Taking Life, Making Life, and Faking Life*:

1

• Taking Life, Making Life, and Faking Life
• An Overview of Bioethics
• for a Brave New World
• Northwest Association for Biomedical Research
• Summer, 2007
• Dr. Andrew D. Shaw
• Westminster Christian Academy, St. Louis

Nigel Cameron, Bioethicist
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What is Bioethics?
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Why is Bioethics important?

• What is at stake
• The elimination of much suffering
• The essence of being human
• The ethical use of technology

• Call it the fault of civilization. God isnt
  compatible with machinery and scientific medicine
  and universal happiness. You must make your
  choice. Our civilization has chosen machinery and
  medicine and happiness. Mustapha Mond (BNW)

4
Some History
5
The Hippocratic Oath 400 BC

• I will use treatment to help the sick
  according to my ability and judgment, but I will
  never use it to injure or wrong them.
• I will not give poison to anyone though
  asked to do so, nor will I suggest such a plan.
  Similarly I will not give a pessary to a woman to
  cause abortion. But in purity and in holiness I
  will guard my life and my art.
• I will not use the knife either on
  sufferers from stone, but will give place to such
  as are craftsmen therein. Into whatsoever house
  I enter, I will do so to help the sick, keeping
  myself free from all intentional wrong-doing and
  harm, especially from fornication with woman or
  man, bond or free.
• Whatsoever in the course of practice I see
  or hear (or even outside my practice in social
  intercourse) that ought never to be published
  abroad, I will not divulge, but consider such
  things to be holy secrets.

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Systematic Dehumanization
7
New England Holocaust Memorial Boston,
Massachusetts

• They came first for the Communists,
• and I didn't speak up because I wasn't a
  Communist.
• Then they came for the Jews,
• and I didn't speak up because I wasn't a Jew.
• Then they came for the trade unionists,
• and I didn't speak up because I wasn't a trade
  unionist.
• Then they came for the Catholics,
• and I didn't speak up because I was a Protestant
• Then they came for me,
• and by that time no one was left to speak up.
• original version attributed to Pastor
  Martin Niemöller (18921984)

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Some genocides going on today www.genocidewa
tch.org

• Sudan (Darfur) Zaghawa, Fur, Massaleit
• Burundi, Rwanda Tutsi, Hutus
• Indonesia Irian Jaya, Moluccas, Sulewesi
• Sri Lanka Tamil, Sinhalese
• India Hindus, Muslims, Sikhs
• China Christians, Muslims, Falun Gong,
  minorities
• Pakistan Christians, Shiites
• Iraq Kurds, Shiites, Sunni

• Viet Nam boat people
• Laos Hmong
• Somalia Isaaq
• Congo Hema, Lendu
• Morocco Sahrawis
• Botswana Bushmen, Namibians
• Nigeria Ibos, Tiv, Hausa, Yoruba, Ogoni
• Israel Jews
• Russia Chechens

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But its science

• Tuskegee (Ala.) Syphilis Study (1932-1972)
• 300 sharecroppers - placebo
• Willowbrook (Mass.) Hepatitis Study (1950s)
• retarded children fed contaminated fecal
  solution
• Jewish Chronic Disease
  Studies (1960s)
• chronically ill injected with
• live cancer cells
• San Antonio Contraceptive
  Study (1970s)
• homeless given contraceptives

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American Eugenics

• Immigration Act of 1924
• Sought to limit influx from southern eastern
  Europe, who were biologically inferior
  and jeopardized the blood of the nation.
• Secretary of Labor, James Davis America has
  always prided itself upon having for its basic
  stock the so-called Nordic racewe should ban
  from our shores all raceswho are physically,
  mentally, morally and spiritually undesirable and
  who constitute a menace to our civilization.
• Not fully reversed until the Immigration Act of
  1965

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American Eugenics
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German Eugenics (WW II)

• 1. Freezing
• 2. High altitude
• 3. Malaria
• 4. Mustard gas
• 5. Intentional infections
• 6. Transplantations
• 7. Making sea water potable
• 8. Sterilizations
• 9. Poisonings http//en.wikpedia.org/wi
  ki/Nazi_human_experimentation
• 10. Burnings

