The Issues Facing Mankind

Editor's note: The text on this web page, including the biographical note on the late Professor Ramsey, is from the published edition of the submission of the Society for the Protection of Unborn Children to the 1982-84 Government Inquiry into human fertilization and embryology. As an archival text, it has not been amended to reflect more recent events and developments. When you click on a link to a footnote, you will be taken to another part of the page. Use the back button to return to the text.

To The Government Inquiry into Human Fertilization and Embryology

PAUL RAMSEY

Harrington Spear Paine Professor of Religion at Princeton University

Professor Paul Ramsey, an Episcopalian, prepared the following submission at the request of the Society for the Protection of Unborn Children. He is author of a number of Works on ethical issues facing society today including: "Fabricated Man"; "The Patient As Person" and "The Ethics of Foetal Research"

The Issues Facing Mankind

In 1970 I wrote (concerning many of the procedures nosy tinder review by the British Government Inquiry into Human Fertilization and Embryology'):

We need to raise the ethical questions with a serious and not a frivolous conscience. A man of frivolous conscience announces that there are ethical quandaries ahead that we must consider before the future catches up with us. By this he often means that we need to devise a new ethic that will provide the rationalisation for doing in the future what men are bound to do because of new actions and interventions science will have made possible. In contrast, a man of serious conscience means to say in raising urgent ethical questions that there may be some things that men should never do. The good things men do can be made complete only by the things they refuse to do.1
Some things to which those words referred have now been done. Others are soon to be done. All were, or are, about to have become inevitable. Persons of frivolous conscience make anticipatory surrender to futures coming upon them, voicing ethical commentary and minuscule reservations about scientific developments that always run ahead of them. Only a people of serious conscience can hope to cut athwart the momentum toward the technological dehumanization of mankind, We must seek our rendezvous with some Nevers, and the good reasons for them.

I cherish the hope that the British Government Inquiry will take the lead in the English-speaking world, and in the industrialized nations, in this urgent matter. After all, Great Britain gave us George Orwell, Aldous Huxley, and C.S. Lewis. The latter two -- writing in years still under the shadow of Nazism -- had the prescience to discern that the final assault upon humanity was not to be from the abuse of political power but of our knowledge of pharmacology and genetics. The questions to ask are: Have we skipped the year 1983? How far are we from Huxley's East London Hatchery with its "decanting rooms"? Is This Hideous Strength already inevitable? Can we stop the passage into The Abolition of Man2? Are these futures already so far our present that we have lost the ability to say it was not right to go there?

If it is objected that I have begun my testimony in a rather emotional tone, I agree. I have invoked imagery fitting in literary works. But this can be immediately translated into statements of ethical principle. My themes, measures or tests will be (A) the moral repugnance in moving from procreation to the manufacture of our progeny, (B) the integrity of marriage and the family, and (C) respect for an individual human life, however small . These principles sometimes work together, sometimes separately, in moral assessment of medical-technical possibilities that now are about to have become -- sonic will then say -- unavoidable. Scientific medicine that does not know where to draw the line of refusal before these violations is no longer civilized medicine. It would rather threaten than tend the human condition.

I

The statement of the British Medical Research Council on "Research Related to Human Fertilization and Embryology"3 laid claim to the noble word "ethics". I find -- and judge that any person instructed in the traditions of Western morality must find -- its ethical analysis fundamentally flawed; or at best, so exceeding thin as to be an example of the sort of new ethics that can aptly be described as rationalization for things men are bound to do because of interventions science has now made possible.

This is clear from the fact that, against the background of a treatment-ethic that justifies in vitro fertilization and embryo transfer, there is then no fundamental limit upon what may be done to a human embryo in order to learn from it, provided only that this research subject is not still intended for transfer. The latter reservation stays within treatment-ethics. No research-ethic is offered, however, except having a definite research aim and the informed consent of relevant donors.

These are easy to come by. Even so notice how this advocacy-ethic is played out in the Council's statement. Ideally, sperm and ova should have been collected, originally, for definite research purposes if used for such purpose. But donors may also be sought out and their consents obtained where the collection was for therapeutic purposes only. This weakens the limitation, and surely must be intended to do so. Are not people, who no longer want or need surplus stored sperm and ova for their original purpose, more likely to change their minds, when asked, than they are to consent to give semen, or to the procedure for obtaining ova, in the first place for research purposes? Thus research aims are governing, almost solely. Participants in sperm and ova banks are a consent-prone population. And are they not wanted so to be, if embryos are wanted as pure research subjects? Such donors may be informed; but in a strong version of "informed consent" -- if the donation is to be fully voluntary -- should not the rule be that no embryos be used in research unless donated in the first place for a specific research aim?

Even so, there is more respect given to the informed consent of conscious individuals than there is respect for the human embryo. Of the latter, there is none at all. There are, indeed, two stipulations upon what may be done with human embryos in experiments. These stipulations, which seem to surround the embryo with some protection, are not principled ones; and for them there is no justifying reason, so far as I can see.

The first is: "Human ova fertilized with human sperm ", i.e. , human embryos, "should not be cultured in vitro beyond the implantation stage" (my emphasis). Why not? Since such research subjects are not intended ever to be transferred to the uterus, is not this stipulation quite arbitrary? Then, is not the line drawn open to be moved on in time when some definite research aim, requiring that, comes into view? And even if such research aims are, step by step, primarily directed to the care of other future individuals, is not the way opened toward the extracorporeal gestation of human embryos, and the manufacture of our progeny? I see no other outcome unless some line can be drawn based upon respect for the human embryo, a unique individual (to claim no more for it) of our species. One can always un-stipulate a mere stipulation.

The second concerns "interspecies fertilization".4 Such "fertilized ova", i.e. hybrid embryos, "should not be allowed to develop beyond the early cleavage stage" (my emphasis). This stipulation parses the arbitrariness of the first. Why not to the outer limit of the implantation stage in humans, or in the "donor" animal species, or the average of the two? It is sun-clear that drawing lines upon research with the human embryo cannot properly be based on extrinsic considerations only, or on emotional revulsion to culturing interspecific products longer, nor upon some moral reasoning also from respect for a human life however small.

In the discussion of the British Government Inquiry in the House of Lords,5 Lady Saltoun asked whether the Government would " find it possible to suggest to the medical profession that, pending the report of the committee, they should call for a halt in experiment in the meantime?" In reply Lord Trefgarne stressed that "The main purpose of the inquiries relates to the promotion of viable pregnancies in women who could not otherwise achieve them", adding that "Your Lordships may have seen the guidelines issued last week by the Medical Research Council which will greatly assist in these matters".

I have said enough to indicate that, in my considered judgment, those guidelines do not constitute a good beginning toward determining what the medical profession and a civil society should refuse to do to make complete the good they do. I respectfully express the hope that the Committee will be initially prepared to say "Never" to a number of things that are now being done or proposed that are now proximately possible to be done, and not merely to things that may be only remotely possible . Remote possibilities are soon proximate, and soon done.

II

The paper provided by Mrs J.C. Croft, Secretary to the Inquiry, entitled "Medical and Scientific Developments Relevant to Human Fertilization", was intended to outline existing techniques and future developments that will be discussed by the Inquiry, as reference points to guide respondents who may wish to submit testimony. This paper has been submitted to me; and I recognize, of course, that it is descriptive only and intends no evaluation of the procedures mentioned and sketched.

Nevertheless, it will be convenient -- and perhaps helpful -- for me to arrange some evaluative testimony around items and statements in this paper.

