Download Every ethical discussion profoundly relies on a adequate description

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Arbeitskreis Biotechnik - INTERNET FORUM
Ethical and Social-Economical Issues of Gene Technology
Ethische und sozio-ökonomische Aspekte zur Gentechnik
der Berliner Wissenschaftlichen Gesellschaft
http://www.bwg-berlin.de/start.html
Ethical Implications of Genetic and Reproductive Technologies Reconsidering the Questions
Nikola Biller-Andorno, Claudia Wiesemann
Abteilung für Ethik und Geschichte der Medizin, Universität Göttingen
Zusammenfassung
Die
medizinethische
Diskussion
um
die
Möglichkeiten
der
Gen-
und
Reproduktionstechnologien konzentriert sich zumeist auf den moralischen und
juristischen Status des menschlichen Embryos, besonders des Embryos in vitro. Doch
wenn die komplexen Fragestellungen aus dem Umfeld der assistierten Reproduktion nur
unter dem Gesichtspunkt konfligierender Rechte (z.B. Lebensrecht des Embryos vs.
Forschungsfreiheit) betrachtet werden, besteht nur wenig Aussicht auf einen Konsens.
Außerdem besteht die Gefahr, dass andere wichtige Fragen nicht hinreichend gewürdigt
werden.
In der Ethik ist in letzter Zeit die Dominanz einer Sichtweise kritisiert worden, die sich
auf die Bestimmung des Rechtsstatus abstrakter Entitäten konzentriert und Lösungen
im Einzelfall mittels einer Anwendung allgemeingültiger, kontextunabhängiger
Prinzipien finden möchte. Eine solche Sichtweise, so die Kritik, bedürfe zumindest der
Ergänzung durch eine andere Perspektive, die die multiplen Verantwortlichkeiten der an
einem Konflikt beteiligten, in einem Beziehungsgeflecht stehenden Personen in den
Vordergrund rückt. Dies bedeutet keine inhaltliche Festlegung, denn sowohl "Rechts-"
als auch "Verantwortungsperspektive" lassen unterschiedliche inhaltliche Standpunkte
zu. Wohl aber ändert sich das Spektrum an Fragen und die Relevanz, die ihnen
beigemessen wird.
Reproductive Medicine and the Moral Status of the Human Embryo
The discussion on assisted procreation has traditionally focused on the moral status of
the human embryo in vitro. The recent debates about reproductive medicine in
Germany are no exception in that respect. The priority that is accorded to the status
question is illustrated by the fact that the German Federal Ministry of Health put this
problem on top of a list of items that were discussed on a national symposion on
reproductive medicine in Berlin in May this year.
Approaching the complex field of ethical implications of genetic and reproductive
technologies this way may seem the straightforward thing to do. It is certainly true that
how we perceive the human embryo plays an important role in our moral judgments.
However, there are considerable problems that come with a predominant focus on the
determination of status.
1. The moral status of the human embryo has been the object of quite
controversial ethical debates for many decades and a clear and simple
solution is still not in sight. Sometimes, however, the determination of this status
has been seen as the prerequisiste just to start an ethics debate. But there is no
agreement, neither on the methodological nor on the content level, rendering a
moral consensus extremely unlikely.1 Building a moral argumentation on one of the
many possible status concepts does therefore not seem a very promising stategy.
2. In contrast to the situation in vivo the embryo in vitro is seen as a being
without relationships exposed to a dangerous environment, and therefore in
The spectrum of positions on the status of human embryos reaches from "a specific group of
particularly vulnerable persons, whose life and integrity are endangered by greedy researchers" to
"conglomerates of human cells with remarkable capacities the investigation of which might lead to very
promising insights and new cures".
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need of a particularly strict protection. Medical technology is indeed now able to
manipulate and - at least for some time - maintain embryos "per se", that is without
physically interfering with the body of a woman. This new relationship of the
embryo and a gynecologist or researcher therefore requires particular consideration.
But in many cases there are also caring parents, who feel a very strong bond to their
developing embryo. There is a certain danger to reduce phenomenological
description of "the" embryo in vitro to an abstract entity, forlorn and isolated in a
Petri dish, disregarding the fact that there may indeed be many other forms of
relationships than the bodily integration in a mother' s womb.
