Human cloning and medical ethics

Gonzalo Herranz, department of Bioethics, University of Navarra, Spain.
Session at workshop of Bioethics, September 4, 1999
department of Humanities Biomedical, University of Navarra.

Index

A. Medical applications

a1. Infertility not salvageable by other assisted reproduction techniques.

a2. Treatment of certain genetic diseases

B. Applications of in vitro nuclear transfer techniques.

C. The final hardness of the discussion

Introduction

Human cloning has been debated ad nauseam. Dolly's cloning took everyone by surprise: no one expected it. But the reaction was lively and abundant. Too much has already been written. Almost everything that can be said has been said. But very little has been decided.

The discussion has been held, above all, at the bioethical, philosophical, political level, with man as the background, as is logical. Curiously, however, there have not been many reactions from the field of medical ethics, the ethics of the relationship between physicians and patients.

In general, physicians, following in the wake of the WMA, have limited themselves to imposing a moratorium. In Hamburg, the 49th Assembly, in November 1997, confirmed the resolution of committee, in May in Paris, which, in view of the news of Dolly and the possibility of applying cloning techniques to humans, which raises serious concerns about human dignity, safety and security Genetics, urges all physicians and researchers to voluntarily refrain from engaging in human cloning until the scientific, ethical and legal issues have been addressed by physicians and researchers and the necessary limits and controls can be identified.

All very cautious and prudent. Two years have passed and nothing has changed.

It is time to make a couple of basic clarifications:

1. Since medical ethics is concerned with the practice of medicine, what interests us here are, in principle, only the applications that cloning techniques could have in the protection of health and the cure of disease.

2. I have used from purpose the expression "cloning techniques". Why? Anyone who has closely followed the discussion on cloning has noticed that, very early on, a distinction began to be made between reproductive cloning techniques (producing cloned children) and investigational or therapeutic cloning techniques (what is now preferably called nuclear transfer technique). 

Thus, two years ago, the European Commission's group of Advisors on the Ethical Implications of Biotechnology, in its Opinion on Ethical Aspects of Cloning Techniques, stated: 1.14. A clear distinction should be drawn between reproductive cloning, which aims at the birth of identical individuals [...], and non-reproductive cloning, limited to the in-vitro phase.

The significance of this differentiated use is not only to serve the technical purpose of distinguishing between two biologically diverse territories, which are well described by the proposed names or their variants. The significance lies, above all, in the design to define both territories as two disparate and unconnected ethical universes: one, reproductive cloning, which is almost universally condemned; and the other, non-reproductive cloning, on which a lively and empathetic ethical discussion is desired in order to set the limits of in vitro experimentation with human clones and to develop the promising applications of these cellular complexes. 

The fundamental ethical problem is far from clear: the starting point for both destinations (reproductive and therapeutic) is the same, a human clone. The same biological and human reality seems to take on paradoxically different ethical meanings depending on the intentionality, the ethical subjectivity, of the one who produces it or of the one who decides its destiny. How is it possible that the same biological entity can be one thing and another at the same time?

How can it be justified that, if we call it a cloned embryo for reproduction, the ethical response becomes red hot and provokes a majority rejection, while if we call it a non-reproductive cloned embryo, this same entity cools down ethically, becomes tame and becomes an appetizing reality? Apparently, in vitro culture transmutes it, dissolves it into a mere cellular aggregate, without unity or soul, into a archive of dispersed stem cells.

We must honestly ask ourselves whether by calling things by different names we change them in their being, we mutate their reality according to the label that we attach to them. Yesterday, on the news, there was a report on a wine grower from La Mancha who marked his wines with the label Rioja. But the label did not change the wine. He was denounced and the Guardia Civil seized the wine and the labels. Something similar happens here to what happened with the harvester. With Julieta we have to ask ourselves: What's in a name? It is not the first time in Bioethics that we have had to face this question.

