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Table of Contents: Letter of Transmittal to the President     Members of the President's Council on Bioethics     Council Staff and Consultants Preface Executive Summary Chapter One: The Meaning of Human Cloning: An Overview Chapter Two: Historical Aspects of Cloning Chapter Three: On Terminology Chapter Four: Scientific Background Chapter Five: The Ethics of Cloning-to-Produce-Children Chapter Six: The Ethics of Cloning-for-Biomedical-Research Chapter Seven: Public Policy Options Chapter Eight: Policy Recommendations Bibliography Glossary of Terms Appendix: Personal Statements

Letter of Transmittal

The President
The White House
Washington, D.C.

Dear Mr. President:

I am pleased to present to you the first report of the President's Council on Bioethics, Human Cloning and Human Dignity: An Ethical Inquiry. The product of six months of discussion, research, reflection, and deliberation, we hope that it will prove a worthy contribution to public understanding of this momentous question.

Man's biotechnological powers are expanding in scope, at what seems an accelerating pace. Many of these powers are double-edged, offering help for human suffering, yet threatening harm to human dignity. Human cloning, we are confident, is but a foretaste – the herald of many dazzling genetic and reproductive technologies that will raise profound moral questions well into the future. It is crucial that we try to understand its full human significance.

We have tried to conduct our inquiry into human cloning unblinkered, with our eyes open not only to the benefits of the new biotechnologies but also to their challenges – moral, social, and political. We have not suppressed differences but sought rather to illuminate them, that all might better appreciate what is at stake. We have eschewed a thin utilitarian calculus of costs and benefits, or a narrow analysis based only on individual "rights." Rather, we have tried to ground our reflections on the broader plane of human procreation and human healing, with their deeper meanings. Seen in this way, we find that the power to clone human beings is not just another in a series of powerful tools for overcoming unwanted infertility or treating disease. Rather, cloning represents a turning point in human history – the crossing of an important line separating sexual from asexual procreation and the first step toward genetic control over the next generation. It thus carries with it a number of troubling consequences for children, family, and society.

Although the Council is not unanimous, either in some of its ethical conclusions or its policy recommendations, we are unanimous in submitting the entire report as a fair and accurate reflection both of our views and of the state of the question. To summarize our findings briefly:

First. The Council holds unanimously that cloning-to-produce-children is unethical, ought not to be attempted, and should be indefinitely banned by federal law, regardless of who performs the act or whether federal funds are involved.

Second. On the related question of the ethics of cloning-for-biomedical research, the Council is of several minds and is divided in its policy preferences:

• Seven Members (a minority), eager to see the research proceed, recommend permitting cloning-for-biomedical-research to go forward, but only under strict federal regulation.

• Ten Members (a majority), convinced that no human cloning should be permitted at least for the time being, recommend instituting, by law, a four-year ban on cloning-for-biomedical-research, applicable to all researchers regardless of whether federal funds are involved.

Third. The same ten-Member majority recommends a federal review of current and projected practices of human embryo research, pre-implantation genetic diagnosis, genetic modification of human embryos and gametes, and related matters, with a view to recommending and shaping ethically sound policies for the entire field. A thorough federal review, during the moratorium, could help to clarify the issues and foster a public consensus about how to proceed, not just on cloning-for-biomedical-research but on all the related reproductive and genetic technologies. We think this Council is well situated to initiate such a review, and we have already begun it. But we also stand ready to assist any other body that may be established to take up this large and complex subject.

The extensive reasoning underlying these recommendations is given at length in the report and is well summarized in the Executive Summary, and so I shall not rehearse it here.

On behalf of my Council colleagues, and our fine staff, allow me to thank you, Mr. President, for the opportunity you have given us to serve the nation on this weighty subject.

Members of the President's Council on Bioethics

Council Staff and Consultants

Preface

Human Cloning and Human Dignity: An Ethical Inquiry is the first publication of the President's Council on Bioethics, which was created by President George W. Bush on November 28, 2001, by means of Executive Order 13237.

The Council's purpose is to advise the President on bioethical issues related to advances in biomedical science and technology. In connection with its advisory role, the mission of the Council includes the following functions:

• To undertake fundamental inquiry into the human and moral significance of developments in biomedical and behavioral science and technology.
  
  
• To explore specific ethical and policy questions related to these developments.
  
  
• To provide a forum for a national discussion of bioethical issues.
  
  
• To facilitate a greater understanding of bioethical issues.
  
  
• To explore possibilities for useful international collaboration on bioethical issues.

President Bush left the Council free to establish its own priorities among the many issues encompassed within its charter, based on the urgency and gravity of those issues and the public need for practical guidance about them.

The Council had little difficulty in choosing its first topic of inquiry. The ethics of human cloning has been the subject of intense discussion in the United States and throughout the world for more than five years, and it remains the subject of heated debate in Congress. On the surface, discussion has focused on the safety of cloning techniques, the hoped-for medical benefits of cloning research, and the morality of experimenting on human embryos. But driving the conversations are deeper concerns about where biotechnology may be taking us and what it might mean for human freedom, equality, and dignity.

Human cloning, were it to succeed, would enable parents for the first time to determine the entire genetic makeup of their children. Bypassing sexual reproduction, it would move procreation increasingly under artful human control and in the direction of manufacture. Seen as a forerunner of possible future genetic engineering, it raises for many people concerns also about eugenics, the project to "improve" the human race. A world that practiced human cloning, we sense, could be a very different world, perhaps radically different, from the one we know. It is crucial that we try to understand, before it happens, whether, how, and why this may be so.

Investigating human cloning also provides the Council an important opportunity to illustrate how bioethics can and should deal with those technological innovations that touch deeply our humanity. Here, as elsewhere, the most profound issues go beyond the commonplace and utilitarian concerns of feasibility, safety, and efficacy. In addition, on the policy side, cloning offers us a test case for considering whether public control of biotechnology is possible and desirable, and if so, by what means and at what cost.

The Council commenced deliberations on the topic of human cloning at its first meeting in January 2002, and continued the discussion at its February, April, and June meetings, all held in Washington, D.C. We heard presentations on the recent cloning report of the National Academy of Sciences; on human stem cell research, embryonic and adult; on the ethics of embryo research; and on international systems of regulation of embryo research and assisted reproductive technologies. We received a great deal of public comment, oral and written. All told, we held twelve ninety-minute conversations on the subject.

Recognizing "the complex and often competing moral positions" on biomedical issues, President Bush specified in creating the Council that it need not be constrained by "an overriding concern to find consensus." In this report we have chosen not to be so constrained. We have not suppressed disagreements in search of a single, watered-down position. Instead, we have presented clear arguments for the relevant moral and policy positions on multiple sides of these difficult questions, representing each as fairly and fully as we can. As a result, the reader will notice that, on some of the matters discussed in the report, Members of the Council are not all of one mind. Members are united, though, in endorsing the worthiness of the approach taken and the importance of the separate arguments made. Accordingly, the Council is unanimous in owning the entire report and in recommending all its discussions and arguments for serious consideration.

Readers interested in delving further into this subject may wish to consult the Bibliography, which includes all of the documents referred to within the report, as well as the verbatim transcripts of our meetings, which are posted at our website (www.bioethics.gov).

It was in his remarks to the nation on federal funding of embryonic stem cell research, on August 9, 2001, that President Bush first declared his intention to create this Council. At the end of that speech, the President said:

I will also name a President's council to monitor stem cell research, to recommend appropriate guidelines and regulations, and to consider all of the medical and ethical ramifications of biomedical innovation. . . . This council will keep us apprised of new developments and give our nation a forum to continue to discuss and evaluate these important issues. As we go forward, I hope we will always be guided by both intellect and heart, by both our capabilities and our conscience.

It has been our goal in these pages – and shall remain our goal in the future – to live up to the President's high hopes and noble aspirations.

Executive Summary

For the past five years, the prospect of human cloning has been the subject of considerable public attention and sharp moral debate, both in the United States and around the world. Since the announcement in February 1997 of the first successful cloning of a mammal (Dolly the sheep), several other species of mammals have been cloned. Although a cloned human child has yet to be born, and although the animal experiments have had low rates of success, the production of functioning mammalian cloned offspring suggests that the eventual cloning of humans must be considered a serious possibility.

In November 2001, American researchers claimed to have produced the first cloned human embryos, though they reportedly reached only a six-cell stage before they stopped dividing and died. In addition, several fertility specialists, both here and abroad, have announced their intention to clone human beings. The United States Congress has twice taken up the matter, in 1998 and again in 2001-2002, with the House of Representatives in July 2001 passing a strict ban on all human cloning, including the production of cloned human embryos. As of this writing, several cloning-related bills are under consideration in the Senate. Many other nations have banned human cloning, and the United Nations is considering an international convention on the subject. Finally, two major national reports have been issued on human reproductive cloning, one by the National Bioethics Advisory Commission (NBAC) in 1997, the other by the National Academy of Sciences (NAS) in January 2002. Both the NBAC and the NAS reports called for further consideration of the ethical and social questions raised by cloning.

The debate over human cloning became further complicated in 1998 when researchers were able, for the first time, to isolate human embryonic stem cells. Many scientists believe that these versatile cells, capable of becoming any type of cell in the body, hold great promise for understanding and treating many chronic diseases and conditions. Some scientists also believe that stem cells derived from cloned human embryos, produced explicitly for such research, might prove uniquely useful for studying many genetic diseases and devising novel therapies. Public reaction to the prospect of cloning-for-biomedical-research has been mixed: some Americans support it for its medical promise; others oppose it because it requires the exploitation and destruction of nascent human life, which would be created solely for research purposes.

The intense attention given to human cloning in both its potential uses, for reproduction as well as for research, strongly suggests that people do not regard it as just another new technology. Instead, we see it as something quite different, something that touches fundamental aspects of our humanity. The notion of cloning raises issues about identity and individuality, the meaning of having children, the difference between procreation and manufacture, and the relationship between the generations. It also raises new questions about the manipulation of some human beings for the benefit of others, the freedom and value of biomedical inquiry, our obligation to heal the sick (and its limits), and the respect and protection owed to nascent human life.

Finally, the legislative debates over human cloning raise large questions about the relationship between science and society, especially about whether society can or should exercise ethical and prudential control over biomedical technology and the conduct of biomedical research. Rarely has such a seemingly small innovation raised such big questions.

The Inquiry: Our Point of Departure

As Members of the President's Council on Bioethics, we have taken up the larger ethical and social inquiry called for in the NBAC and NAS reports, with the aim of advancing public understanding and informing public policy on the matter. We have attempted to consider human cloning (both for producing children and for biomedical research) within its larger human, technological, and ethical contexts, rather than to view it as an isolated technical development. We focus first on the broad human goods that it may serve as well as threaten, rather than on the immediate impact of the technique itself. By our broad approach, our starting on the plane of human goods, and our open spirit of inquiry, we hope to contribute to a richer and deeper understanding of what human cloning means, how we should think about it, and what we should do about it.

On some matters discussed in this report, Members of the Council are not of one mind. Rather than bury these differences in search of a spurious consensus, we have sought to present all views fully and fairly, while recording our agreements as well as our genuine diversity of perspectives, including our differences on the final recommendations to be made. By this means, we hope to help policymakers and the general public appreciate more thoroughly the difficulty of the issues and the competing goods that are at stake.

There is today much confusion about the terms used to discuss human cloning, regarding both the activity involved and the entities that result. The Council stresses the importance of striving not only for accuracy but also for fairness, especially because the choice of terms can decisively affect the way questions are posed, and hence how answers are given. We have sought terminology that most accurately conveys the descriptive reality of the matter, in order that the moral arguments can then proceed on the merits. We have resisted the temptation to solve the moral questions by artful redefinition or by denying to some morally crucial element a name that makes clear that there is a moral question to be faced.

On the basis of (1) a careful analysis of the act of cloning, and its relation to the means by which it is accomplished and the purposes it may serve, and (2) an extensive critical examination of alternative terminologies, the Council has adopted the following definitions for the most important terms in the matter of human cloning:

• Cloning: A form of reproduction in which offspring result not from the chance union of egg and sperm (sexual reproduction) but from the deliberate replication of the genetic makeup of another single individual (asexual reproduction).
  
  
• Human cloning: The asexual production of a new human organism that is, at all stages of development, genetically virtually identical to a currently existing or previously existing human being. It would be accomplished by introducing the nuclear material of a human somatic cell (donor) into an oocyte (egg) whose own nucleus has been removed or inactivated, yielding a product that has a human genetic constitution virtually identical to the donor of the somatic cell. (This procedure is known as "somatic cell nuclear transfer," or SCNT). We have declined to use the terms "reproductive cloning" and "therapeutic cloning." We have chosen instead to use the following designations:
  
  
• Cloning-to-produce-children: Production of a cloned human embryo, formed for the (proximate) purpose of initiating a pregnancy, with the (ultimate) goal of producing a child who will be genetically virtually identical to a currently existing or previously existing individual.
  
  
• Cloning-for-biomedical-research: Production of a cloned human embryo, formed for the (proximate) purpose of using it in research or for extracting its stem cells, with the (ultimate) goals of gaining scientific knowledge of normal and abnormal development and of developing cures for human diseases.
  
  
• Cloned human embryo: (a) A human embryo resulting from the nuclear transfer process (as contrasted with a human embryo arising from the union of egg and sperm). (b) The immediate (and developing) product of the initial act of cloning, accomplished by successful SCNT, whether used subsequently in attempts to produce children or in biomedical research.

Cloning research and stem cell research are being actively investigated and the state of the science is changing rapidly; significant new developments could change some of the interpretations in our report. At present, however, a few general points may be highlighted.

• The technique of cloning. The following steps have been used to produce live offspring in the mammalian species that have been successfully cloned. Obtain an egg cell from a female of a mammalian species. Remove its nuclear DNA, to produce an enucleated egg. Insert the nucleus of a donor adult cell into the enucleated egg, to produce a reconstructed egg. Activate the reconstructed egg with chemicals or electric current, to stimulate it to commence cell division. Sustain development of the cloned embryo to a suitable stage in vitro, and then transfer it to the uterus of a female host that has been suitably prepared to receive it. Bring to live birth a cloned animal that is genetically virtually identical (except for the mitochondrial DNA) to the animal that donated the adult cell nucleus.
  
  
• Animal cloning: low success rates, high morbidity. At least seven species of mammals (none of them primates) have been successfully cloned to produce live births. Yet the production of live cloned offspring is rare and the failure rate is high: more than 90 percent of attempts to initiate a clonal pregnancy do not result in successful live birth. Moreover, the live-born cloned animals suffer high rates of deformity and disability, both at birth and later on. Some biologists attribute these failures to errors or incompleteness of epigenetic reprogramming of the somatic cell nucleus.
  
  
• Attempts at human cloning. At this writing, it is uncertain whether anyone has attempted cloning-to-produce-children (although at least one physician is now claiming to have initiated several active clonal pregnancies, and others are reportedly working on it). We do not know whether a transferred cloned human embryo can progress all the way to live birth.
  
  
• Stem cell research. Human embryonic stem cells have been isolated from embryos (produced by IVF) at the blastocyst stage or from the germinal tissue of fetuses. Human adult stem (or multipotent) cells have been isolated from a variety of tissues. Such cell populations can be differentiated in vitro into a number of different cell types, and are currently being studied intensely for their possible uses in regenerative medicine. Most scientists working in the field believe that stem cells (both embryonic and adult) hold great promise as routes toward cures and treatments for many human diseases and disabilities. All stem cell research is at a very early stage, and it is too soon to tell which approaches will prove most useful, and for which diseases.
  
  
• The transplant rejection problem. To be effective as long-term treatments, cell transplantation therapies will have to overcome the immune rejection problem. Cells and tissues derived from adult stem cells and returned to the patient from whom they were taken would not be subject (at least in principle) to immune rejection.
  
  
• Stem cells from cloned embryos. Human embryonic stem cell preparations could potentially be produced by using somatic cell nuclear transfer to produce a cloned human embryo, and then taking it apart at the blastocyst stage and isolating stem cells. These stem cells would be genetically virtually identical to cells from the nucleus donor, and thus could potentially be of great value in biomedical research. Very little work of this sort has been done to date in animals, and there are as yet no published reports of cloned human embryos grown to the blastocyst stage. Although the promise of such research is at this time unknown, most researchers believe it will yield very useful and important knowledge, pointing toward new therapies and offering one of several possible routes to circumvent the immune rejection problem. Although some experimental results in animals are indeed encouraging, they also demonstrate some tendency even of cloned stem cells to stimulate an immune response.
  
  
• The fate of embryos used in research. All extractions of stem cells from human embryos, cloned or not, involve the destruction of these embryos.

Two separate national-level reports on human cloning (NBAC, 1997; NAS, 2002) concluded that attempts to clone a human being would be unethical at this time due to safety concerns and the likelihood of harm to those involved. The Council concurs in this conclusion. But we have extended the work of these distinguished bodies by undertaking a broad ethical examination of the merits of, and difficulties with, cloning-to-produce-children.

Cloning-to-produce-children might serve several purposes. It might allow infertile couples or others to have genetically-related children; permit couples at risk of conceiving a child with a genetic disease to avoid having an afflicted child; allow the bearing of a child who could become an ideal transplant donor for a particular patient in need; enable a parent to keep a living connection with a dead or dying child or spouse; or enable individuals or society to try to "replicate" individuals of great talent or beauty. These purposes have been defended by appeals to the goods of freedom, existence (as opposed to nonexistence), and well-being – all vitally important ideals.

A major weakness in these arguments supporting cloning-to-produce-children is that they overemphasize the freedom, desires, and control of parents, and pay insufficient attention to the well-being of the cloned child-to-be. The Council holds that, once the child-to-be is carefully considered, these arguments are not sufficient to overcome the powerful case against engaging in cloning-to-produce-children.

First, cloning-to-produce-children would violate the principles of the ethics of human research. Given the high rates of morbidity and mortality in the cloning of other mammals, we believe that cloning-to-produce-children would be extremely unsafe, and that attempts to produce a cloned child would be highly unethical. Indeed, our moral analysis of this matter leads us to conclude that this is not, as is sometimes implied, a merely temporary objection, easily removed by the improvement of technique. We offer reasons for believing that the safety risks might be enduring, and offer arguments in support of a strong conclusion: that conducting experiments in an effort to make cloning-to-produce-children less dangerous would itself be an unacceptable violation of the norms of research ethics. There seems to be no ethical way to try to discover whether cloning-to-produce-children can become safe, now or in the future.

If carefully considered, the concerns about safety also begin to reveal the ethical principles that should guide a broader assessment of cloning-to-produce-children: the principles of freedom, equality, and human dignity. To appreciate the broader human significance of cloning-to-produce-children, one needs first to reflect on the meaning of having children; the meaning of asexual, as opposed to sexual, reproduction; the importance of origins and genetic endowment for identity and sense of self; the meaning of exercising greater human control over the processes and "products" of human reproduction; and the difference between begetting and making. Reflecting on these topics, the Council has identified five categories of concern regarding cloning-to-produce-children. (Different Council Members give varying moral weight to these different concerns.)

• Problems of identity and individuality. Cloned children may experience serious problems of identity both because each will be genetically virtually identical to a human being who has already lived and because the expectations for their lives may be shadowed by constant comparisons to the life of the "original."
  
  
• Concerns regarding manufacture. Cloned children would be the first human beings whose entire genetic makeup is selected in advance. They might come to be considered more like products of a designed manufacturing process than "gifts" whom their parents are prepared to accept as they are. Such an attitude toward children could also contribute to increased commercialization and industrialization of human procreation.
  
  
• The prospect of a new eugenics. Cloning, if successful, might serve the ends of privately pursued eugenic enhancement, either by avoiding the genetic defects that may arise when human reproduction is left to chance, or by preserving and perpetuating outstanding genetic traits, including the possibility, someday in the future, of using cloning to perpetuate genetically engineered enhancements.
  
  
• Troubled family relations. By confounding and transgressing the natural boundaries between generations, cloning could strain the social ties between them. Fathers could become "twin brothers" to their "sons"; mothers could give birth to their genetic twins; and grandparents would also be the "genetic parents" of their grandchildren. Genetic relation to only one parent might produce special difficulties for family life.
  
  
• Effects on society. Cloning-to-produce-children would affect not only the direct participants but also the entire society that allows or supports this activity. Even if practiced on a small scale, it could affect the way society looks at children and set a precedent for future nontherapeutic interventions into the human genetic endowment or novel forms of control by one generation over the next. In the absence of wisdom regarding these matters, prudence dictates caution and restraint.

Ethical assessment of cloning-for-biomedical-research is far more vexing. On the one hand, such research could lead to important knowledge about human embryological development and gene action, both normal and abnormal, ultimately resulting in treatments and cures for many dreaded illnesses and disabilities. On the other hand, the research is morally controversial because it involves the deliberate production, use, and ultimate destruction of cloned human embryos, and because the cloned embryos produced for research are no different from those that could be implanted in attempts to produce cloned children. The difficulty is compounded by what are, for now, unanswerable questions as to whether the research will in fact yield the benefits hoped for, and whether other promising and morally nonproblematic approaches might yield comparable benefits. The Council, reflecting the differences of opinion in American society, is divided regarding the ethics of research involving (cloned) embryos. Yet we agree that all parties to the debate have concerns vital to defend, vital not only to themselves but to all of us. No human being and no society can afford to be callous to the needs of suffering humanity, or cavalier about the treatment of nascent human life, or indifferent to the social effects of adopting one course of action rather than another.

To make clear to all what is at stake in the decision, Council Members have presented, as strongly as possible, the competing ethical cases for and against cloning-for-biomedical-research in the form of first-person attempts at moral suasion. Each case has tried to address what is owed to suffering humanity, to the human embryo, and to the broader society. Within each case, supporters of the position in question speak only for themselves, and not for the Council as a whole.

The moral case for cloning-for-biomedical-research rests on our obligation to try to relieve human suffering, an obligation that falls most powerfully on medical practitioners and biomedical researchers. We who support cloning-for-biomedical-research all agree that it may offer uniquely useful ways of investigating and possibly treating many chronic debilitating diseases and disabilities, providing aid and relief to millions. We also believe that the moral objections to this research are outweighed by the great good that may come from it. Up to this point, we who support this research all agree. But we differ among ourselves regarding the weight of the moral objections, owing to differences about the moral status of the cloned embryo. These differences of opinion are sufficient to warrant distinguishing two different moral positions within the moral case for cloning-for-biomedical-research:

Position Number One. Most Council Members who favor cloning-for-biomedical-research do so with serious moral concerns. Speaking only for ourselves, we acknowledge the following difficulties, but think that they can be addressed by setting proper boundaries.

• Intermediate moral status. While we take seriously concerns about the treatment of nascent human life, we believe there are sound moral reasons for not regarding the embryo in its earliest stages as the moral equivalent of a human person. We believe the embryo has a developing and intermediate moral worth that commands our special respect, but that it is morally permissible to use early-stage cloned human embryos in important research under strict regulation.
  
  
• Deliberate creation for use. We believe that concerns over the problem of deliberate creation of cloned embryos for use in research have merit, but when properly understood should not preclude cloning-for-biomedical-research. These embryos would not be "created for destruction," but for use in the service of life and medicine. They would be destroyed in the service of a great good, and this should not be obscured.
  
  
• Going too far. We acknowledge the concern that some researchers might seek to develop cloned embryos beyond the blastocyst stage, and for those of us who believe that the cloned embryo has a developing and intermediate moral status, this is a very real worry. We approve, therefore, only of research on cloned embryos that is strictly limited to the first fourteen days of development – a point near when the primitive streak is formed and before organ differentiation occurs.
  
  
• Other moral hazards. We believe that concerns about the exploitation of women and about the risk that cloning-for-biomedical-research could lead to cloning-to-produce-children can be adequately addressed by appropriate rules and regulations. These concerns need not frighten us into abandoning an important avenue of research.

Position Number Two. A few Council Members who favor cloning-for-biomedical-research do not share all the ethical qualms expressed above. Speaking only for ourselves, we hold that this research, at least for the purposes presently contemplated, presents no special moral problems, and therefore should be endorsed with enthusiasm as a potential new means of gaining knowledge to serve humankind. Because we accord no special moral status to the early-stage cloned embryo and believe it should be treated essentially like all other human cells, we believe that the moral issues involved in this research are no different from those that accompany any biomedical research. What is required is the usual commitment to high standards for the quality of research, scientific integrity, and the need to obtain informed consent from donors of the eggs and somatic cells used in nuclear transfer.

The moral case against cloning-for-biomedical-research acknowledges the possibility – though purely speculative at the moment – that medical benefits might come from this particular avenue of experimentation. But we believe it is morally wrong to exploit and destroy developing human life, even for good reasons, and that it is unwise to open the door to the many undesirable consequences that are likely to result from this research. We find it disquieting, even somewhat ignoble, to treat what are in fact seeds of the next generation as mere raw material for satisfying the needs of our own. Only for very serious reasons should progress toward increased knowledge and medical advances be slowed. But we believe that in this case such reasons are apparent.

• Moral status of the cloned embryo. We hold that the case for treating the early-stage embryo as simply the moral equivalent of all other human cells (Position Number Two, above) is simply mistaken: it denies the continuous history of human individuals from the embryonic to fetal to infant stages of existence; it misunderstands the meaning of potentiality; and it ignores the hazardous moral precedent that the routinized creation, use, and destruction of nascent human life would establish. We hold that the case for according the human embryo "intermediate and developing moral status" (Position Number One, above) is also unconvincing, for reasons both biological and moral. Attempts to ground the limited measure of respect owed to a maturing embryo in certain of its developmental features do not succeed, and the invoking of a "special respect" owed to nascent human life seems to have little or no operative meaning if cloned embryos may be created in bulk and used routinely with impunity. If from one perspective the view that the embryo seems to amount to little may invite a weakening of our respect, from another perspective its seeming insignificance should awaken in us a sense of shared humanity and a special obligation to protect it.
  
  
• The exploitation of developing human life. To engage in cloning-for-biomedical-research requires the irreversible crossing of a very significant moral boundary: the creation of human life expressly and exclusively for the purpose of its use in research, research that necessarily involves its deliberate destruction. If we permit this research to proceed, we will effectively be endorsing the complete transformation of nascent human life into nothing more than a resource or a tool. Doing so would coarsen our moral sensibilities and make us a different society: one less humble toward that which we cannot fully understand, less willing to extend the boundaries of human respect ever outward, and more willing to transgress moral boundaries once it appears to be in our own interests to do so.
  
  
• Moral harm to society. Even those who are uncertain about the precise moral status of the human embryo have sound ethical-prudential reasons to oppose cloning-for-biomedical-research. Giving moral approval to such research risks significant moral harm to our society by (1) crossing the boundary from sexual to asexual reproduction, thus approving in principle the genetic manipulation and control of nascent human life; (2) opening the door to other moral hazards, such as cloning-to-produce-children or research on later-stage human embryos and fetuses; and (3) potentially putting the federal government in the novel and unsavory position of mandating the destruction of nascent human life. Because we are concerned not only with the fate of the cloned embryos but also with where this research will lead our society, we think prudence requires us not to engage in this research.
  
  
• What we owe the suffering. We are certainly not deaf to the voices of suffering patients; after all, each of us already shares or will share in the hardships of mortal life. We and our loved ones are all patients or potential patients. But we are not only patients, and easing suffering is not our only moral obligation. As much as we wish to alleviate suffering now and to leave our children a world where suffering can be more effectively relieved, we also want to leave them a world in which we and they want to live – a world that honors moral limits, that respects all life whether strong or weak, and that refuses to secure the good of some human beings by sacrificing the lives of others.

The Council recognizes the challenges and risks of moving from moral assessment to public policy. Reflections on the "social contract" between science and society highlight both the importance of scientific freedom and the need for boundaries. We note that other countries often treat human cloning in the context of a broad area of biomedical technology, at the intersection of reproductive technology, embryo research, and genetics, while the public policy debate in the United States has treated cloning largely on its own. We recognize the special difficulty in formulating sound public policy in this area, given that the two ethically distinct matters-cloning-to-produce-children and cloning-for-biomedical-research-will be mutually affected or implicated in any attempts to legislate about either. Nevertheless, our ethical and policy analysis leads us to the conclusion that some deliberate public policy at the federal level is needed in the area of human cloning.

We reviewed the following seven possible policy options and considered their relative strengths and weaknesses: (1) Professional self-regulation but no federal legislative action ("self-regulation"); (2) A ban on cloning-to-produce-children, with neither endorsement nor restriction of cloning-for-biomedical-research ("ban plus silence"); (3) A ban on cloning-to-produce-children, with regulation of the use of cloned embryos for biomedical research ("ban plus regulation"); (4) Governmental regulation, with no legislative prohibitions ("regulation of both"); (5) A ban on all human cloning, whether to produce children or for biomedical research ("ban on both"); (6) A ban on cloning-to-produce-children, with a moratorium or temporary ban on cloning-for-biomedical-research ("ban plus moratorium"); or (7) A moratorium or temporary ban on all human cloning, whether to produce children or for biomedical research ("moratorium on both").

Having considered the benefits and drawbacks of each of these options, and taken into account our discussions and reflections throughout this report, the Council recommends two possible policy alternatives, each supported by a portion of the Members.

Majority Recommendation: Ten Members of the Council recommend a ban on cloning-to-produce-children combined with a four-year moratorium on cloning-for-biomedical-research. We also call for a federal review of current and projected practices of human embryo research, pre-implantation genetic diagnosis, genetic modification of human embryos and gametes, and related matters, with a view to recommending and shaping ethically sound policies for the entire field. Speaking only for ourselves, those of us who support this recommendation do so for some or all of the following reasons:

• By permanently banning cloning-to-produce-children, this policy gives force to the strong ethical verdict against cloning-to-produce-children, unanimous in this Council (and in Congress) and widely supported by the American people. And by enacting a four-year moratorium on the creation of cloned embryos, it establishes an additional safeguard not afforded by policies that would allow the production of cloned embryos to proceed without delay.
  
  
• It calls for and provides time for further democratic deliberation about cloning-for-biomedical research, a subject about which the nation is divided and where there remains great uncertainty. A national discourse on this subject has not yet taken place in full, and a moratorium, by making it impossible for either side to cling to the status-quo, would force both to make their full case before the public. By banning all cloning for a time, it allows us to seek moral consensus on whether or not we should cross a major moral boundary (creating nascent cloned human life solely for research) and prevents our crossing it without deliberate decision. It would afford time for scientific evidence, now sorely lacking, to be gathered – from animal models and other avenues of human research – that might give us a better sense of whether cloning-for-biomedical-research would work as promised, and whether other morally nonproblematic approaches might be available. It would promote a fuller and better-informed public debate. And it would show respect for the deep moral concerns of the large number of Americans who have serious ethical objections to this research.
  
  
• Some of us hold that cloning-for-biomedical-research can never be ethically pursued, and endorse a moratorium to enable us to continue to make our case in a democratic way. Others of us support the moratorium because it would provide the time and incentive required to develop a system of national regulation that might come into use if, at the end of the four-year period, the moratorium were not reinstated or made permanent. Such a system could not be developed overnight, and therefore even those who support the research but want it regulated should see that at the very least a pause is required. In the absence of a moratorium, few proponents of the research would have much incentive to institute an effective regulatory system. Moreover, the very process of proposing such regulations would clarify the moral and prudential judgments involved in deciding whether and how to proceed with this research.
  
  
• A moratorium on cloning-for-biomedical-research would enable us to consider this activity in the larger context of research and technology in the areas of developmental biology, embryo research, and genetics, and to pursue a more comprehensive federal regulatory system for setting and executing policy in the entire area.
  
  
• Finally, we believe that a moratorium, rather than a lasting ban, signals a high regard for the value of biomedical research and an enduring concern for patients and families whose suffering such research may help alleviate. It would reaffirm the principle that science can progress while upholding the community's moral norms, and would therefore reaffirm the community's moral support for science and biomedical technology.

The decision before us is of great importance. Creating cloned embryos for any purpose requires crossing a major moral boundary, with grave risks and likely harms, and once we cross it there will be no turning back. Our society should take the time to make a judgment that is well-informed and morally sound, respectful of strongly held views, and representative of the priorities and principles of the American people. We believe this ban-plus-moratorium proposal offers the best means of achieving these goals.

