We have seen that many of the most dramatic forms of enhancement will use or will be a by-product of therapies and techniques using regenerative medicine and stem cell science to achieve both the therapeutic and the enhancement effects. The ethics of these techniques will continue in part to turn on the legitimacy of sourcing stem cells from embryos and indeed on research using embryos or on embryo-like entities. These are entities either that may be for all intents and purposes embryos, or which those to whom the embryo is “one of us” will regard as embryos or regard as being “possibly” embryos.1 The moral status of the embryo is therefore of vital importance to the possibility of human enhancement, at least for the foreseeable future. However, many have believed that the question of the moral status of the embryo can be avoided if cells can be derived from entities that are not embryos or, more realistically, that it can be argued are not embryos.
The debate about whether or not these ambiguous entities are embryos is fascinating but, as Katrien Devolder has shown,2 it is ultimately unsatisfactory as a way of resolving the ethical issues. In this chapter I want to further explore the ambiguous status of the embryo, already hinted at, and to reveal how this ambiguity will ultimately show that the question of the moral status of the embryo is not simply as yet unresolved, but essentially irresolvable in any way that could accord significant moral status to the embryo.
Those who regard the moral status of the embryo as a significant bar to its use as a source of therapeutic, experimental, or enhancement material maintain what may be called the moral significance thesis.
The moral significance thesis holds that early embryos have equal or similar enough intrinsic worth to that of a person that the intentional or foreseeable destruction of embryos, whether in the sourcing of stem cells or other material from embryos, in therapy, enhancement and medical research, or in any other way is illegitimate.
Against the moral significance thesis I shall argue as follows.
• The moral significance thesis generates absurd implications connected to embryo splitting (namely, it would be immoral to recombine or split embryos, or to fail to split embryos).
• The determinate defense of the moral significance thesis, on which if X has the potential to become Y then X already possesses (much of) Y’s value is unconvincing.
• The moral significance thesis is not rescued by the “future of value” argument.
• The moral significance thesis assumes that early embryos have rights (“intrinsic worth”) but they cannot, and most legislators and the law in most jurisdictions and in international courts agrees that they do not.
• The moral significance thesis assumes that killing is far, far worse than allowing to die, but that would, among other things, condemn the passengers of flight United 93 to moral obloquy and the intended victims of the terrorists to death (see below).
• Even the supporters of the moral significance thesis tend to recognize that embryos lack the kind of worth that would make destroying embryos in embryonic stem cell research wrong. For they procreate (or permit others to do so), although procreation destroys embryos, often for less important purposes. Supporters of the moral significance thesis don’t even support expanding research into ways to improve assisted reproductive technology (ART) so that it can eventually replace natural procreation with an embryo-saving method of procreation.
The embryo is a deeply, perhaps irretrievably, ambiguous entity, one that defies classification and slips seamlessly between moral, biological, and even mathematical categories. While many features of this ambiguity have been evident for millennia, discussed by Aristotle3 and in many religious traditions, it is only really with the advent of modern embryology, genome analysis, and stem cell science that the truly radical features of the power of cells to differentiate and specialize have exploded many of the myths and mistakes concerning the embryo and its moral status.4
If we start by examining some of the ways in which the ambiguity of the embryo is at its most dramatic, the problems created by this dubious status will become clearer.
When identical twins occur in nature, they result from the splitting of the early embryo in utero and the resulting twins, true clones, have identical genomes. This process can be mimicked in the laboratory, and in vitro embryos can be deliberately split, creating matching siblings, one or both or which can be used for biopsy or research.
This process itself has a number of ethically puzzling if not problematic features. If you have a preimplantation embryo in the early stages of development and split it, let us say into four clumps of cells, each one of these four clumps constitutes a new embryo which is viable and could be implanted with the reasonable expectation of successful development into adulthood (given the dramatic wastage rate of embryos in all human reproduction, see below). Each clump is the clone or identical “twin” of any of the others and comes into being not through conception but because of the division of the early cell mass. Moreover, these four clumps can be recombined into one embryo again. This creates a situation where, without the destruction of a single human cell, one human life, if that is what it is, can be split into four and can be recombined again into one. Did “life” in such a case begin as an individual, become four individuals and then turn into a singleton again? We should note that whatever our answer to this question, all this occurs without the creation of extra matter and without the destruction of a single cell.
