Chapter 5
Bioethics : A New God?
In-vitro fertilization, organ transplants, allocation of limited medical resources (triage), surrogate parenting, do-not-resuscitate orders, withholding life support, living wills, proxy-care legislation, fetal tissue, gene surgery, and a host of other bioethical concerns will be "the major civil rights issues" of the 1990s, predicts A. James Rudin, a rabbi prominent in the field of biomedicine and public policy.1 Few would disagree.
"We are poised on the threshold of a great era of biotechnology," says Megatrends author Naisbitt.2
"We are on the threshold of a new world as inconceivable to us as the modern world of biology and technology was at the turn of the last century," echoes psychiatrist Willard Gaylin, president of the Hastings Center, the prestigious bioethical and behavioral research organization. He continues:
With the miracle that is modern surgery we use patches and parts, manufactured and real, borrowed from ourselves, other living human beings, or cadavers, and we stitch them together . . . The inconceivable has become conceivable. How are we expected to make the leap into molecular biology; into DNA and recombinance; into gene splicing and the manufacture of new species, chimera; to the potential of introducing genetic material and the traits they command from one individual to another and from one life form to another? What about this new capacity to design our descendants?3
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Gaylin and others sense that the "new genetics" has generated more anxiety than jubilation. Some, in fact, contend that modern-day biotechnicians are "playing God."
Who will make the decisions about what Rabbi Rudin says are the "rights issues" of the 1990s? And on what basis? Economics? Need? "Advancement of science" or "the need to know"? The sacredness and dignity of life? What about the potential for abuse of autonomy and privacy? These are but a few of the prickly questions of the bioethics revolution that go to the taproot of what it means to be human — and to be created in the image of God.
But the "playing God" rap is begging the question, insists religion commentator Martin Marty: "In a way, all biology applied to humans — all medicine — is 'playing God' and 'interfering with nature,' so the question is how to do this intelligently."4
Anyway, the gene(ie) is already out of the bottle.
It's too late for moratoriums or cautions, declares Fay Angus, an amateur bioethics expert who lectures and writes on the subject. "The best we can do," she says, "is to exercise the depth of the wisest among us. The best we can do is to cope. There is no going back."5
Pull out the core of what the "pew people" want to know, Angus advocated as we talked about this chapter.
"How does that affect me — my body, my life, my death, my well-being, my genetic markers, family planning, and selection of children? Don't confuse me with philosophical ramifications. I'll leave theology to the theologians. My living, my aging — that's where it's at."
There may be, as my friend and writing colleague added, "a gray area of fog to wade through for a glimmer of light," but the pathway is fascinating. And, as Naisbitt notes, to be ignorant about this complex, multifaceted topic is to let other forces play God.
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Reproductive Technology
Baby-making is an ancient art, usually high touch and low tech. Surrogate parenting dates back at least as far as Abraham, Sarah, and Hagar in Bible times.6 Artificial insemination was reported in 1799, and pregnancy after insemination with frozen sperm a hundred years later.
But these days conception is becoming increasingly low touch and high tech. Hitting the headlines in the past twenty-five years have been: commercial surrogate motherhood, in-vitro fertilization (egg and sperm combined in a dish), embryo transfer, and babies born from embryos that have been frozen and thawed later. And now, as medical technology surges ahead, menopausal women can give birth to children conceived with the egg of a younger woman.
The famous Baby M case brought surrogacy to widespread public attention in 1986 when the surrogate mother, Mary Beth Whitehead, had her own egg fertilized with the sperm of the husband from the couple who hired her. Since then, more than 2,000 "traditional" surrogate births have been achieved in this manner. But an increasing number of surrogate cases have involved women who gave birth to children genetically unrelated to them. Conception, using the couple's eggs and sperm, occurs in a petri dish in a hospital lab, and one of the embryos is implanted in the surrogate mother. Perhaps eighty such births had occurred by mid-1990.7 Soon, scientists predict, it will be possible to bring in-vitro embryos to full-term delivery in a totally artificial womb.8
Critics say surrogacy bears the potential for abuse. One form of abuse is by women, both married and unmarried, heterosexual and lesbian, who want to avoid the inconvenience of pregnancy. Others attack the practice as exploitative, creating a "breeder" class of women who are no more than "fetal containers."9 Other opponents charge that hiring surrogates amounts to "baby selling."
Despite invaluable help that "assisted reproduction" has given countless childless couples, lawsuits galore have festered since biotechnology has blossomed well beyond its pioneering stages two decades ago. Indeed, while the technology is racing toward 2001, societal rules for dealing with the consequences have lagged far behind.
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Shari Roan, the health writer at The Los Angeles Times, raises some of the problems and questions:
How should parenthood be defined? Are the parents those who contribute genetic material to the child, bear the child, or raise the child?
