To heal or to kill-that is the question

Jérôme Lejeune

Scarce Medical Resources and Justice. The Pope John Center, Braintree (U.S.A), 1987, 244-275.


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For more than two millenia medicine has fought against death and disease. It is only in recent years that some have questioned whether our engagement for life and care was truly irreversible.

From our actual stage of knowledge, it is possible to extrapolate what medical interventions can be achieved in the near future and to predict them reasonably well. The only difficulty is to do it "reasonably."

In the debates about treatments and non-treatments, reason has been baffled by the most passionate and destructive rhetoric. Never have I heard this more terribly spelled out than some fourteen years ago in a press conference in Royaumont Abbey near Paris. A very impressive woman, speaking with authority on behalf of an undisclosed denomination, said bluntly, "We want to destroy the Judeo-Christian civilization-To destroy it we must destroy the family-To destroy the family, we must attack it in its weakest link-that is the child who is not yet born-hence we are for abortion."

I quote by memory for no one of the fifty newspapermen wrote anything about this short statement. The woman said only that, nothing more, but she had said everything. This statement explains why all these discussions had and will ever have a bitter taste.

Obviously some opinion-manipulators want to use technical questions as weapons against Christianity-from the artificial manufacture of human beings in vitro, to the deliberate disposal of early human beings. They know that each deprecation of human nature could be a blow against Catholic faith. This is so true that in his book. Aborting America, Dr. Bernard Nathanson, now a great pro-life advocate, reveals the strategy fabricated by the strategy team of his pro-abortion group. Realizing that abortion is abhorrent to Catholics, they decided never to attack this position of the Church but always to accuse the hierarchy as an anonymous enmity. Thus they tried to irritate some people of poor judgement against their bishops: If the pastor is under attack, maybe the flock will be dispersed.

It is not for a geneticist to leap into these troubled waters, but before trying to analyze what can be done in medicine, it is necessary to have clearly in mind that some technological assertions are often not as "matter of fact" as they are pretended to be.

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The Fundamentals of Life

Life has a very, very long history, but each of us has a very neat beginning, the moment of the conception. The progeny and the parents are constantly united by a material link, the threadlike molecule of DNA, upon which the complete genetic information is written in a fantastically miniaturized language.

On the head of a spermatozoon, there is a one meter length of DNA, cut in 23 pieces. Each segment is very precisely coiled to form little rods visible in an ordinary microscope, the chromosomes.

As soon as the spermatozoon has perforated the "zona pellucida" the plastic bag inside which the ovum is wrapped, the membrane becomes suddenly impenetrable to any other sperm. In purely operational terms, it can be stated that as soon as the 23 paternal chromosomes carried by the sperm are put in the same bag as the 23 maternal chromosomes (carried by the ovum), the total information necessary and sufficient to dictate the genetic make-up of the new human being is gathered. Not a theoretical or a potential human type, but the very human being we will later call Peter, Paul, or Magdalene.

Exactly as introducing a mini-cassette inside a tape recorder will allow the playing of a symphony, the music of the life is played by the machinery of the cytoplasm, and the new human being begins to express itself as soon as he has been conceived.

Soul and body or spirit and matter are so intricately interwoven at the beginning of life that we use the same word, conception, to describe the process by which an idea, a concept, comes into our mind, and to define the genetic process by which a new being, a conceptus, comes to life.

If we wanted to epitomize in one phrase all of molecular biology, it would sound very similar to an awkward paraphrase of the opening of the Gospel of St. John-"At the beginning there is a message, this message is in life, and this message is life."

And if this message is a human message, then this life is a human life.

The fact that the baby will develop itself for another nine months inside the womb of its mother does not change this conclusion, as amply demonstrated by in vitro fertilization.

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Technicalities of Early Life

Once a month a ripe ovum is expelled from the ovary and enters the fallopian tube in which it will encounter the sperm which, among thousands of others, will fertilize it.

