Twinning. Non reproductive Cloning

“Let me remind you all, however, that the issue on Agenda for today is not cloning but rather the production of identical individuals, that is, persons who share the same nuclear information. This distinction is of the utmost importance because may I remind you that cloning as a technique is not in itself banned.

The latest progress achieved since the Committee last sat in session is related to the possibility of producing human stem-cell lines and also the possibility of obtaining germ-cell lines. These cells are also undifferentiated but not necessarily embryonic cells. They can be obtained from fetuses and even from grown up adults. This new finding has brought about a number of changes with regard to cloning practices.

Last July we discussed artificial twinning and we all agreed this practice was not advisable for various reasons. Now that statement has no sense at all because in the case of a woman who produces few ovules -and therefore, few potential embryos- we can now in view of recent developments make a line of stem cells from one embryo and attempt pregnancy over and over again because we can try and clone the cell once and again so that a baby is finally produced. It may have an application on bad respondants. If only one embryo is transferred each time, the chances for pregnancy are poorer but, on the other hand, this technique will not result in the production of identical individuals because twinning does not occur, and therefore, it could be an alternative.

With regard to cloning without producing identical individuals, that is, without replicating pre-existing individuals, I believe it to be an issue that requires a deeper analysis because it offers a number of possibilities (some of which we have already discussed) that could resolve problems like the example I used before.

In the case of pregnancy disruption, as is the case of ectopic pregnancies where the embryo is lost, we could perhaps use that embryo, get a line of stem cells from it and clone the cells. In that way if the couple wishes to have “that baby” they could eventually have it through cloning. The same applies in the case of a couple where she gets pregnant at the wrong time in their lives: they want that baby but not now. Well, the pregnancy could be disrupted, a line of stem cells obtained and again, through cloning, have that baby born when the couple finds it more suitable, be it for economical or other reasons.

And the latest application that has been suggested (but this poses and added difficulty) is related to the Constitutional right of lesbian couples to procreation. In this case the procedure is simple: we clone an embryo from each woman and then we proceed to fuse them in order to produce a mixed embryo which will have the characters of both the women. We are not copying anyone but we would be producing a chimaera and that practice is forbidden by the Spanish Law on Assisted Reproduction. This is the additional difficulty I made reference to. However, chimaeras have been produced in the animal model with no major difficulty. In mice, for instance, chimaeras of up to 3 embryos have been successfully produced.

I am not going to speak about the utilisation of cloning techniques to copy pre-existing individuals because the general agreement reached by our Committee stated that this practice had no sense and was ethically speaking not advisable. (...) with E-S ( embryonic stem cells) and E-G (embryonic germ cells), the former having a potential for the production of tissues and even organs.

But let us bear in mind that in order to obtain stem cells we have firstly to produce an embryo and then destroy it. In my opinion the issue requires to be assessed in depth due to its ethical implications and perhaps Prof. Lacadena will induce the debate when he tells us about the “estatute of the embryo”.

It is obvious that in order to produce lines of stem cells not many embryos are required because a line of stem cells will in turn produce countless cells, but this should not be the core of our present discussion. The problem lies on whether the destruction of just one embryo might justify the procedure or not. However, there is a potential way of obtaining a stem-cell line without destroying an existing embryo: performing a biopsy on that embryo -as we regularly do for pre-implantational diagnostic purposes. In this way we could start a stem-cell line from a single embryonic cell although, unfortunately, this has not yet been achieved. But in any case, the embryo could still be transferred and have it develop into a baby. The embryo is not destroyed and what happens is that this embryo would have a personalised stem-cell line of its own should it ever need a transplant in its future life as a person. That would be a major achievement for, in the event of a transplant being needed, the tissue or organ would have the same genetic characters as the host and therefore, rejection risks are nonexistant.

I know it sounds complicated but surely we can all imagine a case where application might be perfectly justified, say people suffering from inherited hyperlipemia... These are people who will surely require a heart transplant at one time of their lives. Or take people with polycystic kidney...Moreover, this embryo could have its stem-cell line cryopreserved in waiting to be cultured and developed into a given tissue or organ if needed. All that could be achieved without having to produce the embryo’s identical twin to destroy it afterwards, you see?

We are talking about one embryo whose genetic characters are used to produce a new cell line. With regard to germ cells, it has not been shown for the time being that they are totipotent. We do know they can give way to new cell lines but we do not know whether they may have the same capacity and scope as stem cells. Exhaustive research on their behaviour is needed. The obvious fact is that germ cells are more easily obtained: from cordonal blood, from abortion débris but these germ-cell sources have hardly been used. It remains to be known, however, if their potential equals that of stem cells. If it does, there should be no further controversy as the source of such cells will not be subject to discussion and in addition, our problems as scientists would disappear because there would not be a need to create an embryo in order to provide the cells. All in all, these are the options that seem to stem from recent findings regarding the utilisation of certain cells in cloning practices.

MINUTES N º 3
GIJÓN (Spain) Meetings of 7th and 8th May 1999

(Español)

Human assisted reproduction and individual rights

First of all I wish to remark on the tittle of my Introduction. We originally though of addressing individual rights and we ended up addressing the rights of the individual. What I will try to do through my introduction is to briefly describe the different rights that are affected by assisted reproduction.

