“THERAPEUTIC” vs. “REPRODUCTIVE” CLONING.

IS THERE REALLY A DIFFERENCE?

Paulina Taboada, M.D. Ph.D.

Assistant Professor of Internal Medicine and Bioethics

Pontificia Universidad Católica de Chile, Santiago, Chile

I.                    INTRODUCTION

It has become usual to distinguish between two major forms of human cloning according to their finality: ‘therapeutic’ and ‘reproductive’ cloning. It is well known that several International agreements[1] have already rejected ‘reproductive’ human cloning as a violation of fundamental human rights and dignity. Hence, we should ask ourselves whether or not so-called ‘therapeutic’ cloning involves the same kind of ethical problems as ‘reproductive’ cloning. In other words, we shall answer here the question whether from an ethical point of view an essential difference between so-called ‘therapeutic’ and ‘reproductive’ human cloning can be actually sustained.

II.                  WHAT IS ‘THERAPEUTIC’ CLONING?

The rationality of so-called ‘therapeutic’ human cloning is best understood when analyzed in the context of the new developments in the field of cell therapy with human embryonic stem cells. Indeed, to avoid the immune rejection related to an eventual therapeutic use of human embryonic stem cells in the future, some scientists have proposed to radically change their genetic information trough a technique called ‘therapeutic’ human cloning.

Cell therapy with human embryonic stem cells is - per definitionem - a heterologous cell transplantation,  i.e. the implantation of cells with a different genetic information than the recipient’s one. Hence, the patient’s immune system would reject these cells as “foreign bodies”. In order to avoid the natural immune reaction, one may either:

1.     use strong immunosuppressive drugs (with their well-know undesirable side-effects); or

2.     change some specific receptors located in the cell’s membrane; or

3.     radically change the cell’s genetic information.

This last option can be reached through the technique of ‘somatic cell nuclear transfer’ consisting in the injection of the nucleus of a patient’s adult (somatic) cells into enuclated oocytes. Alternatively the transfer of this nucleus may be performed into an oocyte of an animal or into an enucleated embryonic stem cell. In any case, the purpose is to produce a human embryo with the patient’s genetic information. Then, the development of this embryo is induced up to the stage known as early blastocyst (5-7 day), with the purpose of harvesting embryonic stem (ES) cells from the inner cell mass. The whole procedure permits to isolate autologous embryonic stem cells, i.e., embryonic stem cells with the same genetic information as the patient. Finally, these stem cells are induced to differentiate into the specific cell type needed for cell therapy.

On the surface the goal seems noble: to produce genetically-matched tissues for therapeutic use. However, as shall be analyzed later, there are significant ethical problems with therapeutic cloning, stemming primarily from the production and manipulation of human embryos involved.

Some authors have argued that restrictions on research on therapeutic cloning are questionable as they inhibit the development of a technique which holds the promise for successful application of pluripotent stem cells in clinical treatment of several diseases.[2] According to Hansen, for instance, the ethical concerns related to stem cell harvest are less problematic when using therapeutic cloning as compared with the use of ‘spare’ human embryos (the so-called ‘supernumerary’ human embryos). This author’s argument is that “the moral status of an enucleated egg cell transplanted with somatic cell nucleus is found to be more clearly non equivalent to that of a human being.”[3]

Already in the wording of Hansen’s argument, we encounter a strategy frequently used in current bioethical discussions, namely introducing semantic changes. So, for instance, the US National Academy of Sciences has recently suggested to label the procedure of ‘therapeutic cloning’ “nuclear transplantation to produce stem cells” rather than cloning.[4] The idea is that making an embryo that can supply genetically tailored stem cells by inserting the DNA of a person’s body cell into a enucleated egg is not equivalent to ‘cloning’ if the blastocyst is not going to be implanted in an uterus. Other authors propose to euphemistically call this procedure “cellular replacement through nuclear transfer”.

Schockenhoff[5] has shown that this ‘semantic strategy’ is very efficient in slowly changing common people’s sensibility with regard to the issues at stake. It is well known that there have been already several International agreements rejecting ‘reproductive’ human cloning as a violation of fundamental human rights and dignity.[6] Hence, the very word ‘cloning’ is currently laden with a negative connotation in the public opinion. Thus, avoiding this word by calling the procedure of ‘therapeutic cloning’ differently is the first step to make people think that so-called ‘therapeutic’ and ‘reproductive’ human cloning are completely different things.  Thus, the question whether form an ethical point of view an essential ethical difference between so-called ‘therapeutic’ and ‘reproductive’ human cloning can be sustained needs to be carefully analyzed.