This position is supported by Council Members Rebecca S. Dresser, Francis Fukuyama, Robert P. George, Mary Ann Glendon, Alfonso Gómez-Lobo, William B. Hurlbut, Leon R. Kass, Charles Krauthammer, Paul McHugh, and Gilbert C. Meilaender.

Minority Recommendation: Seven Members of the Council recommend a ban on cloning-to-produce-children, with regulation of the use of cloned embryos for biomedical research. Speaking only for ourselves, those of us who support this recommendation do so for some or all of the following reasons:

• By permanently banning cloning-to-produce-children, this policy gives force to the strong ethical verdict against cloning-to-produce-children, unanimous in this Council (and in Congress) and widely supported by the American people. We believe that a ban on the transfer of cloned embryos to a woman's uterus would be a sufficient and effective legal safeguard against the practice.
  
  
• It approves cloning-for-biomedical-research and permits it to proceed without substantial delay. This is the most important advantage of this proposal. The research shows great promise, and its actual value can only be determined by allowing it to go forward now. Regardless of how much time we allow it, no amount of experimentation with animal models can provide the needed understanding of human diseases. The special benefits from working with stem cells from cloned human embryos cannot be obtained using embryos obtained by IVF. We believe this research could provide relief to millions of Americans, and that the government should therefore support it, within sensible limits imposed by regulation.
  
  
• It would establish, as a condition of proceeding, the necessary regulatory protections to avoid abuses and misuses of cloned embryos. These regulations might touch on the secure handling of embryos, licensing and prior review of research projects, the protection of egg donors, and the provision of equal access to benefits.
  
  
• Some of us also believe that mechanisms to regulate cloning-for-biomedical-research should be part of a larger regulatory program governing all research involving human embryos, and that the federal government should initiate a review of present and projected practices of human embryo research, with the aim of establishing reasonable policies on the matter.

Permitting cloning-for-biomedical-research now, while governing it through a prudent and sensible regulatory regime, is the most appropriate way to allow important research to proceed while insuring that abuses are prevented. We believe that the legitimate concerns about human cloning expressed throughout this report are sufficiently addressed by this ban-plus-regulation proposal, and that the nation should affirm and support the responsible effort to find treatments and cures that might help many who are suffering.

This position is supported by Council Members Elizabeth H. Blackburn, Daniel W. Foster, Michael S. Gazzaniga, William F. May, Janet D. Rowley, Michael J. Sandel, and James Q. Wilson.

The Meaning of Human Cloning: An Overview

The prospect of human cloningⁱ burst into the public consciousness in 1997, following the announcement of the successful cloning of Dolly the sheep. It has since captured much attention and generated great debate, both in the United States and around the world. Many are repelled by the idea of producing children who would be genetically virtually identical to pre-existing individuals, and believe such a practice unethical. But some see in such cloning the possibility to do good for infertile couples and the broader society. Some want to outlaw it, and many nations have done so. Others believe the benefits outweigh the risks and the moral concerns, or they oppose legislative interference with science and technology in the name of freedom and progress.

Complicating the national dialogue about human cloning is the isolation in 1998 of human embryonic stem cells, which many scientists believe to hold great promise for understanding and treating many chronic diseases and conditions. Some scientists also believe that stem cells derived from cloned human embryos, produced explicitly for such research, might prove to be uniquely useful for studying many genetic diseases and devising novel therapies. Public reaction to this prospect has been mixed, with some Americans supporting it in the hope of advancing biomedical research and helping the sick and the suffering, while others are concerned about the instrumentalization or abuse of nascent human life and the resulting danger of moral insensitivity and degradation.

In the United States, several attempts have been made to initiate a comprehensive public review of the significance of human cloning and to formulate appropriate policies. Most notably, the National Bioethics Advisory Commission (NBAC) released a report on the subject of cloning-to-produce-children in 1997.ⁱⁱ The Commission concluded that cloning-to-produce-children was, at least for the time being, unethical on safety grounds, and that the deeper and more permanent moral concerns surrounding the practice should be the subject of continuing deliberation "in order to further our understanding of the ethical and social implications of this technology and to enable society to produce appropriate long-term policies regarding this technology" (p. 106).

In this report, the President's Council on Bioethics takes up this important charge, and considers the ethical and social implications of human cloning (both for producing children and for biomedical research) in their full scope, with the aim of informing public policy on the matter.

Our work toward this end is guided by a number of explicit methodological choices about modes of approach, points of departure, and spirit of inquiry. We locate human cloning within its larger human and technological context, rather than consider it in isolation. We focus first on the broad human goods that it may serve or threaten, rather than on the immediate impact of the technique itself. And we present the strongest arguments for the relevant moral and policy positions, rather than frame the arguments in order to seek consensus. By our broad approach, our starting on the plane of human goods, and our open spirit of inquiry, we hope to contribute to a richer and deeper understanding of what human cloning entails, how we should think about it, and what we should do about it.

Two points of clarification before we proceed. First, all of our considerations and arguments assume that cloning techniques, both for producing children and for providing embryos useful in biomedical research, could succeed in human beings as they have with other mammals. Cloning-to-produce-children has never been successfully carried out in humans, and cloning embryos for biomedical research has not progressed beyond the earliest experiments. We consider it part of our task to judge whether even attempts at human cloning would be ethical or should be lawful. To conduct the analysis and assessment needed for such judgment, we necessarily proceed on the assumption, which we believe is supported by evidence from animal experiments, that human cloning is indeed a possibility – that sooner or later, if it were allowed and attempted, human cloning could be successfully carried out. Practically all public discussion of the ethics of human cloning has, whether expressly or not, proceeded on this same premise, and rightly so.

Second, on some of the matters discussed in this report, Members of the Council are not of one mind. Given that competing goods are at stake, and different people regard them differently, this is not at all surprising. Rather than bury these differences in search of a spurious consensus, we have sought to present all views fairly and fully. Yet transcending these differences is a more fundamental agreement about the worthiness of the approach we have adopted and the arguments we have made. Accordingly, the Council is unanimous in owning the entire report and in recommending, to all, the report's discussions and arguments for serious consideration.

In the remainder of this overview, we describe the context of human cloning and the discussions it has generated. In the course of doing so, we identify the kinds of questions and concerns that would permit a full assessment of the meaning of human cloning. These questions and concerns will guide us throughout the report.

Human Cloning in Context

It is useful to begin by observing how it is that the question of human cloning has come before us. The prospect of cloning human beings confronts us now not as the result of a strong public demand or a long-standing need. Unlike sought-for medical therapies, it was not at the outset pursued as a cure for disease. Neither has it been sought explicitly as a tool for genetic control or "enhancement" of human offspring. Cloning has arisen not so much because it was actively sought for its own sake, but because it is a natural extension of certain biotechnological advances of the past several decades.ⁱⁱⁱ

For more than half a century, and at an accelerating pace, biomedical scientists have been gaining wondrous new knowledge of the workings of living beings, from small to great. Increasingly, they also are providing precise and sophisticated knowledge of the workings of the human body and mind. Such knowledge of how things work often leads to new technological powers to control or alter these workings, powers ordinarily sought in order to treat human disease and relieve suffering.

Questions regarding the meaning of acquiring such powers – both the promise and the peril – have attracted scholarly and public attention. For more than thirty years, ethical issues related to biomedical advance have occupied the growing field of bioethics. Increasingly, these ethical issues have spawned public discussion and debates. A growing number of people sense that something new and momentous is happening; that the accelerating waves of biotechnical advances touch deeply on our most human concerns; and that the centuries-old project for human mastery of nature may now be, so to speak, coming home, giving humanity the power to alter and "master" itself.

One important aspect of human life already affected by new biotechnologies is human reproduction. For several decades now, building on advances in genetics, cell biology, and developmental biology, and on technologies used first in animal husbandry, scientists around the world have been adapting techniques and developing tools to study, influence, and manipulate the origins of human life. Beginning with techniques of artificial insemination and progressing through in vitro fertilization (IVF) and intracytoplasmic sperm injection, artificial aids to reproduction have come into standard medical use.

Cloning is, in one sense, another step along this path. It developed as the result of research into mammalian reproduction and development, where it is desired also as a means of replicating animals especially useful to human beings. It is also proposed as an additional means to overcome infertility in humans.

But the controversy surrounding human cloning, and the widespread sense of disquiet and concern with which the prospect has been received around the world, make it clear that cloning is not just another reproductive technology, to be easily assimilated into ordinary life. Nearly all participants in the public debate over human cloning appear to agree that the subject touches upon some of the most fundamental questions regarding the nature of our humanity and the character of our society. In addition, it raises questions about the aims of biomedical science and about the relation between science and society, including the possibility and desirability of exercising public control over the uses of biomedical technology and the conduct of biomedical research. It is because we sense these larger entailments that the subject of cloning matters so much to us. It is these considerations that give the present debate its force and prominence. Thus only through a serious reflection on these broader questions can the full meaning of human cloning be discovered. The prospect of human cloning may have been brought before us by the march of biotechnology, but now that it is here it is incumbent upon us to look well beyond its technical and medical aspects, if we are to appreciate its significance in full.

Three areas of inquiry in particular seem essential to any understanding of the full meaning of human cloning: the nature and meaning of human procreation; the aims, ends, and means of biomedical science and technology; and the relation of science and technology to the larger society.

Cloning and Human Procreation

Human procreation provides the major context for considering the prospect of cloning, especially cloning-to-produce-children. Much of the time, most of us tend to take for granted this central aspect of human life, through which all of us come to be and through which we give birth to our posterity. But the prospect of creating children by cloning brings this subject sharply before us and compels us to examine the nature and meaning of human procreation. For cloning-to-produce-children, while it may be a potential aid to human reproduction, appears also to be a substitute for it, or at least for its natural, un-programmed, sexual character. Properly to assess the meaning of producing cloned children, one must first of all consider the meaning of human procreation in all its aspects and entailments.^iv

Human procreation, though seemingly an exclusively private act, has a profoundly public meaning. It determines the relations between one generation and the next, shapes identities, creates attachments, and sets up responsibilities for the care and rearing of children (and the care of aging parents or other needy kin). Thus, in considering proposals to clone children, we must ask ourselves what cloning would mean not only for the individual parents and children involved, but also for the surrounding families and for all of society. Opinions on this subject will of course differ, sometimes widely, as they rest on possibly differing perceptions of human procreation and family life. Yet the following basic observations, concerns, and questions seem pertinent, notwithstanding possible differences of opinion among us about how much weight to give them.

Among the important aspects of the topic are these: the meaning of having children; the meaning of sexual, as opposed to asexual, reproduction; the meaning of origins and genetic endowment for identity and sense of self; the meaning of exercising greater human control over the processes and "products" of human reproduction; and the difference between begetting and making.

To understand what it would mean to clone a child, we do well to consider most generally what it means to bring a child into the world, and with what attitude we should regard his or her arrival and presence. Our children are, to begin with, our replacements, those who will one day stand in our place. They are, as Hans Jonas has remarked, "life's own answer to mortality." Though their conception is the fruit of our activity, and though we are responsible for saying "yes" to their arrival, we do not, in normal procreation, command their conception, control their makeup, or rule over their development and birth. They are, in an important sense, "given" to us. Though they are our children, they are not our property. Though they are our flesh and blood, and deeply kin, they are also independent "strangers" who arrive suddenly out of the darkness and whom we must struggle to get to know. Though we may seek to have them for our own self-fulfillment, they exist also and especially for their own sakes. Though we seek to educate them, they are not like our other projects, determined strictly according to our plans and serving only our desires.

If these observations are correct, certain things follow regarding the attitudes we should have toward our children. We treat them rightly when we treat them as gifts rather than as products, and when we treat them as independent beings whom we are duty-bound to protect and nurture rather than as extensions of ourselves subject only to our wills and whims. Might these attitudes toward children be altered by cloning, and, if so, how? Would social attitudes toward children change, even if cloning were not practiced widely? What might these changes mean?

To understand how the introduction of asexual reproduction might affect human life, we must first seek the intrinsic meaning of the sexual character of human reproduction and what it implies for individuals, for families, and for the relation between the generations. Once again, the following observations – while hardly exhaustive – seem pertinent and important.

In sexual reproduction,^v each child has two complementary biological progenitors. Each child thus stems from and unites exactly two lineages, lines that trace backward in similar branching fashion for ages. Moreover, the precise genetic endowment of each child is determined by a combination of nature and chance, not by human design: each human child naturally acquires and shares the common human species genotype, each child is genetically (equally) kin to each (both) parent(s), yet each child is also genetically unique.^vi Cloning-to-produce-children departs from this pattern. A cloned child has unilineal, not bilineal, descent; he or she is genetically kin to only one progenitor. What is more, the genetic kinship is near-total: the cloned child is not genetically unique, but shares almost completely the genetic endowment of the "original" progenitor. Finally, this endowment comes to the cloned child not by chance but by human choice and decision. What do these differences mean for the cloned child, for family relations, and for relations across the generations?

Origins and genetic endowment are significant aspects of who one is and how one regards oneself, of one's "identity," individuality, and place in the social order. The biological linkages and prospects implicit in sexual reproduction help to define us, though, it should go without saying, they do not define us completely. While we are more "what we choose to become" than we are "where we came from," our human beginnings matter, biologically, psychically, and socially. Because of the way we are generated, each of us is at once (1) equally human, (2) equally marked by and from birth as mortal, (3) equally enmeshed in a particular familial nexus of origin, (4) equally individuated in our trajectory from the beginning to the end of our lives – and, if all goes well, (5) equally capable (despite our mortality) of participating with a complementary other in the very same renewal of human possibility through procreation. Our genetic identity – manifest, for instance, in our distinctive appearance by which we are recognized by others and in our immune system by which we maintain our integrity against "foreign invasions" – also symbolizes and foreshadows exactly the unique, never-to-be-repeated character of each human life. In addition, human societies virtually everywhere have structured child-rearing responsibilities and systems of identity and relationships on the bases of these natural facts of begetting. Kinship is tied to origins, and identity, at least in part, is tied to kinship. It is against this background that we must consider the implications of clonal reproduction, and the alterations it might produce in how cloned children would regard themselves and how they would be regarded by others. What would cloning-to-produce-children mean for individual identity, for kinship, and for sense of self, not only for the cloned child but also for his or her family?

Unaided sexual procreation is an activity at once natural, private, mysterious, unmediated, unpredictable, and undesigned. With the arrival of techniques such as IVF to assist procreation in the face of infertility, the process becomes less private and more mediated. But although technique is used, the basic structure of sexual reproduction – the combination of genetic material from father and mother resulting in a genetically unique child – is unaltered, the outcome is still unpredictable, and the genetic endowment of the child remains uncontrolled and undesigned. Cloning-to-produce-children would seem to bring procreation under human control and direction. What would this mean? What are the implications of allowing reproductive activities to become increasingly technological and commercialized? Cloning would be the first instance in which parents could select in advance the precise (or nearly precise) genetic makeup of their child, by selecting the donor to be cloned. It therefore forces us to ask what might be the difference between begetting and making, to wonder whether cloning somehow crosses the line between them, and, if so, to consider whether and why that should worry us.

Though admittedly sketchy and incomplete, these preliminary reflections on the nature and meaning of human procreation should enable us to see cloning – and especially cloning-to-produce-children-in its most important human context and to understand its deepest implications for its practitioners and for society.

Cloning and Biomedical Science

Human procreation is not the only context for evaluating the prospect of human cloning. As a product of biotechnology, a potential means of assisted reproduction, and a possible source of cloned embryos for research and medical use, human cloning also points us to questions about the aims, ends, and means of biomedical science and technology. Ordinarily, we are not prompted to much reflection about what science is for and what goals technology should serve. Our society tacitly accepts the self-directing and self-augmenting character of these activities, and the vast majority of us support them because we esteem and benefit from their contributions to human understanding and human welfare. However, when developments such as cloning raise profound questions affecting fundamental moral values and social institutions, we are forced to consider the ends and means of science and technology, and to explore their standing in the scheme of human goods.

To provide a context for assessing human cloning and its possible benefits, we do well to remember the goals of medicine and modern science: the great value and importance of treating disease and relieving suffering, including the sorrows of infertility; and the great value and importance of gaining knowledge about the workings of nature, our own nature emphatically included. No one can doubt the merit of these noble aims. Yet there has always been some disagreement about the lengths to which we should allow ourselves to go in serving them. Questions therefore arise about the need for limits on scientific pursuits and technological activities, and, conversely, about the meaning of such limits for the scientific and technological enterprises.

To address these questions, we must appreciate the human good of biomedical science in its fullness, and we must ask about the necessary and sufficient conditions for its flourishing. We must recognize, among other things, the unpredictability of scientific discovery and technological innovation, and the importance, therefore, of keeping open lines of inquiry and experimentation regardless of current estimates of their likelihood of success. Although serendipity often favors the prepared mind, nature guards her secrets well, and even the best scientists are regularly surprised by where the keys to the locks are ultimately found.

But precisely because so much of biomedical science is exploratory and experimental, scientific inquiry is not just thought but also action, action often involving research on living subjects, including human beings. And precisely because the use of technologies often has unintended or undesirable side effects, affecting many human goods in addition to health, safety, and the relief of suffering, large questions are necessarily raised when the goods promoted by technology come into conflict with others. For example, is the need to discover new cures for the sick a moral imperative that should trump all other goods and values? If not, then on what basis can it be limited? What moral boundaries should scientists and technologists respect as they continue their quests for knowledge and cures, whether or not they receive public funding? How can society establish and enforce such boundaries? And, on the other hand, how can science and technology be protected against unreasonable limitations imposed by excessively fearful legislators or overzealous regulators?

To be sure, these large questions are hard to answer in the abstract. As a result, they do not recommend themselves for much deliberation. Yet they are very close to the surface of the current debate about human cloning. Moreover, implicit answers to these questions, seldom articulated and rarely defended save by mere assertion, at least color and may even determine what people think should be done about human cloning. A clearer and more thoughtful awareness of the aims of biomedical science could help us assess whether and how human cloning might serve the ends of science and medicine and could help us more fully consider its possible benefits and potential drawbacks.

But we must consider not only the ends of science, but also the means it employs. Cloning, after all, is a technique, a means of reaching some desired end. Even if the purposes it might serve are worthy, it must still be evaluated as a means. Not every means employed in the pursuit of worthy ends can pass ethical muster. This truth is widely recognized in the establishment of canons of ethics regarding the use of human subjects in research. It is also recognized in the established practice of technology assessment, which seeks to find the least problematic and least dangerous means for achieving a desirable end.

For instance, as a means of treating infertility or of providing a suitable source of compatible organs for transplantation, cloning raises difficulties having to do with human dignity and the costs of "manufacture" of the sort discussed earlier. Human cloning also raises questions about the ethics of research with human subjects, with risks of harm to the child-to-be, the egg donor, and the woman who would bring the cloned child to birth, questions that we shall take up in some detail in Chapter Five. Yet the most highly controverted moral argument about human cloning research involves a human subject not always considered when the ethics of research is discussed: the early human embryo. Because all cloning begins with the production of embryonic clones, and because such clones are potentially highly useful in biomedical research, questions of the ethics of means are absolutely central to the debate about the morality of cloning.

Ethical questions regarding the use of human embryos in research are, of course, not unique to cloning. They have been central to the recent and continuing controversy about federal funding of research on human embryonic stem cells, because human embryos produced by IVF offer possibilities for medical advances, beyond their use in assisted reproduction. The use of embryos has aided research on early human development. These embryos are also the source of human embryonic stem cells, pluripotent cells^vii that may be induced to develop into all the tissues of the body. These stem cells thus may hold great promise for future treatment of chronic degenerative diseases and disabilities.

The difficulty arises because the embryos put to use in these ways are themselves destroyed. This fact raises serious and troubling questions about the proper way to regard these nascent human organisms and the morally appropriate way to treat them. Cloning techniques might provide an even more useful source of embryos for biomedical research than current IVF techniques. Human cloning could yield numerous identical embryos, could provide for the study of stem cells derived from individuals known to possess genetic diseases, and might eventually yield transplantable tissues for regenerative medicine that would escape immune rejection. Human cloning-for-biomedical-research therefore brings the moral question of means before us with even greater force. It calls on us to think of the good of medical advances and the relief of human suffering while at the same time considering our responsibilities to nascent human life and the possible harms to ourselves and future generations that may result from coming to regard the beginning stages of human life as raw material for use and exploitation.

While there is almost universal opposition to cloning-to-produce-children, the prospect of using cloned embryos in biomedical research has attracted significant support in the general public and among many scientists, patient advocacy groups, and policymakers. It therefore presents more complicated moral and policy challenges, and requires serious reflection on the duty of society to those of its members who are suffering, as well as its responsibility for nascent life. The precise character of both that duty and that responsibility is a subject of long-standing dispute, giving rise to a contentious but very important public debate.

Cloning and Public Policy

Beneath the current debate about human cloning lie major questions about the relation between science and technology and the larger society. Valuing freedom and innovation, our society allows scientists to inquire as they wish, to explore freely, and to develop techniques and technologies based on the knowledge they find, and on the whole we all benefit greatly as a result. We limit what scientists can do only in certain cases, as when their research requires the use of human subjects, in which case we erect rules and procedures to protect the health, safety, and dignity of the weak from possible encroachments by the strong. In more pervasive ways, we also shape what science does through public decisions about financial support and scientific education. With the uses of technology, we are sometimes more intrusive, establishing regulations to protect public health and safety or to preserve the environment. In rare cases, we even ban certain practices, such as the buying and selling of organs for transplantation. Yet, on the whole, the spirit of laissez-faire governs technological research, development, and use.

But when innovations arise that appear to challenge basic goods that we hold dear, or when the desirability of scientific and technological progress runs up against concerns for the protection of human life and well-being, we are forced to consider the tacit social contract between science and technology and the larger society. The current public and political deliberation about whether and how to restrict or prohibit human cloning forces us to do so in a most powerful way.

In addition, the current deliberation confronts us with the task of balancing important and commonly defended freedoms – the freedom of scientists to inquire, of technologists to invent, of individuals to reproduce, of entrepreneurs to invest and to profit – with the well-being of our society and its members. Circumstances in which otherwise beneficent freedoms can endanger paramount moral and social goods present serious challenges for free societies, and the prospect of cloning presents us with just such a challenge.

This is not an altogether unfamiliar challenge. There are other circumstances in which the freedom to explore, inquire, research, and develop technologies has been constrained. Biomedical science, as we have said, is restricted in its use of human subjects for research, and scientists are required to obtain informed consent and take great care to secure research subjects from harm. Scientific work is also restricted from activities that might harm the health of the general public, and from producing products that may endanger consumers. For example, the federal Food and Drug Administration sits at the juncture between development and marketing of medical products, regulating their introduction and use according to criteria of safety and efficacy. Our society has come to a near-total agreement on the need for such an agency and the importance of its work.

Human cloning, however, does not easily fall into any of the familiar classes of our experience with science. Nor do the ethical challenges it raises fit neatly into the categories of risks to health and safety that are ordinarily the basis of public oversight of science and technology. Raising ethical questions about ends as well as means, cloning is at once a potential human experiment, a possible aid to reproduction, an altogether new sort of procreative technique, a prospective means of human design, and a source of embryos and embryonic stem cells for research. It points back to familiar dilemmas of bioethics – including the ethics of human experimentation and embryo research – and it points forward to the sorts of challenges that will face us as biology gains greater technical prowess. It therefore invites us to think anew about the relationship between society and biomedical science and to evaluate the sufficiency of current institutions and practices that govern that relationship.

The potential dangers we face do not result from ill intent or bad faith. Neither of the prevailing caricatures in the cloning debate – the mad scientist on a blind quest for an inhuman immortality or the puritanical Luddite seeking to keep the future at bay – is accurate, appropriate, helpful, or fair. The challenge we face is not as easy as that. The challenge we face involves the conflict of competing sets of concerns and priorities, each in the service of vital human goods, and each driven by a desire to improve the human condition and to protect essential principles. The widely shared desire to cure disease, relieve suffering, understand human biology, and provide humankind with new and more powerful means of control can conflict, in this case, with the widely shared desire to respect life, individual identity, the dignity of human procreation, and other institutions and principles that keep our society healthy and strong. The challenge for our society is to determine, through public deliberation and thoughtful reflection, how best to adjudicate between these two desires and to determine what form to give to the tacit agreement between society and science, by which society promises freedom within bounds, and science affords us innovation, knowledge, and power while respecting reasonable limits.

The new and distinct challenges that confront us through cloning call upon us to consider the character of that tacit agreement, and to determine whether, and in what way, it might need to be amended and supplemented, especially in the face of the rapidly arriving new biomedical technologies that touch so directly upon our humanity. It is our hope in this report to contribute to just such a thoughtful consideration of the question.

The Report

In Chapter One we present a brief history of human cloning. We summarize the scientific developments, the various public and political debates, and the actions of earlier panels and government bodies.

In Chapter Three we discuss the terminology of the cloning debate. We analyze the controversy over cloning terms, state the terms we intend to use, and lay out the rationale behind our choice of terms.

In Chapter Four we present a survey of the scientific aspects of human and animal cloning. We attempt to clarify what cloning is, where the science stands, and where it may be going.

In Chapter Five we discuss the ethical arguments for and against human cloning-to-produce-children. We consider reasons to create cloned children, concerns over safety and consent, and a series of moral objections.

In Chapter Six we discuss the ethical arguments for and against cloning-for-biomedical-research. We consider the likely medical benefits, the potential social and ethical difficulties, and the concern over the treatment of human embryos.

In Chapter Seven we discuss the public policy alternatives. We consider various options for government action, and present arguments for and against each.

In Chapter Eight, we present the Council's conclusions and offer our recommendations.

1. The term "human cloning" is used in this chapter to refer to all human cloning: cloning-to-produce-children and cloning-for-biomedical-research. When only one particular use of human cloning is intended, we use the more specific term. A full discussion of our choice of terminology is provided in Chapter Three. Back to Text
   
   
2. Cloning Human Beings, Rockville, MD: National Bioethics Advisory Commission, 1997. Human embryonic stem cells had not yet been isolated at the time of the NBAC report, so the Commission did not offer any recommendations on cloning-for-biomedical-research. Back to Text
   
   
3. Chapter One summarizes selected historical aspects of the emergence of cloning research and public reactions to the prospect of human cloning. Chapter Four summarizes selected aspects of the current state of the relevant science and technology. Back to Text
   
   
4. In order to be sure that we explore fully the human meaning of cloning, we shall examine it in comparison with natural unaided human reproduction, rather than assisted reproduction, say, with in vitro fertilization. The established reproductive technologies do provide some useful points of comparison, but they cannot be taken as the most helpful baseline for understanding the significance of cloning. For that, normal sexual reproduction is the appropriate basis of comparison. Back to Text
   
   
5. The term "sexual reproduction" has two related meanings: the first refers to the act of sexual intercourse that initiates conception by introducing sperm into a woman's generative tract; the second refers to the conception itself, the combination of genetic material from egg and sperm that results in a new organism with a unique genotype. Assisted reproduction techniques like IVF do not involve the former, but do involve the latter and are therefore still rightly considered sexual reproduction. (Likewise, children who are adopted are the fruit of sexual reproduction.) Cloning involves neither, and is therefore described as "asexual reproduction." The second and more fundamental meaning of "sexual reproduction," the union of egg and sperm that results in a new genetically unique organism, is the basis of our discussion in this section. Back to Text
   
   
6. The apparent exception of identical twins is discussed in Chapter Five. Back to Text
   
   
7. Pluripotent cells are those that can give rise to many different types of differentiated cells. See Glossary of Terms. Back to Text

Historical Aspects of Cloning

The previous chapter located human cloning in its larger human context. This chapter provides a brief history of human cloning, both as a scientific matter and as a subject of public discussion, debate, and legislation.¹ Although we present only selected highlights, rather than a comprehensive account, we seek to enable the reader to place the present debate about cloning and this report into their proper historical setting. Until recently, all discussion of human cloning concentrated exclusively on the prospect of clonal reproduction, the production of individuals genetically virtually identical to previously existing ones. Our historical account here reflects that emphasis. Yet we will also consider the emerging interest in cloning-for-biomedical-research, a prospect connected to the recent isolation of embryonic stem cells and their potential for the understanding and treatment of human disease and disability.

Scientific Milestones

As a scientific and technical possibility, human cloning has emerged as an outgrowth of discoveries or innovations in developmental biology, genetics, assisted reproductive technologies, animal breeding, and, most recently, research on embryonic stem cells. Assisted reproductive techniques in humans accomplished the in vitro fertilization of a human egg, yielding a zygote and developing embryo that could be successfully implanted into a woman's uterus to give rise to a live-born child. Animal breeders developed and refined these techniques with a view to perpetuating particularly valuable animals and maintaining laboriously identified genomes. Most recently, the isolation of embryonic stem cells and their subsequent in vitro differentiation into many different cell types have opened up possibilities for repairing and replacing diseased or nonfunctioning tissue, and thus possible research uses for cloned human embryos.

The German embryologist Hans Spemann conducted what many consider to be the earliest "cloning" experiments on animals. Spemann was interested in answering a fundamental question of biological development: does each differentiated cell retain the full complement of genetic information present initially in the zygote? In the late 1920s, he tied off part of a cell containing the nucleus from a salamander embryo at the sixteen-cell stage and allowed the single cell to divide, showing that the nucleus of that early embryo could, in effect, "start over." In a 1938 book, Embryonic Development and Induction, Spemann wondered whether more completely differentiated cells had the same capacity and speculated about the possibility of transferring the nucleus from a differentiated cell – taken from either a later-stage embryo or an adult organism – into an enucleated egg. As he explained it: "Decisive information about this question may perhaps be afforded by an experiment which appears, at first sight, to be somewhat fantastical. This experiment might possibly show that even nuclei of differentiated cells can initiate normal development in the egg protoplasms." ² But Spemann did not know how to conduct such an experiment.

Research with frogs fourteen years later encouraged progress toward the "fantastical experiment." In 1952, the American embryologists Robert Briggs and Thomas J. King first successfully transferred nuclei from early embryonic cells of leopard frogs to enucleated leopard frog eggs. The "activated egg" began to divide and develop, became a multicellular embryo, and then became a tadpole. ³ Embryologists in other laboratories successfully repeated these initial experiments on different species of frogs. But additional experience also showed that the older and more differentiated a donor cell becomes, the less likely it is that its nucleus would be able to direct development.

In 1962, the British developmental biologist John Gurdon reported that he had produced sexually mature frogs by transferring nuclei from intestinal cells of tadpoles into enucleated frog eggs.⁴ The experiments had a low success rate and remained controversial. Gurdon continued this work in the 1970s, and he was able to produce tadpoles by transferring the nucleus of adult frog skin cells into enucleated frog eggs. Later experiments established that many factors in addition to the intact nucleus are crucial to success (see Chapter Four for further discussion). In retrospect, it is surprising that any of these earlier experiments produced positive results.⁵ But despite their low success rates, these experiments demonstrated that the nucleus retained its full complement of genetic information and encouraged later investigators to explore mammalian cloning.

The birth of Louise Brown in 1978, the first baby conceived through in vitro fertilization (IVF), was also an important milestone, because it demonstrated that human birth was possible from eggs that were fertilized outside the body and then implanted into the womb. As for the possibility of cloning animals from adult cells – especially mammals – the work in the intervening years focused largely on the reprogramming of gene expression in somatic cells, the transfer of nuclei taken from embryos in mammals (beginning with mice in the 1980s), and finally the work of Ian Wilmut and his colleagues at the Roslin Institute with adult nuclei, which led to the birth of Dolly on July 5, 1996. Since then, similar success has been achieved in cloning other mammalian species, including cattle, goats, pigs, mice, cats, and rabbits (see Chapter Four).

The animal cloners did not set out to develop techniques for cloning humans. Wilmut's goal was to replicate or perpetuate animals carrying a valuable genome (for example, sheep that had been genetically modified to produce medically valuable proteins in their milk). Others, such as the cloners of the kitten CC, were interested in commercial ventures for the cloning of pets.⁶ Yet the techniques developed in animals have encouraged a small number of infertility therapists to contemplate and explore efforts to clone human children. And, following the announcement in 1998 by James Thomson and his associates of their isolation of human embryonic stem cells, there emerged an interest in cloned human embryos, not for reproductive uses but as a powerful tool for research into the nature and treatment of human disease.