As we shall see, the issue is an important distinction. Creating a cloned child is an offense to God and man, but, once created, that creature has all the human dignity and the same right to life as the King's grandchild. At least, we have not finished off one mistake with another. But the experts of the Bioethics Commissions have forbidden us to rectify the error: we must let it die and not allow it to live. 

To create a cloned human embryo to dissect it at the blastocyst stage, to separate the embryonic disc from the trophoblastic vesicle, to subculture it and convert it into a stem cell generator is to create a human embryo with the deliberate purpose to kill it as a human being, degrading it to the condition of a mere cell culture. But the experts of the Bioethics Commissions tell us to go ahead, that along this path we can achieve true wonders.

However, it is not advisable to make such strong judgments. Let us try, for the moment, in view of the preceding clarifications, to make a list of possible medical applications of cloning techniques.

A. On the one hand, we have the medical applications of reproductive cloning, by means of somatic cell nuclear transfer. It has been proposed for remediation:

• a1. sterility that cannot be saved by other assisted reproduction techniques;

• a2. certain genetic diseases, in particular those due to extranuclear genome, diseases caused by mitochondrial DNA defects.

B. On the other hand, the applications of in vitro nuclear transfer techniques, which basically consist of the exploitation of blastocysts for the production of embryonic stem cells.

A. Medical applications

a1. Infertility not salvageable by other assisted reproduction techniques

It has already been said that reproductive cloning received a strong and universal condemnation. But in the times in which we live, so refractory to moral absolutes, as soon as UNESCO, the Vatican, the committee of Europe, the WHO, the CNC of France, and many others condemned reproductive cloning, there was no lack of voices saying that condemnation cannot be taken to the extreme of making it absolute and without exceptions. 

The NBAC, in its 1997 recommendations, pointed out that, despite all the regrets (fear of the harm that cloned children could suffer, concern about the deterioration of parenthood and family life, fear of the malformations and defects that could be induced by somatic cell nuclear transfer techniques, eugenics, disruption of social values), the ability of individuals to choose cannot be limited, nor the freedom of research, nor the possibility of opening new territories to scientific inquiry. Above all, cloning by nuclear transfer could be the only door left open to some individuals to reproduce, so the social benefits derived from the prohibition would have to be very great for it to prevail over the freedom of those same individuals to make a private decision that means so much to them.

Strong has taken matters into its own hands and has argued, on the basis of the preeminence of the principle of autonomy, that, if it could be guaranteed that cloned children do not run genetic risks of malformation or short life span, if they are the same as other children, there would be no inconvenience in producing them in order to give offspring to sterile heterosexual couples who wish to reproduce in this way instead of resorting to other alternative assisted reproduction techniques. As long as the couple so decides, if they find an oocyte donor, if they determine which of them will donate the somatic nucleus to be transferred, and if they find a doctor who wants to collaborate, there is no ethical reason to prohibit them from doing so, nor should there be any law to prevent them from doing so.

Strong asks: which weighs more: the reproductive freedom of infertile couples to have cloned children, or the arguments, religious or secular, against cloning? In a very modern way, he leaves aside the religious arguments, without giving the reasons why he does so, and focuses on the secular ones: the lack of uniqueness Genetics, the psychological damage of not being unique or original, the mechanization of reproduction that cloning entails, which makes children products manufactured according to specific standards, or the disruption of family life that cloned children can create.
It is very difficult, in a cultural climate dominated by the idols of reproductive privacy and the dignity-efficiency of in vitro fertilization and its combinatorics, to refute that reproductive cloning is not an excellent way to participate in the creation of highly desired and beloved human persons as one's own children. The cloned child, like every artificial child, brings with it an enormous sentimental burden: there is an epic of the artificial child, which is not only scientific, but sociological, because he, and only he, is capable of perpetuating one's own genes, of gratifying virility and femininity demonstrated by the ability to have one's own children, of saving marriages that were about to break up. Cloning opens up the opportunity to raise and educate children who would not have been able to exist except through it and can be decisive as an affirmation of the mutual love of the spouses. 