III.                IS THERE A MORAL DIFFERENCE BETWEEN ‘THERAPEUTIC’ AND ‘REPRODUCTIVE’ HUMAN CLONING?

There is doubtless a difference between these two procedures at the level of the intention and this difference has some ethical implications, as we shall see. But an analysis of our most basic human moral experience shows that the ethical character of human acts does not primarily depend on the motivation or intention of the subject. Hence the classical saying ‘the end does not justify the means’.

A moral act is essentially an act in which human freedom is exercised. This means that the act itself is marked by an ‘intrinsic intentionality’ (called ‘moral object’). It is precisely this ‘moral object’ what allows the classification of our moral actions in types or ‘species’ of human acts (such as, for instance, giving alms, paying  debts, suborning, etc.) Thus, in order to find out which is the kind of act we are performing, we have to ask the question: What are you doing?  And an answer like ‘handing money to this person’ would not do it. The proper answer to this question – giving alms - revels the ‘intrinsic intentionality’ of the act itself and not only the performance of some external  physical movements.  Thus, an analysis of the lived ethical experience shows that the moral character of our free actions is basically determined by the very kind of act we are performing i.e., the act as specified by its ‘intrinsic intentionality’[7]: ‘giving alms’, in our previous example.

But to give alms in order to be admired by others would certainly blur the moral value of this act. Hence, daily-life experience shows that the agent’s motivation does also play a fundamental role in determining the moral character of a given act. Thus, we have to add a question: Why (or for the sake of what) are you doing this? The answer to this question – e.g. in order raise the admiration of others - will explain the actual intention or motivation of the agent inasmuch as it goes beyond the motivating role of the finis proximus operis itself. Thus, the  ‘intrinsic intentionality’ of the act itself and the intention of the agent are not the same thing and have to be carefully distinguished.[8]

Furthermore, if in our previous example of giving alms the subject would carelessly throw the money over the beggar’s head, we would also say that the moral value of the action has been blurred. Hence, the particular circumstances of the act – that is the answer to questions like Who?, To whom? How?, When?, etc. - play doubtless also a role in determining its moral character of the act.[9]

In the case of human cloning, the physical act performed both for ‘therapeutic’ and ‘reproductive’ cloning is exactly the same: a human embryo is created by means of somatic cell nuclear transfer. The difference is that in so-called ‘therapeutic’ cloning the embryonic development is interrupted at the 5-7th. day, because the isolation of stem cells destroys the embryo, while in ‘reproductive’ cloning the further development of the embryo would be permitted by implanting it into the womb.

But the fact that the same technique is used in both does not necessarily imply that the moral act is actually the same. As we have already seen, the physical performance of an action (actus hominis) does not necessarily coincide with a moral act (actus humanus).[10] Therefore, the same physical act can be part of two quite different human acts (actus humanus). Hence,  our ethical analysis of human cloning still needs to inquire whether the ‘moral object’ of the act can be said to be identical in both cases. For finding it out we will need to ask: What are you doing? And in both cases the answer will be actually the same: creating a human embryo by means of somatic cell nuclear transfer. Hence, there seems to be no essential difference in the nature of the moral act performed in ‘therapeutic’ and ‘reproductive’ human cloning. In other words, if we do not focus our attention exclusively on the intention of the agent but inquiry into the very nature of the act performed (species of the act), we realize that the supposed difference between ‘therapeutic’ and ‘reproductive’ cloning vanishes.

Indeed, looking at the experiments performed in animals, where it has been possible to bring progeny to full birth after initial somatic cell nuclear transfer to an enucleated egg cell, it would be difficult to deny that the application of the same technique to human beings would give origin to anything other than a full human being (with full human rights). If that is the case one is naturally confronted with the question whether an ennucleated human egg transplanted with a somatic cell nucleus is any different from a fertilized egg which would normally be the beginning of the process leading to a human being. And if there are no significant differences then it would follow that an egg cell with a nuclear transfer is a human being to the same extent that a fertilized egg is a human being. Indeed, the intrinsic teleology of a human blastocyst is to develop into a human being, regardless of whether is has come about through sexual intercourse, artificial insemination, in vitro fertilization or somatic cell nuclear transfer.

