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The ethics of human reproductive cloning

Carson Strong is Professor in the Department of Human Values and Ethics, University ofTennessee College of Medicine. USA. He obtained his undergraduate degree at theMassachusetts Institute of Technology in Boston, and he holds a doctorate in philosophyfrom the University of Pennsylvania. He is co-author of A Casebook of Medical Ethics,published by Oxford University Press, and author of Ethics in Reproductive and PerinatalMedicine: A New Framework, from Yale University Press.

Carson Strong

Departnnent of Human Values and Ethics, College of Medicine, University of Tennessee Health Science Centre. 956Court Avenue. Suite B324, Memphis, Tennessee 38163. USACorrespondence: Tel; +1 901/448-5686; Fax; +1 901/448-1291; e-mail: cstrong@utmem.edu

AbstractThis article addresses the question of whether human reproductive cloning could be ethically Justifiable in at least somecases involving infertile couples who would choose cloning as a way to have a genetically related child. Al present, the riskof congenital anomalies constitutes a compelling argument against human rcprcxiuctive cloning. The article exploreswhether reproductive cloning could be ethically justifiable if, at some future time, cloning becomes possible without anelevated risk of anomalies. It is argued that freedom to use cloning is a form of proereative freedom and. as such, deservesrespect. All of the objections that have been raised against human reproductive cloning fall under three main categories:those that appeal to the interests of the child, those based on consequences for society, and those arising from teleologicalviews. Objections lhat appeal to the child's interests are. in lum, of two main kinds: consequentialist and deoniologicai. Allof these types of objections are examined, and it is found that each involves serious problems that prevent it from being areasonable objection in the context of the infertility cases considered. It is concluded that human reproductive cloning wouldbe ethically justifiable in at least some cases involving infertile couples, provided that it could be performed without anelevated risk of anomalies.

Keywords: deontological. genetic offspring, harm to offspring, proereative freedom, reproductive cloning, teleological

IntroductionMany hold that human reproductive cloning would be wrongunder any circumstances. Others have maintained that incertain situations reproductive cloning would be ethicallypermissible. One type of case in which it has been claimed thatit would be permissible involves infertile couples. This paperfcKuses on infertility cases in order to address the question ofwhether human reproductive cloning could at least sometimesbe ethically justifiable.

A caveat should be stated at the outset. The risk of congenitalanomalies in the offspring makes it reasonable to hold that itwould be wrong to attempt human reproductive cloning at thistime (National Academy of Sciences. 2002). In the future,however, it might be possible to carry out cloning with nomore risk of anomalies than the background risk in procreationby sexual intercourse. Let us assume, for sake of argument,that cloning technology has advanced to that point. Given thisassumption, would cloning in infertility cases be ethicallypermissible?

An example of the type of case in question is a scenario inwhich the woman is unable to produce ova and the man isunable to produce spermatozoa. Like many couples, they wantto have a child genetically related to at least one of them. Oneapproach to having genetically related children would involveusing sperm and ova donated by family members, but supposethat no family members are available in this case. Let usassume, in other words, that cloning using a cell nucleus fromone member of the couple is the only way they could have achild genetically related to one of them. Here is anotherversion: there are family members who could be asked todonate gametes, but the couple wants to avoid the socialcomplications assoeiated with gamete donation by familymembers. Yet another scenario is the following: only onemember of the couple lacks gametes, and the couple couldhave a child using gametes from an anonymous donor;however, the couple prefers cloning because it avoids thesocial complications associated with ihird party collaborativereproduction. In each of these scenarios, ihe couple's purposein using cloning is not to have a child who duplicates someoneelse, but to have a genetically related child.

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Ethics - The ethics of human reproductive cloning - C Strong

Whether cloning in such scenarios is ethically justifiable restson the following question: which should be consideredweightier, infertile couples" freedom to use cloning or thearguments against human reproductive cloning? To addressthis question, let us begin with the importance of the freedomof infertile couples to use cloning.

