The Latest From Clem
August 21, 2008 01:55 PM
US Government and Conscience of Health Providers
Dr. Bill Toffler, a physician and professor at Oregon Health and Science University, says it’s “a sad reality” that the government must protect conscience of health providers.
Dr. Toffler, a member of Holy Rosary Parish in Portland, blames pro-abortion groups, saying their zeal for abortion rights leads them to trample other rights.
“The average secular person will acknowledge the right of conscience,” Dr. Toffler says. “Who wouldn’t want a doctor practicing conscientiously, following his or her ethical compass?”
As the Bush Administration aims to beef-up enforcement so that conscience rights of health providers are not violated, Oregon Catholics are debating the issue, which is not simple.
Regulations soon to be published by the Department of Health and Human Services will clarify and enforce a handful of federal laws outlawing discrimination based on moral and religious convictions of health care personnel in programs receiving federal funds.
Abortion rights organizations and some members of Congress have attacked the regulations, saying they could limit access to abortion and birth control.
So far, few are seeking to force health providers to actually carry out procedures they find morally objectionable. The main part of the debate is whether doctors, nurses and pharmacists should be required to refer such patients to willing providers.
Several developments prompted the Department of Health and Human Services to act.
Earlier this year, the American College of Obstetricians and Gynecologists issued an ethics report that called on doctors who oppose abortion to refer patients to amenable physicians or risk losing board certification.
In March, Health and Human Services Secretary Mike Leavitt wrote to the medical organization’s leaders warning them that they were in danger of violating federal law.
“I am concerned that the actions . . . could result in the denial or revocation of board certification of a physician who — but for his or her refusal, for example, to refer a patient for an abortion — would be certified,” Leavitt wrote.
In the past four years, Catholic Charities in New York and California have been forced by their state supreme courts to offer employees health coverage for contraceptives or eliminate prescription drug benefits altogether. Either move violates Catholic principles.
In 2004, New Mexico officials refused to approve a community-owned hospital lease because it was against the new health system’s policy to perform elective abortions.
The governors of Illinois and Washington have begun requiring pharmacists to fill prescriptions for the controversial “morning-after” pill, which in some cases causes abortions. California and New Jersey have similar laws.
Oregon has made no such move yet, but here and elsewhere, the notion of referral is being contested.
Dr. Toffler travels through time to argue that it is wrong to require a doctor, for example, to refer a patient to someone who will perform an abortion. Imagine a blacksmith in 1857 who has come to see the evil of slavery, he says. A slave owner comes to him with a slave recently caught after an escape. The owner asks the blacksmith to repair the damaged shackles.
“The only answer he could give in good conscience is, ‘I can’t help you with that,’” Dr. Toffler says. “When the owner asks if he’ll refer him to another blacksmith, and he refuses, the owner may throw a fit. But most people recognize that if the blacksmith referred, he would be cooperating with the evil of slavery.”
Dr. Toffler has a standing disagreement with his employer. OHSU requires doctors to refer out for procedures they will not do themselves. In a densely-populated area like Portland, Dr. Toffler counters, it is not an undue burden on patients to refuse referral.
Gary Balo, a member of All Saints Parish and longtime owner of Paulsen’s Pharmacy in Portland’s Hollywood District, emerged in the 1990s as the voice of pharmacists who oppose Oregon’s assisted suicide law.
But Balo believes it is his duty to refer patients if he cannot offer the prescription they want, be it an assisted suicide dose or drugs that might cause an abortion.
“You don’t want to cut somebody off,” says Balo. “You need to allow them a choice to make a decision. If the patient is making that decision, I am not making that decision for the patient.”
By referring, Balo says health providers maintain their own integrity without abandoning the patient and upsetting the medical enterprise altogether.
Dr. Michael Grady, who treats underinsured patients at a Silverton clinic, has over the years seen several women opt for adoption over abortion when he informed them of the option. If the women endure in their desire for abortion, which he refuses to perform, he refers them to a safe place.
Dr. Grady, a member of St. Paul Parish in Silverton, says that if he were simply to announce that he would not refer, he would miss out on a chance to educate and minister.
For the most part, he believes fears of doctors’ consciences being violated are overblown.
Father John Tuohey, ethicist for Providence Health and Services in Portland, says that while Catholicism clearly considers abortion evil and supports conscience, it also views healthcare as part of the common good. That means there must be some predictability in the system.