Human Cloning from Popular Literature to Public Policy:
From Brave New World to the Birth of Dolly

Technological novelties are often imagined and discussed in literature, especially in science fiction, before they are likely or even possible in practice. This has certainly been the case with human cloning, whose place in the popular imagination precedes the earliest successful animal cloning experiments. Perhaps the most famous early modern account of human cloning is Aldous Huxley's Brave New World (1932), where natural human procreation has become a thing of the past, and where babies are produced in identical batches through "Bokanovsky's Process." As the novelist tells it:

One egg, one embryo, one adult – normality. But a bokanovskified egg will bud, will proliferate, will divide . . . becoming anywhere from eight to ninety-six embryos – a prodigious improvement, you will agree, on nature. Identical twins – but not in piddling twos and threes . . . Standard men and women; in uniform batches.⁷

The relevance or irrelevance of Huxley's vision to the dilemmas of the present is of course a matter of serious disagreement. Some believe that fears of a "Brave New World" are fantasy divorced from both the political realities of modern liberal democracy and the facts of science. Others believe the book remains a prescient warning of where biological self-manipulation could take us – which is to say, to a world where family is obsolete, life is engineered to order in the laboratory, and human beings have reduced themselves to well-satisfied human animals.

In the late 1960s, following John Gurdon's successful cloning experiments, a more focused debate on both the likelihood and the ethical and social implications of human cloning began among scientists, theologians, and ethicists. At this time, the still hypothetical possibility of cloning humans was considered as a part of a broader eugenic project to improve the genetic stock of humans as a species. In a famous article published in The American Naturalist in 1966, entitled "Experimental Genetics and Human Evolution," Nobel laureate biologist Joshua Lederberg described what he took to be the prospects of "clonal reproduction." "Experimentally," he wrote, "we know of successful nuclear transplantation from diploid somatic as well as germline cells into enucleated amphibian eggs. There is nothing to suggest any particular difficulty about accomplishing this in mammals or man, though it will rightly be admired as a technical tour-de-force when it is first implemented." He also predicted "there will be little delay between demonstration and use."⁸

While Lederberg concluded his essay by exhorting his readers not to "mistake comment for advocacy," he clearly believed that clonal reproduction might offer a number of human benefits or improvements. "If a superior individual (and presumably then genotype) is identified, why not copy it directly, rather than suffer all the risks of recombinational disruption, including those of sex," he asked. "The same solace is accorded the carrier of genetic disease: why not be sure of an exact copy of yourself rather than risk a homozygous segregant;ⁱ or at worst copy your spouse and allow some degree of biological parenthood." He described other possibilities – such as "the free exchange of organ transplants with no concern for graft rejection" and more efficient communication between individuals in "stressed occupations."⁹

In the end, Lederberg argued that "tempered clonality" – a mix of clonal and sexual reproduction – might, at least from a biological standpoint, "allow the best of both worlds – we would at least enjoy being able to observe the experiment of discovering whether a second Einstein would outdo the first one." Nevertheless, he acknowledged the possibility for "social frictions" and ethical dilemmas that might result from clonal reproduction – including whether "anyone could conscientiously risk the crucial experiment, the first attempt to clone a man." He suggested that the "mingling of individual human chromosomes with other mammals assures a gradualistic enlargement of the field and lowers the threshold of optimism or arrogance, particularly if cloning in other mammals gives incompletely predictable results." And he feared that social policy might become based on "the accidents of the first advertised examples" rather than "well-debated principles." ¹⁰

In 1970, the theologian and ethicist Paul Ramsey responded to Lederberg's portrait of human cloning – and, more generally, to the prospects for human self-modification – in a book called Fabricated Man: The Ethics of Genetic Control. He argued that human cloning would violate the ethical responsibilities of both science and parenthood: it would involve experiments on the child-to-be; it would transform parenthood into manufacture; and it would burden children with the genetic predisposition of their "maker" and so deny the cloned child a unique independence in the very act of bringing him or her to life. "[T]o attempt to soar so high above an eminently human parenthood," Ramsey wrote, "is inevitably to fall far below – into a vast technological alienation of man .. The entire rationalization of procreation – its replacement by replication – can only mean the abolition of man's embodied personhood." ¹¹

Ramsey believed that such a willingness to experiment on human life – or to create sub-humans-showed how the effort to perfect and improve humankind through genetic control leads in fact to ethical coarsening and to a disregard for actual human beings. "In the present age," he wrote, "the attempt will be made to deprive us of our wits by comparing objections to schemes of progressive genetic engineering or cloning men to earlier opposition to inoculations, blood transfusions, or the control of malaria. These things are by no means to be compared: the practice of medicine in the service of life is one thing; man's unlimited self-modification of the genetic conditions of life would be quite another matter."¹²

The debate over human cloning and genetic manipulation continued in the early 1970s. The Nobel laureate geneticist James D. Watson testified before Congress in 1971 on the subject of human cloning. He described the science that was taking us there, including John Gurdon's success in cloning frogs and the work of R. G. Edwards and P. S. Steptoe "in working out the conditions for routine test-tube conception of human eggs."¹³ "Human embryological development," Watson observed, "need no longer be a process shrouded in secrecy. It can become instead an event wide-open to a variety of experimental manipulations." Watson called for the creation of national and international committees to promote "wide-ranging discussion . at the informal as well as formal legislative level, about the manifold problems which are bound to arise if test-tube conception becomes a common occurrence." ¹⁴ "This is a decision not for the scientists at all," he said. "It is a decision of the general public – do you want this or not?" and something that "if we do not think about it now, the possibility of our having a free choice will one day suddenly be gone."¹⁵

In 1972, Willard Gaylin, a psychiatrist and co-founder of the newly formed Institute of Society, Ethics, and the Life Sciences (later called the Hastings Center), made James Watson's warnings about cloning even more dramatic – with a New York Times Magazine article titled "The Frankenstein Myth Becomes a Reality – We Have the Awful Knowledge to Make Exact Copies of Human Beings." Gaylin hoped that the prospect of human cloning would awaken the public – and the scientific community – to the larger ethical implications of the life sciences.¹⁶ The same year, biologist and ethicist Leon R. Kass published an essay in The Public Interest called "Making Babies – The New Biology and the 'Old' Morality," which addressed the prospect of both in vitro fertilization and human cloning, and wondered whether "by tampering with and confounding [our] origins, we are involved in nothing less than creating a new conception of what it means to be human."¹⁷

In stark contrast to Gaylin and Kass, ethicist Joseph Fletcher argued that human cloning would not be dehumanizing at all, but would, in a number of circumstances, serve the good of both society and individuals. In his 1974 book The Ethics of Genetic Control: Ending Reproductive Roulette, he argued that "Good reasons in general for cloning are that it avoids genetic diseases, bypasses sterility, predetermines an individual's gender, and preserves family likenesses. It wastes time to argue over whether we should do it or not; the real moral question is when and why."¹⁸ For Fletcher – unlike Ramsey, Gaylin, and Kass – genetic control would serve the human end of self-mastery and self-improvement, it would improve the quality of life for individuals, and it would aid the progress of the human species. Gunther Stent, a molecular biologist at the University of California at Berkeley, echoed this view that human cloning would contribute to human perfection. As he wrote in a 1974 article in Nature: "To oppose human cloning . . . is to betray the Western dream of the City of God. All utopian visionaries, from Thomas More to Karl Marx, think of their perfect societies as being populated not by men but by angels that embody all of the best and none of the worst human attributes." ¹⁹ With cloning, he suggested, such a city might one day be possible.

For several years, cloning remained a topic for fiction and philosophy, but fantasy had yet to turn into fact. In 1978, in a book titled In His Image: The Cloning of a Man, science writer David Rorvik claimed that he was involved in a secret project to clone a millionaire in Montana named "Max."²⁰ The book caused a flurry of reaction – ranging from horror to amusement to nearly universal skepticism and denunciation in the scientific community – and eventually led to hearings before Congress on May 31, 1978. Robert Briggs, who with Thomas King cloned the first frog embryo from blastula frog cells in 1952, declared that the work in frogs demonstrated not that human cloning is now or imminently possible, but that "cloning in man or any other animal is not just a technical problem to be solved soon but may, in fact, never occur."²¹ James Watson, who just a few years earlier had urged a national conversation and possible legislation on human cloning because of the rapid advances in the science, declared that we would "certainly not [see the cloning of a man] in any of our lifetimes. I wouldn't be able to predict when we might see the cloning of a mouse, much less a man."²² Rorvik eventually admitted that the book was a hoax.

In the years that followed, claims and counter-claims of scientific advances in mammalian cloning – including the controversy beginning in 1981 over whether any of several independent laboratories had actually cloned mice – prompted more public reaction and discussion about the issue. But there was no sustained or widespread public interest, and cloning lost its prominent place within the bioethics literature. The President's Bioethics Commission, in its 1982 report Splicing Life, briefly discussed human cloning as well as IVF, but held that both were beyond the scope of that report because they could be considered reproductive technologies that did not necessarily involve modifying the genome (pp. 9-10). With regard to human cloning in particular, the report added that the possibility had received a good deal of public attention and it was therefore important to emphasize that even if it ever did become possible in humans, it would not result in an identical being.²³

The National Institutes of Health Human Embryo Research Panel, which issued a report in 1994 on federal funding for research involving preimplantation human embryos, deemed research involving nuclear transplantation, without transfer of the resulting cloned embryo to a uterus, as one type of research that was acceptable for federal support. The report noted that the majority on this point was narrow, with nearly as many panel members concluding that the ethical implications of nuclear transplantation should be studied further before any such research could be acceptable for federal funding (Exec. Summ., p. xvii). In its discussion of cloning techniques, the panel noted that many different procedures are all called "cloning," and said in a footnote, "Popular notions of cloning derive from science fiction books and films that have more to do with cultural fantasies than actual scientific experiments." ²⁴

Of course, there had been, in the meantime, continued scientific work in nuclear transplantation in animals – including mammals. And with the 1997 announcement of the cloning of Dolly, the prospect of human cloning once again became a prominent issue in public discussion, debate, and public life.

The Human Cloning Debate:
From Dolly to the Present

In late February 1997, Ian Wilmut and his team at the Roslin Institute in Scotland announced that they had, by means of somatic cell nuclear transfer, successfully cloned the first mammal from an adult somatic cell – Dolly the sheep. President Bill Clinton and British Prime Minister Tony Blair immediately denounced any attempts to clone a human being, and the President asked his National Bioethics Advisory Commission (NBAC) to report within ninety days on the scientific, ethical, and legal questions surrounding the prospect of human cloning. Congress likewise held a series of hearings – the first one on March 12, 1997. A widespread – though not universal – consensus emerged that attempts to clone a human being would at present be irresponsible and immoral. As Wilmut explained before Congress, "Our own experiments to clone sheep from adult mammary cells required us to produce 277 'reconstructed' embryos. Of these, twenty-nine were implanted into recipient ewes, and only one developed into a live lamb. In previous work with cells from embryos, three out of five lambs died soon after birth and showed developmental abnormalities. Similar experiments with humans would be totally unacceptable." ²⁵

Most ethicists agreed, though for different reasons. All agreed that cloning attempts on human beings "at this time" would be reckless experiments on the child-to-be and therefore totally unjustified. Many stressed, as Ramsey, Gaylin, and Kass had done in the 1970s, that human cloning would undermine the human meaning of parenthood and identity; that it would mean a giant step toward genetic engineering, creating the first children whose genetic predisposition was known and selected in advance; and that it would turn procreation increasingly into a form of manufacture.²⁶ In contrast, some bioethicists, including John Robertson and Ruth Macklin, believed that human cloning presented no inherent threat to public or private morality, that government had no legal authority or justification for banning clonal reproduction, and that it must be judged in terms of its particular uses, not dismissed outright.²⁷

At present, the use of this technique to create a child would be a premature experiment that would expose the fetus and the developing child to unacceptable risks. This in itself might be sufficient to justify a prohibition on cloning human beings at this time, even if such efforts were to be characterized as the exercise of a fundamental right to attempt to procreate.²⁸

NBAC also pointed to other moral concerns "beyond the issue of the safety of the procedure," including "the potential psychological harms to children and effects on the moral, religious, and cultural values of society" that "merit further discussion." NBAC recommended a three-to-five-year federal moratorium on human cloning – stating that the consensus came from the fact that the technique was not yet safe – to be revisited and reevaluated after that time. "Whether upon such further deliberation our nation will conclude that the use of cloning techniques to create children should be allowed or permanently banned is, for the moment, an open question." ²⁹

In early 1998, the United States Senate considered legislation, proposed by Republican Senators Christopher Bond of Missouri, Bill Frist of Tennessee, and Judd Gregg of New Hampshire, to ban all human cloning permanently. Nearly all senators denounced clonal reproduction, but many believed that the proposed ban, which would have made it illegal to create human embryos by means of somatic cell nuclear transfer, would undermine potentially valuable scientific research. Democratic Senators Edward Kennedy of Massachusetts and Tom Harkin of Iowa led the opposition, with the widespread support of patient advocacy groups, scientific and medical organizations, and the biotechnology industry. As Senator Kennedy put it:

Every scientist in America understands the threat this legislation poses to critical medical research. Every American should understand it, too. . . . Congress can and should act to ban cloning of human beings during this session. But it should not act in haste, and it should not pass legislation that goes far beyond what the American people want or what the scientific and medical community understands is necessary or appropriate.³⁰

The legislation died after heated debate, and the concern over human cloning temporarily lost urgency and subsided.

In November 1998, a new scientific discovery was unveiled that would soon provoke a different public policy debate, one that would become entangled with the ethical and social questions surrounding human cloning. James Thomson and John Gearhart separately announced the isolation of human embryonic stem cells – multipotent cells (see Glossary of Terms) derived from human embryos that they believed hold great promise for curing or treating many diseases and injuries. The discovery led to another wave of hearings on, and interest in, the ethics of biological science. It also renewed debate over whether embryo research should be eligible for public funding (since 1996, Congress had prohibited federal funding of research involving the destruction of human embryos). One subject under consideration was the possible future use of cloned human embryos for stem cell research, which some scientists believed might be uniquely useful for understanding embryological development and genetic disease and for possible use in stem cell therapies.

In August 2000 – after another NBAC study – President Clinton announced new guidelines that would have altered the ban on federal funding of embryo research. The new guidelines, proposed by the National Institutes of Health, stipulated that the agency would fund research on embryonic stem cells so long as public funds were not used to destroy the embryos, the embryos were left over from IVF clinics, and donors of the embryos consented to the research.

In early 2001, President George W. Bush announced that he would review these guidelines rather than implement them immediately.² Around the same time, a number of pro-cloning groups and fertility doctors – including the Raelians, who believe that humans are the products of cloning by aliens – announced their intention to clone human beings by the end of the year. Other individuals and scientific organizations worked to protect possible cloning research from future restrictions, though some scientists (such as Rudolf Jaenisch and Ian Wilmut³¹ ) publicly argued against cloning-to-produce-children. A flurry of hearings on human cloning soon followed – the first one in the House of Representatives on March 28, 2001, and continuing in both the House and the Senate throughout the summer. The hearings addressed cloning-to-produce-children as well as issues related to cloning-for-biomedical-research.

Two general approaches to banning human cloning emerged. The first approach, proposed in a bill sponsored by Republican Representative David Weldon of Florida and Democratic Representative Bart Stupak of Michigan in the House, and Republican Senator Sam Brownback of Kansas and Democratic Senator Mary Landrieu of Louisiana in the Senate, called for a ban on all human cloning, including the creation of cloned embryos for biomedical research. The second approach, proposed in a bill sponsored by Republican Senators Arlen Specter of Pennsylvania and Orrin Hatch of Utah and Democratic Senators Diane Feinstein of California and Edward Kennedy of Massachusetts, sought to prohibit human reproductive cloning, while allowing the use of cloning technology to produce stem cells, by making it illegal to implant or attempt to implant cloned human embryos "into a uterus or the functional equivalent of a uterus."

On July 31, 2001, the House of Representatives passed the Weldon – Stupak bill (the ban on all human cloning) by a vote of 265 to 162. In November 2001, scientists at Advanced Cell Technology, Inc., of Worcester, Massachusetts, one of the leading commercial advocates of cloning-for-biomedical-research, reported what they claimed were the first cloned human embryos. The announcement – along with continued debate on the possible use of cloned human embryos for stem cell research – left the issue in the United States Senate, where it stands as of this writing.

Meanwhile, the general public has consistently expressed the view that human cloning is wrong – most recently, a Gallup poll from May 2002 that showed opposition to cloning to produce a child at 90 percent, and opposition to "cloning of human embryos for use in medical research" at 61 percent. Asked about medical research using stem cells obtained from human embryos (with no mention of how the embryo was generated), 52 percent found it morally acceptable, while 51 percent found acceptable the "cloning of human cells from adults for use in medical research."³²

In addition to activity at the federal level, many states have been active. As of this writing, twenty-two states have considered various policy alternatives on cloning, and six have passed legislation.³

Several nations, including Denmark, France, Norway, Spain, and Canada have passed or sought either partial or total bans. For example, in the United Kingdom, cloning-to-produce-children is forbidden but cloned embryos up to fourteen days old may be used in biomedical research. In Germany, all human cloning is forbidden by law. There are also efforts now at the United Nations and other international organizations to pass a world-wide ban on human cloning – with many of the same disagreements internationally as there are nationally about what kind of ban to pass.

ENDNOTES

1. Since the birth of Dolly, several volumes on the history and significance of cloning have been published, including Kolata, G., Clone: The Road to Dolly and the Path Ahead, New York: Morrow and Company, 1998, and National Bioethics Advisory Commission [NBAC], Cloning Human Beings, Bethesda, MD: Government Printing Office, 1997. In addition, several valuable anthologies have been edited, including Kristol, W., and E. Cohen , The Future is Now, Lanham, MD: Rowman and Littlefield, 2002, and Nussbaum, M., and C.R. Sunstein, Clones and Clones, New York: Norton, 1998. Back to Text
   
2. See Spemann, H., Embryonic Development and Induction (New Haven, CT: Yale University Press, 1938). As quoted in Kolata, G., Clone: The Road to Dolly and the Path Ahead (New York: Morrow and Company, 1998), p. 61. Back to Text
   
3. Briggs, R., and T. J. King, "Transplantation of living nuclei from blastula cells into enucleated frog's eggs," Proceedings of the National Academy of Sciences (USA) 38: 455-463, 1952. Back to Text
   
4. Gurdon, J. B., "The developmental capacity of nuclei taken from intestinal epithelium cells of feeding tadpoles," Journal of Embryology and Experimental Morphology 10, 622-640, 1962. Back to Text
   
5. A fact also noted by NBAC in Cloning Human Beings, p. 18. Back to Text
   
6. Regalado, A., "Only Nine Lives for Kitty? Not if She Is Cloned," Wall Street Journal, February 14, 2002, p. B1. Kluger, J., "Here Kitty Kitty!" Time, February 17, 2002. Back to Text
   
7. Huxley, Aldous., Brave New World (New York: Harper Perennial, 1998), p. 6-7. Originally published by Harper & Brothers, 1932. Back to Text
   
8. Lederberg, J., "Experimental Genetics and Human Evolution," The American Naturalist, September-October 1966, Vol. 100, No. 915, pp. 527. Back to Text
   
9. Ibid, p. 531, 527, 528. Back to Top
   
10. Ibid, p. 528, 529, 531. Back to Top
    
11. Ramsey, P., Fabricated Man: The Ethics of Genetic Control (New Haven, CT: Yale University Press, 1970), p. 89. Back to Text
    
12. Ibid, p. 95. Back to Text
    
13. Watson, J., "Moving Toward the Clonal Man," The Atlantic Monthly, May 1971, p. 51. (This article is a slightly modified version of Watson's congressional testimony.) Back to Text
    
14. Ibid, p. 51, 53. Back to Text
    
15. Proceedings before the Committee on Science and Astronautics, U. S. House of Representatives, Ninety-Second Congress, January 26, 27, and 28, 1971, p. 344. Back to Text
    
16. Gaylin, W., "The Frankenstein Myth Becomes a Reality-We Have the Awful Knowledge to Make Exact Copies of Human Beings," The New York Times Magazine, March 5, 1972, p. 12ff. Back to Text
    
17. Kass, L., "Making Babies-the New Biology and the 'Old' Morality," The Public Interest, Winter 1972, Number 26, p. 23. Back to Text
    
18. Fletcher, J., The Ethics of Genetic Control: Ending Reproductive Roulette (New York: Anchor Books, 1974), p. 154. Back to Text
    
19. Stent, G., "Molecular Biology and Metaphysics," Nature, Vol. 248, No. 5451, April 26, 1974, p. 781. As quoted in Kolata op. cit., p. 92. Back to Text
    
20. Rorvik, D. M., In His Image: The Cloning of a Man (New York: J. B. Lippincott, 1978). Back to Text
    
21. As quoted in Kolata, op. cit., p. 103. Back to Text
    
22. Interview by C. P. Anderson, "In His Own Words: Nobel Laureate James Watson Calls Report of Cloning People 'Science Fiction Silliness,'" People, April 17, 1978, pp. 93-95. As quoted in Kolata, op. cit., p. 104. Back to Text
    
23. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Splicing Life: A Report on the Social and Ethical Issues of Genetic Engineering with Human Beings, November 1982. Back to Text
    
24. National Institutes of Health, Ad Hoc Group of Consultants to the Advisory Committee to the Director, Report of the Human Embryo Research Panel, September 1994, p. 28. Back to Text
    
25. Hearing before the Subcommittee on Public Health and Safety of the Committee on Labor and Human Resources, United States Senate, March 12, 1997. p. 22. Back to Text
    
26. See, for example, Kass, L., "The Wisdom of Repugnance," The New Republic, June 2, 1997, pp. 17-26, and "Preventing a Brave New World, The New Republic, May 21, 2001, pp. 30-39. Back to Text
    
27. Robertson, J.A., "A Ban on Cloning and Cloning Research Is Unjustified," testimony before the National Bioethics Advisory Commission, March 14, 1997. Macklin, R., testimony before NBAC, March 14, 1997. Back to Text
    
28. NBAC, Cloning Human Beings, 1997, pp. ii-iii. Back to Text
    
29. Ibid, p. iii. Back to Text
    
30. Congressional Record, February 9, 1998, pp. S513-514. Back to Text
    
31. Jaenisch, R., and I. Wilmut, "Don't clone humans!" Science 291: 5513, March 30, 2001. Back to Text
    
32. Saad, L. "Cloning Humans Is a Turn-Off to Most Americans" Gallup Poll Analyses, May 16, 2002. Back to Text
    

We begin our presentation of the important matter of terminology by listing the crucial terms used in this report:

• Human cloning.
  
• Cloning-to-produce-children.
  
• Cloning-for-biomedical-research.
  
• Cloned human embryo.

The rest of this chapter will develop the meaning of these terms and provide the analysis and argumentation that have led us to these choices. Because there is much to be learned about the subject through the discussion of alternative terminologies, and because we believe strongly that the judicious use of language is necessary for sound moral choice, we present our discussion of this matter at some length.

Introduction: The Importance of Careful Use of Names

Fruitful discussion of the ethical and policy issues raised by the prospects of human cloning – as with any other matter – can proceed only if we can find appropriate and agreed-upon terms for describing the processes and products involved. Before we can get to possible moral or policy arguments or disagreements, we need to agree about what to call that about which we are arguing. As a contribution to public understanding, we emphasize that this is not an easy thing to do, and we indicate how and why we have gone about making our terminological choices.

What exactly is meant by the term "cloning"? What criterion justifies naming an entity a "clone"? How is the term "cloning" related to what scientists call "somatic cell nuclear transfer (SCNT)" or "nuclear transplantation"? What should we call the single-cell entity that results from SCNT, and what should we call it once it starts to divide and develop? How, if at all, should our names for such activities or such entities be affected by the purposes we have for engaging in the activities or for using the entities?

As these questions imply, there is much confusion today about the terms used in discussing human cloning. There is honest disagreement about what names should be used, and there are also attempts to select and use terms in order to gain advantage for a particular moral or policy position. One difficulty is the difference between the perspective of science and the perspective of lived human experience. People who look at the phenomena of human reproduction and development through the lens of science will see and describe things in terms that often differ widely from those in ordinary usage; moreover, when an ordinary term is used in scientific parlance, it sometimes is given a different meaning. Similar divergences are possible also for people who look at these matters through the lens of different cultural, philosophical, or religious beliefs. Yet at the same time, all of us – scientists or not, believers or not – encounter these same matters on the plane of lived human experience, for which the terms of everyday speech may well be more suitable. Because this same common (nonscientific) discourse is also the medium of discourse for the ethical and policy discussions, we shall strive to stay close to common speech, while at the same time making the best use we can of scientific findings to avoid mistakes and misconceptions.

Advisers to decision makers should strive not only for accuracy, but also for fairness, especially because the choice of names can decisively affect the way questions are posed and, hence, how answers are given. The issue is not a matter of semantics; it is a matter of trying fairly to call things by names that correctly describe them, of trying to fit speech to fact as best one can. For the sake of clarity, we should at least stipulate clearly the meanings we intend by our use of terms. But we should also try to choose terms that most accurately convey the descriptive reality of the matter at hand. If this is well done, the moral arguments can then proceed on the merits, without distortion by linguistic sloppiness or chicanery.

Many of the terms that appear in the debate about cloning are confusing or are used in a confused manner.

First, there are difficulties concerning the terms that seek to name the activity or activities involved: cloning, asexual reproduction, reproductive cloning, nonreproductive cloning, research cloning, therapeutic cloning, somatic cell nuclear transfer (or nuclear transplantation), nuclear transfer for stem cell research, nuclear transplantation to produce stem cells, nuclear transfer for regenerative medicine. At stake are such questions as whether all acts of SCNT should be called cloning. Some worry that the term "cloning" unfairly prejudices people against the activity when it is used to describe research activities.

Second, there are difficulties concerning the terms that seek to name the entity or entities that result from human cloning (or human SCNT): cell, egg, activated cell, totipotent cell, clonote, reconstituted (or reconstructed) egg, zygote, clump of cells, embryo, human embryo, human organism, blastocyst, clonocyst, potential human being, human being, human clone, person. At stake here is the nature – and the possible moral status – of the entities that are involved in the subsequent manipulations, whether for producing a child or for use in biomedical research. Some worry that use of any term but "embryo" will unfairly prejudice people in favor of embryo-destructive activities by hiding from view the full import of the activity.

Third, there are difficulties concerning the terms that seek to describe the relation between the cloned entity and the person whose somatic cell nucleus was transferred to produce the cloned entity: genetic copy, replica, genetically virtually identical, noncontemporary twin, delayed genetic twin, clone.

Tools of Analysis

As a prelude to examining the activity or the deed of cloning, some general analytical observations will be helpful. Although all aspects of an activity or action are relevant to understanding its full human meaning, when describing a deed it is sometimes useful to distinguish what it is from both how it is done and why it is done. The act itself (what) may be accomplished by a variety of means or techniques (how), and it may be undertaken for a variety of motives or purposes (why). To be sure, there is a danger of distortion in this disaggregating analysis of human activity, and there is disagreement about the degree to which the motives or purposes of the agent are to be reckoned in the description of the act itself. People argue, for example, whether "mercy killing" differs as an act from murdering a rival (or executing a murderer or killing someone in self-defense), or whether they are all equally acts of homicide (literally, "killing a human being") whose moral meaning ("Is it justified or not?" "Is it wrong or not?") we can then proceed to debate, if we wish, by attending not only to the bare act of taking a human life but also to the agent's motive and purpose. Though we do not wish to beg this question, the very existence of this disagreement suggests that we do well not to ignore the naked act itself, for it may have a meaning independent of what moved the agent, a meaning relevant to subsequent moral assessment that we do not wish to overlook.

To illustrate: in vitro fertilization (IVF: the merging of egg and sperm outside the human body [in vitro = "in glass"], yielding a zygote that is the beginning stage of a new living being) is the deed (what). It is an act of "fertilization," of making fertile, of making the egg cell ready and able to develop into a human organism. This fertilization may be accomplished in at least two ways (how): by merely mixing egg and sperm, allowing the sperm to find and penetrate the egg, or by the technique of injecting individual sperm directly into the egg (a technique known as intracytoplasmic sperm injection, ICSI). And it may be done for the (proximate) purpose (why) of initiating a pregnancy, in turn for the (ultimate) purpose of providing a child for an infertile couple; or it may be done for the (proximate) purpose of providing living human embryos for basic research on normal and abnormal embryological development, in turn for the (ultimate) purposes of understanding human development or of discovering cures for diseases and producing tissues for regenerative medicine. Though the technique used or the purposes served may differ, in one crucial respect the deed (IVF) remains the same and bears a common intrinsic meaning: a human zygote, the first stage of a new human being, is intentionally produced outside the body and exists in human hands and subject to human manipulation.

As it happens, this fact is more or less accurately reflected in the descriptive terminology used for IVF. Interestingly enough, unlike the situation with cloning, no one distinguishes between "reproductive IVF" and "therapeutic IVF" or "research IVF," naming the activity or deed after the motive or purpose of the agent. This may reflect the historical fact that IVF was initiated by people who were interested in using it to produce live-born children for infertile couples; the research use of "surplus" embryos produced by IVF came only later. But it happens that this common name is also descriptively apt and remains so regardless of why IVF was done in a particular case: the deed is fertilization of egg by sperm, producing a living human zygote, the first stage of the development of a new human being.

It should be noted that, although we began by trying to describe the deed rather than the product of the deed, the two aspects merged necessarily. The meaning of the act of "fertilization" falls forward onto the nature of the "object" that fertilization produces: the fertilized egg or zygote or earliest embryo.ⁱ (By contrast, there is nothing in the name of the technique "intracytoplasmic sperm injection" that even hints at the immediate result or goal of the intended injection.) Similar attention to the nature of the product may turn out to be indispensable for a proper characterization of the activity of cloning.

Cloning: Toward an Appropriate Terminology

Though much of the terminological confusion and controversy concerns the way to describe the different kinds of cloning practices that are envisioned, the term "cloning" itself is not without its own ambiguities. A "clone" (noun, from the Greek klon, "twig") refers to a group of genetically identical molecules, cells, or organisms descended from a single common ancestor, as well as to any one of the one or more individual organisms that have descended asexually from a common ancestor. Both the group and each of its members are "a clone." "To clone" (verb) is to duplicate or produce a genetic duplicate or duplicates of a molecule, cell, or individual organism. The replication of DNA fragments in the laboratory is called "DNA cloning." The physical isolation of a single cell and its subsequent multiplication in tissue culture into a population of descendants is referred to as "single cell cloning." The laboratory culture of bacteria and the asexual propagation of plants by means of cuttings are instances of organismal cloning. Cloning of higher organisms is more complex: all cloning of vertebrate organisms must begin at the embryonic stages. Contrary to what some people imagine, cloning of amphibians or mammals (including human beings) is not the direct duplication ("photocopying") of an adult organism.

In the sense relevant here, "cloning" is a form of asexual reproduction (parthenogenesisⁱⁱ is another), the production of a new individual not by the chance union of egg and sperm but by some form of replication of the genetic makeup of a single existing or previously existing individual. (In biological or functional terms, the core of sexual reproduction is not bodily intercourse but the fusion of male and female germ cells; thus IVF, though it takes place outside the body, is – biologically speaking – a form of sexual reproduction.) Cloning is the activity of producing a clone, an individual or group of individuals genetically virtually identical to the precursor that is being "replicated."ⁱⁱⁱ

In much of the current public discussion, we encounter a distinction between two sorts of cloning: "reproductive" and "therapeutic." The distinction is based entirely on the differing goals of the cloners: in the first case, the goal is the production of a (cloned) child; in the second case, the development of treatments for diseases (suffered not by the clone, but by others). We recognize the distinction and the need for terms to describe the difference. But the terms currently in vogue have their difficulties. Both terms have been criticized by partisans of several sides of the debate, and for understandable reasons.

