Preserving the Ethics in Bioethics

An interview featuring Nigel Cameron, Ph.D.

Carrie Gordon Earll, Focus on the Family's bioethics analyst, interviewed Nigel Cameron, Ph.D., considered by many to be the father of bioethics. What follows are highlights of their conversation.

Carrie Gordon Earll: Ten years ago, euthanasia and physician-assisted suicide were the hot-button topics in the bioethics arena. Now they seem almost overshadowed by biotechnological developments.

Are you surprised by how quickly human cloning and genetic manipulation have permeated the bioethics landscape?

Dr. Nigel Cameron: Oh yes! A decade ago, such developments seemed so far away. Cloning is the best example of this. People thought, Twenty years down the line, we'll be able to do cloning from nonreproductive tissue. But I don't believe anyone outside of those involved in the research expected it would happen. Then, in February 1997, Dolly the sheep was introduced to the world.

The pace is only picking up. And of course we learn about these things from the press, after the fact. We don't have discussions of "Should we do this? Shouldn't we do that?" Instead, it's "We've done this. Wasn't that a good idea!" followed by, "You stop us." That will be the context for everything that comes in the future.

That's true. Just recently, I read a news report about scientists who tinkered with the genetics of human embryos who are now infant children. Germ lines were altered in order for the mothers to conceive. And scientists are saying, "We don't care what's happened with the animals. We're moving ahead with human cloning."

How far down the road to genetic manipulation and human cloning do you think we are?

The germ-line issues will take time before they come to fruition. But when it comes to baby cloning, it's alarming. Scientists have said they'll deliver a cloned baby 18 to 24 months from now. It's estimated that it will take a thousand cases before one little baby is born. And still they say, "We're going to do it. Stop us." They have thrown down the gauntlet in the path of civilization. And it's uncertain whether we can do anything about it.

Whose role is it to stop them? Policies have not kept up with the pace of technology. Should governments issue controls and bans so that we can regulate what's going on in laboratories?

Yes, although it's unfortunate if we polarize, because people, especially here in the States, don't like the idea of government interference. Government has some basic responsibilities, and one of them is defense. This should include defense of the individual and of human rights and human dignity.

We must have public policy developed so we can shape the way these potentially wonderful technologies are used - so that they take us toward heaven rather than toward hell.

And international policies?

Unless we can stop some of these abuses worldwide, we won't stop them at all. The United Nations does some crazy things, but also some very good things. And we have to be prepared to support the good things. We have to work toward an international convention to ban human cloning, germ-line therapy and some of the other obvious abuses of these technologies.

Interestingly, in the bill presently being debated in Congress, the Brownback-Weldon bill to ban cloning, there's a clause that urges the United States to take the lead in working for an international ban on human cloning. That's the way we have to think.

What You Can Do
By Nigel Cameron, Ph.D.

When I got into bioethics almost 20 years ago, I was concerned about the abortion debate — particularly that it wasn't leading Christians into these broader, bigger issues. Over those 20 years I've seen some improvement; we're more liable to have this kind of conversation now than people were then.

The issues arising in bioethics are the most important questions facing western civilization. They are far and away the most important issues facing us as Christians if we have a concern for God's culture and our witness within it. This should be a major theme in every church, in every college, in every organization. And our Christian physicians and nurses and our social policy organizations and so on should recognize that where they have other concerns, too — in terms of fellowship, evangelism, pro bono work, all these sort of issues — that the central set of questions is how we value human dignity in the context of bioethics. And with some regret, I have to say we have a long, long way to go.

While most physicians will never be academic bioethicists, every Christian physician needs to be well-informed about these issues. Medicine is about more than bioethics, but if you haven't got a bioethics framework and you can't be a leader in your own community to address these issues, then you are nowhere (no disrespect intended!).

If a Christian physician can't talk intelligently about the ethics of germ-line therapy and gene patenting to colleagues in a medical gathering, much less to a Sunday school class, he or she needs to find some way to get up to speed on these issues. These are the questions physicians are uniquely equipped to address in the culture.

Where to Turn?
The Center for Bioethics and Human Dignity (www.bioethix.org) is a clearinghouse for Christian thinking about these issues. Two former students of Trinity University's Bioethics MA program, both RNs, have launched bioethics centers. In Oakland, Calif., Jennifer Lahl has founded the Center for Bioethics in the Church (www.thecbc.org), where materials are being developed for church and pastor education. And Barbara Quigley is setting up the St. Louis Bioethics Center. We need dozens of these projects in order to meet the demand for resources.

One of the prime examples of unrestrained technology is what's happened with in vitro fertilization. In the United States alone, we have thousands of frozen embryos - little boys and girls who are in suspension. Is that an example where public policy did not get involved early enough to stop this kind of moral catastrophe?