It would not do, he says by way of example, for a physician who considers depression a lack of faith to withhold anti-depressents and refuse referral.
“You can’t leave patients on their own to find medical care,” Father Tuohey says. “We need to find a way to respect the healthcare provider’s conscience without abandoning the patient. It can’t be onerous; patient care is what it’s about.” The best solution, Father Tuohey says, is upfront communication. Doctors should make it clear what they will not do. That way, patients will not be surprised. For example, Providence makes it plain that it takes no part in abortion and assisted suicide.
John Brehany, a healthcare ethicist and executive director of the Catholic Medical Association, predicts that government-run and sponsored medicine of the future may require more providers to perform or refer out for morally objectionable procedures.
Cardinal Justin Rigali, chairman of the United States Conference of Catholic Bishops’ Committee on Pro-Life Activities, wrote to all members of Congress in July defending the Bush administration efforts to reaffirm and implement laws on conscience protection.
Cardinal Rigali said this “should be a matter of agreement among members who call themselves ‘pro-life’ and ‘pro-choice’: the freedom of health care providers to serve the public without violating their most deeply held moral and religious convictions on the sanctity of human life.”
The cardinal went on to say that patients with pro-life convictions, including women who require a physician’s care for themselves and their unborn children during pregnancy, deserve access to health care professionals who do not have contempt for their religious and moral convictions or for the lives of their children.
“This issue,” Cardinal Rigali said, “provides self-described ‘pro-choice’ advocates with an opportunity to demonstrate their true convictions….. [I]s the ‘pro-choice’ label a misleading mask for an agenda of actively promoting and even imposing morally controversial procedures on those who conscientiously hold different views?”
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July 4, 2008 09:29 AM
Abstinence papers presented at National Press Club
The Washington Times, 25.04.2008
By Janice Shaw Crouse
Two research studies presented findings this week at the National Press Club indicating abstinence programs produce positive outcomes.
One evaluation shows abstinence programs cut the rate of sexual activity among students roughly in half. Another study, a comprehensive review of 21 abstinence effectiveness studies (two-thirds of them in peer-reviewed publications) indicates remarkable effectiveness — 16 out of the 21 studies found abstinence programs produce lower rates of sexual activity.
These findings soundly refute the accusations of backers of comprehensive sexual education programs who claim abstinence programs are unproven and ineffective.
Further, the research studies are backed by the social trends that indicate declines in teen sexual activity, teen births and teen abortions. These positive outcomes are good news in a culture where there are more than 15 million new cases of sexually transmitted diseases (STDs) every year.
The first study was published in the American Journal of Health Behavior (January/February 2008) by Dr. Stan Weed, Institute of Research and Evaluation. Dr. Weed's study focused on students in Virginia middle schools, and his results were presented today at a hearing in the U.S. House of Representatives.
The second study, authored by Christine Kim and Robert Rector, was produced by the Heritage Foundation. Ms. Kim and Mr. Rector reviewed 21 studies that evaluated the effectiveness of abstinence education and virginity pledge programs. Sixteen of the 21 studies appeared in peer-reviewed journals.
Students need to know the basic "birds and bees" information, but, more important, they need to have a values-based foundation on which to base the physiological information. And they need to have a clear understanding about the building blocks for a solid and successful future filled with hope and the ability to reach their goals.
In short, abstinence programs focus on developing character traits and building relationship skills, including how to effectively say "no" to short-term pleasure in favor of long-term well-being and happiness.
Abstinence programs provide valuable life and decisionmaking skills that lay the foundation for personal responsibility and the development of healthy relationships and marriages later in life.
Numerous studies show clear evidence that abstinent teens have, on average, higher academic achievement and better psychological well-being than those who are sexually active.
Currently, our federal government spends $1 billion annually to promote contraception and condom-based, so-called "safe-sex education;" that figure is at least 12 times what we as a nation spend on abstinence education. Obviously, that spending ratio ends up producing results similar to the money devoted to the "cause."
Thus, during all the years of condom-based sex education, we have had escalating rates of teen sexual activity, teen pregnancies and teen abortions. This, despite the fact more than 80 percent of parents want schools to teach youths to abstain from sexual activity until they are in a committed adult romantic relationship nearing marriage. As we have seen, parental preferences have little impact because the abstinence-until-marriage message is rarely communicated in classrooms where condom-based sex education is the curriculum.
