Science in Christian Perspective

An Ethical Evaluation of Biogenetic Engineering
BERNARD RAMM
Eastern Baptist Theological Seminary
Philadelphia, Pennsylvania

From: JASA 26 (December 1974): 137-143.

The Ramm Defect

In his article on the "Prenatal Diagnosis of Genetic Diseases" Dr. Friedmann¹ tells us that there are 1600 diseases traceable to genetic defects. May I add one more. It is the Ramm defect. It is a defect which prevents a person from saying "no" to a request beyond his education, experience and competence.

Some unknown biologist describes it (by anticipation) as follows,

Oh chromosomes, my chromosomes,
Flow sad is my condition! 
My grandsire's gift for writing well
 Has gone to some lost polar cell 
And so I Write this doggerel, 
I cannot do much better.²

If I knew when I was asked to discuss this issue what I know now, I would never have accepted the request. The more I read the more impossible seems the task. Many times I wanted to send in a letter of resignation but I was restrained by Christian charity. I knew that I would be hanging the weight of the dread anchor on some other dear Christian's neck.

Purpose: To Propose Ethical Guidelines

My purpose was to read the literature on the subject, to attempt to sort out the ethical issues, and to propose some guidelines of an ethical nature in the matters of genetic engineering - the latest of the scientific explosions.

I make no pretense of being a quasi-doctor or quasi-lawyer. The technical details, statistics and mathematics of the subject can be learned from the informed literature on the subject. My specialization in this issue is in ethics. I have never delivered a baby. I have never seen genetic materials through a microscope. I have never tried a case at law. My practice of surgery has been limited to extracting slivers from the hands and feet of my children.

When I read the genetic materials, I had one aim in mind: what were the ethical implications of what was being said? When I read an article, I would ask myself; "What are the writer's ethical presuppositions?" "What criteria of an ethical bearing is he using to sort out the right from the wrong?" "What ethical imperative dictates his conclusions if he makes such conclusions?" It is this sort of specialized reading of the literature that gives me the confidence to write this paper.

The most difficult part of my assignment was that the materials on genetic engineering were so heavily loaded with factual material, and so little with ethical issues.³ Perhaps ethical opinions about some specific procedure were expressed but we are far more interested in broader ethical theorizing. For the most part it was left for me to do the ethical diagnosing or interpreting. This involves risk and I simply had to take the risk. There is also the dilemma of bibliographical materials. Time magazine reported in a recent issue in its essay on man that in a given year 25,000 books on science were published and 1,000,000 articles.⁴

A Basic Cultural Shift Concerning Genetic Defects

The first major fact that I encountered as I started reading the materials is that a major cultural shift has taken place in our society in the past century.

In my reading of the sermons of the nineteenth century I found that the general prevailing opinion about defective children was that God had sent them to us that we might learn the lessons of grace (Calvin had said earlier that God sent us idiots from time to time that we might thank him for our reason.) The care, the labor, the money and the love given to a defective child were to teach us how God loves poor, needy sinners. Our care of defectives, whose whole existence depended on our sacrificial care, would enable us to grasp with some depth the meaning of divine grace for helpless and guilty sinners.

This kind of mentality has not ceased to exist. A very lucid illustration of it can be found in Dale Evans Rogers' book, Angel Unawares.,⁵ In this book she relates how she, her husband, and her other children learned depths of compassion and love far beyond them if they had not eared for a defective child.

In the mid-twentieth century married couples have come to look at defective children as a heavy burden. They are apprehensive of the implication that there was "insanity in the family." But even more. The care of such a child interferes with their social life as well as their vacations. Besides the special hours of care and energy spent, there could also be hundreds of dollars of medical hills per month. They also read of the damage that a defective child could have psychologically on the other children of the family. Hence a defective child is no longer looked upon as a lesson through which we learn of God's mercy and patience with sinners, but as a terrible burden on one's time, a severe limitation of one's social life, and a heavy strain on the family's financial resources.

