Dr. John M. Haas: Well, 27 years ago, when the Pope John XXIII Center was set up, the rationale for this new institution was to have a place where Catholic ethicists could reflect on the latest advances in medicine and life sciences. The idea was that by the time these scientific advances became issues for the faithful—by the time bishops and priests had to deal with them on the pastoral level—the people at this re search institute would have reflected on them, and would be ready to offer some guidance.

Back at that time, Father Moraczewski [Albert Moraczewski, OP, the first full-time president of the Center] and the others who were involved in setting up this center often said that the advances in medicine had outstripped our ability to reflect on them morally or ethically. So for more than a quarter of a century we’ve been saying the same thing.

Actually, it is in the nature of things that new developments will occur, and these new developments will require some reflection. So I don’t think that is a frightfully negative perspective to say that we need to catch up with the latest advances. That is sort of the nature of the work.

And I think the Church has been pretty good at reflecting on these things as they develop. Donum Vitae, the Instruction from the Congregation for the Doc trine of the Faith analyzing the morality of the different means of overcoming infertility, came out in 1987. At that time the new techniques of reproductive technology, such as in vitro fertilization, were still very new. But the Church was right there in the forefront: reflecting on those new techniques, meeting with the doctors who were actually performing these procedures, and giving moral guidance.

I think the Church has done a relatively good job of staying on top of these issues and addressing them as they arise. I think it is interesting to remember that back in 1987, the scientific community thought it would never be possible to clone a mammal. It had been done with frogs, but scientists never thought that it could be done with the highly differentiated cells that were involved in cloning "Dolly" the lamb. And yet in 1987 Donum Vitae already had judged that this would be an immoral means of generating new life. So you had a Vatican document, a decade before "Dolly" hit the scene, already providing a moral analysis of the cloning technique. I think that’s significant.

So perhaps we should rephrase the usual question, and ask whether the rest of society needs to catch up with the moral reasoning that has already been done by the Catholic Church. Isn’t it fair to say, for instance, that the American public in general is only now noticing some of the moral problems involved in artificial methods of reproduction—problems that the Church pointed out many years ago?

Haas: Well, I think even now there is not enough public concern or outrage about some of the things that are being done with reproductive technologies. I mean, in the United States that particular niche of science has been market driven to an extent that is hard to believe. There are people out there who "need" babies and there are others who are going to offer virtually any means that they can devise to provide them. And it is all thoroughly unregulated. I think we are the most unregulated country in the world with regard to reproductive technologies.

Just as an illustration, in England it is against the law to implant more than three embryos in an in vitro fertilization process. Of course, as Catholics we don’t think any of that process is moral. But in the United States there are no limits; five, six, or seven embryos can be implanted.

Even in terms of concern about maternal health, we in the US have not been very responsible in the way we are supervising the development of these new technologies. We’re driven by a goal: If the money is there to support something, it is done. So we have these infertility clinics advertising their success rates and approaching this whole process in terms of manufacturing, efficiency, and productivity rather than moral considerations.

So yes, there is a lot of catching up that needs to be done on the part of society at large.

The first really widespread public backlash against these new forms of reproductive technology—the first editorials raising some moral questions about fertility treatments—appeared after the birth of octuplets to a Nigerian-born woman in Houston. Is there an element of racism in that reaction?

Haas: Well, at least there is an extreme irony here. On one hand there is a drive to achieve a stable (or even declining) population, and a willingness to use every technological means at our disposal to prevent children from being conceived; and on the other hand there is a separate medical business engendering these multiple pregnancies.

But then again, this is not being done out of any love for children. Very, very early on in the development of these methods, there emerged the technique of "fetal reduction"—destroying some children during their uterine development. These techniques are not driven by a love for children, but by a desire to achieve one’s own goals and objectives.

You have mentioned your concerns about the way in which the field of reproductive technology has been influenced by unrestrained market forces. But of course there are other aspects of medical technology which are now being driven by economic factors. Today’s newspaper carried a report about efforts in some states to place some restrictions on the transfer of human organs suitable for transplants. Is that another emerging problem?

Haas: Yes; there is a tremendous regional discrepancy in the availability of organs. Currently these things are controlled at the regional level. For example, there is an organ bank in our region of the country that procures and distributes organs throughout New England. Now there is a major campaign to make these processes—the procurement of organs and the waiting list of patients needing transplants—work on a national basis. There is also some opposition to that move, organized by people who have a vested interest in the current regional approach. That is going to be an increasingly important issue.

The discrepancies between regions today can be fairly substantial. In Texas there are quite a few more organs available than in other areas, because with all the wide-open spaces, there are many more fatal car accidents there. In other places that tend to be more crime-infested you can have a greater availability for organs because of murders. So as a result there are certain parts of the country where there is a greater availability of organs than in other parts. There is going to be a great push for nationalization of that whole process.

But why should we work to organize things equitably only on the national level? Wouldn’t the same logic suggest that we should make things as uniform as possible on the international level as well? If we are worried about the availability of organs for transplants in Missouri, why not worry about the availability in Guatemala as well?

Haas: In some sense that may be true. But you know, charity begins at home. In this case, that means looking at one’s own national interests first.

