Critical Commentary on Summary Article

Here is the link again, for the article listed and summarized below--the pre-publication version of the President's Council on Bioethics report Human Cloning and Human Dignity: An Ethical Inquiry.

(http://www.liebertonline.com/doi/pdf/10.1089/073003102761698007?cookieSet=1)

Now that we've offered a summary of this article--which also serves as a recap for much of this blog--we are interested in engaging with it more fully, and examining it more critically.

This article skillfully outlines nearly all of topics important to the current debates over cloning technologies, and raises the crucial ethical questions that society and science alike must grapple with as cloning technology advances. It recognizes that we cannot separate these ethical questions and debates from cloning, or try to analyze cloning without taking them into consideration. Try as we might, it is nearly impossible to discuss the role and future of cloning in society and science, without thinking about the ethics involved: do we have the right to manufacture life, or "manipulate some human beings for the benefit of others?" Does the potential good that may be derived from therapeutic cloning techniques outweigh moral and ethical qualms? Questions such as these must always remain in the back of our heads as we take on the challenge of exploring the biotechnology of cloning in medicine.

One thing that this article failed to mention, is the notion of cloning genes and genes alone, rather than cloning for reproductive purposes or cloning human embryos for scientific purposes. Although the article distinguishes between "cloning-to-produce-children" and "cloning-for-biomedical-research" it does not make any further differentiations in the types of cloning that may be used "for biomedical research." Yes, of course, one such type of cloning is the cloning of human embryos, so that cloned stem cells may be harvested and manipulated for therapeutic uses in a patient (this is the only type of cloning-for-biomedical-research that the Council considers in this article). But there is another type of cloning, also for research and medical purposes, that is ignored. Scientists are able to clone specific genes, introduce them to a vector of some sort (a plasmid, for instance), and then insert the recombined DNA into an organism; as the inserted cells divide, the target gene will be perpetuated in the organism (see the blog posting on gene-altered goats as an example of this cloning technology). Why does the article neglect this type of cloning? Is it simply that this method is seen as less ethically problematic? Does this method border on gene therapy and DNA recombination, and fall outside the realm of what is considered 'true' cloning?

We find it problematic that the Council does not recognize this type of cloning. Perhaps, even if they did not deem it worthy of greater consideration or evaluation, they might have explained their reason for its exclusion. For instance, they decided not to examine it deeply because they believe it is less of an ethical dilemma, or they think that it is already widely accepted as a safe scientific procedure.

Additionally, in our research we found a number of recent articles on the cloning of other animals. Although the article defines the notion of animal cloning, it is no more than a passing mention of this technology. We wondered why they dismissed this form of technology so easily. True, it is not exceedingly relevant to the issues that the Council focuses on, but we think it is an important omission to acknowledge. As later articles in our blog demonstrate, companies have started saying that they will clone your pets--if this becomes a common practice, our society will slowly become accustomed to the idea of animal cloning (even if the idea is still revolutionary today). What if we become de-sensitized to animal cloning? Then, suddenly, human cloning is not such a big leap to make. We think that the article may have benefitted from delving into the issue of animal cloning a bit more.

The Council does as it promises to do, and provides sound discussions and opinions on the many ethical considerations relevant to cloning technologies. It presents both sides of each debate, even when the Council members were in consensus: for instance, the Council agrees in its position against cloning-to-produce-children, but it still lists the common arguments in favor of this type of cloning. Let us turn to the discussion on the ethics of cloning-for-biomedical-research:

Clearly, both sides of the debate have strong foundational arguments. We think that most people would agree that trying to alleviate human suffering is a noble cause, and one that is generally supported. But we also ideally want to respect all human life, no matter how young. The difference between being for or against biomedical cloning can often come down to a simple time line: at what point in development do we consider an embryo to be morally equivalent to any other human? This is a matter of personal opinion, which is why the cloning debates can be so heated. Some people believe that as soon as an egg is fertilized, it is a potential human, and deserves to be treated as any other human. Others say that an embryo has only "intermediate moral status" until it is a month old... It will always be difficult, perhaps even impossible, to come to any sort of agreement on this. We must consider what this means for cloning--if the people cannot agree, does it fall to the government to decide for us?

The Council, of course, writes this article for the purpose of recommending some course of action for the government to take with regard to public policy. What should we do about cloning? Is regulation necessary? Should cloning be banned altogether? The very fact that this is the purpose of the Council demonstrates how far we are from considering cloning in terms of healthcare. We have not even decided whether cloning should be legal. We recognize that many of the articles considered in this blog do not address cloning's position in the healthcare debates, but this is because cloning is too new of a technology, too underdeveloped and imperfect, to be considered as a viable treatment or therapy just yet. Until we understand cloning, and all its implications more fully, and until we have perfected techniques of cloning and conducted further experimentation and research, we cannot be sure that cloning will actually prove to be as useful as we currently hope.

