The Cedar Lounge Revolution

You might have caught a letter in the Irish Times last week. It started:

The Irish Council for Bioethics (ICB) recently issued an opinion - “Ethical, Scientific and Legal Issues Concerning Stem Cell Research” - which recommended that frozen IVF embryos could be destroyed for research to generate human embryonic stem cell lines.

It continues that:

The fact that the opinion was unanimous (13-0) - curious, given the diversity of opinion on the topic - might signal to legislators that the recommendations represent a general consensus in the academic and biomedical communities.

And then…

This is not the case, and we are writing to express our strongest possible dissent from the ICB with regard to destructive research on human embryos. This opinion has no sound ethical, medical or scientific basis. Incidentally, 69 per cent of respondents in the council’s own public consultation believe the embryo attains “full moral status” at fertilisation.

They continue:

Scientifically it is a fact that a new, unique, human individual comes into existence when the DNA from sperm and ovum come together at fertilisation. The ICB report recognises this and accepts that the embryo has a “significant moral value”, but then asserts that the embryo does not “have the same moral status as those already born”. No valid reasons are given for this extraordinary assertion.

Which leads to the proposition that:

The embryos are human individuals. The disturbing suggestion (from sources referred to in the ICB’s document) that the value of an embryo might be contingent on the attitude of parents is not consistent with any valid concept of individual human rights. Neither the fact that many embryos die, nor that twinning can occur, changes the fact that destroying IVF embryos is destroying the lives of human individuals.

It gets better:

There is, in fact, no need to destroy IVF embryos. With the recent advances in egg freezing and the option of adoption of frozen embryos (if the parents do not wish to have them all implanted), IVF without left-over embryos is perfectly feasible; and the Government should legislate on this basis to protect the interests of parents and of the embryos generated by this technology.

And it concludes that:

The issue of the rights of embryos is often portrayed as a religious one, but our position is based on scientific principles and concern for fundamental human rights, not on religious dogma.

So, there we have it. Science has determined that rights for embryos is a scientific one.

And who is responsible for this letter? Why none other than:

MARTIN CLYNES, Professor of Biotechnology, Dublin City University; WILLIAM REVILLE, Associate Professor of Biochemistry, University College Cork; KEVIN KAVANAGH, Senior Lecturer in Biology, NUI Maynooth; DONAL Ó MATHÚNA, Senior Lecturer in Ethics, Decision-Making and Evidence, Dublin City University; DESMOND O’NEILL, Associate Professor of Medical Gerontology, Adelaide and Meath Hospital/Trinity College, Dublin; KEN CARROLL, Senior Lecturer in Biology, ITT Dublin; GERRY WHYTE, Associate Professor of Law, Trinity College, Dublin; ROSALEEN DEVERY, Senior Lecturer in Biotechnology, Dublin City University; WILLIAM BINCHY, Regius Professor of Laws, Trinity College, Dublin; METTE LEBECH, Lecturer in Philosophy, NUI Maynooth; JOHN KEHOE, General Practioner, Naas; SEAN Ó DOMHNAILL, Consultant Psychiatrist, Louth/Meath Mental Health Service; RONALD GRAINGER, Consultant Urologist, Adelaide and Meath hospital/Trinity College Dublin; DES MacHALE, Associate Professor of Mathematics, University College Cork; PETER CHILDS, Senior Lecturer in Chemistry, University of Limerick; TERESA IGLESIAS Director, Newman Research Centre, School of Philosophy, University College, Dublin.

Hmmm… some of those names seem awfully familiar. For example, doesn’t William Reville write a science column in the Irish Times. Isn’t that the column which seems to have some problems integrating scientific knowledge and… er… religious… well, maybe not dogma, but certainly religious…er talk… stuff… whatever?

For example barely a month ago we were treated to his thoughts on… stem cell research.

Here he stated that:

Human life begins at conception when a sperm cell and an egg cell unite to form a zygote - the first embryonic stage. The embryo grows and develops. After several weeks it is called a foetus, which continues to grow and develop until born as a baby about nine months later. The baby grows and develops into an adult, who grows old and eventually dies. The whole process is a human continuum between the boundaries of conception and death, and is programmed to proceed automatically under normal circumstances.

