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The most interesting moment in President Obama's Tuesday night press conference is something you won't pick up from the transcript. You have to watch the video. Forty-six minutes in, John Ward of the Washington Times asks Obama about stem cells. Obama replies:
[I]t is very important for us to have strong moral guidelines, ethical guidelines, when it comes to stem cell research or anything that touches on, you know, the issues of possible cloning or issues related to, you know, the human life sciences. I think those issues are all critical, and I've said so before. I wrestle with it on stem cell; I wrestle with it on issues like abortion.
What the transcript doesn't convey is that after saying "anything that touches on," it takes Obama a full 15 seconds of stumbling, stalling, and groping before he finds the phrase "human life sciences."
Obama, unlike President Bush, knows his way around the English language. He doesn't stumble, stall, or grope for lack of words. He does it because he was about to say something but decided not to say it. The giveaway here is that he eventually settles on the phrase "human life sciences," which I've never heard before from a politician. Supporters of embryonic stem-cell research talk about "life sciences." Opponents talk about "human life." Neither side likes to focus on the other's magic word: human for pro-lifers or sciences for research proponents.
I think Obama settled on "human life sciences" because he was originally going to say "anything that touches on human life." And he decided at the last minute that he'd better not say that, because that would buy into the other side's framing of the issue and get him into trouble. The human-life frame, planted by Ward, was clearly in Obama's head, as evidenced by his next sentence: "I wrestle with it on stem cell; I wrestle with it on issues like abortion." But strategically, you're not supposed to accept the other side's frame. Once you group stem-cell research with abortion, you're giving away the fight. You're supposed to group stem-cell research with the Bush administration's deceptions about abstinence and global warming. It's all part of the "Republican war on science." So, after his 15 seconds of groping, Obama splits the difference and comes up with the phrase "human life sciences."
We saw the same thing two weeks ago, when Obama lifted the ban on federal funding of stem-cell research using destroyed human embryos. Most research proponents, including his own aides, stuck to the "science" message and didn't mention moral objections. But Obama did mention them. His remarks sounded a lot like what he has said about abortion and other social issues: acknowledging moral disagreement while striving for consensus or at least compromise.
On Tuesday, after Obama's initial answer, Ward asked a follow-up: "Do you think that scientific consensus is enough to tell us what we can and cannot do?" Obama replied: "No. I think there's—there's always an ethical and a moral element that has to be—be a part of this."
Obama, like the rest of us, is grappling with how to think about biotechnology. We're all familiar with social, financial, public-safety, and health-care issues. But this is a new kind of issue: It's moral, economic, and life-and-death. To some of us, it's about life sciences. To others, it's about embryonic human life. It took Obama 15 seconds to put the two perspectives together in words. If it takes him eight years to put them together in practice, that'll be one hell of an achievement.
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Yesterday I wrote about an awful story in California. A number of couples hired gestational surrogates through a fertility brokerage. They were directed to put money in trust accounts to pay the surrogates throughout their pregnancies. Now the money is gone. Andy Vorzimer, an attorney involved in the case, told the New York Times, "We've got couples in the midst of pregnancies with no ability to pay the surrogate." I ended the piece this way:
I hope the women carrying these pregnancies will see them through, even if the company that hired them doesn't. But that financial burden shouldn't fall on them alone. Here's the contact page for an attorney working the case. If you'd like to prevent abortions, help pregnant women, and facilitate reproductive choice at the same time, now's your chance.
Yesterday evening, Vorzimer sent me an e-mail to clarify the situation:
The article has obviously resonated with your readers as my inbox has been flooded with concerned people offering to donate funds so as to avoid possible abortions. I am happy to inform you that there are no situations in which a surrogate has elected to abort because of this financial scandal. While many of the surrogates will not be reimbursed for their out-of-pocket expenses lost wages or even have their medical bills paid, every single one of them has committed to moving forward.
That's great news. I'm impressed with the surrogates. I'm also impressed with all of you who contacted Vorzimer and offered your support so they wouldn't have to end their pregnancies. Pro-lifers are often accused of moralizing and interfering but not helping. You disproved the caricature. And I hope you'll stand by your offers even if no abortions are at stake.
In recent days, I've had a few curious exchanges with friends, readers, and bloggers who wonder why I keep writing about this stuff: abortions, pregnancies, IVF, surrogates—what some of my critics jokingly call "lady parts." What's my agenda? Do I have a problem with women controlling their bodies? Am I a frontman for the religious right, a useful idiot who pretends that compromise on these issues is possible when, in fact, it isn't? Even Vorzimer, in a tweet posted on his blog, initially responded to my article by remarking, "The lengths (or depths) abortion foes will go to make a point."
Vorzimer and I have had some back and forth since then, so we've come to understand each other better. But the misunderstanding was my fault, not his. I need to do a better job of explaining myself.
