Xenotransplantation: A Spiritual Perspective
John Kleinsman
Issue 15, April 2005
Xenotransplantation is defined as the transplantation of living cells, tissues or organs from one species to another. In the wake of a worldwide shortage of organs, and transplant waiting lists that will continue to accelerate due to an aging population, animals are being seen as offering a potentially unlimited supply of organs and tissues.
Until recently xenotransplantation in humans had not been considered a viable option because of barriers presented by the body's immune response to animal organs and tissues. However, recent scientific advances in immunology and in the biology of organ and tissue rejection, including the ability to genetically modify animal cells, have increased the prospects of successful transplantation. Xenotransplantation is now viewed by many researchers as having the potential for treating not only end-organ failure but also many other chronic debilitating diseases that affect major segments of the world population, including epilepsy, chronic intractable pain syndromes, insulin dependent diabetes mellitus and degenerative neurological diseases such as Parkinson's disease and Huntington's disease.
The potential benefits of xenotransplantation for human welfare are considerable. Nevertheless, the use of xenotransplantation raises a number of significant ethical issues. These include (1) the potential risk of transmission of infectious agents from source animals to patients, their close contacts, and the general public; (2) the complexities of informed consent; (3) issues associated with human identity; and (4) animal welfare issues.
The prospect of xenotransplantation draws different reactions from different people. In its brief to all New Zealanders, the Bioethics Council has included as one of its express aims the desire to take account of the spiritual issues that pertain to xenotransplantation.
That we should be concerned about the spiritual issues strikes some people as being strange! "Surely these matters are best decided on scientific and ethical grounds," has been their response.
This response ignores the pervasive and ongoing influence of Christianity on people's prevailing worldviews, including our attitudes to sickness and suffering, health and wellbeing, culture, the common good and the environment, as well as the way we approach moral decisions. This influence is well documented. In New Zealand, a country now labelled by some as 'post-Christian' or 'secular', a lack of active involvement by many in organised religion does not change the fact that the principles of justice, welfare, fairness and truth upon which our society is based are the direct legacy of a period when the Christian narrative prevailed and there did not exist the hiatus between religion and society that characterises our own time. If for no other reason than this, it is vital that in New Zealand the debates about xenotransplantation take account of 'spiritual' as well as scientific, ethical and cultural considerations.
Catholic thought on xenotransplantation is still emerging in the face of recent developments in research and technology. That said, the Catholic tradition - comprising its sacred writings and its body of teachings on social justice and other aspects of morality - provides a rich heritage that can inform our thinking and help us determine certain clear, even if somewhat general, directions for xenotransplantation in the near future.
The issue of animal to human xenotransplantation raises profound questions concerning the nature of the relationship between human beings and other life forms. The way in which these questions are answered will reflect our understanding of what it is to be human - our understanding of 'human nature'. This article explores the meaning of being human by way of a brief theological reflection on the relationship between human kind and the rest of creation.
"In the image of God"
In the Christian tradition the question of what it means to be human is closely tied to the question of God's purpose for the world. In the Book of Genesis we read that God created the world and everything in it and declared it all to be good, "indeed it was very good". (Genesis 1:31) The creation stories at the heart of the Christian tradition also reveal that of all the living creatures, humankind was created "in the image of God". (Genesis 1:26 - 27) Whatever we are to make of this term, it clearly highlights that humans have a relationship with the divine that differentiates them from the rest of the created order.
God's blessing of humankind in the very next verse, Genesis 1:28, provides at least part of the context for interpreting the theologically loaded phrase "image of God". There we read that humans are to "subdue" the earth and to act as "masters of the fish of the sea, the birds of heaven and all the living creatures that creep along the ground." The writers of the Book of Genesis view humans as having a particular and special role in creation, a role that is not shared by other creatures but a role that exists for other creatures as well as being exercised in some way over the rest of creation. The notion of humans as "co-creators" is sometimes employed as a way of expressing this dimension of human nature. That we are to "fill the earth and subdue it" suggests that the work of God's creation is an evolving one, work in progress, a work that is moving towards wholeness rather than a completed masterpiece that we have the task of preserving.
