by Dr Megan Best (1)

Lately, in my bioethical reading, I have been struck by how often people mention Aldous Huxley's 1932 novel, entitled "Brave New World" (2). I remembered it from childhood as a science fiction work predicting a world of assisted reproduction and eugenics. On re-reading the book recently, I was struck by something else. Huxley describes a technological world that many people would consider to be paradise. No sense of oppression here: citizens of the World State have everything they would ever want. Life is ordered and comfortable, with disease, aggression, envy, suffering and guilt having been eradicated from society. But also eliminated are democracy, family, art and self-awareness. The means by which stability is reached is development of a mediocre, homogenous existence for mankind, spent in trivial pursuits and meaningless liaisons. They consume, fornicate, take drugs and aspire to nothing beyond instant gratification. Sound familiar?

In this paper I would like to review some of the recent advances in medical technology and propose a Christian ethical response. Christians take the authority of Scripture as their ethical compass. I believe that the word of God is "a lamp to my feet and a light for my path', as suggested in Psalm 119:105. (3)

In my examination of the trends in emerging technologies I will argue that, while they hold the promise of marvellous opportunities in the improvement of health care, some of them also represent a threat to our humanity. It therefore stands that caution is warranted.

Emerging technologies

There are so many developments in medical technology in recent years that it will not be possible for me to provide a comprehensive overview of the state of the art. However, we cannot sensibly evaluate without understanding the subject matter. Proverbs 15:14 tells us that "The discerning heart seeks knowledge'. For this paper I have chosen to consider advances in stem cell research, human genetics, xenotransplantation and transgenics. If you not aware of recent developments, let me bring you up to date. There are some very exciting things happening.

Stem cells

Human stem cells were first extracted in 1998. There are many sources, but there are only two categories: embryonic stem cells, which are those extracted from embryos about 6 days old, and adult stem cells, which include all other sources though they can come from umbilical cord blood, children and other sources besides adults. Stem cells can be thought of as the cells from which all cells stem. What makes them special is that they can develop into any type of tissue in the body (e.g. muscle, bone, nerve). The other thing that makes them special is that they can replicate indefinitely. They have been the focus of extensive debate in Australia in recent years, as Australians ponder over whether excess embryos in IVF labs should be used as a stem cell source. The result of that debate was that the Research Involving Human Embryos Act 2002 and the Prohibition of Human Cloning Act 2002 (4) were made law by the Australian Parliament in late 2002, outlining the conditions under which excess frozen human embryos could be used for research. The first licenses were issued under the legislation in April 2004.

Scientists are excited about the promise of stem cells in the treatment of many diseases which are currently incurable. This is because, if stem cells can develop into any tissue type in the body and replicate indefinitely, it may be possible to replace tissue which has been damaged by disease or trauma. Problems under investigation include heart disease, Parkinson's Disease, cancer, Multiple Sclerosis, eye problems, diabetes, spinal cord damage and many blood diseases. Indeed, there have been treatments already developed using this technique with adult stem cells. For example,
an 18 year old woman in the USA with quadriplegia has experience some return of function below the level of her spinal cord lesion after treatment with adult stem cells which had been turned into nerve cells. (5)

Embryonic stem cells have a tendency to produce tumours and until this problem is overcome, experiments in animals will continue to have problems and experiments in humans are not safe.

The disagreement over use of stem cells is related to the ways of collecting the stem cells. While adult stem cells can be collected with no lasting damage done, if you take stem cells out of an embryo, it kills the embryo. If human life begins at conception, then use of embryonic stem cells is immoral, on the grounds that murder of an innocent is wrong. Furthermore, if embryonic stem cells are to be used in patients without incurring an immune reaction, scientists suggest that cloning is required. Cloning is also ethically troubling, for many reasons.

Here are some of them. Cloning is ethically troublesome because it brings a child into the world by a process that will be different from that for other children. This alone can bring psychological stress and possibly discrimination. But when you think about it, a clone is made to be a copy of someone else. This brings expectations that we already know what this child will be like, which is a burden for the child to carry through life as they are confused about their individuality and identity. It also risks the rejection of the child if the parent had something else in mind, because even if the genes are the same in two people, it does not necessarily mean they will look the same or behave the same way, because there are many other influences which determine what we are like. The uncertainty of what our children will be like helps us to unconditionally love them. We devalue human life when we think we are replaceable.