Some object to the term "reproductive cloning" used as a term of distinction, because they argue that all cloning is reproductive. Their reason: all human cloning intends and issues in the production of a cloned human embryo, a being distinct from the components used to generate it, a new human being in the earliest stage of development or "reproduction." (This claim, we would suggest, is at this stage a descriptive point, not yet a normative one; it does not necessarily imply that such a being is fully human or "one of us," hence deserving of the moral and social protection accorded "persons.") The fact that only some of these embryonic cloned humans are wanted for baby-producing purposes does not, in the view of these critics, alter this fact about their being. In support of their claim that cloning occurs (only) at the beginning, they note that once the cloning act of nuclear transfer has occurred, all new influences that act upon the new human organism cease to be "genetic" (nature) and are now "environmental" (nurture). Instead of "reproductive cloning," we shall speak of "cloning-to-produce-children."

Others object to the term "therapeutic cloning" for related reasons. The act of cloning embryos may be undertaken with healing motives. But it is not itself an act of healing or therapy.^iv The beneficiaries of any such acts of cloning are, at the moment, hypothetical and in the future. And if medical treatments do eventually result, the embryonic clone from which the treatment was derived will not itself be the beneficiary of any therapy. On the contrary, this sort of cloning actually takes apart (or destroys) the embryonic being that results from the act of cloning.

To avoid the misleading implications of calling any cloning "therapeutic," we prefer the terms "research cloning" or "cloning for research," which also more accurately indicate the purpose of the activity. Yet some may find fault with this replacement. Because it appears to be a deliberate substitution for "therapeutic cloning," it may seem to imply that the scientists have abandoned the pursuit of medical cure in favor of research as an end in itself. Believing that producing cloned embryos just for research would seem to be less justifiable than producing them with healing motives, these critics of the term "research cloning" want to avoid giving the impression that scientists want to experiment on new life just to satisfy their curiosity. We believe that this legitimate concern can be addressed by appending the adjective "biomedical" to make clear that the aim of the research is to seek cures and treatments for human diseases. We therefore opt to use the term "cloning-for-biomedical-research."

Some proponents of the activity called "therapeutic cloning" also now object to the term, but not because of the adjective. Though it was proponents who originally coined and used the term, some of them now want to shed the term "cloning," fearing that the bad or distressing connotations of the latter will weigh against the activity itself. Cloning, they insist, should be reserved for the activity that produces live-born cloned babies; it should not apply to the initial act that starts the process, which they would rather call "somatic cell nuclear transfer" or "nuclear transplantation."¹ The reason for such redescription is not wholly cosmetic and rhetorical; because the researchers are primarily interested in obtaining pluripotent^v stem cells, their focus is on the somatic cell nucleus and what must be done to it (transfer or transplantation) in order for it to revert to the undifferentiated condition of the primordial stem cell stage. Nevertheless, such terminological substitution is problematic, for the following reasons.

Although as a scientific matter "somatic cell nuclear transfer" or "nuclear transplantation" may accurately describe the technique that is used to produce the embryonic clone, these terms fail to convey the nature of the deed itself, and they hide its human significance. The deed, fully described, is the production of a living human entity (or "embryo" or "organism"; of the right name for the product, more later) that is genetically virtually identical to the donor organism, a fact or meaning not captured in the name for the technique or method, the transfer of a somatic cell nucleus (into an unfertilized egg whose own nucleus has been removed or inactivated).^vi As a name, SCNT is not a fully accurate description even of the technique itself. It makes no reference to the intended and direct result of the deed of nuclear transfer. It also omits mention of the fact that the recipient of the transferred nucleus is an (enucleated) egg cell (rather than another kind of cell), which then can be made to initiate cell division as if it were just like a zygote produced by fertilization. The further amendments, "somatic cell nuclear transfer for stem cell research" or "nuclear transplantation for regenerative medicine" or "nuclear transplantation to produce stem cells" only compound the difficulty, mixing in the purpose of the activity with its technique, thus further obscuring the immediate meaning of the act itself, the production of a living cloned human embryo.

Cloned Human Embryo: The Product of SCNT

What shall we call the product of SCNT? The technical description of the cloning method (that is, SCNT) omits all reference not only to cloning but also to the immediate product of the activity. This obscurity enables some to argue that the immediate product of SCNT is not an "embryo" but rather "an egg" or "an unfertilized egg" or "an activated cell," and that the subsequent stages of development should not be called embryos but "clumps of cells" or "activated cells." To be sure, there are genuine difficulties and perplexities regarding what names to use, for we are dealing with an entity new in our experience. Partly for this reason, some people recommend avoiding the effort to describe the nature of the product, preferring instead to allow the uses we human beings have for it to define its being, and hence its worth. But, for reasons of both truth and ethical conduct, we reject this approach as improper. We are all too familiar with instances in which some human beings have defined downward the status of other beings precisely to exploit them with impunity and with a clear conscience. Thus, despite the acknowledged difficulties in coming to know it accurately, we insist on making the effort to describe the product of SCNT as accurately and as fairly as we can.

The initial product of SCNT is a single cell, but it is no ordinary cell. It is also an "egg" and a "reconstituted egg." But even that is not the whole story. The "reconstituted" egg is more than reconstituted; it has been capacitated for development. Because the egg now has a diploid nucleus, it has become something beyond what it was before: it now contains in a single nucleus the full complement of genetic material necessary for producing a new organism. ^vii And being an egg cell, it uniquely offers the cytoplasmic environment that can support this development. The product of SCNT thus resembles and can be made to act like a fertilized egg, a cell that not only has the full complement of chromosomes but also is capable (in animals) or may be capable (in humans) of developing into a new organism. In other words, in terms of its future prospects, it is a "zygote-like entity" or a (cloned) "zygote equivalent." ^vii

The initial product of SCNT is, to be sure, not just a cell but an active cell. (More precisely, it is a cell that can be activated by electric stimulation.) But "activated cell" is much too vague to describe the activity of which it is capable. For, once stimulated, the activity of this "cell" produced by SCNT is nothing other than human embryological development, initiated and directed by the cell itself. The processes of cellular growth, chromosomal replication, cell division, and (ultimately) differentiation into the tissues and organs of the organism are coordinated processes under the governance of the immanent developmental plan encoded in the cell's genetic material. In other words, the product of SCNT is an organism in its germinal stage, and its activities are those of an integrated and self-developing whole.^ix

Another suggested name, better than "activated cell," is "totipotent cell" – a cell that is "capable of all." But this too is ambiguous. If what is meant is that it can (and will, should it be stimulated to do so) become "any and all" of the different kinds of cells in the body, then it is an insufficient meaning. For, as explained in the previous paragraph, this totipotent cell may also become the "all" that is the integrated whole (cloned) mature organism itself (along with a portion of the placenta that would give it nourishment). In this second and fuller meaning of "totipotent," a totipotent cell is then just a functional synonym for the "zygote": "zygote" etymologically reminds one of the cell's origins in egg-joined-to-sperm; "totipotency" describes what it is capable of. A fertilized egg is precisely a "totipotent" cell; the product of human SCNT is, we assume, its equivalent.

In some discussions, the next few stages of the developing cloned human entity have been described as "clumps of cells." Yet, for reasons already given, this is only partially accurate. Viewed externally, under the microscope, the developing embryo will appear as two, then four, then eight cells "clumped" together, and the 100-to-200-cell blastocyst stage will indeed appear as a "ball of cells." Yet there is more here than meets the eye, for the "clump" is governed by an internal principle of development that shapes and directs its transformations. Thus, this ball or clump is not a mere heap or aggregate; it is a primordial and unfolding whole that functions as a whole and that is in the process of developing (or attempting to develop) into a mature whole being. Of course, if development is not pursued or not allowed to happen because of disruption, then the "clump of cells" description may be rendered accurate not just microscopically but also biologically. But as long as development continues and the developing entity is intact, that is not the case.

It would seem, then, that – whatever the reason for producing it – the initial product of somatic cell nuclear transfer is a living (one-celled) cloned human embryo. The immediate intention of transferring the nucleus is precisely to produce just such an entity: one that is alive (rather than nonliving), one that is human (rather than nonhuman or animal), and one that is an embryo, an entity capable of developing into an articulated organismic whole (rather than just a somatic cell capable only of replication into more of the same cell type). This is the intended primary product of performing SCNT, whether the ultimate motive or purpose is producing a live-born child from the cloned embryo or conducting scientific research on the cloned embryo. Also, the blastocyst stage that develops from this one-celled cloned embryo will be the same being, whether it is then transferred to a woman's uterus to begin a pregnancy or is used as a source of stem cells for research and possible therapy for others.

Yet, not surprisingly, objections have been raised to calling this cloned entity an "embryo," objections having to do both with its origins and with the uncertainty about the extent of its developmental potential. There are also objections having to do not with the facts but with public connotations and perceptions: for some members of the public, the word "embryos" apparently conjures images of miniature babies. If "nuclear transplantation to produce stem cells" seems to some people to be unfairly morally neutered terminology, "embryo" seems to other people to be unfairly morally loaded terminology, especially when used to describe an entity barely visible to the naked eye. We acknowledge this problem and recognize that, despite our best efforts, such difficulties in public perception probably cannot be simply corrected. But we do not regard this as sufficient reason to scrap the use of a term if it is in fact most appropriate. The other objections to calling the product of SCNT an "embryo" are not about rhetoric and politics, but about the thing itself. They should be addressed.

First, "human embryo," in the traditional scientific definition of this term, refers to the earliest stages of human development, from the zygote through roughly eight weeks of gestation, after which time it is called a fetus. Because the product of SCNT is technically not a zygote, not having come from egg and sperm, it is argued that it cannot therefore be an embryo. Second, it is said that it cannot be an embryo because it is an "artifact," something produced entirely by human artifice, "made" rather than "begotten." Third, we do not yet know for sure whether this entity can in fact develop into a baby; hence, we do not know whether it has the full developmental potential of a human embryo formed by fertilization.

There are, however, good responses to these objections. The first product of SCNT is, on good biological grounds, quite properly regarded as the equivalent of a zygote, and its subsequent stages as embryonic stages in development. True, it is not technically "zygotic" in origin, and it owes its existence to human artifice. But these objections, dealing only with origins, ignore the organization and powers of this entity, and the crucially important fact of its capacity to undergo future embryological development – just like a sexually produced embryo. True, it originates as a result of human artifice, and it lacks the natural bi-parental (male-plus-female) precursors. But this particular "artifact" is alive and self-developing, and should it eventually give rise to a baby, that child would in its being and its capacities be indistinguishable from any other human being – hardly an artifact – in the same way that Dolly is a sheep. True, regarding its developmental potential, we do not yet have incontrovertible proof that a cloned human embryo can in fact do what embryos are "supposed" to do and what animal cloned embryos have already done, namely, develop into all the later stages of the organism, up to its full maturity (à la Dolly). But if we do not assume this last possibility – an assumption based on the biological continuity of all mammals^x – there would be nothing to talk about in this whole matter of human cloning. As we emphasized in the first chapter of this report, this entire inquiry assumes that cloned human embryos can someday be developed into live-born human beings.

This decision, based on what we believe comes closest to the truth about the product of SCNT, is supported by other, more practical considerations. We are disinclined to introduce other words to describe the early product of human cloning that might deprive discussion of the ethics of human cloning of its humanly significant context. Despite the novelty of cloning and its products, their considerable kinship to elements of normal reproduction and development means that we enter upon the discussion equipped with existing and relevant terms and notions. We do not start in a terminological vacuum or with an empty dictionary. We observe that even people who prefer not to call the one-celled product of SCNT a zygote or embryo use terms like "blastocyst" and "embryo" to name the product a few cell divisions later.^xi We think that using or coining other words will be more confusing to members of the public as they try to follow and contribute to the ethical discussion. And we clearly assume, as already stated, that the product of human SCNT could someday be shown to be capable of developing into a later-stage embryo, fetus, or live human being, even though such capacity has yet to be documented.

There are also very important ethical reasons that support our choice. We want to be very careful not to make matters easy for ourselves. We do not want to define away the moral questions of cloning-for-biomedical-research by denying to the morally crucial element a name that makes clear that there is a moral question to be faced. Yes, there is some ground for uncertainty about the being of the product of SCNT. Yet because something is ambiguous to us does not mean that it is ambiguous in itself. Where the moral stakes are high, we should not allow our uncertainty to lead us to regard the subject in question as being anything less than it might truly be.

The product of "SCNT" is not only an embryo; it is also a clone, genetically virtually identical to the individual that was the source of the transferred nucleus, hence an embryonic clone of the donor. There is, to be sure, much discussion about how close the genetic relation is between donor and embryonic clone, and about the phenotypic similarity of the clone to the donor. ^xii Yet the goal in this process is in fact a blastocyst-stage cloned embryo (in the case of cloning-for-biomedical-research) or a child who is genetically virtually identical to the donor (in the case of cloning-to-produce-children); otherwise there would be no reason to produce a cloned embryo by SCNT rather than an (uncloned) embryo by ordinary IVF. A full and fitting name of the developing entity produced by human SCNT is "cloned human embryo," a term that also allows us to remember that, thanks to its peculiar origins, this embryo is not in all respects identical to an embryo produced by fertilization of egg by sperm.

As if things were not difficult enough, a further complication may soon arise, following reports of successful SCNT experiments in which human somatic cells were fused with animal oocytes, and the resulting product grown to the blastocyst stage of development. What are we to call the product of this kind of cloning? And what kind of species identity does it have? According to the advance reports (based on a presentation at a scientific meeting), the stem cells extracted from the blastocyst stage were demonstrated to be human stem cells (somewhat surprisingly, the mitochondria were also human in genotype). Is this, therefore, a cloned human embryo? The only test that could settle the question – implantation into a woman's uterus for attempted gestation to see if a human child results – cannot ethically even be contemplated without already assuming a positive answer. In the face of uncertainty, therefore, and lest we err by overconfidence, there is prima facie reason to include even these cross-species entities in the category of "cloned human embryos." (When we come to the ethical issues of cloning-for-biomedical-research, we can consider whether this terminological judgment is matched by an ethical one.)

Conclusion

None of the terms available to us is entirely trouble-free. Yet the foregoing analysis leads us to the following conclusion regarding the terms best descriptive of the facts of the matter:

Human cloning (what it is): The asexual production of a new human organism that is, at all stages of development, genetically virtually identical to a currently existing or previously existing human being.

Human cloning (how it is done): It would be accomplished by introducing the nuclear material of a human somatic cell (donor) into an oocyte (egg) whose own nucleus has been removed or inactivated, yielding a product that has a human genetic constitution virtually identical to the donor of the somatic cell. This procedure is known as "somatic cell nuclear transfer" (SCNT).

Human cloning (why it is done): This same activity may be undertaken for purposes of producing children or for purposes of scientific and medical investigation and use, a distinction represented in the popular discussion by the terms "reproductive cloning" and "therapeutic cloning." We have chosen instead to use the following designations:

Cloning-to-produce-children: Production of a cloned human embryo, formed for the (proximate) purpose of initiating a pregnancy, with the (ultimate) goal of producing a child who will be genetically virtually identical to a currently existing or previously existing individual.

Cloning-for-biomedical-research: Production of a cloned human embryo, formed for the (proximate) purpose of using it in research or for extracting its stem cells, with the (ultimate) goals of gaining scientific knowledge of normal and abnormal development and of developing cures for human diseases.

Cloned human embryo: (a) The immediate and developing product of the initial act of cloning, accomplished by SCNT. (b) A human embryo resulting from the somatic cell nuclear transfer process (as contrasted with a human embryo arising from the union of egg and sperm).

1. Vogelstein, B., et al., "Please don't call it cloning!" Science, 295: 1237, 2002. Back to Text
   
2. Leggett, K. and A. Regalado, "China Stem Cell Research Surges as Western Nations Ponder Ethics" Wall Street Journal, March 6, 2002, p. A1. Back to Text
   

Scientific Background

Introduction

The purpose of this chapter is to provide background on basic scientific aspects of human cloning for readers of this report. Background on stem cell research is also included to enable readers to understand how cloned embryos might be useful in stem cell and other biomedical research. This limited treatment only summarizes and highlights basic aspects of these topics, in part because two major detailed reports, Scientific and Medical Aspects of Human Reproductive Cloning¹ and Stem Cells and the Future of Regenerative Medicine,² have been recently published.

This review is based largely on scientific research papers published through June 2002, supplemented by references to several articles in the popular press. However, the research areas of cloning and stem cell research are being very actively investigated, and significant new developments are published frequently. Publication of new results could change some of the interpretations and emphases in this review.

Use of unfamiliar technical terms has been avoided wherever possible. Scientific names and terms used are described and defined in the Glossary of Terms.

Some Basic Facts about Human Cell Biology and Sexual Reproduction

We begin with some basic facts about human cells, germ cells (egg and sperm), and early embryonic development to provide the background for understanding the mechanism of cloning and the differences between sexual and asexual reproduction.

Normal human cells with nuclei contain forty-six chromosomes, twenty-two pairs plus two X chromosomes if the individual is female, or twenty-two pairs plus one X and one Y chromosome if the individual is male. These chromosomes contain nearly all of the cell's DNA and, therefore, the genes of the cell. During formation of sperm cells, a process of specialized cell division produces mature sperm cells containing twenty-three chromosomes (twenty-two unpaired chromosomes plus either X or Y). During the formation of eggs (oocytes), a process of specialized cell division produces a cell containing two pronuclei, each of which contains twenty-two unpaired chromosomes plus an X. During fertilization, a polar body containing one of these pronuclei is ejected from the egg.

Fusion of egg and sperm cells and the subsequent fusion of their nuclei (the defining acts of all sexual reproduction) produce a zygote that again contains a nucleus with the adult cell complement of forty-six chromosomes, half from each parent [See Figure 1]. The zygote then begins the gradual process of cell division, growth, and differentiation. After four to five days, the developing embryo attains the 100-200 cell (blastocyst) stage. In normal reproduction, the blastocyst implants into the wall of the uterus, where, suitably nourished, it continues the process of coordinated cell, tissue, and organ differentiation that eventually produces the organized, articulated, and integrated whole that is the newborn infant. According to some estimates, about half of all early human embryos fail to implant, and are expelled with the menses during the next menstrual cycle.

Not quite all the DNA of a human cell resides in its nucleus. All human cells, including eggs and sperm, contain small, energy-producing organelles called mitochondria. Mitochondria contain a small piece of DNA that specifies the genetic instructions for making several essential mitochondrial proteins. When additional mitochondria are produced in the cell, the mitochondrial DNA is replicated, and a copy of it is passed along to the new mitochondria that are formed. During fertilization, sperm mitochondria are selectively degraded inside the zygote. Thus, the developing embryo inherits solely or principally mitochondria (and mitochondrial DNA) from the egg.

Human reproduction has also been accomplished with the help of in vitro fertilization (IVF) of eggs by sperm, and the subsequent transfer of one or more early embryos to a woman for gestation and birth. Even though such union of egg and sperm requires laboratory assistance and takes place outside of the body, human reproduction using IVF is still sexual in the biological sense: the new human being arises from two biological parents through the union of egg and sperm.

Egg and sperm cells combined in vitro have also been used to start the process of animal development. Transfer of the resulting blastocysts into the uterus of a female of the appropriate animal species is widely used in animal husbandry with resulting successful live births.

The startling announcement that Dolly the sheep had been produced by cloning³ indicated that it was possible to produce live mammalian offspring via asexual reproduction through cloning with adult donor cell nuclei.ⁱ In outline form, the steps used to produce live offspring in the mammalian species that have been cloned so far are:

1. Obtain an egg cell from a female of a mammalian species.
   
   
2. Remove the nuclear DNA from the egg cell, to produce an enucleated egg.
   
   
3. Insert the nucleus of a donor adult cell into the enucleated egg, to produce a reconstructed egg.
   
   
4. Activate the reconstructed egg with chemicals or electric current, to stimulate the reconstructed egg to commence cell division.
   
   
5. Sustain development of the cloned embryo to a suitable stage in vitro, and then transfer the resulting cloned embryo to the uterus of a female host that has been suitably prepared to receive it.
   
   
6. Bring to live birth a cloned animal that is genetically virtually identical (except for the mitochondrial DNA) to the animal that donated the adult cell nucleus.

Cloning to produce live offspring carries with it several possibilities not available through sexual reproduction. Because the number of presumably identical donor cells is very large, this process could produce a very large number of genetically virtually identical individuals, limited only by the supply of eggs and female animals that could bear the young. In principle, any animal, male or female, newborn or adult, could be cloned, and in any quantity. Because mammalian cells can be frozen and stored for prolonged periods at low temperature and grown again for use as donor cells in cloning, one may even clone individuals who have died. In theory, a clone could be cloned again, on and on, without limit. In mice, such "cloning of clones" has extended out to six generations.⁴

Since the report of the birth of Dolly the cloned sheep, attempts have been made to clone at least nine other mammalian species. As summarized in Table 1, live offspring have been produced in a low percentage of cloned embryo transfer experiments with sheep, cattle, goats, mice, pigs, cats⁵ and rabbits.⁶ According to a press report,⁷ attempts to clone rats, dogs, and primates using adult cell DNA have not yet yielded live offspring. In experiments to clone different mammalian species, many of the transferred cloned embryos fail to develop normally and abort spontaneously in utero. In addition, a variety of health problems have been reported in many of the cloned animals that survived to live birth.⁸ However, some surviving cloned cattle appear physiologically similar to their uncloned counterparts, and two cloned cows have given birth to their own offspring.

Normal mammalian embryonic development results from selective expression of some genes and repression of others. Tissue differentiation depends upon several types of "epigenetic modifications" (see Glossary of Terms) of DNA structure and spatial organization that selectively turn genes on and off. The chromosomal DNAs of egg and sperm cells are modified during their maturation, so that at fertilization, both sets of DNA are ready for the complex pattern of gene expression required for normal embryonic development. In order for the DNA of a differentiated adult cell to direct embryonic development in cloning, it must be "epigenetically reprogrammed." That is, the epigenetic modifications that allowed the cell to express genes appropriate for, for example, a differentiated skin cell must be reduced, and the gene expression program required for full embryonic development must be activated.

During cloning, cytoplasmic factors in the egg cell reprogram the chromosomal DNA of the somatic cell. In rare cases, this reprogramming is sufficient to enable embryonic development to proceed all the way to the birth of a live animal (for examples, see Table 1). In many cloning experiments, epigenetic reprogramming probably fails or is abnormal, and the developing animal dies. Incomplete epigenetic reprogramming could also explain why some live-born cloned animals suffer from subtle defects that sometimes do not appear for years. ¹²

The completeness of epigenetic reprogramming is crucial for successful cloning-to-produce-children. It will also be important to assess the impact of variation in epigenetic reprogramming on the biological properties of cloned stem cell preparations. If the extent of epigenetic reprogramming varies from one cloning event to the next, the protein expression pattern and thus the biological properties of cloned stem cell preparations may also vary. Thus, it may be necessary to produce and test multiple cloned stem cell preparations before preparations that are informative about human disease or useful in cellular transplantation therapies can be identified.

At this writing, it is uncertain whether anyone has attempted cloning-to-produce-children. Although claims of such attempts have been reported in the press,^13,14 no credible evidence of any such experiments has been reported as of June 2002. Thus, it is not yet known whether a transferred cloned human embryo can progress all the way to live birth. However, the steps in such an experiment would probably be similar to those described for animal cloning [see above and references to Table 1]. After a thorough review of the data on animal cloning, the NAS panel, in its report Scientific and Medical Aspects of Human Cloning [page ES-1], came to the following conclusion: "It [cloning-to-produce-children] is dangerous and likely to fail."

The subject of stem cell research is much too large to be covered extensively here. Yet the following information on stem cells and their possible uses in medical treatments should facilitate understanding of the relationships between cloning-for-biomedical-research and stem cells (see also the reports Scientific and Medical Aspects of Human Reproductive Cloning and Stem Cells and the Future of Regenerative Medicine).

Stem cells are undifferentiated multipotent precursor cells that are capable both of perpetuating themselves as stem cells and of undergoing differentiation into one or more specialized types of cells (for example, kidney, muscle). Human embryonic stem cells have been isolated from embryos at the blastocyst stage¹⁵ or from the germinal tissue of fetuses.¹⁶ Multipotent adult progenitor cells have been isolated from sources such as human¹⁷ and rodent¹⁸ bone marrow. Such cell populations can be differentiated in vitro into a number of different cell types, and thus are the subject of much current research into their possible uses in regenerative medicine. Cloned human embryonic stem cell preparations could be produced using somatic cell nuclear transfer to produce a cloned human embryo, and then taking it apart at the (100-200 cell) blastocyst stage and isolating stem cells (see Figure 2). These stem cells would be genetically virtually identical to cells from the nucleus donor.

Scientists are pursuing the development of therapies based on transplantation of cells for several human diseases, including Parkinson's disease and Type I diabetes. In Parkinson's disease, particular brain cells that produce the essential neurotransmitter dopamine die selectively. Experimental clinical treatment involving transplantation of human fetal brain cell populations, in which a small fraction of the cells produce dopamine, has improved the condition of some Parkinson's disease patients.¹⁹ Dopamine-producing neurons derived from mouse embryonic stem cells have been shown to function in an animal model of Parkinson's disease.²⁰ Thus, there is a possibility that transplantation of dopamine-producing neural cells derived from embryonic or adult stem cell populations might be a useful treatment for Parkinson's disease in the future.

However, to be effective as long-term treatments of Parkinson's disease, Type I diabetes, and other diseases, cell transplantation therapies will have to overcome the immune rejection problem. Cells from one person transplanted into the body of another are usually recognized as foreign and killed by the immune system. If cells derived from stem cell preparations are to be broadly useful in transplantation therapies for human diseases, some way or ways around this problem will have to be found. For example, if the cells were isolated from a cloned human embryo at the blastocyst stage, in which the donor nucleus came from a patient with Parkinson's disease, in theory these stem cells would produce the same proteins as the patient. The hope is that dopamine-producing cells derived from these "individualized" stem cell preparations would not be immunologically rejected upon transplantation back into the Parkinson's disease patient. Alternatively, if dopamine-producing cells could be derived from the patient's own adult stem cell or multipotent adult precursor cell populations, they could also be used in such therapies. Another possibility is mentioned in a press report²¹ about work with a single Parkinson's disease patient, in which brain cells were removed from the patient, expanded by growth in vitro, stimulated to increase dopamine production, and transplanted back into the brain of the same patient with an observed reduction in disease symptoms.

By combining specific gene modification and cloned stem cell procedures, Rideout et al.²² have provided a remarkable example of how some human genetic diseases might someday be treated. Starting with a mouse strain that was deficient in immune system function because of a gene mutation, these investigators (1) produced a cloned stem cell line carrying the gene mutation, (2) specifically repaired the gene mutation in vitro, (3) differentiated the repaired cloned stem cell preparation in vitro into bone marrow precursor cells, and (4) treated the mutant mice with the repaired bone marrow precursor cells and observed a restoration of immune cell function.

Although remarkably successful, the experimental results included a caveat. The investigators also observed a tendency of even these cloned bone marrow precursor cells to be recognized as foreign by the recipient mice. Rideout et al. were led to conclude: "Our results raise the provocative possibility that even genetically matched cells derived by therapeutic cloning may still face barriers to effective transplantation for some disorders."

Lanza et al.²³ have also evaluated the potential for immune rejection of cloned embryonic materials, while showing the potential therapeutic value of tissues taken from cloned fetuses. Cloned cattle embryos at the blastocyst stage were transferred to the uteri of surrogate mothers and allowed to develop for five to eight weeks. Fetal heart, kidney, and skeletal muscle tissues were isolated, and degradable polymer vehicles containing these cloned cells were then transplanted back into the animals that donated the nuclei for cloning. The investigators observed no rejection reaction to the transplanted cloned cells using two different immunological tests. More investigations with cloned stem cell materials involving different stem cell preparations of varying sizes, different sites of implantation, and sensitive tests to detect low levels of immunological rejection will be required for a complete assessment of the possibility of using cloned stem cell populations to solve the immune rejection problem.

Producing cloned stem cell preparations for possible use in individual patients suffering from diseases like Parkinson's disease and Type I diabetes is one reason to pursue cloning-for-biomedical-research.²⁴ In vitro production of cloned human embryos could also be important to scientists interested in studying early human development. Stem cells derived from cloned human embryos at the blastocyst stage that were produced with nuclei from individuals with genetic diseases could be useful in the study of the critical events that lead to these diseases (for example, see Bahn et al.²⁵ ). Specific genes could be introduced into developing human embryos to obtain information about the role or roles of these genes in early human development.

One attempt at human cloning-for-biomedical-research has been published in the scientific literature by Cibelli et al.²⁶ as of the end of June 2002.ⁱⁱ It involved the following steps (see Figure 1):

1. Obtain human eggs from informed and consenting female volunteers.
   
   
2. Remove the nuclear DNA from the egg cell, to produce an enucleated egg.
   
   
3. Insert the nucleus of a cell from an informed and consenting adult donor into the enucleated egg, to produce a reconstituted egg.
   
   
4. Activate the reconstituted egg with chemicals or electricity to stimulate it to commence cell division in vitro, producing a cloned embryo.
   
   
5. Use a microscope to follow the early cell divisions of the cloned embryo.

In the experiments described by Cibelli et al., the stated intent was to create cloned human embryos that would progress to the 100-200 cell stage, at which point the cloned embryo would be taken apart, stem cells would be isolated from the inner cell mass, and an attempt would be made to grow and preserve "individualized" human stem cells (see Figure 2) for the possible future medical benefit of the somatic cell donor. Because the cloned human embryos stopped dividing and died at the six-cell stage, no stem cells were isolated in these experiments. In light of results in other animal species and the variable completeness of "epigenetic reprogramming," it is perhaps not surprising that sixteen of the nineteen cloned human embryos described by Cibelli et. al. did not undergo cell division and none of the other three divided beyond the six-cell stage.

Although the steps these researchers followed in these experiments were the same as those that would be used by those attempting human cloning-to-produce-children, they distinguished their intent from such cloning by stating: "Strict guidelines for the conduct of this research have been established by Advanced Cell Technology's independent Ethics Advisory Board (EAB). In order to prevent any possibility of reproductive cloning, the EAB requires careful accounting of all eggs and embryos used in the research. No embryo created by means of NT [nuclear transfer] technology may be maintained beyond 14 days of development."

Using chemical or electrical stimuli, it is also possible to stimulate human eggs to undergo several rounds of cell division, as if they had been fertilized (see Figure 1). In this case, the egg retains all forty-six egg cell chromosomes and egg cell mitochondria. In amphibians, this asexual reproduction process, known as parthenogenesis, has produced live offspring that contain the same nuclear DNA as the egg. These offspring are all necessarily female. Parthenogenesis in mammals has not led reproducibly to the production of live offspring. ²⁷

Cibelli et al.²⁶ activated human eggs (obtained from informed and consenting donors) by parthenogenesis, and obtained multiple cell divisions up to the early embryo stage in six out of twenty-two attempts. Although there was no report that stem cells were isolated in these experiments, it is possible that parthenogenesis of human eggs could induce them to develop to a stage where parthenogenetic stem cells could be isolated. For example, Cibelli et al.²⁸ derived a monkey parthenogenetic stem cell preparation from Macaca fasicularis eggs activated by parthenogenesis. Whether cloned stem cells resulting from parthenogenesis have been completely and correctly epigenetically reprogrammed remains to be determined.

