Update
Making Human Life Captive to Biomedical Technology: Christianity and
the Demise of Human Values
by D. Gareth Jones, MB,BS, DSc
by D. Gareth Jones, MB,BS, DSc
University of Otago Dunedin, New Zealand
Excerpts from the Eighth Annual Jack W. Provonsha Lecture
Loma Linda University
March 4, 1995
Is it possible to discern a point at which technology becomes antithetical
to Christian aspirations? Excerpts from the Eighth Annual Jack W. Provonsha Lecture
Loma Linda University
March 4, 1995
Consider the following vignettes:
Harvesting Organs and Selling Kidneys
On April 5, 1990, after a 35-day hearing, the General Medical Council found a physician and two surgeons guilty of serious professional misconduct. Dr. Raymond Crockett, a physician in private practice in London's Harley Street and at the National Kidney Centre, was struck off the medical Register, and Mr. Michael Bewick and Mr. Michael Joyce had restrictions placed on their practice following their involvement in a kidney-for-sale scandal. The case concerned transplant operations with kidneys removed from Turkish donors, unrelated to the recipients, who had been brought to London and paid for their organs.
Repairing Brains Using Aborted Fetuses
In January 1994, the National Institutes of Health (NIH) awarded a grant to study fetal tissue implants as a treatment for Parkinson's disease. The plan is to transplant fetal tissue that produces the neurotransmitter dopamine into the brains of Parkinson's patients, in the hopes of alleviating the dopamine deficit that afflicts them. Similar implants in the past have produced mixed results. But the new $4.5 million study involving 40 patients, is the largest, most ambitious study of implants to date.
Dead Mothers and Living Babies
At noon on 5 October 1992, Marion Ploch, a dental assistant, was on her way home from work. She was 13 weeks pregnant. On the road she crashed her car against a tree. Because she was suffering from a fractured skull, the young woman was taken by helicopter to the university hospital in Erlanger where she was treated in the intensive care unit. Her parents were informed that Marion had no chance of survival. At first the doctors wanted to get their approval for organ donation. Later other doctors came with other views. They also regarded Marion's situation as hopeless, however, on the evidence of comparable cases in the literature they thought the fetus would have a real chance of survival. At this time the doctors sought the parents' agreement to keeping Marion coupled to the apparatus that was maintaining her bodily functions. The father of the child was unknown and did not appear in the days following. On 8 October the doctors confirmed that brain death had occurred, but did not turn off the respirator. On 9 October, Marion's parents sent a cry for help to a newspaper. Amid emotional public discussion, the doctors did everything possible to keep the fetus alive. On 16 November, almost 6 weeks after the diagnosis of brain death, the fetus was spontaneously aborted. (1)
Unraveling Ethical Directions
It is not my intention to discuss any of the vignettes in detail. I am far more concerned to discover what general principles may be of assistance in directing us as we tackle issues of this type. I shall endeavor, therefore, to paint with a broad brush.
Deriving Good from Evil
We are prepared to benefit from tragedies, and this is regarded as an ethically valid stance as long as we are in no way responsible for the tragedies and if we would have prevented them had we been in a position to do so. (2) For instance, many studies of malnourished children have thrown a great deal of light on the effects of malnutrition on the developing brain, while studies of the after effects of the atom bomb explosions at Hiroshima and Nagasaki have proved of enormous value in understanding the long term effects of radiation on human populations. Moreover, Jewish doctors in the Warsaw ghetto made systematic studies of their starving compatriots in order to reap some scientific good from the evil that was destroying them all. (3) Recent studies of relevance in this context would include those on the brains of suicide victims in an attempt to throw light on the pathogenesis of depression, (4) and on fetuses aborted for suspected fetal abnormality in order to determine the accuracy of midtrimester diagnosis of fetal abnormality. (5)
The scientific studies have had as their aim increased understanding of a range of pathologies. Under no circumstances has this desire for increased understanding lent legitimacy to the original acts; it has merely epitomized the possibility of benefiting from tragedies, and of deriving as much good as possible from evil. The one proviso is that killing and maiming are never undertaken in order to yield scientific data. It was the lack of such a proviso that constituted the scandal of the early days of modern anatomy, and the horror perpetrated by the Nazis, although even here the retrospective use of such data to benefit others is another issue.
