In the wake of progressively increasing uses of human gene editing, Dr. David Baltimore addressed an international summit in December 2015, stating, “the unthinkable has become conceivable and today we sense we are close to being able to alter human heredity.”[1] Gametes can be extracted from their hosts and conception achieved ex utero. Mitochondrial disease can now be circumvented using nucleus transfer, leaving resultant embryos with DNA from three different parents. CRISPR-Cas9 laudably promises the eradication of disease but opens doors to other, more disturbing, forms of genetic modification, perhaps permanently altering the human germ line. Scenarios once unthinkable, relegated to the pages of science fiction and dystopian literature, have become a haunting foretelling of the landscape of contemporary reproductive and genetic technologies and other reprogenetic technologies appearing on the near horizon.
Emerging from CBHD’s 2017 summer conference, “Genetic & Reproductive Technologies,” was a profound sense that science and technological advancement do not emerge in a social vacuum. Assumptions pertaining to human origin, identity, and destiny inevitably inform the process of scientific exploration and the direction of biotechnological advancement. As the conference provided an opportunity to evaluate reproductive and genetic technologies for their potential—and potentially devastating—impact, it became clear that bioethical deliberation has a rightful claim and an important stake in shaping not only moral and technological imagination, but also the future of humanity itself.
In the first plenary address, C. Ben Mitchell, PhD, focused on the looming reality and implications of extra-uterine fetal development. In a thought experiment, Mitchell took a cue from Haldane and Huxley, imagining a world in the not too distant future where ectogenesis is routine and traditional pregnancy a thing of the past. His characters boast of having chosen the most exclusive company, with expensive services that allowed them to determine the gender, biological traits, and personality of the fetus gestating within the sterile confines of a synthetic womb.
Moving into cautionary critique, he asked whether we could have persons without pregnancy. Oliver O’Donovan, in his monograph Begotten or Made (from which Mitchell borrowed the title of his address), opens with this claim, “What we ‘make’. . . is alien from our humanity. In that it has a human maker, it has come to existence as a human project, its being at the disposal of mankind.”[2] If we rob a human being of their begottenness, an existence that emerges from the mutual I-Thou relationship, O’Donovan argues that the resulting child represents the embodiment of individual human will and volition, rendering the child’s identity and very being at the disposal of the person who determined it.
Similarly, Calum MacKellar, PhD, in his discussion about artificial sperm and eggs emphasized that knowing from whom and whence we come is fundamental to shaping both individual and corporate identity. If interdependent existences are what create bonds of mutual belonging, how will artificial gametes comprised of several donors, or created from pluripotent stem cells, affect the bonds of mutuality at the core of our identity? MacKellar appealed to the perplexing lament of Dr. Frankenstein’s monster, “I was dependent on none and related to none. The path of my departure was free and there was none to lament my annihilation. . . . Who was I? What was I? Whence did I come?”[3]
At the root of the monster’s identity crisis is his composite existence lacking the correspondence that comes from being made from representative wholes. “Origins,” MacKellar stated, “are stronger than genetics.”[4] Tampering with the representative nature of the sperm and egg union tampers with the very nature of being that enables one to self-identify and belong to the world. Getting genetics “right” does not guarantee that life will find meaning if it is stripped of its corresponding identity and origin.
Issues associated with genetic discrimination are not limited to the existential or ontological, however. Discussing prenatal screening and testing, David Prentice, PhD, described how life-determining decisions are being made based on the results of routine genetic screening. Prenatal screening is a non-invasive routine test assessing risk that has become conflated with the results of a diagnosis, where it is determined whether the individual is an actual carrier. While the results of screening and diagnosis can be helpful for parental education and planning, the pattern of use has increasingly resulted in abortive decisions based on genetic risk rather than a true diagnosis.
