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The Ethics of Xenotransplantation

A Televised Forum Hosted by
Arlene Bynon
with guests
Dr. Margaret Somerville, McGill Centre for Medicine, Ethics & Law, Montréal, Québec
Alastair Gordon, The Islet Foundation

 

Bynon
Global Television Network
Fri, March 5, 1999
12:00 Noon
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Bynon
Prime Television Network
Thur, March 4, 1999
6:00 PM
 
SOURCE: NATIONAL 
NETWORK STATION: GLOBAL
PROGRAM: BYNON
TIME: 12:00 REFERENCE: 244B1-4 LENGTH: 22 MIN. 
DATE: 05 Mar 99 

Xenotransplantation

ARLENE BYNON: Xenotransplantation. The use of animal organs in human transplants could help with Canada's low rate of organ donation. Now the Commons health committee is holding public hearings right now to examine ways to improve the rate of donation. They've heard from a host of medical and ethical people with reservations on organ transplants. Today the case for and against the use of animal organs. We're joined by Alastair Gordon of Islet Foundation and from Ottawa, Dr. Margaret Somerville from McGill University Centre for Medicine, Ethics and Law. Welcome Dr. Somerville. 

Dr. MARGARET SOMERVILLE / McGILL UNIVERSITY: Thank you. 

BYNON: I know there has been bad weather so you're stuck there in Ottawa. Let me ask you first of all, what reservations, what should we be asking ourselves before we move more forward with this kind of transplantation? 

SOMERVILLE: Well there's all of the usual reservations that we have about medical research which you know, are good reservations. They're to make sure when we do medical research we do it ethically. All of those apply to xenotransplantation. But there's two other reservations. One of them I find serious but not insurmountable. That is what we do to animals in order to make them suitable as donors of these organs. 'Cause these animals have a pretty terrible life. I think we have -- pigs are intelligent animals. It seems as though that's what we'll use. And so I think we have to be very sensitive to the issues surrounding that. Some people think we shouldn't use those animals at all in that way. The other set of issues relates to us. You see most medical research really only creates serious risks to the people who are the research subjects. But there is a possibility and we don't know whether this will occur or not, that you could transfer an infective agent from the pig into the person who gets the organ and that person could then spread it first of all to their sexual partners, maybe to their family and ultimately possibly to everybody in the population. That's what we're worried about. 

BYNON: Okay. Let's just stop on that point because is there new information that humans and animals transfer more diseases than we know because you know, as many people say we have been using some aspects of animals' bodies like insulin or whatever for years. So what's different about it? 

SOMERVILLE: Well because I mean, we don't know. That's the point. Look, I'm not an expert. I'm an expert to the extent that I'm an expert on anything is that once I'm given the scientific facts, I can manage to do an ethical and legal analysis of those. What we know here is a lot of very reputable scientists, eminent scientists say that we've got no idea what we might transfer when we say let's say a heart out of a pig and put the it into a human. There could be all sorts of unknown things. We know about some of the things that we could transfer and we could watch out for those. But the other thing that people were talking about this morning in the committee of the House of Commons was that it could even be that for instance a virus that's in the pig which might not hurt us could combine with a virus that's in us which possibly doesn't hurt us at the moment and then you could have something new and very dangerous. And so there's all sorts of unknowns that we're dealing with here. 

BYNON: Now isn't that the case -- I mean, that's how people believe HIV. I mean it was prevalent in a monkey. It didn't affect the monkey. Somehow it got into a human -- 

SOMERVILLE: Yes. Well we've only be able to establish that authoritatively in the last few weeks. And also the other one that we're concerned about is mad cow disease. Now that's a kind of an unusual transfer between a sheep and cow. But that's two different species where that -- I mean they've lived together for as long as humans have lived with animals. There was never that transfer until we did something unusual feed the cows food that was made from the sheep. And so we're doing something here -- we're doing what we call crossing the species and immunological barrier. And that's very different from simply living with another animal. 

BYNON: Okay. Okay. I'd like to turn over to Alastair Gordon with the Islet Foundation. You've just heard some of this. I mean, are you, you believe that this is a good thing as Martha Stewart would say. Do you not have any reservations about xenotransplantation? 

