Hearts and Minds

The final topic debated in the UK House of Commons before its Christmas recess was ‘Animal Testing’. Present in the Chamber for this “important debate”, as its sponsor Margaret Ferrier wistfully called it, were Ferrier herself, a Home Office minister to respond, and one other MP. I could find no mention of the occasion anywhere in the press or broadcasting media. By contrast, the transplantation of a pig’s heart into the body of a man at the University of Maryland Medical Center three weeks later has been given world-wide media coverage. Well of course, because it’s a first-of-its-kind news story, a will-he-survive yarn, and a this-is-the-future drama, all rolled into one. No doubt it would also be a bravely-battling-patient story too, except that this particular patient was unfitted for the role by his conviction for a very violent crime and his history of medical non-cooperation.

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But principally it’s a human-testing story, with ethical problems which affect us. Should a human patient, even one already in mortal danger as this patient had been, be subjected, however willingly consenting, to such hazardous surgery and the associated novel drugs, neither of them yet brought to the stage of clinical trials? Then, even if the operation and its likely successors prove safe to the patients, it’s quite likely that viruses harmless to the animal species may cross to human populations with much more serious effects, of a sort with which we’ve become familiar. Particularly worrying in the case of pigs is the porcine endogenous retrovirus, whose acronym PERV might be regarded as a moral summary of this whole subject.

So much for the human ethics. As to the animals, their claims in the matter were implicitly decided upon years ago. For the Maryland operation is just a moment of sudden visibility in a long history of trying out these Dr Moreau-like possibilities on different animal species. As one of the Maryland scientists has said, by way of justifying the operation, “We’ve done this for decades in the lab, in primates, trying to get to the point where we think it is safe to offer this to a human recipient.” Just that word “trying” has a chronicle of suffering implicit in it.

The nature of that suffering, as it occurred in the UK at the laboratories of Huntingdon Life Sciences from 1994 to 2000, was courageously uncovered by Dan Lyons of Uncaged Campaigns. The web-site Diaries of Despair recounts these experiments and Lyons’ campaign to publicize them (as linked in the notes below). But these cruel and disgusting experiments have continued in the USA, and no doubt elsewhere, and of course they’ll go on into the future. “We really need to do more science,” a specialist in transplant immunology tells the journal Science in its article about the Maryland operation, but it hardly needs saying; even if it hadn’t already been the motto of all scientific research, there are commercial interests making sure that it’s acted upon in this case. Even in that short Science article, we encounter five of them: Revivicor, Makana Therapeutics, Recombinetics Inc., XVIVO, Kiniksa Pharmaceuticals Ltd.

Certainly there has been some official attention paid, over the years, to the welfare of the animals miserably caught up in this research, from the report of the Nuffield Council on Bioethics in 1996 (Animal-to-Human Transplants: the ethics of transplantation), through to the academic bio-ethicists offering their comments this month. In the Nuffield report, only two of the ten chapters were devoted to the animals, but they contained serious and well-intentioned discussion. Still, we have to understand what such pronouncements are really aiming to do. A few phrases from the report will illustrate it: “It can be argued . . . It might be held . . . Those who favour . . . As an alternative, critics advocate . . . For some people . . . for others.” Likewise Oxford University’s Professor of Practical Ethics, lending his weight to the BBC’s report on the Maryland operation: “Some people might say . . . others would say.” His judicious conclusion is that “Those are just positions we are going to have to reconcile.” The momentum of these authoritative voices is always towards a common ground, a sort of pop utilitarianism: what ethics will content the maximum number or offend the fewest?

The argument (repeatedly used) that taking out the organs of pigs in this way will be ethically no worse, and numerically much better, than eating pigs, is really of that same type. What do most people think about eating pigs? They think that it’s all right. There you are then. And that would explain why another Oxford bio-ethicist thinks it worth saying that we should only use gene-edited pigs if we can “ensure they do not suffer unnecessary harm”. I’m not certain when that would last have been a keen point of ethics (1822?), but it’s certainly common-ground thinking in Western society now (however violated in practice). The question being put is not ‘what matters?’ but ‘what do most people think matters?’ Perhaps indeed that’s what ‘bio-ethics’ is: a branch of sociology.

