sign in sign up
<<
Home , Axel Kahn, Dolly (sheep)

Journal ofMedical 1997; 23: 353-360 J Med Ethics: first published as 10.1136/jme.23.6.353 on 1 December 1997. Downloaded from

"Goodbye Dolly?" The ethics of

John Harris The Institute ofMedicine, Law and Bioethics, University ofManchester

Abstract other is by cell mass division or "embryo splitting". The ethical implications of human clones have been We'll start with cell mass division because this is the much alluded to, but have seldom been examined with only technique for cloning that has, as yet, been used any rigour. This paper examines the possible uses and in . abuses of and draws out the principal ethical dimensions, both of what might be done and its meaning. The paper examines some of the major Cell mass division public and official responses to cloning by authorities Although the technique of cloning embryos by cell such as President Clinton, the World Health mass division has, for some time been used exten- Organisation, the European parliament, UNESCO, sively in animal models, it was used as a way of mul- and others and reveals their inadequacies as tiplying human embryos for the first time in October foundations for a coherent public policy on human 1993 when Jerry Hall and Robert Stillman2 at cloning. The paper ends by defending a conc-eption of George Washington Medical Centre cloned human copyright. reproductive rights or "procreative autonomy" which embryos by splitting early two- to eight-cell embryos shows human cloning to be not inconsistent with into single embryo cells. Among other uses, cloning human rights and dignity. by cell mass division or embryo splitting could be used to provide a "twin" embryo for biopsy, permit- The recent announcement of a birth' in the press ting an embryo undamaged by invasive procedures heralds an event probably unparalleled for two mil- to be available for implantation following the result

lennia and has highlighted the impact of the genetic of the biopsy on its twin, or to increase the number http://jme.bmj.com/ revolution on our lives and personal choices. More of embryos available for implantation in the treat- importantly perhaps, it raises questions about the ment of .3 To what extent is such a practice legitimacy of the sorts of control individuals and unethical? society purport to exercise over something, which while it must sound portentous, is nothing less than human destiny. This birth, that of "Dolly", the Individuals, multiples and genetic cloned , is also illustrative of the responsibili- variation ties of and scientists to the communities in Cloning does not produce identical copies of the on September 29, 2021 by guest. Protected which they live and which they serve, and of the same individual person. It can only produce identi- public anxiety that sensational scientific achieve- cal copies of the same genotype. Our experience of ments sometimes provokes. identical twins demonstrates that each is a separate The ethical implications of human clones have individual with his or her own character, preferences been much alluded to, but have seldom been and so on. Although there is some evidence of examined with any rigour. Here I will examine the striking similarities with respect to these factors in possible uses and abuses of human cloning and draw twins, there is no question but that each twin is a out the principal ethical dimensions, both of what distinct individual, as independent and as free as is might be done and its meaning, and of public and anyone else. To Bill Clinton is not to create official responses. multiple Presidents of the . Artificial There are two rather different techniques avail- clones do not raise any difficulties not raised by the able for cloning individuals. One is by nuclear sub- phenomenon of "natural" twins. We do not feel stitution, the technique used to create Dolly, and the apprehensive when natural twins are born, why should we when twins are deliberately created? If the objection to cloning is to the creation of Key words identical individuals separated in time, (because the Cloning; Dolly; human dignity; procreative autonomy, twin embryos might be implanted in different cycles, human rights. perhaps even years apart), it is a weak one at best. 354 "Goodbye Dolly?" The ethics ofhuman cloning J Med Ethics: first published as 10.1136/jme.23.6.353 on 1 December 1997. Downloaded from

