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Thursday, April 25, 2002

Session 4: Human Cloning 10:
Ethics of Cloning for Biomedical Research

CHAIRMAN KASS: Could we come to order? Why don't we begin? I think a few of our members have had to leave either for class or had a conflict for this last session. I think we're just missing Dan Foster at the moment and maybe he — ah, perfect. Good, thank you.

This is a session in which we return to the topic of our last meeting and revisit our project on cloning. The specific questions are the ethical issues of cloning for biomedical research and I would simply remind us of the approach that we have adopted in full recognition that not that we have failed to reach agreement, but we never expected to reach agreement because this is a vexed, moral question where reasonable people put the moral weight in different places, and that our effort is to explore these differences with no expectations that they're going to be overcome, but rather that they can be clarified.

The aspiration in this discussion and, if you will, on this part of what we eventually produce, a common document owned by us all in the sense that we agree that this is, in fact, a good representation of the state of the question, while preserving and even sharpening our differences so that no position held by any member of council or by some person not in council that deserves to be represented in council isn't given its fullest and fairest expression.

We have been proceeding as colleagues, as fallible human beings with a certain, I don't like the term, but it's been used, with a certain kind of epistemic modesty about our own claims, I mean, to encounter thoughtful people who ought to know better than not to agree with us, ought to give us somehow pause and make us a little more humble about where we stand and that we are interested, maybe when we leave this room, we're interested in victory, but at least for the sake of our meetings, we are adopting the pretense we are interested in clarity and wisdom and not simply beating the other side down.

I would suggest and so far, I think with some perhaps exceptions, we have tried to recognize that the people with whom we disagree have something vital to defend and if I might be so bold, vital to defend even for us whether we know it or not, and therefore it behooves us to make sure that we don't shortchange ourselves. And one formulation would be to say that it would be — nobody would want to see us callous to the needs of suffering humanity. Nobody would want to see us cavalier regarding the treatment of nascent life at some stage or other and no one ought to be indifferent to the effects on a society of doing A rather than B, or B rather than A, or C or none of the above.

So I want to tell you where I think we stand in this discussion to see whether I'm right in where we stand and then continue to have — to advance the discussion. The question of the vexed status of this entity, the cloned embryo, we're now back to the cloning topic. It's related, but not identical, with the status of the embryo created by IVF, which will be, I think, central to the question.

I want to remind us of something that we've gotten from Stephen Carter in a message to us about the importance of upholding the distinction between what's legal and what's moral, between the realm of what is permissible legally and what is either good or bad, better or worse, noble or base, right or wrong.

All too often and perhaps for understandable reasons, the question of permission or ban hovers over the moral conversation, but it's certainly possible that someone might conclude that this activity is morally dubious, but ought to be permitted and there are all other kinds of possibilities. So I would like us, as best we can, to have this conversation still on the moral plane which is where we've had it before.

I would also make an observation and this has come also in some of the conversations, that some of us have been adopting the language of competing goods to describe the present situation before us. And I would at least like to put before us that that might be a way of putting the question that is congenial to some, but that there is another way of formulating what's here and might help us understand why this is so intractable.

In moral philosophy there is a distinction made between the right and the good in which the good is an object of desire. There are multiple goods. They don't have any kind of absolute standing for us and you can compromise them to get more of one for the sake of less of the other, whereas claims of right or of justice are things which lay down a kind of marker and at least there's a prima facie claim that they should not be violated, that the burden of proof is on someone to show why they should — why they can't be violated. And I have the sense, at least in some of the previous discussions, that for those people who regard the embryo as either one amongst us or enough like us to be entitled to some kind of irreducible respect, that is not being treated as a category of a good to be preserved, but as a matter of right. And therefore, arguments of that sort are less likely to — people who hold that view are less likely to want to put that into a pan balance of competing goods, but who want to insist that this is one of those markers like "thou shalt not" because there's something inviolable here.

I don't want to shape the discussion, but I at least want to introduce that distinction as possibly being helpful to us and seeing what might seem to be simply a matter if we talk long enough, we can find the right balance, when in fact, for some people this is not a balancing operation at all, but two different kinds of moral discourse.

I think that's — there are other things to be said, but I want to really open the discussion with the following observation. We have tried in staff conversations and in conversations with you all to stake out several moral positions with respect to cloning for biomedical research and while two of them seem to have come to the fore and have commanded at least some support, I suspect that the two might indeed be enlarged to four. And let me state them and see where we are.

It seems to me there are two possible grounds for approving or finding morally acceptable cloning for biomedical research and two possible grounds for disapproving. One would be to approve and to let's say approve with eagerness and without qualification because one does not believe that any harm is being done. This would be a view that held that the embryo in question was beneath the status of having any moral worth and I don't want to get into the language of person and things. I'm not sure that's helpful, but it is not the sort of thing that ought to restrain us from use when good might come of it. Let's call it the position of "approve with zeal" or "approve without qualification."

The second would be to recognize that there is something in the embryonic life here that one is at least agnostic about it or one thinks it has some kind of standing, but that one engages in a balancing operation and it approves with humility and is willing to accept some kind of restrictions or restraint on what can be done, recognizes that there is a harm being done to the embryo, but does not regard that as a moral wrong, that is to say, a violation of some stricture of right. This has been put into a balancing operation.

A parallel on the side of the disapprove, it seems to me I'm going upwards in scale. You'd have a position that one could call disapprove with regret or has been said, with tears. I'm sorry, the tears belong on the other side. Approve with tears and here, disapprove but with regret, recognizing that there might be certain kinds of benefits had, but making calculations on prudential grounds or on certain kinds of moral considerations about where this might lead, that one decides, on balance, that the goods to be had are not worth the cost of the balancing operation. And there could be the position that would disapprove as a matter of principle and without qualification because it is immoral to treat even the earliest of human embryos as anything but one amongst us, no matter how much good might come from it.

I take it those are four positions that have been heard around the table, not necessarily articulated in those ways. In the intermediate conversations between the last meeting and this one, we've been mostly working in the middle, that is to say, we have — I'm not exactly sure about that, but we've had expressions of views that look like disapprove with regret and positions that argue for approve, but with humility and the willingness to accept some kind of restraint.

I think from some of the correspondence that there are at least some amongst us who believe that their view of this matter is not adequately represented and I think it turns on the question of whether we haven't made all too much fuss about these little 7-day old embryos.

Let me see if I have correctly stated analytically where we are and if so, then the question is where we can go to make sure that these viewpoints are properly developed before we actually either try to persuade one another to move from where we now are to some other place or we finally have to choose and come down with what we really think about this.

I think I've said both too much and too little, but let that be — to prime the state of our own discussion. I remind you, cloning for biomedical research, the arguments of course overlap with the question of the embryos used for research, but we're back on our more narrow topic and the larger one is still in the offing though perhaps informed by some of the things we've just been talking about.

Comments, questions, arguments, corrections?

Gil, please.

PROF. MEILAENDER: Just very briefly, I just want to note that it's not necessarily a question of whether someone thinks his or her position has been kind of adequately represented in that focus on the middle. For instance, as I recall, one of Frank Fukuyama's comments that he sent in was really questioning whether the approve with humility position was the right representation of the going argument in a way and I, myself, had questioned whether it was really the strongest form of the argument. So it's not — I think it's not just a question of whether one thinks one's own position is represented, but just where the balance of the argument should lie.

CHAIRMAN KASS: Mike, do you want to get in on this, please?