While interpretation of the verses from Genesis has been and remains a challenge, two juxtaposed realities emerge about the nature of human kind. Firstly, the Genesis account establishes that humankind shares the status of "creature-hood" with all other living things. Secondly, the Genesis creation story proclaims that humankind has a role that is somehow "unique" among the creatures on earth; that the condition of the earth and everything in it somehow depends upon God in co-operation with humankind.
The clear message we can take from the Genesis creation story is that the role of human beings as "unique" and "different" from other creatures needs to be held in tension with, and must always be qualified by, the status of humans as themselves creatures who are always "part of" the created order. Our success in maintaining this tension requires that neither reality overshadow or dominate the other. This remains a significant challenge for bioethics, and is particularly relevant to the xenotransplantation debate. Positively, the need to maintain the tension provides us with a specific reference point for evaluating the acceptability of xenotransplantation in general, as well as particular applications of xenotransplantation should we conclude as to its acceptability in principle.
Recognition of our shared "creature-hood" calls for an acknowledgement of the sacredness of all of creation. It is a consequence of recognizing the sacredness of creation that humankind is called to admit that all of life possesses an "innate" dignity, i.e. a dignity that is independent of whatever value or usefulness a particular species or life form may have for humans. This, in turn, shapes the way we are to think of ourselves – we are part of the web of life, beings that are interconnected with, and in relationship with, the rest of creation. To this end, the biblical calls to live justly and be in right relationship must be applied to our relationships with all of creation, and not just our fellow human beings. In recent times Catholic theologians have employed the phrase "integrity and peace of all creation" as a way of encapsulating the moral responsibility that human kind has to the rest of creation. The "integrity and peace of all creation" needs to inform our bioethical discussions with regard to the lengths to which we humans are prepared to go in order to delay death or to improve the quality of our life.
The advent of the term the "integrity and peace of all creation" calls for Catholics and other Christians to reflect on the fact that certain traditional theological concepts may now need to be used with more care. Our understanding and use of the phrase 'created in the image of God", has been problematical because of our failure to examine closely enough our images of God. If, as has often been the case, God is perceived predominantly as being all powerful, and if that is the image that dominates our religious consciousness - to the neglect of the many other rich metaphors we find in the scriptures - then without doubt we will think differently about the world and our role in it than if we see God as the loving creator who "delights" in making a world in which everything is "good". A God whose nature is defined pre-eminently in terms of "caring" rather than the exercise of power, brings new emphasis to the idea that being created in God's image includes responsibility for the "pastoral care" of creation. Where the image of God as "caring" predominates within a community there exists the ethical headspace within which we are confronted by, and are able to reflect on, the limitations of human dominion. This provides a much needed riposte to the idea that we are co-creators or co-participants in a world that is still in evolution and incomplete, and directs us towards a more humble stance than would otherwise be the case.
Belief in the innate dignity of creation, and the need for limits, is a feature of contemporary Catholic moral teaching. In the words of Pope John Paul II and the Greek Orthodox Patriarch Bartholomew I as stated in the Venice Declaration of June 2002:
We invite all women and men of good will to ponder the importance of ... [being] humble with regard to the idea of ownership and to be open to the demands of solidarity. Our mortality and our weakness of judgement together warn us not to take irreversible actions with what we choose to regard as our property during our brief stay on earth. We have not been entrusted with unlimited power over creation, we are only stewards of the common heritage.
In our own country the New Zealand Catholic Bishops' Conference has recently reminded all New Zealanders it is:
in keeping with the traditions of the Māori of Aotearoa that we need to respect the sacredness of creation, as partners in life with the earth, the oceans, the lakes, the animal world, the mountains, the fish of the sea and the birds in our forests and gardens. From such sources, balanced by the infinite hand of God we draw all life and nourishment. [i]
The very fact that in our time we should need to state and restate our commitment to the idea that all of creation has an "innate" dignity points to the existence of an alternative and dominating perspective both within and outside of the Christian tradition.