We should remember that such twins will be "iden- be ethically unacceptable as it would violate some of tical" in the sense that they will each have the same the basic principles which govern medically assisted genotype, but they will never (unlike some but by no procreation. These include respect for the dignity of means all natural monozygotic twins) be identical in the human being and protection of the security of the more familiar sense of looking identical at the human genetic material".7 The World Health same moment in time. If we think of expected simi- Organisation followed up the line taken by Nakajima larities in character, tastes and so on, then the same with a resolution of the Fiftieth World Health is true. The further separated in time, the less likely Assembly which saw fit to affirm "that the use of they are to have similarities of character (the more cloning for the replication of human individuals is different the environment, the more different ethically unacceptable and contrary to human environmental influence on individuality). integrity and morality".8 Federico Mayor of The significant ethical issue here is whether it UNESCO, equally quick off the mark, commented: would be morally defensible, by outlawing the "Human beings must not be cloned under any cir- creation of clones by cell mass division, to deny a cumstances. Moreover, UNESCO's International woman the chance to have the child she desperately Bioethics Committee (IBC), which has been reflect- seeks. If this procedure would enable a woman to ing on the ethics of scientific progress, has main- create a sufficient number of embryos to give her a tained that the human genome must be preserved as reasonable chance of successfully implanting one or common heritage of humanity".9 two of them, then the objections to it would have to The European parliament rushed through a reso- be weighty indeed. Ifpre-implantation testing by cell lution on cloning, the preamble of which asserted, biopsy might damage the embryo to be implanted, (paragraph B): would it be defensible to prefer this to testing a clone, if technology permits such a clone to be "[T]he cloning of human beings .. . , cannot under created without damage, by separating a cell or two any circumstances be justified or tolerated by any from the embryonic cell mass? If we assume each society, because it is a serious violation of funda- procedure to have been perfected and to be equally mental human rights and is contrary to the principle safe, we must ask what the ethical difference would of equality of human beings as it permits a eugeniccopyright. be between taking a cell for cell biopsy and destroy- and racist selection of the human race, it offends ing it thereafter, and taking a cell to create a clone, against human dignity and it requires experimenta- and then destroying the clone? The answer can only tion on humans," And which went on to claim that, be that destroying the cloned embryo would consti- (clause 1) "each individual has a right to his or her tute a waste of human potential. But this same own genetic identity and that human cloning is, and potential is wasted whenever an embryo is not must continue to be, prohibited".'0

implanted. http://jme.bmj.com/ These statements are, perhaps un-surprisingly, thin on argument and rationale; they appear to have been Nuclear substitution: the birth ofDolly plucked from the air to justify an instant reaction. This technique involves (crudely described) deleting There are vague references to "human rights" or the nucleus of an egg cell and substituting the "basic principles" with little or no attempt to explain nucleus taken from the cell of another individual. what these principles are, or to indicate how they This can be done using cells from an adult. The first might apply to cloning. The WHO statement, for viable offspring produced from fetal and adult mam- example, refers to the basic principles which govern on September 29, 2021 by guest. Protected malian cells was reported from an -based human and singles out "respect for the group in on February 27, 1997.4 The event dignity of the human being" and "protection of the caused an international sensation and was widely security ofgenetic material". How, we are entitled to reported in the world press. President Clinton of the ask, is the security of genetic material compromised? United States called for an investigation into the Is it less secure when inserted with precision by ethics of such procedures and announced a mora- scientists, or when spread around with the character- torium on public spending on human cloning; the istic negligence of the average human male? l l British Nobel Prize winner, Joseph Rotblat, described it as science out of control, creating "a means of mass destruction",5 and the German news- Human dignity paper Die Welt, evoked the Third Reich, comment- Appeals to human dignity, on the other hand, while ing: "The cloning of human beings would fit universally attractive, are comprehensively vague precisely into Adolph Hitler's world view".6 and deserve separate attention. A first question to More sober commentators were similarly ask when the idea of human dignity is invoked is: panicked into instant reaction. Dr Hiroshi whose dignity is attacked and how? Is it the duplica- Nakajima, Director General of the World Health tion of a large part of the genome that is supposed to Organisation said: "WHO considers the use of constitute the attack on human dignity? If so we cloning for the replication of human individuals to might legitimately ask whether and how the dignity J Med Ethics: first published as 10.1136/jme.23.6.353 on 1 December 1997. Downloaded from J7ohn Harris 355 of a natural twin is threatened by the existence ofher concerning persons; so the principle itself is not sister? The notion of human dignity is often also illuminating in this context. Applied to the creation linked to Kantian ethics. A typical example, and one of individuals which are, or will become that attempts to provide some basis for objections to autonomous, it has limited application. True the cloning based on human dignity, was Axel Kahn's Kantian principle rules out slavery, but so do a range invocation of this principle in his commentary on of other principles based on autonomy and rights. If cloning in Nature.'2 you are interested in the ethics of creating people then, so long as existence is in the created individ- "The creation of human clones solely for spare cell ual's own best interests, and the individual will have lines would, from a philosophical point ofview, be in the capacity for autonomy like any other, then the obvious contradiction to the principle expressed by motives for which the individual was created are Emmanuel Kant: that of human dignity. This prin- either morally irrelevant or subordinate to other ciple demands that an individual - and I would moral considerations. So that even where, for extend this to read human life - should never be example, a child is engendered exclusively to provide thought of as a means, but always also as an end. "a son and heir" (as so often in so many cultures) it Creating human life for the sole purpose of prepar- is unclear how or whether Kant' principle applies. ing therapeutic material would clearly not be for the Either other motives are also attributed to the parent dignity of the life created." to square parental purposes with Kant, or the child's eventual autonomy, and its clear and substantial The Kantian principle, crudely invoked as it usually interest in or benefit from existence, take precedence is without any qualification or gloss, is seldom over the comparatively trivial issue of parental helpful in medical or bio-science contexts. As for- motives. Either way the "fundamental principle of mulated by Kahn, for example, it would outlaw modern bioethical thought" is unhelpful and debates blood transfusions The beneficiary of blood about whether or not an individual has been used donation, neither knowing of, nor usually caring exclusively as a means are sterile and usually irresolv-