3. Whereas it is true that the way we regard the human embryo and its status is
of great importance, it is rather to be seen as the result and not as the
precondition of moral reflection. We certainly start with some kind of intuition or
preconception of how to treat the human embryo in different situations. They may
change over time, with exposition to concrete moral conflicts, with social or
technological developments etc. It is helpful to try to make those assumptions
explicit as well as the factors influencing it in order to allow a reflection one's own
moral thinking. It is not necessary, however, to try to mold these ideas into a
decision about a fixed moral status, which is then supposed to serve as the major
guideline for concrete moral judgments. Such a strong general value judgment
concerning the embryo alreadly establishes a strong hierarchy among possible
arguments even before the moral discourse has begun. It also risks that a decision
against the continuation of an embryo's development is interpreted as considering it
"not worth living", even if this decision may have an entirely different background.
Talking about the moral status of the embryo implies talking in a language of rights and
justice. This perspective makes it hard to include situational and contextual arguments
of care and relationship which, however, would be important in order to underline that
reproduction is an essential feature of familiarity and human relationship.2 A pure rights
discourse may thus distort our perception of what is at stake in reproductive medicine.
C. Gilligan, whose studies in moral psychology had drawn attention to a "care perspective" as opposed
to a "justice perspective", had made a similar observation in the context of the US debate on abortion in
the 1970s, which she perceived as dominated by a language of rights (cf. C. Gilligan in Nunner-Winkler,
Gertrud (ed.): Weibliche Moral. Die Kontroverse um eine geschlechtsspezifische Ethik. München: dtv,
1995, p. 85-86.). The current abortion law in Germany, on the other hand, can be considered a very much
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Rights and Responsibilities, Care and Justice
Every ethical discussion profoundly relies on an adequate description of the persons or
situations involved. How we describe them is how we perceive them as moral actors or
morally relevant facts. Kant for example put emphasis on reason as the highest principle
of morality. But from his texts we can learn that he did not attribute full capacity of
reason to women. His thinking therefore necessarily focused on white European men
and their moral problems. As women's rational capacity was considered to be of
objectively minor value, their perspectives and needs were not equally included in Kant's
moral theory.
Although until now serious attempts have been made to include women's perspectives
into moral consideration, we should not ignore the problem that who in different times
and spaces is considered a moral actor and what is thought to be a morally relevant fact
depends on cultural attitudes and beliefs that cannot easily be transcended. For example,
in Germany, ethical problems in reproductive medicine are usually classified as
problems at "the beginning of life". However, they could equally be called problems "in
the middle of life" or "in the age of fertility". Talking about it as we do, we imply that
the embryo's problems are of main interest, not the mother's or the father's. Ethicists
should be aware of this and similar problems. Ethics has also the duty to question the
given "facts" that could be of moral relevance should it not solely function as
legitimation of the present situation.
In biomedical ethics, this is a very common phenomenon. It has been one of the
discipline's main achievements to show that scientific descriptions of seemingly purely
objective "facts" indeed include cultural beliefs and moral judgments. Ethics was one of
the means of criticising the pretention of the life sciences to act with desinterested
objectivity, thus reducing the epistemic gap between natural science and humanities. But
consequently medical ethics itself got critized for focusing too exclusively and
uncritically on universal principles and general statements about rights, neglecting a
perspective that concentrates on the concrete other in his or her specific situational and
relational context: "From a care perspective, the relationship becomes the figure,
contextual solution which is not based on a right to life (or to abortion) but on (bodily) relationship and
the idea that the state should abstain from imposing unreasonable demands on that relationship.
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defining self and others. Within the context of relationship, the self as a moral agent
perceives and responds to the perception of need. The shift in moral perspective is
manifest in a change in the moral question from "What is just?" to "How to respond?" 3
This "care perspective" has been claimed to be more frequently associated with women.
However, the gender association is controversial as well as its causal explanation. It is
also possible, for instance, that being more intimately familiar with a conflict produces a
switch from a predominant interest in the generalizable aspects of a case to its
particularities.4
The consequence of this "discovery" of the existence of multiple perspectives of a moral
conflict should not be to start playing out "justice", "rights" and "equality" against
"care", "responsibilites" and "particular relationships". Rather, it can serve as a reminder
that there is more than one vision, not just regarding the answers to a given problem,
but also regarding the definition of the underlying conflict and the questions deemed
appropriate to address it.