ALASTAIR GORDON / ISLET FOUNDATION: Any reservations I would have about xenotransplantation would have to be driven by actual scientifically compelling information. In other words, I think it's fairly immoral to allow death and suffering to continue in the face of a completely unarticulated fear. A fear that has never once been demonstrated, never proven. 

BYNON: But it happened with HIV in monkeys. Isn't that...I mean it has happened. 

GORDON: Well if we take look at the examples of HIV in monkeys, there was a transfer of disease from an animal to a human. It did not occur as a result of xenotransplantation. 

BYNON: I know but I think the example is clear that if you know, if it happened by accident, couldn't it happen when we do things on purpose? 

SOMERVILLE: Could I just also interrupt here and just sort of say what we're looking at here in terms of ethics? You see I disagree with you that we've got to know about the risk. You see what we're saying is we should take what's called a precautionary ethic. We should be reticent to do this until we know it's reasonably safe and ethical to do it. Whereas what you're saying is let's do it until we found out it's unsafe. We've had so many bad experiences in the past when we've done that. I mean even if you look at our whole -- 

BYNON: Can you hang on Dr. Somerville? Let Alastair Gordon answer. 

GORDON:: I think, Dr. Somerville, what I'm saying is we have a massive body of evidence that shows that there is not disease transfer between pigs and human beings despite about a 75 year history in which we provided innumerable pathways for that to occur. 

BYNON: Do you mean the insulin? 

GORDON:: For example, people with diabetes have injected insulin from pigs for the past 77 years. For about the first two decades that was a non sterile product. People with burns have been treated with living pig skin. People working in slaughterhouses have certainly been exposed to pig tissue getting into open wounds and those are people that have in many cases severely compromised immune systems at the turn of the century, including tuberculosis. 

SOMERVILLE: Look I accept that. I'm not the expert in the transfer of these organisms or these infected agents. But if that's -- and I accept what you say is true -- but all of the people I listen to when I'm at these scientific meetings are world experts on immunology. And they know all of that and they're raising these concerns. And in fact the concerns are so great in Europe that it's very likely that Europe's going to put a moratorium on this. 

BYNON: Okay. I just want to ask Alastair, do you think there should be control over it? Anything that would make -- you know, put your mind at rest about transferring these kind of diseases? Is there any kind of controls that we are doing? 

GORDON:: Yes, there most definitely needs to be controls. 

BYNON: And what are we doing now? Do we check things? 

GORDON:: We're drafting xenotransplantation guidelines which will make sure that we are using purpose-bred pigs whose sole raison d'être is to be a tissue donor. And -- 

BYNON: What are these pigs like? 

GORDON:: They are are kept under very sterile, very humane conditions. Just touching on Dr. Somerville's point of the ethics of using animals in this way, human beings have a long history of using pigs for suede, paint brushes and bacon. To use a pig to save a child from the horrors of diabetes or somebody from dying from liver disease is certainly to me a lot more ethically palatable than eating them and wearing them. 

BYNON: Dr. Somerville, not a bad point there. 

SOMERVILLE: No, no it's a different argument. You see, what you're mixing up the kind of life that the pig has with what you do with the pig after you killed it. I mean I agree with you that if we use pigs for other purposes then that helps to justify using them for this purpose. But those pigs could be for instance pigs that live anywhere and have a good life. You kill them and you use them for what you want to. These pigs are going to have a totally artificial, confined, terrible life. We know that but we still may be justified in doing it as I believe but not everybody agrees with that. You got to be careful with these arguments that you're very accurate about this points you're taking up.  Comment

BYNON: Okay. Now Alastair, considering all -- let's talk about the justification of doing it in the first place. How low is our organ donation in Canada? 

GORDON:: Well I think that we shouldn't really confuse xenotransplantation with a quick fix for low -- 

BYNON: I want to know what the problem is. 

GORDON:: Well in part it is. I would say pigs do not represent a replacement for human organs for probably at least 10 years. Simply because there are major technological hurdles to transplanting a whole organ from a pig to a person, for example a kidney, a liver or heart. 

BYNON: When it comes to organ donations, I mean that's the reason the Commons committee is taking a look at this. How long are the waiting lists? 