Those who think that ensoulment takes place at conception have an interesting problem to account for the splitting of one soul into four, and for the destruction of three souls when the four embryos are recombined into one, and to account for (and resolve the ethics of) the destruction of three individuals, without a single human cell being removed or killed. These possibilities should perhaps give us pause in attributing a beginning of morally important life to a point like conception.6
Embryo splitting allows the use of genetic and other screening by embryo biopsy. In embryo biopsy usually one cell is detached from an embryo for genetic testing. If this cell is totipotent (that is if the cell can become any part of the resulting organism including the extraembryonic tissue and membrane or placenta, and this can result in a complete functioning organism), it is effectively an embryo. It is certainly the sort of entity that those who regard the embryo as sacrosanct would believe to be an embryo (see below). Embryo biopsy would then involve the testing of one embryo to ascertain the health and genetic status of the remaining clone or clones (since the rest of the embryo may be further split to multiply cloned siblings). What would the ethical difference be between taking a cell for cell biopsy and destroying it thereafter, and taking a cell to create a clone and then destroying the clone? The answer can only be that destroying the cloned embryo would constitute a waste of human potential, but this same potential is wasted whenever an embryo is not implanted and is also wasted by the cell biopsy used in PIGD, at least if the biopsied cell is totipotent. Even if the cell is pluripotent, there are now techniques (see below) which might restore that cell, thus raising the same moral issues for those who value the embryo.
We should note an odd tension between how we think of the ethics of the destruction of an individual embryo involving cell loss, on the one hand, and destruction of an individual embryo without cell loss, on the other. As we have seen, the process of embryo splitting also allows for recombination. Assuming this technique to be as safe as the creation of clones by cell mass division, if the embryos are recombined following embryo splitting, a number of individual twins have been “destroyed” without the destruction of a single cell. Is such a process more or less ethically problematic?
If, as seems likely, the reason why it is thought objectionable to recombine such clones is the loss of potential human beings, then perhaps it would be considered unethical not to split any embryo into as many twins as possible? By so doing we would, after all, maximize just that potential, the loss of which, supposedly, inhibits recombination. If all this has a dizzying effect, it is perhaps because the language that we use misleads us.
We are, as Wittgenstein was so fond of reminding us, often misled by the language we use. To think of these early clumps of cells as “twins” tempts us to think of them as “persons.” Imagine an in vitro embryo where all cells are at the totipotent stage; if this bundle of cells were to be split into four clumps of cells, you will have created four (new?) twin embryos. Take three away and destroy them or recombine all four into one and you are in a sense back where you started, having done exactly the same thing in one sense, namely created a single potentially viable embryo with a particular genome. In another sense you have wasted potential experimental material or potentially viable embryos or even killed three human individuals. Yet this waste arguably also occurs whenever a cell mass that could viably be divided is left undivided, or whenever an egg that could be fertilized is left unfertilized. If the recombined embryo, or the surviving quadruplet, is implanted, comes to birth, and grows to maturity, it will have the same genome as it would have had if the division and recombination had never taken place or if its siblings had never been created and disappeared. Will it be the same person as it would have been? Does it have the same identity as it did in its former incarnation? Certainly its life story is different.
It is difficult to analyze the ethics of the possibilities we have just described. In the recombination scenario not a single human cell has been destroyed. In the case of embryo splitting, no new cells or matter have been created and yet three individuals come and go. Certainly no legal rights have been violated and, as we shall see in a moment, no moral rights have either,7 but have the interests of any individuals been harmed? If these embryos may be said to have an interest in actualizing their potential, then perhaps there may be a sense in which they have been wronged if not harmed.8
I have claimed that failing to protect embryos does not involve any violation of the rights, of the embryos at least, although the progenitors or others in lawful possession of embryos may have rights at stake. Perhaps a word or two of explanation for this claim is appropriate. There are two main theories of rights: choice theory and interest theory.9 Choice theory sees rights as securing “the protection and promotion of autonomy or liberty” and interest theory sees rights as serving to further individual well-being or welfare. Clearly on choice theory embryos cannot possess rights because embryos are not autonomous and so their rights cannot be analysed in terms of choices. Nor can you “promote the autonomy of embryos” by trying to ensure that they become autonomous persons because embryos have no autonomy to promote. To be sure the persons they might become will have autonomy, but that is true of the unfertilized eggs and the sperm which will fertilize them and many other entities considered in this chapter which would have to have “rights” for the same reason if the potential for rights conveyed rights. Even according to interest theory embryo rights are problematic, as we have seen, not least because there is no evidence that embryos could experience welfare and therefore they have no welfare interests that can be served. Joseph Raz, for example, suggests that an individual is capable of possessing rights “if and only if … his well-being is of ultimate importance.” If Raz is right about this then, since embryos have no well-being (for well-being is a state of being experienced as good by the subject of the relevant experiences), they can have no rights. Certainly all early embryos such as those we have been discussing in the preimplantation stage, lacking as they do both a central nervous system and indeed a brain, are incapable of experiences of any sort.10
Most legal systems and international human rights laws find no room for attributing rights, particularly the right to life to embryos or fetuses. Two recent cases decided by the European Court of Human Rights have added to a formidable set of precedents confirming that embryos lack both moral and legal personality and therefore have no protectable rights nor interests in life as far as the law of most jurisdictions is concerned.11
We must look at potentiality more closely.
We have already noticed how essential the idea of potentiality is in discussing the ethics of using embryos for research and therapy. One feature of human embryos that members of other species do not share is their particular potential, not simply to be born and to be human, but to become the sort of complex, intelligent, self-conscious, multifaceted creatures typical of the human species.
