Three into one won’t go

The idea of children born of three parents smacks of science fiction. We may well feel that, by comparison, minor tweaks in the DNA of the embryo are small beer. Yet it is a real and immediate prospect allowed by an amendment to British law. Currently the Department of Health has issued draft regulations for its introduction and is requesting reviews from “stakeholders” and the wider public. That means us. So what are we going to do about it?

This is an introductory guide which I hope will lead you study the material.I will, of course, be focusing on the questions which interest us as Catholics. As the survey only addresses draft regulations, opportunities to express our views are limited.

The human cell contains two sets of DNA. The first is the DNA which carries our personal characteristics (nuclear DNA). At conception, the mother and father’s DNA combine a new mix of their DNA to be the “blueprint” for the baby. In turn, this blueprint will be inherited. The second is mitochondrial DNA. This does not contain personal characteristics but provides most of the cell’s energy. They are sometimes called the “battery pack”. They represent a 10th of one per cent of the total DNA, and they are believed to be of bacterial origin. Only the mother’s mitochondrial DNA are passed on to the child. Faulty mitochondria can cause widespread damage because they affect cell function. The list of disorders which may be caused is long and frightening. There is no cure. As a parent of 21 healthy descendants, I blanch when I read it.

In some cases the effect can be mitigated by implanting only the healthiest embryos, or by aborting damaged foetuses at a later stage. But, in more complex cases, another solution – still at an experimental stage – may be proposed. It is possible to remove the faulty mitochondria and to replace it with healthy mitochondria from a donor. There is good evidence that this will work well and safely, but ultimately only long-term experience of use will tell. Two processes are envisaged.

The first (maternal spindle transfer) is to take the mother’s personal DNA from her egg, and to insert it into the donor’s egg (from which the donor’s personal DNA has been removed). The egg is then fertilised. The second (pro-nuclear transfer) involves inserting the maternal and paternal elements from a fertilised egg into a healthy donor embryo from which the corresponding elements have been removed. The transfer takes place during the process of fertilisation but before the parental elements have fused. In either case the resulting child will have three DNA sources: mother, father and donor. In both procedures the donor’s mitochondria will enter the germ line: it will be inheritable.

In reviewing the moral aspect of these processes, we must start by accepting that the immediate benefits of successful mitochondrial replacement are potentially large. It is estimated that there would, at least initially, be no more than 10 eligible cases a year, but these could be 10 tragedies averted. But there are alternatives: adoption, donor eggs (with its own moral questions) and simply accepting the vocation of childlessness.

The issue of a child with three parents immediately comes to mind. But it is argued that this reaction is not justified. Since mitochondrial DNA has only mechanical effects and conveys no personal characteristics, the idea of an additional parent is unwarranted. Yet many will be concerned with foreign DNA being introduced into the germ line and remaining there indefinitely. And can we gauge the long-term effects of such a novel and extreme procedure through future generations?

The “slippery slope” argument will certainly be a consideration. While mitochondrial transfer is altogether different from inserting personal DNA, it can be argued that accepting the alteration of the germ line opens the door to unfettered genetic manipulation. Defenders of the procedure are quick to point out that, if it is not available under what will be our carefully considered legislation, it will certainly be available in other countries, and probably in unrestricted and questionable ways.

The procedures themselves raise moral questions. Both require removal of the ova from the reproductive tract and artificial insemination. The pro-nuclear transfer requires the manipulation of a fertilised egg – but one in which the blueprint DNA of the new baby has not yet formed. Thus it would seem that it does not yet constitute a human individual. Thus it would seem that it does not yet constitute a human individual. But the general prohibition of interference with the process of human reproduction would be breached.

You may be helped here by reference to the Catechism, remembering, of course, that this precise procedure was not considered at the time of drafting, nor was a distinction made between the start of the fertilisation process and the point at which the parental DNAs are fused (approximately 24 hours). Paragraphs 2376/7 address the issue of dissociation of the sexual act from the procreative act. This intervention alone may be sufficient to settle the question for many, but others might argue that the therapeutic intention of the procedures provides justification. The fact that the Church’s views on this may not be persuasive in the public forum should not prevent us from expressing them.

