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MEILAENDER ON GENETIC ADVANCE AND PRENATAL SCREENING

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Meilaender takes these topics up in chapters 4 and 5, of his Bioethics: A Primer for Christians. I will devote more space to the first issue.

CHAPTER 4, GENETIC ADVANCE (pp. 38-47)
Summary and Comment
Meilaender’s principal concern in this chapter centers on a new kind of medical therapy aimed at curing persons suffering from or genetically disposed to different genetically caused diseases such as Down Syndrome, sickle-cell anemia, diabetes, and many, many others. After describing how some of these diseases are caused genetically, Meilaender then examines the basic forms of genetic therapy: germ cell therapy and somatic cell therapy. Modifications of germ cells (i.e., the cells proper to males and females, sperm and ova respectively, that when united become a newly conceived human person) are passed on to future generations whereas modifications of somatic cells (=equals the cells found in different parts of an individual’s body, e.g., in one’s brain, pancreas, liver, colon, etc.) are not and affect only the individual whose somatic cells are modified (39-41). Meilaender repudiates germ cell therapy, judging its supposed great benefit—the overcoming of disease not just in one person but in future generations–to be its “greatest danger…[which] C. S. Lewis memorably characterized as the ‘abolition of man.’” By this Meilaender and Lewis mean that the risks of such therapy and the harmful effects it might have on our children and grandchildren are not known to man but only to God—and we are not God and ought not “play” God. On the other hand, the moral questions raised by somatic cell therapy do not call for “the no that should be spoken to germ cell modification but for caution and a willingness to distinguish acceptable from unacceptable aims of therapy” (42-43).

Meilaender next considers so-called “enhancement” therapy, i.e.,efforts to “enhance” human capacities such as intelligence, muscular strength, beauty. He repudiates over-expansive notions of “health and wholeness,” illustrated by the World Health Organization’s 1946 definition of health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” If this definition is accepted, he says, it will result in our never reaching “a point at which we are prepared to…oppose disease but accept persons no matter what their capacities.” What we really need, he thinks, is “the virtue of humility before the mystery of human personhood and the succession of generations…Were such humility to shape our vision generally, we would…have little to fear from somatic cell therapy. We could pursue its possibilities while also being more accepting of our recalcitrant genes” (44-45).

He ends this chapter with a brief section on “Screening” (45-47), focusing on the screening of the newborn and of carriers of genetic diseases (Chapter 5 will deal with prenatal screening). Newborn screening aims to discover diseases genetically induced that if detected soon enough can be effectively treated. Such screening is in principle morally sound (Meilaender gives the test for PKU as an example; PKU stands for “phenylketonuria,” a genetic disorder that prevents a child from metabolizing his food properly and leading to progressive mental retardation, brain damage, and seizures. It can easily now be detected in newborns and diet plus protein supplements can save the child from suffering these effects).

Meilaender offers sound moral guidance in this chapter. His evaluation of germ cell therapy and enhancement therapy is similar to that made in 2008 by the Congregation for the Doctrine of the Faith in its new document on bioethics, Dignitas Personae. That document, however, did not condemn germ-cell therapy as such. It taught that, “because the risks connected to any genetic manipulation are considerable and as yet not fully controllable, in the present state of research, it is not morally permissible to act in a way that may cause possible harm to the resulting progeny. In the hypothesis of gene therapy on the embryo, it needs to be added that this only takes place in the context of in vitro fertilization and thus runs up against all the ethical objections to such procedures. For these reasons, therefore, it must be stated that, in its current state (emphasis added), germ line cell therapy in all its forms is morally illicit” (no. 27).

Dignitas Personae’s evaluation of “enhancement” therapy is like Meilaender’s but goes into much more detail in offering reasons for repudiating such therapy, expanding on the hybris leading to such therapy, the injustices it could cause, and the arbitrariness of choosing which changes are positive, which negative (no. 27).

CHAPTER FIVE: PRENATAL SCREENING (pp. 48-54) [1]
Summary and Comment
At the beginning of this chapter Meilaender writes:

Precisely because we know ourselves to have been loved unqualifiedly by God, and because we know that we ought to love as we have been loved, Christians ought to set themselves against prenatal screening, at least as it is currently practiced in this country in an increasingly routine way. For it stands in conflict with the virtue that would say to another, ‘It is good that you exist’” (p. 48).

Prenatal screening, as practiced, is not intended to suggest therapy for the unborn child; it simply seeks to identify those who should then be eliminated by aborting, i.e., killing them. After sketching different scenarios, Meilaender points out that the availability of abortion allows the mother of a child identified as not measuring up to standards to “walk away” from the child. As a result a pregnancy today frequently is a “tentative” one. Unless and until the screening give reassuring results, the woman will be reluctant to acknowledge the truth that she is carrying a fellow human person; she will keep a certain “distance,” not knowing whether she will continue any bond with this particular fetus or walk away and consent to its “elimination.” “Thus, prenatal screening with abortion as a possible ‘treatment’ in view if test results are unsatisfactory has a subtle effect on the meaning of motherhood (and eventually fatherhood). It makes the mother’s commitment to the child tentative and conditioned. Modern technology has, as it were, transformed the child into a “product” inferior to its producers and subject to quality controls, to be “eliminated,” i.e. killed, if  it does not measure up to certain standards.