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Nuremberg Code 1947

• Directives for Human Experimentation
• The voluntary consent of the human subject is
  absolutely essential.  This means that the person
  involved should have legal capacity to give
  consent should be so situated as to be able to
  exercise free power of choice, without the
  intervention of any element of force, fraud,
  deceit, duress, over-reaching, or other ulterior
  form of constraint or coercion
• 4. The experiment should be so conducted as to
  avoid all unnecessary physical and mental
  suffering and injury.
• 5. No experiment should be conducted where there
  is an a priori reason to believe that death or
  disabling injury will occur except, perhaps, in
  those experiments where the experimental
  physicians also serve as subjects.
• 7. Proper preparations should be made and
  adequate facilities provided to protect the
  experimental subject against even remote
  possibilities of injury, disability, or death.

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I. Taking Life

• A. Abortion
• B. Infanticide
• C. Euthanasia and Assisted Suicide

Whats the point of truth or beauty or knowledge
when the anthrax bombs are popping all around
you?... Anything for a quiet life. Weve gone on
controlling ever since. It hasnt been good for
truth, or course. But its been very good for
happiness. One cant have something for nothing.
Happiness has got to be paid for. Mustapha Mond
(BNW)
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Some important terms

• Egg
• Sperm
• Fertilization
• Zygote
• Embryo
• Implantation
• Fetus

• Abortion
• Infanticide
• Euthanasia
• Suicide

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Three Days
Early Embryo or dividing Zygote
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Five Days
Early Embryo or Blastocyst
Within ten days from now, the brain and spinal
cord will take form.
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Four Weeks
x 10,000 larger. Heart has been pumping for more
than one week.
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Nine Weeks
Unique fingerprints. Recordable brain
waves. Sensitive to touch. Every bodily system is
present and functioning.
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Seventeen Weeks
Feels pain, swallows, squints, thumb-sucks,
swims, sleeps, awakens, exercises. Hears
mother. Up to one-half birth weight.
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Twenty-two Weeks
Mother can feel movement (quickening). Reacts
to stimuli. If born early, can survive with
proper medical care.
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Forty Weeks
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I. Taking Life (cont.)

• Ethical Questions

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When Does Human Life Begin?

• At birth? (40 weeks)
• At quickening? (22 weeks)
• When the baby can be sustained technologically?
• When brain waves are detected? (9 weeks)
• Jewish and Muslim tradition (40 days)
• When the heart starts beating? (3 weeks)
• At implantation? (1 week)
• At conception.

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When Human Life Begins

• Union of these gametes during fertilization
• produces a zygote or fertilized ovum which is the
  primordium or beginning of a new human being.
  (emphasis in original text)
• Human development begins at fertilization
• This highly specialized, totipotent cell marked
  the beginning of each of us as a unique
  individual.

- Keith L. Moore T.V.N. Persaud, The Developing
Human Clinically Oriented Embryology, 6th
Edition, 1998.
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Biological Attributes of the
Human Embryo

• Genetically complete.
• Genetically unique, hence an individual.
• A single cell organism of the species Homo
  sapiens.
• Directs its own function and development.
• Exists on a continuum of development.
• Will undergo no change in its basic nature.
• (i.e., it will not become a hippopotamus)
• Integrity of being through bodily growth

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When Does Personhood Begin?

• When the Human is big enough?
• When the Human is old enough?
• When the Human becomes conscious?
• When the Human is able to reason?
• When the Human can communicate?
• When the Human is self aware?
• At birth?
• At individuation?
• At ensoulment?
• At conception?

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When Does Personhood Begin?

• At the age of about one?
• Human babies are not born self-aware, or capable
  of grasping that they exist over time. They are
  not persons the life of a newborn is of less
  value than the life of a pig, a dog, or a
  chimpanzee . a period of 28 days after birth
  might be allowed before an infant is
  accepted as having the same right to live
  as others.
• 
  Peter Singer - Practical Ethics

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Types of Euthanasia and
Assisted Suicide

•  1. Termination of Life Support (TLS)
• aka passive euthanasia
• a) If a competent adult patient requests it.
• b) If the treatment is clearly of no benefit
  to the
• patient.
• c) If the burden to the patient outweighs
  the
• benefit.
• 2. Physician-Assisted Suicide (PAS)
• 3. Active Euthanasia aka mercy killing