As a result, we should not be surprised that cadavers may, on occasion, be used to assist others in a variety of ways. This, itself, is not unethical. Indeed, it may be associated with a range of exceedingly worthy motives and actions. Nevertheless, even the possibility that the death of one may contribute to life for another should be approached with caution, since the highest of intentions may be taken advantage of for unworthy ends, and the dying or dead may be exploited or simply overlooked.
Moral Complicity: Can Good be Derived from Evil?
Can the evil that led to the original death be disentangled from the good that could result from it? For example, if induced abortion is considered a moral evil, use of brain material derived from the abortus for transplantation into a patient with Parkinson's disease may itself be tainted with the original evil. (6) According to the notion of moral complicity, the benefit intended to be derived from use of this material becomes no benefit at all, if there is no way of breaking the thread of evil linking the two.
But is the theory of "moral complicity" too all-embracing a notion? I would argue that it is. If human tissue from any source is used, there is almost inevitably inadvertent involvement in some moral evil. It may be in the road toll when organs are used from the victims of automobile accidents, in homicide when organs are used from murder victims, in suicide when organs are used from those who have committed suicide, or in poverty when the cadavers of the destitute are used for dissection. To suggest that the surgeon or anatomist is in a supportive alliance with intoxicated car drivers, murderers, those who commit suicide, or an inequitable social system, bears little relationship to moral reality. There is a moral distance between the evil and the intended good.
Moral Values in the Use of Cadavers
Cadavers have both intrinsic and instrumental value. The closest we come to recognizing a cadaver's intrinsic value, that is, its worth, in and for itself, is when we argue that a person and her body are more or less inseparable, and that the intrinsic value of a living person is bestowed upon her cadaver at death. We recognize each other because we recognize each other's bodies, and while this applies supremely during life, some very important aspects of this identity continue following death.
The instrumental value of a cadaver, that is, its use as a means to an end, emerges when it is recognized as the source of memories and responses. As we remember a person who has died, we respect the person who was, and this leads to respect for the person's remains. In addition, relatives and friends of the deceased are now grieving the death, and the cadaver is an integral part of the initial grieving process. The cadaver's instrumental value is also evident when it serves as a source of organs.
We respect a person-now-dead when account is taken of that person's wishes when alive. Only in this way do we recognize a continuum between the two, and hence the cadaver's intrinsic value. Similarly, when account is taken of the wishes and feelings of still-living relatives and friends, and their relationships with the deceased, the cadaver's instrumental value is recognized. (7)
With respect to organ donation, the first moral value normally considered is that of autonomy, according to which, each individual should have autonomous control over the disposition of his or her body after death, regardless of social need or the public interest. (8) Donation implies that the people concerned made a free and informed decision prior to their death, to allow their own bodies to serve as the source of transplanted organs. In acting in this way, they are giving something more closely identified than anything else with what they are and represent. (9)
This individual also has sets of relationships, and this brings into focus a second set of moral values, that of the interests of family members, who can in certain jurisdictions override the wishes of the deceased. Whenever this occurs, it brings with it an apparent clash of moral values--between the prior autonomy and interests of the deceased, and the actual autonomy and interests of the living.
Underlying these values is a premise that the giving of one's body is preferable to being coerced into doing it. This is the value of altruism, according to which it is better to give than to receive, and the good of others is better than self-interest. (10) The gift element is central to this value, and from this perspective an opt-in scheme for organ donation is preferable to an opt-out scheme that lacks altruistic intentions, since an organ is taken without permission and the person concerned is unable to defend his or her bodily integrity.
A further value stems from a common response, namely, that death, especially when premature or unexpected, is tragic. Some people may find solace and meaning in the use of body parts to assist others. This is the redemptive aspect of organ donations.
Tragedy and injustice can be transformed by redemptive actions. Death for one may usher in life for another, although the manner in which this is accomplished takes us to the heart of ethical discourse.Integral to the values I have sketched is an ideal enshrining the autonomy, decision-making capacities, relationships, and family interests of both the deceased and the living. When these values are recognized, altruism emerges as foundational. With this framework, the inequities of many situations and the unethical nature of others can begin to be addressed.