So, in view of the fact that adult stem cells are available without ethical problems and don't require cloning and indeed have proven more promising than embryonic in research, many people have opposed the destruction of embryos for this technology, despite the potential for therapies.

Genetics

In 2003, the human genome sequence was published, two years ahead of schedule (and apparently under budget " quite a feat for a government funded operation). This was the culmination of an international project, aiming to map the order of the chemicals which make up the genetic information, or the DNA, in our bodies. While this is an enormous breakthrough, scientists found that the structure of DNA hasn't told them as much as they'd hoped about its function. This is the focus of research now and it is hoped that new treatments will emerge. Some people have voiced the hope that the secrets of aging will be discovered and subsequently overcome.

As with other technologies, the benefits of genomic research will only be available to the public with the involvement of private companies. This is because we need their money to develop new drugs, new tests and new treatments. The types of tests include screening to find out whether you are likely to get a particular genetic disease. Already there are tests for breast cancer, colon cancer, Alzheimer's Disease and others on a growing list. Obviously, for diseases with known preventative measures, this is a wonderfully individualized form of preventative medicine. However, one question to ask is"”do we want to know if we have a predisposition to a disease which is incurable? Personally I think I'd rather live happily in ignorance until it hit me (if it hit me"”a bus might hit me first).

A possible solution may lie in another use of genomics"”gene therapy. (This doesn't mean a new pair of Levi's). The idea is to replace a malfunctioning gene with a normal one in the tissue where it's needed. Gene therapy is yet to fulfill its promise, and the death of Jesse Gelsinger during a 1999 gene therapy trial has made the scientific community much more cautious. Jesse was a healthy 18 year-old volunteer and the treatment he received was not going to help him, he was just participating to help others. He died from a massive immune reaction. (6) However, the work is progressing"”just last month researchers cured diabetic mice with this method, and human trials are cautiously being tried again.

Other directions for this research include looking at disease processes. It is possible that by understanding diseases at the molecular level, cures may be found. Drug companies are also using genomics to try to discover why people can react differently to the same drug. These things are probably due to differences in encoding in our DNA.

Concerns in genetic research include issues of privacy of genetic information and the risk of discrimination. Already in Australia there have been cases of genetic discrimination in the workplace " cases where employers have sacked workers with a bad DNA profile. They don't want to have someone on the books with a looming disease risk. Will our health insurers insist on seeing our DNA results and cancel our policies because of the problems revealed? Such outcomes need to be prevented because they are unjust. Australian authorities are currently reviewing the need for regulation of these issues. (7)

Further concerns about genetic tests are that they may leave the research labs too early, before proper validation, because of pressure in the market place. There are concerns about the interpretation of results. Most working doctors haven't received training in genetics. One group in the UK recently found that 150 pregnant women had had tests which put them at risk of a miscarriage because their genetic tests had been misinterpreted. And just because you have a predisposition to a disease doesn't mean you're actually going to get it. Environmental factors are also important. The potential for confusion is enormous.

Xenotransplantation

Xenotransplantation refers to the use of live cells, tissue or organs from a non-human animal source, implanted into a human subject.

Xenotransplantation has developed as a consequence of the success of human to human transplantation and perhaps the wearing of seatbelts. In short, the demand for transplant organs now far exceeds the supply. The system for organ donation in Australia has been "opt-in', but despite alleged public support and marked drivers' licenses, when it comes to the actual donation, many families opt out. Even though many patients have ticked the box to donate their organs, often families won't give their consent for the organs to be taken. Attempts to develop artificial organs has not shown sufficient promise to relieve the problem. This has led some people to consider the feasibility of transplanting animal organs, in particular pig organs, into humans.

Pigs are chosen because their organs are a similar size to humans and because of some genetic factors.