This may sound strange, but I don't consider myself a real abortion foe. I have friends and sparring partners who think abortions should be illegal or at least heavily restricted. To me, that's the chief dividing line in the debate. I don't feel comfortable crossing that line. I don't think a regime of abortion restrictions enacted in the name of life would make this world a better place. I think it would cause a mess—hypocrisy, deceit, interrogations, amateur home surgery, moral crudity backed by the force of law—as ugly as any war fought in the name of peace.
I don't equate abortion with murder. I don't even think it's the worst option available to a woman facing unintended pregnancy. Every abortion dilemma is different, because every situation is different. The person best situated to make the right decision is the pregnant woman. A few years ago, I wrote a whole book on this point.
So why do I keep bringing up abortion as a moral problem? Because it is a moral problem. It's the destruction of a developing human being. For that reason, the less we do it, the better. When I say abortion is bad, I'm not saying it's necessarily worse than bringing a child into the world in lousy circumstances. I'm saying it's worse than avoiding unintended pregnancy in the first place. That's why I keep pushing contraception. If you cause an unintended pregnancy and an abortion because you didn't want to wear a condom, you should be ashamed.
But that's the conventional life/choice debate. The reason I keep you posted on developments in IVF, surrogates, and embryo screening is that they're transforming the debate. They're changing the conditions on which our moral positions rely. Were you pro-choice because the embryo was in a woman? Now we have embryos in dishes. Did you support embryo screening for fatal diseases? Now we're talking about screening embryos for eye color. Does the value of an embryo depend on what its mother thinks? Now we have embryos with two mothers: a genetic one and a gestational one. Should they at least consult each other?
I got into this field because the moral questions are enduring but the facts are always changing. Technology is transforming culture. And I write about the value of unborn life because that's the problem my fellow pro-choicers don't like to talk about. I want to challenge you. Keeping the government out of these sticky moral questions doesn't make them go away. It just puts the burden on you to face them responsibly.
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What if you delivered the money to a broker, and the broker lost, stole, or squandered it? You did your part, but the surrogate is no longer being paid. And she has every legal right to end the pregnancy.
That's the scenario unfolding in California.
More here.
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Remember that bill in Georgia to restrict in vitro fertilization? The Associated Press thought it was dead. Surprise! The Georgia Senate revised it and passed it a week ago.
The bill is part of a nationwide project to regulate the emerging industry of embryo production. In one state or another—and then another and another—legislation will be filed to restrict IVF. The battles will be fought over which uses of preimplantation genetic diagnosis are acceptable. And these fights will be every bit as ugly as the preceding fights over abortion.
More here.
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Would you abort a fetus just because it wasn't yours?
The scary scenario is the one you never expect: going through IVF and discovering, weeks into your pregnancy, that your doctor put the wrong embryo in your womb.
If you think this can't happen, I have bad news: It just did.
More here.
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Two arguments have persuaded the United States to fund stem-cell research using destroyed embryos. One is that the research will save lives. The other is that the embryos, left over from fertility treatments, will otherwise be wasted.
Both arguments are now being applied to fetuses.
More here.
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Is President Obama's decision to fund embryo-destructive stem-cell research purely scientific? Or is it also moral?
I say it's moral. So do two thinkers from opposite ends of the political spectrum. At the Hastings Center's Bioethics Forum, Daniel Callahan, a cofounder of the center, points out that supporters of stem-cell research have been wrong
to conflate opposition to stem cell research and a variety of other actions by the Bush administration. That administration was guilty of manipulating, or suppressing, scientific information on a wide range of issues, including global warming and sex education. I call that behavior patently anti-science as well as a misuse of government power. But its stem cell opposition did not encompass any distortion of the science of such research. That is not how it argued its case.
Meanwhile, in the Washington Post, Yuval Levin, a former executive director of Bush's bioethics council, argues that
science policy is not just a matter of science. Like all policy, it calls for a balancing of priorities and concerns, and it requires a judgment of needs and values that in a democracy we trust to our elected officials. ... To distort or hide unwelcome facts is surely illegitimate. But to weigh facts against societal priorities—economic, political and ethical—in making decisions is the very definition of policymakers' duty.
One reason I like these two guys is that they're clear-eyed critics of spin and self-delusion, even when the spin and delusion are coming from their own allies. On the relationship between science and politics, I particularly recommend Levin's new book, Imagining the Future: Science and American Democracy. He's right that Obama's decision doesn't moot or end the debate about using embryos. So let's honor that debate by continuing it.
Levin quotes President Kennedy, who said that many modern problems require
very sophisticated judgments which do not lend themselves to the great sort of 'passionate movements' which have stirred this country so often in the past. Now they deal with questions which are beyond the comprehension of most men.
Against this "technocratic temptation," Levin argues for democratic oversight. In principle, I agree. But the comments I've received from readers about Obama's stem-cell decision worry me. Many people on both sides seem ill-informed or self-deluded about basic scientific questions. Liberals are denying the simple fact that human embryos are the beginnings of people. Conservatives are pretending that adult stem cells are more powerful than embryonic ones. If ordinary people want to govern science policy, they need to educate themselves so they can govern well.
