[As published in Monash Bioethics Review 2000; 19(2): 34-45.]

The ethics of reproductive and therapeutic cloning (research)[i]

 ASSOC PROF UDO SCHÜKLENK

University of the Witwatersrand Faculty of Health Sciences

DR RICHARD ASHCROFT

Imperial College School of Medicine, London, U.K.

ABSTRACT

In this article we argue that we have no good ethical reasons to prevent research on both, reproductive and therapeutic cloning. Our strategy is for each type of cloning research to demonstrate that no harms will occur to any person if such research goes ahead (and, indeed, if such a to-be-developed technology would be utilised at one point in the future). Furthermore, we show that there is substantial interest in the continuation of this research, and the availability of reproductive human cloning technologies. We argue that satisfying these interests, in the absence of any identifiable harms, would result in a positive, desirable outcome.

Much has been said during the last decade or so on the issue of reproductive and therapeutic cloning. Adolf Hitler, Claudia Schiffer, Albert Einstein and many copies of each of them could be found on the cover of millions of prints of the German news magazine DER SPIEGEL. The message was clear: Now that we have cloned Dolly the sheep, mankind is threatened by the infinite reproduction of dictators, supermodels and geniuses. We imagine at least some readers thinking quietly “what exactly would be wrong with a few million more supermodels and Einsteins”?

Of course, this question is missing the point of human reproductive cloning just as much as DER SPIEGEL magazine’s cover. But more on that in a moment.

Missing the point is not only the privilege of the press and the public. UNESCO and the Council of Europe have declared, independently, that human reproductive cloning is unethical, because it violates ‘human dignity’. The same is true for the advisory commission on human cloning that the European Commission has established.[ii] Pretty much every Christian philosopher in Europe and the USA, as well as many secular philosophers, have warned of dire consequences and even more grossly violated dignity should research on reproductive human cloning go ahead.[iii]

Dignity-related claims have pretty much the same effect on the cloning debate as the neutron bomb has on modern warfare. They kill everything in their way. For a start they kill every argument in their way: who would dare to defend cloning if it is so obviously violating the human dignity?. Who would want to be seen as supporting such a vicious attack on our dignity? The beauty of this rhetorical bomb is that it removes any necessity of engaging proponents of reproductive human cloning in a serious debate.

To those brave enough to question this rhetoric, however, further and nearly insurmountable problems occur. Human dignity covers pretty much everything and nothing. Human dignity related rhetoric is the continental European bioethics equivalent to shifting goal posts in a street soccer match. Human dignity is not based in or derived from a coherent philosophical framework.[iv] Hence it is easy to employ it whenever it suits the needs of those lacking a decent argument for or against whatever they are concerned about. If human dignity is to be invoked in philosophical argument, we must either derive it from such a framework, or give an account of how it is a “primitive term” of moral language.  But if the latter move is made, we are still owed some account of how this term is to be used correctly, and what criteria distinguish legitimate from illegitimate appeals to it.  Many critics of cloning argue as if it were obvious that cloning violated dignity.  But they risk begging the question.  Cloning is wrong.  Why? Because it violates human dignity What’s that? Something violated by activities like cloning. 

So, leaving the dignity argument against cloning aside, we would like to invite you on a journey through the moral maze of human cloning research, both of the therapeutic and reproductive nature. Our strategy will basically be to argue that we have no good reasons to prevent either reproductive or therapeutic cloning research, because both types of technological advancement are very much to be applauded and are likely to be used by a large number of people, should they come into existence. We will begin with a closer look at the possible cons and pros of the more difficult to justify reproductive cloning, because once that case is established it will be a relatively easy task to convince you that therapeutic cloning is a good thing. Therapeutic cloning is less controversial. Even national academies of sciences of various nations support this type of cloning.[v]

Let’s start then with the more difficult to justify type of cloning research, that into reproductive cloning. That there are at least some people interested in cloning themselves is evidenced by the existence of the USA based Human Cloning Foundation’s website. The Foundation is made up of individuals who claim that they are violated in their moral rights if reproductive cloning research remains prohibited.[vi]

Various types of arguments have been put forward to establish that cloning is unethical, and not only that, but that it is unethical to a degree that justifies prohibiting research designed to develop technologies which could be used by people who would like to clone themselves.

