The Dignity of a Person

The Catholic Church released their Dignitatis Personae on Friday, which is an update of the 1987 Donum Vitae. Dignitatis Personae is the most up-to-date view of the Catholic Church on assisted reproductive technologies, and it spells out clearly what and why the Vatican approves (or in this case, largely disapproves) of most modern reproductive options.

It's been 21 years since Donum Vitae, and technology has made incredible leaps forward: IVF, intracytoplasmic sperm injection, all kinds of surrogate motherhood, PGD, etc. And most of these leaps are condemned by the Church.

It's my own personal opinion that it's necessary for everyone involved in bioethics to understand the Catholic position, regardless of your personal or professional inclinations. The Church has a powerful lobbying group, especially in states in the northeast of the United States, and this document has the ability to affect many people simply because it does clear up a lot of the grey areas that existed in Catholic doctrine.

Reading the Dignitatis Personae is an exercise in patience and self-control; it's hard to resist the urge to go wake someone up to have someone to discuss such wince-inducing logic as this: This ethical principle, [ed- that life begins at conceptions] which reason is capable of recognizing as true and in conformity with the natural moral law, should be the basis for all legislation in this area. I can tell you with full certainty that such 'reasoning' (a term I use loosely) would fail a philosophy 101 test. But if you can get through the document, you'll learn that the fresh-off-the-newstands update to Catholicism forbids any reproductive act that does not result in fertilization and implantation happening as a result of the sexual act between a married couple. Or put more simply: if the technology assists in intra-uterine conception, YAY! If conception occurs outside the uterus, BOO!

For better or for worse, the Catholic position is at least internally consistent - and for this I certainly give credit where it's due. There's very little cherry-picking of preferences; life begins at conception, all conceived embryos deserve full moral status of a human, etc. But aside from theological and philosophical differences, two things in the Dignitatis Personae stand out to me as worthy of further discussion and debate.

The first is the idea that

"The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman. Procreation which is truly responsible vis-à-vis the child to be born “must be the fruit of marriage”.

Put plainly, and as I said above, children must be conceived through sexual intercourse. Their conception at fertilization in the woman's body is when they become ensouled. What then, does this mean, theologically, for the multitudes of people now being born outside of this very narrow definition of procreation? It's not an answer I have, it's not an answer that is clear in the Dignitatis Personae, and it's definitely not an answer that anyone my local Catholic Conference has been able to answer. So it is a lingering question, and one that should be answered.

The second, and much larger issue, is the chapter on "The use of human “biological material” of illicit origin". This chapter discusses the obligation of researchers to refuse to use materials of illicit origin - that is, human cell lines obtained from stem cells, aborted fetuses, etc. Many, if not most, news outlets are reporting this to mean that the Vatican has said that Catholics may not use vaccines which are grown on human cell lines created from the lung tissues of aborted fetuses (the Meruvax rubella vaccine, at the very least).

Reading the chapter, though, instead of relying on news reports, gives a slightly different interpretation. While the document is clearly against researchers using any biological material of so-called illicit (theologically) origin, and suggests that ethical researchers will refuse to use these mediums, it draws a different line for the general public. The document allows that

Grave reasons may be morally proportionate to justify the use of such “biological material. Thus, for example, danger to the health of children could permit parents to use a vaccine which was developed using cell lines of illicit origin, while keeping in mind that everyone has the duty to make known their disagreement and to ask that their healthcare system make other types of vaccines available.

Unfortunately, this again raises more questions than it solves. If there is such a thing as a single grave reason that may be morally proportionate to justify the use of illicit biological material - vaccinating your child from a deadly disease - then why are there not other grave reasons? Isn't this suddenly a large degree of "wiggle room" that will allow individuals an out, who can say that this document is not intended for the lay Catholic but the scientist Catholic, the researcher who spends their life in this and thus needs to consider ethics and morality at a different level than the average person (or at least average Catholic)?

As I said, more questions. But in all fairness, I can't say more questions than answers, since the document clearly gives answers that people have been wondering about for the last 21 years.

Give it a read this morning over your coffee, tea, breakfast, and see what you think the impact of this document will be.
-Kelly Hills

Quote of the Day

From Julian Baggini in his New Statesman article: "The justifiable desire to keep religious dogma out of public life has led to an unjustifiable tendency to treat religious views as a whole as separable from civic life. It is in the interests of everyone, believer or not, to end this artificial divide and start a real intellectual tussle in which secular and sacred views battle it out, rationally and in the open."
Full article accessible here.