about, the anonymous donor uses the blood (and its' able. copyright. donor) simply as a means to her own ends. It would We noted earlier the possibility of using embryo also outlaw abortions to protect the life or health of splitting to allow genetic and other screening by the mother. embryo biopsy. One embryo could be tested and then destroyed to ascertain the health and genetic status of the remaining clones. Again, an objection Instrumentalization often voiced to this is that it would violate the This idea of using individuals as a means to the Kantian principle, and that "one twin would be purposes of others is sometimes termed "instrumen- destroyed for the sake of another". http://jme.bmj.com/ talization". Applying this idea coherently or consis- This is a bizarre and misleading objection both to tently is not easy! If someone wants to have children using cell mass division to create clones for screening in order to continue their genetic line do they act purposes, and to creating clones by nuclear substitu- instrumentally? Where, as is standard practice in in tion to generate spare cell lines. It is surely ethically vitro fertilisation (IVF), spare embryos are created, dubious to object to one embryo being sacrificed for are these embryos created instrumentally? If not how the sake of another, but not to object to it being sac-

do they differ from embryos created by embryo split- rificed for nothing. In , for on September 29, 2021 by guest. Protected ting for use in assisted reproduction?'3 example, it is, in the United Kingdom, currently Kahn responded in the journal Nature to these regarded as good practice to store spare embryos for objections.'4 He reminds us, rightly, that Kant's future use by the mother or for disposal at her direc- famous principle states: "respect for human dignity tion, either to other women who require donor requires that an individual is never used . . . exclu- embryos, or for research, or simply to be destroyed. sively as a means" and suggests that I have ignored It cannot be morally worse to use an embryo to the crucial use of the term "exclusively". I did not of provide information about its sibling, than to use it course, and I'm happy with Kahn's reformulation of for more abstract research or simply to destroy it. If the principle. It is not that Kant's principle does not it is permissible to use early embryos for research or have powerful intuitive force, but that it is so vague to destroy them, their use in genetic and other health and so open to selective interpretation and its scope testing is surely also permissible. The same would for application is consequently so limited, that its surely go for their use in creating cell lines for thera- utility as one of the "fundamental principles of peutic purposes. modern bioethical thought", as Kahn describes it, is virtually zero. Kahn himself rightly points out that debates It is better to do good concerning the moral status of the human embryo A moral principle, that has at least as much intuitive are debates about whether embryos fall within the force as that recommended by Kant, is that it is scope of Kant's or indeed any other moral principles better to do some good than to do no good. It J Med Ethics: first published as 10.1136/jme.23.6.353 on 1 December 1997. Downloaded from 356 "Goodbye Dolly?" The ethics ofhuman cloning cannot, from the ethical point of view, be better or the abuse or wrongful use. To ban cloning on the more moral to waste human material that could be grounds that it might be used for racist purposes is used for therapeutic purposes, than to use it to do tantamount to saying that sexual intercourse should good. And I cannot but think that if it is right to use be prohibited because it permits the possibility of embryos for research or therapy then it is also right rape. to produce them for such purposes."5 Kant's prohibi- tion does after all refer principally to use. Of course some will think that the embryo is a full member of Genetic identity the moral community with all the rights and protec- The second principle appealed to by the European tions possessed by Kant himself. While this is a parliament states, that "each individual has a right to tenable position, it is not one held by any society his or her own genetic identity". Leaving aside the which permits abortion, post-coital contraception, inevitable contribution of mitochondrial DNA,'8 we or research with human embryos. have seen that, as in the case of natural identical The UNESCO approach to cloning is scarcely twins, genetic identity is not an essential component more coherent than that of WHO; how does cloning of personal identity'9 nor is it necessary for "individ- affect "the preservation of the human genome as uality". Moreover, unless genetic identity is required common heritage of humanity"? Does this mean either for personal identity, or for individuality, it is that the human genome must be "preserved intact", not clear why there should be a right to such a thing. that is without variation, or does it mean simply that But if there is, what are we to do about the rights of it must not be "reproduced a-sexually"? Cloning identical twins? cannot be said to impact on the variability of the Suppose there came into being a life-threatening human genome, it merely repeats one infinitely small (or even disabling) condition that affected pregnant part of it, a part that is repeated at a natural rate of women and that there was an effective treatment, the about 3-5 per thousand births.'6 only side effect of which was that it caused the embryo to divide, resulting in twins. Would the exis-