There seem to be two problems with potentiality interpreted as the idea that human embryos or fetuses are morally important beings in virtue of their potential or have a protectable interest in actualizing that potential.
The first objection to protecting individuals because of their potential is logical; acorns are not oak trees, nor eggs omelettes. It does not follow from that fact that something has potential to become something different that we must treat it always as if it had achieved that potential. Unless and until we achieve the possibility of immortality, discussed in chapter 3, all of us share one important and inexorable potentiality—we are all potentially dead meat, but it does not follow that we must be now treated as if we are already dead.
The second difficulty with the potentiality argument involves the scope of the potential for personhood which we considered in chapter 6. If the human zygote (early embryo) has the potential to become an adult human being and is supposedly morally important in virtue of that potential, then what of the potential to become a zygote? Something has the potential to become a zygote, and whatever thing or things have the potential to become the zygote have whatever potential the zygote has. It follows that the unfertilized egg and the sperm also have the potential to become fully functioning adult humans. In addition, it is possible to stimulate eggs, including human eggs, to divide and develop without fertilization (parthenogenesis). As yet it has not been possible to continue the development process artificially beyond early stages of embryogenesis, but if it does become possible safely to create humans parthenogenetically, then the single unfertilized egg, without need of sperm or cloning, would itself have the potential of the zygote. However, from the perspective of those who hold the moral significance thesis, this technical problem must be irrelevant, for they believe that anything which is an embryo is protected, regardless of how damaged an embryo it is or how short its life is expected to be.
Cloning by nuclear transfer, which involves deleting the nucleus of an unfertilized egg, inserting the nucleus taken from any adult cell, and electrically stimulating the resulting newly created “embryo” to develop, can, in theory, produce a new human. This was the method used to produce the first cloned animal, Dolly the sheep, in 1997. This means that any cell from a normal human body has the potential to become a new “twin” of that individual. All that is needed is an appropriate environment and appropriate stimulation. The techniques of parthenogenesis and cloning by nuclear substitution mean that neither conception nor fertilization are the necessary precursor processes for the creation of human beings.
To complete this argument we should notice that recent work, brought to philosophical prominence and discussed by Katrien Devolder, explores the consequences of the possibility of returning pluripotent cells to totipotency in the lab and outlines and discusses the ethical and philosophical consequences of being able to do this.13 For our present purposes Devolder’s work highlights a further ambiguity of the embryo, since a pluripotent cell, while it can make any part of the human organism, cannot make the extraembryonic membrane, placenta, etc. It is only totipotent cells which can make absolutely all cell types required not only for the complete organism but also for successful implantation and development. If these possibilities are proved (see below), then there will be elasticity between pluripotent and totipotent cells and it will not be possible to claim that pluripotent cells have permanently lost the capacity to be embryos because they cannot make the required extraembryonic tissue and membrane.
Thus, if the argument from potential is understood to afford protection and moral status to whatever has the potential to grow into a normal adult human being, then potentially every human cell deserves protection. For this important potential is not only possessed by zygotes properly so-called but by whatever has the potential to become an embryo or a zygote or to return to being one.14
The account of potentiality given here may be thought to have misrepresented the argument from potential. John Finnis, for example, has argued that “[a]n organic capacity for developing eye-sight is not ‘the bare fact that something will become’ sighted; it is an existing reality, a thoroughly unitary ensemble of dynamically inter-related primordia of, bases and structures for, development.” He concludes that “there is no sense whatever in which the unfertilized ovum and the sperm constitute one organism, a dynamic unity, identity, whole.”15
However, it is surely the case that A has the potential for Z if, when a certain number of things do and do not happen to A (or to A + N), then A (or A + N) will become Z. For even a “unitary ensemble of dynamically inter-related primordia of bases and structures for development” must have a certain number of things happen to it and a certain number of things that do not happen to it if its potential is to be actualized. If A is a zygote, it must implant, be nourished, and have a genetic constitution compatible with survival to term and beyond. Moreover, insistence on a “unitary ensemble,” on “one organism,” seems also to apply to cloning by nuclear substitution, surely an embarrassing fact. In any adult cell there is a complete single human genome; if treated appropriately, that genome present in the cell nucleus might be cloned. Thus, this method of cloning allows for the “existing reality” of a complete genome which exhibits “dynamic unity, identity, whole[ness]” that the Finnis analysis requires and we can therefore now ascribe potentiality in the Finnis sense to the nucleus of every cell in every body.
The moral importance of drawing attention to the potentiality of something suggests that it is actualizing a particular potential that matters. Our moral concern with what it is that has the potential to become an adult human being would be inexplicable if persons or adult humans did not matter. We are interested in the potentiality argument because we are interested in the potential to become a particular, and particularly valuable, sort of thing. If the zygote is important because it has the potential for personhood, and that is what makes it a matter of importance to protect and actualize its potential, then whatever has the potential to become a zygote must also be morally significant for the same reason. Those who value potentiality for personhood surely do so not because the potential is contained within “one organism.” Rather, they do so because it is the actualization of the potential to become something which has moral importance.