ENDNOTES

1. National Academy of Sciences (NAS). Scientific and Medical Aspects of Human Reproductive Cloning, Washing-ton, DC. National Academy Press, 2002. Back to Text
   
2. National Research Council/Institute of Medicine (NRC/IOM). Stem Cells and the Future of Regenerative Medicine. Washington DC. National Academy Press, 2001. Back to Text
   
3. Wilmut, I., et al. "Viable offspring derived from fetal and adult mammalian cells" Nature, 385: 810-813, 1997. Back to Text
   
4. Wakayama, T., et al. "Cloning of mice to six generations" Nature, 407: 318-319, 2000. Back to Text
   
5. Shin, T., et al. "A cat cloned by nuclear transplantation" Nature, 415: 859, 2002. Back to Text
   
6. Chesne, P., et al. "Cloned rabbits produced by nuclear transfer from adult somatic cells" Nature Biotechnology, 20: 366-369, 2002. Back to Text
   
7. Kolata, G. "In Cloning, Failure Far Exceeds Success" New York Times, December 11, 2001, page D1. Back to Text
   
8. See Table 2 in Reference 1. Back to Text
   
9. Lanza, R.P., et al. "Cloned cattle can be healthy and normal," Science, 294: 1893-1894, 2001. Back to Text
   
10. Cibelli, J.B., et al. "The health profile of cloned animals" Nature Biotechnology, 20: 13-14, 2002. Back to Text
    
11. Rideout III, W.M., et al. "Nuclear cloning and epigenetic reprogramming of the genome" Science, 293: 1093-1098, 2001. Back to Text
    
12. Ogonuki, N., et al. "Early death of mice cloned from somatic cells" Nature Genetics, 30: 253-254, 2002. Back to Text
    
13. Weiss, R. "Human Cloning Bid Stirs Experts' Anger; Problems in Animal Cases Noted" The Washington Post, April 11, 2001, page A1. Back to Text
    
14. Brown, D. "Human Clone's Birth Predicted; Delivery Outside U.S. May Come By 2003, Researcher Says" The Washington Post, May 16, 2002, p. A8. Back to Text
    
15. Thomson, J.A., et al. "Embryonic stem cell lines derived from human blastocysts" Science, 282: 1145-1147, 1998. Back to Text
    
16. Shamblott, M.J., et al. "Derivation of pluripotent stem cells from cultured human primordial germ cells" Proc Nat Acad Sci U.S.A., 95: 13726-13731, 1998. Back to Text
    
17. Reyes, M., et al. "Origin of endothelial progenitors in human postnatal bone marrow" Journal of Clinical Investigation, 109: 337-346, 2002. Back to Text
    
18. Jiang, Y., et al. "Pluripotency of mesenchymal stem cells derived from adult marrow," Nature, 418: 41-49, 2002. Back to Text
    
19. Hagell, P., and P. Brundin, "Cell survival and clinical outcome following intrastriatal transplantation in Parkinson's disease" J Neuropathol Exp Neurol, 60: 741-752, 2001. Back to Text
    
20. Kim, J-H., et al. "Dopamine neurons derived from embryonic stem cells function in an animal model of Parkinson's disease" Nature 418: 50-56, 2002. Back to Text
    
21. Weiss, R. "Stem Cell Transplant Works in Calif. Case, Parkinson's Traits Largely Disappear," The Washington Post, April 9, 2002, p. A8. Back to Text
    
22. Rideout III, W.M., et al. "Correction of a genetic defect by nuclear transplantation and combined cell and gene therapy" Cell, 109: 17-27, 2002. Back to Text
    
23. Lanza, R.P., et al. "Generation of histocompatible tissues using nuclear transplantation" Nature Biotechnology, 20: 689-696, 2002. Back to Text
    
24. Lanza, R.P., et al. "Human therapeutic cloning" Nature Medicine, 5: 975-977, 1999. Back to Text
    
25. Bahn, S., et al. "Neuronal target genes of the neuron-restrictive silencer factor in neurospheres derived from fetuses with Down's syndrome: A gene expression study" The Lancet, 359: 310-315, 2002. Back to Text
    
26. Cibelli, J.B., et al. "Somatic cell nuclear transfer in humans: Pronuclear and early embryonic development" ebiomed: The Journal of Regenerative Medicine, 2: 25-31, 2001. Back to Text
    
27. Rougier, N., and Z. Werb. "Minireview: Parthenogenesis in mammals" Mol Reprod Devel 59: 468-474, 2001. Back to Text
    
28. Cibelli, J.B., et al. "Parthenogenetic stem cells in nonhuman primates" Science, 295: 819, 2002. Back to Text
    

Cloning-to-produce-children has been the subject of two major national reports in recent years – first by the National Bioethics Advisory Commission in June 1997,¹ and more recently by the National Academy of Sciences in January 2002.² Both reports concluded that attempts to clone a human being "at this time" would be unethical, owing to questions about the safety of the technique and the likelihood of physical harm to those involved. But both reports also concluded that the nation required much deeper reflection about the "ethical and social implications" of cloning-to-produce-children beyond the scientific and medical aspects of the procedure. As the National Academy of Sciences report stated:

Our present opposition to human reproductive cloning is based on science and medicine, irrespective of broader considerations. The panel stresses, however, that a broad ethical debate must be encouraged so that the public can be prepared to make decisions if human reproductive cloning is some day considered medically safe for mothers and offspring.³

In this chapter we attempt to take up this charge to engage in a broad ethical consideration of the merits of cloning-to-produce-children.

The prospect of cloning-to-produce-children raises a host of moral questions, among them the following: Could the first attempts to clone a human child be made without violating accepted moral norms governing experimentation on human subjects? What harms might be inflicted on the cloned child as a consequence of having been made a clone? Is it significant that the cloned child would inherit a genetic identity lived in advance by another – and, in some cases, the genetic identity of the cloned child's rearing parent? Is it significant that cloned children would be the first human beings whose genetic identity was entirely known and selected in advance? How might cloning-to-produce-children affect relationships within the cloning families? More generally, how might it affect the relationship between the generations? How might it affect the way society comes to view children? What other prospects would we be tacitly approving in advance by accepting this practice? What important human goods might be enhanced or sacrificed were we to approve cloning-to-produce-children?

In what follows, we shall explicitly consider many of these questions. But as we do so, we shall not lose sight of the larger and fundamental human contexts discussed in Chapter One – namely, the meaning of human procreation and care of children, the means and ends of biotechnology, and the relation between science and society. Indeed, overarching our entire discussion of the specific ethical issues is our concern for the human significance of procreation as a whole and our desire to protect what is valuable in it from erosion and degradation – not just from cloning but from other possible technological and nontechnological dangers. Readers of this report are encouraged to consider the discussion that follows in a similar light.

We will begin by formulating the best moral case for cloning-to-produce-children – describing both the specific purposes it might serve and the philosophic and moral arguments made in its favor. From there we will move to the moral case against cloning-to-produce-children. Beginning with the safety objections that have dominated the debate thus far, we will show how these concerns ultimately point beyond themselves toward broader ethical concerns. Chief among these is how cloning-to-produce-children would challenge the basic nature of human procreation and the meaning of having children. We shall also consider cloning's effects on human identity, how it might move procreation toward a form of manufacture or toward eugenics, and how it could distort family relations and affect society as a whole.

I. The Case for Cloning-to-Produce-Children

Arguments in defense of cloning-to-produce-children often address questions of reproduction, but they tend to focus on only a relatively narrow sliver of the goods and principles involved. This certainly does not mean that such arguments lack merit. Indeed, some of the arguments in favor of cloning-to-produce-children appeal to the deepest and most meaningful of our society's shared values.

In recent years, in anticipation of cloning-to-produce-children, proponents have articulated a variety of possible uses of a perfected technology: providing a "biologically related child" for an infertile couple; permitting reproduction for single individuals or same-sex couples; avoiding the risk of genetic disease; securing a genetically identical source of organs or tissues perfectly suitable for transplantation; "replacing" a loved spouse or child who is dying or has died; obtaining a child with a genotype of one's own choosing (including one's own genotype); replicating individuals of great genius, talent, or beauty, or individuals possessing traits that are for other reasons attractive to the cloners; and creating sets of genetically identical humans who might have special advantages in highly cooperative ventures in both war and peace.⁴ The desire to control or select the genomes of children-to-be through cloning has charmed more than a few prospective users, in the United States and around the world.

Although we appreciate that a perfected technology, once introduced for one purpose, might then be used for any of these purposes, we shall examine further only those stated purposes that seem to us to merit serious consideration.

Human cloning would allow individuals or couples with fertility problems to have biologically related children. For example, if a man could not produce sperm, cloning would allow him to have a child who is "biologically related" to him. In addition, it would allow married couples with fertility problems to avoid using donor gametes, and therefore avoid raising children with genetic inheritances from outside the marriage.

Human cloning could allow couples at risk of generating children with genetic disease to have healthy children. For example, if both parents carried one copy of a recessive gene for the same heritable disorder, cloning might allow them to ensure that their child does not inherit the known genetic disease (without having to resort to using donor gametes or practicing preimplantation or prenatal genetic diagnosis and elimination of afflicted embryos or fetuses).

Human cloning could produce ideal transplant donors for people who are sick or dying. For example, if no genetic match could be found for a sick child needing a kidney or bone marrow transplant, and the parents had planned to have another child, cloning could potentially serve the human goods of beginning a new life and saving an existing one.

Human cloning would allow parents to "replicate" a dead or dying child or relative. For example, one can imagine a case in which a family – mother, father, and child – is involved in a terrible car accident in which the father dies instantly and the child is critically injured. The mother, told that her child will soon die, decides that the best way to redeem the tragedy is to clone her dying child. This would allow her to preserve a connection with both her dead husband and her dying child, to create new life as a partial human answer to the grievous misfortune of her child's untimely death, and to continue the name and biological lineage of her deceased husband.

Human cloning would allow families or society to reproduce individuals of great genius, talent, or beauty, where these traits are presumed to be based on the individuals' desirable or superior genetic makeups. For example, some admirers of great athletes, musicians, or mathematicians, believing that the admired attributes are the result of a superior genetic endowment, might want to clone these distinguished individuals. Just as the cloning of cattle is being promoted as a means of perpetuating champion milk- or meat-producing cows, so cloning-to-produce-children has been touted as a means of perpetuating certain "superior" human exemplars.

The purposes or reasons for cloning-to-produce-children are, as they are stated, clearly intelligible on their face. When challenged, the defenders of these purposes often appeal to larger moral and political goods. These typically fall within the following three categories: human freedom, existence, and well-being.

Strictly speaking, the appeal to human freedom is not so much a defense of cloning itself as it is of the right to practice it, asserted against those who seek to prohibit it. No one, we suspect, would say that he wanted to clone himself or any one else in order to be free or to vindicate the goodness of liberty. Nevertheless, human freedom is a defense often heard in support of a "right" to clone.

Those who defend cloning-to-produce-children on the grounds of human freedom make two kinds of arguments. The first is that because individuals in pluralistic societies have different definitions of the good life and of right and wrong, society must protect individual freedom to choose against the possible tyranny of the majority. This means securing and even expanding the rights of individuals to make choices so long as their choices do not directly infringe on the rights (and especially the physical safety) of other rights-bearing citizens. In Eisenstadt v. Baird (1972), the United States Supreme Court enunciated what has been called a principle of reproductive freedom: "If the right to privacy means anything, it is the right of the individual, married or single, to be free from unwarranted governmental intrusion into matters so affecting a person as a decision whether to bear or beget a child."⁵ Defenders of cloning-to-produce-children argue that, in the event that the physical risks to mother and future child were shown to be ethically acceptable, the use of this new reproductive technology would fall under the protective umbrella of reproductive freedom.

A second defense of human cloning on the grounds of freedom is the claim that human existence is by its very nature "open-ended," "indeterminate," and "unpredictable." Human beings are always remaking themselves, their values, and their ways of interacting with one another. New technologies are central to this open-ended idea of human life, and to shut down such technologies simply because they change the "traditional" ways of doing things is unjustifiable. As constitutional scholar Laurence Tribe has argued in reference to human cloning: "A society that bans acts of human creation that reflect unconventional sex roles or parenting models (surrogate motherhood, in vitro fertilization, artificial insemination, and the like) for no better reason than that such acts dare to defy 'nature' and tradition (and to risk adding to life's complexity) is a society that risks cutting itself off from vital experimentation and risks sterilizing a significant part of its capacity to grow."⁶

Like the appeal to freedom, the appeal to the goodness of existence is not an argument for cloning, but an argument against opponents who speak up in the name of protecting the cloned child-to-be against the harms connected with its risky and strange origins as a clone. This argument asserts that attempts to produce children through cloning, like any attempt to produce a child, will directly benefit the cloned child-to-be, since without the act of cloning the child in question would not exist. Existence itself, it is argued, is the first "interest" that makes all other interests – including the interests of safety and well-being – possible. Even taking into account the possibility of serious genetic or developmental disorders, this position holds that a cloned individual, once born, would prefer existence as a clone to no existence at all. There is also a serious corollary about how, in the absence of a principle that values existence as such, we will and should regard and treat people born with disabilities or deformities: opponents of cloning might appear in a position of intolerance – of saying to cloned individuals, "Better for us (and for you) had you never existed."

The third moral argument for cloning-to-produce-children is that it would contribute in certain cases to the fulfillment of human goods that are widely honored and deeply rooted in modern democratic society. These human goods include the health of newborn and existing children, reproductive possibilities for infertile couples, and the possibility of having a biologically related child. In all these circumstances, human cloning could relieve existing suffering and sorrow or prevent them in the future. Those who take this position do not necessarily defend human cloning-to-produce-children as such. Rather, they argue that a moral and practical line can be drawn between cloning-to-produce-children that serves the "therapeutic" aims of health (for the cloned child-to-be, for the infertile couple, or for an existing child) and the "eugenic" aims of producing or mass-producing superior people.

Some people argue more broadly that an existing generation has a responsibility to ensure, to the extent possible, the genetic quality and fitness of the next generation. Human cloning, they argue, offers a new method for human control and self-improvement, by allowing families to have children free of specific genetic diseases or society to reproduce children with superior genetic endowments. It also provides a new means for gaining knowledge about the age-old question of nature versus nurture in contributing to human achievement and human flourishing, and to see how clones of great geniuses measure up against the "originals."

While we as a Council acknowledge merit in some of the arguments made for cloning-to-produce-children, we are generally not persuaded by them. The fundamental weakness of the proponents' case is found in their incomplete view of human procreation and families, and especially the place and well-being of children. Proponents of cloning tend to see procreation primarily as the free exercise of a parental right, namely, a right to satisfy parental desires for self-fulfillment or a right to have a child who is healthy or "superior." Parents seek to overcome obstacles to reproduction, to keep their children free of genetic disease or disorder, and to provide them with the best possible genetic endowment. The principles guiding such prospective parents are freedom (for themselves), control (over their child), and well-being (both for themselves and what they imagine is best for their child). Even taken together, these principles provide at best only a partial understanding of the meaning and entailments of human procreation and child-rearing. In practice, they may prove to undermine the very goods that the proponents of cloning aim to serve, by undermining the unconditional acceptance of one's offspring that is so central to parenthood.

There are a number of objections – or at the very least limitations – to viewing cloning-to-produce-children through the prism of rights. Basic human rights are usually asserted on behalf of the human individual agent: for example, a meaningful right not to be prevented from bearing a child can be asserted for each individual against state-mandated sterilization programs. But the act of procreation is not an act involving a single individual. Indeed, until human cloning arrives, it continues to be impossible for any one person to procreate alone. More important, there is a crucial third party involved: the child, whose centrality to the activity exposes the insufficiency of thinking about procreation in terms of rights.

After all, rights are limited in the following crucial way: they cannot be ethically exercised at the expense of the rights of another. But the "right to reproduce" cannot be ethically exercised without at least considering the child that such exercise will bring into being and who is at risk of harm and injustice from the exercise. This obligation cannot be waived by an appeal to the absolutist argument of the goodness of existence. Yes, existence is a primary good, but that does not diminish the ethical significance of knowingly and willfully putting a child in grave physical danger in the very act of giving that child existence. It is certainly true that a life with even severe disability may well be judged worth living by its bearer: "It is better to have been born as I am than not to be here at all." But if his or her disability was caused by behavior that could have been avoided by parents (for example, by not drinking or using drugs during pregnancy, or, arguably, by not cloning), many would argue that they should have avoided it. A post-facto affirmation of existence by the harmed child would not retroactively excuse the parental misconduct that caused the child's disability, nor would it justify their failure to think of the child's well-being as they went about exercising their "right to procreate." Indeed, procreation is, by its very nature, a limitation of absolute rights, since it brings into existence another human being toward whom we have responsibilities and duties.

In short, the right to decide "whether to bear or beget a child" does not include a right to have a child by whatever means. Nor can this right be said to imply a corollary – the right to decide what kind of child one is going to have. There are at least some circumstances where reproductive freedom must be limited to protect the good of the child (as, for instance, with the ban on incest). Our society's commitment to freedom and parental authority by no means implies that all innovative procedures and practices should be allowed or accepted, no matter how bizarre or dangerous.

Proponents of cloning, when they do take into account the interests of the child, sometimes argue that this interest justifies and even requires thoroughgoing parental control over the procreative process. Yet this approach, even when well-intentioned, may undermine the good of the child more than it serves the child's best interests. For one thing, cloning-to-produce-children of a desired or worthy sort overlooks the need to restrain the parental temptation to total mastery over children. It is especially morally dubious for this project to go forward when we know so little about the unforeseen and unintended consequences of exercising such genetic control. In trying by cloning to circumvent the risk of genetic disease or to promote particular traits, it is possible – perhaps likely – that new risks to the cloned child's health and fitness would be inadvertently introduced (including the forgoing of genetic novelty, a known asset in the constant struggle against microbial and parasitic diseases). Parental control is a double-edged sword, and proponents seem not to acknowledge the harms, both physical and psychological, that may befall the child whose genetic identity is selected in advance.

The case for cloning in the name of the child's health and well-being is certainly the strongest and most compelling. The desire that one's child be free from a given genetic disease is a worthy aspiration. We recognize there may be some unusual or extreme cases in which cloning might be the best means to serve this moral good, if other ethical obstacles could somehow be overcome. (A few of us also believe that the desire to give a child "improved" or "superior" genetic equipment is not necessarily to be condemned.) However, such aspirations could endanger the personal, familial, and societal goods supported by the character of human procreation. We are willing to grant that there may be exceptional cases in which cloning-to-produce-children is morally defensible; however, that being said, we would also argue that such cases do not justify the harmful experiments and social problems that might be entailed by engaging in human cloning. Hard cases are said to make bad law. The same would be true for succumbing to the rare, sentimentally appealing case in which cloning seems morally plausible.ⁱ

Finally, proponents do not adequately face up to the difficulty of how "well-being" is to be defined. Generally, they argue that these matters are to be left up to the free choices of parents and doctors. But this means that the judgments of "proper" and "improper" will be made according to subjective criteria alone, and under such circumstances, it will be almost impossible to rule out certain "improvements" as unacceptable.

In the sections that follow, we shall explain more fully why Members of the Council are not convinced by the arguments for cloning-to-produce-children, even in the most defensible cases. To see why this is so, we need to consider cloning-to-produce-children from the broadest possible moral perspective, beginning with ethical questions regarding experiments on human subjects. What we hope to show is that the frequently made safety arguments strike deeper than we usually realize, and that they point beyond themselves toward more fundamental moral objections to cloning-to-produce-children.

We begin with concerns regarding the safety of the cloning procedure and the health of the participants. We do so for several reasons. First, these concerns are widely, indeed nearly unanimously, shared. Second, they lend themselves readily to familiar modes of ethical analysis – including concerns about harming the innocent, protecting human rights, and ensuring the consent of all research subjects. Finally, if carefully considered, these concerns begin to reveal the important ethical principles that must guide our broader assessment of cloning-to-produce-children. They suggest that human beings, unlike inanimate matter or even animals, are in some way inviolable, and therefore challenge us to reflect on what it is about human beings that makes them inviolable, and whether cloning-to-produce-children threatens these distinctly human goods.

In initiating this analysis, there is perhaps no better place to start than the long-standing international practice of regulating experiments on human subjects. After all, the cloning of a human being, as well as all the research and trials required before such a procedure could be expected to succeed, would constitute experiments on the individuals involved – the egg donor, the birthing mother, and especially the child-to-be. It therefore makes sense to consider the safety and health concerns that arise from cloning-to-produce-children in light of the widely shared ethical principles that govern experimentation on human subjects.

Since the Second World War, various codes for the ethical conduct of human experimentation have been adopted around the world. These codes and regulations were formulated in direct response to serious ethical lapses and violations committed by research scientists against the rights and dignity of individual human beings. Among the most important and widely accepted documents to emerge were the Nuremberg Code of 1947⁷ and the Helsinki Declaration of 1964.⁸ Influential in the United States is also the Belmont Report, published in 1978 by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research.⁹

The Nuremberg Code laid out ten principles for the ethical conduct of experiments, focusing especially on voluntary consent of research subjects, the principle that experiments should be conducted only with the aim of providing a concrete good for society that is unprocurable by other methods, and with the avoidance of physical or mental harm. The Helsinki Declaration stated, among other things, that research should be undertaken only when the prospective benefit clearly outweighs the expected risk, when the research subject has been fully informed of all risks, and when the research-subject population is itself likely to benefit from the results of the experiment.

Finally, the Belmont Report proposed three basic ethical principles that were to guide the treatment of human subjects involved in scientific research. The first of these is respect for persons, which requires researchers to acknowledge the autonomy and individual rights of research subjects and to offer special protection to those with diminished autonomy and capacity. The second principle is beneficence. Scientific research must not only refrain from harming those involved but must also be aimed at helping them, or others, in concrete and important ways. The third principle is justice, which involves just distribution of potential benefits and harms and fair selection of research subjects. When applied, these general principles lead to both a requirement for informed consent of human research subjects and a requirement for a careful assessment of risks and benefits before proceeding with research. Safety, consent, and the rights of research subjects are thus given the highest priority.

It would be a mistake to view these codes in narrow or procedural terms, when in fact they embody society's profound sense that human beings are not to be treated as experimental guinea pigs for scientific research. Each of the codes was created to address a specific disaster involving research science – whether the experiments conducted by Nazi doctors on concentration camp prisoners, or the Willowbrook scandal in which mentally retarded children were infected with hepatitis, or the Tuskegee scandal in which underprivileged African-American men suffering from syphilis were observed but not treated by medical researchers – and each of the codes was an attempt to defend the inviolability and dignity of all human beings in the face of such threats and abuses. More simply stated, the codes attempt to defend the weak against the strong and to uphold the equal dignity of all human beings. In taking up the application of these codes to the case of cloning-to-produce-children, we would suggest that the proper approach is not simply to discover specific places where human cloning violates this or that stipulation of this or that code, but to grapple with how such cloning offends the spirit of these codes and what they seek to defend.

The ethics of research on human subjects suggest three sorts of problems that would arise in cloning-to-produce-children: (1) problems of safety; (2) a special problem of consent; and (3) problems of exploitation of women and the just distribution of risk. We shall consider each in turn.

First, cloning-to-produce-children is not now safe. Concerns about the safety of the individuals involved in a cloning procedure are shared by nearly everyone on all sides of the cloning debate. Even most proponents of cloning-to-produce-children generally qualify their support with a caveat about the safety of the procedure. Cloning experiments in other mammals strongly suggest that cloning-to-produce-children is, at least for now, far too risky to attempt.¹⁰ Safety concerns revolve around potential dangers to the cloned child, as well as to the egg donor and the woman who would carry the cloned child to birth.

(a) Risks to the child. Risks to the cloned child-to-be must be taken especially seriously, both because they are most numerous and most serious and because – unlike the risks to the egg donor and birth mother – they cannot be accepted knowingly and freely by the person who will bear them. In animal experiments to date, only a small percentage of implanted clones have resulted in live births, and a substantial portion of those live-born clones have suffered complications that proved fatal fairly quickly. Some serious though nonfatal abnormalities in cloned animals have also been observed, including substantially increased birth-size, liver and brain defects, and lung, kidney, and cardiovascular problems.¹¹

Longer-term consequences are of course not known, as the oldest successfully cloned mammal is only six years of age. Medium-term consequences, including premature aging, immune system failure, and sudden unexplained death, have already become apparent in some cloned mammals. Some researchers have also expressed concerns that a donor nucleus from an individual who has lived for some years may have accumulated genetic mutations that – if the nucleus were used in the cloning of a new human life – may predispose the new individual to certain sorts of cancer and other diseases.¹²

(b) Risks to the egg donor and the birth mother. Accompanying the threats to the cloned child's health and well-being are risks to the health of the egg donors. These include risks to her future reproductive health caused by the hormonal treatments required for egg retrieval and general health risks resulting from the necessary superovulation.¹³

Animal studies also suggest the likelihood of health risks to the woman who carries the cloned fetus to term. The animal data suggest that late-term fetal losses and spontaneous abortions occur substantially more often with cloned fetuses than in natural pregnancies. In humans, such late-term fetal losses may lead to substantially increased maternal morbidity and mortality. In addition, animal studies have shown that many pregnancies involving cloned fetuses result in serious complications, including toxemia and excessive fluid accumulation in the uterus, both of which pose risks to the pregnant animal's health.¹⁴ In one prominent cattle cloning study, just under one-third of the pregnant cows died from complications late in pregnancy.¹⁵

Reflecting on the dangers to birth mothers in animal cloning studies, the National Academy report concluded:

Results of animal studies suggest that reproductive cloning of humans would similarly pose a high risk to the health of both fetus or infant and mother and lead to associated psychological risks for the mother as a consequence of late spontaneous abortions or the birth of a stillborn child or a child with severe health problems. ¹⁶

(c) An abiding moral concern. Because of these risks, there is widespread agreement that, at least for now, attempts at cloning-to-produce-children would constitute unethical experimentation on human subjects and are therefore impermissible. These safety considerations were alone enough to lead the National Bioethics Advisory Commission in June 1997 to call for a temporary prohibition of human cloning-to-produce-children. Similar concerns, based on almost five more years of animal experimentation, convinced the panel of the National Academy of Sciences in January 2002 that the United States should ban such cloning for at least five years.

Past discussions of this subject have often given the impression that the safety concern is a purely temporary one that can be allayed in the near future, as scientific advances and improvements in technique reduce the risks to an ethically acceptable level. But this impression is mistaken, for considerable safety risks are likely to be enduring, perhaps permanent. If so, there will be abiding ethical difficulties even with efforts aimed at making human cloning safe.

The reason is clear: experiments to develop new reproductive technologies are necessarily intergenerational, undertaken to serve the reproductive desires of prospective parents but practiced also and always upon prospective children. Any such experiment unavoidably involves risks to the child-to-be, a being who is both the product and also the most vulnerable human subject of the research. Exposed to risk during the extremely sensitive life-shaping processes of his or her embryological development, any child-to-be is a singularly vulnerable creature, one maximally deserving of protection against risk of experimental (and other) harm. If experiments to learn how to clone a child are ever to be ethical, the degree of risk to that child-to-be would have to be extremely low, arguably no greater than for children-to-be who are conceived from union of egg and sperm. It is extremely unlikely that this moral burden can be met, not for decades if at all.

In multiple experiments involving six of the mammalian species cloned to date, more than 89 percent of the cloned embryos transferred to recipient females did not come to birth, and many of the live-born cloned animals are or become abnormal.¹⁷ If success means achieving normal and healthy development not just at birth but throughout the life span, there is even less reason for confidence. The oldest cloned mammal (Dolly) is only six years old and has exhibited unusually early arthritis. The reasons for failure in animal cloning are not well understood. Also, no nonhuman primates have been cloned. It will be decades (at least) before we could obtain positive evidence that cloned primates might live a normal healthy (primate) life.

Even a high success rate in animals would not suffice by itself to make human trials morally acceptable. In addition to the usual uncertainties in jumping the gap from animal to human research, cloning is likely to present particularly difficult problems of interspecies difference. Animal experiments have already shown substantial differences in the reproductive success of identical cloning techniques used in different species.¹⁸ If these results represent species-specific differences in, for example, the ease of epigenetic reprogramming and imprinting of the donor DNA, the magnitude of the risks to the child-to-be of the first human cloning experiments would be unknown and potentially large, no matter how much success had been achieved in animals. There can in principle be no direct experimental evidence sufficient for assessing the degree of such risk.ⁱⁱ

Can a highly reduced risk of deformity, disease, and premature death in animal cloning, coupled with the inherently unpredictable risk of moving from animals to humans, ever be low enough to meet the ethically acceptable standard set by reproduction begun with egg and sperm? The answer, as a matter of necessity, can never be better than "Just possibly." Given the severity of the possible harms involved in human cloning, and given that those harms fall on the very vulnerable child-to-be, such an answer would seem to be enduringly inadequate.

Similar arguments, it is worth noting, were made before the first attempts at human in vitro fertilization. People suggested that it would be unethical experimentation even to try to determine whether IVF could be safely done. And then, of course, IVF was accomplished. Eventually, it became a common procedure, and today the moral argument about its safety seems to many people beside the point. Yet the fact of success in that case does not establish precedent in this one, nor does it mean that the first attempts at IVF were not in fact unethical experiments upon the unborn, despite the fortunate results.ⁱⁱⁱ

Be this as it may, the case of cloning is genuinely different. With IVF, assisted fertilization of egg by sperm immediately releases a developmental process, linked to the sexual union of the two gametes, that nature has selected over millions of years for the entire mammalian line. But in cloning experiments to produce children, researchers would be transforming a sexual system into an asexual one, a change that requires major and "unnatural" reprogramming of donor DNA if there is to be any chance of success. They are neither enabling nor restoring a natural process, and the alterations involved are such that success in one species cannot be presumed to predict success in another. Moreover, any new somatic mutations in the donor cell's chromosomal DNA would be passed along to the cloned child-to-be and its offspring. Here we can see even more the truly intergenerational character of cloning experimentation, and this should justify placing the highest moral burden of persuasion on those who would like to proceed with efforts to make cloning safe for producing children. (By reminding us of the need to protect the lives and well-being of our children and our children's children, this broader analysis of the safety question points toward larger moral objections to producing cloned children, objections that we shall consider shortly.)

It therefore appears to us that, given the dangers involved and the relatively limited goods to be gained from cloning-to-produce-children, conducting experiments in an effort to make cloning-to-produce-children safer would itself be an unacceptable violation of the norms of the ethics of research. There seems to be no ethical way to try to discover whether cloning-to-produce-children can become safe, now or in the future.

A further concern relating to the ethics of human research revolves around the question of consent. Consent from the cloned child-to-be is of course impossible to obtain, and because no one consents to his or her own birth, it may be argued that concerns about consent are misplaced when applied to the unborn. But the issue is not so simple. For reasons having to do both with the safety concerns raised above and with the social, psychological, and moral concerns to be addressed below, an attempt to clone a human being would potentially expose a cloned individual-to-be to great risks of harm, quite distinct from those accompanying other sorts of reproduction. Given the risks, and the fact that consent cannot be obtained, the ethically correct choice may be to avoid the experiment. The fact that those engaged in cloning cannot ask an unconceived child for permission places a burden on the cloners, not on the child. Given that anyone considering creating a cloned child must know that he or she is putting a newly created human life at exceptional risk, the burden on the would-be cloners seems clear: they must make a compelling case why the procedure should not be avoided altogether. ^iv

Reflections on the purpose and meaning of seeking consent support this point. Why, after all, does society insist upon consent as an essential principle of the ethics of scientific research? Along with honoring the free will of the subject, we insist on consent to protect the weak and the vulnerable, and in particular to protect them from the powerful. It would therefore be morally questionable, at the very least, to choose to impose potentially grave harm on an individual, especially in the very act of giving that individual life. Giving existence to a human being does not grant one the right to maim or harm that human being in research.

Cloning-to-produce-children may also lead to the exploitation of women who would be called upon to donate oocytes. Widespread use of the techniques of cloning-to-produce-children would require large numbers of eggs. Animal models suggest that several hundred eggs may be required before one attempt at cloning can be successful. The required oocytes would have to be donated, and the process of making them available would involve hormonal treatments to induce superovulation. If financial incentives are offered, they might lead poor women especially to place themselves at risk in this way (and might also compromise the voluntariness of their "choice" to make donations). Thus, research on cloning-to-produce-children could impose disproportionate burdens on women, particularly low-income women.

These questions of the ethics of research – particularly the issue of physical safety – point clearly to the conclusion that cloning-to-produce-children is unacceptable. In reaching this conclusion, we join the National Bioethics Advisory Commission and the National Academy of Sciences. But we go beyond the findings of those distinguished bodies in also pointing to the dangers that will always be inherent in the very process of trying to make cloning-to-produce-children safer. On this ground, we conclude that the problem of safety is not a temporary ethical concern. It is rather an enduring moral concern that might not be surmountable and should thus preclude work toward the development of cloning techniques to produce children. In light of the risks and other ethical concerns raised by this form of human experimentation, we therefore conclude that cloning-to-produce-children should not be attempted.

For some people, the discussion of ethical objections to cloning-to-produce-children could end here. Our society's established codes and practices in regard to human experimentation by themselves offer compelling reasons to oppose indefinitely attempts to produce a human child by cloning. But there is more to be said.