The proof of this transition in mentality is substantiated in genetic counseling.⁶ One of the most significant things to inform parents who have had a defective child is the statistical possibility of having a second such child. The figures vary with the nature of the disease so they may run from 1 out of 4, to 1 out of 400. Surprisingly the most important factor in the minds of couples with regard to having another child is not the statistical possibilities but the sheer bother of having a defective child. Stated another way this means that the prime concern of the couple being counseled is the nuisance potential of another defective child.

In the mid-twentieth century married couples have come to look at defective children as a heavy burden.

Why Ethical Guidelines are Difficult to Formulate

Most of the definitive original statements about medical ethics have been made by Roman Catholic moralists prior to the time of our current detailed medical information. A moral rule without adequate factual basis can he a very mistaken one. 
Our first task is to unburden ourselves from decisions made in the past without adequate medical knowledge.

General moral virtues such as wholeness, love, "the good," or redemption are difficult to translate into the specifics of medical ethics. Two Christians dedicated to the same ethical virtue may arrive at opposite conclusions.

It sounds as if this next observation contradicts the previous one but in reality it does not. Medical ethics is a special case of ethics. Ethics in turn emerge out of one's total outlook on life. Hence to have a system of ethics one needs first a philosophy; from this philosophy one proceeds to construct his ethics; and from ethics in general one goes on to medical ethics and finally to genetic engineering. We have been asked to fill out a questionnaire (Journal ASA, June 1974) with several specific items. The list of questions gave me the impression that the Christian was to attempt to find the Christian solution for each question as he worked his way through the questionnaire. My point is that a really comprehensive Christian view of life and reality is required before one is able to answer the particular questions.

The speed of the acquisition of new knowledge poses a very difficult task for any person working in the field of ethics. Scientific knowledge is supposed to double every five years. On the other hand, moral principles and systems of values take decades and centuries to pound out. A new breakthrough in science may come overnight. A moral evaluation ot the implications of the breakthrough may take a century to mature. With the principle advances in genetic engineering hardly a decade old, the ethicist simply has not had the time to think through all their implications.

Our American society is becoming increasingly pluralistic. The more pluralistic a society becomes, the smaller becomes the common ground to which appeal can be made for ethical decisions. This "paralysis of pluralism" spills over into medical and biological ethics and makes it difficult to arrive at common ethical interpretations.

Our society has no methodology for resolving the very difficult nest of ethical problems our technological explosion has produced. This technological explosion is felt the strongest in the embarrassing position into which it has placed medical ethics. Let us look at the ways this problem has been attacked.

(a) Leroy Augenstein reports in Come Let Us Play God⁷ that be would present a typical problem in medical ethics to a congregation. Then slips would be passed out and a vote taken. It was not unusual to get back 80% of the slips blank! Apparently we cannot solve our medical ethical problems by appealing to the common consent of Christian conscience. Such problems are too bewildering for the lay mind to interpret.

(b) Suppose that we appeal to Christian theologians who have specialized in medical ethics. Unfortunately there is no consensus here. Paul Ramsey is very cautious and conservative; Joseph Fletcher is very pragmatic and utilitarian; and Gabriel Fackre is open-ended and wide-eyed in his medical ethics.

(c) We may turn in another direction. Perhaps we could appeal to a representative committee from the community, as if such a carefully chosen committee would represent the common moral consciousness of the community. This was (done by the Swedish Hospital in Seattle and is known in the literature as "the Seattle experiment." The problem in this situation has already been anticipated. In our pluralistic society we have no common value system. How, then, can we determine who is the most valuable man for a community among a list of candidates for a dialysis machine? Is it the pharmacist who is the important link between the doctor and the patient with our healing medicines? Or is it the social worker working on healing the ills of the community? Here again we encounter failure or at least serious difficulty in practice.

