SYNOPSIS

The numbers of patients seeking plastic surgery has skyrocketed in the past decade, and this practice has found increasingly uncritical acceptance. Plastic surgery is commonly subdivided into reconstructive surgery and cosmetic surgery. Reconstructive surgery seeks to restore form and function of a defect in the body, and therefore is a positive moral good that mitigates the effects of the fall. Cosmetic surgery differs in that we are seeking to augment otherwise healthy tissues to improve appearance and self-esteem. Looking through the light of Scripture, I do not believe we have license to condemn all forms of cosmetic surgery. We should be discerning, however, regarding our motivations for pursuing cosmetic surgery. First, we should be careful if our motivations for surgery are principally to increase our self-esteem. The evidence shows the long-term effects of cosmetic surgery are not universally positive, and we should be esteemed not based on our own image, but the image of the God who created us and died for us. Second, we should consider whether our goal for surgery is to normalize our appearance or to enhance our bodies to approximate a perfect ideal. If cosmetic perfection to increase the attention others give us is our motivation, we may not be adhering to the principle of biblical modesty. Last, surgical enhancement supports the idea that our bodies are ours to modify without limit.

As an oral maxillofacial surgeon, one of the surgeries I perform is corrective jaw surgery. Corrective jaw surgery is performed by fracturing wrongly aligned upper and lower jaws and fixating them in their proper position. When orthodontic braces are unable to place teeth in their proper position for correct function, surgery is often recommended to align teeth and achieve a correct bite. Although primarily functional, there is unquestionably a cosmetic aspect to the surgery. A quick perusal of the available patient information given out by doctors and their practices shows a number of before and after pictures demonstrating a positive aesthetic change after the surgery.¹ In discussing the ethics of plastic surgery, I wish to contrast the experience of two of my patients.

The first young woman presented with a lower jaw too short, an upper jaw too narrow, and her front teeth did not touch. In other words, her bite was very misaligned. She also complained that her chin was “way too big.” I explained the treatment plan, addressed her problems, and showed that the planned surgery should also help her chin to look smaller. We performed extensive surgery on both jaws so her teeth fit properly together. After she recovered from the procedure, her bite was functioning ideally, and she was overwhelmingly happy about her physical appearance. She then moved out of town and we lost contact for a period of time.

Two years later, she returned to my office. She unfortunately had been having complications from her surgery. The movements we made to her jaws showed evidence of surgical relapse, so her teeth no longer fit correctly together. She was also experiencing some pain in her jaw joints, but the aesthetic changes brought about by the surgery had not changed. In other words, she was still very satisfied with her appearance. I gave her options for more corrective surgery, but she smiled and told me that even if her pain increased tenfold and she could no longer enjoy a steak, the surgery that I performed was the best thing that she had experienced. She was now so happy with her appearance that she was not interested in having her functional issues addressed.

Shortly after, I did another jaw surgery on a second woman who was slightly older than the first. She also had a bite that was misaligned, but not nearly to the extent as the first patient. She had very few complaints about her physical appearance. I performed conservative surgery on her upper and lower jaws, and placed her teeth into an ideal position. After her initial recovery period, she returned to my office quite upset. Although her teeth fit together perfectly, she felt that she “looked older.” We compared the before and after surgery photographs and there was no discernable change in her appearance. From every objective standpoint, the surgery went exactly as predicted with no complications. However, she was still very disappointed with the outcome, and soon left our practice.

These two stories illustrate some of the challenges we have in evaluating the ethics of plastic surgery. Which surgery, for the two women that I treated, was successful? The first did not correct the functional problem but the patient was happy. The second corrected the functional deformity perfectly but the patient was unhappy. Should we base success on how well a surgeon corrected the pathology or how the patient feels about herself even if the pathology is not cured? Is our goal as surgeons to correct deformities or give our patients greater self-esteem? In other words, should the goal of a surgical procedure be to correct a physical problem or to change our physical appearance to correct a psychological one?

A BRIEF HISTORY

Plastic surgery is not new, and most of the techniques that are used today were developed by treating wounds sustained by soldiers in the two world wars.² The term “plastic” surgery comes from the Greek word plastikos, which is to mold or shape. Plastic surgery itself is subdivided into reconstructive surgery and cosmetic surgery. Reconstructive surgery is performed on abnormal tissues of the body in order to improve form and function. There is an aesthetic component to many reconstructive procedures, but the main goal is to restore the general function and appearance of the abnormal tissues. Examples of reconstructive surgery would be cleft lip/palate repair or breast reconstruction after a mastectomy.

According to the American Society of Plastic Surgeons, cosmetic surgery “is performed to reshape normal structures of the body in order to improve the patient’s appearance and self-esteem.”³ Examples would be a facelift or breast augmentation. These are not perfectly distinct categories, and there are a number of procedures that lie between strictly reconstructive or cosmetic in nature. The important distinction is that cosmetic surgery does not attempt to cure any deformity or abnormality, but serves to make someone look more attractive.

There is no question that the popularity of cosmetic surgery has skyrocketed in our lifetime. Shows such as Dr. 90210 and Nip/Tuck bear evidence of our changing attitudes, and cosmetic procedures have become increasingly commonplace and uncritically accepted in our culture. According to the American Society of Plastic Surgeons, the numbers of breast augmentations have risen more than eight hundred percent in the past fifteen years.⁴ Despite the fact that most cosmetic procedures are not covered under medical insurance programs, Americans spent more than ten billion dollars on cosmetic surgery in 2008.⁵ This increase in popularity was not limited to adult patients. There has been a great increase in the number of younger patients contemplating cosmetic surgery.⁶ In fact, the number of cosmetic surgical procedures on patients eighteen and younger tripled from the ten-year period between 1997 and 2007.⁷ Controversial procedures in this age group, such as liposuction, increased greater than three times, and breast augmentations increased more than six-fold during the same ten-year period.⁸ It is very likely that we personally know of someone who has had cosmetic surgery, and increasingly likely that our teenage children have peers that have elected to have their growing bodies surgically enhanced.

THE ETHICS OF RECONSTRUCTIVE SURGERY

Christians believe that human beings are created in the image of God. One of the consequences of the Fall is that we are subject to sickness and pathology. God, in His mercy, gives the human race the ability to subdue the creation and mitigate the effects of the Fall. The main purpose of medical science is to treat sickness and disease, thus helping to alleviate suffering. This is not only the case for surgery, but for all other types of medical treatment.⁹ Reconstructive surgery is simply the application of this principle when there is a pathological, congenital, or traumatic defect. Since the goal in reconstructive surgery is to restore form and function to damaged tissue, this type of surgery is a moral good. For example, to treat breast cancer, many women will need mastectomies to remove the cancerous tissue. Reconstructing the breast in these instances is an attempt to restore normal form and function. Although there is unquestionably an aesthetic component to this decision for many patients, the primary goal remains to restore the body to its previous nonpathological condition. Another example of this surgery is cleft lip and palate surgery. A cleft lip or palate is caused by a disruption in fetal development that results in a very obvious defect of the lip and other facial structures. The surgical correction consists of multiple surgeries to reapproximate the facial structures to their proper function and, whenever possible, their proper form. This is true of virtually all forms of reconstructive surgery.

THE ETHICS OF COSMETIC SURGERY

Cosmetic surgery differs because there is not a restoration of pathologic tissue, but an augmentation of healthy tissue. There historically has been controversy regarding cosmetic surgery because it was seen to corrupt the natural body-self relation.¹⁰ This argument, however, as well as the stigma behind cosmetic surgery procedures, has largely faded from our culture. Does the fact that we are operating on otherwise healthy tissue make cosmetic surgeries unethical in all circumstances? I believe there are a number of reasons why we should not make this blanket condemnation. First, there is no specific biblical prohibition against changing the appearance of our physical bodies. Second, we do not consider other means to improve our outward appearance unethical. For example, few would argue that all forms of makeup, grooming, and fashionable clothing are intrinsically immoral behaviors. In short, the freedom we have in Christ along with the guidance of our own conscience should lead us regarding behaviors that are not specifically prohibited. For this reason, I can find no reason to find cosmetic surgery intrinsically immoral.

Yet, although a specific action may not be intrinsically immoral or scripturally prohibited does not mean that it is profitable in every circumstance. We may be tempted, due to our sinful hearts, to engage in an activity for immoral goals or reasons. Our motivations for pursuing cosmetic surgery have an important impact on the ethics of the act itself. For this reason, there are some important caveats to consider when discerning the ethics of cosmetic surgery.

SELF-ESTEEM FROM A SCALPEL

A common thread through most of the plastic surgery literature is the concept of improving self-esteem through the surgical alteration of the physical body. A Web site designed to help you find a plastic surgeon exemplifies this when it claims to know “five reasons why plastic surgery will make you happier.”¹¹ Reason number one claims that plastic surgery lowers the need for antidepressant medication. Why take medication for your depression when you can treat it by having a surgeon make you more attractive? Reason number four states that “cosmetic surgery can add years to your life and boost your self-esteem.”¹² Who wouldn’t want to look better, have greater self-esteem, and live a longer life merely by having his body made more attractive?

Is cosmetic surgery really surgery on the body or on the mind? Sander Gilman reports, “Over the past decades people have turned more and more frequently to their surgeons rather than their psychotherapists in the pursuit of the ‘body beautiful’ to achieve a ‘healthy psyche.’”¹³ The goal of the surgeon is not to correct deformities, or even to reshape normal tissue into something more aesthetic. The real goal, and ultimate measure of success, is whether or not the procedure has resulted in the nebulous quality of “increased happiness” in the patient. Happiness, in this context, is not the classical notion of happiness, but a general feeling or emotion of pleasurable satisfaction.¹⁴

So has the increase in cosmetic surgery that we have seen resulted in an increase in personal happiness? Not according to the available evidence. A recent study in Clinical Psychology Review compared college students from 1939 and 2007. The study showed a six-time increase in the number of students showing symptoms of depression and “anxiety and unrealistic optimism” in 2009 as compared to the students during the Great Depression era.15 Although there are no doubt a great many variables other than cosmetic surgery that influence such a large increase in depression, the evidence isolating cosmetic surgery is no more favorable. One study showed ten years after having a breast augmentation, there was a threefold increase in the number of suicides compared to women who did not have breast augmentation surgery.¹⁶ A review study from 2004 looked at psychological outcomes for patients who were seeking cosmetic surgery.¹⁷ They found that patients who were young, had unrealistic expectations, had a minimal deformity, had previous surgeries, were motivated by relationship issues, or had a history of depression or anxiety disorders were far more likely to feel worse after having cosmetic surgery. There were patients who reported that they were satisfied with their surgery, but in some sense, the patients that were most in the need of a “happiness infusion” were the ones most disappointed with their cosmetic results. This was the case regardless of the technical success of their operations. Making someone prettier does not always make her happier.

Many patients who are dissatisfied feel more damaged than they did prior to the procedure. This leads them to continue to seek other operations in order to heal their damaged bodies, and frequently their minds. This practice, unfortunately, may be encouraged by other cosmetic surgeons, who promise to “fix” the mistakes the other surgeon caused. This may set up another unrealistic expectation that will not be met. This cycle is often referred to as plastic surgery addiction. Virginia Blum describes a patient named “Barbara” who has had numerous facelifts and other procedures in order to help keep her husband from continuing multiple extramarital affairs.¹⁸ She looked forward to seeing her surgeon, believing that he would take care of her, even if her husband would not. Her view of the surgeon’s role: “To rescue the fair princess, unlock the crone body in which she is trapped, [and] release her to her real and happy life.”¹⁹

This whole idea has wrought unintended changes in the doctor-patient relationship. Cosmetic surgeons no longer have “patients” for whom they diagnose and treat illness, but rather “clients” that demand happiness from the resculpting of their otherwise healthy bodies.²⁰ Even when a patient does not come in with a specific complaint, many surgeons are very willing to offer suggestions on how their skills can improve their appearance. Melanie Berliet, a five-foot-nine twenty-seven-year-old woman who had worked as a model, set out to find what a plastic surgeon would recommend to her.²¹ During one of her undercover consultations, the surgeon recommended liposuction, breast augmentation, reduction rhinoplasty, Botox injections in the forehead and Restylane injections into her lips. The total cost of the proposed surgery was $33,000. Berliet admits, “By this time my self-image is so battered that, had I the money, I sincerely doubt that I could refuse.”²² If a cosmetic surgeon is short on clients with self-esteem issues, he may simply create some.

WHOSE IMAGE SHOULD WE BE GLORIFYING?