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The Case For Assisted Suicide and Active
Euthanasia

• The Argument from Mercy
• The Argument from Utility
• The Argument from Autonomy
• It Is Not a Violation of the
  Hippocratic Oath
• There Is No Morally Relevant Difference Between
  Killing and Allowing to Die
• It Does Not Always Involve Killing a Person

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The Case Against Assisted Suicide and Active
Euthanasia

• It Is Playing God
• Suffering May Be Redemptive
• Misdiagnoses Are Possible
• Euthanasia Will Likely Move from Voluntary to
  Involuntary Euthanasia
• Prohibition of Active Euthanasia Will Keep the
  Law Out of the Medical Setting
• Prohibition of Active Euthanasia Will Humanize
  the Ending Edge of Life
• Prohibition of Active Euthanasia Will Create a
  Safer Context for End-of-Life Decisions

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Important Distinctions6

• Voluntary vs. Involuntary
• Ordinary vs. Extraordinary Means of Treatment
  or
• Obligatory vs. Optional Means of Treatment
• Prolonging Life vs.
  Prolonging Death

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II. Making Life - part 1

• A. Assisted Reproduction
• 1. artificial insemination (AI)
• 2. in vitro fertilization (IVF)
• 3. intracytoplasmic sperm injection (ICSI)
• 4. surrogacy

Well, dutys duty. One cant consult ones own
preference. Im interested in truth, I like
science. But truths a menace, science is a
public danger. As dangerous as its been
beneficent. It has given us the stablest
equilibrium in history. Mustapha Mond (BNW)
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Some important terms

• Artificial insemination
• In Vitro fertilization
• Embryonic stem cells (ESCs)
• Adult stem cells (ASCs)
• Cloning (somatic cell nuclear transfer SCNT)
• Surrogacy

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II. Making Life - part 2

• B. Augmented Reproduction
  (Genetic Therapy)
• 1. stem cell research adult and embryonic
• 2. pre-implantation genetic diagnosis (PGD)
• 3. genetic engineering
• a) somatic vs. germline
• b) xenotransplantation
• and chimeras

Every discovery in pure science is potentially
subversive even science
must sometimes be
treated as a possible enemy. Yes, even
science. Mustapha Mond (BNW)
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II. Making Life - part 3

• C. Alternative Reproduction
• 1. cloning (somatic cell nuclear
  transfer - SCNT)
• a) reproductive
• b) therapeutic (experimental)
• 2. parthenogenesis (egg) and
  androgenesis (sperm)

His epsilon conditioning has laid down rails
along which hes got to run. He cant help
himself hes foredoomed. Even after decanting,
hes still inside a bottle an invisible bottle
of infantile and embryonic fixations. Each one of
us, of course, goes through life inside a bottle.
Mustapha Mond
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Making Life
Mouse with human ear (1997)
Jack, Lisa, Molly Nash (2004)
Baby Fae with baboon/s heart (1984)
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II. Making life
Gattaca
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In Vitro Fertilization

Worlds first test tube baby Louis Brown, July
25, 1978
500,000 frozen embryos, waiting
1 of all births in US 1 million worldwide
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Whats so exciting about stem cells?

• The human body is made of trillions of cells.
• When cells are injured, missing or not working
  properly we experience disease/disability.
• One way to treat some disease/disability is to
  replace injured/missing cells with healthy ones.
• Stem cells can change into other cells and
  sometimes serve as these replacements.

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What is a stem cell?

• A cell that can divide multiple times and give
  rise to specialized cells in the body
• Babies, children, and adults have stem cells
  in their bodies which generate replacement cells
  when needed.
• Embryos in their earliest stage of development
  are made entirely of stem cells which will
  generate every kind of cell necessary to form all
  200 body tissues organs.

