12 Bruce Carlson, Human Embryology & Developmental Biology (St. Louis, MO: Mosby, 1999), pp. 46-47; William J. Larsen, Human Embryology (New York: Churchill Livingstone, 1997), pp. 22-28; Benjamin Lewin (ed.), Genes III (New York: John Wiley & Sons, 1987), pp. 353-354. The use of germ-line gene "therapy" by U.S. scientists has recently been published, producing genetically altered human infants. See, Dr. David Whitehouse, "Genetically altered babies born: Mitochondria contain genes outside the cell's nucleus", BBC News Online, http://news.bbc.co.uk/hi/english/sci/tech/newsid_1312000/1312708.stm.
See also, Tom Strachan and Andrew Read, Human Molecular Genetics: Second Edition (New York: Wiley-Liss, 1999), pp. 539-541], "The ethics of human germ line therapy":
"All current gene therapy trials involve treatment for somatic tissues (somatic gene therapy). somatic gene therapy, in principle, has not raised many ethical concerns. Clearly, every effort must be made to ensure the safety of the patients, especially since the technologies being used for somatic gene therapy are still at an underdeveloped stage. However, confining the treatment to somatic cells means that the consequences of the treatment are restricted to the individual patient who has consented to this procedure. ... The same technology has the potential, of course, to alter phenotypic characters that are not associated with disease, such as height for instance. Such genetic enhancement, although not currently considered, can be expected to pose greater ethical problems; attempts to produce genetically enhanced animals have not been a success and in some cases have been spectacular failures (Gordon, 1999).
Germline gene therapy, involving the genetic modification of germline cells (e.g., in the early zygote), is considered to be entirely different. It has been successfully practiced on animals (e.g., to correct beta-thalassemia in mice). However, thus far, it has not been sanctioned for the treatment of human disorders, and approval is unlikely to be given in the near future, if ever.
Human germline gene therapy has not been practiced because of ethical concerns and limitations of the technology for germline manipulation. The lack of enthusiasm for the practice of germline gene therapy can be ascribed to three major reasons:
[a] The imperfect technology for genetic modification of the germline
Germline gene therapy requires modification of the genetic material of chromosomes, but vector systems for accomplishing this do not allow accurate control over the integration site or event. In somatic gene therapy, the only major concern about lack of control over the fate of the transferred genes is the prospect that one or more cells undergoes neoplastic transformation. However, in germline gene therapy, genetic modification has implications not just for a single cell: accidental insertion of an introduced gene or DNA fragment could result in a novel inherited pathogenic mutation.
[b] The questionable ethics of germline modification
Genetic modification of human germline cells may have consequences not just for the individual whose cells were originally altered, but also for all individuals who inherit the genetic modification in subsequent generations. Germline gene therapy would inevitably mean denial of the rights of these individuals to any choice about whether their genetic constitution should have been modified in the first place (Wivel and Walters, 1993). Some ethicists, however, have considered that the technology of germline modification will inevitably improve in the future to an acceptably high level and, provided there are adequate regulations and safeguards, there should then be no ethical objections (see, for example, Zimmerman, 1991). At a recent scientific research meeting in the USA some scientists have also come out in support of such a development (Wadman, 1998).
From the ethical point of view, an important consideration is to what extent technologies developed in an attempt to engineer the human germline could subsequently be used not to treat disease but in genetic enhancement. There are powerful arguments as to why germline gene therapy is pointless. There are serious concerns, therefore, that a hidden motive for germline gene therapy is to enable research to be done on germline manipulation with the ultimate aim of germline-based genetic enhancement. The latter could result in positive eugenics programs, whereby planned genetic modification of the germline could involve artificial selection for genes that are thought to confer advantageous traits.
The implications of human genetic enhancement are enormous. Future technological developments may make it possible to make very large alterations to the human germline by, for example, adding many novel genes using human artificial chromosomes (Grimes and Cooke, 1998). Some people consider that this could advance human evolution, possibly paving the way for a new species, homo sapientissimus. To have any impact on evolution, however, genetic enhancement would need to be operated on an unfeasibly large scale (Gordon, 1999).
Even if positive eugenics programs were judged to be acceptable in principle and genetic enhancement were to be practiced on a small scale, there are extremely serious ethical concerns. Who decides what traits are advantageous? Who decides how such programs will be carried out? Will the people selected to have their germlines altered be chosen on their ability to pay? How can we ensure that it will not lead to discrimination against individuals? Previous negative eugenics programs serve as a cautionary reminder. In the recent past, for example, there have been horrifying eugenics programs in Nazi Germany, and also in many states of the USA where compulsory sterilization of individuals adjudged to be feeble-minded was practiced well into the present century.