It is because natural fecundation occurs between a free-floating egg and a free-swimming sperm that in vitro fertilization is possible. Here a tube of glass replaces the tube of flesh, but at the cellular level the process is identical.

Because sexually transmitted diseases and other pathological conditions can obliterate the fallopian tube, it was proposed years ago to bypass the obstacle. If the ripe ovum is carefully aspirated through a fine plastic tube into a test tube to which sperms are subsequently added, fecundation can occur.

Two or three days later, the tiny embryo, one millimeter and a half long, is already feverishly organizing itself inside the walls of his private life (the zona pellucida). It can be transferred again inside the uterus of his mother.

If Drs. Edwards and Steptoe for the first time took the risk of replacing in the womb of her mother, the very little Louise Brown, the first test-tube conceived baby, it was because all genetics and embryology were assuring them that this little berry-looking being was neither a tumor nor a parasite, but a marvelously young member of our species, the very child of Mr. and Mrs. Brown.

With more than ten thousand children already born that way, it is an experimental fact that the human being begins at conception.

Protected in its life capsule (the zona pellucida first, then the amniotic bag he constructs around himself), the early human being is just as viable and autonomous as a cosmonaut on the moon: refueling with vital fluids is required from the mother vessel. No artificial fluid supplier has yet been invented; shelter and nurture by the mother organism are absolutely required. But if some day it became possible to witness the whole development of the baby inside a very sophisticated incubating system and if the incubating bottle were suddenly to argue, "This baby is my property," nobody would believe the bottle.

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Biological Pornography

In Latin languages we use the same root word for the duration we measure with a clock and for the heat we check with a thermometer (Ie temps). This is appropriate because temperature is a statistical measure of the agitation of the molecules, and this random movement is the very definition of the passing of time.

Refrigeration slows down the molecular motion so that the local time flows slower accordingly. Close to the absolute zero time comes to a standstill. Because of their extraordinary vitality, human sperms and even early human embryos can withstand deep freezing and can be kept, so to speak, in a suspended time quite indefinitely. Hence we have sperm banks, which are very familiar in animal husbandry, and even possible banks of human embryos which some researchers wish to manage.

Deep-frozen human beings could thus be transferred later on into rented wombs of carrier mothers (after due thawing) and reserves of products of warranted quality could be progressively constituted with highly controlled but classified pedigrees.

Artificial twinning could also be induced so that one twin would be normally implanted while the other would be used either for quality testing or would even be kept in the freezer to have spare pieces if needed later for organ replacement.

In a much less sophisticated way, surrogate mothers are very much "a la mode"-possibly because of a strange modem prudery consisting in the production of a child of adultery through a medically guided syringe. Nine months later the biological mother is supposed to sell her child to the male buyer.

With regard to embryos, there is a campaign, especially in England and in Australia, to legalize the use of human embryos for scientific purposes. Again, exactly as in the abortion campaign, the proponents state vociferously that Catholics are not allowed to impose their moral views upon others. Note, though, that forbidding certain citizens to have their say in such matters is a curious use of democracy.

If I have linked together the selling of babies, the manipulation of embryos and the killing of unwanted fetuses, it is because, under the veil of complex and various technologies, all these proposals are, truly speaking, not medical literature, but biological pornography.

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Respect for Human Nature

It may seem unwise to discuss together abortion which is an act of killing and in vitro fertilization which is apparently open to life. There is nevertheless a tragic common point: the loss of respect for human nature.

This expression "human nature" is not very much in vogue nowadays, nevertheless human nature does exist. Just look at the human chromosomes: we can recognize their number, their shape, and even their banding patterns which are typical for each species. If a student looked under the microscope and could not distinguish a chimpanzee cell from a gorilla or an orangutan cell or a human cell, he would fail his exam!

Even microscopic study is not needed. When I travel, there are two places I like to visit in every country: the university and the zoological garden. Both are very instructive. In universities I have encountered highly scholarly and trained specialists holding meetings and asking themselves very gravely whether their own children were not, after all, animals. But I have never seen a congress of chimpanzees at a zoo asking themselves whether their children will become university students! My personal conclusion is: there must be a difference.