 Examining this view in the light of Scripture shows that our self-esteem should not be based primarily on our physical appearance. Jesus Himself is described in Isaiah’s prophecy as one “with no form or majesty that we should look at him, and no beauty that we should desire him” (Isa. 53:2).²³ Human beings have intrinsic value because we are created in the image of God. Our value does not depend on, nor is it altered due to, the attractiveness of our bodies, “for the Lord sees not as man sees: man looks on the outward appearance, but the Lord looks on the heart” (1 Sam. 16:7).

There is no doubt that many consider themselves unattractive, either based on a disfiguring pathology or simply because they don’t “fit in” in our beauty-obsessed culture. Surgically changing the outward form of their bodies may in many cases increase self-esteem, at least for a time. There is no question that we can get an emotional lift when we believe we feel attractive on a particular day. The difficulties begin, however, when we become dependent on that emotional lift from our own attractiveness as essential to our value. Furthermore, when parents convince their children that cosmetic surgery is necessary for their self-esteem, the unavoidable message is that we are valued based predominantly on our outward appearance.²⁴

This is not to say that there is anything wrong with a desire to be attractive. Being a good steward of the body given to us is a positive good. There is nothing wrong with taking a glance in the mirror when wearing a particularly attractive dress or feeling satisfied with the results of a month-long workout program. I don’t believe there is any virtue in intentionally allowing ourselves to become unattractive, or in highlighting a particularly unattractive aspect of our physical self. The problem ensues when we value ourselves predominantly on the image that we see as we look into that mirror. If our motivation for undergoing a permanent surgical change is to increase the value we have in our own eyes when we peer at our image, then we are looking at the wrong image for our esteem. It is not our image that gives us value, but the God in whose image we were created. Regardless of how we look on the outside, this should not be forgotten.

NORMALIZATION OR SUPER-HUMAN ENHANCEMENT?

 There is another consideration in analyzing the ethics of cosmetic surgery. Cosmetic procedures run the gamut from the removal of a small benign “birthmark” on an infant’s forehead²⁵ to the many procedures that Michael Jackson is purported to have done. In examining the motivation behind these surgical interventions, it may be helpful to differentiate between two types of cosmetic surgery. A procedure such as the removal of a visible, unaesthetic birthmark is attempting to change a physical “abnormality” into a more normal situation. On the other hand, someone returning multiple times to multiple surgeons to get their nose “just right” is attempting to enhance their normal anatomy to some perfect ideal. We can visualize this by looking at a continuum with the concept of “normal” at the center, and “abnormal” and “perfect” at the extremes. Some patients believe they are on the “abnormal” side of the continuum and their goal for their surgery is to look “normal” for the first time in their lives. The goals of other patients are to enhance their normal-looking bodies in an effort to approximate perfection. The ethics of these individual motivations may differ.

There are nuances to this evaluation. An obvious one is who decides the characteristics that make us “normal”? If normal is culturally determined, the greater numbers of individuals having cosmetic surgery is moving the standard. The standard of “pretty” was always somewhat pliable, but now we have to contend with the greater number of surgically enhanced bodies to change that standard even more. Regardless, there seems to be delineation between those who seek cosmetic surgery to not draw attention to their appearance, and those undergoing cosmetic surgery for the reason to draw more attention to their appearance. Motivations for cosmetic surgery that go beyond “normalizing” one’s appearance are problematic for at least two reasons.

First, Scripture gives us guidelines on the principle of modesty. For example, Michelle Brock describes biblical modesty as “an attitude of humility that seeks to please God rather than man or self. It is characterized by self-control, and dignity in dress, speech, and actions.”²⁶ Having surgery in order to enhance our bodies to some perfect ideal is an attempt to draw more attention to ourselves and therefore may not be modest. Since ninety-one percent of cosmetic surgery is performed on women, there is a great chance that the motivation for beautification often encompasses looking more sexually attractive to men.²⁷ Unfortunately, we cannot choose whose attention we are drawing, possibly causing others to stumble and lust after our sensual bodies. In contrast, Scripture describes a woman’s beauty as the “the hidden person of the heart with the imperishable beauty of a gentle and quiet spirit” (1 Pet. 3:4). Once again, this is not to say that wanting to look our best is wrong, but that we should be cautious when our desire is to seek more attention or worth from our enhanced physical bodies.
Second, there is an ongoing debate in bioethics concerning the idea of human enhancement. The rapid development and popularity of enhancement cosmetic surgery is being used as a template to analyze how we may choose to augment our bodies in other ways in the future. Mary Devereaux states, “Cosmetic surgery thus provides a natural starting point for an investigation of the likely future of medical enhancement.”²⁸ If this is the case, then the future of medical enhancement will be based solely on our subjective standards of what we desire or what will makes us happy; at least until we need another enhancement to bring us closer to our idealized standard of perfection. Medical professionals may cease to exist to cure disease. They will instead use their knowledge and skills to make us more enhanced. The standard of success will be the subjective feelings of good we receive when allowing a physician to modify us. In other words, if the future patterns of medical enhancement follow the current trend of cosmetic surgery, we will gladly and voluntarily give up resources to receive treatments that give the promise of happiness. The late columnist William Safire stated: “Tomorrow we can expect a kind of Botox for the brain to smooth out wrinkled temperaments, to turn shy people into extroverts, or to bestow a sense of humor on a born grouch. But what price will human nature pay for these non-human artifices?”²⁹ Our voluntary attempts for superhuman enhancement may actually modify or remove characteristics that help define our shared humanity. This is a future that causes concern.

TURNING MEDICINE ON ITS HEAD

The modern concept of cosmetic surgery and its uncritical acceptance and popularity in our culture has turned some aspects of medicine on its head. For example, for years medical science has sought to eliminate food-borne disease. One of the more rare but dangerous food-borne diseases was botulism, which produced paralysis in the facial nerves and could become lethal when it spread. After isolating the pathogen that caused botulism, we began to use it therapeutically to treat illnesses such as muscle spasms and excessive blinking. The same toxin that caused lethal paralysis is now injected voluntarily as Botox into over two million patients a year in order to smooth out undesirable wrinkles. The same chemical that caused a dreaded disease is now used to paralyze completely healthy and functioning facial muscles and is the most common minimally invasive cosmetic procedure performed today.

What does this tell us about the culture that we live in? We live in a world in which physical appearance is so important that many individuals believe that growing old gracefully means injecting your wrinkled face with a toxic chemical. Our world unquestionably equates physical attractiveness with inner happiness and self worth. Should Christians acquiesce to this notion?

We will never find the perfect ideal from a surgeon’s scalpel or needle. The short-lived boost of happiness that we may receive from having our faces or bodies surgically augmented does not have the ability to satisfy the great longing for perfection that exists in our hearts. The only possible way to true happiness and perfection is to grow in conformity to the image of Christ, the Creator of all beauty and life.

Richard J. Poupard is a board-certified oral and maxillofacial surgeon in private practice in Midland, Michigan. He is a speaker for Life Training Institute and a frequent contributor to the LTI blog.

NOTES

1. For example, American Association of Oral and Maxillofacial Surgeons, “Jaw Surgery,” http://www.aaoms.org/jaw_surgery.php (accessed February 17, 2010).
2. Sander Gilman, Making the Body Beautiful: A Cultural History of AestheticSurgery (Princeton, NJ: Princeton University Press, 1999), 13.
3. American Society of Plastic Surgeons, Plastic Surgery FAQ: What is the Difference between Cosmetic and Reconstructive Surgery, http://www.plasticsurgery.org/Patients_and_Consumers/Plastic_Surgery_FAQs/What_is_the_
   difference_between_cosmetic_and_reconstructive_surgery.html (emphasis added) (accessed February 20, 2010).
4. American Society of Plastic Surgeons: 2009 Report of the 2008 Statistics, National Clearinghouse of Plastic Surgery Statistics, http://www.plasticsurgery.org/Media/stats/2008-UScosmetic-reconstructive-plastic-surgery-minimally-invasive-statistics.pdf (accessed February 23, 2010).
5. Ibid. The actual number of procedures is higher, because this source is only counting procedures done by members of the American Society of Plastic Surgeons. Many other medical specialists and even generalists perform cosmetic surgical procedures.
6. Bill Tancer, “The Young and Plastic Surgery Hungry,” Time, May 7, 2008.
7. Camille Sweeney, “Seeking Self-Esteem through Surgery,” New York Times, January 15, 2009.
8. Ibid.
9. A more robust version of this argument is found in Scott Rae, Bioethics: A Christian Approach to Bioethics in a Pluralistic Age (Grand Rapids: Eerdmans, 1999), 97-101.
10. Victoria Pitts-Taylor, Surgery Junkies: Wellness and Pathology in Cosmetic Culture (New Brunswick, NJ: Rutgers University Press, 2007), 17.
11. http://www.locateadoc.com/articles/five-reasons-why-cosmetic-surgery-makes-you-happier-1514.html (accessed February 4, 2010, emphasis added).
12. Ibid.
13. Sander Gilman, Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery (Durham, NC: Duke University Press, 1998), 24.
14. A deeper discussion of the concept of happiness is found in J. P. Moreland and Klaus Issler, The Lost Virtue of Happiness: Discovering the Disciplines of the Good Life (Colorado Springs: NavPress, 2006).
15. Jean Twenge et al., “Birth Cohort Increases in Psychopathology among Young Americans, 1938-2007: A Cross-Temporal Meta-Analysis of the MMPI,” Clinical Psychology Review 30, 2 (2009): 145-54.
16. L. Lipworth et al., “Excess Mortality from Suicide and Other External Causes of Death among Women with Cosmetic Breast Implants,” Annals of Plastic Surgery 59, 2 (August 2007): 119-23.
17. Roberta Honingman, “A Review of Psychosocial Outcomes for Patients Seeking Cosmetic Surgery,” Plastic and Reconstructive Surgery 113, 4 (April 1, 2004): 1229-37.
18. Virginia Blum, Flesh Wounds: The Culture of Cosmetic Surgery (Berkeley: University of California Press, 2003), 269-70.
19. Ibid., 270.
20. Sander Gilman, Making the Body Beautiful: A Cultural History of Aesthetic Surgery (Princeton, NJ: Princeton University Press, 1999), 4-5.
21. Melanie Berliet, “Plastic Surgery Confidential,” Vanity Fair, February 11, 2009.
22. Ibid.
23. All Scripture quotations are from the English Standard Version.
24. Blum, 1-5.
25. Manny Fernandez, “Birthmark Consultations Offer Answers, and Maybe Normalcy,” New York Times, November 15, 2008.
26. Michelle Brock, What Is Modesty? Discovering the Truth (Newberry Springs, CA: Iron Sharpens Iron Publications, 2005), 18-19.
27. Cressida Heyes and Meredith Jones, Cosmetic Surgery: A Feminist Primer (Burlington, VT: Ashgate, 2009), 3-4.
28. Mary Devereaux, “Cosmetic Surgery,” in Medical Enhancement and Posthumanism, ed. B. Gordjin and R. Chadwick (Cardiff, UK: Springer Science, 2008), 159-73.
29. William Safire, “The But-What-If Factor,” New York Times, May 16, 2002, 25.

First, the issues concerning cloning and abortion are inextricably woven together. In other words, the prevailing logic that permits a woman to terminate the life of a child in the womb may well equally apply to cloning. For example, if defects were detected in developing clones, abortion might well be the solution of choice.

Furthermore, producing a human clone would of necessity require experimentation on hundreds if not thousands of live human embryos. Thus, the entire process would be the moral equivalent of human experiments carried out by Nazi scientists under Adolf Hitler.

Finally, it should be noted that cloning has serious implications regarding what constitutes a family. While children are the result of spousal reproduction, clones are essentially the result of scientific replication. Which raises the question: Who owns the clone? It is terrifying to think that the first human clone might well be owned and operated by the very scientists who conduct such ghastly experiments.

For further study, see Hank Hanegraaff, The F.A.C.E. That Demonstrates the Farce of Evolution (Nashville: Word Publishing, 1998), Appendix E “Human Cloning” and also Appendix D “Annihilating Abortion Arguments”; see also The Center for Bioethics and Human Dignity, 2065 Half Day Road, Bannockburn, IL 60015, www.cbhd.org.

Job 33:4:
“The Spirit of God has made me; the breath of the Almighty gives me life.”

First, while an embryo does not have a fully developed personality, it does have full personhood from the moment of conception. You did not come from an adolescent; you once were an adolescent. Likewise, you did not come from an embryo; you once were an embryo. All human beings are created in the image of God and endowed with the right to life, regardless of size, location, or level of dependency. Make no mistake about it, extracting stem cells from an embryo kills the embryo.

Furthermore, while we should sympathize with those who suffer from debilitating diseases and injuries, cures and therapies must be sought within appropriate moral boundaries. Killing human embryos in the search for cures is tantamount to subjecting one class of people to harmful experimentation for the sake of another. To do so violates the biblical injunction against murdering humans made in the image of God (Genesis 1:26-27; Genesis 9:5-6), as well as the Nuremberg Code compiled by the tribunal responsible for judging the Nazis after World War II.