(d) Then some one approaches us from our blind side: the lawyer. Perhaps it will not he the scientist, nor the philosophers, nor the theologians, nor the priests who will write our texthook on medical ethics, but the lawyers.
As seen in Michael Hamilton's hook, The New Genetics and the Future of Man,⁸ and in Should Doctors Play God,⁹ edited by Claude Frazier and Morris Fishhem, the lawyers have already entered the discussion. The suggestion now comes that the new medical ethics will be worked out in hard eases at law.

Germain Grisez has written the most thorough book on ethics and abortion in recent years,¹⁰ (Abortion: The Myths, the Realities and the Arguments). He has made the most thorough investigation of the decisions of courts, especially about the legal status of the fetus. He has found that the general trend of the law is to treat the fetus as a legal person and not merely a piece of tissue in the mother. My point here is not to settle anything about abortion, but to show how large a role the courts play in settling matters of medical ethics.

A new breakthrough in science may come overnight. A moral evaluation of the implications of the breakthrough may take a century to mature.

Recently we have had the Supreme Court itself making a decision about abortion. It did not make a mere general ruling shout abortion, but set out the legal status of the fetus (by implication) during the three periods of pregnancy.¹¹ The point again is not to comment on abortion, but to comment on how medical ethics is being settled by courts, and not by theologians, philosophers, rabbis, priests, or doctors.

The Seriousness of Ethical Issues

Why has such an enormous literature mushroomed up around genetics and ethics? How much is at stake?

1. The public and the academic worlds respond more strongly toward developments in the life sciences because they eventually may be applicable to man, whereas there are not the same kinds of existential implication in the more impersonal sciences. The one exception is ecology; here physics and chemistry are part of man's concern because their use in industry is part of the infection of the planet upon which he must live.

2. In genetic engineering the biologist and doctor are working with the building blocks of life itself. Granted the division between our genetic cells and our somatic cells is not as sharp as once thought, the distinction still remains in a broad sense. Hence to experiment with genetic cells is to experiment with our future in a way that is not done in working with somatic cells.

3. There is the factor of irreversibility. One of the reasons scientists deplore the extinction of a species is that with its extinction goes the loss of its genetic materials. It brings us to the end of a line. By the very nature of genetic materials we can go down a street so far that we cannot turn around and come back.

4. Doctors cars now keep alive 90% of babies born with genetic defects. This success in lifesaving leads to what is called the contamination of our genetic pool. Just as some have spoken of the heat-death of our world, others now project the genetic death of the human race through such genetic contamination.

5. There are the "weirdo" speculations about genetic warfare (drop virus dust over the enemy and so weaken him genetically that he has no will or capability to fight), cloning soldiers, geniuses or athletes (which will affect the Olympic Games!) or modifying men so that we can have legless astronauts, etc.

6. We should do all we can to eliminate as many as possible of the approximately 1600 genetic oriented diseases. By amniocentesis we can detect at this point (according to Dr. Friedmann) about forty genetic diseases; we must seriously face what this means for the current practice of medicine.

7. Genetic counseling is one of our newer specialties. Fewer defective children will be born the more expert genetic counselors we have. If I interpret the nature of sickle cell anemia correctly it would be eliminated by expert genetic counseling with no recourse to abortion.

Alternative Ethical Systems

The literature soon made apparent to me that writers in the fields of genetics and medicine were making ethical decisions based on a larger ethical system. For me, then, the issue was to attempt to locate and define these larger ethical systems. The systems that I present are to be seen more as programs or policies rather than as a set of tight ethical rules. To some measure they overlap and for purposes of communication I have given them labels. Some scholars consider a label a libel, but I felt for the purposes of clarity I would run the risk of this criticism.

Theory 1: Person-centered medical ethics. Each patient is a person before he is a patient and when he becomes a patient he is still first a person. He is a unique center of values and must be so respected. If he becomes only another case, another bed or the unwitting subject of experimental medicine his dignity as a person has been violated. All biological and experimental and genetic work must he done within this framework. (Ramsey. Kass)¹²

There are five reasons why person-centered ethicists think the way they do. These five reasons are also criticisms of the utilitarian view which we review next.

