480 L'Enfant Plaza, S.W.
Washington, D.C. 20024
February 14, 2002
COUNCIL MEMBERS PRESENT
R. Kass, M.D., Ph.D., Chairman
American Enterprise Institute
L. Carter, J.D.
Yale Law School
S. Dresser, J.D.
Washington University School of Law
W. Foster, M.D.
University of Texas, Southwestern Medical
Johns Hopkins University
Michael S. Gazzaniga, Ph.D.
P. George, D.Phil., J.D.
Ann Glendon, J.D.
B. Hurlbut, M.D.
F. May, Ph.D.
Southern Methodist University
Johns Hopkins University School of Medicine
C. Meilaender, Ph.D.
D. Rowley, M.D., D.Sc.
The University of Chicago
J. Sandel, D.Phil.
Q. Wilson, Ph.D.
University of California, Los Angeles
SESSION 6: HUMAN CLONING 8:
ETHICAL ISSUES IN "THERAPEUTIC/RESEARCH" CLONING
CHAIRMAN KASS: Good morning. I hope people are refreshed. We worked ourselves or I worked you pretty hard yesterday afternoon, and we have a couple of sessions this morning to continue our exploration of human cloning.
A brief backward looked, I promised something of that, as a prelude for what we will do next on the subject that we discussed yesterday.
We had a very rich discussion and in response to the staff Working Paper suggestion that we might take the low but solid road of liberalism. There was an outpouring of suggestion that that would be a mistake, especially when we do not have to, and that we should, in fact, take the high and richer road but in turned out in the second session that this high road is a hard road to travel.
And I think that a number of good things were said but they need to be developed. I mean, there were people who talked the language of dignity. There were people who worried about manufacture. There were people who wanted to emphasize some corruption of the relation of the generations. There were people who saw in this a certain problem of the attitude towards children not confined to technological manipulation but to be found in other practices of the society.
And with the additional exhortation that we not simply present these things in negative terms as what is wrong with this but try to articulate, as I said from the start, those goods that we think are vital to defend so that we can more easily — in fact, it might be that the objections make clearer to us what it is that we find vital to defend but I do think that we are in the position of going away from yesterday's meeting and trying to draft something. I do not mean — we will draft something collectively but in order to do that at the staff level we would very much like some written materials from the various people who have spoken in the name of this or that good that we care about.
I do not think we need additional arguments on the moral implications of the unsafe character of the procedure. That, I think, has been done. The Academy has done it and the moral argument we can make powerfully. What we need help on are these other matters with about which people were so enthusiastic.
If you could get us some comments or if you cannot develop these thoughts in your name but can articulate what it is you would like to see someone else develop, that also would be helpful. So, two, three, four, five pages within a couple of weeks on one of those topics.
And, by the way, although the people from the sciences are not generally used to discussing those sorts of things, it seems to me that — at least I would like to invite you also to contribute on that because we are here not primarily as experts but as fellow thoughtful human beings trying to find the right course here.
And as some people are trying to learn from the scientists the language of discourse and the way to talk about those things, it seems to me all of us would do well to have a crack at trying to formulate the ethical norms and the objections and the goods that we think might be at stake in the cloning for baby making.
I think I am going to try to speak that way. Maybe this vulgarism will catch on and we can get used to it and maybe even use it.
We come to probably the hardest part of our discussion on the ethical issues related to human cloning for biomedical research. We barely started this discussion last time, though a concern about this has intruded itself at various stages in the previous meetings.
There are difficulties about doing this. There is — we could enter into the discussion of the ethics of cloning for biomedical research as it has, in fact, appeared in the public discourse. Namely as a complication en route to trying to do something legislatively about human cloning for baby making. Or we could take it up in its more natural setting, which is to say as one subspecies of the question of the ethics of experimentation on nascent human life, the stem cell discussion, which we have bracketed as a general matter for down the road until we get more evidence as to what is going on with the research.
And to deal with the whole question of the ethics of embryo research through the lens of cloning seems — well, it is in a way peculiar. On the other hand, I do not think we can do the proper job on the discussion of the ethics of cloning for biomedical research without taking up almost all of the same questions that are there and the last time I tried to finesse this difficulty it seemed to me wrong in retrospect that we should not be driven by the way the legislative debate has framed this question but we should be driven really by the internal logic of what is before us here, and so here we are and we will tackle it.
The second thing to say is that for many people this discussion is somehow tied up with ethical questions of abortion and many people who enter into this discussion either are or are accused of being or are suspected of being people who are fighting that battle on other grounds. I would like to suggest that — there will be carry over, I am sure, but I would like to suggest that this is in an important respect distinct.
For one thing, the extracorporeal embryo does not exist in conflict with the interests of a woman who is carrying such an embryo. These embryos would be, at least in the case we are discussing, especially created — especially, excuse me, synthesized for their usefulness in research and in the debate in the Congress and, in fact, in documents that are circulating all kinds of prochoice people have nonetheless come out in opposition to the research on the embryos.
So I would like — whatever your stakes are in the abortion discussion, I would at least like to invite you to try to think about this thing in its own terms and not as the tail that is on the abortion dog. Forgive me.
Third, and in relation to that, and this is — this is perhaps naivete of a classroom teacher. There is nobody in this room who has a thought about this question in one way or another, and lots of people are in here probably with positions which, if not dug in, are annealed.
Nevertheless, it seems to me that if we really constitute ourself as a group that is searching for understanding and the best moral grounds, I would at least like to have the discussion under the — maybe it is a pretense but certainly under the hope that the conversation could be had in a way in which minds might be changed, that we might actually learn something from discussing this together, and I mean that on all sides of the discussion.
You can see that there is a certain nervousness about actually getting to the subject but now —
CHAIRMAN KASS: — but I think this is important because I think this is really quite important and I want to say one last thing.
The warm up points really to this matter: It is clear from the discussions that we have had already that there are going to be probably unbridgeable differences with respect to an outcome on the morality. I am not talking about the law now but just on the morality of the research on cloned human embryos or on embryos generally.
And looking ahead to what it is we might produce, one possibility would be, in fact, that that division should be uppermost in what the result looks like and I have no idea what the count is and much depends, in fact, on whether the conversation moves anybody anywhere.
My, again, I think, perhaps naive, ambition is something to produce something different. As a person who has, I think, sat on more than one side of these questions and knows that there are powerful goods being defended on all sides, I would at least like to aspire to a piece of writing at the end that every person in this body could own. By which I mean that we would produce the statements of the various positions with as great clarity and as great strength as we can. Maybe say that — and the various positions would have to acknowledge or at least encounter and think about the goods that are being defended by what they regard as the weaker side.
And that we will have made a contribution to whoever it is that has to make these decisions if we make perfectly clear what at the price of what and, conversely, what at the price of what if one chooses another way. That would be a rather novel thing for political bodies here to do where usually you are trying to either find consensus or beat down the opposition to such a point where they have to yield and, if they do not like it, write minority reports.
I would much rather — I think we could make a really fine contribution, of course if the discussion warrants it, if we can get very clear and strong presentations in which, say, the right to life people have to say something about what it is owed to people with serious suffering and the people — the scientists who want to go ahead with the research have to say something about what it is that might be owed to embryos or what it means, what it might mean, in fact, to embark upon research on nascent human life, and then in the end we can say some of us agree more with this and some of us agree more with that.
But I would like to postpone the question of the votes and I do not want to discuss it at least in this session under the heavy burden of the ban, which I think unduly influenced, if I may say, Irv Weissman's presentation of the question. That hangs over the discussion. I understand that people are nervous but it seems to me our task is in the first instance not to worry about the legislative options here in this session but to try to think through the ethical questions of this research — of human cloning for biomedical research.
I think I should pause to see if there are serious dissents or criticisms of that suggestion of the spirit of the discussion. It is always revisable if it turns out that it does not work but this is a way, I think, of trying to produce something not heuristic in the first instance but something that is dialectical and which we can actually explore together notwithstanding where we might start out in such a conversation.
Robby, are you — is that a hand on the way to —
PROF. GEORGE: No, but, since you asked, I think it is a very good idea. The idea of working toward a document in which all of us can affirm that the arguments being presented at thorough, articulate, authentic representations of the competing points of view held by reasonable people seems to be not only the best we can do but also to be a genuine contribution to the debate, which is so often marred on all sides by straw man presentations of what competing points of view are. So I think it would be a genuine contribution.
CHAIRMAN KASS: Other comments?
CHAIRMAN KASS: All right. We heard yesterday from Irv Weissman, and he gave us only the barest bones of it, certain arguments as to what the biomedical research with cloned embryos might have to offer us and I think if we were listening carefully there were arguments as to why biomedical research using cloned embryos would offer certain possibilities that are not available from biomedical research just on the spare embryos from in vitro clinics. In particular, the ability to produce embryos with specific disease characteristics, taking them from patients who have those diseases.
For the record, there was a brief discussion, and we might want to get some additional scientific remarks on this last time, but part of the discussion finally of ethical choices depend upon existing alternatives and there was mention of this very exciting but still yet unpublished work out of the University of Minnesota about these not absolutely totipotent but multipotent cells derivable from individuals and they could be from individuals with diseases but the scientific discussion we bracket for a moment.
As Irv Weissman himself indicated, the Academy regards the larger ethical questions, societal questions, still to be had and we want to begin by taking as given, not open up the question at the moment, the scientific promise that we were given yesterday. Whether that promise is going to be realized as an empirical question, one would not know unless one did it so that is before us.
And I would suggest the following: That we try to discuss sequentially in this session, and I am not going to be able to say this in language that everybody is going to like but make the necessary adjustments, on the one side what is it that we owe to the embryo or the nascent stages of human life. What is it that we owe to those who suffer horribly for whom such research holds out great promise of cure?
And then keeping in mind that there are considerations that do not turn on benefits to this individual or that, remarks made by Michael Sandel and others, maybe the question is what do we owe to ourselves or what does it mean for a community to embark on a road in which what is nascent human life, whatever it is worth, and whatever its standing, comes to be treated as a resource for perfectly good reasons?
I mean, I think those are three aspects of this discussion that are worth engaging and I mean that without prejudice. I mean, to raise the question is not to answer it. I mean, some people think to raise it is already to prejudge it but I think it is an important matter.
Let's start with the hard one, which is the question of we are — we would be producing in cloning for biomedical research — Michael, with all — with your permission, I am going to call it an "embryo-like being that can develop at least to the blastocyst stage extracorporeally" and is to be the object of exploration and study. And the question is how to regard it and what do we owe it?
Our predecessor bodies, whether it be the NBAC or the most recent report out of the California Commission, speak about the human embryo or these early stages — the early developmental stages of human life as being deserving of respect or special respect or in some cases even profound respect. And we have had memos from Rebecca Dresser and from Gil on this subject, which I hope you have looked at. Neither of these bodies regard those entities as full human persons or members — the same respect that is owed to babies and thereafter but they also do not regard them as humanly nothing.
And both Rebecca's note and Gil Meilaender's note invite us to ponder what does that — what in the world does that actually mean in practice? I mean, to say that something is deserving of respect but it does not in any way restrain anything that you do to it seems to make the notion of respect vacuous.
So the question is, and this is hard to talk about but abstracting from the question of whether it is a person — let's not fight that one out — first, if we begin with the precedence that we have been given that nascent human life from its beginning is entitled to some kind of respect, what in the world does that mean with respect to what we can and cannot do with this?
And let me just add one last thing. I want to lay the table and then step back and listen.
This might — several people have already indicated that to put the question even in the way in which I have put it is to suggest an all or none matter. Whereas, what we have in embryonic development is something which is a slippery slope, if you will. There is a continuum and part of the reason that slippery slope arguments are especially suited to this discussion is because there is, in fact, in embryological development a continuum and, in fact, it is possible very easily for — if there are no natural boundaries in that continuum, the arguments that are made for dealing with a very early stage might, in fact, be arguments that cover what can be done with later stages. So we have got that particular matter to deal with and the general question.
The last thing, I have handed out a piece of paper that was in an earlier draft of one of the staff documents, which at least lays out before you a partial topology of the various positions that have been taken with respect to human embryos. And it does indicate at least a variety of possible ways to regard them under this heading of special respect or not.
But the floor is open. What would it actually mean? What does this notion, respect, special respect, profound respect mean practically when we start to think about the cloning for biomedical research?
PROF. GAZZANIGA: Just to get the cells going here, the physicians here should speak more to this than I should but everybody who has taught a human neuroanatomy lab receives a lecture from the pathologist in charge about the respect they have to show the dead material. And after the dissections are made, there is a tremendous effort to continue that respect in how the tissue is disposed.
So I think throughout the whole life span our culture has evolved a set of rules that treat all human tissue with respect, whether it is alive or dead, and so the concept of dignity applied has quite a broad use and is commonly used in every medical school and every teaching institution I have ever been in.
So I think that helps us think about how those terms are used in the reports you referred to as well.
CHAIRMAN KASS: Yes, but let me draw you out a little bit. It seems to me that you are in a way assimilating embryonic stages of a developing life with human tissue and —
PROF. GAZZANIGA: I am just speaking to the concept of respect of matters human —
CHAIRMAN KASS: Good.
PROF. GAZZANIGA: — with respect to the body. And that is extended throughout the biomedical profession even after death and that — I think that concept should be clear to all members that there is — you start with a high level of respect for all matters medical.
CHAIRMAN KASS: Rebecca, please?
PROF. DRESSER: I am sorry to complicate things but I do think we have to also consider the role of the women who would have to provide oocytes in this discussion. And, I mean, you mentioned some of the earlier government commissions but there was also this Embryo Research Panel in '94 and they did want to create a procedure by which some synthesis of embryos might be permitted for very deserving grounds. However, they also said that no woman should undergo the oocyte retrieval procedure purely for research and they did not discuss, you know, payment and so forth.
So, I know, this is outside your framework but for me it is an important moral component of this so-called synthesis of cloned embryos purely for research. So I want to keep that in the picture, too.
CHAIRMAN KASS: Well, let's add it to the list of the questions.
DR. KRAUTHAMMER: Excuse me.
CHAIRMAN KASS: Let's not —
DR. KRAUTHAMMER: Can I just interject? Would that not be covered by the principle of informed consent?
PROF. DRESSER: Well, no. They were making a decision that as a — and they were only talking about federally funded research but they were making a decision that it is inappropriate to — it was involved in the sort of co-modification and it would be kind of paying women to produce embryos for research and we want to avoid that, and asking women to undergo these kinds of risks. We should only — they viewed the appropriate sources of the oocytes as women undergoing infertility treatment who would go through the procedure anyway or they also discussed donations, cadaver donations, either from the woman or from the woman's next of kin. Because there is just a view that we do not want to expose women to more risk purely for this purpose. Now that is, you know, something we can discuss but that is a factor.
PROF. MEILAENDER: Leon, could I just make a quick comment?
CHAIRMAN KASS: Please.
