Who Am I and If So How Many? (23 page)

Another new opportunity that has arisen from reproductive medicine is the shift of the age limit up to which women are fertile. The late 1990s saw the beginnings of so-called ooplasmic transfer. If an older woman undergoing artificial insemination was
concerned
about the fertility of her egg cells, she could enhance them by adding cell plasma from the egg cell of a younger woman. The father of this method is Dr James Grifo, who practices reproductive medicine in New York. Grifo was the first to test ooplasmic transfer to produce embryos. The experiment was successful, and Grifo children now live in China. Grifo had chosen China, which was boundlessly supportive of research, so that he could
circumvent
long-drawn-out licensing procedures in the United States.

Soon it was no longer necessary to go all the way to China. In 2001, a research group led by Jacques Cohen at the Institute for Reproductive Medicine and Science of Saint Barnabas Medical Center in Livingston, New Jersey, reported fifteen births of children whose conception had been assisted using ooplasmic transfer. But Grifo neglected to inform his patients that the donated ooplasma from a young woman is not simply neutral raw material, but contains many of the donor’s mitochondrial
chromosomes
, which carry genetic material. If the donor mitochondria blend with the genetic material of the treated egg cell, the embryos conceived by ooplasmic transfer have three parents: the mother and the father for the genes in the cell nucleus, and the mother and the plasma donor for the mitochondrial genes. The child is a genetic mix not of two but of three individuals.

In November 2005, Douglas Wallace, at the University of California, Irvine, discovered that ooplasmic transfer was associated with extremely high risks. Many of the mice created through ooplasmic transfer turned out to be infertile, leading him to conclude that the children created by Grifo and Cohen might also show a high rate of infertility. Studies indicate that in the United States, reproductive medical experiments do not require the prior
extensive animal testing that would be demanded of a hand cream or cough syrup anywhere in the industrialized world. They also show how baffled legislative bodies can be when asked to draw up laws governing the implementation of the latest cures in
reproductive
medicine. Sometimes it takes a grim prognosis like the effects of ooplasmic transfer on mouse fertility to point the way.

Authorizing embryonic experiments and PGD in a somewhat broader framework will eventually make it hard to keep up with the changes in technology and to impose bans on new techniques that grow out of approved methods yet pose unforeseen
consequences
that could run afoul of the law. If a procedure that appears to be harmless produces harmful results, the ensuing legal problems are immense. We cannot even imagine the magnitude of the ethical confusion and litigation that lies ahead. Will the Grifo and Cohen children one day sue their medical birth facilitators because their infertility might have been avoidable? Will they even lay claim to an inheritance and other financial support from their genetically related ‘second mothers,’ who years earlier agreed to provide plasma to enhance someone else’s egg cells? Or, last but not least, will these second mothers demand the right to see and care for the children they did not anticipate having?

As we saw earlier, it is not the job of the state to protect parents-to-be from their own taste and ideas. Legislation of that kind would invariably culminate in totalitarianism. On the other hand, it
is
the duty of government to ward off foreseeable harm to society. The new opportunities offered by reproductive medicine are mired in this moral and legal morass. If matters that used to be determined by chance become matters of choice, the consequences would be enormous, because this kind of society would lose a feature that had been inevitable and inescapable: making the best of the hand you are dealt.

Once cosmetic surgery holds out the promise of a pretty face and body for everyone, reproductive medicine looms as the next step in preventing or eliminating imperfections from the moment of conception, and health and beauty become double entitlements for
parents and children. As a consequence, society loses its
understanding
of and tolerance for perceived imperfections and
deviations
from generally accepted norms, putting parents and children in a tenuous position. Will the children approve of the ‘corrections’ their parents bestow on them? And will they accept their parents’ decision to forgo these corrections and possibly mark them as misfits?

Every new opportunity forces the judicial system to reweigh potential benefits against possible harm. Isn’t it right and proper for Joshua Fletcher to get a sister who saves his life without suffering harm in the process, even if the sister eventually learns why she was created? Most of us were not conceived out of purely selfless love anyway. And who can say whether the sister was created
only
for this purpose and not from her parents’ wish for another child? Choosing not to avail oneself of an opportunity can also be morally reprehensible.

