Roberto Colombo
Professor of General Biology and Bioethics. Università Cattolica del Sacro Cuore, Milan.
Within the themes of relevance of bioethics, moral theology and of the special biolaw, the issue of prenatal human life has occupied a very large space that could even seem to some excessive. Links to the Magisterium of the Catholic Church has repeatedly returned documents with particular authority and depth, not to mention the numerous speeches of the Roman pontiffs and the world episcopate frequent. At the level of other Christian denominations and Judaism need to record a more modest but interesting documentary production and studies, which must be added the contribution from the reflection from non-Christian religions. The issue has received considerable attention by the thought so-called "secular", in respect of which the position of Catholic reflection is some venues, but also of other significant contrast, resulting in recent years to an ethical debate science that has made it very lively discussion, but the arduous effort to develop a full quaestionis status. In this paper we resume the main lines of the approach to the biological nature of the human embryo (Section I), will exhibit some of the key perspectives that discuss the ontological status (Section II), then to propose a short discussion (Section III) and finally take care of some current issues in relation to the possible use of stem cells from human embryos (Section IV).
I. Outlines for a biological status of human embryonic
exhibit here briefly the framework of the conclusions which we believe result of analyzing biomedical scientific data on human reproduction and development at our disposal today, the framework within which you can identify background elements essential to establish a "biological status" of the embryo. Our discussion will necessarily be an example, it is not possible here to address all issues raised by the debate.
1. The beginning of human life . The current human life phone (not individual) began with the appearance on earth of 'Homo sapiens sapiens , and developed on our planet without interruption for tens of thousands of years. Human life organismic (individual), this also exists on the earth since our species, but shows - in its life cycle that defines it - two points of maximum discontinuity, which are represented by fertilization and organismic death. With the fusion of human gametes, one mother and one father, and the reconstruction of a different chromosome diploid organism comes into existence a new male or female, initially for a short time and single cell (zygote) and subsequently multicellular. The first cell of every human body is equipped with a new genome (informational structure determined by the nucleotide sequences of DNA), which characterizes genotypically the body with a specific identity (belonging to the human species) and individual (singularity of the organizations of parents , family members and other individuals of the same human species). While the individual genotype (genetic individuality) is not uniqueness has always absolute, as in the case of identical twins (see below , 5), which may have an identical genome (see Yukota et al., 1994), it is equally certain that the phenotype - which is the organismic identity at every stage of life cycle - is absolutely unique and unrepeatable. It is in fact determined by the interaction of two or more independent variables: the genotype, expression of the genome, and the environment, the sum of all extrinsic factors to the expression of the genome but carries on within or outside the body human influence physical, chemical, biological, psychological or cultural. The possible identity of the first factor (Genotype), as in the case of monozygotic twins are genetically identical, does not negate the internal and external environmental changes that occur during the different life cycles of the twins, thus making it impossible to exactly the phenotype.
2. specific identity and nature of the embryo. The human karyotype, with its specific genome, since the fusion of pronuclei in the fertilization process identifies biologically, that is, genetically, the "nature" of the human embryo, seen as "natural ability" - intrinsic and informationally independent - of develop a show that can be only that which is, of course. The next event, which will recognize the "nature" really "rational" and not just "animal", the human being must go through the full implementation of its faculty homeostatic, somatosensory and mental, which normally occurs in the presence conditions which, in the child after birth, and even more mature man.
The "natural ability" to implement a specific human biological life cycle rule, right from the unicellular stage, any vagueness about the nature of the human embryo. Writes about Lambertino (1993): "Although he has not reached the terminus ad quem the inherent dynamism, is a terminus a quo already committed ex to its nature, result in the terminus ad quem , and not in any terminus ad quem, but only that which corresponds to the indications of its ontological nature "(p. 127). The "natural ability" necessary but not sufficient in itself, could possibly - for reasons intrinsic (genetic) or extrinsic (environmental) - do not give rise to fully developed (so-called spontaneous abortions), induce a degenerative development (moles mole, teratomas) or lead to an abnormal development (congenital) sometimes not able to fully manifest the "rational nature" of the subject. But it can never lead to the development of an organism naturally different from those of the human species. The thesis that natural ability constitutes a human embryo in status of being "animated", considering that already achieve fertilization than is necessary "disposition" of the "subject" biological (body) to receive the forma corporis, it seems be contradicted by any biological, and indeed seems quite reasonable and convincing (cf. Ashley, 1976, pp. 121-126).
3. The development of the human organism . The development process begins in the form of a rapid succession of mitotic karyokinesis and cell segmentation, and then continues in the mode of compaction, cavitation, differentiation embryoblast trophoblastic cell lines, and the formation of three cell sheets from which the action takes place ' histogenesis and morphogenesis leading by 8 th and 9 th week, the complete definition of the basic somatic structures of the fetus, although it is still very small size. This process starts, seamless, from fertilization (syngamy) and does not suffer - if they are not factors negative - no stopping along the phase that precedes, accompanies and follows the implantation of the embryo in the endometrium of the maternal uterus. This complex process, continuous, highly coordinated and teleologically ordered the formation of an adult individual, since the penetration of the spermatozoon in the oocyte (more precisely from the merger of his head with the oolemma) the result of the immediate biochemical oocyte activation by the male gamete and the subsequent gradual introduction of new genetic chromosomal diploid. Shown with the word 'development' or 'epigenesis', it provides for the progressive, gradual and complete expression of the organismic level morphofunctional it all "content" (Meaning "informational" and not "material" or "preformistic" of the term) in the gene pool formed by syngamy. The active expression of this "content" is mediated genetic-informational, that is made feasible, by the interaction with the material that is initially extranuclear oocyte and, subsequently, with the components of the embryo (cells, extracellular matrix, tissue , organs), and with the environment external to it. This could be the mother intracorporeal (biochemist before implantation and also after implantation histological-organic) and from birth, that extracorporeal. In any case, if you excludes artificial induced genetic manipulation, the contribution of the environment is strictly informational type.