It is difficult to see that all these procedures are immediately relevant to the treatment of human infertility, or that they are primarily intended, as Lord Trefgarne puts it, to promote "viable pregnancies in women who could not otherwise achieve them". If they are, the meaning of "achieving a viable pregnancy" is stretched beyond recognition and beyond reason.

That is the way I would express my overall evaluation. Another way to say the same thing is in terms of the task given to the Inquiry. That task is terribly difficult and terribly urgent, namely, to distinguish between things that now or proximately, in intention and primary effect, are for the promotion of viable pregnancies in women who cannot achieve them, on the one hand, and, on the other, things that proximately promote and whose primary effect promotes (A) the replacement of procreation by the manufactury of our children, (B) an assault upon and a fundamental violation of marriage and the family, and (C) exhibit and nurture no respect for that "intervening" individual human life -- the human embryo -- that is now for the first time in human history almost literally "in our hands", i.e., to manipulate as a research subject.

Granting the many "gray areas" and "borderline cases" falling under the Inquiry's mandate, I suggest that at least some light may be thrown upon them by endeavouring in each instance to discriminate between the intention of the research (which may be therapeutic) and the primary effects or consequences it may be reasonably expected to have upon one or more of the moral matters listed above. Is the way to those outcomes paved with therapeutic intentions? What regulations -- including prohibitions -- should be issued in Great Britain by some legitimate authority, professional or governmental?

But here, my comments on selected items in the sequence in which they come in the informational paper:

1. Par. 9(b) describes the case of IVF with the egg of a woman (unable to bear and birth a child) and her husband's sperm, the embryo transferred to the uterus of a surrogate mother who carries the child and returns to its genetic parents after delivery. Par. 10 describes the case in which a husband and wife contract with a surrogate to conceive, carry amid birth a child fathered by that husband by AID, to be returned to the married couple of which only the husband is its genetic parent .

In the first case the husband achieves a pregnancy and the wile achieves a pregnancy, and the pregnancy they achieve is in the surrogate's uterus (if I understand the usage of the term "pregnancy"): she, too, achieves a pregnancy, I also suppose.

In the second case, the donor achieves pregnancy; and, I would say, so does the surrogate. The wife in the contracting couple achieves an infant.

I venture to say members of the Inquiry will have difficulty agreeing upon a different term by which to refer to these different cases in their discussions. More important it is to say that either one is another step toward the manufactury of our children, and both are further assaults upon the integrity of marriage. To suggest that the second "pregnancy, in effect, was no different from other AID pregnancies" is a mistake, even descriptively. The pregnancy was no different, of course; but where, in whose uterus, and perhaps other circumstances (money payment, as in the USA) makes a decisive difference in any moral appraisal, and in public or medical policy concerning the matter. The AID procedure was the same. But two steps of the same sort are still two steps -- unless we are to say that by going to the practice of AID this next step was then already about to have become inevitable, and is now thereby rendered morally justified.

Consider next the surrogate woman in either case and what we are to say about the competence and power to be ascribed to her "informed consent", in morals or in medical and public policy. Choice, I suggest, does not make right right, or wrong wrong. Our common law held that no one has property right in his or her own body; nor did the family of a deceased person have any property right in the body. This language protected persons from --voluntarily, I shall presume -- abusing their bodies by using them in commercial transactions -- today, say, by selling a paired organ to pay a child's $12,500 a year tuition at Princeton University: parents were to be barred from such well-meant devotion. As for the family of the deceased, to say they had no property right in the body was to say their right over it was to provide decent burial.6 In the US, the Uniform Anatomical Gift Act was needed to change the common law by statute. In doing so, that Act legislated precisely the protections from commercial use of one's own or another's body. A pre-mortem power to give an organ was instituted, but not a power in families to give parts of the deceased's body without that pre-mortem gift. I conclude that charitable intentions do not morally warrant violation of one's own or another's body, not to mention money payments (which the British Government Inquiry may readily agree should be given an effective Never).

It is the supposed rightful power of "charitable" voluntarism on the part of the surrogate woman to place herself at the disposal of medical technology and of the husband-wife couple in both the above cases that needs to be questioned. Distinguishing between the therapeutic intention of procedures arid their primary effects and consequences, whatever the intentions were, is the way to parse these "developments", if they are viewed as gray or borderline. Their objective results in promoting self-violations, further assaults upon the natural foundations of the integrity of the marriage relation, and new ways toward manufactury of children are, in my view, evident and sufficient reason to say No to such procedures for promoting viable pregnancies in women who cannot otherwise achieve them. To argue the contrary renders women substitutable for one another in procreation (by consent, of course).

I conclude this point by inserting a copy of news reports published in The Times (New York, that is).

2. Cloning an embryo. Therapeutic aims are stated here, i.e., to culture and test for chromosomal diagnosis some of the clones while one or more is frozen awaiting the test results before transfer (par. 12), and to determine the sex of the one to be transferred and given birth (par. 24). These are definitions of viable pregnancy, provided in the second case the unwanted sex is a defect of a foetus. With no more defect shown, genes for other traits desired in a child can be used to satisfy other definitions of a wanted pregnancy. Do we know no more how to define desirable than that something is desired? That was one of J.S. Mill's fundamental mistakes, it is universally agreed by those who know anything about moral reasoning.

If, however, the description -- " 'the embryo would then be allowed to develop to the two or four cell stage where it would be cloned" (par. 12) --were turned into a norm in morality and for policy, it would be an evidently arbitrary stipulation, with no justifying reason that I can see. But if, in the alternative, the fact is that the procedure of cloning is not (or not now) possible beyond the four cell stage, the procedure could be repeated on each of the four cells when they in turn reach the four cell stage. So we have 16, and so on to an indefinite number of identicals cloned for research from an original fertilized egg. If there is objection to the storage of frozen embryos for some indeterminate research purpose (or for soliciting consent from people who had them frozen for some passing therapeutic purpose), there certainly should be the same objection to their multiplication.

Speaking as one of those clones helped to continue to develop (as I might if only I had been conceived in 1984 instead of 1913), why should anyone be so fearful of a host of us identicals, since there are so many good uses to which to put us if cloning is done again and again during the early cleavage stage?

And why put an end to any of us? Each is the same as the one chosen, by present primitive early transfer, no enter the human community; or, given only time, finally to be placed in Research Park to supply organs to favoured grown "twins".

Cloning as a method of choosing the sex of a wanted child (or the wanted sex of a child), par. 24, requires maintaining a clone obtained at the four-cell stage until that determination is possible (if this is later).

And par. 30 of the informational paper gives already another benefit no come from preserving cloned embryos, beyond sex determination, until foetal organs develop that are suitable for -- are we to suppose -- foetal transplants? Some organs will be usable for transplant later in gestation than other organs; some only very late.

Moreover, to limit this benefit to "foetal organs" in this paragraph serves simply to stay within the mandate of the Inquiry. No reason can be given that I can see for wasting this benefit by stopping at the foetal stage.

I have rehearsed the above front the informational paper simply to conclude that there is here -- from the beginning and not in the end only --absolutely no regard for embryonic life; respect for that novel research subject exerts on experimentation no influence whatsoever; it is already and altogether tissue only, not its later organs only, whatever the therapeutic intention may be. And I also conclude that, from the beginning and not in the end only, this is already the manufactury of our children -- in this instance, by the use of identicals that have been arbitrarily deemed to count for nothing, for a favoured one, who counts for all. In my considered opinion, there is already the odour of totalitarianism in such use of a unique individual human research subject, and in the multiplication of more for like purposes.