News of Note

A couple of stories that have captured our interest:

From the Wisconsin Technology news:
"In the first of several decisions expected in a patent dispute involving human embryonic stem cells, the Wisconsin Alumni Research Foundation said today it has been notified that the United States Patent and Trademark Office has upheld the claims of one of the foundation's key stem cell patents.

The patent challengers, however, said they will continue their challenge of what they termed "three overreaching patents on human stem cells."

According to WARF, the licensing arm of the University of Wisconsin-Madison, the decision pertains to the patent for primate and human embryonic stem cells known as '913.'

Carl Gulbrandsen, managing director of WARF, called the decision of patent examiner Gary Kunz an affirmation. 'We're extremely pleased with this decision,' he said in a statement released by WARF. 'It affirms what WARF has believed all along, that Dr. Thomson's breakthrough discoveries are patentable inventions.' " Full story here.

From Science Daily:
New survey results show that only 29.5 percent in a sample of 1,015 adult Americans consider nanotech morally acceptable. In Europe, significantly higher percentages of people accepted the moral validity of the technology:
"In the United Kingdom, 54.1 percent found nanotechnology to be morally acceptable. In Germany, 62.7 percent had no moral qualms about nanotechnology, and in France 72.1 percent of survey respondents saw no problems with the technology.

'There seem to be distinct differences between the United States and countries that are key players in nanotech in Europe, in terms of attitudes toward nanotechnology,' says Scheufele.

Why the big difference?

The answer, Scheufele believes, is religion..." Read on here.

From the NY Times: Six Killers: America’s Leading Causes of Death: "They are the leading causes of illness and death in the United States today: heart disease, cancer, stroke, chronic obstructive pulmonary disease, diabetes and Alzheimer's disease, in that order. And they have a lot in common." Full article here. [Query: Would more Americans find nanotechnology more acceptable if they knew that it could cure these leading killers?]


From the Washington Post, a study suggesting that man's 'best friend' could be a robot? - a study by Saint Louis University that found the lovable pooch and the interactive dog robot called AIBO were about equally effective at relieving the loneliness of nursing home residents, and fostering attachments. Full story here. I agree with Sara Kiesler, professor of computer science and human-computer interaction at Carnegie Mellon University, who said "the results of the study are encouraging but not completely convincing."

Religion of the Father?

AP reports that the Oregon Supreme Court has ruled that a 12 year old boy's preferences on whether or not to be circumcized should guide the decision in the dispute between his parents.

Excerpt:

The father, James Boldt, converted to Judaism in 2004 and wants the boy to be circumcised as part of the faith. The mother, Lia Boldt, appealed to the high court, saying the operation could harm her son physically and psychologically.

The state Supreme Court ruled that earlier court decisions failed to determine whether the boy wanted the circumcision, as his father contended, or opposed it, as his mother alleged.

The Supreme Court sent the case back to the trial court to answer that question.

If the trial court finds the child agrees to be circumcised, the Supreme Court said, it should deny the mother's requests. But if the trial court finds the child opposes the circumcision, the court has to determine if it will affect the father's ability to care for the child.

The custody dispute began when the child was 4 and the circumcision issue began three years ago when he was 9.

We have several interesting issues impacting this case. First: informed consent of the patient. Is a 12 year old mature and competent enough to make a decision about this permanent operation? There is a precedent in our society that denies non-medically indicated permanent procedures. For reference, most physicians deny elective sterilization operations to women even if they are of legal, consenting age (depending on the state, 25 is often used as a "no questions approval" cutoff).

Second, what is the nature of the circumcision procedure? Ought it be considered a ritual fully protected by free exercise of religion, or an elective permanent surgical procedure for non-health related reasons, thus violating the non-maleficence clause of the Hippocratic Oath? Note the sliding scale of the perceived magnitude of circumcision - from something akin to a piercing to mutilation of one's body and bodily function.

Third, the dispute between the parents should be considered carefully, and both parties' motives must be separated from what is in the best interest of the teenager. However, the "father's ability to care for the child" should not be used as a factor, as it should be categorically seen as a sign of unfit parenting to abuse or neglect one's child for not conforming to religious practice.

