Correspondence
The Politics of Human-Embryo Research
N Engl J Med 1996; 335:1243-1245October 17, 1996
- Article
To the Editor:
As members of the Human Embryo Research Panel of the National Institutes of Health (NIH), we wish to correct what we believe are misrepresentations of the panel's report in the article about human-embryo research by Annas et al. (May 16 issue).1
First, it is not the case that in the panel's report2 the treatment of the moral status of the early embryo represented “a bald political compromise on a moral issue.” Unlike virtually every other national group reporting on embryo research (including Britain's Warnock Committee and the Canadian Royal Commission on New Reproductive Technologies), the NIH panel did not base its recommendations on a consensus of views, but instead put forth a reasoned moral argument for its position. Annas et al. do not describe that argument accurately. The report itself should be read.
Second, it is not true that the panel is guilty of “ignoring the interests of those whose gametes make the embryos” used in research. An entire chapter of the report is devoted to establishing strict guidelines for procuring fully informed consent from gamete and embryo donors. However, respecting the rights of donors is not the same thing as holding that embryo research must always be tied to parents' procreative intentions, as Annas et al. insist. Such a tie would limit the use of embryos in research to embryos remaining from previous infertility procedures and would restrict the use of these embryos to fertility-related research. Because we recognized that some people might wish to donate gametes or embryos for broader purposes, including research on birth defects and childhood cancers, we refused to restrict the scope of research or individual consent so narrowly.
Finally, it is altogether misleading to suggest that the report's permission for the development of embryos for research purposes extended to making embryos available for toxicity testing or commercial sale. The panel would permit the development of research embryos only in those cases in which fertilization was a necessary end point of critically important research or such embryos were needed for the validity of a study with potentially outstanding scientific and therapeutic value. We would explicitly prohibit fertilization of ova for “routine purposes such as toxicology studies” and impose a strict ban on the sale of gametes or embryos for research purposes.
2 ReferencesRonald M. Green, Ph.D.
Dartmouth College, Hanover, NH 03755Carol A. Tauer, Ph.D.
College of St. Catherine, St. Paul, MN 55105John J. Eppig, Ph.D.
The Jackson Laboratory, Bar Harbor, ME 046091
Annas GJ ,Caplan A ,Elias S . The politics of human-embryo research -- avoiding ethical gridlock. N Engl J Med 1996;334:1329-1332
Full Text | Web of Science | Medline2
Report of the Human Embryo Research Panel. Bethesda, Md.: National Institutes of Health, September 27, 1994.
To the Editor:
In the article by Annas et al., the sole focus on infertility research with spare embryos was shortsighted. Except for a mention of preimplantation genetic diagnosis, genetic research was ignored. A panel appointed by the NIH director to evaluate the agency's investment in gene therapy recommended more research on the mechanisms of pathogenesis.1 Ultimately, human-embryo research will be necessary for a scientific understanding of the causation and natural history of certain genetic diseases.
It is likely that animal research will lay the necessary foundation and open up ways to study genetic events occurring in human embryos made from gametes donated by parents at increased risk for transmitting such genetic diseases to their offspring. Experiments comparing mechanisms in the abnormal embryo with those in the normal embryo may yield knowledge that will lead to treatments, including in utero gene therapy. Without such knowledge, in utero gene therapy will be a shot in the dark.
Society's investment in the Human Genome Project and gene therapy is on a collision course with the reluctance to take a step in moral evolution and make embryos for research when, and only when, there is a sound scientific case and a strong link to the relief of human suffering.
1 ReferencesJohn C. Fletcher, Ph.D.
Peter Waldron, M.D.
University of Virginia School of Medicine, Charlottesville, VA 22908Author/Editor Response
The authors reply:
To the Editor: The report of the Human Embryo Research Panel of the NIH was a missed opportunity to obtain federal funding for embryo research. Because the panel failed to provide a persuasive moral argument for manufacturing embryos specifically for research use and made no serious attempt to justify research on spare embryos, its approach was rejected not only by the Republican Congress but also by President Bill Clinton himself. In our article, we suggested a way to avoid this “ethical gridlock” by developing a moral framework for embryo research that would withstand the passions of abortion politics. The correspondents do not challenge any of the basic points we made. Fletcher and Waldron wish we did not have to begin with a “sole focus on infertility research with spare embryos” but do not disagree that this may be the only politically feasible approach. The members of the NIH panel seem to think that we misread their report and that a reading of it by others will demonstrate our mistakes. The problem, however, is not that we (and the President, the Congress, and the NIH director) misread their report but rather that we all understood it only too well. Its core failure was even articulated in the report itself, in the perceptive separate opinion of the panel's policy cochair, Patricia King.
Green et al. make three points, none of which can withstand scrutiny. The first is that the panel did not rely on consensus, as did previous panels, but instead relied on a “reasoned moral argument.” If what they mean is that their votes on issues were recorded not numerically but descriptively, this is true. The Warnock Committee (the U.K. Committee of Inquiry into Human Fertilization and Embryology, which issued a report in 1984) voted nine to seven to permit the creation of embryos for research purposes. But this is a difference without a distinction. The following phrases are used in the NIH panel report to describe its voting: “narrow majority,” “bare majority,” “not unanimous,” “clear majority,” “overwhelmingly concluded,” and “unanimously opposes.”1 The second point made by Green et al. seems to be that they actually did consider the moral framework we suggested because it required the consent of the gamete donors for research. But this is the problem. For although consent is a necessary precondition for ethical research, it is not sufficient. If it were, nothing would prevent gamete donors from consenting to the use of their embryos in toxicity testing or consenting to their sale — two uses the panel explicitly prohibits. Their third point — that we suggested the opposite — is simply false; in describing the panel's conclusions, we stated unequivocally that the panel recommended “that no gametes or embryos be purchased or sold for use in research.” As we stated, “Obtaining consent is not enough. A new framework — one that takes relationships seriously — is essential.”
1 ReferencesGeorge J. Annas, J.D., M.P.H.
Boston University Schools of Medicine and Public Health, Boston, MA 02118Arthur Caplan, Ph.D.
University of Pennsylvania Center for Bioethics, Philadelphia, PA 19104Sherman Elias, M.D.
Baylor College of Medicine, Houston, TX 77030
