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09.- Recherche sur l’embryon humain / Research on Human embryo — CHURCH OF FRANCE / États généraux de la bioéthique — Which world do we want for tomorrow? The brave new world…

09.- Recherche sur l’embryon humain / Research on Human embryo — CHURCH OF FRANCE / États généraux de la bioéthique — Which world do we want for tomorrow? The brave new world…
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Scientific and legal elements :

The imple­men­ta­tion of in vit­ro fer­til­iza­tion tech­niques leads to the con­cep­tion of human embryos, some of which are not implant­ed in a wom­an’s uterus for birth; they are then frozen and stored: more than 220,000 in France at the end of 2015[1]. The ques­tion of using them for research has there­fore arisen. With regard to the cou­ple, the con­di­tions of their nec­es­sary con­sent are spec­i­fied by law[2].

Stem cells. Since 1998, “stem cells” (scs) have been iden­ti­fied in the human embryo. From embry­on­ic cs, one can poten­tial­ly pro­duce a new human organ­ism (cs called “totipo­tent”) or any type of human tis­sue (cs called “pluripo­tent”). Research on these embry­on­ic cs has devel­oped rapid­ly. To date, the expect­ed results have not been achieved except, in part, in car­diac and oph­thal­mo­log­i­cal matters.

There are oth­er so-called adult “stem cells”, espe­cial­ly those from cord blood or the umbil­i­cal cord itself[3]. Thanks to these adult cs, many treat­ments are pos­si­ble (leukaemias, burns, lesions).

Since 2007, sci­en­tif­ic teams have repro­grammed adult cells into “pluripo­tent” cells: these are called “induced pluripo­tent stem cells” (iPS).

French leg­is­la­tion. It went in the direc­tion of a broad­er search pos­si­bil­i­ty. The Act of 29 July 1994, hav­ing enshrined “respect for human beings from the begin­ning of their lives” in the Civ­il Code (art. 16), accord­ing­ly pro­vid­ed for the pro­hi­bi­tion of all research that under­mines the integri­ty of the human embryo. The law of 6 August 2004 intro­duced tem­po­rary exemp­tions to this pro­hi­bi­tion for embryos no longer the sub­ject of a “parental project”, with a view to “major ther­a­peu­tic progress” and “pro­vid­ed that it can­not be pur­sued by an alter­na­tive method of com­pa­ra­ble effec­tive­ness”. The law of 7 July 2011 broad­ened the dero­ga­tions by replac­ing the “ther­a­peu­tic” pur­pose by a “med­ical” pur­pose, while ask­ing to favour alter­na­tive research to that on the embryo[4].

A rever­sal was intro­duced by the law of August 6, 2013: it abol­ished “the for­mal expres­sion of the prin­ci­ple of pro­hi­bi­tion of research on the embryo[5]”, to replace it by a sys­tem of autho­riza­tion under con­di­tions, as well as the oblig­a­tion to pro­mote alter­na­tive research. Final­ly, the law of 26 Jan­u­ary 2016 on the “mod­ern­iza­tion of our health sys­tem” autho­rizes, in the con­text of med­ical­ly assist­ed repro­duc­tion, research on gametes intend­ed to con­sti­tute a human embryo or on the human embryo in vit­ro before or after its trans­fer for ges­ta­tion pur­pos­es, if each mem­ber of the cou­ple con­sents (art. 155). They are then con­duct­ed in accor­dance with research involv­ing the human per­son: pru­dence, con­sent and gratuity[6].

The “Oviedo Con­ven­tion”, rat­i­fied by France, states: “1. Where in vit­ro embryo research is per­mit­ted by law, the law shall ensure ade­quate pro­tec­tion of the embryo. 2. The cre­ation of human embryos for research pur­pos­es is pro­hib­it­ed.” (art. 18).

Anthropological and Ethical Issues

A sim­ple prin­ci­ple guides eth­i­cal reflec­tion: “Med­ical research must refrain from inter­ven­tions on liv­ing embryos, unless there is moral cer­tain­ty that it will not harm the life or integri­ty of the unborn child and its moth­er, and pro­vid­ed that par­ents have giv­en free and informed con­sent for the inter­ven­tion on the embryo.

Accord­ing to CCNE, there is talk of con­tin­u­ing research on human embryos and human embry­on­ic stem cells, in par­tic­u­lar by “main­tain­ing a human pre-implan­ta­tion embryo in vitro[8]”. How­ev­er, since the fusion of gametes, the human embryo has devel­oped in a grad­ual, con­tin­u­ous and coor­di­nat­ed process. From the begin­ning, he is a “new human indi­vid­ual” in his own right who “must be respect­ed as a person.

CCNE has defined the human embryo as “a poten­tial human person[10]”. The expres­sion seems to indi­cate that it would lack ele­ments to reach the full stature of “human per­son”. It can be more accu­rate­ly under­stood as rec­og­niz­ing a “per­son in the mak­ing”: a per­son whose phys­i­cal, intel­lec­tu­al, emo­tion­al and spir­i­tu­al poten­tial will unfold if he is wel­comed into his great vul­ner­a­bil­i­ty and if no obsta­cle is put to his development.

