Published: 1st April 1998
Christian Medical Fellowship is interdenominational and has as members more than 4,500 British doctors and 1,000 British medical students who are Christians and who desire their professional and personal lives to be governed by the Christian faith as revealed in the Bible. We have members in all branches of the profession, and through the International Christian Medical and Dental Association are linked with like-minded colleagues in over 70 other countries.
We regularly make submissions on ethical matters to Governmental and other bodies and are grateful for the opportunity to comment on the issues involved in the HGAC/HFEA consultation. We would be willing to help further if requested.
The following concepts extracted from our Affirmation on Christian Ethics in Medical Practice are relevant to this Submission:
Acknowledging that God is the Creator, the Sustainer and the Lord of all life.
Recognising that human beings are unique, being made in the 'image of God', and that they cannot be healthy in body and mind unless they live in harmony with the natural world around them, which they neither ignore nor exploit.
Maintaining the deepest respect for individual human life from its beginning to its end, including the unborn, the helpless, the handicapped, and those advanced in age.
Upholding marriage as a lasting bond, being the divinely appointed means for the care of children, the security of the family and the stability of society.
Recognising that sexual intercourse is intended by God only for the marriage relationship and hence advocating premarital continence and marital fidelity.
Giving effective service to those seeking our medical care irrespective of age, race, creed, politics, social status or the circumstances which may have contributed to their illness.
Serving each patient according to their need . . .
Doing no harm to patients, using only those drugs and procedures which we believe will be of benefit to them.
Maintaining as a principle that the first duty of doctors is to their patients . . .
. . . fulfilling those just requirements of the State, which do not conflict with these basic ethical standards.
We hold the Bible to be the revealed Word of God and find this helpful in giving us principles such as the above to guide decision-making in the ever more complex areas of ethics and practice.
We acknowledge the confusion current because of different uses of the word 'cloning', but we entirely reject what the consultation paper calls 'human reproductive cloning', ie the deliberate production of genetically identical human beings.
As Christian doctors our intuitions about this are overwhelmingly powerful - at a conference this year to discuss cloning issues, only one of the 50 or so CMF members participating was prepared ever to consider the possibility of such cloning being ethical. However, we admit that defending this intuition in the language of theology and ethics is at a very early stage.
We feel that the deliberate production of genetically identical human beings crosses the boundaries of our conviction stated above that 'God is the Creator, the Sustainer and the Lord of all life'.
The uniqueness of each human individual, made 'in the image of God', is another key concept, and the incidence in nature of 3-4 monozygotic twinnings per 1,000 births is not for us a logical argument against our rejection of deliberately creating 'carbon copies'.
A third key concept is that children should be a gift of God within marriage, thus establishing the family as the fundamental unit for the stability of society. There is a range of views within CMF about the rightness per se of IVF, but reproductive cloning takes technological manipulation of human relationships and reproduction a quantum leap further.
We note that our strong view is in harmony with the intuitions of people across a wide range of nationalities, religions and cultures. We note the UK, European and US legislation mentioned in the consultation paper which seeks to prevent production of genetically identical human beings, and urge that UK law be upheld and strengthened if necessary to prevent operation of any loopholes.
We warn that there is likely to be considerable pressure from infertile couples to produce offspring cloned from a parent, and understand that requests for this are already being expressed on the Internet and that certain professionals are considering responding to meet these requests. Despite the powerful emotional pressures to respond thus to the pain of infertility, we would continue to urge that the deliberate creation of genetically identical human beings should remain prohibited.
We find the confusion of language unhelpful, and would prefer to call this process 'nuclear transfer technology'. Indeed, in response to the request at 9.2 about ways to build public understanding of, and (perhaps) confidence in, new developments in genetic techniques, we would suggest that the language of public discussion be clarified. We suggest the word 'cloning' be reserved for the deliberate production of genetically identical human beings, and that 'nuclear transfer technology' or somesuch may be the right language for the research techniques being proposed.
Answers to some of the specific Questions in Section 9 largely depend on whether destructive research on human embryos is accepted as ethical or not. There is a range of views within Christian Medical Fellowship about this. In a 1995 survey of all members, 65% of 2,580 doctors replying felt human life had 'full value' by 14 days post-fertilisation, and therefore would have degrees of concern about the current position regarding embryo research. We do not know the views of the other 35% about embryo research as presently permitted by the HFE Act and regulated by the HFEA.
Against this background of serious concern amongst a majority of members about any destructive embryo research, yet also recognising that within a democracy Parliament has ruled and has set up a statutory body to implement its rulings, we turn to brief answers to the specific questions set out in Section 9.
Q1. Would research using nuclear replacement technology raise any new ethical issues in relation to what is permitted in work with embryos in the 14 day period?