This difference becomes absolutely unmistakeable when it comes to reproduction. Sure enough, chimps have sexual problems too. As far as we can imagine the inner psychology of a chimp, their drive to copulate is probably quite comparable to our own physiological feelings. But even the keenest of the chimps will never figure out that the act of copulation has some causal relationship to the outcome of a little chimpanzee some nine months later.

Man is the only creature who knows that love and procreation are united by nature. Even the pagans represented the god of love as a child. This discovery comes from the dawn of human memory, the lost paradise.

This knowledge dignifies the reproductive behavior of mankind: it is unnatural to disassociate carnal love from procreation but it is plainly conformed to human dignity to control procreation, thanks to our knowledge of the laws of nature. This suggests continuous chastity in celibacy and periodic abstinence in marriage.

To sum up, these practices are contrary to the very nature of matrimony: artificial contraception, i.e., making love without making a baby; extracorporeal fecundation, i.e., making a baby without making love; deliberate abortion, i.e., unmaking a baby; and biological pornography, i.e., unmaking love from reproduction.

With regard to the beginning of human nature at conception, the early human embryo is not a perishable commodity to be frozen or defrosted on demand nor a consumable good to be purchased or transmitted at will, nor experimental material, nor a stock of spare pieces. From his very earliest youth, the embryo is a human being of its own who must be protected against any exploitation.

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The Future of Medicine

Should we conclude that respect for human nature would impose new taboos and would become, frankly speaking, an impediment to research?

Absolutely not! To understand why, let us examine two questions: The fight against sterility and the fight against constitutional diseases.

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Sterility of the Married Couple

As we have seen, conjugal intercourse is the only natural way of depositing the masculine cells inside the feminine body by the union of the persons.

Fecundation which will possibly occur hours later is a natural consequence of the physiology of the reproductive cell. This step is no longer under the conscious and deliberate control of the spouses. Eventually, this distinction could have moral significance. If the technician extracts the ovum from the feminine body and mixes it with sperms, he performs the act normally reserved for the union of the spouses. In a sense there is a "substitutio personarum''.

But if the technician does not interfere with the deposition of the sperm inside the feminine body but helps the reproductive cells to bypass whatever obstacle prevents fecundation or nidation, he performs "adjutorium naturae", a help to nature.

Although this distinction could seem to be merely academic, the help in intracorporeal fecundation could be fundamentally different from extracorporeal fecundation. Their consequences, at least, are very different. The human being conceived in vitro by extracorporeal fecundation is exposed to all the risks of manipulation and of exploitation already mentioned. On the contrary, the human being conceived "in corpore matemo", that is, inside the secret temple in the female body, is by this very location automatically protected from all these dangers.

If I could risk a guess, I would suppose that the long trip outside the mother's body implied by extracorporeal fecundation will sooner or later be considered as an unnecessary and undesirable complication.

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Constitutional Anomalies

With amniocenteses, chorionic biopsy or advanced imagery, early detection of abnormalities of the fetus can become routine examinations. Elimination of the affected babies is the avowed goal. However, it is worth remembering that in many countries this argument for the elimination of abnormal children has given very powerful support in favor of abortion laws!

Health by death is a desperate mockery of medicine. The complete history is on hand to show that those who delivered humanity from plague and rabies were not those who burned the plague stricken alive in their houses or suffocated rabid patients between two mattresses. The only possible victory of medicine is over the disease, not over the patient.

Some technicians are even requesting the right to experiment on human embryos up to 14 days of age as proposed in one report. They say this will help them to understand, to prevent, and possibly cure very terrible genetic disabilities like hemophilia, muscular dystrophy, cystic fibrosis or Down's syndrome.

