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Human Genetic and Reproductive Technologies: A Muslims Understanding of the Secular Perspective
Shahid Athar, MD, FACP, FACE Department of Endocrinology and Medicine St. Vincent Hospital and Indiana University School of Medicine Indianapolis, Indiana

Original Article

Presented at the International Seminar on Human Genetic and Reproductive Technologies in Cairo, Egypt, on February 8, 2006, and organized by the Islamic Organization of Medical Sciences (IOMS) and the Eastern Mediterranean Regional Office (EMRO) of the World Health Organization (WHO). Correspondence should be directed by email to [email protected]
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or the past several years, I have written and spoken on medical ethics from a religious (Islamic) perspective.1-4 However, in this paper, I will be discussing human genetics and reproductive technology from a secular perspective. I have chosen to do so as I strongly feel that there is common

Abstract Physically and intellectually, man is not the same as he was a million years ago. These improvements in humans have come from within over a period of time by the process of adaptation, new learning, and out of a need. So, what is the need now for biotechnical intervention? The fine line between what can be done technically and what should be done morally is the reason for the role of biomedical ethics in the area of human genetic technologies. What is the relationship between the individual and society? Whose interests and needs are we, the scientists and physicians, to serve? Where does the government fit in between the needs of the individual patient and duties of his or her physician? Are social justice, human dignity, and human rights to be considered in genetic modification? While it may be appropriate and desirable to seek treatment for a disease such as infertility, we have moved beyond treating infertility to the quest of making a super healthy super human. As a result, are we embarking on a path of ethnic cleansing of humans of lesser abilities? In this paper, such concerns and questions are discussed from a secular perspective. Key words: Human genetics, assisted reproductive technologies, cloning, ethics.

ground in medical ethics between the religious and secular camps. My aim is not to promote secularism but for the religious group to understand the secular view. Both groups, in my opinion, support core principles of biomedical ethics, such as autonomy of the patient, beneficence, nonmalfeasance, and distributive justice. The religious group, whether we like it or not, has taken it upon itself to speak and act on behalf of God . It s ees its elf as an extens ion of G ods healing powers . It has a s elf-appointed role of implementing G ods injunctions for the benefit of mankind. The secular camp, on the other hand, also works toward the goal of protecting human values and human rights. It sees God as a creation of the human

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mind. For this group, this life is the only life. It empowers man to the best of its potential. What is good for man is good for humanity. The ends justify the means. However, in spite of some commonality, the two groups have very different opinions on the needs of the individual versus the needs of society in the areas of human dignity, human rights, and the role of physicians (scientists). The religious group believes that physicians and scientists are subservient to God , while the s e cula r group believes that they are s ubs ervient only to the individual. Thus, in the pursuit of scientific knowledge and its effects on the future of the human race, we are sailing in uncharted seas and have created areas of concern that are still being debated. In reviewing the current literature on assisted reproductive technologies (ARTs) and biogenetics, some controversies are obvious. Commenting on the relationship between science and morality, Surbone argues that the role of genetic knowledge is overestimated and may either enhance the control that individuals have on their lives or finalize the decision process of the individual who may feel predisposed to a serious disease.5 On the other hand, Cohen feels that the opposing camps in bioethics about reproductive human cloning are not wholly opposed to each other. In fact, they hold certain beliefs and values which are common concerns and they have reconciled their world views on several issues in human reproductive cloning.6 While discussing the respect for the human embryo, GomezLobo7 feels that since they have potential to become adult persons, they are already persons deserving the same rights as adult persons. Reviewing and commenting on creation and sacrificing embryos for stem cells, Devolder feels that creation and destruction of embryos is at the same plane, i.e. one cannot accept the creation and sacrifice of embryos for infertility but condemn the same for the benefit of injured people.8 The controversy about the use of discarded embryos for human research9 revolves around determining when an embryo becomes a moral person. According to Ken Hilma, this happens when brain activity starts. So, it is postulated, that a human being is a human person by nature and a human embryo is a human person by nature and should be