All this is difficult to refute in the face of those who have a mechanistic and efficiency-oriented vision of the transmission of human life or in the face of those who wish to show moderate attitudes and who are more comfortable in the indeterminacy and postponement of decisions. 

But the battle is usually won by the determined. Strong's article was shortly followed by another from Murphy asking who, by virtue of Strong's arguments, has a right to reproductive cloning. I don't know whether Murphy's rejoinder is a sincere proclamation in favor of a libertarian use of cloning or constitutes an argument ad absurdum for the irrationality of it. Murphy says that Strong's thesis is this: if cloning were safe, it should be available, both ethically and legally, to those infertile couples who choose it. But Strong's arguments apply, letter for letter, to homosexual couples, because they are incapable of having a genetically related child. And, finally, because Strong's arguments validate cloning by nuclear transfer beyond the status of infertility that he studies: Murphy, using Strong's arguments, is able to convince, whoever admits the premises of reproductive freedom and the desire to have a genetically related child, that reproductive cloning can be used by whoever wants to apply it.

For example, why shouldn't those who are fertile be able to have a cloned child? There is no strong argument to deny it: for, a cloned child produced for a fertile couple is no more or less individual than one cloned for an infertile couple, nor will it be more or less reified simply because it is born to a fertile couple than to a non-fertile couple, nor are they more susceptible to abuse by overbearing parents. Strong's premises admitted, there is no way to demonstrate that infertile couples have more merit in having a cloned child than those who are fertile. 

With the same arguments he speaks in favor of cloning children for same-sex couples. For left to their own devices, homosexual couples are biologically infertile. But nothing forbids them from wishing to have genetically related children. They have obtained them through adoption, by artificial insemination, by fivet, by surrogate motherhood. It is true that homosexual couples formed by women have the advantage of being able to gestate a child if one of them so desires, which can be a child of their own or formed by fertilization of an oocyte of their partner. This situational infertility of homosexual couples can also be remedied by cloning. Murphy even goes so far as to say that, with Strong's argumentation, they have no less moral degree scroll to reproductive cloning than heterosexuals.

Murphy even speculates on the possibility of introducing, by gene transfer, some genes from the other member of the homosexual couple (those that determine the color of the eyes or hair), so that the Genetics endowment of the child produced by nuclear transfer would have genes from both, that is, it would have two genetic progenitors, not just one. We would then no longer be dealing with a clone properly speaking, with a genetic twin of the donor of a single and exclusive transferred nucleus, but with someone who shares genes with two parents of the same sex.
All this sample clearly shows how genetic reductionism has taken hold in many people: we are genes, we are contained in our genes, genetic kinship is our basic form of human relationship. This reductionism is a new way of looking at life, conditioned by technological culture, by the idea that it is in technology that we have to find solutions to the most serious human problems. 

How to judge, from the point of view of medical ethics, the treatment, by cloning, of infertility that cannot be saved by other assisted reproduction techniques?

This is a question that puts on test in a very strong way a fundamental topic of the aims and limits of Medicine. It is not a question of once again criticizing the technological imperative (I can do whatever I want as long as it is possible to do it). Nor is it a question of saying that all that is necessary to ethically justify an action is to desire it ardently and to have the money to buy it.

Basically, the history of cloned reproduction comes to tell us that there is no such thing as ethically reprehensible. It is a moral climate, largely created by the cultivators of American-style bioethics, but which finds followers everywhere, with its emphasis on autonomy, on the rejection of limits, on not contradicting anyone, on admitting exceptions to every rule. 