GORDON:: Well I believe around there are three thousand people a year die who are on the list who have qualified for organs. So it's a very serious problem. But I don't want -- again, I don't want to be putting forward xenotransplantation as something that's going to remedy that in the next 10 years. 

BYNON: But there are some scientists who believe that. 

GORDON:: And they're absolutely correct. But they're not saying we'll do it tomorrow. Pig tissue as opposed to organs today could hold a very high degree of promise for curing diseases that were not normally cured through transplantation. For example, curing certain forms of liver disease, curing diabetes, curing Parkinson's and other neurological diseases. So we're not talking whole organ transplants, we're talking about transplanting very small masses of tissue. 

BYNON: Okay. We're going to return. We will be back in a moment. We're going to continue with our look at human problems and animal organs. We'll be right back. 

(ADS) (GRAPHIC): In October 1984, the living heart of a seven- month-old female baboon was transplanted into an infant who was nicknamed "Baby Fae" by the press, in the first introduction of xenotransplantation to the public. 

BYNON: Let's go back to Ottawa. Dr. Somerville, I'm wondering about the psychological. Did anything come up at the Commons committee about the psychological damage of all this both for the donor and the families? I mean is there work being done in that area? 

SOMERVILLE: Well the donor's the pig. I guess we didn't ask the piglets. (Laughs) 

BYNON: Yeah, I mean the person receiving. 

SOMERVILLE: The recipient. What would happen to people -- 

BYNON: Is there a human psychological kind of a factor here? 

SOMERVILLE: I've only heard that briefly mentioned at some of the conferences I've been at on this. It wasn't discussed this morning at the committee. And I don't know very much about it. We do know that transplant recipients can sometimes need to have adjustment to the fact that they've got someone else's organ. And I suppose that would be at least as serious with an animal organ. I don't know. Maybe less. You might think it wasn't somebody else who was a walking around, thinking, you know acting person. Maybe it's less problematic. I've got no idea about that.  Comment

BYNON: Okay. Alastair, is there any psychological factor? Have you talked to people who have had transplants or had you know, some connection? 

GORDON:: Well I've talked to people who have had transplants and I've talked to people who stand to have their lives extended and their suffering minimized by receiving organ tissue from from pigs. And I've not really heard any issue whatsoever, any more than I've heard an issue from somebody I know who has received a pig heart valve. He's just very happy to be alive. 

BYNON: I would imagine though that these people you know, when they're in that condition, when they're waiting that they would have a very grateful. The human being wants to stay alive doesn't it? 

GORDON:: I think the psychological adjustment when compared to the prospect of a life without the procedure, there's just no comparison between the two. 

BYNON: Okay. I want to ask you is there a way to know whether an infectious agent is in of these -- these tissues or organs before it's transplanted? 'Cause we hear there is? 

GORDON:: Yes there are sensitive assays that can test down to one viral fragment. There are thousands of people in the world today who have received, who are living, who have received living pig tissue. And the -- 

BYNON: Does the operation stop if any of that is present? 

GORDON:: Well the operation takes place and then over the next year or two they are tested for infection. 

BYNON: But I'm talking before it happens. If there's an infectious agent, is there a way of testing before the transplant happens? 

GORDON:: Yes. 

BYNON: Would the operation stop? Would the transplant go ahead? 

BYNON: The tissue would not be used from any kind of infected animal. 

SOMERVILLE: Well we can only test for infected agents. It's unknown ones we're worried about. I mean, this was exactly the problem -- for example we've got a problem in this respect at the moment. The CJD which is (unclear) disease and what's called new variant CJD which came from mad cow disease. I mean we're concerned still that that could be transmitted by blood transfusions. We've got no way to test for that. That's the problem. 

BYNON: The dilemma is people don't know whether we stop and whether we're causing a big problem or whether we're holding back science. Is that the problem here? 

SOMERVILLE: In one way I think what we can do is we can talk about science time and medical time and we can talk about ethics time. And the problem is they're not all on the same scale. When you look at science -- and this is totally understandable. The people who are doing it are really, they're enthralled with what. They're doing they want to do it as fast as possible. That's right. They want to discover. You talk about medical time and again, the people that you look at the individual and you think gosh, you know anything I could do to help that person and save their life of course we should do it. At the individual level that's right. Then you talk about ethics time and you say wait a minute, what if what we're doing in all good faith to help this individual and let science go ahead actually gets us into some really serious situation for a very large number of people in the future because of what we've done? That's what we're worried about. 