Thus, we have teens engaged in sexual activity where they risk STD infection, emotional and psychological harm and out-of-wedlock childbearing. In fact, every year some 2.6 million teenagers become sexually active — a rate of 7,000 teens per day. Abstinence teaches a different message with an expected standard: Students should refrain from sexual activity outside of marriage.
Opponents of abstinence education contend that abstinence-based programs fail to influence teen sexual behavior. We can be thankful that the new studies revealed this week report different results: 21 studies of abstinence education were reviewed; 15 primarily intended to teach abstinence. Of those, 11 reported positive findings. In the six studies that analyzed virginity pledges, five reported positive findings.
Those positive findings included delayed sexual initiation and reduced levels of early sexual activity. The vast majority of parents concur that they want these goals for their adolescents. Experts agree that these goals are best for an adolescent's well-being and bright future.
As the research field of abstinence program evaluation is developing, relatively few programs have been evaluated so far. Programs vary substantially, and the few evaluated programs inadequately represent the spectrum of abstinence programs. The evaluations reported on this week are quasi-experiments (that is, they incorporate certain elements of experimental design and use statistical methods to account for pre-intervention differences between youths who received abstinence education and those who did not).
Further, the report this week includes discussions of the five studies that report no significant impact from abstinence programs — a point of honesty and objectivity that should be noted.
Abstinence teaches not only lessons for the here and now, but for the future too. It's like math: First you learn to add and subtract, then you learn to multiply and divide, and then you continue learning to solve the more complex and intricate problems. As noted earlier, abstinence teaches the biological basics and then moves on to the more intricate nature of relationships, whereas comprehensive sex education teaches only the mechanics of sex for the here and now with the assumption that teens will succumb to peer pressure and their hormones.
Granted, nearly half of all high school students report they have engaged in sexual activity. Sad to say, for most of them, it is a one-incident affair that leaves them feeling "used," and the negative emotional and physical fallout of such experiences is well-documented. Our teens deserve better. It is unconscionable that adults would be enablers of that type of sexual initiation.
Janice Shaw Crouse is the director and senior fellow of the Beverly LaHaye Institute at Concerned Women for America.
All site contents copyright © 2008 The Washington Times, LLC.
http://www.washtimes.com
June 27, 2008 11:27 AM
Protecting the Consciences of OB/GYN's
Protecting the
Consciences of OB/GYN’s
June 24, 2008
A recent issue of the Journal of Clinical Ethics published a series of articles addressing the question, to what extent should the consciences of obstetrician-gynecologists (ob/gyns) be protected? The importance of the question lay in the fact that ob/gyns may receive requests to perform controversial sexual or reproductive procedures. Such sexual/reproductive practices as prescribing contraceptives, undergoing in vitro fertilization, and abortion may be requested by the patient. Since all of these procedures are unfortunately legally protected, the physician who has an objection against any of them risks violating the legal “rights” of the patient. That is, there is an apparent tension between the patient’s legal right to have access to the above procedures, and the conscientious physician’s moral integrity in refusing to do them. Similarly, the moral integrity of pharmacists has been attacked by the recent position taken by the American Medical Association's Board of Trustees. The AMA position “supports legislation that would require individual pharmacists and pharmacy chains to fill legally valid prescriptions or to provide immediate referral to an appropriate alternative dispensing pharmacy without interference” (see Proceedings, June 17, 2008).
Edmund Pellegrino contributes a commentary in this series of articles, and I agree in toto with his position. But the other articles take a different stance on this issue. The basic argument seems to be the following: begin by countenancing the apparent tension mentioned above; stipulate that (1) the physician’s professional role is to perform clinical duties consistent with his or her fiduciary duties to the patient, and (2) this professional role ought to be impervious to the moral commitments of the physician. Therefore, the physician ought to comply with the requests of the patient, or at the very least transfer the patient to someone who will. Of course, (2) is patently false. But in its defense proponents make a subtle though quite devastating move. One way to argue for (2) is to equate personal moral commitment with one’s religious beliefs. That is to say, to the extent that one’s moral commitments are “rooted” in one’s religious convictions, they are religious claims, not moral ones. And if they are religious claims, then they ought not to infect the physician-patient relationship. Otherwise the physician is guilty of “paternalism” or of “shoving religious views down the patient’s throat.”