Since I am in agreement with Meilaender, I have only one observation (comment) to offer. He does not take up such non-invasive ways of examining the unborn as sonograms; and these can definitely be used for genuinely therapeutic purposes. Focusing on the routine use of prenatal “screening” to identify unborn children with serious maladies and intended to “eliminate” those so identified by aborting them, Meilaender does not consider forms of prenatal diagnosis that can and are put to good use. Thomas Hilgers, M.D., a great pro-life doctor and pioneer in developing morally legitimate ways of helping couples conceive children through the marital act, says that for the most part invasive procedures which jeopardize the embryo and fetus (e.g., amniocentesis) are medically unnecessary in medical practice in which neither the doctor nor the patient are willing to abort. He points out that in some select kinds of cases having adequate knowledge of the child’s condition can be useful in guiding proper medically therapeutic treatment of the unborn child. Diagnostic ultrasound is noninvasive and is probably not sufficiently employed to afford proper management of pregnancies.[2] Prenatal diagnosis can be very valuable. For example, by detecting neural tube anomalies such as spina bifida it is frequently possible to engage in therapeutic actions on the developing embryo in the womb. This is illustrated in caring for an unborn child shown by a sonogram to suffer from a neural tube defect: a shunt can be inserted into the child’s brain and fluid causing pressure on the brain drained from it, thus providing great benefit to a child suffering from that serious malady. In fact, at a hearing at the US Senate some years ago sponsored by then pro-life Senator Gordon Humphrey,  I witnessed testimony from a couple and their physician, with the child—now born and resting on her mother’s  lap—in which they described the wonderful surgery that had been done on the child while still in womb, a therapeutic intervention indicated after prenatal diagnosis had shown that she suffered from a neural tube defect and that fluids were building up in her cranium, exerting pressure on her brain. This timely intervention was successful in minimizing the harm this child suffered.

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[1] “Prenatal Screening” is testing the human embryo or fetus  (=unborn baby) for diseases or other condition affecting it prior to her or his being born.

[2] “Prenatal and Pre-Implantation Genetic Diagnosis: Duty or Eugenic Prelude?” in Human Genome, Human Person, and the Society of the Future : Proceedings of the Fourth Assembly of the Pontifical Academy for Life (Vatican City, February 23-25, 1998), eds. Juan de Dios Vial Correa and Elio Sgreccia (Vatican City: Libreria Editrice Vaticana, 1999), p. 178-179.

 

 

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Precisely because we know ourselves to have been loved unqualifiedly by God, and because we know that we ought to love as we have been loved, Christians ought to set themselves against prenatal screening, at least as it is currently practiced in this country in an increasingly routine way. For it stands in conflict with the virtue that would say to another, ‘It is good that you exist’” (p. 48).

Prenatal screening, as practiced, is not intended to suggest therapy for the unborn child; it simply seeks to identify those who should then be eliminated by aborting, i.e., killing them. After sketching different scenarios, Meilaender points out that the availability of abortion allows the mother of a child identified as not measuring up to standards to “walk away” from the child. As a result a pregnancy today frequently is a “tentative” one. Unless and until the screening give reassuring results, the woman will be reluctant to acknowledge the truth that she is carrying a fellow human person; she will keep a certain “distance,” not knowing whether she will continue any bond with this particular fetus or walk away and consent to its “elimination.” “Thus, prenatal screening with abortion as a possible ‘treatment’ in view if test results are unsatisfactory has a subtle effect on the meaning of motherhood (and eventually fatherhood). It makes the mother’s commitment to the child tentative and conditioned. Modern technology has, as it were, transformed the child into a “product” inferior to its producers and subject to quality controls, to be “eliminated,” i.e. killed, if  it does not measure up to certain standards.

Since I am in agreement with Meilaender, I have only one observation (comment) to offer. He does not take up such non-invasive ways of examining the unborn as sonograms; and these can definitely be used for genuinely therapeutic purposes. Focusing on the routine use of prenatal “screening” to identify unborn children with serious maladies and intended to “eliminate” those so identified by aborting them, Meilaender does not consider forms of prenatal diagnosis that can and are put to good use. Thomas Hilgers, M.D., a great pro-life doctor and pioneer in developing morally legitimate ways of helping couples conceive children through the marital act, says that for the most part invasive procedures which jeopardize the embryo and fetus (e.g., amniocentesis) are medically unnecessary in medical practice in which neither the doctor nor the patient are willing to abort. He points out that in some select kinds of cases having adequate knowledge of the child’s condition can be useful in guiding proper medically therapeutic treatment of the unborn child. Diagnostic ultrasound is noninvasive and is probably not sufficiently employed to afford proper management of pregnancies.[2] Prenatal diagnosis can be very valuable. For example, by detecting neural tube anomalies such as spina bifida it is frequently possible to engage in therapeutic actions on the developing embryo in the womb. This is illustrated in caring for an unborn child shown by a sonogram to suffer from a neural tube defect: a shunt can be inserted into the child’s brain and fluid causing pressure on the brain drained from it, thus providing great benefit to a child suffering from that serious malady. In fact, at a hearing at the US Senate some years ago sponsored by then pro-life Senator Gordon Humphrey,  I witnessed testimony from a couple and their physician, with the child—now born and resting on her mother’s  lap—in which they described the wonderful surgery that had been done on the child while still in womb, a therapeutic intervention indicated after prenatal diagnosis had shown that she suffered from a neural tube defect and that fluids were building up in her cranium, exerting pressure on her brain. This timely intervention was successful in minimizing the harm this child suffered.

_________________

[1] “Prenatal Screening” is testing the human embryo or fetus  (=unborn baby) for diseases or other condition affecting it prior to her or his being born.

[2] “Prenatal and Pre-Implantation Genetic Diagnosis: Duty or Eugenic Prelude?” in Human Genome, Human Person, and the Society of the Future : Proceedings of the Fourth Assembly of the Pontifical Academy for Life (Vatican City, February 23-25, 1998), eds. Juan de Dios Vial Correa and Elio Sgreccia (Vatican City: Libreria Editrice Vaticana, 1999), p. 178-179.