Medical and Scientific Ethics

 

 

CMDA Position Statement on Eugenics and Genetic Enhancement:

Eugenics has historically been the effort to improve the inheritable qualities of a race or species. Traditionally eugenics has been practiced through the use of selective breeding, but it is now moving toward direct manipulation of the genome. Advances in molecular genetics that make this possible are also leading to a resurgence of the eugenics move-ment. This is emerging as the science of directly treating or eliminating undesirable in-heritable characteristics and as the quest for individual human enhancement.

History

The word, eugenics, was coined in 1883 by Charles Darwin’s cousin, Francis Galton, a biologist who used statistical correlations to study the inheritance of intelligence. The term was built out of the Greek Eu (good) and Genics (in birth).

Eugenics has a sordid history. During the late 19th and early 20th centuries in America, and especially in Nazi Germany, eugenics promoted the practice of eliminating human life and races judged to be “inferior.” While eugenics may initially appear attractive, it has by its very nature always led to morally repugnant consequences involving broad facets of society.* Therefore, we are concerned that the modern practices of eugenics will repeat history. The increased power of modern technology demands increased vigilance.

Goals

CMDA affirms the primary goals of medicine – the treatment and prevention of disease and the reduction of suffering, whenever possible, by legitimate and moral means.

• CMDA supports the effort to understand our genetic code for purposes of increasing knowledge, treating disease, and bettering the human condition.
• CMDA opposes the use of any genetic manipulation that has an unacceptable risk of harm to any human being.

Screening

Mapping the human genome has been a significant aid in the identification and possible treatment of genetically determined diseases. Like all powerful information it can be used for good or for ill. **

• CMDA endorses ethical efforts to increase the scope and accuracy of science used to identify, understand, and treat human genetic diseases.
• It should not be mandatory that persons be genetically screened, be made to know their own genetic information, or be required to act upon that knowledge.
• In this context, no person’s genetic information should be used against him or her.

Determinism

We oppose the concept of genetic determinism, that we are our genome or that genes are destiny. Humanity’s prospects for the future will be enormously impoverished if its outlook is limited to its own perceived genetics.

Morals

The application of genetic knowledge for eugenic agendas is unequivocally problematic.

• The goals of modern genetics must be sought within the limits of moral boundaries and qualifications. Medicine, and therefore genetics, must be practiced according to principles of ethical behavior delineated by conscience under the authority of Scripture.
• When an undesired trait or gender is identified by pre-implantation or prenatal screening the discovery is often followed by destruction of the human life exhibiting the undesired trait. CMDA opposes destruction of human life for eugenic purposes. This includes the destruction of embryos, abortion, infanticide and genocide.

Genetic Intolerance

Society, while advocating tolerance, has become increasingly intolerant of any “defective” human life. Our society exerts increasing pressure on parents to neither accept nor bring to birth a child perceived as defective. This intolerance violates the sanctity of human life.

• We must not deem inferior anyone with a “defective” genetic heritage. We recognize that all persons, no matter how normal in appearance, carry defective genetic information within their genome, and that all human physical life is defective to some degree and with certainty becomes more so with aging.
• There are no superior or inferior racial groups. Any efforts to create or eliminate perceived superior or inferior individuals are to be condemned. Similarly, there is no superior or inferior gender. There are no “lives unworthy of life.”***
• Continued improvements in genetic diagnosis sharpen the dichotomy between those who “have” a good genetic endowment and those who “have not.” With the possible advent of genetic enhancement this dichotomy will increase.
• Far more serious and damaging than our genetic deficiencies are our moral deficiencies. Intolerance of those deemed genetically inferior is an example of this moral deficiency.

Safety

Although the use of somatic and germ cell genetic therapy**** has the potential to correct genetically determined disease, there are significant concerns regarding the safety of genetic therapy, particularly germ line therapy.

• Somatic cell therapy: If critical concerns regarding the safety of somatic cell therapy can be resolved, the use of somatic cell therapy may be acceptable for correcting genetically determined diseases.
• Germ cell therapy: CMDA believes that germ cell genetic therapy is unacceptable - at least until safety issues are resolved. The use of germ cell therapy is more problematic due to the transmission of any changes to future generations. Safety issues are magnified in this instance since changes not only affect the patient but future descendants. Even if safety issues are resolved, germ cell therapy still raises significant moral issues, e.g., the impossibility of obtaining consent from those yet to be born.

