What Is A Human Being?

Anna Holmes

What does it mean to be human? Three days of intensive discussion at the New Zealand Bioethics Conference on Ethics and Emerging Biotechnologies in February 2004 raised exciting possibilities for diagnosis and treatment of genetic diseases. They also left many urgent questions about the meaning and value of human beings. I came away feeling disturbed.

The church tells us we are created in the image of God and that all human life is to be valued. We are both physical and spiritual beings. It forbids the deliberate taking of human life from the time of conception. For many centuries, however, there have been philosophical and theological arguments about where the soul is and when it becomes part of the developing embryo. Two views are widely held. The official one is that we do not know, and therefore must treat all embryos as if they could be fully human. The other is that embryos cannot be fully human, with souls, until they can no longer divide into twins.

It seems to me that the theology and philosophy underlying human development is extremely male centred. Women will often tell stories about their inner knowledge of pregnancy before they have any objective tests to confirm this. Many years ago I was at a workshop about grief. In the final session one woman produced a little clay container with three tiny seeds in it. She said "This is my womb and these are the children I lost before they were born. I realise I have never allowed myself to grieve for them".

Women form a relationship with the child-to-be that persists even if the child is lost at an early stage. The womb space, the creative space, for each child, born or miscarried, remains for the rest of the mother’s life. Such imprinting is not incidental but says something very important about the extent, quality and persistence of human relationships. This is identified in the wonderful meeting between Mary and Elizabeth in Luke 1.28 when Elizabeth knows Mary is pregnant before she is told and John, in Elizabeth’s womb, responds to Jesus in Mary’s.

To be human is to exist in relationship to each other, to the environment and to God. These relationships both form and enable the further development of each person. What biotechnology is doing is altering those relationships in both obvious and very subtle ways. These alterations are already well under way and are not being reflected on by most people. The way people relate affects the social order in a society as well as the individuals within it. Possibilities are emerging for very new ways of relating and very different ways of the state imposing conditions on the existence of certain members of society.

Biotechnology has already changed the relationships of children to their parents. Using IVF it is now possible for a child to have five parents. There can be the donors of egg and sperm, a surrogate mother to bring to birth and the social parents who raise the child. Recently I listened to someone who had been born as a result of sperm donation speaking of her passionate desire to know the anonymous man who made her life possible. The number of children born through new birth technologies continues to rise as child bearing is delayed for economic reasons by more women in Western societies. Will this leave many more people uncertain of their ‘real’ parents?

In the past children were accepted as unique gifts to their parents. Biotechnology now allows children to be designed for the use of others in their families. IVF is used and embryos selected so that the child may donate stem cells or organs. This has already happened in America. What does this do for a child who is specifically brought into being to be of use to another? What is the relationship of that child to their parents and to the person for whom they were created?

People who carry single gene diseases like Huntingdon’s disease or cystic fibrosis can use IVF techniques to ensure that they do not have children who are affected. Cells may be taken from the early embryo and screened for disease genes. We do not know if this has any long-term effects on the embryo. Only healthy embryos are implanted. It may soon be possible for some genetic abnormalities to be cured by inserting healthy genes before implantation.

These uses of biotechnology to reduce severe genetic disease seem to be a real advance. It is the other implications that give pause for reflection. What does it do to a society to destroy some members for the good of others? Does it change the way we view the smallest and most vulnerable members? Will it alter the way people who do not want to use such techniques are seen by their neighbour or the state itself? Will such people be seen as problems rather than ethical human beings making informed choices?

It is usual for women at risk of having a Down’s syndrome infant to have pre-birth diagnosis by amniotic fluid tests, blood tests and ultrasound scans. These may be offered only on condition that abortion is performed if the child is abnormal. The idea that a woman might want to carry an abnormal child to birth is seldom considered.
What will the possibility for eliminating genetic diseases do for those who already suffer from them? I have heard of parents with Down’s syndrome children being asked why they did not get rid of them before they were born. Jean Vanier, founder of L’Arche communities for mentally and physically disabled people has said often that those who are most wounded have important lessons to teach ‘normal’ people who do not acknowledge their wounds. If we eliminate those who now rouse compassion by their vulnerability, what will happen to our society as it becomes less compassionate, or maybe less human?