The link below will take you to the D of H enquiry. The other link will give you further information, including an excellent discussion of different ethical views.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/285251/mitochondrial_donation_consultation_document_24_02_14_Accessible_V0.4.pdf

http://www.closeupresearch.com/mitochondria_replacement.html

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About Quentin

Science Editor, Catholic Herald. Portrait © Jacqueline Alma
This entry was posted in Catholic Herald columns, Church and Society, Moral judgment and tagged , . Bookmark the permalink.

19 Responses to Three into one won’t go

  1. Vincent says:

    I am struck, this Saturday morning, that I can see no comment on this question of the three-parent family. We have all been much too busy beavering away at past problems. (Important enough, I agree) We have been less interested in future problems. No doubt, one day, we will all be wondering why we held back from discussing a far more significant issue.

    The prospect is that we are choosing to become the lords of life. It is starting with a relatively small step by which we modify a human being (and his or her descendants) for such worthy, therapeutic, reasons. What will come next? Already we hear of scientists identifying genes for specific outcomes. It seems so reasonable to search out faulty genes in an embryo (via a test tube and artificial insemination), and to correct the fault. But what next? Below average intelligence is a fault, short stature is a fault — choose what you like. We may one day be able to change personalities — from aggressive to gentle, for instance. I see that scientists are, in other species, identifying the genes which counter aging.

    The final stage here may be to construct sperm and ovum artificially simply by putting together elements from existing biological material. Then, as the Serpent said to Eve, “you shall be like God.”

    • milliganp says:

      Vincent, I had chosen not to comment on this because the moral dilemma bewilders me. I just came to the blog to see if anyone had been brave enough to have started a discussion, so well done! When in-vitro fertilisation first took place I wondered why, given that we believe the soul to be created at the moment of fertilisation, God didn’t just make sure it wouldn’t work; However God created a rational world. Mere ethical tools do not seem to be able to address the difference between what can be done and what should be done, I’m still bewildered.

    • Vincent says:

      If we think we can clearly distinguish between mitochondrial DNA and nuclear DNA, i.e., that mitochondria was in effect only a mechanism to make cells work properly, I think I could live with that. But how do we stop it there? As far as I can see, scientists will eventually do what they discover is possible to do. We have all had experience of unthinkable things becoming thinkable, and then becoming commonplace.
      I put on one side the issue of interfering with the reproductive process — not because I agree with it but because it is the principle of altering the gametes for any purpose which is at question, rather than the necessary methodology.

  2. Ada says:

    Wait what is the Catholic churches issue with IVF? Frankly, I do not see anything wrong with it, someone care to explain?

  3. Iona says:

    “The act which brings the child into existence is no longer an act by which two persons give themselves to one another, but one that ‘entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person. Such a relationship of domination is in itself contrary to the dignity and equality that must be common to parents and children’.”
    CCC, 2377.

  4. Iona says:

    Even apart from the ethics of the thing in itself, what are the costs and the benefits?
    And could the money be better spent alleviating other areas of misery which are chronically underfunded but not so exciting or high-profile or potentially Nobel-prize-winning as intervening in the process of conception?

  5. John Nolan says:

    Louise Brown, the first IVF baby, was born on 25 July 1978. Thirteen days later, Paul VI died. His successor, Albino Luciani, had already given (somewhat guarded) congratulations to the parents, as was on record as not being entirely happy with Humanae Vitae.

    Within twenty years it was confirmed that the Church’s teaching condemned any form of artificial insemination of humans. There is certainly an advantage in holding a ne plus ultra position according to an interpretation of Natural Law. One can thereby avoid the shifting sands of what might be ethical or acceptable at any one point in time. When homosexual acts were decriminalized in 1967 no-one suggested that they be regarded as morally acceptable. Nor, in the same year, did most MPs who voted for David Steele’s abortion bill believe they were legislating for abortion on demand (in fact they were assured that they weren’t).

    In any case, what the Church teaches or doesn’t teach is of sublime indifference to the minority of Catholics who still attend the dumbed-down post-Vatican II ‘liturgies’ or, it would seem, to most of their bishops. Call me a cynic – I am.

  6. To be honest I feel that the CCC sections 2376 to 2379 are somewhat Pharisaical in nature.

    Quentin tells us of two types of procedure :- “maternal spindle transfer” and “pro-nuclear transfer”. In the first case only the mother’s egg is involved, in the second an already fertilised egg is involved. In the first only a ‘potential’ human, while in the second an actual ‘embryo’ is involved.

