron, it had no sentience at all and as a consequence,
common sense, just mere common sense said to me that biologically at least,
this was pre-human and not human and as a consequence I did not think
that it had the same inviolability that I might make at the time 40 days
later. I don't know what the time is, but let's say 40 days or whatever,
which I would move away.
But I speak of this in an agnostic position and one of the things that
concerns me so much is the absolute certainty that some people have that
they can do that. I'm not speaking about -- I'm sure you're probably worried
about this as much as I am, but some people are absolutely certain that
the moment -- we've heard this expressed here, that the moment that the
sperm hits the egg, that that is inviolable.
Now I heard Bill quoted this -- when Gil and I were talking a little bit
later about the estimate that every year, if you just look at a one to
one loss -- if for every child born, there's one that's not born. It's
not implanted, and I was telling him that the World Health Organization
says that there are -- they estimate that there are 363,000 babies born
every day, 100,000 deaths, so that means that nature in one year, I know
these figures may be soft, eliminate 130,495,000 human things. And so
Gil said well, Bill thought that they were not complete. I hadn't seen
this argument. They were not completely fertilized or something like that,
but my point is here that one has to be agnostic about this and that's
all I'm trying to say.
DR. GEORGE: But I don't think you have to be agnostic about what it
is in virtue of which human beings have inviolability. That's what I'd
really like to know. If it's not by virtue of the kind of entity they
are, that is, an entity with a rational nature, then what is it? Is it
sentience? Is it brain wave function? Is it the realized capacity for
self-consciousness or self-awareness as my colleague Peter Singer says.
I'd just like to know what argument it is I'm supposed to answer.
DR. FOSTER: Well, I say I can't answer it because I don't know and I don't
-- I'm further trying to say that I'm not sure that any human knows the
answer to the question that you wanted to -- I can decide -- I mean I
might decide at the time there's the first -- because you can't -- the
highest organ system, as far as I understand it as a physician scientist
is the central nervous system, the body will try to protect that against
all odds and secondarily, it supports the circulatory system in order
to protect the central nervous system. So if you've pushed me, I would
say it's at the point where one had the capacity to sustain life with
an organized or the beginning organization of a central nervous system
because without that, there will be no progression under any circumstance
of this organism to a full human and these are simple arguments.
DR. GEORGE: I know, but I think we're actually getting somewhere. So
if the reason we don't look at just an individual innocent person on the
street, and say gee, that's one person, it's a good thing that there's
one person, but we've got 26 or 27 people in hospitals waiting for organs,
so with that one person's organs, counting two kidneys, one heart, one
pancreas, one liver, etcetera, we could save 26 or 27 people. The reason
we don't do that is because that innocent individual like all other innocent
individuals has inviolability and he has this inviolability by virtue
of having a central nervous system?
DR. FOSTER: No, his inviolability is much more than that. You're asking,
I think, at the embryonic level where I would make this decision.
DR. GEORGE: No. I'm just asking for any human being you think who's
there, the human being has got there, by virtue of what does he have --
DR. FOSTER: Mr. Chairman, rescue me here. I do not wish to be a -- I need
to be rescued. All I was trying to say is I was voting for Proposition
3. That's all.
CHAIRMAN KASS: I'm going to rescue --
DR. KRAUTHAMMER: We need to discuss this.
DR. FOSTER: Not here and not now.
CHAIRMAN KASS: Look, if I could ever overcome my new phobia of all conversations
about embryos which is the result of all of this discussion, I would at
some point down the road after all of this is behind us, it's occurred
to me, it's occurred to me that we could make a useful contribution, separate
from any public policy question at all. In other words, get it out of
the argument to actually have -- get some embryologists in here, get some
philosophical biologists, people whose field is the philosophy of biology
and maybe have a conversation about this with some presented papers, rather
than continue to -- the conversation has to go on and it's obvious it's
not the only thing here. I don't agree with that that it's the only issue.
I think Charles has and Dan has conceded that.
This isn't, I think, the place to do that. I would recommend that the
two of you have dinner together and report the --
DR. FOSTER: I already acknowledge defeat, Charles.
CHAIRMAN KASS: But it seems to me if I may on Dan's behalf say to you,
Robby, since Jim Wilson has, in a way, spoken for many of the people on
the -- I shouldn't take his name in vain because he's absent. I think
he's still out of the country. He tried to make a kind of moral intuition
argument which doesn't settle anything as people who talk about the wisdom
of repugnance know all too well, but that argument can embarrass intuition
or say maybe your intuitions are senseless or wrong, that's a nice ploy,
but when you finish arguing with him, you tell me why your moral intuition
that cannibalism and incest are abominations? You give me an argument
that's adequate to that. Not now.
(Laughter.)
DR. GEORGE: Can I just cite an article I've written?
|