Finally, in light of the promising results of adult stem cell research, state funding for the destruction of embryos is not only morally repugnant but fiscally irresponsible. Stem cells extracted from non-embryonic sources such as bone marrow, blood, brain cells, and baby teeth are similar to embryonic stem cells in their ability to grow into multiple types of tissues. While embryonic stem cells used in research have demonstrated a tendency to grow into tumors, adult stem cells have already shown success in human trials for treatment of multiple sclerosis, sickle cell anemia, stroke, Parkinson’s disease, and more. The frightening conclusion is that the fervor over embryonic stem cell research is more a pretext for human cloning than a context for responsible medical progress.

For further study, see Charles W. Colson and Nigel M. de S. Cameron, Human Dignity in the Biotech Century: A Christian Vision for Public Policy (Downers Grove, Ill.: InterVarsity Press, 2004).

Proverbs 24:11-12:
“Rescue those being led away to death; hold back those staggering toward slaughter.
If you say, ‘But we knew nothing about this,’ does not he who weighs the heart perceive it?
Does not he who guards your life know it?
Will he not repay each person according to what he has done?”

First, there are major moral concerns associated with using biotechnology in place of the natural means for procreation. The fertilization of an egg in a glass dish can lead to viewing children as products to be made (and disposed of) rather than gifts from God. Indeed, IVF is already being used in the production and genetic selection of “designer babies.” It is imperative that we guard against subtle shifts in thinking that ultimately lead to the erosion of our Christian worldview.

Furthermore, the introduction of third parties through sperm or egg donation or through surrogate motherhood is inconsistent with the biblical pattern of continuity between procreation and parenthood (Genesis 1:28; 2:24). Accordingly, if IVF is used at all, the sperm and the egg must come from the husband and wife committed to raising the child. The potentially disastrous consequences of third-party involvement are clearly demonstrated in the lives of Abram, Sarai, and Hagar (Genesis 16).

Finally, because it is an established scientific fact that human life begins at conception (an embryo has a distinct human genetic code and exhibits metabolism, development, the ability to react to stimuli, and cell reproduction), discarding embryos or destroying them through experimentation is the moral equivalent of killing innocent human beings. Freezing embryos is likewise morally objectionable. Thus, if IVF is used, no more eggs should be fertilized than the couple is willing to give a reasonable chance at full-term life.

For further study, see Joni Eareckson Tada and Nigel M. de S. Cameron, How to be a Christian in a Brave New World (Grand Rapids: Zondervan, 2006).

Psalm 139:13-14:
“For you created my inmost being; you knit me together in my mother’s womb.
I praise you because I am fearfully and wonderfully made;
your works are wonderful, I know that full well.”

First, while there is much debate among Christians on the question of whether birth control is appropriate in any form, there is no question that birth control methods designed to destroy or prevent the implantation of a fertilized egg (i.e., embryo) should be avoided at all costs. From the moment of conception, an embryo is a living, growing person made in the image in God (Genesis 1:26-27; 9:6; Exodus 20:13). Thus, the “abortion pill” (RU486) must never be used! Similarly, the “morning after pill” and oral contraceptives (i.e., the birth control pill), must not be used because they are not only designed to prevent fertilization but also to prevent uterine implantation if fertilization should occur.

Furthermore, the necessary openness to children that accompanies the sexual union serves to protect against the abuse of sex for mere self-gratification. When birth control methods are employed out of a selfish unwillingness to have children, sex can quickly degenerate into nothing more than what Oxford’s Oliver O’Donovan has aptly described as “a profound form of play.”

Finally, it is imperative that children be viewed as a blessing from above rather than a burden or blight. While birth control may be used for reasons of health or financial stewardship, birth control should never be employed out of purely selfish motives. If we consider a Cadillac more valuable than a child, our priorities are seriously skewed. Such an attitude towards the miracle of life and the blessings of parenthood pains our Father in heaven.

For further study, see Randy Alcorn, Does the Birth Control Pill Cause Abortion? 7th ed. (Gresham, Ore.: Eternal Perspective Ministries, 1997).

Matthew 19:13-15
“Then little children were brought to Jesus
for him to place his hands on them and pray for them.
But the disciples rebuked those who brought them.
Jesus said, ‘Let the little children come to me, and do not hinder them,
for the kingdom of heaven belongs to such as these.’”

If you pay attention to the news at all, you are probably convinced that stem cell research will eventually solve every medical challenge our society faces. The blind will see. The paralyzed will walk. Cancer will be cured. All this will be possible if the anti-science zealots in the pro-life wing of conservative politics would just get out of the way. And so, on March 9, 2009, our long walk in the scientific wilderness ostensibly came to an end when President Obama issued his Executive Order (EO) removing barriers to responsible scientific research involving human stem cells. The president’s announcement on lifting the ban said, in part:

With the Executive Order I am about to sign, we will bring the change that so many scientists and researchers; doctors and innovators; patients and loved ones have hoped for, and fought for, these past eight years: we will lift the ban on federal funding for promising embryonic stem cell research…in recent years, when it comes to stem cell research, rather than furthering discovery, our government has forced what I believe is a false choice between sound science and moral values…Many thoughtful and decent people are conflicted about, or strongly oppose, this research. I understand their concerns, and we must respect their point of view. But after much discussion, debate and reflection, the proper course has become clear. The majority of Americans-from across the political spectrum, and of all backgrounds and beliefs-have come to a consensus that we should pursue this research. That the potential it offers is great, and with proper guidelines and strict oversight, the perils can be avoided.

No more false choices. No more political interference in our scientific research. The ban is lifted. Change has come! It should be noted that the ethical concerns some claimed to have had about the issue were assuaged by an appeal to the consensus of the majority of unidentified Americans from across the political spectrum. While it may or may not be true that a majority of Americans believe this research should be pursued, it is unclear when it was determined that ethical considerations should be affirmed by a show of hands. In any case, the president clearly implied that it was George W. Bush in particular who thwarted all advancement in scientific research because he placed his anti-scientific, Neanderthal faith ahead of the more reasonable desires of those who wanted to find cures. The new administration ended that long national nightmare with a wistful gaze at a teleprompter and the swipe of a pen. There is just one minor problem with this narrative. It is complete nonsense. The legal and political meanderings surrounding this issue have become so muddled it is instructive to distill them into recognizable form. Though most of us would be vaguely aware of at least some of these events, seeing how the stem cell issue has actually played out is stunning to behold. Consider the following timeline:

1978: In the wake of the controversial July 25th birth of the first “test tube baby,” Louise Brown, Health, Education and Welfare Secretary Joseph Califano appoints an Ethics Advisory Board (EAB), which concludes that “research on very early embryos within the first 15 days of development [is] acceptable to develop techniques for in vitro fertilization (IVF).”¹

• This EAB was appointed because of an earlier decision by the National Commission for the Protection of Human Subjects to prohibit experimentation on IVF embryos unless approved by an EAB.
• The controversy surrounding this policy led President Carter to allow the EAB’s tenure to expire. Presidents Reagan and George H. W. Bush chose not to reestablish it-effectively blocking embryo research.

1994: The Human Embryo Research Panel appointed by the head of the National Institute of Health’s Harold Varmus, recommends allowing the development of IVF techniques and the study of embryonic stem cells.²

• Such research would only be allowed with “spare” IVF embryos obtained through informed parental consent.
• The panel recommended further consideration of the creation of embryos for research purposes and argued for federal funding of the same. The contentious nature of that stance led to further political maneuvers during the Clinton administration.

1996: Congress passes, and President Clinton signs, a rider to an appropriations bill, titled the Dickey-Wicker Amendment, which makes it illegal for the federal government to fund research that destroys human embryos. This rider has been reapproved by Congress and signed by the president in office every year since then.

1998: President Clinton signs an Executive Order enforcing the ban on federal funding for ESCR that destroys human embryos. He bases his decision to do so on the restrictions created by the Dickey-Wicker Amendment.

2000: After six years of taking a position against taxpayer funding of the destructive research, and on his way out of office, President Clinton flip-flops and announces his support for new federal guidelines that would allow taxpayer funding of embryo-destructive research. This apparent set-up for the incoming Gore administration backfires when Gore loses the election.

2001-August 9th: President Bush signs an EO meant to compromise on the restrictions that had previously been placed on ESCR. This order continues the restrictions put in place by the Dickey-Wicker Amendment but allows an exception for more than $200 million in federal funding for twenty-one existing stem cell “lines” that had previously been created (through IVF). Thus, President Bush becomes the first president to allow federal funding of ESCR.³ At this point, federal funding for ESCR is restricted to these twenty-one lines. It is not “banned.” There is not, and there has never been, a ban on privately funded research.

2007-June 20th: President Bush issues Executive Order #13435, which requires the government to fund research into alternative methods of obtaining pluripotent stem cells-methods such as Induced Pluripotent Stem Cells (IPSC)-that do not require the destruction of embryos but instead “induce” regular adult skin cells to act like pluripotent cells.⁴

2008: “Scientific researchers hail the development of IPSCs as the biggest scientific breakthrough of the year.”⁵

2009-March 9th: President Obama rescinds Bush’s August 9, 2001, EO with his own EO entitled, Removing Barriers to Responsible Scientific Research Involving Human Stem Cells. The revocation of Bush’s EO is heralded as “lifting the ban on federal funding for promising embryonic stem cell research (ESCR).” This EO simultaneously revokes Bush EO #13435, which has provided federal funding of successful IPSC research. This aspect of the order is not mentioned at the press conference.

2009-March 11th: President Obama signs and renews the Dickey-Wicker Amendment, which continues the ban on federal funding for ESCR that Obama claims to have lifted two days earlier. No announcement is made and no press conference is called.

Whatever one’s politics, it is hard to deny the purposeful deceit and tactical shenanigans that have gone on with respect to ESCR. Obama claims to want to honor both the scientific promises of stem cell research and the ethical reservations of those who hold them. But the practical outcomes of his policies have done nothing of the sort. Though he refuses to ever acknowledge a difference between stem cell research and embryonic stem cell research, his policies have led us to the point where creating cloned embryos with the purpose of letting the created human being live is illegal, while creating cloned embryos for the purpose of tearing them apart for research purposes is encouraged and federal funding for it has been increased. Though he claims to have “lifted the ban of the last eight years,” two days after he did so he knowingly and quietly resigned the amendment that overrode his own Executive Order. Though he claims to approve of “promising research,” President Obama touts the very kind of research-embryonic stem cell research-that has led to exactly zero cures. At the same time, his revocation of President Bush’s Executive Order #13435 directly eliminated federal funding for adult stem cell research such as IPSC that has already led to more than seventy-three successful therapies. Most disingenuously, and most importantly, Obama believes that his opponents on this issue are offering us “a false choice between sound science and moral values.” Further, in his speech at Notre Dame University, he claimed to seek “common ground” with those who do have ethical reservations about ESCR. One must wonder why, if the conflict some seem to see between sound science and moral values is a false one, there would be any need for compromise at all. Even if we disregard the inconsistency in those two lines of thought, it is clear that research like that being done on IPSC gives us the best of both worlds. Beyond its proven technical success, it holds the principal advantage of avoiding the very aspect of ESCR that some find ethically troubling-the destruction of human embryos. This represents the ultimate political winner. By promoting IPSC, Obama could not only take credit for its scientific success, but also simultaneously allay the ethical concerns that many hold. It is a political dream solution, yet Obama deliberately and quietly defunded it. This can only mean that Obama’s motivations on stem cell research are not political. And if they are not political, one has to wonder just what his motivations are.

-Robert Perry

Robert Perry, M.A. (Christian Apologetics) Biola University, is a speaker with the Life Training Institute and an instructor with CrossExamined.org. He blogs about Christian worldview issues at http://true-horizon.blogspot.com.

NOTES

1 Robert P. George and Christopher Tollefsen, Embryo (New York: Doubleday, 2008), 10-11.

2 Ronald M. Green, The Human Embryo Research Debates: Bioethics in the Vortex of Controversy (New York: Oxford University Press, 2001).

3 Greg Koukl, “Responsible Science and ESCR,” Solid Ground, May/June 2009.

4 Wesley J. Smith, “Stem-Cell Doubletalk,” The Weekly Standard, March 12, 2009.

5 Wesley J. Smith, “Stem Cell Debate Is Over Ethics, Not Science,” The Sacramento Bee, March 19, 2009.

Should Christians take antidepressants? Or is there spiritual benefit in suffering through depressed moods? Are antidepressants overprescribed? Are they more harmful than helpful? How should Christians think about antidepressant therapy? How thoughtful Christians ought to think about treatment with antidepressant medications is, I shall suggest, tightly linked to how thoughtful Christians ought to think about human bodies and about pain.