DR. GAZZANIGA: I'll take the bait. I think we should do everything we do with great humility. You realize how often in life you're wrong, it's a good model. But someone with I guess my particular view would not see the need for the preceding two hours of torturous debate of trying to shoehorn into this problem all of the issues that are trying to be shoehorned into us. So I view the embryo by which we mean the blastocyst, either formed by IVF or through somatic nuclear cell transfer as a thing that deserves human respect like all human tissue, but provides me with absolutely no moral dilemma to proceed into biomedical research on it.

CHAIRMAN KASS: Does someone join on that? This is, in fact, I suspect, a not uncommon position. It might even be more common in this body than simply Michael, so could we have some discussion?

DR. GAZZANIGA: I guess what I was — I don't know what other people think and it's up to them to say. But I do like what you've done here which is to broaden the spectrum of response to the question at hand.

CHAIRMAN KASS: Right.

DR. GAZZANIGA: And I think that was an important gesture.

CHAIRMAN KASS: Right. Rebecca, please?

PROF. DRESSER: This isn't exactly in response to what you were saying, but in thinking and reading about this, it seems to me that people in both 1 and 2 categories, the approval categories are affected by some notion of duty to rescue or duty to be a good Samaritan and that it's not just some judgment about the value of the embryo or the viability of the embryo, but it's a moral — a strong moral feeling that this is what we ought to do to help people who are very ill. And I just wondered if that is a concept worthy of exploring with these two positions, that is, you know the moral philosophy on duty to rescue and when do we have one and what are the considerations that ought to go into determining whether people have a duty not just to refrain from harming, but to actually act to rescue people who are in dire circumstances. So I'll just throw that in.

CHAIRMAN KASS: Let me add one further thing. As you know from the start we have been trying to place our limited moral arguments in the larger context. In the case of cloning for producing children, we tried to put it in the context of human procreation and with the help of some comments from Michael Sandel and others, it's clear that human procreation also means relations between parents and children. It's not just the procreative act. We're trying to put these things — the right context for this is not just what's the status of the embryo, but the right context for this is what is the vocation of healing and what is, in fact, the mission of biomedical research and these are not simply technical activities. These are activities informed by deep moral commitment and principles and the question is whether these duties are absolute or relative and so on is, of course, for discussion. But I think it's absolutely welcome. We can't simply hash this out over the status of these 100 cells. We also have to think really about the moral principles that guide us here. So that's, I think, very welcome.

Elizabeth, please.

DR. BLACKBURN: I've been grappling with this and I think that I'm in position 2, as you've outlined it, approval, but thinking seriously about it and for me a helpful metaphor was thinking about, well, if one were, let's say, there with a blastocyst and you had to do something to keep it alive and then you saw a child drowning, who would you save, if it was a matter of you being in one or the other place and you knew that if you went and helped the child drowning, and I'm using a dramatic example, but if you helped the child drowning, you would have to let the blastocyst die because you couldn't carry out whatever next thing you had to do to keep it alive. So to me, then the choice — it very much comes down to choosing between two things and making a choice as to what is the more morally imperative, so equating research with its goal of therapy isn't therapeutic benefit and other medical advantages to the idea of saving an existing life in some way that is a fully formed life. So to me, it sort of came down to an either/or. Which one does one weight. So I think your category 2 seems to be fitted by that metaphor.

CHAIRMAN KASS: Please, Alfonso?

DR. GÓMEZ-LOBO:: I think that was a very nice illustration, actually, and very helpful, although since both are duties of care, I don't think that there is any really serious and deep moral conflict. I think that it's perfectly legitimate to care more for one than the other, if you can't save both. In fact, I would like to take up the — perhaps the challenge sketched by Rebecca and I think it's a general way of clarifying things or trying to clarify things. I think we do have duties of care, moral duties of care, duties to take action to preserve the goods or to promote them and doubtless, our duties involved in health care are usually of that nature. I mean we make all sorts of effort to say bring our child to the emergency room when the child is sick, etcetera. And of course, that's a very, very important aspect of our moral life.

On the other hand, we have duties of respect and we have duties not to harm. Physicians of the older generation perhaps were quite familiar with this, the "first, do no harm" principle. And now these duties have to do with the impermissibility of taking action intentionally that will deprive someone of a good. So in a way it's symmetrical with the other one and the first case we have a duty to promote, protect a good, otherwise would go unprotected and that would make it a moral obligation.

Now what happens when there's a conflict between the two because that's what we're talking about. If there were no conflict we wouldn't have much of a problem. Now I don't — I do agree that some things we have duties of care, but duties of care are usually not that dramatic because if something goes wrong with one of the options, we're really not 100 percent responsible for it as in the case of letting the blastocyst die.

Now what happens when we have, I'm sorry, did you want to interrupt? Okay. What happens when we have a conflict of care and we have a conflict between care and respect? If I understand it correctly, the tradition of moral philosophy tends to say well, if the duty of respect is such that if you act intentionally, you would be producing an important harm to human good, then that should take precedence over the care.

Let me give you an example, perhaps a trivial one, but one which appears in ethics books very often. You have a bandit who has kidnapped 20 hostages, an American college woman goes by and this man says look, if you kill one, I'll let the other 19 go and of course, that is perceived as a conflict because of course this woman has a duty of care, apparently, to save 19 people. But in order to achieve that goal she has to harm, that is, intentionally kill one person. Since that is the primary action in which she is engaging, it follows that the agent in this case should morally refuse to do it.

Now I'm sketching this argument because for me —

PROF. SANDEL: Excuse me, would you say that even assuming that you know for sure that the villain will kill the 19 of the 20 if you don't?

DR. GÓMEZ-LOBO:: Yes. Well, first of all, you never know for sure because there's another agent making another decision there. I mean we're not as predictable. Bandits are particularly unpredictable and in most ethics books the bandit is called "Pedro."

(Laughter.)

That says something.

PROF. SANDEL: The reason I asked is if that condition did apply, then we would have the nothing is lost principle to argue for killing the one.

DR. GÓMEZ-LOBO:: Sure. Well, I don't subscribe to the nothing is lost principle by all means.

PROF. SANDEL: Nor do I.

DR. GÓMEZ-LOBO:: Don't sign me on on that one. Plus, I don't think there was a good application of the principle of double effect in our previous discussion. So I'm torn. I'm definitely in group 3 here because from the marvelous exposition this morning, I see that, well, we had heard that from Dr. Weissman already. I see how promising all of this is and I see that there are these duties of care, but if — I know many of you will not concede the "if" clauses of the following sentences, but if embryos are human beings at an early stage of the development, and if we should not intentionally kill innocent human beings, it follows for me that I should not violate the harm principle in this case and that's why I'm on level 3. I do think that this is a morally impermissible action, but I regret it and that's why my question is going to be whether the scientist can't figure out a way of harvesting the stem cells without doing harm and the reply, unfortunately, was no.

CHAIRMAN KASS: Gil Meilaender and then Paul.

PROF. MEILAENDER: Well, you're in charge.

CHAIRMAN KASS: No, go ahead. My rudeness and his gentlemanliness give you the floor.

PROF. MEILAENDER: Well, a couple of things. I just want to note with respect to the example that Elizabeth gives, I mean I agree with what Alfonso says in the sense that it really brings us back to your comments kicking off this session. Elizabeth's original way of formulating it was a way of thinking about several goods, clearly in competition since you could only save one. Alfonso's way of reformulating it has to do with how he changed it into the question of respect and care, but it's really — that's a form of the right and the good, in a way. And it's worth noting that there might be other factors that would enter in. I don't know what you'd say to this, but even thinking of it just in terms of the competing goods model, suppose the blastocyst is mine and the drowning child or whatever it was, is somebody else's? Does that count? I mean there are all sorts of factors that enter in here, in fact.