3. Freezing embryos to be unfrozen later for transfer to enable women to establish a pregnancy "years after" they or their partners have been sterilized or "even after" their husband's death (par. 16(a)). Post-sterilization and even posthumous use of an embryo puts a nearby time limit upon the transfer, bearing and birthing of a child, providing progeny -- I assume --for wife and husband. I suggest that while there is here a therapeutic intent, once we learn to do this, and do it, the primary effect and consequence will show those time or marriage limits to be ostensible only. Of the latter I have said enough. The posthumous transfer, as described, assumed the husband's death. But if the wife dies first, from the same motivations of lone or childlessness -- if that justifies -- the husband may secure the blessings of a child "with" his deceased wife only by searching for a surrogate "mother" . Of that, too, I have said enough.

And, of course, that is not the end of the posthumous transfer of frozen embryos. For Nobel laureates to deposit semen in a bank its the backyard of a California millionaire is, after all, a very primitive method of improving the intelligence of human offspring to come. When both egg and sperm can be chosen, i.e. both genetic components, and then when embryos of two brilliant people cams be frozen to await surrogates, married or unmarried, who want such a child, these ways of improving our progeny will offer some measure of greater chance of brilliance than from the frozen semen of (self-) selected man. Such a voluntary programme of genetic improvement would surely be advocated by the late H J. Muller, if he were alive today. And a Hitler if not quite mad -- would relinquish his "natural" method of producing supposedly superior children for a voluntary or involuntary programme -- if quite mad in another sense -- of using frozen embryos, perhaps posthumously if their genetic fathers were killed in battle.

4. Par. 27 gives drug tests on human embryos cultured in vitro as an example of their experimental use. There are an unknowable number of other sorts of experimentation with the human embryo, beneficial to others, counting the embryo for nothing but means. This paragraph also states the reason there will be increasing, almost relentless pressure to keep this novel, "intervening" human subject classed as a mere means for research use (or, what is subject to the same ethical analysis, a mere means to therapeutic goals):

"The protagonists of the use of human embryos for experimental purposes argue that the best species for human experiment is man, and claim that many uncertainties of human embryology and genetics could be resolved by experiments of this kind" (emphasis added).

To pass from "animal work" to human trials is always a move that has unknown and unknowable risks -- no matter how thorough, prolonged, complete and successful are the trials in animal models. So, we are told we must not waste this opportunity to use man to benefit man. That's the significance of what I have called this "intervening" human research subject.

Now, the risks of passing from animal trials to human trials are to be stressed, if we foolishly fail to use this best of all subjects to fill in the gap.

But before this new experimental subject became available in great numbers (whose numbers can be deliberately increased by procedures that will be the same if we continue on to the entire manufactury of our progeny), these same risks of passing from animal to human experimentation are now frequently said to be so minimal as to be negligible.

My comment consists in some observations upon this paradox. Now, we must use the human embryo and foetus to avoid the risks. Before,, we had no proceed at those same risks. The obviousness of these "necessities" before and after the embryo and foetus fell into our hands -- calls for some discrimination to be made.

Of course, it was both necessary and right for medical science and the human community to place innumerable children at unknown and unknowable risks in widespread field trials of polio vaccine. I need not stay to mention other such cases that will occur to any reader of this document.

Another class of cases is worth pondering. The first use of frozen human semen in AID (in the US, I believe) placed the children some women wanted by that means (if, indeed, they were informed that fresh semen was not to be used) at unknown and unknowable risk. This must have been so, if I understand what is involved in moving from animal trials to human. This, despite the fact that good calves had been produced from bull semen frozen for thirty years; the animal work, in this instance, was thorough amid complete. But one could not get to know whether frozen semen would not, uniquely in the human, be seriously damaging to the children-to-be. That, I say, was an immoral, and unnecessary, experiment upon them. No scientist should have done that; nor any woman have consented to in.

The same reasoning applies to freezing and unfreezing the human embryos planned for transfer, or the cloned one planned to be entered into the same sequence of freezing and transfer. No matter how complete and successful in the case of animal embryos, to move to the human puts future human beings at serious risk. If freezing, or cloning and freezing (for a short time, while medical tests are done on identicals), followed by transfer succeeds, that will not show that the human trial was moral when done. A human experiment must be moral in its inception, not in its outcome (I believe I quote the late Dr Henry K. Beecher correctly). The same can be said of long-term storage of frozen embryos for subsequent "treatment" of the childlessness death may bring on a husband or wife. Genetic surgery and gene-splicing may also be listed here -- to raise, at least, the same question about their first human trials. Finally, the physician in the doctor-lawyer team who advertizes for surrogate "mothers" in newspapers all over the US says that one reason he is doing this7 is that he wants to "study" over years of time the effects, psychological or otherwise, upon the surrogates from bearing children for another couple. That information he cannot obtain without putting women at risks he might discover are actualized, and now hopes are not there in what he is doing. Others may draw attention that he has set up no good scientific test to get that knowledge. I say, the experiment is immoral in its inception, and would still be to do wrong with that knowledge may come of it, even if his was good social science testing.

So I conclude that if we listen to the reason now given for using disposable human embryos we ought to know that a number of procedures proposed today ought not to be used upon favoured human embryos, because the first human trial must necessarily be immoral in its inception, regardless of the outcome. We will have brought upon a child-to-be unknown and unknowable risks, unnecessarily and on balance without sufficient over-riding reason. This was my view of the Edwards-Steptoe undertaking to prove that in vitro fertilization and transfer was possible: and would have remained my ethical analysis if the "animal work" with primates was completed before passing to the human.8

I do not put t his judgement of mimic "up front" simply because than is a bridge already under the water -- to coin a phrase, I am must the expert to judge whether Dr Michael Thomas is correct its holding that there is as yet insufficient grounds for a scientific judgement that IVF-transfer babies are not damaged. I do not need to know the scientific requirement no be "about 3000 test babies before we could be sure the risk isn't there".9 No one needs to know that the figure is 50 or 3000 or 30,000 successful test babies, to sustain the argument I put forward.

One has only no listens to what scientists tell us is the gap between "animal work" and human trials (and what is now said about not wasting the opportunity afforded by human embryos as research subjects) in order to know (take any figure as sufficient for a procedure no be classed as no longer "experimental") that up to that point on a descending curve the procedure was subjecting children-no-be (not just "the potentiality of life") to unknown and unknowable risks of unknown amid unknowable damage. This is the case almost analytically, if science is believed. To repeat this commentary refers to artificial insemination with frozen-unfrozen semen, to amniocentesis to select foetuses to be given birth10 over those genetically indicated for abortion, or to IVF-transfer babies only to illustrate how the morality of "setting up a pre-natal adoption service using banks of eggs and embryos" (The Guardian, Feb. 8, 1982) should be analysed, and other future possible way's of producing children or altering them in utero.

Note well, I have not been speaking of embryos planned for research, and so planned for discard. The favoured embryos have also Its count for next no nothing, when thought of as children-to-be. They, too, must be disposable mishaps, if mishaps come upon them in the course of the genesis chosen for them; replaceable by another pregnancy induced by yet another trial of the same procedure.

The other moral standards I suggest be used also apply. Does the goal of providing fertility by these procedures, when successful, open a wider path toward the manufactury of humans progeny, and further threaten the foundations of the marriage relation? I judge no one can read the informational paper and fail to answer these questions in the affirmative.