Cloning and procreative freedomSome have claimed that cloning is not procreation because itdoes not involve the joining of male and female gametes(Massey et al., 2001: Shuster. 2003). In reply, to assesswhether cloning in the infertility cases is procreation, weshould compare it to the paradigm of procreation - what I shallcall 'ordinary procreation". I refer to the type of procreation inwhich a couptc begets, by sexual intercourse, a chitd whomthey then rear. In making this comparison, we need to look notonly at the differences but also at the similarities, and it turnsout that a number of similarities can be identified (Robertson.t998). First, in both types of situation there is a geneticconnection between the child and at teast one member of thecoupte. Second, assuming that tlic woman can gestate. there isgestating and childbirth. Third, the child is raised by thecouple. Fourth, in both types of case, the overall purpose is tocreate a family or add a child to the family. So, the similaritiesbetween the iwo situations are quite substantial. They bothinvolve central features of the project of having chitdren:genetic connection, gestation, childbirth, and rearing. Becauseof these similarities, it is reasonable to regard the use ofcloning by infertite couples as procreation.even though it doesnot consist of the union of male and female gametes.

Based on these considerations, it is reasonable to hold that thefreedom of infertile couples to use cloning is a form ofprticreative freedom. Procreative freedom is worthy of respectin part because freedom in general is worthy of respect. Butmore than this, procreative freedom is an especially importantfreedom because of the significance that procreative decisionscan have for persons* lives (Strong, 1997). For these reasons,the freedom of infertile couples to use cloning is worthy ofrespect.

It might be objected that the desire to have genetically relatedchildren should be given relatively little weight. One mightargue that this desire is a mere expression of vanity and is toofrivolous to outweigh the objections to reproductive cloning.given that there arc other options such as adoption or donorpre-embryos. In reply, it should be acknowledged that somereasons for wanting genetic children seem selfish or confused.For example, sometimes a person desires genetic children inorder to save a shaky marriage. This reason is subject tocriticism; it fails to address the sources of the maritalproblems, and the added stress of raising the child might makethe marital relationship even more difficult. Somecommentators seem to think that the desire for geneticoffspring is always subject to easy criticism, as in this example(Kahn. 1997). Rather than make this assumption, let usconsider whether there are reasons for desiring geneticallyrelated children that are not easy to dismiss.

To explore this, one strategy is to try to understand why havinggenetic children might be meaningful to people in 'ordinaryprocreation', and then use this understanding in addt^ssing

reproductive cloning. It turns out that there are a number ofreasons why people might find it meaningful to have geneticoffspring in the ordinary type of procreation (Strong, 1997). Itwill suffice to discuss two of these reasons. First, having agenetic child might be valued because it involves participationin the creation of a person. When one has a child in ordinaryprocreation, a normal outcome is the creation of an individualwith self-consciousness. Philosophers have regarded thephenomenon of self-consciousness with wonder, noting that itraises perplexing questions: what is the relationship betweenbody and mind; how can the physical matter of the brain giverise to consciousness? It is ironic that although we havedifficulty giving satisfactory answers to these questions, wecan create self-consciousness with relative ease. Each of uswho begets or gestate.s a child who becomes self-consciousparticipates in the creation of a person. One might say that inhaving children we participate in the mystery of Ihe creation ofself-consciousness. For this reason, some might regardcreating a person as an important event, perhaps one withspiritual overtones.

Others might find it meaningful to create a person for differentreasons. For some, it might have religious significance. Somemight regard creating a person as a fulfilment of religious duty.Others might see it as acting as an instrument of God's will.Thus, the idea of creating a person can have different types ofspecial meaning. Perhaps not all who have children thinkabout it in terms of creating a person, but this is a reason thatcan be given for wanting genetic offspring that does not appearto be frivolous.

Turning to the second reason, having genetic children in theordinary situation might be valued as an affirmation of acouple's mutual tove and acceptance. It can be a deepexpression of acceptance to say to another, in effect. "I wantyour genes to contribute to the genetic makeup o( mychitdren'. tVloreover, in such a context there might be ananticipation that the emotional bond between the couple willgrow stronger because of common children to whom each hasa biotogicat relationship. To intentionally seek thestrengthening of their personal bond in this manner can be afurther affirmation of mutual love and acceptance, in statingthese two reasons. I do not mean to imply that one ought todesire to have genetic offspring, but only that the desire can bedefended. These are examples of reasons that are not silly orconfused. Rather, they are reasons that deserve consideration.