PROF. MEILAENDER: I think, in a sense, Rebecca's concern fits under your third category or could be said to fit in the sense that one might ask do we want to be the sort of society that simply, you know, permits women as long as they consent to do this or that takes seriously a certain other kind of concern so that would be — I mean, that would be one way of retaining your basic outline but not losing your concern.
CHAIRMAN KASS: By the way, on this subject, and I do not want to be dictatorial, I would actually like to hear from everybody on this question. Not just the lawyers for the embryos but I would like everyone to really have to grapple with the question. What is it that we think we owe? Granted that there is a long tradition in the medical community that even the mortal remains and even the tissues dissected from mortal remains are not humanly nothing but there is a special question really that is our province, which is these early stages of human life, and what is that and what do we owe it? Even if we choose to experiment on it, I mean, I think that is — or else this notion of special respect just disappears.
Rebecca, do you have a — do you want to start?
PROF. DRESSER: Well, I am reluctant to — I certainly would not want to support a view that we should synthesize human embryos as just another research tool analogous to say an animal model, although I have some problems with some of the things we do with animals, too. So I would not want to support a view that this is kind of a piece of property or a research tool.
I do — I am attracted to this special respect concept. I certainly think where I start with that is that the only situation in which we ought to synthesize embryos purely for research would be there is some sort of compelling need to help the patients because, of course, you know, I do give moral weight to the patients.
So, if anything, I would require a very high standard of justification in terms of scientific merit and no reasonable alternatives. Some concept of necessity that has some substance to it, not just I think it is necessary, therefore let's go ahead.
CHAIRMAN KASS: Comments? Alfonso?
DR. GÓMEZ-LOBO: I would like to start with some reflections on the word "embryo," not to look into its entomology but to think about the concept for which it stands and from yesterday's discussions, particularly from what Robby urged in the discussion with Irv, it became even more clear to me that embryo is what is usually called a "phase sortal" in philosophy. Now that looks complicated but it works like this: We may ask what sort of thing something is and we respond with a term and we say that is a sortal but there are proper sortals, that is the sort of thing that something is throughout its existence, and then sortals are words that tell us the sort of things something is throughout a stage of its existence.
Now it seems to me that embryo is surely of the latter sort. I am looking at the definition of embryo in the National Bioethics Advisory Committee report and it reads as follows: This is in Appendix 2. "Embryo: The developing organism from the time of fertilization until significant differentiation has occurred when the organism becomes known as a fetus." So it is a stage of something that we have to characterize in a different manner.
Now, that should be the next step to think about but in the meantime I cannot but infer from the two figures that Irv Weissman presented yesterday that there was something missing in the oral presentation. Namely that there is at the phase in which both forms of cloning start there is something that is the same, and that was clearly granted.
Now, under this definition of embryo, it seems to me clearly the case that a human embryo is generated, is produced, we can use different verbs, and it is allowed to grow until a certain stage, and then — only then when it reaches the stage of the blastocyst ways part. You can either implant it or retrieve the stem cells.
So from this scientific information it seems to me clear that there is there a stage in an organism that we have to further characterize.
Now, as I think about these matters and the — I have read more about genes and DNA, et cetera, than I had ever read, in the last few days — it seems to me relatively clear that what guides this development are the genes.
Now this has to be refined, of course, and I am not a scientist. I am not competent to do it. But it seems to me that the outcome might possibly be the following: That genetic determinism probably has to be rejected. From what I have read there is so much contributed by the environment in the broad sense, by nutrition, culture, education, et cetera, that it is simply foolish to think that we can clone someone. You know, Michael Jordan and get exactly the same Michael Jordan. That is not going to happen. I have heard a lot of arguments in that regard, right? Michael Jordan may end up being a chess player, you know. There are other factors.
However, it seems to me, and I am very interested in what the scientists say about this, that genetic determinism is one thing but genetic developmental programming is something different. Namely the fact that the genes determine that a certain embryo is going to develop a brain or a certain kind of a brain, you know, human brain instead of a sheep brain, that the organs that are going to start developing very young, et cetera, are going to be different depending on the genetic structure of that being.
Now, the conclusion that I draw from this is that a human embryo is simply the early stages of a developing organism that will, if everything goes well and there is implantation, will become an adult human being. Now, if that is the case, then my reasoning goes like this: Do I have any reason to deny the identity of the adult with a teenager some years back, with the infant, with the unborn child, and I just do not see how I could deny that. How I could argue no, there is a break in the identity here.
Scientists tell me — and again I need confirmation of this — that I — each one of us has the same DNA that he or she had right from the beginning. Now, those would be, in my opinion, underlying facts that I would like to hear about whether they are correctly expressed or not. Upon which, it seems to me, as a further step, the moral judgment would have to be based.
CHAIRMAN KASS: To this, Janet?
DR. ROWLEY: Oh, no, I want to just point out that in the diagram to which you refer that, in fact, it is right at the stage where you obtain an egg that you remove the nucleus for somatic nuclear transfer. You remove the nucleus that is in the egg and you replace it with the nucleus of — in some of Irv's descriptions you would replace it with the nucleus from an individual who has the particular disease you are trying to study and then that single cell develops in tissue culture until it reaches the blastocyst stage, which is when you then separate the stem cells, which would have had — which are derived from that egg with a different nucleus than it had in the ovary.
CHAIRMAN KASS: On the general point that Alfonso makes, can we simply stipulate that there was not a moral point made exactly but there was a — if I heard him rightly — that there was a certain argument of biological continuity. If you start at the beginning you sort of say that could give rise to this. If you look at it backwards, all grown-ups came from that by not necessarily — well, by continuous process and at least the — both the humanoid aspects, as well as the individuated aspects are in a continuum. That does not settle the moral question but, I think, Alfonso is simply trying to give us the general morally relevant biological account or at least part of it. It may not exhaust what is morally relevant.
DR. FOSTER: I personally think there would be no disagreement with the formulation that Alfonso sort of eloquently made. It has been made over and over again that there is potential life which has the capacity to self-direct to a full-blown human being. I do not think that is a question for me as a non-philosopher.
The fundamental question is not whether the zygote or the cloned egg has the capacity to develop into a human being and, therefore, is deserving of profound respect if you wish to use that or even to have certain very strong protective rights, the question for me is — and I have mentioned this before — is this zygote or this clone equivalent to life as we know it in a human being?
Now, if one goes back to ancient literature, it is sort of interesting to me that in the early biblical story of creation, the issue is also posed with a different conclusion that some others have had. You will remember that in that story — and I am just — it is a magical, mystical story and I am not talking about this in terms of a particular faith, Judaeo-Christian faith, but just the story.
And in the first chapter of "Genesis" we are simply told that humans are made in the image of God but in the second chapter, which leads into the sort of luminous story of the Edenic paradise, the story is different. And it says, and I will paraphrase, it says, "And God made humans..." actually said "man" generic but "And God made humans from the dust of the ground and into his nostrils breathed the breath of life and man became a living being."
Now, as the words are written, whoever wrote these words, anciently — people of faith might say under revelation — but said that there was a creature who had nostrils and was developed but was not a living being until the creator of all that is breathed into that life something of essence and it became a living being.
Now, that does not mean anything in a scientific standpoint but it does pose the serious question to me as to the equivalence of two cells or one cell to life itself. I mean, whoever wrote that, perceived of it as a time of ensoulment. I mean, the — you know, the last report, the National Bioethical Advisory Committee report used that term in one of the papers.
I would not particularly use it but I just want to say that it seems to me that it is a great mystery, and everybody who writes on both sides seems to say that they know and I am not sure. I think we know that the program is there but I do not know that we know that this is — I jotted down something that Richard Feinman said one time in this little book "The Meaning of it All."
He says that we ought to view life as part of a universal mystery of greatest depth and we ought to delight in the futility of trying to understand what this atom (sic) in the universe — he is speaking of humans, what this atom in the universe is, this thing, atoms with curiosity that looks at itself and wonders why it wonders.
In other words, I guess what I am trying to say is that I am uneasy and do not know whether a zygote or a cloned cell is actually life or pre-life destined under the right circumstances to come — and I do not know the answer to that. In regard to what Leon said, I think that this sense of mystery ought to be — that ought to be part of the environment of our deliberations rather than the assumption that somebody here or all of us here actually know.
It is sort of interesting. One other biblical statement. There was a great teacher called — I guess all of you know — called Paul the Apostle. He makes a famous statement, too, in his letter to the Corinthians. He says, "If anyone says, 'I know,' he does not know." You see it is a very interesting concept.
So I simply wanted to say where I am in terms of looking at all these matters and I hope that was not offense to anybody and I just wanted to sort of share what goes on inside me when I think about it.
CHAIRMAN KASS: Dan, can I draw you out on this because it seems to me there might be implications from recognizing one's ignorance and standing before this as a mystery that one can ponder but not know. How would that translate into what it is that you might owe this thing whose actual nature of being were if you do not know? In other words, you are talking about a certain general attitude but the question is how does this actually — would this translate in practice if someone says, "Well, what actually does this mean with respect to whether I can use a seven day old embryo, a three month old fetus?"
I am not trying to put you on the spot. That is not the point.
DR. FOSTER: Yes, you are, Leon.
CHAIRMAN KASS: No, seriously.
DR. FOSTER: Yes.
CHAIRMAN KASS: I mean, I think that —
DR. FOSTER: Okay. Well, let me try to give you just one example. I certainly do not need to dominate this. My wife tells me that when I am talking to her I talk too much and I really do not want to do that.
CHAIRMAN KASS: I will not let you.
DR. FOSTER: The question is it seems to me that many people here have as the highest human good life as it begins as a zygote or an embryo or whatever, that is the highest good and that it dominates all other goods. Now, the way I would think about this is in a different way. I would say that there are relative goods, as you have pointed out, and that it might be that this life is not the highest good.
Let me give you an example. Our country and our society — Alfonso and philosophers, do not hold me — I am a scientist, I mean, I do not talk about this very much but we, as a country, even in the light of the terrorist things have always said that there was a higher good than life itself and that higher good is the willingness to give one's life on behalf of the society or for others.
For example, in every war, essentially all the wars, we draft 19 and 20 year old young people. They do not give informed consent. They go into battle. They go to Iwo Jima and it is a slaughter. Society has already invested in them familial love, education. They are potentially Einsteins or potentially other — Mozarts or whatever. And then when they die on our behalf, when they die on our behalf, we lift them up as heroes and heroines, and we say that the sacrifice of life is higher than the preservation of the life. One who flees and is a coward in the face of death preserves life but it is not the same thing as one who gives one's life.
Now, one way that I am trying to think about this because, as it would be evident from comments that I have made, I am one of those odd scientists who is able to have a religious faith and so I think about these things in a lot of different — I realize I am an oddity about that. But maybe the highest respect that one could give societally to a clone or a zygote is to allow those few cells to be used for the greater good of conquering human disease and suffering that is not just in the United States but everywhere else.
So that might be one way in which I would think about this. It would be moving from the concept, as I hear and I have read Robby's views and so forth, that this organism, this — which I am perfectly willing to use the term "embryo" and perfectly willing to accept that if we stop this development, if it is going to be implanted and so forth, we stop a human being — that one might argue that there is a greater good that might come under here.
Now, if later on I will come back to say how this — what I think this might be — how this might be, if one decided to do it how one might regulate it and so forth, I mean no disrespect in any sense to somebody who in their heart believes fervently that this, in essence, is equivalent to which is said — equivalent to ending a life not in terms of a murder or something but in — so that would be a way which I would try to develop this myself.
CHAIRMAN KASS: Charles, I have, and Bill and Michael and Jim Wilson.
DR. KRAUTHAMMER: I would like to take off from that and to suggest perhaps a framework for trying to answer your question, Leon, about does this organism deserve respect and why, and what does it mean.
I would say there are probably two reasons why you might argue that it deserves respect. All of us were once blastocysts and the question is does a blastocyst deserve respect and why? One reason would be — I would call one mysterious and the other prudential.
The mysterious would relate to what Daniel has talked about, that because there is something unique and special about this particular collection of cells, namely that it can become us, there is something — it ought to put us in some kind of awe and some kind of position of granting it moral status and, therefore, practical or moral status and, therefore, treatment different from an ordinary collection of cells.
The other argument would be, well, there is nothing particular about the blastocyst in and of itself that commands respect. It is on the head of a pin. It has potential but it is not — it is — in and of itself it does not command respect.
However, were we to try to manipulate it, to play with it, to strip mine it, to use it, to manufacture it, it will predispose us to treating this kind of thing in a way so that we may break down the barriers towards treating a fetus that way, ultimately a child or a human that way. In other words, it is more an argument about us and the weakness of human nature and the temptations, particularly the temptations of technology than it is a statement about the nature of the cells itself.
In other words, I could believe that there is nothing special about a blastocyst but I do believe there is something special about an infant. There is something special about an eight month old fetus and I would not countenance the killing and experimenting on an eight month old fetus. So at what point looking back — at some point — I mean, all of us would agree a child at birth is a person who deserves ultimate respect. It is on a continuum with that blastocyst. At some point each of us would say, "Here is where I draw the line." I am sure that would be unanimous.
So the question is are you predisposing crossing that line by allowing, in principle, the assault on the blastocyst at that stage?
So I would posit that as two ways of approaching it. Personally I believe in the second way even though I stand in awe of the organism. There is nothing about the 100 cell, the collection, which would in and of itself — if I knew that we could stop right there, I might be disposed to saying given the goods that could come of using this, I might be disposed to saying it is okay to do.
However — and I mentioned this last time — I was raised in the Jewish tradition, which has this notion of the fence. The fence around the law that when you make a prohibition you think of what related activities, which are not prohibited, bring you right up to the edge and predispose you, you prohibit those other activities as well because, knowing human nature, the crossing of the line becomes so easy.
So I would say that the alternatives here in approaching this issue of respect and restraint is that (a) there is something intrinsic. We might call it the mystery of it and which would dictate treating this differently. Or, secondly, what I would call a piratical approach, which would be there is nothing intrinsic here but, knowing who we are, let's stop before we go on to a place where we would all agree it will be immoral to act.
CHAIRMAN KASS: Response directly to Charles? I have a queue but this looks like it might be an occasion where a very clear set of distinctions has been put before us and we might make progress if we actually stayed with it rather than just going in order.
Michael, did you want to say —
PROF. SANDEL: Well, I had some comments that I will reserve for my place in the queue but just to take up the distinction that Charles raised. We have heard from Irv and the scientific account of the goods to be had. We have had a lot of discussion along the lines of Charles — what Charles calls his "prudential consideration" which is really a moral prudential consideration. Where do we stop if we do this? Won't we dispose ourselves to harvesting organs from fetuses and babies and so on?