And…

Each stage along this continuum is fully human, having the full human properties and potential appropriate to its stage - zygote, foetus, baby, adolescent, adult and old person. All the genetic information in the human adult is already present in the single-celled zygote. Each point on this human continuum is dependent on the preceding part of the continuum and determines the succeeding part of the continuum. Interrupt the continuum at any point and nothing happens beyond that point. These are biological facts.

Which led him to the conclusion that:

Accepting these facts, it seems to me to be wrong to arbitrarily pick any point on this continuum and claim that it marks the boundary between the preceding “not fully human and not deserving of protection” section and the succeeding “human enough to deserve protection” section. Obviously, my position on this is not universally accepted amongst scientists or the general public.

Interesting, so the basis on which letter number 1 reproduced in part above is put foward as regards being based in science, not religious dogma, is somewhat more nuanced here in that he accepts:

my position on this is not universally accepted amongst scientists or the general public.

And this isn’t a minor matter for:

But, unfortunately, in order to harvest the embryonic stem cells you must kill the embryo. I consider the embryo to be fully human, hence my ethical problem with HESC research.

The Irish Times hasn’t been behind the door on all this either. It recently ran a piece by FF Senator John Hanafin on just this topic.

For the Senator there was little concentration on the destruction of embryo’s but rather the more exotic outcomes that raised his ire:

The [UK] Bill also makes provision for “saviour siblings”. This would allow for children to be created for the sole purpose of helping to treat a sick sibling. First, it would involve pre-implantation testing of numerous human embryos to find a match for the existing sick brother or sister. The embryos deemed suitable would then be implanted in the womb of the mother, in the hope a baby would be born with a cure for the sibling. Needless to say, the embryos that fail to match the needs would be routinely destroyed.

It is not overstating the case to say that this will inevitably sanction the creation of “spare-part children”.

And it wasn’t just that, but also:

What is taking place in Britain begs some questions. Where are we going as a society? What do human rights mean any more? Surely we meddle with the miracle of human life at our peril? Is it surprising there is growing disregard for human life when we do not value it at its most fragile beginnings?

And then…

The fact that the creation of human-animal hybrid embryos is an affront to human dignity doesn’t seem to matter at all. In the Human Fertilisation and Embryology Bill, it appears the end justifies the means with one simple proviso - regardless of what the practice actually entails, it must be presented as ethical, necessary and progressive.

His core argument was that:

This underlines the complete absence of any principle when it comes to defending life.

But herein lies the problem, because it is not actually lack of principle, but rather different definitions, as indeed Reville points to.

And the letters pages have not been quiet. There has been a wading in by those on the anti-side of the balance sheet. Dr. Séamus Murphy SJ, Senior Lecturer in Philosophy, rather curiously suggested that:

The council’s report fails on that score, for it offers no ethical reasoning on the key issue.

Its ethical flavour appears post-modern, even relativist, as though its authors think there are only different moral opinions and no possibility of reasoned moral judgment.

Post-modernist you say? And then follow it up with ‘reasoned moral judgement’.

Professors Desmond O’Neill and Martin Clynes, signatories to the first letter also appear arguing that:

However, the report lacks a wider perspective on challenges to those with neurological disease, particularly those major brain diseases associated with ageing, such as Alzheimer’s and stroke.

Much of the difficulty of appreciating personhood in dementia lies in an often utilitarian, hypercognitive approach to personhood, rather than a wider sense of what constitutes our human nature. This approach has been expanded by some moral philosophers to support rationing care away from those with Alzheimer’s disease, and another has likened people with dementia to dogs.

…

It is ironic that those with Alzheimer’s disease and stroke are quoted as primary targets for the use of embryonic stem cell treatments, as outlined by the council’s document. For their well-being and care is threatened by a lack of appreciation of their personhood: such a qualified approach to personhood is mirrored by a qualified (or, as they term it, a gradualist) approach to personhood at the beginning of life.

…

Stem cell research holds great promise for our understanding and eventual treatment for the major neuro-degenerative illnesses of later life. However, it remains important that this is not done in a way which erodes the universality of our moral status as persons at the extremes of age, vulnerability and co-dependency.

Now, perhaps it’s me, but the points they raise about certain moral philosophers is a curious one… and hardly more than a hairsbreadth away from alarmism.