(By the way: To all of you who protested that torture is different from stem-cell harvesting: Of course it is. That's the nature of comparisons: The things being compared differ in many respects. The similarity in this case is that on both issues, moral objections are being dismissed as interference in a purely technical question of saving lives. That, not the merits of stem-cell research, was the point of the article.)
Second, Levin writes that in announcing his decision on Monday, Obama "argued that to deny free rein to stem cell science is to ignore and reject the promise of science as such." The president "pledged that his administration would ‘make scientific decisions based on facts, not ideology,'" and his executive order "omits any mention of ethical debate."
I think what happened Monday is more complicated than that. Based on the spin that came out of the administration over the weekend, I expected Obama to make exactly the argument Levin describes. But he didn't. Among other things, Obama said:
Many thoughtful and decent people are conflicted about, or strongly oppose, this research. I understand their concerns, and we must respect their point of view. But after much discussion, debate and reflection, the proper course has become clear. The majority of Americans ... have come to a consensus that we should pursue this research. That the potential it offers is great, and with proper guidelines and strict oversight, the perils can be avoided.
And:
I can also promise that we will never undertake this research lightly. We will support it only when it is both scientifically worthy and responsibly conducted. We will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.
Levin is right about Obama invoking facts over ideology. But that was in the context of Obama's memorandum on scientific issues generally.
It looks to me as though the administration hasn't resolved how it's going to treat these issues. The mentality Levin describes—burying moral objections and portraying embryo research as just another case of Bush's "war on science"—pervades most of the spin coming out of the White House and its feeder institution, the Center for American Progress. That's why the White House paired the stem-cell order with the announcement on restoring scientific integrity. But for some reason, Obama himself isn't entirely playing along. His remarks on Monday sounded a lot like what he has said about abortion and other social issues: acknowledging moral disagreement while striving for consensus or at least compromise. I think the administration is unresolved, and we should encourage it to acknowledge and grapple with the moral questions.
Third, Levin describes the moral question this way:
If (as modern biology informs us) conception initiates a human life, and if (as the Declaration of Independence asserts) every human life is equally deserving of some minimal protections, government support for the destruction of human embryos for research raises profound moral problems.
I cringe at this interpretation of the Declaration. Levin believes that equality means a 5-day-old embryo has the same right to life as a 5-year-old girl. I just can't buy that. I'm a gradualist. I value the 5-day-old embryo because it's on its way to becoming the 5-year-old girl. But it's not there yet. It hasn't acquired the sentience and cognition that characterize a full-fledged human being.
The Declaration says we're created with an unalienable right to liberty as well as life. But that hasn't stopped us from regulating liberties in proportion to maturity, as we do, for example, with curfews and driving. Why can't we exercise the same discretion with respect to life? Yes, life is a more basic right. But maybe that just means that instead of drawing lines after birth, as we do with liberty, we should confine our line-drawing about life to the period before birth.
Slippery slopes run both ways. Let's call that Human Nature's second law. If we don't draw moral lines against the exploitation of embryos, we may end up obliterating respect for human life generally. But if we're so afraid of that prospect that we refuse to draw lines permitting the use of any embryos under any conditions, we may end up obliterating the moral difference between embryos and full-grown people. Liberals should think seriously about the first scenario. Conservatives should think just as seriously about the second.
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The same Bush-Rove tactics are being used today in the stem-cell fight. But they're not coming from the right. They're coming from the left. Proponents of embryo research are insisting that because we're in a life-and-death struggle—in this case, a scientific struggle—anyone who impedes that struggle by renouncing effective tools is irrational and irresponsible. The war on disease is like the war on terror: Either you're with science, or you're against it.
More here.
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Thanks to the octuplets mom and legislative attempts to harness the backlash against her, a political framework for fighting about in vitro fertilization is beginning to take shape. This is a new issue for most of us. Here's an attempt to start making sense of who's proposing what.
You don't often get to see a new issue form before your eyes. It's kind of like the formation of a constellation. There's a big explosion, stuff flies in all directions, and gradually the pieces begin to align in relation to one another. That's what the biotech explosion is doing to politics right now. IVF regulation is one of the constellations taking shape. Let's take a look at who the players are and what they're after.
The initial battle that has brought them together is the fight over Georgia Senate Bill 169, which I wrote about Wednesday ("Crocktuplets"). On Thursday, the bill was sent to a subcommittee. The Associated Press says the bill is dead. The Los Angeles Times says it could survive in some form if a compromise is worked out by Monday.
The bill's sponsor, state Sen. Ralph Hudgens, professes shock that it has become a flashpoint for abortion politics. "There is nothing in this law to limit abortions. I can't believe that people are reading that into it," he told the Times.
Please. We're not stupid. The bill says:
A living in vitro human embryo is a biological human being who is not the property of any person or entity. The fertility physician and the medical facility that employs the physician owe a high duty of care to the living in vitro human embryo.
And:
Nothing in this article shall be construed to affect conduct relating to abortion as provided in Chapter 12 of Title 16; provided, however, that nothing in this article shall be construed or implied to recognize any independent right to abortion under the laws of this state.