4. Cellularity of Organismic and blastomeres. According to some authors, a scientific description of the unborn in the earliest stages of its development (at least, they say, to "shrink" in the structure morula) in the embryo would see a mass of separate individual cells, each as a separate entity in simple contact with the other, enclosed in the zona pellucida. These cells are identical and do not constitute a single contiguous living individual, but each would act as an individual, showing a degree of autonomy and central organization (see NM Ford, When I came into existence? , in "What status for the human embryo Problems and Prospects", Milan 1992, pp. 22-29). After the stage of 8-16 cells, the fusion intercellular would either put an end to this condition so far, each cell is, according to these authors, an entity "totipotent," that is capable of producing a fetus full ( cf. Coughlan MJ, The Vatican, the Law and the Human Embryo , Basingstoke 1990, pp. 69-70). This vision leads to deny the "biological organism" pre-embryo morula, to give it to a mere collection cell. "
In fact, this is not what we now know is the study of the morphology and ultra-structural and structural interactions between the individual cellular components and extracellular as well as by studying the development of early embryos in vitro. Regarding the Organismic embryo is sufficient to recall that its structure - as can be seen easily from one observation in light microscopy - is not at all, schematic and reductive, a set of spherical elements (blastomeres), tangentially in contact between them, suspended in a container (zona pellucida) whose sole function seems to prevent leakage from the embryonic structure, assumed their natural tendency to separate. This interpretive model of type geometric-physical "betrays the true biological complexity of the pre-morula, in which shows the presence of an extracellular matrix - typical of the tissues of multicellular organisms - that is around the blastomeres that already have many points membership, and there is documenting a role not only functional but also for restraining the zona pellucida (see Pereda et al., 1989, Dale et al. 1991; Gualtieri et al. 1992).
Regarding the totipotentiality of blastomeres must first clarify the meaning of embryological, cytological the adjective 'totipotentiality. It does not reveal any spontaneous tendency to separate from the rest of the embryo to give rise to a new one, this event but can not normally determined by the development plan of the human embryo, and that requires the intervention of additional causal factors, intrinsic or extrinsic embryo itself. The qualifications of "totipotent" or "multipotent" refers primarily to the ability of the early blastomeres of "redirect" to the original address already acquired, if you change position within the embryo and transplanted into another embryo, and only secondarily (if necessary) whether they have to go through the entire subsequent process of development once they have been isolated (see Slack, 1991, p. 19). The lysis of the zona pellucida, as demonstrated by in vitro experiments is not in itself sufficient to induce an immediate and spontaneous breakdown of the blastomeres, which tend to stick together and remain in the original position if they are not other factors physical or chemical (see Suzuki et al., 1995).
5. Identical twins, epigenetics and determining embryonic individuality. Of the possibility of human embryonic development, the phenomenon of identical twins is the most controversial, both in terms of explanation scientific ontogenetic process (see Serra, 1993, pp. 89-93) from the point of view of the interpretation of the meta-biological phenomenon. It is, for some philosophers and theologians apparently insurmountable objection to the individuality of the embryo to the stage of development in which the event can still occur, which is made to coincide with the second week of life. According to some, the zygote or early embryo can not be ontologically a human individual because "he has the ability to become two human individuals (see NM Ford, When did I begin? , Cambridge 1988, p. XVI): the lack of individuality Boethian exclude the applicability of the concept of person, which requires a individua substantia.
The objection is based on the contention, of a philosophical, that the identification of a living being is given only in the absence of the biological possibility of dividing into two or more other things. Against this position should first be noted simplistic application of mathematical logic against a biological entity that can not be defined precisely and synchronously, but physically (organic mass) and diachronic (life cycle), and also against a biological process complex that is not reducible to algebraic operation, but must be understood in the manner through which actually happens. This claim also is based on confusion between arithmetic units and metaphysical unity, whose distinction was already placed convincingly by Thomas Aquinas (see Summa Theologiae , I, q. 11,. 1, ad 2 um ) and more recently picked up by Henri Bergson (see The Evolution creative in Oeuvres, Paris 1984 4, pp. 505-506).
Whatever the process leading to the formation of monozygotic twins, it is not, however, the division of an organism into two identical organisms, such that the first no longer exists and instead there are two, discontinuous and indistinguishable to report to the first. On the contrary, the separation of a blastomere, or cell mass from an embryo to form a second embryo, the embryo leaves the original - was now composed of a single blastomere - in their own identity and physical space-time, although not morphological development unit whose integrity had led him. And once you create the conditions for the formation of a new individual embryo, which begins with the establishment of biological existence a second "development plan".
Another flaw of the objection of monozygotic twins can be detected whereas the term 'individual' is analytically applied to the case of the embryo according to the double connotation of formal unity and separation. Multilivellarità but because of its structure, a unit of an organic nature is always relative, and therefore not able to ontological individualism; also the separability of a living, because of its interactions with the environment, it is not a property of the biological, but rather a representation of it. The unit is not predicable of living matter as such, but of being. It structure the institution in a aliquid and it does remain such, distinct from the others by a unique relationship with itself along its development in space and over time. All the embryo, "as is", and is immediately unum aliquid , that is an individual. Whatever the stage of its molecular and cellular organization, the living is in relation to himself, and this relationship is ontologically grounded in his unit, which implements the original richness of being. If during its early embryonic development and the posting of one or more blastomeres, or after the blastocyst stage, the division (splitting ) the inner cell mass gives rise to another living being of the same nature (embryo cogemello), also is a being, it is also a unum and a aliquid, ie an individual.
