Dr. Siegel is an attorney and philosopher and a member of the research staff which advises the National Bioethics Advisory Commission. The NBAC was established by former President Clinton at the time the sheep Dolly was cloned. The NBAC has fully supported the destruction of human embryos to obtain stem cells. Dr. Siegel’s original article was entitled, “Summary of Some Ethical Issues in Human Stem Cell Research” and was presented as an NBAC staff draft document on Feb. 24, 1999.
A. S. Siegel has presented a summary of ethical arguments for and against using human embryos for stem cell research. Some of the arguments he includes that are in favor of such research exhibit significant weaknesses that invite a critical response. The following response centers on three points that are worthy of elaboration.
Faith in the practicality of moral guidelines
We live in a culture that has institutionalized abortion as a woman’s “right.” Insofar as the human fetus has been deemed an object of a woman’s rights, it has been objectivized. Consequently, it is not regarded as a human entity or being that possesses the most fundamental of all human rights, the right to life (or, to state the matter conversely, the right not to be destroyed in an arbitrary fashion). Given this disregard of the inherent right of a broad class of innocent human subjects (all unborn human beings) to live, it is not reasonable to suppose that “guidelines” intended to insulate abortion decisions from considerations of fetal tissue procurement could be expected to work. In a moral atmosphere in which a flagrant disregard for fundamental human rights is taken for granted, it is not likely that “guidelines” would be sufficiently honored so that they would effectively prevent decisions concerning abortion from being influenced by the prospect that stem cells from the aborted fetus might benefit other human beings. If we are reckless about primary matters, it is not likely that we will be cautious about those that are secondary.
It seems na�ve to believe that “guidelines” could serve the needs of justice and humanity if they are set in a cultural context in which a broader and more basic moral vision has been seriously impaired. Inevitably, the more fundamental defect will carry over to the “guidelines,” impairing them in accordance with its own impairment. Society is organic. Moral evils spread from one sector to another as a disease spreads through the body. Neither social evils nor bodily diseases can be effectively compartmentalized. One cannot be complacent about abortion and at the same time be expected to exhibit unimpeachable moral rectitude on the issue of fetal stem cell research.
Naivete with regard to what drives the pro-abortion movement
The abortion movement derives its force and persuasiveness (though not its justification) from two principles: 1) the right to choose (the pregnant woman’s alleged right to choose abortion); 2) the autonomy of the woman (reproductive freedom). These principles are solidly entrenched in what is judiciously termed the “abortion establishment.” Again, it seems unreasonable that these powerful and persuasive positions can be confined to abortion. It is inevitable that those who endorse these two principles will want to give them wider application. This wider application would include the area of human stem cell research using cells taken from human embryos and fetuses.
Cultural ideas have no boundaries. They are like dandelion spores that are carried wherever the wind takes them. The engine that drives abortion will continue to pressure certain scientists to utilize its principles of choice and autonomy in the arena of stem cell research.
It is not plausible that society will accept one set of moral principles for abortion and an altogether different and more highly nuanced set of moral principles for stem cell research. Realistically, one must oppose the gratuitous and acontextual principles of choice and autonomy that drive abortionism, if there is to be any hope that reasonable and effective guidelines could be found to regulate stem cell research.
A loss of the meaning of procreation
Dr. Siegel makes the following remarkable statement: “Whereas embryos created for procreative purposes are originally viewed as potential children, embryos created for research are meant to be treated as mere objects of study from the outset.”
Here is just one of several instances in Dr. Siegel’s summary in which it is only too painfully evident that in an attempt to justify stem cell research, fundamental and hitherto non-controversial realities have been ideologized beyond recognition. To say that embryos can be created for procreative purposes sounds like gobbledygook. Properly speaking, God creates. Human beings procreate. Historically, the notion of human procreation is grounded in God’s act of creation. God creates from nothing. Human procreation proceeds from God’s creation. To assert that humans can “create” for a “procreative purpose” is to give to man a role that belongs to God alone. Only God can create in such a way that He can endow His creatures (in the specific case of human creatures) the capacity to “procreate.”
Furthermore, to assert that humans can create for a “procreative purpose” is to render the word “purpose” entirely superfluous. In procreating a child, a new human being, one is highly impertinent in attaching an arbitrary label to this act. In the face of the intrinsic dignity of the child, all arbitrary claims and purposes that the procreators attach to themselves should evaporate. Procreation has its own purpose and that is the child himself. The child is his own reason for being, not his parents’. A utilitarian perspective is impertinent and barbaric, because it fails to honor the dignity of a newly procreated human being.
In addition, a new child, even at the zygote stage, is not a “potential” child. Rather, it is a real child with plenty of potential. One cannot have the potential unless the child is first present. Researchers know this, though they are often disingenuous about it. They know that in order to access and utilize the potential benefits of stem cell research, they must first obtain not the potential itself but the fetus or unborn child who has the potential. As Aristotle has aptly remarked, “potency is said of act” (that is, potency is referred to a substance that is already in act; potency does not exist by itself).
Human intention, from a moral standpoint, should honor the subject of its concern. We are not morally free to establish any arbitrary relationship with another human subject. We cannot, from a morally valid point of view, say that we have friend A for utilitarian purposes, friend B for loving purposes, and friend C for display purposes.
Initiating new life in a laboratory, apart from a discernible connection with a mother and father, creates the impression that there can be a new human being who is genuinely motherless and fatherless, an orphan even before conception. But such new life is not really “created” or merely “initiated.” It is always procreated, and this fact must be honored not only in the context of properly understanding the moral issue of stem cell research, but in properly understanding who we are as human beings.
