Minnesota Meeting: Art Caplan - The Ethics of Making Babies: And Other Moral Dilemmas in the Brave New World of Medicine

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Dr. Arthur Caplan, Director of the Center for Bioethics at the University of Pennsylvania addresses the Minnesota Meeting. Caplan's speech was titled, "The Ethics of Making Babies: And Other Moral Dilemmas in the Brave New World of Medicine." Minnesota Meeting is a non-profit corporation which hosts a wide range of public speakers. It is managed by the Hubert H. Humphrey Institute of Public Affairs at the University of Minnesota.

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(00:00:00) Thank you Greta six minutes past twelve o'clock time for today's Minnesota meeting and off we go to the Minneapolis Marriott City Center Hotel in Downtown, Minneapolis. A good afternoon. I'm dr. Jim Elin president of Allina Health System and chair of the Minnesota meeting. It's a great pleasure to welcome you all today to the Minnesota meeting members of Minnesota meeting represent the community leaders from business government Academia and the professions. This is our 17th year in the marketplace of ideas. I would also like to welcome our radio audience throughout the Upper Midwest who are hearing this address on the midday program of Minnesota Public Radio. Broadcasts of Minnesota meeting are supported by Oppenheimer wolf and Donnelly with offices in Minneapolis. St. Paul and at www.iowadnr.gov cam providing legal services to businesses around the world today. We will examine the ethics of making babies and other profound moral dilemmas facing modern medicine. The stuff of Science Fiction is quickly becoming a medical reality multiple births are now almost routine in some medical centers. Human cloning once thought as likely as Star Travel may be medically possible in just a few years maybe even shorter. The ability of scientists to manipulate human genes will soon provide amazing cures for everything from cancer to paralysis, but the same knowledge would also allow parents to perhaps genetically design their own children. These changes in biotechnology are happening at a speed never seen before today's speaker. Dr. Arthur Caplan will help us slow down a little and consider the profound moral and ethical questions presented by these amazing developments in medical science. Dr. Kaplan is one of our nation's late leading bioethicist. He is currently the director of the center for bioethics at the University of Pennsylvania. He is also a professor of molecular and cellular engineering a professor of philosophy and the chief of bioethics at the University of Pennsylvania Medical Center. As many of you know before going to Pennsylvania in 1994, Dr. Kaplan was a was a distinguished professor of surgery and philosophy at the University of Minnesota and director of the use prominent Center for biomedical ethics. His most recent book is am I My Brother's Keeper published by the Indiana University, press following his address Dr. Kaplan will take questions from the audience Jayne Marie, sick and Gloria McLennan of Minnesota meaning will move among you and help you manage the question and answer it is my great pleasure to present to you. Dr. Arthur Caplan. Well, it's always fun to be back in front of old friends. Last time I was in this room. I was just reminded and I was talking at lunch. I ate lunch here with Harry blackmun and we had a conference that the center Put on to look at changes in a non controversial topic abortion. And Harry blackmun was here and talked a lot about his thoughts about what had happened and it's appropriate that I think of him because he certainly was one of the most admirable minnesotans. I know even if you don't agree with this decision, he was quite a figure and influence in a lot of ways over bioethics topics. Somebody asked me what I was doing here. Maybe Jim wide come back and I did have a little discussion with Glory. I know about Minnesota meeting and the called up and said, you know, would you like to give a talk there? And I said, yeah, let's see now. Hmm, that's a group of people who come and they actually give them ample time to ask questions. It's not the kind of audience. I'd like that. I think I get to talk for about 20 minutes and then you're supposed to ask me questions for half an hour my goodness. So and I know Minnesota audiences will ask questions. So let me say that I'm happy to take questions on a whole range of topics, even though I'm going to only talk about two themes one is I'll say something about reproductive Technologies the other about cloning. There are many many other topics around in the realm of genetic testing a lot of the questions that you saw earlier to get us going the survey questions touched on a whole variety of issues and happy to get into those if you want to do that in the question and answer when I was thinking about what I wanted to talk about. I didn't know that by the time I got here probably six months ago. I was thinking about a topic that what I had agreed to talk about was going to be in the news so much. Reproductive Technologies and making babies and the ethics of doing cell has just been an explosive area 40 or 50 years ago, you know, the ethics of making babies was something that you decided in the backseat of cars or something and some kind of conversational sense. Even I remember trying to push the envelope of Morality In the making of babies in certain settings, which I won't go into here, but we'll say something about in a little bit but it's changed because there are a lot of ways now to use technology to assist in reproduction. We have fertility drugs. We've learned how to take sperm and egg outside the body and start life and dishes and then put it back sometimes into the place where the sperm and egg came from but sometimes into a wound that was not the in the body of the person who made the gametes available the sperm and the Egg. I did a study About two years ago on a topic that really should make us all think about why this theme where we going I'd found out when I was here in Minnesota that a request has been made to remove sperm from a dead person and I was wondering if that it ever happened and so I had a group of people at the University of Pennsylvania called up a slew of hospitals in Canada the United States, by the way. I see all of you giggling out there particularly women about taking sperm out of dead people, but I'm not casting any aspersions on their personal lives. It's just And idea you'll see why yeah, so you're getting there. You're moving to what did he say and on the radio? No less but when you think about it, it is possible surgically to have someone died and remove sperm. It can be done that I won't describe to hear but it can be done and it