This creates an indeterminate ethical status : nothing is intrinsically good or bad, but only acceptable or unacceptable, and that only conjuncturally. Moral argumentation is not based on objective and permanent moral reasons, but on opportunistic, situational arguments. As the National Bioethics Advisory Commission paradigmatically states in its June 1997 document: "The Commission concludes that at this time it is morally unacceptable for anyone, in the public or private sector, whether at laboratory or in the clinic, to attempt to create a child using the technique of somatic cell nuclear transfer cloning. The Commission reached consensus on this point because the information now available indicates that the technique is not safe enough for human use at this time. Indeed, the Commission believes that attempting to create a child using this particular technology would be a violation of important ethical obligations, as it involves unacceptable risks to the fetus or potential child. In addition to these safety concerns, some ethical concerns have been identified that require more extensive and careful public deliberation before this technology can be licensed." 

This is not a condemnation, but rather a moratorium, which should be included in the legislation. For it is added that "it is a critical point that such legislation include a 'sunset' clause, to be sure that the congress reviews the problem within a specified time (three to five years) in order to decide whether such a ban is still necessary."

Under an appearance of serenity and prudence is hidden the indeterminacy of judgment, the fear of prohibition, the false assurance that things will be resolved not by the discussion thoroughly, but by the management management assistant : because, in the event that reproductive cloning is not prohibited by law, or if this law is repealed, the use of nuclear transfer techniques to create a child should be preceded by clinical trials that are subject to the double protection of an ethical review committee and informed consent, both of which are compatible with the current rules on the protection of human subjects.

The legacy of report Warnock can be seen in all this: the resistance to seriously consider the ethical status of the embryo, in order to go off on a tangent of regulation management assistant. Ethics is replaced by paperwork and management. Everything is possible for those who are determined to obtain something because they ardently desire it and are able to pay the expenses.

a2. Treatment of certain genetic diseases

Let us move on to the second point. The technique of cloning by somatic cell nuclear transfer is presented as a promising therapeutic avenue for treating certain genetic diseases: in particular those due to the extranuclear genome, diseases caused by mitochondrial DNA defects.

In 1995, before Dolly was born, Rubenstein et al. published a paper work that provoked belated interest. It was a study, very thorough in its biological aspect and very detailed in its ethical considerations, in which they proposed to break the current ban on germline gene therapy by means of a new proposal : that of curing mitochondrial diseases by in vitro oocyte nuclear transfer, a technique they called IVONT. 

The work included an update on the knowledge of the structure and functions of mitochondrial DNA and the diseases resulting from the inherited alterations that mitochondrial DNA can undergo. What was innovative was the proposal of a protocol to treat the MELAS syndrome, which combines a mitochondrial encephalopathy with lactic acidosis and episodes that simulate apoplectic crises. The protocol required diagnostic certainty, the genetic committee , the assessment of the oocyte donor, the synchronization of the menstrual cycles of the patient and the donor to ensure oocyte maturation, the microsurgical extraction of the patient's oocyte nucleus and its scrupulous washing to completely remove the abnormal mitochondria, enucleation of the recipient oocyte and its renucleation with the patient's mitochondria-free nucleus, in vitro fertilization with the patient's husband's sperm, in vitro culture of the zygote, preimplantation diagnosis to verify the absence of mutation in the mitochondrial DNA, genetic analysis of the child both before and after birth.

The protocol is inspired by experimental work to treat a model mitochondrial disease in mice. Precisely because of this, it adds some highly refined technical possibilities, with their associated ethical problems. There are several ways of performing nuclear transfer in the mouse, which have the advantage of being performed not in the oocyte, but already in the zygote or in a phase of a few blastomeres. 

Unlike in man, in the mouse there is syngamy, i.e. the two pronuclei fuse into one, a synkaryon. This nucleus is extracted from the zygote with abnormal mitochondria. With the same pipette, the membrane of the zygote whose cytoplasm contains normal mitochondria is pierced: the nucleus is transferred and then the pipette is deflected to capture the native syncarion from the donor zygote with healthy cytoplasm. The success rate is not very high, as the micropipette has to be of sufficient caliber to capture the syncaria. But it has the advantage that fertilization and activation are already underway: it no longer depends on whether or not the oocytes treated with nuclear transfer are fertilized. 

