Senin, 23 Maret 2009

Critique of Dignitas Personae: Problems in the Vatican's Genetic Code?

A Critique of “Dignitas Personae,” or, Two Misspellings in the Vatican’s Genetic Code
by Everett Hamner

In September 2008, the Vatican published a 36-page instruction entitled “Dignitas Personae: On Certain Bioethical Questions” (summary here). Updating its briefer 2004 “Document of the Holy See on Human Cloning,” the text is commendable for its extended engagement with complex scientific and ethical questions. The First Part reviews the Catholic Church’s foundational principles in this area, the Second Part considers new methods of fertility, and the Third Part evaluates emerging possibilities for gene therapy, human cloning, therapeutic use of stem cells, human-animal hybridization, and use of biological material of various origins.

With sincere appreciation but also deep concerns about the Vatican’s effort, I want to offer a critique of “Dignitas” in what seem to me two under-discussed areas. While not pretending any sort of exhaustive treatment, this posting considers (1) the document’s conflation of preference with prejudice and its inconsistent definitions of “normality” in analyzing pre-implantation genetic diagnosis (PGD); and (2) its status quo bias and failure to distinguish between co-creation and sacrilege in considering gene therapy.

First caveat: While not Catholic myself, I am as respectful of this tradition as I am troubled by its historical failings. As a human being, and as a scholar of religion and literature, I am more complete for my encounters with such future saints as J.R.R. Tolkien, Flannery O’Connor, and Walker Percy. I also recognize that this occasion for challenging the Catholic Church exists only because it is one of very few religious organizations to reflect publically and thoughtfully about stem cell research, genetic intervention, and other bioethical realities and possibilities.

Second caveat: While increasingly liberal in my attitudes toward these issues, I am not a freewheeling, technology-will-solve-everything enthusiast. As philosopher Michael Sandel argued in a widely circulated 2004 Atlantic article, “The Case Against Perfection,” there are good reasons to be cautious about genetic engineering. While I find some of Sandel’s concerns badly misapplied, my reservations should not be attributed to a Dawkins-esque, anti-religious scientism. To the contrary, they stem from a desire to hear faith and reason harmonize more complexly.

Before offering my critique, it may help to quickly lay out the Vatican’s own summary of its two foundational principles for evaluating these questions:

(a) “The human being is to be respected and treated as a person from the moment of conception; and therefore from that same moment his rights as a person must be recognized, among which in the first place is the inviolable right of every innocent human being to life” (n. 4).
(b) “The origin of human life has its authentic context in marriage and in the family, where it is generated through an act which expresses the reciprocal love between a man and a woman. Procreation which is truly responsible vis-à-vis the child to be born must be the fruit of marriage” (n. 6).

In this context, I will leave aside widely-critiqued problems with both principles. Regarding (a), many bioethicists (probably a strong majority) would argue that “conception” is a process irreducible to the moment a sperm cell penetrates an egg cell’s outer wall (see a helpfully diagrammed explanation in the blog Human Enhancement and Biopolitics here). Regarding (b), I will simply express my objection to the implicit censure of all LGBT individuals, as well as those whose procreative desires and/or disabilities motivate legitimate laboratory-based efforts.

Now to my main arguments, the first of which focuses on the Vatican’s treatment of pre-implantation genetic diagnosis. PGD involves ex utero selection of disease-free embryos before these are reinserted into a woman’s womb, and the Catholic Church has objected historically because of the association with in vitro fertilization (IVF) and because of the likelihood that unselected embryos will be destroyed. As “Dignitas” explains, “Preimplantation diagnosis – connected as it is with artificial fertilization, which is itself always intrinsically illicit – is directed toward the qualitative selection and consequent destruction of embryos, which constitutes an act of abortion” (emphasis original). Of course this objection turns on the long-debated question of the point at which one ascribes “personhood” and therefore grants protective rights (the “conception” question noted earlier). However, a new emphasis emerges in this document via its selective appropriation of an older source, a 1995 encyclical from Pope John Paul II, “Evangelium Vitae,” which is primarily about abortion but meditates briefly on “prenatal diagnostic techniques.” Eventually quoting John Paul II, “Dignitas” continues,

Preimplantation diagnosis is therefore the expression of a eugenic mentality that “accepts selective abortion in order to prevent the birth of children affected by various types of anomalies. Such an attitude is shameful and utterly reprehensible, since it presumes to measure the value of a human life only within the parameters of ‘normality’ and physical well-being, thus opening the way to legitimizing infanticide and euthanasia as well” (emphasis original).

Setting aside the selective quotation here (John Paul II said more positive, nuanced things about PGD earlier in the paragraph), my objections are that the new document equates preference with prejudice and that it critiques the term “normality” only when convenient. First, the document assumes that if we would prefer our offspring to be spared the experiences associated with a condition like deafness or a disease like Tay-Sachs (which in its most common infantile form, usually causes death by age four or five), we are therefore prejudiced against any human beings who exhibit such conditions or diseases. This is hardly necessary, however. As Ronald M. Green demonstrates (via Frances Kamm) in his accessible, well-argued book, Babies by Design: The Ethics of Genetic Choice (Yale, 2007), “there is a world of difference between caring to have a child with some trait and caring about that child once the child is born” (132). To make an analogy to the (far less serious) realm of internet dating, the premise enabling the Vatican’s newly-extended prohibition against all PGD is like the inference that a request-in-the-abstract for a dark-haired partner denotes hatred of actual blondes.