turned out when we called about three or four hundred centers around the country over 40 centers had received requests from people who had had a husband or boyfriend died unexpectedly to take sperm out of the body so they could have a child after the husband had died and this is not a situation where someone is dying of cancer or dying of some other terminal illness. This is a sudden Unexpected death a stroke. Well, I we did this survey and found out that many requests made but we found out a couple of other things. If you want to ponder the frontiers of reproductive technology and where we could go in one case a person had requested sperm and obtained it from her boyfriend and weren't married then no relationship. And as far as anyone knew the boyfriend had never expressed this made any views known about having a child with that woman, but the girlfriend had gotten the donation and it was obtained and put into a freezer basically it an artificial insemination clinic in another case to parents had made a request for their 15 year old son who had died in a swimming pool accident gone into a swimming pool and injured himself and died. Well, who would the recipient of the sperm be? And normally your mother gets to tell you to do a lot of things in life. But reproduction is not one of them is that an acceptable situation where parents would control obtaining reproductive material from a minor who couldn't give permission for this kind of thing. We're what might that lead. Well some of us in this room. I hope all of us, but some of us carry organ donor cards Should we change them and put on there? Do you want to donate sperm or eggs? Should you die unexpectedly to who so is that part of where we want to head by the way, we this has nothing to do with reproductive technology, but you might think in the land of transplants here in Minnesota most of you when you found out those cards also didn't think about arms and legs but that hand transplant in Kentucky opens the door to the question. We're going to be removing external body parts and transplanting them. Is that what you signed up for if when you signed your donor card, did you have that in mind or were you thinking more about livers and hearts and life-saving organs, but reproductive materials to as some of you may know we're getting pretty close to being able to freeze eggs. We can freeze sperm now technically it's an easier thing to do than to freeze an egg, but we're just about there when that happens. It's going to be possible to bank eggs. And so you could have a situation where a man and a woman died in a car accident a sperm and an egg is removed from both of them and a child is made from parents who both have died. Posthumously is that a good thing? Is that something we want to see happen in society? So in many ways reproductive technology has been pushing the frontier not only about what's in the interests of parents who might want to create a child. But what's in the interest of a child and I'll come back to that theme in a little bit to other things that have happened how many of you saw last week that there were ads placed in some school newspapers for egg donors offering $50,000 to a woman who was 5 feet 10 and had 1400 s 80s Minnesota would be the only place you could find this person. So I assumed that they were script but actually they didn't because they did one other thing. They only took out the ads at Ivy League schools and Stanford. So sort of an IV egg hunt and it was a couple who would retain this law firm and they had a particular idea about what they wanted. Well, you can ask a question. Should we be allowing people to sell eggs historically the phrase that we use and reproductive Technologies egg donor, if you're getting 50 thousand dollars, you've probably left the world of donor pretty far behind and you are in egg selling. Well, if you're going to sell things are we moving toward if you will the selling of babies if a woman who is 5 foot 10 and had 400 it sa 1400 SATs came out and said, I'd like to sell you this baby. We would arrest her you cannot sell children, but it seems as if these days were in a position where you can't buy you can't sell the cake. But you can sell all the ingredients you can sell your egg. You'd sell your sperm and you could rent your uterus and move to grow the baby in. Baby buying not. Alright when you buy the finished product, but it's okay to sell the ingredients there seems something inconsistent about social policy in this area other things that have happened and the reproductive technology or that ought to give us pause and perhaps concern three years ago a group of people at the University of California Irvine had couples come to become pregnant who were infertile sometimes a couple gets lucky and on a first or second try the have a baby even though they may have produced many embryos to store. They may only have to use some of those embryos and they get lucky in the woman becomes pregnant and they don't want the other embryos you might think of them as spare embryos or orphan embryos unwanted now not to be used by that couple. Well what the clinic director did at the University of California Irvine was decided to take some of those embryos for couples who couldn't make them and he and his associates made babies out of them. Brothers but they didn't tell the couples who had left the embryos there. So they made babies without permission. They also didn't tell the other couples that these were embryos that came from people who had left them there whose identities were known. Well a whistleblower decided to blow the whistle. In fact, I played a little role in this because she flew to Philadelphia the box of records and met me in a hotel room and said, I think there's something going on at the clinic that's not good and I looked at him and she said do you think it's unethical and I said, I think it's illegal we've transcended past ethics. We're at the level of the district attorney here and that's what happened. But there are still no laws to prohibit someone from stealing an embryo and making a baby without consent of the couple or persons who created it. About two years ago. There was a man named Jonathan Allen Austin in Allentown, Pennsylvania. Not far from where I am in Philadelphia. He was 26. He's 27 years old at the time fertile single men. He decided he wanted a child. He hired a woman to be a surrogate mother for him. The woman was paid $20,000 deliver the baby to Jonathan Allen Austin, then Jonathan Allen Austin about four months later killed the baby. So he's in prison. Now, it turned out that he had a long history of psychiatric problems. The people who negotiated the contract didn't do much of a screen to find out about him, but he was fertile what was going on here can anybody use reproductive