Human Genetic and Reproductive Technologies
- A Muslim's understanding of the Secular Perspective
By Shahid Athar, MD, FACP, FACE
Physically and intellectually, man is not the same as he was a million years ago. These "improvements in humans have come from within over a period of time by the process of adaptation, new learning and out of a need, and not as a result of any outside biotechnical intervention. So, the question is what is the need now? The fine line between what can be done technically and what should be done morally is the reason for the role of bio-medical ethics in the area of human genetic technologies. What are the relationship between the individual and society and whose interests we the scientists and physicians are to serve needs to be defined? Where does the government fit in between the needs of the individual patient and duties of his or her physician? Are social justice, human dignity and human rights to be considered in genetic modification? While it may be appropriate and desirable to seek treatment for a disease such as infertility. We have moved beyond treating infertility to the quest of making a super healthy super human. As a result, are we embarking on a path of ethnic cleansing of humans of lesser abilities and is it appropriate to discriminate them? In this paper, such concerns and questions are discussed from a secular perspective.
Key words: Human Genetics, ART, Cloning, Ethics
I have been a Muslim throughout my life and for the past several years, I have written and spoken on medical ethics from a religious (Islamic) perspective (1-4).However, in this paper, I will be discussing human genetics and reproductive technology from a secular perspective. I have chosen to do so as I strongly feel that there are common grounds in medical ethics between religious and secular camps. My aim is not to promote secularism but for the religious group to understand the secular view. Both groups, in my opinion support core principles of biomedical ethics such as autonomy of the patient, beneficence, non malefecience and distributive justice. The main difference between the two camps is these:
The religious group, whether we like it or don't, have taken it upon itself to speak and act on behalf of God. It sees itself as an extension of God's healing powers. It has a self appointed role of carrying on God's injunction for the benefit of mankind.
A.
The secular camp, on the other hand, also works toward the goal of protecting human values and human rights. It sees God as a creation of human mind. For this group, this life is the only life. It empowers man to the best of its potential. What is good for man is good for humanity. The aim justifies the mean.
B.
However, in spite of their commonality, both groups have very different opinions on the needs of the individual versus the needs of society in the areas of human dignity, human rights (rights of God supercede the rights of man in the religious group) and the role of physicians (scientists). In religious group, for example, the physician and the scientist are subservient to God, while in the secular group, he (she) is subservient to the individual.
Thus, in the pursuit of scientific knowledge and its effects on the future of the human race, we are sailing in uncharted seas and have created areas of concern that are still being debated.
In reviewing the current literature on ART and biogenetics, some controversies are very obvious. Commenting on the relationship between science and morality, Surbone (5) argues that "the role of genetic knowledge is over estimated and may either enhance the control that individuals have on their lives or finalize the decision process of the individual who may feel predisposed to a serious disease". On the other hand, Cohen (6) feels that "the opposing camp in bioethics about the reproductive human cloning are not wholly opposed to each other. In fact, they hold certain beliefs and values which are common concerns and they have reconciled their world views on several issues in human reproductive cloning". While discussing the respect for human embryo, Gomez-Lobo (7), feels that "since they have potential to become adult persons, they are already persons deserving the same rights as adult persons". Reviewing and commenting on creation and sacrificing embryos for stem cells, Devolder (8) feels that "creation and destruction of embryos is at the same plane, i.e. one can not accept the creation and sacrifice of embryos for infertility but condemn the same for the benefit of injured people".
There is much controversy about the use of discarded embryos for human research (Devolder, 9). It is also a question, when does an embryo become a moral person. According to Ken Hilma, "this happens when brain activity starts. So, it is postulated, that a human being is a human person by nature and a human embryo is a human person by nature and should be treated as such".
On ethics of human stem cell research, worth reading articles are by Outka (10) from Yale and Heineman (11). Mahowald (12) argues that "cloning is necessary to preserve bodily integrity or life of an individual. She suggests that scientists and clinicians may respect the negative right to moral integrity with whom they disagree". On the other hand, Lee (13) suggests that "choice of reproductive means is human right". He feels that "a balance approach be adopted to benefit human society while protecting human dignity". He is of opinion that "a temporary ban on human cloning is appropriate but the ban on relevant scientific research and animal experimentation is inappropriate as it denies the sprit of freedom of scientific inquiry and hinders making the benefits of scientific advancement available to human society as whole".
Paul Lauritzen in a thought provoking article (14) writes" If stem cell research led to therapies that changed the contour of human life, it would unsettle our ethical commitments, including the very notion of a human right, and encourage us to see the entire natural world, the human body along with it as having the status only of material to be manipulated". He quotes Lewis (15) "... the final stage is come when man by eugenics, by prenatal conditioning and by education and propaganda based on perfect applied psychology , has obtained full control over himself. Human nature will be the last part of nature to surrender to man". He goes on to quote Jonathan Clover (16) "Human responses are the core of humanity which contrasts with humanity. Morality must be rooted in human needs and values which are rooted in human nature and grounded in human aspirations".
