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Report98.form.doc

98. The Ethics of Human Cloning
Introduction
In early 1997, a research team in Scotland cloned a sheep, Dolly, by modifying technology developedsome decades previously with amphibians. Then, in July of 1998, researchers at the University of Hawaiiproduced mouse clones and developed a process by which mass cloning could occur. The technique usedin both cases, somatic cell nuclear transfer, involves taking a nucleus from a somatic cell, placing it in anenucleated ovum, and implanting the ovum into a host uterus.
The cloning of Dolly brought to the forefront a longstanding debate about cloning human beings. TheNational Bioethics Advisory Commission recommended a five-year moratorium on any attempts to createa child through somatic cell nuclear transfer in the United States and urged the President to work with allother nations to do the same.i With the moratorium in place in the United States, legislative attempts toexercise permanent control over human cloning, such as the federal “Prohibition of Cloning of HumanBeings Act of 1998,” have been introduced in Congress.
Human cloning is a matter for the medical profession’s attention since it would involve medicalprocedures and technology, and it may result in the creation of new genetic and psychological conditionsthat would require professional care. Therefore, the medical profession must evaluate the ethics of humancloning, and in particular, the potential role of physicians in the practice. The Council’s purpose here isto consider whether physicians should participate in human cloning, not to determine whether it should belegal or illegal.
The Council on Ethical and Judicial Affairs offers the following report to assess the ethical uncertaintiesinvolved in human cloning. It will address what are currently perceived to be the most widely discussedapplications of human cloning, and it will lay the groundwork for future reports. Issues involving embryoresearch, stem cell research, embryo splitting, embryo twinning, and embryo donor organisms will beaddressed in future reports. A scientific analysis of cloning technology can be found in a companionreport issued by the Council on Scientific Affairs.
Definitions
For the purposes of this report, the term “cloning” will refer to the production of genetically identicalorganisms via somatic cell nuclear transfer.ii “Somatic cell nuclear transfer” refers to the process inwhich the nucleus of a somatic cell of an existing (or previously existing) organism is transferred into anoocyte from which the nucleus has been removed. “Human cloning” will be used to refer to theapplication of somatic nuclear transfer technology to the creation of a human being that shares all of itsnuclear genes with the person donating the implanted nucleus.
Cloning is distinct from techniques such as embryo splitting and twinning. Human cloning, as defined inthis report, does not include the use of somatic cells to create a pluripotent cell line that could, forinstance, also be used for extra-uterine production of transplantable tissues without the creation of anentire being. Nor does it include the use of cloning technology for the production of human tissues orhuman proteins from transgenic mammals.
Existing Limits on Human Cloning
Coverage of advances in cloning, especially in the popular press, has described the prospects ofmanufacturing armies of programmed killers, duplicating sports stars or academic geniuses, andrecreating deceased loved ones.iii Based on the intrinsic limitations of human cloning technology, some widely mentioned undesirable applications of cloning are impossible, and others, which may be possibletechnically, are clearly prohibited by existing law, public policy, and professional ethical standards. Thefollowing sections describe these issues in more detail. In order to clarify the many misconceptions abouthuman cloning, physicians should help educate the public about the intrinsic technical limits of humancloning as well as the ethical and legal protections that should prevent abuses of human cloning.
The term “cloning” may suggest that one organism is the exact replica of another. Human clones wouldbe identical insofar as they would have the same nuclear genes as the donor. However, as observed innatural monozygotic twins, having identical genes does not result in two indistinguishable individuals. Aclone must— because of the different environment and circumstances in which he or she creates his or herlife story— be a different person from the person from whom he or she was cloned. Although humancloning may be thought of as a sort of “delayed twinning,” twins may be more similar than clones sincemost twins are conceived and nurtured in the same environment in utero and often during childhood.
Since environment has a profound influence on development, human clones likely would be different interms of personality and other characteristics.
Because cloning would not produce exact replicas, several applications of human cloning are illogical. Inparticular, human cloning would not be a solution to terminal illness or mortality. Children are alreadythought of as a way to “soften the blow of mortality,” and clones may be seen as a more powerfulapproach since there is no sharing or mixing of genomes.iv The possibility of having one’s life to liveover again, or of getting back a lost child, might be attractive. But the clone would not be the sameperson as the cloned individual. The fact remains that the person does die and cannot be replaced.