The main concern with xenotransplantation is the threat of pig viruses. The possibility exists of transmission of Pig Retro Viruses to humans. We already have an example of the dangers of animal to human disease transmission (zoonotic infection) in the Mad Cow Disease outbreak. Researchers are examining the security requirements needed to control any problems before the transplantation programs proceed. (8) When you consider that zoonotic infection is one of the theories of the origin of the recent SARS epidemic, it is easy to see that present safeguards are woefully inadequate.

Other issues include the impact of the "yuck' factor on the psychological welfare of recipients of spare parts from pigs, and then there's the question of animal rights. Though it must be said that these animals must be the most pampered in the world, with air-conditioned pens, gourmet diets, vets on call and special toys for stimulation. All that is asked of them is that when the time comes, they will give up their organs for human beings.

Transgenics

Transgenics refers to the mixing of genes from two different animals to make a chimeric or hybrid animal. I will be focusing on human/animal transgenics only. Individual human genes have long been inserted into animals to determine their function and to provide models for disease processes. This is considered to be more reliable than just testing genes in a test tube. The technology is also being used to develop transgenic pigs for the purpose of developing organs for human xenotransplantation. Recently, the possibility has arisen of injecting human stem cells into animals to produce human tissue and possibly human organs, needed for therapeutic purposes. Scientists are now debating how much mixing between humans
and animals should be permitted. Apart from the obvious concerns about loss of species integrity (what if the animals escape into the wild?), scientists once again fear the zoonotic transmission of disease. This could occur if a genetically-engineered animal developed a typical animal infection which then mutated, allowing it to cross the normal species barrier by recognizing the DNA in humans.

We'll leave it there, but there are many other new biotechnologies that will affect us"”artificial intelligence, nanotechnology, cybernetics"

Technology will surely have a big impact on the way we live in this millennium, but it is not the thought of technology that worries me so much as our ability to control it. Technology fits into the mandate given in Genesis 1:28: fill the earth and subdue it. But our instruction is to exert our stewardship under the Lordship of God; Psalm 24 tells us that the earth is the Lord's and everything in it. That is where we can go wrong"”by forgetting our accountability to God and claiming control ourselves. We all remember what happened to the Tower of Babel (Genesis 11:1-9). For us, God sets the boundaries for the ethical use of technology.

Our next questions will be"”why should Christians get involved in community debate, and, given that the Bible is an ancient text with no references to stem cells, how do we apply it in this century?

Why get involved?

Jesus taught in the Sermon on the Mount in Matthew 5 that Christians are to act as salt and light in the world. As salt we preserve what is good and prevent decay. We are to remind our community of the way to flourish as humans. As light, we expose the dangers and evils of this world. These instructions are easily applied to community discussions of biotechnology. Not only does it help us work out our own responses to technology (how do I feel about leftover IVF embryos), but our conversations with our friends about topical issues give us wonderful evangelistic opportunities as we explain our approach.

How do we use the Bible to determine a Christian ethic?

There are a range of topics on which the Bible remains silent, biotechnology is just one of many. But God has not left us without guidance. The Bible shows us what kind of a God we have and the basic principles by which we are to live. As Rev. Michael Hill has written, the Bible must be read in context, and he has explained the evangelical hermeneutic. In the Bible, God has given us standards by which to judge the ethics of an action. The action must be obedient to Biblical law, it must be motivated by Biblical love, and the outcomes are to be measured by Biblical justice. (9) For the philosophers, this would work out as a form of modified virtue ethics.

Therefore Christians are obliged to contribute to our community debate with reference to the only truly objective source of ethical principles available " God's word.

Common themes

We have covered a lot of ground, but let's now pull some of it together. What are the common themes here?

I would suggest that one theme to emerge is that there is no clarity as to what the goals of medicine are. Should medicine be used to just relieve pain and suffering, or to promote health and avoid disease, or is it legitimate to use it to improve humanity, to prolong life, and if so, how far should we go?

Traditionally, the church has been at the forefront of healthcare delivery, with the earliest hospices set up in Europe from the 4th century. The rationale came from Christ's example of healing in the gospels (e.g. Matthew 4:23), and his instructions for us to do likewise (Matthew 25:40). The development of technology to extend this ability is not in itself wrong. But where is the line between healing and enhancing?