This is one fallacy of Don Marquis’s interesting approach to the value of the embryo. For Marquis it is the loss of a “future of value” that he proposes as the wrong done to embryos when decisions result in their failure to survive to experience that future. For Marquis, having a future of value is what makes a creature valuable, gives it a life of moral importance, a life worth saving, a life it is wrongful to end.
But surely that future of value awaits whatever has the potential to become an embryo.16 Indeed, Marquis’s “future of value” argument is really just the potentiality argument reframed, since for Marquis the individual allegedly wronged by the denial of existence is the individual with the potential for a future of value. That is what matters, since without it the embryo has, on the Marquis view, nothing that calls for protection, nothing that makes it valuable.
Although Marquis insists that the future of value must be possessed by an individual, this seems like a stipulation designed to get over the problem of fertilization so that ununited eggs and sperm are not accorded a “future of value” with the exhausting ethic that would entail. But it is difficult to see why (except to save the blushes of Marquis and others) potentiality should be contained within one organism17 in order to be preserved or actualized or have a future of value. This throws substantial doubt on Marquis’s claim that a future of value is possessed only by single individuals. The scientific potential of things other than embryos to become human individuals has recently been demonstrated by developments in stem cell research.18 Embryonic stem cells (ESCs) are obtained from embryos at the blastocyst stage. A blastocyst consists of two distinct cell types: inner cell mass (ICM) cells, which will become the “embryo proper,” the fetus, and later the adult human being; and trophoblast cells, which will form the placental support system necessary for the development of the fetus in the uterus. ESCs are derived from the isolated ICM. So far, it has generally been accepted that human embryonic stem cells (hESCs) have no significant moral status because, just like ICM cells, they are “merely” pluripotent, which means they can form all embryonic but only some extraembryonic tissues. A totipotent cell, i.e., an embryo, can, as we have seen, produce the extraembryonic tissues as well, and can thus result in a whole new individual. This moral division between pluripotent and totipotent cells, however, may not be as sound a criterion as it has seemed to many to be. Scientific evidence suggests that human ICM cells as well as hESCs can also develop into a whole new person. In the mouse it has been proved that the isolated ICM and mouse ESCs derived from it maintain their capacity to form an adult mammal. When they are aggregated with tetraploid embryos—two cell-stage zygotes that have been fused and have twice the normal number of chromosomes—they develop into normal mice.19 These mice consist only of the ICM cells or the ESCs and not of the tetraploid embryos, which only provide a surrogate trophectoderm. There seems no reason why this same technique would not work with human ICM cells or hESCs. In those for whom the use of tetraploid human embryos as surrogate trophectoderm raises moral issues (involving as it does the instrumental use of embryos), tetraploid embryos could be replaced by trophectodermal cells derived from hESCs.20 This highlights a further ambiguity of the embryo.21 If these possibilities are proved, then there will be elasticity between pluripotent and totipotent cells and it will not be possible to claim that pluripotent cells have permanently lost the capacity to form an embryo and a fetus because they cannot make the required extraembryonic tissue and membrane. If hESCs can do everything a totipotent cell or an embryo can, then those who accord full moral status to the embryo should treat hESCs, as well as ICM cells (which have the same potential), as moral equals to the embryo and thus as if they share whatever moral status the embryo has.
Do cells, which could be reprogrammed to be totipotent, have “a future of value” in Marquis’s sense? Surely they must because they can be individuated; true, they need a facilitating intervention (but so do all embryos: they need to be implanted in a uterus, nourished, and so on) but we certainly can know which cell has or would have had a future of value.
Consider also a different question: does your individual genome and mine have a future of value? If your genome or mine were to be cloned by cell nuclear transfer to create a zygote, then that genome has a future of value in Marquis’s sense.22 Given that “n” things must happen and “n” other things must not happen in order for that future of value to be actualized, would not the cloning process count among the community of “n” things that must happen? If, as Marquis says, his principle is “victim centered,” that is, it is a person-affecting approach to the ethics of embryo sacrifice or manipulation, then in the cloning case it is my genome that provides all of the individuality of the “victim” that Marquis speaks of. In the case of cells that could be reprogrammed to become totipotent, we also and equally know which individual victim has been or will be deprived of a future of value. So, if we ask who or what has been denied a new and different future of value, who is the person affected by the denial of a future of value, the answer is obvious. It is the individual who might have had that future of value, and it is the genome that does most to individuate, to identify, the individual or set of individuals we are talking about. It is this genome that has been denied the opportunity to express itself, and for the individual whose valuable future is at issue this is true in both the reprogramming case and the cloning case.