Technologies? Remember some of the questions that you had up there presume perhaps that you were infertile and wanted to find out something about the risk that your child might face in the future. What if you're not infertile what if you're just interested in a better baby and you choose to go out and hire someone to be a surrogate or an egg donor or a sperm donor, but you're not infertile. There are people I know for a fact out in California who decided not to interrupt their movie careers and if hired surrogates to deliver their children, but they're not infertile. It's just not convenient for them to deliver that baby and it risk taking time off from Project tell you one other tale about reproductive technology. How many of you remember the lady in California who had 55 postmenopausal e used eggs and head quadruplets Well turns out that this lady was an interesting challenge because the clinic that work with her Pacific in fertility program in California said, we carefully screen all our people and we wouldn't use anybody who wasn't a fit parent. Well, it turned out that this woman had no money no house. And in fact had been married six times and each one of her husband's although this may not be all that telling was quite willing to testify that she was quite cuckoo in technical medical terms. One of the babies died from prematurity at Birth and she turns out to be kind of on welfare looking for someplace to live with the three other kids not the most intense screening process ever seen to decide whether someone should have for babies. I would add that if you were trying to adopt for babies, you'd never get this far you never be able to do what has been done by if you will paying so what's going on. That's what I want to spend a few minutes talking about next having told you about some of the stranger otter more bizarre aspects of the world of reproductive technology. We don't have any laws. We don't have much in the way of Regulation. The infertility programs and Clinics are regulated so that the Laboratories have to meet standards and things are done if you will hygienically, but it really is up to individual clinics to decide if they're going to take a sperm from a dead body or let a 27 year old fertile man hire a contract with a surrogate mom or LED a 55-year old lady use donor eggs to make multiple pregnancy. There's no regulation or rule no constraint there. We've even had situations where people have stolen reproductive materials and made children and yet still no regulation legislation or any kind of guidance coming from society about what to do. Well, why is that is it because we can't figure out ethically what's good or bad or Better or Worse here? I don't think so. I'll mention a couple of reasons why nothing has happened yet in the reproductive technology area of I think you can hear from the way I'm talking about having people made after both your parents are dead and Starting to get into Eugenics issues about would you start to let these Technologies be used by fertile people just to make better babies. The $50,000 egg sale we ought to be doing something. So why haven't we done anything? I'll mention just a couple of reasons first Americans Americans really hate telling other people what to do when it comes to making babies. We just don't like to do that. We are very strong Believers in the right to privacy when it comes to making children. We don't have people in the bedroom. We've had abortion as legal not because we agree morally about it. But because we think it's a private decision about making children. Another reason that people have been loath to do anything about the reproductive Technologies. It is a big business. The last time I looked we spent four and a half billion dollars on infertility treatment the United States alone big business not looking for regulation the couples that want to use this technology often are not interested in roadblocks or obstacles. They know what goes on in the world of adoption and that can be a tough world, too. Navigate and they don't want to see those kinds of obstacles in their way. Probably the biggest reason is that people believe that there's a right to have children a kind of constitutional right a fundamental right of procreative Liberty and sometimes called. Well, I'm not persuaded by any of those arguments because I think something else has happened. What I think has happened is we're using technology at the frontiers of reproduction to try and Advance the interests of adults. And what we're not thinking about is what's good for kids what's missing morally is more attention to what's in the best interest of children when you use reproductive technology, we do understand that in the adoption Arena. We try to make sure that couples can afford to raise children that they don't have criminal or child abuse backgrounds before they can adopt. There's a lot of screening that goes on some of it perhaps expensive and intrusive but the goal is to do what's best for the child before you place that child. The reproductive Technologies could use some of that but what they're being driven Sighs what's in the interest of adult my right to reproduce don't interfere with me. Don't tell me what to do. Don't put obstacles in my path. I don't think that's the right attitude to take where might we see some intervention well in the case of this screening and counseling if you're single and fertile, it might be a good idea to say we have some standardized screening process to review with you to make sure that you're having this technology for a reasonable reason that you don't have a background like Jonathan Allen Austin of psychiatric problems that you're not somebody who's been a child abuser that you're not someone with a long criminal record. We should be looking to start to screen in that area. I think we should start reasonably to say it may not be a good idea to make orphans as a matter of public policy. If both parents are dead or the girlfriend is making a baby with reproductive materials from someone who is deceased, but they had no relationship that may not be a good policy public policy in the interest of children. You may be putting Children at Risk. If they don't have parents who are going to be responsible for raising them and caring for them in situations where you see people moving to use bod eggs or donated eggs, like the 55 year old out in California. You may want to put that person through some sort of screening or check to see what's going on. Can they parent reasonably and so on you might say before we get through the roof with the sale of sperm and eggs the $50,000 egg. Maybe we should set some limits on what can be paid. We've done that in human experimentation. You can't pay a subhuman subject $50,000 to get infected with cholera. You could