So the notion that we've only got one kind of thing, namely stages of development that makes a difference, when we weigh competing goods is not the case, in fact. It's considerably more complicated.

We have obligations to try to do good as much as we can, but that means within certain kinds of limits and it means taking account of a whole range of factors, and so it's just worth noting that it's there.

Then the other thing I wanted to comment on was just to come back to Michael's comment that basically what he was saying was he falls into category 1, as you outlined, that there's not really a moral problem here, but that doesn't get us very far to say that because we want to know then what will give us a moral problem. If the early embryo doesn't, at what point would we have a moral problem and why? In order to think about how persuaded we are by that, we need some kind of characteristics or criteria or something that will help us think about it. Otherwise, we only have a position and we don't yet have a kind of a piece of reasoning that we can go to work on. We just need more to do something with it there.

CHAIRMAN KASS: Michael has in previous meetings, in fact, in the very first meeting if I'm not misremembering, articulated what might be the criteria for moral standing and they were pretty much neurological, but I wouldn't speak for him. Could we draw you out on this because it would be welcome.

DR. GAZZANIGA: Sure. One hates to try to answer impossible questions, but you can certainly take approximations. And the approximation that is safe for all concerned who are concerned about your question is that by 14 days the British line in the sand, we're dealing with a system that is brainless and has no capacity for sentience. The brain cells aren't even born and that's pretty raw, elementary biology to — for me to draw the line at the 14th day and then people come back and give you the potentiality argument and I also said something about that which — so yes, I'm willing to draw for — where are we, 2002, that a 14-day line in the sand is a pretty comfortable, keeps you free from thornier issues and I'm going to let someone else draw the next line.

CHAIRMAN KASS: I'm sorry?

DR. GAZZANIGA: I'm going to let someone else draw the next line.

PROF. MEILAENDER: Can we have 20 days maybe?

DR. KRAUTHAMMER: Michael, could I pursue that? Michael, I just want to ask you, forget about the legal issue here. At what point, clearly, you're not at all morally disturbed by working on a blastocyst. At what point in the development of this entity are you personally morally disturbed?

DR. GAZZANIGA: Well, you know, let's see how she goes. One step at a time. What's before us in terms of what the scientists are saying we can provide untold remedies, hopefully they can be provided. For the time being, they would be happy and everybody would be happy with the line that I've drawn. The line that I've drawn — a line. So in 10, 15, 20 years, if they come back to the meeting and say look, we need to move that line, how much — how good their argument is, what people think about it is for another time to be considered. I don't think we have to think that far into the future. I think can we make a comfortable decision in 2002 and I think we can.

DR. KRAUTHAMMER: But clearly, what you think about when this organism deserves some respect has to have some influence on your thinking on this, I would assume that you believe a newborn child deserves protection.

DR. GAZZANIGA: Of course.

DR. KRAUTHAMMER: And I understand that what you're saying of the 7-day-old blastocyst is just a piece of tissue, clearly there's a point at which if you were asked to do the research on this organism, you would say no, and I'm just curious to know what that — you certainly have thought about this.

DR. GAZZANIGA: Well, I don't know if I have.

DR. KRAUTHAMMER: Perhaps you could give it a try.

DR. GAZZANIGA: I mean the obvious, from the neurologic base, the obvious fact on the ground is that the organ that is responsible for everything going on in this room is the brain. And the discussions of the issues of human dignity, of human concern, piety, sympathies, those are all constructs of the human mind and so that means you need a brain around to enable those concepts to be used. So one could say that you at least needed the presence of a nervous system and a nervous system doesn't start forming for 4 or 5 weeks and that nervous system, as you know, is impoverished, it's not ready to do the kinds of things we're doing now. And then you start getting into all these unanswerable questions and I just would rather set those aside because I don't have those problems at 14 days.

CHAIRMAN KASS: Do you want to continue?

First of all, Michael is very good natured and he's not shy, if I may speak for him. And I think that this, if we're here, let's pursue this a little bit further and see if we can get some clarity on this, if people don't mind. I'm taking advantage of your good nature.

DR. GAZZANIGA: We'll see how good natured I remain.

DR. ROWLEY: Have you checked with his wife?

(Laughter.)

DR. GAZZANIGA: Sure, go ahead, push me, push me.

CHAIRMAN KASS: Did you want to go further?

DR. KRAUTHAMMER: Well, I don't, as a former psychiatrist, I'm guessing here, but I don't think I'm going to succeed. The position I've taken which cut down a lot of trees to publish in The New Republic this week, is based on basically a slippery slope argument. It begins by trying to not assume any intrinsic worth to the 7-day blastocyst, but asking were we to pursue this research, particularly in cloning where you create for the purpose of using the blastocyst and destroying it, what will we become? So I think it is relevant. If you think that it becomes wrong to do the research at a fairly near point after that, and as I understand what you're saying, Michael, it would be at the point where there's beginning of neural development. But you seem to also be saying that you want to draw the line at two weeks, so the slope here, I don't know how slippery it is, but it isn't a big slope between 1 week and 2 weeks.

DR. GAZZANIGA: This is where I am in over my head. I like to call up philosophers I know and say can you help me with this slippery slope thing.

(Laughter.)

And they say oh, that's been written about and there's a pro side and a con side. And I say okay.

(Laughter.)

I'll take the con side and we hang up. You can get a driver's license when you're 16, right? Now someone said well, what about 15 years, 11 months, 30 days, is that really different than 16? Nah, it's not really different. Well, about 15 years, 11 months, and 29 days. Pretty soon with the slippery slope argument you can get down to where babies could be getting driver's license. And of course, that's nonsensical. So what we develop as a species is a capacity for form categories, categories of action, what is generally acceptable. And all I'm suggesting is that we have a category here that we can make a clear decision about and in that way get around the slippery slope analogy which I think can find you in some pretty slippery situations.

CHAIRMAN KASS: Bill?

DR. HURLBUT: Here's what it seems to me to come down to. Some people would say that what you're talking about here is not a license to drive, but a license to kill. Now I'm not a lawyer and unfortunately, as I look around the room, it seems to me there aren't any left.

Oh, good, right, okay. Rebecca, you're here. But my understanding of the law concerning abortion is that it was not fundamentally a right to take a life. That was a circumstantial secondary effect. The woman had a right of privacy to evacuate her womb of this alien presence that was not, she did not have an obligation to have. Okay? Maybe you can correct me in a second, but let me keep going. So now we have — you say we have this capacity to form categories. And I want to say parenthetically, I have a lot of trouble figuring this out too, so I'm not trying to attack in saying this, but I'd like clarification on it. You say we have this capacity for categories. Well, one of our major categories is this distinction between a life present or in process and its right to continue or whatever you want to call it. I don't even want to use the language of rights, but this is a major category, this position that you should never take an innocent life in process.

Now here's what troubles me about all this from the slippery slope side of the argument. I'm also troubled by the potential argument, but let's put that one aside for the moment and here, Mike, I want to ask you a specific question.

So if you really go down and you talk to people about stem cell technology as I've tried to do and by amazing circumstances I know quite a few of the major figures in this field, my assessment of it is, yes, we might be able to find the reagents and bathe the culture in them and get the proper cells we want, but that in fact, we're more likely to get what we want if we were to gestate it for a while, either in utero or artificially of some kind of ectogenesis could be generated.

So now what I want to ask you —

DR. WILSON: Mike, what was that? What could be generated? I didn't hear you.

CHAIRMAN KASS: Growth outside, ectogenesis. It grows outside the womb.

DR. HURLBUT: It turns out that a lot of what happens in the development process is highly circumstantial. So people working with stem cells are beginning to appreciate how there are these other little micro environments, that if surrounded in a semicircle by one kind of cell which are sending a diffusible agent in in a particular way, then another agent coming from the other side will cause the differentiation, but you can't just bathe it in the reagents.