Genetic Enhancement

The practice of genetic alteration evokes deeper concerns on a more fundamental level. The prospect of using genetic technology to enhance human characteristics is now a theoretical possibility. CMDA recognizes that the distinctions between treatment and enhancement are difficult to discern and are arbitrary in many cases. As Christians, we hold that all humans are made in the image of God. This essential characteristic disting-uishes us as human. The goal to recreate man in man’s image raises profound questions about human nature and man’s relationship with his Creator. The ultimate end of man is to glorify God; the re-creation of man to glorify himself is idolatry.

Conclusion

CMDA considers genetic research and therapy to potentially be of great benefit to humanity. We endorse the effort to make progress in this field. We diminish our own prospects both individually and communally if we refuse to work for scientific advancement. However, we must build moral safeguards around our technology. We must accept, learn from, and care for those who are vulnerable and suffering.

CMDA Position Statement on Genetic Information and Manipulation

As genetic knowledge increases and technologies to manipulate genes become more powerful, our need for wisdom in application intensifies. In regard to human genetics in particular, the conditions that allow for hubris call for an even greater measure of humility.

As Christian healthcare professionals, we affirm that:

• All human beings have been individually created through the providential interest and design of Almighty God. Being created in the image of God, every human being has inestimable worth, regardless of genotype or phenotype (see CMDA statement on the Human Life: Its Moral Worth).
• The diversity of individuals is part of the wonder and strength of God's sovereign design.
• Each human life is a composite of genetic, environmental, historical, social, volitional, and spiritual factors.
• God has endowed humans with minds capable of exploring, but only partially understanding, the magnificence and intricacies of His Creation. Human knowledge and wisdom are limited and may be used for evil or for good.
• God has mandated responsible stewardship of Creation, both of ourselves and of the surrounding world.

Therefore, in regard to genetic technologies in medicine, CMDA believes:

• The presence of a disability, either inherited or acquired, does not detract from a person's intrinsic worth.
• Fallen humanity lacks the wisdom and moral restraint necessary to take control of human genetic destiny.

CMDA supports:

• The use of genetic information in guiding the care of patients.
• Strict confidentiality of an individual's genetic information, as for all personal health information.
• Healthcare professionals informing the patient with a genetic diagnosis of potential familial risk and encouraging the patient to share information about heritability risk with family members.
• Somatic cell manipulation (excluding somatic cell nuclear transfer, i.e., human cloning) to replace absent or defective genes, as this is consistent with the goals of medicine and may be good stewardship of knowledge. Such manipulation should be performed only after extensive study demonstrates the specificity, benefits, and risks of these interventions, or as part of an approved clinical trial.
• The scientific exploration of life, including its genetic foundation, as this is proper and consistent with God's mandate and humanity's created nature, but it must be conducted within the constraints of biblical principles in order to conform with God's design for human flourishing.
• Genetic testing of minors (embryos, fetuses, children), provided the result could potientially benefit them prior to majority. Because a minor is unable to give informed consent, presymptomatic testing of a minor should not be performed for disorders that will not either affect his or her health until after majority or lead to therapeutic intervention before majority.

CMDA opposes:

• The search for and use of genetic information to justify destroying an existing human life, born or unborn, for example, as has occurred with Down syndrome.
• The use of genetic information for positive or negative discriminatory purposes, including sex selection of human embryos, or infringement upon the right to procreate (see CMDA statement on Eugenics and Enhancement).
• The use of a patient's genetic information for societal benefit if such use could potentially harm that individual.
• The reductionist belief that humans and their behavior are simply the product of their genetic destiny.

CMDA is especially concerned about heritable germline or embryo manipulations, as these technologies carry a higher risk of harm and abuse than somatic cell manipulations. First, there is the potential that any errors will be transmitted to future generations. Second, germline manipulations will affect the individual for the remainder of his or her life, whereas some somatic manipulations will be self-limited in duration. Third, the proposed and desired uses of germline technologies are fraught with the strong probability of selfish, narcissistic, and eugenic goals, commodifying offspring, supporting the false concept of genetic reductionism, increasing discrimination and intolerance of the disabled, and increasing the number of early human lives being conceived, then destroyed.