As William James points out above, depression, especially in its most severe forms, is often experienced as psychical pain. What he does not there point out, however, is that depressive disorders are not wholly restricted to the realm of experience: significant depression is also accompanied by myriad systemic changes in one’s body. Many depressed persons lose their appetite, become constipated, feel fatigued, experience muscle aches, and have trouble sleeping. What’s more, persons afflicted with clinical depression have a doubling of mortality at any age (independent of smoking, other risk factors related to poor health, and suicide), a loss of brain cells, metabolic problems involving insulin, increased susceptibility to inflammation, and impaired bone development. Depression, therefore, is best viewed as an integrated, “psychosomatic” disorder—a disorder of mind and body—a disorder of the whole person.

Darkness Visible. The painful aspects of depression are perhaps nowhere better described than by Sophie’s Choice author, William Styron, in his autobiographical Darkness Visible.² On the one hand, Styron speaks of “my dank joylessness” (p. 5) and of being “shaken by the certainty…[that] I would never recapture a lucidity that was slipping from me with terrifying speed” (4) as if “my mind was dissolving” (13). On the other hand, however, and above all, Styron speaks vividly about the pain of depression. “I was,” he said, “feeling in my mind a sensation close to, but indescribably different from, actual pain.… Healthy people” have a “basic inability…to imagine [this] form of torment so alien to everyday experience. For myself, the pain is most closely connected to drowning or suffocation—but even these are off the mark” (17). He adds,

In depression, faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come—not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is only temporary; more pain will follow….So the decision-making of daily life involves not, as in normal affairs, shifting from one annoying situation to another less annoying—or from discomfort to relative comfort, or from boredom to activity—but moving from pain to pain. One does not abandon, even briefly, one’s bed of nails, but is attached to it wherever one goes. (62)

Styron is not here describing simple sadness or “the blues.” He is not describing an experience “common to man.” Rather, Styron is describing deep emotional torment, a torture of the soul, something akin to the pains of loss and the pains of sense ordinarily associated only with hell.

The Pain and Treatment of Depression. We can thank God, however, that not all depression is like this. Not all depression is dominated by mental pain. Some depression is dominated by sadness more than by pain, or by a lack of pleasure (anhedonia), or by boredom, or by a feeling of aloneness. The pain of depression is a critical starting point when examining the ways that a Christian ought to think about the treatment of depression. Many Christians already have a fairly good idea how other pains—pains whose sources feel as if they are grounded in the body rather than in the brain—are best treated, namely, some are treated with medications, some with manipulation, some by reinterpreting the meaning of one’s pain, some with electricity, some with surgery.

And so it is with depression: some depression is best treated with antidepressant medications, some with exercise, some by talking, some with electroconvulsive therapy, and some especially severe cases with surgically implanted deep brain stimulation. And, of course, just as with bodily pains, all mental pain is optimally treated also with prayer, sometimes with fasting, a renewed turning back to God, forgiveness, discernment of spirits, gratitude for God’s manifold gifts, love, and acceptance, with as much joy as one is able to contain in whatever one’s circumstances.

There is also another important reason to focus on the pain of depression; namely, as bodily pain has a bodily basis, so too mental pain has a bodily basis—our brains. This is not to say, first, that depression is simply a brain disorder. It is that, but more. And it is not to say, second, that only physical means will ameliorate depression—some physical means will and some will not. And, third, it does not mean that mental and spiritual factors have not played pivotal roles in the genesis of the depression, for such factors clearly have profoundly important roles to play in most depressive disorders.

What is Depression? To say, first, that depression is a brain disorder—although not merely a brain disorder—is to say that clinically significant depression is always accompanied by a disordered brain. In fact, for any given mental state that is abnormal, there is a correlative brain state that is abnormal. This is not to say that all mental states are brain states, but only that mental states and brain states are so tightly linked that a disturbance in the former is sure to be associated with a disturbance in the latter.

Even the great seventeenth-century philosopher Rene Descartes, the father of modern mind-brain dualism, believed this, stating, in a very famous passage in the Sixth Meditation: “I am not only lodged in my body as a pilot in a vessel, but I am very closely united to it, and so to speak intermingled with it that I seem to compose with it one whole.” Descartes appears here to suggest that the brain is more than the mind’s instrument, but rather exists in some sort of deep unity with it.

Similarly, Aristotle and, especially, St. Thomas Aquinas (and through Aquinas, the bulk of the Christian tradition through history), views mind, or more accurately, soul, and body as deeply united. So much so, in fact, that the soul and the body constitute a single thing, a human person, who is identified not merely with the soul, but with the “soul-body composite.” After death, therefore, when I temporarily exist in a state of disembodiment, strictly speaking, the soul that exists is not fully me; rather, it is the glorified soul-body composite that is me, the human person that I am. The resurrection of the dead is, as was our Lord’s, a bodily resurrection: we are not complete, whole, fully us without our bodies. Our bodies are not merely dispensable parts of us, they are not extrinsic to who we really are; rather, they are intrinsic to us, parts without which we would not be. Therefore, to treat our disordered brains is to treat us, not to treat some extrinsic, peripheral, dispensable part of us. In the appropriate circumstances, therefore, to treat our brains physically when we are disturbed emotionally is one way to make us whole again.

Second, there is a fallacy in the claim—a claim that I often hear, especially in the context of discussions concerning sexual orientation—that the origin of a disorder requires a purely “matching” treatment, such that if a problem has a psychological cause, it requires only psychological treatments; if a problem is spiritually based, then only spiritual treatments will do; and if a problem has a physical cause, it can only be treated physically. Those who fall for this fallacy worry that if, for example, homosexuality is strongly biogenetically determined, then it would be implausible to think that psychological therapies could reverse it; or, if alcoholism is a medical (i.e., biological) disease, then it requires medical (i.e., biological) treatment. On the contrary, because we are unified beings, we ought to expect that psychological, spiritual, and physical treatments might play pivotal roles in reorganizing states of disorder in us regardless of whether these have psychological, spiritual, or physical causes.

This suggests that, third, psychological causes of brain and emotional disorder can be profitably treated with physical means (e.g., antidepressants). This is not to say that antidepressants are the best treatments for all depressions. (They are not. In fact most diagnosable depressive conditions are likely best treated with something other than antidepressants.) Nor is this to say that only medication therapy is the optimal choice even for those depressions for which antidepressants are appropriate. Although the psychiatric literature is inconsistent on this point, there is evidence that a combination of pharmacotherapy and psychotherapy is better than pharmacotherapy alone for the treatment of some depressions, but that pharmacotherapy tends to work faster than psychotherapies and that it tends to be more effective than psychotherapies for more severe depression (especially when depression is so severe as to be accompanied by hallucinations and delusions).

Addressing Both Physical and Emotional Pain. So, are antidepressants overprescribed? Yes. And are antidepressants also underprescribed? The answer to this question is also “Yes.” Might one who is taking antidepressants benefit more by working through his or her depression in other ways (psychologically, spiritually, socially), identifying with our Lord in one’s suffering, listening to the messages that depression communicates, relying more on God, repenting of sin, and striving to inculcate the virtues? The answer to that question is also “Yes.” On the other hand, might one who is depressed but who is not taking antidepressants benefit from the drugs’ ability to enhance mood in a manner that would optimize one’s ability to serve God, love others, and care for one’s family, one’s body, and one’s soul? The answer to that question, likewise, is “Yes.” Relieving suffering by relieving physical pain is, in multiple respects, very much like relieving suffering by relieving mental pain. And just as there are myriad ways to address physical pain, there are also myriad ways to address emotional pain. Which method of pain relief is best for which patient is a matter of discernment. Fortunately, Christians are in the business of discernment (1 John 4:1). May we discern well, love well, and thrive.

A. A. Howsepian, M.D., Ph.D., is an assistant professor of philosophy in the University of California, San Francisco-Fresno Medical Education Program whose many articles can be found in philosophy, bioethics, psychiatry, and neurology journals. His Ph.D. is in philosophy from the University of Notre Dame.

NOTES

1. William James, (1902), The Varieties of Religious Experience (Reprinted, [1999], New York: The Modern Library), 65.
2. William Styron, Darkness Visible: A Memoir of Madness (London: Cape, 1990).

SYNOPSIS

Medical and philosophical fascination with the “vegetative” state long predated the case of Terri Schiavo, a Florida woman who was judged to have been unconscious for 15 years. Nevertheless, the controversy surrounding the removal of her feeding tube focused America’s attention on this most profound condition, its diagnosis, treatment, and prognosis, and the ethical puzzles that it poses. How ought we treat those in “vegetative” and other hypokinetic (i.e., profoundly or totally immobile) states? How do we know whether one in such a state is conscious or not? What ought we do if we are uncertain? Misdiagnosis of persons in such states is relatively common in part because too little is known about which areas of the brain are correlated to consciousness. Some barriers to adequate scientific and clinical clarity concerning the neurobiology of consciousness may, in fact, be insurmountable. Care providers, until recently, often did not appreciate the fact that there is a continuum of consciousness that underlies hypokinetic states: some individuals in these states are robustly conscious, others are wholly unconscious, and others are at some point in between. Further, ethical decisions regarding these individuals are complicated by problems inherent in the construction of advance medical directives and by the sometimes unusual or clearly unethical choices of surrogate decision makers. One ethically impermissible option is to proceed in such a manner, whether actively or passively (e.g., by withholding nutrition, hydration, medications, or medical procedures), that is intended to result in the hypokinetic person’s death. Only by exercising careful clinical judgment, attending to the subtleties of ethical decision making under conditions of uncertainty, and engaging in serious theological reflection, will our exploration of the nature of these most vulnerable of patients and of the ethics of their treatment be most clear.

“Terri, alas, is the unwanted, the inarticulate, the one whose membership card in the human race has been revoked, the lump of flesh, the fetus. The Terri Schiavo case is not a ‘test’ of whether she is a human being ‘in the full sense of the word.’ It is a test of whether we are.” —Julie Loesch Wiley¹

There are, in several academic quarters, thinkers who wish to abandon more traditional criteria for human death and, instead, to deem “dead” some humans who, although alive in every other respect, have been judged to be permanently unconscious.² For example, Terri Schiavo, a Florida woman who existed in a persistent state of apparent unconsciousness (which commenced soon after she suffered a cardiac arrest) for 15 years, was so judged. If these thinkers’ views had been widely adopted, there would have been far less debate concerning whether the withdrawal of care from Terri Schiavo should have been effected sooner during the course of her illness, later, or not at all. Rather, Terri, in virtue of having been judged permanently unconscious, thereby also would have been judged to have been a human corpse all along.

In this article I am not concerned primarily with the fitful controversy concerning the diagnosis of human death. Seeing where pronouncements of human death might lead, however, gives all the greater weight to the ethical questions concerning how we ought to consider and treat the seriously handicapped among us. With this in mind, I am concerned, rather, with carefully exploring conditions of apparent unconsciousness in humans and some of the ethical issues that these conditions raise. Persons who are profoundly disabled, particularly in the way that Terri Schiavo was, present us with several difficult ethical, medical, religious, and, more broadly, philosophical problems that, without the proper guidance, might appear to be insoluble. Fortunately, God’s general revelation (as found through the light of natural reason) and His special revelation (as found in the Bible) concerning how we ought to treat one another are, for all people of good will, available guides in this matter.

What “Vegetative States” Are Not

The term persistent vegetative state (PVS) was coined by Bryan Jennett and Fred Plum in 1972 to describe the condition of patients whose initial comatose states had progressed to states of wakefulness but without detectable awareness.³ Jennett and Plum were careful in their seminal essay to emphasize that, in PVS, awareness, or consciousness, is not detectable, not that it is absent. Later commentators, however, have been less than careful. The consensus statement of the 1994 Multi-Society Task Force (MSTF) on the persistent vegetative state,⁴ for example, alleged, “Jennett and Plum thought that patients in a persistent vegetative state could be distinguished clinically from those with other conditions associated with prolonged unconsciousness” (emphasis added).⁵ Clearly, being without detectable awareness is compatible with being conscious, while being unconscious (prolonged or otherwise) is not compatible with being conscious. In fact, Jennett and Plum wisely acknowledged “that a continuum [of conscious states] must exist between this vegetative state and some of the others” (to be described below).⁶ The MSTF’s insistence that PVS patients are, therefore, uniformly wholly unconscious is inconsistent with the spirit of Jennett and Plum’s insights into this condition.

