26E7F511E9C44DFFD7F23D49E7875FB2

Ethical reflection concerning research on human embryonic cells and on human embryos in vitro

https://www.ccne-ethique.fr/sites/default/files/publications/avis_112eng_0.pdf

http://leaux.net/URLS/ConvertAPI Text Files/B4863A5711FC4B13820A5CA6103AAAEA.en.txt

Examining the file media/Synopses/B4863A5711FC4B13820A5CA6103AAAEA.html:

This file was generated: 2020-02-24 02:13:31

Indicators in focus are typically shown highlighted in yellow;

Peer Indicators (that share the same Vulnerability association) are shown highlighted in pink;

"Outside" Indicators (those that do NOT share the same Vulnerability association) are shown highlighted in green;

Trigger Words/Phrases are shown highlighted in gray.

Link to Orphaned Trigger Words (Appendix (Indicator List, Indicator Peers, Trigger Words, Type/Vulnerability/Indicator Overlay)

Applicable Type / Vulnerability / Indicator Overlay for this Input

Vulnerability Type	Vulnerability	Indicator	# Matches
Political	Food Insecurity	hunger	1
Political	Trade Union Membership	union	1
Health	Cognitive Impairment	cognitive	1
Health	Drug Usage	influence	2
Health	Drug Usage	substance	1
Health	Health	health	16
Health	Mentally Disabled	mentally	1
Health	Mentally Incapacitated	incapable	2
Health	Motherhood/Family	family	3
Social	Access to Social Goods	orientation	2
Social	Access to Social Goods	access	3
Social	Child	child	20
Social	Child	children	16
Social	Educational	education	1
Social	Educational	educational	1
Social	Fetus/Neonate	capacity	12
Social	Incarcerated	liberty	2
Social	Incarcerated	prison	1
Social	Incarcerated	restricted	1
Social	Linguistic Proficiency	language	1
Social	Marital Status	single	7
Social	Mothers	mothers	2
Social	Philosophical Differences/Difference of Opinion	opinion	83
Social	Religion	special	2
Social	Religion	belief	1
Social	Religion	religious	2
Social	Social	social	4
Social	Threat of Stigma	threat	1
Social	Women	women	1
Social	Youth/Minors	youth	1
Economic	Economic/Poverty	poverty	3
Economic	Economic/Poverty	economic	2
General/Other	Cultural Differences	cultural	4
General/Other	Cultural Differences	culture	4
General/Other	Diminished Autonomy	age	8

Political / Food Insecurity

Searching for indicator hunger:

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p.000076: country of access to education and adequate assistance in places where they can be close to their families. The two
p.000076: million children in our country who live below the poverty threshold. The nearly ten million children under five
p.000076: years of age who die every year of disease and hunger in the world while the World Health Organization tells us that,
p.000076: collectively, we could have saved six million of them each year over the past several years. The 200 million children
p.000076: under five whose mental development will be hindered and interrupted by poverty, undernourishment and disease in the
p.000076: poverty- stricken countries of this planet.
p.000076:
p.000076: CCNE considers that our respect for the earliest beginnings of human life must bear testimony to our
p.000076: fullest and collective commitment to respect for each person, child or adult, together with the will to prevent and
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Political / Trade Union Membership

Searching for indicator union:

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p.000032: Haldane compares the myth of Daedalus the inventor, a prototype of modern scientists, to the myth of Prometheus, the
p.000032: transgressor, who stole fire from the gods (quoted by Henri Atlan, in L’utérus artificiel, Seuil, 2005.).
p.000032: François Jacob also referred to the myth of Daedalus in his La souris, la mouche et l’homme (1997, Odile Jacob), as
p.000032: a metaphor for “an ailment of our time” and in particular stated that: “With Daedalus, science without a conscience is
p.000032: emerging.”
p.000032:
p.000032:
p.000032: 33As a reminder, Daedalus built a device so that the queen of Crete, Pasiphaë, the wife of King Minos, could mate with
p.000032: the sacred bull that the god Poseidon had made her fall madly in love with, to take revenge on Minos. The Minotaur,
p.000032: half man and half bull, a chimera devouring men for sustenance, was born of this union. Minos then asked Daedalus to
p.000032: construct a prison for the monster, the Labyrinth. Then it was Daedalus again who gave Minos’ daughter Ariadne, who
p.000032: was in love with Theseus, the thread (Ariadne’s thread) enabling Theseus to escape from the Labyrinth
p.000032: after killing the Minotaur. Minos punished Daedalus and his son Icarus by imprisoning them in the
p.000032: Labyrinth. Daedalus, the inventor of glue, then crafted wings out of birds’ feathers stuck together. With
p.000032: the help of their wings, they flew out of the Labyrinth and escaped, but Icarus ignored the cautionary advice he had
p.000032: been given and flew too close to the sun so that the wax holding his wings together melted and he fell to his death in
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Health / Cognitive Impairment

Searching for indicator cognitive:

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p.000048: gene therapy applications which, in fact, are only now, after half a century, beginning to demonstrate their
p.000048: feasibility.
p.000048:
p.000048: Restricting the derogation to research on embryonic stem cells to solely the kind that is likely to “lead to major
p.000048: therapeutic advances” can also cause the public to entertain false hopes49 because of the degree of emphasis given to
p.000048: therapeutic promises50,51.
p.000048:
p.000048: “No, a thousand times no,” said Pasteur, “there is no such thing as a scientific category for which ‘applied science”
p.000048: is an appropriate name. There is science and there are scientific applications, bound together as are the
p.000048: fruit to the tree which bore them.
p.000048: Society is often tempted to only consider the fruit and ignore the tree. And yet, so-called fundamental
p.000048: or cognitive research and so-called applied or finalised research are both essential, and one is not
p.000048: reducible to the other52.
p.000048:
p.000049: 49
p.000049:
p.000049: In its Opinion N° 109, dated February 4, 2010, on Society and the communication of scientific and
p.000049: medical information: ethical issues, the Committee warned on the danger that “…Some of these statements may give rise
p.000049: to false hopes or disillusion and magnify some of society's doubts on the role of scientific research, in particular
p.000049: medical research.”
p.000049:
p.000050: 50
p.000050:
p.000050: One of the most scandalous (and retrospectively absurd) expressions of such representations may be
p.000050: remembered. South Korea issued a stamp after scientific publications (which later turned out to be fraudulent) in
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Health / Drug Usage

Searching for indicator influence:

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p.000002: Amandine.
p.000002: It was precisely these ethical issues, which arose following the profound changes due to advances in ART in France that
p.000002: led to the creation of CCNE in 1983.
p.000002: The following year, this dissociation in time acquired an entirely different dimension with the development of in vitro
p.000002: embryo freezing (or cryopreservation) which made it possible to defer transferring the embryo to the body of the
p.000002: mother, thus eliminating any a priori notion of a maximum time limit between the moment of fertilisation and the
p.000002: moment when pregnancy begins.
p.000002:
p.000002: Since then, over four million ART births have occurred worldwide, some 200,000 of which in France.
p.000002: Such changes could not but have a major influence on perceptions.
p.000002: Not only were perceptions concerning embryos radically changed, but also those concerning parental projects which took
p.000002: on a new dimension. A prior parental project now needed to be formulated for the possibility and reality of IVF to
p.000002: apply, that is through embryo conception outside the mother's body.
p.000002: In tune with the new importance acquired by parental projects emerged a new form of medical and social
p.000002: responsibility concerning the embryo's fate before transfer to the mother's body.
p.000002: In this radically new context for the start of a human life, emerged the new issue of the future of the in vitro
p.000002: embryos if they were not to be transferred to their mothers' bodies.
p.000002:
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p.000054: and necessary condition for such research to be possible, i.e. parental consent, and an accumulation of an
p.000054: extremely restrictive set of subsequent conditions, although their objective's feasibility is less credible than the
p.000054: expression of their severity.
p.000054:
p.000054:
p.000054: G. Conditional authorisation or derogation from a prohibition? Ethical reflection on legal formulations.
p.000054:
p.000054: 1. The destruction of human embryos is the primary ethical issue, not the decision to perform research on cells after
p.000054: embryos are destroyed.
p.000054:
p.000054: The possibility of research on isolated cells sampled from an embryo which was destroyed because the parental project
p.000054: has been abandoned, or in the course of a PGD procedure, has no influence whatsoever on the decision to destroy the
p.000054: embryo. It happens later.
p.000054:
p.000054: In other words, in no way does the possibility of research have an effect on the decision to destroy the embryo.
p.000054:
p.000054: Prohibiting research does not protect human embryos from destruction. The primary ethical issue, therefore, is the
p.000054: destruction of human embryos.
p.000054: The legal formulation chosen by lawmakers to define this approach, that CCNE described as being as a 'lesser evil', is
p.000054: (as CCNE has always recommended in all of its Opinions) is a 'conditional authorisation'.
p.000054:
p.000054: The question of possible destruction of spare embryos, in the event of the termination of a parental project, in fact
p.000054: arises at an earlier time, when they are created and stored55. The creation and cryopreservation of these spare embryos
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Searching for indicator substance:

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p.000071: And in Opinion N° 67, dated January 18, 2001 on the Preliminary draft revision of the laws on bioethics, CCNE
p.000071: reiterated this rejection and made a clear distinction between the question of research using embryos
p.000071: created in the context of ART and the question of the creation of embryos for the sole purpose of research72.
p.000071:
p.000071: stage, is prohibited."
p.000071:
p.000071:
p.000071:
p.000072: 72
p.000072:
p.000072: “Mindful of the risk of ethical misuse which could result from the reification of the human embryo, i.e. considering it
p.000072: as a thing and no longer as a potential human being, CCNE has already make known its views regarding research on the
p.000072: embryo. On the substance, it agrees with choices made in the preliminary draft :
p.000072: • on the one hand, re-stating the principle whereby producing human embryos by in vitro fertilisation for research
p.000072: purposes is prohibited;
p.000072:
p.000072: B. An ethical conflict: respect for the embryo and the creation of embryos specifically for the development and
p.000072: evaluation of new ART procedures.
p.000072:
p.000072: The ethical concern to refrain from creating embryos in vitro for research purposes could be in conflict with a medical
p.000072: ethical concern, i.e. do the best one can to avoid endangering an unborn child in the context of implementing a
p.000072: new technique intended to improve ART.
p.000072:
p.000072: This ethical concern not to create embryos in vitro for research purposes could also be at odds with another ethical
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Health / Health

Searching for indicator health:

Health / Mentally Disabled

Searching for indicator mentally:

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p.000076:
p.000076: The essential ethical issues which are of concern to today’s world are not those which bear on the earliest stages of
p.000076: development of future human beings, but rather on premature death and the sufferings of children and adults, caused by
p.000076: famine, infectious diseases, massacres, inhumane treatment, and the denial of health, liberty and dignity.
p.000076:
p.000076: Concern for the earliest stages of the development of a future embryo should make us even more attentive and sensitive
p.000076: to the sufferings of children already born. Mentally handicapped children, who are so frequently deprived in this
p.000076: country of access to education and adequate assistance in places where they can be close to their families. The two
p.000076: million children in our country who live below the poverty threshold. The nearly ten million children under five
p.000076: years of age who die every year of disease and hunger in the world while the World Health Organization tells us that,
...

Health / Mentally Incapacitated

Searching for indicator incapable:

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p.000034: that is the diversity of the cell families to which they can give birth.
p.000034:
p.000034: A spectacular illustration of the effects of the environment on the way in which genes can be used was given by the
p.000034: experiments on nuclear transfer (or cloning) mentioned above: the nucleus of a skin cell transplanted to an
p.000034: oocyte cytoplasm from which the nucleus has been removed will enable genes to be used leading to the creation of an
p.000034: embryo.
p.000034:
p.000034: Where are the boundaries of cellular plasticity? What are the specific features of molecular composition or
p.000034: structure of the cellular body (the cytoplasm) of an oocyte which allow it, once it is fertilised, to give
p.000034: birth to embryonic stem cells, while a skin cell which has the same genes is incapable of doing so spontaneously?
p.000034:
p.000034: Up to what point can modifications to the environment, in some or most of the adult body’s cells, restore the initial
p.000034: potentialities that the environment of the developing body seemed to have progressively frozen?
p.000034:
p.000034: Research on human stem cells has progressed in four major directions:
p.000034:
p.000034: • The first two of these consisted in imitating nature.
p.000034:
p.000034: To begin with, for over 30 years, by using the spontaneous properties of multipotency of certain stem
p.000034: cells in the adult body, i.e. the hematopoietic stem cells in bone marrow, to reconstitute with
p.000034: remarkable therapeutic efficacy, the production of all blood cells by bone marrow transplantation.
p.000034:
...

p.000074: consider transporting to France new ARTs which have been successful in giving birth to a large number of children in
p.000074: other countries.
p.000074:
p.000074: that it is in fact the creation of an embryo, or should it be considered on the contrary that this is simply an
p.000074: experiment in cellular dedifferentiation which would not raise ethical issues of a similar nature?
p.000074:
p.000074: Reflection on the possibility of such discoveries also leads to raising a more general and more complex issue, which
p.000074: can be outlined in the following way, reverting to start with to the “natural” embryo. The totipotent
p.000074: cells composing an embryo in the very first phases of its development are incapable of giving birth to a new embryo as
p.000074: long as they are included in the embryo they are constructing. However, when they are isolated from this embryo,
p.000074: depending on the in vitro environment provided for the totipotent cells, they will give birth to a new
p.000074: embryo or will become cells of one of the more than 200 families of body cells which cannot, spontaneously, give birth
p.000074: to an embryo.
p.000074:
p.000074: In other words, it is the nature of the environment which is provided for them artificially in vitro which will
p.000074: determine the future of these cells; the environment can either unlock, or constrain, some of the cells’
p.000074: potentialities.
p.000074:
p.000074: But if, in the near future, it became possible to derive, depending on the environment provided for them
...

Health / Motherhood/Family

Searching for indicator family:

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p.000025:
p.000026: 26
p.000026:
p.000026: This question is connected in particular to the progress of research aiming to develop new assisted reproduction
p.000026: techniques, but such research is prohibited in France because it involves in principle, the creation of embryos for
p.000026: research purposes (see below, chapter IV. B. The specific question of research for the evaluation of new ART
p.000026: procedures).
p.000026:
p.000026: But even if that came to pass, an entirely different indication for ART, that is PGD — which allows a couple to give
p.000026: birth to a child free of the genetic sequence or sequences which were identified as the cause of a severe and incurable
p.000026: genetic family defect, without the need for possible termination of the pregnancy — will have as a
p.000026: consequence the destruction of embryos conceived in vitro in a currently very small number of cases compared to the
p.000026: number of spare embryos stored using cryopreservation27. (As a reminder, in a recent Opinion bearing on issues in
p.000026: connection with prenatal diagnosis, in particular PGD28, CCNE recommended that PGD should continue to be
p.000026: practised as currently legally authorised and controlled).
p.000026:
p.000026: And so, problems in connection with medical ethics have given rise to decisions to destroy embryos in the
p.000026: context of an ART procedure independently of any consideration of the possible use of embryos or of embryo cells for
p.000026: research purposes.
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p.000034: They will contribute to the formation of the placenta, this essential bridge or bond between the embryo and its mother.
p.000034:
p.000034: The cells in the centre of the sphere forming the embryo are called embryonic stem cells and they will give rise to all
p.000034: the cells in the body, but they are no longer capable of developing into trophoblasts; none of these embryonic
p.000034: stem cells can spontaneously produce a new embryo. These cells are described as pluripotent.
p.000034:
p.000034: As development continues, the potential to differentiate of the stem cells will be further restricted;
p.000034: they become multipotent and for some of them, unipotent which means that they are capable of giving rise to only one
p.000034: family of body cells. Some of the body’s stem cells, after we are born, are multipotent, others are unipotent, but to
p.000034: the best of today’s scientific knowledge, they have all lost their pluripotency (at least spontaneously, see chapter 4
p.000034: below) and a fortiori their totipotency.
p.000034:
p.000034: 3. From the cell to the embryo, or from a scientific fact to an ethical issue.
p.000034:
p.000034: The first appearance of a human embryo is in the form of a single cell, born of the fusion of two cells (an oocyte and
p.000034: a spermatozoon).
p.000034:
p.000034: This first cell, all on its own, is a human embryo.
p.000034:
p.000034: Later this cell will give birth to new cells and each of these first generations of totipotent cells,
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p.000057:
p.000057:
p.000058: 58
p.000058:
p.000058: And that it is precisely this symbolic weakness regarding the destruction of the embryo in vitro that led lawmakers to
p.000058: provide for — as a form of compensation — a supplementary symbolic burden elsewhere, in this case on research using
p.000058: cells from the destroyed embryo.
p.000058:
p.000059: 59
p.000059:
p.000059: But then should be taken into consideration the risk of aggravating an already frequent feeling of
p.000059: transgression, or even of guilt, on the part of couples resorting to ART, and to a greater degree PGD, who are already
p.000059: acting as a consequence of distress, due to infertility on the part of the former, and to the suffering due to the
p.000059: unfortunate appearance in their family of particularly severe incurable disease, for the latter. It would also seem
p.000059: important with such an approach, to separate ethically the case of the creation and preservation of spare embryos,
p.000059: which is a prior condition to the possibility of their destruction, from the case of the destruction of embryos in the
p.000059: context of PGD, since the two ethical situations are very different.
p.000059: CCNE has always distinguished between the two and considered the possibility of reducing future recourse
p.000059: to preservation of spare embryos, so as to limit the possibility of their destruction, without including in this
p.000059: approach the issue of destruction of PGD generated embryos. For example, see on this subject, Opinion N° 67, dated
...

Searching for indicator orientation:

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p.000014: - conditional authorisation for research on cells originating from human embryos destroyed in vitro according to
p.000014: stipulations described above;
p.000014: - conditional authorisation for some kinds of research on human embryos conceived in vitro, before destruction is
p.000014: authorised according to stipulations described above;
p.000014: - prohibition of the creation of human embryos for the purpose of research, together with “the introduction of an
p.000014: exception to this principle in the context of an evaluation of new Assisted Reproductive Technologies.”
p.000014:
p.000014: E. Opinions expressed by various competent bodies over the last two years
p.000014:
p.000014: The work done in preparation for the review of the law on bioethics dated August 6, 2004, has been the subject of a
p.000014: number of reports, including one by the Conseil d’Orientation de l’Agence de la Biomédecine15, CCNE’s
p.000014: own report16 and in particular reports containing recommendations of a legal nature, among them
p.000014: those by the Office Parlementaire d’Evaluation des Choix Scientifiques et Technologiques (OPECST)(Parliamentary
p.000014: bureau for the evaluation of scientific and technological decisions), the Conseil d’Etat, the Estates
p.000014: General on Bioethics and the Mission d’Information Parlementaire (Parliamentary Advisory Mission) on the revision of
p.000014: the bioethics law.
p.000014: As regards specifically research on embryos and embryonic stem cells, the report by the Mission
p.000014: d’Information Parlementaire on the revision of the law on bioethics recommended that the current
p.000014: prohibition of research with derogations should be retained, whereas the OPECST, Conseil d’Etat and Estates
...

p.000053: procedure.
p.000053:
p.000053: When, in biomedical matters, the possibility of research is subject to a free and informed consent
p.000053: procedure, the first step is evaluation of the research by one single (or several) scientific and
p.000053: ethical body or bodies. It is only if the research is judged to be both scientifically legitimate and
p.000053: ethically acceptable that free and informed consent procedures are initiated.
p.000053:
p.000053: In this case, the free and informed consent procedure is submitted to the couple before the research project is
p.000053: considered by the Conseil d’orientation de l’Agence de la Biomédecine, which carries out an ethical evaluation after
p.000053: receiving the scientific evaluation provided by a group of experts the Agency had designated.
p.000053:
p.000053: It is therefore the principle of research itself which is in this case the subject of the free and informed consent
p.000053: procedure submitted to the couple, and not the specific research project which will be undertaken if consent
p.000053: is given.
p.000053:
p.000053: It may be supposed that the already exceptional nature (see above) of the a priori restriction on research which
p.000053: will be authorised only if it “would be capable of leading to major therapeutic progress” is a form of
...

Searching for indicator access:

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p.000053: applications, could dramatically alter the state of the art and lead, at some future time, to entirely unexpected
p.000053: therapeutic breakthroughs.
p.000053:
p.000053: Obviously, any research can raise ethical issues and should therefore be subject to meticulous evaluation
p.000053: of the way in which it is carried out and its possible applications.
p.000053:
p.000053: As regards research on stem cells, in particular human embryonic stem cells, in its Opinion N° 93, dated November 11,
p.000053: 2006, on the Commercialisation of human stem cells and other cell lines, CCNE insisted on the importance of giving
p.000053: thought to patents and licenses, and on the need to make sure that commercial considerations do not lead to limiting
p.000053: access, for the world’s less fortunate inhabitants, to the possibly useful applications for health of
p.000053: such research.
p.000053:
p.000053: A further paradox is worthy of note: although a derogation to the prohibition on research involving
p.000053: embryonic stem cells requires it to be capable of leading to major therapeutic progress, so far none of the
p.000053: institutions implicated in the regulation of therapeutic trials — be it AFSSAPS (the French Health Products Safety
p.000053: Agency), the Agence de la Biomédecine, DGS (Direction Générale de la Santé/ Public Health Authorities), etc. — has
p.000053: responded to even one of the requests made by a French research team to initiate clinical research for
...

p.000053:
p.000053: In its Opinion N° 93, dated November 11, 2006 on the Commercialisation of human stem cells and other cell lines, CCNE
p.000053: suggested that another form of information should also be given to the couple enabling them to choose when the
p.000053: research project involves human embryonic stem cells: not just information on the nature and object of research,
p.000053: but also on the economic model governing the project, in particular whether applications would be developed
p.000053: for profitmaking or non-profitmaking purposes, whether a patent would or would not be filed and, if a patent were to be
p.000053: filed, whether provisions would be made, or not, to avoid excluding access to applications by the underprivileged.
p.000053:
p.000053: The inversion of the customary sequence — a scientific and ethical evaluation procedure,
p.000053: followed by the free and informed consent process — also has the consequence that it sets no time
p.000053: limit on the conservation of embryos after termination of the parental project and consent is given to research by the
p.000053: couple concerned.
p.000053:
p.000053: It follows that this particular situation does have the effect of improving the quality of research since
p.000053: it means that a research project would not be undertaken until the time comes when, and if, are met all the criteria
p.000053: for it to be authorised.
p.000053:
...

p.000076: famine, infectious diseases, massacres, inhumane treatment, and the denial of health, liberty and dignity.
p.000076:
p.000076: Concern for the earliest stages of the development of a future embryo should make us even more attentive and sensitive
p.000076: to the sufferings of children already born. Mentally handicapped children, who are so frequently deprived in this
p.000076: country of access to education and adequate assistance in places where they can be close to their families. The two
p.000076: million children in our country who live below the poverty threshold. The nearly ten million children under five
p.000076: years of age who die every year of disease and hunger in the world while the World Health Organization tells us that,
p.000076: collectively, we could have saved six million of them each year over the past several years. The 200 million children
...