[c] The questionable need for germline gene therapy
Germline genetic modification may be considered as a possible way of avoiding what would otherwise be the certain inheritance of a known harmful mutation. However, how often does this situation arise and how easy would it be to intervene? A 100% chance of inheriting a harmful mutation could most likely occur in two ways. One is when an affected woman is homoplasmic for a harmful mutation in the mitochondrial genome and wished to have a child. The trouble here is that, because of the multiple mitochondrial DNA molecules involved, gene therapy for such disorders is difficult to devise.
A second situation concerns inheritance of mutations in the nuclear genome. To have a 100% risk of inheriting a harmful mutation would require mating between a man and a woman both of whom have the same recessively inherited disease, an extremely rare occurrence. Instead, the vast majority of mutations in the nuclear genome are inherited with at most a 50% risk (for dominantly inherited disorders) or a 25% risk (for recessively inherited disorders). In vitro fertilization provides the most accessible way of modifying the germline. However, if the chance that any one zygote is normal is as high as 50 or 75%, gene transfer into an unscreened fertilized egg which may well be normal would be unacceptable: the procedure would inevitably carry some risk, even if the safety of the techniques for germline gene transfer improves markedly in the future. Thus, screening using sensitive PCR-based techniques would be required to identify a fertilized egg with the harmful mutation. Inevitably, the same procedure can be used to identify fertilized eggs that lack the harmful mutation. Since in vitro fertilization generally involves the production of several fertilized eggs, it would be much simpler to screen for normal eggs and select these for implantation, rather than to attempt genetic modification of fertilized eggs identified as carrying the harmful mutation." [Back]
13 Tom Strachan and Andrew Read, Human Molecular Genetics: Second Edition (New York: Wiley-Liss, 1999), p. 541: " There are powerful arguments as to why germline gene therapy is pointless. There are serious concerns, therefore, that a hidden motive for germline gene therapy is to enable research to be done on germline manipulation with the ultimate aim of germline-based genetic enhancement. The latter could result in positive eugenics programs, whereby planned genetic modification of the germline could involve artificial selection for genes that are thought to confer advantageous traits." [Back]
14 Benjamin Lewin (ed.), Genes VII (New York: Oxford University Press, pp. 81-86, 174-175, 546; Tom Strachan and Andrew Read, Human Molecular Genetics: Second Edition (New York: Wiley-Liss, 1999), pp. 60, 140-141. [Back]
15 Back-breeding has been done "naturally" for centuries by farmers using plants and animals. See discussions of back-breeding in, e.g.: http://www.aces.edu/department/extcomm/publications/he/he-728/he-728.htm, HE-728, New June 1996. Jean Olds Weese, Extension Food Science Specialist, Associate Professor, Nutrition and Foods, Auburn University: "Farmers have been trying for years to improve crop yields from both plants and animals. This has been accomplished through cross-breeding in animals and grafting in plants. Through this selective mating the plant or animal receives the genes from another plant or animal that will improve a trait in that species. The problem with this is that along with this one good trait comes several traits that may not be so positive. This is because plants have more than 100,000 genes and with each gene comes a character trait. After cross-breeding two plants, the farmer must then go through back-breeding to keep the good traits and breed out the bad traits."