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What is a stem cell?
Blood Cells
Nerve Cells
Muscle Cells
Embryonic Stem Cells (totipotent)
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Two types of stem cells

• Adult stem cells come from
• Placentas and Umbilical cord blood
• Various body tissues in babies through adults
  (fat, blood, bone marrow, brain, skeletal
  muscle, esophagus, stomach, pancreas,
  nasal tissues, eye, liver, hair
  follicles, skin, pulp from lost baby teeth,)
• Embryonic stem cells come from
• 5 day-old human embryos

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ESCs vs. ASCs

• Easier to find
• Easier to culture
• More active (regenerates faster)
• pluripotent
• Immortal (can be maintained in vitro
  indefinitely)

• Not subject to autoimmune rejection
• Easier to control
• Totipotent
• More focused
• Does not form tumors
• Does not destroy the embryo

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Sexual Reproduction
Embryonic Stem Cells
(Zygote)
The development of a human being begins with
fertilization, a process by which the
spermatozoon from the male and the oocyte from
the female unite to give rise to a new organism,
the zygote. Langman J., Medical Embryology, 4th
edition. Baltimore Williams Wilkins 1981, p.
1.
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Asexual Reproduction CLONING
Somatic Cell Nuclear Transfer (SCNT)
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Therapeutic cloning cloning-for-biomedical-resea
rch (CBR)
BLASTOCYST TAKEN APART
FERTILIZATION OCCURS HERE
CLONING OCCURS HERE
BLASTOCYST PLACED IN WOMB
Reproductive cloning cloning-to-produce-children
(CPC)
Using somatic cell nuclear transfer (SCNT)
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II. Making Life (cont.)

• Ethical Questions

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When do we become human and when do we become a
person?
Birth
Natural
Baby Child Adult
Zygote Embryo Fetus
IVF
Gestation
Death
Clone
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Where will we get all the eggs?

• A woman is injected with powerful hormones
  that cause her ovaries to produce multiple
  eggs.(superovulation)
• The eggs are surgically removed.Up to 14 of
  women experience complications, some
  life-threatening.

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Potential Complications

• Possible negative effects on future fertility
• Ovarian cysts
• Severe pelvic pain
• Rupture of the ovaries
• Stroke
• Death
• Exploitation of women
• Eggs become a commodity

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One Common Adult Stem Cell Use

• Bone marrow-derived stem cells are used in
  cancer and auto-immune disease treatment
  protocols.
• Stem cells are given to replace the patients
  bone marrow after high dose chemotherapy or
  radiation.
• This is done over 15,000 times a year in the U.S.
  alone and has resulted in formerly unattainable
  cures regressions.

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Other Current ASC Therapies

• Brain Tumors
• Retinoblastoma
• Ovarian Cancer
• Solid tumors - sarcomas, etc.
• Testicular Cancer
• Multiple Myeloma
• Leukemia

• Breast Cancer
• Neuroblastoma
• Non-Hodgkins Lymphoma
• Renal Cell Cancer
• Autoimmune - SLE, JRA, RA, MS
• Crohn's Disease

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Other ASC Applications

• Kidney Failure grow new kidney for transplant.
• Alzheimers modify cells to produce nerve growth
  factor.
• Muscular Dystrophy neural stem cells transformed
  into muscle.

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Proposed ASC Applications
1. Functional Genomics - To help scientists
understand the complex events of cell
development. 2. Drug Testing - Easier discovery
and testing of new drugs. 3. Correction of
genetic disorders - Stem cells could deliver gene
therapy. 4. Cell Therapy - Cells could be
generated that would be implanted into damaged
tissues. 5. Transplantation - Unlimited source of
organs for transplantation that could be grown in
the lab.
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Proposed ASC TherapiesMiracle Cures for
Incurable Diseases

• Diabetes transplant insulin-producing islet
  cells.
• Multiple Sclerosis replace damaged nerve cell
  sheath.
• Paralysis re-grow destroyed nervous tissue.

• Stroke repair brain damage.
• Heart Attacks skin cell ? stem cell ? to replace
  damaged heart muscle.
• AIDS replace damaged immune system.

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Stem Cells and Parkinsons

• 2006 - ASC from umbilical cord blood to
• treat rats significant recovery
• - ESC to treat rats many severe tumors
• 2005 - used protein to stimulate patients brain
• stem cells significant improvement
• - turned monkey ESC into neural ASC
  mild relief
• 2004 - successfully treated mice with nerve cells
  developed
• from their own bone marrow
• - turned human ESC into neural ASC and
  treated mice
• partial improvement, but too early to
  detect tumors
• 2003 - injected protein into patients brain,
  stimulating neural ASC
• 61 improvement in motor function
• - neurons from mice ESC transplanted
  into mice some decrease in
• symptoms but 20 died due to teratomas
• Parkinsons Treatments, Family
  Research Council, www.frc.org

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Embryonic Stem Cell therapies

• None

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What should we do with the leftover frozen
embryos?