Another way to argue for (2) is to say that the physician’s specifically clinical judgment ought not to be informed by his or her personal moral commitments. A clinical judgment is one that is tethered to reliable clinical evidence of expected benefit vis-a-vis the available alternatives. And, what counts as a benefit is determined by the patient, not the physician. So, if the physician were to refuse to perform an IVF procedure, the physician is defining what the benefits are, not the patient. The patient sees the benefit of “having children.” The physician sees having children as a benefit, but for IVF, this is by means of destroying other children and violating the nature of the conjugal relation. In the end, the values of the patient matter, not the physician’s.
Though I think this pattern and the various justifications for each step are open to an extended analytical critique, I have space only to make some broad comments in criticism of them. Notice the strategy behind the pattern. It is either to reduce the physician’s professional role to making expert statistical judgments, or it is to reduce the physician’s moral commitments to religious ones – and then excluding religious beliefs from infecting the physician-patient interaction. In either case, an important bifurcation takes place between medical judgments and ethical ones. In fact, it is common to see in the literature on this issue (i.e., the issue of conscience) a distinction drawn between medical concerns and moral ones, between clinical judgments and ethical judgments. But such a bifurcation is a grossly inapt description of the physician’s task. The task of healing the person is an inherently moral task. A physician friend of mine, after I told him I was doing research on a bioethical issue, said it best: “I did bioethics all day too.”
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May 13, 2008 01:08 PM
Basic Care for Patients in the Vegeative State
Health Progress
May-June 2008Volume 89, Number 3
On Basic Care For Patients In The 'Vegetative' State
A Response to Dr. Hardt and Fr. O'Rourke
BY CARDINAL JUSTIN F. RIGALI, JCD, & BISHOP WILLIAM E. LORI, STD
Cardinal Rigali is archbishop of Philadelphia and chairman of the Committee on Pro-Life Activities, U.S. Conference of Catholic Bishops (USCCB); and Bishop Lori is bishop of Bridgeport , Conn. , and chairman of the Committee on Doctrine, USCCB.
Download a PDF of this article
In a 2004 address on care for patients diagnosed as being in a "vegetative state," Pope John Paul II affirmed the human dignity of these patients and the obligation to provide them with ordinary care, including food and water, even with artificial assistance. On Sept. 14, 2007, through its "Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration," the Congregation for the Doctrine of the Faith (CDF), with the approval of Pope Benedict XVI, reaffirmed and further explained this papal teaching. (The CDF's "Responses" was accompanied by a "Commentary," which offered further explanation.) The U.S. Conference of Catholic Bishops (USCCB) has welcomed this important clarification of Catholic Church teaching and has provided its own set of questions and answers to promote a better understanding of it in the United States. 1
Unfortunately, confusion about this teaching and opposition to some aspects of it persist in some quarters. For example, a recent Health Progress article by John J. Hardt, Ph.D. and Fr. Kevin D. O'Rourke, OP, JCD, STM, titled, "Nutrition and Hydration: The CDF Response, In Perspective," misinterprets the Holy See's documents in important respects, and even makes the charge that the CDF interprets euthanasia in a way that is "at odds with the traditional teaching of moral theology." 2
As chairmen of the U.S. Bishops' Committees on Doctrine and on Pro-Life Activities, we offer the following points to prevent misunderstanding and to help those involved in Catholic health care ministry more fully understand the church's teaching.
First, contrary to the "Rules for Interpretation" referred to by Hardt and Fr. O'Rourke, 3 the CDF document was not issued in the form of a canonical decree. Nor is it merely a public policy statement motivated by the threat of legalized euthanasia in certain countries in Europe. It is an authoritative statement of moral truth, reaffirming a teaching by the Catholic Church's ordinary magisterium regarding how we are to exercise our freedom responsibly as children of God.
Second, not everything in the CDF's "Responses" applies solely to patients in a "vegetative state." For example, the CDF's first response states that "the administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life." Certainly this basic principle applies when patients have chronic but stable debilitating conditions that are less extreme than the "vegetative state." As the CDF "Commentary" notes, helpless patients with conditions such as quadriplegia, mental illness or Alzheimer's disease also must not be deprived of basic care and "abandoned to die" because their long-term care may burden others. The phrase "in principle" (which in this context means "as a general rule") is also important, because providing assisted food and fluids may cease to be obligatory in particular circumstances. The U.S. bishops asked whether such circumstances occur only when food and fluids "cannot be assimilated by the patient's body or cannot be administered to the patient without causing significant physical discomfort," and the CDF answered in the affirmative. The CDF "Commentary" notes that such circumstances will be "rare" and "exceptional" for a patient in a "vegetative state"; they may occur far more frequently for patients with progressively deteriorating or terminal conditions.