In no essential respect should proposals for the manipulated genesis of a human embryo be compared with placing young lives, for example, at unknown risks of unknown damage in field trials of polio vaccine. Those lives were already members of a population at severe risk: each individually bore the risk and stood to benefit. Nor is the new genesis to be compared with venturing gene-splicing to learn to perfect genetic treatment of Tay-Sachs babies. This will be "surgery" (not "engineering" new beginnings); no new medical moral landscape will be brought into view: the life at risk is already a life and already at graver risk. In new forms of human genesis, however, the life placed at risk is not the same as those whose desires may be satisfied by thus overcoming infertility -- posthumously, even -- or by those risks brought upon another life so manufactured in order to make scientific progress .

I cannot conclude these comments without expressly addressing the matter of abortion. If in is said only that abortion stands ready to take care of any mishaps before they are children I might ask whether early infanticide --delayed birth certificates, as some have proposed -- also stand ready? And ask, why not? The more fundamental response, however, is to say that this recourse demonstrates that now -- not by some "slippery slope" into the future -- we would already in principle be manufacturing our progeny. By primitive methods at first, of course. General Motors has sometimes to recall 500,000 automobiles to replace defective parts. The analogy to using abortion as an escape from producing defective children would be recalling those automobiles and destroying them.

But a more basic objection to the foregoing moral reasoning appeals not to the fact of the availability of abortion but to a persons' views on the morality of abortion. . In will be said than ethical objection no the new genesis of human beings depends on one's view that abortion itself is always or nearly always immoral. This mis-association must be answered.

Of course, any individual who believes that abortion as such is a moral wrong will also for that reason oppose the new proposals for human genesis, because in order no get to know how to do any of the proposed procedures we must be prepared to use abortion for a longer or shorter series of trials. Grant than. Still I want no suggest that people who wholly approve of the British Abortion Act, and of ins execution, may nevertheless and should nevertheless disapprove of the abortions here necessarily contemplated. This I have wanted, ins the above, no isolate -- no bracket -- from any general moral objection to abortion. So, while I do not know Dr Michael Thomas opinion of abortion as currently legal and practised in Great Britain, I must say that the Guardian Weekly's editorial, February 2, 1982, was flawed. That editorial linked Dr Thomas objection to the new genesis no his views on abortions in general (I do not deny that this may be so in his case) and went on no say among other things:

If our society accepts that abortions are permissible until a life is considered no be viable on ins own, an 28 weeks gestation, then logically it would seem possible to devise a code of practice under which test-tube embryos could be experimented upon up to 28 weeks.
I suppose it is possible no devise such a code, but it in no way logically follows from current British abortion practice.

For in the latter case (in principle) we are balancing existent life against other existent lives. Suppose we agree that the mother's life and health broadly interpreted, that the family's economic and other welfare, that the welfare of children already born may be deprived by another child born into the family, and that these are countervailing considerations that are over-riding and that justify therapeutic abortion -- ins the broadest possible meaning of "therapeutic" -- all that in no degree justifies creating a new human life at risks that foreseeably may require subsequent abortion.

So I suggest that people who wholly approve the British Abortion Act and in practice have good reason to oppose recourse to abortion necessary in developing new forms of human genesis. However rapid and extensive the developments in contemporary abortion practice, these are extensions of the concept of "necessity" in conflict-of-life situations. To continue on the way oh the new genesis of human lines involves no such "necessity" -- not in the genesis itself. Appeals no the morality or the practice of abortion must rather be viewed as demonstration that modern society means to proceed, under than guise, no the making of its children.

A final objection will be that the analysis arid moral reasoning I propose would stop medical and scientific progress. Indeed it would, because I refer to experiments immoral in their inception. . To this ostensible objection I can only refer to what I said about a serious moral conscience in these matters. The questions is whether we have tine ability to say "Never" . It w ill be something, an least, if its Great Britain in says "Never" . to surrogate motherhood, not no be expected in the United States. The argument holds as. firmly for saying Never no any human genesis than entails first creating human life that then may be destroyed if not the desired "product".

5. I ought, responsibly, no comment on one further, distinct items in the informational document. This is also most complex, and incorrigible to certain analysis. On the genetic manipulation of embryos, the instance given (par. 29) is identifying arid replacing the gene for cystic fibrosis ins an IVF embryo. Other single gene diseases are mentioned. The limitation no IVF embryos can, I think, be ignored; and the suppositions be that this could be done in embryo, foetus, child or adult, the course of future possible genetic treatment ("surgery") of suffering individuals. That surely would be a consummation desirably to be wished, if the relief of specific genetic illness were the only consequence to be considered. If only the afflicted individual needs no be considered, one should ask only -- but one should ask, as in all surgery -- whether the genetic treatment of cystic fibrosis is likely or not no produce less or more debility than the illness itself. This is a question all major surgery faces.

Sadly, one must add to the above statement of ordinary treatment-ethics that the elimination of one gene (defective) requires its replacement by another gene (neutral, or improving of that individual). So even in the case oh genetic treatment of an individual we face the fact that negative genetics cannot be separated from electing positive genetics of one sort or another. So far good -- except to say that a facile conclusion to that effect without US Nobel laureate Marshall Nirenberg's sombre pondering of the awesomeness of our ever learning to move one gene around (involving another in its place) shows inadequate understanding of the gravity of the step taken.

The measure of risks to be accepted in proceeding with genetic treatment is the balance of the seriousness of the illness no be relieved against possible debilitating outcomes of the treatment itself.

To proceed against Tay-Sachs, for which there is no known cure, Yes. Against cystic fibrosis, for which there is some relief, less certainly. To proceed no gene change in the case of diabetes, however, would surely be an immoral trial. The aim of medicine is no make a patient well, or at least less ill than before.
The simple medical situations, however, is further complicated if we ask what happens to the gametes of the afflicted individual. If his or her reproductive cells are unaffected, or if sperm or ova are in turn deprived of the transmission of cystic fibrosis to offspring, that would be additional defense of the original genetic treatment. But what if the effect of that genetic treatment of individual sufferers may have unpredictable effects upon their gametes? Then instead of eliminating a deleterious gene from the human gene pool, we shall have thoughtlessly begun to "engineer" their progeny in unknown and unknowable ways. Shall our policy be that those benefiting from genetic therapy shall accept sterilization to prevent these outcomes?

This would seem to be sufficient cautionary "go slow" signs facing the medical application of genetic knowledge to human beings. Still these signs are not negative. (All said above about creating or cloning embryonic human research subjects for the purpose of carrying out such tests remains in place.) The treatments proposed for trials, properly limited by the usual medical estimates of costs and benefits to the patient, are sound. Modified only, but significantly, by the effects upon the patient's progeny.

Today DNA research, gene-splicing, whole chromosomes replaced by others, have leapt light-years ahead of the foregoing situation, however simple; even its complexities seem simple by comparison. Under the production of inter-species embryos, the informational document speaks of hamster-human hybrids; and, one might say if this were an evaluative document, with some regret that such hybrids can now be maintained only to the two-cell stage (par. 26). In the United States we have Mighty Mouse, a creature produced by gene-splicing, that from small mice produces very large rats.

What future does this hold for genetic engineering of the human race? It remains the case, I suppose, that a splice of genes eliminated must be replaced by another splice of genes. That, therefore, negative energies cannot be separated from positive eugenics. The apology -- in the best sense of that word -- in the United States for DNA research and application is that we are learning about cell development, and specifically that we may learn how to cure "cancer" -- a code word that instantly gains approval. But surely more is involved than that, in the primary consequences to be expected from DNA, whatever the subjective intentions of the researchers.

