Living in the Biotech Century -- February 14, 2007

“If people want to choose their baby’s sex before pregnancy, should doctors help?

“Some parents would love the chance to decide, while others wouldn’t dream of meddling with nature. The medical world is also divided. Professional groups say sex selection is allowable in certain situations, but differ as to which ones. Meanwhile, it’s not illegal, and some doctors are already cashing in on the demand.

“There are several ways to pick a baby’s sex before a woman becomes pregnant, or at least to shift the odds. Most of the procedures were originally developed to treat infertility or prevent genetic diseases.

“The most reliable method is not easy or cheap. It requires in vitro fertilization, in which doctors prescribe drugs to stimulate the mother’s ovaries, perform surgery to collect her eggs, fertilize them in the laboratory and then insert the embryos into her uterus.

“Before the embryos are placed in the womb, some doctors will test for sex and, if there are enough embryos, let the parents decide whether to insert exclusively male or female ones....”

“Jyoti Dave is pregnant, but when the 30-year-old gives birth in March the baby will not be taken home to bond with her other child, but will instead be handed over to an American couple unable to conceive.

“For her trouble, the Indian surrogate mother will be paid. She won’t say how much, but she says it’s money she desperately needs to feed her poor family after an industrial accident left the family’s only breadwinner unable to work.

“‘My husband lost his limbs working in the factory,’ Dave told Reuters. ‘We could not manage even a meal a day. That is when I decided to rent out my womb.’

“Surrogate motherhood is among the latest in a long list of roles being outsourced to India, where rent-a-womb services are far cheaper than in the West.

“‘In the U.S. a childless couple would have to spend anything up to $50,000,’ Gautam Allahbadia, a fertility specialist who helped a Singaporean couple obtain a child through an Indian surrogate last year, told Reuters.

The White Parents, an Indian Baby and the New £3bn Fertility Tourism

“Wendy Duncan and her husband Brian are white. Nineteen months ago, the Lincolnshire housewife gave birth to a beautiful, healthy, Indian daughter.

“Freya, brown-skinned and dark-eyed, is not a medical miracle after a long and fruitless quest through IVF and adoption, but the product of a booming industry in India that is offering embryos for adoption.

“India is fast cornering what is forecast as a £3 billion-a-year market in ‘reproductive tourism’. It has highly trained, English-speaking doctors and medical procedures that cost a third of the price charged in Europe.

“Couples such as the Duncans are lining up to be treated. Their experience was so successful that they are returning next week to the Bombay fertility clinic that produced Freya, to try for a second child....”

“Every pregnant woman in the country regardless of age should have access to prenatal genetic screening to identify more babies with birth defects and disabilities before they are born, according to new guidelines from Canada’s obstetricians and gynecologists.

“Such testing in Canada is generally only offered to women aged 35 and older, when the chances of having a child with Down syndrome and genetic abnormalities increase.

“These guidelines could well fuel fears that society may enter a new phase of eugenics with more couples choosing not to have less-than-perfect children....”

Raymond Verdague

“You, or someone you love, may die because of a gene patent that should never have been granted in the first place. Sound far-fetched? Unfortunately, it’s only too real.

“Gene patents are now used to halt research, prevent medical testing and keep vital information from you and your doctor. Gene patents slow the pace of medical advance on deadly diseases. And they raise costs exorbitantly: a test for breast cancer that could be done for $1,000 now costs $3,000.

“Why? Because the holder of the gene patent can charge whatever he wants, and does. Couldn’t somebody make a cheaper test? Sure, but the patent holder blocks any competitor’s test. He owns the gene. Nobody else can test for it. In fact, you can’t even donate your own breast cancer gene to another scientist without permission. The gene may exist in your body, but it’s now private property....”

Everyone’s making money in the market for body tissue—except the donors.

“Alistair Cooke’s body lay cold in the embalming room of an East Harlem funeral home, suspended in the brief limbo between death and cremation. A ‘cutter’ soon arrived to make a collection. He sliced open Cooke’s legs, sawed the bones from the hip, and took them away. The quintessentially British presenter of Masterpiece Theatre and Alistair Cooke’s America—the face of genteel, urbane Albion to millions of Americans—was being carved up for parts....

“Alistair Cooke’s remains were only the most famous of more than a thousand bodies plundered by Michael Mastromarino, owner of Biomedical Tissue Services (BTS). He had a simple business model: Pay funeral directors for access to bodies and resell bones, heart valves, spines, and other tissues to biotech firms in need of spare parts....

“Yet a small but growing number of academics, doctors, and legislators believe the Cooke scandal wasn’t an aberration but an inevitability. They believe the tissue industry as a whole, even as it strives to distance itself from Mastromarino, is abusing families on a scale well beyond the reach of any one body broker. ‘The industry will argue that these are aberrant, isolated events that are irrelevant,’ says Todd Olson, a professor of anatomy and structural biology at the Albert Einstein School of Medicine. ‘My view is it’s exactly the opposite. What we’re really dealing with here is the tip of the iceberg.’