6. single story. In thinking about the identification from transcendental properties of being, theoretical reason circumscribing the real identity in the most fundamental difference, which also plays on the biological and ontological. The "place" just for this difference is the story, through which the essence of being implemented over time to become, so that the embryo is instantaneously and simultaneously an individual and an individual's biological metaphysical, and early in time an individual's biological (body) coincides with the beginning of the individual metaphysical (person). Quest '"unique history" begins, and will continue to be described in the chapters of genetics and embryology, but it was clearly foreseen by s. Vincent of Lerins, who in the fifth century wrote in his Commonitorium: "The bodies are still growing and developing with the passing of years, remains the same as before. There is certainly a great difference between the bloom of youth and the harvest of old age, but adolescents are the same ones that once they become old. You then change the age and condition, but still the same individual only. Remains one and the same nature, one and the same person. [...] Nothing new is found in adults that has not already been present in children, albeit in embryonic form. There is no doubt about that. This is the true and authentic organic law of progress. This is the order placed by the wonderful nature for any growth. Mature age unfolds and develops in ever more extensive knowledge of all that the Creator had formed in anticipation of the corpicciolo small ( Commonitorium Primum , 33: PL 50, 668).
II. The question of the ontological status of the embryo
1. Introduction and location of the problem . The question of 'ontological status' human embryo is equivalent to asking the questions: "be" the embryo and fetus are human? This is the same "being" which we ordinarily recognize in the newborn, in children and adults? Or are we to do with "being" different, similar or even equal? When and how did life begin with a "human being" who are we?. The question today is very controversial, not because of its intrinsic theoretical interest, but rather for the practical implications that would arise about "respect" due to the embryo and human fetus, and on their legal protection. The ontological question presupposes, therefore, the practical relevance to another question, that ethics: what kind of "respect" - or, rather, that "care" who "love", that "reception" - must regard the human embryo and fetus?. The subjects involved in the practice of this second question are: the torque generated, in particular the mother, doctors and staff obstetrician, also, for some years now, doctors and biologists involved in assisted reproductive technologies and researchers who undertake investigations on fertilization and prenatal human development, health and ultimately the legislature.
Addressing the question of moral duties to the embryo and the fetus does not seem depend neither logical nor justified, and some of the preliminary solution of the ontological question, as shown by both the recent Catholic teaching (see CDF, Quaestio de abortu procured , EV 5, 674; Donum Vitae, EV 10, 1174 -1179; Evangelium Vitae, 60), and some documents "secular," such as the Warnock Report (tr. it. What frontiers in life? , edited by D. Tettamanzi, Milan 1985 ). The first, by adopting the way tuzioristica, come to say with John Paul II that "the only sufficient likelihood of facing a person to justify an absolutely clear prohibition of any intervention aimed at killing a human embryo "(Evangelium vitae , 60). The latter, choosing the utilitarian, rather grant a degree of protection vary according to the supposed interests of the torque generated, the unborn child or of scientific research: the life of the embryo and fetus is not recognized as an intrinsic value, but only instrumental.
The relevance of the ontological status with regard to the "moral status" and that "legal", although not decisive, however, can not be easily diminished: know what or who is determined to be not indifferent to it determine how treat, even if our behavior toward it requires the further approval of a "good" and an "evil" against him (see Angelini, 1991, pp. 152-157). It should, however, that the old record and strong relationship between them and bonum, between ontology and morality, it is now frequently replaced by a new and weak relationship between bonum factum and . The experimental knowledge of the science requirement seems to have the whole field of knowledge about man and nature living, thus replacing the metaphysical knowledge. We then addressed directly or exclusively to biology and medicine to try to know what or who is the embryo and fetus, and consequently found a behavior of "good" (in ethics) or "right" (the law) against them.
the biological knowledge on the embryo and fetus (see above , I) appeal and those who wish to address the ontological question theoretically as a precondition of the moral (see Gilbert, 1991, pp. 33-74; Serra, 1993), those judged to be too pretentious to know the "metaphysical", they move directly from an ethical or legal nature of practical reason. Embryology are also explicitly interested in the Magisterium of the Church when it states that "are the same conclusions of science regarding the human embryo provide a valuable indication for discerning by the use of reason a personal presence from the first appearance of a human life. " Although not "expressly committed itself" within the scientific debates and those philosophical affirmations, the Magisterium has always held in high regard the "clear confirmation" of the biological sciences (see Evangelium Vitae, 60). This position is consistent with a long-standing theological tradition, from Albert the Great in Bonaventure, in particular to Thomas Aquinas, a tradition that has always faced, about the prenatal human life, with knowledge of medicine and embryology era (See Caspar, 1987, Caspar, 1991, pp. 43-93 and 105-123).
regard to a dependency between "ontological" and "biological status", it must first recognize that it is in fact already made, because no factual ontological status without regard to genetic, cytological, embryological, neurological or midwife. Just keep in mind the concepts of 'conception', 'individuality', 'epigenesis',' nesting ',' sensitivity ',' fetal movements, "" vitality, "and so on. that refer to many phenomena, properties, or biological processes. And, on the other hand, any empirical conception of a biological entity implies a philosophical view of the living that makes it intelligible not only analytically (breakdown of tissues, cells, subcellular structures, biomolecules, genome), but briefly, that is, for example an organic, systematic and organismic. Even those who deny the existence of any philosophical assumption or "meta-biological" in its scientific interpretation of physical facts obtained through experimental research, thereby maintains an implicit metaphysics option in favor of a radical reductionist approach-physicalistic (statistical and mathematical chemical or physical) to the study of living nature.
In several anthropological orientations that characterize the contemporary cultural landscape, it is possible to identify different theoretical perspectives within which they were designed various ontological status of man, and in some way also human embryo and fetus. Henceforth we will indicate this status - properly and fully human - with the traditional term of "human person", without it bound to any particular significance that the term "person" has changed over the course of his long and troubled history or with which it is currently used (see Cotta, 1989, pp. 59-82, Novaes, 1991, pp. 27-85). Because of the ambiguity which now is charging the word 'person', not a few authors suggest alternative terms, but does not appear that sufficient agreement has been reached: the fact remains that it is not in question semantics, but the ontology of what language commonly referred to that period. Necessarily sacrificing the nuances in the key conceptual and comprehensive analysis of each position, you can groped to bring the complex debate within the following conceptions of the human person.