Assisted Procreation - More than One Central Question
For those familiar with the development of assisted reproductive technologies
(abbreviated "ARTS") it comes as no surprise that the spectrum of applications of invitro fertilization is widening from the treatment of infertility to preventive or selective
purposes. The question if and to what degree such an expansion can be justified is
currently being hotly debated in Germany.5 We shall very roughly outline the major
problem of a focus on the moral status of the human embryo and then sketch some
examples for possible care arguments.
Concerning in-vitro fertilization the Embryo Protection Law prohibits the production
of more than three embryos. Therefore, in Germany it is not possible to further increase
the birth rate and to reduce the chance of multiple pregnancies by producing more
embryos than necessary and implanting only those who have developed best. Similarly,
preimplantation diagnosis is currently not offered to couples who suffer from a genetic
Gilligan, Carol: Moral Orientation and Moral Development. In: Kittay, Eva F., Meyers, Diana T.
(eds.): Women and moral theory. Totowa, NJ: Rowman and Littlefield, 1987, p. 23.
4 "Particularities" need not necessarily refer to the individual or personal level, but can also include the
sociocultural context, e.g. when the introduction of a new technology is being discussed.
5 Together with embryonic stem cell research preimplantation diagnosis was the "big issue" discussed at
the Berlin meeting on reproductive medicine mentioned above.
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disease and would like to use assisted reproduction in order to prevent the birth of an
afflicted child instead of prenatal diagnosis and abortion.6
Both strategies would entail producing embryos that are not implanted and have to be
stored or disposed of and are thus open to manipulation by researchers. To address this
problem, a rights perspective could refer to a gradually increasing protection at the
beginning of life. For several reasons, among others the particular history of Germany,
this option is treated by some with suspicion. Or it could claim an absolute right to life
for the embryo, which would then consequently lead to a renewed discussion of
abortion and some sort of contraception.7
A care-oriented perspective, on the other hand, would focus on the relationships
involved. One could, for example, underline that the main aim of producing more
embryos than necessary is to help a desired child come into being and reduce the risks
and discomfort for the mother. Another argument, which was also used to legitimate
prenatal diagnosis with consequent abortion in Germany, would stress the relationship
of mother and fetus and concede that the mother as the person who would be mainly
responsible for the care may feel physically or psychologically unable to bear the
consequences of a pregnancy. But still another care argument might point to the burden
on the parents who would have to choose from their embryos or might feel pressured
to let some one else do research with the ones that were not selected.
Evidently a "care perspective"can work in different argumentative directions and would
not automatically imply any decisions in terms of content. But it might change the usual
priority of questions and arguments: From a "care perspective", the nature of
relationship becomes a central concern. What do they look like under which
circumstances, which responsibilities do the entail? Which relationships can be freely
chosen resp. rejected, and for what reason? Another important aspect would be the
suffering involved, on all sides of the conflict. What ways are there to prevent or
minimize the suffering? How can compromises be justified? The care aspect would
The legal status of Preimplantation Genetic Diagnosis in Germany is not clear. It hinges on the question
if the cells used for diagnostic purposes are still totipotent or not. But all we can know about the
totipotence of human embryonic cells we can find out only by doing research on the embryo. So in
Germany we find ourselves in the paradox situation that the criterion to prohibit research on embryonic
cells (or diagnosis with the consecutive death of the cell) can only be specified by doing what is
prohibited.
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finally try to identify vulnerable groups, whose concerns are easily marginalized and
strive to help their voice to be heard.
However, a "care perspective" should not strive to replace or superseed a rightsoriented argumentation. Both are in need of mutual correction. Also, they do have
important common goals: a transparent dialogue, which does not instrumentalize
arguments or groups, and the serious reflection, not instantaneous delegitimization of
contrary positions. Whereas law may be in need of clear-cut solution, the participants in
the preceeding debate in the public, academic and political arena can take the liberty to
acknowledge the existence of various perspective and to gain by listening closely to the
ideas of the other.
In many respects, the recent conference of the Ministry of Health in Berlin has shown
promising signs that such a discourse is in fact feasible in Germany. And it is going to
be facilitated further if we do not insist on solving or determining the question of the
moral status of the human embryo first and foremost, deducting all other moral
consequences. Questioning that takes into account the intricate web of relationships and
responsibilities in which we all find ourselves will perhaps be more cumbersome and
less clear. But it will present a fuller, richer, and more satisfying debate.
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Devices preventing the fertilized egg from implantation in the uterus.
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