What we have not heard in any of these discussions any arguments of the intrinsic kind that Charles very helpfully distinguished, and I think that we should give an opportunity to those who hold the intrinsic view that quite apart from the worry about what next, what about harvesting organs from fetuses, from those who think on moral grounds and/or religious grounds, which should be entirely appropriate here to voice and to examine and discuss, that the five to seven day blastocyst, that taking the life of the seven day blastocyst is intrinsically morally wrong.
CHAIRMAN KASS: Someone want to speak to that? Bill, are you still on this?
PROF. MAY: No.
CHAIRMAN KASS: You want to go back to Charles.
PROF. MAY: Responding to Charles.
CHAIRMAN KASS: Paul to Charles and someone else to Charles. We now then also owe to Michael what he has invited but, please, Bill.
PROF. MAY: Well, you may recall that I — a month ago is a long time ago, though — referred to the comment of E.B. White about every morning I am torn between the twin desire to reform the world and enjoy the world and it makes it hard to plan the day. And I mentioned that the twin impulses of savoring and saving, and I wrote a short paragraph and I pointed out in science there are two sides to science, beholding and molding. I mean, research and research directed toward therapy. And it seems to me that respect bears on both sides of what I talked about.
We talked at the beginning mainly about the question of what does respect have to do with regard to our behavior and that it should be an important cause and indispensable en route to achieving that end and so forth.
It seems to me if you talk about the beholding side, it seems to me one is talking about awe, which is a term that has been used now several times. That seems proper and right to use. When one thinks about the molding side of things, one wants to explore appropriate restraints, caution and so forth, and one can begin to talk about criteria important in making good on that caution.
Now, Michael earlier mentioned that while medicine always preaches this, and I think that is right, but it reminded me that there is a problem for all professionals with regard to the profaning, I think, of the problems faced by priests and ministers, relating to that which is the ultimate object generating awe and wonder but you traffic in it regularly and so there is a process of profaning precisely because you constantly deal with, constantly handle the thing and so the relationship, shyness of approach, and restraint in behavior tends to get worn away by this constant trafficking.
I think that happens for physicians, "I have got a myocardial infarct in 407." And the fact that this is a human being tends to fade before the urgency and the speed and the rapidity with which one has to perform and handle things.
I can remember in the early days of my marriage sometimes I felt I was talking all the time in school, I came home to discover my wife complained that I did not talk. I said, "Well, I have worn out words," you know, and that was a terrible self-defense in the relationship but teachers as well. I mean, here you should use those words respectfully and carefully with respect for the subject about which you are talking and the rest but one profanes in the course of relating. So awe is constantly at risk for those who traffic in things that — if not ultimately wholly, derivatively command our awe and beholding and our caution and restraint in molding.
CHAIRMAN KASS: If I could — it seems to me this is — this seems to me a very important point to stress in this conversation. It ties in with the discussions of desensitization that we have worried about with respect to clonal reproduction.
And I did not — I practiced — I trained in medicine and did a little medical research for a number of years, and in some ways did not have the kind of awe and reverence for the materials until much later when as a teacher of biology at St. John's College I looked down a microscope and I saw a single cell divide. It was a sea urchin egg. And while I am watching, this one cell becomes two cells.
And I have to say it is one of the most powerful experiences of my life. That did not somehow constrain me from continuing to do other things but I knew that I was in the presence of something. There was a power at work here that was really just astonishing. And that gives way to manipulation and one loses it even as one tries to retain it.
And it does seem to me that whatever — whether one thinks that the embryo is a person, fully one of us or not, there is something here that calls for this kind of response if we allow ourselves to notice it and I think that to somehow trample that is to do damage to ourselves, never mind to the thing at issue.
So this is an aspect of this discussion that I hope we could develop. It does not finally, I want to say, settle the moral question of what to do here or whether the research should be done but it does seem to me part of what it means to stand properly beholding the material before us, however one finally decides the question of personhood. I am sorry to have — just Bill's comment just moved me very much.
Let me go back to the queue. I have a long list of people. I have Bill Hurlbut. I have Jim, then Michael, Paul, Alfonso and Gil.
And, Mary Ann, did I miss you, too? Sorry.
DR. HURLBUT: I want to speak to the — in continuity with what you just said but also to the intrinsic dignity of the embryo. I always every year in my classes bring the assisted reproductive technologies lab director and clinical director to speak to my students and one day one of the students said to the lab guy, "What does it feel like to be handling these cells and how do you think of your role in this whole process of infertility?" And he said, "Well, I do not think of myself as an embryo pediatrician." Which was kind of a shocking statement because it seemed to imply that having dealt with this tissue so long and having it so unlike what it will become that it did not seem like a patient in any sense but it seemed like something to be used instrumentally for the sake of the desires of the parents who were the real patients.
And what this brings to my mind is the difficulty either intrinsically or through over familiarity with trying to reach into the — what is before you in the case of an early embryo and try to make some connection of its deepest human significance.
Yesterday I mentioned when Irv was here that I had a long conversation with Ian Wilmont, who is — as you probably all know — the man who cloned Dolly and I mentioned that we were talking about, well, when does human life have an intrinsic dignity. And he said, "I do not know when exactly it is but it is like midnight and noon. Dawn is somewhere between them. And the way we can handle this is just be so safe that we go to maybe 15 minutes after midnight and then we know we are not violating its dignity."
But what strikes me as the problem there is, as I said yesterday, that is imposing a metaphor over what is emerging. It is implying that there is something — that its intrinsic dignity is accrued or cumulative or has to do with its organization. And yet if you take it a little bit differently and consider that it has a kind of form to it that is not just a static form but a being in process like a narrative that has its quiet early beginnings, maybe you think of a symphony where the first notes are very quiet, almost indistinct, and then finally you realize in retrospect what those notes were.
You look back at an embryo and it is an amazing thing to think of. Think about the one cell that starts a human being. Every one of us was once a one cell and when you look at it backwards you see more clearly what it is. It strikes me that with Ian Wilmont's metaphor one might just turn it around on him. And I am not saying I understand this. I am struggling deeply in my own mind about this issue, too, but it strikes me that maybe the darkness is not because there is no intrinsic — whatever you would want to call that — personal being unfolding presence of personhood, maybe the darkness is not because it is not there but because our type of mind is made for the practical realities of existence.
There is no question in my mind but that there is a sense in which evolution or God through evolution has shaped us for what we need to be able to do in life, not for every kind of understanding. We never needed to worry too much about what the embryo was in human history. It was not something we needed to have an instinctive knowledge of. It just happened. We did not even actually have to know what sexual intercourse was for. There is at least one culture in which they did not associate sexual intercourse with reproduction but somehow the job got done.
And here I would suggest that maybe the darkness that Ian Wilmont — and here I am just exploring this idea — is not so much an ontological reality but perceptual reality, an aesthetic reality.
Every year I ask my students to give some sense of what the depth of the tragedy is at death at every stage from fertilization to 100 years old and they draw a curve for me. And it is amazing, that curve barely ramps off of the baseline until maybe six months of gestation and then it rises up, peaks around three years, dips a little for adolescence —
DR. HURLBUT: — then it goes soaring back up at fertility and then slowly descends down to death. It spikes a little just before death because people become interesting again if they get very old.
DR. HURLBUT: But it always strikes me that it is an aesthetic judgment. It is what we are made to value. We value young children because I think nature has made to value those beautiful big eyes and those chubby little cheeks because we need to protect them. We value people in their fertile years because we need to be attracted to them. They are the most valuable commodity, if you will, or being in any species but that does not mean that there is not some intrinsic dignity here and it seems to me there is another way where we could put this dignity in.
We have always, it seems in some form or another, defended this usually with the notion of something called the soul, which one might say is the something more of matter. We can — I do not want to go on any longer because I do not want to talk about what a soul is but I think it is an interesting thing for us to enter.
I would just like to at this point introduce this notion that maybe our problem is an aesthetic sense, not so much — in other words, we are confusing our intuitive aesthetics with clear thinking about ontology. Does that make sense?
CHAIRMAN KASS: Mm-hum. Jim Wilson?
DR. WILSON: I would like to raise an issue that stems from Leon's remarks and Dan's remarks based on my inadequate understanding of the science and then ask two questions from the scientists present have I got the facts even approximately correct and then from everyone present what, if anything, do these facts mean. I am not sure I am confident I know the answer to the first question and I am not sure I even have a good guess about the second question.
The issue is viewing life prospectively versus retrospectively. If you view it retrospectively it is obvious. Everybody in this room, everyone in the world comes from a fertilized egg. There are no exceptions. If you view it prospectively from the point of view of fertilization, however achieved, by sexual congress, by in vitro fertilization or by cloning, it is a very different matter.
I asked the staff to see if they could find any estimates on how likely it is that a pregnancy — a fertilized egg will proceed to implantation and then to become a fetus, and they provided me with some estimates. One estimate was that 50 percent of all pregnancies are not viable and that occurs before the first missed menstrual period. Now, of course, I raised the question how do they know this if there was not a missed menstrual period.
Second, from the New England Journal of Medicine of November 8th last year, maximal fecundity is approximately 30 percent and of the pregnancies that are lost, 75 percent represent failure of implantation and, therefore, are not clinically recognized as pregnancies. And then at another point, the incidence of pregnancy loss after implantation is high, estimated at 25 to 40 percent, and though some of these losses may involve genetic abnormalities there is often no known cause.
So prospectively we see here something that I am not sure I can describe accurately. I was tempted to call it a lottery but that is not true because it suggests it is mechanistic and purely random when, in fact, there are probably important causes here that we do not understand but prospectively the fertilized egg has a small chance of becoming a fetus and, therefore, it seems to me that may influence how we evaluate pregnancies in their early stages up to the point perhaps of implantation, which occurs shortly after the blastocyst is formed, in those circumstances where it occurs at all.
This is not to say that a blastocyst or even a fertilized egg deserves no respect but it is to say that we are giving respect to something that has somehow managed to survive a bitter struggle for survival and this may color, I think, how we view it as opposed to how we view a fetus.
DR. HURLBUT: Why should that color it?
DR. WILSON: Pardon? I cannot hear you, Bill.
DR. HURLBUT: Why should that color it? I am just not clear.
DR. WILSON: I asked the question should it color it. This is the question I am asking. Does it make a difference that retrospectively we all came from fertilized eggs but prospectively the chances of a fertilized egg even becoming a fetus, much less a child, are very, very small.
DR. HURLBUT: Well, for example, death at one year old would not change the intrinsic value of a one year old, would it?
DR. WILSON: No, it certainly would not.
DR. HURLBUT: I mean, like in poor countries where a lot of people die at birth or soon after.
DR. WILSON: Quite right.
DR. HURLBUT: Okay.
DR. WILSON: No.
CHAIRMAN KASS: And one does not know prospectively which one of those is destined not to implant, right?
DR. WILSON: That is right.
CHAIRMAN KASS: So, forgive me, but how does this help?
DR. WILSON: I am not saying it helps. I am just calling —
CHAIRMAN KASS: You are asking the question.
DR. WILSON: Earlier people said that prospectively and retrospectively —
CHAIRMAN KASS: Was the same.
DR. WILSON: — we all deserve the same degree of respect. I am raising the question of whether prospectively respect is owed in the same degree as it is retrospectively.
CHAIRMAN KASS: Does someone want to join that? Alfonso?
DR. GÓMEZ-LOBO: I would view it as follows: I would say that indicates that there is a great deal of uncertainty about particular cases. In other words, there is no doubt that we are not clear about a particular instance, say a blastocyst, will make it or not but I doubt whether that carries over to uncertainty about the general class of the action in which we are — we would be engaged if we take a blastocyst apart. Because there it would seem clear that if this very important clause that I see biologists always using, "if all goes well" — in other words, if that is added, "if all goes well", we would be destroying an organism at a certain phase of its life.
DR. WILSON: We would be destroying an organism at a certain phase of its life when it has approximately a one in four chance of becoming something other than that simple organism. Does that make a difference? I am raising the question. I am not trying to answer it.
PROF. GEORGE: Jim, I did not hear what you said in that last comment.
DR. WILSON: I said, I am raising the question of whether an organism, let's say the blastocyst, that has — pick a ratio — one in four chance of becoming implanted and surviving implantation to become a fetus, does protecting that organism deserve as much respect as protecting the fetus?
DR. GÓMEZ-LOBO: It seems to me that Bill answered that question already. In other words, infant — high infant mortality in a country does not justify infanticide.
DR. WILSON: But that is because a recognizable human being is in existence and the question is does an entity containing 60 to 200 cells constitute the same thing as a child that has died of starvation of malnutrition or whatever?
DR. GÓMEZ-LOBO: Well, if all goes well, that is if it is constituted properly, and of course in the particular case we may not know, the reply would be, yes, it should be worthy of the same respect.
CHAIRMAN KASS: I have Michael Sandel, Paul, Alfonso for a different point, Gil, Mary Ann, Rebecca, and we are five minutes to 10:00. Let me make the following proposal: Let's go a little past 10:00 to get at least some of these people in the queue into the discussion. The agenda called for moving to the policy questions but with your indulgence I would like to continue this discussion. We also have the other part of this matter to take up, which is to say what is owed to the people who are suffering severely. I mean, the embryo is only part of the discussion of the goods that we have here to be thinking about.
So rather than do two conversations badly, I want to propose that we actually proceed with this one and try to some progress if that is — if that is all right. Let's see how far we can get.
PROF. SANDEL: One striking thing to me about the discussion is that everybody here seems to agree that the embryo is not a mere thing and the only differences of expression so far really have to do with different answers to Leon's question. Given that it is not a mere thing, how best to describe the obligations we have with respect to it.
I think Bill May's distinction between beholding and molding was a very good way of getting at two competing impulses behind which lie two sets of human goods that bear on the way we regard the world and creation and life. And that distinction, the one that Bill has offered, corresponds very closely to the way Judaism views nature and human relation to nature because on the one hand — and this is the beholding idea — the sanctity of life is grounded in the idea that life is a gift, a gift of a creator so that is the beholding and that is the element of awe.
Corresponding to the molding idea in Judaism is an obligation to heal. The idea that nature is not — was not complete or perfect at creation and, therefore, man is a partner with God in creation. And the covenantal idea is the most vivid expression of the partnership of man with God in creation and with that goes an obligation of mastery and dominion with respect to nature. This is brought out even in rituals, these two dimensions.
In the ritual for the first born child, the redeeming of the first born, the (Hebrew). I had to sort of symbolically buy back from God my first born son as part of the bris but it is also a part of the bris that there is a circumcision and the circumcision expresses both the covenantal idea and the idea that nature is not complete.
PROF. MAY: It certainly is molding.
PROF. SANDEL: Well, there you have it.
PROF. SANDEL: And then when we get to these questions then about how to regard nature and how human beings should — what role, there is a tension between the commandment of mastery and dominion or molding and at what point does that come into tension with the idea of life as a gift or the beholding idea, the idea of awe. I think those two moral impulses run through these debates about cloning and about biomedical research, cloning in particular.