2. The terms "strong" person . It is first found a strictly ontological concept that is based on a substantive ontology or an ontology relationships. It belongs to the first foundation the concept of person as " rationalis naturae individua substantia" due to Severinus Boethius (ca. 480-524) (person De duabus et Naturis , III, 4-5), then taken up by Thomas' Aquino as " Individuum subsistens in rational nature" (cf. Summa theologiae , I, q. 29,. 3) and as "naturae rationalis identifies existentia " by Richard of St. Victor (d. 1173) (see De Trinitate, IV). Because the "rational nature" is, among all organisms, its only human, every member of the species Homo sapiens sapiens is ontologically a person from its formation as "individual substance". The "person" is coextensive with "the man" - as a human individual - throughout its life cycle. Since the coming into existence of a new human being is typically where the biological process of fertilization, in which it generates a new "individual substance" human embryo is a person from the unicellular stage (zygote). Within hylomorphic interpretation of reality, most of the major proponents of the ontological conception and therefore explicitly acknowledges the metaphysical thesis infusion of "instant" of the soul (known as thesis of the 'immediate animation "), as a logical implication of finding a substantial" immediately ". Not all those who adopt the definition Boethian recognize that the human embryo is - since fertilization - person. And this for two separate objections, the first of which has to do with the rational nature of human beings and the second with its substantial individuality.
In the first case, in relation with nature that is rational, we speak of the theory of "mediate animation" or "next animation", which goes back historically to some statements of Aristotle and St. Thomas (see Di Giannatale, 1981, Caspar, 1991b, pp. 239-255; Seidl, 1992). It states that the infusion of the rational, forma corporis, only occurs when the organism is sufficiently developed and therefore able to receive it (see Zalba, 1972, pp. 35-57, Ashley, 1976, pp. 113-133; Cottier, 1995). In view of this order hylomorphism others add or replace a consideration ex parte Dei , which raises the question dell'elevatissima - they say - the frequency of early spontaneous abortions (miscarriages preclinical), before implantation of the embryo in the maternal . This phenomenon is summed degenerative processes of development following the fusion of gametes, such as formation of moles mole and serious birth defects such as anencephaly or other forms of aplasia. Given all this, it is inconceivable that God could "spoil" so many souls, which he "immediately" infused in embryos that die early. In the second case, which concerns the substantial individuality, we have the thesis of "finding the next 'or' epigenetic '. The thesis argues that the embryo is considered to be "individual" only as to when, during its development, will form a single fetus, since, that is, it is not documented to occur the phenomena of monozygotic twins and the so-called "Embryonic Fusion" or "embryonic recombination (chimerism). The lack of continuity and ontological identity between before and after the formation of chimeric embryos twins or an individual leans down substantially in the early stages of development (according to various authors up to 14 ° -15 ° day). In either case we reach the conclusion that the personal human life does not begin with the formation of the biological organism, but only in a subsequent period of epigenesis, thus denying the coextensiveness the person with the whole phase prenatal development of man, before implantation in the endometrium (endotubarico period, when natural, or extracorporeal in vitro) and then plant (Intrauterine period).
The second perspective of "strong", their ontology, the person is the one that is based on the relational concept. The person is understood here as "intersubjectivity" or "consoggettività": according to this philosophy of the fundamental relationship is the "I-Thou relation" that constitutes man as a person. The 'I-in-itself ", individuality substantial rational nature, replacing the' I-with-you", relational nature of subjectivity. Life is so personal to coincide with the organismic human life only when it enters into a relationship with another personal life. The relational conception of ontological research in the development of the embryo then fetus those "facts" biological or psychological factors that would mark the beginning of the relationship between the body and the embryonic or fetal maternal organism, the earliest of which comes from the supporters of this thesis identified in the 'nesting' (implantation of the blastocyst in the uterine endometrium), which is considered to begin around 6-7th day after fertilization. If the organic life of the human being begins with fertilization, then his life would begin, according to some relationship with the nesting: it is from this moment that we could talk about the embryo as of a human person in power (see Malherbe, 1985 and 1988). But if it is true that the problem of ontological foundation of the human person refers to an "other", it must be identified in the "totally Other" metaphysically speaking (ie, the Being, and theologically, God) as the First Cause, and two "other self", the biological parents who donated their gametes, which causes the second. The constitutive relationship is part of the order of causation so radical ontological or "creation" and the biological causation-personal or "pro-creation." Since the report "I-thou" is not subsisting in itself, itself needs to be founded, referring to the substantive issue of the ontology of 'I'.
We thus introduced a further metaphysical concept of "human person", the theological one. Within a perspective open to the transcendent divine revelation and Incarnation - his Christian theology - the deeper nature of the human person is understood in the context of the creature-soteriological relation that defines the theological anthropology. Human life is defined by personal Evangelium vitae, in its consistency as "a reflection of the very reality of God," and in his vocation as "participation in the life of God "(n. 34). This view can find very well defined and documented throughout the biblical text (cf. nn. 1-2, 34-38, 104), where the "truth of life" of man is included in anthropology from the unfolding theology of the 'imago Dei to that of verbs dear, exemplary explicit the Christological dimension of the' anthropology of the image "that Vatican II had just taken up and re-evaluated (see Colombo, 1995).
There is also a conception of the human person that identifies it as essentially a "rational" or an "ethical subject" is the concept of "moral" proposed by Kant in his Critique of Pure Reason . "Person" means here a concept of non-ontological, substantial, but the order rational ethics. According to the original Kantian-transcendental approach, with strict separation of the noumenal phenomenal, there is no possibility of the relationship between "personal status" and "biological status" of man, nor any empirical criterion that allows to draw a dividing line between "person" and "person" or "thing". Some authors who call themselves neo-Kantians, such as HT Engelhardt, however, have transgressed the veto put by the metaphysical philosopher from Königsberg to report between noumenon and phenomenon, looking for - from empirical phenomena and biopsychological data - to establish human development in the presence of "conscience" and therefore the "person". It loses the moral character that was only in Kant, to become a bundle of "higher functions" or "consciential were" capable of verification, but that refer to a "core ontology" permanent constitutes the anthropological subject of inherence duties.