Searching for indicator child:

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p.000002: before transfer to the mother;
p.000002: 2. when preimplantation genetic diagnosis (PGD) reveals that an embryo is carrying the genetic sequence
p.000002: involved in a particularly severe inherited disorder, incurable at the time of
p.000002:
p.000002: diagnosis, the genetic sequence in question being the one which initially motivated the PGD1. procedure.
p.000002: In both cases, the human embryo is destroyed.
p.000002: 3. There is a third set of very different circumstances in which embryos created in vitro are not transferred: in this
p.000002: case the decision is taken to cryopreserve the embryos so that they may be transferred later in the event of the first
p.000002: attempt at transfer being unsuccessful, or if the couple wish to have another child at a later date without
p.000002: having to undergo over again hormonal hyperstimulation and oocyte collection procedures, thus avoiding additional
p.000002: risk to the mother's health. They then become so-called spare or supernumerary embryos, awaiting later
p.000002: transfer.
p.000002: But if, at some later time, the parents of these cryopreserved supernumerary embryos cease to have plans involving
p.000002: them, the embryos are no longer simply in excess in the context of the ART procedure involved: they become in
p.000002: excess — surplus to requirements
p.000002: — to the very parental project that was at the origin of their conception. This is the situation
p.000002: which led to the issue of ceasing to keep them, i.e. the issue of their destruction.
p.000002:
...

p.000002: have children should only be fulfilled if it can be achieved without IVF.
p.000002: But with the exception of this view, there is at least one point — and it is all too infrequently
p.000002: underlined — common to all the radically different opinions on how human embryos in vitro should be treated: the
p.000002: embryo's integrity must not be breached as long as it is still included in the parental project which was the cause of
p.000002: its creation.
p.000002:
p.000002: In other words, there is one true interdict, shared by everyone: the integrity of embryos in vitro cannot be
p.000002: jeopardized as long as they are included in the concerned couple's plans to have a child.
p.000002:
p.000002: This common stance of respect for human embryos in vitro, as long as a parental project persists, is
p.000002: held by all, including those who consider that a parental project cannot in itself be the only reason for respecting
p.000002: human embryos.
p.000002:
p.000002: This common stance also has a characteristic which deserves to be underlined: both respect and interdiction
p.000002: are related to the preservation of a human bond.
p.000002:
p.000002: This human bond between the future parents and their future child, is pre-existent to the creation of an embryo in
p.000002: vitro. It is the very condition for its creation by ART.
p.000002:
p.000002: It is because of the existence and persistence of this human bond that an embryo in vitro,
p.000002: already a "potential human being", becomes an incipient2 "potential human being".
p.000002:
p.000002: Nor is it any longer biological development which determines — and determines alone
p.000002: — the future of an embryo; it is the human bond of which the embryo is a part. To become one with human
p.000002: lineage is not defined in purely biological terms; being part of a human relationship is the determining factor.
p.000002:
p.000002: But the creation of excess human embryos opens up the possibility of this bond being broken. Excess embryos are
...

p.000003: in the mother's uterus. This stage occurs on the 7th day of embryo in vitro development. An embryo created for
p.000003: research should therefore be destroyed before it reaches that stage5, 6.
p.000003:
p.000004: 4
p.000004:
p.000004: Report by the États Généraux de la Bioéthique. Annex 9. Contributions from Regional Forums. Citizen opinion given by
p.000004: the Marseilles panel. Estates General on Bioethics. Chapter I. Stem cells and research on embryos of the Citizen
p.000004: Opinion begins as follows:
p.000004: "We, the citizens, consider that a protective status should be granted to embryos, in the framework of a parental
p.000004: project, based on the principle of non instrumentalisation of the unborn child. Embryos should have the status of an
p.000004: incipient person only when they are enrolled in a parental project. It is this project which confers a status on
p.000004: embryos and therefore defines them. The absence of a parental project cancels the status given to them.
p.000004: If and when the parental project becomes redundant, as may be the case for excess embryos, we are in favour of using
p.000004: the embryos for research, subject to explicit agreement from those who conceived them.
p.000004: Conversely, we are opposed to any form of research on embryos intended for implantation, since they are part of a
p.000004: parental project."
p.000004: As regards the length of time excess embryos should be kept for, the Opinion continues:
p.000004: "We consider that the five year time period provided for the conservation of excess embryos that are no longer included
...

p.000006: radical as the first kind. In the chapter on the Nature of the Embryo, (dealing with the subject of creation of
p.000006: embryos for the purpose of research by nuclear replacement, i.e. “so-called therapeutic cloning”), “CCNE stresses the
p.000006: fact - in its opinion a very positive one - that the preliminary draft law designates all three kinds of embryos by the
p.000006: expression "human embryo", which was not a foregone conclusion for two reasons. Firstly, if one considers the procedure
p.000006: consisting in transferring a cell nucleus into an enucleated oocyte, the resulting product must needs be a human embryo
p.000006: by its very nature. To deny this would mean, were the pro- hibition disregarded, denying in advance human status
p.000006: to the child produced. Such a dividing line must not therefore be drawn between an IVF embryo and an embryo
p.000006: [created by nuclear replacement for research], even though it is clear that their origins - sexual reproduction in one
p.000006: case, and asexual in the other - introduce an es- sential difference which is due in part to the nature of the project
p.000006: which originated them and which justifies the radical difference in treatment introduced by the law.”
p.000006: CCNE concluded with a “firm reminder of the principle that creation of human embryos for the purpose of research is
p.000006: prohibited.”
p.000006: But “On the subject of therapeutic cloning, however, opinions differ. There is general agreement that this subject
p.000006: raises extremely difficult ethical issues, but members of CCNE are divided, depending on their vis- ion of the world
...

p.000006: favour of authorising the creation of human embryos by nuclear replacement for research pur- poses!
p.000006:
p.000007: 7
p.000007:
p.000007: This is the case in the U.K. (see below, Chapter III of the Consideration of the issues). Previously, in the first two
p.000007: weeks, the embryo in vitro is as nothing (in terms of dignity and respect). The creation of embryos for the sole
p.000007: purpose of research and destruction, be it by fertilisation, nuclear replacement, or the creation of
p.000007: cybrids, does not raise, as in the previous configuration, any ethical issue as long as the embryo created in vitro
p.000007:
p.000007: In this context, attaching exclusive importance to the parental project, to a couple’s intention of giving birth to
p.000007: a child, could lead to no longer ascribing any importance at all to the creation and future of spare
p.000007: embryos. Conversely, granting exclusive importance to the future of spare embryos could lead to no longer
p.000007: ascribing importance to the human connection which is the very reason for the creation of embryos in vitro, that
p.000007: is the relationship between the partners and the projection of that relationship in a parental project, seeking for a
p.000007: bond in the couple’s future with their future child.
p.000007:
p.000007: It is the existence of this human bond, this inclusion in a parental project, which, as the Estates
p.000007: General on Bioethics stated, turns the “potential human being” that an embryo in vitro is for CCNE, into an
p.000007: “incipient” potential human being.
p.000007:
p.000007: As CCNE remarked nearly twenty-five years ago: “…although it cannot be demonstrated, the belief that a human
p.000007: life cannot be entirely controlled because it is not a manufactured product is a guarantee of our
p.000007: liberty and dignity8.”
p.000007:
p.000007: CCNE’s position has always (or nearly always9) consisted in not drawing a boundary which would lead to an
...

p.000017: genetic sequence which motivated PGD research18.
p.000017:
p.000017: In both of these circumstances, the human embryo is destroyed.
p.000017:
p.000017: There is a third set of circumstances of a very different kind when the embryos created in vitro are not
p.000017: transferred: this is when the decision is taken to keep them by cryopreservation with the object of
p.000017: transferring them later in the event that the first transfer fails. They then become what are called spare embryos,
p.000017: created by IVF as part of an ART procedure.
p.000017:
p.000017:
p.000018: 18
p.000018:
p.000018: PGD is a very specific form of ART, in which the indication for IVF is not infertility, but is motivated by the
p.000018: parents’ wish to abstain from transmitting to their child a genetic sequence leading to a particularly severe medical
p.000018: condition which is incurable at the time of diagnosis.
p.000018:
p.000018: With IVF, the future mother (or the woman donating oocytes) must undergo hormonal hyperstimulation and
p.000018: ovarian puncture to retrieve the oocytes. This is an extremely taxing procedure and also endangers the mother’s
p.000018: health.
p.000018:
p.000018: Cryopreservation of spare embryos is designed to allow the parents to resort to ART procedures in the
p.000018: future in the event that the first pregnancy fails (the probability of childbirth occurring after IVF is still today
p.000018: less than around 20%), or if they wish to have another child at a later date, without having to go through the
p.000018: whole procedure involving hormonal hyperstimulation and egg retrieval again, and therefore avoiding additional
p.000018: risks to the health of the intended mother (or of the woman donating eggs) 19.
p.000018:
p.000018: But if the spare embryos, stored by cryopreservation, cease to be included in the parental project of
p.000018: the couple who were the originators of their creation, they are no longer just spare in the context of an ART
p.000018: procedure, following the initial implantation after IVF, they become spare — that is, “surplus” — to the parental
p.000018: project which was the origin of their creation. The same adjective — spare — designates two entirely different
...

p.000024: diagnosis (PND) and Preimplantation Genetic Diagnosis (PGD).
p.000024:
p.000025: 25
p.000025:
p.000025: In Opinion N° 8, dated December 15, 1986, on Research and use of in-vitro human embryos for scientific
p.000025: and medical purposes: “The Committee notes that the development of procreation by in-vitro fertilisation
p.000025: reinforces the trend which uses the human body as an instrument. Moreover, techniques such as the freezing of embryos
p.000025: increase the artificial nature of reproduction, especially as a result of the dissociation between
p.000025: conception and pregnancy. […] One can envisage and hope that, in the future, research will allow
p.000025: fertilisation only of the necessary oocytes for transfer for the birth of a future child.”
p.000025:
p.000026: 26
p.000026:
p.000026: This question is connected in particular to the progress of research aiming to develop new assisted reproduction
p.000026: techniques, but such research is prohibited in France because it involves in principle, the creation of embryos for
p.000026: research purposes (see below, chapter IV. B. The specific question of research for the evaluation of new ART
p.000026: procedures).
p.000026:
p.000026: But even if that came to pass, an entirely different indication for ART, that is PGD — which allows a couple to give
p.000026: birth to a child free of the genetic sequence or sequences which were identified as the cause of a severe and incurable
p.000026: genetic family defect, without the need for possible termination of the pregnancy — will have as a
p.000026: consequence the destruction of embryos conceived in vitro in a currently very small number of cases compared to the
p.000026: number of spare embryos stored using cryopreservation27. (As a reminder, in a recent Opinion bearing on issues in
p.000026: connection with prenatal diagnosis, in particular PGD28, CCNE recommended that PGD should continue to be
p.000026: practised as currently legally authorised and controlled).
p.000026:
...

p.000039: has not ripened to a conclusion and may never do so. The substantive position defended by the Committee is to
p.000039: recognise that the embryo or fœtus has the status of a potential human being who must command universal respect.
p.000039: Successive Opinions on the subject seek to attune this demand for respect to other intents which are also
p.000039: ethically acceptable.”
p.000039:
p.000039: • It then addresses the issue of research on embryonic stem cells41. It refers to the distinction made in
p.000039: Opinion N° 1 between the pre-implantation in vitro phase and the in vivo phase, after transfer42 and the
p.000039:
p.000039:
p.000039: “The Committee states inter alia that the purpose of human fertilisation is first and foremost procreative and cannot
p.000039: ignore the benefit for a child to be born, nor its right to be born to a united couple. The use of so- called spare
p.000039: embryos for research purposes can only be secondary when it has become patently impossible to transfer all the
p.000039: embryos”.
p.000039:
p.000040: 40
p.000040:
p.000040: “Human stem cells of this kind, equivalent to ES cells in mice, do not exist as yet, but several laboratories outside
p.000040: France are working on their creation. Thus, the CCNE considers that its mission demands that it should as of now
p.000040: formulate recommendations on the conditions according to which they could, possibly, be established and used.”
p.000040:
p.000041: 41
p.000041:
p.000041: “This point represents the main ethical debate. As mentioned above, as early as 1997 the Committee
p.000041: pronounced itself in favour of the removal of legal obstacles which, up to the present day, prevented
...

p.000054: destruction of human embryos.
p.000054: The legal formulation chosen by lawmakers to define this approach, that CCNE described as being as a 'lesser evil', is
p.000054: (as CCNE has always recommended in all of its Opinions) is a 'conditional authorisation'.
p.000054:
p.000054: The question of possible destruction of spare embryos, in the event of the termination of a parental project, in fact
p.000054: arises at an earlier time, when they are created and stored55. The creation and cryopreservation of these spare embryos
p.000054: is not a systematic procedure and is only actually implemented, once the parents are informed and have consented, for
p.000054: 25% of
p.000054:
p.000055: 55
p.000055:
p.000055: So as to enable a new attempt at embryo transfer if a pregnancy fails, or a new parental project after the birth of a
p.000055: previous child without having to undergo more hormonal hyperstimulation and further ovarian puncture.
p.000055:
p.000055: couples resorting to ART and IVF56. Some opinions are in favour of more detailed prior information on
p.000055: the future of spare embryos to be given to parents before creation and conservation takes place 57.
p.000055:
p.000055: Some bodies of opinion consider that this formulation of conditional authorisation for the creation,
p.000055: conservation (and therefore also destruction) of embryos in the context of an ART procedure, as it is
p.000055: currently expressed by law, is not sufficiently emblematic58.
p.000055:
p.000055:
p.000055: Should we consider that the destruction of spare embryos in the context of a PGD procedure should be expressed in the
p.000055: form of a derogation to a prohibition? 59
p.000055:
p.000055:
...

p.000059: appears as a conditional authorisation.
p.000059:
p.000059:
p.000059: In Opinion N° 8, dated December 15, 1986 on Research and use of in-vitro human embryos for scientific and medical
p.000059: purposes, CCNE wrote: “The de facto situation resulting from the production of a larger number of embryos than can
p.000059: be medically transferred raises questions that we should try to answer. However, solutions proposed in the
p.000059: present opinion do not legitimate this de facto situation. Such solutions are, therefore not final: one can envisage
p.000059: and hope that, in the future, research will allow fertilisation only of the necessary oocytes for transfer for the
p.000059: birth of a future child”.
p.000059: But almost a quarter of a century later, CCNE noted in Opinion N° 107, dated October 15, 2009 on
p.000059: Ethical issues in connection with antenatal diagnosis: Prenatal diagnosis (PND) and Preimplantation Genetic Diagnosis
p.000059: (PGD) that research in this respect had not made significant progress and that the “live birth success rate after
p.000059: oocyte retrieval is around 20% and there is little likelihood of this figure improving in years to come since it is in
p.000059: fact quite close to the figure for natural conception”.
p.000059:
p.000059:
p.000059:
p.000059:
p.000060: 60
p.000060:
p.000060: Article 16 of the Code Civil situates this measure in a much broader context: “The law ensures the
p.000060: primacy of the individual, prohibits any encroachment of to the individual’s dignity and guarantees respect for human
...

p.000072: as a thing and no longer as a potential human being, CCNE has already make known its views regarding research on the
p.000072: embryo. On the substance, it agrees with choices made in the preliminary draft :
p.000072: • on the one hand, re-stating the principle whereby producing human embryos by in vitro fertilisation for research
p.000072: purposes is prohibited;
p.000072:
p.000072: B. An ethical conflict: respect for the embryo and the creation of embryos specifically for the development and
p.000072: evaluation of new ART procedures.
p.000072:
p.000072: The ethical concern to refrain from creating embryos in vitro for research purposes could be in conflict with a medical
p.000072: ethical concern, i.e. do the best one can to avoid endangering an unborn child in the context of implementing a
p.000072: new technique intended to improve ART.
p.000072:
p.000072: This ethical concern not to create embryos in vitro for research purposes could also be at odds with another ethical
p.000072: concern, that of developing new techniques aiming to improve ART, which could avoid having to create and cryopreserve
p.000072: spare embryos and thereby steer clear of the possible destruction of embryos if they are not transferred.
p.000072:
p.000072: This question is connected, in particular, to the possible technical progress which could either lead to improving the
p.000072: results of IVF as regards the probability of a child being born following implantation, or to oocyte conservation
p.000072: (for example, using a new rapid cryopreservation procedure, called vitrification) so that in the event of ART
p.000072: failure, new IVF procedures could take place without needing to go through a another oocyte sampling phase.
p.000072:
p.000072: These questions cannot be investigated based on research using spare embryos already in storage, awaiting destruction
p.000072: because the parental project is no longer current, since they were cryopreserved using the older ART techniques
p.000072: previously authorised and used in France (and still in use today).
p.000072:
p.000072: Research is ongoing in several countries on these new techniques and, in some countries, are already viewed as being
p.000072: current medical practice. But, in the present circumstances, research cannot take place in France as before
p.000072: any transfer of such embryos could be considered, there would have to be embryo creation for the
p.000072: purpose of research, which is prohibited (without any possible derogation) by the 2004 law on bioethics.
p.000072:
p.000072: CCNE has been deliberating for some time on how best to deal with this issue.
p.000072:
p.000072: For instance, in Opinion N° 8, dated December 15, 1986 on “Research and use of in vitro human embryos for scientific
p.000072: and medical purposes”, CCNE wrote: “…one can envisage and hope that, in the future, research will allow
p.000072: fertilisation only of the necessary oocytes for transfer for the birth of a future child. Medical
p.000072: research should endeavour to reduce the number of cases raising ethical issues, rather than accumulate an
p.000072: ever-growing amount of problems of a degree of severity which is disproportionate to the intended objective73.”
p.000072:
p.000072: • on the other hand, opening up regulated possibilities of research on spare embryos "which are no longer included in
p.000072: a parental project".
p.000072:
p.000073: 73
p.000073:
p.000073: In this Opinion, CCNE was not in fact considering the creation of embryos for research purposes with a view to
p.000073: evaluating new ARTs. Nevertheless, it was considering the possibility of creating embryos in the context of a medical
p.000073: test for diagnosing fertility. It expressed, as mentioned above, the rejection of allowing the creation of embryos
...

p.000074: from iPS cells derived from skin cells. The only way of finding out whether they really are gametes (a spermatozoon
p.000074: or an oocyte) would be to discover when the cells are capable of fertilisation, i.e. participating in the creation of
p.000074: an in vitro embryo. Could such experiments be seriously considered and therefore the possibility of creating, in this
p.000074: context, an embryo for the purpose of research?
p.000074:
p.000074: An additional problem arises in connection with the fact that scientists working in this field are pointing out the
p.000074: value of a possible medical application of this research if the approach were to give infertile individuals the
p.000074: possibility of producing gametes. Can we consider using ART to conceive and bring to term a child born of the skin
p.000074: cells of an adult?
p.000074:
p.000074: Furthermore, a problem arises, similar to the one raised by reproductive cloning, that is the possibility of conceiving
p.000074: an embryo or even bringing a child to term, using sperm and oocytes derived from the skin cells of a single person76.
p.000074: In 1994, at a time when embryonic stem cell lines had been isolated for over ten years, using mouse embryos and other
p.000074: animal species, but not humans as yet, legislators did not consider there was any need to anticipate this possibility,
p.000074: although it was a very probable development. They banned any kind of research based on embryonic cells.
p.000074:
p.000074: When (only four years later) human embryonic stem cells were isolated and possible medical applications were
p.000074: formulated, legislators decided to include these advances in their considerations and the law was
p.000074: modified: prohibition was replaced by prohibition with the possibility of derogation…
p.000074:
...

p.000076: collectively, we could have saved six million of them each year over the past several years. The 200 million children
p.000076: under five whose mental development will be hindered and interrupted by poverty, undernourishment and disease in the
p.000076: poverty- stricken countries of this planet.
p.000076:
p.000076: CCNE considers that our respect for the earliest beginnings of human life must bear testimony to our
p.000076: fullest and collective commitment to respect for each person, child or adult, together with the will to prevent and
p.000076: repair to the best of our ability the tragic lives to which so many children are exposed from birth.
p.000076: Ethical reflection on the earliest beginning of life becomes fully meaningful in this context alone.
p.000076:
p.000076: Paris, October 21, 2010
p.000076:
p.000076: Reservations expressed by certain members
p.000076: Although we are aware of the distinctions made by this Opinion and the refinement of the reflection to which it leads,
p.000076: we must emphasise that the ethics of respect, referred to several times in the document, entails the exclusion of any
p.000076: form of instrumentalisation of human embryos.
...

Searching for indicator children:

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p.000002: which human embryos in vitro should be treated, nor of the various legislative interpretations of such treatment in
p.000002: different countries around the world. Rather, we seek to highlight both the essential differences which
p.000002: oppose them, frequently very
p.000002:
p.000002:
p.000002: 1See CCNE's Opinion N° 107, October 15, 2009 on ethical issues in connection with antenatal diagnosis: Prenatal
p.000002: diagnosis (PND) and Preimplantation Genetic Diagnosis (PGD)
p.000002:
p.000002: radically, in ethical terms and, transcending these differences, to discover possible points of convergence.
p.000002:
p.000002: In some opinions, the very creation of an embryo in vitro as part of an ART procedure should be banned and the wish to
p.000002: have children should only be fulfilled if it can be achieved without IVF.
p.000002: But with the exception of this view, there is at least one point — and it is all too infrequently
p.000002: underlined — common to all the radically different opinions on how human embryos in vitro should be treated: the
p.000002: embryo's integrity must not be breached as long as it is still included in the parental project which was the cause of
p.000002: its creation.
p.000002:
p.000002: In other words, there is one true interdict, shared by everyone: the integrity of embryos in vitro cannot be
p.000002: jeopardized as long as they are included in the concerned couple's plans to have a child.
p.000002:
p.000002: This common stance of respect for human embryos in vitro, as long as a parental project persists, is
...

p.000002: vitro. It is the very condition for its creation by ART.
p.000002:
p.000002: It is because of the existence and persistence of this human bond that an embryo in vitro,
p.000002: already a "potential human being", becomes an incipient2 "potential human being".
p.000002:
p.000002: Nor is it any longer biological development which determines — and determines alone
p.000002: — the future of an embryo; it is the human bond of which the embryo is a part. To become one with human
p.000002: lineage is not defined in purely biological terms; being part of a human relationship is the determining factor.
p.000002:
p.000002: But the creation of excess human embryos opens up the possibility of this bond being broken. Excess embryos are
p.000002: no longer the sole purpose of the bond, in other words, no longer future children. The embryo becomes in
p.000002: fact one of the means to that end, no longer incipient, but in waiting, while another "potential human being"
p.000002: is the present tense of the bond, the reality of what is to come.
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: 2
p.000002:
p.000002: It is with explicit reference to this human bond that the Avis citoyen du Panel de Marseille used the term "personne
p.000002: humaine en devenir" (incipient human being) to characterise an embryo which is still included in a parental project at
p.000002: the Etats Généraux de la Bioéthique in 2009.
p.000002:
p.000002: 2. When the embryo in vitro is no longer — or never was — part of a parental project: radically
p.000002: different positions.
p.000002:
p.000002: There is a radical opposition between the various opinions on how embryos should be considered. These
...

p.000018: independently of the ethical issue of research using human embryonic cells.
p.000018:
p.000018: The creation in vitro, as part of an ART procedure, of spare embryos and their storage by
p.000018: cryopreservation, was intended to solve a problem of medical ethics, i.e. preserving as much as possible the health
p.000018: of the future mother (or of the oocyte donor). But the inevitable a priori consequence raised another
p.000018: ethical issue, the future of spare embryos in the event of the couple forsaking their parental project (regardless
p.000018: of whether the cause was repeated ART failures, or on the contrary the birth of children, or the couple
p.000018: separating or the death of one or both partners, etc.).
p.000018:
p.000018:
p.000018:
p.000019: 19
p.000019:
p.000019: In Opinion n° 107, dated October 15, 2009 on Ethical issues in connection with antenatal diagnosis:
p.000019: Prenatal diagnosis (PND) and Preimplantation Genetic Diagnosis (PGD), CCNE remarked, in connection with PGD, that IVF
p.000019: “requires a fairly elaborate and invasive procedure (ovarian stimulation and puncture, etc.). “There are,
p.000019: on the one hand proven risks in hyperstimulation and ovarian puncture.”. And “It [IVF] is also a source of anxiety
p.000019: since at each stage of the procedure, there is a high risk of failure.”
p.000020: 20
p.000020:
...

p.000028: process consisted in creating in vitro an embryo, genetically identical to an adult ewe, by transferring the
p.000028: nucleus of a cell of the adult ewe to an oocyte from which the nucleus had been removed.
p.000028:
p.000028: In theory, this approach provided for the first time a new possibility, that of being able to create in
p.000028: vitro human embryos genetically identical to the cells of a particular adult person and to extract embryonic stem
p.000028: cells from the embryos which are destroyed. The discovery — although at the time no one knew whether it could apply to
p.000028: human cells — on the one hand raised international censure regarding the possibility of its use in the context of ART
p.000028: with the aim of giving birth to children by ‘reproductive cloning’; and on the other hand, led to
p.000028: projects for purely scientific purposes involving the creation of embryos in vitro by nuclear transfer of human cells
p.000028: to human oocytes, thus raising the issue of creating embryos in vitro
p.000029: 29
p.000029:
p.000029: A great deal of importance has been attached sometimes to the ethical value of such technical progress. However, it
p.000029: would not solve at all the issue of the destruction of embryos in the context of PGD. In fact, a situation
p.000029: would ensue where the link between embryo destruction and research on embryonic cells would be
p.000029: maintained, albeit indirectly. PGD, which leads to destruction for medical reasons of certain embryos created in
p.000029: vitro, would also become a way to make available for research embryonic cells sampled from live embryos, free of the
...

p.000073:
p.000073: And CCNE concluded Opinion n° 67 with the following:
p.000073: “ – a firm reminder of the principle that creation of human embryos for the purpose of research is prohibited;
p.000073: - the introduction of an exception to this principle in the context of evaluation of new medically assisted
p.000073: reproduction techniques.”
p.000073:
p.000073: It is worth noting that, so far, many IVF technical advances have been arrived at for ART without the
p.000073: benefit of prior research, in particular as regards embryonic development before embryo transfer. It so happens,
p.000073: fortunately, that these medical procedures do not seem to have proved a significant threat to the health of children
p.000073: born with the assistance of such innovative techniques.
p.000073:
p.000073: Ethical issues connected to the advances of ART deserve to be considered comprehensively. For
p.000073: example, apart from any prospect of research aiming to improve ARTs, the simple translocation to France, for medical
p.000073: implementation, of a new and improved ART, validated in a foreign country74 without the benefit of
p.000073: authorisation for any prior clinical research to validate the technique on embryos that will not be
p.000073: implanted, raises an ethical issue as regards the protection of unborn children.
p.000073:
p.000073: Furthermore, the existence of a major problem in this respect must be pointed out: none of the specialised agencies —
p.000073: Agence de la Biomédecine, AFSSAPS, DGS, etc. — are currently ready to pronounce themselves on whether the
p.000073: cryopreservation of oocytes, be it by the known slow freezing method or by more recent vitrification
p.000073: techniques (which have been implemented in ART procedures in several countries and have led to the birth
p.000073: of a large number of children) is to be related to research or to clinical practice.
p.000073: In this context, it would be worthwhile to ask an independent body to carry out a medical, scientific and ethical
p.000073: evaluation of the criteria which would allow for the use in France of new ARTs which are already standard medical
p.000073: procedure in other countries.
p.000073:
p.000073: But the Opinion did introduce the idea of a derogation specific to this prohibition: “It is, however,
p.000073: possible to envisage that oocytes could be fertilised with the husband's sperm (excluding cross fertilisation test)
p.000073: with a view to establishing a diagnosis. It is up to the couple to decide, with the doctor's approval, whether such
p.000073: embryos should be implanted, destroyed or donated for research purposes, exactly as if they were excess
p.000073: embryos. Such embryos are dealt with according to the rules described above.”
p.000073:
p.000073:
p.000073:
p.000074: 74
p.000074:
p.000074: This is the only possibility for the improvement of ARTs which is currently allowed by law.
p.000074:
p.000074: As regards the complex matter of the possible creation of embryos in vitro for the purpose of evaluating new ARTs, the
p.000074: ethical issue in this instance is to question whether respect for human embryos and refusal to allow them to be
p.000074: instrumentalised should, or should not, be infringed in order to protect unborn children.
p.000074:
p.000074: But obviously, if the possibility of carrying out such research was considered, with the aim of evaluating the
p.000074: feasibility and safety of new ARTs, such research projects would raise major research and medical ethics issues as
p.000074: regards the evaluation of their objectives and the risks involved75.
p.000074:
p.000074: It can well be imagined that such approaches could relate to very diverse situations, for example the
p.000074: destruction of an embryo created with a new technique in the event of doubt on its development, or systematic
p.000074: implementation of a number of evaluations before transfer, with the possible consequence of destruction of the
p.000074: embryo in vitro. Between such possible approaches and the creation of embryos truly for the purpose of research in
...

p.000074:
p.000074: Would it be allowable to raise such a question experimentally, the positive response to which could only be obtained
p.000074: via the creation, for research purposes, of an in vitro embryo? And supposing this first experiment was successful,
p.000074: should it be prohibited to repeat it, knowing
p.000074:
p.000074: 75If such research was being considered, it would require specific organisations and scientific, medical and ethical
p.000074: evaluation methods to be set up as part of the assisted reproductive technology context. In any case, if such research
p.000074: was to remain prohibited, resources of this kind would be just as essential, as mentioned above, to evaluate and
p.000074: consider transporting to France new ARTs which have been successful in giving birth to a large number of children in
p.000074: other countries.
p.000074:
p.000074: that it is in fact the creation of an embryo, or should it be considered on the contrary that this is simply an
p.000074: experiment in cellular dedifferentiation which would not raise ethical issues of a similar nature?
p.000074:
p.000074: Reflection on the possibility of such discoveries also leads to raising a more general and more complex issue, which
p.000074: can be outlined in the following way, reverting to start with to the “natural” embryo. The totipotent
p.000074: cells composing an embryo in the very first phases of its development are incapable of giving birth to a new embryo as
p.000074: long as they are included in the embryo they are constructing. However, when they are isolated from this embryo,
...

p.000076: of a human being unfolds. And respect, affection, tenderness in the beginning and at the end are only truly meaningful
p.000076: through the respect, the affection and the tenderness of which they are made — the stuff of our lives, the progression
p.000076: of our days. From birth to childhood, from childhood to adolescence, from adolescence to adulthood, from adulthood to
p.000076: old age, as long as persists within us the pulsation of awareness whose interruption defines — or so we have decided —
p.000076: the end, the end of the human being.
p.000076:
p.000076: The essential ethical issues which are of concern to today’s world are not those which bear on the earliest stages of
p.000076: development of future human beings, but rather on premature death and the sufferings of children and adults, caused by
p.000076: famine, infectious diseases, massacres, inhumane treatment, and the denial of health, liberty and dignity.
p.000076:
p.000076: Concern for the earliest stages of the development of a future embryo should make us even more attentive and sensitive
p.000076: to the sufferings of children already born. Mentally handicapped children, who are so frequently deprived in this
p.000076: country of access to education and adequate assistance in places where they can be close to their families. The two
p.000076: million children in our country who live below the poverty threshold. The nearly ten million children under five
p.000076: years of age who die every year of disease and hunger in the world while the World Health Organization tells us that,
p.000076: collectively, we could have saved six million of them each year over the past several years. The 200 million children
p.000076: under five whose mental development will be hindered and interrupted by poverty, undernourishment and disease in the
p.000076: poverty- stricken countries of this planet.
p.000076:
p.000076: CCNE considers that our respect for the earliest beginnings of human life must bear testimony to our
p.000076: fullest and collective commitment to respect for each person, child or adult, together with the will to prevent and
p.000076: repair to the best of our ability the tragic lives to which so many children are exposed from birth.
p.000076: Ethical reflection on the earliest beginning of life becomes fully meaningful in this context alone.
p.000076:
p.000076: Paris, October 21, 2010
p.000076:
p.000076: Reservations expressed by certain members
p.000076: Although we are aware of the distinctions made by this Opinion and the refinement of the reflection to which it leads,
p.000076: we must emphasise that the ethics of respect, referred to several times in the document, entails the exclusion of any
p.000076: form of instrumentalisation of human embryos.
p.000076: The impossibility of defining an indisputable line of departure for when a person begins should not be confused
p.000076: with an absence of ethical and legal boundaries to our attitudes regarding human embryos. The enigmatic
...