Interestingly, Robin Lovell-Badge has recently pointed out23 that
[t]he ability to derive both sperm and eggs from ES cells entirely in vitro would mean that you could put the two together, obtain blastocysts and then new ES cell lines from these, again all in vitro. In other words, it would be possible to do multigenerational human genetics in the lab, introducing whatever genes or mutations you wanted along the way, without having to worry about men and women liking each other and over a much shorter timescale than occurs naturally. Occasionally you could check what the mature phenotype really looked like after embryo transfer.
Thus, if there is a protectable “interest” in actualizing potential or even a powerful moral reason for doing so, then the consequence is a very demanding ethic and one which would surely require us to actualize all human potential whenever we have an opportunity to do so. This would be a very demanding ethic indeed for women, particularly in the present state of technology. That is not of course a decisive argument against acceptance of the ethic of always attempting to actualize valuable potential. However, those who use this argument as a reason for protecting embryos must in consistency protect whatever has the potential to become an embryo in the same way and to the same extent. This, among many other things, would entail an ethic of maximal procreation, or never knowingly missing an opportunity to create and protect embryos.
It would also entail an ethic of promoting human reproductive cloning on as massive a scale as humanly possible so that the potential locked in the nucleus of almost every cell in every body could be “released” and its potential actualized.
A further feature of current attitudes to the embryo which reveal not only the ambiguous status of the embryo but also the ambivalence of most humans toward the precursor forms of themselves concerns the extremely high rate of embryo loss and abnormality in human reproduction. It is doubtful that natural sexual reproduction, with its risk of sexually transmitted disease, its high abnormality rate in the resulting children, and its gross inefficiency in terms of the death and destruction of embryos, would ever have been approved by regulatory bodies if it had been invented as a reproductive technology rather than simply “found” as part of our evolved biology.
Recent research has confirmed abnormality rate for live births associated with sexual reproduction is almost certainly more than 6%24 but given the moral importance attached to embryos and the fact that embryos are regarded by many as sharing the same moral status with the rest of humankind, it is the tolerated rate of embryo loss that is particularly interesting. Embryo loss in normal sexual reproduction including unprotected intercourse is certainly very high. There is the loss to be associated with every live birth as well as the loss that occurs routinely in unprotected intercourse. To this must be added embryo loss as a direct result of a number of widely used methods of “contraception.” In connection with embryo loss associated with sexual reproduction including unprotected intercourse not directly intended to result in conception, Robert Winston gave the figure of five embryos lost for every live birth some years ago in a personal communication.25 Anecdotal evidence I have received from a number of sources confirms this high figure but the literature is rather more conservative, making more probable a figure of three embryos lost for every live birth.26 Again, in a personal communication,27 Henri Leridon confirmed that a figure of three lost embryos for every live birth is a reasonable, conservative figure. Ron Green has suggested that between two-thirds and three-quarters of all embryos do not implant.28
Additional embryo loss occurs as a result of the operation of the combined oral contraceptive pill, which has a number of modes of operation, one of which prevents implantation of the embryo at between five and eight days’ development. Equally, the so-called “morning after” contraceptive pill also prevents implantation, as does the intrauterine device or “coil.”29 The combined effects of these various contraceptive methods increase the tally of embryo loss as a “side effect” of human sexuality, but it is impossible to arrive at reliable estimates as to the total numbers of embryos involved. Interestingly, most of this embryo loss involves the death of embryos at precisely the stage of development at which stem cells are usually harvested for ESC research, namely between five and eight days’ development. This stage is preferred because the cells have not begun to specialize (which takes place at implantation in vivo) and so are still totipotent or pluripotent and therefore can be made to specialize into almost any required cell types.
Those who attempt to have children in the light of these facts and indeed those who have unprotected intercourse, or who use contraceptive methods which risk embryo loss, all must accept that what they are doing or trying to do justifies the creation and destruction of embryos.
In the case of attempts to procreate using sexual reproduction, one obvious and inescapable conclusion is that God and/or nature has ordained that “spare” embryos be produced for almost every pregnancy, and that most of these will have to die in order that a sibling embryo can come to birth. Thus, the willful creation and sacrifice of embryos is an inescapable and inevitable part of the process of procreation. It may not be intentional sacrifice, and it may not attend every pregnancy, but the loss of many embryos is the inevitable consequence of the vast majority of (perhaps all) pregnancies. For everyone who knows the facts of life, it is conscious, knowing, and therefore deliberate sacrifice; and for everyone, regardless of “guilty” knowledge, it is part of the true description of what they do in having or attempting to have children.
The inescapable conclusion is that the production of spare embryos, some of which will be sacrificed, is not unique to ART; it is an inevitable (and presumably acceptable, or at least tolerable?) part of all reproduction.