3. The terms "weak" person . A different approach to the anthropological concept of person, that defined as "functionalist," "procedural" or even "works" (see Botturi, 1992; Mordacci, 1992). Before outlining should be noted that we have so far dealt with the scope of the concepts "strong" in the metaphysical sense-foundational and non-truthful in that sense of the word. The term "weak" is used here instead of in the last sense just indicated. The field now seems much more logical to visit and explore the ontological, especially by those who are looking for a "status" of the embryo and fetus less demanding from a philosophical perspective, but the ontological question, as often marginalized from the discussion bioethics can not be easily removed.
approach "functionalist," which further elaborates on different operational concepts, consider the human person as a bundle of transactions or a combination of features currently present and functional, though not continuously active. A human being is a "person" if you will, or can immediately act like one. Where such capacity is not empirically verifiable we would be facing "non-persons", although it would remain to "be" (organisms) belonging to the human species. According to the "operations" that are identified as characterizing the human person - the so-called "Indicators of humanity" - you can then get a concept of "sensory", "psychology of consciousness", "life-autonomy" or "rational-volitional" in person.
The first focuses on the exteroceptive and proprioceptive sensory abilities, and in particular the painful sensitivity: from neurobiology becomes crucial to know whether the somatosensory pathways and the region of primary somatosensory cortex of the embryo and fetus are sufficiently developed and functional to allow perception of stimuli, particularly painful ones, to peripheral or central (brain). The beginning personal life is well established around 5-8 weeks after fertilization. The concept "psychological-conscience" or "psychic" means "person" every human being capable of varying levels of experience "conscious," "subconscious," "preconscious," and - according to some authors - even "not aware" if they have a effects on conscious levels that will occur later. With "experience" is shown every event psychophysiological able to "leave traces that affect the psychological development and the character of mental life." These experiences require an organization morphofunctional of the cerebral cortex rather than that required for the perception of stimuli in the central nervous system, which would be reached no earlier than the second to third month of pregnancy. There is therefore aimed at prenatal and perinatal neuropsychology and neuropsychiatry for information on behavioral and cognitive intrauterine life, able to record these experiences. The other two concepts "functionalist" both refer to the idea of \u200b\u200bindividual autonomy of the individual human being: the former would in a biological sense as "independent vitality", or the ability to separate from the mother's life, with or without assistance Medical (currently considered to from 22 th - 24 th week of pregnancy), the second sense in conceiving of mental autonomy as "rational-volitional" (ability to understand, to will and perception of memory). It is the latter, the more radical thesis, which involves referring to a stage 'higher' mental and physical development for the express mental activities to meet the 'high' functional concept proposed.
III. Comparison of the biological and ontological perspective
The current guidelines for biomedical research in the field of embryonic and some of the most Recent scientific results which it is received, if strictly interpreted according to its method of experimental science of life (see Serra, 1993, pp. 56-58 and Serra, 1995), allow to delineate a biological status of the embryo and fetus human compatible or not incompatible with the assignment to both the ontological status of person - the meaning of "substantial" of the term - from taking place since the process of fertilization. This is possible within the modern concept of molecular-genetic (informational), organismic and physiological (homeostatic) and dynamic-epigenetic (diachronic) that characterizes the current biological understanding of the living individual (see above, I).
If a person recognizes the concept of value "strong" (ontological status in the strict sense), for a fundamental epistemological reason is obvious that no data or concept in the biomedical sciences could directly infer that a human being is a "person". As briefly noted Angelini (1991), 'biology in fact knows nothing about the person. This was said by many and in many ways "(p. 152). But if you want to save the "realism" of empirical science, we must recognize the ontological significance of biological knowledge about the "human person" as "Human body" and his training and organismic constitution. The argument will consist then in the search for points of consistency (or inconsistency) between the biological and ontological embryo and fetus, between 'being in development "of the human species, with their genetic, epigenetic and morphofunctional, and the "human person" early in his life, that still does not show fully and currently its "personality."
1. The comparison with the concepts of "strong" person. By incorporating the definition in the first instance Boethian in person (see above , II.1), you can document that none of the scientific knowledge we possess allows them to bear with reasonable certainty the biological objections raised by several authors to the rational nature of the embryo and fetus or substantial human individuality of the early, giving it the benefit of not (yet) "falsification" (Popper's epistemological theory that is equivalent to the "truth"; 
2. One can not compare with the concepts "weak" in person. The approach "functionality" to the concept of a person escapes it to a real and fair comparison between the empirical bio-psychological and philosophical anthropology, because it dissolves the relationship between the two entrances to the cognitive nature of man, by implementing a reduction in the second to first. The "operations" that indicate the presence of the human person does not postulate in this case, their foundation, a "core ontology" - the place of consistency and inesione functions and the acts themselves - but simply refer to the manifestation of "property "or" right "that ultimately coincides with the current, or are reducible to, biological substrate and psychological man. The identification of transactions in which a human being are really "personal" but is independent of any interpretation of the living that can phenomenologically emerge from biological processes of reproduction, morphogenetic and homeostatic, and making it intelligible in its specific nature. Paradoxically, the formality of this conception of the person is in some cases as to make irrelevant the "biological nature" of the organism (species), or even the presence of a single biological organism, conferring the status in person: may be a "person" even a non-human animal, but can prove pain, fear expressions, to express desires or interests, or a physical entity that does not belong to the living nature, such as a computer able to perform rational operations, interact with other systems, to communicate with the operator. The reference to specific biological knowledge ends up be it unnecessary or purely instrumental.