In the mouse, a less traumatic technique can be applied, which consists of aspirating with a micropipette an area of cytoplasm from the zygote close to where the pronuclei are. This nucleated cytoplasmic bud, whose plasma membrane is spontaneously sealed, is placed under the pellucida of a previously enucleated donor oocyte, and cell fusion is induced with an electric pulse or Sendai virus. This technical variant is more efficient than the previous one, but involves the transfer of abnormal mitochondria.

It is also possible to take the nucleus of a blastomere from the embryo that has inherited the mitochondrial disease and implant it into a healthy enucleated oocyte.  

What about project IVONT?

Helen Watt has offered a sharp critique of project. She begins by pointing out a decisive point that is in great need of clarification. She comes to say that those who practice assisted reproduction techniques, as well as those who experiment with embryos, have made their own a very interesting phrase -I remember that it is in report Warnock- which says: "the human embryo is a form of human life that deserves a certain measure of respect". We could all support that proposition. But it would be unwise to do so without clarifying what that measure actually is.
We could accept it if it were recognized that the embryo deserves the measure of respect accorded to other human beings, to any human organism, since the human being is the same individual as the human organism, that this human organism begins with fertilization, that human dignity is an attribute of every human being. But IVONT implies that it has to be carried out, in order to increase its effectiveness, after fertilization. The starting materials are already zygotes or embryos somewhat more advanced in their development. One embryo provides the nucleus (with genes received from both parents) and the other embryo provides its enucleated cytoplasm, with healthy mitochondria. This means that two individuals are deliberately created with no intention of respecting their life expectancy. On the contrary, one of these embryos is created in order to sacrifice it to the usefulness of certain human adults: the parents who order a healthy child and the scientific technician who collaborates in constructing it. If things go well, a child will be born, created from pieces of two precursor embryos. 

But the idea of worrying about the measure of respect to which the embryo is entitled is a matter that only seems to concern a few, somewhat quixotic types. They are embryos of one or a few cells, which, in a phrase a thousand times repeated, have no human face, no hands, no feet, no brain, no experiences and no memories. Watt tells us that the answer to this is not to be guided by feeling: by whether the embryo is visually familiar to us, whether it interacts socially with us, whether it attracts us emotionally. But an embryo is always a human being open to the future, which is the same individual as the human being it becomes over time, which has a substantive interest in realizing the fullness of its humanity.

To take this embryo and strip it of its nucleus to serve as a receptacle for another nucleus that has an endowment Genetics preferred to its own is to destroy a living reality endowed with a future that is stolen from it. It is an abusive exercise of power: to discard it as an empty shell. It is, as I have already said, like lighting a cigar with a hundred dollar bill.

We physicians must cure diseases, but not at that price.

B. Applications of in vitro nuclear transfer techniques.

The applications of in vitro nuclear transfer techniques basically consist of the exploitation of blastocysts for the production of embryonic stem cells.

With grateful frankness, the Geron website informs us that the human pluripotent stem cells are derived either from human blastocysts fertilized in vitro (through a procedure of laboratory patented in the United States) or from fetal material obtained from medically terminated abortions. The origin, if not ethically irreproachable, was administratively correct, since the blastocysts and fetal tissue were donated under the conditions required by label bioethics: with the informed consent of the donors, after approval by an ethics committee of research.

The information goes on to detail the amazing properties of human pluripotent stem cells (their pluripotency, their ability to self-renew in an undifferentiated state, their marvelous ability to express telomerase that makes them perpetually young, and their efficiency in maintaining unblemished replication of their DNA that allows them to remain free of genetic errors.

