Darryl R. J. Macer, Ph.D. Eubios Ethics Institute 1990
The arguments concerning the status of the embryo at different stages of development, which affect the way we consider an embryo, are discussed at first. Before considering these technologies it is important to discuss the status of the human embryo.
The human embryo is formed from the fusion of a sperm and an egg at conceptio after which it undergoes a series of complex and as yet poorly understood stages in the development to a human adult. The gametes are produced in the testis and ovary of male and females. The series of cell divisions is delicately controlled, and the result of these series of cell divisions is to half the number of chromosomes in the germ cells, from 46 to 23. The steps in this process are represented in figure 5-1. After penetration of the egg by the sperm, the nuclei of the sperm and the oocyte fuse, and the chromosomes align, in a process called syngamy. It is here that a new genotype is formed. There are numerous accounts of the process in more detail, in most biology textbooks, or in books discussing the status of the human embryo in more depth (e.g. Ford 1988).The important subsequent steps in embryonic and fetal development are summarised below, in Table 5-1.
* There are about 300 million spermatozoa in a single ejaculation.
* Conception, the penetration of the egg by a sperm is followed 22 hours later by syngamy, the alignment of paternal and maternal chromosomes to form the the new genotype.
* At 2-3 days, or the 8-cell stage, probably every cell is totipotent.
* 45-70% of "preembryos" do not successfully implant.
* Can predict identical twinning at day 7, and by day 10 they are forming individual embryos.
* Up to 14 days the embryo may develop into a cancerous tumour (hydatidiform mole), or two embryos may recombine to form one individual.
* At 14 days implantation is complete.
* After 14 days the primitive streak starts to form,one per individual
* At 8 weeks the first neural cells start to be differentiating, and the name changes to fetus.
* By 12 weeks, about half of the embryos that implanted may have spontaneously aborted (about 80% since conception).
* By 12-16 weeks the fetus has taken on a distinctively "human" form, and may feel pain or respond to stimulation (not necessarily the same thing, as brain dead people also have some responses from the spinal cord).
* At 17-20 weeks quickening occurs.
* By 22-24 weeks viability is reached, in some cases, if in good hospital.
* At birth severely handicapped newborns may be left to die if the parents do not want extraordinary treatment to proceed.
One could commence this discussion with the question when does a human life begin? Many people have thought of possible answers to this. In fact the question should be more carefully stated, as there are different meanings possible, which are relevant to the status of the human embryo. In this section we will consider alternatives, from conception to birth.
Human life, as commonly termed, is constituted through the union of the sperm and egg. In western religions this life is endowed with a particular form of "life", or soul, by God. The central issue then becomes when this created means of our relatedness to God and other humans appears, is it emergent or is it inseparable from the conceived embryo. In Islam there are identified stages, the fetus becomes a person when it receives its soul from God at the end of 17 weeks (though it is not right to create life in order to destroy it, that is God's domain). This perceives human life as an individual, which is the common belief among peoples of most cultures and countries at the end of the twentieth century. This view is in contrast to the view of traditional eastern religions, which believe in long sequences of continuity, death being merely a means of transition to a new outcome, until you break outside of the cycle (Bowker 1986). This view of human life considers it more as a species than individual lives, but together with other living organisms. However, for the discussion of the status of the human embryo, the more useful approach, and certainly the more relevant to most people, is to consider the question from the viewpoint of the individual. The question of human identity is also complex in itself, there are genetic, bodily, spiritual and social identities which are intertwined (Kjessler et al. 1989).
Modern medical embryology has been interpreted in two ways. One approach is illustrated by the current Roman Catholic view, which considers that at no stage of fetal development there is a significant reorganisation to indicate that a major qualitative change occurs before which the fetus could be identified as not ensouled, and after which it could be considered completely ensouled (Iglesias 1986). So in the absence of such a critical moment one is left with the idea that the fetus has been ensouled from conception (Vatican 1974). The argument of genetics supports this, since following fertilisation the full genetic blueprint of a new individual is created, which may begin to develop (though the first few weeks are more under the developmental control of the egg, the natural process is embryonic development). One could also say that the Bible verse Genesis 2:7 can be interpreted to say that, "man became a living being (soul)", does not imply that he was entered by one, but it is quite inconclusive in meaning, even for Christians. The original meaning of the word "conceive" refers to the woman receiving the seed in her womb and becoming pregnant by taking the fetus to herself. There are various linguistic expressions for conception, but they do not answer the question of when a human individual comes into existence (Ford 1988). During the past century the process of fertilisation has come to be associated with conception.
The other interpretation of embryology stems from the pioneering experimentation and philosophical interpretation of Aristotle. His view was that there was a biological development of the early embryo through several intermediate stages of growth, considered first to be vegetative, then animal, and then at 40-90 days after conception, the human was sufficiently organised and disposed to be the recipient of the specifically human form, the rational soul (Aristotle III). The influence and content of Aristotelian reproductive biology has been discussed by Ford (1988). Thomas Aquinas extended this view, maintaining that our flesh is conceived before it is animated. In the case of a subject which was not suitably disposed, God would not ensoul them. This view was also held until the last century by the Roman Catholic church.
People agree that the new human life begins at conception, or in the following twenty four hours, when the genetic information from the egg and sperm join to form the new genotype. Although the egg and sperm were alive, they were not a new life. We could also say that the unfertilised egg or the sperm that does not join an egg, will perish so can not be considered the start of a human life.
Most people agree that a fertilised egg, an early embryo, is of a higher status than two gametes alone, the egg and sperm, though the consequentialist approach (Kuhse & Singer 1982, Singer & Wells 1984) would say that the fertilised egg and gametes are indistinguishable. Fertilisation does not begin life, life in terms of a living cell is continuous. The egg cell, or oocyte develops from the germ plasm, and is inherited across generations. The patterns of early embryonic life are laid down prior to the trigger of fertilisation. Fertilisation establishes a new genotype, and activates the oocyte to develop into a embryo. However, the developmental program of the embryo can be activated by some agents without fertilisation taking place. The precise time of fertilisation can not actually be pin-pointed within a 2-3 hour period, so it may be difficult to measure the time of this change in status, but it still occurs. It can be philosophically distinct despite our inability to measure it.
During the recovery of eggs from the ovaries of women prior to IVF or GIFT it has been found that as many as a quarter of them are activated, and are developing parthenogenetically. Parthenogenesis is where the egg is activated without the presence of sperm. The high frequency is not thought to be because of the treatment, but is thought to occur naturally (Braude 1989). The moral status of a parthenogenetically developing egg, which has no potential for further embryonic development, is equivalent to the unfertilised egg. There may be several cells, but it is still different to a fertilised egg which has potential to develop.
The life of a 1 cell embryo is not sacrosanct, and has never been, even in theological circles (Dunstan 1984, BSR 1984, 1985). The current Roman Catholic view does have doubts, and does not categorically state that the human soul is present from conception, despite the genetic material being present (Vatican 1974, 1987). However, in the absence of certain knowledge it views embryo experimentation or abortion as wrong as it is taking the risk of killing an ensouled human (Mahoney 1984). It may still be held that developing human life is inviolable, irrespective of whether it has an immortal soul.
The First Two Weeks
There are several major difficulties with the view that eEnsoulment;, or personhood, starts at conception. A high percentage (perhaps 70+%) of fertilised eggs do not naturally implant, or result in a live birth (Leridon 1977). Most failures occur during the first few days, including fertilisation itself during which many abnormalities, mostly chromosomal in nature, occur (Murphy 1985). It is argued that this is a very inopportune moment for ensoulment to occur (Gardner 1972, Dunstan 1984, Jones 1985, 1987). The actual embryo at this stage might not even develop into a human being, but instead form a hydatidiform mole, which develops into a tumour. This is the argument of wastage, and it is a significant one. Critics note that in cases of infant mortality which is as high in many countries, as was in earlier times here, but in this case we don't say that a newborn infant is not a human person. Often the cause of pregnancy loss is genetic, but genetic disease kills people throughout the human lifespan.
Many scientists refer to the embryo before two weeks as a conceptus or pre-embryo (Huxley 1985), but for the sake of this discussion there is no need to introduce more words into the moral debate, as words may be biased in there use (Chargaff 1987). After consideration of the issues we may consider this term appropriate.
While a new genotype is formed after fertilisation, the genetic information does not appear to be significantly used until the 8-cell stage. Before this the egg cells use existing genetic messengers (mRNA). The egg cell has inherent natural capacity to direct and organise its own self development for several cell divisions. The maternal and paternal genetic information is differentially used, the paternal information is used to make the membranes around the embryo itself, which result in the placenta and the maternal genetic information is used for early embryo development but not for placental tissue. This is despite the fact every cell has the same genetic information, half maternal and half paternal. Depending on where the cell is in the embryo different genes are used.
Not all the cells in the early embryo differentiate into the fetus, the placenta, chorionic membranes and umbilical cord also develop, and these are discarded. In animals, any cell isolated from a 4-16 cell embryo can redevelop to form complete individuals, clones. Animal clones have been made by this method (Willadsen 1986). The individual cells in the embryo do not behave as a individual embryo until after the 32-cell stage, when intercell connections start to appear, and the morula forms. The cells are kept together physically by the zona pellucida, a thick surrounding coat, as they travel towards the womb prior to implantation. Cells can also be removed for genetic analysis, while the remainder of the embryo can develop normally, this has been used for preimplantation genetic diagnosis (see chapter 13). Human embryos share most features of embryogenesis with other mammals. Though some aspects of gene expression and determination are not common to all species, such as brain and nervous system development (Williamson 1986).
In the process of IVF, if it is known that the embryo is abnormal, e.g., those possessing 3 pronuclei at fertilisation, it should not be replaced into the mother. The potential is for this embryo to grow as a triploid fetus and child, grossly abnormal, or to even transform into a growth in the mother's womb (like a hydatidiform mole which develops into a chorioepithelioma, a fatal tumour) which would threaten her life. The placental abnormality of a hydatidiform mole, is usually found to arise when all 46 chromosomes are of paternal origin only, thus only placental tissue develops, no embryo. A teratoma is a cancerous growth, and can form at various stages. In this case it would be wrong to replant, as it is potentially a hazard to the mother, if not for only consideration of the possible child.