Also, the CDF "Commentary" notes the obligation to provide assisted feeding may not apply "in very remote places or in situations of extreme poverty" because we are not held to do something that is impossible in practical terms. But the CDF's statement about the general or presumptive obligation to provide food and fluids as a form of ordinary care clearly has broad application.
Third, in applying the church's longstanding moral tradition against euthanasia to the present question, the CDF is in full accord with that tradition. In 1980, the CDF (with the approval of Pope John Paul II) issued a "Declaration on Euthanasia" defining "euthanasia" as "an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated." 4 In its more recent "Responses" and accompanying "Commentary," the CDF is stating that this issue is of particular concern regarding medically assisted food and fluids. Food and water are basic necessities of life, without which anyone (sick or healthy) would soon die. When they are withdrawn from a seriously disabled patient who needs help from others to obtain such basic care—withdrawn not because the means themselves are useless or excessively burdensome, but because someone has judged that patient's continued life to be useless or burdensome—the patient's death is the first result, and any other intended goals would seem to be met only through this death. The argument that in such cases the cause of death is merely the underlying condition (the inability to eat and swallow for oneself) is not valid, and is explicitly rejected by the CDF:
Patients in a "vegetative state" breathe spontaneously, digest food naturally, carry on other metabolic functions, and are in a stable situation. But they are not able to feed themselves. If they are not provided artificially with food and liquids, they will die, and the cause of their death will be neither an illness nor the "vegetative state" itself, but solely starvation and dehydration. 5
Fourth, this brings us to the argument by Hardt and Fr. O'Rourke that the "significant financial hardships" of providing assisted food and fluids to patients in the "vegetative state" in the U.S. may justify withdrawing such care and letting the patient die. 6 In reality, providing the complete range of long-term care for these helpless patients may indeed become very costly, and families should not be abandoned to carry these burdens alone. But providing food and fluids generally accounts for a very small fraction of this cost. If food and fluids are targeted for removal because this will lead to the patient's early death, thus saving the significant costs of other care, then it seems clear that the patient's death is being intended precisely as a means to saving these other costs. In other words, this would be a decision to practice euthanasia by omission.
Fifth, nothing in the CDF's "Responses" or in Pope John Paul II's address of 2004 provides a basis for withdrawing food and fluids based on a far broader category of "psychic burden." Hardt and Fr. O'Rourke say that some may "feel" the continued life of a patient in a "vegetative state" is a burden to others, or is not a benefit. This may be true, but such feelings do not justify euthanasia by omission or the deliberate withdrawal of basic care owed to patients because of their human dignity.
Sixth, regarding advance directives such as the "living will," Hardt and Fr. O'Rourke claim that under the Ethical and Religious Directives for Catholic Health Care Services (ERDs) people may continue to make advance decisions regarding their care (Directives 25 and 28). 7 This is true as far as it goes. However, Directive 28 provides that "the free and informed health care decision of the person or the person's surrogate is to be followed so long as it does not contradict Catholic principles " (emphasis added). Moreover, Directive 24, not cited by Hardt and Fr. O'Rourke, also speaks of generally respecting patients' and surrogates' decisions, but adds:
The institution, however, will not honor an advance directive that is contrary to Catholic teaching. If the advance directive conflicts with Catholic teaching, an explanation should be provided as to why the directive cannot be honored.
The CDF's "Responses" provide clarifications as to what Catholic moral principles require of us on the provision of food and fluids, out of respect for the perduring human dignity of even the most severely cognitively disabled of our brothers and sisters.
On the relationship between the ERDs and the CDF's "Responses," the USCCB had this to say in its Q&A document:
Directive 58 already speaks of "a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration." The Address and the Responses clarify how this presumption applies to the patient in a "vegetative state" as to other patients, and provide further guidance as to how the Directives should be interpreted and implemented. 8
We fully intend that the next edition of the ERDs will be amended to reflect this doctrinal clarification.
While we disagree with other claims by Hardt and Fr. O'Rourke, we believe these are the most important points in need of clarification. Certainly, when they say it is "questionable" whether the Catholic community will rise to the challenge of caring for the basic needs of patients in the "vegetative state," we hope their pessimism is unwarranted. It is precisely in caring for the poorest and most helpless of patients, those whose value and dignity are dismissed by others, that Catholic health care most clearly lives up to its mission and demonstrates the need for specifically Catholic health care providers in our secularized society. It is in meeting the moral challenge of caring for the most helpless that we will live up to our own God-given dignity.