The point is that it seems more logical to me that you reasonably could produce more useful therapeutic tissues by allowing gestation or some kind of artificial gestation to go for a while.

So I want to take the opposition position for a moment and say why not go beyond 14 days and why restrict ourselves to 14 days now if brain criteria — I think even now my assessment is we could learn a lot and progress faster with the science if we didn't draw that boundary. So I really feel as though that boundary is really just shifting the question of not taking an innocent life to 14 days instead of point of origin.

DR. GAZZANIGA: Are you in a position 1, we're haggling price here?

DR. HURLBUT: No, because I said I'm prescinding from the question of potential for the moment. So just on your principles, I want to know why we would draw the line at 14 days. And why now?

DR. GAZZANIGA: I just told you. It is a line that is comfortable for me to draw. It is a line that would allow the research to go forward. I won't keep repeating myself.

DR. HURLBUT: But you said a minute ago that you are comfortable with the fact that until there's a neurologic system which you said was 4 to 5 weeks, that you didn't think there was any increased moral standing, so why would you not set that boundary for the moment at 4 to 5 weeks which would make science progress much faster.

DR. GAZZANIGA: I don't know enough to know whether you're right or wrong. I leave it to the adjudicating regulatory panels might inform us on that. I don't see this as a crucial point whether it's 14 days or whatever. I'm comfortable with 14 days and I'm simply stating my position of 14 days.

DR. HURLBUT: I'd also like to comment on — I'm sorry Mary Ann is not here. Her summation of the last which is relevant here that she seems to be moving towards a conservative position on this issue because of the failure of — to see any demonstrable products or line of research that are coming out of various stem cell efforts.

DR. GAZZANIGA: There's a wonderful article in Science a couple of weeks ago entitled "Some History Should be Repeated." And they review the claims and concerns of people about the recombinant DNA research in 1976 where there was a group of people from Cambridge, Massachusetts where a lot of this was going to go on at MIT that felt funny little organisms were going to ooze out of the MIT labs and envelop Cambridge and people were going to die of these horrible things, yadda, yadda, yadda.

And in a similar meeting held in 1970, the late 1970s, they set up this regulatory agency and as a result of now going ahead with recombinant DNA research, none of which was immediately envisioned at the time, we now have, according to this article, 11 major drugs that are used in diabetes, hepatitis, acute myocardial infarction, rheumatoid arthritis, stroke serving and saving the lives of millions and millions of people.

So the notion that I think some people not scientifically trained don't quite understand is that let the scientists roll. They'll figure it out. They'll figure it out and they're the most conservative people in this room.

DR. GAZZANIGA: They beat each other up on a daily basis as to whether what they're saying is correct or wrong. But you can't project into the future what they'll find out. You have to just understand the competencies that they're currently arguing for and then let them go to work.

CHAIRMAN KASS: Dan.

DR. FOSTER: I just want to interrupt for one second.

CHAIRMAN KASS: Please.

DR. FOSTER: I want to say something a little bit later, but I want to respond to Bill in one sense. We, ourselves, as a council, tend to have different views. We can sort of sense what, as Leon said, and he's come a long way to try to get us into thinking about these things. I think it's critically important in terms of, as Charles would say, building a fence, that we not try to expand what has already been done already when — outside. I think it's critically important. I myself would be perfectly happy to draw the line at the blastocyst level because I think all the initial basic science can be worked out there and to start moving beyond to the 20 days and so forth. Maybe that would speed up the science. I don't know about that at all. We may find something from the blastocyst in terms of mutation rates and all sorts of things, going to pass away.

My own view is I'm starting to get — but I think it would just be crazy from a practical standpoint to try to say the council wants to come up and extend what we can't even agree on here ourselves. So that's not a moral — the only reason I'm hesitating to say this, it's not a moral issue, but sooner or later, we have to get off of the high standards of moral things and talk about practical things as well. I think we're starting to talk about very practical things this afternoon. I maybe want to come back to that a little bit, my comments about that a little bit later, but I sure would — Gil, I always learn things from what you say and write and send me, but I think this time, you're wrong. I think it's wrong to try to expand this thing out, both practically and in terms of trying to get a consensus on some views, our views here in the council.

CHAIRMAN KASS: Let me say I think I understand. I don't want to pretend to have mind reading capacities. But I've been in a number of these discussions and I begin to get to know who's talking. I think what's at issue in this conversation, let me see if I've got it right. Mike Gazzaniga sees no moral difficulty with using blastocysts because he does not regard them as being things of moral worth.

He was asked by several people to say well, all right, and he also enunciates a powerful moral principle for going forward, namely, we're going to learn good things and important things and people will benefit from it.

So no harm, and great good. What's the problem?

Then people want to know well, is there a place where you would have a problem so that if we want to join you we want to know where this train is going and where the limits are which is partly why Charles wants to know, why Gil first of all wants to know what's the ground of this, where is there going to be moral standing and then he gives the argument of nervous system and then the question is well, is the 14 days merely a prudential calculation because that's all we need right now and he's willing 15 years down the road to go some place else. I think that's what, in effect, Michael was saying. But there are people who are nervous and who want to hear the principled defense because what they hear here is something like the duty to care and cure being treated as an unqualified imperative beneath which everything else has to submit. And so part of the question for those of us who would care about something, about not doing harm or not violating that which should not be violated, they want to know is there a place.

Now other people have used the 14-day marker not as a merely time saving place for the time being, but who really think that 14 days is a transitional point, whether it be implantation — I don't mean by that just transfer into the woman, but actual physical implantation into the wall of the uterus where you actually have the beginning of a pregnancy, until that time, you don't — or who want to talk about the primitive streak or who want to talk about the absence of twinning and who try to provide some kind of biological foundation for saying ah, there's something here now not fully one of us, but that's a biologically-based boundary, not in a nervous system, but something else that might count for the discussion.

So for some of the people in the conversation who want to know, is there something in the nature of things that would give us a guide if the blastocyst is not it yet? I think that's part of the conversation.

And the other part of the conversation seems to be to test out what actually is the limit of the moral imperative on the side of going forward or are we simply going to say there are sick people out there who need these things and until you come to newborn infants, which I think was the implication of Charles' question, it's ultimately fair game because we can't really, I think, and this is not my — this was an attempt to summarize what I thought was going on in the conversation. I would add a position of my own. Yes, we are faced with a certain practical decision here and now, but we have to think about the meaning of the kinds of decisions we take here and now for what it legitimates in the future. Yeah, and therefore, we should try and find a good moral foundation as well as being prudential and practically sensible here in trying to reach this and to see whether we can find a place to rest our head, if we can. If not, I think we're in danger of reaching an unprincipled kind of compromise which offers no guidance to those who are going to come after and who might look to this body which was invited to think about this with a view to where this is going, admittedly with uncertain knowledge, but with some power to predict some of the things that might be coming ahead.

DR. FOSTER: Leon, I always seem to start these long speeches that I was not speaking to the issue that you posed before us about the moral things. I was talking about a very practical thing and I didn't want to divert off into some other thing. I want to get back to this. I was not making any moral argument at all. I think it's perfectly legitimate to do that. So if you were lecturing me, I was not attempting to make a moral argument.

CHAIRMAN KASS: Excuse me, it wasn't a lecture to you.

DR. FOSTER: Well, it sounded like it.

CHAIRMAN KASS: No, sorry, Dan. It was heading off what I thought were going to be people pouncing on you.

DR. FOSTER: I'm so delighted that you're going to take care of me just like the fetus, you have to take care of me, right? Okay, I'm just kidding.