With this in mind, I shall turn to a fourth vignette.
Transforming Diseased Lives Using New Genes
Almost nine months before she was born, Brittany Nicole Abshire passed the most important test she will ever take. Her parents, Renee and David, are both healthy carriers of the trait for Tay-Sachs disease. After they lost one daughter to Tay-Sachs in 1989, they swore they would never have another child unless they could be sure it would be free of the disease. Genetic tests could diagnose the condition before birth, but the Abshires' religious beliefs ruled out abortion as a way of screening for healthy fetuses.
There seemed to be no hope until the Abshires learned about a new technology called preimplantation genetic testing. The experimental procedure had already been used to screen more than a dozen children for cystic fibrosis. Ova and sperm were collected from the Abshires and several ova were successfully fertilized in vitro. After three days and with the embryos at the eight-cell stage, one cell was removed and its DNA was analyzed.
For four of the embryos, the analysis worked: one of them showed the combination of genes responsible for Tay-Sachs disease, whereas the remaining three were not even carriers. These three embryos were implanted in Renee, and one survived to become Brittany, who was born in January, 1994. Courtesy of genetic testing, Brittany is the first child ever certified to be free of Tay-Sachs disease before entering her mother's womb. (11)
Precise Control
One might be tempted to argue that, in this case, there is only a good: the elimination of a deleterious gene and hence the disease produced by that gene. A healthy person is born rather than a diseased one. Nevertheless, this has been accomplished by eliminating embryos that could have developed further and may have given rise to living human persons, and also by a considerable degree of control over prenatal existence. While other forms of gene therapy raise different issues, dependence upon a major degree of control over the constitution of future individuals is always present. (12)
This prompts fears that technology is out of control and is subverting the human condition, enslaving human beings, and mocking all they stand for as individuals created by God, with higher purposes, and with responsibilities for themselves, for others, and for their world.
Playing God
Surprising as it may seem, a theological perspective does not of necessity support these contentions, since humans are made in God's image, and so in some of our attributes we are to function like God. (13) Regardless of how much our God-likeness has been shattered by sin and rebellion, we remain images of our maker, albeit tarnished images. As such, we demonstrate a great deal of his creativity and inquisitiveness. Consequently, humans as scientists are humans as God's images, probing and thrusting into the creation, attempting to understand it and make it accountable to God's stewards. Within the medical sphere, the desire is to exercise at least limited control over evil in the form of disease, disease that would ravish and destroy all that is beautiful and worthy in God's world. (14)
Consequently, genetic advance per se is not synonymous with pride and arrogance; in no way does it amount to the aping of God's power, since gene therapy owes its rationale to this power. As long as the aim of gene therapy is the alleviation of human illness, it has the potential to elevate God's images. This is where therapeutic interventions fit in. By contrast, the attempt to create some new creature with superlative powers would be to play God in a pejorative sense, since it would stem from human conceit regarding the all-too-limited nature of human ability and human wisdom. A more balanced view is that playing God should remind us that we tamper with fundamental biological processes only with caution and great humility; there is much we do not know, and there is much over which we have only perfunctory control. We are to play God, but we are to do it with intelligence and compassion.
Tinkering with Nature
Genetic technology is frequently considered to go further than playing God--to be actually interfering with nature. (15) It is difficult to see how genetic technology per se does this. Nature has given us genetic combinations that lead to Tay-Sachs disease, diabetes, and heart disease, but few would argue that these particular combinations constitute a good. Medicine has traditionally done its best to cope with genetic conditions, and these have not, in and of themselves, been regarded as transgressing the boundary of licit human endeavor. Humans have intruded into nature throughout recorded human history, whether it has been by draining swamps infested with malaria-bearing mosquitoes or by using antibiotics. (16) It is far more important to ask whether the intrusions enhance or diminish the human condition.