So that still leaves unanswered the question, well, then what respect is due, what respect is due the seven day old blastocyst? And I think that at least the beginning of an answer is because it is not a thing it is not open to use. It is not open to any use but only certain uses. Only uses for worthy ends but that is not demanding enough.
I would say only those worthy ends that have something to do — and here I think this fits with Dan's — what I found very moving account — only worthy ends that have something to do with healing or preserving life or curing disease. That would be one more stringent answer. Not just worthy ends but ends having to do with appreciating and saving life.
To that you might arguably add "and also the ends of human reproduction itself, which would allow for the sacrifice of embryos involved in IVF. Though, I, myself, am inclined to — here I am unsettled. I do not know the answer but it seems to me that the more stringent restriction, only those ends that have to do with healing, curing disease, healing and in saving life are consistent with the respect owed the seven day blastocyst. That stringent definition would call into question the moral permissibility of sacrificing early embryos that is involved in IVF and we do not have to resolve that question here but I think it is depending on how broadly or narrowly you construe the character of the ends necessary to justify using the blastocyst you might or might not include the sacrifice involved in IVF but I think that the stronger case, morally stronger case, is in curing disease than in providing a means of reproduction for infertile couples. That seems to me the morally weightier.
And I recognize that there is even to the stringent account of proper or appropriate use, there is one possible — possibly powerful objection, which is if the seven day blastocyst is a human life with the same moral status as a baby then even that use would be wrong and there are those who hold that view and I would be interested in hearing an account of that view and an articulation of that view because if it is persuasive then even the stringent use would be morally objectionable, which is why earlier I tried to suggest that I think those who hold that view should have an opportunity to articulate it.
CHAIRMAN KASS: Paul?
DR. MCHUGH: Wow! I do not know that I have anything to really add to what Michael said but I want to put it in another set of terms. The same things in another set of terms and that is to go back and to go with Michael on the idea that we are involved in a conflict of goods here and I want to express the goods the way a doctor of a special sort has looked at these goods because I think the conflict is between my sympathies and my pieties. And with these situations both my sympathy and my piety weigh in and I look for information to help me and guidance from the group.
And, by the way, I do not think it is any different than the rest of America. I think that is exactly what this conflict is about. It is a conflict about sympathy and piety. Sympathy for the sick and the necessity for more information and treatment for the sick. And piety for human life, its giftedness, thankfulness for it, and its manifest joys. Again, I think Bill is saying the same thing.
By the way, such a conflict of sympathy and piety is not unique to this arena. After all, it is at the root of the environmentalist conflict and it spoke to Harry Truman when he decided that two cities in Japan were enough and he stopped further atomic bombing and it may well have had something to say in the debate about the super but it plays out for me in a very special way and I thought I would just go over a little biographical sketch about this because it tells this story.
You know, at Hopkins, for 25 years I have overseen the development of a major neuropsychiatric research center. We are primary in Huntington's disease and secondary in Parkinson's disease and Alzheimer's disease at Hopkins. We know these patients.
These Huntington's patients, in particular, and their families very, very intimately and have cause to join with them in all of their struggles for life and the like. Investing ourselves in basic research and in the clinical service for them. It is not just our center. It is not just a research center. It is a service center and we do prediagnostic testing, brain imaging and the like. And let me tell you, you have to be with somebody who has done a prediagnostic test who is healthy and you have to tell them that, yes, they carry the gene and this is going to — and we do not have a treatment for them, and so we know a lot more about it now. It's genetic etiology, the trinucleotide repeat on chromosome 4, and I have wonderful colleagues now at Hopkins intended to understand this condition.
And, you know, I am probably telling you things that you know perfectly well but Huntington's disease is a disease that you get at conception but it does not show up until you are 35 or 40. That means there is a delay of 40 years before the gene plays itself out.
Now, naturally enough, what we want to do is to make the gene not play — well, we could replace the gene, do better that way, but if we could figure a way in which we could make the gene take 90 years to play itself out or 110 years to play itself out, in a sense we would have cured that condition. And to some extent, our discussions yesterday were that.
So much for the sympathy but do not underestimate it. You are with these patients day after day. You work with them. You work with their thoughts about their children. You are looking for help. What about piety?
The extrapyramidal disorders that we are talking about here, Huntington's disease, Parkinson's disease and the like are characterized by insidious and aggressive tissue loss in the brain and pluripotential cells may well replace this.
Over 25 years ago, both in my department and others, animal investigators demonstrated that fetal neural transplants to brains could replace neural cells deep in the brain and for some humans in other countries, after all this has been done, fetal tissue, not embryonic tissue, not stem cells but fetal brain tissue has been transplanted into the brains. And let me just tell you that I have seen some remarkable results with this. Remarkable results. I have seen them myself. The Parkinsonian patients got better. Not all of them. There have been also catastrophes in that way but they have gotten better.
But the use of human abortions as sources of this tissue is repellant. Not simply because it is wet work but because of the misalignment of power and the subversion of human — one human to another. A kind of desecration.
And if you experience that, like I did in our department, then the idea that maybe a particular kind of stem cells represented an opportunity to move from this desecration to something else, the — I believe, by the way, that same impulse to kind of piety for work did lead to President Bush's Solomonic decision to let cell lines that would — could be used.
Now Irv Weissman yesterday passed rather quickly over that limitation. It is because he emphasized the limitations he saw in that research and that treatment lines permit. But there is much to be said for demanding that the scientists prove with a sample what they could do with — before we give them a whole population and that — I thought that was what President Bush was out to ask them and this is identical to asking an oil rigger or a miner to show in a small place what he could extract without giving them the forest primeval.
We know that some stem cells work by secreting trophic factors though and that is one of the new discoveries. There are other stem cells that replace neurons and so there is no mystery that with each disease it is going to be different but this whole idea that these cells are going to give us a chance to work to help patients for whom we have sympathy and we need to know whether the new technique, the new method will permit us to do so without infringing on our piety.
We learned a lot yesterday from Irv Weissman. You know, he is a gifted scientist and he told us he was a wonderful entrepreneur and, you know, he missed his calling as a salesman because it was amazing to me that he took us up to the mountain top, pointed out the future, but never described a single animal experiment in nuclear transfer that revealed the cellular mechanisms illumining an animal disease as he promised we were going to find out something about Lou Gehrig's disease.
Now, our moralist made a point that he was making moral decisions. I was impressed that he little bit finessed the scientific issue and I really — do not get me wrong, I think there probably is an experiment out there where one of the Jackson Lab mice have been really cured by a stem cell and the like.
Now, this just brings me to my point. What is my point besides the fact that this is sympathy and piety? I cannot walk away from this nuclear transfer method for producing stem cells without grave, grave reasons for it. And Michael Gazzaniga and I yesterday argued for the idea that this method is a distinct method and we go back to using the word "embryo" for these cases, this method, yet it is different from — the cloned cell is different from a zygote for which we have this piety and it has a linkage that looks more like tissue culture in some way than it does exactly like a zygote.
And I am very anxious that as we see our way forward here, we remember that the progress in science may permit us to do the curing that Michael mentions as one of the themes of our effort as human beings but at the same time does not make us kind of committed to dealing with life as though it were insubstantial or just matter in motion. So that is really where I am.
I have not gotten — I have not made my mind up yet on this matter. I am just seeing in these conflicts of goods that we should look at the method itself and decide whether that technology does not permit us to see that we are in a new arena where good things could come and our pieties and our deep concern for human life is preserved.
DR. HURLBUT: What makes that more like tissue culture?
DR. MCHUGH: Well, very simply that you take a cell from someone, the somatic cell, you put it in a medium, okay, and it — like in a tissue culture, it just follows along. It just grows. Now we want to name stages of which it grows but it is not like the union of two gametes. It is — well, it is not exactly tissue culture but it is like it.
What is tissue culture? You go in and you take a piece of — take a cell. You put it in a culture and it grows. This time you take a nucleus, you put it into a particular envelope and it grows and it gets to a particular point. I am saying that is a different thing than taking either IVF embryo or the abortions that used to be — that have been used for Parkinsonism. That is a different species and I am struggling —
DR. KRAUTHAMMER: Could I make a point?
DR. MCHUGH: — to express it, I know, but I would like to say that something is new here and that the scientists have brought us this and we should be at least ready to embrace it before you send me back to Baltimore to tell those people with Huntington's disease, well, back to the drawing boards, we are going to have to do something else yet.
CHAIRMAN KASS: A quick comment and then we are going to take a break.
DR. KRAUTHAMMER: I would like to think that the cloned embryo is just an intermediary, sort of a transitory step between a somatic cell that you start with and the stem cell that you want for your patients but unfortunately for about seven days it is there. I mean, we would like to escape that and perhaps we are going to get a technology which will allow us to go from a somatic cell dedifferentiated just to the point of producing a stem cell and then we are not going to have any of these discussions because we are not going to have a clone.
But, unfortunately, what we have now is this week during which we have an entity which I do not understand how there is any way to say anything other than it is identical to an embryo produced by sexual — by say IVF or sexual union in the sense that it has all of the potentials we would assume to be — to become a human life.
DR. MCHUGH: I would like to agree with you, Charles, but it is just not true. The fact is that a zygote formed between two gametes is a different thing than a cloned cell from a somatic cell from somebody else. It is just different. It is different in its origins and it is different in what it has.
DR. KRAUTHAMMER: It is different in origins but not in its destiny, and that is the point.
DR. MCHUGH: Excuse me.
DR. KRAUTHAMMER: It is different in its origins but not in its destiny.
DR. MCHUGH: Oh, yes, that is true. That is exactly right.
DR. KRAUTHAMMER: And that is what troubles us.
DR. MCHUGH: Well, that was —
DR. KRAUTHAMMER: It is the root of our problem.
DR. MCHUGH: That may trouble — it is a very legitimate thing to be troubled with but all I am trying to say is you should also notice that it is different and that there may be something to honor here or to appreciate here because it is different.
CHAIRMAN KASS: This has to — the argument will continue. Sort it out between yourselves. Fifteen minutes, 10:30.
(Whereupon, at 10:12 a.m., a break was taken.)
CHAIRMAN KASS: Unless I hear strong objection, I would like to follow my intuition and continue the discussion we were having. It is an important discussion that should not be truncated just because the agenda called for us to do something else. Paul McHugh only barely got us started on what has to be said on the side of sympathy, which leads into that other aspect of this as to what it is, in fact, we owe the patients and their families with severe suffering.
Yes, let me not take up time by intervening in the hope of clarifying something. I will try to do that if necessary as we go along. There are still people waiting to speak. Alfonso, Gil, Mary Ann and Rebecca is what I have and others may want to come in. Michael Gazzaniga.
DR. GÓMEZ-LOBO: Okay. A quick comment on what Dan said. As a matter of fact, I find myself in agreement with your approach but on the other hand my tendency is to be in awe of the results of contemporary science. I am just amazed at the kind of knowledge we have today. For instance, what Paul just said that there is a gene that is obtained at fertilization and expresses itself — what is it? — 35 years later. That I find an astonishing discovery and I am really very impressed but that is to me an indication of the identity through time if there ever was any way of arguing for it.
I mean, it really — it has to be the same person. If it is the first cousin then it is not going to work, right? It is the same person. So I would insist that there is this deep intuition that we have to consider, namely that the genes do not determine everything we are but do provide something like a programmed command and control for our development. Proof of it is that there is an illness that can be traced back to a gene, although it appears 35 years later.
Now I have still not really gone into the moral arena and this may be my first gingerly step into it and I want to address the point that Dan mentioned about the good. Now it seems to me that life — I mean, there is no way I would accept the idea that life is the highest good.
Surely, if you have — if you are alive and have other goods, you have something to strive for. You have the good life and that probably could be called the highest good. Life is one good among many goods. However, life has a very special position it seems to me. Life is actually the good that sustains our enjoyment of all the other goods. If I am alive, I can enjoy friendship and such things. If I die, well, that is it. I cannot enjoy those other goods.
And I think that this is recognized by the moral tradition which you rightly illustrated. We highly praise those who give up their lives for others and there are many ways in which that could happen and that is why it sounds to me quite rational to praise those who do that.
On the other hand, it is interesting that we consider the worse crime the intentional taking of innocent life of someone else and we also consider the death penalty that is the deliberate taking of the criminal's life to be the worse punishment. So both of those reflections indicate, it seems to me, that life is a grounding good. Life is a very important good that grounds all of the other ones. And I think that there is a connection between that and the question of respect.
Now the last position I would like to make is this: Sometimes in these discussions there is a lot of reference to potential life. Now, it seems to me that there is a sense in which there is actual life there from what the scientists tell me. And really I admire greatly everything I have learned these days. From what the scientist tell us, right from the beginning in the case of the zygote there is this nutrition, growth, excretion, reproduction there and those are the basic signs of life.
Now, what is potential, it seems to me, in the development probably of any animal are the higher functions. When Dolly was generated or cloned, clearly there was life there. Now the faculty of perception, for instance, was not there. It was potential. But again from what scientists tell me, the genetic programming was there so although this was a clone this was very close to what the — what Molly, the sheep next door, was about because she also had these 46 chromosomes and was going to develop in that direction.
CHAIRMAN KASS: Okay. Gil, Mary Ann, Rebecca, Michael Gazzaniga, Charles, and I do not want to preempt what you are going to say but I am going to make an exhortation to professors that there are some questions that were sort of started on the question of what it was we actually — what this special respect means. Michael Sandel has invited people who want to say something about that to please speak up who think that it has intrinsic meaning. I will pray that some of those in the queue will actually speak to that but, as you wish, Gil, Mary Ann, et cetera.
PROF. MEILAENDER: No, I do want to speak to that, in fact.
CHAIRMAN KASS: I am not disappointed.
PROF. MEILAENDER: I am sorry to be quite so predictable.
PROF. MEILAENDER: If you go way back to when we started down this road, Alfonso and Dan, who spoke very early actually from quite different angles of vision, agreed, I think, that when we talk about this cloned embryo we are talking about one of us in the very earliest and least developed forms but nevertheless one of us. And so if that is what we are doing and we ask what do we owe to one of us in that stage of development, what would it mean to show respect. It seems to me that when I try to sort it out it would mean that we would want to show ourselves people who were not willing to use others simply for our own purposes, even for very good purposes, even for indisputably good purposes.
And, in particular, we would want to show ourselves as people who were not willing to use the weakest ones among us, who cannot, as it happens, sacrifice themselves. We can sacrifice them but they cannot give their lives meaning by sacrificing those lives. So that it smacks a little too much of the strong using the weak and that is hard for me to understand that as being encompassed by the language of respect, much less profound respect or anything like that.
And it is even a little harder to understand it in the context of the particular circumstances that we are discussing when not only would we be showing ourselves willing to use the weakest among us for our purposes but to use them in a circumstance where it can be only using where we are, in fact, I think probably committed to seeing to it that they could not have any continued development and that that is sort of part of the package. That is use only and there is — without remainder.