Arguments against reproductive human cloning

One standard argument against reproductive human cloning has its historical roots in the ethical debate over the use of in-vitro fertilisation. Various representatives of religious organisations argued against the use of IVF on the basis that people whose coming into being was a result of IVF would likely be discriminated against by the wider society. We do know today that these concerns were unwarranted. IVF is a standard procedure in most developed countries, and children born as a result of IVF are as happy as any other average child. This historical experience has not prevented religiously motivated people to once again raise the spectre of discrimination against human clones as a weapon against human reproductive cloning research and, once that is technically possible, human cloning. Bioethicists were quick to create “nightmare visions of baby farming, of clones cannibalised for spare parts”[vii], and similar nonsense. Slippery-slope rhetoric is seemingly as popular today as it was during the religious motivated campaigns against IVF. Unfortunately, for its proponents, they are just as implausible today as they were 20 years ago. For instance, Leon Kass, a University of Chicago bioethicist warns darkly, “it is not at all clear to what extent a clone will truly be a moral agent.”[viii]

This type of argument against reproductive cloning research and reproductive cloning is difficult to sustain. For a start, it is a circular argument, going along the lines ‘I am prejudiced against human cloning. I will act in prejudicial ways against cloned human beings. This harms cloned human beings. Ergo: reproductive cloning is a bad thing.’ This argument is obviously using the prejudices of those prejudiced against human cloning to establish the case that there is anything inherently wrong with human cloning. It’s an argument with approximately as much content as the statement: ‘I don’t like the colour blue. Ergo: the colour blue is (in an objective sense) a bad thing.’ We would not really be prepared to accept this.  Liberal apologists for this view might put the argument differently: we should respect others’ deeply held beliefs that reproductive cloning is wrong.  In other words “She doesn’t like the colour blue.  Ergo: there is (in an objective sense) something wrong with the colour blue.”  We should not accept this either.  Nor should we accept the argument that because others will be prejudiced against a clone, we should prevent the harm to the clone resulting from this prejudice by preventing his or her existence in the first place!  Surely the point is to remove prejudice, not people?

Vice versa, let us imagine for a moment that our planet would be visited by aliens, calling themselves Oimel, from outer space. These aliens are technologically advanced in a manner far superior to our own state of technological development. The aliens stopped all sexual reproduction thousands of years ago, largely because they found it aesthetically unacceptable. They were also concerned about the increasing rate of sexually transmitted diseases, and last but not least they hated the physical effort (work) that had to go into reproductively successful sex acts. Our alien visitors developed cloning techniques that allowed them to reproduce themselves in an asexual way. After many years went by, this species began to look down on those of its kind who were bred in the old-fashioned, sex-reliant ways of reproduction. Active discrimination against those of its members they tend to refer to as ‘breeders’ developed. The leader of the alien visitors explains to the earth population’s representative that they will only negotiate with earthlings produced by means of cloning. She explains that negotiating with sexually produced humans is simply below her. What would we make of such a situation, ethically speaking?  Undoubtedly, our earth population representatives would argue with the aliens, pointing out to them that a person is a person is a person, irrespective of the how the person came into existence. We would argue that the type of discrimination exercised in the alien society is unacceptable on earth, and possibly on the alien’s home planet, too. The reason for this is essentially that dispositions such as a persons’ shape (i.e. fat, slim, tall), its species membership, its language etc. are irrelevant with regard to the question of its moral standing. Similarly irrelevant is how it came into existence, whether it was by means of sexual reproduction, cloning, IVF, or the alien’s latest reproductive technology - oimeling[ix]. As soon as a being has the characteristics of a person it deserves equal recognition to any other person.