Within a Christian context, we may also ask whether they enhance or diminish our ability to respond to God and to appreciate the world He has brought into being and sustains. Nature is not to be worshipped as if it were some unchanging given; neither is the human genome to be elevated to some untouchable status as if it were fixed and immutable. (17) Humans have been given stewardship of the created order, including the human genome. What is required is that we determine the sort of interference with nature and the genome that will advance human welfare, while respecting the dimensions of what it means to be human. This requires a great deal of enlightened ethical discernment, and an awareness of the tentative path along which we are travelling. (18)
Slippery Slope
It may still be objected that gene therapy (for instance, preimplantation genetic testing, or somatic cell gene therapy) is unethical since it represents the beginning of a slippery slope, the inevitable end result of which will be germ line gene therapy and eugenics. But is this progression inevitable? Implicit within the slippery slope argument is the assumption that permission to allow one kind of intervention holds for all kinds of intervention. However, this is not the case in moral reasoning, where there is an immense gulf between different sorts of measures. For instance, there is a considerable moral chasm between gene therapy to treat disease (such as cancer or heart disease) and gene manipulation to alter behavior or morality. (19) This is the boundary between the world of therapy and the alleviation of disease on the one hand, and eugenics and enhancement on the other; and it is a boundary where there is a logical and moral stop sign. (20) Any ethical approach to gene therapy in general has to maintain that gulf and the moral world enshrined by it.
The additional move to genetic enhancement and eugenics is a move from the world of finding cures to diseases that kill and disfigure and that limit basic human capacities, to a world of idealistic attempts to perfect the human species and improve fundamental human attributes. (21) Once we moved into this latter world we would have placed ourselves on a slippery slope towards perfectibility and manipulation. (22) But that is not where we are at the moment, and that is not where any serious geneticist or ethicist would wish us to be.
Some Christians are unhappy with this sentiment, on the ground that sinful humans cannot be trusted to act responsibly. (23) Nevertheless, we do act in these ways in many other dangerous areas, whether these be the use of motor vehicles, or of tranquilizers, or of nuclear power. In none of these areas can humans be trusted as much as we would like, but reflections of God's image still remain and often restrain the more extreme actions of which humans are capable. Nonetheless, the genetic realm is a potentially dangerous one, and this is a salutary reminder to all who would indulge in its possible excesses.
Ambiguity
Genetic knowledge confronts us in a poignant way with ambiguity. On the one hand, we want to know all; our curiosity drives us to search and to keep on searching. (24) Genetics shows us much about why we are as we are, but it also enables us to know something about what we will be like in the future. And it is this ability to look into the future and control what may happen in the future that is so alluring. But is it too alluring? Are we afraid of too much self knowledge?
Alongside this ambiguity goes another--the prospect of greatly increased control over people's lives and all pervasive intervention in their lives. Such control and intervention may be used exclusively for good, but there is always the prospect that this may not be the case, and we recoil from this prospect. This is ambiguity once again; we may be able to control others, but they equally will be able to control us, and may not do it with the best of intentions.
Tension between Perfection and Imperfection
Alongside this perspective stands another: the tension between perfection and imperfection. Some grand genetic vistas allude to perfectibility, improving humans in unspecified ways, (25) and while such vistas are not on any current genetic agendas, they feed the imagination nonetheless. But even in the imaginary realm, we are forced to ask whether we really want perfection, with its message that challenges will be no more? Do we really want total genetic control? Surely such a picture is the complete antithesis of all that human existence means, so that too much genetic control challenges our conception of what it means to be human: we may lose our self identity in the process. (26) This is an issue of fundamental concern to Christians, although I would add it does not inevitably lead in an anti-technology direction. What it does usher in is serious moral reflection about how we can enhance and substantiate our humanity, as people created in the image and likeness of God, and living within the domain of God's grace and the hope enshrined by that grace. (27) In order to illustrate the importance of serious moral reflection, I shall return to the present, and to an area replete with savage moral perplexity: the ever increasing domain of the aging.
A Final Vignette
Too Old and Too Costly
There is no end to the possibility of spending money to combat the inevitable biological decline and death inherent in aging. Unless curbed, therefore, a curative bias will effectively consume a disproportionate share of resources as it pushes forward the frontiers of life extension, a frontier that is in the nature of the case open and endless. That is also an attitude that effectively works to rob old age of meaning, though this has yet to be sufficiently noticed. Its implicit premise is that the only meaningful old age is one that places the highest priority on averting death, not on marshaling our resources to help make old age a time of completion and enrichment.