say I'll pay you anything. You want to face these risk, but we can't we set limits on what we allow in the name of the market and we certainly are in a position to talk about that when it comes to making babies because we've already done it by Banning baby sales. We can extend that framework. So why not do it? Well, let me try and overcome a couple of those objections. I mentioned remember I said we value privacy and we value reproductive Freedom. Those are two big reasons why we haven't done anything Louise Brown was born in 1979 and there isn't a regulation in any state and any federal any Congressional or federal law governing any of this? It's just chugging along by what the market will Bear right now. Well the two arguments about privacy and Liberty to reproduce I think are flawed privacy is very important. But privacy has to yield to the notion of the best interest of the child. I mean, you can't stay private and do anything you want with your children. It's true that we have to overcome the presumption that meddling strangers and bioethicists and hordes of legislators know what's For their kid than a parent but that's a challenge that I think in some sense can be met when we're making babies in non-traditional ways. If you're going to have people making babies with other people's reproductive materials, you're going to have people making babies when the people whose reproductive material they are are dead. If you're going to have people making babies because they want to reach eugenic goals have a better baby and I think the government in the state and we have an interest in who's using that technology and what they're doing. So privacy is interesting, but I think when you're making babies and non-traditional ways, we have an interest and a right if you will as a society to step in there and try and shape that procreative Liberty. Well, it is true each one of us has a right to be left alone in our procreative habits. But that doesn't entitle us to the right to make a baby. Let me give you a crude example in recent months when I've been hanging around bars. I've approached many women and said I've a right to procreate of Liberty. I've read about it and I've decided that you young lady are going to be in the privileged position of honoring my right. This fails dismally becomes very obvious. It's a bad thing to do, but I don't have the right to a mate or to have children with anybody. I want even though I have this right of procreative Liberty. I can't get the state to go out and hire me a surrogate mother or say. Okay, if you want to have a child will give you the means philosophers would call this a difference between a negative right and a positive right? You do have a negative right to be left alone. People shouldn't intrude and tell you what to do in the bedroom and interfere with you but there's no entitlement to the means to have children. If you can't do it we could create one. That's what we talked about in Minnesota some years ago and people said will infertility treatment be covered as a benefit that's creating an entitlement to use infertility Services. We could create an entitlement to that. The government does have to hire surrogate mothers for people who for one reason or another can't make a baby. We could create all kinds of entitlements that way but it's a different decision and the fact that you have a right to be left alone doesn't mean that you have a right to be in. Don't make children in any way possible. So that's a confusion when people say I have a right to reproduce. It doesn't mean they can do anything. They wanted it doesn't mean they're entitled to anything they want. If you overcome privacy and you overcome this argument about reproductive Freedom, then I think you can move the best interest standard in and start to do what I was talking about and say it isn't in anybody's interest to allow someone to make a baby without their Express consent. You can't steal embryos and make them we haven't I haven't had much time to talk about it. But you know in cloning technology in theory, I could go around here collect your napkins get some cells and start making you and I wouldn't necessarily have to tell you I wouldn't need your permission. I just have the cellular material. It was left on a napkin when he wipe your mouth and I could clone something from it. Well, my argument would be no one should be making anybody in reproduce without their express permission that wherever that genetic material comes from whether it's in sperm or eggs or cells you have the right to consent. Before someone makes you reproduce those people who died the girlfriend who said well, I don't know if you wanted to have a baby me with me, but give me his sperm. I would say that's wrong. You shouldn't be making people reproduce who didn't give explicit permission and that might mean actually changing those donor cards to say yes, I would do this with my wife if that's what she wants to do or no. I would never do it or leaving some kind of advanced directive behind filling out something saying, yep. That's alright with me or no. It isn't. All right with me control over your reproductive future seems to me to be a core element of where legislation and government policy should be headed. It isn't going there embryo theft people murdering babies problems coming up about $50,000 egg sales. None of this has triggered the push that I think is long overdue to shape the reproductive Technologies. Am I an opponent of them? Absolutely not it's hard to meet an infertile couple who finally had a baby and think that there's not a lot of good that has come from this but These Technologies are pushing in directions that we really have to start moving law and public policy to catch up add to it. And this will be the second theme. I'm going to talk about much more briefly what we do in genetics and you can see what's awaits us. The reproductive Technologies. Let us start life in a dish take genetics. What happens is it's possible now not only to sample your cells to see what your risks might be. But you can also sample cells from an embryo. We know that we can take cells off an embryo now and see what its risks are going to be in terms of health or behavioral problems in life. And as we begin to learn more and more about our genetic makeup more and more tests are coming online like breast cancer testing or test for depression where there is a strong link to our genes will be able to forecast more about what's going to happen to us. Well, if you can start life in a dish and you can test things in genetic sense that begin in a dish what's going to happen is we're going to Ace a very interesting challenge very soon and this is the other reason we've got to start moving our law and public policy pretty soon. We're going to be making