Safety, identity and consent: A limited defense of reproductive human cloning

Bioethics

Volumn 20, Issue 3, 2006, Pages 125-135

  Lane, Robert ^a  

^a UNIVERSITY OF WEST GEORGIA   (United States)

Author keywords

Consent; Personal identity; Reproductive cloning

Indexed keywords

BIRTH DEFECT; CELL NUCLEUS TRANSPLANTATION; GENETIC DISORDER; HUMAN; HUMAN CLONING; IDENTITY; INFORMED CONSENT; MORALITY; PATIENT SAFETY; REPRODUCTION; REVIEW; SOMATIC CELL NUCLEUS TRANSFER;

ANALYTICAL APPROACH; BIOMEDICAL AND BEHAVIORAL RESEARCH; GENETICS AND REPRODUCTION;

ABNORMALITIES; CLONING, ORGANISM; CONGENITAL ABNORMALITIES; ETHICAL ANALYSIS; HUMAN EXPERIMENTATION; HUMANS; INDIVIDUALITY; INFORMED CONSENT; NUCLEAR TRANSFER TECHNIQUES; PHILOSOPHY; PRESUMED CONSENT; REPRODUCTIVE TECHNIQUES, ASSISTED; RISK ASSESSMENT;

EID: 33646546299     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2006.00486.x     Document Type: Review

References (42)