The same reasoning applies to recreating sports stars, dictators, and geniuses— genetics does not whollydefine a person. Cloning may allow the persistence of certain genotypes and derived phenotypic traits,but it does not provide individual immortality or replication. A clone of a sports star will not necessarilybe a superb athlete, and even if he or she did possess keen athletic ability, he or she would not be identicalto the cloned sports star. However, the idea that the clone’s life choices would be affected by other’sexpectations raises additional disturbing possibilities that are addressed below.
There is some concern that human clones would be developed from cells obtained without one’spermission since, unlike traditional procreative methods, isolated somatic cells potentially could yieldclones. If this technique becomes a possibility, the moral foundations of the therapeutic relationshipwould have to apply. These include trust, personal respect, and the healer’s fiduciary obligation to servethe patient’s health interests. Any attempt to clone a patient involuntarily would violate all three of thesefundamental precepts of medical ethics.
In addition, the doctrine of informed consent would have to apply if this technique becomes a possibility.
In Opinion 8.08, “Informed Consent,” the Council has recognized that “the patient should make his or herown determination on treatment.” v This includes procedures for reproduction. Few exceptions exist tothis basic social policy. In addition to ethical safeguards, there are legal protections against procreationwithout consent. Cloning a patient involuntarily would likely violate the patient’s existing constitutionalrights to privacy and reproductive freedom.vi Therefore, under no circumstances should cloning occurwithout an individual’s permission.
Many of the other unrealistic applications of human cloning, such as creating armies of clones or creatinghuman organ factories, stems from the underlying fear that clones would be denied the same rights asother individuals in society. Children are entitled to the same protections as every other individual insociety. The fact that a human clone’s nuclear genes would derive from a single individual rather thantwo parents does not change its moral standing. This standard should be applied to every supposed use ofclones.
The Realistic Uses of Human Cloning
There are some realistic applications for cloning technology in the medical arena. One of the most likelyuses is as a method of assisted reproduction. To the benefit of many patients, the widespread introductionof assisted reproductive technologies has resulted in a great number of pregnancies and births thatotherwise could not have occurred. The use of in-vitro methods of fertilization, donor eggs, donor sperm,and/or surrogate mothers have proved to be effective treatments for infertility. Assisted reproductivetechnologies are also attractive options to individuals or couples who do not choose to reproduce bytraditional means. Cloning technology might allow any couple or individual to reproduce with minimalgenetic input from another party.
Because of the prevalence of assisted reproductive technologies and the rapid rate of technologicaldevelopment in this arena, cloning rarely would be the only reproductive option available to prospectiveparents. For example, scientists recently have pioneered a technique in which DNA is transferred from aninfertile woman’s oocyte to a viable donor oocyte.vii In addition, the development of somatic cell genetherapy and other technologies may allow for the treatment of genetic disorders— an alternative toavoiding all genetic contribution from a partner with a disease gene. One issue for this report is whetherit would be justifiable to make cloning available to individuals who could use existing or alternativeoptions.
Many of the issues that arise in the context of cloning, for example with respect to medical,psychological, or social harms, can be compared to issues that arise in the use of other assistedreproductive techniques. Generally speaking, the medical profession should be satisfied that the benefitsof commonly used reproductive interventions outweigh the risks to individuals, families, and theiroffspring enough to justify medical cooperation with informed patient requests for these services.
Evaluating whether or not this calculus has been done for all of the currently used reproductivetechnologies is beyond the scope of this report. Regardless, cloning should be subject to such abalancing.
In considering cloning as another reproductive health tool, the profession should evaluate whether theethical concerns introduced by assisted reproductive technologies will be exacerbated in the case ofcloning to the point where they outweigh potential benefits to individuals, families, and their offspring.
For example, human cloning appears to represent a significant step toward turning children into “productsof human will and design,” a situation that many find problematic.viii Determining the balance of possibleharms and benefits will require further investigation and discussion regarding human cloning withconsideration given to the points raised in the next section.