babies. Well think of it this way the natural childbirth argument will be a little different. It's going to be should a responsible couple make their babies in some yucky uterus without appropriate testing and who knows where that uterus has been. Or do you make it in a dish started off with the best possible environment genetically test the propensities of the embryos toss out the losers whatever they are and then begin to grow it artificially and the other technology that's already here. You can look for it in the hospital every time you see a neonatal unit. It's a gigantic artificial womb. That's all it is. It's just spread over an entire floor. It's a begins to miniaturize and is the techniques come on board for going past 24 weeks, which they will by finding out how to support lung function. That's the obstacle now child without lungs can support but if you had fluids that you could put the child into an immersive like it would be in the amniotic fluids of when a woman is pregnant. You'd push that well this is all going to come together and that's what the natural childbirth fight is going to be. I would predict within the next 10 years. We're going to see the possibility of Designing our children by genetic testing starting them in a test tube and growing them in an artificial environment versus natural birth. We were headed the technology ports are all there. That's what test tube technology is genetic testing is and neonatal units are when they come together. We're going to face a very interesting question about what's the best thing to do to make a baby? My prediction would be in a competitive Society like ours which wants to give its kids the best start and parents who feel like they want an advantage or an edge. It's going to be a lot of interest in that artificially created Baby made under artificial circumstances to get that better start if we don't like that scenario, if we don't like that future starting to regulate and control where reproductive technology is now is what we ought to be doing if we continue to say, it's all reproductive Freedom. It's all privacy and let the market sort it out. I don't think we're going to be in a very good position to control. What awaits us. Well that leads me to my last comments before we get to some questions that's about cloning which is obviously an interesting way to make people different from starting them in test tubes. As you know, Dolly style cloning lets you make Theory whole organisms from the DNA that you find in any cell in your body at a meeting recently with Pennsylvania legislators, and I was trying to figure out if they were ready to deal with cloning. So I asked them where are your jeans about a quarter of them think they were in their brains, which I thought was a very optimistic evaluation. And about a quarter of them thought they were located in what I would call their nether regions. And then about fifty percent had no idea. Now as you all know, I'm sure they're located in all the cells of your body except. Hemoglobin doesn't carry DNA and you've only got half in your sperm or eggs, but every cell is a source of DNA. Well, if you don't know where DNA is you don't know where your genes are you're not really ripping ready to go to start regulating human cloning. But so there's some room for improvement here, but We are certainly in a position to start to ask. What would be wrong with you man, Clooney. I mean, we don't have a lot of argument these days about giving birth by cesarean section, although Society once did and said is that natural? There are many people who've had test tube children. There may be some people in this room who are test tube babies are they different or fundamentally somehow less you Min or less entitled to write to me. There's nothing interesting about being a clone except that you originated in a different way. I've never wondered whether clones would have souls. They're clearly people. They clearly are made in a different way, but they're individuals their persons are going to become adults. There's no argument about their individuality or spiritual nature or entitlement to rights. I don't think that's what the issues are. But I think there are some issues there when cloning was first announced. It was really funny to watch The Press coverage and I know that Jeff Khan whose director at the you has spent a lot of time thinking about some of the ethical issues in cloning and I was very interested. This but often times those poor old humble bioethicist get blamed for sort of coming up with all kinds of nutty scenarios that scare people when you think about the ethics of what's going on. Actually the scientific Community came up with a wonderful set of nutty scenarios all by themselves, when dolly was first announced the three I saw were we've got to worry about cloning because we might be able to live forever. We have to worry about cloning because we could make armies of terrible people who would attack places like Washington DC that actually had no sympathy so they began to relocate talk about Des Moines and Well, she can places like no one cared if they attack Washington DC and then a third frightening scenario was that you could recreate the dead maybe bring back at off Hitler or something like that or a child who had died you could have them back again. Well, none of this made any sense. And by the way, none of it speculated on by bioethicist, but as people begin to talk about this, you can't be immortal by being cloned because all that happens is you're going to make a copy of yourself, but that's not you anymore than if you have a twin or triplets, they're not you either you're going to feel a little bit disappointed. If you find out that you've died and your twin is still alive and people say well he's still with us. I mean that would leave you a little, you know, sad to find out that people had confused you with your twin. You're not gonna be able to recreate people because you're making new people in an unusual way but their traits and properties aren't going to turn out to be the same unless you raise them in the same environment that you were in so that's not going to be a way. Recreate people from the past and if you want to make armies my suggestion is you go hire them. If you try and breed them. I'd bet on adolescents over genetic breeding programs. Any day. You raise somebody to be a philosopher your kid and you know what, they're not going to be right away. So if I breed you to be a militant Soldier killer, I know I'm going to produce, you know, Hari Krishna types at the airport. I mean, there's no way that you can sort of Drive children to do exactly what you want. Not because their genes don't predisposed but you've got to deal with their development their growth their Free Will what emerges from these