DR. HURLBUT: Can I respond, Leon, just to that because I have a very salient point to respond to that.

CHAIRMAN KASS: Okay.

DR. HURLBUT: And it ties to what you're saying.

CHAIRMAN KASS: Okay.

DR. HURLBUT: Dan, we were told this morning that fetal primordial neural cells may be useful in Parkinson's disease, right? Okay.

DR. FOSTER: Some people believe that.

DR. HURLBUT: But let's assume it's right for the moment. Now it's not abstract and it's not way off in the future. It's here and now. So why then would we say, on what principle will we say that a person should not clone himself, gestate or hire somebody or gestate for themselves the embryo up to the age to harvest out those particular very useful cells? This is right here, right now. And yet, the question — and look, let me make two other points. I am a physician. I really want to see the science go forward very, very, very much. I feel the weight of this. I dream it actually, but I think if we define our principles, we will allow the science to go forward because then we will, for example, if we say, full, generative potential is not acceptable to violate, then we've got the possibility of creating partial generative potential, perhaps, and going around it, the moral problem in a moral way.

If we define our larger principles well, it will allow the science to go forward. Otherwise, it's going to get stuck in this morass of conflict. So what I see myself as saying here is something positive to try and set the future in an open way.

Moral reality is a fragile reality in any given society and it's something we have to contend with. We can't just ignore it. I think it's harder to set a moral tone of cooperation in a society than it is to make scientific progress. But hopefully, they can go forward together.

CHAIRMAN KASS: Paul McHugh. Thanks for your patience, Paul.

DR. MCHUGH: Well, I'm going to distract us, I think, from that kind of conversation, but only to reiterate what has been and to emphasize what has been the subject of the conversation between you and me in our epistolary debate in the e-mails.

I feel that we will totally submerge into arguments of opinion over actions if we don't agree or come to hear that the somatic cell nuclear transfer clonote is different than the zygote. With Michael, I can partially agree that the clonote should have — be the subject of study because I think of it as an artifact and I think it different from a zygote. Where I disagree with Michael is that dealing with a zygotic natural program is equally okay. In fact, I wanted to make a point about Mary Ann Glendon. I think she would say her argument was not conservative, but liberal in the sense of wanting to encompass more people under the umbrella of our protection, but the issue of the science here in what we're talking about is an effort to bring science forward in the best way.

I want to emphasize what I said in those notes, that is, that the lived experience of scientists making somatic cell nuclear transplants is not that they are creating a new individual, that they are then going to destroy. They are thinking that they are producing tissue that has a particular program and that they're going to use that tissue at some time for the benefit of everyone and I'm approving of that and I want to support that. In fact, I do support it. I believe that the artifact can then be misused if brought on into reproductive cloning, but the fact of it as a different kind of thing permits different kinds of actions towards it.

CHAIRMAN KASS: Do you want to answer publicly one question on this?

DR. MCHUGH: Yes.

CHAIRMAN KASS: You believe that the clonote is an artifact different in kind because it's different in origin from a zygote, correct?

DR. MCHUGH: Different in its origins and in its constitution.

CHAIRMAN KASS: And in its constitution. And should that cloned — should that become cloned at the blastocyst stage and should it be implanted for reproductive purposes and should a child emerge, would that be a human child or would that be an artifact?

DR. MCHUGH: Well, first of all, those actions should not be done.

CHAIRMAN KASS: But —

DR. MCHUGH: That human person would be a different person, although you would extend to him because he was tragically created, natural rights to him, but you would see him as a person mistreated and never to have been created.

CHAIRMAN KASS: But not a member of our species?

DR. MCHUGH: Not quite a member of our species in the same way, yeah.

CHAIRMAN KASS: Even if capable of reproducing with another member of our species to produce more members of our species?

DR. MCHUGH: He would be different.

DR. KRAUTHAMMER: Is Dolly not a sheep?

DR. MCHUGH: Dolly is a sick sheep.

DR. KRAUTHAMMER: But Dolly is —

DR. MCHUGH: But this would be a sick person and we would have to take care of him.

DR. KRAUTHAMMER: But Dolly is a sheep, sick or not, she's a sheep. I think she's a sheep, right?

CHAIRMAN KASS: The question has been joined. I don't know if we can sort it out.

DR. MCHUGH: The point of saying that the clonote has these potentials, that if they are illegally and I would believe that this would be as illegal as slavery or as genocide, that because it has those potentials, that therefore it should be treated as though only those potentials characterize it or that it should be conceived of as only characterized by potential would be an error, an error of logic and an error that would hold back the advancement of science.

CHAIRMAN KASS: Instead of arguing, let me see if I can put you on the map of positions, the moral positions on this question so we know what homework we have to do.

If I now understand you, you do not regard cloning for biomedical research to be a moral problem because the thing that is produced isn't on the human moral scale and therefore —

DR. MCHUGH: I found it problematic to take your spectrum because I was looking at where I would place myself.

CHAIRMAN KASS: You're in a fifth position.

DR. MCHUGH: To some extent I hold myself in the place where — between 1 and 2, okay? I don't think any harm is being done by creating a clonote. I think something good is being done by creating a clonote. But because it is a special kind of new, a kind of biology, I would therefore not permit it to be implanted in a uterus, so maybe therefore I'm treating — approving with humility in some way because I'm putting limits around what I would do with it.

CHAIRMAN KASS: Okay.

DR. MCHUGH: You see, if you take the point that the clonote is something different, it's something manufactured rather than begotten, then you would want to study, use its best potentials for human kind and not let its potentials for error and slavery appear, okay?

CHAIRMAN KASS: I owe you a 5-page e-mail.

DR. MCHUGH: Yes.

CHAIRMAN KASS: You'll get it. Dan, please?

DR. FOSTER: I don't want any e-mail. I never write e-mails in these things and the one that I sent I said don't circulate. I'd rather talk personally, but that's okay.

Let me make a preliminary remark. Leon said a moment ago in passing, he used a phrase that I think Adam Seligman popularized called epistemological modesty that in the philosophy of studying knowledge that you looked at limits and so forth. I think epistemological modesty means that you believe certain things, but you're modest about these claims and you can be a believer and yet say I'm not really sure. And that's sort of a fundamental fault line here in the discussion.

I take seriously and I've been influenced by the people who occupy position 3 here and I'm not willing to agree with Paul that this is just an artifact. I think there's serious issues here that make me nervous.

But if you live in what Alfred Shutz called paramount reality, that is being wide awake in the every day world, that's what paramount reality is, it seems to me that common sense shows that a 100-cell human embryo with a potential to ultimately, if everything goes right, becomes a human, has to be taken as serious, as being serious. But it seems to me from this wide awake view that it's different and it doesn't have the same demands for protection and respect as let's say something a little bit later. But I don't know that for sure. And that's why I think one has to occupy what I think I and what I know I occupy which will be position 2.

It seems — I don't — I'm not comfortable with Rebecca's view that there's some messianic demand to rescue people. I think there are great virtues in suffering and death that come to humanity. I think none of the things that are great in humanity would occur without threat and suffering in the world. If there were not pain, there wouldn't be any need for mercy. If there were not fearful things, there would be no room for courage. One could go through the whole litany of what makes humans different and great or the consequences of risk and suffering in the world. That does not mean that when we're given these brains that we should not try to make the world better. I'm distressed enormously by the fact that the slope of evolution in science appears to be steadily upward and that the slope of evolution for human kindness and beneficence and morality seems almost not to have moved at all.

And therefore, I think there's an obligation for those of us who live in this world and want it to be better to try to make wherever we can the world better and if you take — I may be the only one in the room that really actively takes care of patients and —

DR. MCHUGH: Hold on.