First, many people who are repelled by or opposed to the prospect of cloning human beings are concerned not simply or primarily because the procedure is unsafe. To the contrary, their objection is to the use of a perfected cloning technology and to a society that would embrace or permit the production of cloned children. The ethical objection based on lack of safety is not really an objection to cloning as such. Indeed, it may in time become a vanishing objection should people be allowed to proceed – despite insuperable ethical objections such as the ones we have just offered – with experiments to perfect the technique.^v Should this occur, the ethical assessment of cloning-to-produce-children would need to address itself to the merits (and demerits) of cloning itself, beyond the safety questions tied to the techniques used to produce cloned children. Thus, anticipating the possibility of a perfected and usable technology, it is important to delineate the case against the practice itself.

Moreover, because the Council is considering cloning within a broad context of present and projected techniques that can affect human procreation or alter the genetic makeup of our children, it is important that we consider the full range and depth of ethical issues raised by such efforts.

How should these issues be raised, and within what moral framework? Some, but by no means all, of the deepest moral concerns connected to human cloning could be handled by developing a richer consideration of the ethics of human experimentation. Usually – and regrettably – we apply the ethical principles governing research on human subjects in a utilitarian spirit, weighing benefits versus harms, and moreover using only a very narrow notion of "harm." The calculus that weighs benefits versus harms too often takes stock only of bodily harm or violations of patient autonomy, though some serious efforts have been made in recent years to consider broader issues. In addition, we often hold a rather narrow view of what constitutes "an experiment." Yet cloning-to-produce-children would be a "human experiment" in many senses, and risks of bodily harm and inadequate consent do not exhaust the ways in which cloning might do damage. As we have described, cloning-to-produce-children would be a biological experiment – with necessary uncertainties about the safety of the technique and the possibility of physical harm. But it would also be an experiment in human procreation – substituting asexual for sexual reproduction and treating children not as gifts but as our self-designed products. It would be an experiment in human identity – creating the first human beings to inherit a genetic identity lived in advance by another. It would be an experiment in genetic choice and design – producing the first children whose entire genetic makeup was selected in advance. It would be an experiment in family and social life – altering the relationships within the family and between the generations, for example, by turning "mothers" into "twin sisters" and "grandparents" into "parents," and by having children asymmetrically linked biologically to only one parent. And it would represent a social experiment for the entire society, insofar as the society accepted, even if only as a minority practice, this unprecedented and novel mode of producing our offspring.

By considering these other ways in which cloning would constitute an experiment, we could enlarge our analysis of the ethics of research with human subjects to assess possible nonbodily harms of cloning-to-produce-children. But valuable as this effort might be, we have not chosen to proceed in this way. Not all the important issues can be squeezed into the categories of harms and benefits. People can be mistreated or done an injustice whether they know it or not and quite apart from any experienced harm. Important human goods can be traduced, violated, or sacrificed without being registered in anyone's catalogue of harms. The form of bioethical inquiry we are attempting here will make every effort not to truncate the moral meaning of our actions and practices by placing them on the Procrustean bed of utilitarianism. To be sure, the ethical principles governing human research are highly useful in efforts to protect vulnerable individuals against the misconduct or indifference of the powerful. But a different frame of reference is needed to evaluate the human meaning of innovations that may affect the lives and humanity of everyone, vulnerable or not.

Of the arguments developed below, some are supported by most Council Members, while other arguments are shared by only some Members. Even among the arguments they share, different Members find different concerns to be weightier. Yet we all believe that the arguments presented in the sections that follow are worthy of consideration in the course of trying to assess fully the ethical issues involved. We have chosen to err on the side of inclusion rather than exclusion of arguments because we acknowledge that concerns now expressed by only a few may turn out in the future to be more important than those now shared by all. Our fuller assessment begins with an attempt to fathom the deepest meaning of human procreation and thus necessarily the meaning of raising children. Our analysis will then move onto questions dealing with the effects of cloning on individuals, family life, and society more generally.

Were it to take place, cloning-to-produce-children would represent a challenge to the nature of human procreation and child-rearing. Cloning is, of course, not only a means of procreation. It is also a technology, a human experiment, and an exercise of freedom, among other things. But cloning would be most unusual, consequential, and most morally important as a new way of bringing children into the world and a new way of viewing their moral significance.

In Chapter One we outlined some morally significant features of human procreation and raised questions about how these would be altered by human cloning. We will now attempt to deepen that analysis, and begin with the salient fact that a child is not made, but begotten. Procreation is not making but the outgrowth of doing. A man and woman give themselves in love to each other, setting their projects aside in order to do just that. Yet a child results, arriving on its own, mysterious, independent, yet the fruit of the embrace.^vi Even were the child wished for, and consciously so, he or she is the issue of their love, not the product of their wills; the man and woman in no way produce or choose a particular child, as they might buy a particular car. Procreation can, of course, be assisted by human ingenuity (as with IVF). In such cases, it may become harder to see the child solely as a gift bestowed upon the parents' mutual self-giving and not to some degree as a product of their parental wills. Nonetheless, because it is still sexual reproduction, the children born with the help of IVF begin – as do all other children – with a certain genetic independence of their parents. They replicate neither their fathers nor their mothers, and this is a salutary reminder to parents of the independence they must one day grant their children and for which it is their duty to prepare them.

Gifts and blessings we learn to accept as gratefully as we can. Products of our wills we try to shape in accord with our desires. Procreation as traditionally understood invites acceptance, rather than reshaping, engineering, or designing the next generation. It invites us to accept limits to our control over the next generation. It invites us even – to put the point most strongly – to think of the child as one who is not simply our own, our possession. Certainly, it invites us to remember that the child does not exist simply for the happiness or fulfillment of the parents.

To be sure, parents do and must try to form and mold their children in various ways as they inure them to the demands of family life, prepare them for adulthood, and initiate them into the human community. But, even then, it is only our sense that these children are not our possessions that makes such parental nurture which always threatens not to nourish but to stifle the child – safe.

This concern can be expressed not only in language about the relation between the generations but also in the language of equality. The things we make are not just like ourselves; they are the products of our wills, and their point and purpose are ours to determine. But a begotten child comes into the world just as its parents once did, and is therefore their equal in dignity and humanity.

The character of sexual procreation shapes the lives of children as well as parents. By giving rise to genetically new individuals, sexual reproduction imbues all human beings with a sense of individual identity and of occupying a place in this world that has never belonged to another. Our novel genetic identity symbolizes and foreshadows the unique, never-to-be-repeated character of each human life. At the same time, our emergence from the union of two individuals, themselves conceived and generated as we were, locates us immediately in a network of relation and natural affection.

Social identity, like genetic identity, is in significant measure tied to these biological facts. Societies around the world have structured social and economic responsibilities around the relationship between the generations established through sexual procreation, and have developed modes of child-rearing, family responsibility, and kinship behavior that revolve around the natural facts of begetting.

There is much more to be said about these matters, and they are vastly more complicated than we have indicated. There are, in addition, cultural differences in the way societies around the world regard the human significance of procreation or the way children are to be regarded and cared for. Yet we have said enough to indicate that the character and nature of human procreation matter deeply. They affect human life in endless subtle ways, and they shape families and communities. A proper regard for the profundity of human procreation (including child-rearing and parent-child relations) is, in our view, indispensable for a full assessment of the ethical implications of cloning-to-produce-children.

Beyond the matter of procreation itself, we think it important to examine the possible psychological and emotional state of individuals produced by cloning, the well-being of their families, and the likely effects on society of permitting human cloning. These concerns would apply even if cloning-to-produce-children were conducted on a small scale; and they would apply in even the more innocent-seeming cloning scenarios, such as efforts to overcome infertility or to avoid the risk of genetic disease. Admittedly, these matters are necessarily speculative, for empirical evidence is lacking. Nevertheless, the importance of the various goods at stake justifies trying to think matters through in advance.

Keeping in mind our general observations about procreation, we proceed to examine a series of specific ethical issues and objections to cloning human children: (1) problems of identity and individuality; (2) concerns regarding manufacture; (3) the prospect of a new eugenics; (4) troubled family relations; and (5) effects on society.

Cloning-to-produce-children could create serious problems of identity and individuality. This would be especially true if it were used to produce multiple "copies" of any single individual, as in one or another of the seemingly far-fetched futuristic scenarios in which cloning is often presented to the popular imagination. Yet questions of identity and individuality could arise even in small-scale cloning, even in the (supposedly) most innocent of cases, such as the production of a single cloned child within an intact family. Personal identity is, we would emphasize, a complex and subtle psychological phenomenon, shaped ultimately by the interaction of many diverse factors. But it does seem reasonably clear that cloning would at the very least present a unique and possibly disabling challenge to the formation of individual identity.

Cloned children may experience concerns about their distinctive identity not only because each will be genetically essentially identical to another human being, but also because they may resemble in appearance younger versions of the person who is their "father" or "mother." Of course, our genetic makeup does not by itself determine our identities. But our genetic uniqueness is an important source of our sense of who we are and how we regard ourselves. It is an emblem of independence and individuality. It endows us with a sense of life as a never-before-enacted possibility. Knowing and feeling that nobody has previously possessed our particular gift of natural characteristics, we go forward as genetically unique individuals into relatively indeterminate futures.

These new and unique genetic identities are rooted in the natural procreative process. A cloned child, by contrast, is at risk of living out a life overshadowed in important ways by the life of the "original" – general appearance being only the most obvious. Indeed, one of the reasons some people are interested in cloning is that the technique promises to produce in each case a particular individual whose traits and characteristics are already known. And however much or little one's genotype actually shapes one's natural capacities, it could mean a great deal to an individual's experience of life and the expectations that those who cloned him or her might have. The cloned child may be constantly compared to "the original," and may consciously or unconsciously hold himself or herself up to the genetic twin that came before. If the two individuals turned out to lead similar lives, the cloned person's achievements may be seen as derivative. If, as is perhaps more likely, the cloned person departed from the life of his or her progenitor, this very fact could be a source of constant scrutiny, especially in circumstances in which parents produced their cloned child to become something in particular. Living up to parental hopes and expectations is frequently a burden for children; it could be a far greater burden for a cloned individual. The shadow of the cloned child's "original" might be hard for the child to escape, as would parental attitudes that sought in the child's very existence to replicate, imitate, or replace the "original."

It may reasonably be argued that genetic individuality is not an indispensable human good, since identical twins share a common genotype and seem not to be harmed by it. But this argument misses the context and environment into which even a single human clone would be born. Identical twins have as progenitors two biological parents and are born together, before either one has developed and shown what his or her potential – natural or otherwise – may be. Each is largely free of the burden of measuring up to or even knowing in advance the genetic traits of the other, because both begin life together and neither is yet known to the world. But a clone is a genetic near-copy of a person who is already living or has already lived. This might constrain the clone's sense of self in ways that differ in kind from the experience of identical twins. Everything about the predecessor – from physical height and facial appearance, balding patterns and inherited diseases, to temperament and native talents, to shape of life and length of days, and even cause of death – will appear before the expectant eyes of the cloned person, always with at least the nagging concern that there, notwithstanding the grace of God, go I. The crucial matter, again, is not simply the truth regarding the extent to which genetic identity actually shapes us – though it surely does shape us to some extent. What matters is the cloned individual's perception of the significance of the "precedent life" and the way that perception cramps and limits a sense of self and independence.

The likely impact of cloning on identity suggests an additional moral and social concern: the transformation of human procreation into human manufacture, of begetting into making. By using the terms "making" and "manufacture" we are not claiming that cloned children would be artifacts made altogether "by hand" or produced in factories. Rather, we are suggesting that they would, like other human "products," be brought into being in accordance with some pre-selected genetic pattern or design, and therefore in some sense "made to order" by their producers or progenitors.

Unlike natural procreation – or even most forms of assisted reproduction – cloning-to-produce-children would set out to create a child with a very particular genotype: namely, that of the somatic cell donor. Cloned children would thus be the first human beings whose entire genetic makeup is selected in advance. True, selection from among existing genotypes is not yet design of new ones. But the principle that would be established by human cloning is both far-reaching and completely novel: parents, with the help of science and technology, may determine in advance the genetic endowment of their children. To this point, parents have the right and the power to decide whether to have a child. With cloning, parents acquire the power, and presumably the right, to decide what kind of a child to have. Cloning would thus extend the power of one generation over the next – and the power of parents over their offspring – in ways that open the door, unintentionally or not, to a future project of genetic manipulation and genetic control.

Of course, there is no denying that we have already taken steps in the direction of such control. Preimplantation genetic diagnosis of embryos and prenatal diagnosis of fetuses – both now used to prevent the birth of individuals carrying genes for genetic diseases – reflect an only conditional acceptance of the next generation. With regard to positive selection for desired traits, some people already engage in the practice of sex selection, another example of conditional acceptance of offspring. But these precedents pale in comparison to the degree of control provided by cloning and, in any case, do not thereby provide a license to proceed with cloning. It is far from clear that it would be wise to proceed still farther in our attempts at control.

The problem with cloning-to-produce-children is not that artificial technique is used to assist reproduction. Neither is it that genes are being manipulated. We raise no objection to the use of the coming genetic technologies to treat individuals with genetic diseases, even in utero – though there would be issues regarding the protection of human subjects in research and the need to find boundaries between therapy and so-called enhancement (of this, more below). The problem has to do with the control of the entire genotype and the production of children to selected specifications.

Why does this matter? It matters because human dignity is at stake. In natural procreation, two individuals give life to a new human being whose endowments are not shaped deliberately by human will, whose being remains mysterious, and the open-endedness of whose future is ratified and embraced. Parents beget a child who enters the world exactly as they did – as an unmade gift, not as a product. Children born of this process stand equally beside their progenitors as fellow human beings, not beneath them as made objects. In this way, the uncontrolled beginnings of human procreation endow each new generation and each new individual with the dignity and freedom enjoyed by all who came before.

Most present forms of assisted reproduction imitate this natural process. While they do begin to introduce characteristics of manufacture and industrial technique, placing nascent human life for the first time in human hands, they do not control the final outcome. The end served by IVF is still the same as natural reproduction-the birth of a child from the union of gametes from two progenitors. Reproduction with the aid of such techniques still implicitly expresses a willingness to accept as a gift the product of a process we do not control. In IVF children emerge out of the same mysterious process from which their parents came, and are therefore not mere creatures of their parents.

By contrast, cloning-to-produce-children – and the forms of human manufacture it might make more possible in the future – seems quite different. Here, the process begins with a very specific final product in mind and would be tailored to produce that product. Even were cloning to be used solely to remedy infertility, the decision to clone the (sterile) father would be a decision, willy-nilly, that the child-to-be should be the near-twin of his "father." Anyone who would clone merely to ensure a "biologically related child" would be dictating a very specific form of biological relation: genetic virtual identity. In every case of cloning-to-produce-children, scientists or parents would set out to produce specific individuals for particular reasons. The procreative process could come to be seen increasingly as a means of meeting specific ends, and the resulting children would be products of a designed manufacturing process, products over whom we might think it proper to exercise "quality control." Even if, in any given case, we were to continue to think of the cloned child as a gift, the act itself teaches a different lesson, as the child becomes the continuation of a parental project. We would learn to receive the next generation less with gratitude and surprise than with control and mastery.

One possible result would be the industrialization and commercialization of human reproduction. Manufactured objects become commodities in the marketplace, and their manufacture comes to be guided by market principles and financial concerns. When the "products" are human beings, the "market" could become a profoundly dehumanizing force. Already there is commerce in egg donation for IVF, with ads offering large sums of money for egg donors with high SAT scores and particular physical features.

The concerns expressed here do not depend on cloning becoming a widespread practice. The introduction of the terms and ideas of production into the realm of human procreation would be troubling regardless of the scale involved; and the adoption of a market mentality in these matters could blind us to the deep moral character of bringing forth new life. Even were cloning children to be rare, the moral harms to a society that accepted it could be serious.

For some of us, cloning-to-produce-children also raises concerns about the prospect of eugenics or, more modestly, about genetic "enhancement." We recognize that the term "eugenics" generally refers to attempts to improve the genetic constitution of a particular political community or of the human race through general policies such as population control, forced sterilization, directed mating, or the like. It does not ordinarily refer to actions of particular individuals attempting to improve the genetic endowment of their own descendants. Yet, although cloning does not in itself point to public policies by which the state would become involved in directing the development of the human gene pool, this might happen in illiberal regimes, like China, where the government already regulates procreation.^vii And, in liberal societies, cloning-to-produce-children could come to be used privately for individualized eugenic or "enhancement" purposes: in attempts to alter (with the aim of improving) the genetic constitution of one's own descendants – and, indirectly, of future generations.

Some people, in fact, see enhancement as the major purpose of cloning-to-produce-children. Those who favor eugenics and genetic enhancement were once far more open regarding their intentions to enable future generations to enjoy more advantageous genotypes. Toward these ends, they promoted the benefits of cloning: escape from the uncertain lottery of sex, controlled and humanly directed reproduction. In the present debate about cloning-to-produce-children, the case for eugenics and enhancement is not made openly, but it nonetheless remains an important motivation for some advocates. Should cloning-to-produce-children be introduced successfully, and should it turn out that the cloned humans do in fact inherit many of the natural talents of the "originals," some people may become interested in the prospects of using it to produce "enhanced children" – especially if other people's children were receiving comparable advantages.

Cloning can serve the ends of individualized enhancement either by avoiding the genetic defects that may arise when human reproduction is left to chance or by preserving and perpetuating outstanding genetic traits. In the future, if techniques of genetic enhancement through more precise genetic engineering became available, cloning could be useful for perpetuating the enhanced traits and for keeping any "superior" manmade genotype free of the flaws that sexual reproduction might otherwise introduce.

"Private eugenics" does not carry with it the dark implications of state despotism or political control of the gene pool that characterized earlier eugenic proposals and the racist eugenic practices of the twentieth century. Nonetheless, it could prove dangerous to our humanity. Besides the dehumanizing prospects of the turn toward manufacture that such programs of enhancement would require, there is the further difficulty of the lack of standards to guide the choices for "improvement." To this point, biomedical technology has been applied to treating diseases in patients and has been governed, on the whole, by a commonsense view of health and disease. To be sure, there are differing views about how to define "health." And certain cosmetic, performance – enhancing, or hedonistic uses of biomedical techniques have already crossed any plausible boundary between therapy and enhancement, between healing the sick and "improving" our powers.^viii Yet, for the most part, it is by some commonsense views of health that we judge who is in need of medical treatment and what sort of treatment might be most appropriate. Even today's practice of a kind of "negative" eugenics – through prenatal genetic diagnosis and abortion of fetuses with certain genetic abnormalities – is informed by the desire to promote health.

The "positive" eugenics that could receive a great boost from human cloning, especially were it to be coupled with techniques of precise genetic modification, would not seek to restore sick human beings to natural health. Instead, it would seek to alter humanity, based upon subjective or arbitrary ideas of excellence. The effort may be guided by apparently good intentions: to improve the next generation and to enhance the quality of life of our descendants. But in the process of altering human nature, we would be abandoning the standard by which to judge the goodness or the wisdom of the particular aims. We would stand to lose the sense of what is and is not human.

The fear of a new eugenics is not, as is sometimes alleged, a concern born of some irrational fear of the future or the unknown. Neither is it born of hostility to technology or nostalgia for some premodern pseudo-golden age of superior naturalness. It is rather born of the rational recognition that once we move beyond therapy into efforts at enhancement, we are in uncharted waters without a map, without a compass, and without a clear destination that can tell us whether we are making improvements or the reverse. The time-honored and time-tested goods of human life, which we know to be good, would be put in jeopardy for the alleged and unknowable goods of a post-human future.

Cloning-to-produce-children could also prove damaging to family relations, despite the best of intentions. We do not assume that cloned children, once produced, would not be accepted, loved, or nurtured by their parents and relatives. On the contrary, we freely admit that, like any child, they might be welcomed into the cloning family. Nevertheless, the cloned child's place in the scheme of family relations might well be uncertain and confused. The usually clear designations of father and brother, mother and sister, would be confounded. A mother could give birth to her own genetic twin, and a father could be genetically virtually identical to his son. The cloned child's relation to his or her grandparents would span one and two generations at once. Every other family relation would be similarly confused. There is, of course, the valid counter-argument that holds that the "mother" could easily be defined as the person who gives birth to the child, regardless of the child's genetic origins, and for social purposes that may serve to eliminate some problems. But because of the special nature of cloning-to-produce-children, difficulties may be expected.

The crucial point is not the absence of the natural biological connections between parents and children. The crucial point is, on the contrary, the presence of a unique, one-sided, and replicative biological connection to only one progenitor. As a result, family relations involving cloning would differ from all existing family arrangements, including those formed through adoption or with the aid of IVF. A great many children, after all, are adopted, and live happy lives in loving families, in the absence of any biological connections with their parents. Children conceived by artificial insemination using donor sperm and by various IVF techniques may have unusual relationships with their genetic parents, or no genetic relationships at all. But all of these existing arrangements attempt in important ways to emulate the model of the natural family (at least in its arrangement of the generations), while cloning runs contrary to that model.

What the exact effects of cloning-to-produce-children might be for families is highly speculative, to be sure, but it is still worth flagging certain troubling possibilities and risks. The fact that the cloned child bears a special tie to only one parent may complicate family dynamics. As the child developed, it could not help but be regarded as specially akin to only one of his or her parents. The sins or failings of the father (or mother), if reappearing in the cloned child, might be blamed on the progenitor, adding to the chances of domestic turmoil. The problems of being and rearing an adolescent could become complicated should the teenage clone of the mother "reappear" as the double of the woman the father once fell in love with. Risks of competition, rivalry, jealousy, and parental tension could become heightened.^ix

Even if the child were cloned from someone who is not a member of the family in which the child is raised, the fact would remain that he or she has been produced in the nearly precise genetic image of another and for some particular reason, with some particular design in mind. Should this become known to the child, as most likely it would, a desire to seek out connection to the "original" could complicate his or her relation to the rearing family, as would living consciously "under the reason" for this extra-familial choice of progenitor. Though many people make light of the importance of biological kinship (compared to the bonds formed through rearing and experienced family life), many adopted children and children conceived by artificial insemination or IVF using donor sperm show by their actions that they do not agree. They make great efforts to locate their "biological parents," even where paternity consists in nothing more than the donation of sperm. Where the progenitor is a genetic near-twin, surely the urge of the cloned child to connect with the unknown "parent" would be still greater.

For all these reasons, the cloning family differs from the "natural family" or the "adoptive family." By breaking through the natural boundaries between generations, cloning could strain the social ties between them.

The hazards and costs of cloning-to-produce-children may not be confined to the direct participants. The rest of society may also be at risk. The impact of human cloning on society at large may be the least appreciated, but among the most important, factors to consider in contemplating the morality of this activity.

Cloning is a human activity affecting not only those who are cloned or those who are clones, but also the entire society that allows or supports such activity. For insofar as the society accepts cloning-to-produce-children, to that extent the society may be said to engage in it. A society that allows dehumanizing practices – especially when given an opportunity to try to prevent them – risks becoming an accomplice in those practices. (The same could be said of a society that allowed even a few of its members to practice incest or polygamy.) Thus the question before us is whether cloning-to-produce-children is an activity that we, as a society, should engage in. In addressing this question, we must reach well beyond the rights of individuals and the difficulties or benefits that cloned children or their families might encounter. We must consider what kind of a society we wish to be, and, in particular, what forms of bringing children into the world we want to encourage and what sorts of relations between the generations we want to preserve.

Cloning-to-produce-children could distort the way we raise and view children, by carrying to full expression many regrettable tendencies already present in our culture. We are already liable to regard children largely as vehicles for our own fulfillment and ambitions. The impulse to create "designer children" is present today – as temptation and social practice. The notion of life as a gift, mysterious and limited, is under siege. Cloning-to-produce-children would carry these tendencies and temptations to an extreme expression. It advances the notion that the child is but an object of our sovereign mastery.

A society that clones human beings thinks about human beings (and especially children) differently than does a society that refuses to do so. It could easily be argued that we have already in myriad ways begun to show signs of regarding our children as projects on which we may work our wills. Further, it could be argued that we have been so desensitized by our earlier steps in this direction that we do not recognize this tendency as a corruption. While some people contend that cloning-to-produce-children would not take us much further down a path we have already been traveling, we would emphasize that the precedent of treating children as projects cuts two ways in the moral argument. Instead of using this precedent to justify taking the next step of cloning, the next step might rather serve as a warning and a mirror in which we may discover reasons to reconsider what we are already doing. Precisely because the stakes are so high, precisely because the new biotechnologies touch not only our bodies and minds but also the very idea of our humanity, we should ask ourselves how we as a society want to approach questions of human dignity and flourishing.

Cloning-to-produce-children may represent a forerunner of what will be a growing number of capacities to intervene in and alter the human genetic endowment. No doubt, earlier human actions have produced changes in the human gene pool: to take only one example, the use of insulin to treat diabetics who otherwise would have died before reproducing has increased the genes for diabetes in the population. But different responsibilities accrue when one sets out to make such changes prospectively, directly, and deliberately. To do so without regard for the likelihood of serious unintended and unanticipated consequences would be the height of hubris. Systems of great complexity do not respond well to blunt human intervention, and one can hardly think of a more complex system – both natural and social – than that which surrounds human reproduction and the human genome. Given the enormous importance of what is at stake, we believe that the so-called "precautionary principle" should be our guide in this arena. This principle would suggest that scientists, technologists, and, indeed, all of us should be modest in claiming to understand the many possible consequences of any profound alteration of human procreation, especially where there are not compelling reasons to proceed. Lacking such understanding, no one should take action so drastic as the cloning of a human child. In the absence of the necessary human wisdom, prudence calls upon us to set limits on efforts to control and remake the character of human procreation and human life.

It is not only a matter of prudence. Cloning-to-produce-children would also be an injustice to the cloned child – from the imposition of the chromosomes of someone else, to the intentional deprivation of biological parents, to all of the possible bodily and psychological harms that we have enumerated in this chapter. It is ultimately the claim that the cloned child would be seriously wronged – and not only harmed in body – that would justify government intervention. It is to this question – the public policy question of what the government should and can do to prevent such injustice – that we will turn in Chapter Seven. But, regarding the ethical assessment, Members of the Council are in unanimous agreement that cloning-to-produce-children is not only unsafe but also morally unacceptable and ought not to be attempted.^x

1. National Bioethics Advisory Commission, Cloning Human Beings Bethesda, MD, 1997. Back to Text
   
2. National Academy of Sciences (NAS) Scientific and Medical Aspects of Human Reproductive Cloning, Washington, DC: National Academy Press, 2002. (Referred to in subsequent citations as NAS Report.) Back to Text
   
3. NAS Report, pp. 6-7. Back to Text
   
4. Lederberg, J. "Experimental Genetics and Human Evolution" The American Naturalist, September-October 1966. Back to Text
   
5. Supreme Court of the United States. Eisenstadt v. Baird, 405 US 438, 1972. Back to Text
   
6. Tribe, L. "On Not Banning Cloning for the Wrong Reasons" in Nussbaum, M., and C. R. Sunstein. Clones and Clones: Facts and Fantasies about Human Cloning. New York: Norton, 1998, p. 321. Back to Text
   
7. Nuremberg Report. Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10, Vol. 2, pp. 181-182. Washington, DC: Government Printing Office, 1949. Back to Text
   
8. Helsinki Declaration. 18th World Medical Association General Assembly Ethical Principles for Medical Research Involving Human Subjects, adopted in Helsinki, Finland, June 1964, and amended in October 1975, October 1983, September 1989, October 1996, and October 2000. Back to Text
   
9. Belmont Report. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Bethesda, MD: Government Printing Office, 1978. Back to Text
   
10. See, for instance, Chapter Four of the present report, as well as Chapter 3 of the NAS Report. Back to Text
    
11. These issues are discussed in the NAS Report (3-2) as well as in Wilmut, I., Roslin Institute, Scotland. "Application of animal cloning data to human cloning," paper presented at Workshop: Scientific and Medical Aspects of Human Cloning, National Academy of Sciences, Washington, DC August 7, 2001; and Hill, J., Cornell University. "Placental defects in nuclear transfer (cloned) animals," paper presented at Workshop: Scientific and Medical Aspects of Human Cloning, National Academy of Sciences, Washington, DC, August 7, 2001. Back to Text
    
12. See, for instance, Chapter 3 of the NAS Report, and Kolata, G. "In Cloning, Failure Far Exceeds Success" New York Times, December 11, 2001, p. D1. Back to Text
    
13. See, for instance, Rimington, M., et al. "Counseling patients undergoing ovarian stimulation about the risks of ovarian hyper-stimulation syndrome." Human Reproduction, 14: 2921-2922, 1999; and Wakeley, K., and E. Grendys. "Reproductive technologies and risk of ovarian cancer." Current Opinion in Obstetrics and Gynecology, 12: 43-47, 2000. Back to Text
    
14. These issues are discussed in greater detail in Chapter 3 of the NAS Report. Back to Text
    
15. Hill J.R., et al. "Clinical and pathologic features of cloned transgenic calves and fetuses (13 case studies)" Theriogenology 8: 1451-1465, 1999. Back to Text
    
16. NAS Report, p. 3-2. Back to Text
    
17. NAS Report, Figure 3. Back to Text
    
18. See for instance the NAS Report, Appendix B, tables 1, 3, and 4. Back to Text
    

The Ethics of Cloning-for-Biomedical-Research

I. The Manner and Spirit of This Inquiry

The question of whether or not to proceed with human cloning-for-biomedical-research is a morally serious and difficult one. On the one hand, there is the promise that such research could lead to important knowledge of human embryological development and gene action, especially in cases in which there are genetic abnormalities that lead to disease. There is also the promise that such research could contribute to producing transplantable tissues and organs that could be effective in curing or reversing many dreaded illnesses and injuries – including Parkinson's disease, Alzheimer's disease, juvenile diabetes, and spinal cord injury. On the other hand, there are the morally relevant facts that this research involves the deliberate production, use, and ultimate destruction of cloned human embryos, and that the cloned embryos produced for research are no different from cloned embryos that could be used in attempts to produce cloned children. Complicating the moral assessment are questions about the likelihood that this research will deliver its promised benefits and about the possibility of equally promising, yet morally less problematic, approaches to the same scientific and medical goals. Finally, there is the ever-present danger of creating false hope among patients, and the risk of allowing the goodness of the end (finding cures for disease) to justify moral indifference to the means used to achieve it. Morally serious people may differ in their final judgment of the ethics of cloning-for-biomedical-research. But they do – or should – agree on this: that fidelity both to the highest moral and human aspirations of science and medicine and to the moral standards of the wider community requires that we consider not only why and how to proceed with new lines of research, but also whether there might be compelling reasons not to do so or certain limits that should be observed. Both the facts (scientific and moral) and our ethical principles must be consulted in trying to judge what is best.

Yet despite this general agreement, it is difficult to know how best to proceed in the present case. There are multiple questions about the right context for considering the ethics of cloning-for-biomedical-research. First, we must weigh whether to take up this matter in the context of deciding what to do about cloning-to-produce-children or in the somewhat different context of the ethics of embryo and stem cell research more generally. The issue has in fact emerged in the public moral debate over anti-cloning legislation, as a complication in the effort to stop cloning-to-produce-children. Generally speaking, the most effective way to prevent cloning-to-produce-children would arguably be to stop the process at the initial act of cloning, the production (by an act of somatic cell nuclear transfer [SCNT]) of the embryonic human clone. Yet such a measure would rule out cloning-for-biomedical-research, and many scientists and patient advocacy groups have argued that the human and moral costs of doing so are too great. Alternatively, we could take up this matter in what seems philosophically to be its more natural context, namely, as a sub-species of a larger inquiry into the ethics of embryo and stem cell research.

Each of these contexts – what to do about cloning-to-produce-children and what to do about embryo research – is certainly plausible. Yet each, by itself, is less than satisfactory. The first risks giving excessive weight to the fact that the embryos wanted for research are cloned embryos; the second, ignoring the aspect (central to cloning) of genetic manipulation, risks the opposite error by requiring that the ethics of cloning-for-biomedical-research be argued entirely in terms of what it is proper to do with embryos as such. We can imagine, in advance of any discussion, a variety of moral opinions that would emerge, influenced in part by how the question is formulated: one person could defend stem cell research performed using embryos produced by IVF but oppose research using cloned embryos for reasons of prudence (such as decreasing the likelihood of cloning-to-produce-children). Another person, holding IVF embryos in higher regard than cloned embryos, could reach precisely the opposite conclusion. Some people will hold that research on any human embryo, cloned or not, is always morally unacceptable (or acceptable), independent of whether ethical or legal guidelines are in place, while others will judge one way or another depending on whether appropriate guidelines and effective regulations have been established.