In other words, lawyers have inserted a "this doesn't affect abortion" clause so that Hudgens can claim the bill doesn't affect abortions. And we're supposed to take this seriously, even though the bill makes every embryo a human patient and stipulates that if Roe v. Wade falls, this bill can't be construed to keep abortion legal.
Did I mention that Georgia Right to Life helped Hudgens draft this supposedly abortion-neutral bill? Actually, I did. But I missed the bill's more important source: the Bioethics Defense Fund. BDF, whose self-proclaimed mission is to "address the human rights violations involved in human cloning and embryo research, abortion, and end-of-life," says two of its lawyers flat-out wrote the Georgia bill. The group adds:
BDF is grateful for the consultation and analysis provided by the National Catholic Bioethics Center, who opined that with added conscience protections and with public education on how this legislation limits violations against vulnerable human life, the Georgia bill "could be supported consistent with John Paul II's position on incremental legislation contained in his encyclical Evangelium Vitae."
A statement by Fr. Thomas Berg, L.C., Ph.D., of the Westchester Institute for Ethics and the Human Person concluded that the BDF drafted bill is "an incremental approach aimed at minimizing the harm done [and] is an essential tool for undermining the greater evils in our culture."
I know these people. I spent several days with them at the Vatican four years ago. They're as pro-life as you can get. When they call the Georgia bill an "incremental" approach toward the pope's vision, I assure you that abortion is in the crosshairs.
By the way, BDF proudly quotes a supporter's description of the Georgia bill as "model language" for legislation in other states. So you can expect more Georgia-style bills elsewhere.
That's the pro-life camp. At the other end of the spectrum, we have the American Society for Reproductive Medicine. Sean Tipton, the ASRM's public affairs director, told the Atlanta Journal-Constitution that the Georgia bill "says that decisions about how to treat [infertility] patients will not be made by patients in consultation with their physicians, but by politicians." That line comes straight out of the pro-choice playbook on abortion. It's a categorical indictment of government interference. And politically, it's highly effective.
Much of the muscle against the Georgia bill seems to have come from Resolve, a group whose mission is "to ensure equal access to all family building options for men and women experiencing infertility." Resolve may be emerging as the NARAL of IVF regulation. It says its members pumped thousands of e-mails and letters into Georgia to stop the bill and helped opponents "pack" Thursday's hearing.
In addition to the pro-life and pro-choice camps, at least two hybrid positions are taking shape. One is to broadly regulate the fertility industry, preferably under federal control. This is the agenda of the Center for Genetics and Society. CGS has a complex philosophy that could roughly be described as leftist. Here's its mission statement:
The center supports benign and beneficent medical applications of the new human genetic and reproductive technologies, and opposes those applications that objectify and commodify human life and threaten to divide human society.
The Center works in a context of support for the equitable provision of health technologies domestically and internationally; for women's health and reproductive rights; for the protection of our children; for the rights of the disabled; and for precaution in the use of technologies that could alter the fundamental processes of the natural world.
Basically, CGS is a home for people who don't trust private industry and prefer to regulate it, but from the standpoint of environmentalism, equal access, and women's rights. It's for pro-choicers who are more socialist than libertarian.
CGS wants congressional hearings and federal regulation to address the octuplets case and the fertility industry's lack of oversight. Its agenda is ambitious but unclear in its details. If you have the time, check out its proposal for "Responsible Federal Oversight of the New Human Biotechnologies."
A fourth position is to embrace government intervention but much more modestly. This is the idea behind legislation recently filed in Missouri, which would put some of the fertility industry's voluntary guidelines into law. The ASRM says self-regulation is already preventing octuplets-type abuses. But Missouri state Rep. Rob Schaaf has filed legislation to enforce these limits. Unlike the Georgia bill, Schaaf's bill is short and direct. Its operational text consists of one sentence:
When treating infertility, physicians within the state of Missouri shall not implant more embryos into a human than the current recommendations set forth by the American Society for Reproductive Medicine, or its successor.
Schaaf argues that "it is within the realm of the state to make sure that doctors don't participate in things that are harmful to people." So if you don't trust complex regulatory schemes like the Georgia bill but aren't afraid of government intervention in the fertility industry per se, piecemeal measures like this one may be the way to go.
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Thanks to the eagle-eyed Center for Genetics and Society, I just learned that the fertility company that was advertising eye-, hair-, and skin-color selection in human embryos (which I've provisionally nicknamed Color ID) has dropped the plan, at least for now. Here's the full text of the statement released Monday by the Fertility Institutes:
In response to feedback received related to our plans to introduce preimplantation genetic prediction of eye pigmentation, an internal, self regulatory decision has been made to proceed no further with this project. Though well intended, we remain sensitive to public perception and feel that any benefit the diagnostic studies may offer are far outweighed by the apparent negative societal impacts involved. For those patients with albinism or other ocular pigmentation disorders, we continue to offer preimplantation genetic diagnosis in general but will not be investigating the genetics of pigmentation of any body structures.