Two years ago I had the honor of explaining to members of the British Parliament that research on those diseases could not be performed at all on human embryos less than 14 days old for a very decisive reason: at this state of development, the relevant organs (brain for mental retardation, pancreas for cystic fibrosis, muscle for muscular dystrophy, or blood-forming organs for hemophilia) are not yet developed.

Such a "matter of fact" statement was very severely condemned by the proponents of experiments on human embryos. It was considered as a "French influence on Britain" (1) as tided in the journal Nature. I had to feel guilty! I should have felt even more guilty for I had asserted that nobody had ever produced a protocol of an experiment showing convincingly that the investigation proposed could only be achieved on a human embryo and could not at all be made on an animal embryo. In "an appeal to embryologists"(2), the journal Nature offered a free one year subscription to the authors of the best submissions to refute my assertion.

Today, nearly two years later, I have to feel even more guilty because Nature has not published any paper on the topic and no embryologist is receiving a free copy of this interesting weekly scientific publication.

This little story just shows how poorly scientific the arguments of the experimenters on human embryos can be.

I had also predicted that success will probably be achieved in these four diseases by the study of adult patients with cultures of their cells and examination of the relevant DNA.

Indeed, without any responsibility on my part, thanks to the work of many different researchers in many countries, the genes of cystic fihrosis (3) and of Duchenne's muscular dystrophy (4) have been found and cloned, as well as those of Huntington's chorea (5) and of retinoblastoma(6). For hemophilia, the special coagulation factor is now manufactured by manipulated bacterias so that patients can be treated with a pure product without any risk of transmission of AIDS through contaminated blood! For several other diseases, beneficial modification by bone-marrow transplants has been successfully achieved (7).

All these successes in 1985 have been obtained without endangering any human embryos at all.

For Down's syndrome, the disease in which I am particularly interested, research is even more difficult because here a whole chromosome is in excess which provokes a kind of "overdose" of genetic information.

The situation is roughly comparable to a car with a four cylinder engine mounted by mistake with five spark plugs! Sure enough the motor would not run smoothly. A good car repairman, instead of throwing it away, (as an abortionist would do), would delicately disconnect the extra spark plug and thus put back the function to normal.

We do not know yet how to unplug an extra chromosome, but nature does. She unplugs the extra X chromosomes when necessary. Maybe some day we will leam how to do it and apply the trick to the extra chromosome 21, responsible for the trisomy, the cause of Down's syndrome.

We can also continue deciphering the genetic content of this chromosome. Already five genes are known and it is reasonable to suppose that in less than 10 years, the whole DNA of this chromosome will be unraveled. In between, we can look for some regulation of the "carburation," so to speak. Last year we demonstrated that the cells of trisomic 21 babies are more sensitive than normal to a drug blocking the metabolism of monocar-bons (8). These monocarbons are tiny pieces of molecules containing only one atom of carbon, hence their name. They are the smallest building stones for the construction and maintenance of our nervous system but they are the most used ones.

The hypothesis that an extra supply of some chemicals involved in this metabolism could be of interest for the children is under scrutiny.

This is not to say that the destiny of all these cheerful children will soon be alleviated. On the contrary, it means that discovery successes are just beginning and that respect for human nature does not impair research but stimulates it. The proponents of selective abortion, or of exploitation on human embryos were mistaken when offering Catholic doctors this cruel dilemma: either you take part with us in this search and destroy mission and you accept the massacre of the innocents, or you refuse to help the families affected by incurable children and you wash your hands of their sorrow. No, medicine is not forced to choose between playing Herod or Pontius Pilate. There arc possible lines of research in full accordance with moral norms. Even if I cannot prophesize about the future, there is one thing of which I am totally sure: we will never give up and, Deo Juvante, (with God's help), we shall overcome someday.

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Faust or Jesus

A last question remains: Why are in vitro fertilization and manipulation of human embryos so fascinating?

Although often quoted, the production lines for specially programmed human beings is not the most important reason. Aldous Huxley had a deeper insight.

