!! spellx done 40 A Test Tube Daddy The Washington Post, Sunday, April 16, 1967 Freezing Male Sperm for Future Might Contribute to Genetic Improvement "Of course we -- that is humanity -- will take our biological evolution into our own hands, and try to steer its direction. And are there not means already by which we can influence our heredity and other means that we are likely to gain? "Some detractors may call the use of them tampering, tinkering, or even blasphemy. But this attitude is like that of the recalcitrants who still hold out against whatever foods, remedies or measures they consider 'unnatural', and like that of the Amish who even today consider higher education to be a perversion of the mind. "It is of all life's essence to utilize, wherever possible, more and more effective means of servicing itself. That implies doing things in ways that were previously unnatural for it. Moreover the rise of man to ascendancy over all other forms of life has resulted from his having been so unusually successful in this very respect." These remarks are quoted from "What Genetic Course Will Man Steer?" by Herman Joseph Muller, America's most renowned geneticist, who died April 5, aged 76, in Bloomington, IN. It was his last paper, delivered last fall at the International Congress of Genetics in Chicago. His program of genetic betterment was based on the faith that genetic constitution plays a significant, not necessarily an exclusive, role in developing personality traits that might be essential for survival of the species. Above all, he put cooperativeness, followed by intelligence, joy of life, empathy, humility, fortitude, curiosity, physical vigor, and so on. He did not insist that the genetic components of these traits necessarily outweighed the environmental influences, and he would have spared nothing to learn and apply the child-rearing and later educational techniques that could facilitate the most positive development. But if genetic betterment can contribute, how can we refrain from seeking it? As the first step in genetic betterment, he advocated rational germinal choice. An idealistically motivated group would designate outstanding men and would arrange to save frozen samples of their sperm. By deferring the large-scale use of any of these samples until some decades after the death of the donor, durable appreciation rather than momentary fascination would dominate the rational choice. To begin with, the use of pre-evaluated, stored sperm for artificial insemination would be advertized mainly to couples with male-sterility. Many of these already practice artificial insemination from secret, almost random donors. If this limited experiment gave encouraging results, Muller envisaged that other families would be quite eager to foster at least one child from a historically outstanding donor with genetic qualities of particular appeal to that family. It is hard to criticize Muller's proposal on strictly biological grounds. Our knowledge of the genetics of personality is far too thin to give it solid justification, but the scheme could hardly do any worse than our existing mating system. The main criticism is that it suffers from an excess of idealism. Once germinal choice becomes fashionable, even if initially only within the intellectual elite, how long will it remain rational? Nor can it then long remain free, governmental regulation being quite essential to keep the industry free from misrepresentation in advertising, premature release of sperm, undue economic coercion, incestuous combinations and so on. It has also been argued that germinal choice may interfere with the healthiest family life; however, where sterility or genetic disease has been plainly diagnosed, germinal choice could even vitalize an otherwise hopeless constellation. On the whole, however, a society able to manage germinal choice as an institution may already be wise enough not to need it. Muller's proposal nevertheless brings to a focus many of the fundamental difficulties of any rational system of human biology. A central core in Muller's thinking about the human germ plasm survives the most satirical criticism. His most seminal idea is to conserve rare genetic information. Our social wisdom does not yet tell us how to use such information. But this should not deter us from preserving unusual examples, good or bad, for future research, if not application, just as we seek and save seeds of rare plants for scientific agriculture. From a technical standpoint, it would be well to deep-freeze some small samples of other tissues as well as sperm, to help future investigators to learn how hereditary disease or even genius is encoded in DNA. ______________________________________________________________________ 41 Informed Guinea Pigs The Washington Post - Sunday, April 23, 1967 Modern, scientific medicine rests on controlled observations of human beings. Every person whose health and life has been improved by medical care is indebted to a previous patient who undertook some risk in an experiment for the benefit of his fellows. Clinical experimentation poses some of the most poignant dilemmas of the scientist's responsibility to society, but the responsibility is shared by everyone who benefits from modern drugs and advanced surgery. Intemperate attacks have lately been leveled against clinical research, since we do not yet have workable norms. Nevertheless, for every patient who may have been abused by some insufficiently regulated clinical trial, a thousand patients suffer by being untreated or maltreated with scientifically unsound or less than ideal drugs and procedures. In a society dedicated to personal liberties, no one should be subjected to arbitrary risks against his will. Hence, every responsible physician and clinical investigator would support the principle of knowing consent as the basis for recruiting subjects into research studies which involve significant new risks. The criterion of "informed consent" is, however, still controversial. Its application to situations involving trivial risks may frustrate the experimental design for a trivial advantage of personal security. Equally important, informed consent requires an understanding of experimental medical science that goes far beyond the training of most laymen, and sometimes of the investigators. Will it be necessary for every patient to have the advice of counsel before a physician uses any technique unknown to Hippocrates? Some criticisms of sophisticated medicine could be answered only by such an absurdity. The ethical issue rests in part on the vagueness of the patient's moral responsibility for participating in medical progress, in contrast to the reality of his motives and legal rights to protect his body. How much information must a person have before he could "prudently" risk his life? To take an unhappy example, it is plain that astronauts have volunteered to undertake one of the most hazardous of occupations, but did their informed consent reach to the perception that trial runs on the ground might be more hazardous than spaceflight? Yet far more detailed criteria of informed consent are being proposed for medical research, with grave penalties for physicians and institutions who would substitute their own moral judgments for legally airtight forms. Risk is part of life, but the purpose of medicine is to mitigate hazards. No subject should be asked to make any sacrifice that could be avoided, and especially so if the essential aims of clinical investigation can still be achieved. The very expression "risk" brings to mind "insurance", and there is an important step that we could take to rationalize the participation of human subjects. Besides giving their knowing consent, they should be insured against the potential hazards, the cost of premiums being accepted as a plausible charge to the research projects. A subject who has possibly suffered damages in an experiment should not have to sue for redress on a claim of culpable negligence or fraudulent misinformation, no more than should an industrial employee in a potentially hazardous occupation. The registration of subjects for appropriate levels of insurance would become a self-enforcing system of control, particularly if the patient were required to endorse the registration. It would then be a cause of action if a patient were enticed into an experiment without being insured at a level appropriate to his risks. The cumulative costs of the premiums would discourage the overexposure of patients to risks beyond the significance of the expected results. Above all, the insurance concept would provide a basis of evaluating the rights of the patient-subject, for which informed consent might be an ideal but practically unworkable alternative. Research-risk insurance might be attacked as adding to the costs of research. However, these costs are already paid, in the currency of the risks taken by the subjects, and this is an unfair burden that should be accepted by the whole community. -----------------------------------------------------------------------