Searching for indicator education:

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p.000076: famine, infectious diseases, massacres, inhumane treatment, and the denial of health, liberty and dignity.
p.000076:
p.000076: Concern for the earliest stages of the development of a future embryo should make us even more attentive and sensitive
p.000076: to the sufferings of children already born. Mentally handicapped children, who are so frequently deprived in this
p.000076: country of access to education and adequate assistance in places where they can be close to their families. The two
p.000076: million children in our country who live below the poverty threshold. The nearly ten million children under five
p.000076: years of age who die every year of disease and hunger in the world while the World Health Organization tells us that,
p.000076: collectively, we could have saved six million of them each year over the past several years. The 200 million children
...

Searching for indicator educational:

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p.000047: conservation is at least equal to five years. This is also the case if the members of the couple disagree regarding
p.000047: continuance of the parental project or on what is to be done with the embryos.
p.000047:
p.000047: When both members of the couple, or the surviving member of the couple, have consented, in accordance
p.000047: with conditions set out in articles L. 2141-5 and L. 2141-6, for their embryos to be hosted by another couple and no
p.000047: donation has been made after five years have elapsed since the day on which consent was expressed in
p.000047: writing, these embryos cease to be preserved.
p.000047:
p.000047: In addition to their essential object of regulating human behaviour and human interaction in everyday life, laws
p.000047: contain an educational dimension reflecting the way in which our society applies the values which are its foundation
p.000047: and therefore are a reference for these values.
p.000047:
p.000047: The law states that, in specific circumstances, it is allowable to destroy a human embryo created in vitro in the
p.000047: context of an ART procedure, but which will not be transferred. But using embryonic cells for research purposes once
p.000047: the embryo has been destroyed would be a major transgression and should therefore be prohibited.
p.000047:
p.000047: Prohibition would therefore seem in this case to relate not to the deed itself, i.e. destruction, but
p.000047: the fact that it may, or may not, be the source of research leading to scientific progress.
p.000047:
p.000047: The contradiction was even more pronounced in the 1994 bioethics law, since the destruction of human
...

Searching for indicator capacity:

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p.000034: ten years or so, to branch out into a real scientific revolution.
p.000034:
p.000034:
p.000034: 1. An ancestral property of life itself.
p.000034:
p.000034: In simplified terms, stem cells are highly fertile and have great plasticity, meaning that they are highly capable of
p.000034: renewal and of giving birth to different cells.
p.000034:
p.000034: In very general terms, it was in the form of stem cells that life has propagated since its dawn, over 3.5 billion years
p.000034: ago. Unicellular organisms, which were the only life forms in the first phases of evolutionary life, were
p.000034: composed of stem cells, capable of both renewal and a certain degree of plasticity. The subsequent
p.000034: emergence of multicellular animals and plants went together, for animals in particular, with a progressive reduction
p.000034: of the cells’ capacity for renewal as they constructed the complexity of a body and with a considerable increase
p.000034: of their capacity to give rise to diversity. It is at the beginning of our embryonic development that our stem
p.000034: cells possess their greatest fertility potential and their greatest diversification potential, giving rise
p.000034: gradually to the over two hundred families of different cells composing our bodies.
p.000034:
p.000034: 2. The epigenetic revolution, or the effects of the environment on the way our genes are used.
p.000034:
p.000034: The name of the major research domain currently exploring these matters is epigenetics. This is the study of the
p.000034: interaction between genes and their environment and is a rapidly expanding field of scientific activity.
p.000034:
p.000034: Literally, epigenetic means what is above genes, beyond genes, i.e. the effect of various environmental
p.000034: factors on the way in which cells and bodies use their genes.
p.000034:
p.000034: One of the essential, ancestral and universal dimensions of life’s complexity is the capacity that genetically
p.000034: identical cells have of using their genes in very different ways depending on their environment and their background,
p.000034: leading to a diversification of the characteristics and potentialities of cells, which we call cellular
p.000034: differentiation.
p.000034:
p.000034: One of our liver cells is very different from one of our skin cells, or one in our heart or our brain. The differences
p.000034: between these genetically identical cells are due to the fact that they do not use the same genes. Born of the
p.000034: same initial cell (the result of fusion between a spermatozoon and an oocyte), later of the same embryonic
p.000034: stem cells, their history and their environment have had as a consequence that most of their twenty thousand
p.000034: genes have
p.000034:
...

p.000034: the best of today’s scientific knowledge, they have all lost their pluripotency (at least spontaneously, see chapter 4
p.000034: below) and a fortiori their totipotency.
p.000034:
p.000034: 3. From the cell to the embryo, or from a scientific fact to an ethical issue.
p.000034:
p.000034: The first appearance of a human embryo is in the form of a single cell, born of the fusion of two cells (an oocyte and
p.000034: a spermatozoon).
p.000034:
p.000034: This first cell, all on its own, is a human embryo.
p.000034:
p.000034: Later this cell will give birth to new cells and each of these first generations of totipotent cells,
p.000034: making up the embryo, will keep this capacity of giving birth on their own to a new embryo if they are isolated from
p.000034: neighbouring cells (as mentioned above). At this point they are components of the embryo, as long as they remain in
p.000034: the embryo, but they are also the possible origin of a new embryo if they are separated from the original embryo. If
p.000034: they are isolated in vitro from the embryo they are components of, they will proceed, depending on the environment they
p.000034: are given in vitro, either to spontaneously irreversible transformation into pluripotent stem cells, or to the
p.000034: construction of a new embryo.
p.000034:
p.000034: These totipotent cells, once they are isolated from the embryo, could be viewed as the potentiality of a
p.000034: human embryo, in other words — if one chooses the wording that CCNE used to characterise the human embryo —
p.000034: as the potentiality of a “potential human person.”
...

p.000034:
p.000034: At this point, the embryo can no longer be reborn of its constituents.
p.000034:
p.000034: Therefore science seems to make it possible in this case to operate a clear distinction, in ethical
p.000034: terms, based on the spontaneous potentialities of the cells depending on the phase of development of the embryo in
p.000034: vitro (but for a debate of this issue in a broader, and more complex context, see below, Prospective
p.000034: reflection: ethical issues raised by research on non embryonic human stem cells).
p.000034:
p.000034: 4. From an imitation of nature to the discovery of novelty.
p.000034:
p.000034: There are at least two major scientific questions arising with reference to stem cells:
p.000034:
p.000034: • The first relates to the nature of the molecular mechanisms underlying their capacity to give birth to other
p.000034: identical stem cells, that is their capacity for renewal.
p.000034: • A second question relates to the nature of the molecular mechanisms underlying their plasticity, their repertoire,
p.000034: that is the diversity of the cell families to which they can give birth.
p.000034:
p.000034: A spectacular illustration of the effects of the environment on the way in which genes can be used was given by the
p.000034: experiments on nuclear transfer (or cloning) mentioned above: the nucleus of a skin cell transplanted to an
p.000034: oocyte cytoplasm from which the nucleus has been removed will enable genes to be used leading to the creation of an
p.000034: embryo.
p.000034:
p.000034: Where are the boundaries of cellular plasticity? What are the specific features of molecular composition or
p.000034: structure of the cellular body (the cytoplasm) of an oocyte which allow it, once it is fertilised, to give
...

p.000034:
p.000034: With this kind of manipulation it becomes possible to induce a cell from an adult human body along a course of
p.000034: dedifferentiation in vitro, although this was previously thought to be impossible in animals, and
p.000034: transform them into cells possessing all (or almost all?) the characteristics of human pluripotent stem cells,
p.000034: without having to pass through the embryo formation phase.
p.000034:
p.000034: In fact, all that is needed is to force skin cells (fibroblasts for example) to use four of their genes which had
p.000034: spontaneously become inaccessible to them. These four genes are used by embryonic stem cells in the first
p.000034: phases of embryo development. This resumption of the capacity of skin cells to use the four genes (for the time
p.000034: being, by artificially introducing extra copies of the genes into the cells) makes it possible for a small fraction of
p.000034: these adult skin cells to acquire similar stem cell properties to those of pluripotent embryonic stem cells. In other
p.000034: words they are capable of self-renewal and, in an appropriate in vitro environment, of giving birth to most, or even
p.000034: all of the 200 cell families constituting adult human bodies.
p.000034:
p.000034: Research involving adult somatic stem cells has implications which overturn many concepts which so far were considered
p.000034: to be well established35.
p.000035: 35
p.000035:
p.000035: As regards ageing for instance, recent work indicates that iPS stem cells, with their capacity for
p.000035: pluripotence and renewal which seem similar to those of embryonic stem cells, can be obtained from the skin cells of
p.000035: people over the age of 80. The so-called “aged” nature of these cells is not therefore due to intrinsic wearing out
p.000035: of the cells. Rather, it is because they belong to the environment of a person over 80 years of age that they are
p.000035: “senescent”. If they are given the opportunity of using four of their genes that their history and their environment
p.000035: had made unavailable to them, they recover “youthful” properties similar to those of embryonic stem
p.000035: cells. In other words, at least a part of the potentialities which characterise the “youth” and “age” of
p.000035: these cells appears to be not so much an intrinsic characteristic as an “update” of potentialities,
p.000035: reversible by the environment.
p.000035: For cancers, recent work indicates that, on the one hand, cancers emerge not only out of genetic
p.000035: alteration to normal stem cells, but also out of epigenetic alteration, modifying not so much the cellular gene
p.000035: sequence as the cell’s capacity to use some of its genes. And, on the other hand, that many cancers are made up
p.000035:
p.000035:
p.000035: These major scientific ventures — imitating spontaneous cellular differentiation processes in the course of
p.000035: development, or inventing new forms of cellular differentiation — are now proceeding in parallel and
p.000035: complementarily, with their respective advances acting in mutual enrichment as they progress in the exploration
p.000035: of an unknown continent, whose borders no one is capable of defining at this time.
p.000035:
p.000035:
p.000035: H. Research on embryonic cells and research on human embryos: an issue central to CCNE's deliberations since it was
p.000035: first created.
p.000035:
p.000035: Since its creation in 1983, CCNE has devoted a significant amount of its time to ethical issues involving the embryo or
...

p.000042: In its view, tissue differentiation is in fact an abstract and ambiguous reference, since it relates to a continuing
p.000042: process, rather than to a specific stage of development. For instance, depending on whether one considers the moment
p.000042: when tissues that will become the placenta differentiate from those which will become the inner cell mass, or the
p.000042: moment when one or the other embryonic tissue differentiates, these events occur at very different times in the process
p.000042: of development. Conversely, implantation of the embryo into the uterus is a major single event. The Committee therefore
p.000042: recommends that instead of the proposed reference, a reference designating the end of the pre-implantation stage should
p.000042: be preferred, i.e. the moment when the embryo acquires the capacity to implant in the uterus.”
p.000042:
p.000042:
p.000043: 43
p.000043:
p.000043: “Introducing a reference of this nature should not however in CCNE's view, give any support to those who consider that
p.000043: the embryo can be reified in the early phases of its development. It would be just as excessive to consider the
p.000043: pre-implantation embryo as simply a bundle of cells of human origin, as to consider it sacred because it is a potential
p.000043: human person. The notion of "ongoing embryonic process" could perhaps represent the enigma which veils the exact
p.000043: nature of the embryo in the very first moments of life. Be that as it may, and precisely because of
p.000043: this enigma, the Committee declares its attachment to the view that the human embryo must, as soon as it
p.000043: is formed, receive the respect owed to its status.”
p.000043:
p.000044: 44
p.000044:
...

p.000052: of turmoil which is part of a more general upheaval in the field of the life sciences.
p.000052:
p.000052: What do we know about stem cells? Are they “immortal” as is often said, or rather are they cells which are capable of
p.000052: asymmetric division, which age and then die, but are capable of giving birth to younger and more fertile cells, which
p.000052: in turn age and die, as is the case for instance for ancestral stem cells like yeast cells? What mechanisms
p.000052: control the survival, ageing and death of stem cells?
p.000052:
p.000052: The relation between stem cells and embryonic development, their connection to the ageing of the body and its capacity
p.000052: for repair, their link with cancer, are other essential issues.
p.000052: On all of these subjects, research has already begun to overturn our knowledge and tenets and could lead to future
p.000052: therapeutic avenues which are unpredictable today and which could go infinitely further than the only horizons of
p.000052: which we are aware at this point, that is the injection of curative stem cells for “regenerative” purposes.
p.000052:
p.000052: The pursuit of knowledge — which could be viewed as the true purpose of research — and the possibility of attempting to
p.000052: develop possibly beneficial applications — which could be viewed as one of the uses of research — are deployed in two
p.000052: different time spans.
p.000052:
p.000052: When useful applications become possible, their development becomes a priority, but it is illusory and
...

p.000074: embryo or will become cells of one of the more than 200 families of body cells which cannot, spontaneously, give birth
p.000074: to an embryo.
p.000074:
p.000074: In other words, it is the nature of the environment which is provided for them artificially in vitro which will
p.000074: determine the future of these cells; the environment can either unlock, or constrain, some of the cells’
p.000074: potentialities.
p.000074:
p.000074: But if, in the near future, it became possible to derive, depending on the environment provided for them
p.000074: in vitro, totipotent cells from the skin cells of an adult, should we prohibit, in retrospect and for ethical reasons,
p.000074: research on adult body cells in view of the discovery of their hitherto unknown potential capacity to give birth to an
p.000074: embryo? Or should we rather prohibit providing them with the environment which enables the creation of an embryo,
p.000074: that is forbid the creation of an embryo in vitro?
p.000074:
p.000074: This is a complex issue, which brings us back to the ethical problem raised by the possible use of totipotent cells
p.000074: isolated from “natural” embryos (see above, chapter I.G.3, on the subject of totipotent embryonic cells). Should
p.000074: we, for ethical reasons, ban the process of isolation, because of the cells’ potential, or should we simply ban
p.000074: providing them with the environment which allows the creation of an embryo using these cells? And if, in the future,
p.000074: it became possible to obtain, depending on the environment chosen for them, totipotent cells from
...

Searching for indicator liberty:

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p.000007: is the relationship between the partners and the projection of that relationship in a parental project, seeking for a
p.000007: bond in the couple’s future with their future child.
p.000007:
p.000007: It is the existence of this human bond, this inclusion in a parental project, which, as the Estates
p.000007: General on Bioethics stated, turns the “potential human being” that an embryo in vitro is for CCNE, into an
p.000007: “incipient” potential human being.
p.000007:
p.000007: As CCNE remarked nearly twenty-five years ago: “…although it cannot be demonstrated, the belief that a human
p.000007: life cannot be entirely controlled because it is not a manufactured product is a guarantee of our
p.000007: liberty and dignity8.”
p.000007:
p.000007: CCNE’s position has always (or nearly always9) consisted in not drawing a boundary which would lead to an
p.000007: all or nothing approach to respect for the embryo, and in considering the “issue of the exact nature of the
p.000007: embryo” to be an enigma: “It would be just as excessive to consider the pre-implantation embryo as
p.000007: simply a bundle of cells of human origin, as to consider it sacred because it is a potential human person.
p.000007: The notion of "on- going embryonic process" could perhaps represent the enigma (italics added) which veils the exact
p.000007: nature of the embryo in the very first moments of life. Be that as it may, and precisely because of this enigma
p.000007: (italics added), the Committee declares its attachment to the view that the human embryo must, as soon as it is formed,
...

p.000076: of our days. From birth to childhood, from childhood to adolescence, from adolescence to adulthood, from adulthood to
p.000076: old age, as long as persists within us the pulsation of awareness whose interruption defines — or so we have decided —
p.000076: the end, the end of the human being.
p.000076:
p.000076: The essential ethical issues which are of concern to today’s world are not those which bear on the earliest stages of
p.000076: development of future human beings, but rather on premature death and the sufferings of children and adults, caused by
p.000076: famine, infectious diseases, massacres, inhumane treatment, and the denial of health, liberty and dignity.
p.000076:
p.000076: Concern for the earliest stages of the development of a future embryo should make us even more attentive and sensitive
p.000076: to the sufferings of children already born. Mentally handicapped children, who are so frequently deprived in this
p.000076: country of access to education and adequate assistance in places where they can be close to their families. The two
...

Searching for indicator prison:

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p.000032: transgressor, who stole fire from the gods (quoted by Henri Atlan, in L’utérus artificiel, Seuil, 2005.).
p.000032: François Jacob also referred to the myth of Daedalus in his La souris, la mouche et l’homme (1997, Odile Jacob), as
p.000032: a metaphor for “an ailment of our time” and in particular stated that: “With Daedalus, science without a conscience is
p.000032: emerging.”
p.000032:
p.000032:
p.000032: 33As a reminder, Daedalus built a device so that the queen of Crete, Pasiphaë, the wife of King Minos, could mate with
p.000032: the sacred bull that the god Poseidon had made her fall madly in love with, to take revenge on Minos. The Minotaur,
p.000032: half man and half bull, a chimera devouring men for sustenance, was born of this union. Minos then asked Daedalus to
p.000032: construct a prison for the monster, the Labyrinth. Then it was Daedalus again who gave Minos’ daughter Ariadne, who
p.000032: was in love with Theseus, the thread (Ariadne’s thread) enabling Theseus to escape from the Labyrinth
p.000032: after killing the Minotaur. Minos punished Daedalus and his son Icarus by imprisoning them in the
p.000032: Labyrinth. Daedalus, the inventor of glue, then crafted wings out of birds’ feathers stuck together. With
p.000032: the help of their wings, they flew out of the Labyrinth and escaped, but Icarus ignored the cautionary advice he had
p.000032: been given and flew too close to the sun so that the wax holding his wings together melted and he fell to his death in
p.000032: the sea. And so the succession of Daedalus’ inventions, each one of which was a remedy for the problems caused by his
p.000032: previous inventions, closed (for the while) on this tragedy.
p.000032:
p.000032:
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Searching for indicator restricted:

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p.000034: trophoblasts, the cells which anchor to the uterine mucous membrane and so allow the implantation of the embryo.
p.000034: They will contribute to the formation of the placenta, this essential bridge or bond between the embryo and its mother.
p.000034:
p.000034: The cells in the centre of the sphere forming the embryo are called embryonic stem cells and they will give rise to all
p.000034: the cells in the body, but they are no longer capable of developing into trophoblasts; none of these embryonic
p.000034: stem cells can spontaneously produce a new embryo. These cells are described as pluripotent.
p.000034:
p.000034: As development continues, the potential to differentiate of the stem cells will be further restricted;
p.000034: they become multipotent and for some of them, unipotent which means that they are capable of giving rise to only one
p.000034: family of body cells. Some of the body’s stem cells, after we are born, are multipotent, others are unipotent, but to
p.000034: the best of today’s scientific knowledge, they have all lost their pluripotency (at least spontaneously, see chapter 4
p.000034: below) and a fortiori their totipotency.
p.000034:
p.000034: 3. From the cell to the embryo, or from a scientific fact to an ethical issue.
p.000034:
p.000034: The first appearance of a human embryo is in the form of a single cell, born of the fusion of two cells (an oocyte and
p.000034: a spermatozoon).
p.000034:
p.000034: This first cell, all on its own, is a human embryo.
p.000034:
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p.000062: important and the most difficult to solve64.
p.000062:
p.000062: While the thought was never formulated in those terms, it could be inferred from CCNE’s past Opinions
p.000062: taken as a whole that it has always considered that the two circumstances in which it sees as inevitable
p.000062: the destruction of non implanted embryos created in vitro in the context of ART are, firstly the case of
p.000062: spare embryos after the parental project has been abandoned and no other infertile couple wishes to take them on
p.000062: and, secondly when in the course of PGD, the genetic defect which motivated the PGD procedure is detected.
p.000062: But although destruction may be inevitable, this does not mean that it is ethically satisfactory, which CCNE
p.000062: translates in ethical language as the lesser evil.
p.000062:
p.000062: In this Opinion, the ethical approach should include all of the following:
p.000062:
p.000062: • affirmation of respect for human embryos as “potential human beings”,
p.000062: • recognition at least that there is a great deal of perplexity on how to define the status of embryos,
p.000062: • and the contingent acceptance of the possibility that their integrity may be breached in particular circumstances,
p.000062: depending inter alia on whether they can, or cannot, be included in a human relationship, a parental project
p.000062: which is a necessary condition for their future existence.
p.000062:
p.000063: 63
p.000063:
p.000063: Opinion N° 8, dated December 15, 1986 on Research and use of in-vitro human embryos for scientific and medical purposes
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p.000004: If and when the parental project becomes redundant, as may be the case for excess embryos, we are in favour of using
p.000004: the embryos for research, subject to explicit agreement from those who conceived them.
p.000004: Conversely, we are opposed to any form of research on embryos intended for implantation, since they are part of a
p.000004: parental project."
p.000004: As regards the length of time excess embryos should be kept for, the Opinion continues:
p.000004: "We consider that the five year time period provided for the conservation of excess embryos that are no longer included
p.000004: in a parental project is too lengthy. We would recommend that this time should be reduced to one year, with the
p.000004: possibility of a single one year renewal. No response from parents by the end of this period signifies the end of the
p.000004: parental project. We would also consider it highly desirable that detailed information be given at this time to
p.000004: intentional parents and that they should be asked at the outset to take a decision on what should be done with
p.000004: superfluous embryos should they not respond to enquiries at a later date (destroyed, given to another couple or donated
p.000004: for research purposes). In this way, the point could be made more clearly that the intended parents, and not the
p.000004: doctors, would bear the responsibility for the possible destruction of the embryos. It would also be appropriate at
p.000004: that point to explain more fully the usefulness of donating embryos for research."
p.000004: This recommendation for shortening the time of conservation of excess embryos to one year with the
...

p.000008:
p.000009: 9
p.000009:
p.000009: The exception concerns CCNE’s comment on therapeutic cloning, see above, note 7.
p.000009:
p.000010: 10
p.000010:
p.000010: Opinion N°67, January 18, 2001 on the Preliminary draft revision of the laws on bioethics
p.000010:
p.000010: Stating that the potential human being is an enigma means that, after hearing out these two extreme and mutually
p.000010: exclusive positions, however justified they might be in principle, one chooses to adopt an attitude which can
p.000010: truly cope with this difficult and essential in between concept: a “potential human being”.
p.000010:
p.000010: Faced with this enigma, CCNE considered that there was no single and absolute response regarding the conduct to be
p.000010: adopted out of respect for the embryo; this conduct will depend on the context in which decisions have to be taken and
p.000010: what those decisions imply. “Ethical requirements cannot always be formulated in "absolute" dogmatic terms.
p.000010: Elaborating and implementing rules implies compromises made tolerable by the ethical principle of the lesser of two
p.000010: evils. The lesser evil, can be determined by weighing immediate and medium or long term risks and
p.000010: advantages, of a scientific, medical, psychological, social, cultural or philosophical nature11.”
p.000010:
p.000010: “The substantive position defended by the Committee is to recognise that the [human] embryo or [human] fœtus has the
...

p.000034:
p.000034: As development continues, the potential to differentiate of the stem cells will be further restricted;
p.000034: they become multipotent and for some of them, unipotent which means that they are capable of giving rise to only one
p.000034: family of body cells. Some of the body’s stem cells, after we are born, are multipotent, others are unipotent, but to
p.000034: the best of today’s scientific knowledge, they have all lost their pluripotency (at least spontaneously, see chapter 4
p.000034: below) and a fortiori their totipotency.
p.000034:
p.000034: 3. From the cell to the embryo, or from a scientific fact to an ethical issue.
p.000034:
p.000034: The first appearance of a human embryo is in the form of a single cell, born of the fusion of two cells (an oocyte and
p.000034: a spermatozoon).
p.000034:
p.000034: This first cell, all on its own, is a human embryo.
p.000034:
p.000034: Later this cell will give birth to new cells and each of these first generations of totipotent cells,
p.000034: making up the embryo, will keep this capacity of giving birth on their own to a new embryo if they are isolated from
p.000034: neighbouring cells (as mentioned above). At this point they are components of the embryo, as long as they remain in
p.000034: the embryo, but they are also the possible origin of a new embryo if they are separated from the original embryo. If
p.000034: they are isolated in vitro from the embryo they are components of, they will proceed, depending on the environment they
...

p.000042: development within the mother’s body, as regards ethical issues and the way in which embryos may be treated;
p.000042: • Rejection of creating human embryos for the purpose of research45;
p.000042: In its view, tissue differentiation is in fact an abstract and ambiguous reference, since it relates to a continuing
p.000042: process, rather than to a specific stage of development. For instance, depending on whether one considers the moment
p.000042: when tissues that will become the placenta differentiate from those which will become the inner cell mass, or the
p.000042: moment when one or the other embryonic tissue differentiates, these events occur at very different times in the process
p.000042: of development. Conversely, implantation of the embryo into the uterus is a major single event. The Committee therefore
p.000042: recommends that instead of the proposed reference, a reference designating the end of the pre-implantation stage should
p.000042: be preferred, i.e. the moment when the embryo acquires the capacity to implant in the uterus.”
p.000042:
p.000042:
p.000043: 43
p.000043:
p.000043: “Introducing a reference of this nature should not however in CCNE's view, give any support to those who consider that
p.000043: the embryo can be reified in the early phases of its development. It would be just as excessive to consider the
p.000043: pre-implantation embryo as simply a bundle of cells of human origin, as to consider it sacred because it is a potential
p.000043: human person. The notion of "ongoing embryonic process" could perhaps represent the enigma which veils the exact
...