DR. FOSTER: I'm sorry, Paul. He's retired, but he still takes care of them. Okay, forgive me for that.

But it is a daunting thing to deal with death. I just lost my long-term colleague. We did 30 years of science together. We did good science together and from a glioblastoma multi-form and there are papers, somebody read the PNAS paper last year where you can mark, you can put human glioblastomas in and then just infuse adult neural stem cells in the peripheral blood targets, the glioblastoma, you can take the mass out, but they infiltrate, you can just see pictures. There are two new articles in Nature and Medicine just showing them infiltrating. But these adult cells clamp on to them and you modified them so that you can give a small drug and convert it into a chemotherapeutic agent across the blood-brain barrier. I mean we tried to see if we could do anything for humans like that.

So myself, for myself, it's perfectly clear that we ought to try to do better in terms of medicine and the relief of suffering and I don't think the worry, although I'm very worried about it is sufficient to stop that.

Here's another point that I think I made —

DR. MCHUGH: Can I ask you a question then about that, Dan?

DR. FOSTER: yes.

DR. MCHUGH: Can I ask you would you take a blastocyst that was naturally formed, taking it out of a uterus, a natural blastocyst and use it in the way you want to use the clonote?

DR. FOSTER: No.

DR. MCHUGH: Why wouldn't you?

DR. FOSTER: Because then I would clearly be interrupting a progression, unless nature took it away.

DR. MCHUGH: Well —

DR. FOSTER: Let me answer it another way. Everybody talks about if you use this, you're going to destroy it. Well, I don't know what the figure is, but 30 to 70 percent of the embryos that form normally are deleted by nature. So what do we say that God is destroying these —

DR. MCHUGH: Would you put a filter in a uterus and pick up those and then use them the way you want?

DR. FOSTER: I would not.

DR. MCHUGH: I'm coming back to my artifact which you wish to use as an artifact, but deny. That's what I'm saying here.

DR. FOSTER: Well, I guess —

DR. MCHUGH: You are saying that things which occur naturally you wouldn't use, but things which come out by cloning you would use and I believe that that's because you see an artifactual nature to the clonote.

DR. FOSTER: Well, I don't think that's what I believe —

DR. MCHUGH: Well, would you use a naturally occurring blastocyst formed —

DR. FOSTER: You mean while it's in the uterus?

DR. MCHUGH: Yes, when it falls out of the uterus.

DR. FOSTER: You mean if you take it out of the uterus?

DR. MCHUGH: yes.

DR. FOSTER: No, I wouldn't. I don't want to get into —

PROF. SANDEL: that's not the only possibility.

DR. MCHUGH: No, that's not the only possibility.

DR. FOSTER: I don't want to get into one of these long e-mail exchanges that you and Leon try to do. I'm just trying to make a simple, succinct point and then I'm going to stop right here in just a second, but I do think that we — that I feel a strong obligation not to stop this and the only thing I was going to say and I argued this with Charles a moment ago, I think if we allowed this to go forward, that is biomedical research, if it turns out that it doesn't work, I agree with Mike, the scientists would be the first to quit and so will biotechnology companies because if it doesn't work, if it's got mutations in it we'll end it. Or, if there are better ways to do this as I think there may well be, it will be abandoned quickly. We've seen that all over in medicine that we abandon things when they go through. So my view is, let's try to learn from this and keep it very limited and I'll pay the price of tears, if that's what it is, if it turns out that in some sense that the universe thinks I've killed a child, which I hope we get rid of that murdering and killing things. I mean there's some sort of an implication that scientists are unethical or immoral or less ethical or less moral than people who are not scientists and I want to try to get away from that. But if that's wrong, then I'll try to tell the universe sometime, I'm sorry, I made a bad mistake. But on the other hand, in the meantime I want to try to see if we can't help a whole lot of humanity with what to me seems to be a different sort of moral problem than the idea of beyond ending a life that's not neurons and other organs and things of that sort.

I didn't mean to talk so long. I just was really trying to say that I'm in the position of with a lot of concern as to whether I'm right or not about that.

CHAIRMAN KASS: Charles?

DR. KRAUTHAMMER: I'm a 3 and I'm there for prudential reasons. Mike says and I think if I have the quote correctly, those not trained in science don't understand that what we need to do is let science roll.

Well, we let science roll in the 20th century. We got eugenics. We got the Tuskegee experiment. We had such horrors in mid-century that we needed the Nuremburg Code. Humanity hadn't had to write it before, but it had to write it after. So I'm a little skeptical about letting science roll. Scientists are one of the great resources in any society. They do the science, but they don't own the science. And the reason that we're here is because we don't have a guild system in this society, we have a democracy. We don't say to auto makers you know how to make cars, therefore you will determine what safety standards will be in cars. No, it's the nonexperts, it's the lawyers and the Congress who decide what are going to be the safety requirements in cars and that is imposed on the experts who make the cars and that's how we do it in a democracy and that's why we have this council to advise the President and the country on what restrictions might or might not be applied on what is undoubtedly a wonderful enterprise.

But we don't have a guild system in which all the rules are made internally, not in a democracy.

The reason I'm against research cloning is not because of the reasons underlying position 4 which is somehow attributing a worth to the blastocyst equal or at least comparable to that of a human, but out of a prudential consideration as to what happens if we don't.

The first slippery slope and I think an argument that in and of itself would be enough for a person to oppose research of cloning is that I think there can't be any doubt that if we sanction an industry — and it will become an industry — for the creation of cloned embryos, it is absolutely inevitable that we will begin to see those embryos implanted and we will have the moral horror of having a cloned embryo in gestation which under penalty of law would have to be destroyed and that is a moral certainty that I think is intolerable. But as I wrote in my piece in The New Republic, that is a little bit too easy. I think it would be reason enough to prudentially oppose research cloning, but let's assume, put it aside. I think there are other reasons and the reasons are that once you start on this, once you start rolling along this road, it will lead us to places where I think that we don't want to go. I may be wrong, obviously nobody knows exactly how we will end up or where this will take us, but I think a prudent society needs to make choices based on past history and some understanding of human nature.

The problem, Daniel, is not that the research might fail. The danger is that it might succeed wonderfully and we will then have scientists say as we just heard, give me three more weeks with this embryo. Why not have a fetus where the organs are developed and use them for transplantation rather than have a Rube Goldberg system of growing it into a blastocyst, teasing out stem cells, tweaking them into developing into cell lines. Why not let nature produce with that wonderful machine a fetus and let's strip it apart for its parts? Most of us would say today that is unconscionable. Well, I suspect that if we live in a society where we do this kind of stuff at an earlier level, for a decade or two or three, it will be less unconscionable.

In the end, I think the major issue here is that we are crossing a new barrier with research cloning and that is the creation of embryos solely for their use and I'm afraid that once you do that and we create an industry in which this will be the business of that industry, embryo creation, that we will so desensitize ourselves to the use or misuse of this entity that we will end up doing things that we don't want to do and don't want a society to do.

I think that prudential argument is one on which we can argue about well, what are the likelihoods of these things happening, but I think we ought to be realistic, that once you start on that road, we will be, as a society, far less able to resist the temptations that today seem obvious that we ought to resist, but tomorrow, probably won't.

CHAIRMAN KASS: Jim Wilson?