We have decided to discuss the ethics of cloning-for-biomedical-research in the broader moral – philosophical context, rather than the narrower moral – political one that has taken shape around the current debate over anti-cloning legislation. Though we are mindful of the importance of these public policy debates – and will consider them in the following chapter – we do not want our moral analysis to be skewed by the specific legal or policy questions at issue, especially as the moral questions discussed here have implications beyond the current political debate and even beyond the question of human cloning itself. We opt to take up the moral questions in their fullness.

A second question about context is even more difficult to assess. Should we regard cloning-for-biomedical-research as just the latest – and continuous – step in trying to unlock the secrets of human development and to discover cures for diseases? Or should it be seen – instead or also – as the earliest stage of a revolutionary new science of enhancement or eugenics, which will go beyond treating individuals with disease and disability to attempt engineered improvements in human genetic endowments? Because innovations like cloning come to us gradually and piecemeal, and because it cannot be known in advance how exactly they will be used or where they might lead, there is a temptation to stay close to the present and to ignore possible future implications.

Yet the alleged perils of going ahead with the research are arguably no more speculative than the promised benefits. And it would be morally and prudently shortsighted for this Council, charged with investigating "the human and moral significance of advances in biomedical science and technology," to refuse to think about where this research might lead. We will therefore consider, even if we cannot know in advance, whether and how the sort of genetic manipulation of embryos exemplified by cloning-for-biomedical-research is new or "revolutionary." Genetic therapy for existing diseases and non-therapeutic genetic modifications of our native endowments raise profoundly different questions. Accordingly, we will keep in sight not only the moral questions surrounding the means of cloning-for-biomedical-research – which is to say, the significance of using or not using nascent human life as a resource – but also the possible ends to which our expanding knowledge and capacities might be put. At the same time, we will be careful not to equate genetic medicine that is truly in the service of human life with genetic manipulation that is not, and to avoid both the unjustified fear and exaggerated promises that sometimes accompany biomedical progress.

A third difficulty concerns the relation between the ethics of research on embryos (cloned or not) and the ethics of abortion. For many people, these issues are linked, and there is doubtless an overlap in the moral questions involved. Yet the issues are, in important respects, quite distinct. In the case of abortion, the fetuses whose fate is at issue are unwanted and (usually) the result of unintended conception. The embryos produced for research are wanted, indeed deliberately created, with certain knowledge and intent that they will be used and destroyed. More important perhaps, the extra-corporeal embryo (whether produced specially for research or left-over in IVF procedures) does not exist in conflict with the wishes, interests, or rights of a woman who is pregnant. Also, although abortion is widely practiced, each decision to abort is made one at a time, case by case. In contrast, to embark on creating cloned embryos only for purposes of research is to countenance at one stroke the large-scale production of developing human life for routinized use and destruction. For these reasons, we shall try to consider the question of the ethics of research on embryos in its own terms, distinct from the ethical questions about abortion.

Finally, there is the question of the spirit in which this examination should be conducted. Reflecting the situation in American society, there are major differences within the Council regarding the morality of research involving early human (cloned) embryos. These differences turn largely, though not exclusively, on different judgments regarding the nature and moral status of the early human (cloned) embryo: namely, to what extent is it, or is it not, "one of us," a human life in process? Having explored these questions collegially among ourselves, we have come to think that all parties to this debate have something vital to defend, something vital not only to themselves but also to their opponents in the debate, and indeed to all human beings. No human being and no human society can afford to be callous to the needs of suffering humanity, cavalier regarding the treatment of nascent human life, or indifferent to the social effects of adopting in these matters one course of action rather than another.

We believe, therefore, that we can make our best contribution to a truthful and appropriate moral understanding of the issue by developing, in a single document, the moral cases both for and against proceeding with cloning-for-biomedical-research (and also articulating, where necessary and as clearly as possible, important differences within each of these cases). Each Member of the Council has been asked to help strengthen the case made for both sides, regardless of which side he or she inclines toward. By proceeding in this way, we hope to make clear to the President and the nation exactly what is morally and humanly at stake in the controversy and what may be gained and lost in whatever choice is finally made.

Thus, notwithstanding our differences, we stand together as the authors of the entire chapter, hoping by this means to shed light rather than heat on this most vexing of moral and policy questions. At the same time, we have tried fully and fairly to articulate our differences, and to do so by speaking, in the first person, as members of a deliberative body called upon to make our own best judgments. This means that the "we" that now embraces all Members of the Council will stand in the particular sections presenting the moral case for and the moral case against cloning-for-biomedical-research (Parts III and IV, respectively), only for those among us who subscribe to the specific arguments being made in those sections. In other words, each opinion is a self-contained brief, representing not the Council as a whole but only a portion of the Council. And even within the cases for and against, Members of the Council disagree over matters of substance and emphasis. But while the Council has strong differences of opinion, as delineated in the sections that follow, the Council speaks in a single voice in its affirmation that the debate must not be won by dismissing, ridiculing, or demonizing the other side. Important human goods are to be found on all sides of the debate, a fact too often overlooked.

We begin, in Part II, with a discussion of the human meaning of healing, for it is only by an analysis of this uniquely human activity that the contours of the debate over cloning-for-biomedical-research can be properly traced and understood. Here the Council speaks as one. What follows this framing discussion are two separate opinions: in Part III, a portion of Council Members make the moral case for biomedical research; in Part IV, a portion make the opposing moral case against. Going beyond just listing the arguments, pro and con, each opinion is a sustained attempt at moral suasion. Yet each opinion, by self-imposed stricture, has tried to respect and respond to the legitimate moral concerns of the other side and to indicate how it means to do them justice. Each has tried to address what is owed to embryonic human life, what is owed to suffering humanity, and what is owed to the moral well-being of society. This approach to public moral discourse is, we are well aware, an experiment. Whether it is successful or not is for the reader to judge.

II. The Human Meaning of Healing

Before presenting the two opinions, we will place the moral questions surrounding cloning-for-biomedical-research in their larger human context. Just as we did in discussing the ethics of cloning-to-produce-children, we step back from the particular technological possibility at hand to look carefully at the larger human goods that we seek both to serve and defend. We look specifically at the human meaning of healing the sick and aiding the suffering, as well as the spirit and practice of biomedical research that aims to make such healing possible. This exploration will better prepare us to see what is humanly at stake in our moral judgment about cloning-for-biomedical-research, and to face soberly both what is gained and what is lost in either proceeding or not proceeding. The subsequent moral arguments, both pro and con, are informed by these larger reflections.

To be human is to be mortal. To be alive is to be vulnerable to suffering. No one is better situated to appreciate these truths than the physician. To understand what it means to heal, one must therefore understand the doctor's special encounter with human suffering – as both an experience (a crying out) of the patient who lies before him and as a central mystery of human existence. Why do human beings suffer? Why do they suffer in ways that cannot be explained – entirely or perhaps at all – with human notions of justice? In this role, the doctor is sometimes a messenger of human finitude. He must tell patients that their days are numbered or that their time has come; he must tell grieving family members that death is at the door. But the healer is also and more importantly – in the eyes of both doctor and patient – a deliverer. Not only is he well armed to deliver us from specific maladies and miseries. He is also a much needed ally against the deadly disease – traditionally regarded as a sin – of despair. Because of the moral aspirations of his calling, the physician is a trusted source of hope that the living might yet still live and that in his skill and the powerful techniques of modern medicine might lie the possibility of renewal. The doctor is, at different times, a reminder of the intractable sadness of human life, but also explicitly a conqueror who beats back suffering and disease with the saving hand of medical knowledge and technique, and who inspirits us with hope to go forward even in the absence of cure and relief.

Until roughly the second half of the twentieth century, physicians delivered more hope than cure, and they conquered few diseases. Since then, their arsenal against disease (at least in technologically advanced nations) has grown enormously, and it promises to grow greater in the decades ahead. New healing powers will surely emerge from the work of medicine's ally, biomedical research, firmly grounded in the principles and methods of modern biomedical science. This noble field of human endeavor also has a context in the larger domain of human life. Celebrating its achievements and eager for its gifts to human welfare, modern societies embrace and invest heavily in medical research and grant scientists great freedom to inquire and experiment. Because of the way science advances, freedom is crucial to the successful realization of its goals.

Dr. William Osler, one of the founding figures of modern medicine, described the aspirations of biomedical research as follows:

To wrest from nature the secrets which have perplexed philosophers in all ages, to track to their sources the causes of disease, to correlate the vast stores of knowledge that they may be quickly available for the prevention and cure of disease – These are our ambitions.¹

It is in the very nature of a "secret" that one cannot know in advance which areas of research and discovery will prove the most fruitful. One proceeds by trial and error. One makes hypotheses grounded in what is already known, in the effort to discover what remains a mystery. One begins with basic research into disease processes and mechanisms, in the hope that new knowledge will yield new medicines and new cures.

One motive for such research is simply the love of knowledge itself – the distinctively human desire to know, to see, to understand more than one already does. But biomedical research is also guided, above all, by the humanitarian desire to apply new knowledge in the service of those who suffer, to correlate knowledge that it "may be quickly available for the prevention and cure of disease." Biomedical scientists aim to weld the virtues of charity, beneficence, and responsibility to the human ambition to "wrest from nature" her secrets. This is the moral heart of both the medical profession and the research tradition that supports it: to do everything in our power, consistent with law and morals, to provide cures, amelioration, and relief to those who need them.

"Consistent with law and morals": this requirement qualifies "everything in our power." This limitation has been traditionally understood to be part of the healing vocation. Moral philosophers and philosophers of medicine have long held that the duty to heal is an "imperfect duty," meaning that it does not trump all other considerations. Physicians perhaps understand this best of all, learning their limits empirically from their encounters with patients whom they cannot save or even comfort. The duty to heal this patient, at this time, is also an imperfect one. After all, a cure for one person at the direct expense of another – for example, harvesting a vital organ from someone who is living to save someone else who is dying – would violate the first principle of medicine to "do no harm."

It is also true that scientific freedom and medical progress are not the only human goods worthy of our commitment and protection. Research must be judged both by the means it employs and by the ends it serves (both those that were intended and those that were not). The Nuremberg Code, the Helsinki Declaration, and the Belmont Report, discussed in the last chapter, are all efforts to set moral limits on biomedical research and to ensure that science serves human beings rather than the other way around. Among other things, these ethical codes embody the recognition that those who do research about human beings can never escape (nor should they) their status as human beings. Those who investigate human biology are always both the knowers and the subject that is known, both the potential healers and the potentially afflicted. And therefore they must never treat that which is their equal – their fellow human beings – as something less than human.

But in the end, however imperfect it is as a duty and whatever its less than supreme place among all other human goods, the obligation to heal and to seek remedies is a powerful one. It is a mark both of man's natural limits (as the being in need of healing) and his capacity for goodness (as the being who heals). And so, the freedom of inquiry that makes biomedical research possible should be restricted only for the most important reasons, lest we do damage to the entire enterprise, or to the human beings and the society that benefit from the "vast stores of knowledge" it creates.

At the same time, however, those who have accepted the "healer's covenant" – and those who defend, engage in, and benefit from the research that improves and expands the human capacity to heal – must avoid the seduction of medical triumphalism: the belief that all human suffering, both physical and psychic, can be conquered by modern technique, and therefore that no form of biomedical research should be opposed. Doctors and scientists must not become partial human beings who evade moral responsibility by claiming that they are not qualified to judge the moral implications of their own medical research or, worse, that medically beneficial research is always self-justifying, and hence that there are no real moral dilemmas at all. In addition, they must avoid the cruelty of creating false hopes among patients and their loved ones, and the folly of creating messianic or utopian visions of what science and medicine can accomplish. And patients, even as they heroically fight against suffering, must not forget their own mortality – including the often unpredictable nature of how and when death comes.

These reflections point to the following conclusions: In judging the moral beneficence and moral hazards of medical research, we must remember that suffering should not be opposed by any means possible. We would be less than human if we did not desire to alleviate such suffering, but we would be imagining ourselves to be more than human if we thought and acted as if we could alleviate it once and for all. Rather, we must acknowledge that as human beings we live in a difficult "in-between." Whether as doctors, scientists, or as patients, we all wish for the possible renewal of life through medicine, but also acknowledge that suffering and mortality are part of being alive. We are morally obliged to seek relief of suffering, but only in ways that preserve our humanity.

With these realities in mind, this chapter will now take up the ethics of cloning-for-biomedical-research, and specifically the moral and human questions raised above: What is owed to those who suffer from debilitating injuries and diseases? What is owed to nascent human life? And what is owed to the moral well-being of society? These are the central questions in the debate, questions that Members of the Council over the past year struggled to answer, and that indeed every member of society must ponder when considering the ethics of cloning-for-biomedical-research.

III. The Moral Case for Cloning-for-Biomedical-Research

The moral case for cloning-for-biomedical-research can be stated in the following straightforward way: American society and human communities in general have an obligation to try to heal the sick and relieve their suffering. This obligation, deeply rooted in the moral teaching of "love of neighbor," lies heaviest on physicians and health-care professionals who attend to individual patients. But it guides also the activities of biomedical scientists and biotechnologists whose pioneering research and discoveries provide new and better means of healing and relieving those who suffer. Research on cloned human embryos is one more path to discovering such means. Like embryonic stem cell research, to which it is partially related, it offers a promising approach to gaining knowledge and techniques that could lead to new treatments for chronic genetic or acquired degenerative diseases and disabilities.² If successful, it could help save countless human lives and ameliorate untold human suffering.

It is true that human cloning-for-biomedical-research raises ethical questions, mainly because it involves the production, use, and destruction of cloned human embryos. It is also true that cloned embryos produced for research could be used in attempts to produce cloned human children, and the availability of such cloned embryos for research and the perfection of cloning techniques might increase the likelihood that people will succeed in cloning children. We appreciate the concerns of people who voice these objections and risks, and we are prepared to accept certain limits and safeguards against possible abuses. Yet we believe that, on balance, the objections to cloning-for-biomedical-research are outweighed by the good that can be done for current and future individuals who suffer. The moral balance lies on the side of endorsing and encouraging this activity.

We who endorse cloning-for-biomedical-research will attempt to make a version of this case here. But we will do so, for the most part, in a somewhat different spirit, one that is informed by the discussion of healing just concluded. In moral debates about these matters, people often speak as if saving lives is the only value that counts and that everything else must be sacrificed to advancing potentially beneficial research. Others speak as if any failure to prevent death or suffering from disease is sinful. Our defense of cloning-for-biomedical-research is more complex and nuanced and, we believe, more true to the merits of the case in question. As we make our case, we will also confront-and accept-the burden of what it means to proceed with such research, just as those who oppose it must accept the burden of what it means not to proceed.

In making our case, we begin in Section A by summarizing the specific medical benefits that might be achieved by proceeding with this avenue of research. We then consider in Section B the moral dilemmas of this research. However, among those of us who believe the research should go forward there is disagreement about how seriously to take certain moral objections, and thus two distinct positions for proceeding are presented.

Many people suffer from chronic debilitating diseases and disabilities, including, among others, juvenile diabetes, Parkinson's disease, Alzheimer's disease, spinal cord injuries, heart disease, and amyotrophic lateral sclerosis. These terrible diseases shorten life, limit activity (often severely), and cause great suffering both for the afflicted and their families. The inspiring example of exceptional persons who bear bravely the great burdens of illness or injury should not blind us to the powerful warrants for research and therapy that might lift these burdens. The likelihood of premature death, in particular, can shadow the life of the patient and the patient's family even before it arrives, and its advent can impoverish and devastate families, dash hopes, and cast a chill on the lives of survivors. It is certainly admirable to confront, endure, and redeem these unchosen afflictions. But it is also admirable, where possible, to ameliorate through research and medicine the diseases and injuries that cause them.

Cloning-for-biomedical-research may offer unique ways of investigating and possibly treating several of these diseases. To unlock the secrets of a disease, scientists must explore its specific molecular and cellular mechanisms, carefully observing both normal and pathological development. This research could be greatly facilitated by in vitro cellular models of human disease. It is here that the potentially most valuable and unique benefits of research on cloned human embryos may lie. This section summarizes some of these benefits, with specific examples.

The creation of cloned embryos using nuclei from individuals carrying genetic mutations – specifically, genes that predispose them to particular diseases – might be used to better understand and treat those diseases. Consider, for example, Parkinson's disease. A characteristic of Parkinson's disease is the aggregation in dying brain cells of a protein called alpha-synuclein. Two different mutations in the alpha-synuclein gene produce forms of the protein that aggregate more readily. Individuals carrying these gene mutations suffer from early-onset Parkinson's disease.

To study how genetic disease develops, scientists look for suitable laboratory models. One strategy for producing such disease models is to inject the disease-causing human genes into human or animal cells in tissue culture to produce a cell-system expressing the abnormality. Although it has been possible to introduce copies of mutant genes into various kinds of human and animal cells, the resulting in vitro cell-systems imperfectly model the human disease. In part this is because the behavior of specific proteins within cells is influenced by their interactions with other cellular proteins. For example, human alpha-synuclein in a mouse cell cytoplasm interacting with mouse proteins is unlikely to behave the same way that it does in a human cell surrounded by human proteins. To study human disease, it is generally preferable to work with human cells and tissues.

A preferable alternative to introducing mutant genes into normal cells is to begin with human cells that are already abnormal – in this case, cells carrying the mutant genes that predispose their bearers to Parkinson's disease. If one could obtain embryonic stem cells derived from cloned embryos produced using nuclei from individuals carrying these mutant genes, one could then stimulate them to differentiate into dopamine – producing nerve cells in vitro. These cells would provide a vastly improved model for understanding the metabolism of alpha-synuclein and its role in the development of Parkinson's disease.<ⁱ In this example, the availability of improved in vitro models for genetic and neurodegenerative diseases could shorten the time required to understand them and to devise new treatments.

It is true that adult stem cells (or multipotent adult progenitor cells ^3,4 ), isolated from patients carrying the mutant genes that predispose them to Parkinson's disease, might also be stimulated to become dopamine-producing neurons in vitro. But there are unanswered questions about the ease of culture and long-term viability of such cells, and the likelihood of success with cellular models of disease derived from adult stem cells remains unknown. In the absence of a certain and superior alternative, it would be wrong to forgo the possibly unique benefits of cloning for disease research.

The same cellular model systems used to study disease processes are also potentially useful for assessing and developing chemical or pharmaceutical treatments for the disease in question. To continue with the Parkinson's disease example, neurons derived from stem cells containing the alpha-synuclein aggregation mutations would be very useful for testing compounds that might prevent aggregation of this protein. Chemicals that effectively prevented aggregation in this model system could be useful starting points for the development of new drugs for the specific treatment of Parkinson's disease. Here, too, neuronal cell-systems derived from adult stem cells carrying the mutations might serve as well as those derived from cloned embryonic stem cells. But there is no way of knowing in advance which of the alternative routes is more promising. From a medical and scientific point of view, research on cloned embryos may offer unique benefits.

Some animal studies suggest that tissues derived from embryonic stem cells can, if injected under certain conditions, populate disease-stricken areas and differentiate so as to compensate for the loss of function caused by the diseased tissue. For example, liver or heart muscle cells injected into an animal with liver or heart disease could help regenerate the diseased tissues and restore normal function. But these cells would have a chance to do this only if they can survive the normal immunological rejection response to foreign material. Cloning-for-biomedical-research offers the possibility that scientists could someday generate individualized, "rejection-proof" replacement cells and tissues to help patients fight disease and restore health. Stem cells and tissues derived from an embryonic clone of the patient would have the same genes as the patient, and so, hypothetically, would not be rejected by the patient's body as foreign.

It is true that this possibility (what is sometimes called "therapeutic cloning") remains unproved.ⁱⁱ As before, there may be alternative (nonembryonic or adult) sources of such "rejection-proof" stem cells and tissues derived from them. And there is ongoing research to circumvent the rejection problem altogether, by, for example, modifying the surface of an unrelated (embryonic) stem cell so as to enable it to escape detection as "foreign" tissue when transferred to patients for therapy. But, once again, it is too early to say which approach will work, and therefore it is important, from a medical and scientific perspective, not to close off any avenue of promise. The only way to verify this hypothesis is to try it – first in animals, then in human volunteers.

Cloning techniques could also be combined with precise genetic manipulation to devise genetic treatments for genetic diseases. For example, a cloned embryo produced from a patient with severe combined immunodeficiency could be genetically modified to correct and repair the disease-causing mutation. Stem cells taken from the genetically modified cloned embryo might then be used to develop bone marrow stem cells to transplant back into the patient. This combined approach to gene therapy has shown early promise in one attempt to correct a genetic abnormality in the immune system of mice.⁵

The potentially unique medical benefits of cloning-for-biomedical-research are, to those of us who favor it, abundantly clear. Yet the moral meaning of proceeding, still to be considered, is the subject of some debate among us. Most of us who favor proceeding believe that this area of promising research is nonetheless fraught with moral quandaries and ethical trade-offs; a minority of us do not share these concerns. The minority view, labeled Position Number Two, follows the principal moral case for cloning-for-biomedical-research under strict limits, designated here as Position Number One. Each opinion is presented in turn.

What makes this research morally controversial is that it involves the production, use, and intentional destruction of cloned human embryos. To determine whether or not the science should proceed – or, if it does, what limits should be placed on this research – it must be asked what, if anything, is owed this nascent form of human life. Only then can an evaluation be made of whether the possible benefits of this research justify its potential human cost. Other moral hazards must be considered that are either inherent in, or possible consequences of, this line of research. These hazards include the following: the possibility that cloned embryos will be developed and experimented upon beyond the blastocyst stage (the stage from which stem cells are taken); the possible exploitation of women who would be donors of eggs; the possibility that the production of cloned human embryos will lead – intentionally or unintentionally – to cloning-to-produce-children; and the possibility that engaging in such research will weaken or undermine society's respect for human life, and therefore undermine the very good (life) that it is meant to serve. Each of these moral challenges will now be addressed.

(a) What is owed to the cloned embryo? The subject of the moral status of developing human life is a difficult and controversial matter, one about which American society is and appears likely to remain deeply divided. We are well aware of the fact that we cannot do it full justice in the present context. Yet we believe that the moral defense of cloning-for-biomedical-research requires a consideration of what is owed nascent human life (cloned or not). There is also the question – considered at great length in Chapter Three – of whether cloned embryos are the moral equivalent of fertilized embryos, or whether the different nature of their origins and the uncertainty of their capacity to become full human beings means that our moral duties to them are somehow different.

Nevertheless, those who wish to defend cloning-for-biomedical-research-as we do here – must consider what is owed to embryos as such as well as the significance of the fact that the embryos in question would be cloned. That said, the relevant arguments, especially in this subsection and the next, are in most crucial respects the same as those regarding the treatment of embryos produced by IVF.

Let us be clear about what we are talking about when we speak of cloned embryos. We are talking about the very earliest stages in development, from the single cell product of SCNT, through the early cleavage stages, up to the blastocyst stage. This is a structure comprising some 100 to 200 cells not yet differentiated into specific tissues, let alone organs (though there is differentiation into inner cell mass and trophoblast; see Chapter Four). It is true that the embryos at the blastocyst stage, if implanted in a woman's uterus or (hypothetically) an animal or artificial womb, could be made to develop to later stages, and this potentiality must be taken into account. But it is important to keep in mind the primitive and undifferentiated condition of the embryonic stage that is relevant for the research in question.

We begin with a series of questions: Is destroying an embryo or cloned embryo at the blastocyst stage morally the same as killing a child? Is it the same as clipping a fingernail? Is it more like one of these acts than the other? Is it like neither? Does the moral status of an embryo depend on whether it is implanted in a woman's uterus or remains in a laboratory? Does the moral status of an embryo depend on its origins, or how it was produced? Does it depend on the motives of those who create it?

In our view, embryos have a developing and intermediate moral worth, such that the early human embryo has a moral status somewhere between that of ordinary human cells and that of a full human person. We acknowledge the difficulty of setting perfectly clear lines marking when an embryo's moral status goes from "less than a human person" to "like a human person" to "fully a human person." But we believe there are sound moral reasons for not regarding the embryo in its earliest stages (certainly in the first fourteen days) as the moral equivalent of a human person, though it does command significantly more respect than other human cells. We also hold that the embryo can be used for life-saving or potentially life-saving research while still being accorded the "special respect" it deserves, and while still preventing abuses such as research on later-stage embryos or fetuses or the production of cloned children. We will develop this view by taking up the significance of (i) twinning, (ii) implantation, (iii) the human form, and (iv) the notion of "special respect."

• (i) The possibility of twinning. First, it is still unclear in the initial fourteen-day period whether an embryo will develop into one or more human beings. The possibility for "twinning" is still present, suggesting that the earliest-stage embryo is either not yet an individual or is a being that is not confined to becoming only one individual. There are continuing philosophical debates about how to understand what happens in twinning: for example, whether one individual embryo "clones" itself to produce a second, or whether an organism that resembles (but is not yet) an individual embryo divides into two truly individual beings.³ Nevertheless, the biological – and we believe moral – significance of the possibility for twinning is clear: after fourteen days (or after the primitive streak is formed), the being in question can no longer be anything but a single being – that is to say, no embryo after this stage, and thus no fetus or live-born baby, can replicate or divide to form another identical being. Before fourteen days, this possibility remains.
  
  
• (ii) The moral significance of pregnancy and implantation. Both IVF embryos and cloned embryos in vitro differ from comparable embryos conceived through sexual intercourse, for two reasons. First, the possibility for pregnancy with IVF or cloned embryos requires human assistance – that is, it requires the medical procedure of transferring an embryo into the woman's uterus. There is thus no possibility of the IVF or cloned embryo becoming a human child in its original in vitro environment. Second, embryos that are conceived through sexual intercourse have a direct physical connection with the individual women who carry them, whereas an in vitro embryo (cloned or not) has no such connection unless it is transferred into a woman's uterus. Thus, transfer of cloned or IVF embryos into a woman's uterus is a significant moral step, insofar as such embryos cannot be removed – they can never again be held in human hands – without a direct physical intrusion or violation of the pregnant woman. Of course, it might become technologically possible in the future for in vitro embryos to develop beyond the blastocyst stage – and perhaps even to birth – without implantation into a woman's uterus (that is, in an artificial womb). Moreover, just because those embryos (cloned or not) that exist in vitro cannot continue to develop in a self-directed way beyond the blastocyst stage – that is, they require human artifice of some kind to develop further – does not mean that the preimplantation embryo is morally insignificant. But implantation does mark a significant point in these two respects: after implantation, self-direction toward birth (without external human artifice) becomes possible and external human control of embryos becomes impossible without intruding upon or violating the pregnant woman.
  
  
• (iii) The significance of the developed human form. Generally speaking, our moral sentiments respond very differently to the prospect – or the sight – of the destruction of an embryo and the murder of a child. In other words, there is a difference between what we respect and what we consider inviolable. The destruction of embryos might inspire concern or solemnity. In contrast, our reaction to the murder of a child would be one of horror, outrage, grief, and violation. James Q. Wilson has discussed how these two fundamentally different moral reactions change as the embryo develops into a fetus and then into a child – and correspondingly, how our concern and solemnity transform into horror and outrage.⁶ Specifically, human beings exhibit a distinctly different moral sympathy for, and therefore greater willingness to protect, those organisms that have begun to resemble human beings in their developed form. The practice of sacrificing the life of the unborn in order to save the life of the pregnant woman – while not a moral parallel to the case of using cloned embryos for biomedical research – shows that there is some moral precedent for subordinating nascent human life to more developed human life. Of course, taken to an extreme, such a principle would justify the most grotesque uses of developing human fetuses for scientific experiments. Moreover, the case is not strictly analogous, for in the case of the pregnant woman, two lives are in conflict, a confrontation absent with free-standing embryos. We do not take the life of woman A's unborn fetus to save the life of woman B, not even with consent. But these difficulties notwithstanding, there is (again) a moral insight in this example. It demonstrates the important moral obligation of caring for those who already dwell among us, and the inevitable moral complexity of weighing different forms of human life, especially nascent and developed human life, against one another. It also suggests ways in which the claim on our protection may increase with the emergence of powers of awareness and suffering. Of course, such examples – and our moral sentiments in general – are not by themselves decisive. They are the beginning, not the end, of reasoning about our moral responsibilities. But they should also not be ignored for what they reveal about the nature of particular beings and particular acts – and in this case, for what they suggest about both the developing and intermediate status of the early human embryo.
  
  
• (iv) The meaning of "special respect." Finally, there is the question of whether it is possible to accord early-stage embryos "special respect" while still using them for biomedical research. We might reason here by an admittedly imperfect analogy. Various religions have rules governing the killing of animals for food. These exist in part to restrain cruelty. But they also serve to demonstrate respect for beings that command our affections and our wonder, because they are (like us) part of the mystery of existence. In a similar way, many hunters have a deep-rooted respect and even affection for the animals they kill. This is not to say that human embryos are the same as animals, because, in our opinion, they are indeed human organisms, if not fully developed human beings. But it is to show that there might be ways both to respect beings and to use them – for serious, not frivolous, reasons, and as part of our place in the order of being, not simply as an extension of our subjective will.

For the above-stated reasons, we would assign an intermediate and developing status to the human embryo. Those who treat the developing early embryo as nothing more than "mere cells" (see Position Number Two below) are in danger of ignoring its direct and inherent connection to the profound mystery of the origins of human life and seem willing to ignore the fact that an embryo will (and a cloned embryo might) eventually become one (or more) human being(s). This view greatly underestimates the moral seriousness of the question of whether to proceed with research on nascent human life. And it gravely mischaracterizes the meaning of potentiality – specifically, the difference between having the capacity to become anything at all (a pile of building materials, for example) and the capacity to become something in particular (an individuated human person or persons).

At the same time, those who believe that early-stage embryos are the moral equivalent of a human person (see Part IV below) are also, we believe, misguided. Just as we must listen to – and then articulate – the moral meaning of our disquiet at the idea of cloning-to-produce-children, we must listen to and articulate our fundamentally different moral responses to the destruction of an embryo on the one hand and the murder of a child on the other. While no single criterion like "appearance," "self-consciousness," "the capacity to express needs and desires," or "the capacity to feel pain" can by itself be decisive in conferring human dignity, the absence of all such criteria in the early-stage embryo or cloned embryo suggests that it is not a truly human being, but something different, commanding our respect because of what it is and may become, but yet not fully one of us.

In sum, what is owed the embryo is not the same protections, attachments, and rights as a human person; nor is it no respect at all. In making the decision to proceed with research on embryos or cloned embryos, we must do so only for the most compelling reasons – namely, the reasonable expectation that such research will save human lives – and only with eyes open to the moral burden of doing what we believe to be morally best. Even as we establish the biological and moral grounds for using human embryos in certain forms of research, we must face and accept the solemnity of what we propose. Finally, we must proceed with the paradox that accompanies all human suffering and human imperfection in full view: that sometimes we seem morally obligated to do morally troubling things, and that sometimes doing what is good means living with a heavy heart in doing it.

(b) The problem of deliberate creation for use in research. We next address whether the creation of embryos explicitly for the purposes of biomedical research presents additional ethical problems, beyond those just examined. In the case of research on cloned embryos, this form of deliberate production and destruction – rather than the use of leftover embryos initially created for reproductive purposes – is the only means of proceeding, if, at the same time, society prohibits cloning-to-produce-children. It is one thing to overcome the respect owed to an already existing embryo that would die even if not used for research. It is, some argue, quite another thing to bring the embryo into being solely for use and exploitation in research. Willing to accept the first, they reject the second.^iv In this connection, three issues seem worth considering.

First, the fundamental moral judgment about whether to proceed with cloning-for-biomedical-research must be grounded in our judgment about the moral status of the embryos themselves, not the purpose of their creation. If an embryo or a cloned embryo had no moral standing, then creation for research and eventual destruction would present no moral problem. If the embryo or cloned embryo were morally the equivalent of a child, then regardless of how or why it was produced, experiments upon it would be morally abhorrent. But if, as we have just argued, an embryo or a cloned embryo has a developing and intermediate moral status, certain worthy uses of them may be justified regardless of how and why they were produced. Because the use of stem cells from cloned embryos may in the future provide treatment for serious human diseases, the creation of cloned embryos and their subsequent disaggregation to isolate stem cells can be justified.