Now let us consider the applicabitity of these reasons tocloning. Would it be reasonable for the infertile couple to wantto u.se cloning in part because it would cnabte them toparticipate in the creation of a person? It can tie argued that itwoutd be. The member of the couple who provides a somaticcell nucleus for ctoning would participate by providing thenuclear genetic materiat for the new person, and regardless ofwho provides the cell nucteus, if the woman is capable ofgestating, then she coutd participate tiy gestating and givingbirth to the child. If she has ova. then she could participategenetically by providing mitoehondrial DNA, In addition, thecouple might value cloning because they interpret it as anaffirmalion of mutual love and acceptance. A biologicalpartnership in creating the child is possible if a cell nucleusfrom the man is used and the woman is the gestational mother.In that situation, the child comes forth from their two bodies.

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Assuming mutual love, the woman bears a child having thegenes of the man who loves her and is loved by her.Alternatively, suppose tbat a cell nucleus from the woman isused. The man then can become tbe social father of a ehildhaving the genes of the woman who loves him and is loved byhim. To seek to become social parents in this manner can be anaffirmation of mutual acceptance. These considerations showthai some of the important reasons for valuing the having ofgenetic children in the ordinary scenario also apply whencloning is used. Although not everyone in the infertile couple'ssituation would want to use cloning in order to bave agenetically related child, some might.

Objections to human reproductivecloningA number of objections have been raised againsl huinanreproductive cloning, and they generally fall into three maincategories - those that appeal to the interests of the child, thosebased on consequences tor s(x;iety, and those arising fromteleological views. First we shall consider objections thatfocus on the child's interests. The main ones are of two kinds,consequenlialist and deontological. Let us begin with theconsequentialist type.

Harm to the child

Consequentialisi child-centred objections claim that cloningwill harm the child. An example is the 'life in the shadow'argument (Holm. 1998). It claims that people will expect thechild to lead a life that follows in the footsteps of the olderperson who has the same DNA. These expectations willpressure her to follow in that person's footsteps, and this willbe harmful becau.se it will prevent her from following adifferent path that might be more conducive to ber wellbeing.Another example is the argument that there will be confusionover family lineage and kinship (President's Council onBioethics, 2(X)2). The nucleus donor will be both the socialparent and the twin sibling of the child. This unusualrelationship could result in some type of family turmoil that isharmful to the child, so the argument goes.

These consequentialist objections sometimes rest on the beliefthat persons with identical nuclear DNA will be identical. Thisbelief is mistaken.For one thing, the imprinting of the DNA ofparent and child might differ, resulting in phenotypicdifferences even though they have the same DNA (Simpson,2003). Even if the imprinting is ihe same, the parent and ehildwill be exposed to different environments in utero and will beraised in different soeial environments. Differentenvironments can result in different outlooks, ambitions, andlife choices. In addition, cloning does not duplicate the brain.As a child's brain develops, neural connections are made inresponse to environmental stimuli. Different stimuli result indifferent patterns of connections (Eisenberg, 2000). Thechild's brain will differ in many ways from the parent's.

Some authors who put forward these consequentialistobjections acknowledge that the parent and child will not beidentical (Holm. 1998). However, they bold tbat there will bea widespread petreption that the parent and child are identical.based on the mistaken belief that people wilh identical nuclearDNA are identical, and tbat this perception will cause tbe harm

in question. In reply, it is difficult to predict what people'sperceptions will be when and if reproduciive cloning becomessafe and feasible. That might be some distance into tbe future.Perhaps by then many people will have eome to understandthat genes alone do not determine who one is. If there is aconcern that some infertile couples who use cloning mightexpect the child to follow in the footsteps of the parent, thisconcern could be addressed by means of prepregnaneycoun.selling. Psyehoiogical counselling is already widely usedin preparing infertile couples for various methods of assistedreproduction. Couples pianning to use cloning could becounselled about the psyehosocial dimensions of tbis methodof procreation, including a possible tendency to assume,erroneously, that genetics determine who the child will be.