I'd say two things about that. First, the church didn't get involved in educating its people. That's one reason public policy didn't get involved. Whenever I meet with pastors, I say, "When was the last time you spoke about in vitro technology from your pulpit?" I have yet to find one who's been able to name a specific date. And yet it's a factor for every congregation: One in seven couples is infertile. And that number is rising.

Essentially, there is no basic public policy on in vitro. Many European countries have policy positions in place, some of them quite conservative, like in Germany and Ireland. In some countries, such as Britain, there's a lot of regulation going on, so at least everyone knows where those babies are and how many are stored.

Here in the States, it's a free-for-all. No one knows how many embryos there are. I've heard possibly 2 million. I wonder how many of those are from Christian parents. I suspect they proportionately mirror the church-going and the nonchurch-going population. But this isn't an issue we have engaged at all in the church. And - surprise, surprise! - our policymakers have backed off as well.

What is your opinion of infertile couples adopting frozen embryos? Are there ethical problems attached?

If you have a frozen embryo, and the alternative to implanting it in a uterus is destroying it, or leaving it in the freezer until it decays, you should implant it. But some of the same problems exist that are inherent with using aborted tissue for research.

Many believe that using aborted tissue - even though they had nothing to do with the abortion - allows good to result from a tragedy. But perhaps that's giving a new motive to those who do the abortions. It seems to me there are some parallels here with embryo adoption. We're giving some new excuse to people who are abandoning the embryos by saying, "Well, isn't it wonderful some infertile couple can adopt them."

On balance, I think certainly we should have these embryos implanted in a womb, sooner rather than later. That's a wonderful thing. But if we get into a systemized routine, I have some ethical concerns about it.

There's research that indicates embryonic stem cells may hold great promise for treating diseases such as cancer and diabetes. But in order to remove stem cells, the embryo must be killed. Does it surprise you that advocates of embryonic stem-cell research are undaunted by the fact that it destroys human life?

It does surprise me. We've been using stem cells for a long time in research, but embryonic stem cells? This is a brand new field.
There was an editorial in The Washington Post back in 1994 that said it would be appalling if you created embryos specifically for research. It defended using so-called spare embryos from clinical work for research, making a fundamental distinction between spare ones and created ones. Even people in the research community weren't happy about creating embryos for research.

It concerns me greatly that now there's sudden interest in mass production of human embryos for stem-cell research. People who have anxiety about creating a human embryo just for laboratory purposes are being regarded as if they are from the Stone Age. Yet we had something approaching a consensus on this just five or six years ago.

With so many embryos in frozen storage, people say, "Why throw them away or let them rot? Why not use them for research?"

It's a compelling argument, but we have to say no. Some might say of prisoners on death row, "Let's use them for research," or "Let's kill them certain ways so we can take their organs." If we have to kill these people, let's kill them in a way that's dignified and respectful, and not actually profit from their death.

As this country has less and less moral sensibility, we're going to find a lot of good people seduced by that kind of argument.

Almost weekly we see news reports of scientists finding alternative sources - umbilical cords and possibly even fat - to embryonic stem cells. With such promising alternatives, why the continued push for the embryonic stem cells, and who's behind the demand?

I see a few forces behind this push to research on human embryos to get stem cells. One is the research community which, by and large, doesn't want to be regulated. They're not all bad: Some are ethical people. But they do want science to pursue its own path.
And increasingly it's not publicly funded science, but business-funded science. No longer are disinterested scientists doing work in labs using our money. Huge commercial interest is at stake.

There are many "pro-choice"people pushing here, too, because they see this as another way of debating Roe. They see reproductive rights as an issue here, and they want to maintain, if you like, the indignity of the early embryo as a part of retaining their defense of abortion. But it's important that we not get into this as a rerun of Roe, because there are some different issues there.

Let's turn to some of the traditional bioethical issues, starting with abortion. It's amazing to me that Americans, as documented in countless opinion polls, know that it's a baby being killed, but they still think it's okay if the mother wants to abort. Why do you think Americans choose to ignore the reality of what abortion does to the unborn child?

We live in a culture in which most people are still very moral, but their morality has increasingly narrowed horizons. It's morality for me and my family, but I don't want to impose it on my neighbors, let alone in public policy.

Add to this the fact that most people now have friends who've had abortions or who've had them themselves. That seriously compromises their capacity to extend their moral vision to public policy and to prevent people from doing likewise.

Another factor is the church: There's still a very narrow personal piety that does not give people a vision for their culture and for our capacity to reshape it for God.