IV. The contemporary debate about the use of stem cells from embryos and adult organisms
1. Introduction . In the field of tissue grafts in patients with severe metabolic disorders, neurological, muscular, cardiovascular, cancer and others, researchers are able to grow in the laboratory, the biological material required (differentiated cells and tissues) from isolated lines of multipotent cells (stem cells, see above , I.4) grown on suitable substrates physiological. These specialized cells have in fact the property of self-renewal in culture (preserving their replicative potential and epigenetic) and to differentiate under certain conditions, giving rise to cell types that make up tissues and organs. He hopes to be able to obtain, for example, neurons (nerve cells) to replace or supplement those degenerate and no longer function in patients suffering from Parkinson's disease, Alzheimer's disease, multiple sclerosis, spinal injury or ischemia, or B cells of pancreatic islets of Langerhans, capable of secreting insulin after grafting in patients with diabetes mellitus type I, and even blood cells, the muscle, cartilage, bone and skin, but also liver and retina: in these cases, applications should be from blood disorders to osteoarthritis, osteoporosis from the burns, and could include liver cirrhosis and macular degeneration eye. These and other attractive targets for transplant surgery new hope for patients and their families, especially for diseases that today can not be addressed by resolving a therapeutic strategy.
completed his preliminary studies on laboratory animals, biomedical research that pursues these objectives now needs to have adequate amounts of human stem cells to grow and analyze in terms of gene expression and cellular biochemistry, and submit stimulation by environmental conditions, growth factors and other molecules that can direct the differentiation toward epigenetic expected or desired that particular cell phenotype which is used for the graft to the patient and perhaps one day even for the partial or organogenesis total. The sources of human stem cells so far identified are a) the inner cell mass of the embryo at the blastocyst stage (about 5 days after fertilization, when the number of cells of the embryo is equivalent to 150-200, and are distinguishable embryoblast and trophoblast), b ) embryonic tissues (endometrium after implantation, the fourth week of development, primordial germ cells of the yolk sac) and fetal cells, including those of the liver, bone marrow and brain, which are rich in stem cells; c) contained in umbilical cord blood, which still links the portal circulation of the placenta to the baby during delivery, and d) some adult tissues in the body, including the peripheral blood. Thus we see recently extended interdisciplinary reflection on the human embryo of a new debate about the use of cells from embryos for therapeutic purposes, perhaps represented by the first two of the four cases listed above.
addition to the possibility of obtaining human stem cells 'natural', that is not found in genetically modified organisms, nor subject themselves to changes in genomic, but simply picked and grown in vitro , another aspect of the same research could instead relate to obtaining stem cells having predetermined genetic identity (eg, identical to that of the patient which will be made on the graft, if such cells were not withdrawn from his body) or modified (thus suppressing the possible reactions of rejection or the emergence of uncontrolled cell proliferation of neoplastic). In the case of a pre-order the genetic heritage - available only through embryonic stem cells - has been suggested the use of cloning by nuclear replacement (methodology similar to that of the experiment on the Scottish sheep Dolly, have already applied to cattle, goats, pigs and mice), which could create an embryo from an enucleated oocyte from a donor and the nucleus of a somatic cell of the patient. The second case, that of a change to it can also be applied to non-embryonic stem cells, such as those obtained from umbilical cord blood or from tissues of adult organisms, as it involves the replacement of nuclear genes and their epigenetic reprogramming (that only the factors contained in 'maternal oocyte seems to be able to be), but is limited to intervention content and targeted genomic very similar to that of somatic gene therapy.
2. Scientific aspects and clinical . The issue that concerns us here has been the subject of a speech by Pope John Paul II addressed in August 2000 to XVIII International Congress of the Transplantation Society . In that occasion it was stated that "Science itself points to other forms of therapeutic intervention which would not involve cloning or the use of embryonic cells, but rather would make use of stem cells taken from adults. This is the direction that research must follow if it wishes to respect the dignity of every human being, even at the embryonic stage (OR, 30.8.2000, p. 1). The claim has not only considered as an anthropological point of the high dignity enjoyed by the individual human being from conception, and a subsequent explanation of the moral requirement of respect and loving care of embryonic life, avoiding all his manipulation . In addition this value, and consistent with it, John Paul II has also stated clearly a line of positive research in the field of stem cells and their use in transplant therapy: the ability to 'use stem cells taken from adults' rather than resort in embryonic cells. The same scientific and ethical perspective is stated in the declaration of the Pontifical Academy for Life on The production and use scientific and therapeutic use of human embryonic stem cells (see OR, 25.8.2000, p. 6).
The most recent biological literature and the ongoing debate between those who work in research reveal more and more evidence that some stem cells isolated from fetal and adult differentiated tissues can be grown in vitro , expanded into a stable cell line and autorinnovantesi, and induced to differentiate in cell phenotypes other than the tissue of origin. The amazing flexibility that these cells are equipped with comforts the reasonableness of the words of John Paul II makes first reported and the perspective they indicate not only satisfies the requirements of biomedical anthropology and moral man, but really viable in terms of procedure and open to empirical research results equivalent to those assumed in the alternative choice, which would use cells taken directly from embryos.