p.000053: the ethical quality of the research process.
p.000053:
p.000053: This is the reason why must be examined the details of the free and informed consent procedure proposed
p.000053: to the couple who have explicitly made known the ending of their parental project. (In the event of
p.000053: implicit termination of the project, i.e. no response after five years have elapsed, the embryo is destroyed and no
p.000053: research is permitted).
p.000053:
p.000053: At least three points concerning the free and informed consent procedure provided by the 2004 bioethics
p.000053: law merit consideration.
p.000053:
p.000053: 1.One single consent (or refusal) for research on cells isolated after the embryo’s destruction and for
p.000053: research on a live embryo before its destruction.
p.000053:
p.000053: The law has put research on a live human embryo and research on human embryonic cells on the same footing, under the
p.000053: one heading of “research on embryos and embryonic stem cells”.
p.000053:
p.000053: The two situations have therefore been dealt with in the same way (although they raise different kinds of
p.000053: ethical issues, see below, chapter III).
p.000053:
p.000053: As a result, a couple can only consent to research in terms of ‘all or nothing’: if they consent to research, it may
...

p.000053:
p.000053: When, however, research involves isolated cells sampled from the destroyed embryo, the ‘or’ should be replaced by
p.000053: an ‘and’: consent (or refusal) should be for ending storage of the embryos, then (therefore ‘and’) the cells
p.000053: taken from the destroyed embryos would the subject of research.
p.000053:
p.000053:
p.000053: 2.The connection between ethical evaluation of research and consent to research is in reverse order to the usual
p.000053: procedure.
p.000053:
p.000053: When, in biomedical matters, the possibility of research is subject to a free and informed consent
p.000053: procedure, the first step is evaluation of the research by one single (or several) scientific and
p.000053: ethical body or bodies. It is only if the research is judged to be both scientifically legitimate and
p.000053: ethically acceptable that free and informed consent procedures are initiated.
p.000053:
p.000053: In this case, the free and informed consent procedure is submitted to the couple before the research project is
p.000053: considered by the Conseil d’orientation de l’Agence de la Biomédecine, which carries out an ethical evaluation after
p.000053: receiving the scientific evaluation provided by a group of experts the Agency had designated.
p.000053:
...

p.000074: context, an embryo for the purpose of research?
p.000074:
p.000074: An additional problem arises in connection with the fact that scientists working in this field are pointing out the
p.000074: value of a possible medical application of this research if the approach were to give infertile individuals the
p.000074: possibility of producing gametes. Can we consider using ART to conceive and bring to term a child born of the skin
p.000074: cells of an adult?
p.000074:
p.000074: Furthermore, a problem arises, similar to the one raised by reproductive cloning, that is the possibility of conceiving
p.000074: an embryo or even bringing a child to term, using sperm and oocytes derived from the skin cells of a single person76.
p.000074: In 1994, at a time when embryonic stem cell lines had been isolated for over ten years, using mouse embryos and other
p.000074: animal species, but not humans as yet, legislators did not consider there was any need to anticipate this possibility,
p.000074: although it was a very probable development. They banned any kind of research based on embryonic cells.
p.000074:
p.000074: When (only four years later) human embryonic stem cells were isolated and possible medical applications were
p.000074: formulated, legislators decided to include these advances in their considerations and the law was
p.000074: modified: prohibition was replaced by prohibition with the possibility of derogation…
p.000074:
p.000074: Rather than assuming that every five years, ethical reflection must be reinitiated de novo to take account of the
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p.000002: Not only were perceptions concerning embryos radically changed, but also those concerning parental projects which took
p.000002: on a new dimension. A prior parental project now needed to be formulated for the possibility and reality of IVF to
p.000002: apply, that is through embryo conception outside the mother's body.
p.000002: In tune with the new importance acquired by parental projects emerged a new form of medical and social
p.000002: responsibility concerning the embryo's fate before transfer to the mother's body.
p.000002: In this radically new context for the start of a human life, emerged the new issue of the future of the in vitro
p.000002: embryos if they were not to be transferred to their mothers' bodies.
p.000002:
p.000002: Today, there are at least three sets of circumstances leading to a medical decision not to transfer an embryo created
p.000002: through ART in vitro in the context of a parental project:
p.000002: 1. when the presence of a major defect or the fact that an embryo has ceased to develop in vitro is clearly visible
p.000002: before transfer to the mother;
p.000002: 2. when preimplantation genetic diagnosis (PGD) reveals that an embryo is carrying the genetic sequence
p.000002: involved in a particularly severe inherited disorder, incurable at the time of
p.000002:
p.000002: diagnosis, the genetic sequence in question being the one which initially motivated the PGD1. procedure.
p.000002: In both cases, the human embryo is destroyed.
p.000002: 3. There is a third set of very different circumstances in which embryos created in vitro are not transferred: in this
...

p.000013: both embrace the complexities of ethical issues and respond to them as humanly as is possible, without
p.000013: obliterating them.
p.000013:
p.000014: 14
p.000014:
p.000014: Opinion N°8, dated December 15, 1986 on Research and use of in-vitro human embryos for scientific and medical purposes.
p.000014:
p.000014: - rejecting the reification of human embryos and recognising the respect owed to embryos as “potential human persons”;
p.000014: - rejecting the idea of “giving a normative definition” of human embryos;
p.000014: - respect to be expressed by the nature of the conduct prescribed to deal with human embryos;
p.000014: - a distinction between ethical issues and conducts authorised as a result of their
p.000014: preimplantation status, in vitro, or their development in their mothers’ body;
p.000014:
p.000014: And made a number of specific recommendations of a legal nature, in particular:
p.000014:
p.000014: - authorisation to destroy spare human embryos in the event of the parental project no longer being extant and in the
p.000014: absence of other couples wishing to host them;
p.000014: - conditional authorisation for research on cells originating from human embryos destroyed in vitro according to
p.000014: stipulations described above;
p.000014: - conditional authorisation for some kinds of research on human embryos conceived in vitro, before destruction is
p.000014: authorised according to stipulations described above;
p.000014: - prohibition of the creation of human embryos for the purpose of research, together with “the introduction of an
p.000014: exception to this principle in the context of an evaluation of new Assisted Reproductive Technologies.”
p.000014:
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p.000002: National Consultative Ethics Committee for Health and Life Sciences
p.000002:
p.000002:
p.000002: OPINION N° 112
p.000002:
p.000002:
p.000002: Ethical reflection concerning research on human embryonic cells and on human embryos in vitro
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: Members of the Working Group: Jean-Claude Ameisen (rapporteur) Ali Benmakhlouf
p.000002: Claude Burlet
p.000002: Alain Cordier (rapporteur) Patrick Gaudray
p.000002: Xavier Lacroix Claude Sureau Bertrand Weil
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: Outline
p.000002:
p.000002: Putting the issues in context.
p.000002:
p.000002: A. A brief history of Assisted Reproductive Technology (ART): from in vitro fertilisation to the issue of destroying
p.000002: spare embryos.
p.000002:
p.000002: B. From the issue of destroying spare human embryos to the issue of research on embryonic cells and on
p.000002: human embryos in vitro.
...

p.000002: isolated and suddenly became of major scientific interest in a large number of biomedical research domains, which led
p.000002: to considering the possibility of human embryos as a potential source of stem cells for biomedical research
p.000002: and other medical purposes.
p.000002:
p.000002: C. Positions which are a priori irreconcilable.
p.000002:
p.000002: 1. Beyond divergences: a position in common?
p.000002: We are not intending to give an exhaustive description of the very great diversity of opinions regarding the manner in
p.000002: which human embryos in vitro should be treated, nor of the various legislative interpretations of such treatment in
p.000002: different countries around the world. Rather, we seek to highlight both the essential differences which
p.000002: oppose them, frequently very
p.000002:
p.000002:
p.000002: 1See CCNE's Opinion N° 107, October 15, 2009 on ethical issues in connection with antenatal diagnosis: Prenatal
p.000002: diagnosis (PND) and Preimplantation Genetic Diagnosis (PGD)
p.000002:
p.000002: radically, in ethical terms and, transcending these differences, to discover possible points of convergence.
p.000002:
p.000002: In some opinions, the very creation of an embryo in vitro as part of an ART procedure should be banned and the wish to
p.000002: have children should only be fulfilled if it can be achieved without IVF.
p.000002: But with the exception of this view, there is at least one point — and it is all too infrequently
p.000002: underlined — common to all the radically different opinions on how human embryos in vitro should be treated: the
p.000002: embryo's integrity must not be breached as long as it is still included in the parental project which was the cause of
...

p.000002:
p.000003: 3
p.000003:
p.000003: It is worthy of note that, in biological terms, the demarcation point of fertilisation, between the nothing yet status
p.000003: and the already everything status, is in fact a continuum and that the dividing line becomes much more visible with
p.000003: hindsight. About 24 hours elapse between the time when the spermatozoon penetrates the egg and the moment when its
p.000003: chromosomes have merged with the oocyte's, leading to the creation of the embryo's chromosomes and its
p.000003: first cell.
p.000003:
p.000003: link. If the parental project itself becomes redundant, then retrospectively the protection granted to the
p.000003: embryo in vitro against a breach of integrity is also lost4.
p.000003:
p.000003: - Yet other opinion groups consider that respect for embryos is solely conditioned by their inclusion in a parental
p.000003: project and that the absence of any such parental intention therefore authorises their creation in vitro for
p.000003: research purposes, independently of any ART procedure.
p.000003:
p.000003: The ethical issue arising in that situation is the maximum amount of time allowed before destruction of the embryo.
p.000003: This would be a boundary, a limit corresponding to a specific stage in the development of the embryo in vitro.
p.000003:
p.000003: There are several different perceptions regarding such a boundary.
p.000003:
p.000003: - For some, the dividing line is the stage of biological development which corresponds to the possibility of implanting
p.000003: in the mother's uterus. This stage occurs on the 7th day of embryo in vitro development. An embryo created for
p.000003: research should therefore be destroyed before it reaches that stage5, 6.
p.000003:
p.000004: 4
p.000004:
p.000004: Report by the États Généraux de la Bioéthique. Annex 9. Contributions from Regional Forums. Citizen opinion given by
p.000004: the Marseilles panel. Estates General on Bioethics. Chapter I. Stem cells and research on embryos of the Citizen
p.000004: Opinion begins as follows:
p.000004: "We, the citizens, consider that a protective status should be granted to embryos, in the framework of a parental
p.000004: project, based on the principle of non instrumentalisation of the unborn child. Embryos should have the status of an
p.000004: incipient person only when they are enrolled in a parental project. It is this project which confers a status on
p.000004: embryos and therefore defines them. The absence of a parental project cancels the status given to them.
p.000004: If and when the parental project becomes redundant, as may be the case for excess embryos, we are in favour of using
p.000004: the embryos for research, subject to explicit agreement from those who conceived them.
p.000004: Conversely, we are opposed to any form of research on embryos intended for implantation, since they are part of a
p.000004: parental project."
p.000004: As regards the length of time excess embryos should be kept for, the Opinion continues:
p.000004: "We consider that the five year time period provided for the conservation of excess embryos that are no longer included
p.000004: in a parental project is too lengthy. We would recommend that this time should be reduced to one year, with the
p.000004: possibility of a single one year renewal. No response from parents by the end of this period signifies the end of the
p.000004: parental project. We would also consider it highly desirable that detailed information be given at this time to
p.000004: intentional parents and that they should be asked at the outset to take a decision on what should be done with
p.000004: superfluous embryos should they not respond to enquiries at a later date (destroyed, given to another couple or donated
p.000004: for research purposes). In this way, the point could be made more clearly that the intended parents, and not the
p.000004: doctors, would bear the responsibility for the possible destruction of the embryos. It would also be appropriate at
p.000004: that point to explain more fully the usefulness of donating embryos for research."
p.000004: This recommendation for shortening the time of conservation of excess embryos to one year with the
p.000004: option of a renewal for one more year, had already been formulated, almost 25 years ago, by CCNE in Opinion N° 8,
p.000004: December 15, 1986 on Research and use of in-vitro human embryos for scientific and medical purposes.
p.000004:
p.000004:
p.000005: 5
p.000005:
p.000005: It was in this context that the proposal was made to give the name of pre-embryo to the embryo in vitro as long as it
p.000005: has not reached the stage of development when implantation becomes possible. The creation of embryos in
p.000005: vitro for the sole purpose of destruction and research is seen as not raising any other ethical issue than the one
p.000005: mentioned above, i.e. collecting oocytes for research (see above), provided the embryo in vitro is destroyed before the
p.000005: 7th day following its creation.
p.000005:
p.000005: - For others again, the radical frontier appears later in the process, i.e. on the 14th day of development in vitro
p.000005: with the emergence of the first differentiated cells giving rise to the nervous system7.
p.000005:
p.000005: 3. “Seeking the lesser evil”.
p.000005: It is perhaps starting from this sole point in common between two positions which seem a priori mutually exclusive —
p.000005: respect for the embryo in vitro included in a human connection, a parental project, the very condition for its
p.000005: future — that the ethical issue of a common mutually acceptable approach, regarding the embryo, may be based.
p.000005:
p.000005: This concept of a boundary and of the absence of any ethical problem is shared by other opinion groups as regards the
p.000005: method used to create in vitro embryos when there is no fertilisation process, such as transferring the nucleus of a
p.000005: somatic cell to the cytoplasm of an oocyte from which the nucleus was removed (or cloning for scientific purposes), or
p.000005: again the formation of cybrids (transferring the nucleus of a human cell to an animal cell from which the nucleus has
p.000005: been removed). In such cases, some people are of the opinion that not only is there no ethical issue because these are
p.000005: pre-embryos, but that there is even less of a problem since the pre-embryo is artificial and the decision in advance
p.000005: was that it would never be implanted, whatever the circumstances.
p.000005:
p.000006: 6
p.000006:
p.000006: Reading CCNE's Opinion N° 67, dated January 18, 2001, on the Preliminary draft revision of the laws on bioethics, shows
p.000006: just how much this concept of a boundary has resonance, and how the refusal to validate one form of a radical boundary,
p.000006: because of an apparent rejection of this very principle, can lead to validating another form of boundary — just as
p.000006: radical as the first kind. In the chapter on the Nature of the Embryo, (dealing with the subject of creation of
p.000006: embryos for the purpose of research by nuclear replacement, i.e. “so-called therapeutic cloning”), “CCNE stresses the
p.000006: fact - in its opinion a very positive one - that the preliminary draft law designates all three kinds of embryos by the
p.000006: expression "human embryo", which was not a foregone conclusion for two reasons. Firstly, if one considers the procedure
p.000006: consisting in transferring a cell nucleus into an enucleated oocyte, the resulting product must needs be a human embryo
p.000006: by its very nature. To deny this would mean, were the pro- hibition disregarded, denying in advance human status
p.000006: to the child produced. Such a dividing line must not therefore be drawn between an IVF embryo and an embryo
p.000006: [created by nuclear replacement for research], even though it is clear that their origins - sexual reproduction in one
p.000006: case, and asexual in the other - introduce an es- sential difference which is due in part to the nature of the project
...

p.000007: (italics added), the Committee declares its attachment to the view that the human embryo must, as soon as it is formed,
p.000007: receive the respect owed to its status10 ”.
p.000007:
p.000007: If the embryo in vitro, as soon as it is created, is considered to be a person already, the ethical issue of the
p.000007: creation of spare embryos and therefore of their possible destruction, does not even arise: creating spare embryos is
p.000007: unacceptable.
p.000007: If, on the contrary, the embryo in vitro is seen as nothing more than a bundle of cells, the ethical issue of creating
p.000007: embryos for research purposes does not arise either: creating embryos for research is not a problem.
p.000007:
p.000007:
p.000007: for research is destroyed before the 14th day following its creation.
p.000007:
p.000007:
p.000008: 8
p.000008:
p.000008: Opinion N°8, dated December 15, 1986 on Research and use of in-vitro human embryos for scientific and medical purposes.
p.000008:
p.000009: 9
p.000009:
p.000009: The exception concerns CCNE’s comment on therapeutic cloning, see above, note 7.
p.000009:
p.000010: 10
p.000010:
p.000010: Opinion N°67, January 18, 2001 on the Preliminary draft revision of the laws on bioethics
p.000010:
p.000010: Stating that the potential human being is an enigma means that, after hearing out these two extreme and mutually
p.000010: exclusive positions, however justified they might be in principle, one chooses to adopt an attitude which can
p.000010: truly cope with this difficult and essential in between concept: a “potential human being”.
p.000010:
p.000010: Faced with this enigma, CCNE considered that there was no single and absolute response regarding the conduct to be
p.000010: adopted out of respect for the embryo; this conduct will depend on the context in which decisions have to be taken and
p.000010: what those decisions imply. “Ethical requirements cannot always be formulated in "absolute" dogmatic terms.
...

p.000010: status of a potential human being who must command universal respect. Successive Opinions on the subject seek
p.000010: to attune this demand for respect to other intents which are also ethically acceptable12.”
p.000010:
p.000010: In such a context, the issue of the possible destruction of embryos in vitro is not one which stands
p.000010: alone, in ethical isolation; it must first of all be considered in the context of the ethical issues which arise out of
p.000010: the particular circumstances which may lead to their destruction. For example, destroying embryos that are not going
p.000010: to be transferred following an ART procedure should not be viewed in the same light a destroying embryos in other and
p.000010: different circumstances.
p.000010:
p.000010: In Opinion n° 8 of December 15, 1986 on Research and use of in-vitro human embryos for scientific and medical
p.000010: purposes, CCNE — before recommending the legal wording of a conditional authorisation — began by
p.000010: considering the issue of the destruction of spare embryos once the parental project had been dropped in ethical
p.000010: terms related to a lesser evil: “It is also possible to stress the contradiction embedded in in-vitro fertilisation
p.000010: which, acting to create life, is compelled at the same time to destroy life. […] Destruction seems
p.000010: paradoxical in the case of a technique [ART] intended to create life. […] The Committee considers that such
p.000010: destruction can only be envisaged as the lesser of two evils and that it is inevitable whenever conservation is
p.000010: not possible. Such destruction shocks those who consider that the life of embryos should be protected as soon as
p.000010: they are conceived.”
p.000010:
p.000010: “Whenever the parents renounce their project or the project becomes impossible (for instance, due to
p.000010: separation of the couple), the only solution considered by the Committee,
p.000010:
p.000010:
p.000010:
p.000011: 11
p.000011:
p.000011: Opinion N°8, dated December 15, 1986 on Research and use of in-vitro human embryos for scientific and medical purposes.
p.000011:
p.000012: 12
p.000012:
p.000012: Opinion N°67, January 18, 2001 on the Preliminary draft revision of the laws on bioethics
p.000012:
p.000012: as the lesser of two evils13, is destruction of the embryos (with the reservation of possible donations for research).”
p.000012:
p.000012: It was in such a context that CCNE considered “compromises made tolerable by the ethical principle of the lesser of two
p.000012: evils14.”
p.000012:
p.000012: D. Previous CCNE Opinions on human embryo destruction, research using embryonic cells and research on human embryos in
p.000012: vitro.
p.000012:
p.000012: Ethical issues related to research on human embryos — and more generally to Assisted Reproductive Technology (ART)
p.000012: advances which led to fertilisation in vitro and the creation of embryos in vitro — have been central to CCNE’s work
p.000012: from the start.
p.000012: In the more than a quarter of a century since CCNE’s creation, over twenty of its Opinions have been
p.000012: devoted to various ethical issues connected to human embryos or fœtuses, such as Assisted Reproductive
p.000012: Technology (ART), which led to fertilisation in vitro and the conservation of spare embryos, or preimplantation
p.000012: genetic diagnosis, prenatal diagnosis, research on embryonic stem cells or on the embryo.
p.000012:
p.000012: This was true of the first Opinion filed by CCNE, Opinion n° 1, dated May 22, 1984 on Sampling of
p.000012: dead human embryonic and fœtal tissue for therapeutic, diagnostic, and scientific purposes.
p.000012: Five other Opinions — starting with Opinion N° 8, dated December 15, 1986 up to Opinion N° 67, dated January 18, 2001
p.000012: on the revision of the previous 1994 Bioethics law — dealt specifically with ethical issues connected to research
p.000012: on non transferred human embryos created in vitro, or research on cells from a human embryos after their
p.000012: destruction.
p.000012:
p.000012: All of these various CCNE Opinions reflected, with a variety of developments, the major lines of Opinion N° 1, in
p.000012: particular:
p.000013: 13
p.000013:
p.000013: The Etats Généraux de la Bioéthique (as also the Conseil d’Etat and OPECST/Office parlementaire
p.000013: d'évaluation des choix scientifiques et technologiques) later formulated in legal terms the same recommendation as the
p.000013: one authored by CCNE in all of its earlier Opinions, i.e. conditional authorisation, in all of the following cases: for
p.000013: the destruction of embryos in vitro once a parental project has been abandoned, for research based on cells from
p.000013: destroyed embryos and for research on human embryos in vitro before their destruction.
p.000013: But CCNE’s views, as expressed in previous Opinions, differed from those of the Etats Généraux de la Bioéthique in that
p.000013: they were significantly qualified on two essential points. On the one hand, CCNE has always considered the embryo in
...

p.000013: that the destruction of embryos in vitro because a parental project has ceased to exist was the only solution that
p.000013: could be found as representing the lesser evil. This is a very different position from the one proposed by the Etats
p.000013: Généraux de la Bioéthique, which is an “all or nothing” stance, in which the ending of the parental project seems to
p.000013: remove any further ethical problem.
p.000013: CCNE’s position, up to the present time, has been that this solution — which is open to question in that it depends on
p.000013: current ART modalities and constraints which, one may hope, will not remain static — is the only solution which can
p.000013: both embrace the complexities of ethical issues and respond to them as humanly as is possible, without
p.000013: obliterating them.
p.000013:
p.000014: 14
p.000014:
p.000014: Opinion N°8, dated December 15, 1986 on Research and use of in-vitro human embryos for scientific and medical purposes.
p.000014:
p.000014: - rejecting the reification of human embryos and recognising the respect owed to embryos as “potential human persons”;
p.000014: - rejecting the idea of “giving a normative definition” of human embryos;
p.000014: - respect to be expressed by the nature of the conduct prescribed to deal with human embryos;
p.000014: - a distinction between ethical issues and conducts authorised as a result of their
p.000014: preimplantation status, in vitro, or their development in their mothers’ body;
p.000014:
p.000014: And made a number of specific recommendations of a legal nature, in particular:
p.000014:
p.000014: - authorisation to destroy spare human embryos in the event of the parental project no longer being extant and in the
...

p.000014: General on Bioethics and the Mission d’Information Parlementaire (Parliamentary Advisory Mission) on the revision of
p.000014: the bioethics law.
p.000014: As regards specifically research on embryos and embryonic stem cells, the report by the Mission
p.000014: d’Information Parlementaire on the revision of the law on bioethics recommended that the current
p.000014: prohibition of research with derogations should be retained, whereas the OPECST, Conseil d’Etat and Estates
p.000014: General on Bioethics all recommended that prohibition should be replaced by conditional authorisation for research.
p.000014:
p.000014: ***
p.000014:
p.000014:
p.000015: 15
p.000015:
p.000015: Leçons d’expérience (2005-2008) et questionnements. (The lessons of experience (2005-2008) and questions.)
p.000015:
p.000015:
p.000016: 16
p.000016:
p.000016: Opinion N°105, dated October 9, 2008. Questions for the Estates General on Bioethics
p.000016:
p.000016: In this context, CCNE considered that the most useful contribution it could make at this time to society’s and
p.000016: legislators’ reflections on this subject, was to review the ethical issues in relation to research on
p.000016: human embryonic stem cells and research on human embryos, and to draw up in this way a general outline for
p.000016: reflection with the object of highlighting the ethical aspects of the various options, rather than make
p.000016: recommendations
p.000016: — as it had done previously and as many of the authorities recently consulted also did — on
p.000016: what the law should prescribe.
p.000016:
p.000016: An absence of legal recommendations, however, does not imply an absence of submission. As we shall observe, in
p.000016: this Opinion, specific recommendations will be formulated with reference to the various issues; in particular
p.000016: they will consist in drawing attention to the various essential ethical issues which need to be taken into account.
p.000016:
p.000016: CCNE insists on the importance of finding a compromise, not as the result of being unable to choose, but on the
p.000016: contrary, as a reasoned response, as behaviour that various opinions can choose to share, as a rejection of
p.000016: certitudes and instead, consideration of the full complexity of the enigma represented by “potential human
p.000016: person”, while granting full pride of place to parental projects involving human embryos in a human relationship that
p.000016: is the very condition for their future, even before their creation.
p.000016:
p.000016: Along the same lines it has always chosen to pursue, in this instance CCNE’s thinking bears on a fundamental issue
...

p.000016: within the mother’s body, suddenly turned into a discontinuous process, beginning before and elsewhere, in a
p.000016: test tube. The maternal bond, in this first phase, was disincarnated at least to begin with, and was entirely
p.000016: replaced by its symbolic component — the parental project — under the temporary but complete control of biologists and
p.000016: doctors17 until the embryo was transferred.
p.000016:
p.000016: This dissociation in time then took on an entirely and even more disturbing different dimension, with
p.000016: the development of freezing for embryos conceived in vitro, so that transfer to the mother’s body could be
p.000016: deferred, leading in 1984 in Australia, to the birth of Zoe.
p.000016:
p.000016:
p.000017: 17
p.000017:
p.000017: In its Opinion n° 3, dated October 23, 1984, on Ethical problems arising out of artificial reproductive techniques,
p.000017: CCNE stated: “These new techniques open up uncharted territory. Procreation, that complex act, is dissociated. This
p.000017: act, which hitherto was decided and accomplished together by a man and a woman, conducted to its term by the
p.000017: association of the embryo and that woman, can now be a decision which is taken separately and at a different time.
p.000017: Others may play a role.”
p.000017:
p.000017: Not only could the embryo begin to live autonomously for several days outside the mother’s body after in vitro
p.000017: fertilisation, but the freezing process (or cryopreservation) could suspend the course of development, and more
p.000017: radically the very course of life as a biological process. As a result, the very concept of a maximum a priori time
...