The terms I will use might be difficult to grasp and differentiate but then I did not want to run the risk of making reference to just fundamental rights. Needless to say, some of the rights involved are “fundamental” while others are not, in spite of the fact that they are equal in importance to the individual.

When I first approached the issue, I reviewed each and all techniques for assisted human reproduction described in scientific and juridical literature in order to delimit the likely rights involved or those which might be easily violated. So, in the first instance, I looked at artificial insemination or IVF techniques and tried to assess the scenario before these techniques are even performed. From the juridical point of view I then started to sort out the potential problems and rights related to the signing of the contractual document. However, this morning I was skimming through the Minutes of last July’s meeting and I read that you had discussed on a very interesting issue: the likely right to human procreation. Somebody made reference to Art. 12 of the Universal Declaration on Human Rights in order to point out that the right to get married and start a family was therein considered... Juridically speaking a married couple are “a family unit” whether they have children or not but in my opinion the meaning of Art. 12 is that two individuals, a man and a woman, have the right to get married and have children together. I am not specialised in Private International Law and so I do not know whether what I am saying makes any sense from that perspective. As I am an expert in Civil Rights, what I understand is that the concept of “marriage-based family” is the one underlying the right described by Art.12 and so an analogy could be established for non-marital situations and as from there a wider interpretation of that right could be inferred .That, in my opinion, would much better suit the current social reality to which the rules are to be applied . It cannot escape us that there are couples, non-married couples, who start families together and whose stability as a couple equals that of traditional married couples. It is in that sense and in that context that I studied in depth the “right to procreation” because this right is inferred but does not appear described as such in any of the texts I read on the issue. Perhaps in the International Law context analogic interpretations are to be found correct; were that the case, I would then have to look into the matter in greater depth and even perhaps change my mind on this.

To the contract of artificial insemination or IVF, or any other technique, whose juridical and ethical problems are not different, the only one right I would see at stake is the right to information.This right ought to be granted to the person on whom the reproduction technique is to be performed and also to the husband/partner who agrees to have it done, be it his own genetic material or somebody else’s genetic material that is to be used. We simply cannot forget that -at least in our System- the right to information is contemplated within the general Law on Health issues, which is soon to be complemented with a law on Informed Consent. Nevertheless, reference to documents need not be made now as this right is widely recognised in all the countries in our cultural area. The only potential problem I see with the right to information is the presumed liability on the part of the medical team intervening in that assisted reproduction. On this particular aspect I once wrote that the information provided to the individual should be extended to biological, juridical and ethical considerations over the potential action... Well, perhaps the ethical aspects have already been considered by the couple that have made the choice... It is also possible that they are aware of the juridical aspects involved but, in my opinion, the medical team in charge should remind them of the fact that the filiation link that it is going to be established will be permanent and inviolable. I am not sure that this information is actually provided but I definitely believe it should be so.

As regards gamet or pre-embryo donation, information on every related aspect should also be considered. Presumably, a person who donates his sperm -in the case of artificial insemination- knows what he is donating for but, nevertheless, information on the likely consequences of his action should be provided. In our System, for instance, the anonymous condition of the donor is something relatively kept because under certain exceptional circumstances his name can be made known, although in principle the only information that might be available on the donor is that regarding his general characters as biological father.

In the field of gamet and pre-embryo donation, the concept of “human dignity” is frequently used to prevent any such donation. Some people claim that assisted reproduction with donor sperm is unworthy, or attemts against “human dignity” because the act itself, the donation of sperm, is unworthy. But I personally do not understand why it should be more worthy in the case where the husband’s sperm is used. Frankly, there is no reason whatsoever to state that dignity is not offended when insemination is done with the husband’s sperm and that the use of donor sperm is an offense to human dignity.

Another right involved in gamet or pre-embryo donation is the right to privacy (on the part of the donor) which is established in terms of “secrecy”. Other likely rights involved are related to filiation. The right any child has to have a mother and a father is frequently alleged and I myself believe it desirable for a child to have a mother and a father but there is not such a right .. I have not come across this right in any legal text, be it national or international...No matter how desirable it may be.

On the other hand and with regard to the filiation of children born from these techniques, I see another right or principle (it is both things) that can be easily violated, a principle which translates itself into a non absolute right and that is the right to the biological truth and a right to investigate one’s paternity. This is foreseen in our Constitution but nevertheless violated with the performance of these techniques. However, this right does not pose an obstacle for the practice itself because the principle or the right to investigate one’s paternity is not recognised as a fundamental right. The truth is that numerous exceptions do exist, sometimes stemming from the very time-period established in the Law for the exercise of action...That time passes and action cannot be taken although one may be able to prove that the biological father is someone different to the man being considered the legal father. This is to say that the principle of the biological truth and the right to investigate one’s paternity are quite vulnerable in the context of assisted reproduction but are equally vulnerable in the context of natural procreation. We can try and assess whether the child actually has any possibility to investigate paternity and the the answer is - in accordance to my earlier argumentation - that the right to investigate one’s paternity is a non absolute right. But one may find a escape valve because filiation can be objected by the child or his/her parents (depending on the legal recognition status they might have) in accordance with regulations in the country where the claims and objections on paternity are presented. There might be a possibility - in a hipothetical situation - that an investigation is started... but not because of artificial procreation in itself but for the sole reason that, should that possibility exist for natural procreation, the same possibility there would be if artificial insemination were involved. However, the investigation would not take place on the basis of fundamental rights.

