The recent attempt to save the life of Baby Fae, who suffered from an immanently life-threatening cardiac condition, by implanting a baboon heart in her has stirred the emotions of all and has created a deep debate in the medical and ethical communities. Despite the virtually unanimous opinion of medical experts that the baboon heart would ultimately fail, physicians at the Loma Linda University Medical Center implanted the baboon heart because they believed that no other procedure available would offer the infant any significant chance of survival. Medical experts claimed that the “xenographic” (interspecies) transplant was doomed to failure because the body rejects tissues from other species even more sharply than it rejects human tissues. It was just not clear to these experts how this heart with different metabolic requirements, a different DNA structure and a different neurological structure could survive long in Baby Fae.
The moral questions in this case are quite complex, and I would like to sort them out by seeking answers to the following questions:
•Are xenographic transplants simply and inherently immoral?
•Are xenographic transplants morally permissible either as temporary measures or as the last measure to be taken when all other courses of action have been tried and have failed?
•Is it permissible to resort to xenographic transplants before attempting other courses of action when the failure of the xenographic transplant will entail the death of the subject?
To answer the first question, it must be affirmed that if xenographic transplants could be successfully performed they would resolve a major problem that is developing in medical ethics. The problem stems from the fact that there is more and more evidence that many individuals who are being declared “brain dead” are not in fact dead, but are in the last stages of dying. There have been reports of “brain dead” persons having cardiac and respiratory function for an extended length of time, developing pneumonia and even delivering babies. The Journal of the American Medical Association reported the case of a woman declared “brain dead” who was sustained by hyperalimentation and antibiotics for eight days, at which time she gave birth to a 26 week-old infant by Cesarean section. As a result of these and other cases, more and more medical and ethical authorities are coming to the conclusion that there are grave moral problems in removing the organs from individuals who are diagnosed as “brain dead” because it is not at all certain that they are in fact dead. If xenographic transplants ever become successful, they would eliminate the risk of killing innocent human organ donors mistakenly diagnosed as dead but only in the final stages of dying. Thus, from one perspective, cross-species transplants are commendable because they would eliminate a serious moral problem if they prove successful.
Would cross-species transplants be inherently immoral because they degrade and demean the human recipient? A claim that this is the case is not entirely persuasive—even though it has some merit in heart transplants—because animal tissues are used on other occasions without creating moral problems. Just as it is not morally objectionable to use plastic and shark skin compounds to treat burn victims, so also it would seem not to be morally objectionable to use animal organs to save humans from death.
Are xenographic transplants morally objectionable because it is immoral to kill animals in order to save human lives? From the Catholic perspective, this argument is not strong because Catholic doctrine holds that animals do not have spiritual souls, are not persons and do not possess moral rights. Animals have material souls, and bringing harm to them for sound moral reasons is not a moral violation. Killing an animal for a sound moral reason is a physical evil, but not a moral evil. This does not mean, however, that cruelty can be inflicted on animals, for this is contrary to moral virtue. In the Catholic perspective, the animal kingdom is a gift from God for human benefit; animals are to be respected and revered. It is morally permissible to kill animals to protect human life or when significant human benefit comes from killing them. But cruelty to animals in any form should be avoided as being contrary to the natural virtue of mercy. I sympathize with animal rights advocates who are ardently trying to prevent cruelty to animals, and I am concerned that unfettered research with animals could become gravely immoral. This concern does not mean, however, that animals cannot be killed for genuine and morally upright human needs and purposes.
In response to the second question as to whether xenographic transplants are immoral as temporary measures or as a means of last resort, it does not seem that there is anything immoral with their use in either of these cases. If there is a sound medical and moral reason for using cross-species transplants to temporarily save a life, it is hard to find a solid reason to object to them. Similarly, if there is no other means available to save a human life, it would seem that no persuasive reasons could be found to object to their use.
But in response to the third question, there are serious reasons for not permitting xenographic transplants until other procedures and therapeutic measures have been tried. The reason is that when one deals with innocent human life, one must take the safer course of action. This principle applies not only to therapies but also to experimentation and research. This principle must be upheld so that patients and subjects of experimentation and research can be given every reasonable possible means of protecting and promoting their life. In the case of Baby Fae, taking the safer course of action meant that non-experimental procedures should have been tried before experimental procedures, and treatments that would not entail her death if they failed should have been tried before those that would be certainly lethal if they failed. Specifically, the physicians at Loma Linda were morally required by the principle of safer action to provide her with the “Norwood” procedure (to restore surgically interim cardiac function) before giving her a baboon heart. This procedure is less experimental (if experimental at all) than the implantation of a baboon heart, and it had a better chance of success than a baboon transplant. And if it failed, it appears that it might have been possible to resort to other measures to save her life. With Baby Fae, however, all other possible chances of saving her life were eliminated by removing her heart and replacing it with the animal heart. When her heart was removed, any chance of surgically repairing it was eliminated; and when the baboon heart was implanted, any chance of implanting another heart was also eliminated. By proceeding immediately to the baboon transplant, the physicians foreclosed resort to other measure if the heart failed, and thus they eliminated any other chances of Baby Fae surviving a failure of the baboon heart. Thus, it must be concluded that the experiment performed by the physicians at Loma Linda was morally blameworthy; by removing her repairable heart and then replacing it with a heart that was virtually assured to fail, they eliminated any other reasonable hopes of survival for this infant.
The failure of Baby Fae’s heart provides us with a moral principle that should be heeded in future experimental situations: experimental life-saving procedures which will certainly cause death if they fail should only be attempted after all other life-saving procedures have been tried. If this principle had been followed with Baby Fae, her chances for survival would have been much greater. Because the Loma Linda team did not follow it, they unjustly and unduly eliminated whatever chances she might have had to survive by other measures.
This tragic experiment not only provides us with a needed moral principle, it also provides us with an insight into the incompetence of some bioethical review committees in their dealing with difficult moral issues. It could not be expected that the physicians or the parents should be aware of the above-mentioned moral principal in all of its ramifications. But one could expect that bioethical review committees understand it. Just as the Loma Linda bioethical review committee did not protect the right of Baby Fae to all reasonable chances for survival, we should not expect most ethics committees in the future to be able to protect other incompetent patients. Just as the bioethics committee in this case caved in to the wishes of the team of physicians, so also will most bioethical committees in the future cave in to the demands and wishes of parents and physicians.
What is regrettable is that the Baby Fae case seems to be the first of many. It is now apparent that a number of children in the future will probably be given baboon hearts before other measures to save their life are taken. This is a grave injustice to these children. Again, the call must go forth to the Church to renew its resistance to immoral experiments and practices such as these.