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NOTES
The U.S. Conference of Catholic Bishops news release of Sep. 14, 2007, on this development, with links to the CDF's "Responses" and "Commentary," and the USCCB's related Q&A, can be found at www.usccb.org/comm/archives/2007/07-143.shtml. Pope John Paul II's March 20, 2004, address can be found at
www.vatican.va/holy_father/john_paul_ii/speeches/2004/
march/documents/hf_jp-ii_spe_20040320_congress-fiamc_en.html.
John Hardt and Kevin O'Rourke, "Nutrition and Hydration: The CDF Response, In Perspective," Health Progress , November-December 2007.
Hardt and O'Rourke, 45.
Congregation for the Doctrine of the Faith, "Declaration on Euthanasia," (May 5, 1980) www.vatican.va/roman_curia/congregations/cfaith/documents/
rc_con_cfaith_doc_19800505_euthanasia_en.html.
Congregation for the Doctrine of the Faith, "Commentary." See note one above for link information.
Hardt and O'Rourke, 46.
U.S. Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services , (Washington, D.C.) Fourth Edition, 2001, www.usccb.org/bishops/directives.shtml.
See note one above.
Copyright © 2008 CHA All rights reserved. Last updated: 04/21/08
May 13, 2008 11:55 AM
Re: Proposed Human/Animal Hybrid Ban
Cardinal Rigali Welcomes Proposed Human/Animal Hybrid Ban
WASHINGTON—Commenting on the introduction in Congress of a “Human-Animal Hybrid Prohibition Act,” Cardinal Justin Rigali, chairman of the United States Conference of Catholic Bishops’ Committee on Pro-Life Activities, today welcomed the legislation as “an opportunity to rein in an egregious and disturbing misuse of technology to undermine human dignity.”
The Human-Animal Hybrid Prohibition Act (H.R. 5910) was introduced in the House on April 24 by Rep. Chris Smith (R-NJ). Identical legislation, S. 2358, was introduced in the Senate last fall by Senator Sam Brownback (R-KS).
Cardinal Rigali’s statement follows:
“I commend Senator Brownback and Representative Smith for their leadership in seeking to prohibit the creation of human-animal hybrids. Their legislation offers an opportunity to rein in an egregious and disturbing misuse of technology to undermine human dignity.
“While this subject may seem like science fiction to many, the threat is all too real. The United Kingdom is preparing to authorize the production of cloned human embryos using human DNA and animal eggs, setting the stage for the creation of embryos that are half-human and half-animal. Researchers in New York have boasted of implanting ‘mouse/human embryonic chimeras’ into female mice, and California scientists say they may produce a mouse whose brain is entirely made up of human brain cells.
“The alleged promise of embryonic stem cells has already been used in attempts to justify destroying human embryos, and even to justify creating them solely for destructive research. Now, the same utilitarian argument is being used to justify an especially troubling form of
genetic manipulation, to create partly human creatures as mere objects for research or commercial use. Nothing more radically undermines human dignity than a project that can make it impossible to determine what is human and what is not.
“I encourage members of all parties to co-sponsor this legislation and bring it to swift approval in Congress, while there is still time for sound ethics and policy to place some restraints on the misuse of science.”
# # # # #
08-061
DD,CATHPRESS,CNS,RNS,Crux
For media inquiries, e-mail us at commdept@usccb.org
Office of Media Relations | 3211 4th Street, N.E., Washington DC 20017-1194 | (202) 541-3000 © USCCB. All rights reserved.
April 2, 2008 11:16 AM
Rethinking Embryonic Stem Cells
Rethinking Embryonic Stem Cells
The Reprogramming Breakthrough
Rev. Tadeusz Pacholczyk, Ph.D.
The recent discovery that regular old garden-variety skin cells can be converted into highly flexible (pluripotent) stem cells has rocked the scientific world. Two papers, one by a Japanese group and another by an American, have announced a genetic technique that produces stem cells without destroying (or using) any human embryos. This technique involves the transfer of four genes into the skin cells, triggering them to convert into pluripotent stem cells. It has been called “biological alchemy,” something like turning lead into gold. Many are hailing “cellular reprogramming” as a breakthrough of epic proportions, the stuff that Nobel Prizes are made of, a kind of Holy Grail in biomedical research.