Some discrimination should be attempted by public authorities, such as medical associations and the British Government Inquiry. I note that I have already reasoned that no such research is ever justified on an unconsenting research subject, a human embryo obtained or cloned for that purpose, who was not before its creation subject to any risks at all. Beyond that, and I suppose on consenting subjects, or unconsenting subjects already existent and in serious need of radical treatment, I can only endorse the recommendations of the (US) President's Commission that all DNA research and applications be monitored in future.11

This means, I take it, monitored in each and every specific use of DNA knowledge in the human -- monitored in every particular case, not simply checking the accord between research and general guidelines laid down for it to follow.

I hope that the British Government Inquiry will endorse this proposal, and go further. No hope should be placed in merely national governmental or medical association regulations. Already, in Australia experiments in freezing embryos have gone beyond what the British Inquiry may approve. So, if there is point in national monitoring of specific applications of DNA, this must be international. So I urge that the Inquiry take the lead in pressing upon the European Parliament, the United Nations, or other international bodies, the need to monitor and control the use of the knowledge of human genetics that DNA has opened to us.

Why I am so concerned that the British Inquiry not parochially limit itself to monitoring DNA research in Great Britain alone can best be expressed by recounting certain personal episodes. Since I became concerned about measures for Fabricating Man in the late 1960s, on many a panel in American universities on the subject of the new genetics I was astonished to hear scientists on the panel (those were the "cold war" days), nay, even stupefied and nonplussed to hear these academic scholars suggest that even now certain powers (Red China was meant) were producing physically superior soldiers. and intimated that we had to do this also. Then the pseudo-question was competition in producing superior men. Now surely the competition is as intense in the furtherance of scientific possibilities. So I say there must be not only national monitoring but international monitoring of DNA research and its specific application. If not, results will outrun all moral and civilized control. So I urge the British Inquiry to take the lead in the international control of these new powers human hands have now obtained.

To conclude: a fellow townsman of mine in Princeton, New Jersey, Freeman Dyson, a member of Princeton's Institute for Advanced Studies, a British citizen and a member of your war department in some capacity in World War II, recently published a book entitled, Disturbing the Creation, concerning the course of past nuclear decisions. This was a very melancholy book; the combination of technology and bureaucracy seemed to him inevitably fateful and erroneous; their momentum beyond human control.

I refer to Dyson's book to say that we are in the midst of another "disturbance of the creation" as a result of the biological revolution. In the revolution of nuclear physics we had not even the foresight to provide for the disposal of nuclear waste before we went for the peaceful use of nuclear energy! Now the Western world is alerted by various movements concerning nuclear arms policy to what may have been flawed decisions past. The public concentrates upon past Faustian bargains made with nuclear power and its sequelae.

Are we unable to concentrate on the Faustian bargain now being made with powers released to human control by the biological revolution? Does the momentum of biological technology rule our future? I myself believe that this may not be so. But if one reads the newspapers the conclusion must be that we the people seem able to try to contain Faustian bargains previously made by past generations, neglecting those currently being firmly enacted, without much notice, by the momentum of biological technology. So I conclude with some words from C.S. Lewis:

. . . All long-term exercises of power, especially in breeding, must mean the power of earlier generations over later ones . . . If any age really attains, by eugenics and scientific education, the power to make its descendants what it pleases, all men who live after it are the patients of that power . . . The last men, far from being the heirs of power will be of all men most subject to the dead hand of the great planners and conditioners and will themselves exercise least power upon the future . . . There neither is nor can be any simple increase of power on Man's side. Each new power won by man is a power over man as well. Each advance leaves him weaker as well as stronger. In every victory, besides being the general who triumphs, he is also the prisoner who follows the triumphal car . . . The man-moulders of the new age . . . we shall get at last a race of conditioners who really can cut all posterity in what shape they please . . . Nature will be troubled no more by the restive species that rose in revolt against her so many millions of years ago, will be vexed no longer by its chatter of truth and mercy and beauty and happiness. Ferum victorem capit: and if the eugenics are efficient enough there will be no second revolt, but all snug beneath the Conditioners and the Conditioners beneath her, till the moon falls or the sun grows cold . . . (We should) not do to minerals and vegetables what modern science threatens to do to man himself.12
Respectfully submitted,

Paul Ramsey
Harrington Spear Paine
Professor of Religion, Emeritus
Princeton University

Footnotes

1. Fabricated Man: the Ethics of Genetic Control. New Haven and London: Yale University Press, 1971.), pp.122-123 (emphasis added).
2. This is the title of C.S. Lewis' prose essay that should be read as. a companion piece to his fictional This Hideous Strength.
3. British Medical Journal, Vol. .285 (1982 ) p.1480ff.
4. The Council's statement gives the aim or possible benefit of creating such novel research subjects. There will be citizens of Great Britain who will invoke Leviticus as basis of their religious and moral objection to it. Lev. 19:19 is the verse. A fresh interpretation was offered by Benjamin Freedman, "Leviticus and DNA: A Very Old Look am a Very Old Problem", Journal of Religious Ethics.
5. Official Report of the Proceedings, House of Lords, November 30, 1982.
6. The reference I am familiar with is Paul Ramsey, The Patient As Person, New Haven and London: Yale University Press, 1970, pp.204-206.
7.The lawyer has stated that he wants to clarify our muddled law - which, being interpreted by this layman, means that he wants to bring about widespread social acceptance of the practice before our laggard law can do anything about it.
8. See Paul Ramsey, "Shalt We Reproduce?" 1. The Medical Ethics of In Vitro Fertilization. II. Rejoinders and Future Forecast", Journal of the American Medical Association, Vol.220, nos.10 and 11 (June 5 and 12, 19721, pp.1346-1350, 1480-1485; and Paul Ramsey, On In Vitro Fertilization, which was my testimony before the Ethics Advisory Board of the US Department of Health, Education and Welfare shortly after Louise Brown was born in England, published in the Law and Medicine pamphlet series of Americans United For Life, Inc., 230 North Michigan Avenue. Chicago, Illinois 60601. See also two articles by Professor Leon Kass, M.D.. Ph.D., the Henry Fuce Protessor of the Liberal Arms of Biology at the University of Chicago." Making Babies Revisited", Public Interest, No.54 (Winter 1979) pp 32-60: and "Making Babies - The New Biology and the 'Old' Morality", Public Interest, No.26 (Winter 1972). Professor Kass' articles were published at about the same time as my two listed above, and were also roughly eight years apart in time. His first article and my first, were written in preparation for an international conference on our medical-mechanical futures sponsored by the Joseph P. Kennedy, Jr., Foundation in Washington DC, for a panel on which Dr Robert G. Edwards was also a participant. Subsequently Dr Edwards published his article, "Fertilization of Human Eggs in Vitro: Morals, Ethics and the Law", The Quarterly Review of Biology Vol. 49, No. 1 (March 1974. pp. 3-26 (Stoney Brook Foundation Inc.). The second roughly contemporary articles by Kass and myself were occasioned by the apparent success of the Edwards-Steptoe experiment. Both of us - I venture to say, the two persons in the US who have given the most sustained attention to the moral and public policy issues of IVF - had occasion to comment in these articles on Dr Edwards' 1974 analysis of such implications of his work. A shorter and revised version of my On In Vitro Fertilization was published in Great Britain in Crucible London: Board of Social Responsibility, Church of England, Oct.-Dec., 1981, pp.175-181.
9.Dr Michael Thomas' figure, as reported by Peter Williams and Gordon Stevens, "What Now For Test Tube Babies?", New Scientist, Feb. 4, 1982.
10. Concerning amniocentesis Dr Henry Nadler, Children's Memorial Hospital, Chicago, wrote (in an article written in 1970, published in 1972) than only defects established before amniocentesis was performed could be excluded from its possible adverse effects. "There is no way with present studies", he wrote, "of establishing ten or fifteen years from now if these children lose 5 or 10 IQ points. We might be able to get an approximation during the first years of life if their rate of growth significantly different. However, more subtle damage will be difficult to evaluate", in M. Harris, ed. Early Diagnosis of Human Genetic Defects: Scientific and Ethical Considerations (Symposium, May 18-19, 1970) US Government Printing Office, 1972, p.182 (my emphasis). This suggests that to declare a procedure manipulating human genesis to be no longer experimental needs more than any number of grossly successful trials. Longitudinal psychological tests over many years against an equally numerous "control" group seem also to be required.
11. Splicing Life: A Report On The Social And Ethical Issues of Genetic Engineering With Human Beings. Nov. 1982, p.87. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioural Research. US Government Printing Office, Washing DC 20402. The "President's Commission" was the chronological successor of the Ethics advisory Board within the department of Health, Education & Welfare. The latter was short-lived, reporting to the Secretary only on IVF research. It was successor to our temporary Nation Commission for the Protection of Human Subjects of Biomedical and Behavioural Research.
12. C.S.Lewis, The Abolition of Man, New York: MacMillan Co., 1947, p.48Footnotes, addendum, & press reports referred to.