http://www.cmf.gc.ca/en/cf/1998/vol3/html/1998fca22348.p.en.html, president and Fellows of Harvard College v. Canada (Commissioner of Patents): "What is involved here is the insertion of the myc gene and the subsequent breeding, cross-breeding and back-breeding of a mouse. ... The inventors were able to "backcross" and in-breed in order to obtain offspring with more widely varying sites of the new myc gene. ... As described by the Commissioner, 'analysis of the DNA of the resulting transgenic offspring indicated that the injected oncogene was transmitted through the germline in a ratio consistent with Mendelian inheritance of single loci.' In other words, the transgene will be passed on to the offspring in accordance with the ordinary principles of inheritance. "
http://www.biology.iupui.edu/biocourses/K338/338_14.html, Cogenic MHC Mouse Strains: "Syngenic (mice with all identical locus) Cogenic (mice with all identical locus, except a single genetic locus) Cogenic mice are isolated by inter-breeding, selection, back-breeding for at least 12 generations." [Back]
16 The Nuremberg Code was part of the Judgement against Karl Brandt during the Nuremberg trials; see the full judgement, and the Nuremberg Code, in Jay Katz, Experimentation with Human Beings: The Authority of the Investigator, Subject, Professions, and State in the Human Experimentation Process (New York: Russell Sage Foundation, 1972), pp. 305-307. See also in United States Department of Health and Human Services, Office for the Protection of Research Risks: Protecting Human Research Subjects: Institutional Review Board Guidebook (1993), at A6-3 to A6-6. [Back]
17 The 1998 Declaration of Helsinki can be found at Codes of Ethics Online: http://csep.iit.edu/Codes/coe/World_Medical_Association_Declaration_of_Helsinki_1975.htm; see also in United States Department of Health and Human Services, Office for the Protection of Research Risks: Protecting Human Research Subjects: Institutional Review Board Guidebook (1993), at A6-3 to A6-6. [Back]
18 Declaration of Helsinki (1998), see Codes of Ethics Online: http://csep.iit.edu/Codes/coe/World_Medical_Association_Declaration_of_Helsinki_1975.htm. [Back]
19 See Richard McCormick's testimony in The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research; Report and Recommendations; Research on the Fetus; U.S. Department of Health, Education and Welfare, 1975, pp. 34-35; McCormick, How Brave a New World? (Washington, D.C.: Georgetown University Press), p. 76; McCormick, "Proxy Consent in the Experimentation Situation", Perspectives in Biology and Medicine (1974), 18:2-20; McCormick, "Who or What is the Preembryo?", Kennedy Institute of Ethics Journal 1:1 (1991).. McCormick was following similar earlier work by Andre Helegers, founder of the Kennedy Institute of Ethics at Georgetown University: see, Andre E. Hellegers, "Fetal Development", Theological Studies (1970), 31:3-9; Hellegers, "Fetal Development", in Thomas A. Mappes and Jane S. Zembatty (eds.), Biomedical Ethics (New York: Macmillan, 1981). See also, Clifford Grobstein, "The Early Development of Human Embryos", Journal of Medicine and Philosophy (1985), 10:213-236; also, Science and the Unborn (New York: Basic Books, 1988), p. 61; See also, Clifford Grobstein, "The Early Development of Human Embryos", Journal of Medicine and Philosophy (1985), 10:213-236; also, Science and the Unborn (New York: Basic Books, 1988), p. 6. For a brief historical account of bioethics, containing extensive references from the bioethics and government literatures, see Dianne N. Irving, "What is 'bioethics'?", in Joseph Koterski (ed.), University Faculty for Life: Proceedings of the Conference 2000 (in press). [Back]
20 See D. N. Irving, "When do human beings begin? 'Scientific' myths and scientific facts", International Journal of Sociology and Social Policy 1999, 19:3/4:22-47) [Back]
21 See D. N. Irving, Philosophical and Scientific Analysis of the Nature of the Early Human Embryo (doctoral dissertation) (Washington, D.C.: Georgetown University, Department of Philosophy, 1991); see also similar analyses in peer-reviewed published articles, listing the pros and cons in the bioethics literature, e.g., Irving: "Science, philosophy and expertise: An evaluation of the arguments on 'personhood'", Linacre Quarterly Feb. 1993, 60(1):18-46; ibid., "Politicization of science and philosophy: The 'delayed personhood' debates and conceptual transfer", C.E.R.P.H. Newsletter 1995, no. 2, p. 4 (Centre d'Etudes sur la Reconnaissance de la Personne Humaine [CERPH]), CHU La Miletrie, B.P. 577, 86021 Poitiers, France); [Back]
22 Claims abound that such fields as "logic" or "meta-ethics" are inherently "neutral"; however further research demonstrates the fallacies in such claims. There are many different schools of "logic", each school using terms and definitions peculiar to very specific metaphysical and epistemological schools of philosophy, or cosmology (which determine the different terms and their definitions). That is, these different schools of "logic" drag with them very specific metaphysical and epistemological presuppositions. That is why the dozens of very different schools of "logic" come to different "logical" conclusions. See, e.g., the sections on "logic" in Paul Edwards (ed.), The Encyclopedia of Philosophy (New York: Macmillan Publishing Co., Inc. and The Free Press, 1967), Vols. 3/4 pp. 504-571; and Vols. 5/6 pp. 1-83. Thus there is no such thing as a "neutral logic".