While, in concept, specific single disease-producing mutations could be corrected early in life, which could be consistent with the proper goals of medicine, this process would necessarily alter the germline. Development of germline manipulation technology would irreversibly open the door to proportionately greater harms. This concern is not merely hypothetical. The proven record of maleficence by some scientists, physicians, governments, bioethicists, and social engineers in the historical record and in contemporary experience demonstrates contempt for appropriate ethical boundaries and guidelines.

In conclusion, CMDA opposes:

• All forms of human germline manipulation; these should remain prohibited.
• The use of genetic manipulation to augment human attributes (see CMDA statement on Human Enhancement).
• The deliberate use of genetic manipulation to disable or kill.

In deciding how to apply genetic knowledge in medicine, we should prayerfully seek God’s wisdom and guidance, for He is the Author of the genetic code and the Creator and Redeemer of humankind.

CMDA Position Statement on Cloning:

As Christian physicians and dentists, we believe that human life is sacred because each individual is made by God in His own image. God's design is that each individual is formed by the union of genetic material from a husband and wife. We further believe that the family is the basic social unit designed by God to receive and nurture new human life.

There are moral reasons to refrain from proceeding with human cloning.

First and foremost, the development of this technology will require the deliberate sacrifice of human embryos. We believe this to be immoral. The use of human life merely as a means to an end is likewise morally unacceptable. Another moral concern is the question of the timing and significance of ensoulment. Furthermore, cloning may deviate from the wisdom of God's design for human genetic diversity and therefore may be unwise.

There are scientific reasons to oppose human cloning such as the potential for mutation, transmission of mitochondrial diseases, and the negative effects from the aging genetic material. There are also societal reasons to be hesitant about human cloning such as questions about parentage, lineage, family structure and the uniqueness of the individual.

Therefore, we believe that human cloning should not be pursued given our current understanding and knowledge. We affirm the need for continued moral scrutiny as research on animal cloning proceeds and proposals for the application of this technology to humans are advanced.

 

CMDA Position Statement on Immunization:

Personal Safety and Public Health

Since the pioneering work of Edward Jenner and others in developing a vaccination for smallpox over 200 years ago, immunization has been of great benefit to individuals as well as the public. Immunization practices have prevented outbreaks of communicable diseases and resultant deaths or disability and continue to prevent an ever-increasing variety of illnesses.

The immunization process is based on safely activating the body’s own defense system against a specific disease. As with other medical treatments, it carries a small but real risk of an adverse reaction.

CMDA agrees with current medical opinion that immunizations are of great benefit to the individual and society. The decision to immunize an individual relies on the similar decision-making process used for that of any other medical treatment.

CMDA recognizes that immunization benefits society by protecting public health and that individual members of society have some reciprocal obligations to the society in which they live.

CMDA acknowledges the right of an individual to refuse immunization except in extraordinary public health circumstances. This decision may be motivated by moral or religious convictions, known risk, misinformation or fear. The Christian community needs to base its decisions on accurate information. Those who model their lives in imitation of Christ should reflect on their obligation to take personal risk for the good of others.

CMDA supports the current scientific literature that validates the general practice of immunization as a safe, effective, and recommended procedure.

Immunization and Potential for Moral Complicity with Evil

The use of medical information and technology obtained through immoral means raises concerns about moral complicity with evil*. Some currently available vaccines were developed using tissue from aborted fetuses, while others use technology or knowledge acquired from the use of aborted fetuses. We need to consider carefully whether it is morally permissible to benefit from knowledge or technology obtained from the intentional destruction of human life.

We attempt to determine whether our participation is appropriately distanced or inappropriately complicit by consideration of the medical facts and of our conscience as informed by the revealed Word of God.

CMDA provides the following examples to help determine whether it is permissible to manufacture, administer or receive a specific vaccine:

• Using technology that was developed without any intentional destruction of human life or other evil is morally ideal. Most vaccines in use to date fall into this category.
• Using technology developed from tissue of an intentionally aborted fetus, but without continuing the cell line from that fetus, may be morally acceptable.
• Continued use of a cell line developed from an intentionally aborted fetus poses moral questions and must be decided as a matter of conscience, weighing the clear moral obligation to protect the health of our families and society against the risk of complicity with evil.
• Using a vaccine that requires the continued destruction of human life is morally unacceptable.

CMDA encourages the use of and endorses the further development of medically effective and ethically permissible alternatives that do not raise the question of moral complicity.