Tag Archives: ethical

Organs and Chimeras

January 2017 Pulse

The shortage of transplantable organs is a public health crisis globally. In the United States, for example, 120,000 people are on the waiting list. It is estimated that 35 percent of all deaths in the U.S. can be prevented by organ transplantation.

In Singapore, the average waiting time for a kidney transplant is still 9 to 10 years, despite changes in the law to enlarge the donor pool.

In an effort to solve this global shortage of transplantable organs U.S. research centres are conducting studies on chimeras, trying to grow human tissues in animal hosts, with the aim of creating kidneys, livers and hearts for transplant.

Scientists are proceeding with such studies despite the fact that the National Institute of Health has clearly stated that it will not support chimera research until greater clarity is achieved concerning its ethical, legal and social implications.

Chimeras are currently used in many different studies. For example, the potential of human pluripotent cells in vivo is analysed by microinjecting these cells in a mouse embryo. The aetiologies of metabolic diseases in the ageing population are studied by creating ‘humanised’ mice to which cells from the liver and pancreas of human donors have been introduced.

In Singapore, human and bovine genes are combined to create cytoplasmic hybrid embryos that are purportedly 99% human. These hybrid embryos are used in embryonic stem cell research.

The National Council of Churches in Singapore has made a robust response to this initiative (See http://nccs.org.sg/2010/12/04/human-animal-combinations-for-biomedical-research/).

There are serious ethical issues associated with research involving human-animal chimeras. They include the violation of human dignity, the question of the moral status of the chimeric creature, the risk of creating humanised animals, the violation of the order of nature, and the many uncertainties accompanying such research.

These concerns notwithstanding, the advances in cutting-edge technologies such as stem-cell biology and gene-edition have made the incredible advances in chimera research possible.

For example, scientists can change the DNA of a mammal through genetic engineering, making it incapable to forming a specific tissue. Human stem cells are then added to the animal in the hope that a particular tissue, for example a human kidney, can form in the host animal.

However, for a number of technical reasons scientists are still unable to create a viable human organ in an animal host at this point.

One of the most challenging obstacles to their success is what has been described as the xenogenic barrier. The host animal – for example, a pig – and the human organ that it is supposed to incubate are two different species, making the viability of the chimeric creature itself problematic.

Scientists working on human-animal chimeras have long theorised that the closer the species are to each other, the higher the chance the chimera has of surviving. So, if the human-bovine chimera is not viable, perhaps a primate can be used to host the human organ.

We must ask how far we are willing to go to create transplantable human organs to save lives. If primates prove to be equally unsuitable hosts, what’s next?

Taking the discussion to the extreme, will we consider using people in permanent vegetative state but who are otherwise in relatively stable condition as possible hosts? What about people who are suffering from senile dementia? Can they also be used to incubate organs for transplantation?

Many bioethicists see the importance of imagining a fictional dystopia to address the possible future scenarios presented by the trajectories of current medical and technological capabilities that would enable them to anticipate ethical and social issues that might arise.

This brings us to a fundamental question in bioethics, one that is sometimes unfortunately muted if not silenced by the thick rhetoric in support of the technological imperative and biomedical triumphalism.

The question is: Without in any way trivialising the suffering of people with organ failure, is it society’s duty to save their lives at all cost? Or are there larger moral considerations that should govern our actions?

Bioethicists – both Christian and secular alike – have argued that although saving the lives of people with organ failure is important, it should not be achieved at all cost. They believe that there are other more important moral and social considerations. That is why killing a healthy individual to procure his or her organs and the trading of human organs are both unethical and illegal and should never be countenanced.

With the unprecedented advancements in stem-cell research and gene-editing technology, we must carefully reflect on where the line should be drawn as we work towards enlarging the organ pool.

In the midst of the bio-tech hype we must remind ourselves that in our noblest attempts to ameliorate suffering and cure diseases, we must never allow ourselves to pursue strategies that would in the long run distort our moral sensibilities and dehumanise our society.


Roland Chia (suit)_Large
Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor for the Ethos Institute for Public Christianity.

The Human Face

December 2016 Pulse

In August 2015, injured volunteer firefighter Patrick Hardison received a face transplant in a 26-hour surgery performed by plastic surgeon Dr Eduardo Roderiguez and his team, a procedure which cost US$1 million (S$1.36 million). The donor was David Rodenbaugh, who had died in a cycling accident.

The first person to receive a full face transplant was a French woman called Isabelle Dinoire, who sustained multiple severe facial injuries after being mauled by a dog in 2005. Since then, more than 20 patients across the globe have received partial or full face transplants.

Although serious ethical and social issues surround face transplants, they will not be the focus of this article. Instead, the question that will occupy us has to do with the significance and meaning of the human face.

This question is of special currency and relevance in our ‘pornified’ culture in which different parts of the body – often divorced from the face – are de-personalised and perceived hedonistically as mere instruments of pleasure.

Yet, as the authors of the 2004 Royal College of Surgeons report rightly saw, “The face is central to our understanding of our identity. Faces help us understand who we are and where we come from.”

Drawing from the rich theological anthropology of the Old Testament, the Jewish philosopher Emmanuel Levinas could say that the human face is “in and of itself visitation and transcendence”.

By this Levinas means that the face comes into our shared world from beyond it while at the same time always remaining beyond it. It is a presence that cannot be contained, a revelation that is also always shrouded in mystery.

Unlike humans, animals have no concept of the face and are therefore said to be face-blind, that is, they are unable to recognise faces as faces. Some scientists and philosophers tell us that only sophisticated language users (i.e., humans) have this ability.

For humans, then, to see a human face is to see more than just the physical features of another human – nose, eyes, lips, mouth, etc. It is to see something of the whole person. It is to encounter the other as “visitation and transcendence”, to recall Levinas’ extraordinary expression.