Some people speak of “a right to the free development of personality “ which in some circumstances might apply to the investigation of one’s paternity. That is, upon assumption that a child might undergo serious psychological trauma and as a result his/her personality would not be properly developed unless he/she gets to know his/her genetic, biological background. It is a spiky and tricky issue which a person could use to his will because it is doubtful that the right to the free development of one’s personality actually implies a right to know one’s genetic origin. Moreover, were it understood in that sense, it is still doubtful that such right would not be satisfied when the child born from these techniques is given the chance to know the phenotipic characteristics of his father. In my opinion it is a right that might be equelly involved in the case of a natural procreation and, therefore, openly disputable.

Then we have the principle of equity in relation to the born child - not the parents. This one is even harder to handle in the event the legal father-to-be, who has agreed upon donor sperm artificial insemination of his wife, would eventually deny paternity should his marriage go wrong in the mid-term. Some similar cases have been described in France but in Spain that could have never been possible because of the couple’s formally stated agreement.But then, of course, denying that child the possibility to object or even investigate his/her paternity because he/she was born from artificial reproduction and granting that particular right to the child born through natural procreation would, in my opinion, violate Art. 14 of the Constitution.

When a child reaches legal age, jurists establish a clear difference between what really is the interest of the claimant (the grown up child) and what might be the interest of his/her parents but when a child is not of age, the parents might claim in his/her behalf - as in the case of paternity impugnation in natural fecundation - were that same right recognised for children born form assisted reproduction techniques. The problem , then, would be how to actually establish that difference when that father or that mother is objecting to paternity in the interest of the child and when he or she is executing action in his/her own interest - notwithstanding the law openly forbids impugnation of paternity.

And with regard to post-mortem reproduction, in our System the previous consent from the deceased person is required. The System also seems to establish a clear difference between post-mortem insemination performed within the 6 month period after the partner’s death and posterior post-mortem insemination. The spirit on the law on Assisted Reproduction Techniques is not very clear with regard to the recognition of filiation and to the likely rights of heirs- at- law in the event of a post-mortem insemination performed out of the 6 month period therein established.. And that, in my opinion, would be discriminatory for the resulting child, conceived with his biological father’s own genetic material because had he/she been conceived in the 6 months after his death, the child would be legally and genetically speaking his/her father’s child whereas in the other case, he/she would still have the same genetic load but filiation could not be determined in legal terms. I do not think many women find themselves in situations such as the one I have described but the issue here is that sooner or later there might be a case and we need to know how to handle it.

Another spiky issue at stake in the context of artificial reproduction is that of single women who are alone, that is, a woman who is neither married nor lives with a male partner. I am not going to say whether I find this a desirable situation or not. I will simply try and approach the issue from the juridical standpoint. We must admit that the very principle of equity leads to the following situation : if we grant the right to assisted reproduction techniques to a married woman, we cannot deny the same right to a single woman on the basis of that equity. But the law clearly forbids that even in the case of a woman living more usorio with a male partner. But, suppossing a woman, neither married or living with a male partner, wanted to benefit from assisted reproduction....should it be not granted to her... discrimination would be more striking than in the former example I gave you. So the right to procreate would come hand in hand with the principle of equity and, in a related context - with the right to have her health protected in the event the woman - in spite of her status - were infertile though sterility is a disputable condition in terms of justifying access to health protection.

On the other hand we have the right to the free development of personality, which is clearly established in our Constitution. It seems that the experience of maternity is important to many women, and a particularly strong urge on reaching a certain age and therefore it is something that deserves assessment.

The right to privacy in relation to the way in which she chooses to procreate is a related right to the right to freedom. One cannot tell a woman to just jump into a man´s bed to have that baby she so much wants when there are other ways available, right?. Well, in any event, the rights that I have described in relation to health protection, free development of personality and privacy are not as “ strong” so to speak as the right to be treated with equity at the time a woman wishes to have access to assisted reproduction techniques.

And to end my presentation ... well, there are couple of references yet to be made. In surrogate pregnancies the major problem I woud see is that of “breaking” the principle of the biological truth but then this principle is often overseen in natural procreation as well so this would be no obstacle as to forbid this type of reproduction and so one might say that the prohibition to surrogate pregnancies is well expressed as to undesirable. But there is no legal fundament to prevent a single, alone woman from demanding access to it and who should have a right to on the basis of equity. We cannot find a single one Constitutional principle or fundamental principle that obliges to the recognition of a real possibility of access to surrogate pregnancy, might a man or a woman demand it. However, we would find a principle that opposed to the claim, though the principle might not be strong enough to enforce prohibition due to numerous exceptions one could come across. All in all, as there is no strong argument in favour or a strong argument against it, surrogate pregnancies have been prohibited altogether. It is forbidden and that is it, and I myself find it reasonable or desirable.