treated as such. On the ethics of human stem cell research, Outka10 from Yale and Heineman11 have written noteworthy articles. Mahowald12 argues that cloning is necessary to preserve bodily integrity or life of an individual. She suggests that scientists and clinicians may respect the negative right to moral integrity with whom they disagree. On the other hand, Lee suggests that choice of reproductive means is a human right. He recommends that a balanced approach be adopted to benefit human society while protecting human dignity. He is of the opinion that a temporary ban on human cloning is appropriate but the ban on relevant scientific research and animal experimentation is inappropriate as it denies the sprit of freedom of scientific inquiry and hinders making the benefits of scientific advancement available to human society as whole.13 Paul Lauritzen writes: If stem cell research led to therapies that changed the contour of human life, it would unsettle our ethical commitments, including the very notion of a human right, and encourage us to see the entire natural world, the human body along with it as having the status only of material to be manipulated. He quotes C.S. Lewis ... the final stage is come when man by eugenics, by prenatal conditioning and by education and propaganda based on perfect applied psychology, has obtained full control over himself. Human nature will be the last part of nature to surrender to man. He goes on to quote Jonathan Clover: Human responses are the core of humanity which contrasts with inhumanity. Lauritzen concludes that morality must be rooted in human needs and values which are rooted in human nature and grounded in human aspirations.14 Professional scientific societies have stated their positions on stem cell research. The Endocrine Society is of the opinion that stem cell research holds promise for 128 million Americans suffering from diseases such as diabetes mellitus, Alzheimers disease, Parkinsons disease, spinal cord injury, stroke, muscular dystrophy, Lou Gehrigs disease, heart diseases, lung diseases, kidney diseases, acquired immune deficiency syndrome (AIDS), liver disease, arthritis, anemia, and leukemia. While the ongoing research on adult stem cell is promising, it does not have the same potential for pluripotency as embryonic stem cells. It is for this reason the society
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Question 3: If it is true that selection and design of babies undermines human dignity, does that potentially also undermine human rights? Answer: Yes, it is true to some extent that designing a baby undermines human dignity. However, it is a matter of choice. If individuals have a right to make Social I mpact s of Genet ic an d Re productive the choice, they must live with that choice. While it Technology: The Secular Perspective may be appropriate for a certain couple to want all Question 1: What in the secular tradition is the vision healthy babies with a specific appearance, it may not of good society and the relationship between individuals be appropriate to want all babies to be of the same and society? How does it differ from the Western secular sex for social reasons. Human rights will be infringed liberal vision of a society composed of rational, self-inter- upon if society declares that all children be born ested and autonomous individuals, which emphasizes the with the same genotype. importance of individual freedom? To what extent, are questions of social justice, who benefits and who loses, relQuestion 4: Is there a philosophical basis within a secevant in clinical consideration in secular society? ular tradition for concerns about social discrimination on Answer: The secular vision of a good society is a the basis of genes, for example, in insurance and employsociety that is based on human rights and human ment? Answer: Social discrimination in employment freedom, caring for everyone who lives in that society, irrespective of color, gender, social status, polit- and health care is prevalent in all societies, secular ical, or religious affiliation. It emphasizes the impor- or not. Women and African Americans receive lower
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supports funding for further stem cell research. Its members have witnessed transplantation of human tissues such as kidney, heart, and bone marrow cells and the improved quality of life it has given to many patients. The society supports the collection of stem cells through voluntary donation only, without monetary incentives, and after thorough informed consent. Furthermore, the society agrees with National Academy of Science report, which recommends that biomedical research using nuclear transplantation to produce stem cells be permitted and a ban on reproductive cloning be imposed.15 Another controversial topic between religious and secular forces is the current status of nearly 400,000 surplus or unused frozen embryos in the United States.16 On one hand, the Republican administration, which is collectively against abortion, is in favor of promoting embryo adoption, while other groups are in favor of donating them for stem cell research. This has opened a Pandoras box of ethical and legal concerns. The difference between what can be done and what should be done is the reason for ethics. Thus, we see that much has been written already and published in this area by many organizations, including the Islamic Organization of Medical Sciences (IOMS)17 and the American Society for Reproductive Medicine18-20, as well as from the Islamic perspective.21 Below are my responses to the questions the IOMS posed to a panel at the International Seminar on Human Genetic and Reproductive Technologies in Cairo, Egypt, on February 8, 2006.

tance of individual freedom and choices in the interest of the individual. All programs in this society are geared toward empowering individuals and the community. It sees the practice of religion as a private and a personal matter. Religion in a secular society is allowed, but coercion of others on the basis of religion is not. Social justice is distributive justice and ideally, everyone is an equal loser or beneficiary. Ethics is not morality but a sum of values.