In my opinion, a case would be made for supporting such a procedure on someone not legally competent only if 1) there were a medical indication or 2) there were a time-sensitive factor to the procedure in terms of reducing side effects or discomfort. Thus, there is potential for supporting circumcision of infants over children or teenagers because some believe less pain is felt at that time (I do not endorse this position, I simply present it for argument) than would be felt later on. And there are rare cases where a circumcision is medically indicated in a child or a teenager due to developmental or other impairments.

However, this situation does not fulfill either criterion - a 12 year old does not have time-sensitive reasons for seeking a circumcision, there is no medical indication, and even the religious argument falls short due to the father's recent conversion. I do not see a reduction in suffering that would result from the operation occuring now or occuring six years from now, but the difference legally, cognitively, and ethically would be significant. Therefore, while I applaud the court's intent to look to the teenager's wishes, I do not feel that he is able to ethically consent to such a procedure at this time, and there should not be a circumcision until he comes of legal age of consent.

Addendum: Upon further reflection, I suspect that this is an attempt by the court to foist responsibility for the act (or non-act) onto the teenager so they do not have to risk appearing to be anti-religion. If so, that is an irresponsible course of action.

do you sing the body electric?

A case going before the Ohio Supreme Court this week has the potential to change autopsies in the state - but also, potentially, surgeries and other procedures. At the heart of the matter is whether or not the state has the right to classify removed portions of the body as medical waste, and dispose of them in a timely fashion, or if those items of the body must eventually be returned to the family/loved ones. The specific plaintiff in this case is the family of a man who was buried without his brain.

The reason for this isn't as gruesome, nor as forensic show plot-y as it sounds. It's actually rather simple; when preparing a brain, during an autopsy, it typically takes longer to prepare the brain for viewing than it does to release the rest of the body for burial/cremation. Once the examination of the brain is done, and final cause of death has been determined, the brain is disposed of like most other medical waste - incineration.

But it raises a host of ethical, legal and social issues. Many people, backed by many different religions, believe that the body must be returned to the ground whole, for various reasons involving religious tenants and the afterlife/Resurrection. Others, perhaps fueled by media reports of wrongdoing on the part of funeral directors and the like, simply fear what is happening to those body parts - are they being used for research without permission? Unauthorized grafts or transplants? They want accountability for the whole of their loved one's body, and feel that it is well within our cultural history to demand it.

The defendants argue that this will severely harm their practice, of forensics and crime scenes, of autopsies, and perhaps more. After all, they point out, when a body dies, fluids - blood and more - are lost at the scene, and this is not collected for return. Likewise, there are times when the entire body simply cannot be returned, due to the natural of the death itself. Or most simply, as attorney Mark Landes has pointed out, it is a definitional impossibility to both do an autopsy and return the entire body.

Unfortunately, this is a situation of cultural and social beliefs hitting up against practical considerations and laws - we need to know how people died, particularly when it is a suspicious death, but we want to respect the religious and cultural beliefs of the people involved. And there are times when the two simply cannot be reconciled - and in those cases, what do you do?

I know what my decision would be - what's yours?
-Kelly

More Time to be Wise?

The potential to radically extend the human lifespan raises all sorts of bioethical questions from theologically based concerns (Is it moral to seek immortality?) to more practical considerations (Will radical life extension bring increased happiness or despair to the human condition?) "Radical Life Extension and Religious Evolution" by Sonia Arrison, TechNewsWorld, 12/14/07 offers a positive spin:

...not all scholars saw radical life extension as a negative development.

Professor Ron Cole-Turner of the Pittsburgh Theological Seminary discussed how life extension could benefit many religious orders. "Technology will inject competition into religion and force religious authorities to clarify what they mean by immortality." This is important, according to Cole-Turner because "there is currently a lot of evasiveness about what immortality means." This is a good point and, of course, the conversation is not a one-way street.

Religion will also serve to inject ethical competition into technology circles. If the future of evolution is now more in human hands, the religious question is: toward what end? In other words, if humans could live longer, what good should result? Perhaps the Buddhist scholar had the most clear and concise answer.

Professor Derek Maher explained that in Buddhism each person is responsible for their own karma which, taken care of properly, can bring one to a state of nirvana, which is the cessation of suffering. Buddhists, he explained, already embrace the idea of radical life extension because it "gives you more time to attain wisdom and advance spirituality." Essentially, it gives you more time in this life to improve your karma so you can reach nirvana.

Older and wiser? Maybe...