p.000018: cryopreservation, was intended to solve a problem of medical ethics, i.e. preserving as much as possible the health
p.000018: of the future mother (or of the oocyte donor). But the inevitable a priori consequence raised another
p.000018: ethical issue, the future of spare embryos in the event of the couple forsaking their parental project (regardless
p.000018: of whether the cause was repeated ART failures, or on the contrary the birth of children, or the couple
p.000018: separating or the death of one or both partners, etc.).
p.000018:
p.000018:
p.000018:
p.000019: 19
p.000019:
p.000019: In Opinion n° 107, dated October 15, 2009 on Ethical issues in connection with antenatal diagnosis:
p.000019: Prenatal diagnosis (PND) and Preimplantation Genetic Diagnosis (PGD), CCNE remarked, in connection with PGD, that IVF
p.000019: “requires a fairly elaborate and invasive procedure (ovarian stimulation and puncture, etc.). “There are,
p.000019: on the one hand proven risks in hyperstimulation and ovarian puncture.”. And “It [IVF] is also a source of anxiety
p.000019: since at each stage of the procedure, there is a high risk of failure.”
p.000020: 20
p.000020:
p.000020: CCNE has used interchangeably the expressions “ending conservation” or “destruction” of spare embryos (see, for
p.000020: example, Opinion n° 60, dated June 25, 1998: Re-examination of the laws on bioethics
p.000020:
p.000020: 1. An ethical issue inherited from past practices…
p.000020: One of the possible futures for spare embryos currently stored by cryopreservation, once the couple originating
p.000020: their creation have forsaken their parental project, is for another couple wanting ART treatment to host
p.000020: them. In this case, a woman unable to undergo IVF using her own eggs, asks for an another couple’s spare embryo to be
p.000020: implanted, providing of course that the embryo’s biological parents are in agreement21.
p.000020:
p.000020: Another theoretical possibility to avoid destroying spare embryos once their genitors’ parental project has been
p.000020: dropped would be to continue cryopreservation as long as possible, even indefinitely, leaving to others, at
p.000020: some future time, the responsibility of the embryos’ future.
...

p.000021: court, occurs only very rarely for the time being. By way of comparison, since the procedure to adopt a spare embryo
p.000021: became legal, less than ten cases have been recorded, while out of the more than 150,000 spare embryos in
p.000021: cryopreservation at the end of 2007, there were 50,000 spare embryos for which there was no longer any parental project
p.000021: or whose genitors were not responding.
p.000021:
p.000022: 22
p.000022:
p.000022: The 2004 bioethics law provides for a maximum conservation of spare embryos for a period “at least equal to 5 years” if
p.000022: there is no response from the couple originating the embryo’s creation to the annual letters sent asking them if they
p.000022: wish to pursue their parental project. In contrast, 25 years ago, CCNE in its Opinion N° 8, dated December 15,
p.000022: 1986, on Research and use of in-vitro human embryos for scientific and medical purposes, and the Estates
p.000022: General on Bioethics, in 2009 (Rapport des Etats Généraux de la Bioéthique. Annexe
p.000022: 9. Les Contributions issues des forums régionaux. Avis citoyen du panel de Marseille. Etats Généraux de
p.000022: Bioéthique) recommended a shorter maximum cryopreservation time for spare embryos, of no more than a year, renewable
p.000022: for one further period of a year.
p.000022:
p.000022: parental project being abandoned23. And this problem has grown proportionately with the extension of recourse to ART.
p.000022:
p.000022: 2. … And an ethical issue as regards the practices of tomorrow.
p.000022:
p.000022: To this reflection on a retrospective ethical problem, bearing on the way in which we can best act today to remedy a
...

p.000022: likelihood of this figure improving in years to come since it is in fact quite close to the figure for natural
p.000022: conception24.”
p.000022:
p.000022: Will subsequent ART progress allow bypassing the creation in future of spare embryos, as CCNE had expressed
p.000022: the hope already almost 25 years ago25, — and therefore avoiding their conservation — without endangering the health of
p.000022: the future mother in the event of a failed pregnancy and new need of ART26?
p.000022:
p.000022: In the event of such progress, the question of the destruction of spare embryos would cease to be a problem
p.000022: connected to the use of ART, at least when the ART indication is a couple’s infertility.
p.000023: 23
p.000023:
p.000023: In its Opinion N° 8, dated December 15, 1986, on Research and use of in-vitro human embryos for scientific
p.000023: and medical purposes, CCNE remarked that “It is also possible to stress the contradiction embedded in in-vitro
p.000023: fertilisation which, acting to create life, is compelled at the same time to destroy life.” “Destruction
p.000023: seems paradoxical in the case of a technique [ART] intended to create life. From an ethical
p.000023: viewpoint, destruction, because it is deliberate, like fertilisation, can not be justified by the argument that, in
p.000023: nature, many embryos fail to nest. The Committee considers that such destruction can only be envisaged as the lesser of
p.000023: two evils and that it is inevitable whenever conservation is not possible. Such destruction shocks those who consider
p.000023: that the life of embryos should be protected as soon as they are conceived.” “Whenever the parents renounce their
p.000023: project or the project becomes impossible (for instance, due to separation of the couple), the only solution considered
p.000023: by the Committee, as the lesser of two evils, is destruction of the embryos (with the reservation of possible donations
p.000023: for research).”
p.000023:
p.000024: 24
p.000024:
p.000024: Opinion N°107 dated October 15, 2009, on Ethical issues in connection with antenatal diagnosis: Prenatal
p.000024: diagnosis (PND) and Preimplantation Genetic Diagnosis (PGD).
p.000024:
p.000025: 25
p.000025:
p.000025: In Opinion N° 8, dated December 15, 1986, on Research and use of in-vitro human embryos for scientific
p.000025: and medical purposes: “The Committee notes that the development of procreation by in-vitro fertilisation
p.000025: reinforces the trend which uses the human body as an instrument. Moreover, techniques such as the freezing of embryos
p.000025: increase the artificial nature of reproduction, especially as a result of the dissociation between
p.000025: conception and pregnancy. […] One can envisage and hope that, in the future, research will allow
p.000025: fertilisation only of the necessary oocytes for transfer for the birth of a future child.”
p.000025:
p.000026: 26
p.000026:
p.000026: This question is connected in particular to the progress of research aiming to develop new assisted reproduction
...

p.000026: research purposes (see below, chapter IV. B. The specific question of research for the evaluation of new ART
p.000026: procedures).
p.000026:
p.000026: But even if that came to pass, an entirely different indication for ART, that is PGD — which allows a couple to give
p.000026: birth to a child free of the genetic sequence or sequences which were identified as the cause of a severe and incurable
p.000026: genetic family defect, without the need for possible termination of the pregnancy — will have as a
p.000026: consequence the destruction of embryos conceived in vitro in a currently very small number of cases compared to the
p.000026: number of spare embryos stored using cryopreservation27. (As a reminder, in a recent Opinion bearing on issues in
p.000026: connection with prenatal diagnosis, in particular PGD28, CCNE recommended that PGD should continue to be
p.000026: practised as currently legally authorised and controlled).
p.000026:
p.000026: And so, problems in connection with medical ethics have given rise to decisions to destroy embryos in the
p.000026: context of an ART procedure independently of any consideration of the possible use of embryos or of embryo cells for
p.000026: research purposes.
p.000026:
p.000026: It was only much more recently, a little over 10 years ago, that embryonic human stem cells suddenly became of
p.000026: major scientific interest for a whole chapter of biomedical research, which led to considering human embryos as
p.000026: a potentially important source of stem cells for research.
p.000026:
...

p.000026: the embryos, could be using the cell (or the two cells) which are sampled when PGD is performed on an embryo in
p.000026: vitro which turns out to be free of the genetic defect under investigation and which will therefore be
p.000026: transferred.
p.000026:
p.000026: Despite research in this field, it has not been possible so far for technical reasons to derive embryonic stem cell
p.000026: lines using the cell or the two cells sampled from a human embryo when PGD is performed. If it becomes possible
p.000026: in the future to overcome these technical
p.000027: 27
p.000027:
p.000027: Between 150 and 200 IVFs per year (leading to some 50 births per year) were performed as part of a PGD in France in
p.000027: 2006 and 2007.
p.000027:
p.000028: 28
p.000028:
p.000028: Opinion N°107 dated October 15, 2009, on Ethical issues in connection with antenatal diagnosis: Prenatal diagnosis
p.000028: (PND) and Preimplantation Genetic Diagnosis (PGD).
p.000028:
p.000028: obstacles, research on embryonic stem cells would no longer need to be done using cells from embryos that had been
p.000028: destroyed29.
p.000028:
p.000028:
p.000028: But for the time being, research on human embryonic stem cells is only possible using a destroyed human embryo.
p.000028:
p.000028: And there are at least two circumstances, very different as regards their ethical implications, in which
p.000028: such research could be undertaken:
p.000028:
p.000028: • Using for research purposes, cells isolated when a spare embryo created in vitro via ART is destroyed and not
p.000028: transferred, and when destruction is decided for reasons unconnected with the possibility of doing research.
...

p.000029: identity between the embryonic stem cells and the patient made it likely that these cells would not give rise to immune
p.000029: rejection. As a result, an inappropriate and premature name was chosen for the technique: ‘therapeutic
p.000029: cloning’, which purposely introduced a confusion between a technique — nuclear transfer — and a research approach —
p.000029: cloning for scientific purposes — with one of the possible applications that could be hoped for at some future time,
p.000029: that is treating severe and as yet incurable diseases.
p.000029:
p.000029: The major ethical issue presented by cloning for scientific purposes is the creation of embryos in vitro
p.000029: with the sole aim of destroying them so as to be able to use their cells for research.
p.000029:
p.000029: For some currents of opinion, the major ethical issue is not so much the creation of embryos in vitro for the sole
p.000029: purpose of research, but rather the possible use of such research by people wishing to apply the nuclear transfer
p.000029: technique in the context of ART in order to arrive at so- called ‘reproductive cloning’.
p.000029: In other sectors of opinion, there is no major ethical issue since the embryo was not created by fertilisation and is
p.000029: therefore less than or different from an embryo30.
p.000029:
p.000029: Be that as it may, one of the ethical issues raised by these activities, and everyone can agree with this, is the
p.000029: fact that human oocytes must be obtained, so that women are exposed to the risk of ovarian stimulation
p.000029: and oocyte retrieval without any medically assisted reproduction project being involved, either for the
p.000029: benefit of the couple concerned or for another couple.
p.000029:
p.000029: 3. Cybrids: a scientific solution (and a new ethical problem) for an ethical issue created by a scientific advance?
p.000029:
p.000029: A comment in CCNE’s Opinion N° 8 dated December 15, 1986 on Research and use of in- vitro human embryos for scientific
p.000029: and medical purposes, noted that certain people believed: “that if science generates problems, more science will solve
p.000029: them31.” Almost a century ago, the geneticist John Haldane likened this vision of science to the myth of
p.000029: Daedalus32, as
p.000029:
p.000029:
p.000029: 30 In its Opinion n° 67, dated January 18, 2001 on The preliminary draft revision of the laws on bioethics,
p.000029: CCNE remarked on the issue of ethical problems arising out of “therapeutic cloning” and mentioned that
p.000029: its members had not reached agreement on this point. CCNE’s conclusion was the following: “On the subject of
p.000029: therapeutic cloning, however, opinions differ. There is general agreement that this subject raises
p.000029: extremely difficult ethical issues, but members of CCNE are divided, depending on their vision of the world and of the
p.000029: future, between two positions which have been outlined above. There is a majority in favour of the second of these
p.000029: positions, i.e. the one which favours controlled authorisation to engage in 'therapeutic' cloning.”
p.000029:
p.000031: 31
p.000031:
p.000031: Comment by France Quéré.
p.000031:
p.000032: 32
p.000032:
...

p.000035:
p.000035:
p.000035: H. Research on embryonic cells and research on human embryos: an issue central to CCNE's deliberations since it was
p.000035: first created.
p.000035:
p.000035: Since its creation in 1983, CCNE has devoted a significant amount of its time to ethical issues involving the embryo or
p.000035: the fœtus. These deliberations have given rise, in over a quarter of a century, to more than twenty Opinions,
p.000035: broaching various ethical issues involving human embryos and fœtuses, ranging from ART procedures,
p.000035: preimplantation diagnosis, prenatal diagnosis, to research on embryonic stem cells or on embryos.
p.000035:
p.000035: Six of the Opinions concerned specifically research on human embryo cells and on in vitro human embryos.
p.000035:
p.000035: Such was the case in the very first Opinion CCNE published, Opinion n° 1, dated May 22, 1984 on Sampling of dead
p.000035: human embryonic and foetal tissue for therapeutic, diagnostic, and scientific purposes.
p.000035: In this Opinion N° 1, some of CCNE’s statements seem at first sight to be in contradiction:
p.000035:
p.000035: • On the one hand, CCNE stated that “The embryo or fœtus must be recognised as a potential human
p.000035: person who is or was alive and who must be respected by all concerned.”
p.000035:
p.000035: • On the other hand, CCNE recommended authorisation of research on dead embryos, providing in particular that parents
p.000035: did not object.
p.000035:
p.000035: • Finally, CCNE recommended a distinction to be made between embryos in vitro and embryos in vivo after implantation in
p.000035: the mother’s body, specifying that “As far as ethical problems arising out of the use of human embryos are
p.000035: concerned, they are of a different nature in each of the two phases which must therefore be dealt with
p.000035: differently36”, and that considerations regarding
p.000035:
...

p.000036: provided many safeguards for the conception, implantation and conservation of fertilised embryos in vitro” but “did not
p.000036: consider that “all embryos already formed should be stored, regardless of circumstances and for an indefinite time; […]
p.000036: they considered that the principle of respect for all human beings from the beginning of life did not apply to them.”
p.000036: As for the European Court of Human Rights, they decided (July 8, 2004, Judgment Vo v. France,
p.000036: paragraph 82) that “the issue of when the right to life begins comes within the margin of appreciation which the Court
p.000036: generally considers that States should enjoy in this sphere”.
p.000036:
p.000036: specifically embryos in vitro would be the subject of a further Opinion.
p.000036:
p.000036:
p.000036: Five Opinions — the first of which was Opinion N° 8, dated December 15, 1986, and the last, Opinion N° 67 of
p.000036: January 18, 2001, on the subject of the revision of the previous 1994 law on Bioethics — deal
p.000036: specifically with ethical issues in connection with research on human embryos created in vitro and not
p.000036: transferred, or with research on cells originating from these human embryos after their destruction.
p.000036:
p.000036:
p.000036: These opinions refer to, and develop in various forms, the reflections and recommendations
p.000036: contained in Opinion N° 1.
p.000036: For example, Opinion N° 8 dated December 15 1986, on Research and use of in-vitro human embryos for
p.000036: scientific and medical purposes:
p.000036: • States that “From the time it has been conceived the human embryo is a being and not a possession, a person, not a
p.000036: thing nor an animal. It should be considered as a would be subject, as an "other" of which we cannot dispose and whose
p.000036: dignity defines limitations for the power or control of others” and that “Not only should the anthropological, cultural
p.000036: and ethical meaning of the beginning of life be taken into consideration, but also the consequences or upheavals that
p.000036: certain practices or research could imply for the overall representation of the human person. […]Such consideration
p.000036: should take precedence over the advantages that might result from using human beings as though they were objects, even
p.000036: though it represents potential for the improvement of medical knowledge and furtherment of science. Respect for human
p.000036: dignity must guide both the development of knowledge and the limits or rules to be observed by research.”
p.000036:
p.000036: • But it specifies that “Ethical requirements cannot always be formulated in "absolute" dogmatic terms37.
p.000036:
p.000036: • It rejects the creation of human embryos for the purpose of research38.
p.000036:
p.000036: • But “However, it is of the opinion that the donation of spare embryos for research is acceptable
p.000036: provided it is strictly regulated39.”
p.000036:
p.000036:
p.000036:
p.000036: 37“Elaborating and implementing rules implies compromises made tolerable by the ethical principle of the lesser of two
p.000036: evils. The lesser evil, can be determined by weighing immediate and medium or long term risks and advantages, of a
p.000036: scientific, medical, psychological, social, cultural or philosophical nature.”
p.000036:
p.000036:
p.000036:
p.000038: 38
p.000038:
p.000038: However, the Opinion does introduce the idea of possible derogation from this prohibition in the context of ART:
p.000038: “Fertilisation of oocytes for research is not possible. It would be contrary to the principle described above. It is,
p.000038: however, possible to envisage that oocytes could be fertilised with the husband's sperm (excluding cross fertilisation
p.000038: test) with a view to establishing a diagnosis. It is up to the couple to decide, with the doctor's approval, whether
p.000038: such embryos should be implanted, destroyed or donated for research purposes, exactly as if they were excess
p.000038: embryos. Such embryos are dealt with according to the rules described above.” This possibility of
p.000038: derogation was taken up again and expanded upon fifteen years later in Opinion N° 67.
p.000038:
p.000038:
p.000039: 39
p.000039:
p.000039:
p.000039: Opinion N° 53, dated March 11, 1997 on The establishment of collections of human embryo cells and their use for
p.000039: therapeutic or scientific purposes (which preceded by one year the discovery of pluripotent human stem cells derived
p.000039: from the destruction of embryos created in vitro) lists its recommendations in a prospective reflection40:
p.000039: “…only frozen embryos donated by couples who have given written consent, forsaken their parental project and decided to
p.000039: put an end to conservation, could be used for research.” And “…any creation de novo of human embryos for any purpose
p.000039: other than a parental project, is still not permitted.”
p.000039:
p.000039: Finally, Opinion N° 67, dated January 18, 2001 on the Preliminary draft revision of the laws on bioethics:
p.000039:
p.000039: • Begins by recalling that “The issues of legitimacy and of ethical limits to research on the human
p.000039: embryo were addressed in the early days of CCNE, and the Committee has given much thought and published several
p.000039: reasoned Opinions on this subject. Its consideration is part of a philosophical and ethical debate which
p.000039: has not ripened to a conclusion and may never do so. The substantive position defended by the Committee is to
p.000039: recognise that the embryo or fœtus has the status of a potential human being who must command universal respect.
p.000039: Successive Opinions on the subject seek to attune this demand for respect to other intents which are also
p.000039: ethically acceptable.”
p.000039:
p.000039: • It then addresses the issue of research on embryonic stem cells41. It refers to the distinction made in
p.000039: Opinion N° 1 between the pre-implantation in vitro phase and the in vivo phase, after transfer42 and the
p.000039:
p.000039:
p.000039: “The Committee states inter alia that the purpose of human fertilisation is first and foremost procreative and cannot
p.000039: ignore the benefit for a child to be born, nor its right to be born to a united couple. The use of so- called spare
p.000039: embryos for research purposes can only be secondary when it has become patently impossible to transfer all the
p.000039: embryos”.
p.000039:
p.000040: 40
p.000040:
p.000040: “Human stem cells of this kind, equivalent to ES cells in mice, do not exist as yet, but several laboratories outside
p.000040: France are working on their creation. Thus, the CCNE considers that its mission demands that it should as of now
p.000040: formulate recommendations on the conditions according to which they could, possibly, be established and used.”
p.000040:
p.000041: 41
p.000041:
p.000041: “This point represents the main ethical debate. As mentioned above, as early as 1997 the Committee
p.000041: pronounced itself in favour of the removal of legal obstacles which, up to the present day, prevented
p.000041: French researchers from constituting embryonic stem cell lines unless the embryos or fœtuses were the
p.000041: result of spontaneous or induced abortions. […] (Opinion n° 53 on the creation of human embryonic organ and
p.000041: tissue collections and their use for scientific purposes). Rapidly developing scientific progress, opening up
p.000041: therapeutic possibilities, motivated this position. Since then, such hopes were amply met, at an even faster rate
p.000041: than was expected at the time. For this reason the Committee approves the fact that the preliminary
p.000041: draft authorises researchers to use spare embryos as a source of stem cells.
p.000041: CCNE believes that two essential considerations must regulate this possibility. The first is that only embryos
p.000041: with no reproductive future can be viewed as available for this purpose. The second is that being subject to the
p.000041: constitution of stem cell lines cannot, for any reason and in whatever form, serve to give these embryos a new
...

p.000042: reference to a stage of development, that of tissue differentiation. CCNE understands the reasoning, but suggests the
p.000042: adoption of clearer references in biological terms.
p.000042:
p.000042: rejection of reificating the embryo in vitro43.
p.000042:
p.000042: • And it concludes the “Main points of agreement include:
p.000042:
p.000042: ° firm reminder of the principle that creation of human embryos for the purpose of research is prohibited44;
p.000042: ° controlled possibilities for the use of spare IVF embryos for research purposes, in particular research on embryonic
p.000042: stem cells.”
p.000042:
p.000042: And so we find that these various CCNE Opinions have all adopted the main lines of the position expressed as far back
p.000042: as in Opinion N° 1, recommending all of the following:
p.000042: • Rejection of the reification of human embryos and a recognition of the respect owed to them as “potential human
p.000042: persons”;
p.000042: • Refusal to “attach normative definition” to human embryos;
p.000042: • Respect expressed by the nature of the way in which it is recommended they be treated;
p.000042: • Distinction made between the embryos’ status in the pre-implantation phase, in vitro, and the phase of embryo
p.000042: development within the mother’s body, as regards ethical issues and the way in which embryos may be treated;
p.000042: • Rejection of creating human embryos for the purpose of research45;
p.000042: In its view, tissue differentiation is in fact an abstract and ambiguous reference, since it relates to a continuing
p.000042: process, rather than to a specific stage of development. For instance, depending on whether one considers the moment
...

p.000043: the embryo can be reified in the early phases of its development. It would be just as excessive to consider the
p.000043: pre-implantation embryo as simply a bundle of cells of human origin, as to consider it sacred because it is a potential
p.000043: human person. The notion of "ongoing embryonic process" could perhaps represent the enigma which veils the exact
p.000043: nature of the embryo in the very first moments of life. Be that as it may, and precisely because of
p.000043: this enigma, the Committee declares its attachment to the view that the human embryo must, as soon as it
p.000043: is formed, receive the respect owed to its status.”
p.000043:
p.000044: 44
p.000044:
p.000044: But there is also agreement (as in Opinion N° 8) on “the introduction of an exception to this principle in the context
p.000044: of evaluation of new medically assisted reproduction techniques.”
p.000044:
p.000045: 45
p.000045:
p.000045: With the possibility of an exception, cf previous footnote.
p.000045:
p.000045: • Authorisation to destroy human embryos in excess when parental projects are forsaken and no other couple wishes to
p.000045: host them;
p.000045: • and conditional authorisation, in this context, for some research to be performed on human embryos conceived in
p.000045: vitro before their destruction and on cells from human embryos conceived in vitro and destroyed before transfer.
p.000045: The destruction of embryos which were created in the context of medically assisted reproduction techniques, but are not
p.000045: implanted, is the issue on which we shall focus with the 2004 Law on bioethics as our starting point.
p.000045:
...

p.000047: context of an ART procedure, but which will not be transferred. But using embryonic cells for research purposes once
p.000047: the embryo has been destroyed would be a major transgression and should therefore be prohibited.
p.000047:
p.000047: Prohibition would therefore seem in this case to relate not to the deed itself, i.e. destruction, but
p.000047: the fact that it may, or may not, be the source of research leading to scientific progress.
p.000047:
p.000047: The contradiction was even more pronounced in the 1994 bioethics law, since the destruction of human
p.000047: embryos in vitro was authorised in some of the situations mentioned above and research was prohibited without
p.000047: exception.
p.000047:
p.000047: CCNE remarked on this contradiction in the conclusion of Opinion N° 53, dated March 11, 1997 on The establishment of
p.000047: collections of human embryo cells and their use for therapeutic or scientific purposes: “We are approaching paradoxical
p.000047: situations as a result of legislation: there is a ban on research which can be detrimental to an embryo in vitro and
p.000047: therefore on research which could destroy it, but it can be destroyed after it has been kept for more than five years.”
p.000047:
p.000047: Concerning the issue of research using embryonic cells, it is the destruction of a human embryo, for
p.000047: reasons unrelated to any thought of acquiring new scientific knowledge, which can open the way for the
p.000047: possibility of research, not the acquisition of new scientific knowledge which leads to destruction.
p.000047:
...

p.000048: therapeutic advances” can also cause the public to entertain false hopes49 because of the degree of emphasis given to
p.000048: therapeutic promises50,51.
p.000048:
p.000048: “No, a thousand times no,” said Pasteur, “there is no such thing as a scientific category for which ‘applied science”
p.000048: is an appropriate name. There is science and there are scientific applications, bound together as are the
p.000048: fruit to the tree which bore them.
p.000048: Society is often tempted to only consider the fruit and ignore the tree. And yet, so-called fundamental
p.000048: or cognitive research and so-called applied or finalised research are both essential, and one is not
p.000048: reducible to the other52.
p.000048:
p.000049: 49
p.000049:
p.000049: In its Opinion N° 109, dated February 4, 2010, on Society and the communication of scientific and
p.000049: medical information: ethical issues, the Committee warned on the danger that “…Some of these statements may give rise
p.000049: to false hopes or disillusion and magnify some of society's doubts on the role of scientific research, in particular
p.000049: medical research.”
p.000049:
p.000050: 50
p.000050:
p.000050: One of the most scandalous (and retrospectively absurd) expressions of such representations may be
p.000050: remembered. South Korea issued a stamp after scientific publications (which later turned out to be fraudulent) in
p.000050: Science, authored by Hwang Woo-suk in 2004 and 2005, describing the (fictitious) procurement of human
p.000050: pluripotent embryonic stem cells in vitro, obtained from embryos created in vitro by nuclear transfer. The stamp
...

p.000051: But it should, quite simply, be repeated once again that research is above all a search for new scientific knowledge
p.000051: and that, if it should happen that therapeutic applications emerge from such research, they might be entirely
p.000051: unrelated to simply using embryonic cells for “medication”. In other words, today’s research on
p.000051: embryonic cells cannot forecast in any way possible “requirements” for embryonic cells in tomorrow’s medical world.
p.000051:
p.000052: 52
p.000052:
p.000052: It could be remarked on this point, that CCNE has on several occasions, but in a non exclusive manner, connected its
p.000052: recommendations regarding authorisation for research on embryonic stem cells or research on em- bryos, to the question
p.000052: of the therapeutic interest of such research. For example, in Opinion N° 8, dated Decem- ber 15, 1986 on Research and
p.000052: use of in-vitro human embryos for scientific and medical purposes, the point is made that research should “take into
p.000052: account how it can improve therapy” and further on, “…the value and med- ical interest of a research project must also
p.000052: be taken into consideration”. In Opinion N° 53, dated March 11, 1997 on The establishment of collections of human
p.000052: embryo cells and their use for therapeutic or scientific pur- poses, the point is made that “the use of embryonic stem
p.000052: cells must be limited to fundamental research activities
p.000052:
p.000052: 2. “Measuring the worth of a scientific project by the yardstick of the intensity of surprise it
p.000052: generates.”
p.000052:
p.000052: Research on stem cells, be they embryonic, fœtal, neonatal (from the umbilical cord), or adult in origin, is in a state
p.000052: of turmoil which is part of a more general upheaval in the field of the life sciences.
p.000052:
p.000052: What do we know about stem cells? Are they “immortal” as is often said, or rather are they cells which are capable of
...

