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.
Haut
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.
Haut
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.
Haut
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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[ Questions and Responses]
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