Many researchers and scientists claim that cloning holds great promise: that some cloning techniques may help to develop treatments for diseases such as Parkinson's, or may lead to a huge leap forward in regenerative medicine. But for now, we do not know. We do not know if we will ever succeed in these ventures, or if we will ever be able to clone safely enough. There are many hurdles to overcome before cloning will be considered in the formal healthcare debates.

For now, we, the people of America, must engage in these debates on cloning technologies. We must decide whether we believe that cloning is ethically wrong, or whether we think potential benefits outweigh known costs. We must show our support of cloning, or we must petition for a ban on this technology. But first, we have to make sure that we have all the facts straight.

Summary Article

http://www.liebertonline.com/doi/pdf/10.1089/073003102761698007?cookieSet=1

In 2002, the President's Council on Bioethics published the results of their discussion on the issue of cloning technologies. This article is the "Pre-Publication Version" or outline of their report, Human Cloning and Human Dignity: An Ethical Inquiry. It summarizes clearly and concisely many of the issues that we have presented in this blog, regarding the technology of cloning, both for reproductive and therapeutic purposes. The Council strives to answer some of the important questions that we also have been exploring: what is cloning, and what does it mean? Where does it now stand in society and in science, and how do we think about it? How should we deal with cloning? Do we accept and embrace it as a potential therapy, or do we reserve such positive judgment because of the many ethical dilemmas it entails?

In this article, the President's Council tackles the problem of cloning, and seeks to offer advice about what the public policy regarding cloning should be. Why? Because, they claim, cloning has broad implications in both science and society, and we have now reached the point where we must address the issues it raises, rather than trying to ignore them. The article starts off by asking, "Human Cloning: What is at Stake?""The notion of cloning raises issues about identity and individuality, the meaning of having children, the difference between procreation and manufacture, and the relationship between generations. It also raises new questions about the manipulation of some human beings for the benefit of others, the freedom and value of biomedical inquiry, our obligation to heal the sick (and its limits), and the respect and protection owed to nascent human life."

These are, in a nutshell, the big ethical questions surrounding both reproductive and therapeutic cloning technologies. They are also the many reasons why such a careful examination of cloning is necessary. The authors recognize that in general, "people do not regard it [cloning] as just another new technology." Along with the fact that cloning as a technology is still underdeveloped and far from the perfection that we require of our medicines and therapies, this is perhaps the biggest reason that cloning has not factored into healthcare debates at all. People are scared of cloning. Cloning cannot be accepted as simply as prosthetics or biopharmaceuticals; it is far too personal, and "touches fundamental aspects of our humanity" in ways that other biotechnologies do not. We are not ready, as a society, to think about cloning in terms of healthcare just yet.

The Council describes the common methods of cloning, including somatic cell nuclear transfer. It also recognizes the proximity of cloning to stem cell research, and differentiates between 'regular' human embryonic stem cells (and the discovery of multipotent cells, which are "currently being studied intensely for their possible uses in regenerative medicine") and stem cells from cloned embryos, which may overcome the problem of transplant rejection (i.e, the implantation of foreign tissue triggering the immune system; note that if cloned cells are used, these cells may not be perceived as "foreign"). The article also distinguishes between what is widely termed reproductive cloning, or "cloning-to-produce-children," and therapeutic cloning, or "cloning-for-biomedical-research." It explores each technology separately, and analyzes each one (in terms of ethical dilemmas) on its own.

After offering such background information, the Council begins to discuss the ethics of cloning-to-produce-children. It acknowledges that this technology may serve positive purposes, but goes on to say that arguments in favor of reproductive cloning "pay insufficient attention to the well-being of the cloned child-to-be." It also states that the cloning technologies currently available have rates of morbidity and mortality far too high to be considered acceptable--the procedure is unsafe for both parent and child, and there is no plausible way to conduct research in an ethical way in order to determine whether the technology may be improved to make it unquestionably safe. Five main other objections to this type of cloning are presented:

1. Problems of identity and individuality: wouldn't a cloned child be overshadowed throughout his or her life by memories of the original person? How well could he or she develop a sense of identity, knowing that someone identical has already lived a life and established an identity?

