Author Jumps Into the Ethical Fray of Embryonic Life

Syndicated columnist George Will suggested earlier this month that, when U. S. Supreme Court justices head off for summer vacation, they take along “Science & the Unborn,” a thought-provoking book by Clifford Grobstein, a biologist from Rancho Santa Fe.

In an unexpected boost, the conservative commentator, called the book “a lucid guide to reasoning about how to assign status to a fetus” and urged that the justices read it before tackling their next round of abortion-related decisions.

“That was a nice touch,” said Grobstein, a UC San Diego professor emeritus who has studied embryology for more than four decades. His “Science & the Unborn” painstakingly outlines what scientists know and don’t know about life in the womb. The book also defines six stages of human development in the womb, and attempts to assign rights based on each stage.

Need for Public Policy

Forty years as a biologist and medical doctor have convinced Grobstein that a zygote, the single human cell produced at conception, should not hold the same legal and social status as a full-grown adult, or even a month-old fetus.

His endorsement of the “pre-embryonic” stage has sparked debate among scientists, most of whom agree with the need for public policy decisions to address the issue of early life.

The book seems certain to outrage right-to-life advocates, who contend that human life should be fully protected from conception on. Already, experts in the medical and scientific community are debating key parts of Grobstein’s six-stage description of “individuality” in the womb.

The book is among a growing number that grapple with the ethical questions raised by rapid advances in science and technology. At the Central Library downtown, it sits on a shelf with “Life Choices,” “Playing God,” “Exploring Medical Ethics,” “Brave New People” and “Tough Decisions.”

One of the key ethical questions Grobstein deals with is whether embryos should be used in medical research. He is among a group of scientists who use the term pre-embryo to describe the first two weeks after fertilization.

Research Uses

Because pre-embryos have not yet attached to the uterine wall, they are “too immature structurally, functionally and behaviorally to warrant classification as a person,” and therefore may be used for research, Grobstein said in the book.

But that research must be carefully controlled because pre-embryos are “recognized as a member of the human family entitled to protection against treatment or deprivation of life that is casual or demeaning.”

“I’m aware that these issues are very difficult,” Grobstein said in an interview. “On some of them we’ll never reach unanimity because of differing philosophies and religious background. But (the book attempts) to give guidance which . . . won’t leave people floundering in a sea of uncertainties.”

Columnist Will wasn’t the only conservative to add Grobstein’s book, published in late 1988, to the must-read list: “It seems to me (the book) would be of interest to anyone who is interested in human life and the protection of human life,” said Richard A. McCormick, a Jesuit priest who serves as professor of Christian Ethics at the University of Notre Dame.

So far, the national debate on the status of embryos and fetuses has revolved almost exclusively around the explosive issue of whether abortion should be allowed.

But Grobstein urges society not to ignore a number of equally pressing public policy issues generated by “developments in reproductive biology and medicine (that) have raised new questions about the status of the unborn.”

Grobstein points to life-and-death questions raised by the growing ability to generate “test tube” babies, the heated debate over fetal tissue transplants and stunning advances in fetal surgery and gene therapy.

He is concerned that the clouded legal status of a rapidly developing embryo could preclude the use of some existing forms of birth control--as well as the introduction of new methods, including the already-controversial “morning after” pill developed by French scientists.

Grobstein worries that research into human development will grind to a halt unless society gives scientists access to cells gathered from early embryos.

And he cautions that decisions made in the near-term could haunt future generations as science makes it possible to discover--and, in some cases, repair--severe abnormalities.

“These things are all caught in the public policy tangle,” Grobstein said. “Although abortion is indeed an important issue, taken cumulatively, the other (issues) cannot play a minor role” as the nation debates the thorny issue of whether an embryo’s status changes as it matures, he said.

What About Extra Eggs?

For example, Grobstein said, society might determine that scientists should be allowed to experiment with cell tissues taken from select newly fertilized embryos, most likely those generated during in vitro fertilization.

Reproductive experts are already facing tough decisions about the status of what Grobstein and others define as pre-embryonic life. Grobstein gives as an example doctors who need guidance on how to dispose of fertilized eggs that are created during in vitro fertilization, but that, for various reasons, are not returned to the donor’s womb.

Those that do not move forward to the next “stage of individuality . . . ought not to be discarded as if there were no value there at all,” said Grobstein, who suggests that those pre-embryos might well be used for research that could benefit humanity.

Not surprisingly, his endorsement of the pre-embryo concept has enraged right-to-life advocates.

“All he’s doing is refining the viability argument” that the U. S. Supreme Court used in the controversial Roe vs. Wade decision in 1973, which legalized abortions but set limits on when they can be performed, said Bob Marshall, director of research for the Stafford, Va.-based American Life League, a 240,000-member organization that opposes abortion.