Individuals do not have a right to demand that physicians participate in human cloning. Beforephysicians would be justified in participating in human cloning, the harms and benefits need to beevaluated further with some of the issues requiring discussion on a societal level. Until these issues arebrought closer to resolution and benefits clearly outweigh harms, it would be inappropriate for physiciansto participate in human cloning.
Cloning technology also potentially may be used to create a person with tissues immunologically matchedto an existing individual. If the technology uses somatic nuclear transfer for cell or tissue productionwithout creating a human being, then this is not human cloning by the definition used here. One scenariothat has been discussed in the context of human cloning is the possibility of manufacturing “donororganisms.” In this context, donor organisms are humans in early stages of development created for thesole purpose of harvesting their organs.ix The creation of human embryo or fetal donor organisms will beaddressed in a future report.
Legal and ethical protections already preclude the use of cloned children as discardable donor organisms.
Medical ethics is grounded in the principle of nonmaleficence, or the avoidance of harm. Anyinvolvement by a physician in the deliberate sacrifice or harm of children in order to harvest organswould violate this axiom. Further, this practice would be considered murder.
Even where the clone would not be destroyed, the ethical prohibition against using human beings merelyas means rather than as ends in themselves makes the possibility of using human cloning to create anorgan donor controversial. Nevertheless, even without human cloning, the practice of having children inorder to create matching tissue for an older sibling already occurs. One couple unable to find a matchingdonor for their first child’s bone marrow transplant decided to have a second child on the chance that heor she would also have the rare marrow type.x Notably, the couple indicated that they had wanted anotherchild and that they would care for the resulting child irrespective of his or her marrow type. In thissituation, hoping the child had the same marrow type as its sibling did not preclude the couple fromvaluing the child for its own sake. xi A cloned person, however, would be born with assurance of tissuecompatibility, and perhaps with the expectation of tissue donation.
There are limits on the types of procedures to which parents can consent. In a previous report, “The Useof Minors as Organ and Tissue Donors,” the Council has described the standards that proxies should usewhen making a decision to donate a minor’s organs.xii One of the standards the Council recommends is a“best interests test” based on the principles of beneficence and nonmaleficence in which the proxy“attempts to ascertain what would bring the most good to the person… and at the very least… do no harmto that person.” Physicians can help parents with the calculus of determining the best interest of the child.
Technological advances in organ and tissue research might alleviate the need to develop a human being inorder to produce a matching organ. For example, somatic cell nuclear transfer may be used to produceonly the matching, transplantable tissues. Improved pharmaceutical interventions to lower the rate oforgan and tissue rejection could also reduce the need for tissue compatibility.
Ethical Concerns Regarding Human Cloning
Physicians have an ethical obligation to consider the harms and benefits of new medical procedures andtechnologies. In weighing the harms and benefits, physicians should consider the possible implications ofhuman cloning. Potential physical harms, psychosocial harms, adverse effects on familial relations, andchanges to the gene pool are all legitimate issues. Compared to other technologies that might be used toaddress reproductive limitations and organ and tissue shortages, these potential harms of human cloningappear to outweigh the potential benefits at this time.
While the Council will address the harms and benefits of embryo research in a future report, it isimportant to note that techniques used for cloning humans could potentially endanger the developingindividuals. The Human Embryo Research Panel of the National Institutes of Health (NIH), in its 1994 study, advised that embryos should be transferred to a woman’s uterus only when “there is reasonableconfidence that any child born as a result” will not be harmed.xiii At present, this cannot be assured withany degree of certainty with human cloning. Somatic cell nuclear transfer has not yet been refined and itslong-term safety has not yet been proven. The possibility of genetic or cellular conditions, and perhaps anarray of illnesses associated with cloning, is of great concern. While the demise of countless amphibian,lamb, and mouse fetuses may be disturbing, similar wastage and mortality among human fetuses isunacceptable. Moreover, we might have significant concerns about offering such technology to women asa mechanism to facilitate reproduction given the potential harms from the expected high miscarriage rate.
