Experiments in Democracy

Human Embryo Research and the Politics of Bioethics

Benjamin Hurlbut

• Publisher: Columbia University Press
• Year: 2017
• ISBN:
  9780231542913
• Topic: Medicine
• Subtopic: Gynecology, Obstetrics & Midwifery

Human embryo research touches upon strongly felt moral convictions, and it raises such deep questions about the promise and perils of scientific progress that debate over its development has become a moral and political imperative. From in vitro fertilization to embryonic stem cell research, cloning, and gene editing, Americans have repeatedly struggled with how to define the moral status of the human embryo, whether to limit its experimental uses, and how to contend with sharply divided public moral perspectives on governing science.

Experiments in Democracy presents a history of American debates over human embryo research from the late 1960s to the present, exploring their crucial role in shaping norms, practices, and institutions of deliberation governing the ethical challenges of modern bioscience. J. Benjamin Hurlbut details how scientists, bioethicists, policymakers, and other public figures have attempted to answer a question of great consequence: how should the public reason about aspects of science and technology that effect fundamental dimensions of human life? Through a study of one of the most significant science policy controversies in the history of the United States, Experiments in Democracy paints a portrait of the complex relationship between science and democracy, and of U.S. society's evolving approaches to evaluating and governing science's most challenging breakthroughs.

1

NEW BEGINNINGS

When Louise Brown, the first child conceived in vitro, was born on July 25, 1978, the image of her tiny newborn body was overwhelming evidence that a revolution in human biology was underway. Between the anatomical blockages to the Browns’ legacy and the image of a joyful and exhausted Lesley Brown with tiny Louise cradled in her arms, had come the interventions of a mysterious, yet clearly powerful, medical science. The compelling presentation of this remarkable technological achievement arrived not in a medical journal, but in the maternity ward. The demonstrative power of this moment left little room for doubt about the reality of these emerging powers, though ample room was left for mystery. The details of the act of procreation that had given rise to Louise Brown remained hidden from the world: the displacement of the oocyte from opaque body to transparent glass, conjugation and synthesis of gametes, the cleavages of cell from cell in the first steps of embryogenesis, the efficiency of the process, the presence (or nonexistence) of embryonic siblings sharing the same dish—all of these details remained shrouded in darkness. An unprecedented conjugal act had taken place, that much was self-evident, but the details of its circumstances and its meaning for the social order remained unclear. What was clear, however, was that the technology that had produced Louise Brown also offered unprecedented powers of control over embryonic human life.

This chapter explores the early moments in the development of debates around human embryo research in the United States. It examines the technical, moral, and political uncertainties that emerged alongside the in vitro human embryo as a material presence in American laboratories and clinics. It follows the lines of early bioethical debate that took shape around emerging human biotechnologies, examining the framings, discourses, and novel forms of authority that shaped them.

During this period, political cleavages, epistemic differentiations, and conceptual axes developed that would prove to have profound consequences for the future of both scientific practices and the forms of ethical scrutiny and governance to which they were subject. The early development of the technology of human in vitro fertilization (IVF) was deeply informed by the surrounding medical, legal, and political environments. Ambiguously positioned between biological matter and human being, between research and therapy, and between radically distinct moral outlooks and imagined futures, the developmental forces that shaped the question of human embryo research reflected broader imaginaries of the right ordering of science, technology, and democratic politics. As the in vitro embryo became a familiar presence in the laboratory and clinic, a corollary set of increasingly familiar concepts, logics, and normative understandings also emerged in ethical deliberation about the status—ontological and moral—of this entity.

THE BEGINNINGS OF BIOETHICAL DEBATE

Control over human reproduction represented a central focus of emerging public anxieties about advances in biotechnology in the 1960s and 1970s. It was partly within this context that the category of issues and corollary forms of expertise that would later acquire the label of “bioethics” took shape. Initial discussions tended to be grounded in anticipation of a fast-approaching future in which humanity would wield the technological power to direct its own evolution, promising new forms of flourishing in some visions and a dehumanized “fabricated man” in others.¹ Prominent scientists like Julian Huxley, Hermann Muller and J. B. S. Haldane envisioned radical technological transformations of human life, not least through the control of reproduction, asking the question, as Huxley put it, “What are human beings for?”² Emerging biotechnologies seen in this light raised broad but fundamental questions about human purpose and dignity that looked beyond specific emerging technologies to the visions of transformation and control in which they were implicated. These technologies also raised fundamental questions about the right relationship between science and democracy, particularly vis-à-vis the role of publicly articulated values in shaping agendas of technological development.³ These broad topics captured public attention during the late 1960s and early 1970s.⁴

In the early 1970s, however, scandals related to human subjects research channeled public attention toward an apparent deficit in oversight in this self-evident ethically weighty domain. In 1974, U.S. Congress developed a new mechanism for dealing with such issues: the public ethics body. Created by the National Research Act, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research set about to articulate the principles and practices that would guide ethical oversight in human research matters. Its work immediately preceded the birth of Louise Brown and heavily shaped ethical and policy deliberation on IVF.