tence of the supposed right conjured up by copyright. the Genetic variability European parliament mean that the therapy should So many of the fears expressed about cloning, and be outlawed? Suppose that an effective vaccine for indeed about genetic engineering more generally, HIV was developed which had the effect of doubling invoke the idea ofthe effect on the gene pool or upon the natural twinning rate; would this be a violation of genetic variability or assert the sanctity of the human fundamental human rights? Are we to foreclose the genome as a common resource or heritage. It is very possible benefits to be derived from human cloning difficult to understand what is allegedly at stake on so flimsy a basis? We should recall that the here. The issue of genetic variation need not detain natural occurrence of monozygotic (identical) twinshttp://jme.bmj.com/ us long. The numbers of twins produced by cloning is one in 270 pregnancies. This means that in the will always be so small compared to the human gene United Kingdom, with a population of about 58 pool in totality, that the effect on the variation of the million, over 200 thousand such pregnancies have human gene pool will be vanishingly small. We can occurred. How are we to regard human rights viola- say with confidence that the human genome and the tions on such a grand scale? human population were not threatened at the start of the present millennium in the year AD one, and yet the world population was then perhaps one per cent A right to parents on September 29, 2021 by guest. Protected ofwhat it is today. Natural are usually said to The apparently overwhelming imperative to identify be endangered when the population falls to about some right that is violated by human cloning some- one thousand breeding individuals; by these stan- times expresses itself in the assertion of "a right to dards fears for humankind and its genome may be have two parents" or as "the right to be the product said to have been somewhat exaggerated.'7 of the mixture of the genes of two individuals". The resolution of the European parliament goes These are on the face of it highly artificial and prob- into slightly more detail; having repeated the, now lematic rights - where have they sprung from, save mandatory, waft in the direction of fundamental from a desperate attempt to conjure some rights that human rights and human dignity, it actually have been violated by cloning? However, let's take produces an argument. It suggests that cloning them seriously for a moment and grant that they violates the principal of equality, "as it permits a have some force. Are they necessarily violated by the eugenic and racist selection of the human race". technique? Well, so does prenatal, and pre-implantation screen- Ifthe right to have two parents is understood to be ing, not to mention egg donation, sperm donation, the right to have two social parents, then it is of surrogacy, abortion and human preference in choice course only violated by cloning if the family identi- of sexual partner. The fact that a technique could be fied as the one to rear the resulting child is a one- abused does not constitute an argument against the parent family. This is not of course necessarily any technique, unless there is no prospect of preventing more likely a result of cloning, than of the use of any John Harris 357 J Med Ethics: first published as 10.1136/jme.23.6.353 on 1 December 1997. Downloaded from of the other new reproductive technologies (or particular cell types from non-diseased parts of an indeed of sexual reproduction). Moreover if there is adult. such a right, it is widely violated, creating countless Any attempt to use this technique in the United "victims", and there is no significant evidence of any Kingdom, is widely thought to be illegal. Whether it enduring harm from the violation of this supposed would in fact be illegal might turn on whether it is right. Indeed war widows throughout the world plausible to regard such cloning as the product of would find its assertion highly offensive. "fertilisation". Apparently only fertilised embryos If, on the other hand we interpret a right to two are covered by the Human Fertilisation and parents as the right to be the product of the mixture Embryology Act 1990.21 The technique used in of the genes of two individuals, then the supposition Edinburgh which involves deleting the nucleus of an that this right is violated when the nucleus of the cell unfertilised egg and then substituting a of one individual is inserted into the de-nucleated from an existing individual, by-passes what is egg of another, is false in the way this claim is usually normally considered to be fertilisation completely understood. There is at least one sense in which a and may therefore turn out not to be covered by right expressed in this form might be violated by existing legislation. On the other hand, if as seems cloning, but not in any way which has force as an logical, we consider "fertilisation" as the moment objection. Firstly it is false to think that the clone is when all forty-six chromosomes are present and the the genetic child of the nucleus donor. It is not. The zygote is formed the problem does not arise. clone is the twin brother or sister of the nucleus The unease caused by Dolly's birth may be due to donor and the genetic offspring of the nucleus the fact that it was just such a technique that donor's own parents. Thus this type of cloned indi- informed the plot of the film "The Boys from Brazil" vidual is, and always must be, the genetic child of in which Hitler's genotype was cloned to produce a two separate genotypes, of two genetically different fuehrer for the future. The prospect of limitless individuals, however often it is cloned or re-cloned. numbers of clones of Hitler is rightly disturbing. However, the numbers of clones that could be produced of any one genotype will, for the foresee- Two parents good, three parents better able future, be limited not by the number of copies copyright. However, the supposed right to be the product of that could be made of one genotype (using serial two separate individuals is perhaps violated by nuclear transfer techniques 470 copies of a single cloning in a novel way. The de-nucleated egg nuclear gene in cattle have been reported),22 but by contains mitochondrial DNA - genes from the the availability of host human mothers.23 Mass pro- female whose egg it is. The inevitable presence ofthe duction in any democracy could therefore scarcely mitochondrial genome of the egg donor, means that be envisaged. Moreover, the futility of any such the genetic inheritance of clones is in fact richer than attempt is obvious. Hitler's genotype might conceiv- http://jme.bmj.com/ that of other individuals, richer in the sense of being ably produce a "gonadically challenged" individual more variously derived.20 This can be important if of limited stature, but reliability in producing an evil the nucleus donor is subject to mitochondrial and vicious megalomaniac is far more problematic, diseases inherited from his or her mother and wants for reasons already noted in our consideration of a child genetically related to her that will be free of cloning by cell mass division. these diseases. How this affects alleged rights to par- ticular combinations of "parents" is more difficult to imagine, and perhaps underlines the confused Dolly collapses the divide between germ on September 29, 2021 by guest. Protected nature of such claims. and somatic cells There are some interesting implications of cloning by nuclear substitution (which have been clear since What good is cloning? were cloned by this method in the 1950s) One major reason for developing cloning in animals which have not apparently been noticed.24 There is is said to be4 to permit the study of genetic diseases currently a world-wide moratorium on manipulation and indeed genetic development more generally. of the human germ line, while therapeutic somatic Whether or not there would be major advantages in line interventions are, in principal, permitted. 13 human cloning by nuclear substitution is not yet However, inserting the mature nucleus of an adult clear. Certainly it would enable some infertile people cell into a de-nucleated egg turns the cells thus to have children genetically related to them, it offers formed into germ line cells. This has three important the prospect, as we have noted, of preventing some effects. First, it effectively eradicates the firm divide diseases caused by mitochondrial DNA, and could between germ line and somatic line nuclei because help "carriers" of X-linked and autosomal recessive each adult cell nucleus is in principle "translatable" disorders to have their own genetic children without into a germ line cell nucleus by transferring its risk of passing on the disease. It is also possible nucleus and creating a clone. Secondly, it permits that cloning could be used for the creation of somatic line modifications to human cells to become "spare parts" by for example, growing stem cells for germ line modifications. Suppose you permanently 358 "Goodbye Dolly?" The ethics ofhuman cloning J Med Ethics: first published as 10.1136/jme.23.6.353 on 1 December 1997. Downloaded from insert a normal copy of the adenosine deaminase own" genetic child was by cloning herself; what are gene into the bone marrow cells of an individual suf- the strong arguments that should compel her to fering from severe combined immuno-deficiency accept that it would be wrong to use nuclear substi- (which affects the so called "bubble boy" who has to tution? We must assume that this cloning technique live in a protective bubble of clean air) with obvious is safe, and that initial fears that individuals beneficial therapeutic effects. This is a somatic line produced using nuclear substitution might age more modification. If you then cloned a permanently rapidly have proved groundless.26 We usually grant genetically modified bone marrow cell from this the so called "genetic imperative" as an important individual, the modified genome would be passed to part of the right to found a family, of procreative the clone and become part of his or her genome, autonomy.27 The desire of people to have "their transmissible to her offspring indefinitely through own" genetic children is widely accepted, and if we the germ line. Thus a benefit that would have grant the legitimacy ofgenetic aspirations in so many perished with the original recipient and not been cases, and the use of so many technologies to meet passed on for the protection of her children, can be these aspirations,28 we need appropriately serious conferred on subsequent generations by cloning.25 and weighty reasons to deny them here. The third effect is that it shows the oft asserted It is perhaps salutary to remember that there is no moral divide between germ line and somatic line necessary connection between phenomena, attitudes therapy to be even more ludicrous than was pre- or actions that make us uneasy, or even those that viously supposed.'5 disgust us, and those phenomena, attitudes, and actions that there are good reasons for judging unethical. Nor does it follow that those things we are Immortality? confident are unethical must be prohibited by legis- Of course some vainglorious individuals might wish lation or regulation. to have offspring not simply with their genes but We have looked at some of the objections to with a matching genotype. However, there is no way human cloning and found them less than plausible, that they could make such an individual a duplicate we should now turn to one powerful argument that of themselves. So many years later the environ- has recently been advanced in favour of a tolerantcopyright. mental influences would be radically different, and attitude to varieties of human reproduction. since every choice, however insignificant, causes a life-path to branch with unpredictable conse- quences, the holy grail of duplication would be Procreative autonomy doomed to remain a fruitless quest. We can We have examined the arguments for and against conclude that people who would clone themselves permitting the cloning of human individuals. At the