Also, we underrate the significance of the women's movement and feminism in its various forms, some of which has been for good, such as recognition of human dignity. We often have taken a yes-no, black-white approach to that whole debate. For many women who've grown up in the last 20 and 30 years, there's been a very close connection between their sense of self-worth, their sense of their capacity to have careers and fulfill themselves, and their "reproductive rights."Many younger women today are ambivalent about abortion because it's tied in with the notion of their own dignity and with a confusion of good and bad.

Do you see abortion moving toward the chemical and away from the surgical?

The evidence is that this [RU-486] is just the first generation of serious abortifacient drugs that can be used significantly into pregnancy. And it will be followed by others. This has been very sensitive politically, which is what's held up the production and distribution of this drug in the States; it was available years ago in some European countries.

The manner in which this debate has been politicized is going to be undermined by the privatizing of abortion medication. And while there are genuine safety concerns about the drug, we have reason to believe those issues will eventually be addressed. In 10, 15 or 20 years' time, there will be pretty efficient chemical abortion.

Right now we can use the secular argument that this is dangerous for women: It hasn't been tested well and we don't know its impact. Once it's perfected, will we have to return to moral arguments?

Yes. We need to be very candid about this issue within our churches. Whenever I speak to a group of Christian women about this subject, I say, "I know there are women here who've had abortions." We need more candor and more recognition of this.

People aren't talking about it because, increasingly, there are those who've encouraged a girl to engage in an abortion very privately, just as the Internet has made porn an almost entirely private enterprise. We've got to have different kinds of conversations.

About euthanasia, the Netherlands recently became the first nation to legalize both physician-assisted suicide and euthanasia. Dutch data from the 1990s document the high rate of abuse in that nation: patients euthanized without explicit consent; patients given assisted-suicide who weren't even ill. Why do you think the Dutch, and others, are ignoring these facts and continuing to press for the legalization of assisted suicide and euthanasia?

Accounting for the Dutch euthanasia experience is very difficult. Holland has taken a very liberal view on prostitution, drugs and so on. Its culture, which used to be very conservative, has loosened up on a range of disturbing issues. Also, the Dutch are strongly autonomous people. Euthanasia is being argued there almost exclusively on grounds of personal autonomy. This isn't to say that there aren't some Dutch people who are profoundly disturbed by this and who vigorously oppose it.

The abuse factor is swept under the carpet in favor of autonomy. In essence, people whom we weren't sure really wanted to be are put to death, because it's more important to recognize autonomy.

Many Americans think this is a result of socialized medicine. But it really isn't. Cost elements are irrelevant to the Dutch euthanasia situation. This is exclusively an argument about patient decision-making, which has become an argument about doctor decision-making.

A significant majority of Dutch physicians have killed people and have falsified death certificates. Even though the government wouldn't hold them criminally liable, there would be a minor investigation. To avoid it, they've lied on death certificates. The guilt factor translates to this: If just once you've killed somebody, and you've lied about it, this makes you a different person than you were before. And that is the context in which they're now moving into - the formalization of 20 years of euthanasia.

We know that untreated depression and pain will lead people to consider assisted suicide and euthanasia. But the autonomy issue is really driving it. How can we, in the United States, prevent that mentality from becoming more entrenched than it already is - head off the euthanasia crisis that we're seeing in the Netherlands?

It's going to be quite a challenge. The evidence is that few people in western medical systems need to die in serious discomfort. There are cases that are very difficult to treat without long-term sedation, and I see no ethical problem with such care.

There is no national set of standards for provision of palliative medication, and there should be. The most practical and wonderful thing Christian physicians can do is get into palliative medicine, becoming the best-educated and clinically expert people in their communities in this field. Palliative care is the best argument against euthanasia, which is pretty much veterinary medicine. Euthanasia is an appropriate way for your favorite dog to be put out of its misery. But this isn't about your dog; this is about your father or mother. Or yourself. We have to read Genesis 1 again: We're made in the image of God.

Of all the topics we've discussed, and even ones we haven't, which are the greatest concerns for the next 10 to 20 years?

I have two topics of great concern. Euthanasia is going to eclipse abortion as an issue of morals and public policy and as a threat to human dignity. We should be moving great amounts of our pro-life resources into that debate, and we haven't done that. It's been a footnote, and that's tragic.

Second, we have the new wave of technology, specifically germ-line therapy and cloning. These new issues are less about killing and more about making life of our own devising. Someone said we're moving from killing human beings made in God's image to making human beings in our own image.

We're locked in the abortion debate, which is profoundly important. But with euthanasia, we're moving into round two of the old ethics, killing people who are already born. Unless we can begin to work at how we defend human dignity there, we won't just lose another political debate: We're going to lose the human species.

Dr. Cameron is dean of the Wilberforce Forum (Christianity.com/Wilberforce) and the founding editor of Ethics and Medicine (EthicsAndMedicine.com).

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Preserving the Ethics in Bioethics