p.000052: develop possibly beneficial applications — which could be viewed as one of the uses of research — are deployed in two
p.000052: different time spans.
p.000052:
p.000052: When useful applications become possible, their development becomes a priority, but it is illusory and
p.000052: dangerous to believe that future applications will emerge from anything but the fundamental exploration of the unknown
p.000052: and unceasing questioning of the apparently already known.
p.000052:
p.000052: François Jacob wrote: “the worth of a scientific project can almost be measured by the yardstick of the
p.000052: intensity of surprise it generates. […] The really interesting part is the one which is unforeseeable53.”
p.000052:
p.000052:
p.000052:
p.000052: or therapeutic research…”. And in Opinion N° 67, dated January 18, 2001, on The preliminary draft revision of the laws
p.000052: on bioethics, CCNE speaks of “therapeutic research projects” and of “research for medical purposes”. Thus, while
p.000052: legislators did not choose to follow CCNE’s recommendations for conditional authorisation of re- search on embryonic
p.000052: cells, research on the embryo and (by derogation from prohibition) the creation of embryos for research in the context
p.000052: of the evaluation of new ART procedures, they did — to a very restrictive degree — follow CCNE’s recommendations in the
p.000052: specific field of the therapeutic implications of research.
p.000052:
p.000052:
p.000053: 53
p.000053:
p.000053:
p.000053: “There is a category of people for whom the unpredictable character of research is hardly tolerable,
p.000053: namely politicians and administrators of science, who are wary of projects that lack a precise goal.”
...

p.000053: definition it must be something we cannot know in advance.”
p.000053: (François Jacob. Of Flies, Mice and Men. Op. cit).
p.000053:
p.000053: From this ensues also the frequently totally unexpected nature of the applications to which it may give
p.000053: rise. It is quite possible that some research on embryonic stem cells with no currently foreseeable therapeutic
p.000053: applications, could dramatically alter the state of the art and lead, at some future time, to entirely unexpected
p.000053: therapeutic breakthroughs.
p.000053:
p.000053: Obviously, any research can raise ethical issues and should therefore be subject to meticulous evaluation
p.000053: of the way in which it is carried out and its possible applications.
p.000053:
p.000053: As regards research on stem cells, in particular human embryonic stem cells, in its Opinion N° 93, dated November 11,
p.000053: 2006, on the Commercialisation of human stem cells and other cell lines, CCNE insisted on the importance of giving
p.000053: thought to patents and licenses, and on the need to make sure that commercial considerations do not lead to limiting
p.000053: access, for the world’s less fortunate inhabitants, to the possibly useful applications for health of
p.000053: such research.
p.000053:
p.000053: A further paradox is worthy of note: although a derogation to the prohibition on research involving
p.000053: embryonic stem cells requires it to be capable of leading to major therapeutic progress, so far none of the
...

p.000053:
p.000053: It is therefore the principle of research itself which is in this case the subject of the free and informed consent
p.000053: procedure submitted to the couple, and not the specific research project which will be undertaken if consent
p.000053: is given.
p.000053:
p.000053: It may be supposed that the already exceptional nature (see above) of the a priori restriction on research which
p.000053: will be authorised only if it “would be capable of leading to major therapeutic progress” is a form of
p.000053: information on at least the purpose of research, but it does not inform, contrary to what is usual, on the nature and
p.000053: object of research. Be that as it may, the information is incomplete.
p.000053:
p.000053: In its Opinion N° 93, dated November 11, 2006 on the Commercialisation of human stem cells and other cell lines, CCNE
p.000053: suggested that another form of information should also be given to the couple enabling them to choose when the
p.000053: research project involves human embryonic stem cells: not just information on the nature and object of research,
p.000053: but also on the economic model governing the project, in particular whether applications would be developed
p.000053: for profitmaking or non-profitmaking purposes, whether a patent would or would not be filed and, if a patent were to be
p.000053: filed, whether provisions would be made, or not, to avoid excluding access to applications by the underprivileged.
p.000053:
...

p.000054: is not a systematic procedure and is only actually implemented, once the parents are informed and have consented, for
p.000054: 25% of
p.000054:
p.000055: 55
p.000055:
p.000055: So as to enable a new attempt at embryo transfer if a pregnancy fails, or a new parental project after the birth of a
p.000055: previous child without having to undergo more hormonal hyperstimulation and further ovarian puncture.
p.000055:
p.000055: couples resorting to ART and IVF56. Some opinions are in favour of more detailed prior information on
p.000055: the future of spare embryos to be given to parents before creation and conservation takes place 57.
p.000055:
p.000055: Some bodies of opinion consider that this formulation of conditional authorisation for the creation,
p.000055: conservation (and therefore also destruction) of embryos in the context of an ART procedure, as it is
p.000055: currently expressed by law, is not sufficiently emblematic58.
p.000055:
p.000055:
p.000055: Should we consider that the destruction of spare embryos in the context of a PGD procedure should be expressed in the
p.000055: form of a derogation to a prohibition? 59
p.000055:
p.000055:
p.000056: 56
p.000056:
p.000056: Currently, cryopreservation is only implemented for 25% of couples resorting to ART and IVF procedures.
p.000056: In Audition of Mme Jacqueline Mandelbaum, p. 83 of Rapport d'Information n° 2235, drawn up in the name of the Mission
p.000056: d'information sur la révision des lois de bioéthique, Assemblée Nationale (Chair: Alain Claeys, Rapporteur Jean
p.000056: Leonetti), January 2010.
p.000056:
p.000056:
p.000057: 57
p.000057:
p.000057: This is what was proposed at the Estates General on Bioethics in 2009: We would also consider it highly desirable that
p.000057: detailed information be given at this time to intentional parents and that they should be asked at the outset to take a
p.000057: decision on what should be done with superfluous embryos should they not respond to enquiries at a later date
p.000057: (destroyed, given to another couple or donated for research purposes). Report by the États Généraux de
p.000057: la Bioéthique. Annex 9. Contributions from Regional Forums. Citizen opinion given by the Marseilles panel.
p.000057: Estates General on Bioethics. (For more exhaustive extracts from this Opinion, see Chapter V.II).
p.000057:
p.000057:
p.000058: 58
p.000058:
p.000058: And that it is precisely this symbolic weakness regarding the destruction of the embryo in vitro that led lawmakers to
p.000058: provide for — as a form of compensation — a supplementary symbolic burden elsewhere, in this case on research using
p.000058: cells from the destroyed embryo.
p.000058:
p.000059: 59
p.000059:
p.000059: But then should be taken into consideration the risk of aggravating an already frequent feeling of
p.000059: transgression, or even of guilt, on the part of couples resorting to ART, and to a greater degree PGD, who are already
p.000059: acting as a consequence of distress, due to infertility on the part of the former, and to the suffering due to the
p.000059: unfortunate appearance in their family of particularly severe incurable disease, for the latter. It would also seem
p.000059: important with such an approach, to separate ethically the case of the creation and preservation of spare embryos,
p.000059: which is a prior condition to the possibility of their destruction, from the case of the destruction of embryos in the
p.000059: context of PGD, since the two ethical situations are very different.
p.000059: CCNE has always distinguished between the two and considered the possibility of reducing future recourse
p.000059: to preservation of spare embryos, so as to limit the possibility of their destruction, without including in this
p.000059: approach the issue of destruction of PGD generated embryos. For example, see on this subject, Opinion N° 67, dated
p.000059: January 18, 2001 on the Preliminary draft revision of the laws on bioethics: “CCNE points out, however,
p.000059: that the number of spare embryos which could be available for research is likely to decrease in the future because of
p.000059: improved technical skills, and because of smaller numbers needed on average for embryo transfer on each
p.000059: occasion. Care should therefore be taken to make sure that medically assisted reproduction is not used to voluntarily
p.000059: stock up on spare embryos so as to be able to use them later for research”.
p.000059:
p.000059: The main ethical issue is perhaps discovering whether society as a whole would be ready to stand by the principle
p.000059: of forbidding the creation, preservation and possible destruction of spare human embryos, thereby
p.000059: expressing the respect owed to human embryos, and of a derogation to this prohibition, under specific
p.000059: conditions. The derogation would be seen as representing the ‘lesser evil’.
p.000059:
p.000059:
p.000059: 2. The various possible meanings of a derogation from a prohibition.
p.000059:
p.000059: Article 16 of the Code Civil states that the law “guarantees respect for human beings from when life begins60.”
p.000059:
p.000059: But the law also authorises putting an end to conservation, and therefore also the destruction of spare embryos in
p.000059: cryopreservation when they are no longer included in a parental project, as well as the destruction, in the context of
p.000059: PGD, of those embryos carrying the genetic defect which was the object of the PGD procedure.
p.000059:
p.000059: In fact, the law’s formulation on this point agrees with the Conseil Constitutionnel’s opinion (in its July 27th 1994
p.000059: decision) in which it stated that “legislators had provided a large number of guarantees regarding conception,
p.000059: implantation and preservation of fertilised embryos in vitro,” but “had not considered it necessary to ensure the
p.000059: preservation of all already formed embryos for an indeterminate period of time and in every possible circumstance.”
p.000059:
p.000059: Be they spare embryos, or embryos carrying the genetic sequence under investigation in the context of PGD, the
p.000059: destruction of human embryos does in fact correspond to an exception from the provisions of Article 16 of the
p.000059: Code Civil.
p.000059:
p.000059: And yet, lawmakers did not regulate this procedure in the form of derogation from a prohibition; it
p.000059: appears as a conditional authorisation.
p.000059:
p.000059:
p.000059: In Opinion N° 8, dated December 15, 1986 on Research and use of in-vitro human embryos for scientific and medical
p.000059: purposes, CCNE wrote: “The de facto situation resulting from the production of a larger number of embryos than can
p.000059: be medically transferred raises questions that we should try to answer. However, solutions proposed in the
p.000059: present opinion do not legitimate this de facto situation. Such solutions are, therefore not final: one can envisage
p.000059: and hope that, in the future, research will allow fertilisation only of the necessary oocytes for transfer for the
p.000059: birth of a future child”.
p.000059: But almost a quarter of a century later, CCNE noted in Opinion N° 107, dated October 15, 2009 on
p.000059: Ethical issues in connection with antenatal diagnosis: Prenatal diagnosis (PND) and Preimplantation Genetic Diagnosis
p.000059: (PGD) that research in this respect had not made significant progress and that the “live birth success rate after
p.000059: oocyte retrieval is around 20% and there is little likelihood of this figure improving in years to come since it is in
p.000059: fact quite close to the figure for natural conception”.
p.000059:
p.000059:
p.000059:
p.000059:
p.000060: 60
p.000060:
p.000060: Article 16 of the Code Civil situates this measure in a much broader context: “The law ensures the
p.000060: primacy of the individual, prohibits any encroachment of to the individual’s dignity and guarantees respect for human
p.000060: beings from when life begins.”
p.000060:
...

p.000062: While the thought was never formulated in those terms, it could be inferred from CCNE’s past Opinions
p.000062: taken as a whole that it has always considered that the two circumstances in which it sees as inevitable
p.000062: the destruction of non implanted embryos created in vitro in the context of ART are, firstly the case of
p.000062: spare embryos after the parental project has been abandoned and no other infertile couple wishes to take them on
p.000062: and, secondly when in the course of PGD, the genetic defect which motivated the PGD procedure is detected.
p.000062: But although destruction may be inevitable, this does not mean that it is ethically satisfactory, which CCNE
p.000062: translates in ethical language as the lesser evil.
p.000062:
p.000062: In this Opinion, the ethical approach should include all of the following:
p.000062:
p.000062: • affirmation of respect for human embryos as “potential human beings”,
p.000062: • recognition at least that there is a great deal of perplexity on how to define the status of embryos,
p.000062: • and the contingent acceptance of the possibility that their integrity may be breached in particular circumstances,
p.000062: depending inter alia on whether they can, or cannot, be included in a human relationship, a parental project
p.000062: which is a necessary condition for their future existence.
p.000062:
p.000063: 63
p.000063:
p.000063: Opinion N° 8, dated December 15, 1986 on Research and use of in-vitro human embryos for scientific and medical purposes
p.000063: and Opinion N° 67, dated January 18, 2001 on the Preliminary draft revision of the laws on bioethics.
p.000063:
p.000064: 64
p.000064:
p.000064: As regards the destruction of embryos in vitro, after the parental project has been abandoned, and research on cells
p.000064: from these destroyed embryos, as mentioned above CCNE has always considered that the most appropriate
p.000064: legal formulation to take account of the complexity of the ethical issues involved, was neither simple
p.000064: authorisation nor derogation from prohibition, but rather conditional authorisation.
p.000064:
p.000064: It would be in such a context that could be entertained, “compromises made tolerable by the ethical principle of the
p.000064: lesser of two evils65,” as formulated previously by CCNE.
p.000064:
p.000064: CCNE wishes to emphasise the importance of seeking such compromise solutions66, not because of being unable to choose
...

p.000064:
p.000064: A. From the issue of research on cells isolated after destruction of the embryo in vitro to the issue
p.000064: of research on the embryo in vitro before destruction.
p.000064:
p.000064: Be it for research on cells isolated from an already destroyed human embryo or research on a human embryo before its
p.000064: destruction, research was not the cause of the embryo’s destruction in either case. The cause of the
p.000064: embryo’s destruction is the fact that it will not be transferred, either because the parental project is no
p.000064: longer current (in the case of spare embryos) or because the embryo is carrying the genetic sequence which is related
p.000064: to an incurable and particularly severe hereditary disease (in the case of PGD).
p.000064:
p.000064:
p.000064:
p.000065: 65
p.000065:
p.000065: Opinion N°8 dated December 15, 1986 on “Research and use of in vitro human embryos for scientific and medical
p.000065: purposes”.
p.000065:
p.000065:
p.000066: 66
p.000066:
p.000066: This compromise would need to be formulated in legal terms:
p.000066: • either following CCNE’s previous considerations with a view to using the legal formulation of
p.000066: ‘conditional authorisation’, an approach that was validated by the Conseil d’Etat,
p.000066: • or by adopting a legal system of ‘prohibition with possible derogation’, so as to
p.000066: give the greatest exposure to the potential human life symbol, and adding an explanation of the ethical issue,
p.000066: • or by drafting a new legal formulation, if it is thought that:
p.000066: o the ‘conditional authorisation’ system would not be sufficiently potent as a symbol,
...

p.000070: currently defines death in legal terms, and therefore the passing away of the human being, absence of the emergence of
p.000070: the brain defines the absence of the human being’s inception. The maximum time of 15 days of in
p.000070: vitro development corresponds to the appearance of the very first events of cellular differentiation which will later
p.000070: lead to the emergence of a nervous system.
p.000070: This argument, which turns the beginning into a mirror image of the end, has the advantage of being extremely logical
p.000070: and entirely straightforward. But perhaps the beginning is more than (or at least different from) the
p.000070: simple mirror image of the end, and perhaps a promise is more than (or different from) the simple inverse image of
p.000070: regret…
p.000070:
p.000070:
p.000071: 71
p.000071:
p.000071: In Opinion N°67 dated January 18, 2001, on the Preliminary draft revision of the laws on bioethics,
p.000071: CCNE suggests: “Allowing the development in vitro of a human embryo beyond the end of the pre-implantation
p.000071:
p.000071: Whatever view one chooses to adopt, which will, to at least some degree, be arbitrary, it would seem
p.000071: important that this problem, which is specific to research on the living human embryo, be taken into account and, in
p.000071: particular, that a maximum time limit be set by law for development in vitro, in view of the fact that this would be
p.000071: minimal mark of respect for the embryo as a potential human person, that is an incipient being.
p.000071:
p.000071:
p.000071: IV. A major ethical issue: the creation of human embryos in vitro for the purpose of research.
p.000071:
p.000071: A. The creation of human embryos for the purpose of research and the reification of the human embryo.
p.000071:
p.000071: The statement that the human embryo cannot be defined is in itself a call for ethics based on respect: to treat human
p.000071: embryos as though they were merely instrumental to scientific experiment amounts in practice to deciding on their
p.000071: status as beings by integrating them into the order of objects.
p.000071: In Opinion N° 8 on Research and use of in-vitro human embryos for scientific and medical purposes, CCNE stated: “From
p.000071: the time it has been conceived the human embryo is a being and not a possession, a person, not a thing nor an animal.
p.000071: It should be considered as a would- be subject, as an "other" of which we cannot dispose and whose dignity defines
p.000071: limitations for the power or control of others.” Also that “Not only should the anthropological, cultural and ethical
p.000071: meaning of the beginning of life be taken into consideration, but also the consequences or upheavals that certain
p.000071: practices or research could imply for the overall representation of the human person. […]Such consideration should take
p.000071: precedence over the advantages that might result from using human beings as though they were objects, even
p.000071: though it represents potential for the improvement of medical knowledge and furtherment of science. Respect for human
p.000071: dignity must guide both the development of knowledge and the limits or rules to be observed by research.” And: “Even
p.000071: with the consent of genitors, fertilisation should not be done for research purposes alone. If it were, human
p.000071: embryos would purely and simply be used as tools or objects…”
p.000071: And in Opinion N° 67, dated January 18, 2001 on the Preliminary draft revision of the laws on bioethics, CCNE
p.000071: reiterated this rejection and made a clear distinction between the question of research using embryos
p.000071: created in the context of ART and the question of the creation of embryos for the sole purpose of research72.
p.000071:
p.000071: stage, is prohibited."
p.000071:
p.000071:
p.000071:
p.000072: 72
p.000072:
p.000072: “Mindful of the risk of ethical misuse which could result from the reification of the human embryo, i.e. considering it
p.000072: as a thing and no longer as a potential human being, CCNE has already make known its views regarding research on the
p.000072: embryo. On the substance, it agrees with choices made in the preliminary draft :
...

p.000072: because the parental project is no longer current, since they were cryopreserved using the older ART techniques
p.000072: previously authorised and used in France (and still in use today).
p.000072:
p.000072: Research is ongoing in several countries on these new techniques and, in some countries, are already viewed as being
p.000072: current medical practice. But, in the present circumstances, research cannot take place in France as before
p.000072: any transfer of such embryos could be considered, there would have to be embryo creation for the
p.000072: purpose of research, which is prohibited (without any possible derogation) by the 2004 law on bioethics.
p.000072:
p.000072: CCNE has been deliberating for some time on how best to deal with this issue.
p.000072:
p.000072: For instance, in Opinion N° 8, dated December 15, 1986 on “Research and use of in vitro human embryos for scientific
p.000072: and medical purposes”, CCNE wrote: “…one can envisage and hope that, in the future, research will allow
p.000072: fertilisation only of the necessary oocytes for transfer for the birth of a future child. Medical
p.000072: research should endeavour to reduce the number of cases raising ethical issues, rather than accumulate an
p.000072: ever-growing amount of problems of a degree of severity which is disproportionate to the intended objective73.”
p.000072:
p.000072: • on the other hand, opening up regulated possibilities of research on spare embryos "which are no longer included in
p.000072: a parental project".
p.000072:
p.000073: 73
p.000073:
p.000073: In this Opinion, CCNE was not in fact considering the creation of embryos for research purposes with a view to
p.000073: evaluating new ARTs. Nevertheless, it was considering the possibility of creating embryos in the context of a medical
p.000073: test for diagnosing fertility. It expressed, as mentioned above, the rejection of allowing the creation of embryos
p.000073: for research: “Fertilisation of oocytes for research is not possible. It would be contrary to the
p.000073: principle described above.”
p.000073:
p.000073: In Opinion N° 67, dated January 18, 2001 on the Preliminary draft revision of the laws on bioethics, CCNE agreed
p.000073: “with the article [in the law as proposed], which calls for a compulsory evaluation of new medically
p.000073: assisted reproduction (MAR) techniques before they are implemented. This sensible step, which aims to
p.000073: prevent a repetition of previous errors, raises the issue of what happens to embryos which will inevitably be
p.000073: produced by in vitro fertilisation during these validation procedures, which appears to be a reasoned
p.000073: exception to the general principle of not allowing the production of human embryos by in vitro
p.000073: fertilisation for research purposes. The course chosen, which is the destruction of embryos used in
p.000073: evaluation protocols, is clearly fitting.”
p.000073:
p.000073: And CCNE concluded Opinion n° 67 with the following:
p.000073: “ – a firm reminder of the principle that creation of human embryos for the purpose of research is prohibited;
p.000073: - the introduction of an exception to this principle in the context of evaluation of new medically assisted
p.000073: reproduction techniques.”
p.000073:
p.000073: It is worth noting that, so far, many IVF technical advances have been arrived at for ART without the
p.000073: benefit of prior research, in particular as regards embryonic development before embryo transfer. It so happens,
p.000073: fortunately, that these medical procedures do not seem to have proved a significant threat to the health of children
p.000073: born with the assistance of such innovative techniques.
p.000073:
...

p.000073: Agence de la Biomédecine, AFSSAPS, DGS, etc. — are currently ready to pronounce themselves on whether the
p.000073: cryopreservation of oocytes, be it by the known slow freezing method or by more recent vitrification
p.000073: techniques (which have been implemented in ART procedures in several countries and have led to the birth
p.000073: of a large number of children) is to be related to research or to clinical practice.
p.000073: In this context, it would be worthwhile to ask an independent body to carry out a medical, scientific and ethical
p.000073: evaluation of the criteria which would allow for the use in France of new ARTs which are already standard medical
p.000073: procedure in other countries.
p.000073:
p.000073: But the Opinion did introduce the idea of a derogation specific to this prohibition: “It is, however,
p.000073: possible to envisage that oocytes could be fertilised with the husband's sperm (excluding cross fertilisation test)
p.000073: with a view to establishing a diagnosis. It is up to the couple to decide, with the doctor's approval, whether such
p.000073: embryos should be implanted, destroyed or donated for research purposes, exactly as if they were excess
p.000073: embryos. Such embryos are dealt with according to the rules described above.”
p.000073:
p.000073:
p.000073:
p.000074: 74
p.000074:
p.000074: This is the only possibility for the improvement of ARTs which is currently allowed by law.
p.000074:
p.000074: As regards the complex matter of the possible creation of embryos in vitro for the purpose of evaluating new ARTs, the
...

p.000076: poverty- stricken countries of this planet.
p.000076:
p.000076: CCNE considers that our respect for the earliest beginnings of human life must bear testimony to our
p.000076: fullest and collective commitment to respect for each person, child or adult, together with the will to prevent and
p.000076: repair to the best of our ability the tragic lives to which so many children are exposed from birth.
p.000076: Ethical reflection on the earliest beginning of life becomes fully meaningful in this context alone.
p.000076:
p.000076: Paris, October 21, 2010
p.000076:
p.000076: Reservations expressed by certain members
p.000076: Although we are aware of the distinctions made by this Opinion and the refinement of the reflection to which it leads,
p.000076: we must emphasise that the ethics of respect, referred to several times in the document, entails the exclusion of any
p.000076: form of instrumentalisation of human embryos.
p.000076: The impossibility of defining an indisputable line of departure for when a person begins should not be confused
p.000076: with an absence of ethical and legal boundaries to our attitudes regarding human embryos. The enigmatic
p.000076: character of the embryo calls for respect. And this respect for embryos has primacy over practical consequences
p.000076: regarding their use.
p.000076: In response to the point made regarding parental projects, we consider that the dignity of embryos does not
p.000076: stem from the plans other persons have made for them, but from the embryo’s actual being, that is the development of a
p.000076: human life as such. As a consequence, while the boundaries presently set by law can be the subject of discussion,
p.000076: other common expressions of moral interdiction must be formulated. This interdiction bears on the rejection of any
p.000076: form of instrumentalisation of human life, even for research purposes. The inference is that respect has primacy and
p.000076: that only exceptionally can it be departed from.
p.000076: As a result, as the Opinion does state, although it is not research as such which is a difficulty and although the fact
p.000076: that the destruction of spare embryos is provided for by law may appear to be ethically the lesser evil, it is the
p.000076: connection between the two which raises an issue. Using spare embryos for research opens the door to a justification
p.000076: of their production. We would wish that early attention be given to the possibility of reducing, or even ceasing, the
p.000076: production of cryopreserved embryos.
p.000076: Furthermore, the creation of embryos for research purposes is unacceptable in our view since it is the most
p.000076: advanced form of instrumentalisation of an emerging human being.
p.000076: In addition, a legal boundary would encourage scientists to continue research on other subjects of
p.000076: investigation besides human embryos. It also sets a curb on the logic of profit and competition.
...

Searching for indicator special:

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p.000048: embryo.
p.000048:
p.000048: Much more generally, apart from the case of embryonic cells, there is no prohibition on research involving human
p.000048: cells once their isolation and culture in vitro has been authorised.
p.000048:
p.000048: Human embryonic stem cells are therefore an exception.
p.000048:
p.000048: Why should there be such an exception?
p.000048:
p.000048: • The reasons might be connected to the isolation procedures used for embryonic cells.
p.000048:
p.000048: The prohibition on research using cells isolated after the destruction of a human embryo could of course express the
p.000048: idea that it is not research on these cells as such which is seen as a major ethical issue, but the isolation of the
p.000048: cells when the embryo was destroyed, or rather the fact that special destruction modes could be used because of
p.000048: the decision to isolate the cells. Conversely, simply ceasing conservation together with prohibition of research,
p.000048: would lead to the spontaneous disappearance of the human embryo without any cell sampling action.
p.000048:
p.000048: And yet, it should be noted that the law makes no recommendations on the way in which the preservation of human embryos
p.000048: should be regulated. In other words, neither destruction itself, nor any particular method of destruction, and not
p.000048: even cell sampling and isolation are prohibited: the only ban is research on the cells.
p.000048:
p.000048: • Another possible reason for the existence of such an exception is the special properties of certain
p.000048: human embryonic stem cells, in particular their initial totipotency in the earliest stage of embryo
p.000048: development. It is true that the totipotent cells can, if they are isolated from the embryo, give
p.000048: birth to a human embryo.
p.000048:
p.000048: However, the law already bans (without any possibility of derogation) the creation of in vitro human embryos for the
p.000048: purpose of research. It could not only forbid de creation of human embryos in vitro for research purposes, but also
p.000048: forbid the isolation and culture of totipotent cells. If that were the case, only pluripotent embryonic stem cells,
p.000048: those which appear after several days of embryo development in vitro, could be isolated and cultured. (However, see
...

