Wednesday, May 27, 2015

Old Interests

The central issue of my thinking in high school was the compatibility of faith and reason (or, as I initially phrased it, religion and science). As I'm packing to move out of state for residency, I'm digging through  all this stuff from high school and college. Take a look:

I was also struck to find the first article I ever read in a medical course (our medical careers class in high school), which was about doctors having to close practices because of the cost of malpractice insurance. I often remembered this article as I pursued my undergraduate and profession degrees, but always remembered the article as a problem of insurance payments, not malpractice. 

I was surprised (first of all, that I had kept the article, and second) to see that it was about malpractice, not insurance. The article is a little time capsule: medical malpractice is no longer such a big monster, at least where I intend to to practice, thanks to tort reform. In its stead, insurers and government fees are now lined up to make bank from patients and their physicians, in the country's newest industry. And hauntingly, there's a little news piece about Ella (before it was Ella) attached to some clip I saved about ethics. 

Wednesday, May 20, 2015

When do we Truly Twin?

Many use twinning as an argument that life does not begin at conception/fertilitzation/gamete fusion.

Although what we do know of the inner workings of cells is tantalizing and beautiful, cells are still black boxes. The single-celled human zygote is the blackest (and most interesting) of these boxes. We have known for decades that there is early asymmetry in the zygote that later shows up in the division of the inner cell mass (ICM) and the trophectoderm.

We also know that intracellular components are moving as soon as sperm affects egg (cortical reaction, pronuclear migration events, etc). There is a great deal of mechanical action taking place, by which this tiny organism's body is quickly building infrastructure by which it will direct the rest of its development. Such organized activity promoting the development of a single organism is directed, like all operations of a living body, by a soul. This indicates (for those who don't realize this), that ensoulment occurs "at conception" (in non-scientific language), during fertilization, or at/around sperm-egg fusion.

But what about twinning? Complete twinning cracks a complex, tiny body into two between days 0 and 13 of life. Depending on when the cleavage occurs, the twins share zero, one or more tissues.

Twinning is a natural and normal process. We can tell this because a) it occurs frequently, and b) there is a falling-short of it--conjoined twinning.

What causes twinning? I propose that infusion of two souls occurs at conception/fertilization/sperm-egg fusion. These two organizing principles begin directing development of a single zygotic body. There are too many cooks in the kitchen, leading to an unstable union, perhaps because the processes directed by the two new souls don't place adherent components (e.g. desmosomes) where single souls would. This results in fracturing of the conjoined body (a process disrupted by some defect in the material in the case of conjoined twins).

Technology probably won't allow to see the difference between the intercellular workings of single-soul-driven and multiple-soul-driven zygotes for many years. Nevertheless, we can observe the end effect (what appeared to be a single body breaking in two parts and surviving, forming two complete sets of parts) and work back to the presence of two directing principles working from the outset on their completely totipotent cell.

Friday, May 15, 2015

Avoiding Eugenics: It's Easy!

I want to prevent inheritable disease. I think we should explore pre- and perinatal therapies as part of this. And not all the therapies I can imagine are approved by Church officials. Am I a eugenicist?

It the original sense of the word, no. I'm not a member of a "social movement claiming to improve the genetic features of human populations through selective breeding and sterilization." But more recently, the eugenics ideal has gone underground, and motivates some (not all) uses of prenatal diagnosis and abortion (related to race and mental disability). It creeps behind the language of "every child a wanted child," "working together for stronger healthier babies," and "healthy babies are worth the wait."

What if you could freeze oocytes (not morally illicit per se according to Dignitas Personae) and inject them later (e.g. after chemotherapy) in a woman's ampulla and allow conception to occur after natural intercourse? We'd need to learn more about construction of a zona pelucida and cumulus oophorous, but I bet we could do it.

What if you could CRISPR the ΔF508 out of all of a man's sperm, not only preventing this from being passed onto his sons, but also assisting the act of procreation, allowing him to build working sperm? This is germline gene therapy.

What if you could engineer a neo-ovary for a BRCA-positive woman, with her genome, minus the affected gene? That way, her offspring would not carry her genetic predisposition to breast and ovarian cancer. CRISPR would make it possible, and bioprinting would could make it real.

I don't think any of these things are eugenic in themselves (per se). Eugenics is marked by the erroneous equation between essential dignity and accidents like quality of life, health, beauty, intellect, usefulness, etc (paragraph 319 in the link). This error affects the intention behind the action, and the selection of means to the end of promoting those separable accidents.

None of the techniques I just listed are evil in themselves (malum in se). Printing tissue is not immoral, even printing tissue to replace reproductive organs. (Even though the reproductive system is set apart as half of a whole, meant to be used with a complementary system by a couple in a very sacred act, replacing an organ is a medical act that promotes the natural act of the human body.) Freezing cells, thawing them, and implanting them without IVF might be a roundabout way to assist fertility, but is not evil in itself. And germline therapy (I'm arguing something that not everyone agrees about now) is no different from somatic cell therapy, since it assists, rather than replaces or demeans, procreation and the health of offspring.

But any of those actions could be used with eugenic motives. A woman who wants to "clean up" her family tree or her society should re-examine her motives for neo-ovary creation. A woman who wants to freeze her eggs so that she doesn't use "the Down's duds" at the end of her reproductive life needs to re-think her intentions for egg freezing (and don't get me started on women who do this for their careers; that's a disaster of mixed priorities and apparent goods). A woman who plans to use germline therapy because she doesn't want to raise a child with mental retardation, or lose a child early, or pay for expensive drugs, needs to reconsider her reasons for germline gene therapy.

With a loving intention to contribute to the health of children conceived, and an attitude of acceptance of whatever children are conceived, we can avoid becoming eugenicists when we use morally neutral means to achieve a good.