1. They are apprehensive of the amount of unannounced medical experimentation that is taking place today in medical practice. This raises the problem of consent, which is one of the stickiest in medical ethics.¹³

2. They are still apprehensive of the terrible abuse of medical experimentation by the Nazis - a paradigm of what may happen whenever the state makes the rules in medical ethics.

Recently it was suggested that each baby be tatooed with his social security number in his arm pit upon birth as his permanent identification. The arm pit was chosen, as in all kinds of accidents that part of the human body was most likely to survive destruction. The protest of the Jewish doctors present was immediate and forceful, for still strong in their minds was the Nazi practice of branding people with numbers on their arms.

3. They are very apprehensive of the recency of the major advances in genetic engineering most from the 1960's-and therefore the tentative character of our knowledge. We are in no position as yet to have any sort of policy or program in genetic engineering for the masses.

4. They are very apprehensive of a certain amount of double-talk in the literature. The word "therapy" is used many times when it is not therapy at all. To eliminate a person from existence is not therapy! For example, an abortion, no matter how well it may be justified, is not therapy. The notion here is that certain practices may not he contested if called "therapy," but might be if more accurately labeled as "feticide."

5. The theological wing of this school believes strongly that Genesis 1-2 set out the pattern in which our true humanity is discovered and realized. It is in the male-female, husband-wife, and parent-child relationships in which we realize our humanity. Our humanity is destroyed and not established in the world of test tube babies, plastic wombs, frozen embryos and computerized ovum and sperm banks.

In our pluralistic society we have no common value system. How can we determine who is the most valuable man for the community among a list of candidates for a dialysis machine?

Theory II: Utilitarian medical ethics. Utilitarian is not used here in a pejorative sense. Rather, it is the best description of the general policies governmental agencies follow in matters of public health. The health of a large population cannot rest upon personal choices. We do things on the principle of the best possible good for the most number of people. Rules of immunization, sanitation, purity of food, and control of drugs are all city, state or national policies. This is the only way we can live together in safety and freedom from plagues and epidemics. Therefore in that we are all pan of the one human genetic pool such matters of medical decision should eventually he made on a utilitarian basis as they are with infectious diseases.

I register this as a dominant mood in the literature although I cite no names. However it was the implication of numerous articles and hooks, although the authors might be startled to know that in essence they were arguing for a utilitarian ethic.
For example, one segment of Jewish descent suffer a high incidence of Tay-Sachs disease. Deterioration and death occur within four years in infants so affected. As far as I could ascertain in my reading, all Ashkenazy Jews wish that they were free from this disease; this is a utilitarian judgment.

Or all blacks could wish that sickle cell anemia could he eliminated from blacks in America. In fact some extremists have charged the practice of medicine by white doctors as a form of racial genocide in their ignoring of sickle cell anemia among blacks. The black desire for the elimination of this disease among all blacks is a utilitarian judgment.

The logic follows, then, that if 1600 of our diseases are of a genetic origin, there should be some sort of law that helps to reduce that number. Further, the more extreme of these diseases of genetic origin cause such suffering, demand so much money and care, and require so much personnel for maintenance of life, that some sort of across-the-board law should exist for the decrease and at best elimination of these severe diseases. We are all together in the human genetic pool. Hence only a ultilitarian ethic is adequate to cope with the problems.

Already Denmark has adopted the utilitarian ethic: no couple in Denmark with a serious genetic defect in their heritage may marry without sterilization. The beginning of a genetic, utilitarian ethic is found in the U.S.A. in states like Massachusetts and New York which have a mandatory sickle cell anemia test for children entering their school system .¹⁴
There are two opposing points that should be made with respect to a utilitarian ethic. First, does the very nature of genetic diseases (being involved in the reproductive process) keep the ethics of practice of our genetic knowledge forever in the personal dimension? To many the obvious answer is "yes." Second, if genetic diseases do affect the total genetic pool, and if way down the line we may even dream of the genetic death of man, does not this demand that to some measure our ethics about genetics be utilitarian? Those who believe that as we eliminate infectious diseases and other diseases that kill especially children, we also materially increase the incidence of genetically originated diseases, will say "yes."