But as already said, the answer to the question Why are you creating a human being? would be certainly different in the case of ‘therapeutic’ and ‘reproductive’ cloning. In the first case the agent’s intention will be the isolation of stem cells with a given genetic information that makes them suitable for therapeutic application. In the other, the end of the act is the creation of an adult human person genetically identical to an existing one. But the different motivation of the agent does not alter the fact that in both cases a human embryo with identical genetic identity as an other existing human being is created. And the fact that in ‘therapeutic’ cloning the final motivation is to use this embryo as a source of cells for therapy implies a more radical form of instrumentalization of human embryos in this case than in so-called  ‘reproductive’ cloning. Indeed, it implies an intention to destroy the created embryo. Thus, the  euphemistic term ‘therapeutic’ points towards two gravely wrong intentions of this act of human cloning: the intention of destroying a human embryo at a specific point of its development and the intention of instrumentalizing it for the sake of another person’s benefit. Hence, although the intention of the agent does not change the objective nature of the act of human cloning itself, it certainly influences the agent’s moral responsibility for the act.

Moreover, the act of using a human embryo as a mere means and the intention and the act of destroying it are free human acts which can be distinguished from the act of ‘human cloning’ as such, not only physically but also ethically. In the case of ‘reproductive’ cloning there is also a new personal act: the intention to ‘artificially produce’ a new human being that has the same genetic make-up of a pre-existing adult. And this new act must be ethically criticized, though for different reasons.

In any case, regardless of the subject’s intention, the moral act of ‘human cloning’ as such – i.e. generically speaking - remains the same: generating a human being with the same genetic information of an already existing one. This might be done trough the technique of somatic cell nuclear transfer or through other techniques.

If we accept that there is only one kind of moral act on this level of the ‘cloning act’ itself – ‘human cloning’ - and not two different kind of acts - ‘therapeutic’ and ‘reproductive’ human cloning – we will still need to ask ourselves further questions to find out which are the ethical principles or values that may be actualized or violated through human cloning. Can we sustain that ‘human cloning’ us such is always morally wrong, regardless of the intention of the agent (‘therapeutic’ or ‘reproductive’) or the concrete circumstances? The key questions in this context are:

a) Does human cloning respect human life and dignity?

b) Does it guarantee other fundamental human rights?

c) Is it coherent with the meaning and value of human reproduction?

a) Human cloning and the respect due to human life and dignity.

The human body is an integral part of personal identity and individual dignity. Hence, an arbitrary manipulation of the human body as a mere research tool is morally illegitimate. The cloning technique involves a manipulation, selection and elimination of human embryos. A living human being shall be respected also in the embryonic stage. Hence, the experimentation with human embryos involved in cloning violates the most fundamental of all human rights: the right to life and physical integrity.

Human cloning also violates the dignity of the cloned person for several reasons, some of which apply to all forms of cloning, while others apply just to ‘reproductive’ or still others only to ‘therapeutic’ cloning. In cloning procedures, the individual is not affirmed for his own sake but reduced to a means towards some end. In the case of ‘therapeutic’ cloning, the human embryo is destroyed to serve for the therapy of other persons, and in the case of ‘reproductive’ cloning, the embryo is used to satisfy somebody’s wishes. From an ethical point of view, this reduction of human embryos to means appears unjust in both forms of cloning because as it involves a manipulation and instrumentalization of human beings (embryos) that violates human dignity. This contradicts Kant’s great insight that persons must never just be used as mere means, but always also end in themselves,[11] an insight in the center of Kant’s ethics[12], but much more deeply conceived in the personalistic principle that a person ought to be affirmed and loved for his or her own sake: persona est affirmanda (amanda) propter seipsam.[13] [JS1] 

Closely related to this is the fact that in both forms of cloning the human embryo is not truly affirmed for his own sake but affirmed only in virtue of being the ‘copy’ of another human being: in ‘therapeutic’ cloning a biological copy to be used for curing others; in ‘reproductive’ cloning a of another being who was ‘worthwhile cloning’. Furthermore, in reproductive’ cloning [JS2] [JS3] [JS4] this individual will be the object of expectations that will question his biological constitution and his personal subjectivity.

Through human cloning the ‘inner logic’ of life as a ‘gift-to-be-accepted’ is replaced here by the logic of technological production, governed by the rules of industrial production: market research must be explored and promoted, experimentation refined, and proper ‘control of quality’ secured. If the product is not up to the expected standards, it will have to be eliminated as a superfluous or waste by-product.