We would do well, I believe, to return to Jennett and Plum’s conceptualization that highlights the observing person’s inability to detect consciousness in certain seemingly unconscious persons, rather than a conceptualization that highlights the disabled person’s apparent lack of consciousness in all instances. One manner of drawing attention to this issue is by changing our terminology. I suggest, therefore, that we no longer refer to persons who are in states of apparent unconsciousness as vegetative—a term that emphasizes unconsciousness and a term that might be considered pejorative by some severely disabled patients and their caregivers; rather, I suggest we refer to them as hypokinetic—a term that emphasizes a profoundly (or totally) restricted ability to move and is, thereby, neutral with respect to whether or not persons in this state are having (conscious) experiences.⁷

In the peculiar terminology of neurology, wakefulness is compatible with unawareness (and hence, with unconsciousness). What does it mean to say that someone is unconscious, yet awake? It means simply that one in this state is in total phenomenal darkness—not conscious of anything at all—yet continues to exhibit sleep/wake cycles: one “awakens” in the morning by opening one’s eyes, at which times one’s electroencephalogram (EEG) reflects the electrical activity of an awake person’s brain, and one “goes to sleep” at night at which time one closes one’s eyes and one’s EEG reflects this change. These changes in brain electrical activity and spontaneous eye openings/closings are absent in traditional coma where there occurs no wakefulness at all. To be comatose in the traditional sense, therefore, is to be in a state of unconsciousness without wakefulness.

To be in a so-called persistent vegetative state requires wakefulness without detectable awareness that has persisted for at least one month. The causes of this state are, most commonly, head trauma, cardiac arrest, and other conditions that compromise oxygen delivery to the brain, including strokes. According to the MSTF, sometimes persistent vegetative states become permanent vegetative states. One might think that a condition called permanent vegetative state, if accurately diagnosed, would be in fact permanent; but, surprisingly, that is not the case. Being in a permanent vegetative state requires only that one be in a vegetative state for at least 3 months following a nontraumatic brain injury, and for at least 12 months following a traumatic brain injury. Should one recover after having been in such a vegetative state after, say, multiple years—as has occurred in several cases⁸—then one would thereby have recovered from a permanent condition. The observation here is not that some patients are misdiagnosed as being in a permanent vegetative state, but that properly diagnosed patients in so-called permanent vegetative states have been known to recover.⁹

Allied Diagnoses

Some hypokinetic states in which patients are conscious resemble traditional vegetative states to such a degree that there is a real danger that one type of condition might be mistaken for the other. The most unfortunate instances of such errors involve the mistaking of a hypokinetic state, in which the patient is wholly unconscious, for a locked-in state—a condition in which a person appears to be unconscious and is largely or wholly unable to move, but, typically, is as robustly conscious as you and I are. Many persons in locked-in states are able only to move their eyes or to blink, and often can do so in such a manner that limited communication is possible. It is important, therefore, always to presume that an apparently unconscious person is in fact conscious and, subsequently, it is prudent to arrange a system of communication with such a person that would allow one who is in a locked-in (or other less serious hypokinetic) state to convey to caregivers, in a consistent manner, that one is aware (and in the case of purely locked-in patients, fully aware) of what is transpiring in one’s environment. There is, in fact, a technologically sophisticated communication system in the works that, when perfected, promises to allow direct brain communication with such persons—communication that requires no skeletal muscle movement at all, by way of a “thought translation device.”¹⁰

One further segment of the elusive continuum of consciousness about which Jennett and Plum spoke is recognized by the medical community as a minimally conscious state. Persons in a minimally conscious state exhibit unequivocal, but intermittent, and often very difficult to detect, behavioral evidence of being conscious. The minimally conscious state is sometimes conceptualized as a state of limited responsiveness. This is, I suggest, the best way to think about it and in fact suggests a much more illuminating name for the condition—the minimally responsive state (a subtype of hypokinetic state). The idea here is that being minimally responsive is compatible with being as conscious as you and I are when we are awake. One need not be minimally conscious in order to be minimally responsive. In fact, many locked-in state persons are minimally responsive in virtue of their profound motor disability, yet these persons are robustly conscious. There is recent evidence (although with only a very small number of patients) that even those persons who are in a minimally responsive state and who are believed to be minimally conscious exhibit patterns of brain activation (when, e.g., listening to a taped narrative of familiar events recorded by a familiar person) that are similar to normal subjects.¹¹ There is more surprising evidence that some apparently unresponsive vegetative patients demonstrate normal brain activation to face stimuli presented visually¹² and display what appear to be scattered episodes of clearly purposeful behavior.¹³ There are multiple research labs in the United States as well that are devoted to a type of neurotechnology that is sometimes called cyberkinetics, which, albeit only rudimentarily at this time, allows persons who cannot move their bodies to communicate via electrodes using only the electrical activity generated by their brains.¹⁴ This is further evidence that their brains are generating such activity.

Diagnostic Uncertainty and the Problem of Consciousness

How does one distinguish one hypokinetic state from another? How, for example, does one distinguish a locked-in state from a traditional PVS? Or a PVS from a minimally responsive state? The MSTF in 1994 stated that various neurodiagnostic tests (including EEGs, which are nearly normal in up to 10 percent of alleged PVS cases late in their course, as well as other tests¹⁵) “do not distinguish reliably between the locked-in and vegetative states.”¹⁶

In light of the fact that the person in a locked-in state enjoys such a robust level of consciousness, this admission is striking. Only one type of test, cerebral metabolic studies, was picked out by the MSTF as reliably showing higher rates of brain metabolism in locked-in state persons as opposed to those who are in traditional vegetative states. The relevance of this finding is unclear, since even the MSTF admits that “questions have been raised about the validity of cerebral metabolic studies to determine whether patients in a vegetative state are conscious or can experience pain and suffering. These questions remain unanswered.”¹⁷ According to the MSTF, then, just over 10 years ago, medical science had no reliable way of distinguishing between the states of certain hypokinetic persons who are fully conscious and those who lack consciousness altogether. This situation has not changed. Positron emission tomography (PET) scans have, for example, not yet been sufficiently standardized in this context to be a routinely useful tool for reliably differentiating one hypokinetic state from another; nor have event-related potentials¹⁸ (i.e., the brain’s electrical discharges when presented with certain physical stimuli); nor have magnetic resonance or other forms of neuroimaging. Curiously, in the medical literature there are case reports regarding PET scans in which the metabolism of the brain’s gray matter overall does not change from one’s being in a purported vegetative state to having recovered from this condition (although some regional changes in cortical metabolism appear to take place).¹⁹ In the event, however, that medical science discovers a fairly reliable test to distinguish those patients that we now call “vegetative” from those that we now call “minimally conscious” or “locked-in,” we would still not be able to state with confidence that all of those that we now call “vegetative” are wholly unconscious, since as Laureys states, “In the absence of a generally accepted neural correlate of human consciousness [i.e., the areas of the brain that are correlated to consciousness], it remains very difficult to interpret functional neuroimaging data [e.g., PET scans] from severely brain-injured patients as a proof or disproof of their ‘unconsciousness.’”²⁰

One of the most vexing questions in all of neuroscience and in the philosophy of mind concerns the precise manner in which consciousness is related to brain functioning. Even if we were to put aside these questions concerning the metaphysics of consciousness (e.g., whether consciousness is generated by brain function, and if so how it is that brain function could possibly generate the qualitative characteristics of consciousness, such as the taste of an artichoke, the smell of dark chocolate, or the feel of silk), we still are left with questions concerning which brain areas are correlated with consciousness.²¹ This is, primarily, a question for the neuroscientist or the physician, rather than for the philosopher. One would expect this task to be a relatively simple one, but it is not. In fact, one of what was thought to be the most well-established locations of consciousness—the cerebral cortex itself (i.e., the brain’s grey outside layers)—has recently been shown not to be necessary for consciousness.²² Furthermore, all that we know about the neurobiology of pain perception strongly suggests that one’s being in a vegetative state, as currently understood, is compatible with one’s perceiving pain—including, it would seem, the pain and discomfort that can be associated with starvation and dehydration.²³ A central problem with bringing this project to fruition is that the methods that we have for detecting consciousness rely on a conscious subject’s alerting us to the presence of consciousness. There is, therefore, a fundamental conceptual problem in this domain that cannot be ignored: not only are physicians and neuroscientists unsure about which parts of the brain underlie or are correlated with conscious human experience, but it does not even seem possible, even in this era of cyberkinetics, for us to achieve an acceptable degree of clarity on this problem. This is because there does not appear to be a way, perhaps even in principle, for us to discern when consciousness is absent, as opposed to when consciousness is present but not apparent to an outside observer. There is always the real possibility that the conscious person is in such a condition that he is not able to communicate to us his conscious experience.

Ethical Reflections

All living human beings are deserving of respect, love, and care, in virtue of their intrinsic dignity and worth as bearers of God’s holy image. It is always and everywhere, for any reason whatsoever, evil to kill an innocent human being intentionally, on one’s own (private) initiative; to participate in the intentional killing of an innocent fellow human at any stage of development or disability is a grave evil. The circumstances do not matter. The motives do not matter. The consequences do not matter. This is what is meant for an act to be intrinsically evil: the act in itself is evil; nothing outside of the act itself makes the act evil (and, hence, there is no way for an act of this type to be modified so that it is no longer an evil act). In moral theories such as this, including virtue, divine command, natural law, or deontological theories, some acts are judged to be wrong and hence to be avoided no matter what.

On the other hand, in consequentialist moral theories, elements independent of the act itself—specifically, the act’s consequences—solely determine whether an act is right or wrong, good or bad. The result, then, is that any act, no matter how apparently degraded or perverse or heinous, can be morally permissible, or even obligatory, under the “proper circumstances.” The Ten Commandments, however, do not make allowances for bearing false witness or for murder or for coveting under certain circumstances, for example, or even under any circumstances; rather, they admonish us to refrain from such acts under all circumstances.²⁴ Christians would do well, therefore, to distance themselves from consequentialist moral theories.

Much of what is written these days concerning what is often called “end-of-life care” is couched in consequentialist terminology.²⁵ What is important, it is claimed, is that a patient’s care is dictated by the relative values of the overall outcome of that care alone. If caring for someone in a hypokinetic state resulted, in the long run and in general, in less overall happiness for humanity (as those who are consequentialists of the utilitarian persuasion would have it), then it would be either permitted or obligatory to end that person’s life, perhaps as quickly, directly, and intentionally as possible.

Nutrition, Hydration, and Futility

Is it ever morally permissible to withdraw food and fluids, elements that sustain human life? Let’s explore this possibility using the case of Terri Schiavo. Her condition required tube feeding to maintain her survival. In the end, her feeding tube was withdrawn by court order against the wishes of her parents and in accord with the wishes of her husband, Michael Schiavo, who argued that he had knowledge of Terri’s not wanting to be kept alive in a PVS by artificial means. Her parents’ legal appeals to have the feeding tube reinstated failed. The end result of this series of events was Terri Schiavo’s death on March31,2005, at the age of 41.

Was it ethically permissible to remove Terri’s feeding tube in accord with the demands of her husband? There are several reasons to doubt the moral propriety of this removal.²⁶ First, she might not in fact have been in a PVS, but in another hypokinetic state—one in which consciousness is present (there was, in fact, provocative evidence for this conjecture in Terri’s case). Second, perhaps Michael intended his wife’s death in virtue of this directive. Although it is legal for the time being in the United States for those with homicidal intentions to order or perform the removal of one’s feeding tube resulting in one’s death, such acts would not, simply in virtue of their legality, thereby be ethically permissible.²⁷

Suppose, however, that we knew all along that Terri was in a PVS (and hence wholly unconscious); is not the treatment of such an individual futile? Not necessarily; for a treatment to be futile for some particular individual, it must be the case that the “treatment” not benefit that particular individual overall. Clearly many available treatments for persons in hypokinetic states—including the administration of nutrition and hydration—benefit them greatly, namely, by saving their lives. Granted we are often uncertain whether people in such states consciously appreciate these benefits, although clearly some of those who deeply care about them do.²⁸ Still, they benefit nonetheless. If they did not, that is, if our “treatment” were killing them or otherwise causing them to decompensate medically, or if their death were imminent in spite of the “treatment,” then it would be morally permissible to discontinue such procedures, even if they involved the administration of food and fluids.

Rushing in the Wrong Direction?

In light of Terri Schiavo’s case, there have been cries from many quarters that the best solution regarding ethical treatment in all conditions of medical extremity is to adopt an advance directive strategy. An advance directive is a document, prepared while one is competent to make sound medical decisions, that is intended to make clear one’s treatment wishes should one ever fall into a state of incompetence with respect to medical decision making. It appears that at least with an advance directive, one might avoid the problem, made so clear in the Schiavo case, of a surrogate decision maker (or “durable power of attorney”) making decisions on one’s behalf that are counter to one’s best interests, perhaps for motives that are less than pure. An advance directive would codify one’s wishes in the event of a medical catastrophe, preventing one’s being treated in ways that are contrary to one’s expressed wishes.