And at least as I try to sort it out for such beings who are the weakest and who cannot sacrifice themselves, I have a hard time encompassing that within the language of respect. I mean, I can understand doing it and I can understand powerful motives for doing it but I would not try to call it moral respect.
CHAIRMAN KASS: For the sake of clarification so that we know on something of the underlying premise of the discussion where you talk about one of us because I am sure that people will be interested in this, one of us in the category of this list of five that we have here, embryos are the more equivalent of both a later stage fetus and all living beings. One of us in that sense? And there are people in this room —
PROF. MEILAENDER: Yes, the earliest form of nascent human life.
CHAIRMAN KASS: Is one of us in a full sense is what you want to say. That is the premise of the rest of the discussion.
PROF. MEILAENDER: Right. Yes, which I thought was actually — that, subject to correction, was where we started quite a long time ago.
DR. MCHUGH: Can I just say that — come back to my point? The real question — no one denies what you are saying, Bill. I do not think anyone denies that the use of the strong over the weak and the destruction is repellant. What I am concerned about is why we begin by assuming that somatic nuclear transplant produces one of us. That is what Charles and I are discussing and you might be able to persuade me.
Leon says it is a difference but a difference that does not matter ultimately but it is a difference. And we are talking today, not like we talked yesterday, about the creation of a human being, which we have prohibited and said we will not do and for all the reasons this is something different and it is new to be able to do the somatic. And the question is why do the same things apply to it as to a zygote?
PROF. MEILAENDER: Leon, may I have just a sentence?
CHAIRMAN KASS: Yes, please.
PROF. MEILAENDER: And I do not wish more than a sentence. I have already said this to Paul and it is not going to persuade him but —
DR. MCHUGH: You might. You might. We are here to be persuaded. We are not here with fixed opinions.
PROF. MEILAENDER: If you want to call that cloned embryo a different species then were it to be gestated and given birth to, it would not be a homo sapiens. The question of its rights and dignity would be entirely an open question at that point. I do not think that that is the position you really want to defend.
DR. KRAUTHAMMER: And yesterday when Irv spoke of it as an embryo, did you object, Paul?
DR. MCHUGH: Yes, I objected. I object to the use of the word "embryo" on these — at the beginning of these things if you are not going to call it a special embryo. And, you know, it really does come back to this idea of where we are in our science.
CHAIRMAN KASS: Look, it seems to me that the move that Paul is making in this discussion is to say, yes, we might owe special respect to the embryo but that is not the question in this discussion because the cloning for biomedical research does not involve embryos or, if I might extend your remarks, things that are embryo enough like — things like unto embryos sufficient to even warrant the question of respect coming up in the first place. You have defined the problem out of existence, right? I mean, you really have.
DR. KRAUTHAMMER: And you also contradict the conclusions of the National Academy of Science report. I mean, I am not arguing on my own authority. I am saying he gave us a report of the finest scientists in the world on this subject. I do not think any of us question the biological and medical expertise behind that report and he had no question either in his presentation or in the report that this was an embryo.
DR. MCHUGH: I have said my piece on that and —
CHAIRMAN KASS: Let's go ahead. Mary Ann?
PROF. GLENDON: I know you wanted to hear from all of us on your first question but I have to say that I find it very difficult to separate the first question from the third question and it seems to me in listening to the comments of others that many of the comments addressed to the first question really are more properly related to the third. So let me —
CHAIRMAN KASS: Would you remind us so that everybody knows the first question?
PROF. GLENDON: Yes. I am thinking of the reasons that Charles gave as prudential reasons.
CHAIRMAN KASS: Right.
DR. GLENDON: I think that that kind of argumentation has less to do with the respect that we owe to human life in its earliest stages of development than it does to your third question, which is — you might say the connection is this: The emphasis should be on the "we". Who is the "we" and how do we envision ourselves or how are we constituting ourselves as a "we" with the decisions that we are going to make about the respect that we owe to these two very important poles that Paul described as sympathy and piety.
So, I guess, it is a good idea that I waited until the end because I think my comment is really a suggestion that we restore the connections among your three questions and that we think about what I think a lot of our fellow Americans are thinking about.
What kind of society are we bringing into being? What kind of people do we want to be and how will these decisions that we are making now constitute us in the future?
CHAIRMAN KASS: Let me say hurrah for the insistence that we do that and ask you to turn the mic on and put your toe in the water on the very — speak to the very question you have just articulated with respect to what we are talking about.
PROF. GLENDON: Well, we have not yet talked about the second question but maybe let me take this occasion since I am not going to be able to stay for the public comment to say — I mean, the question of what we owe to those who hope for cures. At our last meeting in the public session someone made the comment that there is no representative of patients on this Council and I think it is very important to state publicly and for the record that all of us are patients, potential patients, friends and relatives of patients, many of us treat patients, and so I would like most emphatically to say that representation of patients does not require the presence of a paid lobbyist on the Council but it does require the presence of people who are interested in and sympathetic to patients.
CHAIRMAN KASS: As we are friends, let me bully you a little longer.
CHAIRMAN KASS: You have tied together, you have now made comments about the importance of all three of these things and that we owe something there. Let's disaggregate them slightly and I am not going to spend the rest of this morning simply on the side of the — shall I say "embryo" in quotation marks.
We really want to turn to the other side of this but Gil has posed a challenge in saying that he finds it very hard to encompass under the notion of respect for human life in its earliest stages that that life should be regarded simply as useful for even, if I understand them, the very best of human purposes.
You might be able to justify doing it. This is not my gloss on Gil's but you can justify it in the name of respecting it if that is an acceptable loss and everybody that has spoken — everybody prior to us that has spoken about these matters has said, as Michael Sandel said earlier, everybody agrees that the earliest stages of human life are not things. Either because of what they are now or because of what they will become or some combination thereof.
And the question — that seems to imply treating them differently or regarding them differently and treating them differently from not just things but from other cells of the body, and I guess the question is do we have an answer? Shall we abandon the language of "respect" or does it have — I mean, Rebecca and Michael have said respect which produces restraint save in the presence of certain necessary compelling, otherwise not available benefits to certain high human goods like healing disease. Okay. There is a certain formulation here but there is a presumption of respect which sets restraints on violation.
Gil says that is not right, that to use even for those goods is disrespectful even if worthy and even if finely morally defensible but you cannot somehow claim it — correct me because I do not want to —
PROF. MEILAENDER: No, I just want to add that it is a heavy burden to demonstrate that there is no other way to achieve the good in this particular case.
CHAIRMAN KASS: That is correct. Correct.
And I not only wanted to hear from everybody but I wanted to hear from everybody on this particular question that has been joined and if you would just add.
PROF. GLENDON: Well, we agreed — we started out with the terminology on the sheet we were handed this morning that these nascent examples of human life are not nothing and then we moved, as Michael suggested, to a somewhat more positive assertion. They are not only not nothing but they are not things. That is an important move and we may be in one of those situations where, although we would all agree, they are not things, that does not settle a lot of important issues.
So the question then might become one about burdens of persuasion, about what follows from the fact that they are not things. You could have many people who would say, "Well, I understand they are not things," but also I write up in "A" here they should be used for research anyway with proper respect. We will handle them carefully but we will do whatever we want.
So this is what brings me into your question number three. How are we as a society going to handle all these issues without really treating these — I do not know what word to use. Treating nascent human life as a thing to be mined, to be exploited, to be put at the disposition of the wealthy.
I think I mentioned last month that in the civil law systems of Continental Europe there is a deep principle in the structure of these systems that the human body shall not be in commerce and they have in various ways made exceptions to that principle. They passed statutes to permit sale of blood for blood transfusions but it is interesting that they have to pass a statute to permit it.
So I think maybe this is a useful way to think about it. The "thing-ification" of whatever it is we are talking about and the commercial and other implications that that may have. That is about all I can say at the moment.
CHAIRMAN KASS: Thanks very much, Mary Ann. By the way, on this last point, I hope people have noticed that the AMA is — the morning paper — again reconsidering lifting the statutory — trying to have statutory language that would permit a certain financial incentive for organ donation. There was a statute, I think, in the mid '80s that simply prohibited all commerce in organs. The bill might be introduced, in fact, as early as today. That is under consideration. That might come our way. We might choose to take this up.
I have Rebecca, Michael Gazzaniga and Charles and Bill Hurlbut and then Robby.
PROF. DRESSER: A few different points. I do think that Paul's comments, and to some extent Jim Wilson's comments, really take us back to what Michael Gazzaniga said at the beginning of our meeting yesterday, which is are these embryos. And I know you are tired of hearing this but I guess I really do have a question that — well, we know Dolly existed but we do not know whether it is possible for this different — very different entity to become a person, to become a baby. And so it is either in terms of what Jim was talking about, the odds of this entity becoming a person. They are either — there is a much lower chance at least at this point of this entity becoming a person than there is for an IVF embryo or a created for research regular embryo, and it might not be possible. You know, it might not be possible in the human species for it to become a baby.
So I think we should at least acknowledge that and say whether we think that makes a difference in terms of what this entity is owed. Whether it is a quantitative or a qualitative difference. Are they more like parthenodes? I mean, in that same experiment by Michael West. Didn't they get that parthenodes to go farther than cloned entities?
CHAIRMAN KASS: Exactly.
PROF. DRESSER: So are these more like parthenodes? Now how would we regard a parthenode? So I do think we need to discuss that issue.
Going back to what Dan was saying about respect and awe for life, I do think we have to talk about the need to draw a line. I mean, for example, we would not say that we would think it appropriate to draft people for important medical research, you know, in the way that you were talking about the military. I think most everyone would have problems with that. So the question is to — when is it appropriate to use a particular entity for important research without consent, you know?
And on the other hand I do think we want to think about respect and awe for life of the patients. I mean, the patients have lots of things that these — that nascent human life does not have. They have relationships. They have projects. They have pain and suffering and loss and all these things, and so I think that is important.
So that gets us to the question of what is the nature of any responsibility we might have to try to help them? How far does that go? Does that take us to a point where we give up some of these social considerations that trouble me? Again, I would say that one of the primary things that troubles me is this idea that we already have this oocyte provider situation in the fertility area where women have procedures done and hormones given that are not risk-free. They are not extremely risky but there is a risk there and they are paid for it.
I do not see how we could develop much of a supply of these entities without money changing hands. I do not think there will be that many women volunteering. So to take — to get into that whole area really troubles me and we have to count that, too.
CHAIRMAN KASS: Michael Gazzaniga?
PROF. GAZZANIGA: So let's see here. Go back to your wonder of the cell dividing back at St. John's College, which is — we all remember that moment. It is not so exhilarating when it is a tumor cell. In fact, you grow to hate it and you are sitting there trying to figure out how can I stop this thing from killing somebody, and so that is what we are talking about here.
So let's go back to the —
CHAIRMAN KASS: Well —
PROF. GAZZANIGA: Let me make my point.
CHAIRMAN KASS: Sure.
PROF. GAZZANIGA: Let's go back to the woman who is undergoing in vitro fertilization and she is having her eggs harvested. She can harvest — they can harvest six to 20 eggs in that procedure. And she says in informed consent, "By the way, I want to give a couple of those eggs to science," and signs off on that and the rest of the eggs are used for her procedure so she has given two eggs to the scientists.
The scientists then take them and put them mixed with a somatic cell and put it in a culture and it grows up to the blastocyst stage. They harvest the stem cells, the blastocyst is destroyed. That is what we are talking about.
Now the concern, the moral concern here, as I understand it, is that that blastocyst by assertion of some people's religious belief is a person and if you believe that there is just no scientific statement or data that can change that belief.
But for those who do not believe that, they can consider, well, what is this blastocyst? And the argument generally is, well, it is potentially a human being and so you have the potentiality argument, which is a hot argument in philosophy and it is argued both ways. But an analogy helps me think about it, which is you go into a Home Depot — it is not a perfect analogy but it is good enough for this time of day — you go in a Home Depot there are the elements for 30 homes and they have the potential of 30 homes in that Home Depot. The Home Depot burns down. The headline is not Community Burns Down Houses; A Home Depot Burns Down. That is the stage those goods were at.
So the notion that this blastocyst is something else or can be something else, it is a truism. Of course, it can be. That is the whole point but are you concerned about it — I am talking to the people here who have not made up their mind. Are you that concerned about it as a clump of 200 cells or not? And a lot of people are not.
CHAIRMAN KASS: May I take this one on?
PROF. GAZZANIGA: Sure. May I consult my lawyer?
CHAIRMAN KASS: Yes. Look, as far as I know, this opinion that you will hear has no theological foundation. It has got nothing to do with religion. My religion is Jewish and they are very liberal with respect to these matters. My opinions about this matter are formed as a biologist and as a reflecting biologist and has something to do with certain philosophical notions which are not foreign to biology but upon which biology richly understood, I think, rests.
I would not say that an early human embryo — let's leave the clones out for the moment because there is dispute about whether they belong in this discussion at all. Ordinary zygote or blastocyst formed sexually, whether in vivo or in vitro, that is I think the right way to say that, to talk about it, is to say that it is a human organism at that stage of development. It is not a potential human organism at that stage of development. It is a human organism at that stage of development. That is all it could be at that stage of development. It has potentiality for other powers and one of the funny things about potentiality is that it both is and is not what it is. I mean, to be potential is to be — to have a potentiality is to have something real which is not yet. A long discussion, not for now.
So there is something there that is of worth because of what it is now and even more because of what it might become. That does not mean to me that you cannot touch it but it means to me you should not somehow define it into something else in order to enable you easily to touch it. It is not a religious argument. It is simply — and the unfolding — the division of a zygote to two, and then four, and then eight, and so on is very different from the division of wild cancer cells because this is guided by an imminent unfolding plan to produce a whole. The thing divides as a whole, forms as a whole, grows as a whole. It even has polarity at a very early age, which tumor cells — as masses of clumps of cells do not.
That is very different from the way in which you could say the boards in the Home Depot are potential houses but only if some outside force would come along and put them together. Whereas, the potentiality to become a full organism in this case is imminent to the thing that is unfolding.
PROF. GAZZANIGA: Well, do we really want to do this?
CHAIRMAN KASS: Well, I think it partly helps to determine what it is we are talking about here because if you are right, the conversation really in some ways is over.
PROF. GAZZANIGA: Well, I am not disagreeing that the blastocyst is a human in a stage of development. That is a truism. Can anybody argue with that? That is just the way it is. The question is what kind of agency you want to assign that blastocyst at that point in development and my argument is not much.
PROF. GEORGE: Agency?
PROF. GAZZANIGA: Sure.
PROF. GEORGE: What do you mean by "agency"?
PROF. GAZZANIGA: Well, what do you mean by it?
PROF. GEORGE: The act of capacity to act on the basis of one's will and choice.
PROF. GAZZANIGA: Right. So you have a clump of 200 cells and it is not there.
CHAIRMAN KASS: Organism comprising 200 cells.
PROF. GAZZANIGA: Whatever.