There is an even more serious problem wilh this objection, aproblem that ali versions of the objection that have been putforward share in common. Namely, the objection focusesexelusively on harms to the child, without consideration ofbenefits to the child. Il makes Ehis mistake precisely beeause itoverlooks the fact that without the cloning the child in questionwould not exisl. If one holds that bringing a child intoexistence through cloning can result in harms to her, tben onemust also bold that bringing a child into existence throughcloning can result in benefits to her. It would be arbitrary tomake one claim but deny the other. In assessing the objection,we need to consider tbe benefits as well as the harms and therewould be benefits in the infertility eases. After all. cloninggives tbe child a life. Life generally is a good thing. Il isexpected that the child will experience pleasures assoeiatedwith being alive and that she will have many goodexperiences. Moreover, what counts in a consequentiaiistargument is the overall balance of harms and benefits, and it isreasonable to expect that tbe benefits are going to outweigh theharms - that the child is going to have a good life on balance.If the child benefits on balance, then no wrong is done increating her. at least as far as barms and benefits areconcerned.

Perhaps the opponents of eloning will claim that cloning iswrong beeause .wme harms will occur, although admittedly nota net harm. However, the claim Ihal ii is wrong lo createchildren who will experience some harms, although not a netharm, leads to unacceptable conclusions. We would have tosay. for example, that it is wrong for minorities who arc subjectto discrimination to have children because the children wouldexperience harms caused by discrimination. Surely, this wouldbe an incorrect conclusion. The objection amounts to sayingthat it is wrong to procreate when some ideal involvingfreedom from harm cannot be met (Pennings. 1999). But thereis no obligation to have children only if their lives will be freefrom harm, as this counterexample illustrates.

Deontological objections

Deontological child-centred objections hold that creating achild through cloning amounts to treating her with insufficientrespect. This might be expressed in various ways. Some elaimthat the child has a right to a unique genetic make-up (NationalBioethies Advisory Commission, 1997. p. 67; Williamson,1999). or a right to ignorance of the effect of one's genome onone's future (Jonas. 1974), Others assert that cloning violatesthe Kantian categorical imperative by treating the child as a

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mere means (Kahn, 1997: Shuster, 200T). In reply, severalpoints can be Eiiade. First, merely asserting that there is a rightto a unique genetic make-up does not make it convincing,much less true, that there is such a right. An argument isneeded supporting the claim that there is such a right, butopponents of reproductive cloning have not provided asuccessful argument for this. In the absence of a justificationfor the claim that there is such a right, the claim should berejected. Second, to create a child through cloning can beconsistent with respect for persons. It can be an instance oftreating another as an end in herself and not as a mere means.We can imagine that the couple has purposes such that, increating the child, they are not using her as a mere means butare acting, in part at least, in order to give her a life that willbe her own. Third, in making a judgetnent about whether achild is treated with disrespect, it is not enough to look only atthetechniqueofcreation.lt is also necessary to look at how thechild is treated after she is bom. Suppose she is brought into aloving family, with parents who nurture her, foster herdiscovery of her own interests and talents, and help herdevelop her autonomy as she grows older. In that scenario, thechild is treated with respect. To put it differently, the problemwith the objections that appeal to the categorical imperative isthat they commit the fallacy of assuming that every case wouldbe an instance of the worst case scenario - that every casewould involve using the child as a mere means. Thisassumption seems rather extreme, and it is not reasonable.

Consequences for society

Let us consider the objections that focus on adverseconsequences for society. These too are expressed in variousways. It is argued that cloning and designing our children willtransform procreation into a process similar to manufacturing,thereby altering the attitudes of parents ttiward their childrenand harming society (National Bioethics AdvisoryCommission. 1997, pp. 69-70). Another version is theargument that abuses might occur if eioning is used bytotalitarian regimes or other unscrupulous persons (Massey etal., 2001). In reply, when these various objections are appliedto the specific context of helping infertile couples, they losewhatever persuasiveness they might initially have had (Strong.1998). The purpose of cloning in these cases is not to choosethe characteristics of the child, but to have a genetically relatedchild. There is no genetic manipulation to make the child'better' in some sense. In this context, cloning is not aboutdesigning the child. It is about helping the couple experiencethe personal meaning that procreation can have when itinvolves having genetically related children. If there were aplausible concern that a widespread practice of cloning wouldbe harmful to society, there would be a middle ground that wecould take. Cloning could be restricted to a relatively smallnumber of cases, such as cases involving Infertile couples. Inthat event It would be doubtful that the particular adverseconsequences in question would occur.