BYNON: Okay. Alastair, what is your response to that? Is there such a thing as ethics time and have we taken it? 

GORDON:: I think there are those different time scales involved in any new science. But I think any ethical principles we apply to this must be consistent with ethical principles that we apply elsewhere. Using Dr. Somerville's reasoning, if a patient with AIDS required surgery, there is a very real risk that the surgeon will pick up the HIV virus and will pass it on to his intimate contacts. This is not some theoretical unproven risk. 

BYNON: But we can protect ourselves. 

GORDON:: Not to anything near the extent you need to. 

SOMERVILLE: That's not true. 

GORDON:: Dr. Somerville, let me finish please. And yet we make the decision that that risk is worth taking even though it's a very real and demonstrated risk. In this case we are talking about a risk which has never manifested itself. Not once. And it is very prejudicial to say that one particular group will be denied medical care, the best available, because some people harbour fears of the unknown. 

BYNON: Okay. Dr. Somerville? 

SOMERVILLE: Well I don't think the HIV is a good example. First of all, we can test for HIV. Secondly, we know what the conditions for transmission and risks are. And thirdly, we can take steps even if someone does get infected to protect other people from it. And that's precisely -- none of those things can we do with the risks that we're worried about now. If we could do those things -- 

GORDON:: Dr. Somerville, we can apply those controls to the handful of people that will receive pig tissue during early clinical trials. It's a far more controllable situation than the one you're describing. 

SOMERVILLE: Well what you have to be talking about then is that you would have these people agree to live in isolation and their sexual partners and their families to live in isolation with them. Is that what you're thinking of? 

GORDON:: No, I am not thinking reducto ad absurdum. I am thinking of reasonable monitoring and controls. 

SOMERVILLE: But the problem is we don't know that reasonable monitoring and controls will work. That's precisely the problem. 

GORDON:: We don't know that that doctor operating on that patient with AIDS will not nick his finger and pick up the virus and pass it on. We don't know any of those things. We don't know that that doctor will comply with restraints not to be sexually active. We don't know any of those things. That is the world that we live in. And you cannot apply an unrealistically high standard which prejudices one group of people when those same standards are not applied across the board. 

BYNON: Okay I would like to ask -- just a minute. Alastair Gordon, is there not, I mean a new -- do you have no fear of some of the new connections between human and animals transferring disease. I mean it's very real. We're learning from some kind of new mutations of viruses. It's not things that we've known before. There's a new frontier there. Does it concern you at all? 

GORDON:: I would have reservations if we were talking about organ donors being primates, being monkey and baboons. 

BYNON: But not pigs? 

GORDON:: Not pigs because we have a long history of pig tissue in human beings. We have had hundreds of thousands of opportunities for infection to occur. 

BYNON: But aren't there new animal human things happening though? That's the research that I've been doing stories on for a while. There's new connections between animals. 

GORDON:: Well then perhaps we shouldn't coexist with chickens or cows or -- 

SOMERVILLE: We're worried about that. I mean somebody gave evidence this morning in the House of Commons about the fact that the human virus and a chicken virus started this -- was the cause of the Hong Kong flu, which was thought to be immensely threatening so that they wiped out the chicken population in Hong Kong just last year. 

GORDON:: That's correct Dr. Somerville but to control that you would have to likewise bring a moratorium on eating chickens. And we don't do that. We recognize -- 

BYNON: They did kill off a lot of chickens. We are out of time, okay. I would like to thank you both for joining us. Joining us from Montreal is Dr. Margaret-- 

SOMERVILLE: No, from Ottawa. 

BYNON: You're from Ottawa. You were supposed to be in Montreal and the weather kept you there. I hope you eventually get home to Montreal. 

SOMERVILLE: So do I. 

BYNON: You know, hang in there in Ottawa. The weather will heal. And Dr. -- and you're not a doctor -- Alastair Gordon with the Islet Foundation. Thank you so much. 

