Recapturing the Soul of Bioethics

April 1, 2007. Modern bioethics seems to be going through a kind of identity crisis. With ethicists available for hire, drug companies and biotech firms have easy access to "experts" who can provide them with the veneer of respectability if they decide to head in the direction of unethical science. Erwin Chargaff, a pioneer in the field of biochemistry, once quipped that, "Bioethics didn't become an issue until ethics started being breached. Bioethics is an excuse to allow everything that is unethical." One common approach to allowing the unethical is to claim that, "We have already made certain choices, and now we really must move on to the next step - we must yield to the inexorable progress of science." Rather than examining and rejecting certain poor choices that may have been made in prior years, and trying to regain lost ground, bioethicists today unwittingly continue to grease the slippery slopes by their lack of courage in disavowing some of the unethical practices they have aided and abetted in the past.
 
Today, for example, we see enormous pressure on the public to support embryo-destructive stem cell research. Where do the embryonic humans come from that are to be destroyed for this research? They come from in vitro fertilization (IVF), a practice very few bioethicists have been willing to confront or challenge. IVF has become a kind of "sacred cow" that few outside the Catholic Church are willing to question. Yet it requires very little ethical reflection to see, for example, how making "extra" embryos during IVF and freezing them is a grave moral problem. Relatively few countries (among them Italy and Germany) have legal restrictions regarding IVF. In Italy, it is illegal to freeze embryos, and whenever you do IVF, you are not permitted to make more than three embryos at a time, all of which must be implanted into the woman. Germany has a similar law, and the country has almost no frozen embryos as a result. Such a law is a straightforward attempt to limit some of the collateral damage from IVF, and any reasonable person can see the benefit of enacting such legislation. But in the United States, we face what has been termed the "wild west of infertility," where few regulations of any kind exist and close to half a million frozen embryos are trapped in liquid nitrogen tanks in fertility clinics. As couples get older and no longer intend to implant their own embryos, researchers begin to clamor for those embryos to use in their research experiments. Bioethicists and politicians then further muddy the waters by suggesting that "they are all going to be thrown away anyway," which is neither true nor morally relevant. Even when somebody else will perform the dastardly deed of destroying a group of humans (discarding them as medical waste), that does not suddenly make it OK for me to choose to destroy them with my own hands. Here we have a perfect opportunity for some serious introspection about the mistakes of the past, an opportune moment to limit some of the collateral damage from IVF through laws like Italy's and Germany's. Yet one finds very few bioethicists willing to step up to the plate to tackle such an unpopular topic.
 
As the biotechnology juggernaut forges ahead with minimal ethical oversight, additional concerns quickly arise. Embryonic humans who will be sacrificed for research can be created not only by IVF but also by cloning (SCNT: somatic cell nuclear transfer). But in order to clone, you need women's eggs. Currently, women can be paid significant sums of money to "donate" their eggs to infertile couples who will use them for IVF. However, if they donate their eggs to science, for purposes of research cloning, they generally cannot receive payment except for incidental costs like travel expenses to get to the clinic. Hence, when donating eggs for fertility treatments, a woman can earn as much as $20,000 or even $30,000. If she donates her eggs to science for research purposes, on the other hand, she receives nothing. An article in March of 2007 in the New England Journal of Medicine refers to the "central contradiction" of this situation:
 

"…in the United States, we already allow women to 'donate' their eggs for profit. We allow them to undergo the same procedure and to undertake what is arguably a far more emotional endeavor - passing their genes to a child they will never know. How can we conclude that providing eggs for reproduction is less exploitative or dangerous than providing them for research? We can't."

 
The outcome of this line of thinking is that a growing number of bioethicists are recommending policy changes so that women can also be paid when their eggs are harvested for research. This assures "that science can go forward." A proper ethical analysis of this question, however, would mean promoting exactly the opposite position, namely, that women (and men) should never be paid for their egg or sperm, as we insist they not be paid for organ donations. This is done to prevent the human body from becoming "commodified" by powerful economic and market forces, and to stave off the prospect of trafficking in human parts. Additionally, there are known risks associated with harvesting a woman's eggs. Five women are reported to have died as a result of egg harvesting in the United Kingdom, and between 0.5 to 5% may typically have side effects of some kind, ranging from respiratory distress to renal failure. Providing payment for eggs is essentially a form of coercion, encouraging women to be reckless with their own bodies. Here again, we encounter a unique opportunity to insist on a thoroughly ethical approach for the future, by banning the sale of human gametes and acknowledging that past practices have not been ethical. Yet few bioethicists seem willing to broach the topic.
 
Bioethics is an exceedingly important discipline for the future of our society, addressing critical issues in science and life. This discipline cannot afford to compromise its integrity as new controversies arise, selling its soul to the highest bidder or playing to powerful special-interest groups like universities or biotech companies. Only by rejecting the demands of expediency and courageously acknowledging past mistakes can it regain the kind of principled moral foundation and credibility it needs to effectively assist scientists, medical professionals, and researchers in the future.
 
Rev. Tadeusz Pacholczyk, Ph.D. earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the diocese of Fall River, MA, and serves as the Director of Education at The National Catholic Bioethics Center in Philadelphia. See www.ncbcenter.org