What are frozen embryos? Are they people or property? Who has the rights to the embryos in a dispute? And how should "unwanted" embryos be disposed of?
Should the child born with the aid of an egg or sperm donor be entitled to know who the genetic parent is?
Should egg donors, sperm donors, and surrogate mothers be paid for their services, as they often are?
Should infertility clinics be required to reveal success rates? And should couples pay for treatment that many experts still regard as experimental?10
"There needs to be one person who works with the [infertility] patients who is on the patient's level," advises Andrea Shrednick, a reproductive psychologist and faculty member at the University of Southern California. "Not someone with the power to play God. Not someone with the power to make them a baby. But someone who can sit down and help them work through and understand the issues involved."11
Fetal Tissue and Abortion
To work through the ramifications of fetal tissue experimentation and its relationship to abortion is another difficult and sometimes daunting task.
Fetal tissue has a much higher chance of being accepted by the recipient's immune system than tissue from an "older" donor. Fetal tissue can be used by surgeons to replace worn-out parts in a diseased person, and fetal-cell implants are especially effective for adults suffering from diabetes, Parkinson's disease, and Alzheimer's. The procedure shows possible promise also for sickle-cell anemia, some forms of cancer, and even stroke.12
The catch, of course, is that the transplanted tissue comes from an aborted fetus. Citing ethical concerns, the National Institutes of Health
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in late 1989 yanked federal funding from fetal research, thus halting such study except in privately financed work.
The ban hasn't stopped debate, however, and ethical clouds will likely brew into new storms before the century's end as conflicting attitudes concerning abortion continue to dominate and divide. The controversial legal concept of fetal rights lies close to the storm center.
Basically there are two camps regarding fetal-tissue research and use. The first is those who consider aborted fetuses cadavers and therefore appropriate material for research and tissue implants. Abortion, they reason, is a separate tissue issue.
Not so, say those who consider the aborted fetus a victim. Although some bioethicists in this camp would allow for spontaneously aborted fetuses to be used for fetal-tissue research and surgery, their real worry is that elective abortion will be used. This creates "a tragedy [abortion] for some other good," says Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota.13
Another fear expressed by opponents is that couples may conceive for the express purpose of providing — or selling — tissue from an abortion for someone else's use. (As I write this, abortions are still legal in most states, but it is illegal to buy or sell fetal tissue.)
Euthanasia
In a society that can't agree when human life begins, it's no surprise that we have trouble deciding when it should end.
"If you think the abortion issue was emotional," declares Margaret Battin, a philosopher and ethics expert at the University of Utah, "just wait until we get fully into euthanasia and death."14
In fact, a celebrated 1990 case of a terminally ill woman focused national attention on what Time magazine called "an unfortunate consequence of modern medicine's ability to keep people alive in a state of semi-death."15
Nancy Cruzan, whose case had led to a landmark U.S. Supreme Court decision, passed away peacefully in Missouri the day after Christmas that year, "her parents by her side and euthanasia foes camped outside the hospital."16 She was allowed to die, the plastic
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feeding tube that sustained her removed, after a four-year legal battle pursued by her family. In June, in a wrenching 5-4 decision, the high court for the first time established the right to die for terminally ill patients who make their wishes clear.
And in November, 1991, in the first popular vote ever held on legalized euthanasia, the voters of Washington state grappled with and then defeated — by a margin of 54 to 46 percent — a proposed "Death with Dignity" referendum that would have legalized physician-assisted suicide. If approved, the measure would have made Washington the only jurisdiction in the world where doctors could legally offer a lethal injection or drug overdose to terminally ill patients who wished to die.
Many evangelicals and Catholics condemned the measure as an attack on the sanctity of life, while others — mostly mainline Protestants and Jewish leaders — praised the initiative for its potential to ease the suffering of terminally ill patients and their families.
More carefully crafted euthanasia initiatives are sure to crop up in other states. And the complex situations of life and death created by modern technology — indeed, even definitions of life and death — are not easily settled. The issue reflects not only the ambiguity many people feel, but also the entwining of moral and civil law.
Donald C. Lamkins, administrator of the rehabilitation center where Nancy Cruzan's life was ended nearly eight years after an auto accident caused her heart to stop beating for at least fifteen minutes tried to explain:
"There are two kinds of law here — our legal laws, those are society's laws — and moral law. Moral law is God's law; it comes from religion. Man's laws said it's all right, but that doesn't change moral law."17
Recent public opinion surveys show that 50-60 percent of Americans favor the legalization of euthanasia and physician-assisted suicide under certain circumstances.18
As life expectancy continues to advance beyond the ability of medical science to provide a comfortable existence, the medical community, lawmakers, ethicists, and religious leaders will have to fashion guidelines concerning passive — and active — euthanasia that they can live with.