Proper consideration of the interconnection between human life and all other forms of life has to be an integral part of the framework for making just bioethical decisions. The reality of our shared creature-hood forms a moral imperative that demands a bottom line for the sake of our solidarity with all of creation. Further, the notion of solidarity suggests that to act "in the image of God" we will at times need to exercise hard choices by stepping back from what we are technologically capable of doing. It highlights that the concept (or promise) of human welfare and benefit cannot exist on its own as a criterion for judging whether or not a particular application of xenotransplantation might be pursued. It suggests that there will be times when we may have to forsake power for powerlessness in the face of human suffering and death for the sake of honoring our role as the stewards of creation.
The thought that we might not do something for the sake of our responsibility to other forms of (animal) life may be difficult for some to accept in a world in which it is becoming increasingly acceptable for human life to be used as a means to an end for the welfare of other humans. Nevertheless, the belief that we might choose to forsake power and control for powerlessness and vulnerability is very much in keeping with the "image of God" revealed by the suffering and crucified Jesus at the centre of the New Testament Gospels. A philosophically and theologically grounded appreciation for the limitations of human dominion remains one of the great contributions that spiritual perspectives bring to bioethical debates in our time, a contribution that is often lacking - or at best an add on - in many of the secular narratives that feature in bioethical argumentation.
"Fill the earth and subdue it"
The history of humankind shows that at various times in our history we have failed to keep in proper tension the twin realities that we are both "part of" the rest of creation and the fact that we have a special role to play within it. The Christian role in such failure has very often been fuelled by very narrow and unbalanced interpretations of selected passages of scripture, including Genesis 1:28 – "fill the earth and subdue it". This has contributed to excesses that are for the most part the product of an overemphasis on the uniqueness and superiority of humankind. As one writer has put it: "Humans do not like to think of themselves as animals ... The real fruit of that perspective is, in fact, tragic isolation on an earth that has been eroded by our moral assumptions. Science has something much wiser to tell us about who we are." [ii] To which we would add: The Scriptures also have something much wiser to tell us.
By definition, xenotransplantation involves using animals in a "destructive" way for human ends. Consequently, a key theological question regarding this technology has to be whether or not the use of animals for the purpose of harvesting organs and tissues sufficiently respects their innate dignity. Does xenotransplantation represent a legitimate and ethical contribution to the evolution of the world in which we live? Or, is xenotransplantation, either in whole or in some of its applications, unethical in the sense that it will further the legacy of "tragic isolation" that is such a shameful part of our heritage.
Renewed awareness of the innate value of all beings is now widespread, and within Christian spirituality the notion is broadly accepted by most Christians. The conclusions drawn about the acceptability of xenotransplantation, however, vary greatly even among those who claim to uphold the innate value of all creation. On the one hand there are those who see that the only way to uphold the notion of the innate dignity of all life is to rule out xenotransplantation as ethically unacceptable in principle. For such people, humans are simply one animal species among others with no special rights or dignity. Any other conclusion, it is argued, amounts to "speciesism", defined as an ill-founded belief in the superiority of one group, namely the species homo sapiens. The assumption, often implicit or unspoken, behind such a response is that acceptance of the innate dignity necessarily implies an equality of value between humans and animal life.
In critiquing the idea that there ought to be a fundamental equality of status and moral interests among species it is arguable that:
... the position that all beings are equally valuable is a difficult one for humans to live out consistently since it seems to imply that no being may use another at all. Human beings along with many other living beings must use other beings for their own survival. A decision that all other beings are equal to me and may not therefore be used by me for food, clothing or shelter would amount to a requirement to commit suicide. [iii]
Neil Darragh refers to this dimension of our earthly existence as the "conflictual nature of our relationships with other beings". New Zealanders generally recognise and relate to this dimension of life as a consequence of our pioneering and agricultural heritage. "This conflictual aspect of the relationships among beings should not be understood as merely unfortunate and unavoidable ... conflict is an inevitable ingredient in many of Earth's processes and is constitutive of our participation and interdependence in the earth." [iv] In other words, acceptance of this dimension of our existence is synonymous with a proper acceptance of our creature-hood, our status as created beings part of the web of life. Given that it has been humankind's refusal to recognise its status as interdependent creatures that has been the philosophical and theological impetus for much of the unwarranted destruction of the resources of the earth in the past, it is then but a small step to conclude, somewhat paradoxically with Darragh, that "a failure to recognise the conflictual element in the Earth's current processes distorts and perhaps eliminates the possibility of humans adopting a realistically caring relationship to the Earth." [v] (emphasis added)
Reconciling the conflictual element with belief in the innate dignity of all creation, and simultaneously developing an effective ethic of caring, remains a significant challenge for the future. In the meantime one can conclude that a carefully nuanced theological analysis of the Genesis creation story - and the scriptures in general - allows for the destructive use of animals by humans for the sake of human health and welfare. Thus, the Catholic scriptural moral and social tradition, while it has nothing specific to say on the topic of xenotransplantation, does not rule out – in principle at least –the prospect of xenotransplantation as a legitimate expression of the divine mandate that humankind is to "fill the earth and subdue it."
