The Medical Ethics AllianceThe Medical Ethics Alliance
The Medical Ethics Alliance
28th June, Wiseman Conference, London
Dr J Qureshi
Psychiatrist, Director, Woodbourne Priory Hospital, Birmingham
Pure science without faith will have pitfalls. Blending faith and science is required. This conference is to encourage clinicians, scientists and people of faith. Cloning is an enormous subject of which only a little is known. The frontiers are immense. Human endeavours must be in accordance with the principles of faith, should serve humanity and be in line with divine principles.
Dr John McLean Embryologist,
Adviser to the Bishops Conferences Committee on Bioethics.
The early research, dating from the end of the 19th century, was descriptive. Embryos were obtained from miscarriages and hysterectomies. The first 8 weeks after fertilisation completes embryogenesis, implantation occurring between 6-10 days when the embryo forms an intimate relationship with the maternal circulation.
The Human Fertilisation and Embryology Act 1990 permitted research up to 14 days in vitro for specified reasons. These included studying the causes of miscarriage, infertility, congenital abnormalities, inherited diseases and the development of contraceptives. An analysis of the 27 current licences for research reveals that 4 are for the study of implantation. These may lead to the development of substances, which although likely to be described as “contraceptives”, are in fact abortifacients. Pre implantation diagnosis of inherited diseases is also being licensed. To date there has been no new treatment of maternal infertility from the research and concerning congenital abnormalities: these arise outside of the 14 day limit allowed. In any case embryos rarely continue to live outside the body beyond 6 days: the 14 day limit is meaningless.
Some progress has been made with intracellular micro-insemination, but this technique having been developed now appears to be successful at about 20% per treatment cycle for the last three years. IVF rates have not improved beyond a maximum 15% per treatment cycle.
The future, following the recent amendment to the Human Fertilisation and Embryology Act, allows experimentation, including the creation ot cloned embryos for treatment or therapeutic purposes. Claims are being made for benefits for virtually all diseases, but in fact only 2% of cloned animal embryos come to birth and many of these have congenital abnormalities. The reasons why the other 98% fail are unknown.
Embryos produce chemicals for the organisation and development of tissues. It is thought that the principal use of cloned embryos is to produce these chemicals in amounts that can validate their function and be manufactured by the biotechnology industries.
Dr Abid Sharif
Geneticist, City hospital Nottingham.
Man was ordained to live in harmony with nature. Recent times have seen unprecedented challenges to religious values. Islam should be considered within the context of Islamic jurisprudence, that is “Sharia”.
Muslim scripture, the Koran and teachings of the prophet, are the guiding principles of this law. One important way of coming to the truth is by consensus of the scholars or “ijma”. If there is unanimity or near unanimity on a point, then they have the assurance of faith, that the believers will not be misled. Revelation ended long ago but scholarly commentaries continue to guide and inform the believer. Sharia allows space for free movement, and is a guiding force, its objects being the preservation of faith, soul and mind in a unity. Some questions are left to conscience and common sense.
In Muslim scriptures man s origin is in stages. He progresses from sperm to a clot, to bone sheathed with tissue, to a foetus. Before 40 days there is no ensoulment. The faithful are only God s ambassadors holding everything in trust and must seek to preserve the balance created by God. Ultimately Allah has dominion.
There are strong scriptural statements which are relevant to cloning a baby, the most important and direct of which is “There is no altering the laws of Allah s creation”. Cloned babies would be contrary to the natural order and family relationships. It would also disrupt the social order. Islam is concerned about the social order and the impact of cloning beyond those who may feel the need of a family. Stem cell research would be allowable if it led to treatment of diseases, because to relieve affliction is to bring a blessing.
There is a consensus against cloning a baby. Scholars also condemn germline manipulation. Plant cloning is permissible, and on animals there is still uncertainty: the balance of advantage and disadvantage will only emerge in time.
Islam does not impose a restriction on science, but not anything that is practical is necessarily applicable. All knowledge is a blessing and can be used, but family life is preeminent. It is agreed cloning babies would disrupt life and bring about chaos in the natural order.
Dr Anthony Cole Paediatrician,
Director, The Lejeune Clinic, London
In this talk the clone referred to is a genetic copy of another individual. A cloned embryo is created by cell nuclear transfer from an adult cell into an enucleated oocyte. “Therapeutic cloning” is a misnomer as the cloned embryo is used as a source of stem cells only. Other stem cells occur in umbilical cord blood, or the tissues after birth.
The Human Fertilisation and Embryology Act 1990 was primary legislation debated in both houses. The Warnock Report, which preceded it, said that the human embryo had a special status. The recent parliamentary debate however, was on an unamendable statutory instrument, or a simple yes or no to extending the permitted use of embryos, and the creation of cloned embryos. Government documents wherever possible use euphemisms and avoid the word “clone”.
The Catholic position has always been that human life is to be respected from the moment of its beginning till natural death. Even the Warnock Committee had a minority report which regarded the human embryo as unsuitable for destructive experimentation. Nevertheless hundreds of thou sands of embryos have been created most of which would be destroyed, and the talk of the useful research into diseases made in the 1990 debate has been spurious.
There is no official Catholic pronouncement on the status of a human cloned embryo. If it embarks on normal embryonic development it is arguably of equal status to a normal embryo and, therefore, not exploitable as a commodity. The alternative view amongst some Christians, that prenatal life is “a value adding process”, does not in fact help us with questions of when it is scientifically exploitable, or when after implantation it is too valuable to abort. These questions are never answered. Even the point of viability is changing.