Prominent scientists have called for the application of genomics to eliminate stupidity on the grounds that it is a disease. I have met many parents who think the creation of designer children would be an extension of the nurturing process. Remember that Brave New Man was so carefully designed he lost his humanity.

We also need to consider the wisdom of pursuing technology that will mask our symptoms rather than treating our underlying problems. Many diseases we seek to cure are caused by drug abuse, smoking, sexual promiscuity. Technology may be harmful in distracting us humans from coming to grips with our own sinfulness and need for salvation.

This leads us to another theme, the question of what is a human? When does life begin? Embryonic stem cell research clearly brings this into focus. In scripture, I find that reference is made to the unborn in a relationship with God which is continuous with life outside the womb (Job 31:15; Psalms 139:13-16; Isaiah 49:1; Jeremiah 1:5; Galations 1:15). As life in the womb begins with conception, it would be arbitrary to choose any other point at which the child develops value. Genesis 9:6 warns against us killing fellow man, who has been created in the image of God and is thus intrinsically valuable (Genesis 1:26-27).

The question of what is a human is also challenged in genomics " are we really just programd by our genetic codes? Discussion of "a gene for this and a gene for that' can get to the point of denying the existence of free will. Time magazine has published information about an infidelity gene. There has been question of a spiritual gene, the absence of which may explain why some people don't go to church. One could start thinking you are a victim of your DNA. This is not a biblical view. We know from Galations 5 that a man reaps what he sows.

Cloning removes a child from the normal social network. Do humans need mothers AND fathers? Families? Can we unconditionally love a child who we think we already know? The Bible describes us as social beings. Before the fall, God said that Adam's loneliness was "not good'. Eve was created to be Adam's human partner " man was made to be a social animal from the beginning. In Genesis 4, Cain's question "Am I my brother's keeper" is answered with a big YES by scripture. Relationships are an important part of our flourishing as humans and should not be discarded lightly.

Scripture also explains that we are different to animals, who are not made in the image of God. Animal rights proponents have long complained against the manipulation of animals which makes them diseased or disabled. However, the use of animals to model a disease process has long been a standard tool of medical research, and it is acceptable to most people when basic care of the animals is sufficient and suffering minimalised, and the research itself is justified. Man was given dominion over the created order in Genesis 1:26, and as such, Christians can ethically justify careful use of animals in science for the purposes of healing.

Another Biblical theme to keep in mind is the sinfulness of man. I have mentioned several possible dangers in biotechnology development today. These include zoonotic transmission of disease from animals to humans. In the wrong hands, this process could be used to create bugs for biological warfare. We have considered the risk of human cloning with the development of embryonic stem cell technology. Our community accepts that there is a risk of misuse with any technology, but the feeling is that regulations and prohibitions will control use of new techniques. As Christians we know that the good book is very clear about our predisposition to sin. Romans 3:23: for all have sinned and fall short of the glory of God. Paul also says in Romans 7 that when he wants to do good, evil is right there with him. Regulations don't work. Someone, somewhere, will break them.

This problem is compounded by the enormous opportunity for financial gain due to the number of people who would benefit from the development of these technologies. This has been a key factor in the focus on biotechnology and the money spent on its research. The concern is that the desire for profit may interfere with or control research and its results. 1 Timothy 6 tells us that people who want to get rich fall into temptation. The only way to positively avoid abuse of any technology is to avoid its development. The decision not to pursue a branch of technology is a serious one, but one that we may need to consider. Such decisions require careful consideration as we weigh up what is at risk.

This is not as way out as it might sound " there have already been attempts to develop an international ban on human cloning like the nuclear testing ban.

Yet we keep hearing that if it can be done it should be done. What is it that makes technology so attractive? Several reasons have been suggested. First, technology promises to free us from the pain and suffering inherent in a fallen world. It offers freedom from the limits imposed by our humanity. Even the final act of death is thought to be avoidable through cryopreservation and cloning, according to their proponents.