The embryo can form two genetically identical embryos, twins. In some cases two embryos can combine into one, which can become one individual (Mahoney 1984). The process of twinning depends on the place were cell division in the early embryo occurs, and what determines this process is being investigated.
Implantation and Formation of the Primitive Streak
After implantation is completed there is much more biological stability. If ensoulment occurs at a fixed time after conception, it is probably after this stage, though the argument of predestination (God creating a person) could be applied at any stage in the process. However, it seems that ensoulment should only occur when there is an unambiguously individual subject. In an important book in this area, Ford (1988) argues that the criteria for the presence of a human individual is when the living individual has the inherent active potential to develop towards human adulthood without ceasing to be the same ontological individual. He places this around this time because of implantation and the formation of the primitive streak. At the time of completion of implantation the cells in the embryo start to differentiate in a process called gastrulation. By 19 days, three layers of cells that are going to remain separate for the development of different tissues are forming. The neural tube starts to form, and a primitive circulation system is forming by the end of four weeks. The formation of the primitive streak occurs at 14 days, and is a major sign of ontogeny. This concept of individuality is shared by some scientists, such as McLaren, and some theologians such as Mahoney or Ramsey (Ford 1988), and by the Warnock Committee (HMG 1984). This is why the 14 day stage is important in government guidelines in several countries.
There is one note of caution however, regarding the use of incomplete scientific data to set guidelines. The argument that twinning occurs at 14 days was also used to support this time, however, recent data suggests that twinning can be detected at 7 days, and individualisation at 10 days (Edwards 1989). Ford makes a negative claim, that a developing mass of cells cannot be regarded as a human individual until the formation of the primitive streak. However, this bases human individuality on current scientific data, but the embryo may be biologically destined to be an individual before this time, but we are unable to detect this. The beginning of an individual could occur prior to this. However, the arguments of stability of the implanted embryo prior to primitive streak development remain powerful.
The Fetus and Feeling Pain
At about 8 weeks the embryo is called a fetus, as it takes on a recognisable form. By 12-16 weeks the fetus has distinctive "human" body characteristics. By 12 weeks, about half of the embryos that implanted may have spontaneously aborted (about 80% since conception). In some studies, two thirds of spontaneously aborted fetuses between 2-7 weeks have been shown to have the wrong chromosome number. If the implantation was a multiple pregnancy, it is very likely that some of the embryos will of been aborted, in one study of 25 multiple implantations, only four sets of twins were born, and the seventeen single births, the rest spontaneously aborted (Barron 1985). These observations are important, and suggest that after implantation there is continued selection of fetuses, much of which has the end result of aborting abnormal fetuses. Further research is needed to study the factors which cause a mother's body to reject or retain the developing fetus.
The ability to feel pain is also important. There can be two general types of moral significance. There is intrinsic moral significance when an organism can feel something, such as pain. It has a greater intrinsic moral significance when it can be self-conscious. This is different to extrinsic moral significance. Some things can be of high extrinsic moral significance, but have no intrinsic interests, and this depends on circumstances. To a fertile couple, sperm and eggs are of little extrinsic moral significance, many are wasted during life. However, to an infertile couple a single egg can be of high extrinsic moral significance. An embryo can be of high extrinsic moral significance, but it may not have intrinsic moral significance until it can feel something. To a person of particular religious views some act may have high extrinsic moral significance, but the same act to another person is of no concern. If we are forming public policy than acts of high intrinsic moral significance are more compelling than those that only involve extrinsic moral significance to a proportion of the population. Until, an embryo has intrinsic moral significance, in a pluralistic society the public policy should represent the difference between the types of moral significance and public opinion.
What is a Person?
Since this book is written by and for human beings it is clear that the status of human beings will be a major question to consider. The actual term "human being" is an abbreviation of the legal term "human in being". We must decide when the life of a human being begins. A central issue in developing an ethical framework in which to examine issues involving human life is to examine if there is a difference in the way we regard different human lives, and to examine what we mean by a "person". There are two basic approaches that have been used in discussing questions of life and death. One centres on whether it is ever morally permissible to take the life of any human person; and draws parallels between abortion, warfare, self-defense and capital punishment. The other centres on asking the question of what constitutes a human person, and ranges over the issues of brain death and permanently comatose patients, abortion and the quality of life. The discussions are often very emotive, but it is a controversy which needs a rational decision, and not simply dogmatic utterances. We must ask whether we view ourselves as a member of the human species, or as a person. In our common experience, all the persons we communicate with are human beings, but there are several cases of chimpanzees that have been taught how to communicate with us, in some limited way, we need to ask whether we consider them as persons. Philosophically it is safer to use the word person, than to use the term human being. This point is often argued when discussing animal rights (Singer 1990). For the purpose of this argument we should use the term person. I consider the subject of animal rights in chapter 6.
A person is generally referred to as someone who is rational, capable of free choices, and is a coherent, continuing and autonomous centre of sensations, experiences, emotions, volitions and actions, these are what may be called the characters of a person. The word person, has two ideas. The Anglo-Saxon reductionist philosophy produces the idea of a person as something which acts in certain characteristic and identifiable ways. The other philosophical approach, has its roots in ancient Greek thought which has had a powerful influence on Christian thinking, goes behind the observable phenomena and activities to identify their sources, the nature of these sources and the relationships between these natures (Mahoney 1984). It stresses being more than behaving. The Greek idea is present in Christian speculation and language about the human soul. When a "human" possesses a soul they are a person. In Christian terms a human person is someone made in the image of God, which is not dependent on a criteria of actions. A human person may be more than human cells with the potential to become a human person (Mackay 1979, Jones 1985). We would all agree that the human person is entitled to protection and respect. No human person is property, and all have equal status.
There are several aspects of a human person. The word person comes from the Greek 'persona', meaning an appearance or face, an individual appearance that has continuity through a story (O'Donovan 1984). An individual becomes an important part of our ideas, as does the idea of the soul. Human beings change with time and experience, in a way persons grow, creating themselves. We change especially when born, as we become rational, self-aware, and through our childhood as we learn or are moulded. We also change when aging at the end of life, such as with disease. We have some of the responsibility for what we make of ourselves (Macquarrie 1987). However, in order to change our personality we have to be a person already, so while it is important as persons to be able to learn from experience, does it mean that if we lose this ability to change we are not persons? Human beings could be thought of as embodied spirits, though in a non-dualistic way. There may be limitations imposed on us by the world, or our body, or our current existence, however we can be persons despite these. Being human often implies a capacity to experience both limitation and freedom.
Our dialogue between persons, social interactions are important. Our selfhood only finds its growth in social relationships, we are made fully human by our web of social relationships. However, if a person loses the capacity to communicate with others, but can receive sensory input, we still consider them a person. If they lose the capacity for self-awareness in the usual way, but have split brain personalities, do we regard them as two persons or one?
Another crucial part of our person is self-awareness, or personal identity. Personal identity is important, so that even if an exact replica was made (Gillet 1987) we would have two persons, and if the original died,they would still regard themselves as dying. Our experience of the physical world is centreed upon ourselves, and specifically around the sites of our senses. Each individual may reach a point where they are self-aware (Harre 1987). Though this view has important extensions, as nonhuman animals can be self-aware, and also higher apes can interact with humans in this way. For instance in experiments using chimpanzees, they can be taught sign language and then they can create short sentences in conversation. Beings can also be treated as persons in a linguistic way, by names, and by ascribing emotions. Parents can do this as they interact with their infants in terms of psychological attributes that they assign to the infant, and we may do this to domestic animals too.
The Soul and Ensoulment
Before considering the origins of personhood, during our development, we should consider some aspects of thinking on the human soul, as this would seem to be the essence of a person. One of the important reasons for Christians, Jews and Muslims to place a high value on human life is the belief in the soul (Ward 1985). Each person is precious and unique because they possess a soul, a spiritual status. Although nonreligious people may not accept the word, soul, many share the view that members of the human species have a higher status than other animals because of the same characters associated with what Christians will call the soul. The body, soul and spirit of the human individual are not separated, all are integral in a Christian view. All human life is not the same, although it always has a derived worth, derived from the value given by God. Human dignity comes from our creation in God's image. The person is both a moral agent and subject.
For as long as man has known of the soul there have been ideas on where it is located, and whether it is in the body as a whole, or in the heart, or air that we breathe, or liver, or brain, or some combination of these. This thinking has moulded our concepts of what is essential to human life, and is relevant to the questions of when we believe human life or personhood begins and when it ends. This is because most human thought has made the soul paramount over the body; the "wise" soul has been considered superior to the "foolish" body. Twentieth century thought would give the brain prime importance, as it is the only organ that is largely irreplacable. Many of the features of the human brain are being understood, and while it is extremely complex, it is commonly assumed by some sociobiologists that eventually human personality will be reducible to neurophysiology. Conscious behaviour has a neurophysiological basis, and can be affected by drugs, surgery or electrical stimulation. There are some important consequences of a mechanistic brain, the idea of "free" and responsible persons may be replaced by the image of a machine, however, the influence of environment and genes in shaping our behaviour, will mean such a view is not compulsive. The brain may be understood to a fine degree, however it is still possible to view it as a free agent. The body is uniquely the body of this brain and no other, as the brain is uniquely the brain of this body and no other, but parts of the body may be transplanted, except for the brain - though nowdays the brain cells may be transplantable.