DR. WILSON: I've listened for years to Charles and read Charles for years without, I think, disagreeing with a single word he's uttered until today. And my problem is with the slippery slope argument. The slippery slope argument which we hear much of in the literature although it's rarely defined, is kind of a warning sign that's put up on a highway, don't go any further or unknown bad things will happen to you. But rarely is it carried out to show that if you walk past that sign, these unknown, soon-to-be-named bad things will, in fact, happen to you. The slippery slope argument here does have a name as what's going to happen to us if we permit the use of somatic cell transfer for the purposes of creating clones for biomedical research. It is inevitable that we will soon have cloning to make babies and perhaps cloning to produce from fetal organs parts to be used by human beings and after that God knows, perhaps organs taken from babies.

That's an argument that can be used against every advance in medical science that has been made that I can think of. We must not invent surgery because the use of the scalpel to take out an appendix will inevitably, on the slippery slope, lead to organ harvesting and the selling of kidneys and livers on the public market. We must not allow neurosurgery, even to cure a terrible tumor because it will lead inevitably to lobotomy. Now, in fact, lobotomies have occurred. And in fact, some instances of organ harvesting have occurred, but the public's horror and the government's horror at these things has quickly shut down those enterprises and penalized, often severely, the people who did it. Or perhaps we shouldn't have automobiles because we will have fatalities. Well, we do have fatalities, but then we balance the value of the automobiles with the value of the fatalities. Or we shouldn't — you can make an argument about any human innovation and say we must not adopt it because we'll be on the slippery slope and it is, in fact, a Luddite argument, unless you're able to show that sliding down that slope is inevitable.

Now you might be able to say that sliding down that slope is inevitable in the case of cloning because there will be such a huge financial demand for the benefits of cloning that any form of cloning, however benign in original intention, will lead to the worse forms of cloning to satisfy that demand. But from all the scientific testimony I've heard so far, there isn't this huge financial demand and there isn't because nobody has found yet the exact techniques that competent, but ordinary physicians can use to cure these diseases, so that I want us to back away from the prudential or this particular prudential argument because I don't think it's correct unless Charles is in a position to show that the slope is so slippery, so covered with banana oil, that one step past the warning line we have now drawn on the pavement will bring us down into chaos.

DR. KRAUTHAMMER: Well, let me give you a recent and empirical example of that slope. The country had a debate on stem cells about a year ago and the major argument by the proponents of stem cell research — and I was one of them — was that we are using discarded embryos, everybody understood that, and we were going to bring a benefit from something that would otherwise bring no good. The understanding was, in fact, Senator Frist made the presentation on the floor of the Senate and he established conditions under which he would support stem cell research, the regulations that we ought to institute in support of that research and among them he listed very emphatically that the research would not be done with embryos created for the purpose of using for stem cells. That was what he said.

Now and here we are a year later and we're arguing over a technique of cloning which can only be done in a manner in which an embryo is created in order to destroy. So within a year, what we have is the ground shifting on this debate on precisely a point that a year ago we had been assured would be excluded by regulation and by law.

DR. WILSON: The Senator Frist example is a good one, a particularly good illustration of the proposition that Congress doesn't often mean what it says. You could use an even better example with the 1964 Civil Rights Act and Senator Humphrey's assertion to the Senate at large that it would never be used to establish quotas or goals. These things do happen. But the fact that a year later, a year ago or two years ago, whenever Senator Frist spoke, we now find ourselves discussing this subject. It's very different from saying that the subject, once having been discussed and some authorization once having been past, we have now slipped down the slope to the point where we are creating clones for the making of babies and harvesting organs from fetuses.

CHAIRMAN KASS: Janet, did you want to comment? Please.

DR. ROWLEY: Well, let me first just respond to Charles because I think though Senator First may have made some comments, I'm sure that anyone in the field of cloning and embryonic stem cells would not have supported his point of view. So it isn't as though we started and we're downslope. I believe that individuals in embryonic stem cell research had already envisioned that, so we haven't — that position has not been changed of the people who are involved in it.

I would like to respond to the discussion that Leon framed as we began this session and my points of view are certainly influenced substantially by my view that we are really, we have the potential of being on the threshold of some major biological discoveries that will be of enormous importance, but I qualify that with the same statement I made when we began this discussion in January, that this is a hope and at the present time we have no idea as to how much that hope will actually be successful and that was reiterated and confirmed again by both speakers this morning, that these are very, very, very early days and the promise that many of us see in this kind of research may — I think it's not fair to say that the promise will not be realized, but I think that it is fair to say that the promise may take a very long time. And I just want to point out that we began the war on cancer in 1970 with the notion that it was all going to be over in 10 or 20 years and we're far from it. We're far from it because we're dealing with very complex systems in cells about which we are woefully ignorant, but I think the part of the research that will be permitted by going ahead with cloning and some of the aspects of experiments with somatic nuclear cell transfer will enlighten us so much that we'll be able to see better how to expand on these in the future. And I would only echo our morning speakers by saying that I think that to ban this kind of research which has the potential for therapy would be a great tragedy.

CHAIRMAN KASS: Michael Sandel?

PROF. SANDEL: I just wanted to pick up on the last small uncharacteristic slip of Charles where he slipped back into the polemical action description to use Professor Outka's phrase of what cloning for biomedical research is. I thought following Paul's and Leon's corrective which Outka accepted, we agreed that there are two possible action descriptions for both of these practices. By both, I mean creation of embryos for reproductive purposes and creation of embryos for purposes of medical research, a charitable description and an uncharitable one. The charitable description in each case describes the action in terms of the end it's aimed at. So in the case of embryos created for reproduction we point by the description to the end. Likewise, in the case of cloning for biomedical research, the end there is the creation of an embryo for the sake of promoting the curing of disease. There is an uncharitable description available equally to both and if we want to compare them, compare the moral status of these practices, we should use either the charitable descriptions of each or the uncharitable descriptions of each. The uncharitable descriptions in each case doesn't refer to the end being aimed at, but instead to the foreseeable, though undesirable effect.

So it would be fair to say that with Charles and with Outka's paper that in the case of creating an embryo for the sake of biomedical research to describe that as creating an embryo in order to destroy it, but only in the same sense that we should describe creation of embryos for reproduction purposes as the creation of embryos in order to discard the inevitable extras that will accompany the practice of IVF. So both activities admit of charitable and uncharitable descriptions and if we're going to compare their moral status, we should compare them either under one description, the things they aim at or under the other description, the foreseeable, but undesirable side effects that accompany both.

DR. KRAUTHAMMER: Michael, I'm surprised that you also made an uncharacteristic slip when you said the inevitable destruction of the embryos in IVF because you know, as I know, we could, in principle, establish an IVF clinic tomorrow in which you assign only a single embryo to a woman. So you would thereby have a process of IVF where you have no inevitable, indeed, indeed no discarded embryos.

On the other hand, in cloning, it is absolutely inevitable that that embryo, because it will be disassembled, will be destroyed.

PROF. SANDEL: Well, if the practice of creating embryos for reproductive purposes involved no spares, no extras, then it would have a different moral status and character from the practice we currently have.

CHAIRMAN KASS: Elizabeth?

DR. BLACKBURN: It would be different from natural which, in fact, if anything the majority of embryos naturally are lost and destroyed —

DR. KRAUTHAMMER: We'd be improving on God.

DR. BLACKBURN: That's good.

PROF. SANDEL: What the natural case Elizabeth raises is the — there's also an uncharitable description of natural procreation which would be very odd, which is you're engaging in the inevitable creation of spare embryos that will be sacrificed for the sake of having one that works.

DR. BLACKBURN: Well —

PROF. SANDEL: And there's no more warrant for that description than for the contentious version of the description in the cloning for medical research case.