The Stem Cell Research: The Endocrine Society's Position (17)
The Endocrine Society is of the opinion that Stem cell research holds promise for 128 million Americans suffering from diseases such as Diabetes Mellitus, Alzheimer's disease, Parkinson's disease, Spinal cord injury, Stroke, Muscular Dystrophy, Lou Gehrig's disease, heart diseases, lung diseases, kidney diseases, AIDS, liver disease, arthritis, anemia and leukemia. While the ongoing research on adult stem cell is promising, they don't have the same potential for pluripotency as embryonic cells. It is for this reason, the society supports the funding for further stem cell research as society's members have witnessed that transplantation of human tissues such as kidney, heart and bone marrow cells has given improved quality of life to many patients. The society supports the collection of stem cells through voluntary donation only without monetary incentives and after thorough informed consent. Furthermore, the society agrees with National Academy of Science report, which recommends that biomedical research using nuclear transplantation to produce stem cells be permitted and a ban on reproductive cloning be imposed.
The Status of Frozen Embryo (18)
The future and status of surplus or unused frozen embryo, nearly 400,000 in USA remain a controversy between religious and secular forces. While the pro life Republican administration is in favor of promoting embryo adoption while other groups are in favor of donating for stem cell research. This has opened a "Pandora's
Box" of ethical and legal concerns. As I pointed out in the abstract, the difference between what can be done and what should be done is the reason for ethics. This is highlighted by the current controversy the cloning experiment of Korean scientist Dr. Hwang Woo Suk who is accused of fabricating the data on human cloning and compensating the donors. (19)
Thus we see that much has been written already and published in this area by many organizations including IOMS and American Society for Reproductive Medicine.
Now, I will give my personal thoughts on secular perspective, as posed to me.
"Social Impacts of Genetic and Reproductive Technology - the Secular Perspective."
Question 1: What is in secular tradition is the vision of good society and the relationship between individuals and society? How does it differ from the Western secular liberal vision of a society composed of rational, self interested and autonomous individuals which emphasizes the importance of individual freedom? To what extent, the questions of social justice who benefits and who loses is relevant in clinical consideration in secular society.
Answer 1: The secular vision of a good society is a society which is based on human rights and human freedom, caring for everyone who lives in that society, irrespective of color, gender, social status, political or religious affiliation. It emphasizes the importance of individual freedom and choices in the interest of the individual. All programs in this society are geared toward empowering individuals and the community. It sees the practice of religion is a private and a personal matter. Religion in a secular society is allowed but coercion of others on the basis of religion is not. Social justice is a distributive justice and ideally, everyone is an equal loser or beneficiary. Ethics is not morality but a sum of values.
Question 2: How are the genetic and reproductive technologies affecting the relationship between individuals and society? Is it fair to say that they tend to encourage greater emphasis on individuals' inherent characteristics and competition and therefore greater inequality and less social solidarity.
Answer 2: While it is true that in a secular society there is more emphasis on individuals than at the society large. However, since the society is made mostly of secular individuals, the society itself is not at the cost of individuals. There is a possibility of some equality but that is related to availability of resources more than the intent. On the other hand, in a religious or ethnic society, the majority is more beneficiary of the available benefits while secularists and minorities are treated as second class citizens in terms of the ethical rights.
Question 3: If it is true that selection and design of babies undermines human dignity, does that potentially also undermine human rights?
Answer 3: yes it is true to some extent that designing a baby undermines human dignity to some degree. However, it is a matter of choice. If the individual, for example the mother or the couple, has a right to make the choice that they feel appropriate and live with that choice and can afford to do so. They also have a choice not to do so. While it may be appropriate for a certain couple to want all healthy, fair skinned, blue eyed babies, it may not be appropriate to want babies of the same sex for social reasons. Human rights will be infringed upon if society declares that all children be born in the whole society of the same genotype.
Question 4: Is there a philosophical basis within a secular tradition for concerns about social discrimination on the basis of genes, for example in insurance and employment.
Answer 4: Social discrimination in employment and insurance health care is prevalent in all societies, secular or not. Women and blacks get less salary, less bypass procedures, less dialysis, less heart and kidney transplants in the USA compared to men. In my opinion, such discrimination will still be seen in secular societies based on the socioeconomic status of the individual but less. A religious society (unless a religion is practiced 100% in its purest form) in my opinion is more discriminating. Religion is not an employer but the secular government is. Therefore, a secular government will have more obligation than the religious government.
Question 5: To what extent can arguments about the appropriate use of limited resources be made within the secular tradition?
Answer 5: In a true secular society, theoretically, since there are no discrimination religious factions, the usage of resources will be appropriate and only the only limitation will be the availability of the program. If a heart or kidney transplant, for example, is needed, it will be on a first come first serve basis not on the basis of who can pay more. The question is will a secular society give preference to secular over non-secular citizens. It is possible, but most likely will not happen.
Question 6: Are genetic and reproductive technologies leading to a new form of eugenics in which disabled people and others who have less of the abilities that society values are gradually eliminated from society? If so, what is the argument against this?