What is expected from these cells is not only to use them as source cells that can give rise to an infinite number of cell strains available to repopulate organs worn out by age or destroyed by disease. What is more important than anything else is that they help us to discover the secrets of reprogramming. The lesson will have to be learned above all in the cytoplasm of the oocyte, but once the mechanism has been discovered, there will be no need for cloning or for storing cells: it will be possible, Geron's scientists believe, to give the cytoplasm of any somatic cell the capacity to reprogram itself and intelligently reconstitute the structural defects of organs. It will then be possible to avoid the growth of red numbers in our organ count: we will always be able to add new cells to the brain, the heart, the articular cartilage, the pancreatic islets, to compensate for the lost ones. 

The promises of the technique are considered fabulous. It is true that Geron's page at network has more promotional than scientific intentions. But the propaganda is very cleverly done: aimed at the ailing population of the great American nation, it instills hope in science, while describing the bleak picture of the disease: five million patients with congestive heart failure, one and a half million annual cases of myocardial infarction, half a million strokes per year, more than a million sufferers of Parkinson's disease, more than four million with Alzheimer's disease, an undetermined issue of paraplegics and quadriplegics, more than 1.5 million insulin-dependent diabetics, 16 million victims of osteoarthritis, a growing issue of patients who have to receive hematopoietic precursor transplants, plus burn victims.

But what do stem cells have to do with cloning?

Magazines are bringing us amazing news every week. Trading brain for blood: clinical applications of research on stem cells in Neurobiology and Hematology. This is the title of an amazing commentary publishing house from the BMJ, last August. It tells us about incredible things a few years ago: researchers isolated neural stem cells from the brains of mice that they were able to maintain in culture indefinitely: by changing the culture conditions, the stem cells differentiated into neurons of many subtypes, oligodendrocytes and astrocytes. When neural stem cells were injected into mice that had been subjected to sublethal irradiation, they differentiated into hematopoietic cells of all varieties, including B and T lymphocytes, as shown by genetic markers that distinguished the transplanted cells. And, in a reverse experiment, they found that, in mice injected with labeled hematopoietic cells, descendants of these cells appeared with all the features of microglia, fibrous astrocytes of the white matter, protoplasmic astrocytes of the cerebral cortex and also elements of the neuronal lineage in the subependymal region. 

Between the incredible potential stem cells of the adult organism that we must learn to isolate, culture and differentiate, and the no less incredible possibilities of cell xenotransplantation, it does not seem necessary to continue sacrificing supernumerary human embryos or creating cloned embryos in order to advance stem cell science.

Because, after all, if cloning means anything in relation to stem cell transplantation, it means limitation. Some time ago I wrote that "There is, in the cloning process, something of narcissism, if not perverse, then extreme. And this is not only in the reproductive aspect (making a genetically identical copy of oneself), but also in the 'therapeutic' aspect of nuclear transfer techniques that seek to produce precious reserves of stem cells".

It is claimed that, if an embryo, a copy Genetics of the nuclear donor, were created and cultured in vitro within the 14-day limit tolerated by many legislations, different types of stem cells would be produced, from which cell reserves of different tissues and organs could be generated, which, transplanted into the clone, would be perfectly tolerated, as befits cells that are its own. 

For whom will these cell collections derived from a clone derived from an individual be of use? Irretrievably only for that same individual; for no one else. 

The beneficial potential of this subject from research is thus severely restricted. At laboratory, it will be possible to investigate the culture conditions, study the mechanisms of induction, expansion and modulation of these stem cells. However, at the moment of therapeutic truth, in the clinical phase, the value of these cells will be extremely limited. Nuclear transfer techniques will be of strictly individual application, and will remain closed in a kind of therapeutic solipsism. Their economic cost, even if the techniques are perfected, will necessarily be very high, prohibitive for the vast majority. It will always be an elitist treatment, which only the very powerful will be able to afford.