A response to the good Professors from Dr. Richard Hull and Dr. Siobhán O’Sullivan who are on the Irish Council for Bioethics argues the blindingly obvious that:

There are many other differences between issues at the beginning of life and issues toward its end, which reinforce the point that they should be treated separately. It is also worth noting that being hopeful about the future therapeutic applications of stem cell research is not in the slightest bit incompatible with a strong desire to see a society that is more inclusive and sympathetic with respect to all of its members. The council’s report encourages reflection on these and other issues.

Still, that doesn’t help. For another letter writer argues that:

The problem, as I see it, is that science moves faster than moral understanding. There is a real genuine problem and moral dilemma involved in the mindless art of “engineering” our human nature. This problem cannot be glibly glossed over merely by a facile reference to secular humanistic arguments based on utility. Perhaps we really need some kind of “spiritual” values if we are to put the brakes on humankind’s “will to mastery”. Although what is proposed sounds repugnant on a gut level to many, the “gut” is a flimsy thing to build arguments around. In the end, perhaps those who are opposed to what the council is proposing must fall back on something like a genuine moral plea for reverence and humility in face of the mystery of life, rather than a lawyer’s watertight “case against”.

And the even more, to me, unsatisfying:

The council is advocating the destruction of living embryos “for the good of society” - specifically for the purpose of health; the health of sick individuals. But the line between health and enhancement may be in the end impossible to draw. Indeed health itself is a form of enhancement. Perhaps we ought, at least, to think about the line, however imaginary - and think about where, in a hyper-competitive world, re-engineering our natures will ultimately lead

Okay.

But one letter cuts to the heart of the obfuscation. Dr. Dolores Dooley suggests the following:

The letter of May 10th from a group of Irish academics raised a number of issues in relation to the Irish Council for Bioethics’ (ICB) opinion document on stem cell research. We take issue with the assertion that the council’s stem cell report “has no sound ethical, medical or scientific basis”.

She continues:

The letter claims “it is likely” that therapies for diseases will be developed using adult stem cell research and induced pluripotent stem cells, thereby obviating the need for embryonic stem cell research.

Science is based on the systematic testing of hypotheses and observation and does not rely on likelihoods for its results. While induced pluripotent stem cells hold significant promise, they will not provide a replacement for embryonic stem cells in the short term.

She notes:

There was also a reference to the possibility of IVF without the need for supernumerary embryos. Again, while future progress may indeed alter IVF practices, egg-freezing is a new technology and is still considered experimental. Thus, until sufficient data show there are no increased genetic or congenital abnormalities in babies born using frozen eggs, it will not become mainstream IVF practice. In addition, a significant body of research has also demonstrated that the majority of couples are not willing to donate their supernumerary embryos for other people’s parental projects. Both these issues are discussed in some depth in the ICB opinion document.

And she concludes:

The assertion that the council gives “no valid reasons” for its opinion that embryos do not have the same moral status as those already born is incorrect. We would direct the signatories to pages 34-41 of the report, which discuss issues such as moral status, personhood, potentiality and human dignity, which form the basis of our conclusions.

But look, the ‘group of Irish academics’ are arguing from a scientific position, not from one based in religious dogma. Although they appear not to have read, or at least to have understood the actual report… which somehow I in my non-technical way managed to.

And this, as Dr. Dooley notes;

…this places an ethical responsibility on all sides of the debate to provide balanced and accurate information.

Yet this is not sufficient for Reville, for on Saturday he wrote:

I refer to the letter of May 14th from my former UCC colleague Dr Dolores Dooley, chairperson of the Irish Council for Bioethics (ICB), regarding the recent opinion published by the council entitled The Ethical, Scientific and Legal Issues Concerning Stem Cell Research, and in reply to a joint letter from 16 Irish academics, including myself (May 10th).

He argues that:

The debate on the ethics of human embryonic stem cell research hinges entirely on the moral status assigned to the early human embryo. The joint letter charged that the ICB opinion “gives no valid reason” why it assigns less moral value to the embryo than to the born person. Dr Dooley denies the substance of this charge and directs readers to pages 34-41 of the ICB opinion to prove her point.

Which he finds insufficient because:

It merely lists a wide range of the diverse opinions of many people on issues such as moral status, potentiality, personhood and human dignity, before plumping for its own position of “granting significant moral value rather than full moral status to human embryos”.