GORDON:: Thank you. 

BYNON: When we return we're going to talk about a romantic comedy called "Jack and Jill." Don't go way.


Comment re Psychology of Xenotransplantation:
It is worth noting that Dr. Somerville was not always as indifferent to arguments of psychological damage resulting from xenotransplantation as she purports to be in this discussion.  In her own abstract (below) presented at the National Forum on Xenotransplantation: Clinical, Ethical and Regulatory Issues (November 6-8, 1997 in Ottawa, Canada), her arguments are predominantly philosophical and psychological. 
 
Plenary Session I: Overview

XENOTRANSPLANTATION:
ETHICS AT THE HUMAN/-ANIMAL/-GENE/-MACHINE INTERFACE

Dr. Margaret Somerville,
McGill Centre for Medicine
Ethics & Law, Montreal, Quebec

Abstract

Xenotransplantation raises profound ethical issues, which means that ethical concerns and analysis must be embedded in the research and development of this technology. These issues are not ones that can be addressed adequately just by scientists, physicians, ethicists or ethics committees. They require public debate by an informed public. Indeed, it is an ethical requirement that the public be fully involved in the development of Canadian public policy on xenotransplantation.

We must first ask whether xenotransplantation is intrinsically acceptable, that is, is it inherently right or wrong? This raises ethical questions in two areas: First, the ethics of the use of animals as a source of organs for human transplantation, in particular, our treatment of these animals in order to make them suitable as organ donors and the ethics of modifying the genome of animals to include human genes. Second, are the risks of xenotransplantation, especially possible unknown risks, of such a nature and seriousness that we ought not to run them? The major risk usually considered in this context is that of the transfer of an animal virus across the species barrier to humans with potentially tragic results, not simply for the person who received the organ, but for other people, including possibly the community at large who could subsequently be infected by this virus. This means that we must balance, not only harms, risks and benefits to potential individual xenotransplant recipients, but also harms to them in not having access to these transplants and risks to the community in allowing them, in deciding whether xenotransplantation is intrinsically acceptable.

If we decide that, in principle, xenotransplantation is ethically acceptable, we must then examine the ethical issues raised by research, development and use of this technology, in particular, the ethics of human subject research; the ethics of the allocation of scarce health care resources, including opportunity costs in both research and health care; and the ethics of access to xenotransplantation.

Finally, and at the broadest and deepest level, we need to consider the impact that the advent of xenotransplantation technology will have on our societal paradigm, that collection of attitudes, values, myths, beliefs, symbols - the "shared story"- that we buy into in order to form society and which we use to give meaning to our individual and collective lives. For instance, does this take us yet one more step away from an integrated theory of personal identity - seeing ourselves as unique, indivisible human beings - and further along the line of a modular theory of human identity - that we are simply a series of interchangeable parts, and these parts can now include animal parts - and a "gene machine" view of human life? Or could the "miracle" that this technology makes possible deepen our sense of awe and wonder about ourselves, our world, and life in general?

Return to Transcript
Comment re Animal Care:
On several occasions, Dr. Somerville raises the specter of profound cruelty to animals in the practice of xenotransplantation -- in particular, "These pigs are going to have a totally artificial, confined, terrible life". This assertion is simply untrue. I have spoken to a veterinary caregiver at a SPF (Specific-Pathogen-Free) facility where pigs are raised for medical applications, and the level of care and supervision is greater than in any commercial hog farming operation. In fact the greatest difference between a commercial and an SPF facility, to quote this individual, is that "You will not find any SPF pigs coughing, scratching, or suffering from bloody diarrhea. They are disease free." They have the same degree of freedom, and the main difference is that their human handlers must shower and wear protective clothing before entering the facility. At this facility, the welfare of the animals is overseen by an Animal Care Committee (ACC), consisting of academic members from philosophy, zoology, veterinary medicine, and other faculties, members of the humane society, and concerned members of the public.