The Blessing of Mortality
Leon Kass has argued that: "The attachment to life--or the fear of death--knows no limits, certainly not for most human beings. It turns out that the simple answer is best: we want to live and live, and not to wither and not to die." (28) Alternatively, one may have more modest aims: not adding years to life, but life to years. This looks to a time when all who are alive, or at least the lucky ones in the lucky countries, will know increased health, increased vigor, and an absence of decay or dementia, until the day of one's death. And yet even here there may be a problem. Within such a scenario, death would seem even more shocking than it does now.
Perhaps both these approaches are misleading, because they fail to acknowledge the Christian conception of the "fall." In their different ways, both approaches attempt to escape the all pervading effects of the evil that permeates everything we touch or experience. They are of little help in sorting out ethical issues of significance in coping with the aged and demented, since they are attempting to escape from aging and its consequences. It may be better to start from the premise that mortality is a blessing. Leon Kass has asked the question: "Is not the limit on our time the ground of our taking life seriously and living it passionately? To number our days is the condition for making them count, to treasure and appreciate all that life brings." (29)
A longing for human immortality is a longing for more of the same. By contrast, the Christian view seeks to redirect our goals and longings towards God and away from ourselves. It is a transformation of all we have ever been, even if it builds in some way on our responses and priorities during this life. It heals our present estrangement from God in a fundamentally more radical way than anything possible in this present existence, and it will bring fulfillment, wholeness and completeness of a sort only barely discernible now. Such immortality has no connection with the longing for a prolonged earthly life, which cannot possibly begin to satisfy our deepest aspirations.
Using a different approach, Hans Jonas (30) reaches a similar conclusion when he writes: "We are finite beings and even if our vital functions continued without impairment, there are limits to what our brains can store and keep adding to. It is the mental side of our being that sooner or later must call a halt even if the magicians of biotechnology invent tricks for keeping the body machine going indefinitely. Old age, in humans, means a long past, which the mind must accommodate in its present as the substratum of personal identity... we could go on interminably only at the price of either losing the past and therewith our real identity, or living only in the past and therefore without a real present... this would leave us stranded in a world we no longer understand even as spectators, walking anachronisms who have outlived themselves." (31)
The implications of these approaches are considerable, since once we acknowledge and accept our finitude, we can devote our attention to living well and establishing important priorities for both ourselves and others. This, in turn, should serve as a powerful directive when treating others and determining health care priorities. This is also a directive with Christian underpinnings, as we seek to redeem the time, to be holy, to devote ourselves to the service of others, and to live as though we will meet Christ today.
Toward a Synthesis
The vignettes were selected to demonstrate a range of beneficiaries and a range of donors. Where do we go in the light of problems such as these?
Human Dignity
My starting point is that all human beings are to be viewed as having an inalienable dignity, stemming from our creation by God and revealed supremely in the redemption made possible by Christ. It rests not on what human beings can accomplish in material, social or spiritual terms, but on the rock of God's love. (32) Consequently, human dignity is always based on what individuals are in the sight of God and never on what they may be able to do for society, for mankind, or even for God. From this it follows that those who are of no functional value to society still retain a dignity, since they remain important in the sight and purposes of God. Elements of this dignity are also to be found in those who have now died, but a short time ago were one of us. In a somewhat different way, elements of this dignity attach to human fetuses, since they have a high chance of becoming one of us. The dignity of human beings, therefore, to some degree encompasses and characterizes fetuses and cadavers.
The theological notion of human dignity is implicit within notions of servanthood, by which we give ourselves for others, serving them in a self-sacrificial way, and putting their interests before our own. Such a lifestyle finds its warrant in the worth of others, and in the claims others make upon us because they are so like us and because they are of such value in the sight of God. In theological terms, these "others" are not simply our friends and those who will repay us fully for our concern, but they include our enemies, those unable to protect their own interests, and those on the borders of human personhood.
Neighborliness
All human beings should be valued, but all human beings cannot be of equal value to me--in the sense that I am obligated to serve and help those in question. I am still to feel at one with all humanity, but I cannot rescue all humanity however much I may wish to do so. I am never to close my eyes to those in need--after all, whenever I see need about which I could do something, that human being fits into what I have described as neighbor. I have responsibility for all such people.