Similarly, if "meta-ethics" is defined as the "merely logical" analysis of ethical propositions, then by necessity "meta-ethics" too is not "neutral", but carries with its use and the selection of its terms, definitions and analyses very specific metaphysical and epistemological presuppositions. See any basic ethics textbook; see especially the most widely used text, Frederick Copleston, A History of Philosophy (New York: Image Books/Doubleday, 1993). Specifically addressing the possibility of a "neutral ethics" in bioethics see Irving, "Quality Assurance Auditors: Between a Rock and a Hard Place", Quality Assurance: Good Practice, Regulation, and Law (March 1994), 3(1):33-52; Irving, "Which Ethics for Science and Public Policy?", Accountability in Research (1993), 3(2-3):77-99; Irving, "Maryland State Proposed Statute for Research Using 'Decisionally Incapacitated' Human Subjects: The Legalization of Normative Bioethics Theory", Accountability in Research (in press). [Back]
23 See, e.g., Tom Beauchamp and James Childress, Principles of Biomedical Ethics (New York: Oxford University Press, 1979), pp. 7-9; also, Tom Beauchamp and LeRoy Walters (eds.), Contemporary Issues in Bioethics (Belmont, CA: Wadsworth Publishing Company, Inc., 1982), pp. 1-3. [Back]
24 See e.g., Wesley J. Smith, Culture of Death: The Assault on Medical Ethics in America (San Francisco, CA: Encounter Books, 2000); Smith, "Is Bioethics Ethical?" Weekly Standard (April 3, 2000), pp. 26-30; Smith, "The Deadly Ethics of Futile Care Theory," Weekly Standard (November 30/December 7, 1998), pp. 32-35; Ruth Shalit, "When We Were Philosopher Kings", The New Republic (April 28, 1997); Eugene Russo, "'Bioethicists' Proliferate Despite Undefined Career Track", The Scientist (Apr. 12, 1999), 13:8:16 [http://www.the-scientist.com/yr1999/apr/prof_990412.html]. See also Dianne N. Irving, "The Bioethics Mess", Crisis Magazine, May, 2001; Irving, "The Woman and the Physician Facing Abortion: The Role of Correct Science in the Formation of Conscience and the Moral Decision Making Process", Linacre Quarterly November 2000); Irving, "NIH Human Embryo Research Panel Revisited: What is Wrong With This Picture?", Linacre Quarterly (May 2000); 67:2:8-22; Irving, "Individual Testimony Before the NIH Human Embryo Research Panel - March 14, 1994", reprinted in Linacre Quarterly (Nov. 1994), 61(4):82-89; Irving, "Embryo Research: A Call for Closer Scrutiny", Linacre Quarterly (July 17), 1994. [Back]
25 The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research; U.S. Department of Health, Education and Welfare (Washington, D.C.: Government Printing Office, 1978). [Back]
26 See the recent book by one of the National Commissioners, founding bioethicist Albert R. Jonsen, The Birth of Bioethics (New York: Oxford University Press, 1998), p. 295; also, David J. Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making (New York: BasicBooks/Perseus Books, L.L.C., 1991). [Back]
27 E.g., Tom Beauchamp and James Childress, Principles of Biomedical Ethics (1st ed.) (New York: Oxford University Press, 1979), pp. 45-47; Tom Beauchamp and LeRoy Walters (eds.), Contemporary Issues in Bioethics (2nd ed.) (Belmont, CA: Wadsworth Publishing Company, Inc., 1982), p.26; Tom Beauchamp, Philosophical Ethics (New York: McGraw-Hill Book Company, 1982, pp. 124-128, 141, 188-190; Tom Beauchamp; and Laurence B. McCullough, Medical Ethics: The Moral Responsibilities of Physicians (New Jersey: Prentice-Hall, Inc., 1984), pp. 13-16, 21-22, 39-40, 46, 48, 133-35, 162-64. [Back]
29 The Belmont Report, supra, pp. 6-7. [Back]
30 Tom Beauchamp and James Childress, Principles of Biomedical Ethics (1st ed.) (New York: Oxford University Press, 1979), pp. 135-167; Tom Beauchamp and LeRoy Walters, Contemporary Issues in Bioethics (eds.) (2nd ed.) (Belmont, California: Wadsworth Publishing Company, 1982), pp. 28-43. [Back]