At the same xenotransplantation conference in November 1997 attended by Dr. Somerville, Dr. Dilly Griffin of the Canadian Council on Animal Care described the standards for raising animals for medical purposes in Canada:
 
Plenary Session III: Scientific, Medical and Ethical Issues

Ethical Use of Animals for Medical Treatment

Dr. Gilly Griffin, Canadian Council on Animal Care
Ottawa,Ontario

Abstract

The Canadian Council on Animal Care (CCAC) is the national agency responsible for the oversight of the care and use of animals used for research, teaching and testing in Canada. The keystone of the oversight afforded by the CCAC rests at the local Animal Care Committee (ACC) level. These ACCs are established at each institution which uses experimental animals, according to Terms of Reference laid down by the CCAC and are responsible for providing ethical review of any proposed animal-based study. ACCs are asked to adhere to the CCAC guidelines on: animal use protocol review in making their ethical judgments. ACCs must attempt to reconcile public demands for medical, scientific and economic progress with demands for reduction in animal use, pain and suffering. The cost in terms of animal welfare and integrity must be measured against the expectation of a proportional contribution to the understanding of fundamental biological principles, or to the improvement of human or animal health or welfare. ACCs are also responsible for ensuring that animals receive proper housing, husbandry and veterinary care and that any procedures are carried out by qualified personnel according to Standard Operating Procedures or best practices.

Return to Transcript

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Thursday, April 29, 1999
Doing science in 'ethics time'
Experts need time to consider new science, like cloning

Margaret A. Somerville
National Post

The birth of Arnold, Danny, and Clint, three transgenic goats (these cute babies carry spider genes) cloned from a single adult cell, is a world first -- and means the successful cloning of (transgenic) humans is not far behind. To say the least, we need time to work out the ethical rules that should govern this technology. In particular, to decide whether or not it is inherently wrong to use it on humans and, if so, to pass legislation to ban such use. A striking example of the time it can take is provided by the Royal Commission on New Reproductive Technologies. After extensive research and hearings, it recommended that human cloning should be prohibited. Five years later we still have not moved to do this.

Xenotransplantation confronts us with a similar necessity to make decisions about what, ethically, we should not do with our new science. There is, in Canada, a serious shortage of human organs for transplantation for which a remedy must be found, urgently. Some people have urged that, among other measures, Canada should seize the xenotransplantation initiative (the transplant of animal organs into humans), even if future risky consequences have not been resolved. 

These examples raise an interesting question about the time-lines that should apply to using new technologies, such as cloning or xenotransplantation. 

"Science time," "medical time," "business time," "political time," and "ethics time" are on different scales. This can be a source of serious difficulty in doing ethics regarding our new science. As the above examples show, extraordinary developments are announced almost daily in the fields of genetics and molecular biology and scientists have an enormous drive and enthusiasm for discovery. They want to get on with what they are doing as fast as they can. The same is true, as it should be, for physicians faced with a seriously ill patient for whom some new development, such as xenotransplantation, offers the only hope. Likewise, business wants to proceed as quickly as possible with "doing business." "Political time" is more complex. There needs to be at least an appearance of considered and wise decision-making. But at the same time, politicians are subject to the "do something" pressure of the electorate, especially in relation to threats to health or life, such as the shortage of organs represents. Moreover, political viability can often depend on short-term answers rather than approaches that would, over the long term, be the most appropriate ones. 

In contrast to all these time-lines, it may be impossible to rush the ethical one. There may be an irreducible minimum time needed both to obtain the necessary facts on which to base good ethics, and for a sedimentation-of-values process to take place.

For instance, there is a possibility that viral fragments embedded in the DNA of an animal could recombine with viral fragments embedded in human genes, if an organ from the animal were transplanted to a human. This could result in serious risks to the health of the transplant recipient and other humans and/or animals. These risks may take a considerable period of time to become manifest. Should we, therefore, require carefully isolated, long-term studies on xenotransplantation between different species of animals, before involving humans? 

Likewise, there is a minimum amount of time needed for the public to become familiar with what a new scientific development means in terms of its benefits, potential benefits, risks and harms, not only at the physical level, but also at the level of its potential impact on values, norms, traditions, customs, cultures, beliefs, attitudes, etc. There is, as well, a difference between simply delivering information on ethics to the public and engaging the public in "ethics talk" about a new technology. The latter takes time. Indeed, how to adequately and effectively engage the public in "ethics talk" is a difficult question, that itself needs in-depth research. 