As important as this advance may prove to be scientifically, it may be even more important to the ethical discussion. It offers a possible solution to a long-standing ethical impasse and a unique opportunity to declare a pause, maybe even a truce, in the stem cell wars, given that the source of these cells is ethically pristine and uncomplicated. As one stem cell researcher put it recently, if the new method really produces equally potent cells, as it has been touted to do, “the whole field is going to completely change. People working on ethics will have to find something new to worry about.”(1) Thus, science itself may have devised a clever way to heal the wound it opened back in 1998, when human embryos began to be sought out and destroyed for their stem cells. Dr. James Thomson (whose 1998 work originally ignited the controversy, and who also published one of the new breakthrough papers) acknowledged just such a possibility in comments to reporters: “Ten years of turmoil and now this nice ending.”(2) Whether this nice ending will actually play out remains to be seen, but a discovery of this magnitude, coupled with a strong ethical vision, certainly has the potential to move us beyond the contentious moral quagmire of destroying human embryos.
Respecting Ethical Boundaries in Research
Reprogramming addresses significant ethical concerns even as it offers a highly practical technique for obtaining pluripotent stem cells. As Dr. Thomson himself put it, “Any basic microbiology lab can now do it, and it’s cheap and quick.”(3) Reprogramming also offers a way to avoid getting entangled in “therapeutic cloning,” a complex and unethical procedure which uses women’s eggs to clone embryos and get patient-specific stem cells. Reprogramming allows researchers to get patient-specific stem cells without using women’s eggs, without killing embryos, and without crossing moral lines.
The sheer practicality of the new reprogramming approach, coupled with its ethical advantages, makes it appealing enough that some researchers are in fact changing their research plans. Dr. Ian Wilmut, the researcher responsible for cloning Dolly the sheep, went so far as to announce that he will no longer pursue human therapeutic cloning, but will instead turn to reprogramming techniques. Yet when pressed by reporters, he still insists that all avenues need to be investigated: “Certainly using skin cells is much easier to accept socially than the use of embryos, but this was very much a personal decision and I still think we need to continue to work in both areas.”(4) There are a number of reasons that scientists and politicians continue to argue that the bio-industrial-complex emerging around destructive human embryo research must be safeguarded and every avenue of research, even unethical ones, must be pursued.
First, the financial investment that has already been made in this area is significant. Certain state initiatives, like Proposition 71 in California, have earmarked enormous sums of state taxpayer money (about $3 billion) to promote research that fosters human embryo destruction. When such astronomical sums are involved, and researchers, universities, and pharmaceutical companies sense a gold rush in the offing, ethics often become the first casualty of the scramble.
Second, some of the scientists who advocate the destruction of human embryos have never really taken the moral concerns too seriously, because the creed they subscribe to is that of the so-called “scientific imperative,” namely, that science must go forward, no matter what, as if it were the highest and most incontrovertible good known to mankind. This kind of modern dogmatism results in the view that science must be able to do essentially whatever it wants, and ethical viewpoints should not be allowed to interfere with experiments that researchers might want to do. That, of course, is a completely untenable position, because we regulate scientific research all the time. The very mechanism by which we dispense federal research money and grants imposes all kinds of checks and balances on what researchers can and cannot do. Certain types of research, like germ warfare studies or nuclear bomb development, are strictly regulated by the government today, and have been for decades. Other kinds of research are outright criminal, such as performing medical experiments on patients who do not give their consent. The idea that we ought to allow science to do whatever it wants is ultimately little more than “pie-in-the-sky” wishful thinking.
The Connections to IVF and Abortion
Another reason that embryocidal research in our laboratories can be expected to continue in the foreseeable future is that we have become largely acclimatized to human embryo destruction as part of what happens during infertility treatments. Many thousands of embryos are frozen or die each year at fertility clinics, and hardly a word is mentioned in respectable society. One of the most successful rallying cries in the stem cell debate has been, “Just give us the frozen embryos. They’re all going to be thrown away anyway.” Because of our unflinching pragmatism as a society, the proposal to get some good out of something that will be thrown into the dumpster seems like a no-brainer. We recycle our aluminum cans religiously, and try to maximize returns on every investment we make, so if young human embryos could be mined for their parts, we conclude that they would “not be wasted” either.