It's not clear how long the company's decision "to proceed no further" will last. The statement is titled "Eye and Hair Color Program Suspension."
CGS calls this a mere "postponement" and urges Congress to step in. "Like the financial industry, the fertility industry has shown that it is incapable of regulating itself," the group argues. The Fertility Institutes' announcement of a "self-regulatory decision" to suspend Color ID seems to have been crafted to head off such regulation.
What's really interesting about the statement is the reference to being "sensitive to public perception." I wonder whether that evolving factor—public opinion about aesthetic embryo selection—will determine when the suspension ends.
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Under a Georgia bill, if you're 39, your doctor is forbidden to fertilize more than two of your eggs per treatment cycle. Take all the hormones you can stand, make all the eggs you want, but you get two shots at creating a viable embryo, and that's it.
How does this restriction "protect the mother" and "reduce the risk of complications" for her? It doesn't. ... So why limit the number of embryos created per cycle? Because the bill's chief purpose isn't really to help women. It's to establish legal rights for embryos.
More here.
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An idea passes from one person to another to another, changing shape with every transaction. No one controls the outcome. Everyone in the chain knows what the idea means to him, but no one knows how the idea will turn out.
That's the story of PGD so far. I wonder how it ends.
More here.
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Yesterday we talked about the emergence of embryo screening for eye, hair, and skin color. Scientists are becoming proficient at identifying the relevant genes. A Los Angeles clinic is advertising the service and says customers are beginning to line up.
When the screening starts for real, what will it look like? Would we really select babies based on such superficial criteria?
It's impossible to predict the course of such a revolution with certainty. But we know that 10 percent of couples who seek genetic counseling say they'd screen for traits such as height and athleticism if they could. And we have a loose precedent that illuminates our propensity to tinker with aesthetic traits: dog breeding.
One of my favorite writers, Amy Harmon of the New York Times, explained two years ago why we should study dog breeding before plunging into trait selection in humans:
Free of most of the ethical concerns—and practical difficulties—associated with the practice of eugenics in humans, dog breeders are seizing on new genetic research to exert dominion over the canine gene pool. Companies with names like Vetgen and Healthgene have begun offering dozens of DNA tests to tailor the way dogs look, improve their health and, perhaps soon, enhance their athletic performance. But as dog breeders apply scientific precision to their age-old art, they find that the quest for genetic perfection comes with unforeseen consequences. And with DNA tests on their way for humans, the lessons of intervening in the nature of dogs may ultimately bear as much on us as on our best friends. "We're on the verge of a real radical shift in the way we apply genetics in our society," said Mark Neff, associate director of the veterinary genetics laboratory at the University of California, Davis. "It's better to be first confronted with some of these issues when they concern our pets than when they concern us."
So dog breeding offers cautionary lessons about what trait selection does to its targets. Does it also offer cautionary lessons about what trait selection does to its perpetrators?
Three years ago, I thought so. I argued that dogs were the world's longest self-serving, ecologically reckless genetic experiment, perpetrated by the world's first genetically engineering species: us. So here we are, three years later, turning the experiment on ourselves. What does dog breeding tell us about the culture of aesthetic eugenics?
As it happens, we got a good look at that culture last week, when the Westminster Kennel Club held its annual dog show. The Times' Katie Thomas used the occasion to examine the increasingly efficient practice of breeding dogs from frozen semen. "In 2006, the most recent year for which data is available, frozen semen was used to conceive 760 litters of [American Kennel Club]-approved puppies," she reported. Among other things, "[f]rozen semen has been used for decades by breeders who want to inject a dash of nostalgia into a litter of puppies." The owner of a canine semen bank explained, "One of the reasons people like to use frozen semen is to be able to dip back into a gene pool for a more classic look."
That's what the breeder of one of this year's winners at the dog show did: He made the dog using 25-year-old frozen sperm from a previous champion named Snapper. The breeder "said he had long lamented the decline of pizazz in modern-day poodles, the trademark ‘poodly temperament' that gives them such stage presence in the ring," Thomas reported. "He wondered if Snapper's genes would do the trick and create an exciting show dog."
The good news: The Frankenstein experiment worked. The poodle brought its long-dead sire's "sashay," "balance," and "fluid movement" back to life. It won the show.
The bad news: I want to throw up.
That's what aesthetic trait selection in humans will do to us. It will make our bodies prettier—and our souls uglier.
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Is the era of designer babies finally upon us?
Every week, it seems, we're told that this discovery or that technology might lead to "designer babies." I've heard this so many times that I've stopped taking it seriously. Genetic engineering always turns out to be more complicated than expected, and our latest technology always turns out to be less capable than advertised.
But now trait selection seems to be coming into view for real.
More here.
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Does science support our laws against incest and cousin marriage? If so, does it also support other laws that would restrict sexual or procreative freedom in the name of genetic health?