In a report known as document Donaldson , some British experts had already highlighted the possibility that 'long-term perspective offered by stem cells derived from adult tissues is equal or even superior to that of embryonic stem cells "( Stem Cell Research: Medical Progress with responsability , London 2000, p. 19). Moreover, for many years kind of multipotent stem cells, taken from the bone marrow or peripheral blood of adult donors, are used clinically in the treatment of acute and chronic leukemia, lymphoma, myeloma and myelodysplasia, and some metabolic diseases Monogenic (hemoglobinopathies, congenital immunodeficiencies, lysosomal storage diseases, Fanconi's anemia). However - as mentioned in the above statement by the Pontifical Academy for Life and in the same document Donaldson - are the most recent research on laboratory animals indicate that, for example, "an adult neural stem cells have a ' extensive development and can potentially be used to generate a variety of cell types suitable for transplantation in different diseases (Clarke et al., 2000, p. 1660). Not only that "these studies suggest that stem cells in different adult tissues can be much more alike than hitherto thought to embryonic stem cells, and perhaps have an epigenetic repertoire that is close to that of embryonic ( ibid., p. 1663), but also open up a gap in a strictly determinist biology development, which would like to see in some tissues and organs (such as those of the nervous system) the outcome of a process of irreversible and rigid segregation of multipotent embryonic cells. Evan Y. Snyder and Angel L. Bishops have pointed out that "the plasticity intra-germ, through which stem cells give rise to derivatives of the same germ package (for example, mesenchymal stem cells generate cartilage, bone and fat cells, bone marrow cells undergo myogenic differentiation, and vice versa) is certainly important. But even more impressive is the possibility of a transdifferentiation inter-germ (eg, neural stem cells, resulting dall'ectoderma to give hematopoietic cells, which are of mesodermal origin, stromal cells of bone marrow-derived mesodermal, producing hepatocytes of endodermal origin, and glial cells of neuroectodermal origin) "(" Nature Biotechnology "in August 2000, n. 18, p. 827). This valuable considerations regarding the philosophy of developmental biology, which apparently might seem relevant only theoretical, "will have a relapse practice regarding tissue engineering by stem cells, because the organs could be" re-created "[laboratory] based on the processes of development" (ibid. ) natural. Although the authors do not consider that this adult stem cells can replace embryonic cells in basic research and application, they nevertheless recognize that "the recent wave of studies suggest unsuspected degree of plasticity, can certainly stimulate experiments up to three years is unimaginable "(ibid. , p. 828).
Even scholars U.S. called to process the report of the National Bioethics Advisory Commission stressed the potential of replication and differentiation of adult stem cells, when exposed to a favorable external environment (see Issues in Human Stem Cells , Rockville (MD) 1999 , vol. I, p. 13). The research aimed to identify the conditions under which stem cells isolated from adult tissues can grow in number and are then induced to differentiate. Among the conditions that can induce differentiation seem important: an environment of suboptimal in vitro culture , limiting stem cell renewal (once it reaches the desired expansion their course), but without causing death, the addition of growth factors, such as proteins of the TGF-β and Wnt families, cytokines and chemokines, some hormones (eg insulin) and other substances, such as dexamethasone and indomethacin, and induced the expression of certain genes such as c-myc .
In conclusion, one can recall the main advantage that adult stem cells present in terms of experimental and clinical. As noted by the hematologist Catherine Verfaillie, who has recently isolated from the bone marrow of children and adult stem cells "almost identical to embryonic" in their ability to give rise to different cell types, stem cells from adult tissues are easier and safer to handle and insert, because it does not tend to differentiate spontaneously and uncontrollably as embryonic ones, which could also develop teratomas in vivo (tumor foci are composed of cells heterogeneous). Do not act so adult cells, which differ only if induced to do so. On the other hand, they seem to lose their ability to divide and differentiate after a certain period of time in culture, and this could be a limitation to the production of perennial stem cell lines, the only suitable to be marketed on a large scale for purposes of research and application. Inconvenience this, much less significant if we should move to an autologous or from a single individual, having to proceed in this case from time to time in an isolation and differentiation in vitro cells, and targeted content.
3. Anthropological and moral . Anthropological point of view, three issues seem to be underlying the current debate on the extension to humans of studies on stem cells and their therapeutic potential. The first and most fundamental, question concerns the man as a subject (patient) to treat, but also at the same time, the subject (biological) scientific research, diagnosis and therapy. It is a special case of the anthropological question for excellence, succinctly and persuasively that echoes in the words of the Psalmist: "What is man that you remember, the son of man that you care for him?" (Ps 8, 5). Drew the same as John Paul II, to take care of man, "it must first be from an integral vision of his being, that is, an anthropology in which he is considered for what he really is, that as a creature of God, made in his image and likeness, such as being able to know the unseen, stretched to the absolute of God, made to love, called to an eternal destiny "( Participants in the Colloquium of the International Foundation "Nova Spes , 11.09.1987, Teachings , X, 3 (1987), p. 1051). In the dramatic tension between their own finitude - that the disease, and particularly the degenerative and fatal, emerge in a more pungent - and its constituent call to total perfection (cf. Evangelium Vitae , 34-37), it consumes 'earthly existence of man and gushes his cry for salvation, that in some circumstances of life in medicine is collected through the more obvious health. The demand for health because it can never be separated from the prayer of salvation.
Whether you arrive at a resolution of the disease that is the basis of physical and spiritual suffering of the patient, and when this is not technically possible or morally acceptable, the salvation of man in his unitotal ( corpore et unus soul ) does not coincide with the newfound health, nor its eventual destruction by the persistence of the disease or the onset of death. Faced with the prospect of biological cell lines have many so-called "immortals" who might one day be a virtually inexhaustible source of autologous or heterologous "tissue replacement" for the human body, it must be firmly based on the non-reducibility of the human dimension of eternity to the possibility of indefinite self-replication of its cells (or those of a donor), and non-identifiability of personal salvation with the achievement of this objective healthy. In this light it is not ultimately inconsistent with the truth about man and his transcendent destiny (cf. Evangelium Vitae , 38) even if the prospect of limited availability of human stem cells as a result of the respect due to life and the dignity of the human embryo, or, more likely, that's expected to win more of the same therapeutic target through alternative pathways involving adult stem cells. Freeing doctors and patients derives from a utopian perfection biological eliminating the finitude of man, and then the illness and death, the design encourages the above mentioned first in the search for therapeutic strategies more appropriate and relevant to the integral good of the individual patient's and enables it, in its fight against the disease, finding a sense to this suffering and to sustain a hope for their lives that is challenging the application of salvation contained in that of health.