"Be masters of ... all the living creatures that move on the earth"
Human persons are fundamentally relational beings. Due recognition of this highlights the responsibility we have of living in "right relationship." This is no easy task. The problem of responsibility presents itself paradoxically as both power over God's creation as well as solidarity within it. Our interconnectedness with the rest of creation needs to be held in tension with the notion that as humans we have a special role as "masters" (Genesis 1:28) within creation for ensuring the peace and integrity of all creation.
The term "master" or "mistress" carries with it certain pejorative overtones of patriarchal and hierarchical ownership and power. As highlighted above the special role that the Christian tradition attributes to humans must not be equated with 'absolute dominion' – to put it colloquially, we 'owe' the animals rather than 'own' them. In bygone eras, while they had certain legitimate rights, good "masters" and "mistresses" also observed certain responsibilities. How then can Christians fulfil their biblical call to exercise "mastery" over creation today in a good and caring way that includes the ethical use of xenotransplantation?
A realistic ethic of caring not only allows for, but in fact demands, that we accept the conflictual nature of human existence, including the killing of animals for human needs. With respect to individual animals, an ethic of caring will insist that we scrutinise carefully our reasons for killing animals and rules out killing animals simply for the sake of killing. An ethic of caring is incompatible with a lack of compassion towards animals. It demands that animal suffering be kept to an absolute minimum. It will rule out the killing of animals in anything other than a merciful way. Scriptural reflection upholds such actions as legitimate expressions of the biblical mandate to "subdue" the earth and exercise mastery over it. It is a consequence of accepting and living out our shared creature-hood.
At another level however, an ethic of caring will demand an absolute commitment to the preservation of species in all their biodiversity. It is incompatible that humankind, through its actions, should bring about the destruction of any particular species. An ethic of caring will also call for a resolute commitment to the preservation of the current genetic makeup of all species in the event that genetic modification of certain members of a species is deemed acceptable. Such an absolute commitment is a consequence of accepting that humankind is created in the image of a loving God who delights in the absolute goodness of everything created (Genesis 1:31).
Conclusion
The fact that elements within the Western Christian tradition have both challenged and contributed to human failures in relation to the environment highlights the need for, and the validity of, a Christian spiritual contribution to the current debate on xenotransplantation. Faithfulness to our creator God calls for us to show responsibility to other humans and to all other forms of created life. The Christian story shows that the ethical pursuit of xenotransplantation is possible in principle if carried out within certain limits and against the backdrop of a theological awareness that animals share in the same innate dignity that humans have. Indeed, xenotransplantation may even be regarded as a moral responsibility based on our call to "co participate" with God in promoting the welfare of human beings while caring for the earth and all that is in it.
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John Kleinsman teaches Moral Theology at the Wellington Catholic Education Centre and is also a part time researcher for The Nathaniel Centre.
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[i] New Zealand Catholic Bishops' Conference. (1997) A Consistent Ethic of Life – Te Kahu-O-Te-Ora. Wellington: Catholic Communications.
[ii] Editorial. (2005). My Little Chickadee in The New York Times, (March 3).
[iii] Darragh, N. (2000). At home in the earth: Seeking an earth centred spirituality. Auckland: Accent Publications, p.79.
[iv] Ibid., p.68.
[v] Ibid., p.68-69.
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2005