The locus of death is related to the position of the soul. We could ask the question where we look to see if a person is dead? While being concerned with the death of the individual as a whole, different concepts of death had led people to consider different body functions and structures in order to diagnose the death of a person as a whole. The loci corresponding to the irreversible loss of vital fluid flow are the heart and the blood vessels, and the lungs and the respiratory tract. The Greek, pneuma, meaning both breath and soul, illustrates where the loci of death were. With modern life-support machinery, the locus corresponds more with the loss of capacity for bodily integration, the central nervous system and the brain. This concept includes the unconscious homeostatic mechanisms and the higher reflex mechanisms like spontaneous respiration and pupil reflexes. This does not necessarily give the human soul a loci or substance, as Wittgenstein said "the human body is the best picture of the human soul", a human being needs a capacity for physical functioning of some sort. Karl Barth viewed the difference between soul and body in the theological context of reflection about the human being Jesus Christ and the experience of God's Spirit (Barth 1942). He calls the human being "the soul of his body", a literal translation of the Aristotelian/Thomist definition anima forma corporis. The soul rules, the body serves the soul dominates the body.
The timing of the beginning of the human individual actually coincides with the time of ensoulment. The soul is not necessarily associated with a material structure. The only characteristic biological substratum which the infusion of the soul requires is a new human life, which exists from conception. The origin of the individual soul has perplexed philosophy since Plato and Confucious. The metaphor of ensoulment was used to explain how the individual person does not originate from its parents, but primarily from outside as a directly creative intervention from God in each case. The Christian position however, is not Platonic dualism, it is more the integrated Aristotelian view. Body and soul are not two separate "things", but two aspects of the same individual. The soul is infused by God in the act of creating each individual human person, since the soul has no material parts, it is either present fully or not at all, it is not a developmental process. Yet it is believed there is no intermediate in the animal kingdom, while it is difficult to comprehend, if the soul is from God then it is not necessary to envisage intermediates (Teilhard 1963), but the threshold can be crossed in a single step, between animal instinct and human reflection. Matter and spirit are not totally disparate though, as God who is spirit, created matter, and did so essentially for the sake of spirit and orientated towards it.
Human ideas about the soul, or self, have changed over history. At one stage, breathing was the most important, with a person being alive in the rhythm of their breathing. The pulse of the heart became important, and the heart was seen to be the centre of the emotions. From the Alexandrian medical school in the third century BC the brain was known to be the centre of the will and the powers of reason, though for some period this knowledge was lost. The location of the soul has long been thought to be with the brain, and for the last two centuries with the thinking activities of the cerebral cortex. The soul is generally no longer viewed as some dualist being, as it was in Ancient thought, but is connected much more with the thinking, the rational, or part of us that makes us people, which is attached to the living cerebral cortex, though people continue to remain divided on the question of immortality. There is still divided opinion whether the whole brain is involved, but this seems to be moving more to exclude the mere brain stem, the part we share with all animals, to involve only the higher brain, parts of which we share with the so-called higher animals.
Brain death is a recent term, and is still not accepted by some countries as an alternative to cardiac arrest such as Denmark, and is still being debated in others, such as in Japan or India. In countries where brain death is accepted as being able to be detectable, the philosophical debate has moved again to the site that we place the soul, where human reason is located. The debate is whether human death is signified by the death of the higher regions of the brain alone, the cerebrum and neocortex, even if the brain stem is alive. The higher brain is concerned with the content of consciousness, while the brain stem must be alive to generate the capacity at all for consciousness (Lamb 1985). Some draw distinctions between "alive bodies", "persons", and "corpses" (Agich 1985). There could be alive bodies that contain persons, and alive bodies that are brain dead, that do not, yet it may still not be a corpse. The body of a comatose patient may not be alive in the sense of being the embodiment of a person, though to relatives the warm body may still contain the soul of the dead. We have to decide whether death is socially constructed in its definition, and whether it is the death of a human person that is the crucial element. It is the role of a physician to determine when life has ended, and if we adopt these criteria there is an important role for science in deciding when life begins.
There are still strong feelings concerning the moving heart, as it remains the most visible vital organ. This association faded from philosophical thought with the advent of understanding of the central nervous system, several millenium ago, but the heart has remained the verbal and visible sign. There has been a very considerable time lag between of concept of where the soul is, to our concept of the locus of death, however, part of this could be accountable by the lack of technology available to measure brain death. Linguistically, we may still talk of our heart, some languages, such as Japanese have different words for the emotional and physical heart, but in English the word has multiple meanings. While we may scientifically be able to define death, the definition of death of a person may remain socially defined (Veatch 1989), and different people may accept different criteria. There are legal problems if we retain differences, but these are greatly exasperated at the other end of life, the beginning. While we can respect different peoples views when they deal with themselves, if they involve what is seen as another human being, the fetus, it becomes much more difficult. Some legal standard is necessary, that reflects peoples differing views plus scientific evidence.
The Beginning of Personhood
During fetal life the characters of personhood are apparent in increasing ways. We can examine the different stages in embryonic development, and fetal growth. We can look back in our lives and consider whether there is some point at which we can say that we became a human person. It is clear that the biological qualities of personhood are not present at conception, what is present is something we call the embryo (I use this term rather than conceptus or preembryo), but it does not manifest the activities of a human person. It is a potential human person, at the biological level at least, rather than a human person with potential.
To function as a human person a brain is needed, and in a parallel way with brain death the criteria used by some is brain life (Mackay 1979). The concept of brain birth was stimulated by the development of the criteria for brain death, in changing the way we define a living human being (Van der Vyver 1990). The concept of brain birth is a mixed one, and has been placed at various points between 12 days and 28 weeks gestation. There are different parts of the brain. Hominisation can be related to the development of the cerebral cortex. Teilhard de Chardin argued that the human species had transcended itself by a major leap in the development of the cerebral cortex, and without it, no specifically human attributes are possible (Teilhard 1959). Bernard Haring asked the question, whether "a living being could be a person at all without the development of the biological conditions and/or presupposition of person life?" (Haring 1972). He noted that the anencephelics with their lack of a cerebrum are incapable of any personal activity.
There is controversy over the status of anencephalic babies, which with the shortage of organs available for transplantation into children, are being used as organ donors (Nolan et al. 1988). These babies have no higher brain, and a new term has been proposed to consider them as "brain-absent" (Harrison 1986). They can neither feel pain or be self-aware, so they lack any self interest in being kept alive. Since they are brain absent they are not even in the category of brain dead, suggesting that it may be ethical to use them as organ donors. There are strong arguments that we should introduce the concept of brain life, as the beginning of the individual (Engelhardt et al. 1989). In West Germany they are declared still-born at birth. If this is accepted it would further strengthen our society's statement that the soul is located in the brain, and in the neocortex to be more precise. We may maintain their bodies respectfully, as we would for brain dead adults, and use organs for transplantation. What may prevent this is extrinsic moral factors, like the reaction of relatives to this.
There are several ideas in these arguments. The emphasis is on a point in development when brain tissue begins to function. The appearance of a cerebral cortex provides a physical site for personhood, or a soul. The cerebral cortex develops in the period of 25-40 days of pregnancy. An alternative to the cerebral cortex formation is the establishment of a functioning nerve net at 40 days gestation. One measure of a functioning nervous system is a positive EEG signal which represents electrical activity in the brain, which occurs at about 8 weeks. The completion of brain structure at 12 weeks. The Soul is the subject of moral and rational consciousness, so some argue it does not exist before consciousness begins. This view leads to the idea of the soul beginning to exist between the completion of neural tube at 3 weeks, at the beginning of brain activity, or with the first conscious experience. The experience could be of many types, but some sort of experience. At this stage the embryo could be said to be of a different kind of being, a conscious being. Before that there have been differences in the type of being, but now there is a different kind. The appearance of consciousness has to be distinguished from the awareness of sensations such as pain. The brain develops gradually, so it is difficult to mark a particular time when a sudden change occurs. Most brain developmental pathways have begun at 24-28 weeks gestation, and this is another possibility (Jones 1989a). Brain birth is a major criteria for personal origins.
Another view is that birth itself is the time of ensoulment, such as that taken by Gardner (1972) from a literal translation of the Biblical verse Genesis 2:7, "God breathed the breath of life into man". However, one could also argue that at the time Genesis was written the breath was a crucial part of the soul, but now we associate the soul with something which appears earlier. Birth has the advantage that it is easy to define. The child that is born is the same developing individual as was in the mother's womb, birth alone does not confer human individuality or personhood. If babies are born prematurely, they can still be viable, but this can occur at very different times. The chance that birth occured at six months and the infant is viable suggests that individuals born at nine months have some individuality, though a different degree of dependence on the mother. Rather than using birth, the important stage is viability (Campbell 1985), and many countries have legal limits on abortion around 22-24 weeks, the maximum viability using modern technology.
An extreme argument is that rationality is the criteria that distinguishes human persons. This may not be noted until many months after birth. Rationality allows people to form relationships, which themselves are very important (Berry 1987). Some philosophers have argued that since a person needs to be rational, and the human infant only appears to become rational after 1-2 years, then they are not persons until them. However, this is a very narrow sense of the word person, even if newborns have not developed to the stage of acquiring the ability to exercise selfconscious rational acts, they are still legally a person, and certainly exhibit self interest. This is normal human experience. It is understood that the infant has an inherent natural active capacity to develop to the stage of being self-conscious and acting rationally while retaining the same ontological identity as a human individual (Ford 1988).
The current attitude of society is that there is a steady and gradual unfolding of life and a gradual assumption of rights by the embryo. The murder of a newborn is as serious an offence as the murder of an adult. From the mystery of human existence we will have respect for creation, whatever our philosophy. We can reflect on the status of human life at several stages of development, and we may be lead to conclude with some degree of moral certainty that human personhood is not ascribable to early stages of embryonic development. However, the intrinsic promise and potential contained means we will treat it with very high regard. Human beings can not treat each other as means to ends but only as ends, but the duties owed to a one cell embryo are not the same as those due to a newborn child, or adult.
When we think of justice we think of the law. We can think of the cases of moral thinking which have been "decided" by making a new law. New laws can have a major effect upon our behaviour and attitudes, well thought out laws are necessary. It is nice to have laws for our "conscience" as it makes things black and white, however some areas are clearly grey and will remain so for the foreseeable future, and we must accept that. This is something that we do not know, and should not claim to, when motives and complex factors dependent upon the situation are involved, in some areas some sort of situation ethics is appropriate. This does not mean that there is not also a class of events which may be seen to be morally wrong but which are to remain legally permitted in a pluralistic society, for reasons that will be expounded such as that of human dignity and freedom of decision making.