And my last reference will be related to the pre-embryo, that what we call pre-embryo. The likely and questionable right here involved is the right to life and at the time of arguing about the pre-embryo’s right to life as we understand it to be, we find that from the juridical perspective - no matter how strongly we may want to do so - it is impossible because there is a law on Assisted Reproduction which does not consider that right as such. Rather, it implies that the pre-embryo has to be born first. We may ask ourselves whether the law has abused any existing juridical ordaining, in the sense that something contrary to the exisiting juridical principles was done. I personally do not think so for various reasons. The Constituion speaks of a right to life and then our Constitutional Court one day comes up and very nicely tells us that NOT everyone has a right to life because , even though it is said that everyone has that right ...” ... life is a continuous process....” And, well, Marcelo Palacios himself referred to this in the morning session so I will not go back to that. And it was this very statement by the Constitutional Court that resolved the issue of abortion in Spain.

Therefore, the question is that in the western society there are many countries where legislation on abortion is more or less exhaustive but nevertheless pro-abortion. Then in the context of those countries where the possibility of abortion is regognised, we cannot say that when speaking on the right to life, any reference is being made to beings that have not been born - or at least not to ALL the beings before they are actually born.

In our System, the right to life is granted to these yet unborn beigns as from a given stage of development and gestation. And let me remind you, a cryopreserved pre-embryo is not being gestated...

So in our Constitution and in our System we cannot find a fully protected right to life for ALL those which are not born. The same can be said with regard to the countries where abortion is permitted under certain circumstances. On the other hand, international texts or documents or Conventions intended for the majority of countries in their cultural area to ratify are usually very ambiguous and when they make reference to “the right to life” they do it in relation to the lives of born individuals so as to bring in as Signatories those countries with anti-abortion legislation.

Our Civil Code, for instance, in Art. 29 there is a subtle recognition of the right to life for “the conceived” , that is, human-like entities - so to speak - are recognised as worthy of protection even before they are actually born...But one must understand that this Article in the Spanish Civil Code was aimed at protecting the likely succesory rights of posthumous children and it was written or described upon the basis of the only one thinkable reality in those days : that it was something human-like being gestated in its mother’s womb.

In the days the Civil Code was devised artificial insemination and artificial reproduction of people were unthinkable ,yet current realities to us... And that is the reson why I argue that we may have to re-interprete the Declaration on Human Rights in accordance to our current reality , and that includes interpretation of Art. 29 of the Spanish Civil Code as well.

The problem lies in how to determine the “reality” to be protected and in my opinion that reality translates into “a being in gestation in the human womb that may eventually be born or not “ because we all know spontaneous abortions occur, miscarriages... So the question is that the protection of the conceived- but-not-born applies only to the being in the mother’s womb. Therefore, adaptation of this interpretation to current reality and times leads us to think that it should equally apply to the protection of the being within the mother’s womb under Art. 29 independently from the fact that” that being” might have originated under in vitro or in vivo conditions. However, stating that Art. 29, because it applies to the conceived-but-not born, should also protect the pre-embryo... is an argument I cannot accept because the pre-embryo (cryopreserved at minus 176 degrees in liquid nitrogen) is a “reality” the legislator did not take into account and then adaptation of the rule to current social reality and times is everything else but possible. We are facing a new reality for legistators to study and in Spain we have considered this new reality in the drafting of the law on Assisted Reproduction Techniques. The Law on Assisted Reproduction Techniques does not recognise that “right to life” nor was it recognised in pre-existing juridical oradining either. And so, whether that new reality is to be protected, it remains for us jurists to determine on the basis of what philosophers have to say to this regard. Biologists are equally most helpful in terms of providing scientific factual information on embryo development, the different stages and “moments” a living entity undergoes before it can be said to have reached human sustantivity, leaving potentialities aside. Because potentiality cannot be an argument for jurists to take into account... One can say that all of us sitting here represent a potential number of human-beings to become, on our part and on the part of our descendants... but the juridical body and the law does not take a concern in potentiality, despite the fact that it may be correct to assess potentials at any given time in order to enlight our discourse. Nevertheless, it is “reality” jurists have to work on and in our case it is the human reality we are working on not the human nature. My nails have human nature, for instance, and I do not intend to compare my nails to a spermatocyte or an oocyte or whatever... But there are so many other things that have this human nature.. The pre-embryo has it, for instance, but... is that really enough to regard it as “a human being “

MINUTES Nº 3
GIJÓN (Spain), Scientific Committee Meetings on 7th and 8th May 1999

(Español)

