Posted by Al Gordon on September 21, 1999 at 21:28:48:
In Reply to: Re: WHO Xeno Discussion posted by Al Gordon on September 16, 1999 at 14:38:13:
Subject: EDX> Question One - Ethical Considerations Vol.1 #26 990920
Date: Wed, 22 Sep 1999 01:13:33 +0200 (MET DST)
From: andre_la_prairie_AT_hc-sc.gc.ca
To: xenodiscussion_AT_who.int
WHO EDX September 20, 1999 Volume 1: Number 26
In this issue:
1) D. Lyons on the ethics of xenotransplantation
2) WHO Moderators comment
I wish to respond to two comments made by A. Gordon (Vol. 1 #23 990823)
in his response to E. Goldman, and make some further observations on the
ethics of xenotransplantation.
Gordon rebuts Goldman's assertion [Vol.1 #22 990818]:
> By contrast, every single organ xenograft tried
> on humans has led to painful and rapid demise
> of the recipient."
by claiming:
> There is, to my knowledge, absolutely NO basis in
> reality for this statement. Hundreds of humans have
> been recipients of pig tissue in experimental clinical
> trials. There has not been a single case of
> death or illness as a result of the xenografts."
I disagree with this statement and suggest that Goldman refers to "organ
xenografts", while Gordon's response refers to "pig tissue" instead.
It is quite obvious that these two sets of xenografts are not identical.
It seems to me that the problems of rejection, tissue function and
xenozoonosis are probably greater with organ xenografts that "simpler"
cell and tissue xenografts. (Though this is not to say that the cell and
tissue xenografts are problem-free: far from it in fact.)
I would like to support Goldman and state that it is absolutely correct
to say that every ORGAN xenograft has been unsuccessful, and I am
surprised that the WHO moderators have not clarified this fact already.
(I apologize if this has happened and for some reason I have failed to
spot it.) To quote a few examples from the UK Department of Health
Report (also known as the Kennedy Report) published in 1997:
> 2.14 In 1992 a pig's heart was transplanted into
> a human patient in Poland, but the patient died
> 24 hours after transplantation. This RELATIVELY
> EXTENDED SURVIVAL...." (my emphasis)
> 2.19 In 1992/3 two baboon to human liver transplants
> were performed in the USA. The patients died at 26
> days and 70 days following the transplants."
> 2. In 1995, in the USA, a pig liver was
> heterotopically transplanted to provide
> temporary metabolic support for a patient with
> fulminant hepatic failure.... [T]he patient
> suffered brain damage and died 34 hours after the
> xenotransplant."
Indeed, it is this unsullied record of failure which prompted the
Kennedy Report to conclude that there was insufficient evidence on
immulogical rejection and transplant viability to justify a move to
clinical trials of xenotransplantation in general.
Gordon also calls into question Prof. Goldman's suggestion about using
material from aborted fetuses by asking:
> [W]hy is it acceptable to trample on the wishes of
> tne advocacy group (Pro-Life) in order to appease
> another advocacy group?"
Well, one obvious possible answer would be that the wishes of the
Pro-Life advocacy group are not as morally compelling as the wishes of
the other advocacy group. Just because an advocacy group exists, it
doesn't necessarily mean that their wishes are morally legitimate.
Which brings us to the broad question of the moral legitimacy of
xenotransplantation. The main thrust of the published EDX discussion on
the ethics of xenotransplantation has focused on whether the risks to
the human population of xenozoonoses outweigh the potential benefits to
individual patients. I shall comment on the basic question of whether a
cost/benefit analysis is a truly ethical decision-making formula later.
But for the time being I think that it is in order to bring another cost
into the equation - the suffering of animals used in both breeding
programs and research into xenotransplantation.
Lest anyone think this far-fetched, I'm simply relating the approach
taken by the Kennedy Report to the ethics of xenotransplantation, and
which is supposed to form the basis of the UK's regulation of
xenotransplantation.
The central conclusion (9) of the Kennedy Report was this:
> We conclude that the use of the pig for
> xenotransplantation may be ethically acceptable. We
> conclude further, however, that the acceptability
> lies in balancing the benefit to humans against
> the harm both to the pig and to humans.
One of the fundamental problems with cost/benefit analyses is how on
earth do you measure suffering? To complicate this further, consider,
how do you come up with a figure for POTENTIAL benefits or costs?
If we agree, at the very least, with the Kennedy Report, that the
suffering of animals needs to be considered when deciding whether
xenotransplantation is morally acceptable, then this increases the
weight of costs (and remember, this is a definite cost, not a potential
one).