CHAIRMAN KASS: It is an organism. It is growing.
PROF. GAZZANIGA: The point being that if that tachistoscopic shot of that stage brings upon a great number of people all these problems that I know you feel and I know you feel; fine. It does not bring that problem to a lot of other people and that is all I am pointing out and what I happen to believe.
CHAIRMAN KASS: I think I will subside on this. I mean, this really should be continued, Michael.
DR. KRAUTHAMMER: Let me pick up on it if I may and to go back and sort of look at the shape of the debate if I may. It seems that to me that what we are talking about here is research cloning and there are three possible objections.
The first would be sort of the one that Michael is rejecting. The idea of the intrinsic worth. The mystery, the awe, the respect owed of this organism. The blastocyst would impel us to do — treat it in a way different from other tissue, the intrinsic value.
The second would be for those of us, because I — whereas I share the —
PROF. SANDEL: Could I just ask, Charles, the first one, the way you characterized it is relatively uncontroversial. The issue is not whether there is an intrinsic worth that commands respect. The issue in the strong claim is the equal moral status view.
DR. KRAUTHAMMER: I think Michael would reject that there is intrinsic worth that commands respect.
PROF. SANDEL: Maybe Michael would but the — maybe Michael would but we do not —
DR. KRAUTHAMMER: I was following up no it as a way to say that even if you have that lack of objection there are two other issues at stake here.
PROF. SANDEL: But even before we get to the two other issues there is the equal moral status view that is carrying a great deal of weight for some people and yet no one has offered any articulation of it.
DR. KRAUTHAMMER: I was endorsing Michael's position, which is that there is a view, a very widespread view, perhaps not here, but certainly in the country that a blastocyst is not owed any particular respect, that it is simply a clump of cells. Do I misunderstand your position?
PROF. GAZZANIGA: With all the caveats that we respect those clump of cells but it is not respect in the sense that —
DR. KRAUTHAMMER: Right, and that is a very widespread position. I would say it might even be a majority position in the country and it reflects the fact that the majority of Americans would support stem cell research which involves tearing up a blastocyst. So it may not be a widespread position here but it certainly is in the country.
Number one, intrinsic respect for this organism. But even if you reject that, as I think Michael does and a lot of people do, and I think I would as well, there is the question of the slippery slope. Prudential arguments, yes, a blastocyst we could tear up and use but it will predispose us to tearing up and using a fetus ultimately transgressing on their lives.
But there is a third issue and that is should we as a society be engaged in the creation of blastocysts solely for the purpose of tearing them up? And that I think is a separate issue because — and it involves the example you brought up of donating IVF embryos. It would also be involved in the issue of cloning. Even if you thought that a blastocyst in and of itself is not something that needs protection, do we as a society want to begin a new industry, the commercial creation of human embryos, for the sole purpose of their destruction?
I think that is a third element in this discussion that has to be introduced because of what that — how that would affect society and how it affects our views of life and how it might coarsen us and predispose us in the future to the kinds of violations of embryos, fetuses, ultimately humans that might occur. So I wanted to put that on the table as a third possible argument against research cloning solely on the grounds that it introduces the idea of creating human embryos for the sole purpose of their use and destruction.
CHAIRMAN KASS: A small footnote, Charles, to the beginning first point that you made and I think it was very helpful in illuminating Michael's remark. We have so far been speaking about nascent human life homogeneously, although some people want to make distinctions about various stages. The Brits in their own regulations treat 14 days, the time of the primitive streak, as a boundary.
When we do this right, it seems to me, we have to — at least people who holds Charles' view at least tacitly are saying that there might be boundaries later on where "intrinsic worth" somehow has some greater standing and if not for the cloning discussion when we get around to the stem cell and embryo question, I suspect, that age of embryo might be one of the factors that enters into the discussion at least for those people who do not regard the embryo as one of us fully in the full moral sense from the very start. So we are not doing that right now but I just want to flag that consideration because I think we will have to take it up.
DR. FOSTER: Leon, could I just make one quick response to Charles?
CHAIRMAN KASS: Please.
DR. FOSTER: Implicit in Irv Weissman's statement yesterday was a historical reference to the Recombinant DNA Advisory Committee and the safety that was involved by the scientists there, which when Marty Klein deviated from that, he was — I mean, he simply lost his whole career because of that. Implicit, as I heard him speak, is that one recommendation might be, if it was considered that research could be carried out, that there would be appointed an equivalent of the RAC committee, which was one — in my view, in recombinant DNA — was one of the glories of what the NIH and others have done.
And then that committee would draw the lines, I think, maybe along the lines that we might recommend — I mean, there clearly would have to be an external body of scientists and others, ethicists and so forth, which would say this much is acceptable and beyond this is not acceptable, and that is the way that it — and it worked very well so that the RAC is essentially functionally out of business now.
So I simply wanted to say that it would not be — I do not think that you would be freely available commercially or otherwise to move beyond that if and when there was a possibility.
CHAIRMAN KASS: Janet, on this point?
DR. ROWLEY: I just want to follow-up on that and say this was a voluntary committee. Well, the committee was not necessarily voluntary but it was the scientists themselves said that in order for us to go forward we want this kind of regulation. It was not Congress that said we will legislate that you are regulated. It was the scientists themselves who recognized many of the issues and they, through NIH, had this committee formed. And there is, therefore, precedence.
Implicit in some of the discussions are that it is the wild scientist who is going to just destroy us all and I think it is very important to come back to this as an example that scientists are responsible and that they do understand in certain circumstances, particularly the development of a new critical area that review and restraints are perfectly appropriate.
CHAIRMAN KASS: Thank you. I have Bill — Robby, Bill and Gil, and then I want to shift to the other neglected part of this discussion.
PROF. GEORGE: Leon, I want to — Michael, I want to take you up on your invitation to argue for the equality and dignity or worth, moral status of all human beings, irrespective of age or size or stage of development or condition of dependency or any other contingent factor. And my proposition is that we should reject the view that worth or dignity is contingent on those factors in the same way that we reject the view that dignity is contingent on other contingent factors such as race or sex or ethnicity or any other factor that we were all agreed should not enter into a consideration.
And I want to suggest that what is really at stake in this issue is not the question when does a human being acquire intrinsic worth or dignity but rather whether human beings have intrinsic as opposed to some other category, some other descriptive word, worth and dignity.
I think that if we reject the idea that even the youngest and tiniest human beings have intrinsic worth and dignity, rather their's is acquired by the activation of capacities which are merely radical at the stage at which we are talking, we will, in effect, be giving up the proposition that any of us at any stage of development or size or age have intrinsic worth, that our work depends instead upon contingent factors which exist in people as actuations of capacities in matters of degree such as strength, intelligence, wisdom, beauty and so forth and which some people have in very low degree if at all.
Irv Weissman said two very important things, I thought, yesterday. One was that the blastocyst stage of human existence is just that. It is a stage. There is not this entity that is a blastocyst that might be on a list of entities with human being along with rabbit and palm tree and garden post.
No, the blastocyst is a human being at a certain stage of development such that the proposition that at that stage the blastocyst, the human being, lacks worth and dignity. The rejection of that is to say that at that stage what that human being is, is a human nonperson. A human being who lacks the intrinsic worth and dignity that some other human beings because of some factors, some stage of development, age, size, et cetera, have.
Michael suggested — Michael S. suggested — Michael Sandel suggested that the possibility that between the category of person and mere thing there could be a third category. I realize Michael did not assert it. Here merely suggested it and I agree that we should consider whether there is such a possibility and I want to say now why, having considered it myself, I reject it, although I am certainly open to counter argument.
I think that it is impossible to find room — if we eliminate the words "thing and person" just for purposes of — heuristic purposes at the moment — find room between something being a subject of respect or rights or what have you and something being an object that can be used for the purposes of others. And here I am simply trying to reenforce, I think, something that Gil said earlier.
Now it is certainly true that some objects have such importance or value, and in an analogous but merely analogous sense we might say intrinsic value, that we would not want to sacrifice them lightly. For example, great art. The Mona Lisa we would not want to sacrifice or dispose of lightly but we do not consider the painting, the Mona Lisa, to be a person. It is a painting of a person obviously but we do not consider the painting to be a person. Something of extraordinary value could never be lightly sacrificed.
If it were to be sacrificed it could only legitimately be sacrificed to a very high cost like the saving of life. Let's say that someone had the painting, was trying to escape from the Nazis, running out the door with his family, the Nazis were coming at him, he threw the painting at them in order to make the escape. We would consider that justified in a way that we would not considered justified the Nazis destroying the Mona Lisa because it was allegedly the work of an inferior race or whatever their reasons are. But, of course, the Mona Lisa is nevertheless an object and not a subject. It is property. There are circumstances under which it could be disposed of. It can be owned. Others can exercise power over it and use it for their ends.
If we conclude that human beings at some stages of their existence, whether it is the very young, tiny, dependent, or the very old, frail, dependent, or the very severely retarded and, therefore, dependent, if we conclude that in any of those cases we are justified in — for high reasons like the reasons we might sacrifice the Mona Lisa — using them, harvesting their parts, then we will be treating them as objects rather than subjects, whether we use the word "thing" with respect to them or not and even if we think that the word "thing" does not do justice to the rare and high importance that we attach to them. Again, whether it is the Mona Lisa or a very severely retarded child who happens to have two good kidneys or whether it is an early embryo.
What is it then that we have in common that is the core of our dignity on the account I am offering if it is not age and size and stage of development, if it is not strength and wisdom, and intelligence and ability and beauty. All these things are obviously unequal. What is it in terms of which we are equal?
My own judgment of why we are equal and what gives that — gives us a fundamental equality and moral dignity and worth justifying requiring us to treat each other as subjects of rights and justice rather than as objects is our common possession of a rational nature. What do I mean by that?
I mean, the radical, at least, capacities for the exercise of some rational faculty, life, love, laughter, the capacity to be loved and to be cared for as a person by others who can reasonably understand us as one of us, as part of the human family and part of the family, and that capacity, those radical capacities, that nature is not contingent on any other factor like age, size, stage of development, race, sex, but rather exists just in case, just in the event that, just when there exists a being possessing in the human case the epigenetic primordium for self-directed maturation through — self-directedly through the stages of human existence from the embryonic, through the fetal, the infant, the adolescence and so forth such that looking retrospectively as Irv Weissman told us yesterday, we can identify the Leon Kass now before us directing our deliberations as the same Leon Kass who earlier in his life was a precocious adolescent and a mischievous infant, and a fetus and embryo and so forth.
Let me then address Daniel's point about whether we treat life implausibly as the highest good when we say that the lives of all human beings at every stage of development must be protected and respected. I want to say I think with Bill Hurlbut and possibly Gil as well that we do not do that. And to explain that, let me step back to say why I deliberately frame the position I am defending as a defense of the equal rights and dignity of the human being rather than the question of whether the early human being deserves equal moral weight.
The reason for that is that the language of equal moral weight invites, although Michael of all people I know because of my respect and admiration and knowledge of his philosophical work does not subscribe to this view, nevertheless it invites in general discussions the idea that the proper way to evaluate, to make moral decisions is one where we weigh pre-moral goods against each other according to a consequentialist utilitarian calculus to decide which one weighs more.
Now that is a respected position in philosophy. My colleague, Peter Singer, holds it and many other people hold it. I would be very happy — I am lecturing too much the way it is but I would be very happy to give a critique of that as would Alfonso and others, I think.
I am going to assume, though, that we do not want — that probably none of us here want to end up making decisions of life and death of this moral magnitude on the basis of a utilitarian calculation because the consequences of that are things that I think we would not want to live with.
Now Professor Singer is willing to live with them, such as the permission of infanticide and so forth but let me just lay that aside.
But it relates to what Daniel says for this reason: When we conscript the soldiers and send them into battle and even into certain death, we do not do that on the basis of a calculation that their lives are less worthy of respect and concern than others. They are going to be victims of decisions that we make but we are not treating them as simply body parts that are expendable because of their inferior status by comparison with us.
I think the way to see that very clearly is to notice that even people who strongly accept the morality of conscription would recoil in horror at the proposal. To heal diseases, to save lives by conscripting, let's say the same people, those same 18 year olds, in order to harvest their body parts, despite the fact that every single one of those conscripts possessing two kidneys, two lungs, a heart, a liver, a pancreas, represents — could represent the possibility of saving 18, 22, 25 lives.
That difference in reaction, I think, signals the fact that we do not want to treat these issues as issues of a calculus of moral weight as between those human beings who weigh more on the scale than those who do not but rather want to address them by way of a principle that says we can never intentionally choose — at least in the case of an innocent human being — to destroy his life and harvest his body parts for the sake of helping other people. That the killing involved, even though certain — the death involved even though certain in the case of the conscript soldier does not all into that category of us deliberately willing the death of another either as an end or as a means to another end but rather accept it as a side effect, which if miraculously does not come about we are very happy about indeed.
I wanted to address some other points. I think I have spoken far more than I should have. Certainly I would want to address Michael's — I forget whether it was Home Depot or Lowe's. The Home Depot example. But let me just sort of invite Michael and others into conversation on the basis of what I have said so far.
CHAIRMAN KASS: Could we have just a few brief responses? We owe the other part of this discussion at least some serious time. A brief response, Michael, because he was answering your question.
PROF. SANDEL: Well, a quick comment and then a question. The comment is, yes, utilitarianism is something that should be opposed but the question is whether the way to oppose the widespread utilitarian tendencies in our moral culture is to insist on a dualism between persons on the one hand and mere things on the other or subjects and objects.
I think it is a mistake, because it will fail, to combat utilitarian assumptions that have a powerful grip by imposing and insisting on that dualism. The reason is illustrated by exactly the Mona Lisa example, Robby, that you raised because the Mona Lisa is neither a person nor a mere thing open to any use. It is neither a subject nor a mere object fit for utilitarian treatment, nor should it be treated as property in the sense of ordinary property. We would not imagine — wouldn't we have objections if the Mona Lisa were bought by an eccentric billionaire who wanted to use it as a doormat for people to wipe their feet on when they came into his house. We would regard this as a failure of respect. It would be natural to speak of this as a failure of respect for this great work of art even though to use the language of respect does not require that we say that the Mona Lisa is a person.
Well, what this suggests is that it is a mistake to claim that respect is all or nothing, on or off. Instead it suggests that we should understand respect, that to respect something is to treat it in ways that are fitting or appropriate to its nature.
Now to come to our case then, then we have to answer the question what is the nature of the embryo? And Robby has addressed this question and I understand, and I think I see the force of his answer, but this brings me to my question. Is it a consequence of your view, would you say, that extracting stem cells from the seven day blastocyst is as morally objectionable as harvesting organs from a baby?
PROF. GEORGE: I believe that in principle it is. That the fundamental — by "in principle" I am signalling the idea that the fundamental wrong is the same. Having said that, there are probably additional factors, additional wrongs in the case of the baby, additional social consequences in the case of the baby that would make it, one might say, even worse but having in mind that by even worse we mean in addition to, not more wrong in terms of the fundamental wrong.