The risk of producing individuals with developmental anomalies is serious and precludes human cloningfor the time being. Producing disabled human clones would give rise to an obligation to seek betterunderstanding of— and potential medical therapies for— the unforeseen consequences that could arisefrom human cloning.
B. Psychosocial harms introduced by cloning Human cloning has the potential to introduce psychosocial harms to individuals. If a person with knowngenetic predispositions and conditions is cloned, the cloned child’s genetic predispositions and conditionswill, due to the very nature of cloning, also be known to a certain extent. For the most part, environmentwill also play a significant role. Presently, a child’s genetic predispositions can be predicted to varyingdegrees if the parent’s genetic predispositions have been determined. Knowledge of a child’s geneticpredispositions raises concerns about the autonomy and best interests of the child. The Council has urgedcaution in this area in its ethical Opinion 2.138, “Genetic Testing of Children.”xiv Knowledge of geneticinformation holds great significance to an individual. The harm of preempting the child’s future choice inknowing or forgoing knowledge of his genetic status and the danger of abrogating the child’s right toprivacy with respect to this status must be weighed carefully.
Foregoing choice in learning one’s genetic predispositions may seem trivial compared to the concernsabout identity raised with human cloning. If raised by the clone-parent, a clone-child could see what heor she has the potential to become. In this respect, human clones would differ dramatically frommonozygotic twins who develop simultaneously. The timing of development is a key difference betweenmonozygotic twins and human clones. Having insight into one’s potential may cause enormous pressuresto live up to expectations (or inappropriately relieve pressure to do so), even more so than those generallyexperienced by children.
Presumably, a person would clone him or herself or another individual because that person has desirable
characteristics that would be reflected in the clone. For example, the person who cloned a sports star
presumably would hope that the clone-child develops into another sports star. A sports star’s clone-child
unable to live up to these expectations could be dubbed a failure unable to capitalize on his or her genetic
gift. Moreover, although the clone-child of a sports star might feel more confident of his or her abilities
from the outset, other clone-children may feel limited by their genetic lot. If a clone-child saw that he or
she was likely to develop certain diseases or had failed at certain tasks, his or her undertakings might be
bounded by what the clone-parent had done. Therefore, cloning might limit the clone-child’s perception
of self and increase external pressures. Human cloning may diminish, at least psychologically, the
seemingly unlimited potential of new human beings and may exacerbate disturbing motivations for
having children.
C. The impact of human cloning on family and society In addition to concerns about individual privacy and identity, the implications of cloning for family andbroader social relationships remain uncharted. What would be the consequence to, say, the father-daughter relationship if the daughter and wife were genetically identical? Would a woman have a normal mother-daughter relationship with her clone?xv These examples illustrate that the family unit might bequite different with the introduction of cloning. As one philosopher wrote: “cloning shows itself to be amajor violation of our given nature as embodied, gendered, and engendering beings— and of the socialrelations built on this natural ground.”xvi Additionally, some problems are technical and legal in nature. For instance, birth cousins could begenetic siblings, and this might result in a need to revisit laws governing marital eligibility. Also, thecourts have had difficulty sorting out parental rights in cases of assisted reproduction. In one case, a courtfound a child conceived using assisted reproductive technologies to have no parents despite having eightindividuals from which to choose.xvii While discussion and resolution of these issues is not the province of physicians, the impact of humancloning on family and society is an important factor for physicians to consider when weighing the costsand benefits of cloning. Until more thought is given on a societal level regarding how to constructfamilial relations in this context, physicians should not participate in human cloning.
D. The effects of human cloning on the gene pool Although not the most imminent threat, human cloning has the potential to alter the gene pool. In orderfor human cloning to have a significant effect on the gene pool, cloning would have to be widespread, andclones would have to reproduce. If cloning became widespread, human genetic diversity would decrease.
Over time, the benefits of genetic diversity, from having individuals with disease immunity to fostering apopulation with a wide variety of talents, have helped human beings survive and succeed.