The "pew people" are already doing it.
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The Cruzan case prompted hundreds of thousands of requests for "living will" forms from the Society for the Right to Die.19 And the American Hospital Association has estimated that 70 percent of the 6,000 daily deaths in the United States are "already somehow timed or negotiated with all concerned parties privately concurring on withdrawal of some death-delaying technology or not even starting it in the first place."20
"At the bedside level," says Marsha Fowler, who trains nurses for church-staff jobs, "the single most important bioethical issue for the 21st century is the way in which one goes about dying — withholding treatment and withdrawing treatment once it's started; and how you evaluate this in terms of the person's spiritual walk and beliefs."21
People deal with end-of-life issues in church, Fowler adds, and she expects more involvement on the part of churches to help people decide, for example, about such things as "durable power of attorney," a legal instrument that designates a decision-maker to determine a person's end-of-life treatment in the event the person herself or himself is unable to do so.
Genetic Engineering
In 1980, ten years before the U.S. Supreme Court ruled that life support could be terminated if there is "clear and convincing" proof that is what the patient would want, the court made another historic five-to-four decision: that new forms of life created in a laboratory could be patented.
Ever since, designer genes have been big business. Before eight years had passed, the U.S. Patent Office had been flooded with 8,000 biotech patent requests for new life forms, 21 of them for genetically engineered animals.22
Genetic engineering, explains scientist Ian Barbour,
offers the prospect of the deliberate alteration of the genetic structure of organisms and even of human beings. Here again is an unprecedented power of the human future. We face promising possibilities for improving the agricultural productivity of crops in the midst of food scarcities and for lifting the burden of human suffering caused by genetically inherited diseases. But we also face risks of unintended repercussions and controversial ethical issues, especially if human genes are altered not just to cure diseases but to achieve improvements in human characteristics.23
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Fertilizers and pest-resistant traits are being placed in seeds, and biotech farmers say bioengineered crops and farm animals could become commercially available by 1995.
"Imagine a cow that produces skim milk, a canola seed rich in sperm-whale oil, or a naturally decaffeinated coffee bean," gushes J. Madeleine Nash in a Time magazine article. Changing the genetic endowments of plants and animals "could spawn a revolution in farm fields, feedlots and dairy barns."24
Harvard University patented the first genetically engineered mouse in 1988, the same year that seven genetically identical, purebred bull calves were produced from man-made embryos.25
By the 21st century, predicts Ed Cornish of the World Future Society, we will have the capacity, through DNA transfers, to create an elephant that glows in the dark. "But we might not want to bother."26
If revolutionary changes are already in progress in the plant and animal worlds, can genetically engineered humans be far behind?
A human's total gene composite (genome) contains up to 100,000 genes stored on twenty-four pairs of chromosomes. Genetic scientists are busy "mapping" these genes to decipher the genetic code — "with its instructions for building, running and reproducing bodies." This, Naisbitt and Aburdene affirm in Megatrends 2000, "may well prove to be the greatest scientific achievement in this century."27
Once a gene is located, it can be copied, or cloned, and cloned genes can be used to find carriers of genetic disease, diagnose genetic abnormalities — even predict a person's tendencies to develop certain defects or illnesses.
The Human Genome Initiative, a $200 million-a-year project to "list the whole encyclopedia-length recipe for making a human being," was launched through the National Institutes of Health and the Department of Energy in 1988.28
Gene therapy offers a host of beneficial uses just becoming available.
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In 1990, in the first federally approved use of gene splicing, a team of doctors introduced some one billion cells containing a copy of a foreign gene into a four-year-old girl's bloodstream. The object: the new cells produce enzymes needed to overcome the deadly genetic disease that incapacitated her immune system; healthy replacement genes take over for defective ones. So far, the experiment has been successful.
The impact of gene therapy could be astoundingly positive, specialists say, helping to stop or even wipe out previously incurable genetic diseases such as cystic fibrosis, Down's Syndrome, and hemophilia. But altering human genes poses risks and threats as well as benefits. Some object to manipulating genes in ways that don't seem representative of the natural order; again, "playing God."
The scare word is eugenics, the attempt to make hereditary "improvements."
So far, the gene therapy being practiced affects only the patients. But it is conceivable (pun intended) that we may move in the direction of Brave New World with genetic engineering of sperm and egg cells that would affect the genetic inheritance of future generations.