Governments try to control health budgets by reducing the number of expensive patients. Patients with genetic abnormalities who need full hospital care will definitely be targeted. Will more pressure be put on those who might have genetic diseases to use IVF, or early abortion, to prevent the birth of such children? Social control is at present subtle and hidden. Will it become an accepted part of government policy in the future as compassion becomes less common?

There are many diseases like diabetes, Alzheimer’s disease, coronary heart disease and schizophrenia that have a complex genetic component. It is possible only to predict risks of these diseases within broad limits – 20 to 70 percent. Will it be justified to abort or select embryos on such risks? There are already countries where sex selection of children – either by IVF or by selective abortion of the unwanted sex (usually female) – is altering the sex ratios in society. What will this mean in twenty years time when there are no women for these men to marry? Could this destabilise social order through wife stealing from nearby societies?

One conference session discussed genetic enhancement of children who would be taller, brighter, stronger, more musical, or better athletes. What does it do to the relationship of a parent and child when the parent selects a particular sex, physical characteristics and talents for the child? It makes children seem just another commodity or possession. If they can be designed to suit the parent’s wishes, it raises expectations for the parents and puts enormous pressure on the children. Coming to terms with the uniqueness of their children, and learning to value them for themselves, not for their usefulness or talents, has always been an important way for humans to grow. Are we wise enough to select the characteristics that will make a balanced, compassionate and fruitful community?

There is an issue of justice in all this. It is extremely expensive to have pre-birth screening or gene technologies. They are only available to those who can afford them. Thousands of normal mothers and infants die daily in countries that lack basic health and pregnancy care. Will enhanced children further deepen the divide between the haves and have-nots?

There were many other issues raised by the conference. Transplantation of human genes to animals to use them for production of human proteins was one. Transplantation of animal tissue into humans was another. The patenting of genes from particular patients or diseases was also relevant as it makes the difference between huge costs for new therapies and reasonable ones. These patients are being harvested and exploited in the same way that plants were harvested for therapies in the last century.

One paper looked at production of stem cells. Stem cells are cells that may become many different tissues – muscle, heart, brain and kidney. They may be able to repair damage in these tissues. The most flexible stem cells are harvested from embryos, killing the embryo in the process. What I found shocking was that no one on the panel discussing stem cells questioned the destruction of embryos to treat other people. It seems New Zealand legislation that allows abortion makes unnecessary any further discussion on the value of human embryos. Stem cells could be obtained from spare embryos left over from IVF, or embryos could be made just for stem cells. This is already being done in the United Kingdom and in private, though not public, institutions in America.

Legislation in the area of human biotechnology has not been addressed in New Zealand. The 1984 the Law Conference held in Christchurch looked at the implications of New Birth Technologies but came up with no new laws. Twenty years later The Human Assisted Reproductive Technology Bill is under discussion. This will address the use of stem cells.

We live in a rapidly changing world where reverence for human beings is being replaced by a utilitarian attitude to them It is a society where there is a danger that compassion will be progressively withdrawn from the weakest members. Are they really human if they are unable to think and reason? Is it sensible to keep alive those who will not contribute to the economy, or use up too many health dollars? What about the vast numbers of old people who will overload society over the next 50 years, as the ‘baby boomers’ grow old? Is it really coincidental that the euthanasia debate is winding up just at this time?

What is a human being? The more I reflect the less clear it becomes. Perhaps we need to humbly accept the mystery of our relationships and give the last word to Isaiah:
Does a woman forget her nursing child, or show no compassion for the child within her womb?.. I will never forget you my people, see I have carved you on the palms of my hands (49,15-26).

Anna Holmes is a Dunedin-based general practitioner with a special interest in bioethics