On the other hand, consumer eugenics – selection according to physical characteristics – gives free rein to an unwelcome societal development: profound and universal unease. Even if consumer eugenics cannot be firmly rejected on any solid moral principle in a particular case, if the common good is the main objective, we cannot help feeling troubled by what we would be setting in motion when bringing children into the world. Do we want to expand our parental obligations to ownership of an object of our own design? It is not necessarily a bad thing to accept that not everything in life is correctable. In any case, the potential for modification offered by genetic engineering and reproductive medicine may soon be dwarfed by a sleeping giant: neuroscience.

‘The monkey could see. His eyes followed you around the room. He could eat, and if you were stupid enough to put your finger in his mouth, he would have bitten it off.’ Robert White, a neurosurgeon from Cleveland who is now eighty-five years old, enjoys discussing his rhesus monkey experiments, which made him famous virtually overnight some thirty years ago. This bite-happy monkey was unique because its head was attached to a body that was not its own.

White cannot recall exactly how many primates he has decapitated in his laboratory at Case Western Reserve University in Cleveland since the 1970s, but the number appears to run in the several hundreds. He performed these procedures in a side wing of the medical school, an enormous wedding cake of a building with a classical columned doorway. White carefully removed a rhesus monkey’s brain and attached it to the circulatory system of another living monkey. When the experiment succeeded, the
neurosurgeon
took to transplanting the heads by severing the skin, muscles, and tendons, then the windpipe, esophagus, spinal column, and marrow. Now only six vessels were supplying blood to the brain. Within a few minutes, White connected the blood supply of the
monkey’s head with a monkey’s body that had been prepared for this purpose. The transplanted monkey’s heads survived for several days, after which their faces swelled, their tongues became bloated, and their puffy eyelids closed for good. Their immune systems had rebelled against the foreign body and shut down. But the intrepid experimenter jumped for joy when he realized that the brain had evidently not been rejected.

Once the youngest professor of neurosurgery in America, he is now a father of ten. A practicing Catholic, he decided to seek support for his infamous experiments from way on high, and he talked at length with Pope Paul VI, then with Pope John Paul II, and he was invited to join the most exclusive research group in the world, the Vatican’s Pontifical Academy of Sciences. The new pope, though, is likely to have grave reservations, particularly since White, who has been dubbed ‘the Frankenstein from Ohio,’ has been announcing plans to transplant heads and brains in humans as well.

The Catholic doctrine of the soul has helped the surgeon overcome his moral qualms about conducting experiments on primates. In his view, a monkey has ‘nothing in common with man, at least nothing having to do with the brain or soul.’ White’s dream of providing new bodies for people with conditions like Christopher Reeve’s (the late actor who was paralyzed in a riding accident) or Stephen Hawking’s (the physicist suffering from amyotrophic lateral sclerosis) was daring in the extreme. ‘What’s the difference whether I implant a liver, replace an arm, or transplant a body?’ White asked me eight years ago. ‘No one would ever think of looking for the soul in the liver or in an arm. The soul is only in the brain.’

The pope presumably sees the matter differently, but he does not have to finance the project. White told me that all he needed was the sum of $4 or $5 million, and he could go to Kiev in Ukraine and carry out his first human head transplantations. He conceded that the ‘greatest operation in the history of mankind’ would have flaws; the patient would not be able to move his arms or legs, nor
could he speak, swallow, or digest food. Still, White laughed, he couldn’t really complain. It would take another twenty years to make the connection to the spinal cord work, which would eliminate these drawbacks. I asked White whether he would make his own body available for this procedure. Again, he laughed: ‘Of course – but I’d rather it be my head, which is worth more.’

Robert White has made several trips to Ukraine, but the ‘greatest operation in the history of mankind’ has yet to take place, so philosophers, physicians, and legal experts are spared for now from addressing the thorny issues of what is actually being transplanted, the head or the body, or whom the family of the donor body is encountering when visiting the recipient. But the fact that White’s plans have so far come to naught should not put our minds at rest. His experiments are only the tip of the iceberg. Neuroscience poses the greatest scientific challenge of the twenty-first century – and a profound challenge to our morality. Successes in neurobiology are transforming our traditional view of humankind and at the same time producing entirely new prospects and perils.