DR. BLACKBURN: Well, I think it might be helpful to return to somewhat more the homely and something Gil said that he said to me, well, would you say the blastocyst, if it were yours versus the child and I think I wouldn't be able to look the parents of the child in the face if I hadn't made an attempt to save the child. And I think that also addresses the issue of should we be trying to do cures, even though we know that they're not inevitably going to work tomorrow, next year, 10 years or 20 years. I think we have to try and so I think this question of the fact that we don't have successful answers right now for whether embryonic stem cells or somatic cell nuclear cloning is going to work, I don't think that absolves us from the necessity to try when we see real human disease and suffering that we should try to act on, even though we know we may not be necessarily successful in every attempt.

CHAIRMAN KASS: Gil, and I then I think I would like to put my oar in and I'll give rebuttals, but we should probably wind up. We need a nap before we drink, right?

Gil, do you want to comment?

PROF. MEILAENDER: Well, just a couple of things quickly. To pick up Elizabeth's point again. The hypothesis was and I think it's worth thinking about, the hypothesis was that you could only save one of the two entities, so that I don't know how we set up this case the way the philosophers do it, but there's a fire and you can go up one stair to save the newborn in the crib who's not yours or you can go up the other stairs to save the blastocyst in vitro that is yours. Okay?

CHAIRMAN KASS: That's a copy of your dead child, if you want to make it —

PROF. MEILAENDER: Whatever. It's not — it's not immediately apparent, kind of, that one choice must be made and that suggests that there are other considerations and it's not just stage of development. The other thing I just wanted to say in response to what Michael — just — I mean Gene Outka can sort of take care of himself, but as a matter of interpretation, I think he didn't quite grant what you described him as granting. I think he granted that creating in order to destroy was a tendentious description. He did not grant that the two situations were the same where he had recourse or double effect line which because he did still think that in the description of the one act, the killing was inextricably involved and I take that's really what Charles was getting at. So it isn't in terms of what he was granting, I want to be clear.

CHAIRMAN KASS: Okay, I'm winding up to — I want to say a couple of substantive things, but come to a procedural suggestion for what we should do next. First, since Jim Wilson began by being surprised that he could disagree with Charles, I'm surprised that I have to disagree with Jim Wilson with whom I've disagreed only once before and he since told me that I've persuaded him, but I'm not going to do it again.

DR. WILSON: Not this time.

CHAIRMAN KASS: The slippery slope, to call something a slippery slope argument is already to put it in a category where you can abstract it and then say you like those arguments or you don't. Rather, it seems to me, it's worth thinking about, not in general in the light of other examples, but to think about it in the context of the particular thing we are talking about.

I think I might have said once before that the reason that arguments about continuity of action are so appropriate in the area that we are here talking about is because development is itself a continuum and the value of the thing being developed, never mind morally, but biologically, increases with development and if it should turn out that tissues down the road are really more valuable for the treatment of the same patients we now want, the argument that's now being made for doing it will be very hard to resist.

The real essence of the slippery slope argument is not a prediction, an empirical prediction. It is a question of the logic of justification and it's very important how you somehow justify what you're doing here because if, as in this area, the continuity of development and the continuity of research offers such great promise, you might, without even knowing it, be countenancing the next sort of stages and in the end you will wind up as Bertrand Russell said about pragmatism. It's like a warm bath. It warms up so imperceptibly you don't know when to scream. Eventually, we will get to some place that none of us would want to be and we therefore have to be very careful. It's not a prediction of a certain kind of certainty, although we have seen, I mean five years ago The Washington Post editorialized on this question. No creation of embryos, especially for research — use these others. The newspapers are no better than the Senators on this and times change and there were no stem cells five years ago. The benefits to be had were less.

I think it's very important that we, instead of calling this a slippery slope argument, talk about the question of prudence and if we put it in those terms, then the question is: Is it really prudent to head down this road and I don't think you have to believe that the embryo is a full human person, at least to be worried, not just about what's — the destruction question. It may be a terrible thing to say in public, but I worry much less about the destruction of the embryos as I worry about the exploitive mentality on the part of not just the scientists, scientists are trying to do good, but of a community that comes to accept as routine, the instrumentalization of nascent life and in which we become sort of desensitized to this. This is not a question about the ontological status of the embryo, but about how we come to regard those earlier stages of our own being. I don't know what they are, but that they're somehow part of a continuity with what we are. Of that, as a biologist and not as a religious figure, I mean I see the continuity.

Two other things, just for your thought. I don't want to harangue much longer. The IVF case has been around a number of times, but let me suggest one thing. The fact that there are a lot of embryos lost in normal sexual procreation doesn't settle anything. It doesn't really settle anything. And it seems to me one could say something like this with respect to that in the IVF clinics. When a couple now undertakes to procreate by ordinary sexual means, if they've learned the facts about this, they know that they are saying yes to the sad fact that there will be a lot of loss.

That's just the way things are and without going Charles' route about improving God's way, when a couple now goes to the IVF clinic even with the extra embryos, they are saying yes in advance to the sad necessity that some of these embryos are going to be frozen in perpetuity or put to some kind of use. They're simply compressing into one month or into one visible time what in ordinary biology might take months. Well, situations are fairly comparable. I think it is a matter, somewhat different when you undertake to produce the embryos for the purpose of exploiting them for use in which the destruction is — I won't say a minor thing, but it is the deliberate exploitive disposition is what bothers me.

Lastly, to Elizabeth, if I might, the lurid cases are wonderful for focusing the mind and the examples, both of the business about the child and the exchange we had last time between Michael Sandel and Robby George about dismembering one's 2-year-old child for the organs and dismembering a blastocyst for the cells spoke, it seems to me, volumes. It seems like for my own sake a knockout case.

On the other hand, I'll give you another knockout case and we can wander away and ponder it. Let's imagine that you've got the last couple on earth and a couple of embryos and he has Alzheimer's disease. And the question is, do you sacrifice the embryos for the sake of the cure of the living or do you allow them to be what they in fact are, biologically speaking, the seed of the next generation? We can force ourselves not to look at that because there are so many extra seeds, but if you somehow focus the question and ask, then the merely instrumental use of this seed, even though it doesn't have a nervous system somehow begins to look rather different.

There's a lot there to be quarreled with and I probably abuse the privilege of the chair, but there were a number of things floating around here that only make the subject for me more complicated.

What we'll sort out finally is we have to move forward on this. I think if I understand the discussion here and Paul, you and I will have to work out a way to find room for your so far eccentric, that doesn't mean wrong, but unique position in this conversation, whether you want to have a separate —

DR. MCHUGH: I'm glad you say it doesn't mean wrong. One could be —

CHAIRMAN KASS: On this point we agreed last time that we don't want to simply decide on the basis of the wisdom of the vote of the majority to silence any arguments sincerely held and properly defended. It might very well be that an argument made and held by one person is the best argument and we would deprive our readers of the benefit of having to weigh that.

I'm serious about that.

DR. MCHUGH: I appreciate that.

CHAIRMAN KASS: And it goes across the board. I think we have to tidy up our work on the ethics of this and move on to the policy questions by the next time we gather.

I would like to ask everybody here, if they haven't already, if things that haven't been passed before you don't already speak for you and there are some people who we haven't properly, I think, taken care of. If you would write from 3 to 5 pages and if it turns out that the argument is shorter, less, a statement of your view not on the question of ban or no ban, the policy question, but on the question of the morality of cloning for biomedical research and let's have it in two weeks and then we can put this particular part of our discussion in a form that can be circulated for everyone's approval. I hope that's not too onerous. If there's anybody who's writing another paper for another course, I'll give you an extension, but tomorrow morning we meet at 8:30 to take up the enhancement discussion and then the regulatory discussion. Thank you for your endurance, your patience, your good will and we're adjourned.

(Whereupon, at 5:33 p.m., the meeting was adjourned.)


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