A point may come where invidious choices have to be made, and where all courses of action will involve loss and suffering. When this is the case, the lesser of the two evils is the course to be adopted. Unfortunately, under such circumstances human dignity will be sacrificed whichever course is followed. At this point of unavoidable tension, knowingly and very regrettably, the value to be ascribed to some human beings will have to be overridden. There is a differential, since there are limits. However, any course of action that downgrades or ignores human value (in the broader sense) is never the course of choice, but reflects the plight of humans in a suffering world.
Relatedness Rather than Namelessness
People become nameless when no one cares about them. This transformation into namelessness occurs, as I have indicated, in tragedies of huge magnitude, and yet it is also found in families, societies, hospitals, and health care situations.
Namelessness is a frequent accompaniment of illness. As dignity is lost through illness, especially when the illness is debilitating and catastrophic, enormous effort is required to maintain personhood and status. Namelessness may occur when adult and fetal cadavers are treated as little more than organ farms, when fetuses are regarded as impediments to an upwardly mobile lifestyle, when the demented aging are little more than expensive and unwanted byproducts of high technology medicine, and when infants are brought into the world to serve the medical needs of others. Relationships break down for the nameless ones, since relationships with a nameless individual cease to be meaningful. The nameless rapidly become relatedless, the antithesis of any moral evaluation that wishes to bestow dignity, hope and meaning on human beings as people made in the image and likeness of God.
Humility
In the last analysis the health professional should be characterized by humility. This is the religious sense of our dependence on God, in which we recognize that we are not our own, but belong to God to be used according to His purposes. Allen Verhey has argued that humility in this sense is not fatalism; "it does not deny the brokenness of our world or of [some people's bodies]... it does not glibly identify automobile accidents with God's intentions. It does not call for an end to passion, it calls rather for us to share the passion of Christ. It disposes persons to bear the brokenness, sadness, and tragedy of our world in hope and faith and love." (33)
Technology, per se, will never eliminate suffering and tragedy; neither will it create hope. The quality of human lives comes from our recognition of our place in God's world, our willingness to learn from Him, and our ability to grow in wisdom and understanding. Only in this way will human values and human society be enriched.
Ambiguous Presences
The values I have just enunciated are nothing more than a beginning as we come to terms with what I refer to as "ambiguous presences." They will not solve the specific dilemmas I have laid before you, and they are not intended to do so. Rather, they serve the important role of providing a paradigm based on the dignity of human beings, our role as neighbors, and the crucial importance of ensuring as far as possible that those with ambiguous presences are treated in ways that recognize and build on their relatedness.
The ambiguous presences I have alluded to have included adult and fetal corpses required as sources of transplanted organs, embryos detected as carriers of certain deleterious genes, a dead pregnant woman as the receptacle for a growing fetus, and the elderly when exposed to the possibilities of expensive high technology medicine. Note that it is the context that renders these various individuals and groups ambiguous presences. It is the context that imposes the ambiguity and necessitates decision making. This should come as no surprise. Ambiguity is at the core of the human context, accentuated as it is by the successes and failures of biomedical technology. And ambiguity is essential to the human condition. It makes us view with seriousness the larger picture, forces us to ask deeper questions, and confronts us with profound theological issues. Unless we ensure that human values are central to this debate, they will be overwhelmed by dubious priorities and ill conceived technological endeavors. But this need not be so, and I hope this lecture has demonstrated both the grounds of my hope, and some pointers to a way forward.
REFERENCES
1 Anstötz, C. (1993). "Should a brain-dead pregnant woman carry her child to full term? The case of the 'Erlanger Baby.'" Bioethics, 7(4), 340-50.2 Jones, D.G., (1991). "Fetal neural transplantation: Placing the ethical debate within the context of society's use of human material." Bioethics, 3(1), 23-43.
3 Tushnet, L. (1966). The Uses of Adversity Studies of Starvation in the Warsaw Ghetto. New York: Thomas Yoseloff.
4 Gross-Isseroff, R., et al., (1990). "Autoradiographic analysis of [3H] ketanserin binding in the human brain postmortem: Effect of suicide." Brain Research, 507, 208-15.