Many of these prospects are clearly a blessing. A relatively new research discipline is neuroprosthetics, a combination of
neuroscience
and biomedical engineering. Its successes to date give rise to visions of fantastic opportunities. Neuroprosthetics stimulates human organs such as the heart, the bladder, and the ear and achieves impressive results. A notable example is cochlear implants for severely hearing impaired to nearly deaf individuals (‘cochlea’ being the scientific term for the auditory portion of the inner ear). Here is how it works: a small speech processor behind the ear of a severely hearing impaired person converts sounds into electrical signals, then a coil relays them through the skin to the implant. From there, the impulses are passed on via microelectrode arrays in the cochlea to the auditory nerve and finally processed in the brain. The trick to neurostimulation of this kind is that the processor behind the ear processes sounds to make brain neurons understand them without ‘hearing’ them in the usual sense. Neurostimulation
is the art of making electrical signal transmissions in the brain bypass impaired sensory functions in the body.

Retinal implants, aimed at restoring vision to the visually impaired and nearly blind, work in much the same way. Implant patients are already able to distinguish between light and dark, and clinical trials are showing promising results. Researchers have also gone to great lengths to find ways to help paraplegics walk. Here, too, the idea of artificially stimulating the body’s electrical pathways shows great promise. In the early 1990s, researchers began using sensors to measure the precise mobility level of patients. The language of the neurons responsible for movement was known; the question was only whether it would be possible to guide movement. A research group in Munich achieved this breakthrough a few years ago. For the first time, a paraplegic, using the handles of his walking aids, was able to give orders to a computer he carried with him in a backpack: ‘Stand up!’ ‘Walk!’ or ‘Climb stairs!’ The computer relayed impulses to electrodes fastened to the patient’s legs, and the impulses made the muscles react accordingly while different sensors evaluated the process and reported the results to the computer. The computer, in turn, adjusted the commands to the requirements of walking.

Another option is a motion implant, which, like a cochlear implant, is placed under the patient’s skin; here, too, the research to date looks quite promising. Paraplegic patients have been able to walk just a few steps so far, but significant advances are likely in the future.

Documentary films have captured amazing and impressive images of Parkinson’s and epilepsy patients experiencing dramatic and instant relief from their symptoms with deep brain stimulation. Both ailments are associated with a precise region of the brain. Electrical signals from what is referred to as a ‘brain pacemaker’ target pathologically overactive areas of the brain and alleviate symptoms on the spot. A Parkinson’s patient previously unable to hold a cup in his trembling hands sits in his easy chair sipping his coffee, instantaneously free of all suffering. An epilepsy patient
stops writhing in midseizure. And neuroprosthetic aids for hearing and walking might also be used to help patients with psychological disorders. Electrodes in the brain could intervene directly in neurochemical pathways to activate ‘positive’ neurotransmitters and lift patients out of depression.

These are wonderful advances, and cures of downright biblical proportions are on the horizon, enabling the deaf to hear, the blind to see, and the lame to walk. So where is the problem? What do neural implants and deep brain stimulation have to do with head transplants à la Frankenstein? The answer is simple: all these new manipulations of our nervous system in the brain, which go far beyond what has been possible with biochemical medication, could be used for nefarious purposes and open the floodgates to alarming abuses.

The military or the CIA could use deep brain stimulation to interrogate prisoners. Who needs a traditional lie detector when you can use a modern brain scan? Daniel Langleben, a psychiatrist at the University of Pennsylvania, had this same idea seven years ago. Since MRIs make it possible for researchers to see what goes on inside the brain, it was just a matter of locating the spot where lying occurs. According to Langleben, a region in the premotor cortex is activated when resolving conflicts. Langleben claims that because lying is considerably more strenuous than telling the truth, lies are inevitably accompanied by increased brain activity. This may not always be the case, of course; in fact, seasoned liars might expend less energy telling their usual lies than straining to tell the truth. Two companies are now planning to market Langleben’s lie brain scanner.