people so I'm not worried about any of those things but there are two things. I want to mention to you the tie-in to the reproductive technologies that I do worry about what is wrong with you man cloning might be this if you're made in someone else's image and that person is an adult from where the cells come from and you see what happens to you in terms of your behavior your appearance and certain genetic traits are known to you then your May be limited because you find out things about what you're going to be like into the future that you may not want to know. So if I clone someone and they look like me and they you know, suffer from certain diseases or have certain behavioral traits. Then I'm taking away some of the openness of my offsprings future because they are it's like being in the greatest genetic test of all time. You're going to see every trait not just breast cancer, or would you want to know if you were going to get Alzheimer's you're going to know all sorts of things bald at 40 and stomach cancer at 50 and depressingly boring at 70 and on and on so you're going to see all these things and it's going to limit who you might be doing things that limit a child's future seemed to me to be that seems to me to be a ethical principle. We don't want to violate don't make a child worse off don't hinder someone and similarly if you make someone out of vanity or love and you say well, I think I'm going to make a clone because having looked at the human population. I'm about the best you can do so I'll make one another of me. This is another thing not to try a date boars when you're meeting people. You're also saddling somebody with a bunch of expectations. You will be what I want. I think about that a lot when I think about the $50,000 egg donor the couple spent $50,000 and you know, you can't guarantee. There's not going to be a birth defect. You can't guarantee that you're going to get out of the combination of genes a little 1400 scoring five foot ten person height is notoriously subject to environment and genetic mixing. Are you going to say well we bought you to be a little genius and you're not one so we don't love you or how come you're not g we expected a child who's very smart and we got a child with Down Syndrome. Are you going to layer on expectations? Are you going to layer on a kind of weight to a person because you've made them to be a product and that's the other principle. I want to lay out which I mentioned earlier about reproductive Technologies. I don't think we should be treating the creation of Life as a market phenomenon. I think it has to be more than that. I think it needs to be treated with a set of moral principles. Don't disadvantage the child. Don't make someone worse off don't reproduce without consent. Make sure that the people who are using these technologies have been through some sort of screen or counseling so that you know that they're up to the job of parenting those sorts of principles. I think have to be put into the genetic and reproductive technology mix in order to show that reproduction is special in order to show that the creation of new lives of special and most importantly in order to protect the best interests of children if you layer somebody with Burns and expectations, if you take their future away, if cloning does that I'm not saying it does it's just a worry but if it does do that I think we shouldn't have it. We should ban it not because people wouldn't want to try it but it may not be in the interests of the child. You may make them to it may be too onerous to go through life in someone else's image when they're aging and changing ahead of you and when they've layered all their expectations upon you it's bad enough to be told by your dad everyday be a doctor be a baseball player. It's another thing to be bred to be one and then have to decide whether or not you're going to be able to set out your own life and make your own choices that way. So what I'd say about the reproductive Technologies making babies and integrating them into the new world of genetics is believe it or not. There's a lot of good that's going to come out of these areas. We're going to be able to diagnose illnesses and treat them. We're going to find tricks around mother nature to help couples who can't make babies who really do want them and will love them and raise them just like any other child there may even be ways in which we can use these Technologies to try and Shaping and modify Behavior so that someone can avoid an illness in midlife or later in life by knowing early on that certain risk factors of their I wouldn't turn back at all from the reproductive and genetic Revolution. I really wouldn't but I'm very nervous that what we're doing now is we're afraid to say anything if no rules. No regulations. No principles. No consensus, nothing happening and what we're doing and you can see it everywhere is we're turning it into a business was the $50,000 exhale with I hire the surrogate for whatever fee I can charge no matter what reason that is and you stay out of my way every place you look the business ethic is what's driving reproduction and I think we owe it to children to do more than that. Thanks. Well, I think you're going to circulate a little bit. We are indeed. Thanks art and for our Radio audience, you're listening to Arthur Caplan the director of the center for bioethics from the University of Pennsylvania speaking to the Minnesota meeting on the station's of Minnesota Public Radio. We have a first question here from Gary Hanson, who is the senior vice president of marketing at st. Paul companies Dr. Kaplan. The United States is a is an island and a much larger. See obviously is anything going on on an international basis to address the development of a framework to be able to attack these kinds of issues. Number one. And what what particular challenges do you have on the international scene that that go to things like differences in value sets and and cultures. That's a great question. First of all some countries because of history have banned a lot of what I'm just talking about. Germany will not allow genetic testing of embryos. It's almost impossible to get infertility treatment unless you're a married couple in Germany gay people single people know, Those people would be allowed to do it and certainly cloning has been banned in Germany and least 19 other countries have said no cloning. No human cloning whatsoever. So a number of countries have taken those steps. There are some steps going on at the Council of Europe level to try and shape these Technologies and I'd say in the reproductive area. We're the ones that are pushing hard for the market places like the United Kingdom, Canada, Australia are trying to set out a little more regulation and oversight of what's