Searching for indicator belief:

(return to top)
p.000007: ascribing importance to the human connection which is the very reason for the creation of embryos in vitro, that
p.000007: is the relationship between the partners and the projection of that relationship in a parental project, seeking for a
p.000007: bond in the couple’s future with their future child.
p.000007:
p.000007: It is the existence of this human bond, this inclusion in a parental project, which, as the Estates
p.000007: General on Bioethics stated, turns the “potential human being” that an embryo in vitro is for CCNE, into an
p.000007: “incipient” potential human being.
p.000007:
p.000007: As CCNE remarked nearly twenty-five years ago: “…although it cannot be demonstrated, the belief that a human
p.000007: life cannot be entirely controlled because it is not a manufactured product is a guarantee of our
p.000007: liberty and dignity8.”
p.000007:
p.000007: CCNE’s position has always (or nearly always9) consisted in not drawing a boundary which would lead to an
p.000007: all or nothing approach to respect for the embryo, and in considering the “issue of the exact nature of the
p.000007: embryo” to be an enigma: “It would be just as excessive to consider the pre-implantation embryo as
p.000007: simply a bundle of cells of human origin, as to consider it sacred because it is a potential human person.
p.000007: The notion of "on- going embryonic process" could perhaps represent the enigma (italics added) which veils the exact
...

Searching for indicator religious:

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p.000002: is the present tense of the bond, the reality of what is to come.
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: 2
p.000002:
p.000002: It is with explicit reference to this human bond that the Avis citoyen du Panel de Marseille used the term "personne
p.000002: humaine en devenir" (incipient human being) to characterise an embryo which is still included in a parental project at
p.000002: the Etats Généraux de la Bioéthique in 2009.
p.000002:
p.000002: 2. When the embryo in vitro is no longer — or never was — part of a parental project: radically
p.000002: different positions.
p.000002:
p.000002: There is a radical opposition between the various opinions on how embryos should be considered. These
p.000002: differences are founded, in particular, on philosophical or religious positions which are difficult to
p.000002: reconcile. The various positions can be summed up, probably in an over-simplification, as follows:
p.000002:
p.000002: - For some, a human embryo can only be created in the context of a parental project, but in strict subordination to
p.000002: respect for the future of the embryo. Once fertilisation has taken place, the dignity of the human being is
p.000002: already fully present: all is already there (as regards dignity and respect)3, even if this all is only
p.000002: present in the form of a beginning, a development, an incipient future.
p.000002:
p.000002: In this representation, the embryo in vitro is already entirely at one with the "human lineage" insofar
p.000002: as the embryo is the starting point in a developing human continuum. The embryo is where human life began, and this
...

p.000016: contrary, as a reasoned response, as behaviour that various opinions can choose to share, as a rejection of
p.000016: certitudes and instead, consideration of the full complexity of the enigma represented by “potential human
p.000016: person”, while granting full pride of place to parental projects involving human embryos in a human relationship that
p.000016: is the very condition for their future, even before their creation.
p.000016:
p.000016: Along the same lines it has always chosen to pursue, in this instance CCNE’s thinking bears on a fundamental issue
p.000016: which calls for conscientious discernment and response based on sober humility. Within CCNE, different
p.000016: positions are expressed originating in philosophical and religious foundations that are so difficult to
p.000016: reconcile that they appear to be mutually exclusive. This document does not claim to rise above these dissenting
p.000016: positions; it seeks to pick out the path that society could follow to identify ethical issues and piece together the
p.000016: best possible solutions.
p.000016:
p.000016: This approach complies with one of CCNE’s essential tasks, which is to help raise public awareness and encourage debate
p.000016: on ethical issues.
p.000016:
p.000016: Consideration of the issues.
p.000016:
p.000016: I. From in vitro fertilisation to research on human embryonic stem cells: an issue central to CCNE's deliberations
p.000016: since it was first created.
p.000016:
p.000016: A. A revolution in assisted reproductive technology: in vitro fertilisation and the in vitro emergence of the embryo.
...

Searching for indicator social:

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p.000002: mother, thus eliminating any a priori notion of a maximum time limit between the moment of fertilisation and the
p.000002: moment when pregnancy begins.
p.000002:
p.000002: Since then, over four million ART births have occurred worldwide, some 200,000 of which in France.
p.000002: Such changes could not but have a major influence on perceptions.
p.000002: Not only were perceptions concerning embryos radically changed, but also those concerning parental projects which took
p.000002: on a new dimension. A prior parental project now needed to be formulated for the possibility and reality of IVF to
p.000002: apply, that is through embryo conception outside the mother's body.
p.000002: In tune with the new importance acquired by parental projects emerged a new form of medical and social
p.000002: responsibility concerning the embryo's fate before transfer to the mother's body.
p.000002: In this radically new context for the start of a human life, emerged the new issue of the future of the in vitro
p.000002: embryos if they were not to be transferred to their mothers' bodies.
p.000002:
p.000002: Today, there are at least three sets of circumstances leading to a medical decision not to transfer an embryo created
p.000002: through ART in vitro in the context of a parental project:
p.000002: 1. when the presence of a major defect or the fact that an embryo has ceased to develop in vitro is clearly visible
p.000002: before transfer to the mother;
p.000002: 2. when preimplantation genetic diagnosis (PGD) reveals that an embryo is carrying the genetic sequence
p.000002: involved in a particularly severe inherited disorder, incurable at the time of
p.000002:
...

p.000010: truly cope with this difficult and essential in between concept: a “potential human being”.
p.000010:
p.000010: Faced with this enigma, CCNE considered that there was no single and absolute response regarding the conduct to be
p.000010: adopted out of respect for the embryo; this conduct will depend on the context in which decisions have to be taken and
p.000010: what those decisions imply. “Ethical requirements cannot always be formulated in "absolute" dogmatic terms.
p.000010: Elaborating and implementing rules implies compromises made tolerable by the ethical principle of the lesser of two
p.000010: evils. The lesser evil, can be determined by weighing immediate and medium or long term risks and
p.000010: advantages, of a scientific, medical, psychological, social, cultural or philosophical nature11.”
p.000010:
p.000010: “The substantive position defended by the Committee is to recognise that the [human] embryo or [human] fœtus has the
p.000010: status of a potential human being who must command universal respect. Successive Opinions on the subject seek
p.000010: to attune this demand for respect to other intents which are also ethically acceptable12.”
p.000010:
p.000010: In such a context, the issue of the possible destruction of embryos in vitro is not one which stands
p.000010: alone, in ethical isolation; it must first of all be considered in the context of the ethical issues which arise out of
p.000010: the particular circumstances which may lead to their destruction. For example, destroying embryos that are not going
...

p.000017: the mother until the embryo was transferred to her body.
p.000017:
p.000017: Similarly, the fact that an embryo was created and was, in the initial part of existence, isolated for the first
p.000017: time, signified that the biologists and doctors who had created it, on whom it depended entirely until
p.000017: the time came for implantation, were fully responsible actors committed to the embryo’s future. And through
p.000017: their action, society itself, which had made it possible for them to be responsible for this very first phase
p.000017: of a human life, suddenly discovered itself to be in an entirely novel position of responsibility.
p.000017:
p.000017: In this way, the new importance of the parental project was accompanied by the emergence of a new form of
p.000017: medical and social responsibility.
p.000017:
p.000017: This unprecedented situation led to addressing new issues connected to the respective rights and duties of the
p.000017: couple who had formed the parental project and of society which had provided the conditions for the project
p.000017: to be implemented.
p.000017:
p.000017: Should it be the mother, as is the case when the embryo develops within her own body, who alone has a right of
p.000017: decision over the embryo’s future? Or the couple, because the future father and the future mother are still,
p.000017: at this point, connected in the same way to the embryo through the same symbolic parental project and the
p.000017: embryo is not yet within the mother’s body? Or should it be society’s decision, because at this point
p.000017: the future of the embryo, depends indirectly on society, through the action of its physicians?
p.000017:
...

p.000036:
p.000036: • But it specifies that “Ethical requirements cannot always be formulated in "absolute" dogmatic terms37.
p.000036:
p.000036: • It rejects the creation of human embryos for the purpose of research38.
p.000036:
p.000036: • But “However, it is of the opinion that the donation of spare embryos for research is acceptable
p.000036: provided it is strictly regulated39.”
p.000036:
p.000036:
p.000036:
p.000036: 37“Elaborating and implementing rules implies compromises made tolerable by the ethical principle of the lesser of two
p.000036: evils. The lesser evil, can be determined by weighing immediate and medium or long term risks and advantages, of a
p.000036: scientific, medical, psychological, social, cultural or philosophical nature.”
p.000036:
p.000036:
p.000036:
p.000038: 38
p.000038:
p.000038: However, the Opinion does introduce the idea of possible derogation from this prohibition in the context of ART:
p.000038: “Fertilisation of oocytes for research is not possible. It would be contrary to the principle described above. It is,
p.000038: however, possible to envisage that oocytes could be fertilised with the husband's sperm (excluding cross fertilisation
p.000038: test) with a view to establishing a diagnosis. It is up to the couple to decide, with the doctor's approval, whether
p.000038: such embryos should be implanted, destroyed or donated for research purposes, exactly as if they were excess
p.000038: embryos. Such embryos are dealt with according to the rules described above.” This possibility of
...

Searching for indicator threat:

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p.000073: evaluation protocols, is clearly fitting.”
p.000073:
p.000073: And CCNE concluded Opinion n° 67 with the following:
p.000073: “ – a firm reminder of the principle that creation of human embryos for the purpose of research is prohibited;
p.000073: - the introduction of an exception to this principle in the context of evaluation of new medically assisted
p.000073: reproduction techniques.”
p.000073:
p.000073: It is worth noting that, so far, many IVF technical advances have been arrived at for ART without the
p.000073: benefit of prior research, in particular as regards embryonic development before embryo transfer. It so happens,
p.000073: fortunately, that these medical procedures do not seem to have proved a significant threat to the health of children
p.000073: born with the assistance of such innovative techniques.
p.000073:
p.000073: Ethical issues connected to the advances of ART deserve to be considered comprehensively. For
p.000073: example, apart from any prospect of research aiming to improve ARTs, the simple translocation to France, for medical
p.000073: implementation, of a new and improved ART, validated in a foreign country74 without the benefit of
p.000073: authorisation for any prior clinical research to validate the technique on embryos that will not be
p.000073: implanted, raises an ethical issue as regards the protection of unborn children.
p.000073:
...

Searching for indicator women:

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p.000029:
p.000029: For some currents of opinion, the major ethical issue is not so much the creation of embryos in vitro for the sole
p.000029: purpose of research, but rather the possible use of such research by people wishing to apply the nuclear transfer
p.000029: technique in the context of ART in order to arrive at so- called ‘reproductive cloning’.
p.000029: In other sectors of opinion, there is no major ethical issue since the embryo was not created by fertilisation and is
p.000029: therefore less than or different from an embryo30.
p.000029:
p.000029: Be that as it may, one of the ethical issues raised by these activities, and everyone can agree with this, is the
p.000029: fact that human oocytes must be obtained, so that women are exposed to the risk of ovarian stimulation
p.000029: and oocyte retrieval without any medically assisted reproduction project being involved, either for the
p.000029: benefit of the couple concerned or for another couple.
p.000029:
p.000029: 3. Cybrids: a scientific solution (and a new ethical problem) for an ethical issue created by a scientific advance?
p.000029:
p.000029: A comment in CCNE’s Opinion N° 8 dated December 15, 1986 on Research and use of in- vitro human embryos for scientific
p.000029: and medical purposes, noted that certain people believed: “that if science generates problems, more science will solve
p.000029: them31.” Almost a century ago, the geneticist John Haldane likened this vision of science to the myth of
p.000029: Daedalus32, as
p.000029:
p.000029:
...

Searching for indicator youth:

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p.000035: pluripotence and renewal which seem similar to those of embryonic stem cells, can be obtained from the skin cells of
p.000035: people over the age of 80. The so-called “aged” nature of these cells is not therefore due to intrinsic wearing out
p.000035: of the cells. Rather, it is because they belong to the environment of a person over 80 years of age that they are
p.000035: “senescent”. If they are given the opportunity of using four of their genes that their history and their environment
p.000035: had made unavailable to them, they recover “youthful” properties similar to those of embryonic stem
p.000035: cells. In other words, at least a part of the potentialities which characterise the “youth” and “age” of
p.000035: these cells appears to be not so much an intrinsic characteristic as an “update” of potentialities,
p.000035: reversible by the environment.
p.000035: For cancers, recent work indicates that, on the one hand, cancers emerge not only out of genetic
p.000035: alteration to normal stem cells, but also out of epigenetic alteration, modifying not so much the cellular gene
p.000035: sequence as the cell’s capacity to use some of its genes. And, on the other hand, that many cancers are made up
p.000035:
p.000035:
p.000035: These major scientific ventures — imitating spontaneous cellular differentiation processes in the course of
p.000035: development, or inventing new forms of cellular differentiation — are now proceeding in parallel and
...

Economic / Economic/Poverty

Searching for indicator poverty:

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p.000076:
p.000076: Concern for the earliest stages of the development of a future embryo should make us even more attentive and sensitive
p.000076: to the sufferings of children already born. Mentally handicapped children, who are so frequently deprived in this
p.000076: country of access to education and adequate assistance in places where they can be close to their families. The two
p.000076: million children in our country who live below the poverty threshold. The nearly ten million children under five
p.000076: years of age who die every year of disease and hunger in the world while the World Health Organization tells us that,
p.000076: collectively, we could have saved six million of them each year over the past several years. The 200 million children
p.000076: under five whose mental development will be hindered and interrupted by poverty, undernourishment and disease in the
p.000076: poverty- stricken countries of this planet.
p.000076:
p.000076: CCNE considers that our respect for the earliest beginnings of human life must bear testimony to our
p.000076: fullest and collective commitment to respect for each person, child or adult, together with the will to prevent and
p.000076: repair to the best of our ability the tragic lives to which so many children are exposed from birth.
p.000076: Ethical reflection on the earliest beginning of life becomes fully meaningful in this context alone.
p.000076:
p.000076: Paris, October 21, 2010
p.000076:
p.000076: Reservations expressed by certain members
p.000076: Although we are aware of the distinctions made by this Opinion and the refinement of the reflection to which it leads,
...

Searching for indicator economic:

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p.000020: One of the possible futures for spare embryos currently stored by cryopreservation, once the couple originating
p.000020: their creation have forsaken their parental project, is for another couple wanting ART treatment to host
p.000020: them. In this case, a woman unable to undergo IVF using her own eggs, asks for an another couple’s spare embryo to be
p.000020: implanted, providing of course that the embryo’s biological parents are in agreement21.
p.000020:
p.000020: Another theoretical possibility to avoid destroying spare embryos once their genitors’ parental project has been
p.000020: dropped would be to continue cryopreservation as long as possible, even indefinitely, leaving to others, at
p.000020: some future time, the responsibility of the embryos’ future.
p.000020:
p.000020: Apart from technical and economic feasibility, the ethical problem that would arise would be leaving to people who were
p.000020: not the couple originating their creation, or even leaving to future generations the burden of choosing what to do with
p.000020: the spare embryos.
p.000020:
p.000020: The alternative would be to decide, after a specific period of time and subject to the couple’s agreement, to end the
p.000020: conservation of spare embryos. In other words, to destroy them. The very question of how long that period of time
p.000020: should be already raises a complex issue22, as does the question of the relationship between the decisions taken by the
p.000020: couple themselves and those taken by the community.
p.000020:
p.000020: As it happens, the solution that the cryopreservation of spare embryos as part of an ART procedure contributed to a
...

p.000053: will be authorised only if it “would be capable of leading to major therapeutic progress” is a form of
p.000053: information on at least the purpose of research, but it does not inform, contrary to what is usual, on the nature and
p.000053: object of research. Be that as it may, the information is incomplete.
p.000053:
p.000053: In its Opinion N° 93, dated November 11, 2006 on the Commercialisation of human stem cells and other cell lines, CCNE
p.000053: suggested that another form of information should also be given to the couple enabling them to choose when the
p.000053: research project involves human embryonic stem cells: not just information on the nature and object of research,
p.000053: but also on the economic model governing the project, in particular whether applications would be developed
p.000053: for profitmaking or non-profitmaking purposes, whether a patent would or would not be filed and, if a patent were to be
p.000053: filed, whether provisions would be made, or not, to avoid excluding access to applications by the underprivileged.
p.000053:
p.000053: The inversion of the customary sequence — a scientific and ethical evaluation procedure,
p.000053: followed by the free and informed consent process — also has the consequence that it sets no time
p.000053: limit on the conservation of embryos after termination of the parental project and consent is given to research by the
p.000053: couple concerned.
p.000053:
...

General/Other / Cultural Differences

Searching for indicator cultural:

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p.000010:
p.000010: Faced with this enigma, CCNE considered that there was no single and absolute response regarding the conduct to be
p.000010: adopted out of respect for the embryo; this conduct will depend on the context in which decisions have to be taken and
p.000010: what those decisions imply. “Ethical requirements cannot always be formulated in "absolute" dogmatic terms.
p.000010: Elaborating and implementing rules implies compromises made tolerable by the ethical principle of the lesser of two
p.000010: evils. The lesser evil, can be determined by weighing immediate and medium or long term risks and
p.000010: advantages, of a scientific, medical, psychological, social, cultural or philosophical nature11.”
p.000010:
p.000010: “The substantive position defended by the Committee is to recognise that the [human] embryo or [human] fœtus has the
p.000010: status of a potential human being who must command universal respect. Successive Opinions on the subject seek
p.000010: to attune this demand for respect to other intents which are also ethically acceptable12.”
p.000010:
p.000010: In such a context, the issue of the possible destruction of embryos in vitro is not one which stands
p.000010: alone, in ethical isolation; it must first of all be considered in the context of the ethical issues which arise out of
p.000010: the particular circumstances which may lead to their destruction. For example, destroying embryos that are not going
p.000010: to be transferred following an ART procedure should not be viewed in the same light a destroying embryos in other and
p.000010: different circumstances.
...

p.000036:
p.000036:
p.000036: These opinions refer to, and develop in various forms, the reflections and recommendations
p.000036: contained in Opinion N° 1.
p.000036: For example, Opinion N° 8 dated December 15 1986, on Research and use of in-vitro human embryos for
p.000036: scientific and medical purposes:
p.000036: • States that “From the time it has been conceived the human embryo is a being and not a possession, a person, not a
p.000036: thing nor an animal. It should be considered as a would be subject, as an "other" of which we cannot dispose and whose
p.000036: dignity defines limitations for the power or control of others” and that “Not only should the anthropological, cultural
p.000036: and ethical meaning of the beginning of life be taken into consideration, but also the consequences or upheavals that
p.000036: certain practices or research could imply for the overall representation of the human person. […]Such consideration
p.000036: should take precedence over the advantages that might result from using human beings as though they were objects, even
p.000036: though it represents potential for the improvement of medical knowledge and furtherment of science. Respect for human
p.000036: dignity must guide both the development of knowledge and the limits or rules to be observed by research.”
p.000036:
p.000036: • But it specifies that “Ethical requirements cannot always be formulated in "absolute" dogmatic terms37.
p.000036:
p.000036: • It rejects the creation of human embryos for the purpose of research38.
p.000036:
p.000036: • But “However, it is of the opinion that the donation of spare embryos for research is acceptable
p.000036: provided it is strictly regulated39.”
p.000036:
p.000036:
p.000036:
p.000036: 37“Elaborating and implementing rules implies compromises made tolerable by the ethical principle of the lesser of two
p.000036: evils. The lesser evil, can be determined by weighing immediate and medium or long term risks and advantages, of a
p.000036: scientific, medical, psychological, social, cultural or philosophical nature.”
p.000036:
p.000036:
p.000036:
p.000038: 38
p.000038:
p.000038: However, the Opinion does introduce the idea of possible derogation from this prohibition in the context of ART:
p.000038: “Fertilisation of oocytes for research is not possible. It would be contrary to the principle described above. It is,
p.000038: however, possible to envisage that oocytes could be fertilised with the husband's sperm (excluding cross fertilisation
p.000038: test) with a view to establishing a diagnosis. It is up to the couple to decide, with the doctor's approval, whether
p.000038: such embryos should be implanted, destroyed or donated for research purposes, exactly as if they were excess
p.000038: embryos. Such embryos are dealt with according to the rules described above.” This possibility of
...

p.000071: embryos as though they were merely instrumental to scientific experiment amounts in practice to deciding on their
p.000071: status as beings by integrating them into the order of objects.
p.000071: In Opinion N° 8 on Research and use of in-vitro human embryos for scientific and medical purposes, CCNE stated: “From
p.000071: the time it has been conceived the human embryo is a being and not a possession, a person, not a thing nor an animal.
p.000071: It should be considered as a would- be subject, as an "other" of which we cannot dispose and whose dignity defines
p.000071: limitations for the power or control of others.” Also that “Not only should the anthropological, cultural and ethical
p.000071: meaning of the beginning of life be taken into consideration, but also the consequences or upheavals that certain
p.000071: practices or research could imply for the overall representation of the human person. […]Such consideration should take
p.000071: precedence over the advantages that might result from using human beings as though they were objects, even
p.000071: though it represents potential for the improvement of medical knowledge and furtherment of science. Respect for human
p.000071: dignity must guide both the development of knowledge and the limits or rules to be observed by research.” And: “Even
p.000071: with the consent of genitors, fertilisation should not be done for research purposes alone. If it were, human
p.000071: embryos would purely and simply be used as tools or objects…”
...

Searching for indicator culture:

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p.000048: performed, any other research on cells already isolated and cultured in vitro, will remain prohibited,
p.000048: unless further authorisation to derogate is given.
p.000048:
p.000048: These provisions are the results of lawmakers’ general concern that embryos should not be subject to any form of
p.000048: reification.
p.000048:
p.000048: But, to prohibit — with the possibility of derogation — any research on cells which are already isolated and cultured
p.000048: in vitro cannot but suggest that it is specifically research on those cells, which is viewed as transgressive.
p.000048:
p.000048: Is there a major ethical issue arising out of new knowledge-seeking research based on cells with an embryonic origin?
p.000048: And conversely, would refusal to seek new knowledge based on the study of these cells, which are already isolated and
p.000048: in culture in vitro, be an expression of retrospective respect for a human embryo?
p.000048:
p.000048: Are we encountering here the application of a general principle, or does this approach only apply in the case of human
p.000048: cells with an embryonic origin?
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: D. Ethical reflection on an exception.
p.000048:
p.000048: After elective termination of a pregnancy or a therapeutic termination, the law authorises cells
p.000048: to be isolated from the human embryo or the destroyed fœtus and research using these cells, as prescribed by
p.000048: the general provisions applying to research on human cells, subject to informed absence of maternal opposition,
p.000048: specific consent not being required.
p.000048:
p.000048: When human fœtal cells have already been in culture for a period of time and subject to their having been isolated in
p.000048: accordance with the stipulations outlined above, authorisation to perform research on these cells, as on any other
p.000048: human cell, depends on an evaluation indicating that the research project is bona fide but is not conditioned by
p.000048: derogation from a prohibition — contrary to the case when isolated cells originated in a destroyed in vitro human
p.000048: embryo.
p.000048:
p.000048: Much more generally, apart from the case of embryonic cells, there is no prohibition on research involving human
p.000048: cells once their isolation and culture in vitro has been authorised.
p.000048:
p.000048: Human embryonic stem cells are therefore an exception.
p.000048:
p.000048: Why should there be such an exception?
p.000048:
p.000048: • The reasons might be connected to the isolation procedures used for embryonic cells.
p.000048:
p.000048: The prohibition on research using cells isolated after the destruction of a human embryo could of course express the
p.000048: idea that it is not research on these cells as such which is seen as a major ethical issue, but the isolation of the
p.000048: cells when the embryo was destroyed, or rather the fact that special destruction modes could be used because of
p.000048: the decision to isolate the cells. Conversely, simply ceasing conservation together with prohibition of research,
...

p.000048: even cell sampling and isolation are prohibited: the only ban is research on the cells.
p.000048:
p.000048: • Another possible reason for the existence of such an exception is the special properties of certain
p.000048: human embryonic stem cells, in particular their initial totipotency in the earliest stage of embryo
p.000048: development. It is true that the totipotent cells can, if they are isolated from the embryo, give
p.000048: birth to a human embryo.
p.000048:
p.000048: However, the law already bans (without any possibility of derogation) the creation of in vitro human embryos for the
p.000048: purpose of research. It could not only forbid de creation of human embryos in vitro for research purposes, but also
p.000048: forbid the isolation and culture of totipotent cells. If that were the case, only pluripotent embryonic stem cells,
p.000048: those which appear after several days of embryo development in vitro, could be isolated and cultured. (However, see
p.000048: below, chapter VI, for a discussion of the more general implications, in ethical terms, of such an approach).
p.000048:
p.000048: But it is not only this prohibition of research on embryonic cells which constitutes an exception; this
p.000048: is also true of the particular kind of derogation allowed for this prohibition.
p.000048:
p.000048: E. The ethics of research and the therapeutic end-purpose of research.
p.000048:
p.000048: 1. “…The research could lead to major therapeutic advances”
p.000048:
p.000048: The 2004 law on bioethics states that “…research on the embryo and embryonic cells may be authorised when it could lead
...