Theory III: Utopian or Futurologist medical ethics. Given enough time with the growth of our knowledge of genetics we may eliminate most if not all of man's genetically caused diseases. Furthermore, we may use this knowledge for the continuous perfection or use of the human race. (Gabriel Fackre, A. J. Muller, R. L. Sinsheimer).

A. J. Muller has written in most technical detail of the continuous contamination of our gene pool. Although he does not have the dreams that Fackre does, he does believe something remedial must be done to preserve the relative purity of our genetic pool.¹⁵

In glowing terms Sinsheimer projects a genetic utopian future:

We now glimpse another mote-the chance to ease the internal strains and heal the internal flaws directly-to carry on and consciously to perfect, far beyond our present vision, this remarkable product of two billion years of evolution. We are, it is true, very young for this task-young in skills, young in wisdom-hut also fortunately young in heart^.l6

Gabriel Fackre has written many articles on man's genetic future, characterized by "futurology." This is a new mood in theology called neo-optimism or even neopostmillennialism. According to Fackre, God has turned the universe over to man to subdue it. This means to Fackre not only to clean up crime, poverty and injustices, but to do miracles with our new genetic knowledge. He operates with the categories of liberation and shalom, Among the many things meant by liberation is liberation from all genetic defects. By shalom (the Hebrew word for peace) he means wholeness, richness, and the healing of defects. If man is guided by shalom in his genetic engineering, he will not do the terrible things the Nazis did. Fackre has written much more on futurology, science and genetics but we cannot give his views more space.
Both Christian and non-Christian are slowly coming to the conviction that the supreme norm in ethics is the quality of life and not the sheer fact of life.

Utopian ideals indicate that genetic engineering is concerned not only with clearing up problems of health and disease, but also with those speculative and positive things it might do. We may gradually increase the "intelligence quotient" of the entire population; we may breed a man with more moral and artistic sensitivities; we may clone geniuses by the dozens and accelerate science, or art, or whatever we wish. It has already been prophesied that the Olympic Games twenty years from now will reflect genetic engineering to produce better athletes. Cloning may also solve the problem of tissue rejection in transplants. Perhaps we shall solve some of our pressing problems in the area of aging. The greatest achievement of all was suggested by a theologian, no less, who said that we should locate the gene which carries original sin and knock it out with a laser beam!

Fackre faces the issue raised by Ramsey about Genesis 1-2 and the meaning of life. He thinks there are many ways of creating meaningful human relationships other than the Genesis pattern. Therefore the new world of genetic engineering does not disturb him at this point. We might add that the Russians and Chinese apparently consider children the ward of the state and have set up massive day care centers with minimum contact of mother and child. In time we will know if such a disturbance of the traditional family pattern is harmful or not.

Theory IV: The humanitarian ethics of scientists. It is unfair to pick out the biologists and doctors and make them special targets for discussions about ethics. They are scientists among scientists. They have their own internal control and standards. They do not torture animals. If pain is involved in any experiment it is treated as humanely as possible. If we trust physicists, chemists, and geologists, why not trust biologists and doctors? Their aim is the good of man and we may then trust them in their laboratory work and not mark them out for subjects of ethical harangues) ¹⁷

The argument is not difficult to construe. Scientists make progress only as all options are open to them. Geneticists and doctors need this breathing room too. If society puts restrictions upon them in the name of humanity they may be doing a very inhumane thing inadvertently. A certain experiment may outrage somebody's sensibilities, but it may lead to a cure for schizophrenia. What may appear to some person as a barbarous treatment of a colony of rats may lead to the cure of cancer.

If there are 1600 diseases of a genetic origin, the genetic engineer should be encouraged in every way and not hemmed in by law or censorship.