Like other interventions that can change individuals’ reproductive patterns and the resulting geneticcharacteristics of a population, human cloning raises the specter of eugenics. xviii The possibility thatphysicians might play a part in deciding which persons are or are not “worthy” of cloning is contrary toprofessional medical values by all respectable accounts. For the most part, those individuals thought topossess desirable characteristics or lack undesirable ones would be cloned. In addition, as is the worrywith many assisted reproductive technologies, only those who have the ability to pay or are members offavored social groups will have access. This would have the potential to skew the gene pool in thedirection of favored social groups and whatever characteristics are thought to be advantageous at the time,even though the long-term desirability of the characteristics is unknown.xix The possibility that physiciansmight be the agents of a social policy that make such judgments is contrary to professional medicalvalues.xx The application of cloning for eugenic or discriminatory practices is incompatible with theethical norms of medical practice.
In addition, since the somatic cell from which clones originate likely will have acquired mutations, serialcloning would compound the accumulation of mutations that occur in somatic cells. Although thesemutations might not be apparent at the time of cloning, genetic problems could become exacerbated infuture generations. These possibilities need to be investigated further before physicians participate inhuman cloning.
The Need for International Regulations
Even if the United States developed sound ethical guidelines and well-crafted regulations to address thepractice of human cloning, some fear that human cloning would simply be forced into other locales.
Individuals could travel to other countries where human cloning would be available and potentiallyunregulated. Because cloning technology is not limited to the United States, physicians should helpestablish international guidelines regarding human cloning.
Conclusion
Human cloning raises a variety of concerns, some realistic and others less so. It would be irresponsible to
forge ahead with this new technology in the absence of serious discussion regarding the possible harms
and benefits of cloning human beings. Until the benefits of human cloning are thought by society to
outweigh the harms, it would be inappropriate for physicians to participate in human cloning.
Recommendations

The Council on Ethical and Judicial Affairs recommends that the following be adopted and that the
remainder of this report be filed:
For the purpose of these guidelines, “somatic cell nuclear transfer” refers to the process in which thenucleus of a somatic cell of an organism is transferred into an oocyte from which the nucleus has beenremoved. “Human cloning” refers to the application of somatic nuclear transfer technology to thecreation of a human being that shares all of its nuclear genes with the person donating the implantednucleus. Human cloning, as defined in this report, does not include the use of somatic cells to create apluripotent cell line that could, for instance, also be used for extra-uterine production of transplantabletissues without the creation of an entire being. Nor does it include the use of cloning technology for theproduction of human tissues or human proteins from transgenic mammals. This report does not addressthe issue of embryo or cloning research, stem cell research, embryo twinning, or embryo splitting.
1) In order to clarify the many existing misconceptions about human cloning, physicians should help educate the public about the intrinsic limits of human cloning as well as the current ethical and legalprotections that would prevent abuses of human cloning. These include the following: a) using human cloning as an approach to terminal illness or mortality is a concept based on the mistaken notion that one’s genotype largely determines one’s individuality. A clone-child createdvia human cloning would not be identical to his or her clone-parent.
b) current ethical and legal standards hold that under no circumstances should human cloning occur c) current ethical and legal standards hold that a human clone would be entitled to the same rights, freedoms, and protections as every other individual in society. The fact that a human clone’snuclear genes would derive from a single individual rather than two parents would not change hisor her moral standing.
2) Physicians have an ethical obligation to consider the harms and benefits of new medical procedures and technologies. Physicians should not participate in human cloning at this time because furtherinvestigation and discussion regarding the harms and benefits of human cloning is required.
Concerns include: a) unknown physical harms introduced by cloning. Somatic cell nuclear transfer has not yet been refined and its long-term safety has not yet been proven. The risk of producing individuals withgenetic anomalies gives rise to an obligation to seek better understanding of— and potentialmedical therapies for— the unforeseen genetic consequences that could stem from human cloning.
b) psychosocial harms introduced by cloning, including violations of privacy and autonomy. Human cloning promises to limit, at least psychologically, the seemingly unlimited potential of newhuman beings and to create enormous pressures on the clone-child to live up to expectationsbased on the life of the clone-parent.
c) the impact of human cloning on familial and societal relations. The family unit would be different with the introduction of cloning, and more thought is required on a societal levelregarding how to construct familial relations.
d) potential effects on the gene pool. Like other interventions that can change individuals’ reproductive patterns and the resulting genetic characteristics of a population, human cloning hasthe potential to be used in a eugenic or discriminatory fashion— practices that are incompatiblewith the ethical norms of medical practice. Moreover, human cloning could alter irreversibly thegene pool and exacerbate genetic problems that arise from deleterious genetic mutations,resulting in harms to future generations.