Question 2: How are the genetic and reproductive technologies affecting the relationship between individuals and society? Is it fair to say that they tend to encourage greater emphasis on individuals inherent characteristics and competition and therefore greater inequality and less social solidarity? Answer: It is true that in a secular society there is more emphasis on individuals rather than on the society at large. Because society is directed by secular individuals, the society will tend not to implement policies detrimental to the individual. There is a possibility of some inequality, but that is related to availability of resources more than the intent. On the other hand, in a religious or ethnic society, the majority is more beneficiary of the available benefits, while secularists and minorities are treated as second-class citizens in terms of ethical rights.

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Question 5: To what extent can arguments about the appropriate use of limited resources be made within the secular tradition? Answer: In a true secular society, theoretically, because there is no discrimination based on religion or social class, the use of resources will be appropriI end by quoting a friend of mine, Dr. Gary ate and only limited by availability. If a heart or kid- Wright, anesthesiologist and chair of medical ethics ney transplant, for example, is needed, it will be on a at the Catholic hospital where I have practiced first come, first serve basis, not on the basis of reli- endocrinology for the last 30 years: gion or ability to pay. Given a choice, one may prefer to live in a Question 6: Are genetic and reproductive technologies religious society where the religion is pracleading to a new form of eugenics in which disabled people ticed in its purest form and the citizens of and others who have less of the abilities that society values nonruling religions and secularists are treatare gradually eliminated from society? If so, what is the ed with equal human rights and human digargument against this? nity. However, in the absence of such utopian Answer: This is a very touchy subject. Yes, it is society at this age, one may accept to live in a possible to some degree that there will always be secular society holding on to the above the survival of the fittest. However, because the secular values to the maximum. society, or as a matter of fact, in a true religious society, all individuals will have equal rights, it will not Dr. Wright wrote to me: happen. There always will be forces that will advocate for the rights of the disabled. This will include The Late Pope John Paul has taught me much not only the disabled individual but also the unborn. about human dignity. Commodifying new Thus, total elimination or discrimination or ethnic biotechnology will be both wonderful as we cleansing of the weak and disabled will never happen discover cures for chronic illness and human no matter how oppressive or how fair the establishenhancement and at the same time worriment is, secular or religious. some. Social hierarchies are the greatest barrier to compassion as they intertwine attitudes of superiority and entitlement. Social In conclusion, I believe the controversy between hierarchies define access to advantageous the religious and secular groups will continue, but I biotechnologies. Genetic biotechnologies will ask both groups to continue to interact and commuprovide more opportunities for the privinicate with the each other. They need each others leged to ensure that the advantages they buy input and suggestions. I ask that religious scholars will become a permanent part of their bodies keep up with the changing scientific knowledge and and their heirs. Equitable access and true usetechnologies. They should not accuse scientists of fulness should be litmus test for new biotechplaying God, as we all try to do the same at times. nologies. Compassion too easily gives way to We really do not know what the future of stem personal profit, unfortunately, a stable part cell and cloning research hold for humanity. Thus, it of human nature.23 will be premature to foretell. As Ted Peters, the prinJIMA: Volume 39, 2007 - Page 171

salaries and fewer bypass procedures, dialysis treatments, and heart and kidney transplants in the United States compared to Caucasian men. In my opinion, such discrimination will still be seen in secular societies based on the socioeconomic status of the individual but to a lesser extent. A religious society, unless religion is practiced in its purest form, in my opinion, practices greater discrimination.

cipal investigator of the Center for Theology and the Natural Sciences research project funded by the United States National Institutes of Health (NIH) to study the Human Genome Initiatives ethical and theological implications, pointed out: If a primitive man had said now I have discovered fire that we can use for cooking and keeping ourselves warm, the holy men would have objected saying that this fire will burn our huts and trees, thus it is bad for humanity. Well, such objections did not prevent the progress of science.22