General/Other / Diminished Autonomy

Searching for indicator age:

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p.000034: these adult skin cells to acquire similar stem cell properties to those of pluripotent embryonic stem cells. In other
p.000034: words they are capable of self-renewal and, in an appropriate in vitro environment, of giving birth to most, or even
p.000034: all of the 200 cell families constituting adult human bodies.
p.000034:
p.000034: Research involving adult somatic stem cells has implications which overturn many concepts which so far were considered
p.000034: to be well established35.
p.000035: 35
p.000035:
p.000035: As regards ageing for instance, recent work indicates that iPS stem cells, with their capacity for
p.000035: pluripotence and renewal which seem similar to those of embryonic stem cells, can be obtained from the skin cells of
p.000035: people over the age of 80. The so-called “aged” nature of these cells is not therefore due to intrinsic wearing out
p.000035: of the cells. Rather, it is because they belong to the environment of a person over 80 years of age that they are
p.000035: “senescent”. If they are given the opportunity of using four of their genes that their history and their environment
p.000035: had made unavailable to them, they recover “youthful” properties similar to those of embryonic stem
p.000035: cells. In other words, at least a part of the potentialities which characterise the “youth” and “age” of
p.000035: these cells appears to be not so much an intrinsic characteristic as an “update” of potentialities,
p.000035: reversible by the environment.
p.000035: For cancers, recent work indicates that, on the one hand, cancers emerge not only out of genetic
p.000035: alteration to normal stem cells, but also out of epigenetic alteration, modifying not so much the cellular gene
p.000035: sequence as the cell’s capacity to use some of its genes. And, on the other hand, that many cancers are made up
p.000035:
p.000035:
p.000035: These major scientific ventures — imitating spontaneous cellular differentiation processes in the course of
p.000035: development, or inventing new forms of cellular differentiation — are now proceeding in parallel and
...

p.000035: person who is or was alive and who must be respected by all concerned.”
p.000035:
p.000035: • On the other hand, CCNE recommended authorisation of research on dead embryos, providing in particular that parents
p.000035: did not object.
p.000035:
p.000035: • Finally, CCNE recommended a distinction to be made between embryos in vitro and embryos in vivo after implantation in
p.000035: the mother’s body, specifying that “As far as ethical problems arising out of the use of human embryos are
p.000035: concerned, they are of a different nature in each of the two phases which must therefore be dealt with
p.000035: differently36”, and that considerations regarding
p.000035:
p.000035: of a tiny subpopulation of cancerous stem cells, giving birth not only to the very large population of cancerous cells
p.000035: which invade the body, age and disappear, but also to the tiny population of new stem cells responsible for the
p.000035: renewal and propagation of the cancer. These discoveries suggest that the efficacy or failure of cancer
p.000035: therapy could depend on its ability to target this small subpopulation of stem cells.
p.000035:
p.000036: 36
p.000036:
p.000036: There is another reference to this distinction in both French and European law, in an entirely different form,
p.000036: concerning the legal protection of embryos. In France, Article 16 of the Code Civil states that the law “guarantees
p.000036: the respect of the human being from the very start of life.” But the Conseil Constitutionnel
p.000036: (Constitutional Council of the French Republic) (decision of July 27, 1994) states that “legislators
...

p.000052: embryo cells and their use for therapeutic or scientific pur- poses, the point is made that “the use of embryonic stem
p.000052: cells must be limited to fundamental research activities
p.000052:
p.000052: 2. “Measuring the worth of a scientific project by the yardstick of the intensity of surprise it
p.000052: generates.”
p.000052:
p.000052: Research on stem cells, be they embryonic, fœtal, neonatal (from the umbilical cord), or adult in origin, is in a state
p.000052: of turmoil which is part of a more general upheaval in the field of the life sciences.
p.000052:
p.000052: What do we know about stem cells? Are they “immortal” as is often said, or rather are they cells which are capable of
p.000052: asymmetric division, which age and then die, but are capable of giving birth to younger and more fertile cells, which
p.000052: in turn age and die, as is the case for instance for ancestral stem cells like yeast cells? What mechanisms
p.000052: control the survival, ageing and death of stem cells?
p.000052:
p.000052: The relation between stem cells and embryonic development, their connection to the ageing of the body and its capacity
p.000052: for repair, their link with cancer, are other essential issues.
p.000052: On all of these subjects, research has already begun to overturn our knowledge and tenets and could lead to future
p.000052: therapeutic avenues which are unpredictable today and which could go infinitely further than the only horizons of
p.000052: which we are aware at this point, that is the injection of curative stem cells for “regenerative” purposes.
p.000052:
...

p.000076: is probably no true symmetry between emergence, the promise of a future being and the being’s extinction; the end
p.000076: of a person who is no longer present, but who once was.
p.000076:
p.000076: This insistence on two extremes, on conception and death, is constitutive of our respect for others. But it can also
p.000076: lead to the attenuation, or even the obliteration of respect. Because it is between those two extremes that the life
p.000076: of a human being unfolds. And respect, affection, tenderness in the beginning and at the end are only truly meaningful
p.000076: through the respect, the affection and the tenderness of which they are made — the stuff of our lives, the progression
p.000076: of our days. From birth to childhood, from childhood to adolescence, from adolescence to adulthood, from adulthood to
p.000076: old age, as long as persists within us the pulsation of awareness whose interruption defines — or so we have decided —
p.000076: the end, the end of the human being.
p.000076:
p.000076: The essential ethical issues which are of concern to today’s world are not those which bear on the earliest stages of
p.000076: development of future human beings, but rather on premature death and the sufferings of children and adults, caused by
p.000076: famine, infectious diseases, massacres, inhumane treatment, and the denial of health, liberty and dignity.
p.000076:
p.000076: Concern for the earliest stages of the development of a future embryo should make us even more attentive and sensitive
p.000076: to the sufferings of children already born. Mentally handicapped children, who are so frequently deprived in this
p.000076: country of access to education and adequate assistance in places where they can be close to their families. The two
p.000076: million children in our country who live below the poverty threshold. The nearly ten million children under five
p.000076: years of age who die every year of disease and hunger in the world while the World Health Organization tells us that,
p.000076: collectively, we could have saved six million of them each year over the past several years. The 200 million children
p.000076: under five whose mental development will be hindered and interrupted by poverty, undernourishment and disease in the
p.000076: poverty- stricken countries of this planet.
p.000076:
p.000076: CCNE considers that our respect for the earliest beginnings of human life must bear testimony to our
...

Orphaned Trigger Words

p.000002: H. Research on embryonic cells and research on human embryos: an issue central to CCNE's deliberations since it was
p.000002: first created.
p.000002:
p.000002: II. Research on human embryonic cells after destruction of the embryo previously created in vitro as part of
p.000002: an ART procedure: ethical reflection in the context of the 2004 law on bioethics.
p.000002:
p.000002: A. The destruction of embryos which have not been transferred is authorised by law...
p.000002: B. ...but the same law prohibits research on cells from human embryos that have been destroyed.
p.000002: C. The prohibition on research also applies to embryonic cells which have already been isolated and
p.000002: cultured in vitro.
p.000002: D. Ethical reflection on an exception.
p.000002: E. The ethics of research and the therapeutic end-purpose of research.
p.000002: F. The ethics of research and the process of free and informed consent.
p.000002: G. Conditional authorisation or derogation from a prohibition? Ethical reflection on legal formulations.
p.000002:
p.000002: III. Research on human embryos developing in vitro (embryos created as part of an ART procedure but not
p.000002: transferred): ethical reflection in the context of the 2004 law on bioethics.
p.000002:
p.000002: A. From the issue of research on cells isolated after destruction of the embryo to the issue of research on the embryo
p.000002: before destruction.
p.000002: B. The concept of embryonic development and the issue of the maximum time allowed for in vitro development.
p.000002:
p.000002: IV. A major ethical issue: the creation of human embryos in vitro for the purpose of research.
p.000002:
p.000002: A. The creation of human embryos for the purpose of research and the reification of the human embryo.
p.000002: B. An ethical conflict: respect for the embryo and the creation of embryos specifically for the development and
p.000002: evaluation of new ART procedures.
p.000002: ...

p.000002: transfer.
p.000002: But if, at some later time, the parents of these cryopreserved supernumerary embryos cease to have plans involving
p.000002: them, the embryos are no longer simply in excess in the context of the ART procedure involved: they become in
p.000002: excess — surplus to requirements
p.000002: — to the very parental project that was at the origin of their conception. This is the situation
p.000002: which led to the issue of ceasing to keep them, i.e. the issue of their destruction.
p.000002:
p.000002: B. From the issue of destroying spare human embryos to the issue of research on embryonic cells and on
p.000002: human embryos in vitro.
p.000002:
p.000002: The solutions provided by ART (by the creation and cryopreservation of spare embryos) and preimplantation genetic
p.000002: diagnosis to medical ethics issues (see above) have brought in their wake another kind of ethical problem, that of the
p.000002: possibility that embryos could cease to be preserved, and therefore that embryos in vitro could be destroyed,
p.000002: either in the course of PGD, or when spare human embryos are no longer part of a parental project. Furthermore, the
p.000002: problem has never ceased to grow in importance along with the development of the use and practice of ART.
p.000002:
p.000002: And so, medical ethics issues, dating back to over twenty five years ago, have led to the decision of destroying
p.000002: human embryos in an ART context, independently of any consideration of possible research on embryos or
p.000002: embryonic cells.
p.000002:
p.000002: It was only much more recently, a little over 10 years ago, that embryonic human stem cells were identified and
p.000002: isolated and suddenly became of major scientific interest in a large number of biomedical research domains, which led
p.000002: to considering the possibility of human embryos as a potential source of stem cells for biomedical research
p.000002: and other medical purposes.
p.000002:
p.000002: C. Positions which are a priori irreconcilable.
p.000002:
p.000002: 1. Beyond divergences: a position in common?
p.000002: We are not intending to give an exhaustive description of the very great diversity of opinions regarding the manner in ...

p.000032: was the production of cybrids, i.e. a hybrid human-animal embryo, by transferring the nucleus of a human cell to
p.000032: the cytoplasm (hence the cy prefix) of an animal oocyte from which the nucleus had been previously removed.
p.000032:
p.000032: But the possible creation of these cybrids raised new scientific issues and new ethical issues34. The rapid
p.000032: succession and accumulation of these various scientific and technical developments — creation of human
p.000032: embryos in vitro by fertilisation for research purposes; creation of human embryos in vitro by nuclear transfer for
p.000032: research purposes; creation in vitro of cybrids for research purposes — and the dizzying emphasis in
p.000032: announcements of expectations of major therapeutic applications gave rise to concern on what limits should
p.000032: apply and to fears that the world of ethics had lost its bearings.
p.000032:
p.000032:
p.000032: In this paper read in 1923, entitled (and published under that same title) Daedalus, or, Science and the Future,
p.000032: Haldane compares the myth of Daedalus the inventor, a prototype of modern scientists, to the myth of Prometheus, the
p.000032: transgressor, who stole fire from the gods (quoted by Henri Atlan, in L’utérus artificiel, Seuil, 2005.).
p.000032: François Jacob also referred to the myth of Daedalus in his La souris, la mouche et l’homme (1997, Odile Jacob), as
p.000032: a metaphor for “an ailment of our time” and in particular stated that: “With Daedalus, science without a conscience is
p.000032: emerging.”
p.000032:
p.000032:
p.000032: 33As a reminder, Daedalus built a device so that the queen of Crete, Pasiphaë, the wife of King Minos, could mate with ...

p.000034: human nucleus and genome.
p.000034: Ethically, this possibility was the cause of serious misgivings at the idea of a creation very close to a chimera.
p.000034: Would this be a degradation of the beginning of human life? Or would it be the beginning of non human life?
p.000034: The prospect of such an approach raised, in even more disquieting terms than the prospect of human
p.000034: ‘reproductive cloning’, the fear of the possibility of a transfer (either to an animal, or a fortiori,
p.000034: to a woman) to await the birth of cybrids created in vitro, and therefore the issue of how to prohibit such actions
p.000034: effectively and absolutely.
p.000034:
p.000034: It was in this context of radically new and rapidly evolving scientific developments, of spectacular
p.000034: announcements of possible medical and therapeutic applications and growing concern about ethics that the
p.000034: consultations and debates took place regarding the revision of the 1994 law on bioethics, followed by the framing of
p.000034: the 2004 law.
p.000034:
p.000034:
p.000034: G. From embryonic stem cells to adult stem cells: recent developments in research using non embryonic human stem cells.
p.000034:
p.000034: Leaving aside spectacular and premature announcements for effect, research on human stem cells had begun, in the last
p.000034: ten years or so, to branch out into a real scientific revolution.
p.000034:
p.000034:
p.000034: 1. An ancestral property of life itself.
p.000034:
p.000034: In simplified terms, stem cells are highly fertile and have great plasticity, meaning that they are highly capable of
p.000034: renewal and of giving birth to different cells.
p.000034:
p.000034: In very general terms, it was in the form of stem cells that life has propagated since its dawn, over 3.5 billion years ...

p.000046: PGD.
p.000046:
p.000046: The intention of lawmakers when they prohibited research, was to eliminate any possibility of instrumentalisation of
p.000046: spare embryos. The subject for additional reflection on this point is considering the questions that come to mind on
p.000046: reading the text of the law, as regards the meaning of prohibition applying specifically to research.
p.000046:
p.000047: 47
p.000047:
p.000047:
p.000047:
p.000047: 2004)
p.000047: Article L2141-4, modified by Law (Loi n°2004-800 du 6 août 2004 - art. 24 JORF 7 août
p.000047:
p.000047: The two members of the couple whose embryos are preserved are asked in writing every year whether
p.000047: they wish to pursue their parental project.
p.000047: If they no longer have a parental project or if one of them has died, the two members of the couple or the surviving
p.000047: member, may consent to their embryos being donated to another couple in accordance with the conditions set out in
p.000047: articles L. 2141-5 and L. 2141-6, or for those embryos to be the subject of research in accordance with
p.000047: the conditions set out in article L. 2151-5, or for cryopreservation of those embryos to cease. In each of these
p.000047: events, consent and/or requests must be expressed in writing and be confirmed in writing after three months
p.000047: delay allowed for reflection.
p.000047:
p.000047: In the event that one of the members of the couple has been consulted on several occasions and has not responded to the
p.000047: question of whether he or she wishes to pursue the parental project, the embryos cease to be preserved if the time of
p.000047: conservation is at least equal to five years. This is also the case if the members of the couple disagree regarding
p.000047: continuance of the parental project or on what is to be done with the embryos.
p.000047:
p.000047: When both members of the couple, or the surviving member of the couple, have consented, in accordance
p.000047: with conditions set out in articles L. 2141-5 and L. 2141-6, for their embryos to be hosted by another couple and no ...

p.000048: in itself an ethical issue.
p.000048:
p.000048:
p.000048: C. The prohibition on research also applies to embryonic cells which have already been isolated and cultured in vitro.
p.000048:
p.000048: Most of the research on embryonic stem cells done in France so far, in compliance with the 2004 law, did not involve
p.000048: isolated cells from surplus embryos destroyed in this country after an ART failure. It mainly involved — by virtue of
p.000048: the derogation from prohibition provided by law — cell line cultures isolated from embryos that had been destroyed
p.000048: several years ago in other countries, but in circumstances corresponding to those required in France for
p.000048: the destruction of embryos conceived in the context of ART and for which the couple concerned had given free and
p.000048: informed consent to the cells being used for research purposes.
p.000048:
p.000048: The prohibition in this case therefore bears on using, for research to acquire new scientific knowledge, cells which
p.000048: were isolated and cultured in a test tube, sometimes for quite a long time.
p.000048:
p.000048: The same prohibition problem arises when cells were already isolated from a human embryo destroyed in France and had
p.000048: already been used, by derogation, for a specific research project. Once that particular research project has been
p.000048: performed, any other research on cells already isolated and cultured in vitro, will remain prohibited,
p.000048: unless further authorisation to derogate is given.
p.000048:
p.000048: These provisions are the results of lawmakers’ general concern that embryos should not be subject to any form of
p.000048: reification.
p.000048: ...

p.000053: one heading of “research on embryos and embryonic stem cells”.
p.000053:
p.000053: The two situations have therefore been dealt with in the same way (although they raise different kinds of
p.000053: ethical issues, see below, chapter III).
p.000053:
p.000053: As a result, a couple can only consent to research in terms of ‘all or nothing’: if they consent to research, it may
p.000053: involve isolated cells sampled from the destroyed embryo, but could just as well involve a live embryo before
p.000053: destruction.
p.000053:
p.000053: The law does not allow the couple to accept only research on cells but not on the embryo. In other words, the
p.000053: information given to the couple presupposes a priori that consent to research is equivalent to consent for
p.000053: research on a live embryo.
p.000053:
p.000053: This ambiguity in the free and informed consent procedure is expressed in the actual formulation of the
p.000053: choice: the law says that the couple can consent to their embryos being the subject of research or [and the emphasis is
p.000053: ours] that they cease to be stored. Obviously, the ‘or’ becomes highly significant when research concerns
p.000053: live embryos, before their destruction.
p.000053:
p.000053: When, however, research involves isolated cells sampled from the destroyed embryo, the ‘or’ should be replaced by
p.000053: an ‘and’: consent (or refusal) should be for ending storage of the embryos, then (therefore ‘and’) the cells
p.000053: taken from the destroyed embryos would the subject of research.
p.000053:
p.000053:
p.000053: 2.The connection between ethical evaluation of research and consent to research is in reverse order to the usual
p.000053: procedure.
p.000053: ...

p.000053: it means that a research project would not be undertaken until the time comes when, and if, are met all the criteria
p.000053: for it to be authorised.
p.000053:
p.000053: But such conservation without any upper time limit, potentially indefinite, between the abandonment of the
p.000053: parental project and the possible time when some future research project is undertaken, represents in fact a
p.000053: considerable change in the way in which the ethical issue of the embryo’s fate is approached. In this situation, the
p.000053: embryo can now be cryopreserved for an indefinite time solely for the purpose of research54.
p.000053:
p.000053: 3. Free and informed decision and research "capable of leading to major therapeutic advances".
p.000053:
p.000053: The exceptional character (compared to all the other research projects subject to the free and informed consent
p.000053: procedure) of the mandatory conditions required when embryonic cell research is involved, plus their required
p.000053: evaluation by the Agence de la Biomédecine, before the parental couple are asked for consent, could suggest to the
p.000053: couple that in this case, unlike
p.000053:
p.000053:
p.000054: 54
p.000054:
p.000054: These thoughts give rise to three comments, which are related to the discussion above concerning research
p.000054: on embryonic cells after destruction of the embryo or on live embryos before they are destroyed.
p.000054: The first comment is that embryo cryopreservation while awaiting the possibility of a research project
p.000054: should only be considered if the couple gave consent to research on the embryo.
p.000054: The second is that, in this case, it would be appropriate to propose a time limit on embryo conservation.
p.000054: The third comment is that if the couple could choose between giving specific consent only to research on isolated
p.000054: cells sampled from the destroyed embryo, it would not be necessary to continue embryo
p.000054: cryopreservation. Conservation could be brought to an end and isolated cells from a destroyed embryo could be put into
p.000054: cryopreservation without any ethical issue arising out of a possible time limit.
p.000054: As already mentioned above, it would only be in the event of a couple consenting to research on the
p.000054: embryo itself that there would be a true alternative — a real ‘or’ — to ceasing conservation, with this alternative
p.000054: including the temporal dimension of prolonging cryopreservation. Consent to research on the embryonic cells would
p.000054: correspond to an ‘and’, that is stopping conservation of the embryo and then isolating cells from the
p.000054: destroyed embryo.
p.000054:
p.000054: the situation for all other kinds of research, society may be making a commitment that the research could lead to the
p.000054: development of treatment for patients.
p.000054:
p.000054: There is therefore a risk that the couple's free and informed consent to research will be guided in the direction of
p.000054: acceptance, because the necessarily uncertain nature of the results of any form of research will be somewhat
p.000054: obscured, and the impression will be given that it is not so much a question of searching to acquire new scientific
p.000054: knowledge as of finding treatment. As a result, there is a probability of bias in favour of parental consent.
p.000054:
p.000054: This is a paradoxical situation which needs thinking about: not only is there a time inversion, as noted
p.000054: above, in the usual sequence of an independently generated scientific and ethical evaluation of the research project,
p.000054: followed by submission of the project for free and informed consent, but there is also a prior bias given to the first
p.000054: and necessary condition for such research to be possible, i.e. parental consent, and an accumulation of an
p.000054: extremely restrictive set of subsequent conditions, although their objective's feasibility is less credible than the
p.000054: expression of their severity.
p.000054:
p.000054:
p.000054: G. Conditional authorisation or derogation from a prohibition? Ethical reflection on legal formulations.
p.000054:
p.000054: 1. The destruction of human embryos is the primary ethical issue, not the decision to perform research on cells after
p.000054: embryos are destroyed.
p.000054:
p.000054: The possibility of research on isolated cells sampled from an embryo which was destroyed because the parental project ...

p.000064:
p.000064: It would be in such a context that could be entertained, “compromises made tolerable by the ethical principle of the
p.000064: lesser of two evils65,” as formulated previously by CCNE.
p.000064:
p.000064: CCNE wishes to emphasise the importance of seeking such compromise solutions66, not because of being unable to choose
p.000064: but, on the contrary, out of choosing a behaviour that is reasoned, that can be acceptable to others, that refuses to
p.000064: cling to certainties, and that takes fully into account the complexity of the “potential human being” enigma and grants
p.000064: full pride of place to the parental project which registers the human embryo, even before its creation, as a part of a
p.000064: human relationship which is the very condition for its future existence.
p.000064:
p.000064:
p.000064: III. Research on human embryos developing in vitro (embryos created as part of an ART procedure but not transferred):
p.000064: ethical reflection in the context of the 2004 law on bioethics.
p.000064:
p.000064: A. From the issue of research on cells isolated after destruction of the embryo in vitro to the issue
p.000064: of research on the embryo in vitro before destruction.
p.000064:
p.000064: Be it for research on cells isolated from an already destroyed human embryo or research on a human embryo before its
p.000064: destruction, research was not the cause of the embryo’s destruction in either case. The cause of the
p.000064: embryo’s destruction is the fact that it will not be transferred, either because the parental project is no
p.000064: longer current (in the case of spare embryos) or because the embryo is carrying the genetic sequence which is related ...

p.000066: development, which will be the object of research before destruction. And the research itself, although it is not the
p.000066: cause of destruction, raises an ethical issue.
p.000066:
p.000066:
p.000066: B. The concept of embryonic development and the issue of the maximum time allowed for in vitro development.
p.000066:
p.000066: All living entities are always more than, and always different from, their constituent parts. This is true
p.000066: in scientific and biological terms67, but also on other levels, in particular philosophical or ethical. If the embryo
p.000066: is not transferred, carrying out research on an in vitro embryo before destruction does not raise the same ethical
p.000066: issues as carrying out research on the cells from that embryo after destruction. In the first case, research will be
p.000066: taking place on a living and developing human being — an incipient being, even if the decision to interrupt that future
p.000066: has already been taken. In the second case, research will be carried out on living cells removed from a destroyed
p.000066: embryo68.
p.000066:
p.000066: Lawmakers, with regard for the protection of human embryos, have put research on a living embryo and research on
p.000066: embryonic cells on the same legal footing.
p.000066:
p.000066: And this approach has at least three implications.
p.000066:
p.000066: As stated above, the first two implications concern the nature of the free and informed consent given by the parents in
p.000066: the event they are not pursuing their parental project. And it would be advisable that:
p.000066:
p.000066: • on the one hand the couple should be able to choose specifically to consent to research on isolated cells from the
p.000066: destroyed embryo without necessarily having to also consent to research on the live embryo before destruction69;
p.000066:
p.000067: 67
p.000067:
p.000067: “The whole is greater than the sum of its parts”, said Aristotle. This is true of a living being but also of an organ:
p.000067: for example, a line of nerve cells isolated from a brain is not the equivalent of a brain.
p.000067:
p.000067:
p.000067:
p.000068: 68
p.000068:
p.000068: The specific case of totipotent cells has already been referred to above (chapter II.G).
p.000068:
p.000069: 69
p.000069:
p.000069: • and on the other hand, in the event of consent to research on the living embryo before its destruction, a maximum
p.000069: lapse of time allowed for cryopreservation before research begins should be specified.
p.000069: The third implication does not concern the parenting couple’s consent, but the actual future of the human embryo.
p.000069:
p.000069:
p.000069: Although the legal system is identical for a living human embryo developing in vitro before destruction
p.000069: and for cells sampled from an embryo that was destroyed, the law does not stipulate a time limit for any
p.000069: research which might be undertaken using a living human embryo: theoretically, such research could be carried
p.000069: out as long as the in vitro embryo’s development is (or will be in future) technically possible. There is
p.000069: nothing in the law as it is currently written to prohibit this from taking place.
p.000069:
p.000069: In Great Britain, on the contrary, where research on human embryos in vitro is authorised under certain
p.000069: conditions, any research on the embryo is strictly prohibited after a certain time has elapsed, i.e. a maximum of
p.000069: fifteen days of in vitro development of the embryo, this being the stage where nerve cells appear70.
p.000069: ...

Appendix

Indicator List

Indicator	Vulnerability
access	Access to Social Goods
age	Diminished Autonomy
belief	Religion
capacity	Fetus/Neonate
child	Child
children	Child
cognitive	Cognitive Impairment
cultural	Cultural Differences
culture	Cultural Differences
economic	Economic/Poverty
education	Educational
educational	Educational
family	Motherhood/Family
health	Health
hunger	Food Insecurity
incapable	Mentally Incapacitated
influence	Drug Usage
language	Linguistic Proficiency
liberty	Incarcerated
mentally	Mentally Disabled
mothers	Mothers
opinion	Philosophical Differences/Difference of Opinion
orientation	Access to Social Goods
poverty	Economic/Poverty
prison	Incarcerated
religious	Religion
restricted	Incarcerated
single	Marital Status
social	Social
special	Religion
substance	Drug Usage
threat	Threat of Stigma
union	Trade Union Membership
women	Women
youth	Youth/Minors

Indicator Peers (Indicators in Same Vulnerability)

Indicator	Peers
access	['orientation']
belief	['special', 'religious']
child	['children']
children	['child']
cultural	['culture']
culture	['cultural']
economic	['poverty']
education	['educational']
educational	['education']
influence	['substance']
liberty	['prison', 'restricted']
orientation	['access']
poverty	['economic']
prison	['liberty', 'restricted']
religious	['special', 'belief']
restricted	['liberty', 'prison']
special	['belief', 'religious']
substance	['influence']

Trigger Words

consent

developing

ethics

protect

protection

risk

sensitive

Applicable Type / Vulnerability / Indicator Overlay for this Input

Vulnerability Type	Vulnerability	Indicator	# Matches
Political	Food Insecurity	hunger	1
Political	Trade Union Membership	union	1
Health	Cognitive Impairment	cognitive	1
Health	Drug Usage	influence	2
Health	Drug Usage	substance	1
Health	Health	health	16
Health	Mentally Disabled	mentally	1
Health	Mentally Incapacitated	incapable	2
Health	Motherhood/Family	family	3
Social	Access to Social Goods	orientation	2
Social	Access to Social Goods	access	3
Social	Child	child	20
Social	Child	children	16
Social	Educational	education	1
Social	Educational	educational	1
Social	Fetus/Neonate	capacity	12
Social	Incarcerated	liberty	2
Social	Incarcerated	prison	1
Social	Incarcerated	restricted	1
Social	Linguistic Proficiency	language	1
Social	Marital Status	single	7
Social	Mothers	mothers	2
Social	Philosophical Differences/Difference of Opinion	opinion	83
Social	Religion	special	2
Social	Religion	belief	1
Social	Religion	religious	2
Social	Social	social	4
Social	Threat of Stigma	threat	1
Social	Women	women	1
Social	Youth/Minors	youth	1
Economic	Economic/Poverty	poverty	3
Economic	Economic/Poverty	economic	2
General/Other	Cultural Differences	cultural	4
General/Other	Cultural Differences	culture	4
General/Other	Diminished Autonomy	age	8

Ethical reflection concerning research on human embryonic cells and on human embryos in vitro

Applicable Type / Vulnerability / Indicator Overlay for this Input

Political / Food Insecurity

Political / Trade Union Membership

Health / Cognitive Impairment

Health / Drug Usage

Health / Health

Health / Mentally Disabled

Health / Mentally Incapacitated

Health / Motherhood/Family

Social / Access to Social Goods

Social / Child

Social / Educational

Social / Fetus/Neonate

Social / Incarcerated

Social / Linguistic Proficiency

Social / Marital Status

Social / Mothers

Social / Philosophical Differences/Difference of Opinion

Social / Religion

Social / Social

Social / Threat of Stigma

Social / Women

Social / Youth/Minors

Economic / Economic/Poverty

General/Other / Cultural Differences

General/Other / Diminished Autonomy

Orphaned Trigger Words

Appendix

Indicator List

Indicator Peers (Indicators in Same Vulnerability)

Trigger Words

Applicable Type / Vulnerability / Indicator Overlay for this Input