The first lapse in reasoning here, of course, occurs when we grant the assumption that it is somehow okay to discard very young humans. We wring our hands and tell ourselves that this is “inevitable”—we really can’t be expected to stop scientists from discarding young human beings as medical waste, because that could have the practical effect of generating suspicion around the sacred cow of in vitro fertilization. Hence, it must follow that it is okay for researchers to directly cause the death of young humans who have been thawed out and are now growing in the Petri dish on the laboratory bench, as long as somebody else was going to do the dastardly deed “anyway.” So long as clinics were planning to do evil anyway, that makes it okay for me to jump ahead of them in line and do the evil myself as a researcher. The flawed logic here is glaring, yet it sadly passes for respectable thinking and illuminated discourse in our universities and legislative bodies every day.
Yet another reason that embryo-destructive research will still likely be promoted in the future has to do with abortion. Several astute commentators have observed how the whole field of embryonic stem cell research has come to serve as a kind of “hedge” for abortion. In the same way that a hedge is placed around a garden in order to protect it, embryonic stem cells are becoming a place holder for abortion. As long as a kind of medical neo-cannibalism of embryos can be declared necessary for the maintenance of our personal health and well-being, then abortion on demand will more likely curry favor in our culture as well.
We Were Embryos
The argumentative continuity behind this position springs from the fact that each of us, remarkably, is an embryo who has grown up. This biological fact stares researchers in the face every time they choose to “disaggregate” a human embryo with their own hands. It makes many researchers edgy, touching them on some deeper level of their being. It makes many Americans queasy and eager to find alternatives. Dr. Thomson, who has overseen the destruction of numerous embryonic humans himself, had the honesty to acknowledge this fact in comments he made to The New York Times: “If human embryonic stem cell research does not make you at least a little bit uncomfortable, you have not thought about it enough.”(5) Dr. Shinya Yamanaka, the Japanese researcher who developed the reprogramming approach and published one of the two recent breakthrough papers, memorably described the problem after visiting a friend who worked at a fertility clinic. After looking down the microscope at one of the human embryos stored at the clinic, he later reflected back on the moment: “‘When I saw the embryo, I suddenly realized there was such a small difference between it and my daughters,’ said Dr. Yamanaka, forty-five, a father of two and now a professor at the Institute for Integrated Cell-Material Sciences at Kyoto University. ‘I thought, we can’t keep destroying embryos for our research. There must be another way.’”(6)
Drs. Yamanaka and Thomson have managed to pioneer another way, a powerful and practical way, but it is clear that several complex factors will influence how this major new stem cell discovery plays out in medicine and society. One thing is certain, however: those renegade researchers, lawmakers, and Hollywood personalities who have long dismissed ethical concerns and advocated human embryo destruction now find themselves at an important juncture because of this breakthrough. We can only hope that in the wake of this discovery, the siren call of harvesting human embryos will cease ringing in their ears and allow for a new era of ethical science to begin.
Rev. Tadeusz Pacholczyk, Ph.D.
Father Pacholczyk is a priest of the diocese of Fall River, Massachusetts, and serves as the Director of Education at The National Catholic Bioethics Center. This article is based on a nationally syndicated column.
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1 - Gretchen Vogel, “Researchers Turn Skin Cells Into Stem Cells,” Science Now Daily News, November 20, 2007, 1.
2 - Rick Weiss, “Advance May End Stem Cell Debate,” Washington Post, November 21, 2007, http://www.washingtonpost.com/wp-dyn/content/article/2007/11/20/AR2007112000546_pf.html.
3 - Marilynn Marchione, “Wis. Stem Cell Pioneer Shuns Limelight,” Associated Press, November 20, 2007; available at http://www.redorbit.com/news/health/1151927/wis_stem_cell_pioneer_shuns_limelight/index.html (reference updated March 31, 2008)
4 - Sarah Freeman, “‘Science Is a Wonderful Thing,’” Yorkshire Post, December 5, 2007, http://www.yorkshirepost.co.uk/features/Science-is-a-wonderful-thing.3555334.jp.
5 - Gina Kolata, “Man Who Helped Start Stem Cell War May End It,” New York Times, November 22, 2007, http://www.nytimes.com/2007/11/22/science/22stem.html.
6 - Martin Fackler, “Risk Taking Is in His Genes,” New York Times, December 11, 2007, http://www.nytimes.com/2007/12/11/science/11prof.html.
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