From the reasoned argument based on biological knowledge, and ethical principles it is possible to draw different lines in the status of the embryo at fertilisation, implantation, formation of the cerebral cortex, and viability. An early embryo is a body in preparation at least, and the likelihood of homicide increases with the age of the individual. As Mahoney (1984) says, we may not be able to say "this is where I began", but we can say "from this early embryo I as a person took my origin".
I will discuss embryo research in the next section. The embryo may constitute an individual prior to the formation of the primitive streak, at 14 days. This would challenge the boundary that has been placed at 14 days. The argument of the in vivo stability at 14 days, following implantation remains important. We will consider the details of laws protecting the early embryo, or preembryo, in the section discussing scientific research on these embryos. It is also relevant to contraception, as discussed in the next chapter. Prior to new chemical tests, it was never possible to show a woman was pregnant until she missed her period, about 14 days after the conception of any embryo. It was only after the advent of scientific research on these embryos that lawmakers started to consider the legal status of preembryos.
There are sufficient doubts over the commencement of human personhood until the cerebral cortex begins to function, not to consider the embryo a person until at least 8 weeks and possibly up to 24 weeks. We await further scientific knowledge. Before this period, the status is lower than a human person, and should be recognised as such in law. After this period, the next clear mark is viability, and during this period the fetus takes on the status of an individual human being. Our scientific data does not allow any finer demarcation than this. As previously stated, a society may put earlier limits to protect the human embryo or fetus because of social or religious reasons, but they will not do so because of scientific reasons.
The mention of the word "abortion" can insight great argument. In the United States it has been a key political issue for the past decade, until recently the Republican party was unanimously against abortion. In the USA the two groups of people that represent the opposing views are often called "pro-life", those who are against abortion, and "pro-choice", those who support the freedom of the mother to decide to have an abortion. The groups are both politically powerful, and make rational discussion of the issue very difficult. Fortunately, in most other countries, although people may hold strong personal views, they have not tried so hard to force their views onto others. I will not dwell on this debate, except to observe that it is probable that in most societies there will remain people of these views, some of whom viewing public policy contrary to their own view, as wrong.
A summary of international abortion laws with respect to the time limits placed on fetal age is presented in Table 5-1. As stated, there are very different criteria used, this summary is only to illustrate how important to most countries abortion laws consider age to be. For more serious conditions, abortion at older age is permitted. In most countries fetal handicap is considered more serious condition, but this attitude is not universal. In Japan, among some groups, there is more acceptance of social abortion than selective abortion for handicapped fetuses because of concerns that this selection will lead to bad attitudes to handicapped people. However, to Europeans these ideas can be dissociated. In Islamic countries such as Egypt or Kuwait, the maximum limit is 17 weeks, from Koranic decree, but strict criteria are applied to any abortion until that time. In Hungary there is a sliding scale, so that the increasing likelihood of fetal handicap from 10% to 50% chance increases the fetal age limit from 12 to 20 weeks of pregnancy (Hungary 1986). In some countries the age limits and abortion laws are under continue review and debate. In Australia the state abortion limits range from 14 weeks in the Northern Territory to 28 weeks in Victoria and South Australia. In the USA the state laws are much more complex, and also changing.
Country; Law Limit (Time in weeks after Conception, ? indicates uncertainty) for indications: Demand; Distress; Rape; Handicap to fetus; Maternal Risk
Australia State Laws 14 28 28 28 28
Belgium 1990 Bill 12 12+ 12+ 12+ No Limit
Canada No - 22? 22? 22? 22?
Denmark #350,1973 12 22 22 22 22?
France #79-1204, 1979 10 10 10 No Limit No Limit
Germany #15, 1976 0(in East 12) 12 12 22 No Limit
Greece #1609,1986 12 19 19 24 No Limit
Hungary 1986 12 12 20 No Limit No Limit
Islamic Countries General, Koran 0 <17 <17 <17 No Limit
Italy #194, 1978 13 13 No Limit No Limit No Limit
Japan #1948 24 24 24 24 24?
Nederland 1981 13 24 24 24 24
Norway #66,1978 12 12 18 18 18
Spain #9,1985 0 No Limit 12 22 No Limit
Sweden #595, 1974 18 18+ 18+ 18+ 18+
U.K. 1990 - 22 22 No Limit No Limit
U.S.A. 1973 & 1989 court, future? 12 20 20 20? 20?
In most religions there is much concern about abortion. To be morally consistent, if the embryo is considered to be of full protectable human status at a certain time, than if at any period after those dates the living embryo is aborted the death of an embryo is unethical. This is an argument which stands, even if we bring other factors to bear, as an absolute moral principle stands absolute.
It is not inconsistent, for example, to prohibit human embryo experiments after 14 days, but permit abortions until 12 weeks, because in the case of abortion the mother's interests are involved. An embryo in utero has the potential to develop into a human embryo, which is something an embryo still in vitro does not clearly have. The factors relating to the parents, principally the mother, require consideration, but they should not be given priority once the embryo has protectable human status. What they can determine is whether the abortion of an embryo/fetus before this stage is ethical or not. There is an increasing recognition that fetuses should be regarded as the second patient. This will increase as fetal surgery increases. The fetus makes claims for a right to nutrition, protection, and therapy (Blank 1984). The mother also has important claims, as the raising of a fetus and child requires considerable devotion. These interests must be balanced, and it can be argued that until the fetus has intrinsic moral significance, that the mother's serious interests can overrule the fetal claim for nutrition.
The situation can be further complicated by advances in the practise of multifetal pregnancy reduction. This is also called selective termination of pregnancy. The birth weight of babies from a multiple pregnancy is lower, and they often have significantly lower chances of survival. As discussed earlier, it is possible that the majority of multiple pregnancies are naturally reduced to one fetus, which is probably a reflection of the increased chances of a single fetal pregnancy. This process can be performed at hospitals, especially for those pregnancies with more than two fetuses. In one set of 85 cases of triplets or greater, 80 were reduced to twins, of which most gave birth (Lynch et al. 1990). Given the enhanced chances of survival and normal life, it may justify the use of reductive abortion. It is an alternative option to parents, especially when the numbers are very high and premature birth is very likely, with the high probability of abnormality or the other option of total abortion.
Some have suggested that there is a need for national guidelines for this procedure, such as restricting the procedure to pregnancies of three or more fetuses. However, it is unlikely that this procedure will be abused, and it should not be forgotten that most of these pregnancies are found in women who were using drug treatment or assisted reproductive techniques in order to satisfy their great desire for a child. They are going to want to protect the fetuses that they have undergone extensive therapy to conceive. To respect the woman's autonomy, any selective termination of pregnancy within the time limits for general abortion should be permissible (Overall 1990). In fact, there is more ethical justification than many reasons for abortion as this is designed to enhance the survival of the remaining fetus(es).
Some Christians believe that all conceptions are known by God and that He wills them all to develop to their full potential, in which case there is no room for human interference in the process, however this view would seem to ignore human freedom. This is especially obvious in cases of the abuse of human freedom, such as rape cases. Most Christians place strong restrictions on the type of abortion which is viewed as ethical. In Hinduism it is an offence to kill the fetus, as it is a sentient being. The belief is that the process of continuity is co-terminous with conception (Bowker 1986). There is much concern in Buddhist religion also, in Japan there is a ritual like a funeral for each dead embryo, called a mizugo prayer (Miura 1983), as life is seen to start from conception. In Islam, the views differ on whether abortion is legal before 17 weeks (120 days), but in most Muslim countries abortion for serious fetal handicap is possible prior to this time.
If we were able to find an absolute moral principle saying that to kill the fetus is murder, than it would always be unethical to kill the fetus; however, this type of principle does not emerge from a study of the status of the embryo, even if it may generally be considered unethical to kill a fetus. The quality of man, the soul, his essence, his unique individuality, with its associated dignity or reverence means that man has a sanctity. However, we should not contend, as some arguments against abortion do, that existence is a good in itself as all other goods depend upon it. Some types of existence are not, and especially if there is no person, than there is no spiritual existence.
A working policy needs to consider many consequences and compare these with some basic rights. In a pluralistic society, no one religious view may be accepted for public policy, rather a view that attempts to accommodate and be consistent with the major public opinions, including religious, cultural values and scientific evidence and rational secular philosophy. Different approaches are possible in similar countries, as evidenced by the different laws. Some countries permit abortions, others do not. Many countries allow abortion at later stages of pregnancy if the fetus is shown to be suffering from a genetic disease or is handicapped. There are also differences in contraceptive policies, and embryo research regulations.
The law in Britain was changed in mid-1990. A brief discussion of it illustrates ideas that are common to other countries when deciding public policy. The previous law permitted approved abortions up to a time limit of 28 weeks after the last menstrual period, which is the time of viability stated in the 1929 Infant Life Preservation Act. The new law separated the abortion law from the Infant Life Preservation Act, and reduced the time of viability to 24 weeks, due to the modern techniques for neonatal life support. This was in line with the recommendations from the Royal College of Obstetricians and Gynecologists. In actual fact, the number of cases is very small. Out of 160,000 abortions in Britain in 1988, only 23 took place after 24 weeks, and 19 of these were due to fetal abnormality. The new law will not change the situation much. The actual age after conception is 22 weeks, because in Britain the time is counted from the last menstrual period. There are potential problems for countries that link abortion limits to the age of viability because as our technology advances over the next few decades the age of viability will be lowered. More importantly, although premature babies may be saved, they may not recover to live a normal life. In Britain in 1985, only 9 out of 58 babies born and treated at 24 weeks, survived beyond 4 weeks life. Those who survive are exceptional cases, and may have serious physical and mental retardation. In practise many countries place weight limits, such as 500 grams or higher, as the minimum before that premature baby may be treated. Even at 910 grams (two pounds), there is a high incidence of handicap among such babies. We must know reasonable limits to impose advanced technology in medicine, the same as we do at the end of life.