In the purely materialistic society which he describes in The Brave New World, totally desacralized and free of any taboos, all the obscenities were in common use and even inculcated in the school children. Nevertheless, the editors were obliged to reprint all the literature in order to expurgate from it the only incongruity which could not be pronounced nor even be read. It was to be replaced by three points of suspension. This word was the word "Mother".

Motherhood has become a pure obscenity; this complete inversion of values is the real danger Aldous Huxley has warned us about.

But 150 years ago, another visionary, the mightiest of the poets, had seen even deeper. In the first Faust, Goethe tells about the beloved woman seduced and abandoned, killing her child. The damnation of Dr. Faust is the tragedy of the aborted love.In the second Faust, Goethe embraced the times to come. After the death of Marguerite, Faust comes back to his old laboratory with his diabolic companion. They watch the successor of Faust producing an homunculus in an alchemic vessel (a test tube baby). The tiny creature escapes from the test tube and greets Mephistopheles, calling him, "my cousin." Then, guided by this strange dream baby, Faust attempts his impossible passion with the ghost of Helen of Troy.

At the very end of the drama, the magic of Mephistopheles has produced a modern society exclusively technical and rationalized. Faust gives his last orders: silence this little bell of the old chapel, the only one still ringing in my whole empire, and move away the little cabin in which Philemon and Baucis are still living, to enlarge the channel through which the wealth is flowing.

And when Mephistopheles returns after having burned the old lovers in their cabin, when the silence becomes heavier, when the last vestiges of human and of the divine love have at once been destroyed, then, inexorable and deadly, sorrow invades the heart of the doctor.

Great writers do not create science, but they foresee it. Producing men artificially, manipulating them at our own whim, is it not the temptation of absolute pride: "Man is now made in our own image, he is not made to the image of God."

Especially appointed "ethical" committees will probably continue to try to change the moral judgment, but their contradictory oracles will not exorcize the sorrow for a decisive reason: Technology is cumulative, wisdom is not.

To guide us Catholic doctors there is only one moral principle. Very simple and clear, it is an argument which Judges everything. "What you have done to the smallest of mine, you have done it unto Me."

If doctors always remember this Word, the most sophisticated technique will remain the honest servant of medicine; but if they forget it, then anything shall be feared from a denatured biology.


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Bibliographie

1. Walgate R., "French influence in Britain," Nature 313, 21 Feb. 1985, p. 618.

2. Editorial, Nature, "An appeal to embryologists," Nature 316, 11.

3. Beaudet et coll., "linkage of cystic fibrosis to two tightly linked DNA markers: joint report of a collaborative study," Am.J. Hum. Genet. 39, 681-693, 1986.

4. Monaco A.P., Neve R.L., Colletti-Feener C., Bcrtelson CJ., Kumit D.M.. Kunkel L.M., "Isolation of candidate cDNAs for portions of the Duchenne muscular dystrophy gene," Lancet, 323, 646-650, 1986.

5. Landegent J E., Jansen in de Wal N., Fisser-Groen Y.M., Bakker E., Van Der Ploeg M., Pearson P.L., "Fine mapping of the Huntington disease linked D4S10 locus by non-radioactive in situ hybridization," Hum. Genet 73, 354-357, 1986.

6. Friend S.J., Bernards R., Rogel J.S., Weinberg R.A,, Rapaport J.M., Albert D.M., Dryja T.P., "A human DNA segment with properties of the gene that predisposes to retinoblastoma and osteosarcoma," Nature, 323, 643-646, 1986.

7. Hobbs J.R., "Displacement bone-marrow transplantation and immunoprophylaxis to treat some genetic diseases," Bone-Marrow Transplantation 1, 333-335, 1986.

8. Le|eune J., Rethorc M.O., de Blois M.C., Maunoury-Burolla C., Mir M., Nicolle L., Borowy F., Borghi E., Recan D., "Metabolisme des monocarbones et trisomie 21: sensibility au mdthotrexate" Ann. Genet. 29, 16-19, 1986.

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