And continues:

The ICB opinion does not tell us how and why its authors were unanimously persuaded to come to that conclusion and I remain happy to stand over the charge made in our joint letter of May 10th.

There is no definitive judgement on these matters, and Reville has noted this way back when. But as ever there is the effort to leverage opinion into certainty - and note the significance to him of the fact that it was “…a joint letter from 16 Irish academics”. And it seems to me to be near-specious to pretend that there is, or that this lack of definitive judgement leaves us in other than a contingent area.

And what of the report that raises such heat? On the pages Reville refers to we read:

A range of positions can be taken with respect to the moral status of embryos. At one end of the
spectrum, is the view that embryos are balls of cells that have no more moral value than any other
piece of human biological material. At the other end, some would consider embryos to have the
same moral status as any adult. This is the view that embryos have “full” moral status from the
moment fertilisation is complete. Others grant significant value to early embryos but not the same
status as they would grant to an adult. In this view, embryos will acquire full moral status at a later
point during embryonic development.

It goes further and makes a point that Reville one presumes must implicitly hold to, yet curiously does not enunciate:

In the view that embryonic life must be preserved from the moment fertilisation is complete, it is
implied that embryos have an absolute right to life, which cannot be violated at any cost. Proponents
of this view would object to current AHR practices because many of the embryos produced through
IVF will not be used and, as such, will never develop and are, therefore, denied their right to life.
The use of several types of contraception, such as intra-uterine devices and the “morning after pill”,
for example, can lead to the destruction of embryos in their earliest stages of development. Thus,
their use also violates this ethical position. It is often argued that, given that human development is
continuous from fertilisation to birth, any point at which full moral status were to be granted, other
than at fertilisation, would necessarily be arbitrary and, therefore, unsound.

There is more, and here’s a taste of it…

However, others have argued that the acquisition of moral status is as continuous a process as
biological development and that embryos gradually gain their moral value. This is referred to as a
gradualist view of moral status. Within this broad ethical position, some people do not think that there
is a single point at which full moral status can clearly be attributed to the embryo. Where research on
embryos is considered, it is argued that the relative moral value of the embryo should be considered
in the context of the other values that can be realised through stem cell research in order to decide
whether or not to proceed with it.

Anyhow, cutting to the chase:

On consideration of the various arguments relating to the moral status of the
embryo, the Council adopts a gradualist position, granting significant moral value
rather than full moral status to human embryos. The moral value they are seen
to possess is based on recognition of their potential to develop into persons, as
well as the value they derive from representing human life in its earliest stages.

This seems a rational and sensible position. To suggest that it is simply plucked from the ether is unfair - there are pages after 41 which deal with other issues relating to, for example, the nature of acts and omissions in moral terms (and raises some important points i.e. “Nonetheless, it can be argued that moral consistency does not always lend itself well to practical
policy solutions, especially when a plurality of opinion exists within society.”). Would more explanation on the discussions be useful? To a degree. But, again, Reville recognises that difference exists. So it appears his gripe is that he and the other ‘academics’ appear to hold the differing view.

And lest this seem to be a gratuitous lash at Reville, et al, let me be straight about it. I’m not entranced with stem cell research. There is an ‘yuck’ factor (discussed on page 51 of the report) that makes me wince to some degree. That said I have some experience as regards embryos and the implications of same and that perhaps colours my view. I can see situations where embryo’s are massively precious dependent upon circumstance. But that’s the thing. Precious dependent upon circumstance. The human body itself sheds embryo’s with an incredible profligacy. And this alone makes contingency perhaps of greater importance than Reville and co. might like to pretend. That contingency, to me at least, belies the absolutism of their arguments. I don’t know for sure what the answer is, or whether one exists. I suspect that like many many medical/bioethics issues this is one beyond clear resolution, and that there will always be different camps on it. But, we are sweeping into the future, and flawed as the ICB opinion document may well be, and wrong as it may well appear to some, at least it constitutes an honest effort to put some structure on these issues and to quote Dr. Dooley once again…the seriousness of these issues, and how they strike at the root of many many difficult individual and familial circumstances:

…places an ethical responsibility on all sides of the debate to provide balanced and accurate information.