A more controversial decision in Britain, was the separation of the Abortion Act from the 1929 Infant Life Preservation Act. This means that a doctor is exempt from the new 24 week limit where an abortion is needed to "prevent grave permanent injury to the physical or mental health" of a woman or where there is a "substantial risk of serious fetal handicap" (Wood 1990). This decision was welcomed by doctors, as although there are small numbers of these abortions, they are very stressful for patient and doctor if they are unsure of the real law. However, the exception will apply to a tiny proportion of abortions, and people favour early abortions.
There is a trend in Europe for the liberalisation of abortion laws, even in strongly Catholic countries such as Spain and Italy. Abortion is still illegal in the Republic of Ireland, but elsewhere certain types of abortion are legal. The time limits vary widely, as seen in Table 5-1. West Germany and the Netherlands have liberal laws. Britain is fairly liberal. The most restrictive abortion law, outside of Ireland, is in Italy, where abortion on medical and socio-economic grounds is permitted only up until 12 weeks.
In the USA many states want to ban all abortions, and in July 1990 the state of Lousiana passed such a law. The 1973 Supreme court decision in the case Roe versus Wade protected a woman's right to privacy by granting a constitutional right to terminate pregnancy before the fetus is viable. Up until 12 weeks, abortion is available upon request, during the second trimester a state can regulate abortion to protect the mother's health, but a state may ban abortion in the third trimester, except if the mother's life is in danger. In 1989, the Supreme Court upheld a Missouri state law limiting abortion to 20 weeks. The Louisiana law will directly challenge the Supreme Court, though it may be several years before the law has finished challenges through the state courts. During this time the law will not be in effect. The composition of the Supreme court has been deliberately adjusted over the last decade, to introduce new members who are against abortion, thus the balance of views is very different to 1973. Rather than abortion being only an ethical issue, it has become a political issue in the USA, and the results are impossible to predict at this stage.
As a result of IVF there are numerous spare eggs, and embryos. The ownership, and fate of these embryos is one of the major questions arising from the use of IVF. There are also many eggs that have been taken from women being sterilised, and increasingly they have donated the eggs for scientific research. These eggs can then be fertilised to provide a large supply of human embryos for scientific research.
There have been many experiments performed on animal embryos created by IVF techniques, or embryo transfer. Similar experiments could be performed on human embryos. However, genetically manipulated embryos may not be implanted with the intention of producing a baby, because of laws in most countries. Human embryos have be cultured in vitro for at least 14 days (Williamson 1986). After this stage they cease dividing in culture, and there is research required if human embryos are desired to be grown past this stage in vitro.
Experimental Goals of Human Embryo Research
Most of what we know about mammalian embryos comes from in vitro growth of them (Austin & Short 1985). There are some studies which are said to be urgent, such as research into urgent clinical treatments, for the treatment of infertility, the alleviation of genetic disorders, detection of the causes of human anomalies, analysis of the relationships between embryonic and cancer cells, and the development of fetal tissue for use in transplantation (Edwards 1985, 1989). The meaning of scientific research on human embryos is generally misunderstood within even the scientific community. Some studies can only be made on early embryos. There are different types of research, they can involve observation only, with no damage to the embryos, such as the testing of different culture conditions. There is research on dead embryos, and experiments involving the destruction of living embryos. The report of the British Interim Licensing Authority (VLA 1989, ILA 1990), which regulates IVF clinics and embryo research, approved 53 research projects involving human embryos in 1988-1989. 41 were aimed at improving IVF, 11 at preimplantation diagnosis, and one experiment was to study the development of new contraceptives.
Alleviation of Infertility
The goal of recent embryo research was aimed at successful alleviation of infertility, and has now led directly to the births of many children by IVF. There are many experiments being done in direct connection to clinical uses of IVF (Vines 1987). The first experiments on early embryos were a necessary prerequisite to the technique of IVF (Steptoe 1985). The preimplantation embryos needed to be studied before being used clinically, especially the cell nuclei and chromosomes, to ensure that they were normal. Only after numerous studies of animal embryos were some human embryos studied to see their resistance to noxious agents, and manipulation that was needed for IVF. The procedures for safe fertilisation and transfer for implantation were studied.
There have more recently been many embryos used in the development of conditions for freezing of embryos, cryostorage, which has now yielded births. About half of the patients undergoing IVF treatment have embryos frozen, but only half these embryos currently survive the process. As a medical technique, IVF is best used by taking many eggs in one operation (Trounson & Wood 1984, Edwards 1985, 1989). These eggs are then frozen until needed. The procedure to remove eggs is complicated, and involves a period of hormonal stimulation of egg maturation, so it is easier, cheaper and less traumatic to take all the eggs that can be recovered (may be 20) at once. The better laboratories only need to replant 2-3 embryos to have a reasonable chance of a successful pregnancy. In fact a limit of three embryos implanted per cycle is enforced in some countries to lower the risks of multiple pregnancies. If it is unsuccessful, another set of embryos will be replanted at a later date. The overall increase in the efficiency of the IVF procedure due to freezing is about 15%, but new methods are being developed (Wood 1988). Low temperature storage of human embryos is one means used to improve the clinical success of IVF, as it avoids the need for repeated oocyte extractions. There are also methods being developed to improve the freezing of unfertilised oocytes.
Many experiments are aimed at the improvement of in vitro embryo growth. An example of this type of research is the use of "spare" embryos (judged as unsuitable for freezing because of poor quality) in coculture experiments. The embryos were grown for five days on a layer of kidney epithelial cells to determine whether this provided a better medium for embryo growth. Epithelial cells from the kidney are similar to epithelial cells from the genital tract. There was significantly higher growth of cocultured embryos, many continuing development (Menezo et al. 1990). This type of culture system makes it possible for longer in vitro culture so that frozen embryos can be grown to the blastocyst stage (5-7 days), and frozen then, as the success rate of freezing has been found to be highest at that stage.
Currently IVF techniques are unable to treat severe male infertility, such as when the sperm are immobile, or in too low a concentration. An alternative is to use mechanical injection of sperm nuclei into the oocyte, or chemical or physical methods of fusing the egg and sperm membranes. This might allow fertilisation with only one sperm (Wood 1988). So far the only method tried on animals is drilling a hole in the eggs' zona pellucida, the thick coat around the egg cell, to allow the sperm to enter (Gordin & Laufer 1988).
The egg cells, or sperm, may be used in interspecies fertilisation tests, but the hybrids are not grown past the early cleavage stage. The interspecies fertilisation test (Aitken & Lincoln 1986) is where oocytes of different species, with more easily obtainable eggs, are fused with human sperm, to test fertilisation. It is preferred to use eggs from other species to test sperm functions, rather than fertilisation of the human oocyte. This would be useful in measurements of male infertility. There is debate as to whether a hybrid embryo is of lower status than a human embryo at the 2 to 4 cell stage, but the normal 2-4 cell embryo is generally accepted to be of low status. There are various types of hybridisation, or chimera production, that are possible, which provide information about the way genetic information of maternal and paternal gametes are used, and the interaction of different embryonic cells.
The production of any human/animal hybrids or chimeras should not pass beyond the stage where the primitive streak is formed, though in practise most would not survive beyond the 2-4 cell stage. The situation regarding chimeras of different human embryonic cells is unclear, but should only be used if it is going to be a therapeutic advantage to the individual made. It is possible that this situation could be reached in the future, though the technology for making chimeras has existed for several years.
They can be used for testing human cell sensitivity to drugs or for carcinogen testing. Embryos could be used to test the effects of newly developed drugs or substances that may possibly be harmful, toxic or cause abnormalities. If done on a small scale where other ethical alternatives are not available, this might be ethical. It should not become commercially routine, but on a small scale would seem to be the best alternative in some cases. The presence of embryonic cell lines might be a preferable alternative and should be possible, so that embryos would not need to be considered.
There needs to be experimentation to examine the question of embryo splitting. This requires the judgement of what is desirable. As discussed above, this would be used to increase the number of embryos available for embryo transfer when few have been obtained after IVF. Extremists distort the use of embryos, from the many possible real benefits of research. A scenario the extremists suggest is that cloned embryos could be grown up and put into a "research park" to provide spare organs to the favoured "twin". This would be recognised as an abuse of science by almost all, and is not a research goal. By the time it became possible much easier alternatives for organ transplantation should have been developed. The clone would be regarded for what they were, another human individual
With recent advances it is possible to genetically analyse a single cell removed from an early embryo, within several hours, prior to implantation (Handyside et al. 1989). Preimplantation diagnosis will be discussed in chapter 7, it is an area of active research in several countries, and the first babies have been born after its use.
If there are many people suffering from currently incurable diseases and disorders that may be cured after the results of work on early embryos, the use of embryo experimentation could be seen as the just decision in an imperfect world. It does not call for indiscriminate research, but after carefully designed animal experiments it may be necessary to do pertinent human experiments to clarify and understand fundamental biological diseases.
Related to the clinical uses are experiments to study embryonic development (Vines 1987), including optimisation of conditions needed to grow embryos as long as possible in vitro. There is a large supply of human eggs and sperm available, so these experiments are not limited by material supply. Developmental genetics will be unlikely to get a high priority in the immediate future, as there are many experiments to be done in animal models before contemplating the "need" for human embryos (Weatherall et al. 1986). Others claim human embryo research is needed for research into congenital diseases now (Williamson 1986) as animal experiments have already been performed. There are many medically useful questions to answer, such as why twinning occurs, how different cells start to form different parts of the embryo and development of tissues (Edwards 1989). There is undoubtedly much knowledge to learn, but preliminary research should be restricted to studies with lower animals. There are many similarities between human and mouse embryos, but there are also important differences, which mean that animal embryos can not be used to model everything. Human eggs are much more sensitive to cooling than mouse eggs a fall in temperature below 37C irreversibly disrupts microtubules that hold the chromosomes together in human eggs, but not in mouse eggs.