New York Times, January 23, 1983.

Surrogate Mother's Deformed Baby Rejected

LANSING, Mich., Jan. 22 (AP) - The surrogate mother of a deformed baby says she plans to put the boy up for adoption because the man she contends is the father has also rejected him. The baby was born Jan. 10 and remains in the hospital without a name.
Judy Stiver, 26 years old, of Lansing, gave birth to the child nine months after she was artificially inseminated with sperm from Alexander Malahoff of Middle Village, Queens.
But Mr Malahoff says the child is not his and he has refused to pay a $10,000 fee to Mrs Stiver for carrying the child.

The baby was born with microcephaly, in which the head is smaller than normal and may indicate mental retardation. The baby also had an infection. Lansing General Hospital had to obtain a court order to treat the child.
Mr Malahoff says the baby's blood type does not match his and therefore he could not be the father.

Tells of Examination

But Mrs Stiver said she had a thorough examination to guarantee that she was not pregnant before being inseminated with Mr Malahoff's sperm in April and that she and her husband then abstained from sexual intercourse for 30 days.
"We don't feel the baby is ours", said Mrs Stiver's husband, Ray, 41. "We feel no maternal or paternal relationship. We feel sorry for it, but we don't want it."
Mrs Stiver said she feels "some affection" for the baby "but there is no bond".
"I've only seen him through the glass," she said.
"When we saw Malahoff last Thursday, he considered the baby his," said Mr Stiver, who is a part-time bus driver. "He accepted the deformity and had the baby baptized because he didn't expect it to live through the week. He only asked the hospital not to do a spinal tap on the infant and that he never gave them a blanket request not to treat the child."

For Paying Bill and Vacation

The Stivers, who have a 2-year-old daughter, said they agreed to the arrangement for money to "pay bills and take a vacation."
"We feel we performed our part of the bargain," Mr Stiver said. He said legal steps were being explored to guarantee payment of the $10,000.
"We should be paid," he said, "We feel like we've been stabbed in the back."
Ingham County probate officials said the Stivers probably would be allowed to release the baby for adoption and even named it - Alexander. He planned to have it institutionalized.
"Everything was fine," Mr Stiver said, "until he got to Dearborn," the Detroit suburb where the lawyer, Noel Keane, who set up the surrogate arrangement, practices.
"Keane started making all these medical statements, but he's not a doctor," Mrs Stiver said. The doctors they have consulted do not agree with the blood test results Mr Keane is relying on, the couple said.
Mr Keane said last week that doctors he had consulted had confined that Mr Malahoff had Type AB-positive blood while the baby's had 0-positive, meaning Mr Malahoff could not be the father.
Mr Keane said, "Malahoff said that several couples had expressed interest."
Hospital officials described the baby as in "in good condition". They said they did not know when he would be released.

New York Times, February 3, 1983

Baby Doe to Go Home

CHICAGO, Feb. 2 (AP) - Blood tests prove that a sickly child born to a Michigan woman was not fathered by the man who paid her to be a surrogate mother for his baby, lawyers agreed today, and the mother said she would now seek custody."
"There were no winners, said Alexander Malahoff, 46 years old, of Queens, Y.Y., who had entered into a $10,000 contract with Judy Stiver to carry and deliver the child for which he provided the sperm by artificial insemination. "Everybody suffered."
Mrs Stiver, 26, said she and her husband, Ray, 41, would now move to gain permanent custody of the male child she delivered Jan. 10 at a hospital in Lansing, Mich. At birth, the child, known only as Baby Doe, had a strep infection and microcephaly, a condition in which the head is smaller than normal. This is often an indication of mental retardation.
The Stivers said they obeyed the contract strictly and could only have conceived the child because they were not properly instructed to abstain from intercourse in the days immediately before the artificial insemination.
"We are thoroughly satisfied with the results of our testing that Mr Malahoff is not the father of Baby Doe," Dr W.E. Maldonado, director of the Department of Laboratories at Lansing's Sparrow Hospital, said at a news conference after informing lawyers for both sides. "Our exclusion of Mr Malahoff is 100 percent."
Noel Keane, a lawyer in Dearborn, Mich., who represented Mr Malahoff in the contractual arrangement, said he would return the money paid by Mr Malahoff.
William Leininger of New York, an attorney for Mr Malahoff, said doctors had told his client the extent of retardation was "severe" and that the child had only a few days to live. Mr Leininger said Mr Malahoff had the child christened Alexander in accordance with his Roman Catholic faith. Mr Malahoff had agreed to assume "legal and moral responsibility" for the baby if he was proven to be the father.
Mr Stiver said the child would be renamed Christopher Ray.

New York Times, February 7, 1983

Legal Snarl Developing Around Case Of a Baby Born to Surrogate Mother

By IVER PETERSON
Special to The New York Times

DETROIT, Feb. 6 - Perhaps Christopher Ray Stiver will be able to go home soon. If he does, Judy Stiver knows she will love him as one of her own, which he is.
Or perhaps he will spend a life in a state institution for the brain-damaged, and never find out about his early hours as the paid-for baby who lay sick while grown-ups argued whether he should live or die.
"It's just that I've always thought this baby was for somebody else," Mrs Stiver said in an interview last week in Lansing. "Whenever we talked about it, it was never 'my baby', it was the baby for someone else their baby - so I never developed a maternal feeling about him.
"But I'm sure the feeling will come real fast when I bold him, because I love all babies. "

Legal Fight Developing

The people Mrs Sliver thought the baby belonged to were Alexander and Nadja Malahoff, a childless couple from Queens. They agreed to pay her $10,000 to be artificially inseminated with Mr Malahoff's sperm, bear the ensuing child and give them custody of the baby.
But the baby was born with a birth defect that suggests that he will be retarded, and with a severe infection. Medical tests showed that Mr Malahoff was not the father, and he does not want the child. Mrs Stiver and her husband, Ray, lost no time in declaring that they would take the baby home and raise him.
Late last week, The Associated Press reported, Mrs Stivers said she had been told that the baby might be too mentally impaired to return home and might have to be kept in an institution.
Mr Malahoff, who has separated from his wife, is suing the Stivers for $30,000, asserting they violated the terms of their contract by having intercourse in the insemination period, and the Stivers, who say they faithfully followed the instructions of doctors, are contemplating a suit against the doctor who inseminated Mrs Stiver.
The lawyers who manage this growing practice call it "surrogate parenting." Critics call it baby selling. Whatever the name, the growth of the practice arises less from any new technology than from evolving attitudes about women and babies, and families, and money. Artificial insemination, even of humans, has been practiced for years.
With an estimated 100 women across the country carrying babies for someone else, the Stiver case attracted attention only because everything that could have gone wrong did go wrong. The infant spent his first minutes sick and in danger of dying while the grown-ups argued about whether he should be given treatment to save his life.