Flimsy justifications for stem cell research can serve as a kind of “black hole” that threatens to drag all of us into a moral void. We cannot risk forgetting that all human beings have intrinsic dignity (and therefore should not be exploited or used, no matter how noble the intended purposes), and that through procreation human beings beget new human beings and in the process become mothers and fathers.
MEDICAL INDICATIONS FOR THERAPEUTIC ABORTION?
By Bernard N. Nathanson, M.A. (Bioethics), M.D.
Member, American Bioethics Advisory Commission
and
Fr. Joseph C. Howard, Jr., M.Div.
Executive Director, American Bioethics Advisory Commission
The authors acknowledge the contribution of Professor Charles Rice, Notre Dame Law School and member of the American Bioethics Advisory Commission
Though commonly proposed today, abortion is never medically necessary to save the life of the mother. Many legislators today insist on certain “exceptions” for the mother’s life. The result of such “exceptions” allows for abortion on demand throughout all nine months of pregnancy. We present here but one more case where we were mistakenly informed that an abortion was “necessary” to preserve the mother’s life.
It is common today to hear the claim that abortion is sometimes necessary to save the life of the mother. We were informed of a case by a nurse (at a major medical center) who cared for a hospitalized patient and who described the status of the patient as follows: “Jane” was pregnant and a severe diabetic, suffering from chronic hypertension and was in the process of dying from kidney failure-she was experiencing end-stage diabetic renal disease (Kimmelstiel-Wilson disease). An induced abortion, however, was deemed necessary to save the life of the mother since she was “dying of kidney failure.”
Our review of the chart of this patient found a completely different set of facts than were presented by the nurse involved in the case. Jane was a 35 year-old woman who was obese, who had been clinically diabetic since age 17. In 1991, she suffered from diabetic nephropathy and retinopathy, and was experiencing end-stage renal disease. She was also an uncontrolled hypertensive. She had previously been on renal dialysis. In 1989, she had undergone a parathyroidectomy, followed by a liver biopsy in 1990 with subsequent internal bleeding requiring a laparotomy for hemostasis. Jane underwent renal transplantation in 1991. At the time of the events in question, her medications included Humulin, Catapres, Procardia, Lasix, and Cyclosporin.
Jane became pregnant in July of 1999. She was first seen for a small amount of vaginal bleeding along with light abdominal cramps; her hemoglobin, hematocrit, and platelet counts were normal. The patient was next seen 8 days later at 10.5 weeks gestation and presented with a weight of 231 pounds and a blood pressure of 142/92. The patient was negative for HIV-1 antibody and nonreactive for syphilis; gonorrhea and chlamydia probes were negative. It was noted at 13.5 weeks gestation that the blood pressure was 170/110, there was a trace of protein in the urine and the blood glucose was within normal limits. She was also positive for Hepatitis-C and Cytomegalovirus antibodies. At this time, Jane stated that she was considering “termination of pregnancy.” However, at 16 weeks gestation, Jane stated that she desired to keep the pregnancy if possible. A renal transplant consultation was ordered, and it was emphasized to her that pregnancy was not contraindicated. Following this, Jane once more changed her mind and desired “therapeutic termination of pregnancy,” despite the fact that her blood pressure was now increasingly well-controlled and her blood glucose was under reasonable control. The nephrology consultant opined that the patient was clinically stable with no hint or suggestion of significant decrease of renal function. All laboratory data assessing renal function were within normal limits; nonetheless, the patient still desired “therapeutic termination of pregnancy.” It is important to note that while the patient may have had some subtle degree of renal insufficiency, the glomerular filtration rate was rising steadily, as expected. (There is an 80% success rate of pregnancy resulting in live birth in renal transplant patients.) The chart did not note any mention of deterioration of renal function nor was there any evidence that the patient was advised by her primary physician and consultants “to terminate the pregnancy.” In short, the patient elected on her own to undergo an induced abortion.
Dilation and Evacuation were performed at 16 weeks gestation. The chart also documents that she had had two previous “elective terminations of pregnancy,” for reasons unstated.
While the case we reviewed showed no valid medical reason as to why the patient should have elected abortion, one could legitimately ask what ethical medical options would have been available had the pregnant patient indeed been in renal failure. It is not at all uncommon today to encounter patients with diabetes who become pregnant and whose renal function may be marginal. If the patient we have presented had been in renal failure, she could have been carried on renal dialysis and considered for a second renal transplant. One should note that the United States federal government subsidizes most dialysis treatment through the Medicare program. It is thus clear that there is no medical indication to perform an abortion on a woman who is pregnant and suffering from diabetes, even if her renal function is threatened. This is not to say that the combination is not medically formidable-merely that the resort to such a drastic remedy as abortion is unjustified.
In conclusion, the case we presented and reviewed demonstrates that it is critical that everyone involved in the health care of such a patient-including the medical staff-have an accurate and complete database regarding the unvarnished facts of the entire case. This case demonstrates that a nurse who cared for the patient mistakenly concluded that the patient was dying from renal failure owing to diabetes and that it was medically necessary to perform an abortion “to save the life of the mother.” If the patient had truly been in renal failure, her alternative would have been dialysis with the immediate prospect of a second renal transplant. As health care and biotechnology have progressed in an unlimited manner, there are in fact no conceivable clinical situations today whereby abortion is “medically indicated” for a woman whose life is “threatened” while she is pregnant. We are dealing with two lives of equal value here, that of the mother and that of the unborn child, and the notion of sacrificing one to save the other (“lifeboat ethics”) is not only inapplicable but obsolete as well-given the advanced state of contemporary medical technology.