Relatedly, it has been suggested that people might use clones of themselves as something like a living spare parts factory. That is, at one point in time, when need be, someone might simply rob a clone of a liver, heart, or whatever other organ, in order to put it into a person who is not a clone. This proposition seems similarly unacceptable, for the reason mentioned already. As soon as a clone (or any other human being) has achieved personhood, it deserves the same respect as any other being with those dispositional capacity. The ethical principle of equality demands no less.

Means and ends

The just mentioned argument is also often presented as based in a different ethical framework, one based on Kant’s philosophy. Here the argument goes that using cloning technology to produce human beings exclusively in order to use them for various purposes is unacceptable, because using human beings merely as means and not – as is considered appropriate by proponents of this view – as ends in themselves, is wrong. So, if parents use cloning technology to have additional off-spring in order create a suitable bone marrow donor for a sick child of their’s, that would be seen as ethically unacceptable. Why would it be seen as unacceptable by Kantians? To quote Kant: “Act in such a way that you always treat humanity, whether in your own person or in the person of any other, never simply as a means, but always at the same time as an end."[x] Fellow German philosopher Arthur Schopenhauer didn’t think much of Kant’s ends formula. He wrote, “I must say frankly that ‘to exist as an end in oneself’ is an unthinkable expression, a contradictio in adjecto … Nor does the absolute worth that is said to attach to such an alleged but inconceivable end in itself fare any better, for this too I must without mercy stamp as a contradictio in adjecto. Every worth is a quantity of comparison, and even stands necessarily in a double relation. First, it is relative, in that it exists in comparison with something else by which it is valued or assessed. Outside these two relations, the concept worth loses all meaning; this is so clear that there is no need for further discussion.”[xi]

Obviously, if you are convinced by Schopenhauer’s criticism of Kant’s means/ends argument, you are able to consider the argument against cloning that is based on the Kantian criticism as settled in fgavour of the pro-cloning camp. If, however, you still think that Kant’s argument has some merits, you might want to ponder the question of why  people have children in the first place. Undoubtedly, they will have all sorts of motives, among them might even be the objective to create a bone marrow donor, or someone who will provide support in one’s old age, etc etc. Only very few people, if any, will exclusively have the child-to-be in mind. We tend to accept this, because we know that children born for all these reasons and motives are still loved by their parents. This is what matters. The availability of reproductive cloning would not make any difference to this. In this latter interpretation, whereby children would be produced not exclusively as means, but also as ends in themselves (for their own sake, so to speak), Kantians could not see this as ethically problematic. Even though there is, at least to our knowledge, no empirical evidence available that analyses the motives parents have for wanting offspring, it seems quite likely to us that their motives will be a mix of both ‘selfish’ motives and motives of wanting children for their own sake. As Pence suggests, “Simply because a person is originated in a new way does not mean that, to use Kant’s classic terms, he can be used as a ‘means’ to the good of others. Instead, he will be an end-in-himself with the same rights as any other person.”[xii]

Open future worries

The argument that cloning could rob people of an open future and is therefore ethically unacceptable can be approached from various angles. Some people, for instance, harbour the idea that cloning could lead to some sort of genetic production line of identical soldiers designed to create an army of fighting machines, much like in Van Damme or Schwartzenegger movies. Obviously this worry ignores something rather basic, that is that it would be a very ineffective means of army production for any dictator, because it would take some 2 decades to create these soldiers. One would also need tens of thousands of women to gestate these soldier-to-be foetuses. In short: a neat horror scenario that is impossible to realise.

Other open future related worries argue that because so much genetic information is pre-determined, that a person’s future seems too pre-determined to be compatible with the vision of human beings as persons capable of living their own lives (i.e. as being in charge of their lives). Of course, if one partner of a reproductively active couple is known to have inherited a serious genetic illness, such a couple might decide to use the means of reproductive cloning to produce a genetically linked child without the risk of this child inheriting the genetic illness of one of his or her parents. One wonders, how these sorts of limitations on the off-spring’s open future (i.e. the reduction of risk for serious illness) could amount to an ethical problem. In many ways it is unclear how the lottery that this open future really amounts to is something that is necessarily and/or always better than a future the choices of which are more limited by way of eliminating risks.