Citing a UK sampling, Prentice reported that every individual studied chose to abort a fetus based on the results of a disappointing prenatal screening, having not distinguished between risk and condition. The moral landscape has shifted to allow life-determining, society-shifting decisions based on chance and not on actuality. As the lines between risk and diagnosis blur, Prentice described it as a lethal discrimination occurring under the guise of duty and socio-economic responsibility, and “when you start to choose which kinds of people should exist based on genetics, you have eugenics.”[5]
Therefore it is clear that humanity’s stake in genetic and reproductive technology is not only rooted in the ethics of the procedures themselves, but the underlying assumptions that inform their pursuit and application. The eugenic sympathies of Dr. Robert Edwards, the father of IVF, informed an imagination that prized product over persons, and commodity over community.[6] “Soon it will be a sin of parents to have a child that carries the heavy burden of genetic disease,” Edwards said, “We are entering a world where we have to consider the quality of our children.”[7]
Dr. Edwards’s belief that the human gene pool should be manipulated and improved reveals that an attitude of quality control has seeped into the assumptions behind pre-implantation genetic diagnosis, prenatal screening and testing, selective reduction, and other procedures. Gilbert Meilaender summarizes, “we share together the dignity of being human. We are therefore not at each other’s disposal, not fit subjects for ‘quality control’ by one another.”[8] Considering “the quality of our children” creates a world where the erasure of a mutual human dignity leads to value judgments based on two things of the same worth.
Understanding how Edwards’s moral imagination shaped his scientific research, we must ask ourselves, “how can we govern and shape the next generation of science and technological innovation?” The current moral trajectory informing the use of genetic and reproductive technologies is quickly moving beyond treatment or cure to enhancement or elimination. For example Iceland recently boasted of its eradication of Down Syndrome, but this is not the elimination of Trisomy 21, but of persons who possess the genetic anomaly. This moral trajectory changes what it means to be human.
J. Benjamin Hurlbut, PhD, called for greater ethical accountability in the process of scientific aspiration, rather than reactive responses to technical application: “Governing the future well requires that we understand the trajectory we’re on.”[9] The future of Christian bioethics does not lie in a defensive posture that shakes its fist at every new technology presented to society. Our role instead ought to be proactive, making a timely contribution in light of the high stakes and the need for clear theological insights, before a technology is adopted, because too often the “public is only invited to evaluate the end product, when the unthinkable has already become conceivable.”
Hurlbut’s focus on the trajectory of scientific exploration and Prentice’s appeals to the genetic ramifications for future generations evoke another analogy from O’Donovan: “We live not at the seedtime but at the harvest of the modern age, when we have the privilege of seeing what is its true character more clearly than those who have gone before us. And we have to think of the next seedtime, if one is given to us, and ask what we shall sow.”[10]
Ours is an unprecedented moment in which advancements in science and technology are able to leave a permanent legacy for our offspring. What standards and qualities do we presume to impose upon succeeding generations? What norms will we establish as fitting for a human being to exist? Putting it more simply, in Prentice’s words, “who counts?”[11]
Finally, it is suitable to ask what role the church should play in governing the future and shaping the moral and technological imagination, especially for believers who are contributing to scientific research, doctors and clinicians who are faced with their application, and for those who are the intended beneficiaries.
Revisiting Mitchell’s opening thought experiment, his characters portrayed an apparent evangelical commitment to sexual purity and pro-family ideals while simultaneously lacking critical theological engagement with the procedures to which they consented, theological anthropology, and the sacrificial call of Christ. When discussing the archaic practice of pregnancy, one of his characters remarked, “It seems so messy and inconvenient.”[12] Mitchell aptly included the church’s lagging response in his thought experiment, not necessarily because the church is unaware of the issues, but because the body of Christ is often ill equipped to critically evaluate the implications of the procedures themselves and identify the theological assumptions communicated through their use.
The church’s response (or lack thereof) highlights the distinct role of organizations like CBHD that recognize the dangers of the church’s silence on matters of bioethics and seek to bring scientific and theological clarity to these complex issues in service of the church. This commitment was highlighted in the final colloquium session, which was dedicated to an ecumenical dialogue on reproductive technologies between representatives of the three great Christian traditions. While varying in approach and theological commitments, each panelist represented both an aptitude in their field of study (ranging from canon law and ethics to molecular biology) and a high level of theological engagement from within their ecclesial tradition on matters of bioethics.
The predominant mood was one of general agreement and amiable clarification from the panel. With thoughtful prohibition characterizing the Catholic approach, the Protestant and Orthodox traditions both granted modest permission in their assessments of reproductive technologies, appealing to theological principles such as virtue, stewardship, and oikonomia (household management). The panel unequivocally agreed, however, that engaging theologically on matters of reproductive technology was undeniably pastoral in nature.