Second, the moral responsibilities for producing new embryos solely for research and for producing extra IVF embryos later used in research are not really so different. In the case of IVF and leftover embryos, the individuals who create them for reproductive purposes typically and deliberately create more embryos than they are likely to use, and therefore know in advance that some will probably be destroyed. It is true that they are produced with the intent of initiating a pregnancy and that the embryo wastage is not all that different from what obtains in efforts to conceive in vivo. But the moral responsibility for production, use, and destruction of leftover embryos are finally no less than for deliberate production for use (and subsequent destruction in research). (We acknowledge that some who accept this logic come to the opposite conclusion – namely, not that cloning-for-biomedical-research is morally permissible but that IVF should be morally restricted to creating one embryo at a time, if permitted at all.)

Third, in both cases – creating embryos to aid fertility or creating embryos for biomedical research – the ultimate goal is something humanly good: a child for an infertile couple or research that holds promise for curing debilitating diseases and easing suffering. Thus, in the case of cloning-for-biomedical-research, it is wrong to argue, as some do, that embryos are being "created for destruction." Certainly, their destruction is a known and unavoidable effect, but the embryos are ultimately created for research in the service of life and medicine.

In the end, while we acknowledge the risk of turning nascent human life into a "resource" – fully separate from its intrinsic connection to human procreation – we hold that the concern over deliberate creation and destruction is misplaced. What matters instead is whether a proper regard is shown for the created embryos, and therefore whether a proper moral and legal framework can be established that limits and governs their use in accordance with the respect they are owed as human cloned embryos.

(c) Development and use of cloned embryos beyond the earliest stages. A perceived danger of allowing cloning-for-biomedical-research is that some researchers will develop cloned embryos beyond the blastocyst stage for research purposes. There are good scientific reasons and even moral arguments for doing so: one could learn much more about development, normal and abnormal, by going to later stages; and differentiated tissues taken from cloned fetuses would likely be more useful in regenerative medicine than stem cells. There is already at least one animal study showing the potential of this approach.⁷ Transplantable functioning kidney tissue has been attained from six-week-old cloned cow fetuses, developed from cloned cow embryos transferred into a cow's uterus for partial gestation. Cloned human embryos might be developed past the blastocyst stage by implantation into an animal or human uterus, by the development of artificial wombs, or by advances in sustaining nascent human life in vitro.

This is a serious concern for those of us who believe that the cloned embryo has only an intermediate moral status and who also recognize the difficulty of drawing bright lines for when developing human life changes from "less than a human person" to "like a human person" to a "fully developed person." Clearly, the longer cloned embryos are allowed to develop, the more severe the moral burden in using them. And at some point, the moral burden of proceeding becomes a moral obligation not to proceed – even if significant medical benefits might be gained from doing so. In such circumstances, the medical principle of "do no harm" must override the researcher's desire to do good, lest we undermine the humanistic principles and spirit of the entire medical enterprise.

The moral tradition of "erecting a fence around the law"^v may provide a useful guide in this case. We recommend that research on cloned embryos be strictly limited to the first fourteen days of development – a point just about when the primitive streak is formed and before organ differentiation occurs. We acknowledge that by erecting the fence more widely, we might be more certain to prevent this particular abuse (developing cloned embryos beyond the blastocyst stage). We also acknowledge that relaxing this limit to permit research beyond fourteen days might yield additional medical benefits. There is a moral burden in both directions. But we hold that there is a point of development beyond which research on nascent human life is morally intolerable no matter what the potential medical benefits. By raising a permanent fence at fourteen days, the dignity of human life will be sufficiently protected.

These are genuine concerns. But they can be addressed by strictly adhering to the established body of ethics for research on human subjects. These ethical codes suggest the following requirements: regulation to prevent the creation of improper financial incentives for participating in such research; full disclosure by the users of human eggs of their practices; a commitment to consider using nonhuman eggs, so as to decrease the need for human egg donors^vi ; and strict limits on the uses of cloned embryos for only those investigations that uniquely require them.

(e) The connection to cloning-to-produce-children. The final moral concern is that cloning-for-biomedical-research will lead – intentionally or not – to cloning-to-produce-children. For the reasons described in Chapter Five, we believe that the creation of cloned human children would be unethical and that society has a moral responsibility to ensure that this does not happen. Thus we are obliged to consider whether the pursuit of cloning-for-biomedical-research is consistent with a serious commitment to stopping cloning-to-produce-children. A number of points must be considered.

First, the production of cloned embryos, even for research purposes, crosses a new line by bringing into existence for the first time forms of nascent human life that are asexually produced. Second, experience with producing cloned embryos for biomedical research might well improve the technique of cloning itself, and therefore result in the greater perfection of the first step toward cloning-to-produce-children. Third, cloning-for-biomedical-research means that cloned embryos would exist in laboratories where they could be available for efforts to initiate a pregnancy. Finally, a society that allows cloning-for-biomedical-research, while setting strict legal limits on cloning-to-produce-children, will likely require the mandatory destruction of nascent human life.

The first concern is intrinsic to cloning-for-biomedical-research in itself. Are we a different society because we have brought asexually produced human embryos into existence? In some ways, perhaps we are. We are confronted by the scope of our powers to change human life, to alter human procreation, and to modify the nature of human origins and the genetic makeup of new life. But we are also reminded of what should be the animating purpose of that power: to cure disease and relieve suffering. We are reminded of both new and unique possibilities for human harm (from the production of human clones) and new and unique possibilities for human benefit (from research on cloned embryos). This is, we suggest, the meaning of crossing this line.

The second and third concerns are connected to where this research might lead: namely, to a perfected cloning technique and to the intentional production of cloned children. This is indeed a genuine concern. It is perhaps the case that the best way to prevent the production of cloned children is to prohibit the creation of cloned embryos. But in the end, we are not convinced that cloning-for-biomedical-research will inevitably lead to cloning-to-produce-children; rather, we believe that the best approach is a system of regulation that prevents such an abuse. Such a system would include: a legal ban on the implantation of cloned embryos in any uterus (human, animal, or artificial); a prohibition on developing cloned embryos beyond fourteen days; a requirement that any individual or group engaging in cloning-for-biomedical-research register with proper regulatory authorities; prior scientific review of all proposed uses of cloned embryos to judge their medical and scientific benefits; and strict accounting of all cloned embryos that are produced to prevent their removal from the lab of origin or their use in attempts at cloning-to-produce-children.

Of course, no system of regulation is perfect. There is always the possibility of malfeasance or error. The prudential question in this case is whether the likelihood of cloning-to-produce-children is increased – at all, slightly, or significantly – by allowing the production and use of cloned embryos for biomedical research. But there is also the question of whether some additional risk of cloning-to-produce-children is justified or tolerable given the human goods that might be achieved through cloning-for-biomedical-research. In our view, it is.

The final concern is that to pursue research on cloned embryos while preventing cloning-to-produce-children would require laws that mandated the destruction of nascent human life. In assessing the moral significance of this fact, we return to our judgment about the moral status of cloned embryos, what is owed to them, and whether the human goods that can be achieved by cloning-for-biomedical-research justify the real and potential human costs. In our view, the possible existence of a law requiring the destruction of cloned embryos at or before fourteen days of development would force moral clarity about what we are doing – and the burdens of doing it. Such a law might remind society of the ambiguity and limits of the efforts to "heal the world," and therefore the dangers of trying to do so by any means possible. The need for such a law requiring the destruction of nascent human life would also remind us that there is a burden in acting just as there is a burden in not acting.

(f) Conclusion. The case for cloning-for-biomedical-research – as with all research that involves the use of nascent human life – should not consist simply of guessing how many people might be saved and how many embryos might be lost. The moral concerns cannot so simply be taken up, addressed, and retired. They are permanent concerns and permanent burdens.

We believe, in this particular case, that the promise of cloning-for-biomedical-research justifies proceeding, but that the genuine possibility of moral harm requires strict regulations of how we proceed. We have tried to articulate what such a system of regulation might include: (1) a legal requirement not to develop cloned embryos beyond fourteen days of development and not to implant cloned embryos in any uterus, human, animal, or artificial; (2) the creation of a governmental oversight body to regulate individuals and groups who engage in this research, and to account for all cloned embryos that are produced so as to prevent their removal from the lab of origin or their use in cloning-to-produce-children; (3) a ban on commerce in living cloned human embryos; (4) adherence to the highest standards of the ethics of research on human subjects, especially when it comes to procuring eggs; (5) a prior scientific review of the proposed uses of cloned embryos to judge their unique medical and scientific benefits; and (6) continued research into possible non-embryonic sources of stem cells and tissues for developmental studies, and ways other than cloning to solve the immune rejection problem. Such regulations amount to much more than mere bureaucratic red tape. They embody a profound ethical insight – namely, that the means of serving human beings must never corrupt our responsibilities to human beings.

A few of us who favor proceeding with cloning-for-biomedical-research have few of the ethical qualms expressed by our colleagues in Position Number One. It is our view that this research, at least in the forms and for the purposes presently contemplated, presents no special moral problems, and therefore should be endorsed with enthusiasm as a potential new means of gaining knowledge to serve humankind. Because we accord no special moral status to the early-stage cloned embryo, we believe that the moral issues involved in this research are no different from those that accompany many existing forms of biomedical research, requiring mainly the usual commitment to high standards for the quality of research, scientific integrity, and the need to obtain informed consent from, and to protect the health of, donors of the eggs and somatic cells used in nuclear transfer.

It is also our view that there are no sound reasons for treating the early-stage human embryo or cloned human embryo as anything special, or as having moral status greater than human somatic cells in tissue culture. A blastocyst (cloned or not), because it lacks any trace of a nervous system, has no capacity for suffering or conscious experience in any form – the special properties that, in our view, spell the difference between biological tissue and a human life worthy of respect and rights. Additional biological facts suggest that a blastocyst should not be identified with a unique individual person, even if the argument that it lacks sentience is set aside. A single blastocyst may, until the primitive streak is formed at around fourteen days, split into twins; conversely, two blastocysts may fuse to form a single (chimeric) organism. Moreover, most early-stage embryos that are produced naturally (that is, through the union of egg and sperm resulting from sexual intercourse) fail to implant and are therefore wasted or destroyed.

There is a moral precedent for using materials from early human embryos in the widely accepted practice of using organs from brain-dead human beings. Upon determination of death, and with permission from the next of kin, surgeons routinely harvest organs to save the lives of sick or dying patients. In a similar way, donors of somatic cells and human oocytes could justifiably grant a biomedical scientist permission to use cells derived from the resulting cloned five-to-six-day-old blastocyst, which also completely lacks a brain and a capacity for consciousness.

Some argue that the transplantation analogy is misleading, because a blastocyst has the potential to become a fetus and ultimately a child, whereas the brain-dead individual does not. But the potential to become something (or someone) is hardly the same as being something (or someone), any more than a pile of building materials is the same as a house. A cloned embryo's potential to become a human person can be realized, if at all, only by the further human act of implanting the cloned blastocyst into the uterus of a woman. Such implantation is not a part of cloning-for-biomedical-research, whose aims and actual practice do not require it.

Moreover, thanks to the results of nuclear transplantation research, there is reason to believe that every human cell has the genetic potential to develop into a complete human being, if used in cloning efforts to produce a child. If mere potentiality to develop into a human being is enough to make something morally human, then every human cell has a special or inviolable moral status, a view that is patently absurd.

"Slippery slope" warnings that the use of early-stage cloned embryos for research would lead necessarily either to the production of cloned children or to research on later-stage cloned fetuses should be treated with skepticism. Appropriate regulations can easily be established and enforced to prevent any such abuses. Although the continuity of biological development means that there is no naturally given moment after which an embryo or fetus becomes a person, defensible boundaries can be set. It is perfectly possible to treat a blastocyst as a clump of cells usable for lifesaving research, while prohibiting any such use of a later-stage embryo or fetus.

Where to set the boundary is a matter for prudent judgment. For the foreseeable future, the moral line might be safely drawn at fourteen days of development, when no nervous system has developed and when a distinct identity as a single individual has not yet been preordained. Also, derivation of the valuable stem cells can be accomplished well before fourteen days. Whether society will be faced, in the future, with reason to reconsider such a line is for now a matter of speculation. If such an occasion ever arose, it would require an evaluation of the proposed scientific use and its likely medical benefits and a moral consideration of whether the research in question justified using embryos beyond the fourteen-day point.

IV. The Moral Case against Cloning-for-Biomedical-Research

Our colleagues who joined in Part III in making the case for cloning-for-biomedical-research began their analysis by describing the medical promise of such research. Those of us who maintain – for both principled and prudential reasons – that cloning-for-biomedical-research should not be pursued similarly begin by acknowledging that substantial human goods might be gained from this research. Although it would be wrong to speak in ways that encourage false hope in those who are ill, as if a cure were likely in the near future, we who oppose such research take seriously its potential for one day yielding substantial (and perhaps unique) medical benefits. Even apart from more distant possibilities for advances in regenerative medicine, there are more immediate possibilities for progress in basic research and for developing models to study different diseases. All of us whose lives benefit enormously from medical advances that began with basic research know how great is our collective stake in continued scientific investigations. Only for very serious reasons – to avoid moral wrongdoing, to avoid harm to society, and to avoid foolish or unnecessary risks – should progress toward increased knowledge and advances that might relieve suffering or cure disease be slowed.

We also observe, however, that the realization of these medical benefits – like all speculative research and all wagers about the future – remains uncertain. There are grounds for questioning whether the proposed benefits of cloning-for-biomedical-research will be realized. And there may be other morally unproblematic ways to achieve similar scientific results and medical benefits. For example, promising results in research with non-embryonic and adult stem cells suggest that scientists may be able to make progress in regenerative medicine without engaging in cloning-for-biomedical-research. We can move forward with other, more developed forms of human stem cell research and with animal cloning. We can explore other routes for solving the immune rejection problem or to finding valuable cellular models of human disease.^vii Where such morally innocent alternatives exist, one could argue that the burden of persuasion lies on proponents to show not only that cloned embryo research is promising or desirable but that it is necessary to gain the sought-for medical benefits. Indeed, the Nuremberg Code of research ethics enunciates precisely this principle – that experimentation should be "such as to yield fruitful results for the good of society, unprocurable by other methods or means of study." Because of all the scientific uncertainties – and the many possible avenues of research – that burden cannot at present be met.

But, we readily concede, these same uncertainties mean that no one – not the scientists, not the moralists, and not the patients whose suffering we all hope to ameliorate – can know for certain which avenues of research will prove most successful. Research using cloned embryos may in fact, as we said above, yield knowledge and benefits unobtainable by any other means.

With such possible benefits in view, what reasons could we have for saying "no" to cloning-for-biomedical-research? Why not leave this possible avenue of medical progress open? Why not put the cup to our lips? In The Winter's Tale, Shakespeare has Leontes, King of Silicia, explain why one might not.⁸

There may be in the cup
A spider steep'd, and one may drink, depart,
And yet partake no venom, for his knowledge
Is not infected; but if one present
The abhorr'd ingredient to his eye, make known
How he hath drunk, he cracks his gorge, his sides
With violent hefts. I have drunk, and seen the spider.

To discern the spider in the cup is to see the moral reality of cloning-for-biomedical-research differently. It is to move beyond questions of immediately evident benefits or harms alone toward deeper questions about what an ongoing program of cloning-for-biomedical-research would mean. In part, this approach compels us to think about embryo research generally, but cloning (even for research purposes alone) raises its own special concerns, since only cloned embryos could one day become cloned children. We need to consider and articulate the reasons why, despite the possibility of great benefits, society should nevertheless turn away and not drink from this cup, and why the reasons for "drinking with limits" (offered by our colleagues in Position Number One above) are finally not persuasive.

Our analysis proceeds along three pathways: what we owe to the embryo; what we owe to society; and what we owe to the suffering. We differ, among ourselves, on the relative importance of the various arguments presented below. But we all agree that moral objections to the research itself and prudential considerations about where it is likely to lead suggest that we should oppose cloning-for-biomedical-research, albeit with regret.

The embryo is, and perhaps will always be, something of a puzzle to us. In its rudimentary beginnings, it is so unlike the human beings we know and live with that it hardly seems to be one of us; yet, the fact of our own embryonic origin evokes in us respect for the wonder of emerging new human life. Even in the midst of much that is puzzling and uncertain, we would not want to lose that respect or ignore what we owe to the embryo.

The cell synthesized by somatic cell nuclear transfer, no less than the fertilized egg, is a human organism in its germinal stage.^viii It is not just a "clump of cells" but an integrated, self-developing whole, capable (if all goes well) of the continued organic development characteristic of human beings. To be sure, the embryo does not yet have, except in potential, the full range of characteristics that distinguish the human species from others, but one need not have those characteristics in evidence in order to belong to the species. And of course human beings at some other stages of development – early in life, late in life, at any stage of life if severely disabled – do not forfeit their humanity simply for want of these distinguishing characteristics. We may observe different points in the life story of any human being – a beginning filled mostly with potential, a zenith at which the organism is in full flower, a decline in which only a residue remains of what is most distinctively human. But none of these points is itself the human being. That being is, rather, an organism with a continuous history. From zygote to irreversible coma, each human life is a single personal history.

But this fact still leaves unanswered the question of whether all stages of a human being's life have equal moral standing. Might there be sound biological or moral reasons for according the early-stage embryo only partial human worth or even none at all? If so, should such embryos be made available or even explicitly created for research that necessarily requires their destruction – especially if very real human good might come from it? Some of us who oppose cloning-for-biomedical-research hold that efforts to assign to the embryo a merely intermediate and developing moral status – that is, more humanly significant than other human cells, but less deserving of respect and protection than a human fetus or infant – are both biologically and morally unsustainable, and that the embryo is in fact fully "one of us": a human life in process, an equal member of the species Homo sapiens in the embryonic stage of his or her natural development. All of us who oppose going forward with cloning-for-biomedical-research believe that it is incoherent and self-contradictory for our colleagues (in Position Number One) to claim that human embryos deserve "special respect" and to endorse nonetheless research that requires the creation, use, and destruction of these organisms, especially when done routinely and on a large scale.

The case for treating the early-stage embryo as simply the moral equivalent of all other human cells (Position Number Two, above) is entirely unconvincing: it denies the continuous history of human individuals from zygote to fetus to infant to child; it misunderstands the meaning of potentiality – and, specifically, the difference between a "being-on-the-way" (such as a developing human embryo) and a "pile of raw materials," which has no definite potential and which might become anything at all; and it ignores the hazardous moral precedent that the routinized creation, use, and destruction of nascent human life would establish for other areas of scientific research and social life.

The more serious questions are raised – about individuality, potentiality, and "special respect" – by those who assign an intermediate and developing moral status to the human embryo, and who believe that cloned embryos can be used (and destroyed) for biomedical research while still according them special human worth (Position Number One, above). But the arguments for this position – both biological and moral – are not convincing. For attempts to ground the special respect owed to a maturing embryo in certain of its developmental features do not succeed. And the invoking of a "special respect" owed to nascent human life seems to have little or no operative meaning once one sees what those who take this position are willing to countenance.

We are not persuaded by the argument that fourteen days marks a significant difference in moral status. Because the embryo's human and individual genetic identity is present from the start, nothing that happens later during the continuous development that follows – at fourteen days or any other time – is responsible for suddenly conferring a novel human individuality or identity. The scientific evidence suggests that the fourteen – day marker does not represent a biological event of moral significance; rather, changes that occur at fourteen days are merely the visibly evident culmination of more subtle changes that have taken place earlier and that are driving the organism toward maturity. Indeed, many advocates of cloning-for-biomedical-research implicitly recognize the arbitrariness of the fourteen-day line. The medical benefits to be gained by conducting research beyond the fourteen-day line are widely appreciated, and some people have already hinted that this supposed moral and biological boundary can be moved should the medical benefits warrant doing so (see Position Number Two, above).

There are also problems with the claim that its capacity for "twinning" proves that the early embryo is not yet an individual or that the embryo's moral status is more significant after the capacity for twinning is gone. There is the obvious rejoinder that if one locus of moral status can become two, its moral standing does not thereby diminish but rather increases. More specifically, the possibility of twinning does not rebut the individuality of the early embryo from its beginning. The fact that where "John" alone once was there are now both "John" and "Jim" does not call into question the presence of "John" at the outset. Hence, we need not doubt that even the earliest cloned embryo is an individual human organism in its germinal stage. Its capacity for twinning may simply be one of the characteristic capacities of an individual human organism at that particular stage of development, just as the capacity for crawling, walking, and running, or cooing, babbling, and speaking are capacities that are also unique to particular stages of human development. Alternatively, from a developmental science perspective, twinning may not turn out to be an intrinsic process within embryogenesis. Rather, it may be a response to a disruption of normal development from which the embryo recovers and then forms two. Twinning would thus be a testament to the resilience of self-regulation and compensatory repair within early life, not the lack of individuation in the early embryo. From this perspective, twinning is further testimony to the potency of the individual (in this case two) to fullness of form.

We are also not persuaded by the claim that in vitro embryos (whether created through IVF or cloning) have a lesser moral status than embryos that have been implanted into a woman's uterus, because they cannot develop without further human assistance. The suggestion that extra-corporeal embryos are not yet individual human organisms-on-the-way, but rather special human cells that acquire only through implantation the potential to become individual human organisms-on-the-way, rests on a misunderstanding of the meaning and significance of potentiality. An embryo is, by definition and by its nature, potentially a fully developed human person; its potential for maturation is a characteristic it actually has, and from the start. The fact that embryos have been created outside their natural environment – which is to say, outside the woman's body – and are therefore limited in their ability to realize their natural capacities, does not affect either the potential or the moral status of the beings themselves. A bird forced to live in a cage its entire life may never learn to fly. But this does not mean it is less of a bird, or that it lacks the immanent potentiality to fly on feathered wings. It means only that a caged bird-like an in vitro human embryo – has been deprived of its proper environment. There may, of course, be good human reasons to create embryos outside their natural environments – most obviously, to aid infertile couples. But doing so does not obliterate the moral status of the embryos themselves.

As we have noted, many proponents of cloning-for-biomedical-research (and for embryo research more generally) do not deny that we owe the human embryo special moral respect. Indeed, they have wanted positively to affirm it.^ix But we do not understand what it means to claim that one is treating cloned embryos with special respect when one decides to create them intentionally for research that necessarily leads to their destruction. This respect is allegedly demonstrated by limiting such research – and therefore limiting the numbers of embryos that may be created, used, and destroyed – to only the most serious purposes: namely, scientific investigations that hold out the potential for curing diseases or relieving suffering. But this self-limitation shows only that our purposes are steadfastly high-minded; it does not show that the means of pursuing these purposes are respectful of the cloned embryos that are necessarily violated, exploited, and destroyed in the process. To the contrary, a true respect for a being would nurture and encourage it toward its own flourishing.

It is, of course, possible to have reverence for a life that one kills. This is memorably displayed, for example, by the fisherman Santiago in Ernest Hemingway's The Old Man and the Sea, who wonders whether it is a sin to kill fish even if doing so would feed hungry people. But it seems difficult to claim – even in theory but especially in practice – the presence of reverence once we run a stockyard or raise calves for veal – that is, once we treat the animals we kill (as we often do) simply as resources or commodities. In a similar way, we find it difficult to imagine that biotechnology companies or scientists who routinely engaged in cloning-for-biomedical-research would evince solemn respect for human life each time a cloned embryo was used and destroyed. Things we exploit even occasionally tend to lose their special value. It seems scarcely possible to preserve a spirit of humility and solemnity while engaging in routinized (and in many cases corporately competitive) research that creates, uses, and destroys them.

The mystery that surrounds the human embryo is undeniable. But so is the fact that each human person began as an embryo, and that this embryo, once formed, had the unique potential to become a unique human person. This is the meaning of our embodied condition and the biology that describes it. If we add to this description a commitment to equal treatment – the moral principle that every human life deserves our equal respect – we begin to see how difficult it must be to suggest that a human embryo, even in its most undeveloped and germinal stage, could simply be used for the good of others and then destroyed. Justifying our intention of using (and destroying) human embryos for the purpose of biomedical research would force us either to ignore the truth of our own continuing personal histories from their beginning in embryonic life or to weaken the commitment to human equality that has been so slowly and laboriously developed in our cultural history.

Equal treatment of human beings does not, of course, mean identical treatment, as all parents know who have more than one child. And from one perspective, the fact that the embryo seems to amount to so little – seems to be little more than a clump of cells – invites us to suppose that its claims upon us can also not amount to much. We are, many have noted, likely to grieve the death of an embryo less than the death of a newborn child. But, then, we are also likely to grieve the death of an eighty-five-year-old father less than the death of a forty-five-year-old father. Perhaps, even, we may grieve the death of a newborn child less than the death of a twelve-year-old. We might grieve differently at the death of a healthy eighty-year-old than at the death of a severely demented eighty-year-old. Put differently, we might note how even the researcher in the laboratory may react with excitement and anticipation as cell division begins. Thus, reproductive physiologist Robert Edwards, who, together with Dr. Patrick Steptoe, helped produce Louise Brown, the first "test-tube baby," said of her: "The last time I saw her, she was just eight cells in a test-tube. She was beautiful then, and she's still beautiful now."⁹ The embryo seems to amount to little; yet it has the capacity to become what to all of us seems very much indeed. There is a trajectory to the life story of human beings, and it is inevitable – and appropriate – that our emotional responses should be different at different points in that trajectory. Nevertheless, these emotions, quite naturally and appropriately different, would be misused if we calibrated the degree of respect we owe each other on the basis of such responses. In fact, we are obligated to try to shape and form our emotional responses – and our moral sentiments – so that they are more in accord with the moral respect we owe to those whose capacities are least developed (or those whom society may have wrongly defined as "non-persons" or "nonentities").

In short, how we respond to the weakest among us, to those who are nowhere near the zenith of human flourishing, says much about our willingness to envision the boundaries of humanity expansively and inclusively. It challenges – in the face of what we can know and what we cannot know about the human embryo – the depth of our commitment to equality. If from one perspective the fact that the embryo seems to amount to little may invite a weakening of our respect, from another perspective its seeming insignificance should awaken in us a sense of shared humanity. This was once our own condition. From origins that seem so little came our kin, our friends, our fellow citizens, and all human beings, whether known to us or not. In fact, precisely because the embryo seems to amount to so little, our responsibility to respect and protect its life correspondingly increases. As Hans Jonas once remarked, a true humanism would recognize "the inflexible principle that utter helplessness demands utter protection."¹⁰

B. What We Owe to Society

We are concerned especially about three ways in which giving our moral approval to such research would harm the character of our common life and the way of life we want to transmit to future generations: (i) by crossing the boundary from sexual to asexual reproduction, in the process approving, whether recognized or not, genetic manipulation and control of nascent human life; (ii) by allowing and endorsing the complete instrumentalization of human embryos; and (iii) by opening the door to other – for some of us, far greater – moral hazards, such as cloning-to-produce-children or research on later-stage human embryos and fetuses.

It is worth noting that human cloning-including cloning-for-biomedical-research itself and not simply cloning-to-produce-children-would cross a natural boundary between sexual and asexual reproduction, reducing the likelihood that we could either retrace our steps or keep from taking further steps. Cloning-for-biomedical-research and cloning-to-produce-children both begin with the same act of cloning: the production of a human embryo that is genetically virtually identical to its progenitor. The cloned embryo would therefore be the first human organism with a single genetic "parent" and, equally important, with a genetic constitution that is known and selected in advance. Both uses of cloning mark a significant leap in human power and human control over our genetic origins. Both involve deliberate genetic manipulation of nascent human life. It is, of course, precisely this genetic control that makes cloned embryos uniquely appealing and perhaps uniquely useful to those who seek to conduct research on them. But we should not be deceived about what we are agreeing to if we agree to start to clone: saying yes to cloned embryos in laboratories means saying yes in principle to an ever-expanding genetic mastery of one generation over the next.

By approving the production of cloned embryos for the sole purpose of research, society would transgress yet another moral boundary: that separating the different ways in which embryos might become available for human experimentation. It is one thing, as some have argued, to conduct research on leftover embryos from IVF procedures, which were created in attempts to have a child and, once no longer needed or wanted, are "destined" for destruction in any case. It is quite another to create embryos solely for research that will unavoidably and necessarily destroy them. Thus, for example, the National Bioethics Advisory Commission (in its report on stem cell research) reasoned that in circumstances where embryos were going to be discarded anyway, it did not undermine the moral respect owed to them if they were destroyed in one way (through research) rather than another (by being discarded when no longer wanted for IVF).¹¹ By contrast, the Commission reasoned that it was much harder to embrace the language of respect for the embryo if it were produced solely for purposes of research and, having been used, then destroyed. This argument maintained the following moral and practical distinction: that embryos created for reproduction but no longer desired could, with proper consent, be used as research subjects, but that embryos ought not be produced solely in order to be used as research subjects. So long as we oppose morally and may perhaps one day prohibit legally the production of cloned children, it is in the very nature of the case that cloned human embryos will not be acquirable as "spare" embryos left over from attempts at reproduction. To the contrary, they will have to be produced solely and explicitly for the purpose of biomedical research, with no other end in view.

Some have argued that there is no significant moral difference between creating excess IVF embryos for reproduction knowing in advance that some will be discarded and creating cloned embryos for research that leads necessarily to their destruction. Because in both cases embryos are wittingly destroyed, there is, so the argument goes, no moral difference here.

When viewed simply in terms of the fates of embryos once they are created, the distinction between using leftover embryos and creating embryos solely for research may indeed be morally insignificant. But when viewed in terms of the different effects these two activities might have on the moral fabric of society – and the different moral dispositions of those who decide to produce embryos for these different purposes – the issue is more complex. In the eyes of those who create IVF embryos to produce a child, every embryo, at the moment of its creation, is a potential child. Even though more eggs are fertilized than will be transferred to a woman, each embryo is brought into being as an end in itself, not simply as a means to other ends. Precisely because one cannot tell which IVF embryo is going to reach the blastocyst stage, implant itself in the uterine wall, and develop into a child, the embryo "wastage" in IVF is more analogous to the embryo wastage in natural sexual intercourse practiced by a couple trying to get pregnant than it is to the creation and use of embryos that requires (without exception) their destruction.

Those who minimize or deny this distinction – between producing embryos hoping that one of them will become a child and producing embryos so that they can be used (and destroyed) in research – demonstrate the very problem we are worried about. Having become comfortable with seeing embryos as a means to noble ends (be it having a child or conducting biomedical research), they have lost sight of the fact that the embryos that we create as potential children are not means at all. Even those who remain agnostic about whether the human embryo is fully one of us should see the ways in which conducting such research would make us a different society: less humble toward that which we cannot fully understand, less willing to extend the boundaries of human respect ever outward, and more willing to transgress moral boundaries that we have, ourselves, so recently established, once it appears to be in our own interests to do so. We find it disquieting, even somewhat ignoble, to treat what are in fact seeds of the next generation as mere raw material for satisfying the needs of our own. Doing so would undermine the very prudence and humility to which defenders of limited embryo research often appeal: the idea that, while a human embryo may not be fully one of us, it is not humanly nothing and therefore should not be treated as a resource alone. But that is precisely what cloning-for-biomedical-research would do.

This leads directly to our third concern – that the cloning of human embryos for research will open the door to additional (and to some of us, far greater) moral hazards. Human suffering from horrible diseases never comes to an end, and, likewise, our willingness to use embryonic life in the cause of research, once permitted, is also unlikely to find any natural stopping point. To set foot on this slope is to tempt ourselves to become people for whom the use of nascent human life as research material becomes routinized and everyday. That much is inherent in the very logic of what we would do in cloning-for-biomedical-research.

In addition, the reasons justifying production of cloned embryos for research can be predicted to expand. Today, the demand is for stem cells; tomorrow it may be for embryonic and fetal organs. The recent experiments with cloned cow embryos implanted in a cow's uterus¹² already suggest that there may be greater therapeutic potential using differentiated tissues (for example, kidney primordia) harvested from early fetuses than using undifferentiated stem cells taken from the very early embryo. Should this prove to be the case, pressure will increase to grow cloned human blastocysts to later stages – either in the uteruses of suitably prepared animal hosts or (eventually) using artificial placenta – like structures in the laboratory – in order to obtain the more useful tissues. One can even imagine without difficulty how a mother migh