would probably be foolish and ill-advised, but would heart ofthese questions is the issue of whether or nothttp://jme.bmj.com/ they be immoral and would their attempts harm people have rights to control their reproductive society or their children significantly? destiny and, so far as they can do so without violat- Whether we should legislate to prevent people ing the rights of others or threatening society, to reproducing, not 23 but all 46 chromosomes, seems choose their own procreative path. We have seen more problematic for reasons we have already that it has been claimed that cloning violates princi- examined, but we might have reason to be uncom- ples of human dignity. We will conclude by briefly fortable about the likely standards and effects of examining an approach which suggests rather that child-rearing by those who would clone themselves. failing to permit cloning might violate principles of on September 29, 2021 by guest. Protected Their attempts to mould their child in their own dignity. image would be likely to be more pronounced than The American philosopher and legal theorist, the average. Whether they would likely be worse Ronald Dworkin has outlined the arguments for a than so many people's attempts to duplicate race, right to what he calls "procreative autonomy" and religion and culture, which are widely accepted as has defined this right as "a right to control their own respectable in the contemporary world, might well role in procreation unless the state has a compelling depend on the character and constitution of the reason for denying them that control".29 Arguably, genotype donor. Where identical twins occur freedom to clone one's own genes might also be naturally we might think of it as "horizontal defended as a dimension of procreative autonomy twinning", where twins are created by nuclear sub- because so many people and agencies have been stitution we have a sort of "vertical twinning". attracted by the idea of the special nature of genes Although horizontal twins would be closer to one and have linked the procreative imperative to the another in every way, we do not seem much dis- genetic imperative. turbed by their natural occurrence. Why we should be disturbed either by artificial horizontal twinning "The right ofprocreative autonomy follows from any or by vertical twinning (where differences between competent interpretation of the due process clause the twins would be greater) is entirely unclear. and of the Supreme Court's past decisions applying Suppose a woman's only chance of having "her it.... The First Amendment prohibits government J Med Ethics: first published as 10.1136/jme.23.6.353 on 1 December 1997. Downloaded from Jfohn Harris 359 from establishing any religion, and it guarantees all constitutions may be compromised by attempts to citizens free exercise of their own religion. The limit procreative autonomy, at least where greater Fourteenth Amendment, which incorporates the values cannot be shown to be thereby threatened. First Amendment, imposes the same prohibition In the absence of compelling arguments against and same responsibility on states. These provisions human cloning, we can bid Dolly a cautious "hello". also guarantee the right of procreative autonomy."30 We surely have sufficient reasons to permit experi- ments on human embryos to proceed, provided, as The point is that the sorts of freedoms which with any such experiments, the embryos are freedom of religion guarantees, freedom to choose destroyed at an early stage.34 While we wait to see one's own way of life and live according to one's whether the technique will ever be established as most deeply held beliefs are also at the heart of pro- safe, we should consider the best ways to regulate its creative choices. And Dworkin concludes: uptake until we are in a position to know what will emerge both by way of benefits and in terms of "that no one may be prevented from influencing the burdens. shared moral environment, through his own private choices, tastes, opinions, and example, just because these tastes or opinions disgust those who have the Acknowledgements power to shut him up or lock him up."31 This paper was presented to the UNDP/WHO/World Bank Special Programme ofResearch, Development and Thus it may be that we should be prepared to accept Research Training in Human Reproduction Scientific both some degree of offence and some social disad- and Ethical Review Group Meeting, Geneva 25th vantages as a price we should be willing to pay in April 1997 and to a hearing on cloning held by the order to protect freedom of choice in matters of European parliament in Brussels, 7th May 1997. I am procreation and perhaps this applies to cloning as grateful to participants at these events for many much as to more straightforward or usual pro- stimulating insights. I must also thank Justine