The beginning of life: the statute of the embryo

The things I will talk about will probably help us in the later discussion of an issue which first came into scope a number of years ago and will continue to be discussed for many years to come because the Estatute of the embryo started with the Warnock Report and it still remains an unresolved issue. I will spend most of my Introduction time in describing human development. In fact, when I was preparing the paper I had originally intended to call it “The beginning of life: the estatute of the embryo” but, before going into the matter I would like to make some general considerations. In the first instance, let me say that the beginning of human life implies two fundamental questions: when that new life actually begins and when that human life, once it has started its existence, becomes individualised. These two questions can be approached from a biological perspective, from a genetic perspective, from the comparison and assessment of the embryo in evolution vs. the born baby. But also from a philosophical perspective which, in line with Zubiri, means that the “being” in development has reached “constitutional sufficiency”, that is to say when its personality, its uniqueness, is already characterised. Other authors claim that the human person “is” from the very moment of fertilization. Yet there are others who claim that a human being becomes a person much later in the development process....As you may see such vast range of opinions, beliefs or suggestions all make reference to how to apply Zubiri’s philosophical standpoint. I am not a philosopher myself and thus I will not defend that argumentation for fear of entering unknown grounds but, nevertheless, I do find this line of reasoning most suggesting.

Another preliminary remark I want to make is that in every biological process -be it at molecular or at evolution level- any biological phenomenon is continuous in nature. This means that it is impossible to determine the “before” and the “after” of an evolutional event in terms of a time scale. When people speak about the embryo and talk of the 14-day stage post fertilization one wonders why 14 days and not 13 or 15? I would like to stress on “continuity” as a fact in every biological process, even in fertilization. When does fertilization occur? When the spermatocyte approaches the zona pelucida to enter the oocyte? When the masculine pro-nucleous is released into the cytoplasm? When does cell cleavage start? Determining any one of those evolutional “whens” is just impossible. However, the very nature of continuity in the biological process is compatible with the spontaneous emergence of new properties and I can give you a number of examples to make my point clear. Say that we have 2 chemical molecules, two proteins. Each of them taken separately will exhibit its own properties and function. If we fuse those two proteins an entirely new function to their individual original ones will then emerge. However, the process itself was a continuous one. That then means that within the continuity of any development we should expect new things to spontaneously occur.

A third remark is that in a most general sense, when people discuss on scientific matters they tend to be quite reductionistic and do not distinguish between ordinary organisms and human beings. With regard to DNA, some people might be tempted to reduce the complexity of the concept “human being” to just a person’s DNA. The idea I want to launch here is that reductionism in Biology is quite a risky business because the biological “whole” does not equal the summation of its parts. That might have something to do with ordinary practice in laboratories: looking at life, or at the human being under the scope of a single lens. Too reductionistic.

Having made these general remarks, I will move into a few particularities with regard to human embryo development from the genetical and biological perspectives.

The process of development can obviously be subdivided into a series of stages: on the one hand, (conventionally ordinating them) we have the stage gamet-fertilization-zygote. Then comes the stage zygote-morula-blastocyst-hatching (of that blastocyst on the uterus walls). A third stage would follow from the end of the hatching period to the fetus stage to the moment of delivery itself. All these stages are distinct biological events whose ethical and juridical treatment is different in the same manner.

From the perspective of genetics, again in my opinion, the most crucial stage is the second one (in the order that I have listed them): zygote-morula-blastocyst-hatching because it has straight link with the issue of our concern, the Estatute of the Embryo, and as I will soon explain it is in that stage when we can still question the individualisation of the new being. Consequently, that is the reason why people either in favour on embryo manipulation or in favour of getting rid of cryopreserved embryos claim that the embryo has no Estatute because its characters of individuality have not yet appeared and thus ethical considerations are unnecessary. This argument is very much significant from the juridical perspective as well.

The terminology in use has been subject of much controversy (Dr. Palacios, who has sat in many different discussion forums has great experience).Whether we should speak in pre-embryo terms or refer to this entity in terms of “pre-implantational embryo”. The truth is that since 1988 -at the time when the Spanish Law on Assisted Human Reproduction was underway and the so called Palacios’ Report was presented- terminology has been the focus of attention.In my opinion and with regard to the likely ethical consequences that one given term might have upon people’s attitudes and ideas when discussing scientific progress is significant enough to consider the matter in depth. The simple fact of using the term “pre-embryo” changes the whole perspective in people’s minds because as it has not yet reached embryo status, it is not worhty of protection under the Estatute and can therefore be handled, manipulated or whatever. Other people prefer the term “pre-implantational embryo” or a 2-cell embryo, or a 4-cell embryo or a 16-cell embryo.

International literature, both scientific an juridical, compiles a great many contributions from different authors and expert Committees in which different terms have been used to describe the same biological reality. In my Introduction I intend to analyse both from the scientific as from the ethical perspectives whether a pre-embryo is nothing else but a conglomerate of human cells or if that cluster of cells actually carry the characters that make it a unique human being. Were this so, ethical considerations should be imperative.

I said before that from the genetics perspective the most important stage in the evolution of a human being is the second one, from zygote to hatching in what regards the questions of when a human life comes into being and when that human life becomes individualised, that is, when the new entity acquires the features of unity and uniqueness. From the biological and genetic perspectives there is no doubt whatsoever that “the new life” as a new human entity will come into being at the very “moment” of fertilization -bearing in mind the continuous nature of processes in Biology- because it is then that the newly formed zygote comprises genetic information resulting from the fusion of two distinct entities (the two gamets) to become a third entity (the “tercium”, a term sometimes used in juridical documents). This new entity carries genetic information which is strictly human, that is, the resulting product of its natural course of development will be a human beig not an apple-tree nor an elephant. Once having said this, the following consideration is what happens next. And what happens next is that two biological phenomena can occurs during the development of the embryo which has just come into being and these can actually alter the course of things with regard to the properties of unity and uniqueness I mentioned before. Unity as the quality of being one entity and uniqueness as the quality of being different from any other entity.