The first U.S. public ethics body charged with assessing questions related to IVF was the Ethics Advisory Board (EAB) of the Department of Health, Education, and Welfare (HEW; now the Department of Health and Human Services [HHS]). The board’s work, though largely forgotten, played an important role in shaping approaches to ethical deliberation over human embryo research. Some of the board’s judgments had consequential ramifications in subsequent debates, though in ways the board itself could not have anticipated. This chapter examines these beginnings, from the utopian visions of reproductive control of the early twentieth century through the efforts of the EAB to grapple with the suddenly real technology of human IVF and the deep ethical uncertainties that accompanied it.

A TEST-TUBE BABY

Louise Brown’s birth elicited a tremendous response in the United States and around the world. Though it was a surprise to most, revealed only a few weeks before Louise’s birth, the technical feat of reproduction through IVF had long been anticipated. A number of researchers had been actively engaged in experimental work on human in vitro fertilization for some time. In vitro fertilization and embryo transfer (ET) efforts had been undertaken concurrently in the U.S, the U.K., Australia, and India. The researchers who “produced” Louise Brown, Robert G. Edwards and Patrick C. Steptoe, had been working closely in this area for years. They had announced what was perhaps the first clearly successful human in vitro fertilization and embryo culture nearly a decade before the birth of Louise Brown. On the basis of their success in fertilizing human ova in vitro in the late 1960s, Edwards predicted in 1971 that human IVF with successful embryo transfer to the womb and pregnancy was “close at hand.”⁵

Edwards and Steptoe’s efforts were themselves not unprecedented. Others had made similar attempts, though claims to success were generally met with skepticism. In 1944, John Rock, a renowned Harvard University obstetrician, announced he had successfully fertilized and briefly cultured a human oocyte in vitro.⁶ In the mid-1950s, Columbia University gynecologist Landrum Shettles claimed to have achieved in vitro fertilization, though not with any reliability. He later recalled that in these experiments, “fertilization was as rare as hen’s teeth.”⁷ In 1961, Italian researcher Daniele Pettrucci claimed to have cultured a human embryo in vitro for 29 days. He destroyed the embryo, he claimed, because it had developed into a “monstrous” form.⁸ (He never published his work, and his claims were never verified.)

Related work in animal species had been ongoing for some time. In 1934, Gregory Pincus at Harvard Medical School fertilized rabbit oocytes in vitro and achieved pregnancies in recipient rabbits. Though Pincus claimed the pregnancies resulted in live young, the experiment could not be repeated successfully until 1959 when M. C. Chang produced live-born rabbits through IVF and transfer.⁹ Pincus’s and Chang’s work laid the foundation for extensive IVF research in nonhuman mammals and, ultimately, in humans.¹⁰ Experimental work in laboratory animals went well beyond simple efforts to perfect IVF as a reproductive tool. For instance, in 1971, Johns Hopkins–based embryologist Yu-Chih Hsu cultured mouse embryos beyond the blastocyst to the early somite stage.¹¹ But it was the work of Robert Edwards from the mid-1960s onward that drew the most attention.

Edwards made clear from the outset that his efforts were therapeutic: he wished IVF to be a tool for treating infertility by producing pregnancies in bodies that could not accomplish it on their own.¹² He argued that, although it is reasonable for certain social concerns to attach to this research, IVF was in essence a therapeutic attempt to overcome a medical disorder and nothing more. Nature had failed the infertile, and the proper role of the physician—and of the technology of IVF—was merely to assist the body in circumventing its own failure. Thus, in Edwards’s words, “Infertility is a defect to be remedied if possible by medical attention.”¹³

There was, however, significant skepticism that the uses of this technique would remain so well circumscribed. Many saw this emergent domain as more closely associated with technologies of human transformation, including species transformation. IVF was one of several essential tools that would allow radical control of human biology: what one prominent religious commentator in the 1970s described as “ending reproductive roulette” and another saw as a step on the path to “species-suicide.”¹⁴ During the 1960s and 1970s, the most vocal critics of technologies of human genetic engineering—which included IVF—were theologians.¹⁵ Figures like Paul Ramsey were concerned with the broad meaning of the project of human self-mastery that the new biotechnologies portended. For individuals such as Ramsey, these technologies signified an aspiration to transgress the natural order: an impulse to “play God” and bring about a “second genesis” that rejected the goodness of the first.¹⁶

Expressions of concern regarding human IVF came from scientific quarters as well. In 1971, Nobel Prize–winning geneticist James Watson raised concerns about in vitro fertilization as a potentially dehumanizing technology. He told the U.S. House Committee on Science and Aeronautics that the birth of a child through IVF might be seen within a year and that “techniques for the in vitro manipulation of human eggs are likely to be general medical practice within 10 to 20 years.”¹⁷ Watson argued that research in this area was distressing not so much for its potential application to overcoming human infertility as because these techniques were critical steps on the path to human clonal reproduction. He pointed to the recent research of Oxford embryologist John Gurdon on frog cloning as indicative of the trajectory of the science.