Secondly, technology promises freedom and independence, humanism's idea of what it means to be fully human. It gives us choices. Thirdly, technology promotes happiness, which for your average materialist means comfort and physical pleasure. Of course, the pleasure may be momentary " or perhaps a diversion to distract us from meaningful contemplation. Perhaps technology is most desired as a way to replace God.

And surely that is another basic problem: the benefits we seek through technology are shallow and ultimately unsatisfying. Perfect bodies, perfect children, eternal youth" We humans are underselling ourselves, we need a much richer conception of the good we seek to use technology in a way which will enrich our lives. Jesus came so that we could have life to the full. Which will do justice to the body and soul of imperfect man seeking to know the perfect God. We need things like relationships, art, beauty and wisdom.

Leon Kass, the chair of President Bush's Bioethics Committee, has suggested that mortality is good for us. It increases our appreciation of our time here and motivates us to act on our ideas. (10)

Writing 15 years after the publication of "Brave New World', Huxley reviewed his work. His only regret was that he had not included, between the options of insane utopia or extremely primitive life, that of sanity. He believed it was possible, and envisioned in this third community:

Science and technology would be used as though, like the Sabbath, they had been made for man, not (as at present and still more so in the Brave New World) as though man were to be adapted and enslaved to them. (11)

Promising though the new technology is, I think that many claims have been exaggerated in the enthusiasm of discovery. Certainly claims of the benefits of embryonic stem cells and genomics have a long way to go to live up to the hype. Criticism of technology is not popular because it is not what people want to hear. People want a quick fix, easy hope. Most people value immediate benefits and the sense of control above the distant risks of deformed babies or pig virus epidemics. Do we do society a favour by playing along with this idea that you can always save yourself? (11)

In conclusion, Christians do not need to fear technology, though we need to be careful we are not seduced by its claims. We need to approach it with critical evaluation and be vigilant in looking ahead for possible problems so that they can be addressed before implementation. We need to assess what we hope to achieve by technology, and weigh the benefits against the costs. We can enjoy the benefits of those technologies which are ethically achieved and indeed encourage this work.

In the end, Christians believe that this is a fallen world, and though we may use our God-given intelligence and curiosity to improve things somewhat, in the end our tears can only be wiped away by the hand of God:

“He will wipe away every tear from their eyes, and
death shall be no more, neither shall there be
mourning nor crying nor pain anymore, for the
former things have passed away.”
Revelation 21:4 (ESV)

© Megan Best. April 2004

ENDNOTES

1 This article is based on the Halifax-Portal lecture given by Dr Best in May 2003.
2 Huxley, A. (2001). Brave New World. London: HarperCollins.
3 All scripture quotations are taken from the Holy Bible, New International Version © unless otherwise
noted.
4 An electronic version of both Acts is available at
[url=http://scaleplus.law.gov.au/html/comact/browse/TOCN.htm]http://scaleplus.law.gov.au/html/comact/browse/TOCN.htm[/url]
5 Globe and Mail (Toronto), June 15, 2001.
6 Shreenivas, S. (2000). Who killed Jesse Gelsinger? Ethical issues is human gene therapy. Monash
Bioethics Review, 19(3), 35-43.
7 The Australian Law Reform Commission and the Australian Health Ethics Committee of the National
Health and Medical Research Council released a report in 2003 following their inquiry into matters
relating to the protection of human genetic information. It is entitled Essentially Yours. The protection
of human genetic information in Australia.
8 The National Health and Medical Research Council has convened a Xenotransplantation Party which
is currently exploring how Australia should proceed with regard to animal-to-human transplantation
research. More information is available at [url=http://www.nhmrc.gov.au]http://www.nhmrc.gov.au[/url]
9 Hill, M. (2002). The How and Why of Love: an introduction to evangelical ethics. Kingsford:
Matthias Media.
10 Kass, L. (2002). Life, Liberty and the Defense of Dignity. San Francisco: Encounter Books.
11 Huxley, A. (2001). Brave New World. London: HarperCollins. This edition includes the forward
written by Huxley in 1946.