Furthermore, it seems disingenuous for “Dignitas” to challenge impositions of “normality” when normalization is precisely the Vatican’s intention. The teaching’s final sentence, after all, dares to assert that not just Catholics but “all persons of good will […] will understand and agree with these principles and judgments.” Such compliant individuals can participate in an acceptable “norm”; those of LGBT orientation and those who would attempt IVF cannot. Also, just a few pages after rejecting PGD because of its “eugenic” reliance on “normality,” the instruction blithely reintroduces this very category. Defining appropriate uses of gene therapy, “Dignitas” allows those that “seek to restore the normal genetic configuration of the patient” (n. 26, emphasis added). Apparently, if the Vatican wants to reject a procedure designed to avoid disease before an embryo is implanted, any kind of normative language is anathema; if, however, it wants to affirm treating diabetics by raising their insulin to “normal” levels, or even to embrace certain uses of gene therapy, such language is just fine.

Admittedly, this first critique of the Vatican’s engagement with PGD is partly semantic. By contrast, my second critique of the document’s response to genetic manipulation is founded on my understandings of both biology and Christian theology. In short, the authors adopt a status quo bias appropriate if Christians were called to padlock themselves inside Eden, but not if they are to help build the “Kingdom of God” or “the New Jerusalem” to which Jesus and the Greek scriptures regularly refer. Put another way, we might ask what is really behind the Vatican’s insistence on “accepting human life in its concrete historical finite nature” (n. 27). Scientifically, such conservatism ignores the fact that human life expectancy in developed countries has risen by approximately two decades over the last century, a development to which the Catholic Church presumably does not object. Theologically, the Vatican’s emphasis on passive acceptance of our fates implies that the story of Christianity ought be one merely of returning to our Edenic origins, a very problematic assumption in the minds of many biblical scholars (including Catholics like Luke Timothy Johnson). The mistake is that this requires the Garden to constitute a state of perfect human completion and fulfillment, suggesting our only purpose since the Fall has been to eradicate sin so that our tickets may be validated for reentry. This seems to woefully miss the broader arch of the Genesis-to-Revelation narrative, eclipsing the significance of the Imago Dei and limiting humanity’s vocation to the most banal self-purification.

So what, though—why am I so uptight? Such an Eden obsession, I think, allows us to uncritically adopt the historically known, even when highly unattractive, over the future unknown, even when it holds great potential for good. In the immediate case, “Dignitas” explains in its discussion of IVF that “the replacement of the conjugal act by a technical procedure […] leads to a weakening of the respect owed to every human being” (n. 16). There are a whole host of problems with this assertion: by extension, a person needing to be fed by a robot would be less worthy of respect than people who could lift their own spoons; more mundanely, the manufacture of a syringe would make one party to heroin abuse. The flaw here is not so much the attempt to confront sin as the compulsion to prevent its possibility. Because some people might allow the circumstances of a person’s birth to reduce their respect for an individual, all of humanity must forego the potential blessings of IVF or genetic therapy? Particularly thorny is the argument’s reliance on phrases like “opens the way” and “leads to”: by implication, any morally licit behavior that might conceivably enable a morally illicit behavior becomes itself illicit. The impracticality here should be evident, but just in case, here is another analogy: because posting this critique may “lead to” others’ questions about “Dignitas” and even about the authority of the Holy See, I am responsible for their eventual excommunication.

Perhaps the greatest reason not to accept such fear-driven decision-making arises from the tension between the Vatican’s simultaneous enthusiasm for scientific discovery and its concern that human beings not usurp God. I share both impulses, but even if I didn’t, I would be worried by the Vatican’s willingness to charge sacrilege one moment and encourage that we “transform creation” the next, without laying out criteria by which to separate those actions. At the conclusion of the section on gene therapy, for instance, “Dignitas” is adamant: “in the attempt to create a new type of human being one can recognize an ideological element in which man tries to take the place of his Creator” (n. 27, emphasis original). Leaving aside the echoes of Mary Shelley, this begs the question of how genetic manipulation is any more impious an act of “transform[ing] creation” than elevating life expectancy by treating heart disease. Who gets to say what constitutes “a new type” of person, and why are genetic changes more likely to hinder than to assist in laying aside the “old self” and putting on the “new”? Or, as in the last sentence of “Dignitas,” why cannot genetic engineering itself become a way of “participat[ing] in the creative power of God” and “transform[ing] creation by ordering its many resources toward the dignity and wellbeing of all human beings”?

I may not be quite as gung-ho about all genetic engineering as this might sound, but I hope such critiques will assist those who take religion seriously in avoiding the extremes of both genetic determinism and genetic dismissivism. The opportunities and reasons for stem cell research, genetic testing, genetic manipulation, and non-reproductive cloning are likely to keep multiplying, and we will need many more thoughtful analyses if religious individuals and groups in the U.S. and the world are to play constructive roles in the changes ahead. Incidentally, I would welcome constructive critiques of my own thinking at e-hamner@wiu.edu, as this is far from my last wrestling match with these issues.

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