If the human embryo needs a “parental project” to devel­op, it is not this project that grants it a per­son­al sta­tus: “The real­i­ty of the human being, through­out his exis­tence, before and after his birth, does not allow us to affirm either a change of nature or a gra­da­tion of moral val­ue, because he pos­sess­es a full anthro­po­log­i­cal and eth­i­cal qual­i­fi­ca­tion. The human embryo thus has, from the begin­ning, the dig­ni­ty prop­er to the per­son.” It is there­fore not pos­si­ble to dis­tin­guish between a pre-implan­ta­tion sta­tus and a dif­fer­ent sta­tus of the implant­ed embryo. He is an “embry­on­ic body[11]”.

Research on both embryos and embry­on­ic stem cells, inso­far as it involves the destruc­tion of human embryos, con­sid­ered and used “as mere “bio­log­i­cal material”[12]”, rep­re­sents a seri­ous eth­i­cal trans­gres­sion because it affects a human being whose extreme vul­ner­a­bil­i­ty tends to mask his dig­ni­ty. The instru­men­tal­iza­tion of a human being can nev­er be jus­ti­fied, even for a hoped-for ther­a­peu­tic pur­pose. And even less to feed basic research, for exam­ple to improve the results of the GPA. Debates and law have always expressed, with embar­rass­ment, the respect due to the human embryo, even if it means orga­niz­ing excep­tions to this respect, often in order to be able to do research.

Eth­i­cal trans­gres­sion is all the less jus­ti­fied since stem cell research, whether adult, cor­don-derived or induced pluripo­tent, does not encounter any major eth­i­cal objec­tion. They should be more strong­ly encour­aged as they pro­mote cell ther­a­py. On the con­di­tion that the ben­e­fits are opened joint­ly and sev­er­al­ly, avoid­ing pure­ly pri­vate man­age­ment of cell banks, which would be reserved for wealthy patients or bet­ter-off countries[13].

Research on the human embryo itself is to be pro­mot­ed pro­vid­ed that it respects its integri­ty and has as its pur­pose a bet­ter diag­no­sis in order to treat it while allow­ing its devel­op­ment until birth. The Church encour­ages “sci­ence as a pre­cious ser­vice for the inte­gral good of life and for the dig­ni­ty of every human being” (Dig­ni­tas per­son­ae, no. 3).

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[1] Cf. Rap­port médi­cal et sci­en­tifique de l’Agence de bio­médecine 2016. Les recherch­es sur l’embryon et sur les cel­lules énumérées dans la fiche sont soumis­es à un rap­port annuel ren­du pub­lic ; Code de la San­té Publique, art. L. 1418–1‑1.

[2] Voir J.-R. Binet, Droit de la bioéthique, LGDJ, 2017, p. 298–299.

[3] La pre­mière greffe mon­di­ale de cel­lules souch­es issues du sang de cor­don a été réal­isée en France en 1988 par Éliane Gluck­man. Voir CCNE, Avis n. 117 du 23 févri­er 2012.

[4] La loi a prévu une clause de con­science pour les chercheurs ne souhai­tant pas tra­vailler sur les embryons humains ni sur leurs cel­lules souch­es. Notons que la ques­tion du statut juridique de l’embryon humain demeure en sus­pens : voir Aude Mirkovic, « Statut de l’embryon : la ques­tion inter­dite », La Semaine juridique (JCP), G, 2010.

5 J.-R. Binet, op. cit., p. 293. A été sup­primé « le principe explicite d’interdiction qui tradui­sait […] l’essentiel devoir de respect de l’être humain dès le com­mence­ment de la vie », in ibid., p. 54.

[6] Cf. J.-R. Binet, op. cit., p. 278–289.

[7] Con­gré­ga­tion pour la Doc­trine de la foi, Instruc­tion Don­um Vitae, 22 févri­er 1987, I,4.

[8] Cf. CCNE, Dossier de presse, « Les thèmes des États généraux », fiche n. 2, 18 jan­vi­er 2018.

[9] Voir, Don­um Vitae, I,1. Selon deux objec­tions, la présence d’un indi­vidu humain dans le zygote est niée : les jumeaux monozy­gotes et les fauss­es couch­es naturelles. À ce sujet, voir Pas­cal Ide, Le zygote est-il une per­son­ne humaine ?, Téqui, 2004, ch. 7 ; Vin­cent Bour­get, L’être en ges­ta­tion, Press­es de la Renais­sance, 1999.

[10] Avis n. 1 du 22.05.1984. Voir aus­si les dis­cus­sions dans deux Avis : n. 8 du 15.12.1986 et n. 112 du 21.10.2010.

[11] Con­gré­ga­tion pour la Doc­trine de la foi, Instruc­tion Dig­ni­tas Per­son­ae, 8 Sep­tem­bre 2008, n. 5 et 4. Voir Alain Mattheeuws, « Le « corps embry­on­naire ». Une avancée de Dig­ni­tas per­son­ae », NRT, 134/n. 4, 2012, pp. 606–627.

[12] Ibid., n. 19. Voir Mgr P. d’Ornellas et alii, Bioéthique. Ques­tions pour un dis­cerne­ment, Lethielleux/DDB, 2009, ch. 2.

[13] L’Église « exprime le voeu que les fruits de cette recherche soient ren­dus disponibles même dans les zones pau­vres et dans celles qui sont touchées par la mal­adie », in Dig­ni­tas per­son­ae, n. 3.

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