There is another assumption which goes with this theory. In fact, the assumption may be the theory itself. If scientists achieve the cure of a disease it is then assumed that the cure is moral. If the cure is moral, then the means of achieving the cure is moral.

It could he argued that this is the history of medicine. We no longer consider the dissection of a body as desecration of the human body. When a surgeon operates on us we want him to know our interior geography very expertly. We no longer consider anaesthesia an attempts to avoid the pain from our "curse unto death". Millions of surgeries performed every year to heal bodies and save lives would be impossible without it.

In short, if the proof of the pudding is in the eating, then an edible pudding is an ethical pudding. This comes out clearly in the study of Roman Catholic medical ethics. The Roman Catholic laymen are steadily drifting towards a medical ethics which virtually says that what cures or helps is moral, rather than taking their guidance from Roman Catholic moralists. About 100% of the girls brought up with strict Roman Catholic training will (prior to the time of their marriage) consider birth control to be wrong. After they have had five or more children, 60% and perhaps more will accept it as moral.
Applied to genetic engineering, this approach means that as geneticists rid us of our genetic diseases or greatly reduce their effects, we will consider their work as ethical. Reinforcing this is the concept that the fundamental consideration in medical ethics should be the quality of life and not the mere existence of life.

Concluding Observations

1. I think that, of the four options mentioned, the first is the most viable for most Christians. At least they are more comfortable with it. It is a general conviction that the more morally sensitive portion of our population (theologians, priests, rabbis, ministers, humanitarians, scientists) should have a larger say in medical ethics than lawyers and politicians (speaking of them as a class and not as persons).

2. I think that the medieval moralists were generally right in arguing that ethical decisions must grow out of a total worldview. Their program was right; their error was a lack of knowledge and perhaps some of the additional stuff that must go into such a total world view. Unfortunately Christians suffer from pluralism as much as society. Hence there is no great evangelical Christian synthesis today. This is an embarrassment for the contemporary evangelical, for he is as tormented about medical ethics as others who investigate the subject.

3. I think that both Christian and non-Christian are slowly coming to the conviction that the supreme norm in ethics is the quality of life and not the sheer fact of life.

This issue comes out critically in the unnecessary prolongation of life. It is more and more felt that the notion that the patient is to he kept alive at all costs is less and less capable of defense.

It also comes to the surface over the question: "When does human life begin?" Supposing we consider that to be a false question or a misguided question. There is no agreement on the issue. For the first ten days or two weeks of pregnancy there is no way of knowing whether the woman actually has a fetus or a growth. But if we ask: "What is human life intended to he?" perhaps we can get around this highly emotional question. If the goal of life is a mature, rational integrated adult, then we may say that any human life that is way off course and can never reach that goal can never fulfill what it means to be a complete human person. When medical ethics becomes passionately concerned with what is headed way off target and deciding if such a monstrous or defective fetus ought to survive, then the endless question, which to this point has defied all moralists and biologists, "When does human life begin," is avoided.

Although the ethical content of the material on genetic engineering stresses the moral and humanitarian goals of such engineering as well as physical wellbeing, the emphasis comes down hard on the latter. Perhaps with scientists doing all the experimental work in this area, this emphasis on man's physical well-being is inevitable.

However it has been the contention of the Christian Church that people who suffer from illness, disease, and bodily defects may nonetheless reach spiritual maturity if not sainthood. Disease itself need not be seen as necessarily damaging spiritual self-fulfillment.

The greatest Christian drama of the twentieth  century is judged to be T. S. Eliot's The Cocktail Party. It is a study of modern man's discontent, unhappiness and undiagnosed sense of emptiness. The solution to this spiritual disease is found by the heroine Celia. Celia finds herself and beatific happiness by the hard route of self-denial, cross-bearing, identification with the suffering of Christ and finally martyrdom. One's true humanity, identity and sense of fulfilment in life are found by the way of suffering and self-renunciation. Modern medicine unintentionally creates the illusion that a perfect genetic heritage and a healthy body are the achievement of the fulfillment of our humanity. T. S. Eliot's The Cocktail Party is a brilliant reminder that man treads not only a pathway of physical evolution, growth and improvement hut he also treads a spiritual pathway which is governed by far different rules than the former.