By the way, you often find that the people in Guatemala are concerned about Americans going down there to procure organs. We have friends who have adopted children from Guatemala, and while they were in the country for that purpose riots broke out, because the Guatemalan people were afraid that Americans were coming there to adopt children not because they planned to take them into their homes and raise them, but because they wanted to use them—to harvest their organs! It is dismaying to think that people could have that perception of the United States.

And unfortunately, the fears of those Guatemalan people are not entirely irrational, judged against the background of what some Americans have been doing.

Haas: That’s right. There have been cases in which children have actually been engendered in order to harvest their organs or their cells.

For the most part we are talking now about harvesting cells from unborn babies. And the Guatemalan people you mention are worried about that use of young children. But there is also a lot of uneasiness about the removal of organs from patients at the end of their lives.

Haas: Yes.

Today there are more and more people dying in hospitals, more people on life-support systems, and more people living out their final days in circumstances where it is possible to exert a great deal of control over the process of death. Is it becoming more difficult to make clear moral judgments about death and dying?

Haas: Yes. And the end-of-life issues are going to be increasingly perplexing in the future, because we have an aging population, and we have more developed technologies to prolong life even further. I don’t foresee that the question is likely to get any easier. On the contrary, I think it is going to be increasingly difficult, even within the Church. Even among moral theologians who want to be faithful to the magisterium, there are different opinions today as to just what measures must be taken, what can or cannot be done, at the end of life. This is true particularly with regard to the question of providing hydration and nutrition for comatose patients. I think the whole issue is going to get more difficult.

There are two different sets of moral imperatives for Catholics regarding end-of-life issues, aren’t there? On one hand we need to determine what is morally licit. On the other hand we need to fight against the public acceptance of options that are clearly not morally licit, such as euthanasia and assisted suicide.

Haas: That’s absolutely right. And the question of what is licit is somewhat unsettled right now, even in magisterial circles. The Texas bishops have come out with a statement on end-of-life issues, and that statement is somewhat at odds with the statement issued by the Pennsylvania bishops. In fact it’s even more complicated than that. Three of the Texas bishops refused to sign that statement, whereas all of the Pennsylvania bishops signed the statement for that conference. The Pennsylvania statement was prepared by and for the bishops themselves, while the Texas statement was drawn up by others, and the majority of bishops signed onto what had been prepared for them. So just on the strength of the process—the way the document was prepared, and the fact that it was unanimously approved—I would give more weight to the Pennsylvania bishops’ statement. Still, this is a field in which we definitely still need to do more work.

Among all the latest developments in medical technology, which one causes you the most concern from an ethical standpoint?

Haas: The thing that most concerns me right now is the continuing dehumanization of the person. There is an increasing tendency to use one human life for the purposes of others. One example can be seen in the engendering of life in a petri dish, to provide a child for parents who are infertile. Sometimes this is done with a donated egg and donated sperm. It always involves the engendering of a number of lives, not all of which are going to be brought to term. In fact, there will not even be any attempt to bring them all to term. So there is a willingness to cheapen human life, to discard a human life when it is not of use to somebody else.

One very troubling aspect of this approach can be seen in the development of stem cell research. Stem cells are early, developed, differentiated cells which have the potential for becoming other kinds of cells. So for instance you can have blood stem cells, which can become a variety of different kinds of blood cells: red corpuscles, white corpuscles, and so forth; they become increasingly differentiated. If you can get the blood stem cells themselves, there is the possibility of having them grow into one type of cell or another, and then using those cells for therapeutic purposes.

You can find blood stem cells in bone marrow and you can find them in placentas. They may come, say, as the result of a marrow transplant in the leukemia patient. If you use cells derived from adult bone marrow from a bone marrow transplant for growing the new cells, it has about a 60 percent success rate. If you use the stem cells taken from a placenta, it is a 100 percent success rate, because the cells have greater potential—there is greater diversity, they are more pristine, if you will.

Now there are ways of morally pro curing placental cells that do not pose any moral problem. You can obtain these cells from afterbirth, for instance; there is no moral problem there. But from the afterbirth you just get blood cells. You are not going to get the neurological stem cells, for instance, which can develop into different kinds of other neurological cells, such as nerve cells and brain cells. You can only obtain the neurological stem cells from that portion of a baby in which they are developing. So there is a strong temptation to obtain stem cells from aborted fetuses for the purposes of research. You can get a variety of different kinds of stem cells from the unborn child; there can be more control.

The other thing that some researchers are doing is engendering new life in a petri dish and taking it on to the stage of an advanced blastocyst or early embryo, when the cells differentiate into the three broad categories of cells. Then they are procuring some of these cells, which are then used for experimentation in efforts to "nudge" them into becoming blood cells, neurological cells, or skin cells which could later be used for therapeutic purposes.

The use of stem cells is not perfected yet. There is still a lot of research going on, to discover the uses that can be made of them—the ways in which, let’s say, heart cells can be used therapeutically to repair the damaged hearts of older people; or the ways in which these primitive neurological cells can actually be used to repair nerve damage.

In the past, when people broke their backs, there was no way the nerve damage could be repaired; it was all over. But now there is a possibility that the damage could be repaired. There are wonderful things that can occur through this process. But the means of procuring the cells—at least generally speaking, up to this point—have not been moral.