“He’s talking about an increasing stage of value that society, or Mom and Dad, gets to place on the baby in utero,” Marshall said. “But who the hell am I to place a value on an individual?

They Do or They Don’t

“Either (embryos) have human value or they don’t. Anything (in between) is just allowing me to play God.”

“Grobstein and I agree on many things, but (with the pre-embryo term) he’s creating a boundary that’s arbitrary, that has no great biological significance, in my view,” said John Biggers, a professor at Harvard Medical School’s Laboratory of Human Reproduction and Reproductive Biology.

Biggers has submitted articles to professional journals that seek to counter Grobstein’s contention that a pre-embryonic stage exists for the first two weeks of life.

“ Pre-embryo is a word that was created (for use in public policy debates) that is now being adopted as a scientific word--and it never was that in the first place,” Biggers said.

While he strongly disagrees with Grobstein on the existence of a 14-day pre-embryo stage, he shares Grobstein’s concern that important issues will be ignored or incorrectly decided if status questions are answered solely to end the abortion debate.

Grobstein argues that society must use “the best science” to craft moral, philosophical and theological decisions on the status of an embryo or a fetus. “The early stages of human life have never really been systematically addressed,” he said. “International declarations about human rights are limited to the stages of human life beyond birth. They don’t specifically include . . . the status prior to birth.”

National Commission

McCormick, who said he comes down “pretty conservatively” on moral and theological decisions involving the origins of life, has endorsed Grobstein’s call for a national commission to “frame the issues, and act as a credible force for wide public discussion” of them.

The commission would not “make specific solutions, but (offer) guidance on how these issues would be addressed,” Grobstein said. It would particularly focus on “smoking out” those people who do not readily fall into the right-to-life or pro-choice camps.

“We have to set up a public policy based on consensus, which will be an arbitrary thing,” Biggers said. “But we have to (ensure) that it has a sound scientific basis upon which the philosophy can come out.”

Grobstein maintains that Americans have exhibited “an almost deliberate avoidance (of the status question) because of the difficulties, the sense of contentiousness of the issue.”

Such avoidance means that medical professionals are faced with the “stern reality” that the interests of a fetus might be at “cross-purposes with maternal and familial wishes.” On a daily basis, Grobstein wrote, doctors and parents, lacking public policy guidance, must use a “tortured calculus” to determine whether heroic efforts should be extended to save an extremely premature and very sick infant.

Reproductive experts “would feel much more comfortable . . . if their responsibilities” were better outlined, he said.

Father of Five

Grobstein, 73, first grappled with public policy issues shortly after an Army Air Force hitch in the waning days of World War II.

Then, Grobstein’s concern was the seemingly rapid spread of atomic weapons. The father of five and grandfather of eight has since studied public policy issues surrounding population growth and genetic engineering.

Medicine has become something of a family affair along the way: His wife, Ruth, is a radiation oncologist at Scripps Clinic in La Jolla, two children are doctors and a third is married to a doctor.

Grobstein has written an earlier book, delving into the societal questions generated by genetic engineering. He is preparing another that will “look at life from a cosmic perspective, through cosmology, astronomy, etc.”

“I regard (the study of social issues) as my profession at the time,” Grobstein said. “My own opinions are just like everyone else’s . . . but what I try to provide is a professionally guided approach” to complex social and scientific issues.

“I don’t hold myself forth as philosopher,” he said. “I’m a scientist and I deal with issues as a scientist who is interested in public policy issues.”

Some of Each

Despite that disclaimer, Grobstein has acknowledged that his most recent book will appeal to “people who are on the pro-choice side than the right-to-life side.”

He describes himself as “both pro-choice and pro-life. I don’t see how any thinking and morally inclined people can fail to be both pro-life and pro-choice.”

Grobstein’s interest in reproduction grew from initial work begun 40 years, when he spent days in the lab conducting experiments on material drawn from mice embryos.

While scientists continue to learn about the origins of life from mammalian research, Grobstein believes that certain questions will be answered only through “research on human rudiments.” But it is up to society to “specifically analyze” whether scientists are to have access to human cells drawn from embryos, he said.

For Grobstein, the final decision should reflect the diverse nature of the United States.

“We’re committed to a public policy that’s not expressive on any specific religious doctrine,” he said. “We have to be tolerant of a diversity of religious doctrines, which has always been an important element of American public policy that is to be defended at any cost.”

Grobstein expects medical and scientific experts to help frame the policy questions. But he said the debate isn’t only for professionals: “Even though in one instance it’s a man and woman in the bedroom and in the other its a scientist in the laboratory, it involves people making decisions . . . on matters that are both extremely important to them and the entire society,” he said.