3) Two potentially realistic and possibly appropriate medical uses of human cloning are for assisting individuals or couples to reproduce and for the generation of tissues when the donor is not harmed orsacrificed. Given the unresolved issues regarding cloning identified above, the medical professionshould forsake human cloning at this time and pursue alternative approaches that raise fewer ethicalconcerns.
4) Because cloning technology is not limited to the United States, physicians should help establish international guidelines governing human cloning.
Report of the Council on Ethical and Judicial Affairsof the American Medical AssociationJune 1999 REFERENCES
1. National Bioethics Advisory Commission. “Cloning Human Beings, Report and Recommendations of the National Bioethics Advisory Commission,” Rockville, Maryland; June 1997.
2. Although cloning does not produce exact genetic replicas, it is intended to produce closely identical 3. “Will We Follow the Sheep?” Time March 10, 1997; p. 69, 70-72.
4. Kass, Leon R. “The Wisdom of Repugnance.” In: The Ethics of Human Cloning Kass, Leon R. and Wilson, James Q. Washington, D.C.: American Enterprise Institute for Public Policy Research, 1998.
5. Council on Ethical and Judicial Affairs, American Medical Association. “Opinion 8.08: Informed Consent.” Code of Medical Ethics: Current opinions and annotations. Chicago, IL, 1998.
6. Griswold v. Connecticut 381 U.S. 479 (1965); Eisenstadt v. Baird 405 U.S. 438 (1972).
7. “Ethical questions raised by gene transfer for egg cell fertilization.” Chicago Tribune Saturday, 9. Kass, Leon R. “The Wisdom of Repugnance.” In: The Ethics of Human Cloning Kass, Leon R. and Wilson, James Q. Washington, D.C.: American Enterprise Institute for Public Policy Research, 1998.
10. Robertson, John A. “The Question of Human Cloning.” Hastings Center Report, March-April 1994, 11. ABC News Show: ABC 20/20 (10:00 p.m. E.S.T.) November 6, 1997. “Born to Give.” Transcript # 12. Brock, Dan W. “Cloning Human Beings: An Assessment of the Ethical Issues Pro and Con.” In: Clones and Clones- Facts and Fantasies About Human Cloning, Ed: Nussbaum, Martha C. andSunstein, Cass R. New York: 1998. p. 147-8.
13. Report from Council on Ethical and Judicial Affairs “The Use of Minors as Organ and Tissue Donors,” House of Delegates Proceedings, American Medical Association. December 5-8, 1993. p. 231-240.
14. National Institutes of Health. Final Report of the Human Embryo Research Panel. September 27, 15. Council on Ethical and Judicial Affairs, American Medical Association. “Opinion 2.138: Genetic Testing of Children.” Code of Medical Ethics: Current opinions and annotations. Chicago, IL, 1998.
16. Kass, Leon R. “The Wisdom of Repugnance.” In: The Ethics of Human Cloning Kass, Leon R. and Wilson, James Q. Washington, D.C.: American Enterprise Institute for Public Policy Research, 1998.
17. Kass, Leon R. “The Wisdom of Repugnance.” In: The Ethics of Human Cloning Kass, Leon R. and Wilson, James Q. Washington, D.C.: American Enterprise Institute for Public Policy Research, 1998.
18. In re Marriage of Buzzanca, 5 Cal. 4th 84, 851 P.2d 776 (1993). The appellate court reversed this decision in 61 Cal. App. 4th 1410, 1418 (1998).
19. Kitcher, Philip. The lives to come: the genetic revolution and human possibilities. New York: Simon 20. Eisenberg, Leon. “Would Cloned Humans Really Be Like Sheep?” New England Journal of Medicine, 21. Annas, George A. and Gordin, Michael A. The Nazi doctors and the Nuremberg Code: Human rights in human experience. New York: Oxford University Press. 1992, p. 29.

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