creative preferences.32 Burley, Christopher Graham and Pedro Lowenstein copyright. The nub of the argument is complex and abstract for many constructive comments. but it is worth stating at some length. I cannot improve upon Dworkin's formulation of it. Jfohn Harris is Sir David Alliance Professor of Bioethics and Research Director of The Centre For "The right of procreative autonomy has an import- Social Ethics and Policy, University ofManchester and ant place . . . in Western political culture more gen- a Director of The Institute of Medicine, Law and erally. The most important feature of that culture is Bioethics. a belief in individual human dignity: that people http://jme.bmj.com/ have the moral right - and the moral responsibility - to confront the most fundamental questions about References and notes the and value of their own lives for them- meaning 1 The arguments concerning human dignity are devel- selves, answering to their own consciences and con- oped in my Cloning and human dignity in The victions.... The principle of procreative autonomy, Cambridge Quarterly of Healthcare Ethics [in press].The in a broad sense, is embedded in any genuinely issues raised by cloning were discussed in a special issue `33

democratic culture. of the Kennedy Institute of Ethics J7ournal 1994; 4,3 and on September 29, 2021 by guest. Protected in my Wonderwoman and Superman: the ethics of human In so far as decisions to reproduce in particular ways . Oxford University Press, Oxford 1992, or even using particular technologies constitute deci- especially ch 1. sions concerning central issues of value, then 2 Human embryo cloning reported. Science 1993; 262: freedom to make them is 652-3. arguably the guaranteed by 3 Where few eggs can be successfully recovered or where the constitution (written or not) of any democratic only one embryo has been successfully fertilised, this society, unless the state has a compelling reason for method can multiply the embryos available for implan- denying its citizens that control. To establish such a tation to increase the chances of successful infertility compelling reason the state (or indeed a federation treatment. or union of states, such as the European Union for 4 Wilmut I et al. Viable offspring derived from fetal and example) would have to show that more was at stake adult mammalian cells. Nature 1997; 385: 810-13. than the fact that a majority found the ideas disturb- 5 ArlidgeJ. 1997 Feb 26: 6. ing or even disgusting. 6 Radford T. The Guardian 1997 Feb 28: 1. in the case of human such 7 WHO press release (WHO/20 1997 Mar 11). As yet, cloning, 8 WHO document (WHA50.37 1997 May 14). Despite compelling reasons have not been produced. the findings of a meeting of the Scientific and Ethical Suggestions have been made, but have not been sus- Review Group (see Acknowledgements) which tained, that human dignity may be compromised by recommended that "the next step should be a thorough the techniques of cloning. Dworkin's arguments exploration and fuller discussion of the [issues]". suggest that human dignity and indeed democratic 9 UNESCO press release No 97-29 1997 Feb 28. J Med Ethics: first published as 10.1136/jme.23.6.353 on 1 December 1997. Downloaded from 360 "Goodbye Dolly?" The ethics ofhuman cloning