Both natural procreation and ART involve a process in which embryos additional to those which will actually become children are created only to die. If either of these processes is justified, it is because the objective of producing a live healthy child (and, for some, simply having sex) is judged worth this particular cost. It follows that no one who regards it as acceptable to try to have children (or indeed to have unprotected sex) has any principled objection to the creation and destruction of embryos in a good cause. The only question is how good the cause must be to justify such deliberate embryo destruction. As we have seen, conservatives attracted to Don Marquis’s arguments that embryos are to be protected because they possess a future of value (potential) should have no objection to creating embryos that have no chance of survival to experience such a future (but not of course turn them into such embryos). However, those impressed by Marquis’s arguments will have to give up procreation because, while sexual reproduction does not usually involve the deliberate or knowing sacrifice of a future of value, Marquis does not seem to think this lack of knowledge or intentionality is entirely exculpatory. Marquis holds that “the future of value theory is a victim-centered theory” and “what is needed for the wrong of killing is an individual who is deprived of a future of value.”30 But that victim is created and killed by normal sexual reproduction with monotonous regularity. The process of procreation both produces and destroys an individual with a future of value just, for example, as does the creation of embryos for research.
As I have demonstrated elsewhere, Marquis and others would have to favor stem cell research and other forms of embryo experimentation if they afforded the same chance of a future of value or of developing personhood as does sexual reproduction. While Marquis might respond that the concept of “deprivation” involves an alternative and it is not the case that there is a way of saving the embryos lost in sexual reproduction, this may not be or may not remain true.31 If (or when) assisted reproduction or cloning are, or become, methods of reproduction with a better success rate than sexual reproduction, they will, for all who accept the moral significance thesis or the future of value or potentiality arguments, become the only legitimate or ethical methods of reproduction.
As we noted in chapter 9, sexual reproduction is like offering future children the following bargain: “Here’s the deal, you have a chance of coming into existence but only if you accept greater than normal risks—take it or leave it!” A rational embryo or would-be embryo would take the deal, because the alternative is nonexistence. Marquis and others would have to accept research on embryos if the research protocols gave research embryos the same chance of a future of value as does sexual reproduction, or they would have to deny the legitimacy of sexual reproduction. As I noted elsewhere:32
[I]t might be claimed [that] embryos produced specifically for research would not rationally choose to participate, for they stand to gain nothing. All research embryos will die and none have a chance of survival. If this argument is persuasive against the production of research embryos it is easily answered by ensuring that the population of research embryos to some appropriate extent have a real chance of survival. One would simply have to produce more embryos than were required for research, randomize allocation to research and ensure that the remainder were implanted with a chance to become persons or have a future of value. To ensure that it was in every embryo’s interests to be “a research embryo,” all research protocols permitting the production of research embryos would have to produce extra embryos for implantation. To take a figure at random but one that as it happens mirrors natural reproduction and gives a real chance of survival to all embryos, we could ensure that for every, say, 100 embryos produced for research, 10 would be produced for implantation. The 100 embryos would be randomized: 90 for research, 10 for implantation and all would have a chance of survival and an interest in the maintenance of a process which gave them this chance.
Those who accept such destruction as part of a procreative project accept that the creation of new life is a cause good enough to justify such a course of action. Since most people believe that the saving of existing life takes priority over the creation of new life, the use of embryos in the production of lifesaving therapies is clearly justified. Research directed toward lifesaving therapies or the production of those therapies is, it is true, at one further remove from lifesaving, but I believe it must also justify embryo loss if reproduction does.33
It is plausible to assume “that those who will the end will the means also.”34 No contemporary therapies are developed without research, and this of course goes as much for lifesaving therapies as for any others. Of course, attempts at lifesaving may always be unsuccessful, as any human attempt may be. If attempts to save lives and the costs of making those attempts are justifiable because of the end to which they are directed, the probability of success is part of the justification. This must also be true of research directed toward lifesaving therapies. The justification is of course weakened in inverse proportion to the probability of success, as it is with more direct forms of lifesaving. The principles are obviously the same. The rest is argument about the likelihood of success.
Those who doubt that attempts to save existing life take precedence over creating new life should consider the ethics of the emergency-room doctor in the following dialogue.35
The phone in the doctors’ station at the hospital rings.
“Doctor, there is an emergency! You are the only doctor who can help: a life is at risk.”
“Nurse, I have more important things to do. My boyfriend and I have just retired to bed intent on procreation, the time is propitious and you will know that creating new life is at least as important as saving existing life (and far more fun!). Tell the patients I am busy with more important things.”
Of course, as noted, the probability of success in each case is relevant. We will assume that the chances of the doctor conceiving and subsequently losing the baby prior to birth, taking full account of the potency and fertility of her partner, are balanced by the seriousness of the life-threatening condition of her patient and the doctor’s skill levels, etc., so that the probabilities of saving the patient’s life and the doctor creating a new life are sufficiently similar for the choice to be between clear alternatives. Those of course who value the embryo from conception equally with all other human beings will be interested only in the probability of successful conception and will discount calculations which include the probability of successful implantation or subsequent miscarriage, etc. For those who regard the embryo as “one of us,” female medical and nursing staff of reproductive age will almost always have something more morally important to do than look after patients36 and at least some male medical and nursing staff (and possibly some patients) may be expected to be among the available procreational partners.37
In the case of accepted embryo loss by those not intending to procreate, using perhaps embryo-risking methods of contraception including timing of intercourse, the levels of benefit to be derived from other embryo-costly activities will be proportionately less exacting.