Unity has a lot to do with what Prof. Egozcue illustrated us on: chimaeric entities. Well, zygote-chimaeric or post-zygote chimaeric entities may result, the former being produced as results of double fecundation, that is, the oocyte and a polar body fuse and result in two distinct genetic information entities that fuse and produce an individual whose cells carry different genetic information. Or it may be that two embryos at a very early stage of development (say 4-8-16-cell embryos) fuse. I am trying to make you understand that embryo fusion is an event which can spontaneously occur at a very early stage of embryo development but fusion is unlikely once the embryo has started configuration of the future nervous system,when the primitive neural crest appears. After that particular moment in the evolution of an embryo fusion is no longer possible. But where and how to delimitthat “moment” in the time scale? It has been fixed at day 14 post-fertilization, just after hatching has actually taken place. The same could be said with regard to “unity”, and when monozygotic twinning spontaneously occur (zygote splitting) resulting into 2-3 monozygotic babies, the splitting seems to take place in the same time period. That would then mean, again from the perspective of genetics, that “unity” and “uniqueness” do not become defined until day 14 post-fecundation and this is a fact accepted worlwide.

MINUTES Nº 2
GIJÓN (Spain), Scientific Committee Meetings on 7th and 8th May 1999

(Español)

Euthanasia: an approach

I would like to establish in a few words a distinction that is both common and problematic with respect to the terms of treatment or non-treatment to accelerate the process of death. They seem to be two different things although in reality they form the head and tail of the same coin. In the Western culture, the principles of autonomy and election bring implicitly the right of the citizens to accept or reject medical treatment. Nevertheless, these principles also imply that the person has the right to choose ending his own life by euthanasia. Well, we have what is known as passive euthanasia and active euthanasia. This distinction, which must be made, presents some doubts, ambiguities, etc. Here we must attack or face things that allow to differentiate distinct degrees of reaching a common objective, which is death. Well, when for example we allow death to arrive directly, using a lethal injection for example, or indirectly, related with termination of the treatment.

This difference leads to important discussions of a legal, moral and ethical type, although for example in these situations where passive death, that is let somebody die, is very well established and very accepted by public opinion, a distinction must be established between allowed natural death and death, pardon, termination of life by termination of assistance. That is, one must look for what is extraordinary and what is ordinary. There are specific differences between not treating and letting die and treat to die. There is a differentiation between cause and effect and it has to be regulated. The argument, for example that the act which produces a similar result when it is done with the intention of arriving at the death of a patient in an illicit manner, is murder and therefore the law regulates it with the law and nevertheless, for example the cutting down of life, for example people who have assisted respiration or are maintained alive artificially, when they are disconnected the result is the same it leads to the accelerated death of the patient and nevertheless the legal or ethical treatment is completely different. Therefore, this must be regulated, one thing is, for example, in the field of medical prescription, there is a clear difference between prescribing a lethal drug, it is perceived in a different form by justice as by society than administering a drug which can be lethal. Therefore the treatments are different and the perceptions of these concepts are distinct. And I believe that one has to know whether a person who chooses not to be treated and awaits the development of natural effects until dying commits suicide or not. For example, when in sedated state because of terminal illness, the nourishment aspects of the patient are not covered, that is nutrition is denied to the patient, it is also an act that could be considered "borderline" with these ethical aspects that regulate the acceleration of death. Therefore, we have to look for an identical objective at the moment of defining the legal and medical aspects, as much with euthanasia as with artificial reproduction; both need to be oriented towards the same objective and apart from that conceptual differentiation try to define the legal, ethical and constitutional framework of people.

If a doctor, because of his Hippocratic oath has to cure the patient, why is he not obliged to apply this Hippocratic oath when a patient refuses to be treated, not to improve, but to make him suffer less in his terminal estate? I think that all these things that appear very separated, are very inter-related. All this culture has to be changed, because when doctors have the idea that not applying a therapeutic treatment because the patient is rejecting this assistance is not euthanasia, don’t they understand this as a passive euthanasia or however they want to call it? Therefore a pragmatic compromise must be sought which combines all these until now conflictive arguments which are on the table. We are at this moment in a society which, on one side, is arriving to the extreme of the sacrosanct veneration of the principle of human life, that is, that life is an inalienable right. And on the other side, we are discussing things like passive euthanasia, abortion, etc. I believe that this has to be regulated in a clear way.