10 The European parliament. Resolution on cloning. 21 Margaret Brazier alerted me to this possibility. Motion dated March 11 1997. Passed March 13 1997. 22 Apparently Alan Trounson's group in Melbourne 11 Perhaps the sin of Onan was to compromise the Australia have recorded this result. The Herald Sun security of his genetic material? 1997 Mar 13. 12 Kahn A. Clone ... clone man. Nature 1997; 23 What mad dictators might achieve is another matter; 386: 119. but such individuals are, almost by definition, imper- 13 For use of the term and the idea of "instrumentaliza- vious to moral argument and can therefore, for present tion" see: Opinion of the group of advisers on the purposes, be ignored. ethical implications of biotechnology to the European 24 Except by Pedro Lowenstein, who pointed them out to Commission No 9. 1997 28 May. Rapporteur, Dr Anne me. McClaren. 25 These possibilities were pointed out to me by Pedro 14 Kahn A. Cloning, dignity and ethical revisionism. Lowenstein who is currently working on the implica- Nature 1997; 388: 320. Harris J. Is cloning an attack on tions for human . human dignity? Nature 1997; 387: 754. 26 Science and technology: The Economist 1997 Mar 1: 15 See my Wonderwoman and Superman: the ethics of 101-4. human biotechnology. Oxford University press, Oxford 27 Universal Declaration of Human Rights (article 16). 1992: ch 2. European Convention on Human Rights (article 12). 16 It is unlikely that "artificial" cloning would ever These are vague protections and do not mention any approach such a rate on a global scale and we could, of particular ways of founding families. course, use regulative mechanisms to prevent this 28 These include the use of reproductive technologies without banning the process entirely. I take this figure such as surrogacy and Intra Cytoplasmic Sperm of the rate of natural twinning from Moore KL and Injection (ICSI). Persaud TVN. The developing human [5th ed]. 29 Dworkin R. Life's dominion. London: Harper Collins, Philadelphia: WB Saunders, 1993. The rate men- 1993: 148. tioned is 1 per 270 pregnancies. 30 See reference 28: 160. 17 Of course if all people were compulsorily sterilised and 31 Dworkin R. Freedom's law. Oxford: Oxford University reproduced only by cloning, genetic variation would Press,1996: 237-8. become fixed at current levels. This would halt the evo- 32 Ronald Dworkin has produced an elegant account ofthe

lutionary process. How bad or good this would be could way the price we should be willing to pay for freedomcopyright. only be known if the course of future and its might or might not be traded offagainst the costs. See his effects could be accurately predicted. Taking rights seriously, London: Duckworth, 1977: ch 10. 18 Mitochondrial DNA individualises the genotype even And his A matter ofprinciple, Cambridge, Mass: Harvard of clones to some extent. University Press, 1985: ch 17. 19 Although of course there would be implications for 33 See reference 27: 166-7. criminal justice since clones could not be differentiated 34 The blanket objection to experimentation on humans by so called "genetic fingerprinting" techniques. suggested by the European parliament resolution 20 Unless of course the nucleus donor is also the egg would dramatically change current practice on the use donor. of spare or experimental human embryos. http://jme.bmj.com/ on September 29, 2021 by guest. Protected