To longtime readers of Human Nature, this question should be, if you'll pardon the term, familiar. A few years ago, we looked at the science and ethics of "The Love That Dare Not Speak Its Surname." Then we examined the prevalence of inbreeding in nature. Then we considered the awkward question of why, if incest is too genetically risky to permit, maternity in your 40s isn't.
Now biologist Hamish Spencer and political scientist Diane Paul, writing in PLOS Biology, have reviewed the history of U.S. laws against cousin marriage, along with their scientific basis. And again, the evidence raises unsettling implications.
They start with the statistical case against restricting cousin marriages:
[T]he National Society of Genetic Counselors (NSGC) convened a group of experts to review existing studies on risks to offspring and issue recommendations for clinical practice. Their report concluded that the risks of a first-cousin union were generally much smaller than assumed—about 1.7%-2% above the background risk for congenital defects and 4.4% for pre-reproductive mortality—and did not warrant any special preconception testing. In the authors' view, neither the stigma that attaches to such unions in North America nor the laws that bar them were scientifically well-grounded.
But Paul and Spencer point out that the data aren't clear-cut. First, "statistics on the risks associated with cousin marriage are necessarily averages across many traits, and they are likely to be different for different populations." And second, it's
inappropriate to extrapolate findings from largely outbred populations with occasional first-cousin marriages to populations with high coefficients of inbreeding and vice-versa. Standard calculations, such as the commonly cited 3% additional risk, examine a pedigree in which the ancestors (usually grandparents) are assumed to be unrelated. In North America, marriages between consanguineal kin are strongly discouraged. But such an assumption is unwarranted in the case of UK Pakistanis, who have emigrated from a country where such marriage is traditional and for whom it is estimated that roughly 55%-59% of marriages continue to be between first cousins. Thus, the usual risk estimates are misleading: data from the English West Midlands suggest that British Pakistanis account for only ~4.1% of births, but about 33% of the autosomal recessive metabolic errors recorded at birth.
In other words, the American calculations understate the risk for an already inbred population such as British Pakistanis. And calculations based on British Pakistanis overstate the risk for most American cousin couples. You can't draw a uniform line against cousin marriages based on science. Arguably, for the same reasons, you can't draw a uniform line against sibling incest.
The same case can be made against a uniform age of sexual consent. The authors point out,
Beginning in the 1860s, many states passed anti-miscegenation laws, increased the statutory age of marriage, and adopted or expanded medical and mental-capacity restrictions in marriage law. Thus, laws prohibiting cousin marriage were but one aspect of a more general trend to broaden state authority in areas previously considered private.
As Human Nature has noted before, the age of actual maturity varies considerably depending on the person and the type of maturity (sexual, cognitive, emotional) involved. Granted, lawmakers have to draw lines somewhere. But let's not pretend such consistent lines are consistently apt.
Moreover, Paul and Spencer raise a far more troubling problem: The increase in genetic risk caused by cousin marriages among British Pakistanis may actually be overstated, for a curious reason.
[F]or a variety of reasons (including fear that a cousin marriage would result in their being blamed for any birth defects), UK Pakistanis are less likely to use prenatal testing and to terminate pregnancies. Thus the population attributable risk of genetic diseases at birth due to inbreeding may be skewed by prenatal elimination of affected fetuses in non-inbred populations.
In other words, many of the birth defects cited by British politicians as grounds for restricting cousin marriages may actually be the result not of cousin marriage, but of failure to screen and abort defective fetuses. So, in addition to maternity in your 40s, we now have a second logical target for genetic regulation: If inbreeding is too dangerous, what about "inflicting" maladies on your children by failing to screen the embryos? If you know you carry bad genes—and particularly if you're at higher risk of passing down a serious disease than most sibling couples would be—shouldn't we police your procreation just as carefully?
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Should parents go to jail for believing so devoutly in faith healing that they don't seek lifesaving medical treatment for their children?
Leilani and Dale Neumann of Wausau, Wis., will soon find out. Their 11-year-old daughter died of diabetic complications after they relied on prayer rather than doctors to heal her. Now they face trial for reckless endangerment and a potential prison sentence of 25 years. They're the third couple slapped with criminal charges in the last year for failing to seek treatment for a child. In today's New York Times, Dirk Johnson reports:
About 300 children have died in the United States in the last 25 years after medical care was withheld on religious grounds, said Rita Swan, executive director of Children's Health Care Is a Legal Duty ... Criminal codes in 30 states, including Wisconsin, provide some form of protection for practitioners of faith healing in cases of child neglect and other matters ...
Swan lost her own son after failing to seek prompt medical attention. She says she waited, catastrophically, because she thought "once we went to the doctor, we'd be cut off from God." The Neumanns seem to have been under the same impression. Johnson reports that they're "followers of an online faith outreach group" (on the Web here) that includes, among other things, an essay preaching that "Jesus never sent anyone to a doctor or a hospital. Jesus offered healing by one means only! Healing was by faith."
I don't know how the case will turn out. But the more important thing to communicate to parents is that this is bad religion. Science is a way of grappling with what we can know empirically. Religion is a way of grappling with what we can't. Each of these disciplines must recognize its limits and defer, beyond that, to its counterpart. Properly understood, there's nothing unscientific about religion, and there's nothing irreligious about science.