going on standardization and international policies a must in this area. It may recall one of my favorite figures from the world of cloning Richard seed had the best name in bioethics. Who's the guy who said I'm going to clone a human being in fact, he keeps saying it most recently he told his 75 year old wife. He was going to clone her and I guess she lacked enthusiasm. So he's dropped that idea now. He's back to cloning himself because he was going to make her carry the pregnancy to which I don't think was. As exciting a prospect for her as it was for him. Well Richard c 2 turns out is probably the last person anybody in this room has a better chance of cloning. Someone and Richard seat. I mean just you know home cloning kits would get your fire that Richard seed has no knowledge. No money. No friends. No, he just isn't going to be the guy but somebody could run off to an island or get a nation or some place to accommodate them. So you really do we can't continue to believe that if we ban it or we allow it or we take an attitude toward it that we're setting policy for the world. We're not and we've really got to start taking this as an international issue and start to negotiate at the World Health Organization at they with other technologically capable countries. Plus I haven't said much about this but there is even a biological warfare aspect to some of the things that go on in genetics and you want to make sure that you're not because of the medical applications are not losing sight of the military applications if I want to be And the creation of new microbes or agents that could be destructive that requires International agreement as well. Not much happened in there, but it had to be pushed if you let me I'll just add one other thing. It's a hobby horse of mine. I think the other thing we should be doing is on an international level trying to push bioethics into our high schools in into our church and religious groups. There's no reason why these issues were talking about shouldn't be in the curriculum of all these different countries. There's been almost no real effort to support by industry or government anyplace good bioethics curriculum work and I think that's the other place to get this going is to let younger people think about it. They're interested. They're going to face a lot of these challenges and they should have parts of classes or their teachers should know where the resources are to go move on this. So I think that would be another assist in the international areas to get young people talking to one another internet website that that kind of way. Thanks very much to our next question is from Bill Hoffman from the University of Minnesota. Dr. Kaplan with a public apprehension about cloning be any different today. If Mary Shelley had written about say a secret garden instead of a monster of human creation two centuries ago. Well, I'm tempted to say certainly the Pennsylvania Pennsylvania State Legislative delegation is apprehensive. They don't know anything about Mary Shelley or wear their jeans are so they took nothing to terrify them. But of course that would be casting aspersions on politicians, which wouldn't do in Minnesota. I think that the myths that come to us almost from the Greeks of arrogance and the misuse of knowledge Prometheus myths and what we see when we look at even Legends in the Bible about what happens to people who push their knowledge Even Adam and Eve eating the Apple. I think these are deep-seated worries that human found ability and to some extent greed or human nature is such that you can't trust one of the things that a senator said not too far from here Tom Harkin was that once science gets going you can't stop it. There's nothing to do. The cloning because it's out of the bag and it's sort of going to go where it goes. He had this kind of Gulliver model of science kind of squishing everything in its path as a sort of stomped around the countryside. I actually believe that science technology medicine or great things and I'm not I said a number of times I wouldn't argue for turning back. I think a lot of the European attitudes about things like genetically engineered foods are silly. They don't make any sense in a world that short on food. You want to sort of use this to get food? But no, I think that the Miss go deeper. I don't think it's the science fiction or the Frankenstein but I think they represent deeper impulses cultural mistrust of how we apply and use knowledge. That seems very powerful and I think what we ought to do then is move toward setting a framework. Ethically that helps us feel that we're at least thinking deliberating reaching consensus on where we're going to go all too often when I'm at a party or an event. Somebody says gee I just heard that a 55 year old lady had quads or someone transplanted. And it's almost like well it's done. I guess even the way Dolly happened sort of announced post facto not debated as to whether we thought this was a good idea. So I think being proactive is the way to make progress here, but I think those fears have to be addressed. I'm a little nervous. We may lose some of these benefits if we kind of keep going the way we're going now with no deliberation. No discussion. No consensus being reached. Thanks art. And we have a question here from Bert Schechter who is vice president of architecture and engineering a date and Hudson Bert. Thank you, Dr. Kaplan. You touched earlier briefly on the concept of creating organs from fetal tissue. Could you discuss about the status of technology or overview for us briefly and any of the ethical implications you see in that area? Well, that's the next Minnesota meeting topic growing our own parts and how we deal with things like what are called pluripotent cells. It turns out that not too long ago. Some of you have been reading about stem cells and we're having a debate in Congress about whether it's all right to take cells that come from embryos often obtained from abortions that have the ability to become all the cells of our body if you think about it to put it in English when you've got an embryo it has to have the ability to turn into everything livers and skin and head and brained. It's somehow in there are the instructions that are going to let it unfold into all the different parts of us that we know is adults. We've identified what we scientists have identified where some of those crucial cells are and if you can pull them out of fetuses or embryos and grow them you in theory could give directions that would say become a brain cell become a liver cell become bone marrow stem cell. I think we're going to be going in that direction. There are certainly those who would say it is a moral as all can be to deal with anything that comes from abortion and you might be dealing