• Discard, i.e., destroy and kill
• Use in research, i.e., experiment upon (sacrifice
  one life for another)
• Adopt Snowflake Babies

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Evaluating Reproductive Technologies

• 1. Coercion an inferior relationship.
• Sadly, history present and past is
  replete with examples of mans inhumanity to man,
  both at the individual level as well the national
  and international levels. Abominable examples
  include slavery, racism, eugenics, and genocide.
  When these criteria are used, the following words
  and phrases often result manipulation,
  exploitation, discrimination, oppression, caste
  system, and lack of informed consent.
  Consequently, when such terminology is apropos,
  then the reproductive technology in question is
  unethical.

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Evaluating Reproductive Technologies

• 2. Commodification an inhuman relationship.
• The difference between coercion and
  commodification is that at least with the former,
  the human beings are generally acknowledged to be
  beings, though they certainly are not usually
  treated humanly. With the latter, the human
  beings are really not even considered as beings,
  just raw materials, spare parts, or disposable
  property a commodity that is consumable.
  Therefore, any reproductive technology that
  considers a human being as nothing more than a
  plant or animal something to be farmed or
  harvested is deemed unethical.

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Evaluating Reproductive Technologies

• 3. Continuity an inherited relationship.
• Continuity implies a continuum of
  humanity, particularly our relationship to our
  past as well as our future. In other words, when
  this criterion is applied, the impact of our
  heritage and the implications for future
  generations must be considered. What are our
  responsibilities to our ancestors, and what
  claims (burdens, obligations, loss of freedom,
  genetic changes) are we imposing on our progeny?
  Any reproductive technology that deprives future
  human beings of their humanness, including their
  uniqueness, individuality, personhood, and
  genetic freedom is unethical.

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Evaluating Reproductive Technologies

• 4. Collaboration an interactive (shared)
  relationship.
• Particularly in light of the fact
  that humans are created imago Dei in the image
  of God humans are genuinely relational beings,
  biologically, genetically, (and spiritually!)
  hardwired for connections with each other.
  Therefore, any procedure or technology that
  interferes with the opportunity to form deep and
  meaningful relationships must be considered
  unethical. In addition, other relationships that
  might be affected include the relationship with
  God, the relationship with the environment, and
  the relationship with ones self (self-image and
  the sense of ones self-worth).

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III. Faking Life

• A. Nanotechnology
• B. Cybernetics and Artificial Intelligence
• C. Transgenics

O brave new world, he Savage repeated
O
brave new world that has such people in
it.
Lets start at once. You have a most
peculiar
way of talking sometimes, said
Bernard, staring at the
young man in perplexed astonishment. And,
anyhow, hadnt you better wait till you actually
see the new world? (BNW)
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Some important terms

• Nanotechnology
• Cybernetics
• Artificial Intelligence
• Neural Implants
• Transgenics
• Transhumanism
• Posthumanism

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Faking Life Nanotechnology

• The engineering or manipulating of matter
  (and life) at the nanometer scale via a top-down
  approach (manipulating matter atom by atom and
  molecule by molecule) or a bottom-up approach
  (using or controlling or reprogramming existing
  biological materials in new and different ways).
  (p. 80)
• Hook, C. Christopher. Techno
  Sapiens Nanotechnology, Cybernetics,
  Transhumanism and the Remaking of Humankind. In
  Human Dignity in the Biotech Century, ed. Charles
  W. Colson and Nigel M. de S. Cameron, 75-97.
  Downers Grove, IL InterVarsity Press, 2004.