Modern medicine unintentionally creates the illusion that a perfect genetic heritage and a healthy body are the achievement of the fulfillment of our humanity.

This intense concern with the physical side of man in which modern medical science (and again I believe unintentional) gives the impression that good health and the realization of our humanity are identical, is given a satirical commentary in Paul Ramsey's rephrasing of the twenty third Psalm. Ramsey wants to "blow the whistle" on those moderns who are so occupied with the problems of man's physical well-being as achieved through science as to he completely dense about man's spiritual journey. Hence this paraphrase will be understood only if the satirical element in it is grasped.

The Lord is my Genetics Counselor, I shall not want for risks.
He maketh me to lie down in genealogies; he nondirects inc beside karyotypes.
He restoreth my inborn errors; he leads me in the paths of reproduction for my name's sake.
Yea, though I walk through the valley of amniocentesis or under the shadow of fetoscopy, I will fear no evils for thou, the Greatest Good of the Greatest Number, art with me; thy chromosome counts and thy enzyme assays they comfort me.
Thou preparest multi phasie screening before me in the presence of my illnesses; thou anointest my head with check-ups; my profile runneth over.
Surely mutations and heterozygosity shall follow me all the days of my life; and I shall dwell in the house of computerized biomedical information forecer.¹⁸

FOOTNOTES

¹Theodore Friednsann, "Prenatal Diagnosis of Genetic Disease," Scientific American, 225:3451, November 1971
²George B. O'Tnnle, The Case Against Evolution (New York: The Macmillan Company, 1925), p. 42.
³For example McClearn has written a very thorough survey on the whole territory of genetics but not a line on the ethical implications of genetics. "Genetic Influences on Behavior Development." Paul H. Mussen, editor, Conaichael's Manual of Child Psychology, Vol. I. Third edition (New York: John Wiley and Sons, 1970), pp. 39-76).
⁴Time, 101:84, April 23, 1973.
⁵Westsvood: Revell, 1953.
⁶ V. Elving Anderson, "Genetic Control and Human Values" (Minneapolis: Dight Institute of Genetics, The University of Minnesota, unpublished paper, October 20-21, 1972)
⁷New York: Harper and Rosy, 1969.
⁸Grand Rapids: Wm. B. Eerdmaus, 1972,
⁹Nashville: Broadman Press, 1971.
¹⁰R. J'. Gerber, "Abortion: Parameters for Decision," Ethics, 82:137-154, January 1972.
¹¹Cf, James Dc Burst, " 'A New Constitutional Right,' The Supreme Court and Abortion," The Reformed journal, 23:7-10, April 1973.
¹²Paul Ramsey is the most articulate developer of this viewpoint. Cf. his The Patient as Person (New Haven: Yale Press, 1970) and his opinions on cloning, etc. in Fabricated Man (New Haven: Yale University Press, 1970)
¹³Cf Frazier and Fishbein, ibid., pp. 83-98.
¹⁴Oue of the developments of this that is bothering the ethicist is that insurance companies have been able to get hold of these tests and feed them into their computer system. Hence the rates of patients with sickle cell anemia runs much higher. This is just more of the continuous erosion of the rights of privacy in our American democracy.
¹⁵A. J. Muller has written many articles on the subject. His article which stands as a kind of summary of all his articles is "Should We Weaken or Strengthen our Genetic Heritage?" Daedalus, 90:432-450, Summer 1961.
¹⁶Robert L. Siusheinser, "The Prospect for Designed Genetic Change," American Scientist, 57:134-143, 1969, p. 141, One of the finest summaries of the issues of this paper will be found to be that of R. J. Berry, "Genetic Engineering," Christian Graduate, 26:3-8, March 1973. In it he cites Sir Maefarlane Bruuett who strongly asserts that the possibility of knocking out a defective gene and inserting a healthy one is so remote that it will perhaps not happen "to the last syllable of recorded time." p. 5.