Advance directives themselves, however, are for a number of reasons also potentially problematic.²⁹ First, advance directives are static documents, whereas human minds are dynamic faculties that often change, and the documents are not quickly amended to reflect these changes. Second, it is sometimes unclear what the directives specified in advance directives mean. Third, often there are significant omissions in advance directives simply in virtue of the enormous scope of possible treatment decisions one might encounter in the context of medical disability. For example, if you were filling out your own advance directive, it may be clear that you would want to be taken off a ventilator under certain medical conditions. It may be, however, that you would not want to be taken off of a ventilator if you knew that this would cause profound emotional disturbance in certain family members of yours, but this particular reason for staying on a ventilator may not cross your mind while filling out your advance directive on your own. There are likely to be numerous such issues that arise in the context of grave medical disability—issues that one would never have thought about unless one is specifically asked. Fourth, advance directives can be lost or destroyed. Fifth, it is very hard to say ahead of time how it is that one really would want to be treated medically, even in broad outline, if one becomes severely disabled at some future time. For all of these reasons and more, some, including myself, have argued that perhaps the best end-of-life strategy is primarily to designate a surrogate decision maker, one who you are confident would do nothing intentionally to harm (much less kill) you (whether “actively” or “passively”) and who is virtuous—one who displays temperance, fortitude, justice, wisdom, faith, hope, and charity in various other aspects of his or her life. This is not to say that an advance directive that is very precise and very narrow in scope in addition to a surrogate decision maker might not be optimal.

Closing Reflections: On Being Human

It is difficult, on an emotional level, for many people to care for those who, whether at the very beginning of life, toward the very end of life, or suspended somewhere in the middle, do not appear to respond to the care given to them in a way that is reenforcing for their caregivers. All of these disabled persons are, nevertheless, our neighbors in the biblical sense. Sometimes these neighbors of ours surprise us by acting in ways that we would not have expected—including their waking up and talking to us after years of being “vegetative.” Much more often, nothing this dramatic occurs; rather, we see subtle signs that are often maddeningly ambiguous, of what might be awareness or purposeful activity or intentional response. Commonly, we do not even enjoy that degree of hopefulness, but must endure and suffer with these very quiet people in the midst of their silence and our uncertainty. Still, these are our neighbors, and more so. They depend on us for their survival; they are as vulnerable, or more vulnerable, than newborns; and not only do they bear God’s image—not only are they mirrors of God—they are also, as Julie Loesch Wiley implies, mirrors of our humanity. To abandon them or to mistreat them is to neglect and to deform what is most human about us—our capacity to love and care for the most helpless among us and our corresponding capacity to reflect the glory of Christ.

notes

1. Touchstone, May 2005, p. 6.

2. See Robert M. Veatch, “The Impending Collapse of the Whole-Brain Definition of Death,” Hastings Center Report 23, 4 (1993): 18–24.

3. Bryan Jennett and Fred Plum, “Persistent Vegetative State after Brain Damage: A Syndrome in Search of a Name,” Lancet 1 (1972):734–47.

4. Multi-Society Task Force on PVS, “Medical Aspects of the Persistent Vegetative State (Parts 1 and 2),” New England Journal of Medicine 330 (1994): 1499–1508 and 1572–9. For a critique, see A. A. Howsepian, “The 1994 Multi-Society Task Force Consensus Statement on the Persistent Vegetative State: A Critical Analysis,” Issues in Law and Medicine 12, 1 (1996): 3–29. For a clear exposition of other muddles plaguing the vegetative state literature, see D. Alan Shewmon, “The ABC of PVS: Problems of Definition,” Brain Death and Disorders of Consciousness, ed. Calixto Machado and D. Alan Shewmon (Kluwer/Plenum: New York, 2004),215–28.

5. Multi-Society Task Force on PVS, 1499.

6. Jennett and Plum, 737.

7. Hypokinetic states include (among multiple other states) coma, akinetic mutism, and catatonic stupor in addition to what is currently termed persistent vegetative state and permanent vegetative state. The late Pope John Paul II, in the context of his March20,2004, address to the International Conference, “Life Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas,” also protested that the term vegetative state was demeaning, that it failed to evince proper respect for the dignity of one who is in such a state.

8. See Tom M. McMillan and Camilla M. Herbert, “Further Recovery in a Potential Treatment Withdrawal Case Ten Years after Brain Injury,” Brain Injury 18, 9 (September 2004):935–40.

9. For the rates of misdiagnosis of vegetative states in general, see Agnus Shiel et al., “Difficulties in Diagnosing the Vegetative State,” British Journal of Neurosurgery 18, 1 (February 2004): 5–7; Nancy L. Childs et al., “Accuracy of Diagnosis of Persistent Vegetative State,” Neurology 43 (1993): 1465–67; and, especially, Keith Andrews et al., “Misdiagnosis of the Vegetative State: Retrospective Study in a Rehabilitation Unit,” British Medical Journal 313 (1996): 13–16, in which it was found that 37 percent of “vegetative state” cases had been misdiagnosed.

10. Thilo Hinterberger et al., “A Device for the Detection of Cognitive Brain Functions in Completely Paralyzed or Unresponsive Patients,” IEEE Transactions on Biomedical Engineering 52, 2 (February 2005):211–20.

11. See Mélanie Boly et al., “Auditory Processing in Severely Brain Injured Patients: Differences between the Minimally Conscious State and the Persistent Vegetative State,” Archives of Neurology 61 (2004): 233–38. Predictably, the prognosis for patients in a minimally responsive state is better than for those in a hypokinetic state.

12. See David K. Menon et al., “Cortical Processing in Persistent Vegetative State,” Lancet, 352 (1998):200.

13. See Nicholas D. Schiff et al., “Residual Cerebral Activity and Behavioural Fragments Can Remain in the Persistently Vegetative Brain,” Brain 125 (2002):1210–34.

14. See Hinterberger et al., 2005.

15. These include computerized tomography (CAT) scans or magnetic resonance imaging (MRI) scans of the head; evoked responses, during which a person is presented with a stimulus (e.g., a sound or a light) and changes in that person’s brain waves are measured; and single photon emission computed tomogram (SPECT) scans. It is well known, for example, that some persons diagnosed to be in vegetative states have normal evoked responses to physical stimuli. See Eric Brunko and Diederik Zegers de Beyl, “Prognostic Value of Early Cortical Somatosensory Evoked Potentials After Resuscitation from Cardiac Arrest,” Electroencephalography and Clinical Neurophysiology 15 (1987):15–24.

16. This is not to say that we will always be in this predicament. Cyberkinetics labs may well be on their way to improving brain/computer interface technologies that will aid in reliably distinguishing between the two states.

17. Multi-Society Task Force on PVS, 1506.

18. See Paul W. Schoenle and W. Witzke, “How Vegetative Is the Vegetative State? Preserved Semantic Processing in VS Patients—Evidence from N 400 Event-Related Potentials,” NeuroRehabilitation 19 (2004):329–34.

19. See Steven Laureys et al., “Brain Function in Vegetative State,” in Machado and Shewmon (2004): 229–38. Note that although there is an overall decrease in cerebral metabolism in the vegetative state, overall brain metabolism in normal human slow–wave sleep is also known to decrease up to 60 percent.

20. Steven Laureys, “Functional Neuroimaging in the Vegetative State,” NeuroRehabilitation 19 (2004):340.

21. One frequently cited model for how consciousness is supposed to be related to brain function likens the ascending reticular activating system (located in the brainstem) and its connections to a generator, and the cerebral cortex and the thalamus and their connections as light bulbs. In this simplistic model, shutting down the cerebral cortex (the light bulbs) or the brainstem (the generator) will lead to the loss of consciousness. There are multiple clinical counterexamples to this model. For a discussion of the metaphysics of human mind and consciousness embedded in a general theory of persons, see A.A.Howsepian, “Toward a General Theory of Persons,” Christian Bioethics 6, 1 (2000):15–35.

22. See D. Alan Shewmon et al., “Consciousness in Congenitally Decorticate Children: ‘Developmental Vegetative State’ as Self-Fulfilling Prophecy,” Developmental Medicine and Child Neurology 41 (1999):364–74.

23. See Eugene Diamond, “Medical Issues When Discontinuing AHN,” Ethics and Medics 24, 9 (1999):1–2.

24. That is not to say that it is always clear or easy to discern when an act is in fact an instance of lying or murder or coveting, only that such acts on one’s private initiative ought never be performed under any circumstances.

25. It is quite misleading to say of all people who are in hypokinetic states that they are at the “end” of their lives. If they were to be neither fed nor given fluids, then, of course, their lives would end; but on that score, newborns would be at the end of their lives as well; and, of course, so we all would be.

26. Primarily, it was not at all clear that this removal was in accord with her wishes. In addition, her husband had, for several years, been involved in a sexual relationship with another woman with whom he fathered two children, raising the possibility that there were ulterior motives involved in his sanctioning an action that would end his wife’s life. Yet, even if it could be known that Terri clearly and convincingly conveyed to her husband or someone else her wish not to be kept alive by artificial means if she were ever found to be in a PVS, and even if her husband had remained faithful to her throughout the course of her illness (and if there were no reason to be suspicious of any other ulterior motives on his part), it might still be morally impermissible to remove her feeding tube for at least the two reasons noted in the text.

27. See Fr. Robert Barry, “The Papal Allocution on Caring for Persons in a ‘Vegetative State,’” Issues in Law and Medicine 20, 2 (2004):155–64.

28. For a discussion of the multilateral benefits of care for the severely disabled, see A.A.Howsepian, “Philosophical Reflections on Coma,” The Review of Metaphysics 47, 4 (June 1994):735–55.

29. For a more detailed discussion of, especially, the logical problems with the advance directive strategy, see A.A.Howsepian, “Are Advance Directives an Advance?” Ethics and Medicine 14, 2 (1998):34–41.

Parish nursing is a contemporary outgrowth of the late Lutheran minister Granger Westberg’s vision for establishing holistic health centers in churches. It focuses on the integration of physical, spiritual, mental, and emotional health needs of people within a congregation, yet remains grounded in a biblical worldview.

Parish nurses have played a major role in local congregations. They have been influential in reintroducing health-related ministries to the elderly, frail, and other vulnerable populations, as well as healing services that often include the laying-on of hands and anointing with oil, specific prayer ministries for healing, and rituals of remembrance for those who are grieving the loss of loved ones.

One Christian organization, Nurses Christian Fellowship, actively disseminates helpful information on parish nursing. Its Web site includes pages with resources for parish nurses (http://www.intervarsity.org/ncf/pn/main.html) and books for parish nurse reference (http://www.intervarsity.org/ncf/pn/bib.html) that provide comprehensive coverage of all aspects of parish nursing.

The International Parish Nurse Resource Center is also a primary resource for congregations, although some of the programs that it advertises are more open to incorporating therapies such as Healing Touch into parish nurse training. More about the history of parish nursing and other resource material is available through its Web site (http://www.ipnrc.parishnurses.org/index.phtml).

— Sharon Fish Mooney

SYNOPSIS

For years now, advocates of embryonic stem cell research have flatly denied any intention of implanting cloned embryos into volunteer mothers to harvest tissues or organs from later-term fetuses—a practice known as fetus farming. Researchers are growing impatient, however, because stem cells from early-term embryos have yet to deliver even one promised cure, and their tendency to form dangerous tumors could render them therapeutically useless. There is concern throughout the scientific community that usable cells will not be obtained unless cloned embryos can be gestated well past the embryonic stage. Fearing a public backlash, advocates of fetal stem cell research are deceptively trying to legalize fetus farming through a series of phony cloning bans, such as a New Jersey bill that became law in 2004. In each case, what is banned is the birth of cloned human beings, not their creation for destructive research. Further, cloning advocates are busy telling Americans that cloning is not cloning, that embryos are not really embryos, and that some humans are not really persons.

Anyone who thinks cloning technology will remain in the petri dish should revisit January 4, 2004, when then New Jersey governor James McGreevey signed into law the most permissive stem cell legislation in the United States, Senate Bill 1909. Residents of the Garden State were told they were getting an anticloning bill. It was anything but that.

The New Jersey law makes it legal in that state to create a cloned embryo, implant it in a woman’s womb, then gestate it through the ninth month of pregnancy—so long as the embryo is killed before birth, the point at which it magically becomes “a new human individual.”¹ Thanks to the new law, there is nothing to stop researchers from cultivating later-term (cloned) fetuses for spare parts—a process known as fetus farming. In short, New Jersey’s alleged anticloning law not only fails to ban cloning, but it sets the stage for fetus farming at taxpayer expense.