A political principle of research, which John Paul II formulated with extraordinary force and lucidity in Redemptor hominis, applies here like a ring to the finger when he invited everyone to ask themselves these decisive questions in the face of every technological advance: "Does this progress, whose author and author is man, make man's life on earth in all its aspects 'more human'; does it make it more 'worthy of man'?" There can be no doubt that, in many respects, it does so. However, this question must stubbornly be asked with regard to what is truly essential: whether man, as man, in the context of this progress becomes truly better, that is, more spiritually mature, more aware of the dignity of his humanity, more manager, more open to others, particularly to the most needy and the weakest, more available to give and to lend financial aid to all.
I think that the so-called "therapeutic" cloning, because of its closed-mindedness to these human values, should be declared a futile business . There are many other priority objectives for biomedical research .

I still think so. Moreover, I have the suspicion that the insistence on making research on human embryos obtained by nuclear transfer does not only seek to study a new and surprising phenomenon. It seeks, above all, to make it possible to produce many human embryos on which to do research that are excluded from the legal norms and ethical guidelines in force in many countries of the world. The research on human supernumerary embryos obtained from gametes in assisted reproduction clinics is subject to many restrictions: it is either forbidden or requires the approval of the ethics committees of research or requires obtaining the free and informed consent of the embryos' parents or even of the gamete donors.

The formalistic ethics of the Committees, elegantly lukewarm, makes them capable of approving everything. It suffers, at bottom, from a terrible loss of perspective, by allowing the production of cloned embryos and, as with other embryos, prohibiting experimentation on them beyond the 14th day. The scientismists say: let us experiment freely, that on the 14th day we will destroy the embryos we produce with all punctuality. Good moral sense answers: you cannot play at being demiurges, it is indecent to create human beings in this way in order to get rid of them with the approval of some opportunistic laws, passed by ill-advised deputies. 

C. The final hardness of the discussion

Let us imagine that stem cell lines endowed with formidable regenerative capacities are developed from human blastocysts. They are commercialized and become part of the "official" state of the art, as they are supported by the biotechnology industry and many scientific and professional associations.

What does the doctor do, and what does the sick person who wants to remain faithful to the conviction of the sacredness of human life and who does not want to benefit from the fruits of the destructive research of embryos?

It is time to remember some fundamental ethical ideas that have been somewhat forgotten.

One is this: moral values are higher than other natural values. It is worth more to keep one's soul clean than to be a genius, than to be overflowing with health, than to have the world ecologically clean, than scientific efficiency. A generous action, an act of love for one's neighbor is worth more than beating an Olympic record: an act of love of God is greater, more important and more lasting (because it is eternal) than all works of art. Moral evil, a perverse action, is worse than pain, illness, death or the Prado Museum reduced to ashes.

The greats, Plato, St. Paul, repeated that it is better to suffer injury than to do it. To gain the world and lose one's soul is today a very real and immediate temptation.

We may one day find ourselves having to choose between receiving stem cells that are unacceptable because of their origin or suffering a long and debilitating disease. We may even have to choose between dying or extending life by means of cellular replacements obtained from embryos obtained by transferring our own cell nuclei. One can always say: I do not want to survive at the cost of giving death to others, very small and weak, without human appearance, not children of father and mother, but produced in the laboratory, but human beings at last.

It may be that in the future it will be considered acceptable for some to use and consume human beings for their own benefit. It will be very easy to make it acceptable, since it is very easy to redefine words, or to use them with great ease. Today nobody talks about pre-embryos anymore: it is not necessary, because the use of human embryos is tolerated by the academic community, by many ethics committees of research, by many theologians and by some laws. 

Will those who renounce benefits out of delicacy of conscience be called retrograde? Perhaps biotechnology will give us the opportunity to live the gospel more thoroughly: he who loses his life will gain it. We will have to do it with much love and asking God to give light to those who are mistaken.

Cloning thus confronts the physician with a dilemma: that of deciding whether the embryo so artificially produced is just cells or is something more than cells. And, of rejection, it brings us back to the question: it makes us wonder if there is any significant ethical difference between being cells or being men.