Mother Chosen From Album

The Malahoffs picked Mrs Stiver to bear a child for them from an album of pictures of willing surrogates kept by Noel Keane, a Dearborn, Mich., lawyer who has made a speciality of arranging these births. His fee is $5,000.
4 'Most of the girls sent Keane little pictures of themselves and the kids they already had, so people could see," said Ray Stiver, a Lansing bus driver, "but Judy sent this big one of her and Mindy, and they picked her to be the mother."
"Apparently Malahoff really liked Mindy," he said, speaking of their daughter, who is almost 3 years old.
On April 15, Mrs Stiver was examined by a Dearborn physician, according to the Stivers. They said he certified that Mrs Stiver was not already pregnant, then inseminated her with sperm taken from Mr Malahoff.
Mr Stiver, who is 41, had no qualms about it all. "Some people look at it as a form of adultery, some people look at it as a commercial venture," he said. "I don't. I look at it as Judy being inseminated by a man so that she can bear a child for him and his wife, because she can't have children herself."
"Sure, the money is a big thing in it, because it's helping us financially, but in turn we're giving them probably the greatest gift that anyone could ever have, which is a kid of their own."
But is there not an element of renting out her body? Mrs Stiver was asked.
"I've never thought of it as renting my body out, I've just thought of it as having a baby for somebody," she said. "And that's about it, because, like Ray said, we love our kids so much and if somebody can have a kid that's even half their own.. ." and she let the answer trail.

When the Child Was Born

On Jan. 10, after a long labor, and with Mr Malahoff and her husband present, Mrs Stiver delivered a baby boy. And the trouble began. The baby was microcephalic, a condition marked by a smaller than normal head that often indicates retardation. His umbilical cord had two knots in it and he suffered from a severe infection.
Mr Malahoff, who, as the presumed father, had signed the birth certificate with Mrs Stiver, was approached by the pediatrician for permission to begin the medical treatment without which the baby would die. According to the Stivers and court records, Mr Malahoff did not want the baby treated.
"The first thing he said, he asked me how did I feel about all this," Mrs Stiver related, "and I told him I'm leaving the decision entirely up to him, but I didn't think he should let anybody die. But he said, you know, let the baby die and me have another one for him, and I just said" no. Mr Malahoff, a 46-year-old accountant with the New York City school system, has an unlisted telephone number and could not be reached for comment. Mr Malahoff's lawyer, William Leininger of Staten Island, did not return four telephone calls asking his client's position.
Last Wednesday, in a taped appearance on the Phil Donahue television show with the Stivers, to be broadcast later around the country, Mr Malahoff denied that he wanted the baby to die.
Nevertheless, doctors at Lansing General Hospital, where the baby was born, felt moved to seek and obtain a court order barring Mr Malahoff from interfering with the baby's treatment. They submitted affidavits that he had attempted to do so.
The baby was born on a Monday, and on the following Saturday the Stivers received their $10,000 check. On the next Monday, before they could cash it, they were told there was a problem: Mr Malahoff asserted that he was not the father and cited the baby's blood type as listed on the birth certificate.
"Yeah, I'm probably a little disappointed," Mr Stiver said of the finding, "but I'll have to live with it."
Sitting in the kitchen of their little home in Lansing, a pot of coffee bubbling, with Mindy playing on the floor and babbling about the new baby, the Stivers are the picture of a happy family with only smiles for the world's strange events.
"I would do it again," Mr Stiver said without hesitation. "If Judy wanted to do it again I would support her 100 percent."
Mrs Stiver said: "Don't ask me that now. Ask me in six months. My parents put that question again in six months time."

NOTE: In the morning before this report was published, the results of the paternity tests that excluded Mr Malahoff as the father were telephoned to his lawyers who were present with both couples (the Malahoffs and the Stivers) in the studios of a popular daytime TV variety talk show, and the results of those tests were instantly televised to the nation. Gins that broadcast the Stivers announced that they would "accept" the baby despite its defects (which are not deeply serious); and the Malahoffs announced that they now would have done so also if Mr Malahoff's paternity had not been excluded.

ADDENDUM

The British Government Inquiry can - if it so determines - obtain our President's Commission's Splicing Life, and the earlier report on IVF-transfer by our Ethics Advisory Board.

I append here my own analysis of the latter, written some time ago, used in public lectures but never published.

Gruesome Futures

by Paul Ramsey


1 . The Ethics Advisory Board fudged the funding issue. " 'The Board concluded that it should not advise the Department on the level of Federal support, if any, of such research ..." This was proper reticence, if, but only if, the Ethics Advisory Board had been composed of professional ethicists alone. Instead, it was a Board composed of a broad spectrum of professions, with only two ethicists among them. Now, surely, there are ethical aspects pertaining to the allocation of priorities in the use of Federal funds for scientific research and health objectives. It is at the point of funding, for example, that a decision has to be made whether more good can be done for this class of infertile women by doing something about the epidemic of gonorrhea, which is the chief but not the only cause of oviduct blockage. Other priorities might also impinge, such as the use of scarce Federal funds in the assistance of poverty families and attacking our rather high rate of infant mortality which unavoidably compete for funds that would be devoted to the development and application of this new technology.

Indeed, in our National Institutes of Health there is an established procedure of two levels of review; first, a scientific committee assesses the merits and feasibility of a proposal on purely scientific grounds. Then, secondly, there is a " 'public committee" which decides which of the feasible proposals shall be funded in a given fiscal year. Clearly the Ethics Advisory Board was such a public committee and should not have avoided the question of how funds in this and related areas should be ranked in order of priority.

Upon the presentation of this Report to her, the Secretary of DHEW ruled against the use of any Federal funds for IVF, or for pure research on human embryos (rejecting a request for funding the latter at Vanderbilt University).

This did not rule out private or state funding for either of the above purposes. So shortly thereafter the Drs Rogers at Norfolk (Va.) Medical Centre opened its IVF clinic. This in our Federal system required only the authorization of the Health Department of the State Department of the State of Virginia.

The Washington Post summed up the public controversy occasioned by this proposal, coming down in favour of the IVF clinic. This Post editorial (Jan. 19, 1980) concluded with the following statement:

The clinic should be built. But the trade-off for that should be some insistence on the part of medical authorities, religious leaders and others that we begin to get serious and systematic about exploring the ethical issues and setting real limits on the future directions of research and practice in genetic engineering and reproductive biology.