Fanatic parents

It has also been suggested that fanatic parents would try to create carbon copies of themselves (say, Claudia Schiffer would try to clone essentially another super model). This worried some ethicists, because they assumed that such parents would put tremendous pressure on their off-spring to adhere in their lives to whatever the genetics of the clone ‘promises’. Say, the child of a fanatic soccer player might well be forced by its parents to join the local youth soccer team at the tender age of 7 or so, in order to assure that he or she becomes a professional soccer player later in his or her life. Of course, such parental behaviour takes place even without cloning. We have little reason to assume that cloning would make much of a difference to this. Perhaps, if there were such parents seduced by the lure of reproductive cloning, they might reconsider their reproductive choice if they were told[xiii] that a genetic clone isn’t actually a 100% genetic clone. The reasons for this were cogently summarised in an article by New York Times sciences writer George Johnson[xiv]:

“Even cloned cells, with identical sets of genes, vary somewhat in shape or coloration. The variations are so subtle they can usually be ignored. But when cells are combined to form organisms, the differences become overwhelming. A threshold is crossed and individuality is born.”

Two genetically identical twins inside a womb will unfold in slightly different ways. The shape of the kidneys or the curve of the skull won’t be quite the same. The differences are small enough that an organ from one twin can probably be transplanted into the other. But with the organs called brains the differences become profound.

The precise layout of the cells, which neurone is connected to which, makes all the difference. Linked one with the other, through the junctions called synapses, neurones form the whorls of circuitry whose twists and turns make us who we are. In the reigning metaphor, the genome, the coils of DNA that carry the genetic information, can be thought of as a computer directing the assembly of the embryo. Back-of-the-envelope calculations show how much information is required to specify the trillions of connections in a single brain. Neurones in this early stage, are thrown together more or less at random and then left to their own devices. After birth, experience makes and breaks connections, pruning the thicket into precise circuitry. From the very beginning, what’s in the genes is different from what’s in the brain. And the gulf continues to widen as the brain matures.

Even genetically identical twins, natural clones, are born with different neural angles. Subtle variations in the way the connections were originally shaped together might make one twin particularly fascinated by twinkling lights, the other drawn to certain patterns of sounds.”

So, as Pence notes, “the brain, the most complicated human organ and the most essential to the continuity of our self, cannot be cloned or duplicated from a DNA blueprint.”[xv] Of course, environmental factors during the up-bringing of the cloned off-spring will inevitably have further distinguishing impacts on their identity and persona, both physical and psychological.

These reasons make it quite unlikely, we argue, that any parent would use reproductive cloning to a) create a child just like him- or herself, and b) behave in an overbearing manner designed to mould the child even closer to him- or herself.

No harms but many benefits

In short: it is our contention that there are no serious harms attached to reproductive human cloning. At least to our knowledge not one persuasive argument has been presented by opponents of reproductive cloning that would force us to acknowledge that there could be victims (i.e. harmed sentient beings) of research on reproductive human cloning or, if this research succeeds, that there could be victims of reproductive human cloning.

The benefits of this technology are much easier to grasp: there will be infertile people or gay people who would be likely to use such technology if it was available.[xvi] Given that there are no overwhelming inherent reasons[xvii] against providing such people with access to such a technology, we should at the very least allow research on reproductive human cloning to go ahead.

Therapeutic cloning and reproductive cloning

In the opening paragraphs of this chapter we claimed that if we could persuade you of the moral acceptability of reproductive cloning, then persuading you that therapeutic cloning is a good (or acceptable) thing would be much easier.  Before moving to the positive arguments for therapeutic cloning, let’s just see what the relationship is between the arguments for reproductive cloning and those for therapeutic cloning.

Firstly, some reproductive cloning will be for therapeutic ends: as we discussed above, one motive for cloning an individual may be that he or she has need of an organ for transplant.  We noted that even on its own this is not necessarily a bad motive, or exploitative, but more importantly, that it is consistent with love and care for the cloned child in his or her own right.