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On this point both secularists and religious ethi- for therapeutic cloning, and a strategy for fostering cists may agree. respect for moral integrity. Am J Bioeth. 2004 Spring;4(2):56-66. Acknowledgements 13. Lee M. The inadequacies of absolute prohibition I thank Dr. Robert Cleary, professor emeritus of of reproductive cloning. J Law Med. 2004 reproductive endocrinology at Indiana University Feb;11(3):351-72. School of Medicine, and the aforementioned Dr. 14. Lauritzen P. Stem Cells, biotechnology, and Wright for their constructive converstations with human rights: implications for a posthuman future. me on these topics. Hastings Center Report. 2005;35(2):25-33. 15. Stem cell research: The Endocrine Societys posiReferences tion. Endocrine News. 2005;30(9):12-4. Available 1. Athar, S. The Islamic perspective in medical ethics. from: http://www.endoIn Athar, S, editor. Islamic perspectives in medicine. society.org/news/endocrine_news/2005/upload/FI Indianapolis, IN: American Trust Publication; 1994. p. NAL%20Dec%20EN%202005.pdf. 187-94. 16. Crockin S. Embryo wars. Boston Globe. Dec. 4, 2. Athar S. Health concerns for believers: contempo- 2005. rary issues. Chicago, IL: Kazi Publications; 1995. 17. Islam-SET.com [homepage on the Internet]. Al3. IMANA.org [homepage on the Internet]. Lombard, ulaybikht, Al-Kuwait: Islamic Organization for IL: Islamic Medical Association of North America; Medical Sciences. [Cited 2007 Apr 9]. Available from c2002-7. Athar S, Fadel HE, Ahmed WD, et al. Islamic http://www.islamset.com/ioms/cairo2006/index.ht medical ethics: the IMANA perspective. [updated ml. 2005 May 15; cited 2007 Apr 2]. Available from: 18. The Ethics Committee of the American Society http://data.memberclicks.com/site/imana/IMANAE for Reproductive Medicine. Disposition of abanthicsPaperPart1.pdf. doned embryos. Fertil Steril. 2004;82(supp 1):S253. 4. Athar S. End of life issues: an interfaith and Islamic Available from: perspective. Third Qatar International Medical http://www.asrm.org/Media/Ethics/abandonedemCongress; 2005 Nov 12; Doha, Qatar. bryos.pdf. 5. Surbone A. Genetic medicine: the balance between 19. The Ethics Committee of the American Society science and morality. Ann Oncol. 2004;15 Suppl 1:I60- for Reproductive Medicine. Informed consent and I64. Available from: the use of gametes and embryos for research. Fertil http://annonc.oxfordjournals.org/cgi/reprint/15/s Steril. 1997;68:780-1. Available from: uppl_1/i60. http://www.asrm.org/Media/Ethics/informedcon6. Cohen CB. The ethics of human reproductive sent.pdf. cloning: when world views collide. Account Res. 2004 20. The Ethics Committee of the American Society Jul-Dec;11(3-4):183-99. for Reproductive Medicine. Donating spare embryos 7. Gomez-Lobo A. On potentiality and respect for for embryonic stem-cell research. Fertil Steril. embryos: a reply to Mary Mahowald. Theor Med 2002;78:957-60. Available from: Bioeth. 2005;26(2):105-10; discussion 111-3. http://www.asrm.org/Media/Ethics/donatings8. Devolder K. Creating and sacrificing embryos for pare.pdf. stem cells. J Med Ethics. 2005 Jun;31(6):366-70. 21. Fadel HE. Prospects and ethics of stem cell 9. Devolder K. Human embryonic stem cell research: research: an Islamic perspective. J Islam Med Assn. why the discarded-created-distinction cannot be 2007;39:73-83. based on the potentiality argument. Bioethics. 2005 22. Peters T. Playing God? Genetic Determinism and Apr;19(2):167-86. Human Freedom. New York and London: Routledge; 10. Outka G. The ethics of human stem cell research. 1997. 23. Wright G. DO, Anesthesiologist and Ethicist, St. Kennedy Inst Ethics J. 2002 Jun;12(2):175-213. 11. Heinemann T, Honnefelder L. Bioethics. 2002 Vincent Hospital, Indianapolis, (personal communication). Nov;16(6):530-43. 12. Mahowald MB. Self-preservation: an argument
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