with both tainted morally tainted materials and you might be encouraging something that many would find immoral the practice of elective abortion. But my hunch is the rewards in a pragmatic Society of being able to grow these tissues and use the medically are going to overwhelm not arguing. This is the ethical thing. I'm telling you politically. I think it's going to overwhelm objections. The other thing to do is to clone cells and even if you don't start with these magical pluripotent things that come from fetuses, you still can grow other kinds of cells just by learning to clone them and well, I think the human cloning is fun to talk about it doesn't have much of a future. I mean if you think about it people are going to find it a lot more interesting to make babies with someone else than they are going down to the old test tube placed a bruin up on their own. So I thought I'd bet on sex over, you know Richard seed but what I do think is true is that we're going to see a lot of cloning of cells and the kinds of cells that are going to be cloneable or the ones that don't require us to make things that have a lot of shapes and structure are not going to grow a heart too easily in a dish. It's got you know, all kinds of three-dimensional shape that has to be there but growing a sheet of skin cells growing a sheet of stem cells growing blood that was viral free. No hepatitis risk, no mad cow disease no cjd disease that's eminently possible. And that's where the that's where the technology is going to go. I see a lot of fighting about To the use of fetal tissue still but I think the politically we're going to use it and I think cloning technology is going to have its application at the cell level and that we should be arguing about the economics who should control it who should sell it. Do we want to have it more publicly available or is it just going to be sort of the way we traditionally deal with new things and pharmaceutical and biotech. Whoever makes it sells it for what they can get. We may go in that direction too, but I think that's where the action is going to be. Thank you. We have time for one last question from Amy headed from Creighton you to Creighton University. Would you apply the same argument that you proposed against cloning that it would hinder who the person will be to susceptibility genetic testing. And if not, why not? Well, we had that breast cancer question up there. If you had a test that would reveal susceptibility to breast cancer. Would you use it and would you think about ending pregnancies and so on and I'd say unless you have a clear-cut danger of an immediate health risk susceptibility. Testing is a tricky thing to be using why well, I told my students at Penn this and they hate to hear it but genetic tests is something that everyone will fail why because everyone of us going to die from something. We all have a genetic risk of something. The happy news is we just haven't found yours yet. Breast cancer may be what you're going to die of but prostate stomach cancer dementia else. I mean everything has a sort of Jeanette even if you get killed because you have bad Vision that probably has some genetic component. So finding out that your susceptible is almost like finding out that you're not Immortal and at the level of embryos and children. I'm leery at our place. We will not test children and we don't do embryo testing now, it can be done in other places. They haven't found those policy follow those policies, but we don't and so I would in a sense be consistent and say unless there's a cure unless there's something to do for the person I would be very leery of doing susceptibility testing for children and fetuses and embryos at this point if you had clear conditions that you've identified, okay, but just risk, World is a funny Place full of risks got a lot of moral people in it finding out that your child is going to die someday, maybe disconcerting but it's probably something that we're all going to have to live with. Okay. Thanks Arthur Caplan who is the director of the center for bioethics at the University of Pennsylvania speaking today at the Minnesota meeting held in Downtown Minneapolis. The official title of Arthur Caplan speech was the ethics of making babies and other moral dilemmas in the Brave New World of medicine broadcast, Minnesota meeting are supported by Oppenheimer wolf and Donnelly LLP with offices in Minneapolis. St. Paul and at www.olivelawfirm.com owd La w.com providing legal services to businesses around the world. If you missed part of Arthur Caplan speech by the way will be rebroadcasting our Minnesota meeting at 9:00. Tonight here on Minnesota Public Radio. So second chance to hear from Arthur Caplan on baby-making and other moral dilemmas that were facing these days rebroadcast at nine o'clock tomorrow on midday a little uncertain what we're going to do at this point. It looks like we'll hear from the chairman and CEO of America online. One of the preeminent internet services Steve case spoke recently at the Commonwealth Club about where the internet has been more importantly where the internet might go. It's his argument that the promoters of the internet have have succeeded to a point. They've certainly established the internet as an integral part of many people's lives and everybody else will soon be logging on the question though is what to do with this with a service future of the internet coming up probably coming up tomorrow on our midday program now in case you missed it good news from last. Take course. We had our membership Drive last week and boy did things never turn out well over 7000 of you called in with membership pledges many of you with the first time new memberships. We shot right past our goal of $725,000 official figures not available yet, but we made our goal surpassed our goal and we'd sure like to thank all of you who called in also a special thanks to the hundreds of volunteers who help during the drive as well. Quite a membership drive and all accomplished in much less time than we used to do. So your theory that we could raise all that money and less time if we simply made the case and got the phone number out. You turned out to be correct? Keep an eye on the weather. There's a winter storm watch and warning in effect for southern Minnesota this afternoon and tonight with lots more snow and blowing snow likely blowing and drifting could cause some driving problems. So so do take care Gary eichten here. Thanks for tuning in today. On Mondays All Things Considered they escape southeast Asia with their lives and little else decades later. Minnesota's Hmong are still adjusting to their new home. It's all things considered weekdays at 3:00 on Minnesota Public Radio. KN o WF M 91.1


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