Imagine yourself as 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 21stcentury
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 US$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 wheelchair-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 is
director of the Centre for Medicine, Ethics and Law at McGill University, and
author of The Ethical Imagination: Journeys of the Human Spirit.

Margaret Somerville is Professor of Bioethics at the University of Notre Dame Australia School of Medicine (Sydney campus). She is also Samuel Gale Professor of Law Emerita, Professor Emerita in the Faculty...