    I am by no means an expert in this field – although I was acquainted with Anne McLaren when I was a consultant physician and senior lecturer in ‘Edinburgh – but it is worth noting that both techniques involve the use of a ‘donor egg’ [presumably not fertilised] from which the nucleus has been removed. This nucleus is then replaced by a nucleus from the mother’s egg which may be fertilised or not.
    The reason for this [I think] is that there may be many mitochondria in the mother’s egg and it would not be practical to remove them all and replace them with healthy mitochondria because they are very small and diffusely placed whereas the nucleus is single, much larger and well-defined.

    As far as the moral aspect is concerned the use of a fertilised or unfertilised egg clearly has significance [from a purely practical point of view I suspect that the fertilised egg has a much better defined nucleus]. Other things being equal, there are, as far as I can see, no restrictions on manipulating unfertilised human eggs – but it is the subsequent fertilisation and re-implantation of the egg that raises moral difficulties.

    Vincent quite correctly details some of the features of the ‘slippery slope’.

    However to quote CCC 2377 anything that “entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person.’ would be morally unacceptable. Similarly CCC 2378 states, inter alia, “only the child possesses genuine rights” and this sort of attitude irresistibly reminds me of a story that my father used to tell:-
    A colleague of his had delivered a baby in a remote farmhouse in the depths of West Cork and was just leaving when the farmer approached him to say “The missus has sent me to ask if she could be after havin a pup by you?”. (It would seem that an interest in genetic inheritance has a longer history than medical experimentation.)

  7. Quentin says:

    Thank you for your additional explanation. Just one point: while “pro-nuclear transfer” occurs to what is technically (and legally) known as an embryo, before the pro-nuclei have fused, the individual DNA of the prospective life is not yet formed. It is for this reason that we cannot call it an individual person. The phrase used in the relevant CDF document goes ““The zygote is the cell produced when the nuclei of the two gametes have fused.” Not, we notice, simply by the sperm entering the ovum

  8. lochain says:

    It seems to me quite clear from the discussion above that the true moral action is not to interfere with mitochondrial inheritance even if it is to be no more than 10 cases a year. This procedure is not going to be a cure for mitochondrial disease for all those affected but just for those who at some considerable expense can be treated and may be cured. The dangers are clear and the slippery slope has been demonstrated by the history of reproductive medicine over the past fifty years. It would be both ethical and for the benefit of all those affected by mitochondrial disease if the medical profession would turn their attention to finding a real cure instead of tinkering with the contents of the cells either fertilised or unfertilised. To suggest that before the gametes have fused we are not dealing with an individual person is, to my mind, to be splitting hairs and is not very different from the time limit of 14 days introduced into the use of embryos in experimentation. I sometimes think that doctors put forward the sad plight of patients with certain conditions because they actually enjoy the ‘tinkering’ with cells and this gives them a legitimate excuse. Call me cynical if you wish.

    • Quentin says:

      It’s good to have a definite opinion here. Thanks.

      I don’t think that “To suggest that before the gametes have fused we are not dealing with an individual person is, to my mind, to be splitting hairs…” is so. Each individual needs to have his own nuclear DNA – which results from fusion.

      Of course it is true that the natural progress of fertilisation is being artificially managed, but that raises a different, and lesser, issue.

  9. Ana says:

    Having read this article in the Catholic Herald, I was disheartened by some of points you make in response to the arguments in favour of the procedure. I think it is great that you are bringing the issue to light for Catholic readers, but some of the points you make when tackling the ‘opposition’s’ arguments are extremely misleading and can encourage readers to believe the procedure is beneficial and safe; which all current evidence suggests is wrong. Please allow me to elaborate…

    You say ‘we must start by accepting that the immediate benefits of successful mitochondrial replacement are potentially large’ but this simply is not the case. Most of arguments against going ahead with the procedure have come from secular bioethicists and scientists like Marcy Darnovsky and Stuart Newman who emphasise that there is barely any evidence to suggest the outcomes will be significant or even legitimate. It would have been helpful to point that out in your piece.
    Similarly you say ‘10 eligible cases a year [would be] ten tragedies avoided’ but is this really such a large benefit? It has been evident from the recent hearings that the majority of secular opposition to the procedure believe that the risks of manipulating the embryo at this critical stage are too high (especially generationally) compared to the few that may be born without the disease.