Therapeutic cloning in its own right comes in two basic forms: therapy for inherited mitochondrial diseases, and methods we can call for short “stem cell therapies”.  Mitochondrial disease is transmitted down the maternal line because mitochondrial DNA is transmitted through egg cells, there being no mitochondria in sperm cells.  Such diseases can sometimes be treated, but the most effective “treatment” would be to prevent inheritance of the defective mitochondrial DNA.  At present this can be done by not having children, by adoption, or by having children through IVF with a donated egg from an unaffected donor.  For those women who wish to have children genetically related to them there is at present no solution.  If they were able to reproduce through cloning, using a denucleated donor egg cell and a nucleus transferred either from one of their own adult cells, or from one of their own fertilised eggs, then they would be able to have healthy children who were genetically related to them (and in the latter case to a male partner). Similar solutions are possible for lesbian couples to have children genetically related to both of them, but this is not “therapeutic” in the narrow medical sense, so we leave this to one side.

This family of possibilities for preventive treatment of mitochondrial diseases is obviously closely related to reproductive cloning pursued for narrowly reproductive reasons.  In the sense that this technique promotes the good of having a child at the same time as helping prevent such children from incurring the burden of mitochondrial disease, it is as morally unexceptionable as other currently accepted reproductive medical techniques such as donor insemination and pre-implantation genetic diagnosis (PIGD).

Stem cell therapies are less obviously related to reproductive cloning, in that they do not aim at the creation of a child who is to be born, but at using reproductive techniques directly or indirectly to produce stem cells for therapeutic purposes.  Even here, though, there is a connection to reproductive cloning, in that any of the techniques that will be needed to establish reproductive (and mitochrondrial disease therapeutic cloning) we will need to pass through a phase of embryo research, including probably the creation of embryos specifically for research.  This phase will also lead to the development of the stem cell techniques needed for stem cell therapies, so the moral acceptability of both types of cloning (therapeutic and reproductive) will depend in part on the acceptability of embryo research.  Similarly, the kind of critique we attacked in the section on reproductive cloning is also applied to stem cell research – especially the claim that such research creates individuals who are harmed by what is done to them or by or attitudes towards them.  We argue that the form of such arguments is what matters, and hence if we can show that the form of the argument fails in the reproductive case, it also fails, necessarily, in the therapeutic cases.

Embryo research

A generation ago, the big debates in many countries of the world surrounded embryo experimentation.  Since then, so many reproductive technologies have been developed which use embryo research or its results, that these controversies can be considered to be of relatively marginal interest.  One’s attitude to embryo experimentation turns, most significantly, on one’s attitude to abortion.  Issues in embryo research include: up to what point in embryonic development research is possible, whether it is admissible to create embryos solely for research purposes, and what uses can be made of embryonic stem cells or foetal tissues. The significance of these issues depends on whether or not it is permissible to kill embryos (and up to what point in embryonic development such permissibility extends) and, secondarily, on whether such killing needs special justification (e.g., necessity in terms of preserving the life of the mother) or if it is of no intrinsic moral significance.

This is not the place to rehearse arguments over abortion, but it is sufficient to say that most countries do permit it in some form, and most countries also permit embryo research, on the grounds that (a) it is highly beneficial in the development of assisted reproduction as a “treatment” for infertility and as a method of preventing the inheritance of genetic disease and (b) the embryo up to a certain stage of development (14 days in the UK) has no morally relevant physical or other properties (for instance any rudimentary nervous system).  Most countries argue that the embryo has neither interests to be preserved, nor the capacity to be harmed (although the contingent future person into whom the embryo might develop could be harmed), nor even a stable identity (twinning and reabsorption of twins being still possible).

The only live area of controversy within this field is the issue of whether embryos can be created specifically for research purposes.  Most embryos used in research are “spare” embryos created as “by-products” of in vitro fertilisation (IVF).  The justification for the latter practice (if one is asked for) is thought by some to be that it is better to use such embryos for some good purpose than simply to destroy them, once it is recognised that some (most) of such embryos will not be implanted and, even if implanted, will in most cases not come to term. 