31 [National Bioethics Advisory Commission] Federal Register: October 5, 1995 (Volume 60, Number 193), pp. 52063-52065; Presidential Documents, Executive Order 12975 of October 3, 1995: Protection of Human Research Subjects and Creation of National Bioethics Advisory Commission. http://www.bioethics.gov/nbac.html. See, e.g., the commissioned paper by John C. Fletcher, "Deliberating Incrementally on Human Pluripotential Stem Cell Research", especially pp. E-25-E33, and note 75, p. E-40. http://bioethics.gov/stemcell2.pdf. [Back]
32 The Belmont Report, supra, p. 8. [Back]
33 The literature on this is legion, but see several excellent recent books by: David S. Oderberg and Jacqueline A. Laing (eds.), Human Lives: Critical Essays on Consequentialist Bioethics (New York: St. Martin's Press, 1997); David S. Oderberg, Moral Theory: A Non-Consequentialist Approach (Malden, MA: Blackwell Publishers Inc., 2000); Oderberg, Applied Ethics: A Non-Consequentialist Approach (Malden, MA: Blackwell Publishers, Inc., 2000). See also Charles Harris, Michael Pritchard and Michael Rabins, Engineering Ethics: Concepts and Cases (New York: Wadsworth Publishing Company, 1995), esp. pp. 156-165; J.J.C. Smart and Bernard Williams, Utilitarianism: For and Against (New York: Cambridge University Press, 1973); Samuel Scheffler, The Rejection of Consequentialism: A Philosophical Investigation of the Considerations Underlying Rival Moral Conceptions (New York: Oxford University Press, 1982); Scheffler (ed.), Consequentialism and Its Critics (New York: Oxford University Press, 1988). [Back]
34 The Belmont Report, supra, p.8. [Back]
35 John Rawls, A Theory of Justice (Cambridge: Belknap Press of Harvard University Press, 1971); Rawls, "Justice as Fairness", in Tom Beauchamp and LeRoy Walters (eds.), Contemporary Issues in Bioethics (2nd ed.) (Belmont, CA: Wadsworth Publishing Company, Inc., 1982), pp. 44-46, and pp. 23-24. [Back]
36 Norman Daniels, Just Health Care (New York: Cambridge University Press, 1985); Jonsen, p. 222. [Back]
37 See, e.g.: Superintendent of Belchertown State School v. Saikewicz, Mass Supreme Court, 1977. 373 Mass. 728, 736 (p. 7); Jonsen, p. 267. The legal concept of "substituted judgment" has been specifically rejected by many writers and courts, e.g.: Mathy Mezey et al., "Life-Sustaining Treatment Decisions by Spouses of Patients with Alzheimer's Disease," Journal of the American Geriatrics Society (Feb. 1996), pp. 144-150; David C. Thomasma, "A Communal Model for Presumed Consent for Research on the Neurologically Vulnerable," Accountability in Research (1996), 4:227-239; Ralph Baergen, "Revisiting the Substituted Judgment Standard," Journal of Clinical Ethics (Spring 1995), pp. 30-38; Rosalind E. Ladd and Edwin N. Forman, "Adolescent Decision-Making: Giving Weight to Age-Specific Values," Theoretical Medicine (Dec. 1995), pp. 333-345; Jeremiah Suhl et al., "Myth of Substituted Judgment: Surrogate Decision-Making Regarding Life Support is Unreliable," Archives of Internal Medicine (1994), 154:90-96; John Hardwig, "The Problem of Proxies With Interests of Their Own: Toward a Better Theory of Proxy Decisions," Journal of Clinical Ethics (Spring 1993), pp. 20-27; James Coyne King, "The Search for Objectivity in Applying the Substituted Judgment Rule in Medical Care Cases," Boston Bar Journal (1993), 37:10-12, 14; Robert A. Perlman et al., "Contributions of Empirical Research to Medical Ethics," Theoretical Medicine (Sept. 1993), pp. 197-210; Lynne E. Lebit, "Compelled Medical Procedures Involving Minors and Incompetents and Misapplication of the Substituted Judgment Doctrine," Journal of Law and Health (1992-1993), pp. 107-130; Alexander M. Capron, "Substituting Our Judgment," Hastings Center Report (March-April 1992), pp. 58-59; Ezekiel J. Emanuel and Linda L. E. Emanuel, "Proxy Decision-Making for Incompetent Patients: An Ethical and Empirical