Development of Contraceptives
Experiments are also underway to optimise conditions thought to be necessary for correct implantation. This involves studying the methods the mother's body uses to recognise the embryo before it becomes implanted in the wall of the uterus. Human embryos can be used in the study of contraceptive methods. There are various attempts underway to develop a contraceptive vaccine, to work either at preventing fertilisation of the ovum or implantation of the embryo. There are attempts to make gamete specific antibodies, but these need to be tested for the ability to block human in vitro fertilisation. To test some types there would need to be the production of early human embryos.
Clinical trials using a vaccine directed at a well-characterised product of the human embryo, human chorionic gonadotrophin, has begun (Jones et al. 1988). However, the abortifacient mechanism implicit in this approach makes it unacceptable to some. There has been a successful vaccine used in guinea pigs to make eggs infertile, so they can not be fertilised. This was done by producing antibodies against sperm in the female animals. This would be a more widely acceptable method of contraception, to those who view the embryo as protectable. It is found that 5% of women attending infertility clinics have antisperm antibodies, found in their vaginal secretions that reduce pregnancy rate (Aitken & Paterson 1989). The antibody prevents the binding of the sperm to the outside of the eggs, thus preventing fertilisation. This sort of contraception is irreversible if an inhibitor of the antibody is used. The actual molecules that are involved in this process on the sperm are yet to be characterised. Another area of research has been into the mechanism of action of existing methods of contraception. The intrauterine device (IUD) was thought to interfere with the implantation of the ovum, but is now thought to work by interfering with fertilisation itself (Barzelatto 1989).
The control of implantation and why genetically abnormal embryos are spontaneously aborted or fail to implant, is another area. There may be chimeras made with animals, or with genetically modified human embryonic stem cells, to study implantation. This is perhaps the logical extension of the preliminary research conducted on human embryos themselves. It will be important to define the developmental stage, such as cell number, which is the acceptable limit of these experiments, as the rate of development will vary.
How Much Human Embryo Experimentation is Ethical?
In Britain, the ethical factors and lack of legislation have led some scientists to delay the use of human embryos for experimentation. The British MRC (1982) and the Warnock Committee Report (HMG 1984), recommended bans on the experimentation on human embryos of 14 days age or over. This has recently become statutory in Britain. However, Britain has been one of the few countries to support any embryo experimentation. Some of the stated goals of this research have just been described.
The answer to the question how much experimentation is ethical, could be none, or some depending on the age and the experiment in question, or it could be any up to a certain age. One moral assumption that can be made is that it is completely unacceptable to make use of a child or an adult as the subject of a research procedure which may cause harm or death (Warnock 1985). The argument whether an early embryo is of the same status as a fully developed fetus is a slippery slope argument (Williams 1986), and was discussed previously in this chapter.
The pursuit of knowledge itself is not sufficient aim to justify ethically borderline experiments, there has to be a clear medical reason. The research aims are directed at the care of future individuals. There are many "gray areas", the intention of the research, and the primary effects or consequences that it may reasonably be expected to have upon the moral matters are necessary to identify. Many of a wide range of beliefs insist on no research (Chargaff 1987), while a few who believe the embryo has no rights have no ethical qualms about research. There is an intermediate view that human embryos should be respected, but those in the early stages of growth are not so protected that we can not study and learn from them (Edwards 1989). This view means that a human embryo is not equivalent to a mouse embryo, and so not open to any type of research.
A question is whether "spare" embryos created by use of IVF are different to those specifically created. In many European countries, research is only permitted on surplus embryos from clinical IVF treatment. The motive behind the origin may be different, and with the creation of "spare" embryos the original intent is not their death, but death is a consequence now that the donor has had a successful pregnancy and no longer requires more embryos to be implanted. The motive of those creating the embryos for experimentation is beneficial for future patients but means death to the embryos under experimentation. For human persons, the good of an individual comes before the good of a species, and they may not be the same. The doctor is concerned with the individual, while the scientist may be concerned more with the species. In the case of a preembryo, it may however be justified.
Experimentation on human beings carries more moral requirements than for than on animals. If we believe we are justified in exploiting animals for the cause of human betterment the question of using live embryos depends on whether they have a higher moral status. This depends on the status we place on humans as a species. Singer (1990) would argue that beings that feel pain are higher in status than nonsentient beings, such as preembryos. Under that view, we would be able to do embryo experiments, but for the same trial, we might not be able to justify animal experiments. However, many people place higher status on the human preembryo than many animals, for extrinsic reasons. As discussed in the previous section the early embryo even if not yet a human "person", has the promise to be one. Is the sacrifice of such promise justified in the interests of other human beings? However, what if the alternative is to be dumped in the rubbish, as in the case of surplus embryos from IVF, or surplus gametes from normal human life? If we use preembryos it should be only when it yields a necessary contribution to clinical problems, with a reasonable chance of contributing to the well being of other individuals. Some theologians such as Karl Rahner would support embryo experimentation but not IVF, because the early experimentation is on an embryo not a person. There would be more concern for the birth of children after the involvement of third party gametes. However, others are against research itself (Walters 1979).
The early studies had limited supplies of embryos, but now human embryos can be made from the many eggs and unlimited semen is obtainable in storage banks. In the U.K., where embryo research is widely permitted, the shortage of human oocytes for research has led sterilisation clinics to consider offering inducements for those woman who will give their eggs to the clinic for research. The Interim Licensing Authority (ILA 1990), and some members of ethics committees are, not surprisingly, against any inducements. Though it is possible that a woman who did agree to donation would be put on top of the National Health queue for sterilisations. The ILA recommends that the only kind of acceptable inducement is a free operation, which could mean moving the woman to a private hospital to perform the operation immediately. It is certainly a contrast to many countries which only permit experiments on surplus embryos from IVF procedures, instead they appear to be trying to obtain as many eggs as possible (sperm are in abundant supply).
One means of regulation is the expressed need for all experiments on human gametes and embryos to be only done if consent of the donors is obtained, but more control is needed. It is very difficult to justify the use of inducement, of whatever kind, to obtain gametes for embryo experimentation. It is difficult to be precise about what type of scientific research each egg and embryo is to be used for, and once it has been donated to scientific research, even if for the solving of a particular problem, it depends on the scientist how they are exactly used. The alternative is very strictly controlled research, which is the situation in some countries, such as the Australian state of Victoria.
In contrast to putative gene therapy where the experimentation is to aid specific individuals, in embryo research the experiment is intended to benefit the species, with the sacrifice of the embryo(s) involved. There is a distinction between research which is therapeutic, undertaken for the immediate best interests of the subject, and experimentation which has no immediate benefit as it is directed at broader putative long-term benefits. The long term benefit can be to embryos in general, or to medicine in general. Therapeutic experimentation has fewer ethical difficulties than non-therapeutic in cases where consent is not possible. The experimental treatment contemplated carries with it an element of ignorance as to the outcome, and should only be undertaken in the best interests of the patient when it is clear that more established forms of treatment are unsuitable. For therapy on embryos the symptoms treated could be before, though usually after, birth. The benefits hoped for and risks involved must be taken into account. The current situation is that no embryo that has been involved in an experiment should be replanted into a woman. When it is used, the genetic manipulation of embryos would require very delicate clinical judgement.
Embryo biopsy could be argued to be of importance to the future child, but not necessarily to that particular embryo. In many cases the embryo will be implanted after a good result, when in the absence of the technique its conception may not have occured. It is most important to the future child, that the embryo implanted was genetically normal, and free of disease, if the alternative is a serious genetic disease. This is a relatively new philosophical concept, but to many would be the common sense use of modern technology. In the modern family with few children, the future child's interests and parents interests are best served using this. However, we must carefully decide where to draw the line.
The major type of experiment generally considered are sacrificial experiments, the motive being to aid others. The decision on the grounds of motive is difficult. On the purely existential argument any embryos are of similar status. A human experiment must be moral in its inception, not just when it is done (Ramsey 1985).
In the arguments used to support the need for regulations on embryo research, a common objection is to the creation of human/animal hybrids. As stated above, there are some experimental reasons for creating interspecies hybrids as a result of interspecies fertilisation tests. However, some people use images of living animal/human hybrids to insight emotional objection to this type of research. However, most hybrids would fail to divide even at the initial stages of embryo development, let alone ever implant. While it may be a necessary precaution to prohibit such research if it involves later stages of development, if we support human embryo experimentation up to 14 days then we should also support animal/human hybrid research up to the same developmental stage, the implantation stage. However, only if the research is judged to be worthwhile and is subject to a controlling committee's consideration and approval.
Regulations are Required
What is imperative is that some guidelines be established in all countries involved in embryo experimentation (Edwards 1989). The most important regulation is the time limit for the in vitro growth of .human embryos. The situation varies between European countries, all experiments are banned in Norway, and in West Germany. The West German Parliament is considering a law which would ban human gene insertion into germ cells, any destructive research on human embryos, the formation of human hybrids or chimeras with other species, and the freezing of human embryos for IVF itself. It defines an embryo as a fertilised developing human egg from the time of union of the genetic material of the gametes, and also any totipotential cell which is able to divide and develop into an individual. The Bill prohibits clinicians allowing sperm to penetrate an egg other than for the purposes of producing a pregnancy. The main reasons for the harsh laws is the spectre of Nazism. It restricts IVF to married couples, and all embryos must be immediately implanted. While this eliminates the problem of surplus embryos, it may be medically unwise. It is a partway law, which is designed to allow IVF in a country where popular opinion is against embryo research. Any scientist guilty of embryo research may be imprisoned for up to five years!
A similar moratorium is in force in Denmark, which states that any surplus embryo must be immediately destroyed, and no cryopreservation is permitted. There has been a recommendation by the Danish National Research Council that a one year limit be imposed on freezing, and that it be used, but it is unsure if this will be accepted (Gunning 1990). After the Vatican (1987) instruction against "artificial procreation", the Catholic Universities in Belgium decided not to undertake embryo research. However, at Leuven they have introduced cryopreservation for surplus embryos. Research is permitted at private clinics, and there are no formal committees, because in Belgium abortion was illegal until April 1990, and this debate has taken attention away from embryo experiments.
