2 - 2002

Ethics in modern medicine

Pre-implantation Diagnosis ...

and Research on Embryonic Stem Cells — the ethical conflict

by Hartmut Kreß

In Germany there are currently about 100,000 so-called test-tube babies growing up; a few have already reached adulthood. In order to conceive them, surplus embryos were created. These can either be allowed to die off, or be used for therapeutic research. If it is possible to detect the presence of genetic disease in the early embryonic stages, a late abortion of the foetus following amniocentesis can be avoided. — The author of this article pleads for an ethical weighing of the greater and the lesser evil.

These days we often hear the concern expressed that research on embryonic stem cells, or pre-implantation diagnosis, are violations of embryos’ right to protection. There has always been a great ethical struggle over the moral status of embryos. In the history of theology there has even been uncertainty regarding the point at which an embryo becomes a human being at all, in the strict sense. Formative western ethical thinkers, such as Aristotle and Thomas Aquinas, thought that this took place quite late — that the embryo did not receive a soul until the 40th, 80th or 90th day after conception.

In the modern era a stricter view has imposed itself, according to which the embryo becomes a human life, worthy of protection, from the moment of fusion between the egg and sperm cells. The first document which gave this view legal status was the Prussian General Law in 1794, which said that "even unborn children, from the time of their conception” are entitled to "the same general rights as all humankind”. Since then modern science has underpinned the idea that the genes from which a human being develops are all already present from the moment the sperm cell fuses with the egg cell.

This then is the source of the question whether pre-implantation diagnosis (PID) or research on embryonic stem cells can be reconciled with the human being’s deservingness of protection. PID can be used to examine embryos created through artificial insemination outside the womb, to see whether they have severe genetic defects which are known to be inherited within a particular family. In case an embryo is discovered to have the fateful predisposition, by about the fifth day, it would not be placed in the mother’s uterus, but be allowed to die.

Research on embryonic stem cells involves the use of cells taken from five-day-old embryos for medical research. In the long term this research could make new treatments possible which might benefit patients suffering from degenerative illnesses such as Parkinson’s disease or multiple sclerosis, or from diabetes, to mention only a few examples. Thus research on embryonic stem cells could open up future therapies which would be very humane and desirable, if these hopes are fulfilled.

The Hippocratic oath which doctors take has always obligated the medical profession to care for the well-being of patients, to heal or to relieve their pain and illness (the "therapeutic imperative”). Christianity has always affirmed the ethic of healing, help and care for the sick. Early Christianity even spoke of Christ himself as a doctor (Christus medicus). Today the State also has a duty to provide active support to health-promoting measures and structures. This obligation is also included in human rights conventions of which the Federal Republic of Germany is among the signatories. The International Pact on Economic, Social and Cultural Rights of 1966 underlines the right of every person "to the highest degree of physical and mental health which is attainable for him or her”. The State is required to promote this human right according to the measure of its technical, economic, social and cultural possibilities.

The objection to research on embryonic stem cells, or to PID, says that these technologies endanger the individual human worth of embryos. In jurisprudence and in Protestant ethics, arguments are being sought to allow the ethical alternatives to be weighed. These considerations have to do with a difficult and, in this form, new conflict of values and goals, that is, the conflict between the medical and humane duty to promote therapy and health on one hand, and the protection of the embryo on the other.

To briefly indicate some aspects of this debate: Research on embryonic stem cells is intended to be carried out on orphaned embryos which are present in any case due to reproductive medical technologies and are stored in deep freeze facilities. These embryos have no prospects of ever being carried to term in a pregnancy; they will be discarded. This is why it seems justifiable to remove individual cells from them, to be used for particularly important therapeutic research purposes.

It is in no way a convincing solution to rely on other countries to carry out such research, as was repeatedly proposed last year. That would mean consenting in full awareness to a double standard. New therapies which could result from foreign stem cell research would have to be adopted here in our country as well; we could not deny these new therapeutic approaches to our patients here.

With regard to PID, it must be taken into consideration that unborn life is already very frequently subjected to genetic examination. Such examinations are carried out much later in the pregnancy, around the 12th week or even later. If a genetic defect is found, an abortion is usually carried out. The foetus which is then aborted already has brain structures and can experience stress and pain. In comparison, it is possible to see PID, which is carried out very early — around the fifth day of development of the embryo, long before the brain has developed — as a lesser evil. A lesser evil may be regarded, in well-founded exceptional cases, as ethically and legally tolerable.

Dr. Hartmut Kreß is Professor in the social ethics department of the Protestant theological faculty of the University of Bonn. His article, which appears here in abridged form, was also included in the study guide for the "Week for the Defence of Life” (see preceding article) under the heading "The Other View”, and with the following rationale: "Controversies within theology and the church should not be kept out of the study guide.”