The relationship between "science time" and "ethics time" has also changed in other ways. Not only is the scope and power of our new science unprecedented in terms of what we could do to ourselves and our world in using it, but also -- especially because of our communications technology and modern travel -- this science and technology is instantly global in its use and impact, in a way that new scientific and technological developments were never before. We do not have the opportunities we had in the past for limited scope experiments on the benefits, risks, and harms of new developments, when these were undertaken in only one location and only slowly picked up elsewhere. 

The present, instant, worldwide access to new scientific developments, in itself, also raises ethical issues. For example, countries without the research infrastructure needed to develop xenotransplantation can use this technology when it has been developed elsewhere. But they might not do so safely for either the research subject-patients involved or the public -- and, they may not do so ethically. 

A related ethical issue is that some scientists who are prohibited from carrying out certain research in their own countries, because of its unacceptably high levels of moral or physical risks threaten to, or do, take their research to countries where there are no restrictions. But while ethical restrictions are geographically limited, the risks these are meant to protect against, are not. In short, many new scientific techniques, such as human cloning and xenotransplantation, need universal ethical regulation. 

We have profound responsibilities to consider not only our own well-being, but also that of future generations in using new technologies. The new genetics and all the possibilities that flow from it constitute a power of unprecedented scope and gravity, with enormous potential for good, but also harm, in some instances. This means that in deciding what we will and will not do with this power, we all, as the public, must be involved in the decision-making. This, in turn, necessarily means that we need adequate time to undertake this decision-making. Science and ethics must march forward together. But when ethics is in the rear and limping a little, science will need to both wait and help ethics to catch up.

Margaret Somerville is a professor of law at McGill University.

 
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Tuesday, May 04, 1999
Letters

National Post
 

The time is now

Regarding the article, Doing Science in 'Ethics Time' by Margaret A. Somerville (April 29), we see a tragic case of someone's philosophic musings potentially bringing suffering and death to others. Dr. Somerville believes that in the case of xenotransplantation -- the use of animal tissue to treat human disease -- "science time" had moved ahead of "ethics time" and the science should be stopped.

I wonder if Dr. Somerville is prepared to tell the mother of a sick child whose life could be saved through xenotransplantation, "I know this new branch of medicine could help your child, ma'am, but you'll have to wait until ethics time catches up with science time."

An undergraduate ethics course may be the place to engage in such abstract sophistry, but where the lives and health of real people are concerned, it is a cruel indulgence. 

Xenotransplantation is not some new bogeyman. For decades, animal tissue -- including insulin, skin, hepatic cells, and neurons -- have benefited millions of people without a single case of infectious disease. Moving into small, well-regulated clinical trials would be a logical and humane application of nearly a century of experience.

Xenotransplantation represents the best hope for curing diabetes and providing a safe and on-demand source of transplantable tissue and organs. Our regulators must not be swayed by vague fears of the unknown.

Alastair Gordon, Toronto.


 
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Saturday, May 15, 1999
Letters

Ethics course 
Re: The Time is Now, letters, May 4.

Alastair Gordon may benefit from an undergraduate ethics course even though he might regard it as "abstract sophistry." He would learn that good facts are essential to good ethics, and that we must take into account not only risks and harms to individuals, but also to the public, in general. 

Xenotransplantation may pose unacceptable risks to the public. These are not just "vague fears." For example, the U.S. FDA has just announced that it will not allow the transplantation of organs from primates to humans because of the risk of the transfer of infective agents, and that it should not be assumed that approval will be given to the transplantation of organs from other animals into humans.

Mr. Gordon would also learn in his ethics course that ethics requires that we take the least harmful approach that is likely to be effective and reasonably available. The use of human organs or tissues for "a sick child whose life could be saved through . . . transplantation," does not pose the same risks as xenotransplantation. It is true that there is a shortage of such organs. But we need to remedy this, before, ethically, we can turn to xenotransplantation as the only reasonably available option.

I am deeply sympathetic to anybody whose health or life is on the line, and who needs medical treatment. The laudable feeling that we must respond to help them and our intention to do good, does not, however, excuse us for failing to proceed with care.

Margaret A. Somerville, McGill University, Montreal.


 

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