Teleological arguments

Finally, there are teleological objections (Hayry, 2003). Thesetoo can be expressed in several ways. It is claimed that cloningis contrary to human dignity or contrary to the essence t)f beinghuman. These objections are based on the view that humanshave a natural essence or telos which they are meant to fulfill

or strive for in order to be genuinely human. It is claimed thatcloning prevents a human from achieving that essence andtherefore it is contrary to human dignity.

In reply, several points are worth noting. First, within secularbioethics. teleologica! theories have become suspect, and forgood reason. Teleologlcal world views have been displaced byour scientific understanding of the world (Munson. 1979).Science gives us ways of understanding the workings of livingorganisms without appeal to a telos. One can see thecon.scquences of this when one looks at secular bioethics.Approaches such as casuistry and principalism are widelydiscussed, and teleology is rarely mentioned. Second, even ifone accepts a teleological world view, there are seriousproblems in specifying what the essence of a human is and inachieving a consensus on this matter.

ConclusionNone of the objeetions to human reproductive cloningdiscussed above appear to provide good reasons for claimingthat cloning is wrong in the cases considered. The objectionsfail and therefore do not outweigh the procreative freedom ofinfertile couples to use eioning in the cases considered.Assuming these are the main objections, it appears thatreproductive cloning would be ethically justifiable in at leastsome cases involving infertile couples.

References and further reading

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Hiiyry M 2(HI.̂ Philosophical argument.s for and against humatireproduciivc cloning. Bioelhics 17,447^5'-).

Holm S 1998 A life in the shadow: one reason why we should notclone humans. Cambridge Quarlerly of Healthcare Ethics 7,160-162.

Jonas H 1974 Philosophical Essays: from Ancient Creed toTechnoh,iiictil Man, Prentice Hall. Englewood Cliffs. USA.

Kahn A 1997 Clone mammals . . . clone man? Nature 386. 119.Kass L 2(MX) The wi.sdotn of repugnance: Why we should ban the

cloning of humans. In: McGee G (ed) The Huiiuiii Cli>nitii'Debate. Berkeley Hills Books. Berkeley. USA. pp. 6K-106.

Massey JB. Slayden S. Shapiro DM ci al. 2001 Unnatural deeds dobreed unnatural troubles (Macbeth: Act V, Scene 1). Fertility andSleriliiy 76. 1083-1084.

Munson R 1979 inWrvenlion and Reflection; Basic f.s.sttcs in MedicalEihics, Wiidsworth Publishing Co.. Inc.. Belmont. California,USA. pp. 36-37.

National Academy of Sciences 2002 Scientific iind Medical Aspectsof Human Reprodtictivc Cloning. National Academy Press,Washington. DC. USA, pp. 3 9 ^ 2 . www.nap.edu.

National Bioethics Advisory Commission 1997 Cloning HumanBeings. Rockville, Mat7land. USA.www.georgetown.edu/research/nrcbl/nbac/pubs,html.

Pennings G 1999 Measuring the welfare of the child: in search of theappropriate evaluaiion principle. Human Reproduction 14.1146-1150.

President's Council on Bioethics 2002 Human Cloning and HitmanDignity: em ethical inquiry. Washington. D.C.. USA. pp. I lO-l 11.www.hioethics.guv.

Robertson JA 1998 Liberty, identity, and human cloning. Te.xas LawReviewlit. 1371-1456.

Shuster E 200? Human cloning: category, dignity, and the role ofbioelhics. Bioethics 17.517-325.

Simpson JL 2003 Toward scientific discussion of human

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New Eramework. Yale University Press. New Haven, USA,Strong C l*J98 Cloning and intertiliiy. Cambridge Qtiarterly of

Healthcare Elhics 7. 279-29.^.Williiimson R 1999 Human reproductive cloning is unethical because

it undermines autonomy: commentary on Savulescu. Journal ofMedical Ethics 25. 9(,-97.

Received / October 2004: refereed ami accepted 22 October2004.

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