“Olson believes that the generosity of donors is being abused on an ‘epic scale’ by tissue procurement organizations, middlemen, and biotech companies that depend on tissue for their survival. With scientific advances there has emerged an enormously beneficial market in remains. But the players most fundamental to that market, donors, are locked out, prohibited by law from sharing in the benefits that others derive from their bodies. At the heart of this inequity is a confusion over to what extent we control our own persons-over whether we own our increasingly valuable component parts....”

“A disturbing number of doctors do not feel obligated to tell patients about medical options they oppose morally, such as abortion and teen birth control, and believe they have no duty to refer people elsewhere for such treatments, researchers say.

“The survey of 1,144 doctors around the country is the first major look at how physicians’ religious or moral beliefs might affect patients’care.

“The study, conducted by University of Chicago researchers, found 86 percent of those responding believe doctors are obligated to present all treatment options, and 71 percent believe they must refer patients to another doctor for treatments they oppose. Slightly more than half the rest said they had no such obligation; the others were undecided....”

The study of doctors’ moral beliefs, “Religion, Conscience, and Controversial Clinical Practices,” was published in the February 8, 2007 issue of The New England Journal of Medicine and is available online.

CT scan of a human head

Charles O'Rear/Corbis

Using the technology is 'like shining a torch, looking for writing on a wall'.

“A team of world-leading neuroscientists has developed a powerful technique that allows them to look deep inside a person’s brain and read their intentions before they act.

“The research breaks controversial new ground in scientists’ ability to probe people’s minds and eavesdrop on their thoughts, and raises serious ethical issues over how brain-reading technology may be used in the future.

“The team used high-resolution brain scans to identify patterns of activity before translating them into meaningful thoughts, revealing what a person planned to do in the near future. It is the first time scientists have succeeded in reading intentions in this way.

“‘Using the scanner, we could look around the brain for this information and read out something that from the outside there’s no way you could possibly tell is in there. It’s like shining a torch around, looking for writing on a wall,’ said John-Dylan Haynes at the Max Planck Institute for Human Cognitive and Brain Sciences in Germany, who led the study with colleagues at University College London and Oxford University....

“The latest work reveals the dramatic pace at which neuroscience is progressing, prompting the researchers to call for an urgent debate into the ethical issues surrounding future uses for the technology....”

“A ruling by Switzerland’s highest court released Friday has opened up the possibility that people with serious mental illnesses could be helped by doctors to take their own lives.

“Switzerland already allows physician-assisted suicide for terminally ill patients under certain circumstances. The Federal Tribunal’s decision puts mental illnesses on the same level as physical ones.

“‘It must be recognized that an incurable, permanent, serious mental disorder can cause similar suffering as a physical (disorder), making life appear unbearable to the patient in the long term,’ the ruling said.

“‘If the death wish is based on an autonomous decision which takes all circumstances into account, then a mentally ill person can be prescribed sodium-pentobarbital and thereby assisted in suicide,’ it added....”

“There are ways of being that are also degrees of being. Is it necessary to give multiple examples? I am not the same, in being or degree of being, when I admire as compared with when I belittle, when I forgive as when I stay hardened in resentment, when I strain toward truth as when I am riddled with vanity, when I am wholly involved in a common undertaking as when I am turned inward on my own interests, when I am penetrated by love of those close to me, as when I abandon myself to lust, when I give myself as when refuse myself. The more I forget myself and commit my being, the more I am; the more I rise above my inner division in favor of what is deepest in me, the more I am. The egocentrism of the self, and even more the radical egocentrism of the modern self, debases and spoils life. It blocks what nourishes the human heart. What are moments of joy if not those in which the self is silent? These are the moments when being resonates, breathes, swells in the accomplishment of a task well done, the admiration of works of genius, wonder before beauty, collaboration in a common enterprise, an encounter steeped in friendship, being carried away by love. Contrary to what late modernity says, true authenticity is achieved by conquering the self. But the conquest is difficult, always to be renewed and always incomplete. The self is a tireless seducer and its ruses are infinite, as the French moralists of the seventeenth century have said so superbly. To be inwardly torn is our fate. Everything happens, as Bergson says, as if there were in man an original defect of workmanship.

“Is there any need to name all the philosophers and writers who have come to the same conclusion? The preceding discussions are only variations on a theme treated, illustrated, illuminated a thousand times in different ways in the framework of Christian thought and elsewhere. Let it suffice to cite Saint Augustine’s Confessions, Pascal’s critique of the self, Newman’s distinction between the self and the ground of being, Bergson’s concept of spiritual energy, Gabriel Marcel’s analyses of the self and the I...and the whole line of writers that stretches from Dante to Solzhenitsyn and includes Dostoyevsky, Péguy, and Bernanos. The crux is always found at the same point: the self is a barrier, a block. To see, to commune, one must get over the self....”

“Self Against Being” is chapter six in Equality By Default: An Essay on Modernity as Confinement, by Philippe Bénéton, professor of law and political science at the University of Rennes in France.

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