1. J. Robertson. The Question of Human Cloning. Hastings Cent Rep 1994 24 : 6 14
2. R. McCormick. Blastomere Separation: Some Concerns. Hastings Cent Rep 1994 24 : 14 16
3. A similar sort of anti-cloning argument relies on the claim that persons produced by SCNT would suffer, not (or not merely) from physical defects, but from psychological problems. Gregory Pence has, I think, shown that such arguments from psychological harm fail. G. Pence. 1998. Who's Afraid of Human Cloning? Lanham, MD. Rowman & Littlefield: 135-40. So in this article I will attend only to anti-cloning arguments that appeal to the physical risk borne by SCNT.
4. G. Annas. 1998. The Prospect of Human Cloning. In Human Cloning: an Opportunity for National and International Cooperation in Bioethics. J. Humber & R. Almeder, eds. Totowa, N.J. Humana Press: 59.
5. L. Kass. The Wisdom of Repugnance. The New Republic 2 June 1997. Reprinted in G. Pence, ed. Flesh of My Flesh: the Ethics of Cloning Humans. Lanham, MD. Rowman & Littlefield: 26. Elsewhere Kass relies on the notion of presumed consent in arguing against pre-natal eugenic or non-therapeutic intervention: The New Biology. What Price Relieving Man's Estate. In L. Kass. 1985. Toward a More Natural Science: Biology and Human Affairs. New York, NY. Free Press: 17-42. This is a slightly revised version of the essay by Kass published in Science 174, 19 November 1971.
6. A different objection to consent-based arguments like those used by Annas and Kass might be that, since the notion of the consent of people yet-to-be-conceived is absurd, the claim that we are sometimes morally obligated to acquire the consent of such 'people' before performing some action, as well as arguments that rely on that claim, are absurd as well. However, I do not think it is a sufficient criticism of anti-cloning arguments from consent simply to reject the assumptions on which they are based as absurd. One of the goals of this paper is to explain why some thinkers might take such assumptions to be, not only non-absurd, but true.
7. Pence employs this same theater metaphor to describe pre-conception people: op. cit. note 2, p. 133. Heyd considers a similar assumption about the metaphysical status of pre-conception humans but uses a different metaphor, that of 'an ante-world, a corridor leading to the world'. D. Heyd. 1992. Genethics: Moral Issues in the Creation of People. Berkeley, CA. University of California Press: 32.
8. R. Lane. Why I Was Never a Zygote. South J Philos 2003 41 : 63 83.
9. For a critical, philosophical look at the doctrine of reincarnation, see P. Edwards. 1996. Reincarnation: A Critical Examination. Amherst, NY. Prometheus Books. Edwards notes that in the West, 'belief in reincarnation...has been steadily gaining support in recent decades' (p. 7). As he also notes, some western philosophers have defended versions of the doctrine of reincarnation, including Ducasse and McTaggart. See C.J. Ducasse. 1961. Life After Death Conceived as Reincarnation. In In Search of God and Immortality: the Garvin Lectures. J. Bixler et al., eds. Boston, MA. Beacon Press: 142-162; and J.M.E. McTaggart. 1906. Some Dogmas of Religion. London. E. Arnold.
10. E.g. arguments that appeal to Jeremiah 1:4-5 to establish the pre-existence of the soul: 'Now the word of the Lord came to me saying, [Before I formed you in the womb I knew you, And before you were born I consecrated you]... '
11. This is merely a necessary condition of identity, not a sufficient one, since each of a pair of identical twins is physically continuous with one and the same zygote.
12. Pence, op. cit. note 2, p. 52.
13. Ibid.
14. In criticizing this argument, Pence also says that the notion, not of actual informed consent, but of presumed consent, can be used when considering whether to conceive a child by an experimental method. I address this second response to the Argument from Consent in section V.
15. I don't mean to suggest that Annas himself believes WIW, and in exploring the relation between WIW and the Argument from Consent, my intention is not to show that Annas himself has made use of WIW. Rather, my thinking is that, given the widespread acceptance of WIW or something like it among the general public and the widespread sentiment against reproductive cloning, it is valuable to see exactly how WIW could be used to support arguments against reproductive cloning, as well as what the denial of WIW and the acceptance of NV imply for the cloning debate.
16. D. Brock. The Non-Identity Problem and Genetic Harms - The Case of Wrongful Handicaps. Bioethics 1995 9 : 269 275
17. N. Agar. Cloning and Identity. J Med Philos 2003 28 : 9 26.
18. For this reason, the term 'Different People Choice' might be clearer. But I will retain Parfit's terminology.
19. It is irrelevant that a couple capable of conceiving naturally without IVF would probably not consider conceiving by IVF rather than conceiving naturally. The point of the example is simply to illustrate what Parfit means by 'Same Number Choice'.
20. Here I am assuming NV. The child born in the first outcome and the child born in the second outcome would not be physically continuous with one and the same zygote. This is because two different gametes are combined in each of the two outcomes. Thus, the zygote formed in the first outcome will not be numerically identical to the zygote formed in the second outcome. So the child born in the first is not the same person as the child born in the second. Note that even if WIW were true and NV false, this choice could still be a Same Number Choice. It would be a Same Number Choice if the pre-conception person who would enter the physical world in the first outcome would be other than the pre-conception person who would enter the physical world in the second outcome.