steps of science, and so emblematic of those of biology and medicine, which directly relate to human life, are guided by a purpose and moved by a method that need to be carefully considered and evaluated. The claim of limitless freedom for the research objectives and the means adopted to achieve them reveals an idea of \u200b\u200bscience's sake, ideal exercise of theoretical knowledge (or practical) means of self or a technological advance without reference to a authentic human progress. Instead, "science in general and medical science in particular, is justified and becomes an instrument of progress, liberation and happiness only insofar as it serves the welfare of man" (John Paul II, Address to Congress of Neuropsychiatry , 12.4.1986; Teachings , IX, 1 (1986), p. 995). The consciousness of this task, which makes it very noble science and the human stature of its practitioners, it implies the awareness of a certain limit is not the creativity of the work or the horizon of the investigation, but the tools applied in each empirical research and to choice of method to be followed in the investigation. The integral good of man requires, in fact, the recognition of "humanity" that can not be wounded or trampled in the path of a search, and not only in any subsequent applications of the results achieved. In scientific knowledge, no less than in the ordinary, the method is dictated by the object investigation, so it is not correct to use the same method in each case. This limit "objective" of the cognitive process that requires the study of human stem cells can not be conducted with the same procedures adopted for the stem cells of other animals, such as isolating them from living embryos developed in the laboratory. The specification of "human" is substantial and not accidental, and requires an essential change in the scientific method of the object / subject "man", to each man and all men since their coming into existence.
As with other issues of ethics of scientific research and clinical medicine, even if the study of stem cells and their application to treatment of transplants, "the basic criterion for assessment is defense and promotion of the integral good of the human person , according to his own dignity. In this regard it is worth remembering that every medical procedure on the human person is subject to limits that are not reducible to any technically possible, but is linked to respect for human nature itself, understood in its fullness: what is technically possible is not that very reason morally admissible "(John Paul II, Address to the XVIII International Congress of the Transplantation Society , 08/29/2000). Among the paths that do not respect the dignity and worth of the human person, there are procedures that involve the manipulation and distribution of human embryos for research purposes or to graft tissue in patients, and that "there are morally acceptable, even when their proposed goal is good in itself "(ibid. ). The affirmation of this principle, which equates to the already born conceived in terms of the protection of his life, is in continuity with the ordinary Magisterium of the Church and the tradition of Catholic moral theology. It may be synthetically made, knowing that, even in the case of experimentation on human embryos, in expanding the field biomedical research (and legally permitted in some states), the general principle that the direct and voluntary killing of an innocent human being is always gravely immoral, even if it was done in order to bring benefit to other humans, is a always act morally unacceptable (cf. Evangelium Vitae , 57, 63).
Faced with the prospect of a therapeutic application of stem cells taken from human embryos generated in the laboratory on artificial insemination and no longer used because intrauterine development has long been cryo-preserved in the centers for the treatment of conjugal sterility, some authors of Christian inspiration believe that we can not make an absolute prohibition of such experiments. Some of them, according to teleological ethical theories such as proportionality and consequentialism, and not recognizing its life, the human embryo - at least to a certain stage of development - a fundamental moral value, they see the embryonic stem cell research a mixture of good and bad effects, such as to require to judge the morality of this action in a different way: his "goodness" of morality based on the positive intention of the researcher referred to the possible treatment of certain diseases, and its "ingiustezza" in consideration of the adverse effects on the life of the embryo (Given a value of order "pre-moral, physical or ontic). Consequently, while acknowledging that the in vitro fertilization or cloning if done to create a human being, are "wrong", they do not come to judge as morally "bad" the will that allows the sampling of the designs or runs stem cells from human embryos stored for long periods in liquid nitrogen or "donated" recently, to this end, the couples who are subjected to techniques of artificial procreation. This is in consideration of the fate of these embryos would otherwise be devoted to (progressive deterioration or destruction) and the intention of the biologist and physician - and possibly the donor couple - who turns to a high moral value (the search for a treatment for patients) judged to be decisive in that circumstance.
is understandable that such reasoning can be a persuasive force, because of the immediate line with the scientific and technical mentality, just between the researchers and doctors, who are used operationally to assess their scientific, diagnostic and therapeutic, based on the relationship between results and resources and benefits between different events; mentality that sometimes even those who unintentionally transmit it to the centers for the treatment of sterility in couples, as they are induced to consider the result of human procreation as the "product" of an effective biomedical intervention that "the term dell'Amorosa personal and fatherly providence of God" (Evangelium vitae , 61). However, even the most scrupulous balancing of good and bad effects predictable consequence of an action is not an appropriate method for judging the moral quality of an ethical choice which is relevant to intervene on a human life. Or just a good intention, as' the morality of human act depends primarily and fundamentally object rationally chosen by the deliberate will "(Veritatis Splendor , 78), ie if this is ordered to the good and the ultimate goal of God's reason itself testifies that among the objects of human actions that "are considered" not ordered "to God because they radically contradict the good of the person made in His image" (ibid. , 80) is all that is against human life itself, such as the removal, and the offense of violation of the dignity of a human being from conception to natural death.
Finally, the generation of cloning a human embryo in order to use it as a source of stem cells for the cultivation and differentiation, and subsequently in the graft body patients who provided the core of their somatic cells for cloning the same action is contrary to human dignity because it is opposed to his good, and no good intention or particular circumstances is able to clear its malice. It can not therefore be subject to a positive act of will, even though the intention is to safeguard or promote individual products which is a major health.
The human enterprise, a fascinating and providential, biomedical research on metabolic diseases, hereditary, degenerative and cancer - which opens the prospect of transplanting tissue from stem cells - is not penalized by refinements and clarifications to the Magisterium of the Catholic Church has offered in this regard. Are not censored, nor the legitimate desire of the scholar to know the reality, nor that of the doctor to detect and combat the disease, nor that of the patient to aspire to a better quality of life. The requirement not to use stem cells from embryos but go to those obtained from different tissues, directs energy towards solutions which are fully equivalent to the integral good of man and at the same time, scientifically and clinically convenient. By many scholars and doctors, this was perceived as a natural correspondence with the demands of conscience and professionalism in the full belief that "the Gospel of life is not for believers is for everybody. The issue of life and its defense and promotion is not a concern of Christians alone. Although faith provides special light and strength, it belongs to every human conscience which seeks the truth and which cares for the fate of humanity "(Evangelium vitae , 101).
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