5 Clayton-Smith, J., et al., (1990). "Examination of fetuses after induced abortion for fetal abnormality." British Medical Journal, 300, 295-97.
6 Burtchaell, J.T., (1988). "University policy on experimental use of aborted fetal tissue." IRB: A Review of Human Subjects Research, 10(4), 7-11.
Jonsen, A.R. (1988). "Transplantation of fetal tissue: An ethicist's viewpoint." Clinical Research, 36(3), 215-19.
Strong, C. (1991). "Fetal tissue transplantation: Can it be morally insulated from abortion?" Journal of Medical Ethics, 17, 70-76.
7 Jones, D.G. (1994a). "Use of bequeathed and unclaimed bodies in the dissecting room." Clinical Anatomy, 7, 102-7.
8 Vawter, Dorothy E., et al., (1990). The Use of Human Fetal Tissue: Scientific, Ethical, and Policy Concerns. Minneapolis: Center for Biomedical Ethics, University of Minnesota. 9 May, W. F. (1985).
"Religious justifications for donating body parts." Hastings Center Report, 15(1), 38-42.
Murray, T.H. (1987). "Gifts of the body and the needs of strangers." Hastings Center Report, 17(2), 30-38.
10 May, Ibid.
11 Rennie, J. (1994). "Grading the gene tests." Scientific American, 270(6), 66-74.
12 Anderson, W.F. (1989). "Human gene therapy: Why draw a line?" Journal of Medicine and Philosophy, 14, 681-93.
Elliot, R., (1993). "Identity and the ethics of gene therapy." Bioethics, 7(1), 27-40.
Jones, D.G., (1994b). "Gene therapy: A glimpse into the future." Faith and Freedom, 3(1), 4-8. (1994c).
"Manipulating human life: The ambiguous interface between science and theology." Colloquium, 26(1), 17-31.
Lappé M. (1991). "Ethical issues in manipulating the human germ line." Journal of Medicine and Philosophy. 16, 621-39.
13 Boone, C.K. (1988). "Bad axioms in genetic engineering." Hastings Center Report, 18(4), 9-13.
14 Jones, (1994b) Ibid.
15 Ramsey, P. (1970). Fabricated Man. New Haven: Yale University Press.
16 Munson, R., and Davis, L.H. (1992). "Germ-line gene therapy and the medical imperative." Kennedy Institute of Ethics Journal, 2(2), 137-58.
17 Ibid.
18 Jones, (1994b) Ibid.
19 Weatherall, D.J. (1991). "Gene therapy in perspective." Nature, 349, 275-76.
20 Boone, Ibid.
21 Anderson, W.F. (1992). "Uses and abuses of human gene transfer." Human Gene Therapy, 3, 1-2.
22 Post, S.G. (1991). "Selective abortion and gene therapy: Reflections on human limits." Human Gene Therapy, 2, 229-33.
23 Anderson, Ibid. Ramsey, Ibid.
24 Van Tongeren, P.J.M. (1991). "Ethical manipulations: An ethical evaluation of the debate surrounding genetic engineering." Human Gene Therapy, 2, 71-75.
25 Post, Ibid.
26 Munson, Ibid.
27 Jones, D.G. (1994c). "Manipulating human life: The ambiguous interface between science and theology." Colloquium, 26(1), 17-31
28 Kass, L.R. (1985). "Mortality and morality: The virtues of finitude." In L.R. Kass (Ed.), Toward a More Natural Science (pp. 299-317). New York: Fress Press.
29 Ibid. p. 309.
30 Jonas, H. (1992). "The burden and blessing of mortality." Hastings Center Report 22(1), 34-40.
31 Ibid.
32 Jones, D.G. (1985). Brave New People. Grand Rapids: Eerdmans.
33 Verhey, A. (1987). "Integrity, humility and heroism: May patients refuse medical treatment?" In S.E. Lammers & A. Verhey (Eds.) On Moral Medicine: Theological Perspectives in Medical Ethics (pp. 467-70). Grand Rapids: Eerdmans.
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