Until now we have found norms and laws which, on the basis of one current or another, establish which is licit and illicit in the case of suicide, passive euthanasia, pain handling, etc, on the theme of passive euthanasia and assisted suicide, to call it thus, that are based on treatments to relieve pain, pain handling and other systems of support. Another scepticism which is known is perhaps the wilfulness to which is left the theme of assisted suicide in the demands for termination of life in a rapid manner. Many patients ask for their lives to be ended, that they be given a treatment that permits an immediate success. There is as we might say a certain ambiguity with respect to the attitudes of the people involved because, for example, there are people, doctors especially, who say that it is illegitimate to proceed to this type of actuation, in spite of the fact that the patient in his individual and autonomous right can require it, because they say that the patient, by reason of his illness, in a terminal condition can be suffering mental confusion, deterioration of his consciousness, etc. At this moment, much of the existing legislation in some countries with respect to assisted suicide, the non-treatment of patients under express request, etc. is based on confused arguments. This is being done above all in developed countries, more occupied with problems which relate health with the perspective of cost-benefit, etc. But therefore, what happens with the other collectives which remain outside this field of action of supply and demand, of the market to call it that, the lonely, the poor, and others?

In order to avoid all this, one must work from two precepts of the medical condition in relation to assisted death, in such a way that starting from the proper Hippocratic oath, from the basic precepts by which the doctor has to rule himself in his profession, we can perhaps open the way to the globalisation of this concept of assisted death, artificial termination, etc. With respect to the religious communities, of all kinds, which register the sacrosanct condition of life as something apart from the human and more in the hands of the supreme being, they also have a type of vacuum with respect to ethics and codes that should be applied in their respective communities or societies in which this act, which little by little is a social act, a demand, although perhaps in isolated cases, etc.

One must look at the subject from the community perspective, and here the intervention of the State with respect to the free option of individuals which compose this State is important at the hour of protecting all those aspects which are relevant. Those who support and those who reject assisted death have some points in common, and it could be, for example, that they agree that the life of the person has to have guarantees of some minimum of comfort, of quality which permit his subsistence, his continuity until death, the final process, that is the exitus, appears in a natural form. The palliatives, the means that really improve the quality of life are as much a right as an obligation. And I believe that is the line by which one has to begin to work, trying to seek solutions within this initial agreement between both confronted parties. It would avoid in the first place in societies the subject of absolute prohibition without taking into account other types of considerations and would permit the flexibilisation of medical practice, combining it with individual and constitutional rights of individuals. It also has to be said that it is the inalienable right of all persons, of all individuals, to have an absolute control of the moment that they are going to die, and that is what has to be regulated immediately with assisted death.

MINUTES Nº 2
GIJÓN (Spain), Scientific Committee Meetings on 27th and 28th November 1998

(Español)

Bioethical Issues for the Next Millennium

Bioethics has focused on the human species and on issues related to the medical practice –euthanasia, organ transplant, AIDS, death. These issues are currently expanded by introducing the questions of cloning, foetal rights etc. There is an urgent need to further expand the field by introducing the environment as a major component of bioethics. “Bios” –life– is the key word in the term “bioethics.” Bioethics should therefore include environmental issues, as well as a re-evaluation of the concepts of space and our place in the universe. The micro- and macro-environment are cases in point. In the macro-environment, we are endowed with the gift of life. We have not yet found life on other planets, and we may never do. Therefore, the continuity of life on earth is the most important ethical issue and should be treated as such.

The core concept of bioethics is precisely that: to promote the continuity of life. As humans, we have become anthropocentric and pretentious. We have lost all perspective of time. We must understand time as the hundreds of millions of years in which life, bios, has evolved. We are confronted with the paradox that life is an eternity and a second within eternity at the same time. In terms of time, the evolution of life has occurred over hundreds of millions of years. In this evolutionary scheme, human life represents only the tiniest fraction. If we compare the evolution of life on our planet to a 24-hour day, the appearance of human beings has occurred only during the last few seconds. However, in the course of a single human life-span every moment is like an eternity, if we are to consider that trillions of reactions, like protein synthesis, take place every second with the highest symmetry.

We cannot talk about the bioethical aspects for the new millennium just in terms of human existence. How are we going to give a satisfactory answer? How are we going to come to a balanced conclusion when society itself is unbalanced? Scientific progress, the new technologies, the human genome project, the procedures that allow prenatal diagnosis, etc., have given us tremendous power to look for future solutions to today’s problems. However, we have let this power develop in an uncontrolled fashion. We have witnessed how technology and progress in science have brought about a degradation of the individual as a social being. This has had many negative consequences. We must take advantage of the positive elements of scientific and technological progress so as to improve the human condition in all regards, both biological and social.

Consequently, bioethics societies like SIBI are morally bound to educate the public in the need to implement new educational systems, strongly based on bioethical values. The message of preserving the continuity of bios, the continuity of life and the appreciation of the gift of life, should constitute the nucleus and framework of all future actions. We know that there are many threats to life. One of them is environmental damage on a global level. Experts say that the dramatic and progressive degradation of the environment will destroy life sooner or later. All the bioethical aspects we have been discussing will be worthless if we are not able to focus on linking our existence to environmental preservation. We must also acknowledge the relationship that exists between the protection of the human species, the protection of the environment and the protection of all the other elements that make up the universal ecosystem. Otherwise, in the not so very distant future, life as we understand it will be over. We all know that if we keep up the current pace of environmental destruction there will be no millennium, no life. We cannot let our children inherit a wasteland planet, even if scientific and technological progress make it possible to preserve biological life.