If human cloning techniques are published, they will be taken up elsewhere to create a cloned baby. At present there is a weak consensus against cloned babies because of the very high incidence of deformities, twisted limbs, squashed faces and enlarged tongues seen in cloned animals. They can be grossly oversized and show premature ageing.
There is a fundamental injustice if one generation chooses whom it will copy for the next, a distortion of kinship; and there will be problems of identity and legal complications over inheritance.
Man is made in the image and likeness of God. This is his dignity. Parents have the privilege of co operating with the creator in procreation. This is incompatible with human cloning.
Prof David Katz.
Department of Immunology, University College, London
The term “clone” has been applied to a cell line that is derived from a single cell, and has been used in this way for many years. An example of this are the cells that are used to study how immunity is control led, the “T cell clone”. Another example of clones are the cells that have been used to make monoclonal antibodies, where originally the nuclei of tumour cell and normal cell were fused within the same cell. Today many of these monoclonal antibodies are part man, part animal (usually mouse) in origin. Yet another use of the term is when genes themselves are “cloned” working down to the level of a single gene, let alone a single cell, and then amplifying that gene (and / or its product protein) (i.e. making many identical copies ) so that they can be studied and used.
It is in this context that “human cloning” deriving an entire human from a single cell in vitro, basically by a technique known as nuclear transfer has to be considered. Cloned individuals would be derived by taking the nucleus of one selected person and transferring it into a germline cell. In Judaism there is already a growing body of secondary literature on the topic. The most important dialogue has thus far taken place in the US and Israel. Most of these new secondary sources refer to the fact that the question of the generation of a “humanoid”, a “Frankinstein -like creature of human fabrication” has been fore shadowed in the Talmudic discussions about the creature of this kind of life form, known as a “golem”. Should a golem be admitted as part of a quorum for worship? Is one guilty of homicide if one kills a golem? The popular version of the debate is associated with the Maharal, the famous Rabbi of Prague, who lived in the 16th century; but in fact discussion about the topic dates back many centuries. However, these theoretical debates are moving closer to reality, maybe before we have had time to resolve some of the ethical issues.
A key question in Judaism is whether or not producing a cloned offspring can be regarded as a fulfilment of the obligation “to be fruitful and multiply”. If so, then it may fall into the category of a “mitsva chiyuvit”, i.e. a positive duty to found a family and have children. Alternatively, is this a procedure which is permissible (“mutar” ) but not obligatory? If so, other variables effects on society, on the role of the individual in society, and practical problems and chances of success – all need to be taken into account in formulating a Jewish response. Do the benefits outweigh the drawbacks?
The other form of cloning that has been discussed relates increasingly to questions where stem cells, derived either from embryos or adults, are the starting points. Here again there has already been considerable debate. Using cell lines as “cell factories”, as exemplified by the production of monoclonal antibodies (which have great commercial value), has not been regarded as in conflict with the basic tenets of Judaism. Core concepts of Judaism include not only the obligation to care for the sick in the best possible way, but also that one should use the best possible methods (technology) that we can devise. We have a partnership with God in creation, and this includes the acquisition of knowledge which helps us fulfil obligation. A notable example of how this is embedded in Judaism is that the blessing we say when we eat bread refers to “bringing forth bread from the ground” when we know that the wheat comes from the ground and requires man to convert it to bread.
Although Judaism thus does not have an inherent problem with the technology of nuclear transfer in principle, and can see intrinsic value in some forms of the procedure, this should not be taken to imply blanket agreement with all that is possible. The need to use embryonic rather than adult cells must be carefully evaluated. Whilst Judaism takes a positive view of steps that will resolve some of the problems posed by current approaches to organ retrieval, “organ farming” and subsequent “organ marketing” raises significant quandaries. Since the product of such cloning would become a commodity, there is considerable misgiving about the concept. Furthermore possible acceptance of nuclear transfer into embryonic cells, for their therapeutic advantage, does not imply acceptance where the procedures are aimed at so-called “improvement” of future generations.
Thus, while there may well be differences of opinion between religious communities about their approach to some of these issues, on one particular issue there is consensus. That is that there is an essential role for “faith ethics” in the debate, and for these communities to be given ample opportunity to contribute, not only in deciding policy but also working at the individual case level, even if they have not been universally successful in the past. Regulatory controls are important, acting as a stabilising influence. Formulation of such controls with support from faith communities would seem to be one useful way forward for the future.
Chaired by Dr Greg Gardner.
General Practitioner, Birmingham
In Islam children need to honour their parents. A cloned child would not be considered as having proper parents. On so called “therapeutic cloning” there is no consensus. There is a strong tradition of respecting life from fertilisation, even before ensoulment.*
Monitoring of public meetings of the Select Committee on Stem Cell Research, reveals that a preponderance of the members are supporters of the Government position. The committees report is likely to have far reaching consequences of which they themselves are unaware.
The global nature of pharmaceutical industries is a major factor. Some decisions seem to be made on the basis of science, commerce and politics.
There is a need for believers to make a strong input. This is best achieved by dialogue rather than token representation on committees.
New treatments dependent on human cloning would not be universally accepted, as has been seen when sections of the community rejected vaccines grown on human cell lines obtained from abortuses. New treatments should be based on non-controversial research to be generally accepted.
Faith inspired persons should engage in the debates generated by such new technologies as cloning.
*In Christian dialogue, whether human life exists prior to ‘ensoulment is controversial. Ed.