"We may begin innocently," suggest Ann Lammers and Ted Peters in a Christian Century magazine article on "genethics,"
by trying to breed out hemophilia and end up breeding in genetic traits that fit the needs of social stratification, economic productivity or nationalist interests. Might the drive for improved human beings lead finally to a drive for racial purity? Well in advance of any brave new world, we need to ask who will be making the decisions and according to what criteria. Who will be allowed to share in the benefits of genetic intervention and who will be compelled to submit to them?29
If it becomes possible to identify and choose genes for any inherited trait, parents could order up children customized to specification!
Such frontier biotech — so-called "enhancement" genetic engineering — gives the shudders to specialists like W. French Anderson,
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chief of the Laboratory of Hematology at NIH. If, for example, it extends to a normal individual the ability to acquire a memory-enhancing gene or a height-enhancing gene, what are the limits? On what basis does one individual get gene enhancement while another person is denied it?
Anderson concludes that our society "is comfortable with" genetic engineering to treat existing serious disease, but he excludes enchancement engineering "on medical and ethical grounds."30
In the health-care field, could this lead insurance companies to reject — or at least limit — coverage for persons whose genetic screening showed them susceptible to certain diseases like colon cancer, Alzheimer's, or a heart attack, even if they had no history of the problem? Could such individuals be required to obtain genetic surgery before they were eligible for health insurance?
Fowler, the parish-nurse and bioethics consultant, believes that access to health care and it's cost will be "the Number One overwhelming bioethical concern" of the 21st century.31
Organ Transplants, Body Parts, and Bionics
In 1989, 13,384 organ transplants were performed, raising questions about whether a commercial market to supply this demand should be created. Enough organs might be available if donors or their heirs were paid. One ingenious proposal is for a "futures market" in which people would be given a discount on their insurance premiums if they agreed to turn in their organs to the insurer after death. But wouldn't rich patients outbid poor ones for spare body parts which, ironically, other poor would be providing out of economic need?32
Prohibiting the sale of the human body or its parts is "one of the ways you show special respect for the body," says Arthur Caplan, the University of Minnesota bioethicist. But other people argue that, for the common good, organ donation should be mandatory at death. The Uniform Anatomical Gift Act adopted by all the states gives patients the right to donate organs after they die and to specify the recipient (either a person or an institution).33
But what about forcing a child to donate an organ or bone marrow
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for an ailing family member? Or consider the social impact of having a recognizable limb from someone else's body?34
Tom Sine predicts that "a new generation of bionics promises to make us more than we can be through technology. As our bodies become a collection of implanted organs and technologies, transplanted limbs and bionic appliances, what will happen to our sense of identity?"35
Other medical experiments to study the power of the mind — the chemical analysis of the brain and its relationship to consciousness and thought, and the possibility of fusing the human brain with implanted microchips — are either in progress or on the drawing board.36 And the new and controversial field of sociobiology — examining the biological basis of social behavior through its genetic roots — is absorbing the attention of molecular biologists and researchers in brain chemistry. The discipline has been called "a view from Darwin's shoulders."37
No Glib Answers
If reading about these innovations and conundrums of biotechnology has your mind swirling and your spirit perplexed, you are not alone. I feel the same way as I write about them. The supremacy of a sovereign God is balanced against the capability of humanity to do good — and to do evil. We're looking ahead to a world far different from any we have known, with a whole new terminology we've never even considered. "Bioethics" wasn't even a word until 1971.
Premarital counseling will take on new meaning as we advance into the next century and face the new options in reproductive techniques, while aging and life-extension will shake up all standards of health care and its attendant costs. It will be a time of tremendous challenge for Christians, "a breaking down of every biblical comfort zone we have."38
"Ignorant about the full range of longterm consequences," say Lammers and Peters, "we face moral choices whose resolution seems to require the benefit of a divine foreknowledge that we humans shall never — despite computer simulations — entirely possess.
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In short, we are by no means God's equals, even if we are in some sense co-creators."39
Yet all this brings tremendous opportunities for ministry — not only for clergy, but also for skilled paraprofessionals. And just plain volunteers with loving hearts who are standing by, reminds my friend Richard Spencer, a pastor who served on the ethics committees of two Southern California hospitals.40
The right to die, when to stop or withhold treatment for the terminally ill or the elderly, what to do for a severely handicapped newborn — these are the big issues of bioethics. But many issues, adds Katherine Bouton in an article about the painful decisions a medical ethicist faces, "involve the crucial small ones: informed consent, the right to confidentiality, the right to choose treatment, the right to know who is treating you."41
Although our future lies in the Information Age, in which technology married to biology will set much of the agenda for human life, the most important kinds of knowledge won't come out of the computer. To make ethical choices, set priorities, and perpetuate the dignity of the human race, we will need wisdom. And, according to the Bible, the beginning of wisdom comes only out of a reverence for and a fear of God.42