I'm not saying the distinction is perfectly clean. It isn't. Sometimes religion and science have to work together. But it's crucial to ask which kind of question you're facing. Healing is a physical phenomenon. Can faith influence it? Yes. Look at the latest study on acupuncture: It sometimes works, apparently because patients believe in it. But what happens when people pray for your recovery without you knowing about it? Answer: Nothing. Belief, not God, is the medically salient factor.
That's how science, at its best, works with religion. It doesn't claim to disprove God's existence. It can't. It addresses only empirically testable ideas, including faith healing. And it reports whatever its methods find. Instead of laughing at acupuncture, it looks at the evidence, admits that acupuncture sometimes works, and tries to figure out why.
Religion, at its best, needs the same humility. God isn't stupid. He doesn't give you a hammer and insist that you bang nails with your head. If this is his world, then so are the tools he has given you: doctors, medicine, and your brain. In the time of Jesus, most people died in childhood. Do you want to go back to that? Do you think that those deaths were God's will—but that today's long lives, made possible by modern medicine, aren't?
As medicine advances, difficult moral questions will arise. If failure to seek available treatment is reckless endangerment, what happens when the available treatment comes, for example, from destroying embryos to get stem cells? Can you be jailed for refusing to give your daughter treatment that's based on what you regard as killing? Or take embryo screening: Already, it has advanced to the point where parents who make babies the old-fashioned way, with all its risks, are seen as "inflicting" genetic maladies on their kids.
But taking your gravely ill child to the doctor isn't one of those tough calls. God doesn't hate doctors. He made them. Want to show your faith? Use what he gave you.
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First, we said IVF embryos weren't pregnancies. That's technically correct: Pregnancy begins when the embryo implants in the womb. Then we called early embryos "pre-embryos" so we could dismantle them to get stem cells. That was technically incorrect, but we did it because it made us feel better. Now we're adjusting the word conception. Henceforth, testing of IVF embryos to decide which will live or die is "preconception." Don't fret about the six eggs we fertilized, rejected, and flushed in selecting this baby. They were never really conceived. In fact, they weren't embryos. According to Serhal, each was just "an affected cluster of cells."
More here.
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I'm just back from vacation and trying to catch up on the war in Gaza. More on that later. But first, something I didn't have a chance to get to before the break: the Vatican's latest pronouncement on fertility technology. Apparently the men in Rome are having trouble understanding some nuances of the female reproductive system.
The pronouncement comes in the form of Dignitas Personae, an instruction from the Congregation for the Doctrine of the Faith, which articulates official Catholic positions. This document covers several interesting topics, which I hope to get to in the days ahead. But the one that calls for rebuttal right away is the section on "[n]ew forms of interception and contragestation." It says:
Alongside methods of preventing pregnancy which are, properly speaking, contraceptive, that is, which prevent conception following from a sexual act, there are other technical means which act after fertilization, when the embryo is already constituted, either before or after implantation in the uterine wall. Such methods are interceptive if they interfere with the embryo before implantation and contragestative if they cause the elimination of the embryo once implanted.
This is an astute and useful set of distinctions. Unfortunately, the CDF immediately proceeds to violate them. Here's its next paragraph:
In order to promote wider use of interceptive methods [a footnote here specifies "morning-after pills"], it is sometimes stated that the way in which they function is not sufficiently understood. It is true that there is not always complete knowledge of the way that different pharmaceuticals operate, but scientific studies indicate that the effect of inhibiting implantation is certainly present, even if this does not mean that such interceptives cause an abortion every time they are used. ...
Really? Is the effect of inhibiting implantation "certainly present"? Let's review the mechanics of morning-after pills, specifically levonorgestrel, marketed as Plan B. The problem with the CDF's statement is that this "interceptive" is chemically identical to the best-known contraceptive: the pill. And the risk that this drug
will prevent implantation of an embryo is purely theoretical. There is no documented case of such a tragedy, since we have no way to verify conception inside a woman's body prior to implantation without causing the embryo's death. Even theoretically, the risk is vanishingly small, since the primary effect of oral contraception is to prevent ovulation, and the secondary effect is to prevent fertilization. To classify oral contraception as abortifacient, one would have to posit a scenario in which the drug fails to block ovulation, then fails to block fertilization, and yet somehow, having proved impotent at every other task, manages to prevent implantation.
So, the assertion of an anti-implantation effect is theoretically unsound. But what do the data show? Two years ago, the world's leading expert on levonorgestrel, James Trussell, co-authored an analysis of the available research in the Journal of the American Medical Association. The analysis confirmed that that anti-ovulation effects wipe out any data suggesting a possible anti-implantation effect. It concluded:
Published evidence clearly indicates that Plan B can interfere with sperm migration by altering the cervical and uterine environment, and that preovulatory use of Plan B usually suppresses the LH surge either completely or partially, which in turn either prevents ovulation or leads to the release of ova that are resistant to fertilization. Epidemiological evidence rules strongly against interruption of fallopian tube function by Plan B. Evidence that would support direct involvement of endometrial damage or luteal dysfunction in Plan B's contraceptive mechanism is either weak or lacking altogether. Both epidemiologic and clinical studies of Plan B's efficacy in relation to the timing of ovulation are inconsistent with the hypothesis that Plan B acts to prevent implantation.