One might argue that the intention to create an embryo in order to create a child is different to the intention to create an embryo for experimental use or for use as a source of stem cells.  This is obviously correct, but of little help morally.  First, even if the intention is reproductive, the fact is that as an unavoidable consequence of acting on this intention one creates spare embryos means that the line between creating embryos for reproduction and creating them for research is blurred.  Second, a Kantian argument about intention to “use” such embryos as “means” to others’ ends can only get going if we establish that such embryos are persons, which most parties agree they are not.  Third, the motives underlying such intentions may not all be altruistic, but we can no more infer from this that embryo experimentation is wrong than could establish that reproductive cloning was wrong on the basis that parents’ motives in having a cloned child were not all altruistic.

In the light of these arguments, most of us would now agree that there is nothing especially problematic about embryo research, because there is nothing especially problematic about abortion.  In passing note that national and international guidelines on creating embryos for research and using foetal tissue prevent the sale of tissues and embryos, and prevent the use of foetal tissue if it has been created “deliberately” for use in research or teaching (e.g., a woman conceives with the intention to abort and use the tissue for her own or others’ purposes).  The best argument in favour of these restrictions is about limiting the exploitation of women and their bodies, rather than about slavery (the commodification and sale of persons).  Our best defence against slavery and exploitation is to assert the human rights of persons; to the extent that we are concerned to protect the interests of embryos and foetuses, it is because we wish to protect (pre-emptively) the interests of future people.  Where there will be no future person, “its” interests are empty.

Stem cell research and therapies

Stem cells are “totipotent” or “pluripotent”, meaning that they have their successors can become differentiated into cells forming any, or any of a wide range of, organs of the body.  Here we concentrate on somatic stem cells, rather than germ stem cells, as the stem cells of interest are those which can be used in organ development or repair, rather than those which can be used in reproduction.  Stem cell research is important because of what we can learn from it about embryology and the study of development, and, clinically, stem cell technologies may be useful in repairing or replacing damaged organs and as vectors for gene therapies.  Currently there is a world-wide shortage of organs for transplant.  Moreover stem cells cloned from the would-be recipient would be a perfect tissue-type match with the recipient, thus reducing or obviating the need for the recipient to take immuno-suppressant drugs for the rest of his or her life after the transplant.

Obtaining stem cells for research from embryos is obviously a type of embryo research in general, and its ethical status is identical.  There are issues that arise out of obtaining stem cells and using them to generate a cell-line, which take us into debates about the patenting and commercialisation of biological material.  These are beyond our scope here, but we would argue that these issues require regulation of these technologies, not “moral” bans on them.

More controversial will be the use of stem cells in “routine” clinical treatment – suppose one day all the current research works out, and stem cell technologies become useable standard therapies in transplantation.  Where are all the stem cells to come from? The worry some critics have is that embryos will be mass produced in order to harvest stem cells, in the process destroying them.  This seems far-fetched to us.  Recall that the point of these stem cells is that they are genetically identical in the nucleus (or differ only in a tiny number of genes) to those of the recipient. At present the efficiency of the process which produces embryonic stem cell lines from cloning is not high, but this research is still in its early stages.  In any event, the image of “industrialisation” of life is  very exaggerated.  There are of course ethical issues around the exploitation of women as donors of eggs for this process, but we do not think that these are essentially different from those surrounding surrogacy or transplantation by donation of organs, both of which are currently accepted but regulated.

Conclusion

We have shown that reproductive cloning, therapeutic cloning, stem cell research and stem cell technologies present “no harms and many benefits”.  We believe that a lot of the so-called debate in this area is merely hysteria, because on closer examination these technical advances represent no new issues.  We can translate all of them back into issues arising in more familiar, ethically well-understood, and well-regulated contexts.  The problem of exploitation is the only one we recognise as outstanding, and it requires regulatory and legislative response, to protect the interests of vulnerable persons. However, we believe that our common interests in liberty, respect for persons, and medical advance require us to promote these new technologies rather than preventing them on what we have shown are entirely spurious grounds.

ENDNOTES