Leon, very quickly to respond to Michael's first point about the Mona Lisa and the utilitarian calculus? Thirty seconds. Fifteen.
I think, Michael, I disagree. I think rather the — your use of the utilitarian calculus actually proves my point that utilitarian does not necessarily believe that anything subject to the calculus can be used for any purpose. It is a matter of relative weighing. What matters is that the Mona Lisa could be used given a sufficiently weighty consideration in a way that was destructive.
CHAIRMAN KASS: Eighteen. Very good.
CHAIRMAN KASS: I have two here and I am going to ask them to be brief because the time is going. Bill Hurlbut and Gil, and then we are going to move subjects.
DR. HURLBUT: I will pass.
CHAIRMAN KASS: You are going to pass. Gil, did you want —
PROF. MEILAENDER: Just a word. In fact, it leads in a certain sense to where you want to go.
CHAIRMAN KASS: Please.
PROF. MEILAENDER: I just want to note in terms of what you, yourself, Leon, outlined at the start as the — what you saw as the most desirable product somewhere down the road that we might come up with.
CHAIRMAN KASS: Right.
PROF. MEILAENDER: That is to say some kind of document, argument in which we were all able to agree that weighty and powerful arguments had been put forward for differing positions about which we had differing views, and I am coming back to Michael Gazzaniga's point here. I am not sure we are on the road to that at this point because, for instance, I was able to say with respect to those goods that we might seek by the research that they were indisputable goods. It seems to me we are going to have to be able to get equal language about the other good that is involved and the respect for that embryonic life or we are not on the way to the kind of document you had in mind.
CHAIRMAN KASS: Thank you. I was going to make the transition, Gil. You anticipated me. To step out of a conversation to talk about it is always a risky thing to do but let me stock of what we have done here at least as I hear it.
It is a lot harder, Gil, I think. It is very easy, I think, to see the worth of gaining knowledge that could be humanly beneficial in saving life. It is relatively uncomplicated. The argument is how likely is it, how much good, et cetera, but we all understand those principles and we want to talk about it in a moment.
Part of the difficulty here is there is some dispute about what it is that we are talking about such that we should respect it from someone who thinks it is like parts in Home Depot. I exaggerate slightly. I mean, it was an analogy to help — it was an analogy to help make a point, not an assertion of the standing to someone who thinks that it is fully one of us, to someone who thinks it is something in between, and yet I would like to think — and some who think that, yes, this is appropriate but not the things created by nuclear transfer.
I would like to think that somehow hovering over this discussion is at least a recognition that that for which people have spoken up, either more eloquently or less, is not humanly nothing and that we should not simply be driven by the conclusion of policy that we want, namely that we want the research to go forward or we do not want the research to go forward, to color how that discussion goes. That is what I mean by suggesting that we should try to own the argument. The difficulty is we have not yet got it to the point where enough of us can say, yes, that seems to speak for — I understand — we can understand it, we cannot yet acknowledge it.
I think the task on this side of the discussion, and most people — many people have weighed in more or less on topic. Some have not. The scientists have — I mean, Dan spoke, I think, really — actually, Janet, I think maybe you are the only one who has not spoken on the question of the embryo proper, and I do not want to put you on the spot now but it does seem to me all of us, all of us should be thinking about this question.
If the embryos are not things or the substitute for it that we — where shall we come out and how can we articulate the goods that are being spoken for here, both with respect to the things under discussion but also to the issues raised by Charles and Mary Ann. What does it mean for us to somehow regard nascent human life without agreeing exactly on its status as a natural resource to be used?
We might decide that we want to do it, that there are great goods here, but there is an issue raised about this that does not have to do with anything that is done to the embryo but has to do with us.
Let me bracket that. I would love to have — this was the first real good conversation on that and it seems to me anybody who is moved to put pen to paper — in fact, that is the wrong way to put it. Please, some further thoughts and comments on this.
DR. HURLBUT: I just want to say that I tried to bring this out with Irv yesterday. I think we have to — as well as acknowledging the — what you might call the positive attitudes toward the embryo, we have to acknowledge that there should be some way once we articulate the positives to subtract them such that we could then instrumentally use what we had.
In other words, once we get to the point where there is just partial generative potential or truly parts apart from wholes, then we need to clear the space for future research because — not by compromise but by principle so that — because the future of this research is truly fantastic and when Paul says that we should not regard this creation as an embryo, I take that seriously. In part, I am just uncomfortable with what might happen if we develop ectogenesis and we could keep it going but there would be a point at which when it was rendered or created less fully capable that we should be able to do such research.
I think it is very important that we allow the research to go forward. There is a sense in which the initiation, the early moments of life are ambiguous and I think we should acknowledge that and not try and walk around it. There is this question of individuation which we have not addressed.
I personally do not sympathize too much with it because I think it is — if you — like one of my students said, the comment here is if it is not yet an individual because it twin, is it sort of like they are just stirring the dough but you cannot call them cookies yet? Or another comment is if you have one worm and you cut it in two, does it mean that the one you had before was not one?
I mean, these are funny analogies but the point is we have to face the question of whether there is this phase in early human development and whether — that it is not fully individual and then we need to find a way to define for all — opening all future research what we mean by the minimum standards. So in that sense, I think, Paul and Mike's comments have some route we ought to pursue.
CHAIRMAN KASS: Thank you very much. Mike, are you moved to —
PROF. GAZZANIGA: I move to just ask you a question.
CHAIRMAN KASS: Please.
PROF. GAZZANIGA: When you hire a lawyer, the lawyer's job is to present the client two, three, five options and for the client to decide what to do.
CHAIRMAN KASS: Right.
PROF. GAZZANIGA: Isn't that our function with respect to the President?
CHAIRMAN KASS: On this matter where we, I am sure, in the end are going to place the weight, the moral weight in different places, I think that is a wonderful public service. But when I said I thought I would like us to own the whole document — in other words, I would like us to be able to say, 'Here, Mr. President, is a brief...' Actually to put it better, "Here is a Supreme Court opinion that holds in favor of this result in which there has actually been deliberation with the other side and which we have taken into account what they have to say. And here, Mr. President, is a different Supreme Court opinion that holds to a different result but has taken into account the other opinions. A small footnote, n of us think more this way, q of us think more that way, but you should know that you have got the best presentation of the issues and what is at stake here, and all of us agree to that.'
I mean, that is, it seems to me, an aspiration. If we could pull it off, it would be remarkable even for the Supreme Court, if I may.
CHAIRMAN KASS: Let me turn — I want to turn to — we have the following change: We have had requests for the public session, which we had originally scheduled for 12:00. There are only two people who have asked to speak. With apologies to people who are counting on beginning that at 12:00, I would like to use some of that public session time.
I know people have to leave promptly at noon and if you have to leave, by all means, go, but I would like to begin and go into some of the time allotted for the public session to make sure that the people who speak with such eloquence on behalf of nascent life have to answer the question what is it that we are going to say to the sympathy side as well as to the piety side of this discussion.
And I want to get him back to the table because he is going to have a turn. Gil, would you mind if I imposed on you since you have made — I mean, you have made a very strong argument that would seem to imply that, though, great good can come from the use of embryos to derive cells or other means of cure, that this is a — not just a balancing judgment but there is a transgression here that at least in terms of respect you could not countenance. What are you going to say to Paul McHugh's patients if the moral argument you are upholding prevails?
PROF. MEILAENDER: Just so we are clear on what I said before, the last thing you said is important that I could not figure out how to work it out under the language of respect.
CHAIRMAN KASS: Right.
PROF. MEILAENDER: If you want a bald faced argument that does not use the language then, you know, we would have to think about that.
Well, what I would say is something like this, recognizing that if you really — if I am actually talking to his patients — I mean, the first thing to say is the language is going to limp and that I am not going to say anything — be able to say anything that is kind of humanly adequate to such a person's condition.
But I would say that what we owe you is not necessarily relief of suffering and not necessarily a cure because we cannot be obligated to give you what we do not that we can provide but we owe you hope. We hope sort of a firm commitment that we will do everything within our moral power, everything that we think we can morally do to try to find ways to, if not cure, at least relieve your condition.
There may be — we may arrive at a moment when we think that here is something that could conceivably be done or tried but that we ought not do and what I would say to them then is that the reason I would not do it is because I would not want to do something that helps to create a world in which neither you nor I would want to live.
Something like that would be what I would say.
CHAIRMAN KASS: Do you want to respond, Paul?
DR. MCHUGH: Yes. I think that the patients to some extent would say, "Gee, I have got a wonderful doctor here in Gil. Paul McHugh has trained him pretty well but here is my concern: I am a 35 year old woman and I have got this Parkinsonism and you could take my ova and put it into my — put my somatic cell in there and develop it. It all belongs to me. It does not belong to somebody else. We are not taking from anybody to give me these cells back in the form that will sustain me from my Parkinsonism and why wouldn't you want to do it. I agree with you that to take embryonic cells and use them for the purposes of others is a transgression but on this occasion — and it gets worse, the transgression gets worse as the cells develop further and further but we are really taking my cells and allowing them to grow and giving them back to me."
What is the matter with that, Dr. Meilaender?
PROF. MEILAENDER: Well, it would be difficult with that patient at that time to have precisely the kind of conversation I might want to have about some aspects of that, namely about whether we really want to think about "my", these things as mine in quite the way that you described them and what that might suggest for other things that we could do with them.
I mean, there would actually be some important points there. It would be difficult just existential to engage in that conversation with the patient at that point but it seems to me that if we are thinking about it, stepping back and reflecting on it, we need to pay some attention to that and we would not want to be quite so casual about that language.
DR. MCHUGH: All the nuclei belong to me. All the —
PROF. MEILAENDER: It is exactly that language that is bothering me. This notion that your body is something that belongs to you. That is exactly what we would want to talk about. If they belong to you, you know, we are not going to let you sell them necessarily for instance. You know, there are a lot of complications there. Now, as I said, we are not necessarily going to have this conversation with the patient but the language would have to be refined considerably it seems to me before I would be prepared to acquiesce in it.
CHAIRMAN KASS: Bill May and then Michael. Bill, are you going to respond to this?
PROF. MAY: May.
CHAIRMAN KASS: Let Michael respond quickly to it.
PROF. SANDEL: I just wanted to respond directly to this, which I think Dr. Meilaender with the patient has been overly timid. Why isn't your answer to the patient to say, 'Well, what you propose is just as bad as if you proposed having a baby with a consenting sperm donor or with your husband, just as bad as if you proposed having a baby and taking organs or something from that baby to cure you? Now maybe you have not reflected on that fact but I could persuade you that on reflection it would be like having a baby and using that to cure you.'
PROF. MEILAENDER: May I?
PROF. SANDEL: Why isn't that the answer?
PROF. MEILAENDER: Well, at one level that is an answer and it is a very good answer. All I was saying was that there are moments when speaking the abstract truth is not necessarily heard as the truth and he had set me up to talk to a patient. I mean, it is like — and there are many other situations in which you do not walk into the hospital room and say, 'Well, I guess you are dying.' So that, yes, that is — that is an issue that one would want to take up but really much better —
PROF. SANDEL: If you were speaking the truth to the patient that is what you would say, isn't it?
PROF. MEILAENDER: No, not necessarily because you want the truth to be heard as truth and it cannot always be received. That is my point. Ideally we would live in a world in which all of his patients or my patients would already have had the kind of conversations that would have prepared them to think about these things in that way and all I was saying is that if they have not, you know, there are moments when you can take up some questions and moments when you cannot but I do not deny that that is intellectual an appropriate issue to raise.
DR. MCHUGH: And I disagree. Of course, I disagree. I do not think that they are the same thing. It is not like having a baby and it is not like having a zygote but I have said that so many times that you are bored with it.
CHAIRMAN KASS: Bill May, please.
PROF. MAY: I think some of the awkwardness Gil would face in front of the patient, timing and all the rest, remind me that respect means recognizing that we can make no totally untroubled decision on the issue that we currently face. I do not see how we can achieve purity. One side is it is not a person, therefore, we are home free in using it for purposes of research grants directed to noble ends. On the other side it is nascent life, sharing a common rational nature of equal status, therefore we are forbidden to use and home free of responsibility for having to cope with the answer for a patient in such urgent need.
It seems to me we occupy a place in between where a clean drip dry purity is not available to us and we will come down somewhere here but respect means acknowledging both sides of the trouble in the decision.
CHAIRMAN KASS: Thank you very much.
Let me make a small modification of the way the question was posed. I did not really mean to make the situation, the existential clinical situation of what do you actually say to that patient but it seems to me what do we say to the legions of patients who stand to benefit and who are suffering greatly so that we do not somehow make the discussion immediately more complicated by the needs for tact and delicacy when one is actually in the face of suffering?
I see Michael Gazzaniga, Charles, Robby.
PROF. GAZZANIGA: Well, just to make the practical point. You might say that a patient buys stock in British Airlines — because this is going to go forward and other nations are already decided on this issue. So what you are doing is you are setting up in America, should this option be foreclosed, two classes of medicine. It will be the rich who can go travel and be healed and there will be those who cannot afford it.
CHAIRMAN KASS: We are not yet talking about the ban, Michael. We are talking about the —
PROF. GAZZANIGA: No, I understand, but what are you going to say to the patient? One of the problems —
CHAIRMAN KASS: Oh, I see.
PROF. GAZZANIGA: I mean, that horrific sort of conversation —
CHAIRMAN KASS: I am sorry. I misunderstood.
PROF. GAZZANIGA: — would not be fun to deliver.
CHAIRMAN KASS: Charles, Robby?
DR. KRAUTHAMMER: Janet?
DR. ROWLEY: This is a discussion in my view remote from the real issues and so when we get to the — what I consider some of the more scientific issues, I will comment.
CHAIRMAN KASS: Could you help? What — could you just say what you think the real is, Janet, so we know what the difficulty is?
DR. ROWLEY: (Not at microphone.)
CHAIRMAN KASS: Can I put you on the list? Charles and Robby and then Janet.
DR. KRAUTHAMMER: You asked the question what do we say to the patient?
CHAIRMAN KASS: Or owe to the patient?
DR. KRAUTHAMMER: Or owe to the patient. Well, as it happens, I am one of those patients. Mary Ann has talked about all of us being patients or having relatives. I have a very obvious connection with this issue and I am one of those in whose name people have spoken and said this research has to be permitted so that I can walk or people like me can walk. Spinal cord injuries are always on the list so I am acutely aware of this issue but I am not only a patient.
I am also a father and what I would say to myself, and I have said to myself about this issue, and I think we ought to say to other people who suffer from similar problems and disabilities, is that we have children and we want to raise them in a world that we want to bequeath to them a world, a moral universe, in which we think they ought to live and that we may be jeopardizing the moral quality of that universe, the humanity of that universe by cavalierly breaking moral rules that we have observed for generations in order that people like me can walk.