Unfortunately, a consideration of these costs on the EDX has been
conspicuous by its absence. Yet it forms an essential part of the
decision-making process. Therefore, I urge the moderators to facilitate
discussion of this important area.
I have closely followed the evolution of the regulatory process in the
UK, and have been struck by how the UKXIRA [the UK Xenotransplantation
Interim Regulatory Authority] has made little effort to apply this
cost/benefit analysis in its entirety. According to the UKXIRA's terms
of reference, animal welfare is a precondition that must be met before
clinical trials can proceed. This should mean that it is possible that
the UKXIRA could decide at some point that the level of suffering
endured by animals would be too high to allow xenotransplantation to
continue to be developed. However, what is really happening is that the
UKXIRA and the UK Government is committed to keeping the
xenotransplantation bandwagon rolling - and therefore animal
welfare is sacrificed to the desires of that bandwagon.
I think it also shows how cost/benefit analysis is unworkable and can
be distorted to suit the priorities of those implementing it.
Inevitably, if the UK Government values the financial health of the
biotechnology industry more highly than stopping the infliction of
suffering on animals, then they will place more weight on the needs of
industry, and animal welfare will be effectively ignored.
Notwithstanding the vagueness and scope for bias in the cost-benefit
analysis, there are other serious question marks over its moral
propriety.
For example, it equates naturally occurring suffering with deliberately
inflicted suffering. My own perspective is this: there is a fundamental
moral difference between the two cases of suffering. All of us will get
ill and die at some point, and some of us will die earlier than others.
While this is tragic, it is not necessarily wrong (unless it has been
deliberately inflicted on a person). However, the deliberate
incarceration, ensuing psychological and physical suffering, and
destruction of a sentient creature (human or otherwise), is wrong.
Of course, this is based on a commitment to a rights-based moral theory,
with those rights based on the possession of a level of consciousness
sufficient to allow an individual to suffer (in other words the
possession of a fundamental interest in avoiding suffering and
preserving one's life.)
It is not a case of saying that humans are more valuable than other
animals, or vice versa. The whole weighing up of each is rejected as
immoral. Rather, the basic position is that it is wrong to ignore the
fundamental right to life and liberty. In defence of the rights-based
ethical framework, I would suggest that one of the advantages of the
rights-based approach to ethics is that it protects individuals from
being sacrificed against their will for some greater good - the value
system that underpinned fascism and fascistic political systems.
My bottom line is that helping to overcome suffering, human or
otherwise, is one of the most noble things our civilization can do.
However, to try to alleviate that suffering through destructive and
violent methods (e.g. xenotransplantation) is completely illegitimate,
and probably counterproductive. (It is probably also illegitimate to
expose people to a risk to their health (e.g. xenozoonosis) without
their consent - but the key here is the issue of consent - something
that humans can give, and nonhumans can't.)
The turn of the millennium, for what it is worth, will probably provide
an opportunity for reflection on the progress of humanity. If we are
countenancing an extension of our tyranny and abuse of other species of
animals then I think that the only honest and dignified assessment will
be a very depressing one.
Dan Lyons
Uncaged Campaigns & PhD Researcher
Ethics and political theory implications of
xenotransplantation at University of Sheffield, England.
WHO Moderator comments:
D. Lyons questions why the moderators did not comment or challenge the
previous posted claim that "there has not been a single case of
death or illness as a result of the xenografts."
We did previously provide a comment to this topic
in Vol.1 #16 990808:
> Dr. Goldman's statements that "every single xenotransplant
> which has been tried has failed miserably and quickly..."
> appear to be directed towards human trials with solid organs,
> it should be kept in mind that xenotransplant research and
> trials also include many cellular transplants. In addition,
> the definition of success should be specified in the beginning
> of a trial and may not incorporate long term survival of
> the graft (i.e. cardiac bridging, or temporary
> hepatocellular filtration).
It should also be pointed out that the WHO Moderators do not verify or
support all statements made in the postings. This would be very
difficult to do with any subject and would severely limit what would be
posted on ethical issues. We certainly would have difficulty confirming
or supporting the opinion made above regarding Pro-Life advocacy groups.
But we are interested in the opinions Lyons has made and those of others
who wish to comment.
Of special interest to us is the challenge of cost/benefit analysis.
Clearly this is desirable, but as noted by Lyons there is "a vagueness
and scope for bias in the cost-benefit analysis.."
We look forward to further discussion.
The WHO Moderators.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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