In the case of  ‘reproductive’ human cloning also the psychological identity of the cloned person would be threatened by the real or even by the merely virtual presence of his ‘other’. This illicit ethical implication of ‘reproductive’ human cloning would be obviously avoided if the procedure is stopped before implantation in order to isolate the stem cells from the inner cell mass of the blastocyst (‘therapeutic’ cloning). But in this last case the reduction of human embryos to mere means seems to be even more radical than in ‘reproductive’ cloning, as stated above. Hence, the procedure of human cloning as such appears to be ethically unjust because it involves a manipulation and instrumentalization of human beings (embryos) that violates human dignity and the fundamental human right to life.

b) Human cloning and other fundamental human rights.

The possibility of human cloning represents a violation of two further fundamental principles on which all human rights are based: the principle of equality among human beings and the principle of non-discrimination. The principle of  equality among human beings is violated because in human cloning we encounter a form of man’s domination over man. The illicit form of human discrimination involved in this procedure comes from the selective and eugenic mentality inherent to the logic of the cloning process. The violation of these two fundamental principles is tightly interrelated. Indeed, human cloning involves an arbitrary selection and fixation of the genetic information (‘eugenic logic’) which in turn implies a dominion of some human beings by others (those who program their genetic identity).

Hence, since 1983 the European Parliament and all the laws passed to legalize artificial procreation, even the most permissive, have always forbidden human cloning. A Resolution of the European Parliament (1997) expressly states the violation of these two principles and forcefully appeals for the prohibition of human cloning and for the value of the dignity of the human person. The same idea is contained in the following quotation from the  Pontifical Academy Pro Vita:

The idea is fostered that some individuals can have total dominion over the existence of others, to the point of programming their biological identity – selected according to arbitrary or purely utilitarian criteria –which, although not exhausting man’s personal identity, which is characterized by the spirit, is a constitutive part of it. This selective concept of man will have, among other things, a heavy cultural fallout beyond the – numerically limited – practice of cloning, since there will be a growing conviction that the value of man and woman does not depend on their personal identity but only on those biological qualities that can be appraised and therefore selected. (Pontifical Academy Pro Vita: 1997, Reflections on Cloning, p. 6).

Furthermore, if somatic cell nuclear is done, the DNA of the transferred nucleus might be manipulated, raising the complex problem of inadvertent or deliberate germ line intervention, yet another ethical issue on which society will have to reflect.[14] Moreover, the experimental evidence with reproductive cloning of animals shows that there is a significant risk that a cloned human being would have a shortened life span and/or that it would have various inborn disabilities or malfunctions.[15] Already this known risk  would make human cloning unethical. In any case, like other human beings born with chromosomal abnormalities or genetic disorders there would be no doubt that a cloned human being is a full human being in every important respect.

c) Human cloning and the meaning and value of human reproduction.

In the cloning project, human sexuality is reduced to those forms of asexual reproduction that have characterized only the biologically simplest and least evolved organisms:

 It tends to make bisexuality a purely functional left-over, given that an ovum must be used without its nucleus in order to make room for the clone-embryo and requires, for now, a female womb so that its development may be brought to term. This is how all the experimental procedures in zootechny are being conducted, thus changing the specific meaning of human reproduction (Pontifical Academy Pro Vita, 1997, Reflections on Cloning, p. 5).

The cloning technique imitates the merely biological component of human reproduction, neglecting its specifically humane dimensions and values.  Indeed, human cloning entails a radical manipulation of the essential relationality and complementarity of human reproduction in both its biological and strictly personal aspects.

Moreover, in the cloning process women are exploited and reduced to a few of their purely biological functions (providing ova and womb) and the most profound relationships of the human person are perverted: filiation, consanguinity, kinship, parenthood. A woman can be the twin sister of her mother, lack a biological father and be the daughter of her grandfather.

To sum up: the main ethical problems related to human cloning are the violation of fundamental human rights and values, such as the right to life, the dignity of the person, the essential equality of human beings, the right to non-discrimination, and the ‘personalist’ value of human reproduction. Hence, the fundamental reason for rejecting the human cloning project is that it denies the dignity of the person subjected to cloning and the dignity of human reproduction.

Therefore, conducting such a project would undermine the necessary conditions for any democratic society: that of treating human beings always and everywhere as an end, as a value, and never as a mere means or a simple object. In democratic systems, the first guarantee of each individual’s freedom is established by unconditionally respecting human dignity at every phase of life, regardless of the intellectual or physical abilities.

IV.               CONCLUSION

Concluding, I want to stress the importance of securing the harmony between the demands of fundamental human values and scientific research in the field of human stem cell research and cloning. The dignity of scientific research rests in the fact that it is able to contribute to humanity’s knowledge and welfare. But this is truly the case only when biomedical research is conducted in accordance to fundamental human rights and dignity.