That was one of the most astonishing statements I have seen in the American press. So also was the following from the New York Tunes editorial, July 22, 1982:

In particular, the question of whether the human germline should be declared inviolable deserves close attention. Such a restriction will probably prove unjustifiable. But deliberate manipulation of the human germline will constitute a watershed in history, perhaps even in evolution. It should not be crossed surreptitiously, or before a full debate has allowed the public to reach an informed understanding of where scientists are leading. The remaking of man is worth a little discussion.

(While these editorials were quite astonishing for a Press that is usually upbeat about scientific breakthroughs, I nevertheless class them as instances of the "frivolous" moral conscience I spoke of at the beginning of my statement to the Inquiry. That is to say, warnings of things to come, with no ability now (i.e., ever) to say Never. So above I set aside IVF-transfer as a "bridge under the water". The moral argument against similar things to come [esp. par. 4 above] remains unquestionable. I send along this addendum simply because it may put before the Inquiry certain peculiarly American barbarisms that I expect Great Britain will avoid.)

2. In the second place, the Ethics Advisory Board reached a unanimous consensus opinion by advising the Secretary that both IVF and embryo research proposals were "acceptable from an ethical standpoint". This expression was then explained:

This phrase is broad enough to include at least two interpretations: (1) "clearly ethically right" or (2) "ethically defensible but still legitimately controverted". In fact that research involving human in vitro fertilization is " 'acceptable from an ethical standpoint", the Board is using the phrase in the second sense. The Board wishes to emphasise that it is not finding that the ethical considerations against such research are insubstantial.

Margaret Steinfels, in her analysis of the Board's report in the Hastings Center Report, said in effect that that statement finessed the ethical issue as well. She wrote: "What does the Board mean by "ethically defensible? Erudite treatises may clarify the matter. In the meantime, only questions can be raised about it". The author of that language was Richard McCormick S.J. Anyone who knows something about the history of Catholic moral theology will recognise that McCormick carried over into a medical and public policy question a confessional distinction devised to apply in cases of "doubtful conscience" where sin and the salvation of an individual soul is believed to be at stake. In case a conscience in irremovable doubt finds that there are a significant number of theologians who say some action is wrong, others that it is morally right, the individual is at no risk of damnation if he follows the "probable" opinion. Indeed, in Jesuit probabilism, one may even follow a minority opinion among those who have seriously thought about the issue!

In the correspondence column of the Hastings Center Report Richard McCormick heatedly defended these statements for which he assumed the responsibility of authorship. If I read his response correctly, anything that is "controverted" is "legitimately" controverted. That is like saying that anything that is desired is desirable. So the Ethics Advisory Board made itself hostage to any controverted opinions to come. Of many proposals in medical and public policy it can be said, in that sense, that it is ethically defensible, but still legitimately controverted.

In her reply Peggy Steinfels immediately saw this point. She wrote:

" Initially the surface meaning seems so unsatisfactory that I assumed there must be more to the phrase than I saw. I now understand that what I see is all there. Richard McCormick is simply saying that a public body, such as the Ethics Advisory Board, should find acceptable from an ethical point of view any position for which plausible arguments have been made. Active euthanasia, deception in research, amniocentesis for sex choice, by-passing informed consent, and possibly even infanticide are all issues where serious, plausible and favourable arguments have been made. Are they ethically acceptable because defensible? In fact, it is hard to imagine any major issue that would occupy a public body's time that was not legitimately controverted".

3. In the third place the Ethics Advisory Board attached certain stipulations that they apparently believed provide assured limitations upon what might in future be done with this medical knowledge. Concerning research on fertilized eggs it stipulated that "no embryos will be sustained in vitro beyond the stage normally associated with the completion of implantation (14 days after fertilization)". Concerning research involving embryo transfer following in vitro fertilization, it stipulated that "embryo transfer will be attempted only with gametes obtained from lawfully married couples". Also the stipulation that there be no more wastage of fertilized human eggs in attempting embryo transfer than the wastage of embryos that takes place normally in human reproduction between fertilization and implantation.

Concerning these stipulations, Peggy Steinfels saw at once that they will not stand. She wrote: "The EAB did, indeed, limit IVF with transfer from husband to wife, a restriction that will not stand a minute if taken to court . But probably the matter will not go that far. There is now good evidence that physicians are doing AID (artificial insemination with donor) procedures on single women: IVF with transfer will be used in the same way once it becomes available. Furthermore all the reasons that the F A B found for declaring I V F "ethically acceptable for married couples can without revision justify IVF for single women, and - pace, the EAB's plan to review in vitro research -surrogate motherhood as well". In short, any of these procedures by the reasoning of the Ethics Advisory Board may and will become "ethically defensible but still legitimately controverted", legitimately controverted because controverted, desirable because desired. Already there is a flood of articles in our newspapers, ironically in the family section, concerning surrogate mothers, and physicians announcing their willingness to engage in the practice.

As a society we would have been better served by a strong minority report stating the arguments against going forward with this reproductive technology. In just this way, on some controversial issue before the Supreme Court that deeply divides our nation, the health of the polity is better served when there is a strong minority opinion issued in which some of the Justices vigorously make the case for the errors in the Court's opinion and the stupidity of their Brothers who were in the majority. Then, in a morally divided nation, the many people who are over-ruled still know that a reasonable voice, a strong voice, was raised for them in our highest councils. The most I expected, and the least we had a right to expect, was a strong minority opinion from the Ethics Advisory Board on this matter of in vitro fertilization. Instead we had a consensus opinion achieving unanimity only by means of some very strange reasoning.

4. The EAB's stipulation that "no embryos will be sustained in vitro beyond the stage normally associated with the completion of implantation (14 days after fertilization)" is very odd. These are embryos to be used as research subjects. Yet the line drawn upon their usefulness, before which anything can be done with them, is implantation for which they are not intended. The arbitrariness of this stipulation is clear; one group favoured with life-expectancy will be transferred; at precisely that same time, another group of embryos must, for no good reason, be "allowed to die". If it is right to use them as mere means in research before 14 days have passed, it is right to use them after 14 days. A society stupid enough to place such a limit will soon recover its wits and extend the time to encompass the acquirement of additional important medical knowledge.

By comparison, there was some degree of respect for the unborn experimental subject in our National Commission's Report on Foetal Research.1 Concerning the connection of foetal research with abortion, the Commission recommended, among other things, that " 'no significant procedural changes are introduced into the abortion procedures in the interest of research alone". Concerning research upon the still living but not-viable foetus (ex utero or during an abortion procedure), it provided that "no intrusion into the foetus is made which alters the duration of life" '2 Background for these provisions was thee Commission's agreement that "moral concern should extend to all who share human genetic heritage, and that the foetus, regardless of life prospects, should be treated respectfully and with dignity".3 Now, that is rather vague ; as also was reference to "the human character of the foetus".4 Still, from only minimum respect for the humanness of this new research subject, the Commission concluded that no research should be done on it that of itself either shortened or prolonged its life, i.e., "altered the duration of life". If this reasoning were applied to human embryos no one would be searching for arbitrary time-limits within which their duration of life could be extended for research purposes, or experiments made that themselves shorten those lives.


If permitted at all, research on the human embryo should be observational studies only, or experiments whose intrusion upon the embryo in no way alters its duration of life. In the alternative no one should expect an arbitrary time-limit to stand. That is even now only a salve for tender consciences, as some "new ethics" gathers strength and social acceptance.




© SPUC 2008