This kind of machine would be in high demand in the American legal system. Expert opinions based on MRIs are already used in the courtroom. Neuropsychiatrists use the device to ascertain whether felons are in full possession of their faculties. Grisly crimes and serial murders are often linked to breakdowns and impairments in the ventromedial region of the perpetrator – as in the case of the famous Phineas Gage. These snapshots of the mental state of
murderers and rapists do not, however, make it easier to figure out whether perpetrators are in full possession of their faculties, and the courts have to decide how to handle these cases.

It is certainly possible that surgical remedies for some kinds of brain damage that result in severe behavioral disorders will soon be developed. Wouldn’t it be better for both perpetrator and society to have brain-damaged criminals undergo brain surgery – perhaps even forcibly – instead of locking them up for life or sentencing them to death? But who has the last word in a case like this: the neuropsychiatrist, the judge, or the criminal or his or her family? And who will prevent abuse of a system that mandates surgical intervention to save the cost of financing a criminal’s lifetime sentence behind bars?

The next potential source of abuse might be the drug mafia. The more we know about the brain, the more effectively it can be manipulated. Psychoactive substances that boost dementia patients’ ability to focus may appeal to teenage drug users, but the effects on serotonin receptors and dopamine metabolism can be quite dangerous. (For a discussion of their function, see ‘Mr Spock in Love,’ p. 49.) Dopamine, for which phenethylamine acts as a releasing agent, has the same chemical composition as mescaline and LSD, and stimulates – or overstimulates – specific regions of the brain. The more effectively we target the dopamine balance in the brain, the more potent the designer drugs that can be produced with it.

And even apart from the issue of criminal hard-core drugs, does the legitimate range of use of attention-enhancing psychoactive substances extend to patients suffering from dementia, forgetfulness, or even just a mild case of ADD?Will parents start popping a little pill into their children’s cocoa to enhance their ability to concentrate on their important schoolwork? Who knows if we’ll even need genetic engineering and reproductive medicine if we can optimize our children’s achievement this easily. Politicians and managers could plow through their sixteen-hour days without drooping, and Tour de France cyclists’ doping would maintain not only their stamina but also their euphoria on even the steepest uphills.

Less deleterious, perhaps, but still frightening are the advertising agencies, Web designers, and other marketing organizations that relentlessly milk every new neuropsychological discovery to manipulate their target groups. No sooner do psychologists establish that people are naturally drawn to the right side of an unfamiliar space than supermarkets scramble to rearrange their shelves and products. Color psychologists use MRIs to put their catalogues to the test. And the manufacturers of home
entertainment
products and Internet games use brain scans to stay on top of their customers’ psychological preferences. Where we used to rely on guesswork and surveys, now the human central nervous system is mined for information.

But what are the repercussions of this enormous experiment beyond the confines of the laboratory? The activities we engage in modify our neuronal circuits, in some cases permanently. People who play a great deal of chess optimize particular abilities, which appears to offer a clear benefit, but what about kids devoted to Ego Shooter, who spend their time gunning down thousands of virtual enemies a day? They, too, will become adept at this task – but what other consequences will the thousands of shootings produce in their brains? Does the incredibly rapid pacing of videos and films really have no impact on the brains of our children? Anyone with any understanding of neuroscience knows the answer.

The momentum to exploit neuropsychological discoveries to rev up the excitement keeps building. Will we soon witness a war of home-entertainment electronics technicians versus
neuropsychiatrists
, the former in hot pursuit of ever greater thrills, the latter demanding regulations to fend off potential or established short-term and long-term damage? It may soon be time to make ‘attention theft’ a punishable offense.

The philosopher Thomas Metzinger at the University of Mainz in Germany has coined the term ‘anthropology assessment’ for a method of gauging the potential societal risks arising from brain research. Neuroscientific advances are creating new hazards and new potential for what Metzinger calls our ‘consciousness culture.’
Metzinger advocates introducing high-school classes in meditation to help children enhance and sustain their mindfulness and fend off the increasing number of distractions with which they are confronted. He has drawn up a catalogue of proscriptions for neuroscientists and neurotechnologists: no collaboration with the military, no excessive commercialization of research results, no skirting strict guidelines for obtaining human tissue, no medical or commercial abuse of patients.