    The next claim you put forward from those in favour is that ‘the idea of an additional parent is unwarranted’ As explained, I agree with your worry that the long-term generational effects are extremely significant. But this should not have been your response to this claim; you should have tackled it directly, and should include that this point itself is wrong. The fact that there are three sets of DNA infers the child has three parents. It is not advisable to right-off this argument completely and encourage others to do so. The use of the phrase “three-parent embryo’ or rather “three-parent child” emphasises the humanity of the embryo and that they are in fact persons at the most vulnerable being manipulated. Allowing readers to simply accept such a fallacy as acceptable can be detrimental to how readers interpret the issue, and furthermore lessens the gravity of what is being proposed.

    ‘Defenders… are quick to point out that… it will certainly be available in other countries’ – it would have been helpful to outline the evident response to this claim that there is in fact severe international opposition to the procedure, making the U.K. (foolishly) the first to allow it. In fact the U.S. FDA recently highlighted several health and safety concerns, and most European countries are not backing the U.K. on this one.

    You state ‘it would seem that it does not yet constitute a human individual’ and that the real problem is that ‘the general prohibition of interference with the process of human reproduction would be breached’ – this is a concern, but the real issue here is that it is a human life being tampered with; the fertilised egg is a human embryo from conception and to imply that we would not really be interfering with human life seriously diminishes the seriousness of this issue.

    It is encouraging that the issue is being brought into the public sphere and people will no doubt be made to think by your article. However the lack of defence against the attacks from opposition you put forward fails to highlight the fact that the procedure is in no way safe or highly beneficial. I think it would have been helpful to stress the dangers, and secular opposition instead of seemingly accepting such incredulous claims and offering little argument against them. It would be disappointing if readers were to think the issue a minor one, or of less ethical relevance because of the little you say against claims like ‘the benefits are large’.

  10. Nektarios says:

    Ana
    Welcome to the blog,
    Your posting outlines safeguards that are needed.
    Scientific advance is going to take place, but we should be on guard, that it does not advance at any price.
    I have to say that one of the links Quentin provided with the three obviously pro contributers, was little more than a sales pitch while massaging of facts, hiding others, and minimizing the dangers.
    Your posting Ana, is not ambigious, clear, factual and to the point. Bravo!

    On a secondary note, I think medical ethics, though appearing to the contrary, have actually
    slipped over the years. Let us remind ourselves, without the Christian Church on Ethics, the medical profession would be prone to carrying out procedures and experiments on people without any ethical constraints.
    Far from letting medical ethics slip any further, it should in fact be tightened up.The present discussion is just a case in point.

  11. Quentin says:

    I have been passed two additional links relating to mitochondrial transfer. I do not have an immediate opportunity to read them this evening, but I reproduce them here to allow maximum time for us to study.

    http://www.geneticsandsociety.org

    http://www.fda.gov/AdvisoryCommittees/Calendar/ucm380042.htm

    • Nektarios says:

      Quentin
      I read through both links:
      The one from the geneticsand society.org certain does not paint a rosy picture for this research; its intent, or the time necessary to complete this research would be extremely long – decades or longer.
      The genetic sand society link is worth reading.

      The second link you gave is just calendar dates for a meeting on various aspects presently under discussion here on the blog. That meeting is past in February this year.

  12. Nektarios says:

    One thing that strikes my mind regarding our discussion that has not be touched on, and that is the
    view of Ethics held by the Christian Church and Medical Ethics which over the last fifty years or so
    has lost much of Christian Ethics, replacing with secular ethics.
    Most of us on this blog think along Christian Ethics that gave rise to the much needed medical profession in the first place.
    It seems any research can be called ethical by secular ethics much of which are being deployed
    in varous fields including the medical profession.
    The Church seems reluctant and effete when faced with the secular ethics bombardments by Scientists in the medical and other professions.
    We can of course be thankful for the many advances in treatments over the years, but many of them, unethical in my view, have lead and continue to lead mankind in to moral and destructive
    behaviour which in some cases threaten the very cohesion and fabric of society.

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