In fact:
Progestational drugs, including levonorgestrel, are used therapeutically in assisted reproduction because they increase the rate of successful implantation and pregnancy. That observation a priori reduces the likelihood that Plan B interferes with implantation; it even raises the counterintuitive but undocumented possibility that Plan B used after ovulation might actually prevent the loss of at least some of the 40% of fertilized ova that ordinarily fail spontaneously to implant or to survive after implantation.
So, in summary:
[T]he ability of Plan B to interfere with implantation remains speculative, since virtually no evidence supports that mechanism and some evidence contradicts it. ... [T]he best available evidence indicates that Plan B's ability to prevent pregnancy can be fully accounted for by mechanisms that do not involve interference with postfertilization events.
So much for the question of effect. But what about the other part of the moral equation: intent? The Vatican document, still referring to morning-after pills, says that "anyone who seeks to prevent the implantation of an embryo which may possibly have been conceived and who therefore either requests or prescribes such a pharmaceutical, generally intends abortion."
But a woman who requests a morning-after pill doesn't necessarily seek to prevent an embryo's implantation. In fact, as we just showed, it would be irrational of her to seek that effect, since no evidence supports it. In fact, given the evidence, it would make just as much sense for her to request the pill in order to prevent embryonic loss. And anyone who has ever taken a morning-after pill knows that at that moment, your actual intent is to avert pregnancy at the earliest possible stage of the process, which happens to be ovulation.
Bottom line: The perceptive analytical framework established by Dignitas Personae, combined with the best scientific evidence and analysis, clearly implies that morning-after pills are contraceptives, not interceptives. Therefore, from the standpoint of respecting embryonic life, you may take them in good conscience.
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From today's piece:
I remember the day my first child was born. He lay sleeping, swaddled, in a plastic bin at the hospital. That's when I finally understood what it meant to be a parent. "If we leave this hospital without this baby," I told my wife, "we'll be arrested."
It was a joke, but it was also true. You arrive at the hospital as two people, and you leave as three. You can't just make a baby and walk away. It's yours forever.
Unless, that is, you make a baby through in vitro fertilization. In that case, you can put the embryo away in a freezer and decide what to do about it later. Or never. ...
More here.
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Starting this week, under orders from the state attorney general and the U.S. Court of Appeals for the 8th Circuit, medical providers in South Dakota must present a scripted statement to women who seek abortions. The script, dictated by the legislature three years ago, declares that any abortion "will terminate the life of a whole, separate, unique, living human being."
Until now, I wasn't aware that the fetus—a term that, according to the South Dakota law, includes "the implanted embryo"—was a whole, separate, living human being. I thought it was ... you know ... implanted. I mean, I'm just a guy, not really an expert or anything. But, um, placenta? Umbilical cord? Do those terms ring a bell? And that's not even getting to the tricky stuff, like the role of maternal RNA in directing embryonic growth or all the work done by the womb to facilitate the embryo's attachment and nourishment.
I have to say, it's a relief to learn that the embryo is so complete and independent. I mean, it solves the whole problem. Here's this woman who just wants to be separated from her embryo. And lo and behold, it's already separate! No need to agonize. Just detach it and let it grow. It's separate, it's whole, it's living. Cancel the abortion. Perform a separation instead.
Sure, some cranky district attorney might take you to court, claiming your separation was really an abortion. Make sure you countersue for legal costs, because you've got a slam-dunk case. The law under which you're being prosecuted doesn't just declare that embryos and fetuses are separate. It also defines abortion as "the use of any means to intentionally terminate the pregnancy of a woman known to be pregnant with knowledge that the termination with those means will, with reasonable likelihood, cause the death of the fetus."
How can South Dakota claim that you should know separation will kill the fetus, when South Dakota has insisted on informing you, prior to the procedure, that the fetus is already whole and separate?
Don't give me some medical-school mumbo jumbo about obstetrics. The legislature mooted all that blather when it superimposed its judgment. Fetuses are whole and separate. Therefore, being a law-abiding citizen, you have no reason to believe that separation will cause fetal death. Therefore, under the law's terms, separation is not abortion. No need to bother with the onerous paperwork and liability threats the legislature has assigned exclusively to abortion. You're not in the abortion business anymore.
Look, I don't like abortions. Fortunately, neither do the women who ask for them. Most abortions happen because women get pregnant when they're not ready. Prevent the pregnancy, and you prevent the abortion. So, here's a word of advice to legislators like those in South Dakota: Stop withholding birth control and stop lying to women about their bodies. You can't even keep your lies straight. That's how you ended up telling doctors to tell women that separation will kill a separate human being. See you in court.