Scott B. Rae, PhD, commented that his interaction with laypeople whose attitude often communicated “don’t bother me with the ethics.”[13] Gayle E. Woloschak, PhD, observed that people simply did not think to get counsel from the church on scientific matters, harkening to Hurlbut’s session that addressed how systems of governance assign authority based on who they judge to know what is best.[14] This mind-set assumes that since clergy are neither scientists nor doctors, one need not bother consulting theology on matters of biology. Marie Hilliard, JCL, PhD, RN, called it “a teaching problem,”[15] sensing that as the church becomes increasingly aware and educated on the intricate details of reproductive technology, and the ensuing theological and ethical implications, the gap between clergy and laity must be addressed and narrowed.
Ministering through infertility is inextricably linked with people. Navigating the heartache is “messy and inconvenient” for the church, but must be taken seriously as a matter of witness. The biblical narrative informs and addresses the fundamental questions of human origin, identity, and destiny. It grounds human dignity in our identification with the Creator, not our genetics. The church has a stake in matters of genetic and reproductive technologies and the colloquium stressed the imperative to prepare and equip the Christian mind in shaping moral imagination to influence and evaluate the future of scientific advancement and technological application.
The summer conference may have left attendees asking more questions than answering them. Yet, as the unthinkable increasingly becomes conceivable, we were encouraged to start asking the right kind of questions. What are the underlying assumptions that will drive the future of technological advancement? What priorities and practices will guide moral and scientific deliberation? What genetic legacy will we leave future generations? As we explored important assumptions and implications in genetic and reproductive technologies, many of the inquiries boiled down to the question, “what does it mean to be human?” Therefore, next year’s 25th annual conference, “Bioethics and Being Human,” is a natural next step for examining science and technology and the underlying metaphysics and ontology that inform what it means to be human.
[1] The Economist, “Time to Think Carefully,” The Economist, December 3, 2015, https://www.economist.com/news/science-and-technology/21679434-international-summit-discusses-use-gene-editing-time-think-carefully (accessed October 12, 2017). J. Benjamin Hurlbut referred to Dr. Baltimore’s speech in “Governing Human Embryo Research at the Nexus of Gene Editing & Developmental Biology” (plenary address, The Center for Bioethics & Human Dignity’s 2017 Annual Conference, “Genetic & Reproductive Technologies,” Deerfield, IL, June 24, 2017).
[2] Oliver O’Donovan, Begotten or Made? (New York: Oxford University Press, 1984), 1.
[3] Mary W. Shelley, Frankenstein (Boston: Sever, Francis & Co., 1869), 101.
[4] Calum MacKellar, “Artificial Sperm and Eggs” (plenary address, The Center for Bioethics & Human Dignity’s 2017 Annual Conference, “Genetic & Reproductive Technologies,” Deerfield, IL, June 23, 2017).
[5] Ibid.
[6] C. Ben Mitchell, “Begotten or Made?” (plenary address, The Center for Bioethics & Human Dignity’s 2017 Annual Conference, “Genetic & Reproductive Technologies,” Deerfield, IL, June 22, 2017).
[7] Osagie K. Obasogie, “Commentary: The Eugenics Legacy of the Nobelist Who Fathered IVF,” Scientific American, October 4, 2013. https://www.scientificamerican.com/article/eugenic-legacy-nobel-ivf/ (accessed October 12, 2017).
[8] Gilbert Meilaender, Neither Beast Nor God: The Dignity of the Human Person, (New York: Encounter Books, 2009), 34–35.
[9] Hurlbut, “Governing Human Embryo Research.”
[10] O’Donovan, Begotten or Made?, 12.
[11] David Prentice, “Prenatal Screening and Testing” (plenary address, The Center for Bioethics & Human Dignity’s 2017 Annual Conference, “Genetic & Reproductive Technologies,” Deerfield, IL, June 23, 2017).
[12] C. Ben Mitchell, “Begotten or Made.”
[13] Scott B. Rae, “Protestant, Catholic, & Orthodox Approaches to Reproductive Technologies” (colloquium, The Center for Bioethics & Human Dignity’s 2017 Annual Conference, “Genetic & Reproductive Technologies,” Deerfield, IL, June 24, 2017).
[14] Hurlbut, “Governing Human Embryo Research.”
[15] Marie Hilliard, “Protestant, Catholic, & Orthodox Approaches to Reproductive Technologies” (colloquium, The Center for Bioethics & Human Dignity’s 2017 Annual Conference, “Genetic & Reproductive Technologies,” Deerfield, IL, June 24, 2017).
