Advances in biotechnologyare driving new moral debates.

October 3, 2000 -- In a breathtaking breakthrough for medical science, a Colorado couple used genetic tests to create a test-tube baby that would have the exact type of cells needed to save their 6-year-old daughter. The medical advance comes weeks after a British court made another highly controversial landmark decision in medical ethics.

The Colorado couple, Lisa and Jack Nash had a daughter, Molly, who suffered from an inherited bone marrow deficiency that is universally fatal without a transplant. The only effective treatment requires a transfer of healthy cells from a perfectly matched sibling. The couple used a new method called preimplantation genetic diagnosis', in which embryos are fertilized outside the womb, and then a single cell is removed from the embryo for testing. Embryos that test negative for the faulty gene are reimplanted in the womb.

The healthy baby boy, named Adam, was born in Denver on Aug. 29. Doctors collected cells from his umbilical cord, a painless procedure, and on Sept. 26 infused them into Molly's circulatory system. She is recuperating in a Minneapolis hospital, and doctors expect to be able to determine the procedure's success within a week or so.

Scientists are calling the procedure both a promising and worrisome harbinger of where scientific advances are taking human reproduction in the near future. The experience of the Nash family shows a benefit of genetic research and in vitro fertilization weeks after the medical community contemplated a British court's decision in an extraordinarily complicated and difficult case.

A British appeals court ruled Friday that six-week-old conjoined twins must be separated, even though the operation will almost certainly mean the death of one of them. The desperate parents fought unsuccessfully through the British legal system to prevent the surgery.

The parents came to England from the Mediterranean island of Gozo when the mother was six months pregnant because they had learned that the babies were joined at the lower abdomen. Their daughters "Jodie" and "Mary" names assigned to them by the courts to preserve anonymity were not merely joined, but Mary had only a "primitive brain" and relied on her sister for heart and lung function. Separating them would kill Mary but improve her sister's chances for survival. Leaving them conjoined would most likely mean the death of both.

When the physicians announced plans to proceed with the separation, the Roman Catholic parents refused, arguing that they could not condone the killing of one child to save the other.

Lord Justice Ward, one of three judges hearing the case, articulated the quandary presented by the medical circumstances. "I freely confess to having found it truly difficult to decide," he wrote in his decision. "Difficult because of the scale of the tragedy for the parents and the twins, difficult for the seemingly irreconcilable conflicts of moral and ethical values and difficult because the search for settled legal principle has been especially arduous and conducted under real pressure of time."

"Saving one is better than none' superficially makes sense, but in reality it can never be right for doctors to kill one person to benefit another," says Colin Hart, director of the Christian Institute, a nonprofit organization which seeks to promote the Christian faith in the United Kingdom. "Judges and doctors must not play God. Just because an operation can be performed doesn't make it right."

While the conjoined twins have focused attentions on matters of ethics and the definition of life, experts in the U.S. believe that the case reflects unique aspects of the British legal system's tradition in dealing with medical cases.

"The British case is interesting because of all the complicating factors, but probably does not represent a watershed case in bioethics," says Gregory E. Kaebnick, editor of the Hastings Center Report, a bioethics journal. "My understanding is that British courts are more willing to step into the place of the parents than American courts are. You wouldn't expect this decision in an American court."

"There is a danger of reducing human beings to a means to an end," says Theresa Wagner, policy analyst for the Family Research Council. "There are risks of a precedent in a case [like the Nashes], where people create human beings in order to serve other human beings It segues to [the conjoined twin] case, where the principle in that instance, that for the weaker one, her death is necessary to save the stronger one. The principle is forming, where you begin to have the interests of one human being subordinate to the interests of another human being."

While the complicated medical issues have received limited attention from policymakers and legislators, health policy experts predict that debate will continue on whose authority is paramount in difficult medical cases: the parent, the doctor, or some other established medical voice or code of ethics. Even the judges in the British twin case recognized the limits of their expertise and confidence in their decision.

"The point at which life becomes worthless', and the point at which the means necessary to preserve it become extraordinary' or inappropriate', are neither set forth in the constitution nor known to the nine Justices of this Court any better than they are known to nine people picked at random from the Kansas City telephone directory," wrote Ward.

Medical Science Advances Benefit Humanity	Is Life Itself Becoming A Commodity?