Many years ago, the esteemed patriarch of bioethics, Joseph Fletcher, spoke loud and clear in favor of rationality in reproduction. By rationality, he meant not merely limiting population growth, which he certainly favored, but bringing to bear human analytic and creative intelligence on the random and instinctive activities of sexual intercourse and procreation that we share with all mammals. In his 1974 book, The Ethics of Genetic Control: Ending Reproductive Roulette, he foresaw most of the issues that we are facing today. He reflected on artificial insemination, prenatal diagnosis, cloning, eugenics, ectogenesis, ovum transfers, and genetic engineering. He examined these innovations to the extent that he felt that each of them represents a way of exercising rational and responsible control over life and reproduction. The subtitle of his book, “Ending Reproductive Roulette,” proclaims his faith. Dr. Fletcher's dedication to rationality led him to make the astonishing statement, “Man is a maker and the more rationally contrived and deliberate anything is, the more human it is. Therefore, laboratory reproduction is radically human compared to conception by ordinary heterosexual intercourse.”

In 1993, investigators from George Washington University (GWU) Medical Center separated the cells of 17 human embryos and produced 48 embryos, an average of three embryos for each original. The method, variously called twinning, cloning, embryo splitting, and blastomere separation, demonstrated that human embryos could be split to create genetically identical entities during conception. When publicized, however, the experiment brought to mind a different view of cloning repeated since the beginning of the new reproductive technologies. In the early 1970s, when research on in vitro fertilization (IVF) was in its infancy, commentators worried that cloning–defined as the duplication of persons–would be next, leading to a scenario of “boys genetically exactly like the father, girls like the mother, or individuals like some true or false hero of art, science, or sports, or like some demagogue or some saint.”

As the possibility of cloning humans emerges on the horizon people are worrying about the morality of using the new technology. They are anxious about the ethical borders that might be crossed when duplicate humans can be produced by separating the cells of a newly fertilized human egg or, in the more distant future, by creating a zygote from an existing person's genetic material. They are apprehensive about eugenics, concerned about creating humans as sources of spare parts for others, uneasy about producing humans without intending to allow them to live and develop, and uncomfortable about using duplicate humans as business ventures.

Technological innovations have transformed our culture's ways of thinking about procreation and pregnancy, and about health and illness. Until not so long ago, the ongoing processes inside women's bodies as they gestated their future babies was up to conjecture. In Western industrialized countries, pregnancy was the slow process during which a woman gradually came to accept the fact that she was sharing her bodily space with another, and that now, as well as after the baby emerged, the primary responsibility for that new person's survival would be hers.

When Jean-Paul Sartre, the French existentialist philosopher, declared some four decades ago that man makes himself, this assertion was based on Sartre's belief that human beings do not possess an essential human nature. Man's self creation had to do with his freedom to choose the roles that he played or could play, and their attendant effects on his attitudes and responsibilities. It said nothing about his freedom to alter his biological nature.

We know today that classical eugenics, of an essentially negative nature, was not only an aggressive and brutal practice but, like its positive counterpart, inefficient as well. In fact, numerous biological, sociological, and psychological events beyond our control arise to prevent the realisation of any eugenic plan. Thus, like all human beings, individuals whose procreation is encouraged by positive eugenics suffer unexpected mutations that are transmitted to their offspring by their gametes. Gene distribution among the gametes at meiosis is the result of an uncontrollable, natural lottery. As an effect of this lottery, positive eugenics could allow the birth of defective babies whereas negative eugenics precludes the birth of normal babies.

Physicians have a sacred commitment to dedicate themselves through their art and through science to the improvement of the human condition. They have the solemn responsibility to focus on both the prevention and the cure of disease. The human genome project, a 15-year effort to draw the first detailed map in human DNA, will inevitably lead to the widespread implementation of human-gene therapy for the treatment and prevention of disease. We are on the verge of nothing less than a biomedical revolution, the likes of which have not been encountered before. The human genome project will lead to profound changes in the ability to manipulate genes. It will change the way we are born, how we live, how we die, and how we view ourselves in relation to our destiny. Before us lies a difficult transition.

The combination of genuine ethical concerns and fear of learning to use germ-line therapy for human disease must now be confronted. Until now, no established techniques were available to perform this treatment on a human. Through an integration of several fields of science and medicine, we have developed a nine step protocol at the germ-line level for the curative treatment of a genetic disease. Our purpose in this paper is to provide the first method to apply germ-line therapy to treat those not yet born, who are destined to have a life threatening, or a severely debilitating genetic disease. We hope this proposal will initiate the process of a thorough analysis from both the scientific and ethical communities. As such, this proposal can be useful for official groups studying the advantages and disadvantages of germ-line therapy.

Reports about possible genetic bases of homoerotic sexual orientation in adults have received a kind of schizophrenic social reception. On the one hand, these reports have been welcomed by some gay men and lesbians as biological confirmation of the commonly held view that sexual orientation is an involuntary trait, that sexual orientation is not in any meaningful sense chosen. Simon LeVay has received mail from thankful correspondents who welcomed his 1991 report about the possible neuroanatomical basis for male homoerotic sexual orientation, and some legal analysts see important implications of biological studies for the ways in which civil rights are recognized, especially those that depend on an immutable characteristic like race or gender.

The prevention of disability has been the driving force behind much research. In epidemiology three levels of prevention are defined: primary, secondary, and tertiary prevention. Primary prevention is the prevention of the initiation or occurrence of a disease; secondary prevention is the prevention or amelioration of the consequences of a disease, and tertiary prevention refers to rehabilitation or the limitation of disability associated with the disease. We have examples of all three levels of prevention in the area of childhood disability. Primary prevention is the protection of infants against congenital rubella syndrome by ensuring that women of childbearing age have adequate immunity before they become pregnant. The prevention of choreoathetosis, mental retardation, and deafness, by treating hyperbilirubinemia and preventing kernicterus in newborns, is a great success story in prevention. Similarly, at the level of secondary prevention, is the reduction in mental retardation caused by phenylketonuria, or PKU, by eliminating phenylalanine in the diets of newborns who lack the enzyme to metabolize this amino acid. Tertiary prevention is the area of rehabilitation medicine, and is regarded as the least desirable level of prevention. Indeed, tertiary prevention can be seen as “doing the best we can” in terms of rehabilitation, often while seeking a means of really preventing the disease.

In March 1988 the People's Republic of China announced the birth of the first test-tube baby born to a 39-year-old infertile peasant woman. This surprise announcement appeared in strong contradiction to China's population reduction goals amidst a population crisis. Yet, the media attention given to this medical achievement would seem to be consistent with the political, social, and economic changes taking place in the last decade, including technological innovation as the key to a modern socialist nation. In short, this announcement highlights tensions facing China as it simultaneously attempts to modernize within a trans-national economy, control population, and maintain traditional Confucian family values within a rapidly changing context.

Hong Kong is a territory of only 400 square miles in size, but with a large population of six million people. We have excellent medical facilities in both the public and private sector and the general health indices of the population are good, with low infant mortality rates (5 per 1000) and long life expectancies (75 years for men and 80 for women).

The Japanese government took significant steps in making decisions about a newly developing clinical application of gene therapy when, on April 15, 1993, the Government officially accepted the Guidelines for Clinical Research on Gene Therapy submitted by the Health Science Council of the Ministry of Health and Welfare of Japan to the Minister.