Furthermore the conference at San Diego indicated how tentative amniocentesis is at the present time. Some criminals have been found to have the XYY pattern at the sex chromosome which made them anti-social, hence criminal. But other men with the same XYY pattern are normal in their social relationships. In other eases a parent will have the same chromosome defect as the defective child yet the parent will be a normal person.
¹⁷This attitude is clearly stated in Gerald Leach, The Biocrats: Ethics and the New Medicine (New York: McGraw Hill, 1970), p. 14ff.
¹⁸Cited in the JAMA, March 13, 1972 and reproduced in Bulletin of the Atomic Scientists, p. 16, December 1972, Vol. 27.
As the reader will note my article is far more general than the specific topic of amniocentesis. The discussion at San Diego centered more on the issues amniocentesis raised than the general subject of medical ethics. Amniocentesis enables the doctor to know about the fourteenth week of pregnancy if the fetus is bearing one of the forty genetic defects which can he so detected at this time all of which may have serious effects upon the neurological system of the baby svhen born. Furthermore, at our present state of knowledge, predictability in amniocentesis is very low, i.e., we cannot always assume with certainty that a given chromosome pattern means that the child will actually he horn with these defects. But granted all of that, the central ethical issue is whether such prenatal knowledge of serious physical detects is a new and justifiable basis for abortion. There is no meaning to doing amniocentesis unless it is already assumed that abortion of defective fetuses is morally justifiable.

BIBLIOGRAPHY

The following bibliography is composed of entrees which do not appear in the footnotes.

I. BOOKS

Bosenfield, Albert, The Second Genesis: The Coming Control of Life. New York: Prentice-Hall, 1972.
Roslausky, John D., editor, Genetics and the Future of Man. New York: Appleton-CenturyCrofts, 1966.
Smith, Harmon L., Ethics and the New Medicine. New York: Abingdon, 1970.
Taylor, Cordon Rattray, The Biological Time Bomb. New York: New American Library, 1969.
Young, David P., A New World in the Morning: The Biophysical Revolution, Philadelphia: The Westminster Press, 1972.

II. PERIODICALS, ESSAYS.

Faekre, Gabriel, "Faith and the Science-Man Questions," Christianity and Crisis, 27:315-318, January 8, 1968.
______"Redesigning Life: "Scenarios and Guidelines." Claude A. Frazier and Morris Fishbeiu, editors, Should Doctors Play God? Nashville: Broadman Press, 1971. Pp. 99-115.
_______"Biomedical Research," Theology Today, 27: 409-421, January 1971.
Huisingh, Donald, "Should Man Control His Genetic Future?" Zygon, 4:188-199, June 1969.
_______Lappe, Mare, "Moral Obligations and Genetic Control," Theological Studies, 33:411-427, September 1972.
"How Much Do We Want To Know About The Unborn," The Hastings Center Report, 3:8-9, February 1973 [Lappe is extremely critical of amniocentesis].
Lederberg, Joshua, "Experimental Genetics and Human Evolution," American Naturalist, 100:519-531.
Lincoln, C. Eric, "Why I Reversed my Stand on Laissez-Faire  Abortion," The Christian Century, 90:477-479, April 25, 1973.
Nelson, Robert J., "What Does Theology Say About Abortion?" Christian Century, 90:124-128, January 31, 1973.
Rebinowiteh, Eugene, et. al., "Can Man Control His Biological Evolution?" Bulletin of the Atomic Scientists, 27:12-28, December 1972.
Robin, Richard, "Recent Developments in Genetics," Theological Studies, 33:401-410, September 1972.
Smith, John Maynard, "Eugenics and Utopia," Daedalus, 94: 487-505, Spring 1965.
Walters, Leroy, "Technological Assessment and Genetics," Theological Studies, 33:666-683, December 1972.