Abridged excerpts from the President's Council on Bioethics, February 14, 2002

CHAIRMAN KASS.... Gil, would you mind if I imposed on you since you have made -- I mean, you have made a very strong argument that would seem to imply that, though, great good can come from the use of embryos to derive cells or other means of cure, that this is a -- not just a balancing judgment but there is a transgression here that at least in terms of respect you could not countenance. What are you going to say to Paul McHugh's patients if the moral argument you are upholding prevails?

PROF. MEILAENDER: Just so we are clear on what I said before, the last thing you said is important that I could not figure out how to work it out under the language of respect.

CHAIRMAN KASS: Right.

PROF. MEILAENDER: If you want a bald faced argument that does not use the language then, you know, we would have to think about that.

Well, what I would say is something like this, recognizing that....if I am actually talking to his patients -- I mean, the first thing to say is the language is going to limp and that I am not going to say anything....that is kind of humanly adequate to such a person's condition.

But I would say that what we owe you is not necessarily relief of suffering and not necessarily a cure because we cannot be obligated to give you what we do not that we can provide but we owe you hope. We hope sort of a firm commitment that we will do everything within our moral power, everything that we think we can morally do to try to find ways to, if not cure, at least relieve your condition.

There may be -- we may arrive at a moment when we think that here is something that could conceivably be done or tried but that we ought not do and what I would say to them then is that the reason I would not do it is because I would not want to do something that helps to create a world in which neither you nor I would want to live.

Something like that would be what I would say.

CHAIRMAN KASS: Do you want to respond, Paul?

DR. MCHUGH Yes. I think that the patients to some extent would say, "Gee, I have got a wonderful doctor here in Gil. Paul McHugh has trained him pretty well but here is my concern: I am a 35 year old woman and I have got this Parkinsonism and you could take my ova and....put my somatic cell in there and develop it. It all belongs to me. It does not belong to somebody else. We are not taking from anybody to give me these cells back in the form that will sustain me from my Parkinsonism and why wouldn't you want to do it. I agree with you that to take embryonic cells and use them for the purposes of others is a transgression but on this occasion -- and it gets worse, the transgression gets worse as the cells develop further and further but we are really taking my cells and allowing them to grow and giving them back to me."

What is the matter with that, Dr. Meilaender?

PROF. MEILAENDER: Well, it would be difficult with that patient at that time to have precisely the kind of conversation I might want to have about some aspects of that, namely about whether we really want to think about "my", these things as mine in quite the way that you described them and what that might suggest for other things that we could do with them.

I mean, there would actually be some important points there. It would be difficult just existential to engage in that conversation with the patient at that point but it seems to me that if we are thinking about it, stepping back and reflecting on it, we need to pay some attention to that and we would not want to be quite so casual about that language.

DR. MCHUGH: All the nuclei belong to me. All the --

PROF. MEILAENDER: It is exactly that language that is bothering me. This notion that your body is something that belongs to you. That is exactly what we would want to talk about. If they belong to you, you know, we are not going to let you sell them necessarily for instance. You know, there are a lot of complications there. Now, as I said, we are not necessarily going to have this conversation with the patient but the language would have to be refined considerably it seems to me before I would be prepared to acquiesce in it.

.....

PROF. SANDEL I just wanted to respond directly to this, which I think Dr. Meilaender with the patient has been overly timid. Why isn't your answer to the patient to say, 'Well, what you propose is just as bad as if you proposed having a baby with a consenting sperm donor or with your husband, just as bad as if you proposed having a baby and taking organs or something from that baby to cure you? Now maybe you have not reflected on that fact but I could persuade you that on reflection it would be like having a baby and using that to cure you.'

PROF. MEILAENDER: May I?

PROF. SANDEL: Why isn't that the answer?

PROF. MEILAENDER: Well, at one level that is an answer and it is a very good answer. All I was saying was that there are moments when speaking the abstract truth is not necessarily heard as the truth and he had set me up to talk to a patient. I mean, it is like -- and there are many other situations in which you do not walk into the hospital room and say, 'Well, I guess you are dying.' So that, yes, that is -- that is an issue that one would want to take up but really much better --

PROF. SANDEL: If you were speaking the truth to the patient that is what you would say, isn't it?

PROF. MEILAENDER: No, not necessarily because you want the truth to be heard as truth and it cannot always be received. That is my point. Ideally we would live in a world in which all of his patients or my patients would already have had the kind of conversations that would have prepared them to think about these things in that way and all I was saying is that if they have not, you know, there are moments when you can take up some questions and moments when you cannot but I do not deny that that is intellectual an appropriate issue to raise.

DR. MCHUGH: And I disagree. Of course, I disagree. I do not think that they are the same thing. It is not like having a baby and it is not like having a zygote but I have said that so many times that you are bored with it.

Here's an exercise for long time readers. Try guessing which of the above gentlemen strikes me as having all his marbles. Remember, it's no fair going back to my old posts...