Answer 6: This is a very touchy subject. Yes it is possible to some degree that there will always be survival of the fittest. However since the secular society, or as a matter of fact, in a true religious society, all components will have equal rights, it will not happen. There will always be forces who will advocate the rights of the disabled. This will include not only the disabled individual but also the unborn. Thus, total elimination or discrimination or ethnic cleansing of the weak and disabled, will never happen no matter how oppressive or how fair the establishment is, secular or religious.
My request to both groups is as under;
Continue to interact and communicate with the each other. . They need each other's input and suggestions.
1.
Religious scholars should keep up with the changing scientific knowledge and technologies .They should not accuse scientists of playing God as we all try to do the same at times.
2.
We do not know what the future of stem cell and cloning research hold for humanity. Thus it will be premature to foretell. As Ted Peters pointed " If a primitive man had said now I have discovered Fire the we can use for cooking and keep ourselves warm , the holy men would have objected saying the this fire will burn our huts and trees ,thus it is bad for humanity. Well, such objections did not prevent progress of science"
3.
My Parting Thoughts:
Given a choice, one may prefer to live in a religious society where the religion is practiced in its purest form and the citizens of non-ruling religions and secularists are treated with equal human rights and human dignity. However, in the absence of such utopian society, one may accept to live in a secular society holding on to the above the values to the maximum.
I end this article with my thanks to Dr. Robert Cleary, Professor Emeritus of Reproductive Endocrinology at Indiana University School of Medicine for his help and to my friend Dr. Gary Wright, anesthesiologist and Chair of Medical Ethics at the Catholic Hospital where I have practiced Endocrinology for last 30 years. He wrote to me (20), "The Late Pope John Paul has taught me much about human dignity. Commodifying new biotechnology will be both wonderful as we discover cures for chronic illness and human enhancement and the same time worrisome. Social hierarchies are the greatest barrier to compassion as they intertwine attitudes of superiority and entitlement. Social hierarchies define access to advantageous biotechnologies. Genetic Biotechnologies will provide more opportunities for the privileged to ensure that the advantages they buy will become permanent part of their bodies and their heirs. Equitable access and true usefulness should be litmus test for new biotechnologies. Compassion too easily gives way to personal profit, unfortunately, a stable part of human nature". On this point both secularists and religious ethicists agree.
Presented on February 8th, 2005 at Cairo, Egypt during International Seminar on Human Genetic and Reproductive Technologies organized by Islamic Organization of Medical Sciences (IOMS) and Word Health Organization (EMRO). Dr. Athar is former Chair of Medical Ethics, Islamic Medical association of North America, www.imana.org . Email sathar3624@aol.com, web www.islam-usa.com
References
1. Athar, S. Islamic Perspective in Medical Ethics in Islamic Perspective in Medicine, American Trust Publication (ATP) 1994, page 187-194
2. Athar S., Ethical Decision Making in Patient care in Health Concerns for Believers, contemporary issue, Kazi Publications, 1996, pate 74-84
3. Athar S., et all- Medical Ethics, the Imana Perspective Position Paper on Medical Ethics by Islamic Medical Association of North America 2005.
4. Athar, S "End of Life Issues- an Interfaith and Islamic Perspective: Third Qatar International Medical Congress, Doha, Qatar, November 12, 2005.
5. Surbone, A, Genetic Medicine, the Balance between Science and Morality, Annals of Oncology, 15th Supplement, 160-164, 2004.
6. Cohen, CB - The Ethics of Human Reproductive Cloning: When the World Views Collide in Accountability and Research, Vol 11, pg 183-199, July-December 2004.
7. Gomez-Lobo, A - On Potentiality of Respect for Embryos Theoretical Model and Bio-ethics, Volume 26 pg 105-110, 2004.
8. Devolder, K "Creating and Sacrificing Embryos for Stem Cell Research" - Review Article, Journal of Medical Ethics, Vol. 33, pg 366-370. June 2005.
9. Devolder, K "Human Embryonic Stem Cell Research, Bioethics, Volume 19, pg 1967-1986, 2005.
10. Outka, G " The Ethics of Human Stem Cell Research, Kennedy Institute of Ethics Journal, Volume 12, pg 213, 1975.
11. Heinemann, T - Honnfelder L Bioethics, Volume 16, pg 530-43, November 2002.
12. .Manowald, MD" Self preservation: an argument for the therapeutic cloning and strategy for fostering respect for moral integrity ". American Journal of Bioethics 4 (2:56-66) 2004.
13. Lee, M- "The inadequacies of absolute prohibition of reproductive cloning": Journal of Law and Medicine; 11(3) 351-72 ,2004
14. Lauritzen , Paul "Stem Cells, Biotechnology and Human Rights: implications for a posthuman future" Hastings Center Report , March- April 2005
15. Lewis, C.J. "The Abolition of Man" (New York: Macmillan , 1947) 81
16. Glover, J" Humanity ; A Moral History of Twentieth Century (New Heaven, Conn. Yale University Press , 1999)
17. Endocrine News, December 2005.
18. Susan Crockin, Editorial in Boston Globe, December 4, 2005.
19. Gordon Fairclough and Antonio Regaldo reporting in The Wall Street Journal December 13, 2005.
20. Gary Wright. DO, Ethicist, St. Vincent Hospital, Indianapolis, USA, (personal communication).
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