21. Once we assume that WIW is true, it is important to describe this sort of choice as the choice to 'conceive', rather than the choice to 'create', a child. This is because, if WIW were true, then the person to be conceived would already exist before he or she is conceived, and thus conceiving him or her would not be the same thing as creating him or her.
22. It doesn't matter whether, on the outcome on which P is not conceived, some other person is conceived or no one at all is conceived. If WIW were true, then both of the following sorts of choice are always Same People Choices: (1) the choice between conceiving a child and not conceiving a child at all, and (2) the choice between conceiving a child by one method and conceiving a child by a different method. In either case, no matter what the outcome of the choice, if P is not conceived as a result of the choice, then P remains 'in the wings' and it is still possible that P will be conceived at some future point.
23. A reproductive choice would be, not just a potential, but an actual, Same People Choice if in fact the same pre-conception person would eventually be conceived no matter what the potential parents choose. In order to settle the question whether a given actual choice to conceive is a Same People Choice, a proponent of WIW would have to appeal to the details of his or her particular version of WIW, details that address issues such as: why a given pre-conception person gets conceived at one time rather than another; whether a pre-conception person chooses his or her parents; whether karma, moral desert, or other factors play a role in determining when and to which parents someone gets conceived, etc.
24. Dylan will not be an exact genetic twin of Sam, however. There is mitochondrial DNA left in the enucleated egg which is fused with the donated DNA, and that mitochondrial DNA becomes part of Dylan's genotype. Pence, op. cit. note 2, pp. 17-18. I take the phrase 'delayed genetic twin' from National Bioethics Advisory Commission. 1997. Cloning Human Beings: Report and Recommendations of the National Bioethics Advisory Commission. Rockville, MD. Reprinted in Flesh of My Flesh: the Ethics of Cloning Humans. G. Pence, ed. Lanham, MD. Rowman & Littlefield: 45-65. However, there is controversy over whether humans created by way of cloning ought to be referred to as 'twins'. For example, Nancy Segal writes: 'Clones are not identical twins because they fail to fulfill the three twinship criteria: simultaneous conception, shared prenatal environments and common birth'. N. Segal. 1999. Entwined Lives: Twins and What They Tell Us About Human Behavior. New York, NY: Dutton: 205. For this reason, she rejects the NBAC's phrase 'delayed genetic twin' and recommends 'intergenerational clone (IGC)' instead. I prefer not to adopt Segal's phrase, however, since, as Pence points out, after decades of science fiction novels and films in which cloned human beings have been represented as, in Pence's words, 'sub-human' and 'zombie-like', the word 'clone' used as a noun has developed a distinctively negative connotation and is now 'in the same class as dozens of other nasty terms that slur the racial, ethnic, and sexual origins of a person'. Pence, op. cit. note 2, p. 49. Further, the qualifications 'delayed' and 'genetic' should make it obvious that cloned human beings and the persons of whom they are clones would be 'twins' in a much different way than are genuine identical twins, i.e. twins meeting Segal's three twinship criteria. For these reasons, I prefer 'delayed genetic twin' over Segal's 'intergenerational clone'.
25. Parfit, op. cit. note 15, p. 356.
26. R. Chadwick. Cloning. Philosophy 1982 57 : 204
27. A contingent future person is simply a pre-conception person whose future existence is contingent. I take the phrase 'contingent future person' from the title of N. Fotion & J. Heller, eds. 1997. Contingent Future Persons: On the Ethics of Deciding Who Will Live, or Not, in the Future. Boston, MA. Kluwer Academic Publishers.
28. M. Warren. On the Moral and Legal Status of Abortion. Monist 1973 57 : 43 61.
29. As I discuss in section VI below, I think it would be immoral.
30. Many readers will share my skepticism about the claim that a person who has not yet been conceived can have desires about anything at all, including desires about the manner in which he or she will be conceived. But this idea has some currency in contemporary popular spiritual literature. For example, Carol Bowman suggests that some souls actually 'choose' the parents to which they will be born. C. Bowman. 2001. Return from Heaven: Beloved Relatives Reincarnated Within Your Family. New York, NY. HarperCollins. And as Edwards, op. cit. note 8, pp. 21-22, points out, the idea that we choose our parents was also defended by both Ducasse and McTaggart.
31. Pence op. cit. note 2, p. 52. Pence argues that, on the assumptions that 'cloning is the only way that a child is going to exist, and [that] there is every expectation that the child will be normal', adult delayed twins would give retroactive consent to being conceived via SCNT. In effect, Pence is agreeing with me that the choice to use SCNT is never a Same People Choice. But he would reject the Argument from Presumed Consent (see below) on different grounds than mine. I think the first premise of that argument is false; presumably, Pence would accept the first premise but reject the second. I do agree with Pence that the second premise is false. But his rejection of that premise seems to be contingent on his assumption that 'there is every expectation that the child [created by SCNT] will be normal'. I think the Argument from Presumed Consent fails, even if we do not have good reason for thinking that a given delayed genetic twin will be normal.