Qualitatively, no. If any research is allowed, these new developments are not fundamentally different ethically, provided no embryos are placed in the womb and no research continues beyond the 14 day limit.
However, we are concerned that new therapeutic possibilities might lead to pressure to extend 'the 14 day period'. Since this limit is arbitrary, it is naive to think it would never be challenged.
Quantitatively, and noting the 276:1 ratio regarding the production of Dolly, a majority of us would be concerned about the possible use of much greater numbers of human embryos in destructive research than at present. We understand that around 300,000 human embryos have already been created in vitro in the UK.
Q2. Are there any medical or scientific areas that might benefit from research involving human nuclear replacement?
Yes. The consultation paper mentions the possibility of creating in vitro stem cells, and lines leading to the production of specific tissues or organs. However, while there might thus be benefit, would the means of attaining it be ethical? Many of us would see any use of a human embryo, either in the process directly of producing such products or indirectly in the research leading to it, as using a human being as a means to an end, and not viewing that human being as an 'end' in himself or herself.
The possibilities mentioned in the consultation paper are speculative. Could equally useful research not be performed with other non-controversial applications of molecular biology techniques, or (in the basic research scenario) with animals?
Q3. To what extent can a person be said to have a right to an individual genetic identity?
Regarding 'rights', the Bible does not use the language of 'rights'. Rather, we have responsibilities and duties towards God and towards other people, from which in practice we are effectively giving those people rights.
Regarding genetic identity, this understanding makes it even harder for us to try to answer the difficult question about 'right to an individual genetic identity'. In a biblical worldview, the question is fundamentally meaningless. As indicated above, we do not think we can meaningfully make any ethical deductions and applications from the existence in nature of 3-4 monozygotic twinnings per 1,000 births. Although monozygotic twins are genetically identical, they are clearly different individuals, who are both, as whole people, unique.
We do not accept that the existence of natural monozygotic twins implies that there would be no theological, philosophical, ethical or psychological issues concerning human identity and individuality if reproductive cloning were to be carried out.
Further, it can perhaps be argued that individuals have a right to a genetic identity distinct from that of each of their parents, thus ruling against any move towards the treatment of infertility by cloning from an adult cell of the mother.
Finally, what would be the motive of anyone wanting to create a 'carbon copy' of themself as a treatment for infertility? The child would be being created to fulfil a function, not to be loved for himself or herself. (Yet we acknowledge that most of us hoping to become natural parents do not have entirely unselfish motives.)
Q4. Would the creation of a clone of a human person be an ethically unacceptable act?
Yes. See our argument under 'Human Reproductive Cloning' above.
Q5. Would the likely cost in terms of failures and/or malformations inevitable in developing a programme of human reproductive cloning be ethically acceptable?
No. We have argued that human reproductive cloning itself is ethically unacceptable. If the end is unacceptable, so are the means, no matter what the quantitative cost.
We have argued above about the possible quantitative cost in experiments in nuclear transfer technology.
Q6. What ethical importance might be attached to the distinction between artificial processes for which there are parallels in natural processes and those for which there are not?
We recognise that it is tempting to argue intuitively from what is 'natural' and what is not, particularly in this area, and we recognise that many will do so. However, we do not consider that the distinction is valid ethically.
Using some medical analogies, we note that pain in childbirth is 'natural' but there is universal agreement that we should use analgesia appropriately to treat it. Surgical operations are 'unnatural' but there is universal agreement that we should use them appropriately to treat disease.
Christians regard us all as having a responsibility to be stewards of the whole of God's creation, and it will therefore sometimes be right to do 'unnatural' things and it will sometimes be right to prevent things happening 'naturally'. The distinction as stated is therefore not at all helpful in this debate.
Christians do however take seriously the concept of a natural moral order within the world of human relationships and wish therefore to use technology so as to uphold this natural moral order rather than to weaken it.
Human reproductive cloning, the deliberate creation of genetically identical human beings, should be prohibited.
We are divided about the ethics of research into nuclear transfer technology using pre-14 day human embryos, but accept that suitably controlled it need not involve anything qualitatively different from the current practice of destructive embryo research which the law permits and seeks to regulate.
We would encourage ongoing public discussion, and would urge clarity of language, particularly regarding the word 'cloning'.
Philippa Taylor (CMF Head of Public Policy) 020 7234 9664
Steven Fouch (CMF Head of Communications) 020 7234 9668
Alistair Thompson on 07970 162 225
Christian Medical Fellowship (CMF) was founded in 1949 and is an interdenominational organisation with over 4,000 British doctor members in all branches of medicine. A registered charity, it is linked to about 65 similar bodies in other countries throughout the world.
CMF exists to unite Christian doctors to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.