It follows that few sexually active people will be able to object to the creation and sacrifice of embryos in scientific research, human enhancement, or therapy if they consistently apply their principles.
It might be said that there is a difference—those who engage in assisted reproduction create and destroy an unnecessarily high number of embryos. However, those who engage in sexual reproduction are not engaged in the destruction of embryos at a greater rate than is required for the outcome they seek. It would be interesting to know whether, if creating a single embryo by IVF became a reliable technique for procreation, those from the rather inappropriately termed “pro-life” position would feel obliged to use this method rather than sexual reproduction because of its embryo-sparing advantages. (Inappropriately termed “pro-life” because those who regard themselves as “pro-life” so often support positions which can only be thought of as anti-life and which moreover are profligate of human life and safety.38)
On September 11, 2001, passengers on flight “United 93” are reliably believed to have overcome hijackers and forced a hijacked plane to crash into a field in Pennsylvania, so forestalling the attempt to target a highly populated and high-profile building, but killing everyone on board. Such an act, while defending the victims in the “target of choice” did involve killing the innocent passengers and crew. Not all the passengers could conceivably have consented to the takeover of the plane and the deliberate bringing about of the earlier crash landing, so there must inevitably have been the decision by some passengers deliberately to sacrifice nonconsenting others. True, they would all almost certainly have died anyway, but they were killed before they otherwise would have been. Although their deaths were probably inevitable, the deliberate (if voluntary for some) killing must have offended against the sanctity of life doctrine, for, on a usual interpretation of pro-life positions, killing the innocent who are posing no threat is not legitimate, however noble the justification. And killing earlier than an inevitable subsequent death is still killing, otherwise euthanasia would be less problematic than it appears to some. So this widely praised act, which probably saved many innocent lives, must, for pro-lifers, be one of pure wickedness on the part of the passengers who resisted the hijack if their intent was to crash the plane before it could reach its target and not exclusively to overpower the hijackers.40 The espousal by successive popes of a rigorous hostility to condom use in the face of the continuing AIDS pandemic is estimated to have cost millions of lives and untold misery.41
It looks as though there would indeed be a strong moral obligation to abandon natural procreation and use only embryo-sparing ART. Indeed, if such an improvement in IVF occurred, this would seem to make using IVF mandatory for those who believe the embryo is one of us. And it is interesting that so-called “pro-lifers” are not (apparently) investing heavily in IVF to this end in the hope that sexual reproduction could eventually be entirely replaced by an embryo-sparing method of reproduction.
What follows from all this? It is difficult to see how most people could live lives that are today accepted as normal while maintaining a strict “pro-life” position or by acting consistently to protect embryos. The alternatives seem clear. We, humankind, must surely accept that human embryos are deeply ambiguous and problematic entities of a kind whose lives or “dignity” simply cannot be protected in ways consistent either with other values that we hold or indeed with the continued existence of the human species. The alternative is consistent but bleak; it involves the strict avoidance of all acts which would violate the sanctity of life of embryos. This would of course include almost all human procreation and certainly all sexual reproduction.
Any radical changes in individuals that significantly affect their self-image or the way in which they can lead their lives are likely to have impacts on identity. This may be true whether the changes take place at the embryonic stage or before, or indeed at any time during life. How serious the impact has to be before we question whether as a result the individual concerned has ceased to be the person that she was is a matter of considerable controversy. Derek Parfit has famously claimed that each person is less connected than most of us believe:
Strong connectedness is not a transitive relation. I am now strongly connected to myself yesterday, when I was strongly connected to myself two days ago, when I was strongly connected to myself three days ago, and so on. It does not follow that I am now strongly connected to myself twenty years ago. And this is not true. Between me now and myself twenty years ago there are many fewer than the number of direct psychological connections that hold over any day in the lives of nearly all adults. For example, while most adults have many memories of experiences that they had in the previous day, I have few memories of experiences that I had on any day twenty years ago.…
Since strong connectedness is not transitive, it cannot be the criterion of identity. And I have just described a case in which this is clear. I am the same person as myself twenty years ago, though I am not now strongly connected to myself then.42
Curing illnesses of and preventing diseases for people who already exist do not usually raise problems of identity. Enhancements of people’s quality of life will take place, hopefully as a result of enhancement technologies, but people do not normally change drastically enough to raise questions as to whether or not they have remained the same person when they recover from a cold or even from cancer. A formerly totally paralyzed person could be an exception. Is someone who can walk and talk for the first time a different person? Some mental ailments could fall under this category as well: “it is still me, only I do not hear voices in my head any more”43 or “now that I no longer hear voices I am a completely different person.” Similarly, with enhancements, if we can change people so that their intelligence is of a different order of magnitude than any existing intelligence or we can improve memory or physical powers in ways that constitute step changes, issues of identity may arise. But again it is unlikely that the identity issues will be crucial or even relevant in determining the ethics of the proposed enhancements because, as we saw in chapter 4, failure of identity does not necessarily vitiate the rational motive for enhancement.