In 1962, Gurdon had successfully generated adult frogs by transferring the nucleus of an intestinal cell from a tadpole into an enucleated frog egg. The resulting adult frog was genetically identical to the donor of the intestinal cell.¹⁸ These techniques, Watson argued, were, in principle, transferable to mammalian species. And, “if the matter proceeds in the current, nondirected fashion, a human being—born of clonal reproduction—most likely will appear on earth within the next 20 to 50 years.”¹⁹ Given this likelihood, he argued, it was urgent that democracy respond in advance to this technological future. It is “absolutely essential,” he argued, that the government take action to track these scientific developments in order to “inform the public as a whole” and shape national science policies. Judgments of the regulation of such activities, from in vitro fertilization to clonal reproduction, are decisions “that the people as a whole must make.” Watson argued that “if we do not think about the matter now, the possibility of having a free choice will one day suddenly be gone.”²⁰

A 1972 Journal of the American Medical Association editorial expressed similar concerns, noting that “Physicians, scientists, philosophers, theologians are astir with thoughts and pronouncements on genetic engineering, especially with growth of a fertilized ovum in vitro (already achieved) and with cloning.” The editorial stated that though some of these technical possibilities seemed remote, in vitro fertilization and embryo transfer were on the immediate horizon. It urged a moratorium on further research on human IVF and ET until the associated ethical questions could be resolved.²¹ That the editors of one of the most prestigious medical journals in the world took this stance is indicative of the widespread reservations about the emerging technologies of human reproduction in the early 1970s.

Yet neither these imagined futures nor the corollary anxieties about their moral meaning were new. A number of prominent biologists in the 1920s and 1930s had envisioned that IVF would become a critical tool in the eugenic management of the human species. In a lecture delivered in 1923, J. B. S. Haldane imagined a future in which human reproduction would be technologically managed. Not only would fertilization take place in vitro using oocytes from cadaveric ovaries, but fetuses would be grown outside the body in artificial wombs, a technology Haldane dubbed “ectogenesis.”²² It was these predictions that inspired Aldous Huxley’s image of “Bokanovsky’s process,” the industrial reproductive organ of his dystopian Brave New World.²³ Haldane’s vision of the future inspired other eugenicists, most notably Herbert Brewer and Nobel laureate geneticist Hermann Muller. Muller and Brewer, who began corresponding in 1935, described a eugenic future in which genetic enhancement of the species would be achieved though the careful technological management of reproduction. Both had been excited by the 1934 report that Harvard endocrinologist Gregory Pincus had fertilized rabbit ova in vitro and successfully transferred the rabbit embryos to a host uterus, producing live births.²⁴ Brewer called in vitro fertilization “penectogenesis,” a preliminary step toward ectogenesis.²⁵

Others anticipated this transformation of life with more equanimity. A 1935 article in the Washington Post, imagining life in 2035, noted that in addition to metal buildings and disposable clothes, we might expect “test-tube babies.” But these radical transformations of life, the author suggested, were perhaps not different in kind from those already experienced. Remarking on Pincus’s recent fertilization of rabbit oocytes in vitro, the author predicted that, “just as we became accustomed to automobiles and planes and tomato juice and cod liver oil, future generations may be entirely calm about even—horrors!—test-tube babies.”²⁶ A 1937 editorial in the New England Journal of Medicine associated Pincus’s research with the shifting sexual mores of early twentieth-century America, commenting, “If such an accomplishment with rabbits were to be duplicated in the human being, we should in the words of ‘flaming youth’ be ‘going places.’”²⁷

Thus, the idea of human IVF had for a long time been conceptually entangled with other kinds of radical interventions in human life, including eugenics, directed evolution, and genetic manipulation. Though these worries persisted beyond the birth of Louise Brown, by 1978, the rhetoric of IVF as a technique of genetic control had already begun to fade. Brown’s birth significantly reinforced this change in perspective. The familiar and disarming scene of the newborn child with tired but proud parents was suggestive more of a medical miracle than a Frankensteinian experiment. NBC Nightly News anchor David Brinkley reported she was a “normal, beautiful baby.”²⁸ As one headline noted, she entered the world “healthy, crying her head off.”²⁹ The editors of the Chicago Tribune declared baby Louise’s birth “a historic medical triumph” and a “time to rejoice w...

Table of contents

• Cover 
• Title Page
• Copyright
• Dedication
• Contents 
• Acknowledgments
• Introduction: The Politics of Experiment
• 1. New Beginnings
• 2. Producing Life, Conceiving Reason
• 3. Representing Reason
• 4. Cloning, Knowledge, and the Politics of Consensus
• 5. Confusing Deliberation
• 6. In the Laboratories of Democracy
• 7. Religion, Reason, and the Politics of Progress
• 8. The Legacy of Experiment
• Notes
• Index