So I think there is a serious moral issue here and I think the assumption that all that people who suffer from disabilities want is a cure at all costs is a misreading of their own humanity.
CHAIRMAN KASS: Robby?
PROF. GEORGE: Well, I am reluctant even to follow something that powerful with language that is a little more technical but on the question of what to say to patient or patient advocacy groups or to potential beneficiaries of research in this area, I think that we should say and honestly say that we have — I can speak for a community that I am not part of, the medical community — will do as our community always has done everything it can do in line with the ethical norms that have shaped the practice of medicine since Hippocrates.
But we cannot transgress them and it would be a transgression to bring into being a new human being to be treated as an entity for harvesting of body parts for the benefit of others. That is something that we cannot do.
To Michael's point about this train already having left the station and the possibility of likelihood, certainty that we will be generating, if there is a ban, and I realize we are not talking about a ban now but the point has been raised, two classes of medicine, rich and poor, I would simply point out that this is not unique to this issue. If there will be ethical norms of medical practice there will always be the possibility that different nations will relax the norms perhaps very substantially in some areas, and regrettably, but making possible the same possibility that we would have in this case here. We could explore various examples of it historically and then various possibilities even for the future outside of this area but I would simply respond that it is not a unique problem by any means but what is at stake is what we want to be here and whether we will be true, in my judgment, to the basic principle of fundamental human equality that is enshrined in our founding documents and makes us the nation we are.
CHAIRMAN KASS: Let me lean on you with the help of Charles earlier. Charles says whatever the philosophers amongst us might say, the moral intuition of the nation is that a blastocyst is not one of us in the full sense. That is just a fact. And this quite apart from abortion or anything like that. And, therefore, that this language of creating beings for their body parts seems somewhat a lurid way of putting — taking this, we do not quite know what it is, relatively undifferentiated, you should excuse me, clump of cells — and let's even add to the argument that — and this is still untested, it is part of the complication. There is promise. There is not certainty but let's take the promise seriously. Real help for people with Parkinson's disease from this line of research and not from other lines of research.
I mean, there is a lot of hype about the embryonic stem cells. There is a lot of putting down of the adult stem cells. It is too early to know but let's put the case forward in its strongest terms and face it.
Does one want to say the intuition of the general public is the well-being and suffering of a million people with serious neurological disease should go unanswered if the real remedy is to be found here?
PROF. GEORGE: First, let me say that a question that we have to address independently would be the status of any research material brought into being, whether it be a parthenode or otherwise, that would at least arguably not be a human being, although it possesses a human genome because it lacked the primordium for self directed maturation.
CHAIRMAN KASS: Okay.
PROF. GEORGE: So I am not quite sure about the basis of the argument that Paul has been pushing here about the status of the clone.
CHAIRMAN KASS: Right.
PROF. GEORGE: But if Paul is wrong about that, it might be that by other procedures, such beings could be brought into existence, and as I say that would be an independent question.
Specifically on your question, and having in mind the need for sensitivity in drawing analogies, including historical analogies, and also having in mind that the American public is not of a single view about this, that view being a muddle, the muddle is there are all sorts of different views along the spectrum about it so different people are in different places just as the Council is different places.
Having said all that, we are not without historical examples of people even in general, populations in general, failing to understand other members of the human family, other human beings as not part of the community that really counts or that counts up to the — you know, counts just like the rest of us.
In 1857, famously, five Supreme Court justices validated public opinion. Treating Dred Scott and the slaves he represented not as strictly speaking its or things — even the Constitution said persons held in a bond in certain jurisdictions counted as three-fifths for purposes of the census — but not also in any real sense as full persons. The dissent said, I think, what is to be said here — one of the dissenting justices putting it in religious terms that perhaps not all of us around the table would be comfortable with, certainly Steve Carter would think there is nothing out of line in this, but putting it in the religious terms that were in that day public discourse that "You see before you..." he said to the majority "...a slave, a mere chattel but he is not that. He is a man amenable to the laws of God and man, bearing the impress of his maker and bound for an existence that is eternal."
I do not think I would want to make the argument in those theological terms and I have pointed out in public writings that the question of ensoulment is actually beside the point here all together and it is not a question of the immortality of the fetus or embryo or anything else. Simply a question of their membership in the human family.
I think that what the dissenting justices said in the face of a public opinion that honestly just could not see the Black man, woman, child as truly one of us, not quite an animal but not truly one of us, is the right thing that has got to be said whenever anybody says that there are some human beings that are not yet or no longer persons, that there are some human nonpersons.
CHAIRMAN KASS: Janet, could I draw you out on what question of import that we are either ducking, skirting, not paying attention to because we need to hear that?
DR. ROWLEY: Well, I am not sure this late in the day whether we want to get into some of these issues. I think that for me it is an issue of competing goods and Michael Sander talked about this the last time, and I pointed out that I thought that it was a very important issue. And I am not prepared to say what status the single cell ovum fertilized egg has and what status the blastocyst has in the context that others have spoken about. I am certainly — it is quite clear that this is or has the potential for developing into a human if it is not otherwise altered.
But, for me, the possibility that it could be altered in ways that have the potential of leading to greater understanding of the consequences of genetic change are extremely important and that from that understanding of the consequences of genetic change, we could great hundreds and thousands of patients. I think that that is a competing good that we run the risk of losing site of.
I think this is a diverse society with many different points of view and we are running a serious risk of really trodding down those points of view by the position that we hold of being able to articulate our own views at the risk of ignoring the views of others who would look at this from a very moral standpoint but from their own different moral perspective.
And I would like to come back to a more practical point of view. I think Rebecca's concerns are very valid. It is absolutely clear that eggs for such a purpose of research with the hope of leading to therapy are going to be very scarce and I think the idea that some investigator is going to take 100 or 1,000 of these and do all sorts of possible experiments on them without a great deal of thought and one would hope experience from doing some of the experiments on animal — using animal eggs, that these experimenters would be very mindful of the importance of being extremely thoughtful in what is done and very thoughtful about the potential goods, the goals that can come from such experiments.
This is not something I think that people are going to enter into lightly and the very scarcity of the eggs will put a great deal of pressure on everyone to try to find alternatives that would be more widely available. And whether this is possible, we do not know. Whether it would be possible for some circumstances and not for others, we have no idea. But again my plea is not to close the door right now because of our ignorance.
CHAIRMAN KASS: Janet, if I might say, I take your comment to be not on a different subject but precisely on the subject that we are exploring.
DR. ROWLEY: But it is from a totally different perspective and that is a perspective some people have expressed but not others.
CHAIRMAN KASS: No, indeed. I mean, I think my original goal was — I mean, the vexed question here seems to be the balance between what this human material is on which the research is done and what is owed to it and to us in dealing with it and on the other side, and I think maybe this part was left out of the discussion so far when we have put it in terms of what do we owe patients who are suffering.
And certainly Irv Weissman's presentation was not just about the text of the report but the peroration and even went so far as to say it would be on our heads if we recommended any curtailment of this in terms of the suffering of various people.
So the case for that was made and is strong and the competing goods here are — I guess the one thing that was left out of the way in which we have been talking about is one cannot somehow be helpful to patients immediately without doing the fundamental scientific research about which — in fact, which was the main emphasis of Irv Weissman's presentation.
I hope everybody noticed that the move away from the much hyped therapeutic cloning, each person, his or her own little individual embryo was a very minor part of what Irv Weissman's presentation was and he stressed instead the need for different models of embryos with different diseases, and the fundamental research and development very different from the way this thing has been played in the media, played in the public. And I think Janet is certainly right to remind us that there is the proximate goal of greater understanding in the service of the ultimate goal of the relief of suffering and the cure of disease.
But I thought that the conversation from the start had as one of the competing goods already articulated and well defended is this kind of benefit. It has hardly been forgotten and I have been trying to lean on — that is what I meant by starting with Robby on this particular point. Here is a man who has been articulately defending the other side. I want to hear what he has to say to this competing good. How to adjudicate among the competing goods? That, I think, is a secondary question. The first thing is to get clarified what they are and what their weight is.
Also, I think your comment to Rebecca, I think, leads me to ask whether Rebecca wants to come back because we have really — you early on wanted to add something to this list, which is to this point, until Janet returned to it, neglected. Janet says, "Look, not to worry so much."
PROF. DRESSER: I think that gets to the part of the discussion we have not had which are the policy recommendations. One option is a ban. One option is it should not be allowed unless it is reviewed by — I mean, the RAC has come up as one example — some sort of committee that would look at the significance, the likelihood of the goal, the lack of alternative procedures. That sort of thing. And, I mean, that might be a way to handle the oocyte donor issue.
I guess, at this point, I just want to make sure that that is in the mix because in some ways to me it bears on category 3, that is the social implications, but it also in some ways bears on category 1 in that this is an essential ingredient to this entity that we are talking about and will require the participation of a woman and I do not want that to get left out of the picture.
Another thing just to get to what you were talking about at the very end is in terms of benefit what this offers. I feel strongly that we do want to try to get across a picture of the benefit. At this point it is not a therapy for people. It is a possibility. As you pointed out, Leon, probably for Irv Weissman, the main reason to do this is to have models to study disease, not to create stem cell therapies.
There is a huge amount of basic research that needs to be done so this misimpression that here we are possibly standing in the way of something that could cure patients today is really wrong and I want to make sure that we state accurately where the science is, and the contingencies, the probabilities, the time factor, the degree of research that is probably necessary before any therapies are available are important to put into that second category of what do we owe the afflicted or what are the possible benefits.
CHAIRMAN KASS: Let me make an executive decision here at the table. We are gradually losing our quorum and here is where I think — this discussion reveals that, among other things, not only is it preliminary and a lot more work needs to be done but as one suspected, one cannot treat the question of the ethics of cloning for biomedical research isolated from a whole range of other things.
One cannot really treat it separately from the question of stem cell research generally, which will be part of our charge. And I am, frankly, somewhat mystified as to how well we can do this as part of the current project or how much it has to overlap with things that will be left for us when we take up the embryonic stem cell question all by itself.
Once again, I mean, staff will try to begin to articulate the arguments of the goods which will be placed in competition. If you have got a favorite good in the race, let's hear from you. Let's hear also how you would really think to address what you owe to the people on the other side of this question because this is not an all or none matter.
SESSION 7: HUMAN CLONING 9:
CLONING AND PUBLIC POLICY: LEGISLATIVE ALTERNATIVES
CHAIRMAN KASS: We have not taken up the policy questions here. It is in a way regrettable but I think I am not wrong that to have cut off this kind of discussion in the midst would have cost us more in the long run and that we have at least the basis for beginning to move further on this, inchoate though the current situation is.
On the policy question, up to this point we have guided ourselves because we entered this discussion where policy alternatives existed out there before us in the form of two competing sets of legislation. In the discussion today, both from you, Rebecca, and from Dan Foster, talk about regulatory bodies as appended to possibly permissive activities was introduced.
And Frank Fukuyama, were he here, and he did ask me at least to allude to this, wants us — since he is much more interested in how we go about making these decisions in the long run rather than what is decided in this case, is very much interested in the question of institutional designs, review mechanisms, things of that sort that might accompany whatever happens here because cloning is not the only issue and, as everybody knows, legislation is a poor weapon or instrument for dealing with most of what we have to deal with. So Frank, also, would like very much for us to broaden our own policy considerations to include things in addition to the legislative alternatives as they now exist.
Let me propose that when we return, we will have, I hope, a draft, thanks to the contributions of all of you, on the arguments of the ethics of clonal baby making. We will try to get some early briefs prepared regarding the moral goods that have been in this discussion and we will try to lay the groundwork for a first serious pass on the policy questions, which you have been thinking about and reading about but we will have to take it up de novo.
I would also like to say that we have to start thinking about what we will take up after we take up cloning in addition to stem cell matters. We are open to suggestions but we have got ten weeks between this meeting and the next so that there is time to do real planning as well as to prepare the materials of a somewhat more sophisticated and thorough sort on this topic.
Lastly, a warning. I have not abandoned the goal of having some sort of self-conscious reflection on what we are doing, whether it be by means of finding other stories or finding someone in the group to do what Gil did for us the last time, to commission some kind of a paper where we do not have — you should forgive me, have to spend all or our time talking about human cloning.
CHAIRMAN KASS: Let me — if that is all right, if someone has an epiphany they want to add, I would like to then just without taking a break, let's just — we have two people who want to make public comments. We have allotted five minutes for each of them and if they would be willing to come to the microphone we would be very glad to hear from you.
The first is Tricia Brooks from the Christopher Reeve Paralysis Foundation. Ms. Brooks, please.
SESSION 8: PUBLIC COMMENTS
MS. BROOKS: Thank you. Is this on?
CHAIRMAN KASS: No, I do not think it is. Would you flip the switch?
MS. BROOKS: It is lit. There you go.
Hi. My name is Tricia Brooks. I am here as a representative of the Christopher Reeve Paralysis Foundation, as well as a member of the Coalition for the Advancement of Medical Research, which is a coalition made up of over 60 patient groups, universities, researchers, all who have come around the issue of embryonic stem cell research, as well as therapeutic cloning.
I want to take a moment to thank you all for your consideration of the patients in this past discussion. It was very heartening to hear you have that discussion. However, none of you are here representing the patient and we certainly appeal to the Council to take a moment and considering having a panel at your next meeting that is representative of the patients because there a lot of voices out here. They are not morally vacuous. They are not without thought or consideration of what the research entails. They are not with an unrealistic point of view of when a therapy will be made available.
We are not overstating the hope of the research. We are not overstating what the research will do for us in the next five or ten years but how can you overstate the hope that this offers? And I think that we all believe embryonic stem cell research, adult stem cell research, somatic cell nuclear transfer, all of these technologies are vital tools to alleviate pain and to ideally get to a cure.
Adult stem cell researchers have continued to say the reason why we know so much about adult stem cell research is from what we find out from embryonic stem cell research. Benefits we will find out for embryonic stem research will be doing this basic research with cloned, even though it is an awful "c" word, but somatic cell nuclear transfer will give us the — ideally give us the opportunity to learn the biology of how you take a differentiated cell and undifferentiate it so five or ten years down the road we will not need these eggs to do this research.
We certainly appeal to you to take this moment to consider having the patients come here instead of having your thoughtful consideration without their voices being heard.
CHAIRMAN KASS: Thank you very much. Robert Morrison, Culture of Life Foundation and Institution. Is Mr. Morrison here?
MR. MORRISON: Yes, I am.
CHAIRMAN KASS: Please. I am sorry, we had — maybe you signed the public guest list as opposed to the — we have a public testimony list.
Is there someone else who would like to say something
before we adjourn?
CHAIRMAN KASS: If not, thank you very much, Panel. Members of Council, thank you very much for your endurance and thoughtful participation. The meeting is adjourned.
(Whereupon, at 12:24 p.m., the proceedings were concluded.)