France was announced it would introduce the Life Sciences and Human Rights Bill in 1989. This law would forbid any attempt to maintain an embryo in vitro beyond 7 days, unless the National Bioethics Committee consented to a 14 day time limit. However, it has been stalled for a year after adverse public debate, and a substantial minority of the committee want a total ban on embryo research. Fears of eugenics, rather than embryo rights, underlie this (Hughes 1990). From 1986 until 1989 no research on preimplantation diagnosis was permitted, but there is research permitted up until 7 days in relation to the methodology of IVF. Only surplus embryos are used.
In Holland there is a moratorium on the creation of embryos for research, but research on surplus embryos is permitted with the written consent of the donors. It is likely that legislation will allow research up to 14 days, but there is currently no embryo research. Research on "nonviable" surplus embryos up to 14 days is permitted in Spain, but the creation of embryos for research is forbidden (as is research involving cloning, parthenogenesis or genetic manipulation). Research is permitted on surplus embryos only in Sweden also, up to 14 days, and after consent of the donors.
The recommendation of the English Medical Research Council, British Medical Association and Royal College of Physicians is that human embryos should not be cultured in vitro beyond the implantation stage, for any purpose. This was the age limit recommended by the Warnock Committee (HMG 1984) and the earlier Government White Paper (HMG 1986). It finally became law in the U.K. in 1990 after a controversial Human Fertilisation and Embryology Bill (HMG 1990). During the voting, the bill had two alternatives in the section on human embryo research, either no research, or authorised research up to 14 days after fertilisation.
The U.K. Bill received much support from the members of the House of Lords. They supported research on human embryos up to fourteen days after fertilisation, by a votes of 234 to 34, and 214 to 80, at different readings. The House of Commons voted in favour of the principle of experiments on human embryos up until 14 days, by 364 to 193. The law allows for the use of deliberately created human embryos for research, which is the source of 75% of embryos currently used in the U.K. The Bill does not place restrictions on the criteria for treatment, except that all research and IVF treatment must be at licensed clinics.
There may soon be some European legislation. There have been two Council of Europe recommendations (Nos. 1046 (1986) and 1100 (1989)) on the use of human embryos. They want to give legal protection to the human embryo from fertilisation, and to decide on limits for experimentation and to try to prevent some countries becoming liberal havens for embryo research, but the situation remains variable.
The situation in Australia is under some legislation, but is still developing. The limit in the state of Victoria is determined by their Infertility (Medical Procedures) Amendments Act 1987. The Act allows for approval of research by a Standing Review Advisory Committee on embryos surplus to requirements, up to 14 days. It prohibits research involving cloning or cross fertilisation of human and animal gametes. It allows research on the process of fertilisation before syngamy (defined as the alignment of the mitotic spindle of the chromosomes derived from the pronuclei), about 22 hours, on eggs not destined to be replaced. There has been confusion on the distinction between the research use of specifically fertilised eggs up to syngamy and the possibility of using surplus embryos from IVF for research up to 14 days. The Victorian government had given powers to this Committee, but when they approved an experiment for after 22 hours, the government overruled them, the experiment was one of embryo biopsy of slow growing embryos. This lead to a moratorium on an embryo biopsy project and other research. In South Australia only nondetrimental embryo research is allowed up to 14 days. In New South Wales the limit may be 14 days, if the New South Wales Law Reform Commission recommendations are adopted. In New Zealand there is no law applying to an embryo prior to implantation, the preembryo has no legal status. However, there are only 3-4 clinics in New Zealand, so little research is possible.
In the USA there was a defacto ban on federal funding of embryo research since 1975 as approval from the Ethics Advisory Board is required. This Board is still to be established, because attempts to balance members who support abortion with those who oppose it have failed. It should be an embarrassment to American politics that quarrelling about the abortion views of members has delayed its approval. It suggests that members will automatically support one side or the other without functioning as a real ethics committee, in advising on individual cases. In 25 states there are statute restrictions on fetal experiments. In other states the federal limit of 14 days may be used. The criteria taken into account include the purposes of the research, the effect of the research on the embryo, whether it is in vitro or in utero, the stage of development, and the relationship to abortion. Research on ex utero embryos is allowed if therapeutic to the embryo, and nontherapeutic research is allowed in thirty states before viability (Andrews 1988). In most states early embryo experimentation is legally possible in facilities not receiving federal funds.
In Canada there is no legislation to control research. There are MRC Guidelines for projects using funding from the MRC. They approve of research if there is no other organism available, the research is considered worthwhile, and up until 14-17 days of development. They do not approve of the creation of embryos specifically for research. The Law Reform Commission of Canada has recommended that all non-therapeutic embryo research should require the approval of an ethics committee. It suggested a limit of 14 days, and that the embryos should not be implanted, and no embryos should be specifically created for research. It recommended the forbidding of research involving cloning, parthenogenesis and cross-species fertilisation. There is a Royal Commission established, which is expected to report in 1991.
The recommendation of a 14-day limit is seen by some as arbitrary, and the time limit could be increased as embryos are able to be kept alive longer. However, as discussed, there are some strong grounds for making 14 days a cut off limit. The limit that some see for scientific research to be associated with is the possibility of nervous coordination, between day 12, when the first neural tissues begin to differentiate, and day 30 (see earlier), when the sense organs begin to develop (Edwards 1989). Some say that it is preferable not to define an exact point, but to relate the nature of studies undertaken between these two periods to the clinical value the work is expected to yield. The Helsinki Statement on human IVF recommends the 25 day limit on growth of embryos. So a better alternative to the 14-day rule would be to establish a powerful ethical committee which demands justification for every piece of research. The 14-day rule is too generous for some types of research, for example, the study of chromosomes can be largely done at day 5, whereas studies on the differentiation of the hemopoietic system would require embryos at day 14 or later, and for some studies, such as those on the myocardium it would need growth until day 20. The arbitrary line required differs. The price to pay for no research on embryos includes a longer continuation of the suffering caused by genetic disorders, and greater risk to mothers using IVF. The committee would have to be scientifically trained so that it could make judgements on whether the research in question could be done on animals. There have been results of some human embryo experiments published which cover research not yet done on animals. Although there are some differences between animals and humans, the preliminary work should be done on animals, then the experiments considered for using human embryos.
However, even if there are many benefits, it would still not be justified if the research is unacceptable ethically. From the results of the discussion on the status of the embryo, my view is that a time limit around 14 days is ethical. The 14 day time is morally safe if the motive of the research is good and the embryos are only used when all possible animal work has been completed, i.e. they are treated with high respect. If we permit IVF treatment, than we should allow research that is needed to improve that treatment. The concept of regulated use of science is not new. Research is not sacrosanct, and there are many areas where researchers are regulated by moral laws, such as in the use of animals, human beings, or of dangerous pathogens. There are many areas which are regulated but do not have an outright ban, so there are reasons to believe regulated research would work. It may be difficult to prevent a time limit for growth of human embryos being exceeded, but if researchers know that they would be imprisoned if they publish results which other scientists would know had been obtained by use of illegal material, this should be a strong enough deterrent. An alternative seen by some researchers is the generation of a tissue culture cell line which has the attributes of a stem cell, i.e. many other cell types could be differentiated from it. Research to obtain such an embryonic cell line is intense. The guidelines will have to include the prohibition of growing an embryo older than the 14 day in vivo equivalent, probably measured by the formation of the primitive streak, from any type of cell line or embryo source.
The cutoff point is arbitrary, and different governments have made different decisions. I support the 14-day age limit for growth of human embryos in vitro, and it is also important that no experimented embryos are replanted until safety can be ensured. Modern embryology does indicate that until an embryo is implanted, and has passed the stage of twinning or recombination, and is clearly an ontological individual, it is of lower status than a biologically stable embryo. In exceptional circumstances which will lead to very important clinical results the established committee should have the powers to grant embryo research licence, for an age limit up to 14 days, as seen necessary from the research to be conducted. The embryos could be used from those which are frozen "spares" from IVF, or those specially created, as the status is the same, but their creation should be regulated. The determination of the number of embryos required will depend on informed scientists being present on the committee, however they should be balanced by nonscientists. The embryos are given a very respected status, but are available when necessary.
The next major step in embryo status must be when the neural tissue is beginning to function, this includes two stages, the feeling of pain and the formation of the cerebral cortex. The idea of brain life is important. Because of the doubts regarding embryo status between 14 days and such a time it is reasonable not to grow embryos past 14 days age. However, it is still consistent to consider an age for selective abortion past that time in vivo. There is sufficient difference between growing an embryo in vitro specifically for experimentation, and the killing of an embryo after that time in certain circumstances when in vivo. However, the limit to that killing could be placed at 6-8 weeks, the beginning of the formation of the cerebral cortex.
Although this is not a genetic or reproductive technology in the narrow sense, because it is a very topical related issue I will briefly consider it. We need to see how how the ethical principles would begin to deal with this issue, because this area of fetal research may result in the use of more human embryos than experiments at the early stage. The prospect of therapeutically effective fetal tissue transplants for diabetes or Parkinson's disease has made people examine older questions about the use of tissue from aborted fetuses. The demand may greatly increase if these treatments are effective, therefore the scale is much greater than the limited experiments previously performed. Fetal tissue from aborted fetuses have been used for many years, and it shares some similarities to the use of surplus IVF embryos in research, except that fetal material must be from a dead fetus. Dead fetuses from induced abortions have been sold and used for research. The opponent of abortion will object to the action of obtaining tissue, but it is argued that it is impracticable for people not to profit from the knowledge that has been obtained. At least the result of some research has led to clinically valued knowledge, from what otherwise could have been seen as a tragic waste of life.
There have been some important scientific and medical contributions from past fetal research. Prenatal diagnosis has been developed which has benefits in reducing the proportion of babies born that are handicapped or suffer from genetic disease. Research is needed on the development of new techniques to extend the range of diseases and to develop earlier testing procedures. Fetal research has been used to develop fetal tissue culture cells which have been used in vaccine development. They are also used in the development of in utero surgical therapies, and the assessment of risk factors and toxicity levels in drug production (Hansen & Sladek 1989).