Analysis," Journal of the American Medical Association (1992), 267:2067-2071; Jan Hare et al, "Agreement Between Patients and Their Self-Selected Surrogates on Difficult Medical Decisions," Archives of Internal Medicine (1992), 152:1049-1054; Thomas G. Gulkeil and Paul S. Appelbaum, "Substituted Judgment: Best Interests in Disguise," Hastings Center Report (June 1983), pp. 8-11; George J. Annas, "Precatory and Mindless Mimicry: The Case of Mary O'Connor," Hastings Center Report (Dec. 1988), pp. 31-33. For recent court decisions, see Illinois. Appellate Court, First District, Fourth Division. In re C.A. North Eastern Reporter, 2nd series. 1992 Oct 15 (date of decision). 603:1171-1194; Illinois. Supreme Court. Curran v. Bosze. North Eastern Reporter, 2nd series. 1990 Dec. 20 (date of decision). 566:1319-1345; Florida. District Court of Appeal, Second District. In re Guardianship of Browning. Southern Reporter, 2nd series. 1989 Apr. 10 (date of decision). 543:258-276; Missouri. Supreme Court, en banc. Cruzan by Cruzan v. Harmon. South Western Reporter, 2nd Series. 1988 Nov 16 (date of decision). 760:408-445. [Back]
38 Arthur Dyck, "Assessing the Population Debate," The Monist 61 (Jan. 1977); Jonsen, p. 302. [Back]
39 Quoted in, Victoria Button, "Control Gene Pool, Says Ethicist", The Age [theage.com.au], October 13, 2000. For lengthy and articulate writings linking eugenics and international bioethics with the United Nations, the Humane Genome Project, genetic pre-selection of embryos, abortion, the use of abortifacients, human embryo research, stem cell research, fetal research, cloning, formation of chimeras, euthanasia, physician-assisted suicide, research with the mentally ill, etc., see bioethicist/biologist and U.N. consultant Daryl Macer 's published books and articles posted on his web site: http://www.biol.tsukuba.ac.jp/~macer/index.html. [Back]
41 R.G. Frey, "The Ethics of the Search For Benefits: Animal Experimentation in Medicine", in Raanan Gillon (ed.), Principles of Health Care Ethics (New York: John Wiley & Sons, 1994), pp. 1067-1075. [Back]
42 Daniel Callahan, "Bioethics: Private Choice and Common Good", Hastings Center Report (May-June 1994), 24:3:31. [Back]
43 See Jonsen's "Preface", in Edwin DuBose, Ronald Hamel and Laurence O'Connell (eds.), A Matter of Principles?: Ferment in U.S. Bioethics (Valley Forge, PA: Trinity Press International, 1994), p.1. [Back]
44 Gilbert C. Meilaender, Body Soul, and Bioethics (Notre Dame, IN: University of Notre Dame Press, 1995), p. x. [Back]
45 Raanan Gillon (ed.), Principles of Health Care Ethics (New York: John Wiley & Sons, 1994). [Back]
46 Renee Fox, "The Evolution of American Bioethics: A Sociological Perspective," in George Weisz (ed.), Social Sciences Perspective on Medical Ethics (Philadelphia: University of Pennsylvania Press, 1990), pp. 201-220. Renee Fox and Judith Swazey, "Medical Morality is Not Bioethics -- Medical Ethics in China and the United States," Perspectives in Biology and Medicine 27 (1984):336-360, in Jonsen p. 358. [Back]
48 Renee C. Fox and Judith P. Swazey, "Leaving the Field", Hastings Center Report (September-October 1992), 22:5:9-15. [Back]
49 See, e.g., Eugene Russo, "'Bioethicists' Proliferate Despite Undefined Career Track", The Scientist (Apr. 12, 1999), 13:8:16 http://www.the-scientist.com/yr1999/apr/prof_990412.html; Dianne N. Irving, "What is 'bioethics'?", in Joseph Koterski (ed.), University Faculty for Life: Proceedings of the Conference 2000 (in press); Irving, "Scientific and Philosophical Expertise: An Evaluation of the Arguments on 'Personhood'", Linacre Quarterly (1993), 60:1:18-47; Irving, "The bioethics mess", Crisis Magazine, May 2001. [Back]
50 Jonsen, pp. 109-110. [Back]
51 See extensive listing of successful scientific studies using adult stem cells on web site by David Prentice: http://biology.indstate.edu/prentice/stemcell/. [Back]