2. Concerns regarding manufacture: cloned children would be the first "designer babies" and might "contribute to increased commercialization and industrialization of human procreation."

3. Prospect of a new eugenics: who will be cloned and who will not be? Will parents opt for cloning a child to avoid the possibility of having a baby with some genetic defect? Will parents clone if they believe that they possess some "outstanding genetic traits"?

4. Troubled family relations: what happens when a child is also his mother's brother, or a grandparent is also a parent to their grandchild? How do family systems still function?

5. Effects on society: if people know that there are cloned children out there, how will attitudes towards children as a whole change? Might this type of cloning "set the precedent for future nontherapeutic interventions into the human genetic endowment"?

The Council offers this conclusion.

"For some or all of these reasons, the Council is in full agreement that cloning-to-produce-children" is not only unsafe but also morally unacceptable, and ought not to be attempted."

Although the Council is able to come to this strong conclusion concerning cloning-to-produce-children, they are somewhat more divided on the issue of ethics of cloning-for-biomedical-research. "On the one hand," the authors note, "such research could lead to important knowledge about human embryological development and gene action, both normal and abnormal, ultimately resulting in treatments and cures for many dreaded illnesses and disabilities. On the other hand, the research is controversial because it involved the deliberate production, use, and ultimate destruction of cloned human embryos, and because the cloned embryos produced for research are no different from those that could be used in attempts to produce cloned children." This is the crux of the matter.

Those in favor of cloning-for-biomedical-research believe that the duty of doctors and others in the biomedical profession to relieve human suffering may be greatly advanced by this technology, and that this type of cloning may allow for the treatment of many diseases and disabilities. These Council members write that, "The moral objections to this research are outweighed by the great good that may come from it." Some members do not see an ethical problem in therapeutic cloning, even though scientists will be creating human embryos with the intention of destroying them. Others acknowledge their own qualms about the ethics of this type of cloning, citing three main issues. Firstly, they understand that nascent human life deserves respect, but believe that embryos before a certain stage do not need to be considered "the moral equivalent of a human person." Secondly, they recognize the concerns regarding the creation of embryos for use and destruction, but emphasize that they will not be mindlessly destroyed, but used "in the service of life and medicine." Lastly, they claim that researchers can be prevented from "going too far" and can be deterred from developing cloned embryos beyond the blastocyst stage.

Of course, several Council members also present the moral case against cloning-for-biomedical-research. Their main argument states that:

"It is morally wrong to exploit and destroy developing human life, even for good reasons, and that it is unwise to open the door to the many undesirable consequences that are likely to result from this research. We find it disquieting, even somewhat ignoble, to treat what are in fact seeds of the next generation as mere raw material for satisfying the needs of our own."

This point of view argues that the human embryo, even in its earliest stages, should be considered as deserving of respect and protection as a baby, a toddler, a child, an adult. It also claims that allowing cloning-for-biomedical-research means that our society is sanctioning the creation of human life solely for the purpose of its use in labs, its use in research, and then its destruction, which is a slippery slope that leads...who knows where? The Council members against this type of cloning list three other risks of allowing therapeutic cloning, all of which involve "significant moral harm to our society."

In conclusion, the Council explores possible options for implementing public policy concerning the technology of cloning, ranging from complete prohibition, to a temporary moratorium, to self-regulation by researchers. In the end, though, the Council offers two recommendations.

Majority Recommendation:

"Ten members of the Council recommend a ban on cloning-to-produce-children combined with a four-year moratorium on cloning-for-biomedical-research. We also call for a federal review of current and projected practices of human embryo research, pre-implantation genetic diagnosis, genetic modification of human embryos and gametes, and related matter, with a view to recommending and shaping ethically sound policies for the entire field." The moratorium on therapeutic cloning would allow (or force) both sides, those for and those against, to present their arguments publicly. This would allow the American people to understand the issues more fully and make an informed opinion. It would also give more time for research to be conducted, which would allow scientists a chance to evaluate how promising this biotechnology really is.

Minority Recommendation:

"Seven members of the Council recommend a ban on cloning-to-produce-children, with regulation of the use of cloned embryos for biomedical research....Permitting cloning-for-biomedical-research now, while governing it through a prudent and sensible regulatory regime, is the most appropriate way to allow important research to proceed while insuring that abuses are prevented." Similar to the majority opinion, this opinion holds that cloning-to-produce-children should not be practiced. However, this opinion differs in that it considers further experimentation necessary in order to make advances in this field, which in turn will help determine this technology's true value. This opinion holds that strict regulation would prevent abuse of the technology. 

Look out for further analysis on this article!