The New Jersey law “has blown the cover off of the true agenda of the biotechnology industry,” says Wesley J. Smith, author of Culture of Death: The Assault on Medical Ethics in America (Encounter Books, 2001) and The Consumer’s Guide to a Brave New World (Encounter Books, 2004). “Rather than restricting therapeutic cloning to the harvesting of stem cells from early embryos, as the industry often pretends in the media, the Biotechnology Industry Organization’s enthusiastic support of the New Jersey bill proves that [pro-cloning types] want an unlimited license to harvest cloned human life from inception through the ninth month.”²

HARVESTING THE UNBORN

Leading pro-life advocates share Smith’s concern. “The New Jersey legislation expressly encourages human cloning for, among other things, the harvesting of ‘cadaveric fetal tissue’ [i.e., tissue from dead fetuses]” writes Robert P. George of Princeton University and a member of the President’s Council on Bioethics. “The bodies in question are those of fetuses created by cloning specifically to be gestated and killed as sources of tissues and organs.”³ New Jersey Right to Life’s Marie Tasy says, “This law will allow human lives to be treated as a commodity, creating classes of lesser humans to be created and sacrificed for the good of humanity.”⁴

At the same time, the legislation expressly permits “reasonable payment” for “removal, processing, disposal, preservation, quality control, storage, transplantation, or implantation of embryonic or cadaveric fetal tissue.”⁵ Put simply, nothing in the legislation prevents cloning entrepreneurs from paying women a “reasonable” fee to gestate later-term fetuses that will be killed for their body parts. Nine other states are considering similar laws.

Douglas Johnson, legislative director for National Right to Life, says we are headed toward using fetuses for spare parts. “Elements of the biotech industry are definitely moving toward fetus farming and Congress must act to prevent that before it’s too late.”⁶

BIGGER IS BETTER

In September 2005, the scientific journal Nature published new research suggesting that embryonic stem cells might be procured without creating, then destroying, living human embryos.⁷ Altered Nuclear Transfer (or ANT) is a new technology that seeks a morally acceptable means of producing pluripotent stem cells (i.e., multipotential cells that are the functional equivalent of embryonic stem cells) without the creation and destruction of human embryos. Researchers, instead of using living human organisms, would use biological entities that have properties similar to human embryos, but are not living organisms.⁸

This should have come as thrilling news for everyone in the cloning debate, but advocates of embryonic stem cell research were anything but thrilled. Despite their talk about promised cures, they knew there were many problems with treatments derived from these cells.

First, embryonic stem cells, though allegedly more flexible than their adult counterparts in terms of what kind of tissue they can form, were hard to control once implanted. They sometimes formed tumors instead of usable tissue. Second, the cloning procedures needed to produce embryos for research were extremely expensive. Smith points out, the National Academy of Sciences claims “it could take about 100 human eggs per patient—at a cost of $1,000 to $2,000 apiece—just to derive one cloned embryonic-stem-cell line for use in regenerative therapy.”⁹ If true, it would be next to impossible to secure the billions of human eggs needed for widespread therapeutic cloning. Further, even if the biotechnology could be developed, “it would either be available only to the super rich or so costly that it would have to be stringently rationed.”¹⁰ Third, as of July, 2005, noncontroversial adult stem cells were treating 65 known diseases while their embryonic counterparts were treating none, leading some scientists to wonder if embryo cells had any therapeutic value whatsoever.¹¹ Fourth, prospective investors failed to supply the cash for research that, in their view, was highly speculative and might not cure anyone for years to come, if at all. Finally, a burst of new research indicated that cloning technology might never yield substantial treatments unless cloned humans were developed well past the embryonic stage.¹²

Advocates of embryonic stem cell research, until recently, have flatly denied any intention of implanting embryos in order to harvest tissues or organs from later-term fetuses. Robert George thinks, however, that their response to ANT points toward a different agenda: full-fledged fetus farming. “Based on the literature I have read and the evasive answers given by spokesmen for the biotechnology industry at meetings of the President’s Council on Bioethics, I fear that the long-term goal is indeed to create an industry in harvesting late embryonic and fetal body parts for use in regenerative medicine and organ transplantation.”¹³

George’s concerns are well founded. Experiments are already underway in which cloned cow embryos are implanted, gestated to the early or late fetal stage, then killed so that their organ tissues can be harvested.¹⁴ Cells extracted from later-term fetuses are stable, which benefits researchers by allowing them to get around the tumor problem associated with embryo cells. “We hope to use this technology in the future to treat patients with diverse diseases,” said Robert Lanza, who coauthored one of the cow studies.¹⁵ Legally, he has a green light; the New Jersey law, and others styled after it, permit this same cloned organ farming to be done in humans.

While the legislative debate rages on, four troubling developments within bioethics are clearing the way for the brave new world of fetus farming. Each development is visibly present in the current debate over embryonic stem cell research.

1. JUNK SCIENCE: POLITICS OVER TRUTH

In a February 2006 New York Times op-ed piece, Michael Gazzaniga, the director of the Center for Cognitive Neuroscience at Dartmouth College and member of the President’s Council on Bioethics, chided President Bush for allegedly misstating the facts about cloning: “Calling human cloning in all its forms an ‘egregious abuse’ is a serious mischaracterization. This makes it sound as if the medical community is out there cloning people, which is simply not true. The phrase ‘in all of its forms’ is code, a way of conflating very different things: reproductive cloning and biomedical cloning.”¹⁶

How are these things different? Gazzaniga’s alleged distinction between “reproductive cloning” and “biomedical cloning” is totally misleading because all cloning is reproductive. So-called reproductive cloning simply means allowing the cloned human to be born alive. Biomedical (or therapeutic) cloning means creating him for research, but killing him before birth. In either case, the act of cloning is exactly the same and results in a living human embryo. I’ll say more about this below, but the important point here is that a cloned human being is created when the nucleus is removed from a human egg and replaced with genetic material from a donor. Once this occurs, the act of cloning is complete. After that, the only question is how will we treat the cloned human being—kill him for research or allow him to grow and develop?

Gazzaniga replies that although adults and children are human beings, cloned embryos are mere “hunks” of cells in a petri dish. This is sloppy science. Living human embryos are not mere hunks of cells, but distinct, self-integrating organisms capable of directing their own physical maturation as members of the human species. Maureen Condic, assistant professor of neurobiology and anatomy at the University of Utah, explains the important distinction between clumps of cells and whole human embryos that Gazzaniga overlooked:

The critical difference between a collection of cells and a living organism is the ability of an organism to act in a coordinated manner for the continued health and maintenance of the body as a whole.…Embryos are not merely collections of human cells, but living creatures with all the properties that define any organism as distinct from a group of cells; embryos are capable of growing, maturing, maintaining a physiologic balance between various organ systems, adapting to changing circumstances, and repairing injury. Mere groups of human cells do nothing like this under any circumstances.¹⁷

Senators Diane Feinstein (D-CA) and Orrin Hatch (R-UT), cosponsors of a pro-cloning measure in the U.S. Senate, meanwhile, have taken junk science to a whole new level. Both insist that the embryos in question are not human organisms, but eggs(!)¹⁸ or stem cells¹⁹ that have the potential to become human beings. This is simply not true. Embryos are not mere eggs; they are living human beings—tiny human subjects that don’t come from stem cells but have stem cells, and extracting these cells is lethal for them. To say anything different is not science but politics.

If politics can explain away the human nature of embryos, however, it will have no problem explaining away the human nature of fetuses. All we need are a few promised cures.

2. STEALTH CLONING AND PHONY BANS

The relationship between fetus farming and cloning is clear. First, cloning (theoretically) provides a rich supply of embryos that can be grown to the fetal stage where organs can be harvested. Second, cloning allows researchers to derive these organs from a fetus that genetically matches the patient, thus minimizing the potential for organ rejection. The bottom line is that you cannot pursue fetus farming unless you first sell the public on embryo cloning. The problem, however, is that when the public is asked directly whether tax dollars should be used to clone human embryos for destructive research, a majority says No! ²⁰

Fearing public backlash, advocates of embryonic stem cell research, including those in the biotechnology industry, are slyly trying to legalize cloning with a series of phony bans. Known more accurately as “clone and kill” laws, these alleged “bans” allow human embryos to be cloned provided they are destroyed for medical research prior to birth.

Shocking though it may seem, some “pro-life” advocates support these bills. In Missouri, for example, former Republican senator John Danforth is honorary co-chair for the Missouri Stem Cell Research and Cures Initiative (sponsored by the Missouri Coalition for Lifesaving Cures), a ballot measure that would amend that state’s constitution to allow embryonic stem cell research permanently. Danforth assures us that he is solidly “pro-life,” has “always voted pro-life,” and that the initiative “respects the sanctity of life”; however, misleading cloning language is all over the group’s “Setting the Record Straight” fact sheet and other documents on their Web site.

The fact sheet, for example, states that the initiative “clearly and strictly bans human cloning.”²¹ Their “Frequently Asked Questions and Answers” section, however, contains this baffling statement: “We believe that ALL [emphasis in original] types of stem cell research should be pursued in the effort to find lifesaving cures, including research involving adult stem cells, Somatic Cell Nuclear Transfer (SCNT) and stem cells from excess fertility clinic embryos (also called blastocysts or pre-embryos) that would otherwise be discarded. We also believe that human cloning should be banned.”²² Several paragraphs later, SCNT is defined as “a process that uses a patient’s own cell and an empty, unfertilized egg to create ES [embryonic stem] cells.”²³

The deception here is breathtaking. First, SCNT is cloning and Danforth knows it. (A decade ago, this exact same technique gave us “Dolly,” the first cloned sheep.) The process begins when a scientist removes the nucleus from a mature, unfertilized human egg (an oocyte) and replaces it with donor DNA. Chemicals are then added and a spark of electricity (scientists hope) jolts the cell into dividing and growing into a cloned human embryo. At this point the act of cloning is complete and we are faced with a choice—nurture the embryo until it is born or destroy it for research. What Danforth’s Missouri Cures proposal strictly forbids is the birth of a cloned human being, not its destruction for medical research.

Second, there is no such thing as a “pre-embryo.” Cloning advocate and Princeton University biology professor Lee Silver points out that the misleading term is used to fool the public deliberately into accepting destructive embryo research and cloning: “I’ll let you in on a secret. The term pre-embryo has been embraced wholeheartedly by IVF [in vitro fertilization] practitioners for reasons that are political, not scientific.”²⁴

Third, SCNT does not make embryonic stem cells from unfertilized eggs. It creates living human embryos that researchers will destroy so that they can get stem cells.

Just when you thought the deception couldn’t get worse, the site also states that the Missouri Cures initiative “resolves concerns about human cloning by strictly banning human reproductive [emphasis added] cloning to create babies.”²⁵ Let’s be clear: cloning is cloning, period! As mentioned above, the alleged distinction between “therapeutic” cloning and “reproductive” cloning is completely misleading because all cloning is reproductive. In each case, what is banned is the birth of cloned human beings, not their creation for destructive research. New Jersey’s clone bill, for example, was sold to the public as a strict prohibition on human cloning, but with a hidden lethal twist: that so-called strict prohibition was simply that all cloned embryos and fetuses must be killed before they have a chance to develop into more mature human beings. California law bans initiating a pregnancy with a cloned embryo, but only if that pregnancy “could result in the birth [emphasis added] of a human being.”²⁶ In other words, human lives may be created with cloning technology if and only if technicians agree—under threat of legal penalty—to destroy any clones prior to birth. That is the proposed ethical safeguard that allegedly bans cloning. It’s a sham.²⁷

Pro-life advocates, moreover, do not oppose the destruction of cloned human embryos because it kills “babies”; rather, we oppose it because it unjustly takes the life of a defenseless human being, regardless of his or her stage of development. The fact that Danforth and a sympathetic press pretend otherwise is shameful, but not surprising.