32. Kass has in mind that presumed consent is required, not (or not only) because SCNT risks birth defects, but because of the psychological problems that delayed twins will, on his view, inevitably face: '... because of what cloning means, one cannot presume a future cloned child's consent to be a clone, even a healthy one': op. cit. note 4, p. 26 (emphasis added). But as I mentioned in note 2, I take Pence to have shown that there are no good reasons for thinking that all, or even most, delayed twins will face such potentially psychologically harmful conditions. For this reason, Kass' argument is stronger if construed as appealing to the physical, not the psychological, risk of SCNT.
33. Pence op. cit. note. 2, p. 52.
34. Ibid: 133.
35. This claim is consistent with my criticisms of the Arguments from Consent and Presumed Consent, and I take it to have great intuitive appeal. But a defense of that claim is outside the scope of this essay.
36. The same may not be true of birth defects that result from blastomere separation, when multiple pre-embryos resulting from one such procedure are implanted in the same womb at the same. This would be a plausible scenario were blastomere separation used as an infertility treatment. Roberts, op. cit. note 1, pp. 190-192, has argued that if the birth defects result, not from the blastomere separation itself, but from the subsequent implantation of multiple pre-embryos in the same womb at once, resulting in a multiple pregnancy, then the birth defect is not an unavoidable trait of the child that bears it. It is not unavoidable, since the pre-embryo with which that child is physically continuous could have been transferred to a different woman's womb or cryopreserved for later implantation. But this argument applies only to cloning by blastomere separation plus multiple simultaneous implantation. It does not apply to cloning by blastomere separation alone, nor does it apply to cloning by SCNT. Roberts also argues against cloning by SCNT, but her argument depends on the alleged 'psychosocial distress' experienced by delayed genetic twins who share their genotype, not just with an original DNA donor, but with several other delayed genetic twins created from that same genotype. As Roberts notes, this argument applies only to cases in which more than one delayed genetic twin is created from the same genotype (pp. 203-206).
37. Here I am in disagreement with Cohen, who argues that it is immoral knowingly to create a child with a serious but not devastating condition (e.g. missing two limbs) because life with such a condition, although not worse than death, is worse than never having been conceived. C. Cohen. 1997. The Morality of Knowingly Conceiving Children with Serious Conditions: An Expanded 'Wrongful Life' Standard. In Fotion & Heller, op. cit. note 25, pp. 27-39. I find Cohen's arguments unconvincing, but a complete response to them is beyond the scope of this paper.
38. Of course, this should not be taken to imply that it would be morally permissible knowingly to subject delayed twins, even those born of Different Number Choices to procreate, to conditions which would lower their quality of life after they are conceived. My position does not imply that once a child is created, it is permissible for his or her parents to fail to help ameliorate the effects of Down Syndrome, or blindness, or deafness, or a missing limb; and it does not justify neglecting to improve the welfare of children with such conditions once those children exist. If it would be immoral to treat a human created by sexual reproduction in a certain way (such as by not doing what one can as a parent to protect his or her interests or improve his or her welfare), then it would be immoral to treat a delayed twin in that way. As Pence says, method of origination is not a morally relevant difference: op. cit. note 2, p. 46.
39. I adapt this example from Pence, ibid: 101ff.
40. Although it might not be obvious, this is consistent with Robertson's claim that if reproductive SCNT 'is unethical, it will be necessary to find a basis for such a judgment other than harm to the resulting child, for the child in question has no other way to be born, and its very existence is unlikely to be so full of suffering as to be wrongful': op. cit. note 24, p. 91. Unlike Robertson, I would not put the point in terms of harm, since I don't think P can be harmed, or benefited, by being conceived in a given manner, if that manner is the only way in which P can be conceived. I prefer to say instead that the fact that SCNT may result in children with birth defects is not by itself a sufficient reason for thinking SCNT is immoral. The scenario to which I object is one in which parents make a Different Number Choice of unsafe SCNT over a method that is known to be safer, and the claim that such a choice would be immoral is consistent with Robertson's position.
41. Parfit op. cit. note 15, p. 360. Explaining why it is better for the 14-year old to wait, although it isn't better for the child that she will have if she waits, is an example of what Parfit calls the Non-Identity Problem. On Parfit's view, Q solves that problem with regard to Same Number Choices, but not with regard to Different Number Choices.
42. J. Savulescu. Procreative Beneficence: Why We Should Select the Best Children. Bioethics 2001 15 : 415.