Perhaps more importantly, there is quite a poor record for successful fetal tissue transplantation, one factor is that multiple donors are often necessary as tissues from a fetus are much smaller than the child or adult (McCullagh 1987). However, there are several advantages that make fetal tissue useful in transplants it grows rapidly, it is very adaptable, and when transplanted properly it evokes little or no immune response in the host (Greely et al. 1989). There is a shortage of small organs that are needed for transplantation into children. During the last two years there has been growing attention on the question of brain cell transplantation, from aborted dead fetuses to adults suffering from neural diseases such as Parkinson's disease. Despite the initial encouraging results saying that the recipients had improved after the transplants (Hitchcock et al. 1988, Madrazo et al. 1988), by mid 1989 and after 350 human tissue transplants in several countries, there were many less positive results. There have also been many adrenal tissue transplants into adult brain, with less success. Often the recipients are already very sick, and one may expect more success in patients in earlier stages of their illnesses. There is uncertainty at present on how they work in the few cases where there is some improvement. At the time of writing in 1990, the only very promising evidence comes from detailed scrutiny of isolated cases . The first very successful case of the recovery from Parkinson's disease symptoms came from a Swedish team, who used fetal implants from several 8-9 week fetuses (Lindvall et al. 1990). The patient regained movement following the transplant, but the long term effects are unknown. The transplanted neurons had increased levels of dopamine, an important neurohormone that is at abnormally low levels in Parkinson's patients. Other successes have been in increasing the amount of time that patients are able to control movements in response to drug treatment.
Animal experiments indicate that fetal brain is better than adrenal tissue, but there are also doubts on these studies, in which animals are given similar symptoms by drug treatment, prior to transplants rather than the longterm progressive neural decay of human adult patients. In those cases with improvement, the transplanted cells themselves seem to die, but they may stimulate dopamine production in surrounding cells. The mechanism is unknown. There are signs that alternatives may emerge, with the discovery that Deprenyl, a monoamine oxidase inhibitor, substantially slows the rate of neurodegeneration in Parkinsonian patients (Tetrud & Langston 1989). There is also hope that neural transplants may aid people with spinal cord injuries, allowing the spinal cord to rejoin at a break.
As I previously mentioned there are many experiments which could be done on human embryos which will provide results of benefit to others, but regard the embryo as expendable. Several aborted fetus of 18-20 weeks gestation, have been kept alive for a few hours in experiments to try to develop an artificial placenta. This type of experiment can be argued to be unethical because such a developed fetus should not be aborted as it has neural activity. However, if the experiment is independent of the abortion, should such an experiment be used, when there is no chance of survival? When passing legislation this type of research should also be considered, and flexibility maintained, by giving powers to an ethics committee to decide on cases which may arise that are not considered in the law. The protagonists of the use of human embryos for experimental purposes argue that the best species for experimentation to help humans is man, as to pass from preliminary animal studies to human trials is a move which has unknown risks, no matter how successful the animal trials are. They argue that we should not waste this opportunity to use human fetal tissue to benefit humanity. Before this new experimental subject became available in great numbers animal experimentation was used. We may not be able to justify research on an unconsenting research subject, even if there are consenting patients (though they are often sufferers of neurological disorders) already in existence and in serious need of radical treatment. However, most would judge that a discarded nonviable embryo or fetus is lower in status than a person suffering from severe disorders, and consider that the principle of the idea is ethical.
A disturbing possibility is deliberate pregnancy to obtain spare parts for a child or adult requiring an organ donor. There have already been over half a dozen cases in the United States of this being reported to provide an organ donor for a sick child in the family. One such case was reported by Clark et al. (1989) for parents who wanted prenatal diagnosis to be carried out to determine whether the fetus would be a compatible bone marrow donor for their first child who required bone marrow transplantation. In this case if the fetus was compatible they would bear the new child as a bone marrow donor after birth. The clinic decided it would not do this screening as it was not concerning the individual fetus and they do not think prenatal diagnosis should be used to benefit a third party or to facilitate the conception or abortion of a fetus for the purpose of generating an organ for transplantation. However, people have still brought about the birth of babies as bone marrow donors for their sick siblings. Actually, if it is a genetic disease, the new fetus could suffer from the same disease and be a bad donor to choice. If we live in a society permitting abortion for minor social reasons, then the desire to provide an organ donor could be seen as a better motivation for an abortion. However, it would begin a trend to viewing babies as consumer materials, which most people view as wrong. Despite the possible worthy motivation in individual cases, the trend should be stopped, as for sex selection. Some philosophers believe that there is nothing wrong with more abortions, especially if done for a "good" reason, but there is a significant, and in my view major, difference between tolerating, what is in terms of motive, an accidental abortion and allowing deliberate pregnancy for abortion.
Even if the treatment can be made to work, there will still be ethical problems. The numbers involved at present of suitable aged abortions is sufficient, however as the age for abortion becomes younger, and if the hope of many that abortion becomes much rarer in the future, is realised than there will be a shortage. The research should develop an alternative, such as some sort of neuronal stem cell line, which would be ethically more acceptable to all. If this sort of use of fetuses is going to be ethical the decision regarding the abortion and the transplantation must be keep separate, there should not be any motivation for the abortion in the woman's mind. The key concern for most people is that the two procedures need to be isolated. That is possible at the level of a hospital. In Britain the Royal Commission chaired by John Polkinghorne (HMG 1989a) has supported the use of fetal tissue transplants, as long as there is no direct contact between the abortion clinic and the research institutes. The Australian National Health and Medical Research Council guidelines allow the use of separated previable fetuses (20 weeks or less than 400g weight) or fetal tissue for approved research or therapy. The abortion procedure must be completely separate. A similar ruling applies in France for the guidelines, however the French National Ethics Committee does not support fetal transplants for Parkinson's disease treatment because of a lack of proven therapeutic value (Gunning 1990), but this may change with positive results.
Fetal research is permitted in the USA, but no federal funding has been given since March 1988 for projects involving transplants to humans. A Human Fetal Research Panel reported in December 1988 supporting therapeutic transplantation of human fetal tissue, as long as abortion is permitted by society and the use of the fetus is subject to informed consent of the mother. However, these guidelines are yet to be approved, and the moratorium on research using federal money was reimposed by the current U.S. Administration. There is research performed in private institutions. Eight states (Arkansas, Arizona, Illinois, Indiana, Ohio, Lousiana, New Mexico and Oklahoma) have laws prohibiting the experimental use of aborted fetal tissue obtained from induced abortion. The Uniform Anatomical Gift Act allows the donation of fetal tissue in every state provided there is documented parental consent (Gunning 1990). There is still federal funding of some projects involving transplantation of human fetal material into animals, for example for use in the study of the human immune system in mice.
Certainly, a prior requisite of any ethical use of fetal tissue is the separation of the abortion decision and later use. These concerns demand the prohibition of the donation of fetal tissue to designated recipients, the sale of such tissue, and the request for consent to use the tissue for transplantation from the mother must be asked for after a final decision to abort the fetus has been made (WMA 1989). It also means that the decisions regarding the technique used to induce abortion, as well as the timing of abortion, are based on concern for the pregnant woman, not in providing a fetus for transplant use.
In the USA many abortion clinics are privately operated as businesses. If the businesses can sell fetal organs, they could lower costs of abortions and be more competitive, while also being available to poorer people. There are many arguments that discourage the commercial exchanges of human tissue, and given the strong feelings aroused by abortion itself, commercialisation would not be generally acceptable. It is better to base social policy upon altruism, than on commercialisation. To use fetal tissue that is specifically aborted for that purpose is to treat the fetus as nothing but a medical product and the uterus as a factory (Greely et al. 1989). It demeans the potential humanity of the fetus. The possibility of the fetus being used could become a redeeming feature in the minds of women, and this would be almost impossible to eliminate if wider therapeutic use arises.
If society accepts abortion, at least up to the time of 12 weeks, as many countries do, then it would be double standards not to allow the controlled use of the aborted fetal material. The most important people who are the subject of this research are not the fetus, or the mother, but the recipient of the transplants. This is not the way that this issue is often presented to the public, but this only illustrates how preoccupation with one issue may cloud our sight from the more important ethical questions.
The fetal brain cells must be alive, which raises the question of determining death, usually the criteria of nonviability is substituted for actual complete brain death. The optimal age for neural tissue donation of aborted fetuses is now thought to be 9-10 weeks, but may change as experience is gathered (Jones 1989). One of the key requirements is that the cells can regenerate, and the best time to take cells is just after they have had a cell division. This limits the window to 8-12 weeks, the best balance of the amount of tissue and the regenerative capacity.
There will always be ethical problems in using fetal tissue at any age beyond which the individual is thought to develop, that varies with people. However, if we have decided on that age then we will strive to have abortions occuring before that time no matter what the uses of the fetuses. While those fetuses may be available as donors now, we should strive to bring the age back, which will lead to the situation where they are not available. There should be alternatives developed in the short term, so it will not be a long term dilemma. The time limit we may be aiming for is 8 weeks.
It will be impossible to satisfy the variety of strongly held views on what time limit, if any, is acceptable for human embryo experimentation. We should work to a society which maintains a high respect for human lfe, at the same time recognising the dilemmas faced. We can be certain that the fetus begins to feel pain at some stage after 8 weeks of development. We can also be certain that the fetus is not self-aware until later than this, perhaps around 20 weeks. Viability is possible at 22 -24 weeks. These stages represent major increases in the moral status, and we should recognise these points in our attitude to ethical questions involving the human embryo. They should be represented in the law, as we protect against other types of human experimentation or abuse. Recognition of these points does not mean we can do anything we like before these times, what the different stages of development present us with, is a hierachical system of the increasing moral status of the human embryo.
To Shaping Genes contents
To Shaping Genes chapter 6
To Eubios Ethics Institute home page