“The mainstream media still discusses these issues as if scientists only want to use embryos left over from IVF procedures,” writes Smith. “But those days are long, gone. It is now undeniable that Big Biotech and its politician and university allies do not even intend to restrict biotechnological research to early embryos situated in petri dishes.” The bills in New Jersey and these other states clearly demonstrate that “the ground is being plowed already to allow cloned fetal farming, the next, but certainly not last, step intended to lead us to a Brave New World.”²⁸

3. ALLEGED MORAL NEUTRALITY

In a 2005 New York Times editorial, Danforth writes that government restrictions on embryonic stem cell research (put plainly, on the practice of cloning human embryos for destructive research) wrongly impose a particular religious view on a pluralistic society: “It is not evident to many of us that cells in a petri dish are equivalent to identifiable people suffering from terrible diseases…the only explanation for legislators comparing cells in a petri dish to babies in the womb is the extension of religious doctrine into statutory law.”²⁹

Danforth’s claim that pro-life advocates who are opposed to embryonic stem cell research provide no rational defense for their position is simply incorrect. They do provide a rational defense. The problem is that Danforth, like others who make this claim, never engages the sophisticated philosophical case that pro-life philosophers present in support of the humanity of the embryo.³⁰ He cannot bring himself to answer a basic pro-life argument—one based on science and philosophy—even at the popular level. Scientifically, pro-life advocates contend that from the earliest stages of development, the unborn are distinct, living, and whole human beings. True, they have yet to grow and mature, but they are whole human beings nonetheless.³¹ Philosophically, pro-life advocates argue that there is no morally significant difference between the embryo you once were and the adult you are today. Differences of size, development, and location are not relevant in the way that advocates of embryonic stem cell research need them to be. Pro-life advocates do not need Scripture or church doctrine to tell them these things. These are truths that even atheists and secular libertarians can recognize, and sometimes do.³²

Nowhere in his editorial does Danforth present a principled argument that explains why pro-life advocates are mistaken on these points. He appeals to neutrality, but this does not help. The nature of the debate over embryonic stem cell research is such that both positions are based on a metaphysical view of human value (i.e., a view of the value of human beings apart from any of their physical characteristics or attributes), and therefore the pro-research position that Danforth defends is not entitled to win by default.³³ The question is not which position has an underlying metaphysical view and which does not, but which underlying metaphysical view is correct.

The view underlying the pro-life position is that humans are intrinsically valuable in virtue of the kind of being they are. True, they differ immensely with respect to talents, accomplishments, and degrees of development, but they are nonetheless equally valuable because they share a common human nature. Their right to life comes to be when they come to be, either at conception or at the completion of a cloning process. The view underlying Danforth’s pro-research position is that humans have value (and hence, rights) not in virtue of the kind of thing they are—human organisms—but only because of an acquired property that comes to be after they come to be, later in the life of the human organism. The early embryo does not appear (to him) to be a human being with rights, therefore, destructive research is permissible.

Notice that Danforth is doing the abstract work of metaphysics—he is using philosophical reflection to defend a disputed view of human value in his quest to defend embryonic stem cell research. Put simply, Danforth’s attempt to disqualify the pro-life position from public policy based on its alleged metaphysical underpinnings works equally well to disqualify his own position.

In the end, it is hard to see how Danforth’s case for moral neutrality would not also justify the destruction of later-term fetuses. For example, during a 2004 presidential debate, Senator John Kerry defended his own record on abortion (which includes his refusal to vote against grisly partial-birth abortion procedures) with language similar to Danforth’s: “First of all, I cannot tell you how deeply I respect the belief about life and when it begins. I’m a Catholic, raised a Catholic. I was an altar boy. Religion has been a huge part of my life.…But I can’t take what is an article of faith for me and legislate it for someone who doesn’t share that article of faith, whether they be agnostic, atheist, Jew, Protestant, whatever. I can’t do that.”³⁴ Presumably, stabbing late-term fetuses in the head and sucking out their brains is a mere preference issue, something we should no more restrict than our right to choose chocolate ice cream over vanilla.

4. PERSONHOOD PROPAGANDA

In his New York Times article, Gazzaniga attacks President Bush’s cloning policy as follows: “The president’s view is consistent with the reductive idea that there is an equivalence between a bunch of molecules in a lab and a beautifully nurtured and loved human who has been shaped by a lifetime of experiences and discovery.…DNA must undergo thousands if not millions of interactions at both the molecular and experiential level to grow and develop a brain and become a person.”³⁵

Notice the unsupported claims here. Why should we suppose that brain development bestows value on a human? As usual with pro-cloning advocates, Gazzaniga does not tell us why development matters, nor does he say why certain value-giving properties are value-giving in the first place. True, he later appeals to one’s immediate capacity to experience memories, loves, and hopes, but isn’t that begging the question, since the issue is whether one is a human subject even if one does not have memories, loves, and hopes? Newborns lack all of these qualities, so does it follow that they, too, are fitting subjects for destructive research?

Gazzaniga further says that it squares with our basic intuitions to accept that adults and children are people while clumps of cells in a petri dish are not: “Look around you. Look at your loved ones. Do you see a hunk of cells or do you see something else?…We do not see cells, simple or complex—we see people, human life. That thing in a petri dish is something else. It doesn’t yet have the memories and loves and hopes that accumulate over the years.”³⁶

The idea that a human becomes a person only after some degree of physical development amounts to saying, “I came to be after my body came to be,” or, “I inhabit a body that was once an embryo.” Gazzaniga does not defend this metaphysical assumption that personhood is an accidental (or nonessential) property rather than something intrinsic (or essential) to the human subject.

Gazzaniga’s appeal to our intuitions—“these embryos don’t look like your relatives” (my paraphrase)—is naïve, though I agree that some people will not be impressed with a two-week-old human embryo. For them, it is counterintuitive to suggest that something the size of a small dot is a human being. (One hundred and fifty years ago, incidentally, many people also thought it counterintuitive to suggest that black slaves were human.) Many others, however, experience a very different intuition when they consider that same embryo, one that tells them we should protect and not harm the weakest members of the human family, regardless of their body size, location, or degree of development. The question now becomes, which intuition is correct, the pro-lifer’s or the pro-cloner’s?

Merely describing our feelings about something will never resolve a conflict between two competing intuitions. We must go back to the evidence. What do the facts of science say? The facts say that from the earliest stages of development, the unborn are distinct, living, and whole human beings. In short, intuitions are not infallible, though we are justified believing them until presented with superior evidence. In this case, Gazzaniga’s appeal to intuition does not refute the strongly evidenced claim for the humanity of the embryo; it merely sidesteps it.

Princeton University philosopher Peter Singer is correct: Once society accepts that human beings have value only because of some acquired property such as self-awareness, there remains no logical reason to exclude only embryos. Fetuses and newborns will also lose their right to life.

WHAT CAN BE DONE?

All is not lost, but pro-life Christians face a daunting task. Singer writes, “By 2040, it may be that only a rump of hard-core, know-nothing religious fundamentalists will defend the view that every human life, from conception to death, is sacrosanct.”³⁷

To thwart the fulfillment of his prediction, pro-life advocates must press for a federal ban on all human cloning. The good news is that a ban on cloning is a ban on fetus farming. The U.S. House of Representatives passed such a ban in 2002, but the legislation failed to pass in the U.S. Senate. The bad news is that should our defeat prove permanent, we will be creating human beings precisely as organ factories long before 2040. You can bet the farm on it. Just ask New Jersey.

notes

1. Kathryn Jean Lopez, “State of Cloning: An Unprecedented Law in New Jersey,” National Review, January 5, 2004, http://www.nationalreview.com/lopez/lopez200401051346.asp.

2. Wesley J. Smith, cited in ibid.

3. Robert P. George, “Fetal Attraction: What the Stem Cell Scientists Really Want,” Weekly Standard, October 3, 2005.

4. Marie Tasy, cited in Lopez.

5. S 1909, 210th New Jersey Legislature, http://www.njleg.state.nj.us/2002/Bills/S2000/ 1909_I1.HTM

6. Douglas Johnson, cited in Staff Reports, “Fetal Farming Is on the Horizon,” Citizen Link, September 27, 2005, Family.org, http://www.family.org/cforum/news/a0038045.cfm.

7. Alexander Meissner and Rudolf Jaenisch, “Generation of Nuclear Transfer-derived Pluripotent ES Cells from Cloned Cdx2-deficient Blastocysts,” Nature, October 16, 2005. Cited in Clementine Wallace, “Controversy-Free Stem Cells,” Scientist, October 17, 2005.

8. Kathryn Jean Lopez, “‘One Small Island of Unity in a Sea of Controversy’: Altered Nuclear Transfer and the Moral Boundaries of Humanity,” National Review, December 6, 2005, http://www.nationalreview.com/interrogatory/hurlbut200512060850.asp.

9. Wesley J. Smith, “Cell Wars: The Reagans’ Suffering and Hyped Promises,” National Review, June 8, 2004, http://www.nationalreview.com/comment/smith200406081105.asp.

10. Ibid.

11. Do No Harm: The Coalition of Americans for Research Ethics, “Benefits of Stem Cells to Human Patients: Adult Stem Cells v. Embryonic Stem Cells,” Fact Sheet, Do No Harm, http://www.stemcellresearch.org/facts/treatments.htm.

12. Robert Lanza et al., “Regeneration of the Infarcted Heart With Stem Cells Derived by Nuclear Transplantation,” Circulation Research 94 (April 2, 2004): 820–827, http://circres.ahajournals.org/cgi/reprint/94/6/820. See also Robert Lanza et al., “Generation of Histocompatible Tissues Using Nuclear Transplantation,” Nature Biotechnology 20 (July 2002): 689–696, www.nature.com/nbt/journal/v20/n7/pdf/ nbt703.pdf; cited in “Research Cloning and Fetus Farming: The Slippery Slope in Action,” report by the United States Conference of Catholic Bishops, http://www.usccb.org/prolife/issues/bioethic/cloning/farmfact31805.htm.

13. George.

14. Robert Lanza et al., “Long-Term Bovine Hematopoietic Engraftment with Clone-derived Stem Cells,” Cloning and Stem Cells 7, 2 (June 2005): 95-106, Advanced Cell Technology, http://www.advancedcell.com/file_download/28.

15. Advanced Cell Technology, “Somatic Cell Nuclear Transfer Gives Old Animals Youthful Immune Cells,” press release, June 29, 2005, Advanced Cell Technology, http://www.advancedcell.com/press-release/somatic-cell-nuclear-transfer-gives-old-animals-youthful-immune-cells.

16. Michael Gazzaniga, “All Clones Are Not the Same,” New York Times, February 16, 2006.

17. Maureen Condic, “Life: Defining the Beginning by the End,” First Things 133 (May 2003): 50–54.

18. Orrin Hatch and Diane Feinstein, cited in Wesley J. Smith, “The Stem-Cell Senators, National Review, June 27, 2001, http://www.nationalreview.com/comment/comment-smith071602.asp.

19. Ibid.

20. Wilson Research Strategies did a poll for the National Right to Life Committee (August 2004) that found 53 percent oppose using tax dollars for destructive embryo research while 38 percent support funding. The complete poll can be viewed at http://www.nrlc.org/ Killing_Embryos/NRLCStemCellPoll.pdf.

21. Missouri Coalition for Lifesaving Cures, “Setting the Record Straight,” Missouri Coalition for Lifesaving Cures, http://www.missouricures.com/settingtherecord.php.

22. Missouri Coalition for Lifesaving Cures, “Frequently Asked Questions and Answers,” under “About the Missouri Coalition for Lifesaving Cures,” Missouri Coalition for Lifesaving Cures, http://www.missouricures.com/faq.php.

23. Missouri Coalition for Lifesaving Cures, “Frequently Asked Questions and Answers,” under “About the Missouri Stem Cell Research and Cures Initiative,” Missouri Coalition for Lifesaving Cures, http://www.missouricures.com/faq.php.

24. Lee Silver, Remaking Eden: Cloning and Beyond in a Brave New World (New York: Avon Books, 1997), 39.

25. Missouri Coalition for Lifesaving Cures, “Citizens’ Initiative Effort Launched to Protect Stem Cell Research and Cures in Missouri,” press release, October 11, 2005, Missouri Coalition for Lifesaving Cures, http://www.missouricures.com/rel_101105.php.

26. California Health and Safety Code §125300, cited in “Research Cloning and Fetus Farming.”

27. Wesley J. Smith, “Stealth Cloning,” National Review, February 15, 2005, http:// www.nationalreview.com/smithw/smith200502150746.asp.

28. Ibid.

29. John Danforth, “In the Name of Politics,” New York Times, March 30, 2005.

30. See, e.g., Francis J. Beckwith, “The Explanatory Power of the Substance View of Persons,” Christian Bioethics 10, 1 (2004): 33–54.

31. Condic.

32. See, e.g., Libertarians for Life, http://www.l4l.org, and Godless Pro-lifers, http:// www.godlessprolifers.org.

33. I owe my thoughts in this section to Francis J. Beckwith’s analysis in “Law, Religion, and the Metaphysics of Abortion: A Reply to Simmons,” Journal of Church and State 43, 1 (Winter 2001): 19–33.

34. John Kerry, Second Presidential Candidates’ Debate, Washington University, St. Louis, Missouri, (October 8, 2004), Commission on Presidential Debates, http:// www.debates.org/pages/trans2004c.html.

35. Gazzaniga.

36. Ibid.

37. Peter Singer, “The Sanctity of Life,” Foreign Policy, September–October 2005, cited in “10 Ideas on the Way Out,” Dallas Morning News, November 27, 2005.