At one point in the Nuffield report, the authors ask “what sort of people do our social and technical practices reveal us to be? If we do not like what we see when we look honestly in the mirror, then there is cause for thought at least.” It’s a disappointingly weak conclusion in that last clause (wasn’t the whole point of the study that “thought” was required?), but the proposition is otherwise an important one. It shifts the ethics, if only for the moment, from utilitarianism to what’s usually termed virtue ethics: what sort of conduct would characterize the sort of humans we wish to be? In this conception of ethics there is always some idealism and therefore some momentum towards moral growth – with some promise, then, of keeping up with the growth in our technical capacities and ambitions, as instanced by the Maryland operation.

Accordingly, when the transplant surgeon in Malorie Blackman’s teen-novel Pig-Heart Boy (1997) says “I have no trouble looking in the mirror”, it confirms that he’s just a stationary character, a datum of the situation (as summarized in the title). The boy himself, in contrast, feels all the ups and downs of the choice facing him. Still, we discover that choosing to go ahead is the brave decision: indeed, going in for it twice (for the first operation fails) makes him positively heroic. He says to his yet unborn brother, “I hope one day you’ll be as proud of me as I am of you.” So even in virtue ethics we remain in the world of opinion, and we find that exploiting animals can be cast in a form complimentary to humans. Accordingly, one science journalist reports the Maryland operation as “The latest promising update in humans’ quest to harvest life-saving organs from our four-legged, porcine friends”. A quest! Yes, that’s a fine thing to be engaged in, as is saving (human) life, and even the not-quite-serious animals seem to cheering us on. As Blackman’s surgeon drearily says, “Everyone’s entitled to their own opinion.”

Is there no way out of this fog of opinionation? Yes, of course there is. Where this operation raised a question of human ethics – is it right to put a human patient through a still experimental procedure? – the ethics professor provides an unequivocal answer (though still, note, a vicarious one): “As long as the individual understands the full range of risks, I think people should be able to consent to these radical experiments.” Then why should the animal ethics be different? That a pig cannot formally consent or withhold consent should put an end to the matter. But anyway we’re fully aware of their preferences, for they express their pleasure in good things, and they make piercingly clear their dislike of being harmed. We can therefore know as a fact that no pig, allowed to understand “the full range of risks”, would consent to be killed in this or any other way. Therefore to speak of animal ethics in connection with xenotransplantation is humbug. If we “look honestly in the mirror”, as the Nuffield report suggests, what we see in this case is a brilliantly clever, cowardly, dishonest gangster: “cause for thought”, perhaps; more importantly cause for a complete change of mentality.

Notes and references:

The BBC’s online account of this operation, which quotes the Oxford bio-ethicists, as well as the Maryland University scientist, can be seen here: https://www.bbc.co.uk/news/world-59951264

The Diaries of Despair web-site is here: https://www.xenodiaries.org/summary.htm

The report in Science can be seen here: https://www.science.org/content/article/here-s-how-scientists-pulled-first-pig-human-heart-transplant

The 1996 report of the Nuffield Council on Bioethics, a very thorough 142pp study, can be read online or downloaded here (the mirror quotation comes from p.44): https://www.nuffieldbioethics.org/publications/xenotransplantation

Pig-Heart Boy was first published by Doubleday in 1997. Quotations are from the Corgi Books edition of 2011, at pp.33-4, and 255.

The “humans’ quest” quotation comes from an online news journal called Fierce Biotech; the whole article can be read here: https://www.fiercebiotech.com/medtech/revivicor-s-genetically-modified-pig-heart-first-successfully-transplanted-human-patient

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