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NANOSCALE

• 1 billionth of a meter
• 10 hydrogen atoms
• DNA 2.3 nm wide

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Nanotechnology Applications

• 1. Miniaturization of electronic components
• 2. Improved durability less pollution and
  more efficient
• 3. Military stealth garments, interface
  with electronics cyborg soldier
• 4. Cosmetic enhancement
• 5. Medical uses (next slide)

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Nanotechnology Medical Uses

• Rational drug design
• Devices specifically targeting and destroying
  tumor cells or infectious agents
• In vivo devices for at-the-site-of-need drug
  manufacture and release
• Tissue engineering or re-engineering
• Early detection or monitoring devices
• In vitro lab-on-a-chip diagnostic tools
• Devices to clear existing atherosclerotic lesions
  in coronary or cerebral arteries
• Biomimetic nanostructures to repair or replace
  DNA or other organelles
• Artificial replacements for red blood cells and
  platelets
• Tools to augment or repair interaction between
  neurons in the brain
• Devices to improve biocompatibility and the
  interface between brain tissue and cybernetic
  devices
• More durable prosthetic devices or implants

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Faking Life Cybernetics

• The science of the control and communication
  in the animal and the machine. (p. 76)

Hook, C. Christopher. Techno Sapiens
Nanotechnology, Cybernetics, Transhumanism and
the Remaking of Humankind. In Human Dignity in
the Biotech Century, ed. Charles W. Colson and
Nigel M. de S. Cameron, 75-97. Downers Grove, IL
InterVarsity Press, 2004.
73
Cybernetics Applications

• 1. Neural-silicon junctions seamless
  integration of electronics with our nervous
  system
• 2. Virtual reality
• 3. Repair nerve damage
• 4. External (wearable)
• computing devices
• 5. Augmented reality supplementing senses
  (e.g., retrograde vision, projected hearing,
  infrared vision, GPS)

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Faking Life Transhumanism

• The study of the means and obstacles to
  humanity using technological and other rational
  means to becoming posthumans, and of the ethical
  issues that are involved in this. Posthumans is
  the term for the very much more advanced beings
  that humans may one day design themselves into if
  we manage to upgrade our current human nature and
  radically extend our capacities.
• from http//www.nickbostrom.com/old/transhum
  anisn.html, p. 85)

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Transhumanism - Issues

• A. The human species does not represent the end
  of our evolution but the beginning.
• B. Technological immortality
• C. Reductionism, libertarianism, postmodernism
• Four transhuman assumptions
• (p. 87, from N. Katherine Hayles How We
  Became Posthuman, 1999)
• 1. information is more important to being human
  than is the body.
• 2. consciousness is an epiphenomenon.
• 3. the body is simply a prosthesis.
• 4. seamlessly articulated with
  intelligent machines.

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Transhumanism - Issues

• E. Accidents, Abuses, Regulation
• 1. just distribution of technology
• 2. impact on jobs and economy
• 3. effects created by increased longevity
• F. The Borgification of Humanity
• 1. physical and emotional safety
• 2. personality fragmentation
• 3. personal relationships ?
  cyber-relationships
• 4. encouragement of inauthentic behavior
• 5. increased dissatisfaction with reality
• 6. cyber-addictions

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III. Faking Life (cont.)

• Ethical Questions

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When does healing become enhancement?

• 1. Human propensity to enslave, destroy, and
  demean
• 2. Clouds the perception of the darkness of the
  unredeemed human heart

79
What is the purpose of technology?

• To improve and enrich the lives of ALL living
  things.
• To countermand the physical effects of natural
  calamity and human evil.
• To more effectively do that which is uniquely
  human.

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Technology Master or Servant?

• 1. Idol worship
•  2. Marginalization
•  3. Isolation
•  4. Held captive

81
Tranhumanism Master or Servant?

• Thesis Technological efforts to make us more
  than human, i.e., to be like God, inevitably make
  us less than human, i.e., enslaved by technology.
  

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Are we playing God?

• Assault on reality Striving for Omnipotence
• Virtual reality
• Augmented reality
• Denying reality
•  2. Aspiration for Immortality
• Striving for Eternality
•  3. Assumption of Knowledge
• Striving for Omniscience
•  4. Presumption of Grace
• Striving for Redemption

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Suggested Reading

• 1. Cameron, Nigel M. de S. The New Medicine Life
  and Death after Hippocrates. Chicago Bioethics
  Press, 2001.
• 2. Colson, Charles W. and Cameron, Nigel M. de S.
  Human Dignity in the Biotech Century. Downers
  Grove, IL InterVarsity Press, 2004.
• 6. Rae, Scott B. Moral Choices. Grand Rapids,
  MI. Zondervan, 2000.
• 7. 8. Smith, Wesley J. Consumers Guide to a
  Brave New World. San Francisco Encounter Books,
  2004.