My face is the part of my body to which others direct their attention when they wish to engage me because they somehow intuitively know that I am behind my face, so to speak.

As the inimitable British philosopher Roger Scruton has put so memorably: “My face is a boundary, a threshold, the place I appear as the monarch appears on the balcony of the palace.”

Furthermore, although I am present in my face and I speak and look through it at the world (and at other faces), I do not see my own face unless I deliberately choose to by looking in a mirror. In looking at my face in the mirror – and in seeing my self in it – I get the sense of who I am in relation to others, and who they are as others.

Thus, as a symbol of individuality, my face identifies me – Roland Chia – as this particular person, and distinguishes me from others who are not me.

In our fallen world, however, the human face is shrouded with an inherent ambiguity in that it not only reveals, but it also conceals and sometimes even deceives. The face can become a mask that deliberately misdirects by hiding or disguising the true self.

Yet, despite the fact that sin has disfigured the human face, it still has the potential to reflect and reveal the Face of faces, that is, the Face of God, about which the Bible speaks about so frequently and eloquently (see Psalm 13:1; Psalm 17:15; 1 Corinthians 13:12).

Hence, the great medieval theologian Nicholas of Cusa could write: “In all faces is seen the Face of faces, veiled and in a riddle.”

Such is the mystery of man, created as he is in the image and likeness of God, with the capacity to ‘mirror’ his Creator, however faintly and imperfectly.

But most importantly, the Bible tells us that the invisible God has revealed himself supremely and perfectly in a particular human face, that of Jesus of Nazareth. “Whoever has seen me,” declares the incarnate Son, “has seen the Father.” (John 14:9, ESV)


Dr Roland ChiaDr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor for the Ethos Institute for Public Christianity. This article is first published in Methodist Message.

 

Three Adults and a Baby

September 2015 Pulse

On 3 Feb 2015, the British Parliament voted 382 to 128 in favour of legalising a technique in assisted reproductive technology known as mitochondrial replacement, after much heated debate. The UK is the first country in the world to legalise this treatment that would result in children with three genetic parents.

Speaking in support of this controversial legislation, UK Prime Minister David Cameron asserts: “We are not playing God here, we are just making sure that all parents who want a healthy baby can have one.”

Mitochondrial replacement is a technique that purportedly would allow women with mitochondrial diseases to have healthy children. Dysfunctional mitochondria inside cells – caused by mutations in the mitochondria DNA (mtDNA) – can result in serious health problems such as neurodegenerative disease, blindness, deafness, muscular dystrophy and diabetes, and could even lead to death.

Researchers think that replacing the disease-linked mtDNA with healthy mtDNA would prevent the transmission of the defective mitochondria to the offspring. While there are a few ways of doing this, the technique that is legalised in the UK is called maternal spindle transfer.

This technique requires an egg donor who is free from mitochondrial disease. The cell nucleus (or the spindle of chromosomes) is removed from the unfertilised healthy donor egg and replaced by the cell nucleus of the mother (i.e., the woman suffering from mitochondrial disease). The resulting ‘combi-egg’ with healthy mitochondria is then fertilised in- vitro by the sperm of the father. The advantage of this technique is that the social parents could also be the genetic parents.

While Christian theologians and bioethicists recognise the plight of women with mitochondrial disease, they have serious concerns about this treatment because of the many ethical and social issues it raises.

An important issue associated with this procedure is that the child would have three genetic parents. Some scientists, however, have tried to downplay the significance of ‘third- party’ mitochondria in a person’s genetic make- up. They assert that third-party contribution is inconsequential since the egg donor who provides the healthy mtDNA provides just 0.1 per cent of the genetic make-up of the child.

However, the fact remains that in maternal spindle transfer, the genes of two women are mixed as the nuclear DNA from the mother’s egg and the donor’s mtDNA are housed together. Thus, the embryo in fact carries a paternal DNA code and two partial maternal DNA codes. As François Baylis points out, “while it is undeniably true that the egg provider who contributes the healthy mtDNA provides less than 0.1 per cent of the total genetic make-up of the newborn, this fact is irrelevant to the accuracy of the claim that there are three genetic parents”.

Even if the success rate of mitochondrial replacement technology is reasonably good (and it’s simply too early to offer an assessment at this stage), questions about safety must still be taken seriously. As A. Bredenoord and P. Braude have candidly put it, we simply “do not know … whether a mixture of mtDNA from two different origins is safe”.

Here, safety has to do not only with the child in question but also with future generations. With mitochondrial replacement technology, the mtDNA of a third-party donor will be passed from women to their children. Female children will in turn pass this donor mtDNA to their children, down the female line. The long-term consequences of this are simply not known at this point.

Aside from the risks involved in the procedure, egg donation itself poses some serious ethical issues in addition to that of the commodification and even commercialisation of women’s bodies. Egg donation also raises questions about the relationship between the donor and the child. These questions apply even though only the mtDNA of the donor egg is used, as is the case with maternal spindle transfer.

Philosophical questions like how such procedures alter our perception of the child, often not addressed in the literature, must also be pressed because of their profound social ramifications. In maternal spindle transfer, the child-to-be is put together like a collage, using genetic materials from the eggs of two different sources in a process that is not dissimilar to an assembly line. The end result is the product (and triumph!) of homo faber (Latin for “Man the Creator”).

More is at stake in mitochondrial replacement technology than simply fulfilling the wishes of parents who want to have a healthy baby. As science and technology advance, the ethical issues raised become correspondingly more profound and ramifications more far-reaching. Society must never respond to these difficult challenges with simple clichés and naïve pragmatism.


Dr Roland Chia


Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor of the Ethos Institute for Public Christianity.
This article was originally published in the April 2015 issue of the Methodist Message.