Imagine yourself a cloned child created from the DNA of a wealthy person who wants to have your organs available for transplant, when he later needs them. The only life you know as a child is as one of a large number of other clones who are kept in the setting of an isolated English boarding school, Hailsham, where none of you has any contact with the outside world. Initially, you have no idea of your intended destiny, as an organ donor.
At age 18, you leave Hailsham for other supervised accommodation, where you will live until you become an organ “donor,” usually in a sequence of “retrieval operations,” finally being killed when an unpaired vital organ is taken.
In the film of Kazuo Ishiguro’s book, Never Let Me Go, which is playing in Canada, we watch this dystopic and unethical example of a rapidly developing field called “regenerative medicine” (which, used ethically, offers great hope), being played out against a tragic love story that involves three of these young people. Through this love story, we understand how fully human they are, in contrast to the immense dehumanization to which they are subjected.
Reviewers have commented that the film is unusual in being a science-fiction story set in the past, the 1950s and ’60s. But what makes it so spine-chilling is that we come to realize that our present world is the future Ishiguro describes. Many scenarios it portrays, such as organ transplantation, and genetic and reproductive technologies, which were unknown in the ’50s and ’60s, are now science-fact. The film delivers a powerful message that we need to become much more sensitive than we currently are to the ethics issues 21st-century technoscience raises.
Here are some of the lessons we can take from it.
The cloned children are regarded by the people who run their school as repositories of organs rather than as individual persons, as objects, not human subjects. This dehumanization is inflicted both through the way in which the children are treated and language.
They are constantly monitored with electronic bracelets, like animals are with computer chips. One supervisor, obviously meaning to be empathetic, remarks, “you poor creatures.” Creatures is a word we use to refer to animals, usually when we are differentiating them from humans. And someone queries whether they have a soul. What is clear is that in dehumanizing the children, these people dehumanize themselves more.
A major current example of dehumanization through language involves human embryos and fetuses. Human embryo research is justified by describing the embryos as “just a bunch of cells” and, in abortion, fetuses are characterized as “just unwanted tissue, part of the woman’s body, not a child.”
The physicians and nurses responsible for keeping the children healthy, so later their organs can be used, also dehumanize them. In medically examining them, they act as though they are mechanics making sure a car is in good running order, not health-care professionals caring for patients. Most horrific in this regard, is the scene showing surgeons undertaking a vital-organ-retrieval-operation that kills the “donor.” They carefully take the organ, then instantly “pull the plug” on both the life support technology and any engagement with the “patient,” simply walking out leaving the dead body on the operating table, bleeding, not even bothering to suture the wound. Even in death the person is not respected as human.
Who were these physicians and nurses? How could they be in involved in such evil, such appalling violation of medical ethics? That same question has often been asked by scholars in relation to the Nazi doctors in the death camps. Are comparable unethical operations taking place in some countries today, for instance, using prisoners as “donors”? Might some Canadians be recipients of these organs?
How could society allow this to happen? Why wasn’t it prohibited and severely punished? Or was society complicit in the evil by funding the technoscience that made it possible, without ensuring that technoscience was used only ethically?
Who were the scientists who made the clones and what ethical requirements should have governed them?
And where were society’s watchdogs, the medical and scientific bodies responsible for ensuring ethics in the professions? Or was it a situation where the legislated safeguards were inoperative.
It’s clear in the book that “farming” these children is a lucrative commercial industry. This brings to mind the “fertility industry” that markets assisted reproductive technologies, bringing in $3.3 billion annually, in the United States alone. It’s an area that needs very close ethical supervision, yet it’s common to hear it referred to as the “Wild West of human reproduction.” Note also the unethical international organ transplant industry that the recent Declaration of Istanbul seeks to eliminate.
Another warning comes from the intentional use of euphemistic or obfuscating language by those involved in the “cloning-transplant project.” Euphemisms can skew our perceptions about ethics, probably by suppressing moral intuitions that clear language would elicit and which would function as ethical red alerts.
The person cloned, is referred to simply as the clone’s “original.” The clones go looking for their “originals.” They describe sighting a person, who might be such, as seeing a “possible.” Especially in the book, Ishiguro captures, exactly as I’ve personally heard donor-conceived people express it, their anguish at not knowing, but longing to know, their biological antecedents.
The word “kill” is never used and even the word “death” is avoided, as is often true of pro-euthanasia advocates. Rather, the final fatal surgery is referred to as a “completion.” A nurse remarks that “some donors look forward to completion,” which is not surprising seeing the immensely debilitated state of the young people, who have already made multiple donations. Towards the end of the film, the former headmistress of Hailsham, now retired and in a wheelchair, remarks, philosophically, “that we all have to complete sometime.” That’s true, but how we “complete” is the critical ethical issue, as we can see in the present euthanasia debate.
That brings us to convergence, which refers to interventions that become possible only through the combination of separate technologies. Never Let Me Go is a story of the convergence of genetic and reproductive technologies — cloning, in vitro fertilization and surrogate motherhood — and organ transplant technologies.
Each technology, taken alone, raises serious ethical issues, but combined they raise ethical issues of a different order, as we see in Never Let Me Go. And such issues might be closer to us, than most of us realize.
Is it ethical for people who are euthanized, in countries where this is legal, to become organ donors? There have been recent reports of this at transplantation conferences and in the medical literature.
And here’s another presently possible scenario of convergence, the only element of which is illegal in Canada would be cloning the embryo, which advocates of human embryo research have argued should be allowed for “therapeutic purposes”: Create an in vitro embryo and take one cell, when all cells are still totipotential (can form another embryo) to make a second embryo. Transfer the first embryo to a woman’s uterus and freeze the second embryo. When, as a born child or adult, the first embryo needs an organ transplant, transfer the second embryo to a surrogate mother, abort the fetus at a late stage and use its organs.
Finally, a statement from the wheel-chair-bound ex-head mistress of Hailsham merits noting with respect to the philosophy and values on which we should base our ethics. It shows her exclusively rational approach to the horror of what she helped to inflict on the children in her charge.
Two of them, who are now adults and in love, come to her seeking a deferral of the “completion” organ retrieval surgery on the young man, so they can have some time together before he is killed. She tells them that is not possible and enquires, rhetorically, “Would you ask people to return to lung cancer, heart failure and other terrible diseases?”
Never Let Me Go is a searing lesson about the “ethics outcomes” that can result from pure utilitarianism and moral relativism, when they are used to govern the new technoscience by people without a moral conscience or moral intuition.
Margaret Somerville DCL, LL.D, is the founding director of the Centre for Medicine, Ethics and Law at McGill University.
Printed with permission of the author.
This article was first published in the Ottawa Citizen