Prenatal (gene) therapy might eventually enable us to remove a seriously disabling condition before implantation of the embryo. Here, such an enhanced individual might well feel disposed to say, on hearing what life would have been like but for the intervention, “I would have been a different person without the intervention.”
Consider serious mental illness or impairment, and cognitive and mood enhancements by surgery, therapy, or medication or even gender reassignment. All of these possibilities might lead the recipient to say: “The real me has now surfaced thanks to Prozac” or “I feel ‘myself’ for the first time in my life!”
How we would or ought to feel about the personal identity issues in any of these cases is difficult to know in the abstract and I strongly suspect that we would need to consider them on a case-by-case basis. However, while the personal identity issues are fun philosophically, they don’t seem, to me at least, to have any ethical impact at all.
Indeed, such puzzles seem to be a gross form of philosophical indulgence at the expense of moral decency. Consider, as we noted in chapter 4, the following suggestion by Leon Kass:
For to argue that human life would be better without death is, I submit, to argue that human life would be better being something other than human.… The new immortals, in the decisive sense, would not be like us at all. If this is true, a human choice for bodily immortality would suffer from the deep confusion of choosing to have some great good only on condition of turning into someone else.44
Kass’s argument seems to suggest, as we have noted, that since the (current) essence of being human is to be mortal, immortals would necessarily be a different type of being and therefore have a different identity. This is the time to note again that while there is a sense in which this is true, there no sense in which it would be irrational to want to change identity to the specified extent. Moreover, it is clearly ethically problematic in the extreme to suggest that the highly intellectualized “identity” issues offer any moral reasons for the individual to forgo benefits on the absurdly scholastic ground that, at least for philosophers and the philosophically minded, this might raise issues of identity that are unlikely to be susceptible to definitive resolution. As noted above, someone who had been profoundly disabled from birth (blind say, or crippled) and for whom a cure became available in his or her mid-forties would become in a sense a different person. They would lead a different type of life in many decisive ways. It does not follow that the blind or crippled individual has no rational motive to be cured because the cure would involve, or would risk involving, the sacrifice of personal identity. It would be both odd and cruel to say to them, as Kass presumably would have us do, “it is deeply confused to want to cease to be disabled, because then you will no longer exist.”
Related paradoxes are also raised for the possibility of time travel. It is, for example, standardly claimed that time travel is not only physically but somehow logically impossible because the idea entails a situation that involves an impossibility. Specifically, if we could travel into the past we could encounter our own genetic parents (or grandparents, etc.) before our conception and prevent that event (usually, it is suggested, by killing one or both of our parents). People who raise this objection seem to think that time travelers are all incipient matricides or else extremely careless! What would actually happen in such an event is of course unknowable, like encounters between irresistible forces and immovable objects or indeed like the question beloved of atheists the world over: if God is omnipotent, can he make a stone that is so heavy he cannot himself lift it? Douglas Adams is among many fiction writers to have considered this and related “impossibilities”:
One of the major problems encountered in time travel is not that of accidentally becoming your own father or mother. There is no problem involved in becoming your own father or mother that a broadminded and well adjusted family can’t cope with. There is also no problem about changing the course of history—the course of history does not change because it all fits together like a jigsaw. All the important changes have happened before the things they were supposed to change and it all sorts itself out in the end. The major problem is quite simply one of grammar.45
Adams’s response does not of course dissolve the paradox, but it reminds us that there are so many unknowns about such scenarios that not much can be learnt from considering them as possibilities. We do not, in short, know what the imagined scenarios will really involve or how the concepts that seem problematic would be analyzed if the imagined events occurred, or what would lead us to say that time travel had been achieved or not. The problem may, as Douglas Adams suggests, be one of grammar. Michael Crichton has also written about time travel.46 In his scenario, such travel involves visiting one or more of an infinite number of parallel universes. Whether killing your parents in a parallel universe does or does not involve your own nonexistence and hence (possibly) the dissolution of the enterprise in a puff of logic is a question for which the resolution must wait upon further empirical research.
The worries about enhancement which focus on issues of identity or psychological continuity, while fascinating, do not, it seems to me, materially affect the ethics of the social policy dimensions of enhancement. For my own part, as Jonathan Glover47 once memorably said, “I would be glad of the chance to sample a few million years and see how it went.” The identity problems that this may give me and others I will happily leave to time and psychiatry to sort out. If I eventually turn out to have personality disorders beyond the wildest dreams of psychiatry this will be good for psychiatrists and may or may not be bad for me. However, this does not seem to be a powerful reason for me to deny myself or for you, paternalistically, to deny me the opportunities that may, but far more likely may not, have these dire consequences.