Based on the need for life on our planet to continue, environmental issues must penetrate every educational system, academic discipline and profession. Bioethics needs to become the active search for millennium values capable of harnessing the effects of science and promoting a new moral code in every profession. Bioethics is the “new ethics” for the millennium.

The SIBI millennium conference must incorporate as may fields as possible. We should not limit ourselves to medicine, but search for bioethical values in every vocation. If we do not acknowledge that all fields are interrelated, we will reduce the chance of expanding our vision for the millennium and will limit ourselves to redefining issues of the past.

I think that bioethics has to expand on the concept of profit. We have forgotten that profit can have cultural as well as economic dimensions, and should therefore include provisions for a better quality of life, progress in medicine, public health, etc. Currently, the concept of profit is only understood in economic terms. Bioethics must transform the popular concept of profit into a new, three-dimensional concept that represents a field open to study. We must be able to determine, quantify and rank how much of this profit is applicable to health, security, quality of life, etc.

MINUTES Nº 2

GIJÓN (Spain), Scientific Committee Meetings on 27th and 28th November 1998Bioethics has focused on the human species and on issues related to the medical practice –euthanasia, organ transplant, AIDS, death. These issues are currently expanded by introducing the questions of cloning, foetal rights etc. There is an urgent need to further expand the field by introducing the environment as a major component of bioethics. “Bios” –life– is the key word in the term “bioethics.” Bioethics should therefore include environmental issues, as well as a re-evaluation of the concepts of space and our place in the universe. The micro- and macro-environment are cases in point. In the macro-environment, we are endowed with the gift of life. We have not yet found life on other planets, and we may never do. Therefore, the continuity of life on earth is the most important ethical issue and should be treated as such.

The core concept of bioethics is precisely that: to promote the continuity of life. As humans, we have become anthropocentric and pretentious. We have lost all perspective of time. We must understand time as the hundreds of millions of years in which life, bios, has evolved. We are confronted with the paradox that life is an eternity and a second within eternity at the same time. In terms of time, the evolution of life has occurred over hundreds of millions of years. In this evolutionary scheme, human life represents only the tiniest fraction. If we compare the evolution of life on our planet to a 24-hour day, the appearance of human beings has occurred only during the last few seconds. However, in the course of a single human life-span every moment is like an eternity, if we are to consider that trillions of reactions, like protein synthesis, take place every second with the highest symmetry.

We cannot talk about the bioethical aspects for the new millennium just in terms of human existence. How are we going to give a satisfactory answer? How are we going to come to a balanced conclusion when society itself is unbalanced? Scientific progress, the new technologies, the human genome project, the procedures that allow prenatal diagnosis, etc., have given us tremendous power to look for future solutions to today’s problems. However, we have let this power develop in an uncontrolled fashion. We have witnessed how technology and progress in science have brought about a degradation of the individual as a social being. This has had many negative consequences. We must take advantage of the positive elements of scientific and technological progress so as to improve the human condition in all regards, both biological and social.

Consequently, bioethics societies like SIBI are morally bound to educate the public in the need to implement new educational systems, strongly based on bioethical values. The message of preserving the continuity of bios, the continuity of life and the appreciation of the gift of life, should constitute the nucleus and framework of all future actions. We know that there are many threats to life. One of them is environmental damage on a global level. Experts say that the dramatic and progressive degradation of the environment will destroy life sooner or later. All the bioethical aspects we have been discussing will be worthless if we are not able to focus on linking our existence to environmental preservation. We must also acknowledge the relationship that exists between the protection of the human species, the protection of the environment and the protection of all the other elements that make up the universal ecosystem. Otherwise, in the not so very distant future, life as we understand it will be over. We all know that if we keep up the current pace of environmental destruction there will be no millennium, no life. We cannot let our children inherit a wasteland planet, even if scientific and technological progress make it possible to preserve biological life.

Based on the need for life on our planet to continue, environmental issues must penetrate every educational system, academic discipline and profession. Bioethics needs to become the active search for millennium values capable of harnessing the effects of science and promoting a new moral code in every profession. Bioethics is the “new ethics” for the millennium.

The SIBI millennium conference must incorporate as may fields as possible. We should not limit ourselves to medicine, but search for bioethical values in every vocation. If we do not acknowledge that all fields are interrelated, we will reduce the chance of expanding our vision for the millennium and will limit ourselves to redefining issues of the past.

I think that bioethics has to expand on the concept of profit. We have forgotten that profit can have cultural as well as economic dimensions, and should therefore include provisions for a better quality of life, progress in medicine, public health, etc. Currently, the concept of profit is only understood in economic terms. Bioethics must transform the popular concept of profit into a new, three-dimensional concept that represents a field open to study. We must be able to determine, quantify and rank how much of this profit is applicable to health, security, quality of life, etc.

MINUTES Nº 2
GIJÓN (Spain), Scientific Committee Meetings on 27th and 28th November 1998

(Español)